EMS Shift Lengths And Overnights At Private Ambulance Companies

[Guest]

Does anyone know if Empire has 24 hour shifts? If not, what length

Well here's the deal,

As an ex-employee of empire state ambulance corp., i can say first hand that there will be conflicting posts on this topic.

According to Empire EMS, they do not condone nor allow ANY Employee to work more that 12 hours consecutively, followed by a 12 break or "rest" period.

Again i say acording to them! As a former employee i can say that this is false...Empire is and has been understaffed for a while now, one of the reasons that they have opted out of the putnam contract, although they say it's because they are not getting enough money, but the true reason behind it is that they do not have the manpower to fulfill the contract hence leading to the extended shift hours, which is why they lost the pawling 911 contract, however i digress.

Empire DOES infact allow their employees to work in excess of 24+ hours at a clip , i know a few emt's including myself who have done this...now there are upsides and downsides to this. The upsides being that you can bang out all your hours for the week in one shot, which leaves the rest of your week open for either free time or working a second job as many empire and other ems agency employees do, eventhough they have those BS non-compete rules.

The down side to this is that you have safety issues, you cannot expect anyone to work for 24+ hours at a clip and still be sharp and able to drive as if they were only working an 8 hour tour, not to mention that patient care is compromised due to the exhaustion and wear on the Technicians.

There is a lot more i can say on this topic, however i think this will suffice to get the ball rolling and see what others have to say on the topic.

[x134 46]

I just read an article on Matts death on LOHUD.COM. Dan Roberts a spokesman for Empire State Ambulance said"the EMTS work 10 hr shifts". Rest in peace Matt.

[irishfire2491 24]

I used to work for empire myself and I have worked a 36 straight hour tour and was held on overtime at points which lead 40 hours not including overtime i have picked up during the week i have done that for about 2 months pirror leavingthe company on other reasons

[x648eng119 2]

Anybody who has ever worked commercial EMS knows that it's near impossible to put consective shift restrictions on emplyoees, especially when most techs and medics are working 2, 3, or sometimes even 4 jobs. I can remember a time I did 24 hours consective in New Rochelle, and the went to my "A" job at the time for another 18 consecutive, had 6 hours off, and then back to the "A" job for another 18.

I know trancare has the policy that employees can only do 24 hours straight, but they have no control over what the employees do once they are off the clock. Also, when staffing is really short, I've done over 40 hours straight with transcare.

I guess what I'm trying to say is, no matter what policies are in effect, in the under-staffed, under-paid world that is EMS, it's damn near impossible to control consecutive hours worked by employees. Each person has to know their own personal limitations.

[Guest alsfirefighter]

I was going to discuss this issue about EMS providers and shift lengths but wanted to wait until things settled down about the accident which took a brother from us. However I also realize the importance of discussing issues and thoughts as they come along in the face of such incidents. I also wondered about how many more such accidents we could have as many who work as EMS providers as their primary income have to work 2 or even 3 jobs in some cases to make ends meet. I have friends whom often look like zombies to be in the profession they love and its a real shame that this has to occur. I remember reading an article about this issue and that when one region I believe it was down south looked at their QA/QI post incident, more medication errors and treatment errors made were attributed to overworked and fatigued providers. This is a no brainer for most of us, being we are often not up to full speed when woken up for calls in the zero dark thirty hours. They also found through patient surveys that providers had better ratings for professionalism, interaction and compassion (if most of us have any of that left) when they polled their employees and found they were off or working normal tour hours.

I have never worked for ESA, and I have my personal reasons and opinions as to why I do not. I have friends who currently and have formerly worked for the company and have heard their hold over stories and all I could do was shake my head. But this is a system wide problem for the most part and also a career issue, not just ESA.

Now before anyone wants to comment, yes the fire service does work 24 hour shifts and I primarily do so. But I also have protections in place that prohibit me from being able to be held over for any additional time then that unless it is A. An emergency (that's obvious) or B. Voluntary and at that point I can only work no more then 34 straight hours and must have 24 hours off. The other side of this is in our fire stations we have the ability to sleep in a bed in between calls. Most private EMS agencies do not have this option and firefighters do not have to hop scotch agencies and jobs to make ends meet.

