sleep deprivation

I buried another Firefighter today - Why it's time to stop killing our First Responders.

The church was majestic.  Organ pipes adorned the walls behind the stage, rising like dawn sunbeams toward the heavens.  The acoustics of the room were such that every sniffle and suppressed cry could be heard.  The screen behind the pulpit showed a muscular man in bunker gear, the kind of firefighter you imagine when thinking of a man in our profession.  One of our brothers in the honor guard stood in front of the shining bell and rang it three times.  Then, as I’d heard so many times in my career, the “Last Call” came through the speakers, calling for my brother firefighter Jim.  After the final call, the dispatcher announced that he had not responded and that this was his last call.  I have never been able to stop the tears from betraying my true emotions, and this was no different.
Lt. Jim Dorminy was a lieutenant at my station and was 2017 line of duty death number 38.  Jim had a medical emergency after coming off shift.  He was doing what he loved, exercising, knowing that it was vital to being able to perform at the highest level as a firefighter.  Earlier that week we had fought a training burn and worked a code together.  Jim had been a lifelong martial artist, teaching at his own studio and when not working at the station, Jim worked on his farm.  But now we stood side by side with brothers and sisters from all over the state to say goodbye to our brother firefighter.  There is no more heart wrenching sight than to watch a folded flag being given to a grieving family.
In the last five short years, I have lost eight firefighters that I personally worked alongside and many more in neighboring departments.  The causes of death weren’t building collapse, backdraft, exploding grain silos or raging wildfires.  Cancer killed six of my close firefighter brothers, an aneurism took another, and cardiac arrest took several more.  The affliction extends to mental health where accidental overdose and suicide claimed even more of my brothers and sisters lives.  The sad thing is that this statistic seems to be viewed at as the “price of doing business”, which illustrates my point.  Protecting your community is not a business and the men and women who sign up for this position are not expendable like some out of date stock in the back of a warehouse.
Computer science professor Randy Pausch once said “If there’s an elephant in the room, introduce him!”  And let me say that that elephant has been in the room for a really long time and should have been paying rent for years.  We have been battling factors that kill us for decades and have a lot to thank our forefathers for.  Whether it is firefighter’s bunker gear and SCBAs or ballistic vests and tasers, advocates have fought tirelessly to keep first responders safe.  The buildings are being made safer to protect the occupants from fire.  Cars have been developed so well that a crew responding to a seemingly fatal wreck will be met with unscathed passengers.  Men like Keith Tyson have educated us on the dangers of carcinogens advocating cleaning bunker gear, removing exhaust from bays and aggressive post fire decon.  Sadly, just like Randy Pausch, who died from Pancreatic, this disease still takes an unacceptable amount of first responders every year.  Keith Tyson also underlined that cancer often manifests after retirement and the current statistics are just the tip of the iceberg. 

