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24-Hour Shifts May Endanger Patients and Employees

MD-05-NIGHT-MEDIC-WORK-1

In July 2006, Austin/Travis County (Texas) EMS changed its work schedules after seeing the results of a study in which EMS employees wore sleep/wake monitors on their wrists to determine their alertness levels and ˙micro sleepÓ periods (when people sleep briefly while appearing to be awake).

ATCEMS presented some results of that study, which was conducted by Circadian Technologies Inc., a company that works with Harvard Medical School, on a poster at the Pinnacle Forum in St. Petersburg Beach, Fla., Aug. 8. The poster reported that 64% of ATCEMS paramedics found it ˙difficultÓ or ˙very difficultÓ to stay awake during 24-hour shifts, and 61.8% felt their health would improve with shorter shifts.

According to ATCEMS Assistant Director Chris Callsen, the study revealed some other troubling findings, including that 44% of the medics reported nodding off several times a month during their shifts, 29% said they provide less than optimal patient care near the end of a 24-hour shift, 50% had accidents or near misses due to fatigue and 5% had fallen asleep while driving an ambulance.

Callsen described to a packed room of EMS executives the process and results of ATCEMS changing its busiest stations from 24-hour shifts a year ago.

Most of the service_s 287 paramedics now work two 12-hour shifts at one of ATCEMS_ 12 busiest stations and a 24-shift at one of the 18 ˙slowerÓ stations. Paramedics must also have at least 10 hours off between each shift.

The paramedics now get to bid their shifts and know what their shifts will be for the next six months. ˙Previously, people were assigned to shifts and stations, so they got some freedom [with] this change,Ó Callsen said.

Under the old system, paramedics worked 56 hours a week, and now they work only 48ƒfor the same base pay. This provides a substantial per-hour raise, but cuts the amount of ˙premium payÓ they were getting for overtime.

Outcomes

˙This definitely cost some money, and it_s not yet clear if the reduction in errors and litigation will make that up,Ó Callsen said.

ATCEMS has, however, already noted a decrease in the number of clinical errors reported, a decrease in the seriousness of reported errors and fewer complaints from hospitals. ˙We_ve had some interesting comments from outside organizations,Ó he said, ˙For example, fire department folks ask us why the paramedics are nicer.

˙By and large, everyone is pretty happy with this,Ó he said, noting that ATCEMS lost only two paramedics due to the shift changes and has attracted more female applicants.

˙The biggest problems with the shift changesƒby a long shotƒcame from management,Ó he said, adding that ATCEMS experienced a ˙significant leadership transitionÓ during the shift change process.

According to Callsen, ATCEMS ˙underestimated the massive cultural changeÓ it would mean for workers. ˙We gave them six months lead time, but 12 months would have been better,Ó he said. ATCEMS also failed to react quickly enough to some initial problems, he said. He advises other services considering shift changes to ˙take a broad-brush lookÓ at how this change will affect employees, management and the system.

Is it worth it? Callsen stressed that it is. He cited a study that shows that a person_s performance begins falling quickly after 16 hours and reaches that of someone who has a 0.8% blood alcohol level at 22 hours. ˙Do you really want a paramedic on the street who is [as impaired as if they were] legally drunk?Ó he asked.

For more information, send an e-mail to„chris.callsen@ci.austin.tx.us.

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