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the research project is in public safety government. read before bidding  background part due now Historical Background Assignment for The Analytical Research Project in public safety My problem statement: STATEMENT OF THE PROBLEM The best method to ensure safety of staff during a pandemic at Lee County Emergency Medical Services Department in order to increase staff safety and reduce work related injuries. If I can improve the safety of the staff that will improve the quality of care to patients The next step after finding a problem statement is: complete the historical background of the problem Using the template attached to the post, complete the historical background of the problem. Describe all aspects of the organization related to the selected problem. This assignment must include the history of the problem, its emergence, and solutions offered in the past. The research for this assignment will most likely be obtained from newspapers, magazines, agency interviews, etc. Does NOT require peer review articles. Remember all resources must be properly cited and referenced in APA format. All these points must be covered · Describe the organization, its number of personnel, its budget, its Jurisdiction, and demographics of the jurisdiction served by this organization · Why does the situation you mentioned in your problem statement need improvement? · What would happen if no changes were made as you propose in your problem statement? · Is solving this problem worth the time, money, and resources that will need to be expended? · What is this problem's history in this organization? · What are the root causes of this problem in this organization? · Who are the stakeholders affected by this problem? · What interest do these stakeholders have in solving this problem? · Has this problem had any attempts at a viable solution in the past? If so, what were the outcomes? · How will a solution to this problem be beneficial to the agency and the public it serves? Remember my problem statement is regarding the Lee County Emergency Medical Services Department located in Fort Myers Florida USA Historical Background Assignment for The Analytical Research Project in public safety My problem statement: STATEMENT OF THE PROBLEM The best method to ensure safety of staff during a pandemic at Lee County Emergency Medical Services Department in order to increase staff safety and reduce work related injuries. If I can improve the safety of the staff that will improve the quality of care to patients The next step after finding a problem statement is: complete the historical background of the problem Using the template attached to the post , complete the historical background of the problem. Describe all aspects of the organization related to the selected problem. This assignment must include the history of the problem, its emergence, and solutions o ffered in the past. The research for this assignment will most likely be obtained from newspapers, magazines, agency interviews, etc. Does NOT require peer review articles. Remember all resources must be properly cited and referenced in APA format. All these points must be covered · Descr ibe the organization, its number of personnel, its budget, its Jurisdiction, and demographics of the jurisdiction served by this organization · Why does the situation you mentioned in your problem statement need improvement? · What would happen if no changes were made as you propose in your problem statement? · Is solving this problem worth the time, money, and resources that will need to be expended? · What is this problem's history in this organization? · What are the root causes of this problem in this organi zation? · Who are the stakeholders affected by this problem? · What interest do these stakeholders have in solving this problem? · Has this problem had any attempts at a viable solution in the past? If so, what were the outcomes? · How will a solution to this problem be beneficial to the agency and the public it serves? R emember my problem statement is regarding the Lee County Emergency Medical Services Department located in Fort Myers Florida USA Historical Background Assignment for The Analytical Research Project in public safety My problem statement: STATEMENT OF THE PROBLEM The best method to ensure safety of staff during a pandemic at Lee County Emergency Medical Services Department in order to increase staff safety and reduce work related injuries. If I can improve the safety of the staff that will improve the quality of care to patients The next step after finding a problem statement is: complete the historical background of the problem Using the template attached to the post, complete the historical background of the problem. Describe all aspects of the organization related to the selected problem. This assignment must include the history of the problem, its emergence, and solutions offered in the past. The research for this assignment will most likely be obtained from newspapers, magazines, agency interviews, etc. Does NOT require peer review articles. Remember all resources must be properly cited and referenced in APA format. All these points must be covered  Describe the organization, its number of personnel, its budget, its Jurisdiction, and demographics of the jurisdiction served by this organization  Why does the situation you mentioned in your problem statement need improvement?  What would happen if no changes were made as you propose in your problem statement?  Is solving this problem worth the time, money, and resources that will need to be expended?  What is this problem's history in this organization?  What are the root causes of this problem in this organization?  Who are the stakeholders affected by this problem?  What interest do these stakeholders have in solving this problem?  Has this problem had any attempts at a viable solution in the past? If so, what were the outcomes?  