Sweeping plan unveiled to curb EMS fatigue in Austin

AUSTIN (KXAN) -- The medics who service all of Travis County are embarking on a broad-based new work philosophy that aims to return them to a work/life balance after a decade of coping with mandatory overtime, high sick leave and resignation numbers as well as a vacancy rate that has topped 13 percent.

The cornerstone of the plan, to begin in October, is a long-awaited transition to a 42-hour work week after about 10 years of 48-hour shifts that include built-in overtime. Currently, field staff work 96 hours over two calendar weeks, each seven days incorporating 2, 12-hour shifts and a 24.

“We want to give our personnel six hours of their lives back so they can use that for recovery, so they can use that time to spend with their families and they can press reset for a little while,” says Austin-Travis County EMS Chief Ernie Rodriguez in a one-on-one interview.

The plan stems from consultations with employees and hinges on ongoing funding for 53 new positions this budget year. Last year, the Austin City Council approved 15 new medics to begin the process. Complimenting the new 42-hour structure, medics who work a 24-hour shift will get a third consecutive day off.

Right now, medics who have just worked 24 hours, get 48 off then return to work, similar to what Austin firefighters do. Austin police officers typically work four, 10-hour shifts each week, exclusive of overtime and other paid duties. Under the new plan, some medics will still work a 12-hour shift aboard what's known as a demand ambulance to offset call volume in busier areas. Rodriguez is worried the medics who are currently stationed in busier areas receive less down time during their shifts, which could lead to fatigue.

“Any medic who feels like they're too fatigued, [they can] just pull the flare and we'll pull [them] off, no questions asked, no repercussions,” Rodriguez says, emphasizing a renewed philosophy of the department's culture.

An outside survey that came out in 2006 found 44 percent of the medics reported nodding off several times a month during their shifts, 29 percent said they provide less than optimal patient care near the end of a 24-hour shift, 50 percent had accidents or near misses due to fatigue and 5 percent had fallen asleep while driving an ambulance.

The most recent consultant’s report from Circadian Technologies released to ATCEMS in November recommended the department study how often medics who work a 24-hour shift actually have uninterrupted sleep (7-8 hours) at their station. The study just now being made public on this post, found fatigue from end-of-shift overtime. One scenario is where a medic is wrapping up 12-hours on the road then is told to keep going because their replacement called in sick.

The study recommended the agency develop a Fatigue Risk Management Program that would include staff training to dealing with fatigue and shift work lifestyles.

ATCEMS appears to be taking up that challenge. A slew of innovations include:

  • tracking paramedic workload in real time using a First Watch product developed in-house
  • training to encourage proper rest and nutrition prior to a long shift
  • allowing medics to permanently ‘bid’ on stations, shifts and partners based on tenure (has been every six months)
  • altering shift start/end times to 8 p.m. from 6 a.m. or 7 a.m. in some cases to better align with human sleep patterns (see Circadian study)
  • continuing with a year-old peer support as well as psychology and chaplaincy programs
  • instituting an annual private medical exam to ensure overall strength and health
  • continuing community health, mental health programs (where people are treated at home)
  • reducing expensive transports by implementing alternate transport units for low priority patients (in testing phase now, and will be dependent on an amended FY17 budget request for $345,000 to fund two Paramedic Response Units)
  • installing ambulance loading devices and hydraulic stretchers to reduce medic injuries

Last year, budget records show 108 injuries, compared with 119 the fiscal year prior. The goal this year is 95.

In a 2013 employee survey as part of an audit, nearly 90 percent of ATCEMS employees said they "often experience fatigue." The survey also showed around 50 percent of the respondents believed fatigue often impacts their quality of work.

Rodriguez admits a bulk of the department's cultural changes stem from a 2015 City of Austin employee survey KXAN News obtained.

One medic commented, "“The morale and protocols keep declining to the point that the system is becoming a joke, and it will be inevitable that tragedy and lawsuits will result.”

Another person addressed the fatigue issue: “Paramedics are overworked, this leads to suicide, heavy alcohol abuse and divorce.”

Over a six-month span during mid-2014 into January 2015, two ATCEMS paramedics took their own lives. While Rodriguez points out there are no studies positively connecting suicide solely to job workload, he was shocked with the loss of two employees in separate incidents.

“Personally, it was probably the toughest thing I’ve ever had to endure… I don’t know that any chief of any organization could ever be prepared for that.”

Time for Change

In FY2016-17 proposed budget documents, Rodriguez writes staff are the department’s "most precious resource." He admits that filling an existing 45-plus vacancies along with the other 53 additional positions in this budget cycle will take at least two years because the capacity of current EMS cadet academies is limited to 24 spots.

“Two years is a long time for a workforce like ours,” says Anthony Marquardt, President of the ATCEMS Association. “We’ve hung in over the years with various challenges.” He suggests taking some of the ideas around the new scheduling and coming up with a six-month plan in concert with elected officials.

Rodriguez says the overall EMS vacancy rate is dropping from a high last year of 13 percent to about 11 percent now. He’s shooting for six percent, the average for public service employees at the state level.

Critics like Marquardt suggest retaining seasoned medics should be more of a priority than filling gaps with new hires.

“The retention issue is the first issue we have to address otherwise we’ll fall behind,” says Marquardt, who is up for re-election this year. He calls the changes from EMS management ‘"reservedly hopeful."

“I think the sincerity is there. I’d like to see the chief succeed and become popular and for our organization to take off… We’ll see.”

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