Vote no against ambulance company greed

November 5, 2018

The largest for-profit ambulance company in the U.S., American Medical Response (AMR), is bankrolling a state ballot measure in California that will strip safety protections from its workers, endanger patients and enhance corporate profits for AMR. The measure would allow ambulance companies to require workers to stay on call during rest and meal breaks, allowing the companies to keep fewer ambulances in service.

Last year, AMR made enormous profits off transporting sick and injured patients. Profiting off the pain, suffering and distress caused by illness and accidents may seem macabre, but under capitalism, caring for patients can be highly profitable. AMR gets its profits from the dedication and hard work of its employees, the low wages paid to those workers, and understaffing, which causes delays in the time it takes an ambulance to reach a patient. Yet AMR wants more, and so it has shamelessly promoted Proposition 11, spending more than $21 million on passing the measure in November 2018.

An AMR paramedic spoke to fellow paramedics Lorrie Beth Slonsky and Larry Bradshaw about conditions at the ambulance company, the disturbing ballot measure and more.

LET’S START with what are working conditions like for paramedics and emergency medical technicians (EMTs) at AMR.

EMTs and paramedics face grueling 12-hour shifts, with the prospect of being held over for two additional hours every day, depending on how busy the EMS system is.

I wake up at 5 a.m. to be ready for my shift at 7 a.m. I get to headquarters early to make sure my ambulance has all the necessary supplies and that everything is in working condition. We aren’t expected to do this, but I’ve been unable to sleep at night because an essential piece of equipment malfunctioned during a critical call. That’s why I check every piece of equipment before logging in.

This has also happened to my co-workers. We log in, knowing that night crews have been waiting for us to go into service so that they can, in turn, go home. Usually, we get a call right out of the gate — and it turns out the call has been holding for a while because there wasn’t another available unit in the county who could run it.

EMTs and paramedics campaign against Proposition 11 in California
EMTs and paramedics campaign against Proposition 11 in California (International Association of EMTs and Paramedics)

After transporting our patient to the hospital, we need time to complete paperwork and return the ambulance into working condition. At that point, our field supervisors pressure us to get it done faster because there aren’t enough units available to run calls.

Our paperwork requires precision and has to capture every detail of our call, because these are legal documents that are part of the permanent medical record for our patients. They are an extension of patient care, and mistakes have dire consequences. Paramedics risk their licenses every time we document something. Private ambulance companies easily throw us, as well as our patients, under the bus rather than have our backs by giving us proper breaks.

After being confronted by our supervisors, we clear the hospital and catch another call before leaving the parking lot.

We’re always on call for the entire duration of the shift. Often, medics are rushing to and from places, with back-to-back calls. In metropolitan areas, this workload is the norm. When it gets really busy, patients experience long wait times for ambulances to arrive. We, as workers, can’t do anything about these response times. As soon as we get a call, we respond immediately and always have.

The common thread here is: not enough ambulances. Private corporations like AMR don’t staff enough units. They create brutal work conditions for us, and, more importantly, they make it harder for our patients to receive the best care.

WHAT IS the effect on the body to work long hours on an ambulance in a busy system with a high call volume, a high workload and too few ambulances?

WE HAVE a lot of pride around being our patients’ safety net. Because we want people to receive the best possible care, we must stay alert at all times. We have to stay ready to respond to a medical emergency at all times. There’s no way to know what the next emergency request or call will be.

There is such variance in our calls, from shootings, to stabbings, to motor vehicle accidents, to delivering a baby. And we must be prepared for all of them. We must be ready to treat our patients the minute we step out of the ambulance, and there’s no way to know exactly what condition they’ll be in.

Even small decisions in our field carry tremendous consequences. This creates a mode of hypervigilance. The sympathetic nervous system — the body’s fight-or-flight response — gets put on overdrive.

For the first year, maybe even the first few years, this is fine. But the longer you do this work, the more fatigued you become. It’s absolutely exhilarating to have an adrenaline rush and save someone’s life, but the reality is that this wears down our bodies. Even if we’re hungry or tired or sleep deprived or need to use the bathroom, we must learn to repress our needs. We have to do that so we can respond to calls with as much mindfulness as possible.

These are the conditions of capitalism crystallized. We’re taught as workers that our needs, even basic ones, aren’t important. And now, AMR is trying to take away our rest and meal breaks.

MEAL BREAKS are one of the issues in Proposition 11. Can you talk about the proposition — what’s in it and what it would do if it passes?

UNDER EXISTING California labor law, AMR employees are supposed to have guaranteed rest and meal breaks. The nature of our job makes it difficult if not downright impossible for us to get a break that isn’t interrupted. AMR is supposed to compensate us when our breaks are interrupted. AMR chose not to do that and instead pocketed the money.

