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 is using generative AI to create some content that is edited and fact-checked by our editors.
