The Hidden Dangers of Fatigue Janette Edmonds BSc(Hons) MSc CErgHF FIEHF CMIOSH Director / Principal Consultant Ergonomist www.keilcentre.co.uk janette@keilcentre.co.uk 07967 164145 v1.0 0215 The Keil Centre, 2015 1 About The Keil Centre Based in the Edinburgh & Australia 23 staff & associates International client base / cross-industry 3 business areas: human factors, assessment & development, clinical psychology Our human factors capability includes: Managing human failure Procedure Design Training and competence Staffing Organisational change Safety-critical communication Human factors in design Fatigue & shift work Organisational (safety) culture Maintenance, inspection and testing Therapy & Counselling Human Factors Analysis Tools - Organisational development - StressTools - 360 degree feedback - Safety Culture Maturity - Coaching v1.0 0215 The Keil Centre, 2015 2 1
Presentation Overview Definitions & Consequences of Fatigue The Science of Sleep & Fatigue Fatigue risk management The Keil Centre, 2015 3 What do we mean by Fatigue? Mental, physical or emotional impairment, caused by inadequate sleep or excessive wakefulness. Insufficient quality, quantity & excessive time awake The Keil Centre, 2015 4 2
Fatigue Related Disasters 5 The Keil Centre, 2015 5 Effects on Task Performance Consequences of Fatigue Reduced alertness Affects tasks requiring vigilance & concentration Momentarily may fall asleep micro-sleep Such as: driving, control room operations Drowsy Driving causes between 15-20% of UK road accidents These account for only fall asleep accidents Absence of skid marks or other signs of hard braking Other causes have been eliminated (e.g. bad road, mechanical defect) Statistic is likely much higher if we account for lower level impairment Source: Horne & Reyner (1998) Vehicle accidents related to sleep: a review, Occupational & Environmental Medicine, Vol. 56, 289-294 The Keil Centre, 2015 6 3
Effects on Task Performance Consequences of Fatigue Interpersonal skills Become more reserved & less communicative Affects activities such as: shift handover, interacting with colleagues & customers Lose situational awareness ( big picture) Affects team / operational management Attention to detail adversely affected Analysing data, working on the right equipment Complex decisions Attention tunnelling, difficulty handling uncertainty The Keil Centre, 2015 7 Wakefulness Comparing Fatigue & Alcohol 40 subjects 2 experimental conditions o Sleep deprivation (28hrs) o Alcohol (1 standard drink every 30mins from 0830) Performance measured half hourly via computer based tests The Keil Centre, 2015 8 4
Wakefulness Comparing Fatigue & Alcohol The Keil Centre, 2015 9 We don t get used to being sleepy feeling Good Alertness Performance Poor 1 3 5 7 9 11 13 # Nights on Shift The Keil Centre, 2015 10 5
Health Effects 11 Short term Immune system / gastrointestinal performance Longer term Physically - cardiovascular disease, colon cancer Mentally / socially early onset dementia and alzheimers. increased rates of divorce Increased rates of social anxiety disorders, stress, depression, Many dealing with issues through drugs and medication Better managed by having enough sleep The Keil Centre, 2015 11 The Science of Sleep With a show of hands..! How much sleep do you get on average per night? How much time do you think you need to perform safely? The Keil Centre, 2015 12 6
Sleep Quality a Picture of Normal Sleep The Keil Centre, 2015 13 Regulation of Sleepiness and Alertness Sleep need (homeostatic mechanism) Increases with time awake Decreases with sleep Sleep urge (circadian mechanism the body clock) Sleepiness & alertness vary over 24 hour rhythm Sleep inertia Temporary grogginess on waking from deep sleep Sleepiness is a function of time since the last sleep & quality of that sleep Folkard, S. and T. Akerstedt, (1991) A three-process model of the regulation of sleepiness and alertness. In Ogilvie, R. and Broughton, R. (eds.) Sleep, arousal and performance: problems and promises, Boston, Birkhäuser, 1991:11-26. The Keil Centre, 2015 14 7
