News

Texas Agency Hiring Outside Help to Rethink Medics` Schedules, Combat Fatigue

Philip Jankowski

07/15/2015

July 15--Tony Marquardt remembers sitting in his car staring at a stop sign, so overcome with fatigue that his tired mind thought he was stopped at a red light.

It happened after his shift as an Austin-Travis County Emergency Medical Services paramedic had stretched beyond 24 hours. Having an active workload for such a long time had taken its toll.

"It was overwhelming," said Marquardt, president of the paramedics union. "When put into a situation where you have exceeded the human capacity to function responsibly, I think you revert to self-preservation."

With work shifts that last as long as 24 hours and mandatory overtime each week, Austin-Travis County EMS is taking a hard look at paramedics' schedules, hoping to curb employee exhaustion.

The agency recently hired the fatigue management consultation company Circadian to examine several aspects of how it conducts business. EMS will pay $19,500 for Circadian's analysis.

Circadian is a consulting firm that specializes in businesses that operate 24 hours a day, seven days a week. They have worked with several EMS agencies, but a spokeswoman declined to name them because of client confidentiality policies. The company has worked with other industries, including airlines, pipeline companies and trucking firms.

Circadian worked with Austin-Travis County EMS before, conducting studies in 2006 that showed paramedics had above-average rates for the amount of consecutive hours they went without sleep and higher instances of nodding off while on the job. The company's work resulted in schedules that the agency still uses.

"Our goal is to optimize the health, safety, efficiency and quality of work-life balance for those individuals engaged in shift work or that work 'extended hours,'" said William Davis, Circadian's vice president of operations and the consultant handling Austin-Travis County EMS.

The 24-hour shifts that Austin paramedics work are not uncommon. Paramedics in San Antonio and Dallas also work for 24 hours straight. But unlike Travis County paramedics, they have required days off.

Dallas paramedics are required to have two full days off before working another 24-hour shift, spokesman Jason Evans said. In San Antonio, paramedics must have at least 72 hours off, spokesman Christian Bove said.

On top of that, neither of those departments require overtime, unlike Austin-Travis County EMS, which requires eight hours of overtime each week.

Changes are in the works. Both Austin-Travis County EMS administrators and the union acknowledge that 48 hours is too many hours to work in one week. The tentative goal is to drop it to 42 hours a week, officials said.

Several years ago, the department mandated a 56-hour work week. Circadian performed consulting work for EMS then as well. At the time, more than half of the department worked about 60 hours a week.

With the transition to a 48-hour work week, Circadian created optimized schedules to reduce the amount of hours worked.

When they created schedules in 2006, it led to 12-hour shifts for many stations in densely populated areas that are the busiest in the county. Of EMS' 33 stations, 11 have 12-hour shifts.

Those 12-hour shifts have helped, Marquardt said. But they can create "cumulative fatigue" when paramedics work too many days in a row with those shifts, he said.

Though 48 hours of work are required, an American-Statesman review of records showed many paramedics work far more each week.

For instance, field medic Michael Shipley worked 1,585.75 hours of overtime (mandatory time included) in 2014. That averaged out to about 70 work hours a week. Those hours netted Shipley $138,486.

That comes near the salaries for some of EMS' leading administrators.

"We have some OT hounds," EMS Captain Rick Rutledge said. "There's a lot out there, and they're getting it. You've got to be younger than me to handle that."