As part of a cooperative agreement, the International Association of Fire Chiefs (IAFC), and the United States Fire Administration (USFA), with assistance from the Oregon Health & Science University, examined the issue of sleep deprivation in the context of EMS and firefighters. In June, they issued a 95-page report detailing the ill effects of sleep deprivation on emergency services personnel.
They should be commended for their efforts in producing a detailed, scientific and well-researched report — a report that will change the face of emergency services and shift work in the future. This report is a must read for fire chiefs, EMS managers and others working in the field of emergency services. Sleep deprivation is an important issue that must be addressed by all fire and EMS services who want to remain on the cutting edge. Put simply, long work hours — defined as shifts lasting more than 10 hours — have been clearly linked to errors in tasks that require vigilance and focused alertness, such as driving an ambulance and providing patient care.
Chronic sleep loss also results in a depressed mood, stress and irritability. Like pilots, truck drivers, marine fisherman and other around-the-clock occupations, EMTs and firefighters suffer cognitive impairments from sleep deprivation. Firefighters and EMTs suffer also from the negative health effects of insufficient sleep, which include increased risk of depression, hypertension, digestive disorders, immunosuppression, diabetes, obesity and a host of other mental and physical health problems. However, our profession has been slow to adopt the measures embraced by other professions to battle the effects of shift work and lack of sleep.
The report begins with a background on the physiology of sleep, circadian rhythms and the physiological effects of chronic sleep deprivation — not the least of which is cognitive impairment. It follows up with a review of the immediate effects of fatigue and the consequences of chronic sleep deprivation, some of which have involved serious motor vehicle accidents as well as medical negligence. The report acknowledges that the work of firefighters and EMTs is a unique setting, and that there are limitations in extrapolating data taken from other occupations into our own. However, it also notes that the transportation industry, and most recently the field of postgraduate medical education, have addressed the issue of chronic sleep deprivation and ultimately have mandated shift structure reform and attention to fatigue countermeasures.
A large section of the report highlights the specific potential implications of chronic sleep deprivation for firefighters and EMS personnel. The number of fatigue-related, single-vehicle EMS accidents provides some evidence of the problem. Long work hours also relate to injuries and errors in judgment. The unique shift structures employed by fire departments and EMS agencies, resulting in work weeks of 48 to 56 hours, are examined. The Firefighter Near Miss Reporting System provides background for statistical data on shift length. Disrupted sleep patterns are a recognized source of occupational stress, and alertness falls after 10-12 hours of work, as well as during the night hours. The episodic and unpredictable nature of our work is associated with fragmented sleep and overall increase in fatigue.
Most important, the report makes recommendations based on data for means to identify high risk individuals in the workplace, as well as how to structure work hours to minimize the catastrophic events that can result from sleep deprivation. The entire topic of sleep deprivation is approached as a major health and safety issue for emergency services personnel. The study goes on to discuss important issues of sleep apnea, sleep habits and lifestyles, the use of caffeine and stimulants, family education, commuting, physical activity and work hour management. It includes legal considerations as well as strategies for education and suggestions for future studies.
The study authors note that in other settings, highly publicized fatigue related adverse events have necessitated change. It acknowledges how difficult it has been to achieve change in the workplace that requires admitting that we are only human, that our abilities are limited, and that we can only do so much before we simply need to rest in order to maintain the top performance that our professions demand. Restorative sleep is needed for us to be able to perform optimally, and to be healthy. Like pilots, truck drivers, and medical residents, our high performance standards demand that we must be at our very best when we are needed. This report challenges fire chiefs and EMS leaders to address a serious problem in our work environment, and provides the tools for doing so.
For complete coverage on the IAFC sleep study, click on the JEMS.com article “Results of National Study on Responder Sleep Deprivation Released” and check out the November EMS Insider article “Detect Sleep-Deprived Employees & Minimize Fatigue-Related Problems IAFC & USFA offer information & mitigation strategies” and December JEMS.