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Fix the late call conundrum to improve retention

Two Australian paramedics are under investigation for refusing a late call assignment because of fatigue


This article originally appeared in the July 12, 2018 issue of the Paramedic Chief Leadership Briefing. Read the full briefing, The late call conundrum | Effective communication | Signs of heat illness, and add the Paramedic Chief eNewsletter to your subscriptions. 

Two Australian paramedics are “under investigation for misconduct” for refusing to take a late call after completing a 12-hour overnight shift. The paramedics were reportedly concerned about their level of fatigue when they turned down the overtime work, which was a non-emergent patient transfer to home.

Though I take a minor amount of comfort in knowing that the morale-crushing late call is ubiquitous worldwide, I am extremely concerned that a misconduct investigation is the result for two paramedics reporting they were too exhausted to accept the assignment. EMS1 regularly reports ambulance crashes attributed to the driver falling asleep, and near-miss and adverse incident reports to the EMS Voluntary Event Notification Tool often cite fatigue as a primary or secondary cause.

Respondents to the 2018 EMS Trend Report ranked retention as the most critical issue facing EMS by a large margin. Any service that’s not proactively mitigating paramedic fatigue, regularly sending paramedics on late calls and uses misconduct investigations as a response to self-reporting of “too tired to work” is sure to have a retention problem. Here’s what should be happening instead.   

A leader’s commitment to fatigue mitigation, paramedic retention and workplace safety rings hollow when they don’t walk the talk. (Photo/Wikimedia Commons)
A leader’s commitment to fatigue mitigation, paramedic retention and workplace safety rings hollow when they don’t walk the talk. (Photo/Wikimedia Commons)

1. Fatigue in EMS: Evidence-based guidelines were previewed at the 2017 Pinnacle EMS conference and published in January 2018. The guidelines conclude several years of NASEMSO-sponsored research and recommend guidelines for fatigue education, on-duty napping, use of caffeine as a countermeasure to fatigue, limiting shift length and fatigue monitoring.

2. Late call procedures need to have more steps than 1) Offer late call and 2) Report paramedics for discipline if they refuse the late call. Intermediate steps might include assessing the urgency of ambulance transport, assessing suitability of alternative transportation methods, holding the call for the next on-duty crew, asking a mutual aid partner to take the call, offering the call to other crews or on-call personnel.

3. Health and wellness is a culture change that happens when actions align with policy and procedures. A leader’s commitment to fatigue mitigation, paramedic retention and workplace safety rings hollow when they don’t walk the talk.

4. Use late call data to make staffing and resource allocation changes. Regular and frequent late calls need a different solution than simply holding over the last shift. When do late calls happen? How often do they happen? Where are late calls coming from? What type of incidents most often result in late calls? How much are late calls costing in overtime?

Don’t limit data collection and analysis to ePCR and CAD data. Use a department survey to ask questions like: How do field paramedics feel about late calls? What’s the best way to be asked to take a late call? How many late calls in a month turn it from a chance to make some extra money to a lifeforce sapping burden?  

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