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How many hours make a paramedic or EMT shift?

Paramedic chiefs and EMS leaders need to set shift length based on call demand, available personnel, equipment supply and time on task


EMS is an always open business, but not every provider needs to work a 24-hour shift

Photo courtesy Dave Konig

The length of shifts for EMS agencies varies widely across the United States. It is important for both the system and the provider that the shift length be appropriate.

Too many hours can potentially lead to fatigue-caused errors. Too few hours scheduled can result in system overload and a delay in service.

Similar to patients, every EMS system is unique. The length of shifts that work for one system may not work in others for a variety of reasons, including availability of qualified personnel, call demand, tradition and equipment supply.

Another influential factor is a unit’s average Time on Task for a dispatched assignment. The average time it takes a unit, such as an ambulance staffed with two paramedics, to complete an assignment is exactly that, an average.

Some systems may see a TOT of under an hour while others may see it stretch to the four-hour mark. Multiplying your agencies TOT by the number of calls a unit needs to complete per shift, adding travel time at the beginning and end of the shift to posting locations or station assignments, and allowing time for the vehicle pre-check and restock will give an estimate of how long shifts should be.

One of the biggest causes of employee dissatisfaction in any field is not getting off their shift on time. This can be especially challenging in an EMS system that is receiving calls from patients with acute conditions. It is common for agencies to have a policy mandating a shift or tour extension automatically for up to three hours past a crew’s scheduled off time.

Holding a crew over their scheduled off time puts a large imposition on the EMS provider in the ambulance. Mandated hours lead to poor morale, high turnover, trouble recruiting and can wreak havoc on a payroll budget.


Not all shifts are the same
Managers need to be flexible when scheduling in order to satisfy all parties while considering as many variables as possible. Here are some shift or tour options for every EMS manager to take into account when creating their agency’s personnel schedule.

8-hour tour
The typical American works a 40 hours over a five-day work week. Unfortunately working in EMS can be described as anything but typical.

With this type of schedule, depending on the agency, anything past a tour’s end time may be considered as overtime. This includes drives back to the garage and any restocking that may need to be done. This can be one of the hardest shift types to control labor costs.

9-hour/12-hour mixed model
This mixed model allows for quite a bit of flexibility. Providers are typically scheduled for four nine-hour tours or three 12-hour tours for a total of 36 scheduled hours.

This allows a bit of a cushion before a provider hits the 40-hour overtime mark in case they are mandated for the acute call. This model also enables providers to have an extra day or two away from the ambulance, improving their life and work balance in the process.

24-hour tour
Having providers work a full 24-hour shift places them squarely in OSHA’s extended unusual work shift category. These shifts are typically found in rural areas with a low call volume that often allows the provider some needed downtime and rest while still being available to respond. Using 24-hour shifts in a system where rest periods are infeasible is a recipe for agency inefficiency and a risk management red flag.

Due to the nature of EMS work, these shifts may need to be used during states of emergency. If the agency plans to exercise that option, have a clear policy in place and embedded within your emergency plans so that providers can prepare as best they can for the excessively long work period.

The effects of fatigue and the negative impact it has on job performance have been well documented. While the onus of being well rested does lay with the provider, it is important to recognize that management plays a large role in empowering providers to do so.

36-hour/48-hour tour
The rare 36-hour/48-hour tour exists in rural locations with low call volume that offers copious amounts of downtime and a proper place for resting. Some locations that may use these shifts are rural communities, oil rigs, wilderness construction sites and remote islands.

Power cars
Busy urban systems that see a call volume peak in a short specific time period may find the power car model very effective. A crew scheduled as a power car will complete a set number of assignments or work their scheduled hours.

The crew comes off the road when either of those occurs and is compensated for their full shift. For example, if a power car that is scheduled for eight-hours or four trips is able to complete the four trips in five hours, they return to the garage and are compensated for the full eight hours.

Finding the right mix of tours can be both daunting and time consuming. Use scheduling software to make the task easier and more efficient for managers and a greater convenience for field providers.

Dave is a New York City based EMS provider working in the field since 1994. He has worked in the private sector, as a 911 provider, and as a volunteer. Since 2005 he has been involved in Social Media aspects through the current major services as well as some defunct ones. He blogs about EMS, Social Media, and Event Medical Services at and maintains for other writings including updates on the books he authors.