The question that needs to be asked is why are so many first responders dying despite increased education on fitness, decon and safety?  The answer is so simple it is almost comical, although there is nothing funny about the deadly results.  According to the Organization of Economic Co-operation and Development (OECD), the average American work week is 34.4 hours.  The average firefighter work week ranges from 48 to 56 hours.  This is the bare minimum, not factoring that many departments will continuously force their firefighters to stay additional shifts to cover staffing shortages.  This can put the average work week well in excess of 80 hours.  Imagine for a moment if you told a candidate for an office job that they would probably be forced to work 80 plus hours a week.  I’m pretty sure you would have an empty office.  Now don’t misunderstand me.  We all have to band together on the odd occasion when all hands are required.  Every department will have incidents where they will need extra manning.  The problem is when this requirement becomes a weekly event.
The shift schedule has always been sold as if it’s some heavenly secret, hidden from the public.  “One day on, two days off” sounds like an amazing pseudo retirement arrangement.  The reality is that by the time you get off shift, you have already worked an eight hour day, rendering the “two days off” null and void.  When you factor in that those eight hours were when you were supposed to be sleeping, you introduce the true elephant in the room; sleep deprivation.  
Instead of well rested first responders making life or death decisions, the reality is that these men and women are worn thin and running on fumes.  Whilst the person bagging your groceries or grooming your pet most likely had a good night’s sleep, the driver of a 50,000lbs ladder truck going code three, opposing traffic, may not have slept for two days.  Green Beret, West Point Psychology Professor and author of “On Killing”; Lt. Col. Dave Grossman, stated that there was no doubt that sleep deprivation was killing first responders.  Lt. Col. Grossman has seen this in military, law enforcement, fire and EMS, and also cites it as one of the underlying causes of the school shootings seen around the globe.  He also pointed out that commercial truck drivers and pilots were required to have a full night’s sleep yet there were no standards for first responders.  
Dr Kirk Parsley, Navy SEAL turned doctor for the west coast SEAL teams has become one of the faces of sleep medicine.  Dr Parsley saw ill health amongst his uber athlete soldiers and was able to reverse many of their issues once sleep was restored.  Dr Parsley postulates that driving home after a hour shift with no sleep is neurologically the same as driving with a blood alcohol level of 0.08.  First responders live an average of twelve years less than their civilian counterparts and are anywhere from 1.2 to 2.1 times as likely to develop cancer.  Dr Parsley cites that the disruption of the circadian rhythm can cause a cascade of physiological effects from limiting testosterone production to inhibiting insulin production.  If the body cannot switch to the parasympathetic state that sleep allows, it cannot repair itself.

So what is the answer?  Shift patterns have been contested for decades.  Two 12s ?  10s and 14s?  48:96?  The rainman-like algebra goes on and on.  The problem is you can try and divide 56 hours in a million different ways but at the end of the day it still adds up to 56 hours.  We are never going to fix the underlying issues that are killing our first responders until we address the work week.  There is no denying that we need to protect our communities at night.  A majority of fires and criminal activities occur outside of office hours and we need to be ready to respond.  The answer to this is not to chop up the day into bite sized pieces.  Lt. Col. Grossman called the split shift, often used by law enforcement, as the worst shift schedule out there.
The answer is to give our first responders time to recover from the shifts they work.  In the fire department, the 24:72 shift pattern would be the best configuration.  This would mean that a firefighter would truly have two full days to recover from twenty four hours without sleep.  This also means that in a circumstance where the firefighter is forced to stay additional hours, there would still be time to recover before the next shift.  When you do the math, this still adds up to a 42 hour week, well above the average American’s.  So ask yourself this.  Would you want the Paramedic fighting to save your child’s life to be sleep deprived?  Would you want the armed police officer that pulled over your teenaged son to be running on fumes?  Would you want the firefighter cutting your mother out of a car with power tools to be fighting to stay awake?  Obviously the answer is a resounding no!  So let’s start changing this profession that we love so much.
We have the power to save lives.  Save lives in our profession and also the lives of those we serve.  Sleep deprivation has undoubtedly contributed to many deaths.  Whether it was a poor decision by a police officer, a missed medication by a paramedic or a missed victim in a primary search, lack of sleep affects every aspect of our job.  This same affliction is also claiming the lives of countless first responders on shift, off shift and after retirement.  Delta force operator Pat McNamara stated that the special forces had been referred to as “disposable heroes”.  I think that is how first responders have been viewed for a long time as well.  We need to address both the work week and the recovery from the high stress shifts our profession endures.  I hope this essay will sow some seeds in this profession I love so much.  “It’s how we’ve always done it” has never been an acceptable answer.  Our forefathers paved the way with bunker gear, SCBAs, air monitors and a multitude of other progressive innovation.  We need to be the generation that carries on this tradition with the health of our peers.
I’m tired of hearing the “Last call”.  I know it is going to keep happening but we truly have the power to reduce the number of deaths caused by this calling we love.  This choice is completely in our power although, as with every other change, there will be resistance.  I hope that the young firefighters in the future will look back and thank us for having the courage to change the very thing that is killing us.  Tears will be shed, bells will be rung and flags will be folded.  How many though, is entirely in our hands.
To hear my interviews with Lt. Col. Grossman, Dr Kirk Parsley, Pat McNamara and the other amazing guests, listen to the Behind the Shield Podcast.