You don’t think much about emergency medical services until you need them. Six years ago my family did, after my brother, David, was robbed and brutally beaten while walking around our quiet Northwest neighborhood. The long string of errors committed by emergency responders, which contributed to his death, propelled us to try to make things better for D.C. residents.
Four years ago the Task Force on Emergency Medical Services, established at our insistence, issued its report. And on the anniversary of David’s death, I am pleased to report that the D.C. Fire and EMS Department has made substantial improvements. The most important of these is that the department has finally started to give EMS the priority it deserves. After all, more than 80 percent of the department’s calls are for medical, not fire, emergencies.
Still, there is work to be done. At the moment, the to-do list is topped by Chief Kenneth B. Ellerbe’s proposal to change firefighters’ shifts from what’s known as 24-72 (24 hours on, followed by 72 hours off) to what the chief is calling 3-3-3, in which firefighters, who often are the first responders on medical calls, would work three consecutive 12-hour day shifts, followed by three 12-hour night shifts, followed by three days off.
The proposal has created much controversy, mostly having to do with cost, effect on morale, change to firefighters’ lifestyles and similar issues. But all those are trumped by safety. The task force recognized this and recommended that the department “implement shorter shifts for all employees . . . to ensure the goal of having alert and awake employees who can provide competent patient care.”
This is backed up by science, where many studies of long work hours and shift work invariably point to one conclusion: Sleep deprivation leads to underperformance and serious mistakes. In fact, in 2008 the National Institute of Medicine recommended that doctors-in-training should not work more than 16 hours in a row, should not be awakened to treat patients and should not even drive home if they have worked longer than 16 hours. And a 2009 article on shift work in the journal Current Neurology and Neuroscience Reports concludes that firefighters’ performance “is likely to be significantly degraded” on shifts like those used in the District.
Setting aside whether it’s proper for anyone to be paid to sleep during work hours, people who have life-and-death jobs need adequate sleep, whether they are doctors or airline pilots or firefighters or EMTs. That’s impossible in a busy firehouse. “If you’re waking up every two hours,” says Charles Czeisler, director of the Division of Sleep Medicine at Harvard Medical School, “you might as well be up all night.”
Shorter shifts are the only way to ensure that our emergency workers get enough sleep. But this doesn’t mean that Chief Ellerbe’s 3-3-3 plan is the right way to do it. Indeed, Czeisler thinks it’s perfectly horrible. First, he says, no one should work six 12-hour days in a row. Ever. Twelve-hour shifts make people “chronically sleep-deprived”; six in a row is a disaster. (Ellerbe says that built-in, rotating extra days off would rarely require anyone to work six days in a row, but to avoid it they would have to forgo quite a bit of overtime pay.)
Second, Czeisler says, no one should have to work three day shifts followed by three night shifts. Instead, people should work days for an extended period, followed by nights for an extended period. “You don’t want to be jerked around from one shift to another,” he says. If you are, your biological clock can never get set, and your body is always out of sync; you’re working below your ability no matter what shift you’re on.
It should be noted that single-role EMTs and paramedics, who eventually will be phased out, already work 12-hour shifts in a 2-2-4 rotation — two 12-hour days, followed by two 12-hour nights, followed by four days off. This may not be as bad as 3-3-3, but it presents the same dangerous problems.
So if shorter shifts are crucial, but 3-3-3, or 2-2-4 for that matter, isn’t the way to do it, what is? Unfortunately, Czeisler says, in many occupations “these things are not decided rationally.”
But they could be. So I offer a suggestion: The firefighters’ union must agree at the outset to eliminate the 24-hour shift. Likewise, Chief Ellerbe must agree that his 3-3-3 plan is not the way to go. Then together they can devise a better, safer schedule — and do so in a reasonable amount of time. Two months; no stalling.
If they approach this with open minds, they can sit down, consult experts and quickly devise a work schedule that will avoid the scientifically proven dangers of extended work hours and sleep-deprivation. It will establish the District’s emergency responders as pioneers in the field. And in the end, the people of Washington will reap the benefits.