By Rob Shaul
BLUF (Bottom Line Up Front):
A systematic review of 43 studies (6,373 participants) found that 85% of Emergency First Responders (firefighters, paramedics) suffer from sleep deprivation during 24-hour shift, and this plus poor sleep quality, high workload, and psychological stress contributie to chronic to fatigue in EFRs.
Fatigue impairs cognitive function, slows reaction times, reduces physical performance, and significantly increases injury and error rates. Sleep deprivation, in particular, is strongly associated with lapses in decision-making, communication breakdowns, and workplace accidents. These findings have critical implications for tactical athletes, law enforcement, military personnel, and other sleep-deprived professions.
Purpose of the Study
- Identify primary factors contributing to occupational fatigue among EFRs.
- Examine cognitive, physical, and safety-related impacts of fatigue, with a focus on sleep deprivation.
- Explore applications of these findings to other occupations vulnerable to fatigue, including law enforcement and military operations.
Subjects
- Total Participants:** 6,373 across 43 studies.
- Occupations Represented:** Firefighters, paramedics, emergency call center personnel.
- Demographics:** Predominantly male (81%), ages 19–68.
- Study Designs:** Cross-sectional (n=15), cohort (n=25), qualitative (n=2), case reports (n=1).
Research Method
- Researchers conducted comprehensive searches using databases like Medline, Embase, CINAHL, and SPORTDiscus. Data collection methods included:
- Subjective Fatigue Measures: Chalder Fatigue Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS).
- Objective Fatigue Measures: Psychomotor vigilance tasks (PVT), actigraphy, cognitive performance tests, and heart rate variability analysis.
- Statistical Analysis: Meta-analyses and regression models determined the relationships between fatigue indicators and occupational outcomes.
Findings ….
Primary Contributors to Fatigue:
- Sleep Deprivation: Most significant factor; 85% of EFRs reported less than 6 hours of sleep during 24-hour shifts.
- Poor Sleep Quality: Over 60% scored in the “poor sleep” range on the PSQI. Causes included frequent night-time awakenings and poor sleep environments.
- High Workload: Intense physical demands during emergencies elevated fatigue accumulation.
- Psychological Stress: Chronic exposure to traumatic events and job-related stress intensified mental and physical exhaustion.
Cognitive Impacts
- Reaction Time:** Post-shift PVT scores revealed a 27% increase in reaction time (355 ms vs. 280 ms when rested).
- Decision-Making:** Accuracy declined by up to 25% following 12-hour shifts.
- Situational Awareness:** Fatigue led to an increased rate of attention lapses, affecting hazard recognition and response.
- Communication Errors:** Verbal miscommunications rose by 35% after night shifts.
Physical Impacts
- Neuromuscular Fatigue:** Muscle strength decreased by up to 15% after 24-hour shifts.
- Balance and Coordination:** Post-shift testing showed a 20% increase in balance errors.
- Reduced Reaction to Physical Stimuli:** Fatigue slowed movement initiation and force production, critical during emergency operations.
Safety / Injury Risks
- Fatigue doubled the risk of workplace injuries.
- Lifting-related injuries increased by 45% on night shifts.
- Firefighters experienced 23,610 non-fatal injuries annually, with slips and trips accounting for 34% of incidents.
Operational Errors
- Medication errors among paramedics rose by 1.6 times after 12-hour shifts.
- Vehicle accidents increased by 80% post-night shift.
- Emergency Call Center Personnel – Fatigue-induced cognitive lapses led to delayed response dispatches and increased communication breakdowns.
Fatigue Mitigation Strategies:
Shift Scheduling
– Limit consecutive night shifts to reduce cumulative fatigue.
– Ensure at least 8 hours off between shifts.
Sleep Hygiene Initiatives:
– Provide quiet rest areas and promote mid-shift naps.
– Improve sleep environments with blackout curtains and soundproofing.
Fatigue Monitoring
– Implement regular PVT and wearable device monitoring for early detection of fatigue.
Cognitive and Physical Training
– Incorporate aerobic conditioning, reaction-time drills, and strength training to build fatigue resilience.
– Offer mental health resources to address fatigue-related stress and burnout.
Conclusion
Sleep deprivation and occupational fatigue significantly impair cognitive function, reaction times, and physical readiness among emergency first responders. Fatigue-related errors, injuries, and operational inefficiencies jeopardize both responder safety and public well-being. Implementing structured fatigue management protocols—including improved shift scheduling, sleep hygiene initiatives, and targeted training—can mitigate these effects. These strategies are equally applicable to law enforcement, military, and other professions prone to sleep deprivation and high-stress work environments.
—
Source:
Marvin, G.; Schram, B.; Orr, R.; Canetti, E.F.D. (2023). Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review. International Journal of Environmental Research and Public Health, 20(20), 7055. https://doi.org/10.3390/ijerph20227055