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A Smarter Schedule

      If I had a dollar for every time I've been asked over the last 20 years how to become a paramedic and help others for a living, we'd surely have that place in the mountains on a lake that my wife and I can only dream about for now.

   There are a remarkable number of folks out there with the desire to help others, so it seems a bit odd to me that EMS continues to experience shortages of men and women willing to make a career of such a worthwhile, rewarding and exciting profession.

   I set out to understand why. At first I was surprised by what I discovered. But, thinking back to conversations I've had over the years with coworkers and those curious about our field, I realized there was a common theme to most. The biggest drawback to a career in EMS isn't the schooling, what we sometimes have to see, hear and do, the responsibilities we're given or even the pay. It's the lifestyle we're left with as a result of the unusual, often grueling schedules we work.

   To a considerable degree, we have continued to use the same traditional schedules utilized in EMS since its inception. In those days, most households were made up of a breadwinner and a full-time homemaker. Schedules didn't present nearly the issues they do for the typical two-breadwinner households of today. As a result, we have inadvertently developed an environment for employees that makes it difficult to accommodate the responsibilities and interests they have outside work, and to have any semblance of a normal lifestyle.

   Back then, too, only a handful of colleges and universities offered night and weekend classes. Now, in response to a changing society, just a handful don't. Year-round schools popping up across the country are another example of institutions modifying their methods of operating to meet the needs of today. Do we suppose EMS to be somehow immune from this need to adapt? If we are to thrive, we, too, need to change how we operate to better serve the needs of our workforce.

   Like many, I'd simply come to accept the schedules we work as the price we pay for being able to do what we love to do. But imagine for a moment that you're used to working 9 to 5 on weekdays, with holidays off. How would you react to a schedule that had you constantly rotating every third or fourth day, flip-flopping between days and nights every few weeks, working straight nights or working half of your waking hours each month? It's not hard to imagine that the traditional schedules we use in EMS are unappealing to others. So the question becomes, are they really necessary?

   My surprise quickly turned to excitement when I realized that by taking our lead from some of the most successful corporations in the world, we can move quickly and cost-effectively toward a solution to some of the chronic personnel shortages we face. If we provide the right environment for staff, they will come, and they will stay.


   Companies that offer lifestyle-friendly schedules often enjoy the greatest success in attracting and retaining staff. It stands to reason, then, that an EMS system offering lifestyle-friendly schedules that meet the most commonly cited needs and preferences of their employees will realize greater success in meeting staffing and service goals. Applying this concept to the field of EMS isn't entirely new, but it has been unfortunately underutilized.

   Our current economy effectively eliminates the ability to offer higher salaries or more benefits as a way to attract and retain staff. This means there's never been a better time to begin implementing lifestyle-friendly programs that accomplish this more effectively and actually save money. Properly designed, the right schedule can even lure those from other fields to consider careers in EMS. The trick is to meet the most needs and preferences of staff, offer as many scheduling options as possible, and make it easily managed while being more efficient and effective than other schedules. The new 51s is such a schedule.

   This schedule has been carefully designed to enhance the lifestyles of those working in EMS, while at the same time help systems meet their staffing and service goals. It lets staff begin planning their work schedules around their lifestyles rather than planning their lifestyles around their work schedules, and gives EMS systems the ability to staff more units than traditional schedules provide, using the same number of staff.

   There are five shift options in 51s to accommodate individuals' preferences. By far, people's most frequently expressed schedule preference is to have a nonrotating, same-day-every-week pattern. So, 51s utilizes set days each week in all five of its options. The next-most-cited preference is to have weekends off to spend with family and friends, and both the first and second shift options of 51s incorporate three-day weekends every week. A third preference is to have the ability to attend standard college course schedules without interruption, so the third shift option gives every Monday, Wednesday and Friday off to do so--and Sunday as well, to catch up with studies or unwind before beginning another week. The fourth shift, in addition to its normal days off, offers regular four-day breaks for those who like to travel, while allowing attendance of Tuesday/Thursday courses. The fifth and final option is a modified Baylor shift requiring 6% fewer hours than the others, with 80% of these shifts worked over the weekend. This provides an option for those facing rising day-care costs or children needing supervision after school, but whose spouses work during the week.

   It takes but a moment to imagine the new choices and lifestyles one can have working 51s.


   Utilizing different combinations of 12- and 24-hour shifts, 51s lets staff choose their shift options according to their preferences for frequency and length. The first three options require working just 12 times every four weeks, with more 12-hour shifts than 24-hour shifts. The last two shift options require working only 10 times every four weeks, but with more 24-hour shifts than 12-hour shifts. For the complete breakdown of each of the five 51s shifts, see Figure 1.

   When you work the typical 12-hour shift, the entire day is gone by the time you've prepared for and traveled back and forth to work—not to mention the occasional late assignments that always seem to occur at the end of the shift. Since that's the nature of our field and can't be avoided, it made sense to instead concentrate on designing a schedule in which fewer overall days would be worked than under traditional 12-hour schedules, then add aspects to each such that working an average of 51 hours a week remained a welcome change and improved the lives of staff. Schedules that entail working more 24-hour shifts than 12-hour shifts are designed into 51s as well; these may be preferred over traditional straight 24-hour shifts, as staff work fewer overall hours while working the same number of days each week, but instead go home the nights of several of their shifts.

