Firefighters’ 24-hour shifts get close look

In the past few years, Clark County fire­fighters have seen their reputations tarnished amid accusations of abusing sick time, and they've responded by using 57,000 fewer hours.

Now county officials are considering taking a look at a firefighter tradition: the 24-hour shift.

Firefighters are one of the last occupations to still work a full day without guaranteed rest, even as health care workers and truck drivers have seen restrictions on work hours.

As cities become strapped for cash, some are wondering whether it still makes fiscal sense. The fire chief in Washington, D.C., said in January his department could save tens of millions by having firefighters work more, and shorter, shifts.

In Clark County, officials are conducting an extensive study of how and where it distributes firefighter resources.

Assistant County Manager Ed Finger said the 24-hour shift pattern could be part of that study, expected to finish this year. But "it's not immediately obvious to me how 12-hour or other shifts would be cheaper," he said.

He might be right. Although paying someone 24 hours of overtime can be costly, it still might be cheaper than hiring more firefighters, which might be required if the shift pattern is changed.

But there might be other reasons for changing. A growing body of evidence in other industries is revealing that extended work hours could be dangerous, leading to more mistakes. For firefighters, whose responsibilities are mostly devoted to responding to medical emergencies and car crashes, extended shifts could carry significant consequences.

In Ontario, Canada, fire departments have been moving toward the 24-hour shift at the urging of collective bargaining units. But in two extensive reports, the Ontario Association of Fire Chiefs urges caution before making the change.

"There are lots of unanswered questions," said Barry Malmsten, the association's executive director. "Can it work? Yes. ... We just owe it to the public to look after them and owe it to the firefighters that they're healthy."

HISTORY AND COST

The origins of the 24-hour shift date back to the birth of big-city firefighting in the United States, when firehouses were filled with people who didn't work shifts - they lived there, according to Lori Moore-Merrell, a former firefighter and assistant to the general president of the International Association of Fire Fighters.

But in the early 1900s, as firefighting became a profession and employees wanted more time for themselves or their families, they started working full-day shifts with full days off. That became popular with agencies across the United States. In Las Vegas, the pattern has been used as long as people can remember.

In big Northeast cities, such as Boston and New York, that are prone to large, heavy fires, the century saw a move to shorter shifts. Those cities needed fresh bodies throughout the day to battle blazes that had the potential to last for hours, Moore-Merrell said.

"When they came to work, they were running fires constantly," she said. "There was no recuperating time at all."

Today, an estimated 70 percent of all firefighters at agencies big and small in the United States use some variation of the 24-hour shift. Las Vegas Fire Department firefighters work every other day for six days, followed by four days off. Clark County firefighters work every other day for 10 days, followed by six days off.

Firefighters for both departments work an average of 10 days per month. While firefighters can sleep in between calls, they get no guaranteed rest time.

Las Vegas Fire Department Chief Mike Myers is often asked by the public why firefighters work full days. He said it's partly history, partly cost-effectiveness.

"When I researched other fire departments, most of them say it's the least expensive way to operate," he said.

That can be true. Staffing for more, shorter shifts could require hiring more firefighters. Firefighters work a minimum of 48 hours per week and don't become eligible for overtime until after working about 56 hours in a week.

But when they do have to fill in for someone, the overtime costs are the equivalent of working two or three shorter days. D.C. Fire Chief Kenneth Ellerbe claims that moving to 12-hour days could make his department more flexible, cut overtime costs, and save more than $30 million annually by 2017.

That agency is more than twice the size of the Clark County Fire Department, where overtime helped push the average county firefighters' salary and benefits to $189,000 in 2010. Amid scrutiny, it fell to $175,000 last year. The amount the county spent on overtime and callback pay fell from $18 million in 2008 to $10 million last year.

The 24-hour shift pattern also doesn't allow for additional staffing during peak hours.

Paramedics with both private ambulance companies - MedicWest Ambulance and American Medical Response - work for 12 hours, and the shifts are staggered throughout the day. Employees bid for their ideal shift, based on seniority.

Michael Gorman, general manager for American Medical in Las Vegas, said he allocates more ambulances during the busiest times of day, typically when people are traveling to and from work.

"We're very, very good at forecasting approximately what the volume is going to be," he said. "We can correlate many different spikes in the volume to time of day ... to the temperature."

Clark County Fire Department Chief Bertral Washington said that because of Las Vegas' 24-hour nature, fire­fighters often can be busy throughout a shift. At their CityCenter station on the Strip last year, for example, exactly a third of their calls came between midnight and 8 a.m. At Station 28, one of their slower stations, in the middle of Summerlin, 21 percent of the calls came during the same period last year.

For firefighters, the vast majority of their job involves responding to car crashes and medical calls, similar to paramedics with private ambulance companies. Last year, only one in every 50 incidents Las Vegas and Clark County firefighters responded to required them fighting an open flame. The departments responded to more than 220,000 calls last year.

IMPORTANCE OF SLEEP

Dr. Dale Carrison is now the head of head of emergency and chief of staff at University Medical Center, but he got a late start in the medical field.

He was a physician-in-training in a hospital at age 51. That was 22 years ago, when 24-hour shifts - or longer - were routine for residents in emergency rooms.

One day, he cared for dozens of patients over a 24-hour span. He was so busy, and had been up for so long, that when he stopped he couldn't drive home.

"I knew that I was exhausted, and I knew I wasn't safe to drive home," he said.

He slept at the hospital for a few hours, drove home, and later told his supervisors he never wanted to work like that again.

That was the last time he worked a 24-hour shift.

Today, residents can still work for 24 hours, although in most places they are limited to 80 hours of work per week, with one guaranteed day off. And there is a push to limit those hours even more, since study after study shows the inherent risks in working for long hours.

A 1997 study published in the scientific journal Nature found that people who have been awake for 24 hours had the same cognitive performance as someone with a blood alcohol content of 0.10 percent. The legal limit for alcohol today is 0.08 percent.

A 2006 Harvard study found that one in 20 resident-physicians admitted a fatigue-related mistake that resulted in a patient's death. Another Harvard study that year found that interns working more than 20 consecutive hours were 61 percent more likely to pierce themselves with needles or scalpels, compared to interns who worked less than 12 consecutive hours.

Studies of truck drivers and airline pilots have found similar issues. But there have been few studies about how extended shifts might affect firefighters.

Perhaps nobody has looked at the issue more in depth than the Ontario Association of Fire Chiefs. Most departments there have been working normal shifts until the last decade, when collective bargaining units started pushing for 24-hour rotations. The association then issued two discussion papers, in 2006 and 2011, that culled much of the peer-reviewed research on the subject.

They cited sleep studies that showed that 24-hour rotations can be beneficial to firefighters' sleep patterns. But also that the shifts could lead to more accidents and slightly slower response times.

They concluded that more research was needed. Until then, "fire departments should not commit to changing to a 24-hour shift pattern."

Malmsten, the association's executive director, said he didn't believe that firefighters were immune to the effects of sleep deprivation shown by research in other industries.

"If it applies to a doctor or intern, if it applies to truck drivers ... why would it not have the same impact on fire­fighters?" he said.

SERVICE SHOULD BE FOCUS

Malmsten said his organization didn't find a significant difference in cost between the different shift patterns, which he said could amount to merely "re­shuffling the cards in the deck."

And that shouldn't be the concern, anyway, he said. The focus should be on whether the public and the firefighters are adequately served by the shift pattern.

Critics have attacked overtime costs, but not the quality or response of firefighters. Washington, the county chief, said his firefighters responded to calls within 7 minutes 77 percent of the time. While that has improved over the last few years, he said he'd like it to be closer to 90 percent and is installing better notification systems in fire stations to reach that goal.

Ryan Beaman, president of Local 1908, which represents Clark County fire­fighters, said the shift pattern is popular.

"It's never been an issue brought to the union," Beaman said. "The firefighters for the county like it."

Changing shifts could be a long shot for officials, considering that it would be part of collective bargaining with the firefighters union.

Neither Beaman nor Myers, the Las Vegas fire chief, say they have experienced fatigue while working for extended shifts.

Washington said his supervisors often go out on calls at all hours of a shift to observe their firefighters and can pull them off a scene if they need to.

Both he and Myers said the shift pattern remains popular.

"I don't hear any complaints," Washington said. "I think it's something that has been here. It's something that firefighters have adjusted to."

Contact reporter Lawrence Mower at lmower@reviewjournal.com or 702-383-0440.