I have worked 16's when I worked part time in the Putnam system and I have done either 16's on the flycar or 12's on the bus for the side job agency I work for. I can attest that that agency is extremely fair to the paid staff and I would have no problems working a 24 for that agency either being they have facilities for volunteers and employees to sleep when necessary. Do you get your gluteus kicked on 24's...of course. Many of you have seen me in the back half of 24's, but it beats working a 14 your first night...getting hammered...and coming back for a 2nd 14 and getting blasted again.

This was an excellent topic and well discussed by those whom has professional intelligent input. The only ones making it inappropriate are the ones whom apparantly can't handle any sort of discussion.

I may be pointed in this comment but do all of you who like to sit in your corner and eat cake write the editors of Fire Engineering and Firehouse Magazine when they post details of LODD's the very next month when "all the details aren't out" or tell them they are "monday morning quarterbacking"? EMS is all about Monday Morning Quarterbacking and no one is directly discussing the incident with the loss of the brother...maybe that was his legacy to be that his tragedy will bring this discussion to the table for employees of private companies and the management the issue.

If you don't like it or you think its inappropriate don't read it. Sit in your corner and eat your cake and keep telling everyone that no issue should be discussed or its monday morning quarterbacking and those of us who work to improve our professions, teach those about and to do our profession and to learn from the loss of others will continue to be leaders in our field.

Good topic Seth and very well presented in light of the situation. I take my hat off to you.

Edited November 9, 2007 by alsfirefighter

[x635 4,066]

I in no way aim to flame you, but who in the heck stays 48 hours at any job? There is no rule ANYWHERE in either any guide or operations manual authorizing anyone to be held over more than a maximum of 16 hours, relieved or not. YOUR health and safety is ALWAYS number one. You are doing no one a service if, after being at work for 20 hours, YOU crash or YOU give the wrond dose of a drug to someone.

I really can't believe that you just took the 'deal with it' and went with it.

Well, it happens, and I really didn't have a choice. There's more to the story then I care to share, and can't give more details without revealing which agency it was. The agency I worked for had a relatively low call volume, and I did have chances to catch naps in quarters, but I was still at work. I know many fellow medics and EMT's that get forced into working double, even triple shifts....and it's especially enticing when you need money with the low pay of EMS.

I know medics that routinely work 36-56 hours in a row at different agencies.

We have some responsibilty for our health and welfare. But, I'm sure if you looked into many EMS health and safety related issues, I'm sure you could identify a few things that the employer could have done diffently to enhance the employee's quality of life. But unlike Police and Fire, EMS is generally not a union job, and when it is, it's generally a weak union. I mean, some FDNY*EMS personel work harder in worse conditions then most FDNY FF's, but get paid much less. Many EMS personel are employed by for-profit companies, some of whom really don't have much incentive or money to improve things.

The people who say "Just Deal With It" are the ones holding us back. Yes, we expect these things when we work EMS and it should be expected, BUT, it doesn't have to be that way. EMS should be a challenging, rewarding, safe, and healthy CAREER and be on the same level as Police And Fire. (Dispatchers should be too)

[Guest Orpi442]

I normally work a 12 & then a 24 hr tours. I also had worked Friday straight threw Sunday night. Which I will say was not the smartest thing I have ever done. I will say that I was afforded the time to sleep at periods. I was out of the truck. This was on my flycar shifts. Last weekend I did a 24 hour tour on a transport truck. I did more running around than I did when I worked at Empress. Also the dispatcher thought it was funny when we asked to get a break for coffee or food. These group of events have lead to me rethinking my schedule. Being from the military I do believe the training to work with little or no sleep has helped me get threw, but the body can only take so much.

Matt I will miss you & Thank you doesn't come close. Rest In Pease, BOSS & BROTHER!

[JetPhoto 626]

I never worked for a paid service but being around people who have over the years I do know that if EMS is your primary job, one can not survive without working tons of O/T

[x129K 1,393]

I never worked for a paid service but being around people who have over the years I do know that if EMS is your primary job, one can not survive without working tons of O/T

...AND a b-job at another EMS company...

[OnTheWheel 43]

Are you guys saying that a transport ambulance company has to stay awake their entire shift? Even when not transporting? Now THATS retarded! Everyone else in the field is REactive, only cops are PROactive. So we stay awake and let fire and ems sleep!