A number of EMTs and paramedics have filed civil suits seeking back pay for their interrupted or missed breaks. Recent case law suggests AMR may lose these lawsuits. AMR’s solution has been to drop more than $21 million into sponsoring Prop 11.

WHAT’S MOTIVATING AMR to spend so much money fighting over whether and how you get meal and rest breaks?

THERE ARE two parts to that answer. First, the state’s independent Legislature Analyst’s Office estimates it would cost private ambulance companies in California more than $100 million a year to adequately staff up enough ambulances to give paramedics and EMTs their legally required breaks.

Second, AMR’s Prop 11 reaches back in time and retroactively defines AMR’s illegal past practice as legal, effectively exempting the corporation from any liability for past violations of existing labor laws. So placed in this larger framework, AMR’s investment of $21 million in its own private ballot measure and rewriting labor law is really a smart, but unethical investment.

WE’VE WORKED on both public and private ambulances, and we don’t ever recall getting a guaranteed meal or rest break while on duty.

THE REALITY is that medics and EMTs routinely already have our rest and meal breaks interrupted. Prop 11 wouldn’t change that. We all drop whatever we’re doing to respond to a call, mid-meal or otherwise. That’s part of our duty and has always been part of our practice.

What would change is AMR being able to walk away from paying workers what they deserve for having had their meals interrupted. Naturally, AMR’s campaign literature says nothing about the lawsuits, retroactive exemptions from breaking the law, and not staffing enough ambulances to give workers a break.

AMR is taking heat from the public for the long ambulance response times. Prop 11 functions as its attempt to appease the public and scapegoat the employees who actually do the work — suggesting the problem is paramedics and EMTs taking breaks, not that AMR is too tightfisted to put more ambulances in service.

And as I said, if Proposition 11 passes, AMR will be relieved of the millions of dollars of back pay to workers who have had their meal breaks interrupted. That’s more money for AMR’s coffers.

The root of the issue is that there are simply not enough ambulances being staffed. These glaring issues around public health and safety don’t stem from EMS crews being late to 911 calls because we’re on meal breaks, like AMR suggests. Corporations like AMR put profits ahead of community needs.

Understaffing ambulances and the high volume of 911 calls create impossible conditions, and EMS crews are unable to respond in the way EMS workers and the public want us to.

WHAT IMPACT do these long and busy shifts with minimal breaks have on the ability of you and your co-workers to perform and do a good job?

AS YOU can imagine, the health of an emergency medical worker can affect our ability to provide the kind of care we would like for our patients. Because we don’t have a guaranteed meal break without interruptions, let alone a meal break at all, many workers I know resort to fast food. It’s no surprise that EMS workers are increasingly overweight and at risk for cardiovascular disease.

We are our patients’ first point of contact with any type of medical help. As first responders, our split-second decision-making and our interventions play a huge role in patient outcomes. This can’t be overstated. If we don’t have real breaks to recharge, we won’t be mentally or physically as sharp.

THERE’S a lot of scientific research on the problems associated with sleep deprivation. In particular, multiple studies have shown that driving sleepy is very similar to driving drunk. Is this a problem you experience with long shifts, few breaks and back-to-back ambulance runs?

YES. FOR one thing, there is little turnover time between shifts.

Let’s say we get off shift on time — that gives us 12 hours until we have to be back at work. Subtract eight hours for sleep, minus another hour for commuting, and we’re are left with only three hours of downtime. During those three hours, we have to find the time to decompress, eat well, hopefully spend time with loved ones and exercise: all the things workers need to do to socially reproduce themselves for the next day.

Like all other workers, we make sacrifices. We have to choose what to sacrifice and what basic needs we can meet. Sleep often takes a hit. A caricature of EMS workers is probably one of us always drinking a caffeinated beverage. That’s because we’re perpetually sleep deprived.

It’s difficult to get off work on time, and even when we do, it requires a robotic type of discipline to get prepared for the next day. Like all workers, we want to be able to enjoy our off time. The small window of downtime between shifts allows for only meeting some of our most basic needs.

THERE’S A lot of stress associated with being a paramedic and an EMT. Does your present working conditions help or hinder your ability to deal that that chronic stress?

WITHOUT TRUE downtime during our 12-hour shifts, our work conditions create burnout. Many of my co-workers experience depression and anxiety. Often, we try to cope in secret and suffer in silence. In general, there is a stigmatization of mental health. Emergency medical service providers especially are expected to “solider on” despite immense challenges.

This has been built into our field since its conception. By the nature of the job, we’re continuously exposed to a multitude of critical events. We’re witness to traumatic events, serious injuries and death. The job carries high risk for post- and continuous traumatic stress disorders.

When we arrive at a hospital and transfer our patients to the ER staff, we are expected to brush off life-altering traumatic events, prepare ourselves and our ambulance for a quick turnaround, and get back in service to run another call.

