Inadequate sleep can help explain high rates of suicide and cardiac events among firefighters

Studies indicate sleep deprivation increases susceptibility to cancer, cardiac disease, and post-traumatic stress disorder.

Firefighters sleep wildfire
USFS photo.

An article by Eric Saylors at Medium.com emphasizes how important sleep is to firefighters.

He reports that one study found men kept awake between 10 p.m. and 3 a.m. showed a 70 percent reduction of cancer-fighting immune cells known as “natural killers” after one night. These cells detect and control early signs of cancer. The data in the study indicates that even a modest disturbance of sleep produces a reduction of natural immune responses.

Below are excerpts from Mr. Saylor’s article, which also draws information from several other researchers:

“Lack of quality sleep could explain why cardiac events are common in firefighters, regardless of fitness programs. ”

“Rosaline Cartwright, professor of psychology in neuroscience, explains the mind needs sleep to processes stressful events. Without sleep the brain cannot decouple the memory of tragic events and the physiological response. Essentially, if you can’t sleep on it, you can’t get over it. This explains a new epidemic in the fire service; firefighter suicide.”

“Cartwright’s research suggests the mind needs dreams followed by REM sleep and to process upsetting experiences. In other words, you have to recreate tough experiences in your dreams so your mind can break them down. Without the combination of REM sleep and dreams, memories of traumatic events remain fresh in the person’s mind. As a result, a firefighter who is sleep deprived accumulates traumatic events like a trash can that is never emptied.”

“Contributing to cancer, cardiac events, and PTSD, lack of sleep may be the greatest cause of firefighter deaths.”

Eric Saylors is an instructor, author, pilot, consultant, and 3rd gen firefighter with a Masters degree in security studies from the Naval Post Graduate School.

The brain needs sleep to perform nightly maintenance — for firefighters and everyone else

At the top of the article: USFS photo.

The brain uses a quarter of the body’s entire energy supply, yet only accounts for about two percent of the body’s mass. So how does this unique organ receive and, perhaps more importantly, rid itself of waste? New research suggests it has to do with sleep.

In the TedMed video above, neuroscientist Jeff Iliff explains the connection between sleep and brain function.

A study of almost 7,000 firefighters from municipal fire departments found that 37 percent screened positive for common sleep disorders, including obstructive sleep apnea, insomnia, restless leg syndrome, and shift work disorder.

The researchers found that compared with sound sleepers, those with a sleep disorder were about twice as likely to have a motor vehicle crash, to nod off while driving, and to have cardiovascular disease or diabetes. They were more than three times as likely to suffer from depression and anxiety.

Wildland firefighters usually work 8-hour shifts —  except when they don’t. While on fires their shift schedules and sleep routines are often disrupted. The 8-hour shift can be extended to 12 to 16 hours, and their usual sleeping and waking times may be changed and sometimes shortened; not unlike the jet lag of traveling to a different time zone. The first shift on a fire may be longer than 16 hours and a crew used to working during the day can be placed on a night shift.

A firefighter sleep study conducted by the Missoula Technology Development Center between 2006 and 2008 found that sleep deprivation contributed to fatigue, stress, and impaired performance of Incident Management Team members.

I talked with pilots and other personnel that traveled with an air tanker to a new assignment. Depending on their original location, they flew across two to four time zones and after arrival, they started work about two hours earlier than usual. So the net change was four to six hours worth of jet lag when taking the new work schedule into account. After a couple of days at the new site two crewmembers told me that they were really tired, even though they were not physically working much harder than normal. Their supervisor eventually recognized this and made sure they got a day off.

That kind of disruption in a work/sleep/wake schedule is common among wildland firefighters, especially those that travel long distances to an assignment. It is possible that wildland fire managers do not recognize this and the negative effect it can have, or if they do, may feel there is little they can do to mitigate the problem.

Crew supervisors and incident management teams should at least strive to give firefighters an opportunity to get an adequate amount of quality sleep.

We have written before about the importance of sleep for wildland firefighters. Articles on Wildfire Today tagged “sleep”.

