EMS: Let 'em rest

Photo By Jana Birchum

Beginning July 23, Austin-Travis Co. EMS paramedics will have a new, more flexible work-scheduling system designed to reduce fatigue brought on, in part, by spotty or nearly nonexistent downtime or sleep for medics working the city's busiest central stations. Although the change is designed to bring relief to an overloaded contingent of medics – and likely will – the real work of alleviating the load is yet to come, as the department seeks to fill a growing number of medic vacancies. At press time, the department had 45 open positions – and that number will only increase in the months to come, says EMS union president Chebon Tiger, as the city adds additional ambulances to its force. A total of six new trucks are needed to handle call volume, Tiger says, meaning that, in total, Austin-Travis Co. EMS will soon (most likely during the next fiscal year) have just over 100 vacant positions that need to be filled. That's no small task, in part because there is a nationwide paramedic shortage; indeed, says Tiger, almost 70% of local medics come to the city from out of state (as did Tiger, who is from Oklahoma). "We are way short on people," he says. But with a progressive – and seemingly, startlingly, unbureaucratic – approach to redefining the medics' work schedules, and with the support of city management, Tiger and others say the department is well on its way to relieving the strain on its workforce while growing a better and more redundant system to serve the ever-increasing workload.

According to the results of a workforce study, conducted by shift-work consulting firm Circadian Technologies and presented to the city's EMS Oversight Committee on June 27, paramedics working out of the city's busiest stations receive little or no downtime – more than 50% of the time, paramedics in the 11 busiest stations receive less than two hours of sleep in a 24-hour period. In contrast, at the more "suburban" stations, paramedics are more likely to get between four to six hours of sleep each night, and in the most "rural" stations – the most far-flung county posts – nearly 40% of the time, on-duty medics catch more than seven hours of sleep a night. Moreover, the results of a questionnaire given to the ATCEMS' 263 paramedics revealed that more than 50% of the medics reported having to work 48 hours or more consecutively within a month; one-third reported having to work 27 hours or more straight, without sleep, in a single week.

In order to better distribute the workload and provide more downtime, the department this month will institute a new work schedule, driven in large part by paramedic scheduling preferences. At the busiest stations, medics will work no more than 12 hours at a time – the maximum amount of time that the vast majority of medics (71.5%) said was safe to spend taking calls in the busiest of stations. A combination of 24-hour and 12-hour shifts will be used to provide around-the-clock coverage for each of the 32 EMS stations. "Right now [the scheduling changes] look like a good idea – reducing work hours is [always] a good deal," says Tiger. "[But] as with any change, people have had some reservations." (The department plans to continue its evaluation of the scheduling changes, Tiger said, and in December medics will have their first chance to "rebid" their work schedules.)

While the new schedule is a great first step – and may buy the city some time – a revamped work schedule alone is not enough to cure EMS' staffing woes, Tiger says. Indeed, while the medics, on the whole, report a "healthier lifestyle" than the average in Circadian's database, the study notes that many medics work 60 hours or more each week, and that the "majority [of Austin's medics] report there is excessive [overtime]" – a clear signal that staffing is stretched thin. Fortunately, that reality is not lost on city management, says Assistant City Manager Rudy Garza, and City Manager Toby Futrell's draft budget to council will contain a number of measures to increase staffing and overall system redundancy. In a July 11 memo to council, Garza explained that recruiting and hiring is "the most significant" challenge for EMS, and that one of the "symptoms of being unable to fill all our positions, yet maintain the high level of customer service we provide, is a heavy workload on existing personnel." The vacancy and attrition rates for EMS are significantly higher than the citywide average – a 16.5% vacancy rate compared to 10% citywide, and an 8.3% attrition rate in EMS versus the 7.5% citywide average. Still, Garza says he's optimistic about the changes he anticipates over the next year – including a proposed hiring bonus, the addition of a new "floating" ambulance unit to provide additional coverage in the city's busiest areas, and a plan to partner with AISD to create an introductory emergency-medicine class for high school seniors. Additionally, he said, the city will explore the feasibility of creating a financial program to help pay for EMS classes at Austin Community College for students who've finished the AISD high school class and are interested in pursuing a paramedic career. The goal, Garza says, is to "grow our own" paramedics. "This is a great opportunity for us and for our young people."