[ny10570 745]

As for the topic at hand, forget playing devils advocate, if you let your employer take advantage of you like several of you have then its your fault. Its their job to get the most out of you and its your job to get the most out of them. If they aren't going to treat you right then bail and move on to the next company. There was an article I believe in JEMS a while ago about the problems with attrition in EMS. They used a Jersey Hospital as a case study that for many years had always had the lowest attrition rates while paying similar pay and benefits as surrounding hospitals. One competitor when faced with now critical staffing problems got new management in house that increased pay and incentives to troubled positions. After their success a the other hospitals followed suit. Before long a hospital that never had a problem with staffing saw it attrition rates go through the roof. To fix it they set their benefits to match the others and the problem disappeared. Not a real complex story but it goes to show that we are the problem. Inter facility transports are only increasing. Sub-acute care is one of the fastest growing segments of the health care industry and the populace is only getting older, in fact for the next 10 to 15 (depending on who you ask) years the average age is going to be rapidly increasing. That means these transport companies are becoming busier and as much as medicaid and medicare hamstring them their profits are higher than they ever were.

If the job you're working doesn't allow you to make ends meet then its time to do something about it. I have many friends who've had to make hard choices and move out to the sticks or leave the area all together. For my own happiness and future security I took a pay cut made some adjustments and set out towards a career that I can support myself with. Any EMT with half a brain should not be working transports for very long. There is no money in it. Work a 40 hour week at Starbucks and you will make more than most of your co-workers with better benefits than many. Anyone with an associates or better and some work experience can go get a job managing at Home Depot, Lowes, Walmart, etc.

Edited November 10, 2007 by ny10570

[ONEEYEDMIC 68]

Here is my take. Studies say that working "THE WHEEL" (around the clock) instead of steady shifts takes 10 years off your life. Your body never gets adjusted to a normal sleep pattern. Of course most of the world WORKS DAYS, but in our LINE OF WORK whether it be LE, FD, or EMS we work CRAZY hours. I preferred to work Midnights in EMS because I like being up at night (and it was a little slower). When I switched jobs I quickly learned that "DAY TOURS" were horrible. Unless it was the weekend I hated them. Luckily I found somebody that hated midnights and soon after I was out of the ACADEMY I switched out of days. I still have to do them sometimes but it is usually my choice. I am not a morning person and I am not a COFFEE drinker either. Of course If I really had my choice I would do steady 4-12's. Don't have that option though.

Now I sure we have all done more than 24hrs of work without sleep. If you think about it, it isn't that hard in the LINE OF WORK WE CHOSE. I am not allowed to do more than 16hrs straight without 8hrs off now. Unless their is an emergency, even then they will get you some sleep. I also have the Luxury of driving 2min to my house though when some guys I work with have more than an hour commute. That is where I see the most danger. Getting hammered with calls on 4-12's or Midnights then driving a long distance IS NOT GOOD. But since they made the HOUSING MARKET SO IMPOSSIBLE TO AFFORD IN WESTCHESTER some people choose to live far away.

The body can take alot without sleep. That is why they train THE MILITARY mainly SPECIAL FORCES to stay up for long periods of time. Sleep Deprivation is stress that the body needs. We need to be able to react under stress. I also don't need much sleep to function either. 1-2hrs and I am good. For the longest time I was called the ENERGIZER BUNNY because I was always up. When my body finally tells me I have to get some sleep i get some sleep. It is also very hard for me to fall asleep. Even if I am off, I can't fall asleep right away.

Hopefully agencies will look at this and start monitoring the hours that people work. Mostly in EMS when you are bouncing from JOB TO JOB.

[Guest alsfirefighter]

Everyone else in the field is REactive, only cops are PROactive. So we stay awake and let fire and ems sleep!

Riiiiiiiiiiiight......LOL.

Oneeye...I'm with you brother. My sleep cycle is so all over the place I sleep when I can.

[OnTheWheel 43]

Riiiiiiiiiiiight......LOL.

It IS a public forum, I have to give a statement the public wants to hear!

[Remember585 815]

It IS a public forum, I have to give a statement the public wants to hear!

I always wondered how you guys slept on your hogs....

