Is Sleep Deprivation to blame for firefighter Slips, Trips and Fall Injuries?
- Apr 25
- 6 min read
Updated: Sep 15
Slips, trips, and falls are serious issues in the fire service, often ranking among the top injuries firefighters face on duty (Orr et al., 2019). I remember my first day at training school when our instructor introduced us to these hazards. He dramatically emphasised, “slips, trips, falls, DEATH!” While we all laughed at his delivery, the message resonated deeply and it sticks with me today. Be aware of your surroundings and focus on what you are doing. Take a tactical pause and execute efficiently.
But after reviewing recent research, I’ve come to realise that the common advice about slips, trips, and falls may be misleading or at least, half of the story. It’s easy to assume and describe that these injuries result solely from environmental factors like uneven ground, wet surfaces, heavy gear, rapid movements, and poor lighting—insights I've gathered from my own experiences and what our instructor was implying. However, recent studies suggest that these incidents may not be as influenced by environmental factors as we think. In fact, research indicates that sleep deprivation among firefighters could play a more significant role in the occurrence of slips, trips, and falls (Hare, Wohlgemuth, and Mota, 2024).
Sleep loss significantly impacts our speed and attention (Waters and Bucks, 2011). When we are tired or sleep deprived, our response times slow down, and our overall alertness and focus diminish. This decline in cognitive and motor performance was demonstrated in a study by Glenville et al. (1978), which involved participants completing four 10-minute performance tests following a night of sleep deprivation.
Both choice and simple reaction times were adversely affected, along with motor tasks and handwriting performance, underscoring the critical importance of adequate sleep where quick reactions and clear focus can make all the difference. If you’re experiencing tiredness or poor sleep while on the incident ground, the implications can be serious. The findings from Glenville et al. (1978) clearly illustrate that fatigue hampers our ability to notice critical details, react swiftly, and make sound decisions. This decline in cognitive function significantly heightens the risk of slips, trips, and falls and this is just the scratching the surface of cognitive function and its effects from sleep deprivation. But when our cognitive abilities are compromised, it’s clear that this doesn’t just stay in the mental realm; it inevitably impacts our physical performance as well.
A recent study by Umemura et al. (2022) reveals that acute sleep deprivation significantly impairs postural control, with chronic sleep deprivation producing similar effects. Even more concerning, the study found that postural control deteriorates further when vision is compromised. In the context of firefighting, this is particularly relevant in situations like navigating a smoke-filled room, where visibility is severely limited. In such environments, the risk of slips, trips, and falls increases dramatically. Our postural control system is essential for maintaining balance and stability against gravity, as it helps align and stabilise body segments to create a reliable reference for our position in relation to the external world (Massion, 1994). When our vision is obscured, and we’re also dealing with the effects of sleep deprivation, the risk to our safety escalates significantly. And that is without metabolic thermogenesis, dehydration, fatigue etc that we all experience as firefighters.
This was further emphasised in the study "Day-to-day variations in sleep quality affect standing balance in healthy adults" by Montesinos et al. (2018). They examined how fluctuations in sleep quality impact postural control in healthy individuals. Researchers monitored the sleep patterns of 20 participants over two nights using sleep diaries, actigraphy, and heart rate variability measures. They found that poor sleep—marked by reduced duration, increased fragmentation, and lower heart rate variability—significantly impaired balance, as indicated by larger centre of pressure (COP) displacements during quiet standing. These results highlighted the crucial link between sleep quality and postural control, suggesting that even minor sleep variations can increase fall risk, especially in vulnerable populations.
Linking these findings to the firefighting profession, it becomes evident that sleep deprivation likely contributes to the prevalence of slips, trips, and falls. While it's easy to attribute these incidents to clumsiness, distractions, environmental factors, or the limitations of personal protective equipment (PPE) affecting mobility (Harbison et al., 2023), the impact of poor sleep cannot be overlooked.
We’ve learnt that poor sleep is associated with diminished attention, slower reaction times, reduced cognitive function, impaired motor coordination, and balance issues—all of which can significantly increase the risk of accidents on duty. This is particularly concerning given that approximately 40% of firefighters experience sleep apnoea and insomnia, with 80% of cases undiagnosed in the U.S. (Staff, 2018).
