Crews with the Cole County Emergency Medical Service voted earlier this month to continue using a 48-hour shift schedule.
The service tested the schedule for three months at the beginning of the year, and Cole County EMS Chief Matt Lindewirth said they are going to continue this schedule with a follow-up vote to be taken at the end of the year.
In a memo to EMS staff, Lindewirth said all 31 staff members who worked the 48-hour shifts voted. The final vote was 24 in favor and seven against, with 77 percent supporting the 48-hour shifts continuing.
Lindewirth noted five ambulances had crews which used the 48-hour shift — including the service's busiest truck, which is housed in the Cole County Jail.
Three ambulances classified as the service's high peak trucks were not on the 48-hour shifts. These ambulances work 12-hour shifts, one starting at 8 a.m., one at 9 a.m. and the other at 11 a.m. Those schedules will remain unchanged.
A 48-hour shift means the paramedic and emergency medical technician work two back-to-back 24-hour shifts, followed by four days off before returning to work.
The staff suggested trying 48-hour shifts in late 2018. Lindewirth said he had some reservations about the schedule, but he said employees should be given the option.
For about a year, the Cole County Commission, which oversees the EMS service, used 12-hour paramedic shifts based on safety concerns, with the belief that having staff work 12 hours rather than 24 would keep them fresher.
However, some paramedics who were dismissed or resigned from the service voiced concerns about doing away with 24-hour shifts as the main reason the service was struggling to attract employees; they said 24-hour shifts give employees more schedule flexibility.
So the staff began working 24-hour shifts in August. Not long after that, the service began filling openings, and it now has a waiting list for potential employees.
After being at full staff for four months, Lindewirth said, the service had some departures after the first of the year but will return to full strength by April 29.
"For our training requirements, we ask our part-time staff to keep up with the same level of training as our full-time staff," Lindewirth said. "Some of those part-timers haven't been able to keep up for whatever reason, so they have left. We'll have four come on by the 29th and two more in June. Part-time workers can move up to full-time spots if they become available. That allows us to evaluate whether or not we think they are ready for such a move."
There will be 45 staff manning trucks, eight dispatchers, four administrators and an administrative assistant to bring the total full-time staff to 58.
Just as when the trial period took place, Lindewirth said, if there are issues with scheduling, widespread fatigue or a change in customer service, the EMS administration reserves the right to immediately make a scheduling change and could stop the 48-hour shifts.
While they didn't see widespread fatigue during the three-month trial, Lindewirth said, there were a few times when a crew requested a "time out" and administrators mandated crews take a break because it was in the interest of the crews and the public.
The time out or break would result in a two-hour break for the staff member, Lindewirth said. "We saw no impact on our operation, and this is common practice in the EMS industry," he said.
The battalion chiefs go through a protocol of checks every morning to gauge fatigue levels, Lindewirth said. The fatigue of crew members is assessed by calculating the amount of time they are assigned to a task compared to the amount of down time they have.
"Say a crew has worked at a high call-volume location like the ambulance based at the county jail, we can transfer them to a lower call-volume location to allow them to get rest," Lindewirth said. "And we've told them there won't be any reprimands if they feel they need a break."
Lindewirth said they have had no patient care errors related to fatigue during the trial and care levels improved while driving incidents slightly decreased. However, Lindewirth noted it's believed the improvement in patient care can be attributed more to increased training.
The other issue to be addressed is maintaining staff when a shift slot becomes open due to an illness right before an employee starts a shift or during the shift and the employee needs to leave work. While there have been times when it's been a challenge to cover those shifts, Lindewirth said, all shifts have been covered and they are working to improve this.
"We'll also be looking at whether or not our call volumes increase, there becomes a change in the workforce mentality about doing 48-hour shifts and changes in the standards of the ambulance industry," Lindewirth added. "We always will be looking at making sure we have a safe and effective service."