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Fla. Study Analyzes Overnight EMS Response Times

NAPLES, Fla.-- An interesting fact comes up when you study the report of the Blue Ribbon Panel that looked at emergency medical response in Collier County.

Or maybe it would be better to say an interesting fact goes up. The study found that emergency medical response times go up in the wee hours of the morning, when traffic is the lightest.

Ed Morton, the former CEO of NCH Health System and vice chairman of the Blue Ribbon Panel says that's attributable to one thing -- the emergency responders are asleep when the call comes in. The findings cause Morton to question the validity of the 24-hour-on, 48-hour-off schedule employed by Collier County EMS and the independent fire districts that between them handle emergency medical response.

"It's anachronistic," he said.

A change in the shift pattern isn't among the recommendations the panel has made. Those recommendations will get consideration later this month when county commissioners meet with fire chiefs, EMS and sheriff's officers and others to try to formulate a better version of a system that most people agree works pretty well right now.

But Morton said a different model is worth investigating. The 24-hour shift inevitably means firefighters and paramedics will spend some of their day getting paid to work out, watch TV, eat and sleep.

The 24-hour shift has its defenders. The nature of emergency work is such that shift changes can interfere with response as equipment has to be inspected and checklists filled out. Sometimes, units are out on a call at the shift change, making a smooth transition difficult. Having three shift changes a day instead of one doesn't make sense, they say.

The long work days lead to overtime costs, as firefighters and medics will work 48 and sometimes 72 hours in a week. An exemption for firefighters in the fair labor laws allow fire departments to pay overtime only if a firefighter works more than 212 hours in a 28-day period, which helps keep overtime at a minimum, local fire chiefs say.

Someone working two or three 24-hour shifts in a week will pile up about 2,700 hours in a year, as compared to a little over 2,000 hours for a 9 to 5 job. Going to a 12-hour shift, such as the one used by the Collier County Sheriff's Office, would mean hiring more people, North Naples Fire Chief Orly Stolts said. Employees could be paid less, however, since they wouldn't work as many hours, he noted.

According to data compiled by the Blue Ribbon Panel, response times are worst around 5 a.m. when they are a full two minutes slower than daytime response times, which consistently stand at 8.1 to 8.3 minutes. Between midnight and 4 a.m. response time ranges between a minute and two minutes over the daylight times. Sheriff's deputies' response times were quicker during the pre-dawn hours than their midday times, Morton said.

A minute or two might not seem like much, but the Blue Ribbon group's conclusion is that the most important element in successful outcomes in emergency medicine is getting basic life support to the patient as quickly as possible. East Naples Fire Chief Kingman Schuldt acknowledged that meeting the goal of having trucks rolling within one minute of getting a call can be difficult late at night.

"It's very difficult to come out of a sleep. It's very taxing," he said. Any effort to do away with the 24-hour shift will probably meet with resistance from the men and women who work it. Having four or five days off a week is part of the appeal of the job.

Still, North Naples Chief Stolts says not everyone would be sad to see it go.

"It's popular with the younger guys. The older you get, the less popular it becomes," he said.


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