[Guest alsfirefighter]

I gotcha ya back Wheel! LOL. Just speaking from experience....

4 am + Caprice + empty parking garage = window licking

[Guest stephentyler20]

Thanks for the info on their shift length. In no way did I mean to stir up a controversy with my question, I was just curious.

[MerlinMedic 5]

Ease up folks! We are in an intense preasure cooker of a field, with little recognotion, poor pay, and horrible working conditions. And most of us love it! We thrive on the chaos and stress.

There are some good ideas out posted in this thread -- like no non-emergent transports after 23.00, mandated rest after X hours of moving, real beds in crew rooms. (I like that one; Mohawk Ambulance in Schenectady had them for the city crews in the '90s, worked well.)

There has been comments made about waiting for the full investigation to be completed. We need that. If your accident investigation skills are like mine ... lets just say I ask the PD what hapened.

But don't bash people for doing what we do -- going the extra distance, yes, I can make it home after a zillion hours on the road. This is a tragedy for all, but especally EMS. Maybe we will wake up & change things, but don't hold your breath.

Rest in Peace Matt!

[crcocr1 8]

As for the topic at hand, forget playing devils advocate, if you let your employer take advantage of you like several of you have then its your fault. Its their job to get the most out of you and its your job to get the most out of them. If they aren't going to treat you right then bail and move on to the next company. There was an article I believe in JEMS a while ago about the problems with attrition in EMS. They used a Jersey Hospital as a case study that for many years had always had the lowest attrition rates while paying similar pay and benefits as surrounding hospitals. One competitor when faced with now critical staffing problems got new management in house that increased pay and incentives to troubled positions. After their success a the other hospitals followed suit. Before long a hospital that never had a problem with staffing saw it attrition rates go through the roof. To fix it they set their benefits to match the others and the problem disappeared. Not a real complex story but it goes to show that we are the problem. Inter facility transports are only increasing. Sub-acute care is one of the fastest growing segments of the health care industry and the populace is only getting older, in fact for the next 10 to 15 (depending on who you ask) years the average age is going to be rapidly increasing. That means these transport companies are becoming busier and as much as medicaid and medicare hamstring them their profits are higher than they ever were.

If the job you're working doesn't allow you to make ends meet then its time to do something about it. I have many friends who've had to make hard choices and move out to the sticks or leave the area all together. For my own happiness and future security I took a pay cut made some adjustments and set out towards a career that I can support myself with. Any EMT with half a brain should not be working transports for very long. There is no money in it. Work a 40 hour week at Starbucks and you will make more than most of your co-workers with better benefits than many. Anyone with an associates or better and some work experience can go get a job managing at Home Depot, Lowes, Walmart, etc.

Actually, intraagency and intrahospital transports is how many private ambulance companies make money to keep their agency alive. Depending on where you work, regretfully, some patients transported on a 911 basis may not have monies to pay the bill, causing the ambulance company to either pay a lawyer to collect the fee OR eat the cost.

Joseph Daniel Remy, 3L, EMT

[ny10570 745]

crcocr1, re-read what I wrote. Transport agencies are making more money than they have in the past. The money is so good that there are a even a few municipal agencies who have started in on this territory. My point is that while the agencies are pulling in more money it is not trickling down to the employee.

You highlighted my comments about how the EMT is not making any more and would be better served working somewhere else.

[x129K 1,393]

crcocr1, re-read what I wrote. Transport agencies are making more money than they have in the past. The money is so good that there are a even a few municipal agencies who have started in on this territory. My point is that while the agencies are pulling in more money it is not trickling down to the employee.

You highlighted my comments about how the EMT is not making any more and would be better served working somewhere else.

Nahhh....The money was better in the early 90's before the Medicaid crackdown.....

[Goose 188]

crcocr1, re-read what I wrote. Transport agencies are making more money than they have in the past. The money is so good that there are a even a few municipal agencies who have started in on this territory. My point is that while the agencies are pulling in more money it is not trickling down to the employee.

You highlighted my comments about how the EMT is not making any more and would be better served working somewhere else.

Like 192 said, your statement is 110% wrong. Transports bring in far less money then they used to and i think the fee for transports is only likely to go down.

