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So if you want to hear more about 511 and their origin story, go to episode 338 of Behind the Shield podcast with their CEO, Francisco Morales. Welcome to the Behind the Shield podcast. As always, my name is James Gearing. And this week, it is my absolute honor to welcome on the show, former volunteer firefighter and EMT and current researcher Joel Billings.
Now in this conversation, we discuss a host of topics from volunteering as a young man, his journey into the research side, his study on the 4896 that is being cited around the country, reducing the firefighter workweek, alert systems, shift start times and so much more. Now before we get to this incredible conversation, as I say every week, please just take a moment, go to whichever app you listen to this on, subscribe to the show, leave feedback and leave a rating.
Every single five star rating truly does elevate this podcast, therefore making it easier for others to find. And this is a free library of almost 1000 episodes now. So all I ask in return is that you help share these incredible men and women stories so I can get them to every single person on planet Earth who needs to hear them. So with that being said, I introduce to you Joel Billings.
Enjoy. Well, Joel, I want to start by saying thank you so much for taking the time and coming on the Behind the Shield podcast today. Oh, you're welcome. No problem. So where on planet Earth will be finding you this afternoon? I reside in Stillwater, Oklahoma. Beautiful. But you're actually part of Emory Riddle, aren't you? Which is on the East Coast here where I am. Yeah, they have three campuses. The Daytona Beach campus that's in Florida, the Prescott Arizona, and then the Worldwide campus.
So the Worldwide is all online and their faculty are also worldwide. How involved, if any, is the Prescott Arizona program when it comes to wildland having such a huge wildland tragedy in their town? I don't know much about any of their programs on that campus. And in regards to emergency services, that program is just on the Worldwide campus. And that's what I share. Okay, beautiful. All right. Well, let's start at the very beginning of your timeline then.
So tell me where you were born and tell me a little bit about your family dynamic, what your parents did, how many siblings. Okay. So I am now reside in the South. So I was very opposite of where I was born. I was in Michigan, Waterford, Michigan, which is about 40 minutes north of Detroit. So I like the snow, but we don't get snow here in Oklahoma. Anytime that there is a threat of snow or ice, it shuts down the entire state, basically.
So I very much miss the snow, but we do visit quite often during the holidays. So I grew up in Waterford. I have three other brothers. I'm number three out of four. And I started, I guess, my background in the fire service as a volunteer firefighter and EMT for Waterford Township Fire Department, which is now Waterford Regional Fire Department. They handle a couple other cities. So back in high school, I enrolled in a cadet program there at the local fire department.
Basically, as a senior high school student, you got to have last two hours to go to the fire department. And then they taught basically first responder, got you used to items on the trucks, and just basically to get those that are interested or might be interested in the fire service as a gateway. Those that graduated from that program, they helped to get connected with the local community college for Fire 1 and 2. And so I did that. And then shortly thereafter, I did EMT basic.
Wasn't much long after that where I decided I wanted to help in a little bit different way. I loved being a volunteer and EMT basic for that department. It was a combination department. So most of it was career full time. And then the volunteers were mainly a lot of younger people that sort of a feeder program into the department. I believe they got more points back then during the application and hiring process. But so I shortly thereafter wanted to pursue a four year degree.
So went up to Lake Superior State University. That's in the Upper Peninsula of Michigan, Sault Ste. Marie, the last exit before Canada, essentially. So there you'd get we would get three feet of snow. And as long as they kept open or kept up with the bridges, the International Bridge and the Mackinac Bridge classes were on. So you were hiking to classes very different than here in Oklahoma. But did that. I was a fire science degree.
And for my senior research paper, that's where I got into research and started loving this idea of sleep. So I read the 2007 sleep deprivation report from International Association of Fire Chiefs. That report is still online. So anybody can Google that. Just type in sleep deprivation IFC and you'll come up. I think it's going to be the first link. And we'll probably talk a little bit more about that here in a little bit. But after that report, I ended it with more questions than I had started.
