We asked readers: What schedule best supports a sustainable EMS career? While no single rotation won out, answers fell into a few distinct camps.
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Long shifts, longer breaks
Many readers favored 24- and 48-hour rotations that trade long shifts for several days off in a row, saying the extended breaks give crews time to recover and plan their lives.
- “24/72.”
- “48/96.”
- “We get 48 on 5 days off. Best schedule I’ve ever had.”
- “24 on/24 off/24 on/5 days off is the best.”
- “24 on, 24 off, 24 on, 5 days off with one extra day every 5 weeks like Seattle Medic One.”
- “My personal favorite was two 24s a week on a two-week schedule; set days, so not rotating. I worked Tuesday/Friday/Sunday/Thursday. I still kick myself for leaving that.”
Shorter shifts and a predictable week
Others wanted to cap shift length at 12 hours or move closer to a traditional work week, arguing that predictability matters more than long breaks.
- “M-F 40 hours a week, no need for OT or to work at three squads.”
- “Never working more than 12 hours in a day.”
- “Three 12-hour shifts per week, keeping whatever your same annual pay is.”
- “35-hour week. Some of those shift patterns are crazy long.”
- “I preferred 1 on/1 off/1 on/4 off in my ambulance days.”
Pay, overtime and staffing matter more than the schedule
A third group argued that no rotation works if crews are underpaid, short-staffed or constantly covering for overtime.
- “The schedule wouldn’t matter so much if the pay was enough that people didn’t have to have a second job to afford to live. But 24/72 would be the best.”
- “The staffing numbers are FAR more important than the schedule. A ‘perfect’ schedule with 40% of the trucks out of service helps no one.”
- “3 12s, consecutive days. Paramedics at $95,000/year. EMTs with endorsements, $75,000/year. EMTs at $55,000/year. Only one extra shift allowed per week.”
- “We work two 24s a week. The only problem we have is people don’t want to come in for overtime, so often shifts go uncovered. I have made a bunch of OT because of it.”
- “The place I worked was so well staffed that you often had to fight for OT lol. I loved that schedule.”
- “2-2-3 and 24/72. PERIOD! Any other schedule has over 800 hours of built-in overtime per year versus the 110 with these. Less time at work is less burnout!”
No one-size-fits-all option
Several readers said the right rotation depends on call volume and what a service asks of its crews.
- “There’s no one-size-fits-all solution.”
- “There is never a one-size-fits-all. At slower services, maybe the 48/96 makes sense. At others, the 24/72 sounds awesome. If you are at a place that is constantly going on long, out of town stuff, a staggered 12-hour shift on a 2-2-3 or 4-4 might be the ticket.”
- “Depends on where you work. I’ve worked where we could run 5-20 calls in a 12-hour shift, and the opposite shift was the same. You are not pulling a 24- or 48-hour shift there. I’ve also worked places where a 48-hour shift was very doable.”
- “If you’re not busy, 48/96. I loved that, with average 6-8 calls max. If you’re short staffed and busy, I’d love 10 hours paid for 12 so I’m not doing paperwork for 2 hours.”
🩺 The EMS Pulse takeaway
Readers leaned toward schedules that give medics long, uninterrupted stretches of recovery, with 24/72 and 48/96 named most often, though several preferred capping shifts at 12 hours or keeping a standard week. The more pointed message was that no rotation can offset low pay, chronic overtime or short staffing.
What schedule best supports a sustainable EMS career?
Additional comments from the inbox:
- “48-hour straight weekend shifts were perfect for me when I was still working (retired now). I loved my job, so those 48 hours went by quickly!”
