Reactive changes to medics working long hours are doomed to fail

Proposed solutions don't match the immediate needs or evolving long-term mission of an urban EMS department


When I first read how medics in Baltimore are making nearly $200,000 annually, I thought, "hey, where do I sign up for this gig?"

Each week only has 168 hours

Then I did some math to figure out how much I would need to work. I would have to work about 82 hours a week, every week. Just for fun, I figured that one week equals 168 hours; that meant I would have 86 hours left for myself. Subtract about 7 hours per day for sleep, an hour for showers and restroom breaks, another hour for eating, and an hour for commuting, and that leaves me about 2 hours a day free for myself to recover, rejuvenate, and refresh.

Sound like paradise? Not so much.

Don't blame willing and opportunistic medics

I don’t blame Baltimore City Fire Department (BCFD) paramedics for doing their impression of Marathon Men (and women) ; it’s a system that allows them to do this, unfettered and unmanaged. I imagine that the chance of someone getting injured on the job is pretty good. There’s probably also a good chance that a patient maybe injured due to a poor decision made by a fatigued provider.

The department and city's response is kind of pathetic . Hire more medics! Cut down on swaps! The same old solutions provided by every other department that doesn’t truly grasp its mission - short term, expensive and doomed to failure.

Like many other organizations, BCFD is an EMS department that provides other services such as code enforcement, hazardous materials mitigation, rescue operations and fire suppression. Yet the department spent about $35 million on EMS operations in 2014, out of a $233 million budget. In another words, 15 percent of the budget goes toward 80 percent of the call volume.

You could slice it this way: 232 out of 1482 line personnel or 16 percent of the workforce, provides 80 percent of the work volume.

Now is the time to initiate long-term solutions

I’m sure I am oversimplifying my math, but it doesn’t take a mathematician to understand the issues associated with these numbers. Simply hiring more medics will not solve this issue, not in the long term.

Nothing short of a paradigm shift will cause the goals and values of the department to match its true mission. Truly great leaders need to tackle this issue now, setting up the dynamics of the organization to allow it to transition to a true all hazards department that responds to the community’s needs effectively by allocating its resources appropriately. Unfortunately, that’s not likely to happen anytime soon.

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