Features Fire & EMS Hot topics
Dual Duty – July 2012

Anyone who has worked in fire/EMS can attest to the harmful effects this profession can have on our minds, bodies and spirits. We all have stories of early morning drives home after long night shifts: Remember the times you could hardly keep your eyes open, and you said to yourself, “I know how impaired driving feels”? I remember being woken up one morning by a concerned neighbour because I had fallen asleep behind the wheel after I had parked in my driveway. I arrived home but did not remember the drive. The evidence lies at your doorway as you drop your uniform bag, walk past your wife and kids and leave a trail of clothing as you head straight for bed. Don’t forget about those times we are reminded of terrible calls and suddenly become distant with our loved ones. We have all had our heart rates suddenly shoot up because of a sound or smell that reminded us of a horrible scene.

If these experiences seem similar to yours, let me set the record straight: you are not alone. From the first class, firefighters/EMTs have been lectured about the stresses of our career choices. Every textbook on emergency care discusses the use of critical incident debriefing after those terrible calls. However, where in our training were were taught how to care for ourselves and  prevent psychological harm? Burnout and fatigue management is just as important as doing a 360 walk-around at any structure fire. Emergency services workers are so used to putting others first, that often they forget about their own welfare. Isn’t it time to make our well-being a tactical priority?

Olin L. Greene, a former U.S. fire administrator, recognized stress as one of the most vexing occupational hazards faced by the modern fire/EMS service in his foreword to Stress Management, Model Program for Maintaining Firefighter Well-Being. This has become even more evident as fire/EMS face increasing call volume, wider scopes of practice, budget cuts and as our professions becomes the catch-all for the inadequacies of the health-care system. Typically, I try to focus on how to advance as a department and be successful as firefighters/paramedics. But as dual-role providers, fire/EMTs take on an increased workload through  fire, rescue and EMS duties and I like to discusses ideas and options to bring the team together to better serve the public.  It’s just as important, and perhaps more important, to care for ourselves. Many topics related to managing emergencies warrant discussion in this column but I can no longer ignore this issue that affects so many firefighters/EMTs.

Fatigue and burnout in emergency workers results in about $8.5 billion in accident damage and $79.9 billion in lost productivity in North America. An additional $28.3 billion is pent on health-care costs as a result of not dealing with this critical issue. You may be sitting there agreeing that you are affected, and that  something must be done,  but what? The answer may lie in improving working conditions that lead to burnout. If we can change these conditions, then possibly we can reduce the impact they have on our well-being.

Five working conditions that can lead to burnout and fatigue:

1. Too much to do and not enough time to do it. You feel overwhelmed all the time: training, calls, tours, updates, station duties, deadlines, inspections.
2. Not enough control. You feel powerless and not in control of simple ground-level decisions that affect your job. Your hands are tied. Employers do not recognize your sacrifices.
3. Unable to rest. Lack of private quiet areas. Irregular sleep patterns and stress during calls.
4. Values conflicts. Your values and your employer’s values do not match up. Meeting benchmarks versus common sense.
5. Missing important family events and not following the normal nine-to-five workweek pattern.

Common effects of stress and chronic fatigue:

• desire to sleep/lack of concentration
• impaired recollection of events/irritability
• poor judgment/reduced capacity
• inconsistent or inadequate interpersonal communication
• reduced vigilance/slow reaction times

North America is the only industrialized continent where the trend for the past 20 years has been to work more hours with fewer personnel and fewer resources. In every other country, the trend is toward more time off, and an improved work/home life balance. We clearly missed the mark and instead we follow a do-more-with-less ideology. So, how can we fix this?

Emergency workers and their leaders must first understand and accept the fact that this is happening in our departments. Employers must realize that they can be held liable for accidents involving their sleep-deprived and stressed-out workers. Members from all levels must join together as a team and address these issues. Developing a fatigue-management policy, allowing adequate respite areas and supporting healthy napping habits are immediate changes that will make a difference. The days of the old belief that you must always look busy must stop immediately. Ensuring access to free confidential assistance programs for emergency workers and their families can support ongoing fatigue and burnout issues. Often the fast pace of our profession makes it easy to neglect these types of issues. Some simple changes can help: fire-service leaders should schedule regular blocks of time to sit down and spend time with front-line emergency workers; allowing tired employees to sleep late after shifts; modifying schedules to accommodate increasing alarm/call loads; and rotate busy crews with slower units.

It’s a good idea to implement control measures, then monitor and review. Controlling fatigue and stress must be a shared responsibility between management and workers. If we cannot take care of ourselves, who will? The fires inside us that trouble us need to be extinguished.

Lee Sagert is a career paramedic/firefighter with the City of Lethbridge in Alberta, and a volunteer lieutenant with Coaldale Emergency Services. Contact him at leesagert@shaw.ca