Issue #71 – September 2021
Welcome to Focus on Fatigue!
The benefit of fatigue education and training has come up in conversation with clients a couple of times recently. So, in this month’s Focus on Fatigue, we thought we would delve into the research to determine whether fatigue education is an effective fatigue management strategy.
Our ‘In the News’ section also features a recently released paper on “Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety and health” by the Academy of Sleep Medicine and the Sleep Research Society. This paper is a comprehensive review of fatigue risk management and a valuable resource, which we highly recommend reading.
The FRMS Team
Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).
Effective Fatigue Management Training
Is fatigue education and training effective in improving sleep, fatigue and safety outcomes?
An effective fatigue management system
An effective fatigue management system involves multiple layers of protection. One of these layers of protection is promoting and fostering a safety culture that recognises fatigue as a safety concern. Organisations and individuals that recognise fatigue as a safety concern are more likely to respond appropriately as fatigue-related risks escalate. A culture of concern can be stimulated by adequate fatigue education and training that focuses on managing fatigue-related risks for the organisation as well as the individual.
Studies on fatigue education & training
A number of studies have looked at the effectiveness of fatigue education and training in the workplace. These studies have been conducted in various industries including emergency medical services, health care, policing, trucking and aviation. The interventions varied in delivery method, length and content but included fatigue training and/or sleep health education.
Benefits of fatigue education and training
Some of the benefits observed following fatigue education and training programs were:
- Improvements to patient safety and personal safety
- Improvement in sleep quality
- Reduction in ratings of acute fatigue, stress and burnout
- Individuals more likely to identify and seek treatment for sleep disorders
- Improvement in fatigue management knowledge, self-efficacy, attitude & behavioural intention
Factors influencing effectiveness of training
Certain factors were found to improve the effectiveness of training in some of the studies:
- Training was found to be more effective when it included content specific to the work setting and tasks
- Training delivered via lecture style or expert led training was more effective than other methods
- Adoption of trained behaviour was more likely when supported by a company safety culture
- Revisiting training every two years assisted retention of benefits
Fatigue education programs equip the individual with the tools and knowledge to proactively manage the effects of atypical work schedules. This assists in putting fatigue risk on the radar and reducing fatigue related incidence.
- Arora, V. M., Georgitis, E., Woodruff, J. N., Humphrey, H. J., & Meltzer, D. (2007). Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help?. Archives of internal medicine, 167(16), 1738–1744. https://doi.org/10.1001/archinte.167.16.1738
- Barger, L. K., Runyon, M. S., Renn, M. L., Moore, C. G., Weiss, P. M., Condle, J. P., Flickinger, K. L., Divecha, A. A., Coopler, P. J., Sequeira, D. J., Lang, E. S., Higgins, J. S. & Patterson, P. D. (2018) Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis, Prehospital Emergency Care, 22:sup1, 58-68. https://doi.org/10.1080/10903127.2017.1362087
- Barger, L. K., O’Brien, C. S., Rajaratnam, S. M., Qadri, S., Sullivan, J. P., Wang, W., Czeisler, C. A., & Lockley, S. W. (2016) Implementing a Sleep Health Education and Sleep Disorders Screening Program in Fire Departments: A Comparison of Methodology. Journal of occupational and environmental medicine, 58(6), 601–609. https://doi.org/10.1097/JOM.0000000000000709
- Fournier, PS., Montreuil, S. and Brun, JP. (2007) Fatigue Management by Truck Drivers in Real Life Situations: Some Suggestions to Improve Training. Work 29(3), 213 – 224.
