The International Association of Fire Chiefs and U.S. Fire Administration partnered with Oregon Health & Science University to review the literature on fatigue and sleep deprivation in the transportation and safety fields, to determine how that information relates to fire and EMS responders, and to develop mitigation strategies.
On Sept. 25, they released a 95-page report,"The Effects of Sleep Deprivation on Fire Fighters and EMS Responders," on their findings and posted it and related training materials on the IAFC and USFA Web sites.
"This is an in-depth culmination of available sleep-deprivation research that, if taken seriously, should keep the fire chief awake at night," said IAFC President Steven P. Westermann.
"Sleep deprivation is linked with increased errors in tasks requiring alertness, vigilance and quick decision-making," wrote the study_s authors Diane L. Elliot, MD, and Kerry S. Kuehl, MD, DrPH, from the OHSU Division of Health Promotion and Sports Medicine in the report_s executive summary."Long work hours often are associated with chronic sleep loss, which may result in decreased ability to think clearly and feelings of depression, stress and irritability. Ú Chronic sleep loss also is associated with a general increase in health complaints and musculoskeletal problems, higher body weights, a greater risk of obstructive sleep apnea, and heightened levels of cardiovascular disease and cancer."
However, the researchers did not issue a blanket recommendation that departments shorten shift lengths. Noting that some departments have recently cut shifts for busy stations and others have recently moved from 24-hour to 48-hour shifts, they suggested departments review their shifts and determine on a case-by-case basis what would work best for both employees and the department.
Fire and EMS employers are urged to:
- Identify workers with sleep disorders and others at higher risk for difficulties in adjusting to long shifts;
- Recognize fatigue is a risk for motor vehicle crashes and workers driving home after long shifts may be at particular risk, and encourage workers to take a short nap before doing so; and
- Work with employees, their families, management and consultants to structure shifts and work hours that best meet the needs of individuals and the department.
"Missing one or two hours of sleep each night adds up,"Elliott said. She noted that after 12 hours of work, fatigued people may slip into momentary"micro-sleeps"without even noticing it," which can be fatal when they are driving at 60 mph." She also noted that half the drivers who fell asleep didn't know how tired they were.
According to Elliott, due to genetics, approximately one-third of the population can tolerate shift work and some sleep deprivation without major impairment, but one-third suffers moderate impairment and the other third suffers severe impairment. She advises fire and EMS employers to identify at least those employees who suffer severe impairment from sleep deprivation. To do so, she said, watch for fatigue-related accidents or errors and for the signs of obstructive sleep apnea (obesity, a neck size larger than 17 inches, daytime sleepiness and snoring, or apneic spells).
Her other recommendations: Educate employees about sleep, create a culture that acknowledges and supports the need for sleep, involve employees in decisions about shift structure and work-hour reforms, and institute such reforms on a trial basis, assessing outcomes before making them permanent.
Elliott and Kuehl also stressed that those working long shifts can"improve their well being by leading healthy lifestyles" and"maximizing their ability to achieve adequate restorative sleep."
"Because there are so many variables out there, you just can't draw any general conclusions about shift work," said IAFC Program Manager Vicki Lee, who managed the project. She recommends downloading the report and watching the 30-minute video, which provides a self-guided tour through the key points, as well as clips featuring the OHSU authors and other sleep experts.Download the report and other materials atwww.iafc.org/sleep.