Edited November 12, 2007 by Goose

[ny10570 745]

The money being paid out per trip is significantly less than it was just a few years ago. The profit comes from the increase in the number of transports. Sub-acute care is increasingly handled outside the hospital. After joint replacement people use to spend days or even weeks in the hospital until they were well enough to go home. Now as soon as they can be moved people are transfered to a rehab facility. There is also an increase in the number of people who will be using the services between the growing number of elderly and advancements in medicine.

[Goose 188]

The money being paid out per trip is significantly less than it was just a few years ago. The profit comes from the increase in the number of transports. Sub-acute care is increasingly handled outside the hospital. After joint replacement people use to spend days or even weeks in the hospital until they were well enough to go home. Now as soon as they can be moved people are transfered to a rehab facility. There is also an increase in the number of people who will be using the services between the growing number of elderly and advancements in medicine.

Your forgetting the days of running from a hospital to the imaging centers and the like are over. You would have two billable transports per individual. Hospitals, today, have all those goodies in house now. Couple that with the crack down in Medicare payouts and your looking at a decrease in the money coming in. I know one of the agencies (its not for profit) i work for loses significant amounts of money every year and there is little that can be done to mitigate that.

[Medibart 55]

First off I have to agree with the suggestion that we should not be throwing around accusations or assumptions. The investigation is not complete. While it certainly sounds like the driver fell asleep, we don't know if it was this crew's first call of the night or 5th call. We don't know if either crew member was on their first shift for the week or their 5th. So the apparent suggestion that this crew was driven to the point of exhaustion by an uncaring, profit hungry company is really nothing more than vitriolic conjecture and is somewhat inappropriate in my view. I'm not defending anyone, I simply do not know exactly what the facts are and I'd rather reserve judgement until I have all the facts.

This accident was an absolutely horrible tragedy. I never met Matt but I have to say I've rarely seen such an outporing of compliments about a person. It seems like Matt was a very special person, which makes this that much harder to bear. By the way, very nice service yesterday. I was truly impressed by the EMS showing. I saw agencies from all over the Hudson Valley and even the Albany area and New York City.

Like I said in my condolence note, the way to properly honor Matt is to try to learn from the incident and hopefully try to prevent it. It's easy to say well the answer is pay people more and work them less but it really is not that simple.

We all say that we didn't get into EMS for the money and that we understood that EMS was a low paying profession. We all also still complain about it. We all need to learn to live with it because it is something that is probably not going to change soon. The reason for this is NOT companies making profits. Most companies are losing money or barely making a profit. If you believe otherwise, you really are sorely misinformed. It's not just me saying this, the General Accounting Office of the United States Government issued a report recently that stated ambulance companies operate at a loss every time they pick up a Medicare patient. Since most of our patients are Medicare patients it's really difficult to believe anyone can make money doing transports. Most private insurances and obviously Medicaid pay even less than Medicare does. The number one problem for most EMS companies is employee attrition. If I don't have employees I can't run buses. If I can't run buses, I can't pick up patients. If I can't pick up patients, I can't make money. Therefore, you would think that a smart businessman, if he had the money, would work on fixing employee attrition. Quite simply, the money isn't there. Even if the money was there, there are medics making $30 an hour who still work crazy per-diem hours. If EMTs could be brought up to that level, would they be any different? I truly wish everyone was making the money they deserve but we'd all still probably spend our nights working somewhere else if we could.

Until Medicare and other insurance providers significantly increase their reimbursements ambulance companies will remain in their precarious financial positions and more of them will be closing. If you work for an EMS agency that relies on billing for funds, there is no issue that concerns you more in your life than this one, so vote accordingly.

So scheduling is another issue. I do the schedule for my company and I can tell you this: the top requests from people are #1 I want to do a 24, #2 If I can't do a 24 I want to at least do a 16, #3 I want to do overnights. I know throughout my EMS career I always preferred working nights. Not once did one of my bosses, and I worked for several private, for-profit agencies, force me to work an overnight. I chose to do them. Was I happy if I slept all night? Absolutely! I still am (I still work per-diem several nights a week). Do I feel entitled to be paid to sleep all night? Absolutely not. If we were to close down at night, the people that chose to work nights would be out of luck and patients would not be moved. Guess what? Patients need to be moved 24 hours a day. Our patients have a right to not have to sit in an ER all night and our ERs need to be able to clear beds for new patients. I understand that no one wants to be woken up at 4 in the morning to take someone home from the ER, hell, I don't want to be woken up at 4 am to take someone TO the ER. But if the calls weren't there, the crews wouldn't be needed. If the crews weren't needed, PEOPLE WOULD LOSE THEIR JOBS. This idea that somehow we should pick and choose the calls that we think deserve our attention is ridiculous. We are a service industry and we respond when requested. Whether it is a heart attack or a take home, both services are important to our patients and the facilities.