- Gander, P, Marshall, N, Bolger W & Girling I (2007) An evaluation of driver training as a fatigue countermeasure, Transportation Research Part F: Traffic Psychology & Behaviour, 8(1), 47-58. https://doi.org/10.1016/j.trf.2005.01.001
- Garbarino, S., Tripepi, G. & Magnavita, N. (2020) Sleep Health Promotion in the Workplace. International Journal of Environmental Research and Public Health, 17(21), 7952. https://doi.org/10.3390/ijerph17217952
- Hu, C. J., Lee, F. P., & Hong, R. M. (2020) Fatigue Management Health Education Intervention Effects on Flight Attendants. Aerospace medicine and human performance, 91(12), 911–917. https://doi.org/10.3357/AMHP.5643.2020
- James, L., Samuels, C. H., & Vincent, F. (2018) Evaluating the Effectiveness of Fatigue Management Training to Improve Police Sleep Health and Wellness: A Pilot Study. Journal of occupational and environmental medicine, 60(1), 77–82. https://doi.org/10.1097/JOM.0000000000001174
- Machin, M. (2017) A Evaluating a Fatigue Management Training Programme for Coach Drivers in L. Dorn (Ed), Driver Behaviour and Training, (pp. 75-83). Aldershot, UK: Ashgate
- Smidt, M, Mitchell, D & Logan, K (2021) The Potential for Effective Training of Logging Truck Drivers, Journal of Agricultural and Biological Engineers, 27(1), 29-41. https://doi.org/10.13031/jash.1408
Columbia River Bar Pilots See Value in Fatigue Training
InterDynamics recently conducted another successful fatigue training workshop with Columbia River Bar Pilots. Columbia River Bar Pilots have shown a strong commitment to fatigue management over many years and enlist InterDynamics to periodically conduct managing fatigue training workshops as part of this commitment.
Derek from Columbia River Bar Pilots offered the following reflection:
“The Columbia River Bar Pilots employ a robust fatigue management system that benefits from periodic in-person training on fatigue and sleep science. Healthy sleep promotes safety by improving alertness and decision-making to prevent accident and injuries to our pilots.”
InterDynamics’ Managing Fatigue Training Workshops have been successfully utilised across aviation, construction, energy, rail and marine industries; equipping participants with general awareness information on managing fatigue, as well as managing the social and lifestyle impacts of working shift work. The workshops provide personally relevant and practical techniques for managing individual fatigue.
Effect of Fatigue Training on Safety, Fatigue and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis
Barger, L. K., Runyon, M. S., Renn, M. L., Moore, C. G., Weiss, P. M., Condle, J. P., Flickinger, K. L., Divecha, A. A., Coopler, P. J., Sequeira, D. J., Lang, E. S., Higgins, J. S. & Patterson, P. D. (2018)
Background: Fatigue training may be an effective way to mitigate fatigue-related risk. We aimed to critically review and synthesize existing literature on the impact of fatigue training on fatigue-related outcomes for Emergency Medical Services (EMS) personnel and similar shift worker groups.
Methods: We performed a systematic literature review for studies that tested the impact of fatigue training of EMS personnel or similar shift workers. Outcomes of interest included personnel safety, patient safety, personnel performance, acute fatigue, indicators of sleep duration and quality, indicators of long-term health (e.g., cardiovascular disease), and burnout/stress. A meta-analysis was performed to determine the impact of fatigue training on sleep quality.
Results: Of the 3,817 records initially identified for review, 18 studies were relevant and examined fatigue training in shift workers using an experimental or quasi-experimental design. Fatigue training improved patient safety, personal safety, and ratings of acute fatigue and reduced stress and burnout. A meta-analysis of five studies showed improvement in sleep quality (Fixed Effects SMD −0.87; 95% CI −1.05 to −0.69; p < 0.00001; Random Effects SMD −0.80; 95% CI −1.72, 0.12; p < 0.00001).
Conclusions: Reviewed literature indicated that fatigue training improved safety and health outcomes in shift workers. Further research is required to identify the optimal components of fatigue training programs to maximize the beneficial outcomes.
In The News
Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.
Matthew Gavidia, AJMC, July 2021
The Academy of Sleep Medicine and the Sleep Research Society issued guiding principles for employers on designing optimal work shift durations in the workplace, which address risk factors, countermeasures, and shared decision-making implications. The complete paper can be accessed here.
AMHSI Research Team, Science Direct, January 2021
The coronavirus pandemic presented a unique opportunity to study the daily temporal patterns and sleep habits of humans. The question to be explored was: Are there discernible differences in sleep between the normal operational environment and the stay-at-home condition?