   Many of EMS' constant worries--fatigue, mistakes, injuries, poor service and burnout--are reduced when just five overnight shifts are required of 60% of staff every four weeks, or six or seven overnight shifts for the remaining 40% of staff. The need for straight night shifts, often the most difficult to staff, is eliminated too. Fewer days are worked per year than traditional 12-hour shift schedules require, and fewer hours are worked per year than with traditional 24-hour shift schedules (see Figure 2).

   Each shift choice of 51s has also been carefully designed to allow maximum benefit from vacation time taken on the right days, and the system is more easily able to anticipate and accommodate the need for fill-in staffing. In addition, because each option has already been designed to meet the needs of staff, less benefit time is needed to accommodate outside interests. And, when benefit time is used, 51s has also been designed to result in more consecutive days off than the same amount of benefit time allows when using traditional schedules. Each of these aspects results in less overtime pay to fill vacancies.

   Another key element is that 51s not only helps to reduce fatigue, but also improves service by steering more resources toward 12-hour peak load units that are staggered throughout the day to saturate busier areas until call volume drops in the late-night and early-morning hours. The 24-hour units share their workload throughout most of the day with even more units than would be available using traditional peak-load schedules, until the call volume drops to where it is easily managed by each unit. This is an important aspect of 51s: By redistributing existing staff to maximize their potential, you can have more units than can be provided by traditional schedules, and greatly reduce the pitfalls associated with them (see Figure 3).

   The answer we most often see today to meeting demand in an area too busy for one crew to handle an entire 24-hour shift is the conversion to shorter, usually 12-hour shifts, worked around the clock, and a resulting doubling of costs and needed manpower. These shortened shifts may reduce some of the pitfalls associated with high-call-volume service areas, but usually improve response times only marginally because in the end, we are still left with just one unit answering calls in that area. A much better solution is to reduce fatigue and improve response times by adding more response units. Using fewer staff rather than more, 51s provides this.

   The 51s schedule has been designed to closely match resources to the changes in call volume normally experienced throughout the day and night, reducing staffing overnight to 50% of daytime peak-load needs. It blends 12- and 24-hour shifts into one schedule in which staff actually share assignments when they work their 12-hour assignment on one unit and their 24-hour shift on another. These assignments are matched inversely according to call volume in order to ensure even distribution of individual workload throughout the staff. In other words, a busy 12-hour unit is paired on the same shift with a slower 24-hour unit, or vice versa.

   The configuration of 51s also results in fewer personnel needed to staff each unit than more traditional schedules require. Your system can now staff more units than before using just the personnel you already have, and individual workload and fatigue decrease along with response times. Or, if hiring freezes or personnel shortages are the concern, you can now staff the same number of units as before, but using fewer people. Simply divide the number of personnel you have by five, and this is the new number of units you could have. Half work the entire 24 hours, and half work 12-hour shifts each day, staggered to cover demand specific to your system.

   The 51s schedule is also highly versatile and can stand alone as a system's single scheduling program, or be plugged in as an addition to schedules already offered. Remember, the more options you can offer, the more needs and lifestyles you can accommodate.


   An accurate cost comparison of 51s is impossible to provide due to all the combinations of schedules and pay schemes used in our field today, but in at least the majority of cases, 51s is more efficient just by its nature of requiring only five personnel to staff each response unit. This is also reflected in Figure 3. Whether you need more units in your system or simply need to staff the ones you have but can't find or afford the resources to do so, 51s makes each choice possible by simply redistributing existing resources. This reduces costs when you no longer have to find, recruit, test, hire, orient, train, clothe, outfit and pay additional staff.

   It would be little more than an educated guess to try to accurately anticipate the costs saved by the reduction in attrition 51s can provide by enhancing staff lifestyles, but logic suggests that employees given the ability to begin planning their jobs and careers around their lifestyles, rather than vice versa, and using fewer people to staff more trucks than traditional scheduling allows will prove of great benefit to EMS systems.

   Many hours went into the conceptualization and design of this schedule. 51s offers a positive solution for EMS systems. Take a moment to imagine what it could mean to you and your service. Contact me, and I'll send you a brief questionnaire designed to help compare and illustrate the benefit of 51s to your particular system.

   Timothy Earles is a 20-year veteran of progressive, high-call-volume EMS systems in Florida and North Carolina. He's served as an instructor, field training officer and supervisor, and was among the original group chosen to participate in Wake County (NC) EMS' advanced-practice paramedic program. For more information, visit, or e-mail

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Seven 12-hr shifts and five 24-hr shifts totaling 204 hrs/4 weeks
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4 12 12 24
Seven 12-hr shifts and five 24-hr shifts totaling 204 hrs/4 weeks
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Seven 12-hr shifts and five 24-hr shifts totaling 204 hrs/4 weeks
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3 24 24 12
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Three 12-hr shifts and seven 24-hr shifts totaling 204 hrs/4 weeks
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Four 12-hr shifts and six 24-hr shifts totaling 192 hrs/4 weeks
SHIFT Type Shifts per week Hrs per week Days per year Hrs per year
24 HR ABC 2-3 56 122 2,912
51s 2-3 51 130-156 2,652
12 HR 3-4 42 182 2,184
SHIFT UTILIZED 51s 24/48 24/72 & 12s
90 STAFF/# OF UNITS 18 15 11
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