Archive for the ‘public safety’ category

The Critical Importance of Sleep for Firefighters

September 11, 2019

September 11 is a day we will never forget. I am forever thankful for the firefighters and others who step forward to watch over us all as first responders.

In honor of the day, here is a summary of what we know about firefighters’ sleep, and the costs they pay to provide 24/7 service.

It is critically important that firefighters are able to perform well when they are on duty, however, a large number are impaired by inadequate sleep. Many common concerns of firefighters such as cancer and cardiovascular disease risk, barriers to physical fitness, food culture, psychological stress from trauma and injuries (1), are related to or can be improved by sleep health.

Health and Safety:

The effects of inadequate sleep on human mental and physical health have been well documented. For firefighters the leading causes of death are heart attack and auto accidents (2).

  • 51.2% of firefighters report disturbed sleep, which contributes to psychological distress (3).
  • 37.2% of firefighters surveyed screen positive for sleep disorders: 28.4% obstructive sleep apnea, 9.1% shift work disorder, 6% insomnia, and 3.4% restless legs syndrome (3). Of these, the majority (80%) have not been diagnosed or treated.
  • Those who have sleep disorders are twice as likely to have an auto accident, and 2.4 times as likely to experience falling asleep while driving. They also are at increased risk of cardiovascular disease, diabetes, anxiety and depression (4).
  • Another study found that 17% have sleep problems, and as sleep hours decreased, so did physical quality of life (5).
  • Sleep deprivation among firefighters appears to increase high-risk behaviors such as alcohol consumption and decrease mental health and physical well-being (6).
  • Compared to firefighters with 8 hours of sleep, sleep deprived firefighters show changes in both their inflammatory cells and evening cortisol levels which has been shown to have adverse health effects (7).
  • Night and extended shifts increase the prevalence of cardiovascular and mental health disorders (8).

Shift Work and Performance:

Night shift and the extended shifts typical among firefighters are inherently difficult, though improved individual sleep plans and administrative policies can improve daytime sleep and alertness at night.

  • Response time by firefighters is slowest at 5am, twice as long as at 4pm (9).
  • The risk of a work related injury peaks at 2am (10).

Costs:

Firefighter injuries in the U.S. are estimated to cost $3.7 to 11.7 billion per year (11). Sleep deprivation is known to contribute to obesity via changes in appetite hormones, calorie intake and the insulin system. Obese firefighters miss five times as many work days as those of normal weight, at an annual cost of $1683 per employee (12), and those with BMI >30 have a three times increase in worker compensation claims due to injury (13).

Public safety personnel need to be able to perform well at all times of the day and night, however firefighters are not getting adequate sleep to perform well, make good judgments, or maintain their physical and mental health. Implementing wellness and fitness programs has been shown to improve cardiorespiratory endurance, experienced health and job satisfaction, while decreasing weight, high blood pressure and anxiety(14). Providing expert-led sleep and fatigue management education to firefighters will assist in achieving a higher level of sleep health(15) and safety on the job. A simple sleep education and screening program for firefighters resulted in a 46% decrease in disability days, and 24% decrease in injury reports (16).

The Cost of Workplace Fatigue

February 26, 2019

Last week, in Seattle, the National Safety Council put on their first Workplace Fatigue Conference, aimed at bringing fatigue experts and corporations together to solve the nation’s fatigue problem.

And no, it’s not overstating the case to say we have a fatigue problem. The costs we pay for being sleep deprived are staggering, here’s a look:

  • Untreated sleep disorders cost up to $3500/employee
  • Direct costs $14B, indirect costs $28B
  • Employees sleeping only 6-7 hours nightly cost employers 3.7 days of lost work
  • Costs come from absenteeism, presenteeism, accidents, injuries and healthcare

A large employer here in my hometown, Seattle, is Amazon. I put their data into the NSC Fatigue Cost Calculator *. Here’s the findings:

  • Fatigue is costing Amazon $47,393,505 per year
  • $6.2M in absent employees
  • $27.8M in decreased productivity
  • And $13.3M in increased health care costs

But this is not the true total cost. There are additional costs resulting from the way sleep deprivation impairs positive human interactions. When sleep deprived, leaders are more abusive and unable to see sleep deprivation in their employees, employees in turn are less satisfied with their jobs, leading to costly employee turnover. There are many other ways that sleep deprivation and sleep disorders raise costs on corporations.

I encourage you to complete the Fatigue Cost Calculator for your own corporation, then take steps by training employees on sleep health, and designing your shift schedule and other safety practices to decrease fatigue. And decrease costs will follow.

 

NSC Fatigue Cost Calculator

*(Assumptions were: 24,000 employees in Washington, computing sector, no shift work. Though of course we know that these employees do work long and sometimes irregular hours).

Reducing Night Nurse Fatigue

March 30, 2014

Lately it’s been a pleasure to provide an intervention program for night-shift nurses to help them sleep well during the day, and thereby improve their alertness at night. For many nurses working nights a typical shift is 12 hours, often from 7pm to 7:30am. This requires them to function well during the hours that human beings are designed for sleep. Many of these employees like to sleep during the night on a similar schedule to their loved ones when not working, which keeps them in a perpetual state of circadian misalignment, making it even more difficult to function well at night.

In December 2011 the Joint Commission issued Sentinel Event Alert #48 on the effect of extended work hours and cumulative work hours on patient safety and nurse health. They summarize the extensive research on the performance effects of working at night. Some of the results of fatigue include:
– impaired information processing and judgement
– inability to focus attention
– reduced motivation
– loss of empathy
Fatigue among healthcare workers increases the risk of adverse events, decreases patient safety, and negatively impacts the health of the night shift workers.

The Commission report goes on to suggest steps organizations take to improve employee alertness and thereby improve patient safety. Fatigue management typically includes steps for both individual employees and the administration. Sleep training for employees so they can sleep well during the day, and entrain their circadian rhythm to the schedule, is one step. Another is fatigue reducing strategies such as precisely-timed caffeine and light to increase alertness on the job. Administrations can optimize their scheduling practices, and provide an alerting work environment. You can see the full Sentinel Event Report of the Joint Commission here: http://www.jointcommission.org/sea_issue_48/

Over the next 6 months I hope to continue this work for Seattle-area hospitals, and expand to help other public safety organizations that are providing 24/7 service, including the police and fire departments. Around the clock service is a must for public safety, and helping these night-shift staff to sleep well during the day, so they can be alert and healthy during the night is extremely rewarding!