How will a solution to this problem be beneficial to the agency and the public it serves? Remember my problem statement is regarding the Lee County Emergency Medical Services Department located in Fort Myers Florida USA HISTORICAL BACKGROUND OF THE PROBLEM HISTORICAL BACKGROUND OF THE PROBLEM (Cont.) HISTORICAL BACKGROUND OF THE PROBLEM (Cont.) 1 1 HISTORICAL BACKGROUND OF THE PROBLEM 1 HISTORICAL BACKGROUND OF THE PROBLEM Bright Dark Blues Grays Night Powered by Beeline Reader https://bit.ly/31jp0sQ Bright Dark Blues Grays Night Powered by Beeline Reader https://bit.ly/31jp0sQ Bright Dark Blues Grays Night Powered by Beeline Reader https://bit.ly/31jp0sQ Bright Dark Blues Grays Night Powered by Beeline Reader https://bit.ly/31jp0sQ FLORIDA SOUTHWESTERN STATE COLLEGE ANALYTICAL RESEARCH PROJECT PAD 4878 REDUCING EMPLOYEE FATIGUE IN LEE COUNTY EMERGENCY MEDICAL SERVICES SUBMITTED BY: DATE: Reducing Employee Fatigue in Lee County Emergency Medical Services 1 Running Head: Reducing Employee Fatigue in Lee County Emergency Medical Services Certification Statement   I hereby certify that the following assignment constitutes my own product. Where the thoughts, ideas, or expressions of another are used appropriate credit is given and, that where the language of another is set forth, quotation marks so indicate. I further understand that if appropriate credit citing the originating author is omitted by me it can result in the failure of this assignment and stricter academic disciplinary action by Florida SouthWestern State College.   Name Printed: Signature: Date: Table of Contents Certification Statement i Table of Contents ii Statement of the Problem 1 Historical Background of the Problem 2 Case Study One: Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report 6 Case Study Two: Mitigate the Dangers of Shift Work 9 Case Study Three: The impact of changing work schedules on American firefighters’ sleep patterns and well-being 11 Literature Review One: The exploration of physical fatigue, sleep and depression in paramedics: a pilot study 13 Literature Review Two: Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services 16 Literature Review Three: Seeking shift work solutions: shift work can harm sleep, and sleep loss can lead to fatigue and errors -- how is that impacting you and your patients? 19 Literature Review Four: A smarter schedule: a new scheduling option could improve recruitment and retention in EMS. 22 Literature Review Five: How Sleep Affects Long-Term Health 25 Alternative One: Eight Hour Shift Schedule 28 Alternative Two: 51S Schedule 30 Alternative Three: 12, 12, 24 Schedule 32 Alternative Four: Hybrid Approach 33 A Discussion of the Methodology of Quantitative and Comparative Analysis 35 LEGAL 37 FINANCIAL 37 ORGANIZATIONAL 38 POLITICAL 38 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-1 40 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-2 40 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-3 40 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-4 41 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-5 41 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-6 42 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-7 42 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-8 42 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-9 43 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-10 43 Discussion of Criteria Used to Determine the Weights for Alternative 1: L-11 44 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-1 44 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-2 44 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-3 45 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-4 45 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-5 46 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-6 46 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-7 46 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-8 47 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-9 47 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-10 48 Discussion of Criteria Used to Determine the Weights for Alternative 1: F-11 48 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-1 48 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-2 49 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-3 49 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-5 50 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-6 50 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-7 51 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-8 51 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-9 52 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-10 52 Discussion of Criteria Used to Determine the Weights for Alternative 1: O-11 52 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-1 53 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-2 53 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-3 54 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-4 54 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-5 54 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-6 55 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-7 55 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-8 56 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-9 56 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-10 56 Discussion of Criteria Used to Determine the Weights for Alternative 1: P-11 57 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-1 57 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-2 58 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-3 58 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-4 58 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-5 59 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-6 59 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-7 59 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-8 60 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-9 60 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-10 61 Discussion of Criteria Used to Determine the Weights for Alternative 2: L-11 61 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-1 61 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-2 62 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-3 62 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-4 63 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-5 63 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-6 63 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-7 64 