Fatigue Management: Training Program for Employee Wellness

1. Managing Fatigue Training Program for Employees

2. Managing Fatigue For the Employee • What is Fatigue • Signs of fatigue • What causes fatigue • Fatigue mitigation strategies • Utility Policy

3. What is Fatigue • “A reduction in physical and/or mental capability as the result of physical, mental or emotional exertion which may impair nearly all physical abilities including: strength; speed; reaction time; coordination; decision making; or balance.” • Source: International Maritime Organization, Maritime Safety Committee Circular

4. Signs of Fatigue

5. Signs of Fatigue • Constant yawning • Blurred vision • Heavy or sore eyes • Poor concentration • Slowed reaction time • Poor judgment • Speech slurred • Headaches • Decreased ability to exert force • Leg pain and cramps • Loss of appetite • Giddiness • Decreased ability to pay attention • Irregular heart beats • Heaviness in arms and legs • Decreased eye-hand coordination

6. What Causes Fatigue • Lack of Sleep • Quality of Sleep • Biological Clock (circadian rhythm) factors • Shift work • Extended Hours • Health (diet and/or illness) • Ingested chemicals (alcohol, drugs, caffeine)

7. Lack of Sleep (an off duty issue) • Individuals’ needs are unique • Recommended 7 – 8 hours of sleep per 24 hour period • 5 stages of Sleep • Stage 1 – Light Sleep - less than 10% • Stages 2-4 – Deep Sleep - approximately 65% • Stage 5 - REM Sleep – Rapid Eye Movement Sleep – approximately 25% • Each cycle takes about 90 minutes = 5-1/2 cycles per 8 hour night • Need all five stages for the body’s recovery from daily fatigue

8. Quality of Sleep(an off duty issue) • Sleep should be Uninterrupted • Try for long periods of sleep • Short naps will not restore the body to normal operation. • One seven hour period of sleep is much more restorative than seven one hour naps • Try for sufficient sleep before any periods you anticipate a sleep deficiency

9. Biological Clock • Most animals (including Humans) follow a daily routine (song birds in the morning, nocturnal animals, etc.) • Called Circadian Rhythm • Time related information controlled within the hypothalamus region of the brain • Melatonin hormone. • Increase in Melatonin – Decrease in alertness

10. Biological Clock • Human Circadian Rhythm is actually on a 25 hour clock. • Did you ever notice it’s easier to stay up late than it is to get up early? • Jet Lag is a symptom of the body trying to reset the biological clock to a new time zone. • It is easier to “reset” when flying east to west (You get to sleep-in in the morning) than when flying west to east (You have to get up earlier than your internal clock expects). • The internal clock can only adjust by an hour or two each day. • This is helped by environmental cues (such as darkness)

11. Biological Clock Humans exhibit two “Troughs” or low points in alertness • One between midnight and 6 am • One between 2 and 4 pm • Fatigue related motor vehicle accidents are: • Twice as high at 2 pm as they are at 10 am • Six times as high at 2 am as they are at 10 am

12. Biological Clock • What do the following have in common? • Three Mile Island • Chernobyl • Bhopal • Exxon Valdez

13. The Midnight Shift • 1979 - Three Mile Island – 4 am local time - Pressure relief valve opens dumping reactor coolant – control room operators failed to recognize the event. Core meltdown • 1984 – Bhopal, India – shortly after midnight Methyl Isocyantate Gas (MIC) leak kills 3,800 • 1986 - Chernobyl Reactor disaster – 12:23 am– 1:28 am local time - critical control room operator error in failing to reset a controller. Core meltdown and release • 1989 – Exxon Valdez – 12:04 am ship hits Bligh Reef and spills 10.8 Million gallons of oil

14. Extended Hours • Normal work day and week = 8 hours per day and 5 days per week • Anything greater is Extended hours • OSHA recommendations: • Limit use of extended hours • Take additional breaks • Tasks that require heavy physical labor should be performed at the beginning of the shift • Monitor for the signs and symptoms of fatigue

15. Extended Hours • A study by sleep researchers in Australia found that: • A person kept awake for 17 hours will exhibit behaviors and performance of someone with a Blood Alcohol Concentration (BAC) of 0.05 • A person kept awake for 24 hours will exhibit behaviors and performance of someone with a BAC of 0.10

16. Health Issues (an off-duty issue) • Fatigue can be associated with: • Medical Conditions (such as heart problems) and • Illness (common cold or fever) • Diet can affect feelings of fatigue • Refined sugars can cause a short term energy boost but are often followed by a rapid drop in blood sugar levels causing weakness and instability • Eating a large meal before bedtime can disrupt sleep • Psychological Issues of stress or family worries can disrupt sleep • There are Sleep Disorders such as insomnia or sleep apnea (waking up suddenly due to interrupted breathing)

17. Ingesting Chemicals (an off duty issue) • Medications can cause drowsiness • Caffeine - short duration alertness but • side affects • hypertension, headaches, mood swings and anxiety • Alcohol is a depressant • however, the important REM sleep is disrupted preventing body recovery.

18. Fatigue Mitigation Strategies • Develop a pre-sleep routine (warm shower, reading a book) • Sleep in a dark, quiet, cool environment • Avoid alcohol prior to sleep • Avoid caffeine at least six hours prior to sleep • Eat regular, well balanced meals • Drink a sufficient amount of water • Exercise regularly • Get enough proper sleep

19. Utility Policy • Insert utility policies

20. References • “Driver fatigue - an accident waiting to happen”, by academy staff of the Australian Academy of Science, June 2006 • “Guidance on Fatigue Mitigation and Management”, MSC (Marine Safety Committee) Circular 1014, International Maritime Organization, June 12, 2001 • “Extended/Unusual Work Shifts”, Occupational Safety and Health Administration (OSHA), September, 2, 2004 • “Sleepless in Seattle: injured worker’s case shows hazards of fatigue”, Shoop, Julie Gannon, Publication: “Trial”, Dec. 1, 1993 • “Personal & Financial Health” Scott, Diane E., RN MSN, Vermont Nurse Connection, Feb. 1, 2008 • “Circadian Rhythms and Shift Work” American College of Emergency Physicians, September 2003