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Allison P, Tiesman HM, Wong IS, Bernzweig D, James L, James SM, Navarro KM, Patterson PD. Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research. Am J Ind Med 2022; 65:878-897. [PMID: 35711032 PMCID: PMC9851314 DOI: 10.1002/ajim.23407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers. METHODS We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue. RESULTS Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs. CONCLUSIONS In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.
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Affiliation(s)
- Penelope Allison
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Hope M. Tiesman
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Imelda S. Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David Bernzweig
- Ohio Association of Professional Fire Fighters, Columbus, Ohio, USA
| | - Lois James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Stephen M. James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Kathleen M. Navarro
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Navarro KM, Butler CR, Fent K, Toennis C, Sammons D, Ramirez-Cardenas A, Clark KA, Byrne DC, Graydon PS, Hale CR, Wilkinson AF, Smith DL, Alexander-Scott MC, Pinkerton LE, Eisenberg J, Domitrovich JW. The Wildland Firefighter Exposure and Health Effect (WFFEHE) Study: Rationale, Design, and Methods of a Repeated-Measures Study. Ann Work Expo Health 2022; 66:714-727. [PMID: 34919119 PMCID: PMC9203592 DOI: 10.1093/annweh/wxab117] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 01/04/2023] Open
Abstract
The wildland firefighter exposure and health effect (WFFEHE) study was a 2-year repeated-measures study to investigate occupational exposures and acute and subacute health effects among wildland firefighters. This manuscript describes the study rationale, design, methods, limitations, challenges, and lessons learned. The WFFEHE cohort included fire personnel ages 18-57 from six federal wildland firefighting crews in Colorado and Idaho during the 2018 and 2019 fire seasons. All wildland firefighters employed by the recruited crews were invited to participate in the study at preseason and postseason study intervals. In 2019, one of the crews also participated in a 3-day midseason study interval where workplace exposures and pre/postshift measurements were collected while at a wildland fire incident. Study components assessed cardiovascular health, pulmonary function and inflammation, kidney function, workplace exposures, and noise-induced hearing loss. Measurements included self-reported risk factors and symptoms collected through questionnaires; serum and urine biomarkers of exposure, effect, and inflammation; pulmonary function; platelet function and arterial stiffness; and audiometric testing. Throughout the study, 154 wildland firefighters participated in at least one study interval, while 144 participated in two or more study interval. This study was completed by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health through a collaborative effort with the U.S. Department of Agriculture Forest Service, Department of the Interior National Park Service, and Skidmore College. Conducting research in the wildfire environment came with many challenges including collecting study data with study participants with changing work schedules and conducting study protocols safely and operating laboratory equipment in remote field locations. Forthcoming WFFEHE study results will contribute to the scientific evidence regarding occupational risk factors and exposures that can impact wildland firefighter health over a season and across two wildland fire seasons. This research is anticipated to lead to the development of preventive measures and policies aimed at reducing risk for wildland firefighters and aid in identifying future research needs for the wildland fire community.
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Affiliation(s)
- Kathleen M. Navarro
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA,Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA,Author to whom correspondence should be addressed. Tel: +1-303-236-5953;
| | - Corey R. Butler
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA,United States Department of the Interior, Denver, CO, USA
| | - Kenneth Fent
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Christine Toennis
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Cincinnati, OH, USA
| | - Deborah Sammons
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Cincinnati, OH, USA
| | - Alejandra Ramirez-Cardenas
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
| | - Kathleen A. Clark
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, VA, USA
| | - David C. Byrne
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Pamela S. Graydon
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Christa R. Hale
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
| | - Andrea F. Wilkinson
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA,First Responder Health and Safety Laboratory, Skidmore College, Saratoga Springs, NY, USA
| | - Denise L. Smith
- First Responder Health and Safety Laboratory, Skidmore College, Saratoga Springs, NY, USA
| | - Marissa C. Alexander-Scott
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Cincinnati, OH, USA
| | - Lynne E. Pinkerton
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA,Maximus, Attain, Falls Church, VA, USA
| | - Judith Eisenberg
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Joseph W. Domitrovich
- United States Forest Service, National Technology and Development Program, Missoula, MT, USA
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Koopmans E, Cornish K, Fyfe TM, Bailey K, Pelletier CA. Health risks and mitigation strategies from occupational exposure to wildland fire: a scoping review. J Occup Med Toxicol 2022; 17:2. [PMID: 34983565 PMCID: PMC8725416 DOI: 10.1186/s12995-021-00328-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: 1. Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and 2. Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire. METHODS Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings. RESULTS The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health (n = 14), mental health (n = 16), and inflammation and oxidative stress (n = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue. CONCLUSIONS While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire.
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Affiliation(s)
- Erica Koopmans
- Health Research Institute, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Katie Cornish
- Health Research Institute, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Trina M Fyfe
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Katherine Bailey
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea A Pelletier
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.
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Broyles G, Kardous CA, Shaw PB, Krieg EF. Noise exposures and perceptions of hearing conservation programs among wildland firefighters. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:775-784. [PMID: 31658434 DOI: 10.1080/15459624.2019.1668001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Wildland firefighters are exposed to numerous noise sources that may be hazardous to their hearing. This study examined the noise exposure profiles for 264 wildland firefighters across 15 job categories. All 264 firefighters completed questionnaires to assess their use of hearing protection devices, enrollment in hearing conservation programs, and their overall perception of their noise exposure. Roughly 54% of firefighters' noise exposures exceeded the National Institute for Occupational Safety and Health recommended exposure limit of 85 decibels, A-weighted, over 8 hr, and 32% exceeded the Occupational Safety and Health Administration permissible exposure limit of 90 decibels, A-weighted, over 8 hr. Questionnaire results indicated good agreement between noise exposures and firefighters' perceptions of the noise hazard. Approximately 65% reported that they used some form of hearing protection; however, only 19% reported receiving any proper training regarding the use of hearing protection devices, with the majority of those firefighters relying on earplugs, including electronic and level-dependent earplugs, over earmuffs or other forms of hearing protectors. The results also suggest that improved communication and situational awareness play a greater role in the consistent use of hearing protection devices than other factors such as risk of developing noise-induced hearing loss. The study highlighted the challenges facing wildland firefighters and their management and the need for a comprehensive wildland fire agencies' hearing conservation program especially for firefighters who were exempt based on their occupational designations.
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Affiliation(s)
- George Broyles
- Technology and Development Program, USDA Forest Service, Boise, Idaho, USA
| | - Chucri A Kardous
- National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, Ohio, USA
| | - Peter B Shaw
- National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, Ohio, USA
| | - Edward F Krieg
- National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, Ohio, USA
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