Re: RE: 24 hour shift

["ajoplinger@myvzw.com" <ajoplinger@myvzw.com>]

I have to say, this has been an extremely 
interesting discussion to watch unfold.  

Im my mind, the entire essence of this topic 
comes down to the following point: we are in the 
business of providing a 24 hour a day, 365 day a 
year emergency service. Doing this requires 
people to work hours outside of the normal 9 to 
5, Monday through Friday, wekends and holdays off 
routine. I think it is the responsibility of each 
program to determine, based on many different 
factors, how to appropriately schedule their 
staff, and to continually monitor those 
scheduling practices and adjust them as the need 
arises.

In all reality, the issue of how tired is too 
tired can be tossed back and forth until we are 
all too tired to talk about it anymore. For 
example, if I am scheduled to work a 12 hour day 
shift but was only able to get a few hours sleep 
the night before because I ate some bad Mexican 
and was up until 0200 with heartburn should I be 
disqualified from working? Who makes that 
decision? 

What does ADEQUATE rest mean? Adequate for you 
might not be adequate for me. I think that it's 
great that our pilots have a watchdog agency 
thats never wrong about anything to regulate the 
amount of hours that they work, but we in the 
medical field do not have that luxury. 

In short, I am glad to see that this topic is of 
concern to people, but in the end, there are 
going to be as many "right" answers as there are 
flight programs because we all operate in 
slightly different environments and what works 
for one will probably not work as well for the 
next.

Adam Oplinger NREMT-P






> --- Original Message ---
>Sent: 01/16/02 19:46:17
>From: emacdonald@satx.rr.com
>To: flightmed@flightweb.com
>Subject: RE: 24 hour shift
>
>Lord knows we wouldn't want to protect the 
public from a flight nurse who
>has worked 12-24-36-48 hours straight.  
Apparently from the gist of that,
>only pilots are subject to fatigue, errors, etc. 
FAA must have been smart
>enough to know that people can't always self 
determine if they are too tired
>to perform safely.
>
>IF a flight nurse or paramedic can guarantee 
ADEQUATE rest during their
>shift...so that they aren't in a position to 
provide fatigued critical
>patient care, decision making, dexterity and 
safety around dangerous
>machines and dangerous scenes--then go for that 
24 hour shift. If a
>crewmember is not too fatigued to know that they 
are too fatigued...sort of
>a catch 22...
>
>I am amazed that some folks in our emergency 
service disciplines don't
>believe that they get tired.  
Paramedic/Firefighters coming on shift
>directly from a FD twenty-four to another EMS 
twenty-four and back to the
>fire department,  nurses coming off an ER shift 
at another hospital to your
>program's twenty-four hour shift. Pilots also 
push it by failing to get rest
>in their 10-12 hours off--ASSUMING that they 
will sleep on Night shift. Some
>folks use the excuse that interns and medical 
students do VERY long
>shifts-------one insane system to justify 
another? How many critical errors
>per shift are acceptable on the 
pilot/nursing/paramedic side of our
>profession? How many small errors before you 
have the really big one? How
>many near misses are OK with you?  If 
crewmembers are hungry for more time
>off, then consider a 4-4 or 7-7 -- 12 hr shift 
schedule like pilots
>do...oops...sorry...that would be changing the 
way we've always done it!
>Make the paramedics full time and treat them 
like real professionals rather
>than hired hands or Christmas help.
>
>If you are in a program that gets one flight per 
day, never risking back-
>to- back- to- back flights-- then go for that 
extended shift.  What's wrong
>with a month on month off?  Where do you draw 
the line?  I have seen tired
>crew members almost walk into tail rotors and 
other potentially
>one-time-last-time events far to often.
>
>The following site may be of interest to some:
>
> 
http://olias.arc.nasa.gov/zteam/fredi/fredi.sec3.h
tml
>
>
>
>Ed
>
>
>
>-----Original Message-----
>From: flightmed-admin@flightweb.com
>[mailto:flightmed-admin@flightweb.com]On Behalf 
Of barb murphy
>Sent: Wednesday, January 16, 2002 8:19 AM
>To: flightmed@flightweb.com
>Subject: RE: 24 hour shift
>
>
>Our program has 24 hour shifts, we also have 5 
helicopters and separate
>sleeping quarters where we can nap as needed 
between flights....The other
>"safety device" is an on-call flight nurse and 
medic that can be used if the
>medical crew cries uncle.
>
>I believe that in reference to the pilots, it is 
not us, but the FAA that
>made that rule.  The rule is not specific to 
helicopter pilots, who may
>sleep all of their 12 hour shift, but made to 
protect the public from having
>a pilot who may have flown 12-14 hrs straight.
>
>I agree that safety is paramount in our 
business, however if systems are in
>place to protect the patient and the crew, it 
seems to work for the schedule
>and the patient.
>
>-----Original Message-----
>From: flightmed-admin@flightweb.com
>[mailto:flightmed-admin@flightweb.com]On Behalf 
Of Helodoc@aol.com
>Sent: Monday, January 14, 2002 7:18 PM
>To: flightmed@flightweb.com
>Subject: Re: 24 hour shift
>
>
>As I have said many times, 24 hour shifts may be 
wonderful for having days
>off, but they have the potential to harm 
patients.  Unless your system has
>multiple aircraft so that there can be a 
guaranteed rest period then I
>cannot
>see how you can assure good patient care.
>
>Why should we feel that 24 hours is a safe shift 
when we make sure the
>pilots
>work no more than 14?  Is patient care any less 
demanding or complex than
>piloting?
>
>Dave Thomson
>
>David P. Thomson, MS, MD, FACEP
>Associate Professor
>Director, Transport Medicine
>Medical Director, Telemedicine
>Department of Emergency Medicine
>SUNY Upstate Medical University
>750 E. Adams St.
>Syracuse, NY 13210
>315.464.6219 voice
>315.464.6220 fax
>
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