And so I kind of fell in love with with research. That led to me applying to graduate school. And that's where I moved to Oklahoma for their fire and emergency management program. Their masters and PhD program. So I continued on with that topic of looking at different shift schedules and sleep. And then for my dissertation, I did a experiment with a fire department that converted to the 4896 from the 2448. So I looked at sleep before and after that transition. So that's a little bit about me.
All right. Going all the way back. What about your parents? What did they do? My dad was always in construction and various roles in construction. And my mom was a cafeteria lunch lady. Totally random question. But I've talked about this recently, especially after the pandemic. Did she see a devolution of what they served in schools? Because if you go far enough back, our lunch ladies made lunch. Men and women, they would actually cook real food.
And then somewhere along the line, it became Cisco and frozen and microwave. And it contributed to a lot of the ill health we have now. Have you ever had that conversation with her by chance? Not not too much. My mom would always have interesting stories of different types of food and or the requirements to meet the nutritional value.
So if I remember correctly, there was one time that, you know, I was making grilled cheese sandwiches and to meet that nutritional value, they had to put six slices of cheese to to meet that requirement. And so I always just thought that was interesting of the requirements that they have to to make. But but I'm sure there are various methods and procedures throughout the years that they had to go through. What about sports and exercise? What were you doing in the school age?
Sports? I was always very athletic. I in high school, it was cross country track and wrestling. Wrestling was my number one sport. And I basically did track and cross country to stay in condition for for wrestling. Talk to me about the cadet program. I think one of the many solutions to the recruitment crisis is obviously educating young people on what we do. And then more importantly, I would argue because there's mentorship program here. One of my friends started, which is phenomenal.
So reaching into maybe underserved populations, obviously that can be done through high school programs and then giving these young people the free training, which will either A, lead them into that profession or B equally as valuable. Make them realize that they don't want to do that before they commit to fire academies and getting hired. Yeah. So the cadet program, I was very fortunate. I didn't hear about it through any major like marketing campaign through the high school or fire department.
It was mainly just word of mouth. And so that led to meeting with a couple of other people. And so then I got more information. It wasn't I think I had to apply when I was a senior, but I did also apply when I was a junior and that was, I think, too young or not the class to apply. So I didn't get in my junior year. But in regards to the cadet program, I think it's a great way to help with recruitment issues. So again, it can show people just a very brief snapshot of what goes on.
Of course, you could do ride alongs and just give the day to day operations of the fire and emergency services to maybe prospective firefighters. What about career aspirations when you're in the school? Were you already thinking of becoming a career firefighter or was there something else on your mind? No, I had I had my heart set on that. Actually, I'll take a big jump back to when I was describing my childhood. My father and parents collected fire trucks.
I think he got his first one when he was 18. And so he collected I think the earliest is in 1941. American LaFrance or Ward LaFrance, I get that one confused. And so we were kind of always around sort of antique fire trucks, which was nice because it gave us mechanical skills of maintenance and so forth, but also naming parts and getting used to concepts of fire trucks and and apparatus.
We have a we have a bucket truck, a tanker is what we call them in Michigan, but it'd be a tender if you're in a different part of the US and a few other pumpers. So they're they're really neat. And that's how we got into or how I got really interested in the fire service. We take them to fire truck shows, believe it or not, those exist and parades as well and go to the local lake and draft and pump and pump and spray water. So it's a lot of fun, memorable moments as a as a child.
And that I'm sure had led a significant part of my journey so far. That must have been some people's minds blown if you kind of walk in as a young, young recruit and are able to be a wizard on the panel already. Yeah, well, just a little bit. It's more, you know, naming things that are on the trucks or capacities and so forth. But not any anything really in regards to a fire response or emergency response and of course, medical response at all.
Well, speaking of that, then what capacity did you volunteer? Like, what would that look like as far as the frequency of calls? And then how did that lead you into the EMT side as well? It was well, leading into the EMT was sort of the next progression. I think it was after we graduated in fall in the fire academy and then I think January is when the EMT course started. So we were in a cohort and so we just all transitioned into into the EMT program.
