Physical and psychological health in intern paramedics commencing shift work: Protocol for an exploratory longitudinal study.

BACKGROUND: Paramedics are routinely exposed to shift work. Existing research shows that shift work exposure is associated with adverse mental and physical health outcomes. However, the current understanding of the impact of commencing shift work in a paramedic role on health is limited. This can be addressed by recruiting new paramedics before they commence shift work, and conducting regular follow-ups of potential biological, psychological and social changes. The present study aimed to examine changes in biological, psychological and social factors relative to pre-shift work baseline in a cohort of paramedics commencing intern employment with an Australian ambulance service. METHOD AND ANALYSIS: This observational, mixed-methods, longitudinal study aims to recruit 40 interns from one Australian ambulance service. Data collection will occur at baseline (standard day schedule for initial training), and subsequently at three months, six months, nine months and twelve months, to measure biological, psychological and social changes relative to baseline measurements. Changes in cardiometabolic markers (cholesterol, triglycerides, fasting glucose), microbiome (self-collected stool samples), sleep and physical activity (actigraphy) will be measured. Interns will also complete a battery of self-report questionnaires, sleep diaries and qualitative interviews to explore various psychological and social variables over time. Statistical analyses will be conducted using mixed effects regression, specifying a random effect of subject on the intercept, allowing participants to vary according to individual baseline levels, as well as tracking progress over time, appropriately accounting for serial correlation. Qualitative study components will be analysed via coding and thematic analysis procedures. DISCUSSION: The present study protocol is a comprehensive outline of the observational study planned. The study will allow for greater knowledge of any changes in biological, psychological and social factors during a 12-month transition to shift work. The findings from the proposed study will have implications for the development of strategies to support early-career shift workers.

Informal management of health and safety risks associated with alarm response by Australian firefighters.

Fire-fighters use informal strategies to manage risks to health and safety during operations. It is not known whether such strategies are used during the high-risk alarm response period. The aim of this study was to determine if informal risk management strategies are employed by Australian firefighters during the alarm response procedure, and if these strategies differ between salaried and retained personnel. Forty-six metropolitan firefighters (all male; mean age 38 years ± 10 years; 22 salaried; 24 retained) participated in semi-structured group interviews. A general inductive data analysis approach revealed that firefighters use multiple informal risk management strategies. Some similar themes were reported by both salaried and retained personnel, for example leveraging team dynamics, communication about sleep and fatigue, stress adaptation, informal debriefs, and enhancing physical preparedness. These findings could be used by fire services to tailor risk management approaches during the alarm response period. Practitioner summary: Identifying informal risk management strategies firefighters use during alarm response will allow their development, refinement and dissemination, and may help other firefighters and emergency service workers to manage these risks. This qualitative study reveals multiple informal strategies that firefighters employ during alarm response to keep themselves and their team-mates safe.

A Test of How Australian Adults Allocate Time for Physical Activity.

The most common reported barrier to physical activity is a lack of sufficient time. Just like most resources in economics are finite, so too is time within a day. We utilized a time-utility model to better understand how people are allocating time for physical activity. Additionally, we tested whether the allocation of physical activity time impacts people's perception of "lack of time" as a barrier for physical activity or their likelihood of being sufficiently physical active. Australian adults (N = 725 participants, 54% men) reported their time use throughout their day, perceived lack of time as a barrier to activity, and physical activity. Cluster analysis and χ2-tests were used to test the study research questions. People tended to either be entirely inactive (29%) or active while doing either leisure (18%), occupation (18%), transport (14%), or household (22%) activities. Those who were active during their leisure or transport time were most likely to be sufficiently active. There were no significant differences among clusters in how much people perceived that lack of time was a physical activity barrier. The commonly reported barrier of not having enough time to be active might be a fallacy. Although a lack of time is a commonly reported barrier of physical activity, these findings bring to light that increasing physical activity behavior is not as simple as adding more time to the day.

