Balance in the balance

     You finish a call for unresponsiveness and back into your garage bay. It's lunch time on the second day of a 48-hour shift, and you're already exhausted. You're irritable, your stomach is twitchy and you have a full afternoon of station duties ahead.

     You never wanted a 48-hour shift schedule, but most of your coworkers are non-paramedic firefighters and it made plenty of sense to them. They opted for the schedule's advantages: fewer commutes for people who live more than 30 miles away, more periods of days away from work for second jobs or time with their families, and so on. But most of them aren't up all night doing medicine.

     On your way into the day room, you notice an announcement on the bulletin board that calls for mandatory attendance at a board meeting tomorrow night. Your daughter has a hockey game tomorrow night, and you can't go to both events. You've already been counseled once about missing mandatory meetings on your days off. As you recall, your chief's advice was for you to become more of a "team player." But it was clearly more than advice.

     How do you balance your work schedule against some of the really important things that make up the rest of your life?
     It's an art form, no question. But every artist depends on a few basic materials. For you, your most basic materials include a livable schedule. Forty-eight hour shifts were never designed for good medicine. In fact, neither were 24-hour shifts. Those are firefighting schedules. They're cheaper for your department, and they provide more contiguous time off than 10s or 12s. Fact is, not one thing about those schedules is good for the public. Twenty-fours and 48s work in EMS when your call loads are really light, like maybe six calls a shift. Anything more than that, and you're gambling with your safety-and other people's as well.

     What I'm telling you is, if you're up a lot at night, this just isn't going to work.

     That's fine, but good jobs don't grow on trees. In some areas, the junior colleges are cranking out paramedics like cookies. You can't just go out and find another job.
     Your life is a ton bigger than your job. If you're routinely not sleeping and there's nothing you can do to fix that, you don't have a good job. You have a job that will destroy your marriage, if it doesn't get you killed first. Along the way, it's going to cost you complaints and medical errors. You can't afford any of those things.

     But everybody around me seems to be doing OK. Maybe I'm just being difficult.
     It's good practice to question yourself. People who don't can be arrogant and impossible to live with. But remember, there's a big difference between the demands of medicine and the rigors of firefighting. Are your colleagues doing OK? To compare oranges with oranges, the ones you need to watch and listen to are the medics-especially the ones who are about your age and who live a lifestyle similar to yours. If you're 30 and married with two kids, don't benchmark yourself against a new paramedic, fresh out of school with no responsibilities (and vice-versa).

     What if the other medics feel like they're getting whipped as well? How do you fix that, when you make up only a small part of the organization?
     A good chief understands that organizations are made up of small parts (about the size of individuals) and knows something about the dynamics of staffing. He or she may already be aware that your schedule isn't working. It's perfectly reasonable to voice your concerns (preferably after you've had some sleep and your brain is functional).

     Maybe it's not reasonable at all in this organization. I don't want to be seen as a whiner.
     There's a simple way to gauge the balance of an organization, and it almost guarantees that you can predict what your chief is going to say. Take a look at the officers. Do they have lives, or are they slaves to the department? If most of them (like 9 out of 10) lead pretty balanced lives, pursue interests outside of work, spend plenty of time with their families and aren't always at the station, that's the norm for your department. But if they're all divorced, they're all addicted to the department and they all seem out of balance, you can be pretty sure that's the organizational expectation. It almost always comes right from the top. It's not normal, it's not healthy, and it's not good for you, your family or the public.

     If that's what you see, maybe you should think about polishing your resume, even if it means moving to a different town. The last thing you have now is a good job. And it's not going to get better all by itself.

Thom Dick has been involved in EMS for 37 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.