But serving as a volunteer firefighter, we would mainly go on anything like public assists, so picking someone up that fell off the floor, small, small items of fire alarms, those kind of things. And then to help on scene for any actual fire and so forth. So what about experiencing yourself, the station life, the alert tones, the sleep deprivation? What kind of depth did you find yourself in the roles that you played? So I actually never had the privilege and I think that's maybe a strong word.
It's a very strong word. To actually to sleep overnight in a station to experience the calls. But our station or this department didn't have mechanical bells. And I know those exist quite a bit local fire department here has mechanical bells. We had electronic tones. And so that was a little bit more peaceful. But I just remember at that time when I was 18, that was just excited for the next one. I hated waiting around for for a call to come in. I would have been the one that was out in the bay.
You know, like, let's let's let's just sit here waiting for one to come in. Absolutely. Well, you found yourself not just in firefighter health, but obviously focusing on the sleep and sleep deprivation conversation, which is where I think this is going to be a great conversation and you and I are going to be in a conference in Orlando next month as well together. Talk to me about the front door when you walk in and you decide to do the research.
What which studies were actually available on the impact of sleep deprivation on firefighters at that point when you entered? You mean back in senior or graduate school when I was starting my thesis? Yeah, whenever the sleep deprivation specifically became your focus. OK, well, I'd say it really became, I guess, the interest back in senior research, but that was what we say more about research paper, a literature review, just reporting what you found on the topic.
It wasn't until grad school where I conducted my first study and I was able to publish those results. But the the information on sleep deprivation was was limited. And if it existed, it focused on just sleep overall, whether or not how much in general firefighters slept. And we know now that, you know, it of course varies amongst departments and within departments and so forth and but also comparing maybe shift schedules.
And so there wasn't much of a comparison between or among shift schedules until my my first first study. And I looked at those three most popular US shift schedules. When you're kind of pulling this apart, obviously there's a lot of research when it comes to firefighter cancer, although they seem to disregard the sleep deprivation part.
There's a lot of research when it comes to the firefighter mental health, although they seem to disregard the sleep deprivation part, so there is research in firefighter health. But more often than not, it's just these certain topics that I think most of the money and research has been focused in. What was your assessment of why that is the case, knowing that we work these insane work weeks, why research wasn't done, why it wasn't prevalent at this point?
I'd say in general with like behavioral health, mental health, cancer, suicide, physical activity, nutrition, those critical areas, and most of which would be called pillars of health. Those those four areas with sleep have, I would say, just been neglected in the fire service as a research topic. In other fields, you know, just for example, on on work hours, there are regulations for pilots and long haul truck drivers and so forth.
But, you know, nothing really exists in the fire emergency services or really at a guidance level for individual departments to maybe even make their own their own policies. In fact, I just got an email the other last week about, you know, is there any information on mandatory rest time after working so many hours? And, you know, unfortunately, there's not there's not any research on that in the fire service outside of the fire service, though there there's lots of research.
And so for a while and in the 2007 sleep deprivation report, you'll see that a lot of that literature presented in there is from outside the the fire service and not necessarily a weakness, but you have to. Be aware and question whether or not that can be generalized into the fire service. So, for example, nursing medical residents like first year graduate medical residents are there's a lot of research in those two two groups, but they're not firefighters.
And so work duration, work function is very different between these two populations. And a lot of people maybe mistakenly correlate those two together. So in terms of direct evidence, we're behind in a lot of areas. But, yes, there there is connection with sleep amongst those other four four areas. And I think we're starting to see sleep become more of a consideration in in those areas of research. See, this is what's been maddening for me for eight years now talking about this.
And again, I'm not the expert. I'm just the conduit between the experts and the people that need to hear it. But I've had people on from the army, the Navy, the Navy SEALs, the Air Force, the sporting community, neuroscientists, I mean, you name it. And the message is exactly the same. But I have the fire service tell me, oh, well, I need to see the data. Show me the data on and we'll get to obviously the shift schedules. And I said there isn't any. How can you call for something?
