Wednesday, July 11, 2001

An emergency medical team negotiated a steep driveway in
Palolo Valley Monday while attending to a sick-person call.
A chronic shortage of emergency medical workers had those
in Honolulu working collectively an average of 200
hours a day of overtime last month.

Ambulance crews
piling up overtime

A union official worries it's
only a matter of time before
fatigue causes an accident

By Rod Antone

The emergency medical workers who operate Honolulu's 16 public ambulances collectively worked an average of 200 hours of overtime a day last month, according to records obtained by the Star-Bulletin.

The city's Department of Emergency Medical Services June staffing records for paramedics, dispatchers and Emergency Medical Technicians illustrate what the workers say is a chronic problem that has left many of them feeling burned out.

What's more, sources within the department say that last month's overtime tally is not unusual for the past few months, with many EMTs working several 16-hour shifts a week and some even working rare 24-hour shifts.

"I hope I don't see it but it may be a matter of time before fatigue causes an accident or leads to something that affects patient care," said paramedic and EMS union steward Vince Park.

Park and others said the situation has left many emergency response workers feeling fatigued and disgruntled because they feel the administration is doing nothing about it.

"It's been building over the last few years and it's about at its zenith now," Park said. "And for some reason management is not recognizing that."

EMS Chief Robin McCulloch said the department employs 113 field paramedics and is attempting to fill six more positions. But "we have no control over the number of trainees that come in," he added.

"We will fill the positions as soon as people are trained," he said.

Park said the problem is "an obvious shortage of paramedics."

At least one paramedic per shift is needed along with one EMT to run any of the 16 county ambulances. Although there is no shortage of EMTs, they are being called upon to work more hours because of the paramedic shortage.

Qualified paramedics are also called to fill vacancies in the dispatch department, where six positions remain open out of a total of 14 slots.

Park said fatigue among workers "may get to the point where people may be reluctant to work if they are asked."

It takes roughly two years for someone to become a paramedic. After completing a semester course at Kapiolani Community College, trainees must go on a minimum of 200 field calls as an EMT before continuing on to the 17-month paramedic program.

The EMS training program is run by Dr. Edward Kalinowski, who said that KCC graduated 49 EMTs last year and 63 the year before. Kalinowski said whether the city hires their graduates and whether the EMTs make it to paramedic training is out of the school's control.

"We don't have a low number of graduates at the EMT level," said Kalinowski. "But we do need EMTs to get back into the system" as paramedic trainees.

McCulloch said there will be seven paramedics in training starting in January.

"We realize that our people have a huge workload," said Donnie Gates, EMS chief of operations. But, he added, "nobody forces anybody to work."

But Park said if paramedics are already at work, they do not have much of a choice. "If you're just coming off your shift and they ask you to work because they can't find someone to replace you, you could still go home, but they could discipline you and say you left your station unmanned."

Gates said no one has ever been disciplined in such a situation.

Other EMS personnel said it is not fear of discipline that leads them to work long hours, but rather devotion to the job.

"When it comes down to a 16- or 24-hour shift, you don't stay for the money or politics involved," said Laurie Grace, who has been a paramedic for seven years. "You stay for the people in the community that you get to know 365 days a year."

If an ambulance unit cannot meet the minimum requirement of one paramedic and one EMT per shift, it will be shut down, and emergency calls must be routed through the next available emergency crew.

Shutting down the unit in Waianae, for example, means the EMS crew in Makakilo must also cover that area as well as its own.

"I will never let Waianae shut down because this is my backyard," said Grace.

Grace said she often works the 3 p.m.-to-11 p.m. shift right after she gets off her regular 7 a.m.-to-3 p.m. shift because Waianae has no one assigned during that time.

"It's about serving the community you work in," she said.

Despite the gratification some get from the job, Park said the fatigue and dissatisfaction with management persists.

Already some paramedics are considering working no overtime should the situation continue, several paramedics said.

"This situation may require drastic measures but not that drastic," said Park. "I'd like to believe that it's all talk."

McCulloch said that as far as the overtime goes, the solution may be a "happy medium".

"Last year we hired part-time paramedics and we got complaints that we were taking away overtime from workers," McCulloch said. "Some people want to work OT, some don't."

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