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 Appendix 6.2: Recommendations As briefly presented in the Executive Summary, this document serves as a resource for fire fighters and EMS responders as they assess the dynamic demands <strong>of</strong> their work and adjust its staffing structure and deployment characteristics to meet their performance standards and maintain the health and well being <strong>of</strong> workers. Potential future directions apparent from this report are presented in the domains <strong>of</strong> education and potential future studies. 6.2a Education This document, presentation <strong>of</strong> its findings and the accompanying education tools will assist fire fighters and EMS responders in understanding the performance and health effects <strong>of</strong> sleep deprivation. However, as noted in the Section on behavior-based work hour management and as exemplified by the U.S. Coast Guard’s Crew Endurance Management program, knowledge is only the first step in an educational program. A culture <strong>of</strong> awareness and support is needed. As presented in Figure 5.1, page 67, this will require ongoing reinforcement <strong>of</strong> education activates and translation <strong>of</strong> that knowledge into attitudes and behaviors that promote appropriate work hour management. 6.2b Future Assessments Fire fighters and EMS responders are in the forefront <strong>of</strong> compiling information and open access to findings related to effective training and work-related injuries, deaths and near-misses. Parallel strategies, using national web-based systems, could obtain information concerning department schedules and work structures. Similarly, as was done with medical interns, carefully designed and validated data collection formats could be used to gather job structure, performance and health characteristics <strong>of</strong> individual workers, including sleeping habits and other fatigue-related indices. The departmental and work setting findings would provide resources for sites/organizations considering different work structures, especially as two competing trends appear to be developing. On one hand, for some sites (e.g., San Francisco and Austin) workloads and the scope <strong>of</strong> services have increased, and with recognition that alertness and abilities decline after approximately 12 hours, shift lengths have been shortened. Alternatively, other departments are following the trend toward longer shifts and switching to 48-hours-on/96-hours-<strong>of</strong>f structures. Although each locale must determine the specifics <strong>of</strong> scheduling, a systematic database could help inform those decisions. With assembly <strong>of</strong> a large database, fire fighters and EMS responders in different settings and health services analysts could better assess relationships among work hours, sleep habits, lifestyle practices, health conditions and costs <strong>of</strong> injuries and work-related illnesses. Those health-related outcomes could be accompanied by work-performance metrics, such as response times, compliance with accepted and applicable work-related standards and economic outcomes. Five areas appear especially appropriate for further study, and they are elaborated in the following paragraphs: 1) better identification <strong>of</strong> the impact <strong>of</strong> fire fighting and EMS response work on the family, 2) monitoring crashes during commuting, 3) utility <strong>of</strong> strategic napping, 4) the prevalence <strong>of</strong> sleep disorders among fire fighters and EMS responders and 5) cardiovascular risks and other lifestyle issues and their relationship to work hours. In addition, available technologies, such as measures <strong>of</strong> vigilance and simulations, could be used to index whether performance is affected by the prolonged but discontinuous work that can characterize the work <strong>of</strong> fire fighters and EMS responders. 73
<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders Information suggests that long work hours may have adverse psychological and social consequences (Section 1). Those issues, compounded by the camaraderie <strong>of</strong> fire fighting and EMS work, and the extended work absences that can attend those occupations, may have an unintended negative impact on families. Assessing these dimensions and the social consequences <strong>of</strong> work structures are important areas for future research, and the need to involve families when considering job and work hour restructuring has been emphasized repeatedly. Driver fatigue increases the risk <strong>of</strong> motor vehicle crashes, and fire fighter and EMS responder databases do not systematically collect information on events immediately after leaving work, such as crashes commuting. One <strong>of</strong> the factors leading to the 48-hours-on/96-hours-<strong>of</strong>f work structure is a reduction in the number <strong>of</strong> commutes. Ironically, those commutes, although fewer in number, may be more hazardous. In general, shift workers are twice as likely to fall asleep behind the wheel, and as was shown with medical trainees and documented anecdotally among fire fighters and emergency medical services responders, the commute home is a particularly vulnerable time for fatigued workers. Special efforts are needed to gather data on crashes during commuting and to educate fire fighters and EMS responders on that risk and means to reduce its potential. Vigilance testing and driver simulations with end <strong>of</strong> shift personnel could be added as a component <strong>of</strong> assessing work structures. The utility <strong>of</strong> naps has been mentioned several times in this report. They have been advocated by the U.S. Coast Guard, the American Transportation Research Institute, and the aviation industry and among emergency room physicians. Researchers who have investigated work habits among fire fighters and EMS responders have suggested naps as a means to manage fatigue, and they are discussed in Section 5. For those needing to work long hours, sanctioned and/or scheduled naps may be effective means to achieve optimal performance during the later work hours, and those formats should be studied for their utility and efficacy in attenuating fatigue. While work performance outcomes are the optimum endpoints, surrogate endpoints, such as measures <strong>of</strong> alertness, simulations and physical measures, could be used to assess naps or other scheduling modifications. Scheduled naps also might allow timelier implementation and evaluation <strong>of</strong> work place structural features, such as sleep space location, means for awakening and acoustic shielding, designed to facilitate individuals’ obtaining restorative sleep in the midst <strong>of</strong> a busy fire station or other worksite. Fire fighters and EMS workers may have a higher prevalence <strong>of</strong> sleep disorders, and untreated, those problems increase morbidity/mortality and impair performance. Focused screening could define the prevalence and severity <strong>of</strong> these problems and determine whether and how assessment for sleep disorders might be added to the IAFF/IAFC Wellness-Fitness Initiative’s annual assessments. Cardiovascular health is <strong>of</strong> particular concern, as it is a leading cause <strong>of</strong> work-related death in certain sectors. Newer markers <strong>of</strong> inflammation relating to cardiovascular risk have been linked to sleep deprivation. The work hour structure <strong>of</strong> fire fighting and EMS responders may be a setting to gather important information about this association. Prospective assessment <strong>of</strong> these and additional sleep-related mental and physical correlates could be coupled with naturally occurring work hour restructuring to better define and understand the risks <strong>of</strong> different occupational formats. The health pr<strong>of</strong>ile <strong>of</strong> most fire fighters and EMS responders is similar to the majority <strong>of</strong> adult Americans, less than 10 percent <strong>of</strong> whom eat healthy, exercise regularly and have optimal body weights (Reeves & Rafferty, 2005). Add to that the recommendation for six to eight hours <strong>of</strong> sleep 74
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