Effects of Sleep Deprivation on Fire Fighters and EMS ... - NAEMT

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<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders 5.10 Behavior-Based Work Hour Management In organizations, the development <strong>of</strong> a esprit de corps among workers and a culture <strong>of</strong> safety may be a critical component for effectively dealing with worker fatigue (Knipling et al., 2004). Rather than a top-down change, behavior-based safety systems have been used to effectively alter the culture <strong>of</strong> workers (Geller, 2005). These programs have been used in settings as varied as pizza delivery (Ludwig & Geller, 1997), mining (Fox, 1987) and manufacturing (Reber & Wallin, 1984). Behavior-based programs include components at multiple levels. Senior leadership demonstrates a commitment to core values embedded into strategic priorities, and employees are involved at each step. Local control is established to manage the process and communicate issues among workers and across the organization. In addition, all participants demonstrate a willingness to learn and try successful techniques from high-reliability organizations. Geller (2001) has described three dynamic, interactive factors relating to cultural change in organizations, and he points out that successful programs include attention to each domain (Figure 5.1). A review <strong>of</strong> occupational health and safety studies found that behavior-based systems were most effective in promoting healthier actions, and their effects were greater than technological interventions, government action, near-miss reporting systems and poster campaigns (Guastello, 1993). Sulzer-Azar<strong>of</strong>f and Austin (2000) reviewed behavior-based reports and found that 32 <strong>of</strong> 33 showed reduced work-related injuries. Of particular relevance to fire fighters and EMS responders is that, because behavior-based organizational change emphasizes peers helping peers, it is most applicable to settings where employees work in groups rather than alone. The same principles <strong>of</strong> management were components <strong>of</strong> the Crew Endurance Management maritime program developed by the Coast Guard (page 25), and others have converged on similar principles. For example Rhodes (2005) writes that effective fatigue management programs should have the following key components: organizational commitment, an explicit fatigue management policy and process, involvement <strong>of</strong> stakeholders at all levels, subjective (opinions and beliefs) and objective measures <strong>of</strong> the programmatic outcomes, and ongoing monitoring and improvement. 5.11 Rules and Regulations Figure 5.1. Safety Triad (from Geller, 2001) Person (knowledge, abilities, motives) Safety Culture Environment (equipment, conditions, engineering) Behavior (demonstrating, coaching, active caring) We have presented information about the existing rules and regulations as it relates to fire fighters, other emergency medical services responders, the transportation industry and postgraduate medical training in Sections 2 to 4. However, in this report, we attempted to focus on the issues pertaining to workers’ health and job effectiveness, rather than the political and economic issues relating to formal regulations. The sometimes contentious regulation issues are compounded by the difficulties in monitoring and enforcing those rules. Even in domains as well publicized as medical graduate training work hour reform, follow-up <strong>of</strong> mandated work hour reform reveals change has been slow (Landrigan et al., 2006; Surani et al., 2007). 67
<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders Commercial vehicle safety is an arena where rules and regulations are prominent (Federal Registrar, 2006). However, publications concerning that industry point out the general ineffectiveness <strong>of</strong> regulatory measures (Knipling et al., 2004). For instance, they cite the example <strong>of</strong> a worksite that used docking pay for safety rule violations. Rather than increasing the desired behavior, they found that there was a paradoxical decrease in the actions with punitive measures. Only positive feedback for compliance, not penalties for violations, resulted in a significant increase in the health promoting behavior (Zohar, Cohan & Azar, 1980). Recommendations <strong>of</strong> occupational experts and available evidence are clear that any effective work structure system involves workers and their families, employee representatives, local administrators, regulatory bodies and <strong>of</strong>ten expert consultants in designing programs that maximize physical and psychosocial health, safety and productivity outcomes. 5.12 Summary <strong>of</strong> Studies on Work Hour Management Fire fighting and EMS response work cover a wide spectrum <strong>of</strong> activities and conditions, and generalizing recommendations is difficult. Principles that apply across the range <strong>of</strong> worksites include becoming educated about the performance and health effects <strong>of</strong> fatigue and assessing work structures and job demands. Involving emergency medical services personnel and their families, management, representatives from labor organizations and national administrative bodies, and sometimes outside consultants is important in the success <strong>of</strong> any fatigue management program. <strong>Sleep</strong> science and the information contained in this report are resources for fire fighters and EMS responders in those efforts. • Those working long duration shifts can improve their well being by leading healthy lifestyles. Chronic sleep deprivation may not be recognized, and it is important for workers to acknowledge their need for and maximize their ability to achieve adequate restorative sleep. • Coping with long work hours may be facilitated by identifying workers at higher risk for difficulties in adjusting , such as those with sleep disorders. • Fatigue is a risk for motor vehicle crashes, and commuting home following long duration shifts may be an especially vulnerable time for workers. • Personnel, their families, management and consultants, working in collaboration, are best able to structure work hours and circumstances to meet the needs <strong>of</strong> pr<strong>of</strong>essional excellence and employee well being that typify fire fighting and EMS work. 68
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Effects of Sleep Deprivation on Fire Fighters and EMS ... - NAEMT

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