Communications & Dispatch, News

South Carolina County EMS Tries to Ease Workload of 24-Hour Shifts

Charleston County EMS schedule switch brings some praise and some grumbling Other agencies such as Berkeley, Dorchester struggle with fatigue, weigh possible changes

Other cash-strapped agencies like Berkeley and Dorchester: Charleston County schedule switch brings some praise and some grumbling; other cash-strapped agencies struggle with fatigue, weigh possible changes in future struggle to ease workload of 24-hour shifts

When Terry Kindred started as a paramedic on James Island, he sometimes would lie down for a two-hour nap at the end of his shift.

After 24 hours straight on the job, getting a little rest before driving home was his way of ensuring that he would see his family again.

It was exhausting, he said, and it was dangerous to get behind the wheel.

With more calls streaming into Charleston County Emergency Medical Services every year, fatigue took a toll on employees like Kindred. The day-long shifts that firefighters were accustomed to no longer made sense for paramedics and emergency medical technicians.

But a lawsuit in which some of those EMS workers sought unpaid overtime wages, which were often a result of the lengthy shifts, helped prompt a change. Charleston County converted the day-long schedules to 12 hours in September and spent $1 million to hire 15 new employees to cover more shifts.

The move hasn’t come without resistance.

The county also slashed the amount of overtime employees could work, alienating some who relied on the extra money to pay their bills and others whose unique schedules allowed them to maintain second jobs. Most of the nearly 170 employees stayed, but four of them quit, EMS Director Don Lundy said.

Lundy suspects that one of the disgruntled employees sent an anonymous email in late January to local government officials, alleging that the change had left some ambulances unmanned and had driven up response times. But that s not the case, Lundy said, and statistics bear that out.

Though the county fielded 166 more emergency EMS calls in September, when the change was made, its average response time for the month was only 2 seconds longer than in August, according to data that The Post and Courier obtained through a Freedom of Information Act request. With the system in full swing by November, the department posted its quickest average time of the year: 7 minutes, 53 seconds.

The change also came as the agency had an 11 percent hike in call volume last year.

If our times went sour, I would be the first one screaming and yelling, Lundy said. But we re doing things differently now, and different is scary for a lot of people.

Similar moves are being made nationwide, but some cash-strapped EMS agencies have struggled to meet the increased workload.

A proposal to convert shifts at Dorchester County EMS has garnered support there in recent years, but it s expected to fail again in 2015 because the county lacks the money to fund it.

Though the plan would cut paramedics workweek from 56 hours to 42, EMS Director Doug Warren said they would still get overtime. To him, though, the primary concern is safety.

The science is pretty clear that someone who has worked more than 14 hours is fatigued and their reaction time and conduct is equivalent to being intoxicated, Warren said. You don t want someone in that position driving an ambulance or doing complex math to mix medications.

Busy Line of Work

Halfway through a 12-hour shift last week, Kindred and a fellow crew member on the Medic 9 ambulance had hardly seen their station on Cross County Road in North Charleston.

He and EMT Juanita Mitchell picked up a man who thought he was suffering a heart attack in North Charleston and a woman who had fallen. Dispatchers later sent them to James Island, where they tended to a woman having a possible stroke.

The crew couldn t find time for lunch. Hospitals such as Trident Medical Center stock a refrigerator with fresh sandwiches to feed paramedics between calls. But the crew had no downtime.

I like being busy, said Mitchell, an EMS employee since 2002. I m burning calories, and the time is moving.

Both she and Kindred have experienced how grueling 24-hour shifts could get.

Kindred started 12 years ago when his daughter was a newborn. But for the past eight years, the Navy veteran has been a crew chief, the lead medical officer on an ambulance.

Technology has changed his job during that time.

Though each has a home station, EMS units such as Kindred s are not tied to it. They often are sent to areas based on computer-generated predictions of where they ll be needed.

The technology puts crews constantly on the go, but EMS officials credit it for response times that are quicker than the nationally accepted standard of 8 minutes, 59 seconds. They touted an 8-minute, 41-second average for all calls in 2014, down from 10 minutes, 17 seconds four years ago, Lundy said.

Kindred welcomed the latest change, but he acknowledged hearing some gripes from his co-workers when their shifts were shortened. Most complaints came from those stationed in remote areas, such as Edisto Island, he said. It forced the workers who live in North Charleston to make the lengthy commute two more times every week.

It was a big change, Kindred said. But it was a big change for the better.

Losing a Rhythm

The new shifts came after about 80 current and former EMS employees joined a federal class-action lawsuit filed early last year. The workers said they hadn t gotten all the overtime wages they were due.

They had complained about the practice, the suit stated, but superiors intimidated and coerced (them) to continue working.

The county denied the allegation, but officials started to adjust policies.

County Council members approved $1 million annually to pay for the 15 new workers needed to switch all shifts to 12 hours. The slots were filled quickly in July, bringing the department to 167 total employees, its director said. The new rules also capped the length of the workday at 16 hours and required an eight-hour break between shifts.

It differed widely from the old system that allowed medics and EMTs to work up to 50 hours straight.

But one employee, who sent the anonymous email to county and city officials, reported noticing some shortcomings after the shifts started Sept. 5. Some ambulances were left unmanned for spans of up to an entire 12-hour shift, the employee said; units that were available needed 30 or 45 minutes to respond to calls far from their home districts.