And the reason you're asking me is because you've Googled it and you can't find it either. So we'll get into some of the some of the studies that you've done. But up to that point, this is the issue is the biggest, arguably the biggest issue that we really have. This related to so many of the other problems, including recruitment, is the one thing that we haven't studied.
And if your response is I need to see the data, then you to me, you're you're turning your back on actually addressing the problem. And like you said, every department can because now in Florida, there's beginning this revolution where departments are going to 24 72 because they're understanding the whole picture, which is beautiful. So they do get to choose their own hours. That's that's that's neat.
Yeah, the the 24 72. Very limited data on that one, but just speculation from what I've been able to see that would kind of offer the benefits of multiple multiple of the schedule, especially the 24 48. And then the 48 96, combining those two benefits of working 24 hours and then having a sufficient time off to to recover. Absolutely. We'll stay with that for a second. I was reading some of the the kind of articles that you had on the website.
You mentioned this about some of the, again, external studies, how the the the greater the demand on the individual, the more sleep deprivation, the greater the need there is between these shifts to recover. Yeah, well, basically it comes down to call volume at at night and the individual firefighters call volume at night. And so that can, of course, be tied to unit specific. But generally you have to or a department probably should. Target or select a policy for the most at risk individual.
Right. So if we have a 24 48 and station one has 20 calls during the night, that's going to be very unhealthy and an increased risk of injury and accident. So the question of having a sufficient time off compared to working, working hours and then not having sleep. That's what we need to factor in is how many or how how many hours you're not sleeping during during work. And then we could talk about, you know, OK, is it is it a shift on shift duration or is it also workload?
Is it I mean, in terms of a number of units at us at a station. So if workload is too high, then maybe that's this is a labor question to increase the number of units within a station to disperse that workload among different units so that now you're lowering that workload per personnel. So there's lots of ways to tackle that particular problem of call volume. See, it's interesting as well because you just kind of hit the nail on the head. And I agree with this philosophy completely.
Every department or a lot of departments have mostly busy stations and then they'll have what they refer to as a retirement stations. There might be some in areas that they're going to develop, but it's not happened yet on the on the kind of out of fringe. And so that's always the pushback. Well, you know, we don't want to change the work week because Steve in Station 10 only runs two calls a week. And the argument is, well, that's completely backwards.
What about Stephanie in Station one who's getting murdered for 24 hours every third day? You're not going to fix it for her because you're worried that a guy who's been a firefighter for 25 years won't be working around the clock without stopping. So I think it's the same as a shore site. It kind of rhetoric you get on food stamps or government housing.
And they always point to the people that abuse it rather than the massive majority that are able to get back on their feet and then and then get back into society or get back into the workforce. So I don't know what it is about our mentality, but we always focus on the few at the detriment of the many. Yeah. And and you can like I said, there's there's a few different ways to handle it. And, you know, I'll say these and they it's easier said than done, of course.
But there are flexible scheduling where some stations can be on one schedule and other stations can be on other schedule. That's a little bit more accommodating to workload there. You can decrease the workload or the individual workload by adding additional units. But you can also subtract the workload by maybe systems such as community based EMS or something that we talked about before on our phone call of other units or.
Other systems like telehealth in being involved to help decrease the the workload on fire and emergency responders. So another question that I struggle with now and this is a totally different conversation eight years ago, but in twenty twenty four is why it's such a hard sell to ask the question, why do firefighters work 56 hours a week when the average population works 40, including the people that refuse to change the firefighter schedule.
So did that kind of strike you as just simply the question, why are the people that we call on a very worst day required to work 16 hours a week more than the average civilian? I mean, it's an interesting question. I don't know what the solution would be. Some people could throw out, oh, let's go with the non twenty four hour schedules. Right. But you're replacing one problem with another because someone always has to work night. Right. I mean, the calls are going to be.
