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On a recent Monday, two Honolulu paramedics asked to come in eight hours early and work a double shift on their Kuakini-based ambulance.

For most people, that might sound like a very long workday, but to Kay Tomasa and Dawne Tsuha, a 16-hour haul was preferable to the possibility of getting “stuck” with a surprise extra graveyard shift at the end of the night.

The request to work a “pre” was denied, but both Tomasa and Tsuha avoided getting stuck at the end of their day, and went home after working their normal 3 p.m.-to-11 p.m. shift.

“It has been good lately. It really has,” Tomasa told Civil Beat during that ridealong.

“Overtime has been dry,” Tsuha said.

Things weren’t always that way in the Honolulu Emergency Services Department. A scathing audit released earlier this month says that despite millions of dollars in overtime pay in recent years, city ambulances have still struggled to respond quickly to emergency calls.

says just three of 21 ambulance units met response time guidelines between Fiscal Years 2008 and 2010, and each of those only cleared the bar in one of three years.

Meanwhile, the Honolulu Department of Emergency Services paid out nearly $16 million in overtime during that stretch — a significant portion of the $95 million the department spent on total operations. In the worst examples, some workers were earning between 200 percent and 350 percent of their regular salaries in overtime.

Staffing Shortages To Blame

The new director of the department has already moved to fix the problems and has other big changes planned.

Dr. James Ireland, the city’s Emergency Services director, says the problem stems from staffing shortages, and the audit agrees.

Medics say it’s a tough job with physical and emotional challenges and long hours. It can be hard to stick with it over the long term.

Emergency Medical Technicians (EMTs) and paramedics work hard and don’t get paid much. From start to finish, the process to become a full-fledged medic can take four or five years. The timeline includes prerequisites, an 18-month program at Kapiolani Community College and another long stretch in Mobile Intensive Care Technician class, plus evaluations and a probationary period.

In the same amount of time, someone looking to break into the medical field could become a registered nurse, and RNs make more than EMTs or medics. Many others leave the city to join the federal fire department.

The job is stressful, and the advancement timeline doesn’t leave much room for struggles, slacking or even bad luck. Before a trainee can move on to the next step in the process, they must complete a patient care checklist. When times are slow and not enough seriously ill or injured patients cross a trainee’s path, some have been known to take things into their own hands.

Tomasa said she’s heard stories about some who have intubated themselves nasally to keep their careers on track. It speaks to the culture and the expectations that EMTs and medics deal with and might explain why so many leave.

For some like Tomasa, the opportunity to help others is enough of a draw to block out the difficult aspects of the job.

“This is the best job in the world. I’m so glad I found it,” Tomasa said. “After I got into this, I never wanted to do anything else.”

But all those factors combine to drive others away, leaving the city with vacancies.

Of 261 positions, 48 were vacant in June 2008. That number dipped to 40 in June 2009 and now 30 this year, Ireland told Civil Beat in an October meeting at Honolulu Hale. He said overtime is directly related to the number of vacancies.

“We’re not like the library. We’re the ambulance. We’re EMS. We have to stay open. We have to staff the shifts. I think the key is the vacancies,” he said. “My goal is to stay within our budget, to increase ambulance services for the City and County without exceeding the budget and doing that by filling vacancies and with that reducing overtime.”

Who Gets The Call?

Overtime has started to dip, from $5.8 million in Fiscal Year 2009 to $4.9 million the next year, according to the audit. That still represents more than 40 percent of base salaries.

There are some concerns overtime is distributed unevenly, adding to the cost.

Employees with more seniority get first priority for overtime shifts, as do those who would be coming in on their day off rather than working a “pre” or “post.” It’s all laid out in the department’s agreement with the public sector employee union representing EMTs and medics, United Public Workers.

The audit said one employee earned more than $207,000. One EMS worker racked up more than 2,400 hours of overtime pay. Another employee took just 27 days off in one year.

Ireland said there’s been only one grievance filed with the union stemming from the distribution of overtime shifts in the year since he took over. A message left at UPW Monday was not immediately returned.

Deputy Director Mark Rigg said staffers use a tracking sheet to log who they call for shifts and whether that person accepted the extra work.

Ireland acknowledged the overtime is not distributed evenly.

“I’ve looked at it, and it’s not distributed equally and I think for the very reason is people don’t want it equally,” Ireland said. “There are a couple people who have worked a lot of overtime. And it comes to the point where, are they working so much that it’s not safe for them? That’s our biggest concern. Our secondary concern is the amount of money and compensation.”

Things might be changing soon.

Ireland said he anticipates changes to the state contract that is going to limit the number of consecutive days that an EMT or medic can work. That will require a meeting with UPW to figure out a new overtime-distribution model.

But the big change on the horizon is the possibility of longer shifts. On the neighbor islands, where emergency calls are few and far between, medics work 24- or even 48-hour shifts, Ireland said. In Honolulu, shifts are eight hours long.

“What we’re doing actively is we have met with the UPW, we’ve met with our HR folks and said let’s create a shift that’s more attractive to our personnel,” Ireland said. He said that might mean 12-hour shifts for the busier in-town stations and 16-hour shifts in the slower “country” stations.

“Instead of getting up, shaving, bathing, driving to work five days a week, if you’re working a 12-hour shift, maybe this week you’ll do it three times and next week you’ll do it four times,” Ireland said. “And so you’re having more days off but you’re working almost the exact same amount of hours. That’s what we think is going to add to retention, it’s going to get more cars off the road, it’s going to make our folks happier because they’re working less during the week. And we’re going to do it and it’s budget neutral — same cost.”

Read the full audit below: