End Core Flex

The Association has been engaged in an extensive professional fatigue impact study with a focus on both the psychological and associated health effects that a Core-Flex staffing model has on Alberta’s paramedics.

The Core-Flex model schedules EMS practitioners to provide emergency health services for an extended period of time which is typically 96 hours or more in duration.  Within Alberta, there are approximately 190 ambulances, providing front line emergency response, utilizing this staffing model.

Within our study, the Association has identified the following three major areas of concern within the Core-Flex model that identifies this practice as an immediate risk to public safety with a high potential to compromise patient care.

Fatigue Management Policies:
In an effort to reduce the liability of fatigue, EMS operations have started to implement fatigue management policies. These management policies are based on a “time on task” formula; which focuses on items such as emergency calls and inter-facility transfers. These policies fail to consider the total time a paramedic is awake within its “time on task” calculation. The result is that paramedics are awake for an extended period of time prior to being assigned a task that can be calculated towards their “time on task” clock. Due to this, practitioners have reported being awake for greater than twenty-four hours but haven’t accumulated enough hours to go out of service for fatigue. Additionally, practitioners have reported micro sleep during patient care or while driving the ambulance.

When the criteria are met within current fatigue management policies, ambulances within our communities are then “out of service” for set periods of time requiring ambulances to respond great distances from other communities who may also be subject to the Core-Flex model. To circumvent the impact that fatigue management policies have on our EMS coverage, fatigue management policies have incorporated a strategy where paramedics who are high on “time on task” hours are being reserved for critical patients and emergency calls. In essence, this results in the requirement of fatigued paramedics to provide care to patients (people of Alberta) who require the highest level of critical thinking and medical interventions.

There is no consideration within the Core-Flex model and the fatigue management policies for paramedics to properly prepare for each shift; determine regular work hours; establish a regular sleep cycle; or address sleep fragmentation and sleep deprivation.

Sleep Inertia:
“Sleep inertia refers to a period of impaired performance and reduced vigilance following awakening from a regular sleep episode”.

  • This is particularly concerning in a Core-Flex model where, by design, paramedics would be sleeping while on shift and be required to make critical decisions within minutes of awakening. Considering that sleep inertia may result in “impaired performance for several hours”
  • The practice of Core-Flex exposes the public, patients, and practitioners to increased risk of accidents, injuries, and medical errors.

Sleep Inertia is strongly connected to the Core-Flex model which is more prevalent in the rural sector. The rural paramedics are more likely to coordinate emergency situations with less available resources, respond greater distances for emergencies and inter-facility transfers while in a state of impaired performance from sleep inertia. This can result in increases in occupational injury, vehicle accidents, and risk of medical errors.

Cognitive Functioning:
The Association consulted with Psychologist and researcher Dr. Jennifer Short to examine the psychological impacts of a Core-Flex model. In her report prepared for the Association, The Impacts of Extended On-Call Hours on the Functioning of Paramedics, it was identified that paramedics experience sleep deprivation or sleep fragmentation, even when they’ve had the opportunity to rest during the shift. Furthermore, it also stated that these sleep disturbances have been extensively linked to disturbances in cognitive functioning, which will consequently impact both the effectiveness of paramedics and public safety.


See below for the corresponding letters to the timeline on the left. This will help keep the letters and correspondence in perspective as well as in chronological order.

6 thoughts on “End Core Flex

  1. I also work at a core-flex service of 2 days on and 4 off. This situation works very well for our remote location. I believe it would be very detrimental to have us change to a standard 12 hr shift. I would have fatigue issues due to the commute (1hr 45 minutes) not to mention the personal hazard driving that much on rural back roads in the winter. I agree some sites need their work shift pattern changed, but not every site. As we have found out with many ‘standardizations’ across the industry you can’t paint the whole province with one brush. There are too many unique factors across this large province to do that.

  2. Core flex works very well in lots of communities. The cost of eliminating core flex across the province would leave many communities with out timely service.
    The Province will never get rid of core flex with day and night cars. The budget for that would be massive. So the only options would be core flex trucks turned into peak cars. So the system as a whole will get even busier.

  3. Can you please list the services who you consider are using coreflex? I work for a 2 on 4 off (48 hours on 96 off) rotation but we are not core flex. I’d like to be sure we’re not lumped into the same category as many people say we are.

  4. I am interested in an answer as well. I have a 2 hour commute to my core-flex position. Staffing these posts will be extremely difficult on a 12 hour basis.

    Has anyone looked at prioritizing non-emergent transfers only during day light hours? Or perhaps improving telehealth where doctors are encouraged to conference & treat in their own communities vs sending out IFTs for “consultations”?

    Another option would be to improve offload times in Metro areas as rural units are often “sucked into the vortex” following a drop off which obviously leads to high amounts of time on task, not to mention the extended drives back to respective coverage areas.

    In the end not all of us have the opportunity to work anything BUT core-flex.

  5. If the Core Flex is such a risk-intensive model, then what would be acceptable to move forwards to?
    How could provincial systems be able to staff the rural jurisdictions that largely rely upon hires from out of town (often with a commute greater than an hour from home to their station of work)?

    1. David l commute well over 1 hour NOT to be involved with core-flex . I know dozens of my co-workers who do the same.

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