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-8 64 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-9 65 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-10 65 Discussion of Criteria Used to Determine the Weights for Alternative 2: F-11 65 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-1 66 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-2 66 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-3 67 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-4 67 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-5 67 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-6 68 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-7 68 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-8 68 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-9 69 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-10 69 Discussion of Criteria Used to Determine the Weights for Alternative 2: O-11 70 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-1 70 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-2 71 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-3 71 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-4 71 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-5 72 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-6 72 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-7 72 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-8 73 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-9 73 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-10 74 Discussion of Criteria Used to Determine the Weights for Alternative 2: P-11 74 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-1 74 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-2 75 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-3 75 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-4 76 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-5 76 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-6 76 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-7 77 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-8 77 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-9 78 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-10 78 Discussion of Criteria Used to Determine the Weights for Alternative 3: L-11 78 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-1 79 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-2 79 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-3 80 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-4 80 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-5 80 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-6 81 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-7 81 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-8 82 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-9 82 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-10 83 Discussion of Criteria Used to Determine the Weights for Alternative 3: F-11 83 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-1 83 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-2 84 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-3 84 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-4 85 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-5 85 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-6 85 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-8 86 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-9 87 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-10 87 Discussion of Criteria Used to Determine the Weights for Alternative 3: O-11 87 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-1 88 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-2 88 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-3 89 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-4 89 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-5 89 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-6 90 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-7 90 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-8 91 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-9 91 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-10 91 Discussion of Criteria Used to Determine the Weights for Alternative 3: P-11 92 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-1 92 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-2 93 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-3 93 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-4 93 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-5 94 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-6 94 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-7 95 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-8 95 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-9 96 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-10 96 Discussion of Criteria Used to Determine the Weights for Alternative 4: L-11 96 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-1 97 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-2 97 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-3 98 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-4 98 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-5 99 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-6 99 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-7 99 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-8 100 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-9 100 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-10 101 Discussion of Criteria Used to Determine the Weights for Alternative 4: F-11 101 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-1 102 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-2 102 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-3 102 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-4 103 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-5 103 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-7 104 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-8 105 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-9 105 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-10 105 Discussion of Criteria Used to Determine the Weights for Alternative 4: O-11 106 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-1 106 