The Real Emergency

   The night air is dreamlike, and everything in it is blurred. You're bathed in big lights that don't so much punctuate the darkness as drift in it. You hear voices, familiar and not, and the hard, busy sounds of tools and broken glass, all clad in that monotonous copper-bell kind of echo you've heard somewhere in another time. Everywhere there are smoky forms, vaguely active, mildly engaged, barely in motion, their verbal discourse mumbled and fragmented, and their conversation unhurried and only partly meaningful. You begin to wonder: What are they talking about? And whom?

   Gradually the seasoned rescuer within you awakens to the scene of a high-energy collision. The violence is over. But for all its other vagueness, two things are unmistakable tonight: the pervasive, immutable presence of death, and an overarching sense that nothing matters anymore.

   Now you see the ambulance, its cab grotesquely twisted and the familiar logo on its metal skin crumpled awry. You remember a feeling of great fatigue, a dullness of senses, the distant sights and sounds of your own warning equipment, and an abrupt, deafening thud. After that, nothing. Darkness, the onset of sleep, and silence, only now disturbed.

   I hope no reader of mine ever recognizes this little scenario. I imagined it, poorly I'm sure, and have proposed it to get somebody's attention on behalf of the thousands of EMTs and paramedics who still work 24-hour shifts in busy systems.

What are we supposed to do? If our agency went to 12-hour shifts today, our personnel costs would increase by a third. We run a good system, the best we know how, and we worry about our crews honestly and earnestly. But we're in the middle of a recession. We're already losing money to the largely indigent population in our service area--many of whom use 9-1-1 as their primary source of healthcare. We simply have no flexibility.

   I feel your sincerity. I'm sharing this now because I'm tired of hearing my own excuses, and afraid to ask my own people once more before they get off duty, "how was your night?", hoping they haven't been hammered. I live in my service area. I hear their sirens at night, and I pray for their safety. They're wonderful people, and like you, we're not sure how to proceed. We've offered to get them and their vehicles home after a busy night, and they won't take us up on it. We've suggested they sleep anytime they want to, during their shifts. We've tried handing transfers off to other agencies. But none of those things seems to be enough to mitigate the fact that these are people, not machines. All it would take is one bad night...

   Our agency tried to switch to 12-hour or 10-hour shifts, and the crews were furious. Especially if you live a distance away from work, 24-hour shifts mean fewer commutes and longer periods of time away from work. In addition, some people rely on those extra days off to pursue part-time interests.

   I know what you mean. EMS is a great way to spend your life, but it's a business you need to get away from-- often and routinely. I have run 25 transports in a 24-hour shift, and I can tell you the patients I saw during the last third of that shift were not getting good medicine. Not only that, but looking back I know they weren't even safe.

   Maybe you're being too nice. Firefighters have been doing 24s for years; in fact, many departments have gone to 48s and even 96s.

   In 1970, a standard shift for an ambulance crew was five 24-hour shifts a week. The fact we endured it said nothing about our intelligence--or our attention to the public's safety. In fact, I'll tell you why we did it. "Ambulance drivers" were some of the poorest, most impotent people on earth. (You could say EMTs still are.) Most of us were students, headed somewhere else. We worked that schedule because it's what there was.

   I took a lot of risks for the sake of a college degree. I ran a lot of calls in my sleep. I shouldn't be alive today, but I am. So I'm using that degree, and those experiences, to tell you this. Please pay attention. We need to get rid of those awful shifts.

   Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS World Magazine's editorial advisory board. E-mail