One thing I've recently seen be a point of contention is whether it's appropriate to disrupt sleep hours of 24 hour units for non-urgent transfers. That is, should 24 hour units have a time in which they're protected from being sent on non-urgent transfers? When this came up in the past, the consensus of "no" seemed to be coming from people whose systems weren't mixed 911/transfer systems and didn't do 24s. On the other hand, most of my 13 years in EMS has been with mixed-service 24 hour systems, one system of which was also a system-status deployment model (yes, I know that system status and 24 hour shifts are supposed to be mutually exclusive, but that fact never bothered company leadership). So, suffice it to say, I've had my fair share of riding 2 hours at 0300 on 30 hours without sleep for what could be an outpatient consult or because the local ED doc really wanted some other doc to take the liability for the discharge. A small company that I work for (mixed service, consecutive 24 hour shifts) recently started turning down overnight transfers for non-urgent reasons. The local (rural) ED was pissed and threatened to call other ambulance companies, but all the other companies got a good laugh when they heard where the hospital is. And in all fairness, they've laid some real stinkers of transfers in their time, including transferring due to CT glitch and transferring an 17 year old to the children's hospital two hours away for uncomplicated strep throat.
To me, it seems clear that 24 hour shifts are still well-suited to rural EMS, and I don't think it's at all unreasonable to not gamble with the lives of your crew, patients, and fellow drivers for what essentially amounts to the convenience of the ED staff. I don't think you can even argue that it's about patient convenience, because if it's ed-to-floor, then the patient realistically isn't going to see the specialist until business hours anyway (and there's a decent enough chance that the transfer is urgent at that), and if it's ed-to-ed, then there's a good chance (in my experience) that they're just travelling 2 hours away for a discharge, and where's the convenience in that? Stranded two hours away with an extra hospital bill and an ambulance bill so that they could get an outpatient appointment; now that's what I call service. The industry has had a nasty habit of pretending that people can just choose not to be affected by lack of sleep for too long, and there's been a lot of unfortunate consequences because of that. I don't have a problem with formalizing it and making sure that it doesn't get abused, but I just don't see the benefit in rawdogging your crews on non-urgent transfers.
What do you guys think?