Understanding EMS Scheduling Options

At some point, most government and elected officials will need to make decisions regarding EMS schedules as part of their duties. It is crucial to have a basic understanding of the different types of scheduling and their effects on provider safety, budgets, and employee satisfaction.

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I wish there were an easy answer to determine the optimal schedule for EMS providers. However, just as delivery models vary based on a community's needs, the options for staffing ambulances differ as well. From a financial perspective, failing to understand the impact of shift decisions could lead to higher costs and potential legal problems if not executed properly. Human resources and legal professionals are essential to ensure compliance with the appropriate regulations.

Two main areas can occasionally lead to complications with EMS shifts and compensation. The first area concerns overtime payment. The Fair Labor Standards Act (FLSA) has specific rules that might differ from those for Police and Fire departments. Even within fire-based EMS, distinct rules may apply to EMS overtime pay. It is crucial to refer to the US Department of Labor website and seek advice from your human resources and legal experts for further guidance. https://www.dol.gov/agencies/whd

The second area involves distinguishing between exempt and non-exempt employees. Many EMS agencies may have leadership roles that primarily function in the field. Consulting with experts is crucial to ensure these positions are correctly classified as exempt or non-exempt based on their job descriptions. A title alone does not determine this classification.

Shift Types

There are numerous types of shifts, and all have advantages and disadvantages depending on the person and agency. While there are multiple variations, I will focus on 24-hour shifts, 12-hour shifts, and 8-hour shifts. (It is also important to note that the staffing numbers I am using do not take into account the need for coverage for time off.)

24-hour shifts enable an ambulance to be staffed around the clock with minimal personnel. Essentially, 6 EMTs/Paramedics are needed to cover an ambulance with 24 hours on duty followed by 48 hours off. This shift appeals to employees because it provides more full days off; by taking 24 hours off, they can enjoy five complete days not working. This setup is beneficial for regions struggling to staff ambulances, as it allows individuals who live far from the agency to work for 24 hours and then return home. It also can be beneficial for employees with second jobs or with kids. Employees working 24-hour shifts log significantly more hours compared to those with a 40-hour workweek, totaling approximately 850 additional hours annually with a 24/48 rotation. This schedule requires a considerable amount of built-in overtime and can pose safety concerns, with the risk of being awake for 24 consecutive hours, particularly in busy agencies or those transporting to distant facilities.

A 24/72 shift is becoming popular among many departments, reducing the average weekly hours to around 42 compared to 56 for the 24/48 shift. This schedule provides an extra day of rest. However, from a budget standpoint, an additional crew of 2 is necessary to implement this rotation, requiring 8 EMTs/Paramedics to staff a single ambulance. This shift has significant budget implications for agencies adopting it. Most agencies have calculated the base pay rate and overtime rate to align with what they believe a position should cost annually. With the reduced hours, EMTs/Paramedics switching to this schedule would face a significant pay cut, placing their earnings well below the position's pay grade. Many agencies have adjusted the low hourly rate to ensure fair compensation. The key point about the 24/72 shift is that it might be ideal for your organization, but it will likely have budgetary impacts due to the need for additional staffing.

Many EMS agencies utilize a 12-hour shift day. While there are multiple types of rotations that can occur with this, one of the more common is the 2/2/3. This schedule is calculated over a 2-week pay period. The rotation example has employees working 2 days on and 2 days off during the week and then working Friday, Saturday, and Sunday every other weekend. Generally, there is a day and night shift and two divisions working opposite each other. It takes a minimum of 8 EMTs/Paramedics to cover one ambulance 24 hours per day. From an employee standpoint, many like having a 3-day weekend every other week, and half of the employees can be home every night in their own beds.

Although 8-hour shifts are available, they aren't commonly used by many agencies. Covering services 24/7 with the typical 8-hour day and 40-hour week requires at least 6 people. However, there are also 2 extra days (48 hours of ambulance coverage) that need to be staffed. Some agencies offer 8-hour shifts for additional ambulances during peak call times.

An important insight and benefit of certain shift adjustments is the capability to adjust ambulance availability and start times. Typically, ambulance requests follow time-based patterns, with call data often outlining request types, times, and locations. By offering varied shift options, staffing can be adjusted for peak demand periods. For instance, a fast food restaurant operates 24/7, but its lunchtime staffing differs from that at 3 AM due to lower demand at that hour. This concept is similar to EMS requests. In areas with several ambulances, maintaining the same number of ambulances at all times may not be practical. You might find that deploying 7 ambulances during peak hours and 3 during off-peak hours is more effective than consistently having 5 ambulances available.

As mentioned at the outset, there is no universal staffing solution, and it's crucial to consider your specific situation when making these decisions. Relying on employee safety, work/life balance, and response data will guide you in making the best choice for your agency.