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An In-Depth Look at the 24 Hour Shift in the Fire Service

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An In-Depth Look at the 24 Hour Shift in the Fire Service
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DiBiasie, Daniel R.
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Fatigue ( jstor )
Fire departments ( jstor )
Firefighting ( jstor )
Labor ( jstor )
Obesity ( jstor )
Overtime ( jstor )
Sleep deprivation ( jstor )
Transponders ( jstor )
Wages ( jstor )
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Undergraduate Honors Thesis

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The fIre service is continuously evolving to create a safer environment for responders. The next step in the evolution of the fIre service is to take a deeper look into the 24-hour shift schedule that many fIre departments currently operate with. First and foremost, the 24-hour shift schedule creates an unfair wage situation in which traditional 24-hour scheduled fIrefIghters earn less hourly than their colleagues who work 12-hour shifts .. Although this seems like a harmless act, shift scheduled fIrefIghters are forced to work several hundred hours more per year to earn a wage equivalent to their colleagues who work a standard work week. Furthermore, studies have shown that mental acuity is drastically decreased as a result of long work hours or extended periods of time where a responder is deprived of sleep. FirefIghting is an inherently dangerous profession which only becomes more dangerous when responders are fatigued or lacking mental acuity. Lastly, recent studies have shown that interrupted sleep cycles and long periods of sleeplessness can lead to both short and long term health problems that can have a drastic impact on a fIrefIghter's quality of life. These health problems include but are not limited to cardiovascular disease, digestive disorders, obesity, obstructive sleep apnea, and even immune system disorders. ( en )
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Undergraduate Honors Thesis -Fire and Emergency Services

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University of Florida
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Copyright Daniel R DiBiasie. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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RUNNING HEAD: An In-Depth Look at the 24 Hour Shift An In-Depth Look at the 24 Hour Shift in the Fire Service Daniel DiBiasie Honors Thesis Advisor: Dr. Klingensmith University of Florida June 15,2016 1

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2 The 24 Hour Shift Abstract The fIre service is continuously evolving to create a safer environment for responders. The next step in the evolution of the fIre service is to take a deeper look into the 24-hour shift schedule that many fIre departments currently operate with. First and foremost, the 24-hour shift schedule creates an unfair wage situation in which traditional 24-hour scheduled fIrefIghters earn less hourly than their colleagues who work 12-hour shifts .. Although this seems like a harmless act, shift scheduled fIrefIghters are forced to work several hundred hours more per year to earn a wage equivalent to their colleagues who work a standard work week. Furthermore, studies have shown that mental acuity is drastically decreased as a result of long work hours or extended periods of time where a responder is deprived of sleep. FirefIghting is an inherently dangerous profession which only becomes more dangerous when responders are fatigued or lacking mental acuity. Lastly, recent studies have shown that interrupted sleep cycles and long periods of sleeplessness can lead to both short and long term health problems that can have a drastic impact on a fIrefIghter's quality of life. These health problems include but are not limited to cardiovascular disease, digestive disorders, obesity, obstructive sleep apnea, and even immune system disorders.

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The 24 Hour Shift Introduction Firefighting is a rewarding and exciting career that offers stability and provides 3 individuals with the moral satisfaction of being able to help others in their worst times. Another unspoken benefit that firefighters also enjoy is the 24 hour shift schedule that many fire departments still employ. The 24 hour schedule provides ample time for firefighters to enjoy social activities or even pursue other employment or educational opportunities. The shift is so popular that an estimated 70% of fire departments across the nation currently utilize some form of the 24 hour shift (Mower, 2012). The origins of the 24 hour shift can be traced back almost as far as the fire service itself. In large cities firefighters did not work shift, instead they resided at the fire station. This arrangement guaranteed that the department would be manned or staffed at all times. As firefighting evolved into a career in the early 20th century, and firefighters sought to spend more time with their families they began working 24 hour shifts following by periods off of24 hours or more (Moore-Merrell as cited by Mower, 2012). Although the 24 hour shift seems as though it would be the optimal situation it does not come without cost. First and foremost, the shift structure creates a pay imbalance in which firefighters who work 24 hour shifts often find themselves making a lower hourly salary than their peers who work a traditional forty-hour work week. Two otherwise identical firefighters with the same qualifications, the same time on the job, employed by the same department can find themselves making significantly different hourly salaries to compensate for built in overtime incurred by the firefighter working the 24 hour shift schedule. This creates an unjust, unfair working environment that should be remedied. Many fire departments have expanded the services offered to include emergency medical response and transport. Therefore, firefighters are also medical practitioners who often find themselves making decisions that could have a life altering impact on the patients that they're

