Fire Fighter Fatigue Management Program: Operation Healthy Sleep

Not Applicable

Completed

Conditions: Obstructive Sleep Apnea
Impaired Driving
Insomnia
Shift-Work Sleep Disorder
Restless Leg Syndrome
Injuries

Interventions: Other: Sleep disorders education and screening

Registration Number: NCT01988129

Lead Sponsor: Brigham and Women's Hospital

Brief Summary: Firefighters work some of the most demanding schedules known under highly stressful and demanding conditions. The need to work frequent extended shifts and long work weeks leads to acute and chronic partial sleep deprivation as well as misalignment of circadian phase. Sleep disorders are common, costly, and treatable, but often remain undiagnosed and untreated and it is likely that a significant proportion of firefighters suffer from undiagnosed sleep disorders which will further impair their sleep and exacerbate fatigue.In the current proposal, we aim to address the health, performance and safety issues related to fatigue in firefighters and test the effectiveness of a Comprehensive Firefighter Fatigue Management Program (CFFMP) that we have termed 'Operation Healthy Sleep.'

Detailed Description: We propose to use a station-level, randomized experimental design to test the hypotheses that implementation of a Comprehensive Firefighter Fatigue Management Program will:

1. improve the mean total sleep, alertness and cognitive performance of firefighters;

2. improve firefighter safety, as determined by:

1. decreased rates of motor vehicle crashes;

2. decreased on-the-job injuries;

3. improve firefighter performance, as determined by decreased response time;

4. improve firefighters' health, as determined by:

1. diagnosis and treatment of sleep disorders

2. improved general health indices

3. decreased number of 'sick' days

5. improve firefighters' and families' job satisfaction and ability to cope with extended work hours.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1189

Inclusion Criteria

This proposal includes research involving human subjects (fire department employees).
Active firefighters working in the study fire department will be eligible to participate in the study.
All applicants will be considered without bias, regardless of race, ethnicity, or national origin.

Exclusion Criteria

Non fire department employees

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Sleep disorders education and screening	Workplace-based fatigue risk management program consisting of sleep health education and sleep disorders screening. The 32 fire department stations were paired according to the previous calendar years' workload. One station from each pair was randomly assigned to receive the intervention program. Sleep education sessions were scheduled according to station. On the education day(s) assigned to that stations, all personnel present that day were instructed to attend, and 542/601 did so.

Primary Outcome Measures

Name	Time	Method
Firefighters' Performance, as Determined by Response Time Over 12 Months	12 months	A lower response time is indicative of better performance. Following detailed review of departmental procedures and records, we determined that 'turn-out time' was already very rapid and not considered an accurate measure of firefighters' performance by the department. Similarly, 'clearance time' (time from the start until the end of the event), which could last for many hours, was also not considered an appropriate measure of firefighter' performance in relation to sleep and alertness given the multiple factors, many of which are not under the control of the firefighters, that could affect clearance times. We therefore did not address this aim.
Firefighters' Health, as Determined by Number of 'Sick' Days Over 12 Months	12 months	We assessed 'sick days' cumulatively over 12 months in two ways from departmental payroll records; the number of 24-hour pay periods coded as 'sick' time per firefighter and the number of 24-hr pay periods coded as injury and disability per firefighter. Fewer sick days is indicative of better health.
Firefighter Safety, as Determined by Motor Vehicle Crashes Over 12 Months	12 months	Fewer motor vehicle crashes is indicative of better health. We assessed motor vehicle crashes cumulatively over 12 months. Accidents were counted as any incident that resulted in the filing and review of a departmental Fleet Accident Report.
Firefighter Safety, as Determined by On-the-job Injuries Over 12 Months	12 months	Fewer on-the-job injuries is indicative of better health. We assessed injuries cumulatively over 12 months. Injuries that triggered the filing of an official city government accident report as the result of following normal departmental procedures were included in this study.

Secondary Outcome Measures

Name	Time	Method
Change in the Mean Alertness and Cognitive Performance of Firefighters - Sleepy During Meetings	Baseline to 12 months	A lower number of times reported falling asleep during meetings is indicative of better alertness and cognitive performance. The outcome measure was assessed in the intervention group only at the start and end of the program. There are no data for the control group and therefore they have not been added or reported as a separate study arm. The analysis for the number of times individuals reported sleeping during meetings is limited to those individuals in the intervention stations who participated in the program, completed both the study start and 12-month follow-up survey.
Change in the Mean Total Sleep Time	Baseline to 12 months	A higher total sleep time is indicative of better sleep. The outcome measure was assessed in the intervention group only at the start and end of the program. There are no data for the control group and therefore they have not been added or reported as a separate study arm. The analysis for total sleep time is limited to those individuals in the intervention stations who participated in the program, completed both the study start and 12-month follow-up survey, and had at least 1 week of work scheduled in the 4 weeks prior to each survey.
Change in Firefighters' Health, as Determined by General Health Indices;	Baseline to 12 months	The outcome measure was assessed in the intervention group only at the start and end of the program. There are no data for the control group and therefore they have not been added or reported as a separate study arm. A higher health index is indicative of better health. We assessed general health with the question ' In general, would you say your health is Excellent/Very good/Good/Fair/Poor?' and coded the answers from 5-1, respectively.
Change in the Mean Alertness and Cognitive Performance of Firefighters - Sleeping on the Telephone	Baseline to 12 months	A lower number of times reported sleeping on the telephone is indicative of better alertness and cognitive performance. The outcome measure was assessed in the intervention group only at the start and end of the program. There are no data for the control group and therefore they have not been added or reported as a separate study arm. The analysis for the number of times individuals reported sleeping on the telephone is limited to those individuals in the intervention stations who participated in the program, completed both the study start and 12-month follow-up survey.
Change in the Mean Alertness and Cognitive Performance of Firefighters - Sleeping While Driving	Baseline to 12 months	A lower number of times reported sleeping while driving is indicative of better alertness and cognitive performance. The outcome measure was assessed in the intervention group only at the start and end of the program. There are no data for the control group and therefore they have not been added or reported as a separate study arm. The analysis for the number of times individuals reported being sleepy while driving is limited to those individuals in the intervention stations who participated in the program, completed both the study start and 12-month follow-up survey.
Change in the Mean Alertness and Cognitive Performance of Firefighters - Sleeping While Stopped in Traffic	Baseline to 12 months	A lower number of times reported sleeping while stopped in traffic is indicative of better alertness and cognitive performance. The outcome measure was assessed in the intervention group only at the start and end of the program. There are no data for the control group and therefore they have not been added or reported as a separate study arm. The analysis for the number of times individuals reported sleeping while stopped in traffic is limited to those individuals in the intervention stations who participated in the program, completed both the study start and 12-month follow-up survey.
Change Firefighters' and Families' Job Satisfaction and Ability to Cope With Extended Work Hours	Baseline to 12 months	In developing the study detail with the department, it became apparent that it would be impractical to assess firefighters' and families' job satisfaction and ability to cope with extended work hours in a meaningful way. We therefore did not address this aim.