I care deeply for the people I work with and I never want to be the one to receive a call like the Empire State management received last week. I hope I have the wisdom to learn from Matt's sacrifice and prevent this tragedy from reoccuring. I do know, however, that the answers are not easy ones. I also know that it's not right to throw around premature blame here. To only get half the story would do Matt and his family a disservice. If anyone has any truly creative and interesting thoughts on the issue I'd love to hear them.

[Guest]

Wow, I am not one to agree with management but Medibart makes very good points. The Medicare and insurance issues I know for a fact to be true. Unfortunately this is the way things are right now, hopefully at some point in my career the days of EMTs/Medics working a 90 hour work week will be a thing of the past. On the 911 side, the only fix that I can see in the near future would be Municipal EMS (tax based), but I'm sure the tax payers will have something to say about that.

[MerlinMedic 5]

This brings up an interesting topic for discussion, outside the issue of Matt's death. Who is responsible for telling someone they are too tired to work? The company? The shift leader/Lt? Your partner? Your self?

NY is a right to work state. You have the right to work as you see fit (and they can fire you for no reason also). Right now, I believe that most private companies expect you to come in to work ready to work your 8, 12, 16 shift reasonably well rested. Even the 24s, although they are know to be "restfull" tours, which is why management allows them.

[firemoose827 324]

Wow...I dont like it when I come in to a thread this late and have to read so many posts. But I got to tell you...I got sick to my stomache about 1/8 of the way in...

Most of you need to either relax, READ what is actually written and attempt to understand it better or both...In no way, shape or form has x635 made any comment or accusation or slander towords any specific person or agency. He, and everyone who supported him, brought up EXCELLENT points that NEED to be addressed. Those of you who cower behind the excuse of "We need to let it calm down, our brother isnt in the ground yet and your bashing this and that..." (read like a 3 year old complaining for a cookie after dinner)...Are actually the ones being disrespectfull to our brother Matt. If it were me that died in an accident, I would WANT all of you to fight for the rights of every other EMS/FIRE/LE brother and sister so that what happened to me didnt happen to anyone else. I did not have the privilege to know Matt, but regardless he was my brother, I mourn for him, I pray for the brother who was driving and offer my courage and strength to him, but I will be DAMMED if I am going to let Matts death be an excuse for me to NOT fight for our rights as EMS workers. The topic Seth brings up and most of you support this far is an EXCELLENT topic, one that should be addressed everywhere. This is not an attack against Empire, this is a justifiable discussion to find solutions to an ongoing problem faced by EMS providers everywhere...and when I say EMS in this topic I mean Fire/EMS/LE in one ball of wax.

I apologise to all of you I have lost track of names and points I wanted to elaborate on so I wont be able to give full credit here...sorry.

I agree with the opinion of making us CDL drivers...that is an excellent way of tracking how many hours spent on calls and how much sleep/rest is needed. I see that offering some type of small solution to this problem, excellent idea, (whoever you were!!)

I dont agree with the cut-back in the hours worked per shift, some agencies dont work as many runs in a 12 or 24 hour shift as others do, and than again some people clock in and never do anything BUT calls untill they clock out. But in my case, I work a ft job, 10 hours a day M-Thurs, leave work thursday at 4pm and go to my PT job as an EMT to do a 24 6p thursday night. In a perfect world this gives me my weekends with my daughter, but those hours STILL do not give me enough money to live, and lately I have been working an additional 24-60 hours a weekend at the ambulance. Sometimes we do 2-3 calls per 12 hour shift, but there were times we ran straight for about 13-16 hours without a break. We do both transports and 911 calls, transports are an average of 2-3 hours per call, depending on the receiving facility and the distance to get there. My company has a policy that states there is a mandatory hold over of no more than 2 hours, so if at the end of your shift you get banged with a trip to the burn unit or trauma center, they can tell you your doing it whether you like it or not. But they take all factors into consideration also, like how many hours have you been going without rest and so on.