Study links firefighter accidents to sleep problems

fire Whiskeytown National Recreation Area
An incident base at Whiskeytown National Recreation Area in California, 2009. Photo by Carol Jandrall.

A study of almost 7,000 firefighters from municipal fire departments found that 37 percent screened positive for common sleep disorders, including obstructive sleep apnea, insomnia, restless leg syndrome, and shift work disorder.

The researchers found that compared with sound sleepers, those with a sleep disorder were about twice as likely to have a motor vehicle crash, to nod off while driving, and to have cardiovascular disease or diabetes. They were more than three times as likely to suffer from depression and anxiety.

The study, published in the Journal of Clinical Sleep Medicine, said that nationwide 61 percent of firefighter on-duty fatalities are caused by heart attacks or motor vehicle crashes.

National Interagency Fire Center data that we reported for 1990 through 2014 shows that 45 percent of the wildland fire fatalities were from vehicle accidents or medical issues.

Wildland firefighter fatalities 1990-2014
Wildland firefighter fatalities, 1990-2014. Data from NIFC, compiled by Wildfire Today.

Most, 97 percent, of the 7,000 firefighters in the study worked extended shifts of at least 24 hours. Wildland firefighters work 8-hour shifts —  except when they don’t. While on fires their shift schedules and sleep routines are often disrupted. The 8-hour shift can be extended to 12 to 16 hours, and their usual sleeping times may be changed and sometimes shortened; not unlike the jet lag of traveling to a different time zone. The first shift on a fire may be longer than 16 hours and a crew used to working during the day can be placed on a night shift.

The municipal firefighters in the study work very different schedules from their brothers and sisters in wildland fire, so a direct comparison of sleep disorders and accidents is probably not valid, but this issue should be watched closely. Crew supervisors and incident management teams should, at least, see that firefighters have an opportunity to get an adequate amount of quality sleep.

The same journal that published this study has another interesting one titled, “The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor”.

How much sleep do tactical athletes need?

sleep firefighter
Tom Sadowski, El Cariso Hotshots, 1972. Photo by Bill Gabbert.

Charles Palmer, an associate professor at the University of Montana who studies performance psychology of wildland firefighters, has called them “tactical athletes”. Mr. Palmer, who spent 20 years as a firefighter and smokejumper, has said:

These aren’t people who ride around in trucks and squirt water on stuff — this is really demanding from a lot of different angles. You travel around, you have to perform, they’re getting very little downtime, they have nutritional challenges … physically you have to perform really well.

A study of wildland firefighters during suppression activities in Spain found that heart rates ranged from 116 to 133 beats per minute depending on the length of the work. Researchers in Australia measured heart rates of firefighters operating hand tools that were 95 percent of their predicted maximal.

When we read an article at the Monday Morning Quarterback about managing the sleep of professional football players, we could’t help but make the comparison between those athletes and the ones who fight wildfires for a living.

According to the piece by Jennie Vrentas, an increasing number of NFL teams are emphasizing an adequate amount of sleep for their players. Below are some excerpts from the article:

A good night’s sleep is directly tied to key factors such as reaction time, mental alertness, muscular recovery and converting what you’ve recently learned into memory. That’s why the science of slumber has become one of the hottest trends in the NFL: Teams are no longer leaving it to chance that their multimillion dollar investments will manage sleep cycles all on their own.

The Dolphins and Patriots have dark rooms at their practice facilities so players can take naps. Eagles players fill out a morning questionnaire on their tablets, self-reporting how long and how well they slept the previous night.

If you run on four hours of sleep a night for a week, it’s the same as drinking a six-pack and then going to work.

“The average athlete probably needs eight to nine hours of sleep, given their physical demands,” [Washington team physician Anthony] Czeisler says, and even more if you can get it. “I wish I could say there’s a shortcut, but if you are going to be a professional athlete, you need to pay careful attention to sleep.”

A single all-nighter, or a week spent getting just four hours of sleep a night, can make one’s reaction time nearly three times slower.

