Randomized, Prospective Study of the Impact of a Sleep Health Program on Firefighter Injury and Disability

Abstract

Study Objectives: Firefighters' schedules include extended shifts and long work weeks which cause sleep deficiency and circadian rhythm disruption. Many firefighters also suffer from undiagnosed sleep disorders, exacerbating fatigue. We tested the hypothesis that a workplace-based Sleep Health Program (SHP) incorporating sleep health education and sleep disorders screening would improve firefighter health and safety compared to standard practice. Design: Prospective station-level randomized, field-based intervention. Setting: US fire department. Participants: 1189 firefighters. Interventions: Sleep health education, questionnaire-based sleep disorders screening, and sleep clinic referrals for respondents who screened positive for a sleep disorder. Measurements and Results: Firefighters were randomized by station. Using departmental records, in an intention-to-treat analysis, firefighters assigned to intervention stations which participated in education sessions and had the opportunity to complete sleep disorders screening reported 46% fewer disability days than those assigned to control stations (1.4 ± 5.9 vs. 2.6 ± 8.5 days/firefighter, respectively; p = .003). There were no significant differences in departmental injury or motor vehicle crash rates between the groups. In post hoc analysis accounting for intervention exposure, firefighters who attended education sessions were 24% less likely to file at least one injury report during the study than those who did not attend, regardless of randomization (OR [95% CI] 0.76 [0.60, 0.98]; χ 2 = 4.56; p = .033). There were no significant changes pre-versus post-study in self-reported sleep or sleepiness in those who participated in the intervention. Conclusions: A firefighter workplace-based SHP providing sleep health education and sleep disorders screening opportunity can reduce injuries and work loss due to disability in firefighters.

Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis

“…Programs ranged from one-hour lectures (31, 32) to a one-day workshop (33), to more extended programs, such as 2+ hour weekly classes for eightweeks (12). Some programs were delivered in-person, led by experts (15,34), or team-based / peer-led (13), and others were email-based (35) or digital (23). Although all of the programs included an element of fatigue education, the focus varied from mindfulness (12) and self-care practices (33) to exercise prescription (14).…”

“…Three studies evaluated the impact of fatigue education and training on measures of personnel safety (15,32,38). Scott et al used a quasi-experimental study design and reported episodes of drowsy driving and motor vehicle crashes (MVCs) as measures of personnel safety (32).…”

“…Lack of statistical tests of differences pre-to-post intervention led to our categorizing these findings as mixed/inconclusive (Online Supplement Table 2). Sullivan et al completed a randomized trial and captured MVCs and injuries (15). No differences detected in the rate of MVCs or injuries between the intervention and control groups.…”

“…One randomized trial that used an in-person health education and sleep disorder screening showed no differences in multiple measures of alertness between the intervention and control groups at 12 months post-baseline measure (15). We categorize these findings as no impact (Online Supplement Table 2).…”

“…Other components of fatigue training may include optimization of schedules or the sleep environment, mindfulness and/or elements of good behavioral health (10)(11)(12)(13)(14)(15). A sleep health education and sleep disorders screening program implemented in firefighters resulted in 42% of focus group participants reporting behavior change, including trying to get more sleep and paying attention to fatigue levels (16).…”