“I Want to Be Safe and Not Still Half Asleep”: Exploring Practical Countermeasures to Manage the Risk of Sleep Inertia for Emergency Service Personnel Using a Mixed Methods Approach

Figures & data

Table 1 Participant Demographic Variables and Work Characteristics

Participant Characteristics	n	%
n	92	100
Gender
Female	28	30
Male	64	70
Age
<25 years old	5	5
25–34 years old	36	39
35–44 years old	17	19
45–54 years old	20	22
55–64 years old	11	12
65 years or over	3	3
Emergency service industry
Fire and rescue	64	69
Ambulance	19	21
State-based rescue and recovery	8	9
Police	1	1
Length of service
<12 months	2	2
1–2 years	2	2
2–5 years	21	23
5–10 years	18	20
>10 years	49	53
Position type
Salaried	33	36
Volunteer	59	64
Type of schedule
Only on-call	53	58
Rotating shift work (combination of days/night and/or evenings)	13	15
Day-time schedule (any time between 7am and 7pm) and on-call at other times	11	12
Day-time schedule (any time between 7am and 7pm) and no on-call periods	4	4
Rotating shifts and on-call at other times	5	5
Night shift	1	1
Other	5	5

Table 2 Themes and Illustrative Quotes for the Question “Why is Sleep Inertia a Concern for You Personally?”

Theme	Quote #	Illustrative Quotes
Cognitive errors	1	Once I woke at 0300hrs and took details for an emergency call …I had two brigades with very similar names (yet geographically several hundred kms apart). In my sleep affected state I dispatched the wrong brigade and only realised my mistake when they called up on the radio ready to respond. Thankfully it was not a life-threatening response…but the consequences of my mistake had things been more serious are deeply troubling…I do not want to kill someone because I made a poor decision due to sleep inertia/fatigue… (M, 35–44 years).
	2	After waking up at work I am often having to either drive under emergency conditions or perform complex tasks and make complex decisions which can be challenging at times. (M, <25 years).
	3	Immediate concerns are for my ability to perform critical thinking and safe emergency response driving when required (M, 45–54 years).
Driving	4	Have to ensure I get all required items and then drive to station immediately. Driving performance likely impacted (M, 25–34 years).
	5	Often having to drive or respond to emergency jobs that have a response time of less than 10 minutes means I am less likely to respond to threats or traffic situations as I would if I was not experiencing sleep inertia (F, 25–34 years).
	6	Slowed response driving and decision making (M, 55–64 years).

Notes: Quotes from different participants are identified at the end of the quote in brackets by the participants sex (M = male, F = female) and age bracket.

Figure 1 Percentage of respondents who indicated that sleep inertia is a concern for them personally, broadly and combined percentage of concern (percentage of respondents who indicated either personal or broad concern regarding sleep inertia).

Table 3 Themes and Illustrative Quotes for the Question “Why is Sleep Inertia a Concern for You Broadly?”

Theme	Quote #	Illustrative Quotes
Driving	1	If I am driving. I want to be safe and not still half asleep, I do not want to cause an accident, injuring myself and partner and others (F, 25–34 years).
	2	All on call members of our brigade must drive to station for call outs along a narrow dangerous road with hazards including many kangaroos. I worry about the safety of members getting to station and other road users (F, 35–44 years).
Own performance	3	Can lead to mis-judgment and vital mental and physical mobility being hindered which could put others in danger (M, 25–34 years).
	4	Due to sleep inertia our lack in judgement decreases and also can be delayed and if we are dealing with violent patients, the effects could be dire (F, <25 years).
Colleagues’ performance	5	The reliability and ability of others to perform their roles when required and the affect that sleep inertia has on them (M, 45–54 years).
	6	Sleep inertia concerns me because my partner may be driving at high speed while not fully alert (M, 25–34 years).

Note: Quotes from different participants are identified at the end of the quote in brackets by the participants sex (M = male, F = female) and age bracket.

Table 4 Personal Strategies Used by Participants to Help Wake Up

Strategy	Percentage of Participants That Use This Strategy	Average Perceived Effectiveness of Strategy (1 = “Does Not Wake Me Up”, 5 = “Completely Wakes Me Up”)
Drink water	17.6	3.6
Cold air	15.7	3.3
Exercise/movement	15.7	3.2
Coffee	13.7	3.4
Wash face	9.8	4.1
Music/noise	5.9	3.6
Talk	5.9	3.5
Think about pager message	5.9	3.0
Light	3.9	3.0
Breathing exercises	3.9	4.0
Chewing gum	2.0	3.5

Figure 2 A comparison of the percentage of respondents who indicated that they believed each countermeasure would work in reducing sleep inertia with the percentage of respondents who indicate that they would use each countermeasure.

Figure 3 Prevalence of perceived barriers reported for each sleep inertia countermeasure.

Note: The percentage of participants who reported “no barrier” for each sleep inertia countermeasure is reported in text.

Table 5 Themes and Illustrative Quotes for the Question: What Changes Could Be Made in Emergency Service Workplaces to Reduce the Impact of Sleep Inertia?

Theme	Quote #	Illustrative Quotes
No possible changes	1	As the on-call is very much an ad-hoc basis, I do not believe there are actions that could be taken. Moreover, initial travel from home to fire station for each call is in a private vehicle (M, 35–44).
	2	Volunteering would require methods to be done on a personal level, there is no easy solution for a responding crew to a night-time call (M, 25–34).
	3	Response times make it difficult to implement (F, 25–34).
Shift scheduling	4	Better resources to help maintain tighter shift schedules which would allow for more time invested in rest and recuperation, and minimise the risks associated with sleep inertia that is complicated by fatigue (M, 45–54).
	5	Pager roster system - 2 weeks on, 2 weeks off (M, 25–34).
	6	More paramedic coverage in area affected by fatigue. Paramedics from other stations cover for fatigued crews occur occasionally, only when fatigue is excessive. This does not guarantee obtaining enough sleep, but can reduce the risk of another call out and try to complete the fatigue window (M, 25–34).
Operational changes	7	Allow more time to respond but this is not able to be done for emergency cases (F, 25–34).
	8	Not calling us out for jobs that we suspect may be cancelled by the time we get to the station because paid staff have also been assigned (F, 35–44).

Note: Quotes from different participants are identified at the end of the quote in brackets by the participants sex (M = male, F = female) and age bracket.