No rest for the women: Understanding the impact of on-call work for women in the emergency services.

BACKGROUND: The unpredictable, "on-call" component of the emergency services (ES) may be difficult to navigate in the context of domestic and work responsibilities, and especially difficult for women, given they tend to take on a greater household burden than do men. Our aim was to understand women's experiences in the ES, particularly the impact of being on-call and related coping strategies. METHODS: Twenty-four women were recruited from two ES agencies in Australia. Participation involved a brief questionnaire and a 45-60-min interview. Interviews were recorded, and audio files were transcribed before analysis using nVIVO software. RESULTS: Interview data identified two major themes: impact and management. Women talked about the impact of on-call for themselves (e.g. disturbed? sleep, fatigue and the relentlessness of the role) but also discussed the, largely negative, impact for their family/household. In terms of management, support (family, social and work) and planning and preparation were identified as important in helping women manage their multiple roles in the context of on-call unpredictability. CONCLUSION: The negative impacts of on-call work on women's sleep supports existing quantitative and qualitative data in the broader on-call area. For those women with children, managing their care presents one of the biggest challenges to being able to manage the on-call component of their work. Future research should to focus on quantifying the impact of on-call for both men and women, particularly the "relentlessness" of the work identified in this study and whether this toll changes based on other factors such as experience, role or gender.

Managing fatigue: It really is about sleep.

Biomathematical models of fatigue can assist organisations to estimate the fatigue consequences of a roster before operations commence. These estimates do not account for the diversity of sleep behaviours exhibited by employees. The purpose of this study was to develop sleep transfer functions describing the likely distributions of sleep around fatigue level estimates produced by a commercial biomathematical model of fatigue. Participants included 347 (18 females, 329 males) train drivers working commercial railway operations in Australia. They provided detailed information about their sleep behaviours using sleep diaries and wrist activity monitors. On average, drivers slept for 7.7 (±1.7)h in the 24h before work and 15.1 (±2.5)h in the 48h before work. The amount of sleep obtained by drivers before shifts differed only marginally across morning, afternoon and night shifts. Shifts were also classified into one of seven ranked categories using estimated fatigue level scores. Higher fatigue score categories were associated with significant reductions in the amount of sleep obtained before shifts, but there was substantial within-category variation. The study findings demonstrate that biomathematical models of fatigue have utility for designing round-the-clock rosters that provide sufficient sleep opportunities for the average employee. Robust variability in the amount of sleep obtained by drivers indicate that models are relatively poor tools for ensuring that all employees obtain sufficient sleep. These findings demonstrate the importance of developing approaches for managing the sleep behaviour of individual employees.

Look before you (s)leep: evaluating the use of fatigue detection technologies within a fatigue risk management system for the road transport industry.

Fatigue is a significant risk factor in workplace accidents and fatalities. Several technologies have been developed for organisations seeking to identify and reduce fatigue-related risk. These devices purportedly monitor behavioural correlates of fatigue and/or task performance and are understandably appealing as a visible risk control. This paper critically reviews evidence supporting fatigue detection technologies and identifies criteria for assessing evidence supporting these technologies. Fatigue detection devices, and relevant reliability and validation data, were identified by systematically searching the scientific, grey and marketing literature. Identified devices typically assessed correlates of fatigue using either psychophysiological measures or embedded performance measures drawn from the equipment being operated. Critically, the majority of the 'validation' data were not found within the scientific peer-reviewed literature, but within the quasi-scientific, grey or marketing literature. Based on the validation evidence available, none of the current technologies met all the proposed regulatory criteria for a legally and scientifically defensible device. Further, none were sufficiently well validated to provide a comprehensive solution to managing fatigue-related risk at the individual level in real time. Nevertheless, several of the technologies may be considered a potentially useful element of a broader fatigue risk management system. To aid organisations and regulators contemplating their use, we propose a set of evaluative and operational criteria that would likely meet the legal requirements for exercising due diligence in the selection and use of these technologies in workplace settings.