Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Ambulance Crash ‘Caused by’ Overtime?


Was this crash caused by paramedics working an extra shift, or two, or three, or . . . ?

Does management’s math work (as reported)? Does management’s math (as reported) suggest that management does not understand math (or that a mistake was made reporting the story)?

HONOLULU (HawaiiNewsNow) – An ambulance crash at Ala Moana Center involved overworked paramedics on overtime.[1]


A paramedic on overtime? Oh, no! In many places, it seems that paramedics (who get paid more than basic EMTs) have to work more than one job to just be able to live paycheck to paycheck. Part of the problem is that we humans spend money unwisely (as a species, we are horrible at money management). Part of the problem is that EMS often does not pay well. If pay is low, people will work other jobs – or they will not be able to continue to pay their bills and complications ensue.

Here is the math problem.

The city wants to reduce chronic vacancies which lead to back-to-back shifts by changing the length of the shift from eight to 12 hours. The move would mean the city’s 22 ambulances could be run with one-third less staff each day, allowing other medics to have much-needed time off, but sources said the United Public Workers union is holding up the negotiations.[1]


If shifts are changed from 8 hours to 12 hours, there will be one third fewer shift changes, but that should not affect the number of calls the ambulances run. If the ambulances are not currently busy, changing the schedules might reduce the amount of time crews are not on calls, but so would cutting shifts. That does not seem to be an option, so this appears to be a bit of bad math that nobody in management has corrected.

If I work six 8 hour shifts a week, I am working 48 hours a week.

If I work four 12 hour shifts a week, I am still working 48 hours. I am only cutting the number of shifts in a week, not cutting the hours worked in a week.

If I work nine 8 hour shifts a week, I am working 72 hours a week. If I work six 12 hour shifts a week, I am still working 72 hours.

Should I expect to be any less tired if my shifts are divisible by 12, rather than by 8?

Will the proposed schedule result in fewer ambulances on the street at peak times. Someone will still have to pick up the patients. If ambulances are not currently busy, this could result in treating and transporting the same number of patients with fewer paramedics, but that can also be achieved with 8 hour shifts. Ambulance contracts often mandate that a certain percentage of response times be under X minutes. If management is able to get that to change, that could result in fewer crews on the street, but working much harder, and might be seen as a success by shortsighted management.


We can speed up what we do, but at some point we will increase the rate of errors. This is to be expected and should not be blamed on the employees. Management deserves the blame. The role of management is to help the income producing employees to do their jobs, not to blame the employees for bad management.

I have worked for people who manage this way – and not just in EMS, but we do seem eager to make excuses for bad management.

If management is not capable of competence with simple math (as was reported here), what are their other weaknesses?

If management isn’t able to manage with 8 hour shifts, will Goldilocks come to the rescue when the shifts are 12 hours long?


[1] First responders hurt in ambulance accident at Ala Moana
Posted: Jul 12, 2014 11:40 PM EDT
Updated: Jul 13, 2014 4:45 AM EDT
Hawaii News Now



  1. The EMS driver should have been more Akamai about the limited height of the parking structure.
    I have seen several trucks of that height that got stuck in the structure. They had to deflate the tires to exit.

  2. If I understand it correctly, they picked up the patient on the third level of the structure, so I’m curious about how they got up there in the first place. Did the architect make the exits lower than the entrances, or is it one of those that you enter from the top at street level and exit at the bottom to a lower street? If so, why wasn’t there one of those hanging clearance signs that would hit the top of the truck (without causing damage) as the ambulance went in, to signal that they were too tall?

    Either way, the driver should have been aware of both the minimum clearance for his ambulance*, and the height of the entrance.

    * This is a pet peeve of mine. I have been trying to get clearance heights posted in our ambulances for years, with no success.