The article refers to studies completed on football and basketball players, but there has also been research on how sleep affects wildland firefighters. In a study of firefighters in Australia during a four-day simulation of an assignment on a wildland fire, it was found that after two nights of being restricted to four hours of sleep their performance on a hand-eye coordination task declined. However their work output remained about the same even after consecutive nights of restricted sleep.

In a related study in Australia, Grace Vincent, a PhD student at Deakin University reported:

The firefighters report [that while working on actual fires they get] only about four to five hours sleep per night. They have trouble sleeping due to other people snoring in locations such as cabins, tents or the floor of school gyms.  Some are simply so wired after spending the whole day in emergency-mode, that they can’t switch off.

This is consistent with research in the United states, in Technology and Development Publication, Wildland Firefighter Health and Safety Report, Issue Number 13, Summer 2009:

…Sleeping in fire camp can be a challenge. Noise from generators, vehicles, and other firefighters all contribute to sleeplessness. Because almost all wildland firefighters need to sleep either in fire camps or in spike camps, they sleep in tents, on the ground, and in hot, smoky, and dusty conditions. Shift work interferes with sleep, especially for those on night shift.

Sleep log data were collected on members of five incident management teams at fire camps in California and Montana during 2008. [Note from Bill: this data appears to be from overhead team members in fire camp, not “tactical athletes” out in the field.] Data for 140 team members (36 percent female, 64 percent male) indicated that they averaged 6.1 hours of sleep, ranging from 3.5 to 9.0 hours per night. On average, team members went to bed at 9:30 p.m. They reported being awakened an average of 2.2 times per night, awakening from zero to six times per night. When team members were asked to rate the quality of their sleep, the average was 6.6 on a 10-point scale. Nearly one-fourth (23.8 percent) reported feeling tired when they woke, while 53.6 percent felt somewhat rested, 20.2 percent felt rested, and 2.4 percent felt very rested.

Eight hours of rest between work periods is inadequate because only 50 to 75 percent of the rest period is devoted to sleep. Thus it is advisable to have longer rest periods (10 to 14 hours) so workers have time for adequate sleep.

Total sleep deprivation for 1 week has led to cognitive impairment when work requires multitasking. In driving, accidents increase as sleep duration is decreased. In tasks requiring judgment, risky behaviors emerge when sleep is limited to 5 hours per night.

Behavioral alertness and a range of cognitive functions, including sustained attention, and working memory deteriorate when nightly sleep is limited to between 4 and 7 hours. Decisionmaking skills, such as the ability to assess risk, assimilate changing information, and revise strategies to solve problems based on new information are likely to suffer.

Eight hours of rest between work periods is inadequate because only 50 to 75 percent of the rest period is devoted to sleep. Thus it is advisable to have longer rest periods (10 to 14 hours) so workers have time for adequate sleep.

What about naps?

The same publication recommended naps when possible, but the length is important:

Naps restore alertness, enhance performance, and reduce the risk of mistakes. To avoid waking up groggy and exhausted, workers should nap for 20 to 30 minutes OR for longer than 90 minutes. A one-hour nap places you in the middle of deep sleep, making it difficult to wake up. You will be disoriented and clumsy, might make poor decisions, and could be at risk of an injury. A 20-minute nap ends before you descend into deep sleep; a 90-minute nap catches you rising out of deep sleep.

Wildfire news, April 27, 2009

Update on Myrtle Beach Highway 31 fire

The estimated size of the fire has been reduced to 19,500 acres due to more accurate mapping.  It is 90 percent contained and the primary activity now is mopping up and improving lines.  Crews continue to report encounters with bears, snakes and other wildlife which may been displaced by the fire.

Another description of one of the two burnovers has now come out, courtesy of the AP.  Here is an excerpt:

Wayne Springs and Terry Cook tried to outrun a South Carolina wildfire as it started ripping through forests and homes near the coast. The two state forestry technicians survived by huddling in portable fire shelters, and four days later they were still stomping out the blaze.

