Overworked and Under Appreciated in Baltimore

Mar 25, 2015

Every day you go to work seems to start the same way.  You clock in on time to the sound of your truck backing in to you station.  Your scope goes on the dash, coffee in your cup holder, and gear in the cabinet.  You pull the bag out of the curbside door and start checking through as the loud speaker overhead crackles to life: “Medic 3 respond. . . “ and you’re off.

The next ten hours of your day is filled with fourteen more responses every one of them with lights and sirens to the scene, and lights of sirens to the hospital.  As you wait for a nurse to give you your bed assignment, from your radio’s shoulder mic you hear the dispatcher of the day: “Holding a chest pain on the west side.  Is there anybody available to clear?”  “Medic 3, are you ready to go yet?”

You’re rushed.  You’re overworked.  The general public thinks that based on the overtime numbers that your department releases you’re overpaid because that choice group of people who torture themselves day in and day out with two or three calls an hour on the ambulance make more than the department’s chief.  And it’s the same thing, day in and day out, for your two days and two nights as you look forward to your four days off.

Until. . .

Until your department decides that since the guys and girls on the fire trucks are on 24 hour shifts that you should be too.  That is exactly what is getting ready to happen in Baltimore, Maryland.  According to the Baltimore Sun, BCFD is a department that has nearly fifty of their 232 paramedic jobs left unfilled from last year.  That leaves approximately 185 paramedics.  Those 185 paramedics make up just shy of 15% of their department’s 1,250 person staff.  That’s right: 15% of the employee base is responsible for handling nearly 160,000 calls which makes up the vast majority of the department’s annual responses.

Now, those 185 paramedics are on the verge of being forced into 24 hours shifts.  It is not right, it is not safe, and it needs to be squashed before it happens.

To dig deeper into the numbers, one just has to look at the Baltimore City Fire Department’s Union page.  In 2013, the busiest fire engine in the city, Engine 6, and the busiest truck company in the city, Truck 5, did less calls than 20 of the ambulances on the street.  That is 2/3’s of the department’s ambulances documented as handling runs and a few of those, based on volume alone, appear to not be full-time units.  Those medics are carrying the department on their backs and they are asked to do more and consistently provided with less.  There is no doubt in my mind based on the stories that I hear from friends within the department, and frankly some of the subtle attitude changes I have seen from a close friend in the department, that things need to change before something bad happens.  Burnout is up, and as the workload climbs and downtime is reduced, it will just continue to go up, and up, and up.

A day in EMS is filled with luck and superstitions.  Heaven help you if you talk about how “quiet” it is, or make a mid-shift announcement that it’s a “slow day.”  You choose your food wisely because there is a good chance that if you try and put a hot meal down in front you because you know that when you do your number will be called and you’ll be off to the next run.  These laws of the EMS day are true if you work at a rural station in the middle of nowhere or if you are at the busiest urban station in the country.    Even those who work 24’s at the slowest possible stations see their luck fail them.  Even those slowest assignments have incredibly busy days, or those fire standbys where you are tied up for hours at a time.  In some places this is a rare exception to the rule, in others it is more common than we would like it to be.

Why then, in a busy urban system that sees units run 30+ calls in a 24 hour day, does leadership see fit to put medics, EMTs, patient and the general public at risk by moving their medical staff to 24 hour shifts?  The outcome is very predictable.  Burnout.  Fatigue resulting in accidents on and off the job.  Medication errors.  Treatment errors.  Poor documentation done by exhausted providers.  The evidence is there.  Let’s just hope that the department leadership gets their head on straight before this happens.

If not them, then it is up to the medical director to advocate for the patients, and it is up to the union to advocate for its people.  It is time for these medics to take priority and not just be an after-thought for a union that would probably have a lot fewer members if not for their existence.

The overtime problems in Baltimore will not be solved by moving paramedic units to 24 hour shifts to try and maximize coverage.  What will solve it is by not only filling those nearly 50 vacant EMS positions but expanding the EMS division so that the department’s staffing levels more closely match their department’s volume.  That does not mean that they need to have more people on the medical side than the suppression side, since it takes more staff to staff a firetruck and perform fire ground operations than it does to handle a chest pain call, but the numbers need to be a lot closer than the 85/15 that it currently reflects.

My fingers are crossed for my friends in Baltimore.  Their struggle is real, and I hope the best for them and their department.  There is no doubt that their department requires restructuring they just need to go about it the right way.