That's the random variable here when a call comes in. So if someone always has to be ready to respond, then someone's has to be there at the station or if it's a career department. That's tricky if you go to like a non 24 hour schedule, because there's like five factors for those types of schedules. The work duration. So it could be three eights, a 10, 14 or 12, 12 or some other type of combination. So the work duration and then you have the non work duration.
So that's your recovery time, essentially. Then you have to decide if it's going to be a permanent schedule or rotating. So is someone always going to work nine hours? So maybe you could find those that have like the night owl chronotype that maybe their circadian rhythm is more apt for night work or you're going to rotate. And so if you do rotate, which direction do you rotate forward or backwards?
So is it night shift working in the morning or is the night shift then going to work the afternoon? And so there's some science on that. And then the last one is how fast is that rotation? So is it every week or is every two weeks or et cetera? So there's a lot of factors that go into the non 24 hour side. And so the 24 hour side was probably just easier maybe to have someone there all the time and when they're not busy, they can rest and sleep and still be on call.
Yeah, I agree completely with everything you said, but I'm talking about 56 hours a week. Civilian works 40 hours a week. Firefighters work 56. To me, the insanity of that in itself, like I tell people, we go around telling everyone that we work one day on two days off and we don't. We work three, eight hour days crammed together. So it's three days on one day off is actually what it looks like. So it's not 10 days a month. It's 30 days a month.
So we've been telling ourselves this fairy tale that we have this amazing schedule and then we shoot ourselves on the foot because we go around telling our neighbors, I only work so many days a month. I'm off all the time. And you look at actually on paper, we work way more than most people. And that's not even mentioning the mandatory overtime. It turns out into an 80 hour week now.
So this is the conversation, not the 12s or 24s, but the people in the office buildings, the chiefs, the administrators, they tap out 40 hours. The firefighters that are up, arguably a lot of them through the night are working 56. It's that concept alone that people struggle to get their head around. And I haven't obviously no one can give me a good answer because there isn't.
It's pure insanity that the people that you call on your worst day are working almost 50 percent more in that week than the person bagging your groceries. Yeah, so that's a tricky one. And I haven't explored that too much because then you could also ask the same question about a 40 hour work week. Right.
And if that's the right number of hours for the general population or with technology and us being able to be more efficient at our jobs, are we getting more out of employees for that 40 hours than what we used to during that same 40 hours? So that could even I mean, it's always going to be a question of that work hours. So that's that's a difficult area to explore.
Well, I mean, I think just to take your example, you look at the corporate world, they're realizing that a four day work week is actually equally as productive. All the Googles and all the Virgin and all these mega companies that are known for excelling in the business space are actually creating flexible work hours and a shorter work week because they're realizing that extra time off creates happy, healthy workforces. So in the fire service, we've gone the other way.
You know, with the mandatory overtime now is making people work more, not less. So I think we can't have a firefighter health conversation if we can't even answer why firefighters are working 56. You see what I'm saying, which is why I think the 24 72 is a beautiful solution. Still 24 hour shifts, but you just get it down to a 42 hour work week, which in turn saves the department money and improves recruitment and all the other
things. But most importantly, you're just giving these poor men and women time to actually be with their families. Yeah, yeah, yeah. And you know, COVID with sort of the general workforce, maybe like day shift occupations. Which flexible scheduling and four day work weeks has really started to ask and open up those questions for even the general population. I was at a conference, I think it was in Arizona.
And one of the fire chiefs there asked or was asked by a firefighter if they could do work from home as a firefighter. So obviously that was I hope it was a joke, at least from that firefighter. But nonetheless, these questions on work hours and work durations, a lot more departments that I see now are asking that question compared to before. So and then in the 24 72 at that same conference.
Now, this is not going to apply to all departments, but that chief had said they were able to go to that schedule with just two additional hires due to the amount of overtime that they saved from having required or mandatory overtime. Yeah, that's what we're seeing.
And I want to obviously make this conversation about you, not me yapping about 24 72, but the departments that I know that have gone to it now, that was basically their entire budget was the overtime and or the amount of money they were wasting on recruits that then turned around and left their department a year, two years later.