“I was nervous going back, but I didn’t want to leave everybody else,” Springs, 43, said Sunday. “I’ve never seen anything like this and I hope I never do again.”

In all, the wildfire that started Wednesday has burned more than 30 square miles and demolished more than 70 homes. Officials said it remained 85 percent contained Sunday but worried an expected wind shift Monday could threaten other houses. Nobody has been injured.

Springs and Cook were hours into battling the wildfire near North Myrtle Beach when their tractor got stuck on a fire break. They were waiting for a tow when the winds changed, pushing a 150-foot wall of flames at them.

“You knew it was coming for you, and that is a bad feeling,” said Springs, of Lake City. “We were scared, but we stayed calm.”

Each took cover in a fire shelter — which looks like a massive piece of aluminum foil — and hunkered in a small ditch filled with water as the fire roared over them. For several minutes they were surrounded by the sounds of popping wood and the whoosh of flames.

“It wasn’t long, but it felt like forever,” said Cook, 43, of Florence County.

Contractor warned about brush piles that started Summit fire

CalFire twice warned a contractor who was burning brush piles, which a month later escaped and started the Summit fire in the Santa Cruz Mountains south of San Francisco last May.  Two of the piles were left smoldering, causing 4,270 acres and 132 structures to burn.

The contractor responsible for clearing the five-acre parcel and burning the piles, Channing Parker Verden, 50, of Los Gatos, California has been arrested and booked into Santa Clara County Jail on $250,000 bail.  The standard bail for the crime he is accused of is $60,000.  He remains in custody.

HERE is a great progression map of the fire….the best progression map I have ever seen.

Deep fire

The Deep fire in Big Cypress National Preserve in south Florida has burned 22,000 acres and is 20 percent contained.  Active fire, heavy smoke, and suppression actions continue to require that a major east-west highway across the state, Interstate 75 also known as Alligator Alley, be closed intermittently.

The Southern Area Incident Management Team with Incident Commander Quesinberry assumed command of the fire on Sunday. More information is at the National Park Service site.

Nepal: 18 die in wildfires

At least 13 army personnel and 5 locals were killed in Ramechhap in central Nepal on Thursday while trying to suppress wildfires.  More than 178,000 acres of forest in 13 districts have burned in Nepal during the current strong wind and drought conditions.

The Department of Forests has directed all district forest offices to start bringing the fires under control by coordinating with the district administration, Nepal Army, Nepal police and the locals.

That sounds easy.  Just direct that the fires be put out.

Sleep Deprivation Hazards

From The Latest:

Numerous health and medical sources indicate that sleep deprivation must be considered among the threats to the well-being, safety, and security of Emergency Services Sector (ESS) personnel.  Sleep-loss-related fatigue degrades performance, productivity, and safety, as well as health and fitness.

Medical and performance specialists generally agree that adequate daily sleep is needed for individuals to function optimally, maintain good health, and avoid the risks resulting from an altered state of awareness. The potential decrements in the performance of duties and the cumulative adverse health effects to personnel are considerable and warrant the attention of the leaders, owners, and operators of ESS departments and agencies.

According to an article seen in the March 2009 National Institute of Justice (NIJ) Journal (Issue No. 262), a researcher in the Washington State University Sleep and Performance Research Center wrote that there are actions ESS leaders can implement to mitigate the undesirable consequences of sleep deprivation among emergency responders.

The EMR-ISAC summarizes five beneficial activities as follows:

  • Review policies that affect overtime, moonlighting, and the number of consecutive hours a person can work.
  • Ensure the policies keep shift rotation to a minimum and give personnel adequate rest time.
  • Assess the level of fatigue personnel experience, the quality of their sleep, and how tired they are while on the job.
  • Create a culture in which employees receive adequate information about the importance of good sleep habits, the risks of sleep deprivation, and strategies for managing the hazards.
  • Encourage personnel to remain physically fit, get enough exercise, maintain a healthy body weight, eat nutritious meals, and stop smoking.