Multiple Jobs and Way Too Many Hours

Last week, actor Tracy Morgan was involved in a serious motor vehicle accident that also killed a friend of his. The pair were struck by a Walmart owned tractor trailer that was being driven by a driver who had reportedly been awake for more than 24 hours. When I heard reports of the accident the circumstances surrounding it, I started to wonder how many responders at the scene were in the same boat as the driver.

Long hours are a well known part of our job, however how long is too long? In the system that I work in now, many of our BLS units are staffed by people who are on 24 hour shifts. A number of the people working these units have a number of different shirts in their drawers from the departments that they work part time for. It is not an unusual occurrence to find some people working back-to-back 24 hour shifts in an attempt to cram a good number of hours into their work week to maximize their days off.

In the study that Fitch & Associates did of Alameda County back in the mid-2000’s, it was noted while riding with some crews that “many responders appeared exhausted.” They added that one even “nodded off during a midday conversation.” Again, ALCO was a system where people would try to cram their work week into a couple of days.

The effects of sleep deprivation and sleep inertia are well documented in the medical industry as well as the transportation industries. This is why medical interns have seen their hours cut, and pilots and truckers are required to have a certain amount of downtime. Here in the world of EMS though, we push forward. Many of us work multiple jobs. For the first time in my career, I do not have one. It was not unusual for me to work sixty-plus hours at my full time job at AMR, and follow that up with a shift or two at my part time job without a second thought. It was natural to me.

I remember days as a supervisor where I would encounter certain employees in the same boat as me who were working multiple jobs. When they would get into their long weeks, you would see the effects of it specifically in their attitudes. People were more prone to snap without warning, and you could almost predict when you would have a nurse or patient phone in a complaint about them.

Far too often, my hands were tied because they were meeting our requirements for downtime, which were loosely maintained anyway. It always seemed like keeping the trucks staffed took precedence over getting people enough downtime.

Part of the problem is figuring out who should be accountable for tracking these hours. Is it the state’s responsibility? Is it the provider’s? Should a specific service make sure their people are fit for duty? I am no lawyer, heck, I don’t even watch all that much Law & Order, but I am sure that a jury would have a lot to say about a medic who was on their 60th hour who made a medication error resulting in harm to a patient.

The bottom line is something needs to be done. Accidents are happening far too often. People are beating themselves up in the name of working 70-80 hour work weeks. I know this because I am one of them. And while I am sure that there will be people who say that “if you paid me more I would not have to work that much.” Well, that is a double edged sword. Of course, you can go by Skip Kirkwood’s old adage of “live within your means” which in my opinion is spot on. We are all guilty of buying too many toys.

Or we can take the higher road. Beg for more education. With a greater investment into a career comes a better paycheck. Write charts more effectively to increase revenue for the industry. Turn paramedicine into the ultimate goal and endpoint for a career and not just a stepping stone in the fire service or to a nursing degree.

I feel like with time that will come. In the meantime though, we need to create a safer environment for our patients and for ourselves. We need oversight at some level, and we need it now.

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