Some of these changes (from the lawsuit) have resulted in wonderful improvements, the email stated. But some … have resulted in what most would consider unacceptable circumstances.

Charleston attorney Michael Jordan, who represents the employees in the pending lawsuit, said he couldn t discuss any changes until the litigation is settled.

Lundy, the EMS director, acknowledged that occasional lengthy response times are inevitable. The flu ravaged his ranks this season, he said, and caused some shortages in manpower. A call for an ambulance in northern Mount Pleasant, Lundy said in citing an example, could prompt a 35-minute response from a McClellanville unit.

But the overall times have held steady, he insisted.

In October, the average time for the Kiawah Island district was 18 minutes, 55 seconds. But its slowest month of the year came before the change, when the average was 19 minutes, 50 seconds in May.

Units in less rural areas like Charleston and Mount Pleasant stayed under 8 minutes all year.

We have taken care of people, Lundy said. We would have to put an ambulance on every block to guarantee that we don t have any extended times.

The county had considered the shift change since 2005, and its busiest units had already been on 12-hour shifts for a while. But the shorter shifts came to fruition for all areas last year after talks with employees, Lundy said. He knew that a small group was upset, likely because they had been using overtime wages to make car payments.

A handful resigned, but Lundy more often loses paramedics to local colleges with medicine, nursing or physician s assistant programs. Some people, he said, preferred the flexibility of a 24-hour shift to pursue outside opportunities like those.

Some of it is also frustration with being at home more, Lundy said. They were in a rhythm before. But they just have to get used to it.

Taxing Work

Other Lowcountry EMS agencies with more rural populations have stuck with the 24-hour shifts.

At Colleton County Fire-Rescue, where firefighters are cross-trained as paramedics, Chief Barry McRoy said calls don t stream in one after another. That s why shorter shifts like Charleston County s don t make as much sense there.

The department once helped Charleston County by responding to some of its calls near the border, McRoy said. The requests became so frequent, though, that his department stopped the practice, he said.

Now, his workers still get the sleep they need, despite working 48-hour weeks.

The ambulances are really busy. No county has enough of them, McRoy said. But it s a dynamic problem, and there s no simple answer.

Soon after Steve Cotter took the reins at Berkeley County EMS seven months ago, employees started asking whether he would adjust the 24-hour shifts for busy ambulances near Goose Creek. But a change in county leadership delayed serious discussion of the possibility, he said.

Cotter examined the effects of shift length during his time as an EMS chief in Kansas and the Upstate. He has written articles for industry publications and a chapter in an EMS textbook.

Studies have shown, he said, that errors by medical professionals most often occur toward the end of a long shift. The data have prompted changes for doctors and nurses, but 24-hour shifts have lingered for some EMS agencies because of tradition.

More are recognizing problems, though, especially if employees work second jobs or go to school during their two consecutive days off, he said.

The work we do is very taxing mentally and physically, Cotter said. My concern is when my EMS employees go home, I can tell them to get rest, but I can t ensure that they do.

No End in Sight

Officials have blamed the expanding EMS workload on the influx of new residents and seasonal visitors that has made the tri-county area one of the nation s fastest growing.

Perhaps nobody is more aware of the effects locally than Warren, the EMS director in Dorchester County, where there has been no rest for the weary. Like Charleston County, Warren s department saw call volume skyrocket by 15 percent in 2014.

Crews manning ambulances are exhausted, Warren said. He fears that their fatigue could cause traffic crashes or mistakes in the mathematical calculations that paramedics make in life-or-death situations for patients. Such errors could expose the county to civil liability.

Their workload continues to get higher and higher, he said. They re fatigued, and it s a real safety issue for both patients and employees.

The county has not found the money to fund shorter shifts since Warren first posed the idea four years ago.

He presented a plan this year that would add one prime time unit to help alleviate demand during peak hours. It also called for 16 employees to join the agency that has 62 full-time and 20 part-time workers.

The annual cost of the new hires and supervisors for seven shifts would be $1,215,695, Deputy County Administrator Ashley Jacobs said. That would take full backing of the local government fund and possibly a tax increase, she said.

We currently do not have funds available to transition to a 12-hour shift schedule, Jacobs said.

Warren s department will have to make do.

There s really no end in sight, he said. It s just over and over and over.

All day, All Night

Kindred and Mitchell, the two Charleston County EMS workers, never slowed down last week.

After she helped load a possible heart attack patient into the ambulance, Mitchell remarked at how 12-hour shifts have allowed her to attend family gatherings that she once skipped. It also keeps her fresh, Mitchell said, and she pours that extra energy into her job by evoking laughter.

Mitchell punched the patient s personal information into a laptop as the man balked when Kindred stuck his hand with a needle.

How s the pain now? Kindred asked after the injection.

It s gone, the man said.

Gone? Kindred said. I guess I scared it away.

That s what happens when you have a face like that, Mitchell joked with Kindred, prompting a chuckle from the patient.

After the crew dropped off another patient at Medical University Hospital, dispatchers sent the ambulance to James Island. Less than 10 minutes later, Kindred and Mitchell tended to an unconscious woman, hoisted her onto a stretcher and rushed back to the hospital.

This is a busy stint, Kindred said. Doing this all day and all night would be horrible.

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