By: Robert Avsec
What would be your answer to that question if posed to you by:
- A member of your community’s governing body during budget
discussions who wants to know why “we pay employees to sleep”; - A physician on a medical review board investigating a series of medication errors by paramedics from your department during post-midnight calls where sleep deprivation has been identified as a contributing factor;
- The attorney representing a family who’s husband and father was killed in a motor vehicle crash at 5:oo a.m. on his way to work when his car was struck by a fire engine that was returning to quarters from an fire alarm activation (the fire crew had only gotten to bed at 3:00 a.m. after being out on a large fire most of the evening.
See: Ambulance Driver Falls Asleep on the Job
My previous post about the “death” of the 24-hour tour of duty for safety reasons provoked some good responses — most of which could be categorized as: (1) I understand the point you’re making, but times are tough and we have bigger issues; (2) I would love to do it, but labor would never allow changing the work schedule; (3) our people have to work second or third jobs to make ends meet 
and need those off days; and (4) we’ve always done it this way and it works.
Research on sleep deprivation and its affect on worker performance is just as applicable to firefighters and EMTs as it is to workers in any other occupation. The National Transportation Safety Board is an independent agency tasked by the U.S. government with investigating all commercial carrier transportation accidents, regardless of the mode of transportation.
Over the years, the NTSB has investigated many accidents, in all transportation modes, in which fatigue was cited as the probable cause or a contributing factor…To make matters worse, people frequently are not aware of, or may deny, ability impairments caused by fatigue. Just because a driver is not yawning or falling asleep does not necessarily mean that he or she is not fatigued.
Source: National Transportation Safety Board, Addressing Human Fatigue.
The English poet and philosopher John Donne wrote, “No man is an island 
entire of itself; every man is a piece of the continent, a part of the main….” The same holds true for the fire and emergency services in the United States. As the leaders of this noble and honored profession, we must constantly be scanning the environment and identifying those critical factors that will influence, for better or for worse, our organizations in the future.
See Related: Ambulance Crash Characteristics in the US Defined by the Popular Press: A Retrospective Analysis
Far too often, the fire service has had to react to external forces. Ponder this incomplete list of issues that many fire and EMS organizations took notice of and addressed only after litigation or regulation forced them to do so:
- Creation of employment or advancement opportunities for gender and racial minorities.
- Adoption and use of the Incident Command System.
- Elimination of the tailboard riding position and open-cab apparatus in favor of enclosed cabs with a seat and seatbelt for everyone.
- Requirement of post–high school education for promotion and advancement.
- Use of two in/two out and rapid intervention crews on emergency scenes.
Several years ago, the Fire Safety Stand Down’s “successor”, Fire/EMS Safety and Health Week, focused on members being fit to respond. Several readers of the previous blog I posted cited issues with people working multiple 24-hour shifts in succession or working multiple 24-hour shifts for several different organizations, eventually being “tired when they show up for duty.”
See Related: IAFC Sleep Deprivation Study
Don‘t those employees who are showing up too tired for work have supervisors? If so, why are these supervisors enabling such behavior? Why aren‘t they fulfilling their responsibilities to their other employees and to the public by allowing only those who are fit for duty to respond to fire and EMS calls? Probably for the same reasons that supervisors allow members to:
- Drive too fast.
- Respond to calls without wearing their seatbelts.
- Respond to calls without the proper protective clothing and equipment for the hazard.
- Engage in unsafe acts on the emergency scene without consequences. Is anyone else as shocked as I am by what I read at the Close Calls Web site?)
- Be overweight and physically out of shape
But wait…who do those supervisors work for? Fire chiefs, deputy chiefs and battalion chiefs. And those folks work for? City Managers, County Administrators, County Supervisor Boards, etc. And let’s not forget those labor unions that represent firefighters and officers.
(I was a IAFF member for my entire career with Local 2803, Chesterfield Professional Firefighters, so I know of what I speak when I say that Safety has always been a primary issue for the IAFF. So let’s hear from Labor on this safety issue).
An Attorney’s Synopsis of IAFC Sleep Study: Advice to their Client
We are all together in recognizing and addressing the significant unmanaged risks posed by Fire & EMS personnel suffering from fatigue. The dots are out there. We just need to start connecting them before, once again, someone else does it for us.
For more information, read:
- Recognizing the Dangers of Sleep Deprivation
- Lack of sleep another safety risk factor
- Sleeping on the job
- The Sleep Well: A well full of information on sleep, sleep disorders, sleep activism, sleep-related events and much more
Comment away on perils of the 24 hr shift and comment firefighters making ” over rationalizations ” and lame justifications for the 24 hour shift.
While its true many firefighters ” must ” work secondary jobs and etc.. And the perils of sleep deprivation are also VERY real due to our biological “day light loving” wiring…
The harsh reality is the 24 hour shift was set up that way decades ago by wisely frugal local government ( unlike the combination of penny wise pound foolish right and anything to buy votes left of today)..
