Introduction: Firefighters often face disrupted sleep, increasing their risk of accidents, cardiovascular
disease, cancer, and mental health issues. They also struggle to balance family and
social obligations with the need for sleep during days off. To address this conflict,
many U.S. firefighter departments have shifted from a 24/48 schedule to schedules
that provide additional consecutive days off-shift such as the 48/96 or the 24/72/48/72
schedules. To guide decisions around work schedules while prioritizing firefighter
health, well-being, and safety, we aimed to systematically assess the impact of work
schedules on these outcomes and develop effective methods for widely disseminating
our findings via the SWIFT (Shift work in firefighters) study, a Total Worker Health
(TWH) initiative.
Methods: This is natural experiment participatory action research designed to respond to the
needs expressed by labor unions and leadership in Fire Services in Oregon and Utah.
A multi-pronged data collection was used to assess objective measures of sleep (actigraph),
heart rate (polar H7), performance (psychomotor vigilance test and number of safety
accidents), and daily subjective measures of stress, mood, and family dynamics. All
measures were conducted over a 14-day assessment interval and to date were collected
among 186 firefighters (10% female). Study outcomes on an individual level and in
aggregate form were shared with all participants. A subset of participants was invited
to participate in interviews to provide feedback on data presentation format and style,
including its digestibility and potential for behavioral change. Interviews were recorded,
transcribed, and analyzed using NVivo 12 Plus.
Results: Participants provided feedback on the data presentation, with the majority expressing
a preference for clear, actionable information that could potentially lead to changes
in behavior. Among the outcomes presented on the individual level, optimum sleep schedules
and related practices were the most discussed among participants. They suggested using
color-coded results to allow easier and quicker interpretation of the severity of
results (e.g., red = the need for more sleep). For data on the aggregate level of
outcomes, the need to address call volume was the most relevant topic discussed, with
additional considerations for organizational programs and policies to address more
comprehensively the mental and physical health needs of firefighters.
Conclusion: This study offers comprehensive data from a Total Worker Health (TWH) perspective
on the impact of shiftwork on firefighters and their families. It also illustrates
how researchers and firefighters can collaborate to implement evidence-based strategies
when disseminating outcomes and making crucial decisions about shift schedule reforms
and related sleep interventions. These efforts aim to enhance research uptake with
attention to firefighters' overall health, safety, and work-life continuum. Support
(if any): This work was supported by NIOSH grant number U19OH010154 and by the Institute
via funds from the Division of Consumer and Business Services, Oregon (ORS 656.630).