I heard Orange County, where I used to work, someone was telling me they've lost, I think they said 200 recruits, 200 recruits over I forget how many a year or a couple of years, whatever it was. But if each recruit is roughly about 20 grand to train, you know, you do the math, there's millions of dollars between overtime and that. So this whole we can't afford a whole shift is like you already are. You just are not paying attention where the money is.
It's downstream being wasted because of the refusal to acknowledge this change. Oh, yeah. I mean, very easily could be. And in the south, like Texas, for example, there were a lot of departments that were going to the 48 96 from the 24 48. And they would be trained in other other departments. And then once that opening was posted and a lot of departments there would post what schedule they were they were working on in the actual flyer. And so that really attracted a lot of people to jump ships.
And then as well as the salary difference as well. I think I mean, there is misinformation. I'm going to put the 24 72 aside because that's the 42 hour work. We obviously that's far better than 24 48 or 48 96.
So moving that over for a moment, when people have this one or the other conversation, though, having always worked in extremely busy departments myself and then now having all these incredible people from the sleep research world, including Professor Russell Foster, who's the one that actually discovered the Kroner receptors in the eye. So a real grandfather of sleep medicine over and over again. I'm told just how how dangerous it is even for the 24. But at 24, like you said, I agree.
That's what we have to do. But when you're getting into 48, you're getting to multiple days how they were like, it's irresponsible. It's dangerous. It's just downright. You shouldn't happen. So I get obviously the four days. That's what everyone focuses on. But when you dive into the science, talk to me about the 48 because 48 hours in the stations that I worked at is 48 pretty much sleepless hours back to back. Yeah. And in that case, that's probably a pretty dangerous schedule.
The fact that you're if it's true that you're not sleeping for 48 hours. I mean, it's just it's a matter of time when not if there's going to be a serious injury or accident. Now, I'll say that with not with a caveat on that discussion is that there are stations that an individual units or firefighters that don't have that type of workload during that 48 hours.
So in that case, that may be just a fine schedule for for them and may work out well for their their work, but also their their home life as well, family and social obligations as well. The as an example, the published work that I had here is a department that had less than one call a night during the 48 96. So you could see that, OK, maybe sleep is a little bit better in that case.
But that's under those circumstances and situations where workload is very manageable, where it's less, you know, less than one time or less than one call a night on average. So, you know, maybe two calls during your entire tour. And so that's probably reasonable if if you're able to still get some sleep and pretty good sleep, some some get light sleep even when they're not, you know, even when they're maybe when they're trying to expect a call at the station. I hear that quite a bit.
But I also hear that some firefighters go to work to sleep compared to home. So it's it's it's very personal topic of work duration in that in that schedule to an individual firefighter. I think this is where research is dangerous. And obviously not the study itself, but the interpretation of research, because I've had literally people say they reject the 24 72 because they want a 48 96.
And I'm like, you are literally saying I voluntarily want to be away from my family for two more days because it's a completely different work week. And then, like you said, you know, the apples to apples, you've got these departments and if they're suburban or urban, they are going to be running multiple calls through the day, through the night. And again, there's this kind of misnomer. Oh, you weren't actually awake. It's like, as you said, though, it's disrupted sleep.
You do not get into deep restorative sleep when you've got one eye open waiting to get a call. It's physically impossible. So, you know, when you have a shift or two shifts back to back of that, that's a completely different conversation than the department that maybe runs what possibly one call a night for two nights in a row, because that's not most of our departments, not at least in the urban and suburban setting.
Yeah. And so there are probably departments that are that busy that just, you know, the chief would probably never even entertain that idea of going to, you know, a 4896 because they see how busy majority of their stations are throughout the day and then also night. Because, I mean, I know we've been focused mainly on sleep, but there are also day concerns, too, of being exhausted, fatigue as well. And that can lead into sleep disruption and issues during sleep. Well, let's talk about that.