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-2 107 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-3 107 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-4 108 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-5 108 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-6 108 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-7 109 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-8 109 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-9 110 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-10 110 Discussion of Criteria Used to Determine the Weights for Alternative 4: P-11 111 Alternative Number One Spreadsheet 112 Alternative Number Two Spreadsheet 114 Alternative Number Three Spreadsheet 116 Alternative Number Four Spreadsheet 118 Selection of Best Alternative 120 Project Implementation 121 Project Evaluation 123 References 125 Reducing Employee Fatigue in Lee County Emergency Medical Services 2 Statement of the Problem The best method of service delivery at Lee County EMS in order to reduce employee fatigue. Historical Background of the Problem Lee County Public Safety’s Division of Emergency Medical Services, or Lee County EMS (LCEMS), is a third-service EMS agency run by the Lee County Board of County Commissioners (Department of Public Safety, n.d.). Lee County EMS employs over 350 full-time emergency medical technicians, paramedics, supervisors, and support staff. The emergency medical professionals at LCEMS respond to over 90,000 emergencies annually with 42 ambulances and one aeromedical helicopter (Public Safety Dashboard, n.d.). Lee County covers 784.51 square miles of land and is home to 754,610 residents as of 2018 (U.S. Census, n.d.). Of Lee County’s 754,610 residents, 66.8% of residents are Caucasian, 9.1% are African American, 21.9% are Hispanic or Latino, 1.8% are Asian, and 0.4% are American Indian, Hawaiian, or Alaskan Natives (U.S. Census, n.d.). Lee County EMS has an annual budget of $44,927,148.00. Of the 42 ambulances that Lee County operates, 30 of them are manned 24 hours a day by employees working 24-hour shifts. This 24-hour staffing pattern was mandated and enacted following a lawsuit brought against Lee County, by EMTs and paramedics, in the ’90s. Before the lawsuit, employees were required to work varying shift lengths with no rest time in a system status management model. Although the 24-hour shift model was successful in the 1990s and the early 2000s, LCEMS has experienced a call growth of 3% each year for the past ten years. This increase in call volume has stressed the ambulance system and led to unit hour utilization greater than 30% at the busiest ambulances in the County. Additionally, the call volume increases over the last ten years have not been equally matched with resource allocation. The recession in 2008 resulted in a five year period where EMS resources did not grow, despite a steady increase in call volume. As a result, employees working on 24-hour shifts are required to respond to 911 calls with little or no rest. Increased calls, coupled with little rest and extended work hours, have led to employee fatigue. Fatigue in emergency medical services has been linked to employee injury, improper patient care, and increased mistakes (Patterson et al., 2017). EMS personnel working shifts shorter than 24 hours have reduced fatigue, improved alertness, better sleep quality, better health, and better patient care (Patterson et al., 2017). As Lee County continues to push toward 1,000,000 residents, failing to adequately address the workload issue within Lee County EMS will lead to increased employee injury, decreased system performance, and patient care errors. This pattern of fatigue can result in fiscal ramifications from workers’ compensation claims and lawsuits resulting from improper patient care and accidents. Although it will be costly and time-consuming to address the issue, it is imperative that employee fatigue is reduced before it has catastrophic consequences. Addressing the issue of fatigue within LCEMS will be complicated and fraught with obstacles. Historically, the International Association of Fire Fighters and Paramedics Local 1826, the Union that represents the EMTs and paramedics of LCEMS, has opposed changes to the 24-hour schedule and the current service delivery model, believing that any move away from a 24-hour schedule is a step toward the system status management model that employees sued against in the 90s. Additionally, changes to the system will likely have a fiscal impact that must be absorbed by the taxpayers of Lee County. The root cause of the increased fatigue in Lee County is due to the system being unable to expand appropriately to adapt adequately to the County’s growth. Operating in the same manner for the past 25 years has led to an inefficient and inflexible system that is prone to employee fatigue. This problem affects more than just the employees of Lee County EMS. While the direct effect of the problem is that EMS workers are fatigued on the job, the secondary effects reach all of the citizens and guests of Lee County. Taxpayer dollars are used to pay workers’ compensation claims. Additionally, citizens and guests who rely on 911 for lifesaving care may find themselves being treated by an EMT or paramedic who is fatigued. Resolving this problem would result in safer providers, decreased injury, and better emergency medical care. Fatigue in EMS and the fire service is not a new problem. Lee County has attempted to mitigate employee fatigue in the past by adding additional 12 and 24-hour advanced life support ambulances, reducing ambulance standbys during nighttime hours, and introducing basic life support ambulances into their response matrix. Although all four of these solutions have reduced employee workload and fatigue at a system-wide level, they have done little to address the busiest ambulances in the County. Employees at those stations continue to spend extended hours outside of the station with little rest in between emergency calls and standbys. Lee County EMS is at a crossroads. As the County’s population continues to head toward 1,000,000 residents, LCEMS will need to change their service delivery model to accommodate citizen