9-1-1; What Is Your Emergency?

Wednesday, July 31, 2013

12-Hour Shifts: A Luxury or a Liability?

Taken from Public Safety Communications Magazine, May 2013
Written by Charles D. Carter, certified litigation specialist and 9-1-1 consultant with more than 30 years of public safety experience.

Twelve-hour shifts have become the norm for 9-1-1.  Employers and employees love it.  Given a choice, employees vote to keep it.  Why?  Shift Schedule Design says there are more days off, more weekends off and longer breaks between shifts; managers enjoy such benefits as better productivity, reduced absenteeism and lower turnover.

Disadvantages: Sitting at a terminal or work station for 12 hours straight can increase the likelihood of ergonomic problems; it's harder to cover absences; employees may find it easier to take on a second job; employees take longer to get back up to speed and to learn procedures and directions.  Managers can alleviate this by avoiding 12-hour work patterns that have long breaks; and training that must be done on the employees' days off.

Is working 12 consecutive hours in a fast-paced, high-stress, physically and mentally demanding environment a good idea?  Does it support the clear judgment, quick thinking and reflexes, and life-and-death decisions that we must make in the public safety environment?

The weight of evidence by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) strongly suggests that extended-duration work shifts significantly increase fatigue and impair performance and safety.  The JCAHO report refers to a study that demonstrated that physicians in training who work extended schedules:
  • Make 36% more serious medical errors;
  • Make five times as many serious diagnostic errors;
  • Have twice as many on-the-job attentional failures at night;
  • Double their risk of a motor vehicle crash when driving home;
  • Experience 1.5 to 2 standard deviation deterioration in performance;
  • Suffer performance commensurate with a blood alcohol level of 0.05-0.10%; and
  • Report making 300% more fatigue-related medical errors that lead to a patient's death.
There are also longer term health detriments due to shift work and chronic sleep deprivation.  Sleep deprivation and the circadian system affect metabolic processes, which may result in increased risk of cardiovascular disease, insulin resistance and diabetes.  Regular nightshift workers also have an increased risk of certain cancers, particularly breast cancer, when compared with non-shift workers.

A NIOSH study says, "Extra caution should be exercised when scheduling critical activities for extended work shifts, especially extended night shifts."

In spite of individual variability, tiredness increases anxiety scores, irritability and depression, and it deteriorates cognitive performances.  The concept of prophylactic rest considers that a subject cannot start work rested if he did not sleep at least five hours the previous night or 12 hours during the previous 48 hours.

Two recent studies funded by NIJ make important additions to this research effort.  The first study examines sleep disorders among law enforcement officers, and the second explores the impact of shift length on officer wellness.  The study focused on police officers, but could apply to 9-1-1 telecommunicators.  To illustrate, I have replaced the words "police officer" with the word "dispatcher."

One of the greatest dangers to dispatchers and their overall performance on the job is often overlooked--fatigue.  Dispatchers work demanding schedules characterized by long hours, frequent night shifts and substantial overtime.  Insufficient rest or irregular sleep patterns--coupled with the stress of the job--can lead to sleep deprivation and possibly sleep disorders.  The result can be severe fatigue that degrades cognition, reaction time and alertness, and impairs their ability to protect themselves and the communities they serve.

In summary, nurses, doctors and police officers who work extended shifts in a high-stress environment are more likely to suffer fatigue, which can effect their health and job performance, and the safety of those they serve.

Are dispatchers exempt from fatigue and health problems?  Hardly!  Where health and public safety are the issues, the public should not be placed at risk for the convenience of employers or employees.

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