I want to get to the chronic impact as well. But the acute elements, when I look back now, you know, 20 years after being a firefighter myself, towards Stine, and I think about all the line of duty deaths, all the horrendous wrecks at intersections, all the people that got lost in fires. And this is arguably as well, you know, the law enforcement, you know, gray area shootings and all these things. How much does sleep deprivation impact that?
The wrong meds pushed, you know, the angry cop against the citizens. So not from a chronic, but an acuity point of view. What impact have you seen as far as sleep deprivation on our performance and then things like accidents as well? So that's a really good question. And our data is, I'd say, maybe preliminary on direct evidence. So what I was able to do with the the last study that we published is look at sleep duration. So nightly sleep duration and next day performance.
And so we so each each day, you know, asked or through actigraphy. So that's our objective way to measure sleep duration versus pen and paper or asking how how many hours did you sleep last night? So we looked at the objective total sleep time and then compared it with a survey data that was taken in the afternoon and it was sleep propensity, basically of how likely you are to fall asleep at at one o'clock each day.
And so that was that was consistent to control for any differences, you know, because if you take it at like six o'clock, you're going to be or nine o'clock, you're going to be sleepier at nine o'clock than you would maybe at at at lunchtime or in your peak performance time. So keeping time was was important. What we were able to see is that basically what you would expect when you didn't get sleep, you had lower performance. So you were more sleepier, sleepier during the afternoon.
And what was neat about that particular study is to chart it each day within these two shift schedules, so the 24, 48 and 48, 96. So day by day, not only were we able to track your nightly sleep time, but then we were able to correlate it with your afternoon performance level and see, OK, when you were on shift, what was that? How many hours did you get sleep? And then through the the recovery days or the non-work days at home. That all led to suggesting maybe shift start time.
And I know we could circle back to that in a little bit. But to your question on acute performance or effects of sleep deprivation, those are very real and we don't need necessarily direct evidence in the fire service. That stuff has been been published in sleep medicine and circadian science literature for quite a bit.
And the two classic studies that I like to always always discuss is the correlation or not the correlation, but the the researchers did an experiment where they gave basically alcohol to participants at an interval and then measured their reaction time on computer and cognitive reaction time. So they were able to basically see after and then compare it to someone that just stayed awake for that entire equal duration. At 17 hours, it was basically point zero five blood alcohol concentration.
And then at 24 hours, 20 to 24 hours, it was point one zero, which is legally intoxicated in each state. So you could see the direct effect of being awake and what that effect is on performance and the equivalent of being intoxicated. So those that maybe are awake for 48 hours, that's a big concern that we would have is if you're not sleeping at all, what what accident is going to happen that you're going to cause?
Of course, a big question is what does the effect of adrenaline adrenaline do to counteract that in the moment? So if you had like an all tone, for example, in a department and you were sleep deprived or if you woke up in deep stages of sleep, what would that do on the body to force you to wake up? That that is an open question. And we don't know that that answer just yet. But I suspect there's going to be something that at least momentarily reverses some of that that effect.
What's interesting, I've said this on a few of conversations with people in the human performance world. When you think about how most studies are done, a lot of times it's the college students of the school where the professor is or the PhD student. And so arguably they probably didn't spend 10 or 15 years not sleeping every third day.
So I would hypothesize that actually, if you're doing the cognitive parallel of a blood alcohol with a firefighter that's been on for a certain amount of time, their baseline is probably going to put that number much higher than point one. It's possible we would just need a, you know, a study to show that. But I'd also be curious to look at, like I said, what the effect is at, say, after that 17 hours, then. Then they get a call and see what their performance would be at that time.
And that's very difficult to do in the field because you can't just say, hey, stop and take this computer test real quick while you're on a call. And that's the problem with, you know, simulations or lab experiments versus, you know, actual field data in the field. Yeah. And also that adrenaline spike when you're a six month broby, the mattress fire gets your heart racing. You know, when you've been on 15 years, if it's not fully involved, you barely even get your heart rate up.
So that would be the other variable, too, is the time on of the person. Yep. Yeah, very true. But I will say that in a study of heart rates, because we were looking at heart rates and alerting systems, we see that it didn't really matter of age or the data is looking. We're just exploring the data right now.