While these statistics are from the U.S., I speculate that similar, if not worse, trends exist in the UK, exacerbated by modern distractions, caffeine consumption, and mental health challenges. I have encountered many firefighters who struggle with sleep and face chronic fatigue, leading me to hypothesise that the risks associated with sleep deprivation in this profession are significant. It is certainly an area that warrants further investigation.
Focusing specifically on isolated incidents of slips, trips, and falls at the service level, there are certainly steps we can take to mitigate these risks. Improving sleep hygiene and understanding the concept of sleep debt could play a crucial role in reducing these injuries. If we prioritise better sleep practices, we may see a significant decrease in incidents.
When a slip, trip, or fall occurs, I believe it should be essential to consider the firefighter's sleep history over the previous 24 hours or even the past week. This approach allows us to assess whether sleep deprivation contributed to the incident, rather than immediately attributing it to clumsiness or haste. This perspective opens up a broader, more complex discussion. But enhancing sleep hygiene should be viewed as one component of a comprehensive strategy to reduce injuries. Coupling it with other interventions, such as strength training and ergonomic practices, could further decrease the risk of slips, trips, and falls and its linked injuries within the UK Fire and Rescue Service. By taking a holistic approach and understanding this whilst being proactive with this information, we can begin to create a safer work environment for firefighters by just improving sleep hygiene.
END.
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References:
Carey, M.G., Al-Zaiti, S.S., Dean, G.E., Sessanna, L. and Finnell, D.S. (2011). Sleep Problems, Depression, Substance Use, Social Bonding, and Quality of Life in Professional Firefighters. Journal of Occupational and Environmental Medicine, 53(8), pp.928–933. doi:https://doi.org/10.1097/jom.0b013e318225898f.
Glenville, M., Broughton, R., Wing, A.M. and Wilkinson, R.T. (1978). Effects of Sleep Deprivation on Short Duration Performance Measures Compared to the Wilkinson Auditory Vigilance Task. Sleep, 1(2), pp.169–176. doi:https://doi.org/10.1093/sleep/1.2.169.
Hare, M.M., Wohlgemuth, K.J. and Mota, J.A. (2024). Sleep Hygiene Within the Fire Service: A Narrative Review. Strength and conditioning journal. doi:https://doi.org/10.1519/ssc.0000000000000871.
Massion, J. (1994). Postural control system. Current Opinion in Neurobiology, [online] 4(6), pp.877–887. doi:https://doi.org/10.1016/0959-4388(94)90137-6.
Montesinos, L., Castaldo, R., Cappuccio, F.P. and Pecchia, L. (2018). Day-to-day variations in sleep quality affect standing balance in healthy adults. Scientific Reports, 8(1). doi:https://doi.org/10.1038/s41598-018-36053-4.
Orr, R., Simas, V., Canetti, E. and Schram, B. (2019). A Profile of Injuries Sustained by Firefighters: A Critical Review. International Journal of Environmental Research and Public Health, 16(20), p.3931. doi:https://doi.org/10.3390/ijerph16203931.
Staff, F.E. (2018). Addicted to Awake: Sleep Deprivation in the Fire Service - Fire Engineering: Firefighter Training and Fire Service News, Rescue. [online] Fire Engineering: Firefighter Training and Fire Service News, Rescue. Available at: https://www.fireengineering.com/firefighting/addicted-to-awake/.
The relationship between physical mobility and firefighter occupational task performance. (2023). International Journal of Exercise Science, 16(3). doi:https://doi.org/10.70252/nuyz9300.
Umemura, G.S., Furtado, F., Santos, F.C. dos, Gonçalves, B. da S.B. and Forner-Cordero, A. (2022). Is Balance Control Affected by Sleep Deprivation? A Systematic Review of the Impact of Sleep on the Control of Balance. Frontiers in Neuroscience, 16. doi:https://doi.org/10.3389/fnins.2022.779086.
Waters, F. and Bucks, R.S. (2011). Neuropsychological Effects of Sleep Loss: Implication for Neuropsychologists. Journal of the International Neuropsychological Society, 17(4), pp.571–586. doi:https://doi.org/10.1017/s1355617711000610.
Disclaimer:
I am not a doctor or medical professional. The opinions expressed in this article are solely my own and are based on the evidence and references provided. This content is intended for educational and informational purposes only and should not be considered medical advice.
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