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4 The 24 Hour Shift treating. One wrong decision, either an incorrect treatment choice or simply not acting at all can be the difference between life and death. The mental fatigue obtained in that last hours of a 24 hour shift can have a drastic effect on the practitioners ability to provide care in these situations. A recent study showed that fatigued medical responders were 1.9 times more likely than non fatigued responders to be injured on the job; 2.2 times more likely to commit a medical error; and 3.6 times more likely to be involved in a safety-compromising behavior (McCallion, 2012). The extended hours that practitioners encounter on a 24 hour shift have a direct impact on these statistics. The evolution of the fire service to include emergency medical services has drastically increased the work load for firefighters in busy systems. A department that once responded only to fire emergencies is now finding itself responding to serve the medical needs of the citizens as well. This service increase provides a great benefit to the citizens of the community being serviced, but it comes at a cost that could be detrimental to the long tenn health of firefighters. In June of 2007 the International Association of Fire Chiefs published a study titled The Effects of Sleep Deprivation on Firefighters and EMS Responders which concluded interrupted sleep cycles and extended periods of sleeplessness can lead to cardiovascular disease, digestive disorders, obesity, diabetes, and immune system infections. In a profession that already has made significant strides to minimize other hazardous occupational exposures it is imperative that those same efforts be afforded to minimize the exposure to illnesses that can be mitigated by simply allowing firefighters to work a schedule that is conducive to healthy sleep patterns. The economic imbalance, enhanced opportunity for practitioner error, and the long term health benefits emphasize the importance of the elimination of the 24 hour shift schedule. The

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The 24 Hour Shift fire service prides itself on tradition. Unfortunately, the 24 hour shift schedule is one tradition that needs to be revisited. Economic Imbalance 5 In 1938, under the umbrella of Franklin D. Roosevelt's ''New Deal" congress signed the Fair Labor Standards Act (FLSA) into law. This landmark legislation established a 44 hour work week (which would be amended to 40 hours in 1940), established a minimum wage, prohibited child labor laws, and set forth provisions which required employers to compensate employees at a rate of at least time plus one half for any hours work above and beyond the standard forty hour week ("1938 President Roosevelt," n.d.). At the time of inception the bill only applied to private entity employees and would not include state and government employees until it was amended in 1966 ("US Department of Labor," n.d.). The current FLSA legislation contains specific provisions which specifically allow for firefighters to be excluded from the 40 hour overtime rules, instead stating that " ... overtime pay is required when the number of hours worked exceeds the number of hours that bears the same relationship to 212 (fire) ... as the number of days in the work period bears to 28." ("Fact Sheet," 2011) This provision creates a 53-hour workweek for firefighters before any overtime wages can be earned. The most common variation of the 24 hour shift is the 24 hours on followed by 48 hours off. This shift variation results in firefighters who are on a two week pay cycle to work two consecutive two week pay cycles of 120 hours (5 shifts) worked followed by a shorter pay cycle of 96 hours (4 shifts). The firefighter exemption from the standard FLSA provisions lead to firefighters working the mentioned shift schedule to receive only 28 hours of overtime pay per 6 weeks of work. Based on this variation of the pay cycle, firefighters are losing 68 hours overtime pay (at a time and a half rate) every 6 weeks worked.

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6 The 24 Hour Shift As mentioned previously, the evolution of the fire service has grown to a situation in which many departments are also offering emergency medical first response and transport services. Many agencies have opted to utilize single certified paramedics to staff transport ambulances or rescues in an effort to keep up with staffing demands. For example, in a given shift a single fire station may have firefighters staffmg a first response engine while non firefighter certified paramedics staff the transport apparatus. Under the current FLSA legislation in order for an employee to "qualify" for the firefighter exemption they must meet the following four criteria: 1. are trained in fire suppression; 2. have the legal authority and responsibility to engage in fire suppression; 3. are employed by a fire department of a municipality, county, fire district, or state; and 4. are engaged in the prevention, control, and extinguishment of fires or response to emergency situations where life, property, or the environment is at risk ("Fact Sheet," 2011 Therefore, under current legislation the single certified paramedics who are working the same shift schedule as the firefighters and essentially responding to the same calls do not fall under the frrefIghter exemption and are required to be compensated for their overtime based on a 40 hour work week. To make the situation even more complex many agencies utilize frrefIghters to fill voids in staffing by assigning them to the transport apparatus as needed. This creates a situation in which the two responders assigned to transport apparatus are being paid based on two completely different guidelines. The single certified paramedic is eligible for overtime after hour 40 whereas the frrefIghter is not eligible until after hour 53 of the given week.

