Sleep Deprivation - The other silent killer of First Responders

The tones scared the shit out of me.  I had managed to enter a deep sleep that night after a busy day of calls and training.  The dorm had been eerily quiet up to that point, in a firehouse that was normally getting hammered at night.  The jarring voice of the dispatcher caused an adrenaline dump that catapulted my heart, feeling like it would burst through my chest.  “Structure fire”, the two words that sent you from unconsciousness to fight mode in a fraction of a second.  The station had a two story pole slide that was challenging, even with all of your faculties.  At 2 am, thirty seconds after being ripped from sleep, it was basically a free fall to the bay floor below.

I threw my bunker gear on as the second repeat came over the loudspeaker.  “Apartment complex, flames showing, multiple calls.”  These magic words told us that this was not a false alarm.  This time of night, most residents would be in their homes and fast asleep.  The chances of people being trapped by the flames was very high.  I threw on my bunker gear and climbed into the doghouse of the tiller truck and signalled to the drive in front that I was ready. The plymovent rails screeched as the truck pulled out of the bay and separated itself from the yellow umbilicus.  As we turned the corner, the familiar yellow glow filled the sky as a column of dark smoke rose through the night air.  I navigated the back of the truck around parked cars and around sharp turns whilst trying to shake off the massive fatigue.

The structure in question was literally a block away from the station so it took less than two minutes to arrive on scene.  Packs were thrown on backs, outriggers deployed and saws were fired up in the cool winter night.  The aerial was surgically placed to the edge of the roof so we could climb to the top of the three story building.  The fire was licking out of the windows below but had not compromised the roof yet.  We cut our inspection hole and then sounded our way to the seat of the fire, cutting indicator holes as the lead firefighter pounded the roof with their hook.  The saws began to scream as if in agony as they tore through the shingles and sunk into the plywood below.  As the louver was pulled back with the rubbish hook, the fire blew out, angry and impatient.  The holes were extended to match the intensity of the fire below and finally sapped the strength from the raging inferno.

This isn’t a story of heroism or inhuman feats of strength or courage.  It’s what firefighters do every day, around the world.  Only five minutes prior, I had been in a dead sleep and now I was standing on a roof, fifty feet in the air, cutting with a chainsaw as fire licked all around me.  A fire like this requires hours of hard manual labor, initially fighting the fire, then overhauling and trying to save the resident’s possessions in the process.  Luckily on this particular fire there were no victims to find, no dead dogs to bring out to a heartbroken child.  But still, people’s lives had been shattered. 

As dawn broke, we wearily drove back to the station to begin the arduous process of cleaning tools, changing saw blades and fuelling the power tools.  Our gear reeked of the toxic chemicals they absorbed during the fire, off gassing into our airways and skin.  Gear needed to be cleaned and switched out to minimise the contact with the potentially life threatening carcinogens.  Bodies are scrubbed in piping hot showers to remove the chemicals from the pores.  Noses are blown to reveal a tissue full of black, noxious snot.  Then, the message is given to dispatch that we are back in service to do this all over again.

The drive home from a night like this is the next challenge.  Many fill themselves to the brim with tar like firehouse coffee to make it through the commute.  Eyelids feel like a thousand pounds as you strain to maintain mental clarity.  Windows are down, music is up and the occasional slap to the face are tools to maintain consciousness.  You finally make it home safely and say a little thank you to your God or the Universe.  You are met by the neighbour from hell who starts bitching at you about your rubbish bins not being put away at the correct time.  The thoughts of knocking him out there in the middle of the street are overwhelming.  You are spread so thin between mental and physical exhaustion, lack of sleep and the memories you carry from your worst calls.  But you find the strength, unfold your fist and just walk away.  “It must be nice having so much time off” you hear him mutter as you close the door behind you.

Sleep deprivation is an issue that is rarely if ever addressed in First Responders.  In the fire department, we have become very good at protecting ourselves from the hazardous chemicals from fires and other incidents, yet we are still twice as likely to get certain cancers than civilians.  When a brother or sister contracts a horrific disease, we look back to a certain incident and assume it was connected to that.  The missing link, the part that is overlooked is the lack of sleep.  A First Responder will lose sleep every night they work for their entire career.  Whether it is a 12 hour night shift or a 24 at at Firehouse, the effects are the same.  The sleep that is allowed on quieter nights is of poor quality as the anticipation of a call blocks the ability to fully switch off.