What I mean is with 3- 24 hour shifts a department can cover 24/7/365 .. If one was to switch to 8 hour shift it would mean hiring another shift and 1/2 of personnel to cover the same 24/7/365 as the 3 -24 hour shift plan… if to switch to 4 -12 hour shifts it’s one more full shift of personnel. In the day of bankrupt local government , pension cuts, manpower cuts , and basically do more with less local government tax dollars due to a bad economy…. No one can afford that manpower budget increase..!!!! No one!!!
Thus despite the biological wrongness of it, it’s a reality firefighters must adapt to and enter into our decision trees a kind of ” my guys have been up all night lets use more caution kinda thing”!!!
Sorry it’s the economics of fire protection plain and simple
Mike, welcome to the conversation and thank you for your insightful thoughts on the subject. I agree with your factual case in favor of 24-hour shifts and realize that this is the issue “on the table” for local governments and their Fire & EMS departments. The cost of providing 24/7/365 service vs. the growing scientific body of knowledge regarding the impact of sleep deprivation and fatigue on the human brain of those personnel operating heavy and complicated machinery, making critical decisions, under stressful conditions. I know and you know that many in local government are willing to “bet the house” on the former and hope for the best.
Except the “best” frequently turns into the worst.
Oh no doubt Robert.
That’s my point, although said more succiently by you… Local govt. will continue staffing us this way, despite any biological evidence it’s a bad idea… Or even worse local govt. is likely to continue cuts to manpower forcing the already fatigued firefighter and medic to push past it and adjust even more…despite evidence that its unsafe. Thus, compounding the issue of sleep deprivation with a lack recovery time between calls…
Unfortunately John Norman and Alan Brunacini also nailed it when they said (and I’m paraphrasing) we firefighters are problem solvers by nature and when saddled with something like this will attempt find a way to take a bad idea and mold it into something workable.
But keep the conversation alive please in hopes that at some point , positive change will come.
I agree there needs to be some serious conversation regarding 24 hr shifts and effects on our members. I feel it’s necessary for Company Officers to monitor the run load and its effects on its crew and have the ability to place those effected on mental and physical rehab. In other words” let them take the ol 1-3 nap”. I realize there are some extremely busy companies working but there should be a way to switch members on and off units and give them rest periods and lay off some of the less important dog and pony shows or tricks for the chief. Most busy companies have some part of the tour that is relatively slow.
The 24-hour shift is also an issue in the HEMS community. One thing that we are allowed to do is call a safety time-out when we have had a busy day and are overly fatigued. Safety time-outs may be called by a single crew member and one will not be subject to any disciplinary action. I have personally called two time outs in my 8-year career & have been on duty when another two or three have been called. This does not mean that one can plan on showing up fatigued to work and call a time out after one flight. At my program, time outs are usually 2-4 hours and one is expected to rest – not work on charts, catch up on emails, do homework, etc. Safety time-outs are a key component of receiving accreditation from the Commission on Accreditation of Medical Transport Systems (CAMTS). We can also take safety naps during the days as our work load allows. The 24-hour shift in HEMS has become a tradition mainly due to the distance some crews have to drive from home to the base. I also feel that it is a bleed over from the fire service.
Our pilots can only be scheduled for 12-hour shifts per 14 CFR Part 135. They are allowed a 2 hour go over time before they turn into pumpkins, as we like to say. And if they do go over the 12 hours, they cannot clock-in at the normal time since they must be off for 12 hours. Even medical interns are no longer required to pull the multi-day grueling shifts due to the error rate associated with fatigue. I know when I worked at the fire department, there were times that both the driver and I were falling asleep while driving back from the hospital at 2 am after a 15 transport day. The only “break” we were offered was to move us to the engine; great as long as it doesn’t go out.
Interestingly, research on nursing shifts has shown that 12-hour shifts should be changed to 8-hour shifts in order to decreased fatigue and the errors associated with such fatigue. Unfortunately, the 12-hour shift is very popular because it means a three day work week. Hospitals that forced staff to switch to 8-hour shifts reported initial dissatisfaction, which changed to almost 100% approval when the nursing staff found that they had more energy and more satisfactory work and home life. Some hospitals are now dictating that nurses can only work two 12-hour shifts in a row and must be off at least 36 hours before switching from day to night shifts (or vice-versa).
So what does all this mean? It means that ALL of these disciplines can either admit that the science shows changes need to be made to schedule length or they can respond emotionally and stick with tradition. Because we can take naps (mine is usually 2pm-4pm), fatigue is limited. When I was in the fire department, it was a HUGE no-no to take a nap, and I think this is the case in many departments. If the fire service insists on the 24-hour shift, napping policies should be re-evaluated & some type of safety time-out policy initiated. Of course if they do this, firefighter fatigue before and after the changes should be done. Measuring the individual’s perception of fatigue and their workload that shift, combined with some simple cognition tests at the start and end of shifts would be helpful.
Jody, thanks for weighing in on this blog’s topic. You provide good insights that are obviously based upon personal and professional experiences!