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7 The 24 Hour Shift Increased call volume has led to many agencies utilizing a hybrid system in which they staff system status "day-trucks" which are staffed during peak demand hours in addition to their apparatus that are manned at their various stations. This type of system provides quicker responses which lead to an improved service offered to the citizens within the jurisdiction. Many agencies staff the day trucks with full-time hourly employees who choose to work the standard 10 or 12 hour shifts in lieu of working the traditional 24 hour shift model. . In order to entice employees to take these shifts an increased hourly wage is offered to offset the employees from missing out on the mandatory overtime that is afforded by the traditional 24 hour shift schedule. This is necessary to offset the fact that a 24 hour shift scheduled firefighter will work 2912 hours (122 shifts) in a year compared to the day staffed firefighter who will work an approximate 2080 hours (40 hour week times 52 weeks) annually. These situations which seem to make a minimal difference at first glance create a pay inequality when overtime is offered. For example, if two seats of overtime are offered on an apparatus and one of the shifts is covered by a firefighter who normally works a 24 hour shift schedule and the other shift is covered by a firefighter who normally works a standard 10-12 hour shift; the second firefighter is going to earn a significant amount more than the first for the simple reason that the second firefighter is employed at a higher hourly rate than the first firefighter. Operational Error or Injury Due to Fatigue In 2006, Firefighter Matt Swatzell made national headlines when he fell asleep at the wheel on the way home from working a busy 24 hour shift in which he states that he received less than 30 minutes of sleep in the past 24 hours. Although Firefighter Swatzell was not on duty at the time of his accident it can still be concluded that the accident was a direct result of the fatigue incurred as a result of the shift schedule. June Fitzgerald, the driver of the other vehicle

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The 24 Hour Shift and her unborn baby were fatally injured in the accident that morning (Blackshere, 2014). The ramifications of shift fatigue can lead to dangerous acts that can have a significant impact on patient care providers, the patient, or innocent victims such as in the case of Firefighter Swatzell's accident. 8 A study published by the Association for the Advancement of Automotive Medicine cites that motor vehicle crashes are the second leading cause of death for firefighters and account for 20-25 percent of annual firefighter line of duty fatalities. The study estimated that 500 firefighters are involved in fatal firetruck crashes and approximately 1 % of the occupants died as a direct result of the crash (Donoughe, Whitestone, and Gabler, 2012). Although the report does not specifically identify the number of accidents in which fatigue was a factor it can be assumed that the mental fatigue of long shifts was likely to have played a role. Another potential problem is the lack of policy that prevents firefighters from operating behind the wheel of an apparatus for extended periods of time. The Department of Transportation has federal regulations to regulate the amount of time that a truck driver can operate behind the wheel. The hours of operations rules state that a truck driver may only operate a vehicle for eleven consecutive hours after coming off of ten consecutive hours off duty ('Summary of Hours," n.d.) yet it is perfectly acceptable for the operator of a fire engine or ambulance to climb behind the wheel in response to a call in hour 23 of a sleepless 24 hour shift. This type of oversight can be deadly. In addition to an increased risk in motor vehicle operations fatigue may also playa major role in fireground injuries. The IAFC's 2007 study, The Effects of Sleep Deprivation on Firefighters and EMS Responders points out that the highest risk of injury on the fireground occurs between the hour of midnight and 6 a.m. The data sample collected revealed that 25.7%

