While there are tests for drugs or alcohol, identifying fatigue as a causal or contributing factor in accidents can be difficult.
Sleep is like water. We take it for granted until we don't have enough or it's gone. When my father was a volunteer, he would come home after a long night fighting a house or barn fire, shower and drive to his full-time job as an upholsterer. Dad had terrible sleep habits, and I often wonder how much of it contributed to his health problems.
So I was surprised to learn that an increasing number of fire departments have switched to a 48-hours-on/96-hours-off shift schedule. According to one chief, 48/96 is an easy bargaining chip for most cities. Minneapolis has worked 48/96 for more than 10 years. The Fresno (Calif.) Fire Department is trying 48/96 shifts on a trial basis and carefully watching for incidents of on-duty injuries or increased sick leave. A number of chiefs said departments compensate for a busy day with a modified work day the second 24 hours.
When Albuquerque (N.M.) Fire Department Deputy Chief Richard Sears entered the as a young firefighter 20 years ago, he worked three days then had three off. Eventually the department shifted to a schedule where some firefighters began a 24-hour shift during the day and others began a 24-hour shift at night. Sears said paramedics and firefighters soon started trading shifts to work 48 hours and have 96 hours off. Sears added that many firefighters felt less stressed about coming in to work two days and having four days off, though the department did no research to confirm that idea. The Albuquerque Fire Department officially transitioned to a 48/96 schedule in 1998.
Asst. Chief Nathan Trauernicht, Operations and Training Division for University of California-Davis Fire Department, said the benefit of a 48/96 lies with the employees. “Young firefighters can't afford to live in the areas they work, so 48/96 reduces the commute the and costs with half the number of trips,” he said.
Firefighting and emergency medical calls are physically and mentally taxing, and sleep deprivation could cause serious problems for both responders and their patients. And there's a big difference between a department that runs 1,000 calls per year versus 4,000 per year, or 12 to 18 calls per day.
Other industries have conducted research on sleep deprivation and patient care. The New England Journal of Medicine published an article in 2002 titled “Patient Safety: Fatigue Among Clinicians and the Safety of Patients.” According to the article, several regulatory agencies recommended hospital residents be limited to 80 working hours per week. Fire department members average 56 hours a week.
The journal cites a large body of laboratory data proving beyond a doubt that fatigue impairs human performance. “The effect of sleep deprivation on a task that involves tracking has been shown to be equivalent to the effect of alcohol intoxication; … 24 hours of sustained wakefulness was equivalent to the performance with a blood-alcohol concentration of 0.10 percent.”
Some cities have decided against the 48/96 schedule. One Northern California department proposed the shift change, but the city's worker's compensation provider threatened to drop the department or significantly increase its rates.
Others caution motivation drop off with a 48/96 schedule. “There is an incentive when you're actually starting your day and that goes away in the second 24-hour period,” one chief told me.
I think it's time for the fire and emergency service to do more research on sleep deprivation for career and volunteers. What if the high rate of accidents are fatigue-related? The National Transportation Safety Board limits over-the-road drivers to 10 hours of driving or 15 hours on duty, followed by eight consecutive hours off. Do fire service drivers need any less sleep. While there are tests for drugs or alcohol, identifying fatigue as a causal or contributing factor in accidents can be difficult.
Would you want a paramedic who's been on duty for 39 hours administering drugs to one of your loved ones?