The next call may be even worse than the previous one. One of the most stressful calls we can run involve cardiac arrests, because the patient appears to have died. It is our duty, of course, to resuscitate this person. The families of our patients go through intense emotions while we do our work.

With training, we learn to control our emotions so that we don’t freeze up on scene. But when patients can’t pull through, and we don’t revive them, it’s a heavy emotional load to carry. The details never leave you: the cries from the family, the smells, the ghastly pale skin, the sheer lifelessness and the internal pleading on our part to get a pulse back. In the little space and time at the hospital, we don’t have time to process these things.

One day, I remember running a call like I described, and the very next call was a pediatric cardiac arrest of a 3-month-old. No amount of training or practice can ever prepare you for something like that.

I’ll carry that with me, I’m sure, for the rest of my life. I’ll remember the gaunt look of desperation that the patient’s mother had and the eerie silence on scene. I’ll always carry with me the sensation of wrapping my hands around a limp infant as I gave compressions with my thumbs.

These are the things that keep us up at night as we obsessively go through the details. What could have been done differently? Could I have been faster here or there? Could I have been more prepared?

We develop a fortitude that allows us to stay healthy. But there are those of us who don’t. We’re at high risk for suicide. EMS workers are 10 times more likely to attempt suicide than the general population.

I hope you can understand why we need more breaks, not fewer.

PRO-PROP 11 mailers say that the ballot measure will mandate more training and better mental health benefits for workers. What do you say to those claims?

A CAREFUL reading of Proposition 11 shows it will not require AMR to provide any new or additional training or mental health benefits above and beyond what the corporation already provides.

When we first start out working in an EMS system, we undergo training academies that cover the medical protocols of the county and the nuts and bolts of ambulance operations. There is a small “self-health” component built into training. Out of the month-long training, I remember spending merely a couple hours on the importance of self-care.

Of course, private companies don’t support us in self-care. They tell us to take care of ourselves without providing material support to allow us to do that on shift. The burden falls upon us.

DOES THE ballot measure impact anyone outside of EMTs and paramedics who work on ambulances?

IF THIS proposition passes, it will usher in even more austere and challenging work conditions. Not just for us, but for all workers. This sets a dangerous precedent. Allowing private companies to circumvent existing labor laws in our industry sets a bad legal precedent and would allow the removal of legal and safety protections from other groups of workers and patients.

IT SEEMS like the labor movement dropped the ball on organizing opposition to Proposition 11.

UNIONS HAVE failed to submit opposition arguments to the California Official Voter Guide on time. So for many voters, there appears to be nothing negative about the proposition.

BUT THERE has been some opposition organized by workers at AMR. What have you and your co-workers done?

“NO ON Prop 11” has become a grassroots worker- and labor-led campaign against a major corporation, a corporation which itself is merely a division of the multibillion-dollar conglomerate KKR. Dozens of workers have demonstrated in Sacramento, including members from three unions. One of the slogans was “people over profits.”

There is also activity in other states, as AMR’s true colors are coming out. EMTs in Seattle have organized against AMR for higher wages because they start at close to minimum wage.

WHAT CAN readers do to help defeat this horrible piece of anti-worker and anti-patient legislation?

DEFINITELY VOTE no on Proposition 11 and encourage everyone you know to do the same. Also, organize and support workplace actions. If they’re coming for us, they’re coming for all of us. It’s clear that Prop 11 is not a solution for patients, It’s not a solution for EMS workers, and it won’t put extra ambulances on the streets to reduce ambulance response times.

WHAT CAN do those things?

MEDICARE FOR All! It’s comprehensive, universal and cost-effective health care. Medicare for All focuses on patients and prioritizes the health of working-class families over profits for corporations like AMR. We need a health care system that works for all us, not just the millionaires and billionaires.

AS FRONT-line emergency and health care providers, your working conditions are also the conditions in which your patients receive their care. If you had one wish, what one thing would you change immediately and why?

HUMANIZE THE field. We aren’t robots, and patients aren’t numbers that generate profit. We can’t function like mechanical beings for 12 straight hours. It’s simple: workers perform better when they’re supported.

Corporations like AMR absolutely have enough money to ensure there is ample coverage by ambulances, yet they strive to provide the bare minimum. This is nothing new and goes across the entire chain of providers.

The profit-driven corporations that provide care for human beings at their worst and most intimate moments have created an ugly behemoth of an industry. They don’t care whether their workers are well-fed or whether patients are getting the best possible treatment. They only care that we’re all making money for them.

When we get told by management to be better, to be faster, to be more efficient, while they consistently understaff ambulances, that isn’t support. Now they’re trying to take away guaranteed meal breaks and get out of paying us what they owe, and it’s a slap in the face.

We deserve better. Our patients deserve better. We have to fight for better work conditions moving forward so we can best serve our communities. In the meantime, we must stop this proposition from passing.

THANKS FOR talking with us, keep up the good work, and thanks for doing the job you and co-workers do every day.

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