Sleepiness and Fatigue Management in Emergency Response Personnel

December 6th, 2010 by Clark Lee

Emergency response providers constitute an occupational group that is particularly vulnerable to the effects of sleepiness and fatigue. Considering the work they do, such a vulnerability poses significant risks to the health and safety of the responders themselves and of the general public. The development and implementation of fatigue management programs, plans, and policies for emergency response providers is therefore essential to protecting the health and safety of this critical segment of the workforce, as well as the people it serves.

In the short term, sleep loss and excessive periods of wakefulness are associated with sleepiness, which can cause both job performance problems (e.g., errors, failure of empathy) and work-related injuries (e.g., driving accidents), and possibly harm to the public if the emergency response provider has a failure in judgment or makes a technical error. In the longer term, working without adequate recovery between shifts can lead to fatigue, which can have many negative health effects and consequences in years to come.

Surprisingly, little attention has been given to this area despite the enormous amount of resources that the U.S. government has dedicated in recent years to researching and developing best practices in various aspects of disaster and public emergency response and preparedness. In a 2009 Technical Assistance Document, the U.S. National Response Team (NRT) found that:

  • “available literature does not address the question of how strenuous work schedules combine with the unique hazards and exposures associated with disaster operations to impact worker fatigue”;
  • “existing literature and work practices generally focus on the effects of shift work [or] extended work hours on employees working normal, non-disaster-related employment and focus on reducing or limiting work hours”; and
  • the work hour restriction approach “does not address the full range of factors that are likely to be associated with disaster operations and that may present fatigue risks for disaster workers.”

Furthermore, an emergency manager in Australia recently completed a graduate student research project in which she evaluated fatigue management in the emergency management context and found that:

  • “much of the available fatigue management research has been undertaken in areas other than emergency management”;
  • it is “not well known how well this [research] fits into the emergency management context”;
  • an assessment of fatigue management policies from Australian emergency agencies and related industries revealed that “the complex interactions between fatigue issues are not well understood and that fatigue management has been developed in other fields and not tested for its appropriateness in the complex emergency management context[]”; and
  • the “scarcity of information in the emergency management context highlights the need for future studies in better determining interrelationships and interactions between fatigue factors and testing fatigue management systems in emergencies to evaluate their effectiveness in the emergency management context.”

The NRT issued its Technical Assistance Document in an attempt to establish a fatigue management approach that takes into account the unique needs of disaster workers and to guide organizations through the process of developing organization-wide fatigue management programs from which incident-specific fatigue management plans may be created. Despite this effort, however, fatigue management and the maintenance of adequate performance levels among tired emergency response providers remain under-studied and under-developed areas of public emergency research, policy, planning, and preparedness.

At CHHS, we are well-positioned to play a key role in the development and advancement of fatigue management research, policy-development, and planning for emergency response providers because of our experience working with emergency managers, but also because of our on-going and developing relationships with the Division of Sleep Medicine at Harvard Medical School and the Work and Health Research Center at the University of Maryland School of Nursing. By taking advantage of these resources, we have the opportunity to work with our partners to make a significant contribution to the development and advancement of an emerging and exciting area of public emergency research, policy, planning, and preparedness.

If you are interested in learning more or partnering with CHHS on our emergency response provider fatigue management efforts, please contact Clark Lee.

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