To whoever said the transport agencies make more money.......HAHAHAHAHAHAHAHA.....LOL-LOL-LOL-LOL-LOL......(tears Dropping)HAHAHAHA!!!!!!!!!!!!!!!!!!!!!!!.......bent over clutching stomache....Thats funny. No. We dont make more money on transfers, we do get more paperwork to fill out, signatures to obtain, and when we cant get the signature or the person doesnt have their insurance info our billing staff have to track it down, and they only have a month to do so or the company eats the bill. I have worked for one paid agency or another since 1996 as PT, FT ALS and BLS and I have seen all aspects of billing and paperwork to deffinately say that Transports do not make more money for the company.

Back to the original topic (sorry, I have a whole bunch going through my head after reading so many posts!) I agree with Seth and the entire EMTBravo family when it comes to dealing with these issues sooner, rather than later, in order to correct mistakes, re-write SOP's and make sure it never happens again, to anyone. (sigh...that was a mouthfull!!!)

I am going to stop here, before I have an angry mob chasing after me with defibrilators trying to convert my sinus rythm to flatline.!!!

Good topic. Excellent points by a lot of you, it definately makes you think...which for some of us is good!!

[helicopper 1,050]

It is not insensitive to discuss a problem that is endemic to the industry - yes, a tragic local incident brought the problem to the forefront but nobody is speculating on the cause of that particular accident nor is anyone casting a negative light on either of the victims (Matt or his partner). A lot of other people have already pointed out that you can't wait to address an issue of safety.

We need to face facts... EMS is not a money industry, most agencies are lucky just to break even and many operate at a loss that must be offset by other ventures or subsidies of some kind. There are no cash cows in the transport industry! In fact, the reimbursement rates are a joke. They don't cover the costs of the calls, have not been adjusted to compensate for the skyrocketing fuel prices that everyone must contend with and not everyone even has the wherewithal to pay (read uninsured!). As a result EMS personnel are poorly paid, understaffed, and in many cases overworked. Labor issues, as already highlighted, are a problem too. Try telling your boss that you're too tired to do a call and you will most likely be terminated.

You can't compare the EMS industry to fire or police either. Police and fire operate in specific municipalities (or at least districts) while ambulances may contract with facilities all over the county or region. That's alot of driving that doesn't occur to the cops or FD. Cops can sit and watch the blinking traffic light in the middle of their town when their eyes are crossing at 4 AM, the FD can sleep between jobs but EMS is out there driving all over the place and that takes a toll on you too.

It is ridiculously expensive to live in our area and EMS wages don't reflect the high cost of living. It's pathetic but that's our world. So, we see EMS'ers going from Job A to Job B to Job C and back to Job A with very little real rest in between. To say that fatigue is NOT a problem in the industry is just plain wrong!

Should there be regulations like those for commercial truck drivers? Maybe, maybe not. I'm not sure what we can do other than be more sensitive to the fact that we're not robots and need some down time once in a while. We just can't sweep the problem under the rug.

[crcocr1 8]

Wow...I dont like it when I come in to a thread this late and have to read so many posts. But I got to tell you...I got sick to my stomache about 1/8 of the way in...

Most of you need to either relax, READ what is actually written and attempt to understand it better or both...In no way, shape or form has x635 made any comment or accusation or slander towords any specific person or agency. He, and everyone who supported him, brought up EXCELLENT points that NEED to be addressed. Those of you who cower behind the excuse of "We need to let it calm down, our brother isnt in the ground yet and your bashing this and that..." (read like a 3 year old complaining for a cookie after dinner)...Are actually the ones being disrespectfull to our brother Matt. If it were me that died in an accident, I would WANT all of you to fight for the rights of every other EMS/FIRE/LE brother and sister so that what happened to me didnt happen to anyone else. I did not have the privilege to know Matt, but regardless he was my brother, I mourn for him, I pray for the brother who was driving and offer my courage and strength to him, but I will be DAMMED if I am going to let Matts death be an excuse for me to NOT fight for our rights as EMS workers. The topic Seth brings up and most of you support this far is an EXCELLENT topic, one that should be addressed everywhere. This is not an attack against Empire, this is a justifiable discussion to find solutions to an ongoing problem faced by EMS providers everywhere...and when I say EMS in this topic I mean Fire/EMS/LE in one ball of wax.