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The 24 Hour Shift of fire ground injuries occurred during this time frame which comprised only 16.4% of the total fIres in the sample. With the exception of active military enlistment, firefIghting is essentially the only career that responders are expected to act in extremely dangerous situations within minutes of being awaken from a late night sleep. Unfortunately, above it is during these early morning hours in which fIrefIghters are at the greatest risk of either getting themselves or their peers injured. 9 Shift fatigue can also have a detrimental impact on patient care. Washington D.C. Fire and EMS made headlines recently when a patient care provider was videotaped asleep in the back of a transport unit while having a patient in her care. A friend of the patient who was accompanying the patient to the hospital utilized a cell phone to video FirefighterlEMT Dominique Rust as she slept during the transport to the hospital (Marraco, 2015). Unfortunately, this type of situation is not uncommon. It is not uncommon or unlikely for a busy transport unit to respond to calls for the entirety of a 24 hour shift without sufficient down time. This fatigue can lead to indecision or treatment mistakes that could be detrimental to the outcome of the patient. In 1997, the scientifIc journal Nature found that people who had been awake for a 24 hour period had the equivalent cognitive performance as someone with a blood alcohol level of 0.10%. The legal limit to operate a vehicle in most states is 0.08% (as cited by Mower, 2012). Fatigue can also lead to a phenomenon called decision fatigue. Although its psychology and neurophysiology are not fully understood, studies have shown that decision-making is negatively affected when the decision maker is involved in activities that require decision making skills to be utilized over an extended period of time without taking adequate breaks from the activity. For example, a paramedic who has been making treatment decisions continuously

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The 24 Hour Shift on a busy shift will be more likely to make choices that not optimal during these periods of fatigue. The additional consequences of decision fatigue are as follows: • Responders will avoid making unnecessary decisions • Responders will choose the easiest of the available options and not necessarily the best option • Responders may make decisions driven by immediate motivations without regard to long-term consequences • Responders may choose to utilize inaccurate and simplified algorithms as opposed to thinking through the situation in its entirety • Responders may also lose their inhibitions and behave impulsively (Oto, 2012) 10 Based on the theories of decision-making fatigue it can be concluded that a fatigued responder is likely to perform a lower level of care at the end of a long shift as opposed to the beginning. For example a heart attack patient who activates 911 in hour 23 of a 24 shift may have a lower chance of a positive outcome than a patient who activates 911 in hour 1 of a 24 hour shift simply because the provider is more prone to making better treatment choices prior to the onset of fatigue. Physical Effects of Long Shift Schedules and Sleep Deprivation The fire service has made great strides in reducing occupational risks that lead to long term health effects on firefighters. One of the more common risks associated with fire suppression activities is the onset of cancer and the onset of an acute cardiac event. Fitness programs have been encouraged to reduce cardiac stress. Firefighters are now encouraged to wear their self-contained breathing apparatus during overhaul activities. Why is the same emphasis not placed on encouragement of firefighters working shorter shifts which allow for

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11 The 24 Hour Shift proper rest patterns? The list of potential health risk associated with long work hours and interrupted sleep definitely warrant a more in-depth look. Cardiovascular Disease Studies have shown that there may be a correlation between long shift schedules and cardiovascular disease. A study of myocardial infarction patients admitted to the hospital revealed that more than half regularly worked more than 60 hours per week (Thiel, Parker & Bruce, 1973 as cited by Elliot and Kuehl, 2007). Sleep allows for a reduction in heart rate and blood pressure which allow for bodily repair functions to occur. Disruption of the sleep sequence can lead to a predisposition to hypertension (Elliot and Kuehl, 2007). The National Fire Protection Agency cites that sudden cardiac death is still the leading cause of death amongst firefighters. As of June 2016, 51 % of the annual firefighter reported deaths were due to a sudden cardiac event ("Firefighter Deaths," 2016). Although there is no way to determine the direct correlation between the 24 hour shift and the cardiac related deaths, one can make the conclusion that the shift schedule may certainly be a factor. Digestive Disorders Digestive enzymes have been found to be excreted in relation to normal cyclical rhythms based on normal dietary patterns. Extended shifts which cause a disruption in these patterns can cause a six-fold increase in gastrointestinal disorders (Reid et al., 1997; Orr & Chen, 2005 as cited in Elliott & Kuehl, 2007). Obesity and Obstructive Sleep Apnea Studies of the United States population have revealed that young adults between the ages of 30 to 50 years who sleep less than seven hours per night are more likely to gain weight and become obese than subjects with longer sleep durations {Ganswich et al., 2005 as cited by Elliot