growth while ensuring that employees are not working while fatigued. By altering the way they provide service to the community, Lee County EMS can provide quality prehospital emergency care in a manner that is safe for the patient, the provider, and the general public. In order to accomplish this, Lee County EMS and its employees will need to embrace a paradigm shift and be willing to redefine their service delivery model. Case Study One: Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report Extended work shifts lead to poor work performance and increased safety risk. Several studies have shown a causal linkage between work-related fatigue and medication errors. Since it is not unusual for EMTs and paramedics to work shifts ranging from 12 to 24 hours, there is a growing concern for the role that those shifts play in fatigue and patient care. A 26-year-old male paramedic who worked fulltime for an advanced life support EMS system voluntarily took part in a SleepTrackTXT trial that measured fatigue through the use of mobile-phone text-messages. To gain a baseline, the participant worked 24-hour shifts. The participant’s Body Mass Index was 29.5. His Pittsburgh Sleep Quality Index at baseline was an eight, which shows a poor quality of sleep. The Epworth Sleepiness Scale showed that he had excessive daytime sleepiness with a score of 16. The Chalder Fatigue Questionnaire and Occupational Fatigue Exhaustion Recovery scales showed that the participant had severe fatigue while on duty with limited recovery time between shifts and chronic fatigue. All of these tests showed that the participant had poor sleep habits with excessive sleepiness and acute fatigue. During the trial, the participant worked a total of 34 shifts. Ten of those shifts were for 24 hour periods, and 24 shifts were for 8 hours. During the trial, the participant’s total hours of sleep before work, perceived fatigue, difficulty with concentration, and sleepiness were measured at the beginning of his shift, the end, and every four hours in between. Examination of the hours of sleep the participant had before being on shift showed no difference between the 24-hour and 8-hour shifts, at approximately 5 hours. While on 24-hour shifts, the participant averaged 5.3 hours of sleep. The participant averaged none on 8-hour shifts. The participant’s 8-hour shifts were busier than their 24-hour shifts, with an average unit hour utilization of .39, compared to 0.05 on a 24-hour shift. Following the 90 day study, the participant repeated the questionnaires from the beginning of the study. The participant’s PSQI score improved from 8 to 5. His ESS score went from 16 to 12, which showed an improvement in situational sleepiness from excessive daytime sleepiness. His overall scores for chronic fatigue at 90 days were substantially lower, going from an 83.3 to a 56.7. The same could be said for acute fatigue, going from 93.3 to 36.7. This result was appreciated despite there being no change in the recovery time between shifts. This study showed that 24-hour shifts caused an increase in end of shift fatigue, sleepiness, and decreased concentration when compared to 8-hour shifts. The study also challenged the assumption that longer shifts result in more work, which was not the case for the participant in this study, who worked more during 8-hour shifts. The participant received more sleep on shift during the 24-hour shifts but showed a higher level of fatigue. This finding highlights that there is no single method for measuring workload in EMS. This study reaffirms that fatigue in the EMS setting is a complicated matter involving multiple social, environmental, physical, and psychological factors. The case also demonstrates that shift length may play a role in sleep health and fatigue for EMS providers. Patterson, P. D., Klapec, S. E., Weaver, M. D., Guyette, F. X., Platt, T. E., & Buysse, D. J. (2015). Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report. Prehospital Emergency Care, 20(1), 132–136. DOI: 10.3109/10903127.2015.1025158 Case Study Two: Mitigate the Dangers of Shift Work In a 2011 survey by the Journal of Emergency Medical Services, just over one-third of all EMS agencies that responded had a policy that addresses fatigue. Before 2006, Austin-Travis County EMS (ATCEMS) paramedics and EMTs worked a 24 hour on, 48 hour off shift schedule. ATCEMS had 12 ambulances that covered 1100 square miles. As the call volume continued to grow, the system attempted to compensate by using peak load, dynamically deployed ambulances, and special event trucks to cover events that were known in advance. Despite those attempts, providers worked around the clock with little rest. ATCEMS hired Circadian, an outside consulting firm, to measure their staff’s health, lifestyles, and sleep. Through a combination of logs and activity monitors, Circadian was able to conclude that the lack of sleep that the ATCEMS personnel experienced was affecting their quality of life and having an adverse effect on their work quality. Studies show that sleep deprivation can have similar impairment as alcohol consumption. Personnel who stay awake for 24 hours can exhibit the same impairments as someone with a blood alcohol concentration of .096%. In response to the findings, Circadian worked with a group of employees to develop a new shift plan. Initially, the group implemented a shift plan that included four 12 hour shifts, followed by one day off. This shift plan failed within the first 60 days and resulted in a second complete rewrite of the staffing model. ATCEMS implemented a staffing plan where personnel works two consecutive 12 hour days on a busy ambulance, one day on a slower 24-hour ambulance, followed by four days off. Each week, the schedule goes backward by one day, to rotate personnel through shifts on the weekend. Daytime and nighttime shifts are assigned based on seniority and are bid on every six months. Employees are not allowed to rotate between day and night shifts, since it does not allow an employee to adjust, and disrupts employees circadian sleep rhythm. ATCEMS also implemented work limits that restrict the number of hours that a person can work on a busy truck to 14. After an employee …