I apologise to all of you I have lost track of names and points I wanted to elaborate on so I wont be able to give full credit here...sorry.

I agree with the opinion of making us CDL drivers...that is an excellent way of tracking how many hours spent on calls and how much sleep/rest is needed. I see that offering some type of small solution to this problem, excellent idea, (whoever you were!!)

I dont agree with the cut-back in the hours worked per shift, some agencies dont work as many runs in a 12 or 24 hour shift as others do, and than again some people clock in and never do anything BUT calls untill they clock out. But in my case, I work a ft job, 10 hours a day M-Thurs, leave work thursday at 4pm and go to my PT job as an EMT to do a 24 6p thursday night. In a perfect world this gives me my weekends with my daughter, but those hours STILL do not give me enough money to live, and lately I have been working an additional 24-60 hours a weekend at the ambulance. Sometimes we do 2-3 calls per 12 hour shift, but there were times we ran straight for about 13-16 hours without a break. We do both transports and 911 calls, transports are an average of 2-3 hours per call, depending on the receiving facility and the distance to get there. My company has a policy that states there is a mandatory hold over of no more than 2 hours, so if at the end of your shift you get banged with a trip to the burn unit or trauma center, they can tell you your doing it whether you like it or not. But they take all factors into consideration also, like how many hours have you been going without rest and so on.

To whoever said the transport agencies make more money.......HAHAHAHAHAHAHAHA.....LOL-LOL-LOL-LOL-LOL......(tears Dropping)HAHAHAHA!!!!!!!!!!!!!!!!!!!!!!!.......bent over clutching stomache....Thats funny. No. We dont make more money on transfers, we do get more paperwork to fill out, signatures to obtain, and when we cant get the signature or the person doesnt have their insurance info our billing staff have to track it down, and they only have a month to do so or the company eats the bill. I have worked for one paid agency or another since 1996 as PT, FT ALS and BLS and I have seen all aspects of billing and paperwork to deffinately say that Transports do not make more money for the company.

Back to the original topic (sorry, I have a whole bunch going through my head after reading so many posts!) I agree with Seth and the entire EMTBravo family when it comes to dealing with these issues sooner, rather than later, in order to correct mistakes, re-write SOP's and make sure it never happens again, to anyone. (sigh...that was a mouthfull!!!)

I am going to stop here, before I have an angry mob chasing after me with defibrilators trying to convert my sinus rythm to flatline.!!!

Good topic. Excellent points by a lot of you, it definately makes you think...which for some of us is good!!

Brian,

I think if you review most major ambulance companies financial statements, you will see that, compared to 911 calls, most revenue is derived from inter-agency transports, in New York and nationwide. Although you might think otherwise from reviewing financials from your organizations, I have reviewed statistics from a much larger database, which includes Rural/Metro, AMR, etc. etc. You might see it similarly if you look around and see that some ambulance companies start off as solely inter-agency transports because there is less regulation (more liability but less regulation) and less overhead needed. Although Medicare/Medicaid rates still are the same as they were when the legislation was first enacted, EMS, much like hospitals in America, still derive a majority of income from Medicare/Medicaid. I can direct you to resources such as the American Ambulance Association and the American Hospital Association websites for statistics. Once these companies get their feet firmly planted on sound financial ground, they then expand to 911 transports to attract a larger employment base.

One member's comment regarding NY being Right to Work State is absolutely correct. For the most part, NY is a Right to Work State. The EMS industry needs to advocate to become more regulated insofar as hour regulation, much like the health care industry, if we are indeed concerned that patient care is suffering from an overworked EMS worker.

As a third year law student, and EMS worker, I look forward to representing the industry in my spare time. I agree with you insofar as the EMS industry needs advocacy. It is ridiculous when it does more call volume than Fire, yet gets paid half of the amount.

Insofar as my original reply, I regret the reply because the comment was targeted toward low wage rates. So, I apologize if I distorted your comment.

JDR

Edited November 19, 2007 by crcocr1