Fire and EMS is a 24/7 operation. That being said, this requires this service to choose a schedule that best accommodates around the clock operation. The shift length that is, historically, preferred by the fire and ems service and its employees is the 24 hour shift.
The majority of fire and ems services in the United States today work a 24 hour shift. These 24 hour shifts have their origins back in the Industrial Revolution of the United States. The 24 hour shifts for fire and ems were born out of necessity and not monetary gains. It made sense for cities with large populations to have fire and ems crews (paid or volunteer) occupying the stations at all times. This was what was best for the city and it citizens.
There are plenty of benefits to a 24 hour shift in the fire/ems service or any shift work job. Workers of 24 hour shifts find that this type of schedule does afford alot more time off then traditional work schedules. 24 hour workers may only work 120 "shifts" per year. Just as these 24 hour shifts have benefits, they also have some downsides. There are studies out there that have shown these 24 hour shifts lead to significant wear and tear on the workers (fire/ems in particular) bodies and minds. 60% of fire/ems workers report moderate to severe levels of fatigue in these studies. This is the second highest rate of all industries in the world.
There are fire and ems departments where the call volume is slow (there are even stations within departments) and the firemen/paramedics have time to get the recommended 7.5 to 8 hours of sleep. However, today's fire and ems services in rural, urban, and suburban areas are becoming busier. Because increases in call volume both absolute and relative to static or reduced staffing levels. The increase in call volume, as well as increased workload due to staffing reductions, magnifies the stresses placed on these firemen/paramedics. This results in a increase in loss of sleep and severe fatigue.
As fire departments and their ems divisions become busier and the firemen/paramedics are increasingly unable to get adequate sleep on shift, serious concerns for the health and safety of the firemen/paramedic as well as the patients, begin to rise.
* increased cardiovascular disease
* increased mood swings
* higher risk of motor vehicle accidents
* increased family problems and divorce rates
* increased risk of substance abuse
* chronic fatigue
Now try and keep in mind these side effects were common to all 24 hour shift work. This also assumes that these workers are getting adequate sleep. Sleep deprivation, which is more along the line of what many fire/ems workers face, creates a whole new set of side effects to go with the previously mentioned ones. They are:
* an increase in reaction time
* a lapse of attention
* poor motor function
* memory loss
* depressed immune system
* psychosis
A interesting note here. Researchers have found it too dangerous to keep people awake for more then 24 hours at a time. The symptoms from above have been seen in subjects that were restricted to only four hours of sleep.
It is worth noting that firemen and paramedics that have been awake for 24 hours straight have the same reaction time and critical thinking ability as a well rested person with a blood alcohol level of .10%. A level that is considered legally drunk in all U.S. states. There are studies that have shown that going 17 to 19 hours without sleep causes the same cognitive dysfunction as someone with a blood alcohol level of .05%. This level is considered legally drunk in over 30 countries.
Here are a few question that must be asked, but are rarely answered...
* How long can firemen/paramedics be expected to make calls(work) before fatigue creates an unacceptable level of risk to themselves and patients.
* What steps can be taken by both employer and employee to assure employees are well rested and risks associated with fatigue are minimized.
* How much time between calls is required to keep fatigue from interfering.
* What are the legal risks to the firemen/paramedic and their employer related to the long shift, high call volume, and fatigue that results from it.
How does one become fatigued you ask? Fatigue is a result of inadequate rest and results in impaired physical and mental abilities. Not something a firemen/paramedic can afford to have happen. Some of the factors that contribute to fatigue are the time of day one works, length of shift(24 hours), the quality and amount of sleep one obtains during and surrounding work hours.
No one in the right mind would allow a intoxicated/drunk person to work, much less try and save someones life. But firemen/paramedics work everyday fatigued to these levels. The ability of these firemen/paramedics to function at a high level of cognitive and precise decision making capacity, at any time, can effect the outcome of critical patients. Especially if these firemen.paramedics are fatigued.
Research has found that there are numerous cognitive dimensions that are affected by fatigue. We will just mention a few:
* Comprehension - this involves the understanding and interpretation of noticeable cues. This requires the ability to draw on previous knowledge. Firemen/paramedics must initiate treatments and treatment processes from memory of past experiences and protocols. Fatigue can cause mistakes due to misdiagnosis or the inability to recall correct treatments.
* Projection - firemen/paramedics need to predict treatment outcomes, bad or good, depending on the treatment they provide. Fatigue affects memory recall and can reduce the ability to choose the correct course of action.
* Mental Simulation - firemen/paramedics must be able to simulate events when moving a critical patient to minimize the impact on the patient's condition.
* chronic fatigue
Now try and keep in mind these side effects were common to all 24 hour shift work. This also assumes that these workers are getting adequate sleep. Sleep deprivation, which is more along the line of what many fire/ems workers face, creates a whole new set of side effects to go with the previously mentioned ones. They are:
* an increase in reaction time
* a lapse of attention
* poor motor function
* memory loss
* depressed immune system
* psychosis
A interesting note here. Researchers have found it too dangerous to keep people awake for more then 24 hours at a time. The symptoms from above have been seen in subjects that were restricted to only four hours of sleep.
It is worth noting that firemen and paramedics that have been awake for 24 hours straight have the same reaction time and critical thinking ability as a well rested person with a blood alcohol level of .10%. A level that is considered legally drunk in all U.S. states. There are studies that have shown that going 17 to 19 hours without sleep causes the same cognitive dysfunction as someone with a blood alcohol level of .05%. This level is considered legally drunk in over 30 countries.
Here are a few question that must be asked, but are rarely answered...
* How long can firemen/paramedics be expected to make calls(work) before fatigue creates an unacceptable level of risk to themselves and patients.
* What steps can be taken by both employer and employee to assure employees are well rested and risks associated with fatigue are minimized.
* How much time between calls is required to keep fatigue from interfering.
* What are the legal risks to the firemen/paramedic and their employer related to the long shift, high call volume, and fatigue that results from it.
How does one become fatigued you ask? Fatigue is a result of inadequate rest and results in impaired physical and mental abilities. Not something a firemen/paramedic can afford to have happen. Some of the factors that contribute to fatigue are the time of day one works, length of shift(24 hours), the quality and amount of sleep one obtains during and surrounding work hours.
Research has found that there are numerous cognitive dimensions that are affected by fatigue. We will just mention a few:
* Comprehension - this involves the understanding and interpretation of noticeable cues. This requires the ability to draw on previous knowledge. Firemen/paramedics must initiate treatments and treatment processes from memory of past experiences and protocols. Fatigue can cause mistakes due to misdiagnosis or the inability to recall correct treatments.
* Projection - firemen/paramedics need to predict treatment outcomes, bad or good, depending on the treatment they provide. Fatigue affects memory recall and can reduce the ability to choose the correct course of action.
* Mental Simulation - firemen/paramedics must be able to simulate events when moving a critical patient to minimize the impact on the patient's condition.
Let's be honest, long shifts and high call volumes create significant risks to all involved, the firemen/paramedic, their employer, and the general public. These risk include higher rates of accidents, increase in medical errors and a decline in proficiency. We also understand that there is no single answer to the problem. So we must continue to try new ideas and be innovative, so that we can help stay away from being fatigued and the errors that come with it. Our profession, our department, and our citizens deserve it.
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