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12 The 24 Hour Shift & Kuehl, 2007). Shift workers are also at a higher risk for obstructive sleep apnea. Obstructive sleep apnea is found in approximately 10 percent of shift workers compared to approximately 5 percent of the general public. Obstructive sleep apnea is also associated with obesity, diabetes, hypertension, and heart disease (Elliot & Kuehl, 2007). Immune Disorders and Infection Sleep deprivation deprives the immune system of normal restorative sleep which is essential for optimum performance of the immune system therefore sleep deprivation has a direct correlation to increased susceptibility to infection (Mohren, Jansen & Kant, 2002 as cited by Elliot & Kuehl, 2007). Conclusion Firefighting is and will always be an inherently dangerous profession. The job itself presents opportunities for firefighters to become severely hurt or even killed. In many situations, a split second decision can be the deciding factor in whether or not a firefighter lives to return home to hislher family at the end of a shift. It is for this reason that firefighters have an obligation to ensure that their mental and physical acuity is in the best possible shape when reporting to shift and throughout the remainder of their time on the job. The 24 hour shift schedule does not promote this goal. If anything, the extended shift is a combatant of mental acuity and should be forbidden. The archaic practice of requiring responders to work 24 hours a day also creates unfair pay imbalances in which two identical responders may find themselves making vastly different hourly wages because of the structuring of their schedules. Instead of paying the shift worker a fair hourly wage equivalent to that ofhislher counterpart (who is working less than 800 hours a year than the shift worker) hislher hourly wages are slashed to provide equal annual incomes

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13 The 24 Hour Shift across the board. This practice should not be tolerated in a world where equal pay for equal work is a commonplace in the work force. Lastly, firefighters spend their lives helping others in need on potentially the worst days of their lives. Many departments offer a pension to reward and repay firefighters for their service unfortunately too many firefighters cannot enjoy that pension due to health issues acquired during their career. Scientific studies have shown that shift work is a contributing factor to these issues and therefore must be reevaluated.

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14 The 24 Hour Shift References Blackshere, R. (2014, February 3). Widower forges friendship with man in crash that killed wife, unborn baby. Retrieved June 13,2016, from http://www.today.comlnews/widower forgesfriendship-man-crash-killed-wife-unborn-baby-2D 12044681 Fact Sheet #8: Law Enforcement and Fire Protection Employees Under the Fair Labor Standards Act (FLSA). (2011, March). Retrieved June 13,2016, from https:llwww.dol.gov/whdlregs/compliance/whdfs8.pdf Donoughe, K., Whitestone, J., & Gabler, H. C. (2012, October). Analysis ofFiretruck Crashes and Associated Firefighter Injuries in the United States. Retrieved June 13,2016, from http://www.ncbLn1m.nih.gov/pmc/articlesIPMC3503424/ Elliott, D., & Kuehl, K. (2007, June). The Effects of Sleep Deprivation on Firefighters and EMS Responders. Retrieved June 12,2016, from https:llwww.iafc.orgifiles/progsSleep_SleepDeprivationReport.pdf Firefighter deaths by cause and nature of injury. (2016, June). Retrieved June 13,2016, from http://www.nfpa.orglnews-and-researchlfire-statistics-and-reports/fire-statistics/the-fire service/fatalities-and-injuries/firefighter-deaths-by-cause-and-nature-of-injury Marraco, M. (2015, September 15). EXCLUSIVE: EMT accused of sleeping while on duty has history of work performance issues. Retrieved June 17,2016, from http://www.fox5dc.comlnewsllocal-news/20312382-story 1938 President Roosevelt signs the Fair Labor Standards Act. (n.d.). Retrieved June 16,2016, from http://www.massaflcio.orglI938-president-roosevelt-signs-fair-Iabor-standards-act McCallion, T. (2012, March 16). Study Measures Effect of Sleep Deprivation on EMS Providers. Retrieved June 12,2016, from http://www.jems.comlarticles/2012/03/study-measures effect-sleep-deprivation.html Mower, L. (2012). Firefighters' 24-hour shifts get close look. Retrieved June 12,2016, from http://www.reviewjournal.comlnews/las-vegas/firefighters-24-hour-shifts-get-close-Iook Oto, B. (2012, May 1). EMS Errors I EMSWorld.com. Retrieved June 13,2016, from http://www.emsworld.comlarticlell 0687160/ems-errors Summary of Hours of Service Regulations. (n.d.). Retrieved June 13,2016, from https:llwww.fmcsa.dot.gov/regulationslhours-service/summary-hours-service regulations U.S. Department of Labor Wage and Hour Division (WHD) Wage and Hour Division History. (n.d.). Retrieved June 13,2016, from https:llwww.dol.gov/whdlaboutlhistory/whdhist.htm


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