Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study
Introduction Firefighters face frequent physical and psychosocial stressors, increasing their risk for hypertension. Rising call volumes with a stable workforce have heightened occupational burdens. To meet their occupational demands while increasing time off-duty, fire departments across the countr...
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| Format: | Article |
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BMJ Publishing Group
2025-08-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/2/e002427.full |
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| author | Steven A Shea Andrew W McHill Nicole P Bowles Kurt T Hegmann Todd Bodner Walaa F Abdelmoaty Shelby L Watkins Aanuoluwakiitan Ayeni David A Hurtado Jeremy J Biggs |
| author_facet | Steven A Shea Andrew W McHill Nicole P Bowles Kurt T Hegmann Todd Bodner Walaa F Abdelmoaty Shelby L Watkins Aanuoluwakiitan Ayeni David A Hurtado Jeremy J Biggs |
| author_sort | Steven A Shea |
| collection | DOAJ |
| description | Introduction Firefighters face frequent physical and psychosocial stressors, increasing their risk for hypertension. Rising call volumes with a stable workforce have heightened occupational burdens. To meet their occupational demands while increasing time off-duty, fire departments across the country have switched from a 24 hours on 48 hours off (termed ‘24/48’) work schedule to one that increases the number of consecutive days off (eg, 1 day on, 3 days off, 2 days on, 3 days off (termed ‘1/3/2/3’) or 48 hours on 96 hours off (termed ‘48/96’)). However, these schedule changes come at the expense of increasing time on-duty, which may have negative health and safety consequences. This paper provides the framework and methods to investigate how these schedules (24/48, 1/3/2/3 and 48/96) impact hypertension risk, well-being and safety among firefighters.Methods and analysis This quasi-experimental study assesses hypertension risk (primary outcome) markers, including 48-hour ambulatory blood pressure and safety (secondary outcome) using the psychomotor vigilance test and incidence of injuries. The study encompasses a cross-sectional analysis that examines three distinct schedules (24/48, 1/3/2/3 and 48/96) and a prospective analysis, capitalising on a pre-planned schedule transition from a 24/48 to a 1/3/2/3, as a natural experiment without any intervention from the study team. Additionally, the mediating role of sleep (assessed objectively using actigraphy and subjectively using questionnaires) and daily stress in the relationship between work schedule and hypertension risk or sustained attention is investigated to inform both mechanisms and general considerations for developing and promoting a healthy work design for firefighters. The feasibility and acceptability of the three schedules are assessed using validated surveys and qualitative interviews.Ethics and dissemination The study received approval from the institutional review boards of Oregon Health & Science University (IRB# 20553) and the University of Utah (IRB#165866) and engages fire departments in the Pacific Northwest and Utah. It leverages community engagement with these fire departments, offering an exceptional opportunity to examine the physical and mental impacts of firefighters’ work schedules. Aggregate findings will be disseminated through practical resources, benefiting both regional and national firefighting communities. |
| format | Article |
| id | doaj-art-0ba9f3cb5cbd4639a51d7dcadde9716a |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Public Health |
| spelling | doaj-art-0ba9f3cb5cbd4639a51d7dcadde9716a2025-08-20T03:47:01ZengBMJ Publishing GroupBMJ Public Health2753-42942025-08-013210.1136/bmjph-2024-002427Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional studySteven A Shea0Andrew W McHill1Nicole P Bowles2Kurt T Hegmann3Todd Bodner4Walaa F Abdelmoaty5Shelby L Watkins6Aanuoluwakiitan Ayeni7David A Hurtado8Jeremy J Biggs91 Oregon Institute of Occupational Health Sciences, OHSU, Portland, Oregon, USA1 Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA1 Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA4 Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USAPsychology Department, Portland State University, Portland, Oregon, USA1 Oregon Institute of Occupational Health Sciences, OHSU, Portland, Oregon, USA1 Oregon Institute of Occupational Health Sciences, OHSU, Portland, Oregon, USA1 Oregon Institute of Occupational Health Sciences, OHSU, Portland, Oregon, USA1 Oregon Institute of Occupational Health Sciences, OHSU, Portland, Oregon, USA2 Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USAIntroduction Firefighters face frequent physical and psychosocial stressors, increasing their risk for hypertension. Rising call volumes with a stable workforce have heightened occupational burdens. To meet their occupational demands while increasing time off-duty, fire departments across the country have switched from a 24 hours on 48 hours off (termed ‘24/48’) work schedule to one that increases the number of consecutive days off (eg, 1 day on, 3 days off, 2 days on, 3 days off (termed ‘1/3/2/3’) or 48 hours on 96 hours off (termed ‘48/96’)). However, these schedule changes come at the expense of increasing time on-duty, which may have negative health and safety consequences. This paper provides the framework and methods to investigate how these schedules (24/48, 1/3/2/3 and 48/96) impact hypertension risk, well-being and safety among firefighters.Methods and analysis This quasi-experimental study assesses hypertension risk (primary outcome) markers, including 48-hour ambulatory blood pressure and safety (secondary outcome) using the psychomotor vigilance test and incidence of injuries. The study encompasses a cross-sectional analysis that examines three distinct schedules (24/48, 1/3/2/3 and 48/96) and a prospective analysis, capitalising on a pre-planned schedule transition from a 24/48 to a 1/3/2/3, as a natural experiment without any intervention from the study team. Additionally, the mediating role of sleep (assessed objectively using actigraphy and subjectively using questionnaires) and daily stress in the relationship between work schedule and hypertension risk or sustained attention is investigated to inform both mechanisms and general considerations for developing and promoting a healthy work design for firefighters. The feasibility and acceptability of the three schedules are assessed using validated surveys and qualitative interviews.Ethics and dissemination The study received approval from the institutional review boards of Oregon Health & Science University (IRB# 20553) and the University of Utah (IRB#165866) and engages fire departments in the Pacific Northwest and Utah. It leverages community engagement with these fire departments, offering an exceptional opportunity to examine the physical and mental impacts of firefighters’ work schedules. Aggregate findings will be disseminated through practical resources, benefiting both regional and national firefighting communities.https://bmjpublichealth.bmj.com/content/3/2/e002427.full |
| spellingShingle | Steven A Shea Andrew W McHill Nicole P Bowles Kurt T Hegmann Todd Bodner Walaa F Abdelmoaty Shelby L Watkins Aanuoluwakiitan Ayeni David A Hurtado Jeremy J Biggs Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study BMJ Public Health |
| title | Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study |
| title_full | Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study |
| title_fullStr | Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study |
| title_full_unstemmed | Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study |
| title_short | Impact of firefighters’ work schedule on cardiovascular disease risk, wellbeing and safety in firefighters: protocol for the SWIFT study, a multidisciplinary prospective and cross-sectional study |
| title_sort | impact of firefighters work schedule on cardiovascular disease risk wellbeing and safety in firefighters protocol for the swift study a multidisciplinary prospective and cross sectional study |
| url | https://bmjpublichealth.bmj.com/content/3/2/e002427.full |
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