Facing a 16% attrition rate in its ambulance division (well above the fire department’s historical average of 5%), the Fort Worth Fire Department plans a three-month pilot moving EMS crews from 12-hour shifts to a 24-hours-on, 48-hours-off schedule. The goal: improve work-life balance and make the job more appealing.
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The proposal reflects a common tension in EMS workforce discussions. Longer shifts can offer more days off and lessen commutes for some providers. But in busy systems, fatigue and safety concerns remain a major worry.
EMS1 readers weighed in on whether a 24/48 schedule helps or harms providers.
For some medics, the schedule is a key reason they stay
Several readers said 24-hour shifts remain one of the few scheduling models that make EMS sustainable as a career.
One reader described a similar schedule used by their county-based third-service EMS agency. Crews work 10 24-hour shifts per month, rotating through A, B and C shifts.
“Our crews love it and many work other jobs on days off,” the reader wrote.
Another respondent was even more direct: “I would quit EMS if it was not for 24/48. That’s the biggest perk of the job.”
Others said longer shifts also widen the hiring pool. A 24-hour shift allows agencies to recruit personnel who live farther away, one reader noted, reducing the burden of daily commuting.
Some readers said they prefer even longer rotations. “24/48 allows agencies to pull in crews from further distance to work. I prefer 48/96 schedule,” one medic wrote.
But fatigue concerns remain
Not all providers are convinced the model works in a high-volume system.
Several readers pointed to research linking long shifts with fatigue-related risks, including driving crashes and patient safety issues.
“24-hour shifts are fundamentally unsafe in a busy system,” one reader wrote. “Accidents and line-of-duty deaths are far more likely to occur toward the end of a 24 than at the beginning.”
Another reader warned that overtime coverage can worsen fatigue if staffing shortages persist.
“This sounds miserable,” the commenter wrote, “24/48 means you’re never off, and overtime coverage means someone is doing a 48/24. In a busy system like Fort Worth, this will absolutely hurt people.”
Some see a deeper workforce problem
A few readers suggested scheduling changes alone won’t solve the underlying issue.
Fort Worth officials noted many EMS providers are leaving for dual-role firefighter/paramedic positions at other agencies. Those jobs often offer better pay, benefits and schedules.
One retired medic said that career path ultimately made the difference for them.
“By far, the best for me was as a dual-role FF/paramedic on our local fire department,” the reader wrote. “Yes, 24-hour shifts can get really tiring, but the next two days off allow for rest — or for you young bucks, a decent second job.”
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What happens next
Fort Worth plans to run the 24/48 schedule as a three-month pilot. In the meantime, EMS crews will sleep on cots at fire stations until additional beds and privacy partitions are installed.
For many EMS providers, the discussion highlights a familiar challenge: finding a schedule that balances staffing needs, provider well-being and system demand.
And as the comments show, there’s no single answer that works for every system.
Weigh in: Do 24-hour shifts improve EMS work-life balance?
EMS1 readers respond
“Maybe the FD taking over from MedStar wasn’t such a great idea.”
“I worked the 24/48 shift rotation for decades. I like that schedule because it allowed me time to work a second job (driving armored trucks for Brinks throughout the side of Chicago and northwest Indiana). The department I worked for (Gary, Indiana FD) had a high call volume. I just had to get used to it.”
“I’ve worked both 24/48, 48/96 and 12-hour shifts. Another option is a 24/72, which some agencies have gone to. Each has their benefits and negatives. All depends on current staffing levels, unit hours available, call volumes, etc. I agree with some writers that 24/48 with staff shortages within a busy system can create issues that drive people away. In my opinion, a 3-month trial pilot might not get the results that are needed to make an accurate decision regarding a more permanent change.”
“24/48 in a busy system is NOT the shift change needed! You will be up all night and dog tired your first day off!”
“24-hr shifts promote unsafe conditions due to fatigue among staff. Management refuses to recognize that EMS staff needs to be paid a living wage while working a safe, sustainable schedule. When your crew is going on its 15th transport at 0300 and the destination is over 1 hour away, this is not safe. Your staff will be continuously looking to escape this schedule and recruitment will inevitably suffer once the word gets out.”
“I stand by my earlier assertion that 24/48 is the worst of all worlds in a busy system. Chronic fatigue, shift inertia, and an inability to staff overtime shifts without forcing 48/24s is a lethal combination to morale, provider attitude and ultimately human safety. If FWFD is serious about providing good service to the community while making EMS better, the 24/72 would be a much, much, much better option. But that would also require investment in EMS that FWFD is unlikely to make.”
“My concern for 24-hour shifts is the fatigue factor. I know of many busy systems where EMS literally runs 24 hours on a 24-hour shift. In the old days, when you actually got to sleep at night, the 24-hour shift made sense. But the reason Ft. Worth is moving to them is a shortage of responders. That means they will be very busy, the entire shift. Countless studies have shown how you decline both physically and mentally after 14-16 hours on duty. Personally, I would be concerned about a paramedic taking care of me or my family after being up and working for 20 hours. And I agree with others. Look deeper at your attrition rate. Not just schedules, but pay, mental health resources and upward mobility. There is so much more to EMS than working on an ambulance. This marks year 46 for me in EMS. I was lucky and have found many other positions in EMS than working on a rig.”
“In regards to Fort Worth EMS, take into account that EMS helicopter pilots are mandated to have six hours downtime during their 24-hour shift. This is for safety. I can tell you from my past EMS experience getting a six-hour rest break was very, very few and far between. Taking care of critical patient at hour 20 with no break is very perilous.”
“I have worked them all. Being up for 24 hours is very unsafe especially when administering medications or performing life-saving interventions. We get tired and we make mistakes. I also did two jobs at a time. You went from job to job. Only way you can survive financially is to work two jobs!”
“When I worked, we had 72 on 96 off but sometimes if your relief doesn’t come in or you got held over at another station so I would work 96 on 72 off. But the time went by quickly if you were at the right station.”
“That shift schedule will accelerate the attrition even more. You get banged up on a 24, held for additional 4 hours, and then go home on day #1 off and collapse.”
“My agency is 24/72 with 4 crews. I love my schedule.”
“The article doesn’t address that this translates to a 56 hour average workweek and would likely dictate a mandatory 16 hours of overtime per week based on a 40-hour pay schedule. In regards to EMS retention, it likely depends on the average amount of night runs. If the personnel can get enough sleep to function on the first day off, it would likely be favorable. But of course, they would have to get used to missing entire holidays.”
“I worked at a very busy service with 24/72 hour shifts. I retired last month at 24 years of service at 62 years of age. A nonstop 24-hour shift is extremely hard no matter your age or how many days you have off after.”
“24-hour shifts are fundamentally unsafe in a busy system. There are many studies on the impact of EMS provider fatigue on safety- driving, patient care, etc. Accidents and LODD are far more likely to occur towards the end of a 24 than at the beginning. I understand the staffing challenges, but this is dangerous and probably unsustainable.”
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