Dr Kirk Parsley is a Navy SEAL who went to medical school to become the SEAL’s doctor.  He was finding the same chronic medical conditions in his young uber athlete soldiers, who were exercising like maniacs and eating all of the right foods.  It dawned on him that the one common denominator was lack of sleep.  Whether going through Hell Week or just extended deployments, the men were coming back with blood work that was less than optimal.  Dr Parsley began to focus on the men’s sleep and saw an immediate change in their overall health.  He began to delve deeper in this field and is now considered one of the authorities on Sleep Medicine in tactical athletes.  

Unlike most professions, First Responders don’t know what a call is going to entail until it happens.  For firefighters it could be a fire, traffic collision, rope rescue, marine rescue or some other emergency that no one else is trained for.  A police officer may be involved in a car chase, foot pursuit, fight or gun battle.  The paramedic may roll up on an active shooting or explosion.  The zero to a hundred nature of our professions takes a huge toll on the human body.  This adrenal fatigue, the constant stress of expecting the worst case scenario to occur prevents the body from repairing and growing.  The fight or flight response is a primitive mechanism that still keeps us safe today.  

The problem is that the same mechanism can kill us if it never turns off.  Stress keeps this sympathetic nervous system ticking over and doesn’t allow the parasympathetic (feed and breed) to kick in and start repairing all of the damage from the previous day.  This is further exacerbated by lack of sleep.  Nighttime is when the body heals injury and grows muscle.  In order to do this, the sympathetic nervous system has to be turned off to allow the parasympathetic system to begin the repair process.  Dr Parsley states that by missing one night of sleep, your body’s hormones become completely unbalanced.  Testosterone is halved, blood sugar rises and you have the same neurological function as having a blood alcohol level of 0.08.

The other element that was often thought as fallacy is sleep debt. In his book “The Promise of Sleep”, Dr William Dement details how sleep debt is in fact a very true phenomenon and it is unknown how long this debt spans.  The other fact that he verified is that the average person needs either side of eight hours sleep, every night, to perform optimally.  So this being said, just one night with no sleep immediately puts you 8 hrs in debt.  Multiply this by a career of 20 to 30 years and you have a big problem.  Naps can certainly help get some of this sleep back but is not a substitute for good REM sleep.

The immune system cannot function well in this deprived state, putting the First Responder at much greater risk to heart disease and cancer, the top two physiological killers in our profession.  The brain is not spared from this destructive sleep behaviour.  In fact it has been shown that sleep deprivation mimics traumatic brain injury.  The same injury attributed to depression and suicide among soldiers, football players and combat athletes.  I am convinced that this is one of the missing pieces in the treatment of PTSD.  

So what is the answer?  Certainly, playing with shift schedules is not the solution.  The bottom line is that someone has to work at night to protect the citizens were serve.  Someone has to climb that ladder to reach the trapped victim or arrest the violent husband before he hurts his estranged wife.  The answer is twofold.  Firstly, the First Responder’s work week needs to be reduced and yes, that includes more personnel but that’s the price of protecting a community.  A 56 hour work week with no sleep is a recipe for disaster.  Time needs to be given to recover from these shifts and catch up on the sleep debt.  Naps need to be encouraged not banned.  Would you want the person driving your child to hospital in an ambulance to be functioning like a drunk driver?

Secondly, as an individual, you need to practice good sleep hygiene at home.  That means being strict with yourself about going to bed early.  Black out your bedroom, as light is a cue for alertness and can stop deep sleep.  Turn down the air.  The optimal temperature is 67 degrees which may sound cold but again, this has been proven.  The last point is to try and avoid alcohol in the evening as it will prevent the REM cycle, which is where the body repairs itself.  We have an opportunity to make a huge difference in our own mental and physical health.  Sleep deprivation is another area that must be brought to the forefront as its physical and mental effects are devastating.  

Dr Kirk Parsley will be on the Behind The Shield Podcast later this month so make sure you listen.  

Stay safe out there!



Artwork by DanSun Photo Art