Individual responsibility Organisational responsibility Causes of Fatigue Fatigue Work-Related Non-Work Related Hours of Work Work Tasks & Environment Situation & Lifestyle Physiological / Medical Reasons The Keil Centre, 2015 15 How Can I Improve My Alertness? The Keil Centre, 2015 16 8
Setting Up the Sleep Environment Minimise Light Temperature 18-24 o C Minimise Noise Minimise Distractions/ Disturbances The Keil Centre, 2015 17 Getting Good Quality Sleep Dispelling the Myths It doesn t matter what time you go to bed Watching TV helps you fall asleep Alcohol / sleeping tablets help you get a good night sleep The Keil Centre, 2015 18 9
Identifying Poor Sleep Quality Dispelling the Myths Snoring is normal Falling asleep quickly means you re a good sleeper If you re tired, you need more sleep Sleep disorders are difficult to treat The Keil Centre, 2015 19 Key Symptoms of Fatigue Physical Yawning Heavy Limbs Appearance Mental Poor Concentration Disorganisation Easily Distracted Emotional Quiet and Withdrawn Lack of Motivation Increased Stress Levels Headache/Nausea Sore Eyes Poor Coordination Slow Reaction Speed Poor Communication Situational Awareness Poor Info Processing Poor Memory Mood Change Decreased Tolerance Irritability Extreme Drowsiness Heavy Eyelids Micro-sleeps Falling Asleep Poor Decision Making Risk Taking Behaviour Errors Uncontrolled Temper Aggression The Keil Centre, 2015 20 10
Symptoms of Sleep Disorders Excessive daytime sleepiness despite a 'good' night's sleep Loud snoring Irritability or mood changes Restless sleep Morning headaches Poor concentration or memory Do I have a problem? Insomnia Sleep Apnea Sleep Walking Narcolepsy The Keil Centre, 2015 21 Fatigue Risk Management Models Traditional FRM Restricted Hours Industrially Negotiated Largely Ineffective at FRM Best- Practice FRMS Multiple Controls Red Flag System Identify Risk Manage Risk The Keil Centre, 2015 22 11
Fatigue Risk Management System Sleep Opportunity (Work Hours) Actual Sleep Symptoms and Behaviours Errors & Nearmisses INCIDENTS Dawson & McCulloch (2005), Sleep Medicine Reviews, 9 (5), 365-380 The Keil Centre, 2015 23 Risk Identification Risk Mitigation ID Have rostered hours been exceeded? ID Has the individual obtained at least 6hrs sleep in the last 24hrs? ID Is the individual experiencing fatigue-related symptoms or behaviours? Mitigation What safety critical tasks is this individual performing? What could potentially go wrong if they re tired? Mitigation Should this individual continue with planned work? What can be done to reduce the likelihood of error? The Keil Centre, 2015 24 12
Sleep Opportunity Biomathematical Fatigue Models Predict sleep based on work hours Provide risk levels across shift patterns Work Hours Parameters Rostering guidelines Actual work hours guidelines The Keil Centre, 2015 25 Biomathematical Fatigue Models Fatigue Audit InterDyne (FAID) The Keil Centre, 2015 26 13
Summary Definitions & Consequences of Fatigue The Science of Sleep & Fatigue Fatigue risk management The Keil Centre, 2015 27 Resources A Manager s Guide to Fatigue Risk Management (2014). Energy Institute, London. UK Heath and Safety Executive (HSE) - Key topic Shiftwork and fatigue IPIECA/OGP Performance Indicators for Fatigue Risk Management Systems: Guidance for the Oil and Gas Industry IPIECA/OGP Managing Fatigue in the Workplace API 755 Fatigue Risk Management Systems for personnel in Refining and Petrochemical Industries The Keil Centre, 2015 28 14