But in terms of age or years of service, people still get that spike and most people go or most of the firefighters in this sample went to tachycardia very quickly within a minute of getting that alarm. Let's unpack that because I worked. I don't think anyone had a Claxton, but I had the ones where it was the obnoxious alarm. All the lights came on. The best one I worked outside of individual dorm rooms was Anaheim had the personal alerting system in each of the cubicles within an open dorm.
And it's amazing how well how acclimatized you get to that. And you would sleep through everyone else's and you get much better sleep. I tried to actually help my previous department, just the last one I was with, get that they were all on board. They fired the communications chief and did a one A and put obnoxious LED lights in the bunk room instead, so they couldn't have been further from it. But so talk to me about that spectrum. You know, what is the worst?
And then what are some of the best solutions that you've seen in your research so far? Yeah, so we we we have a SBIR phase one grant, and that's for a small business research grant with with Easler. Easler is the company that developed this wearable device that like an Apple watch, when you get a text message, it will vibrate. And so the idea was the idea is that this will vibrate instead of the alarm activating. So dispatch will still come on the speaker like normal.
It just no bell, just just a vibration to to alert you of an incoming call. So we haven't analyzed all the data yet. We're still doing some some data cleaning, but we looked at some of the pre pre data. So what the heart rate response was just from the the clock, done well. I mean, it was it was the mechanical bell, what what this particular department used.
And in each of the stations that that the system was put in, we see, you know, steady right before the bell came in and especially at night at night, we're sleeping. It was kind of basically a flat line. And then Bell came in and you can instantly see when that when that occurred. And like I said, the majority of people went into tachycardia within within the minute, because that's what we were looking at before. A minute before average heart rate and then a minute afterwards average heart rate.
But visually, I mean, it just just a huge spike. So the question is, and that whole focus was on maybe reducing line of duty deaths due to cardiac incidences. So the question is, does that spike, you know, for every call that you get over time, add up to something in the cardiovascular system to cause a line of duty death? And so that was their solution to help combat that or reduce the likelihood of a death. So what about other systems, though?
I mean, for example, the the most insane thing I've seen is and this was the last place was a bunk room that had an engine and two rescue crews and the lights would come on, so you're waking up eight people for, for example, a rescue call. So for two people going to call, you wake up eight. And then you've got these chiefs that monitor the radios all night, which I would argue probably is more of an ego thing. If you don't trust your grown up men and women to just let you know if they need you.
So you've got this. To me, that's the worst. And then, like I said, you've got, you know, well run department. They trust their people. You have the individual, whether it's each individual dorms or or compartments in in bunk rooms, and you just wake up the crews that actually need to go on the call. So those are my my career. My observations. Obviously, the worst is the big bell and the lights come on and wake everyone up.
So what have you seen as far as some other interesting solutions to not cranking that from zero to 100 every time you get a call? Yeah, that's that's my my experience is very similar. However, the the worst that I've experienced is during my first study, a department had a guy that slept through the call. And so as a consequence, the chief did open system 24 hours. So in the entire department now, this was a department maybe of 150.
So so not like it, I don't want to minimize it, not a large department, but a medium department in Oklahoma. But nonetheless, you're waking up 150 personnel for every call that came in 24 7. So that was probably what I'd say is a poor decision and not the right way to go about the corrective behavior for for that. What I'd say is an accident of sleeping through. And if anything, it's a it's a symptom that probably needs to be addressed in a different means.
But, yeah, so you have that probably the worst. The best is like what you said, where you have individual sleeping quarters and that particular personnel can select which unit they're on and only they are alerted or that particular unit is alerted for a call. So it's a sleep efficiency for everybody else and sleep disturbances or interruptions during the night would be minimized for those that are not responsible for for responding to that particular incident. That's what I'd say is best.
You also have departments that still have just open bunk rooms. And so the if a station or if a call for any unit within the station goes out, it's activated for everyone. That's that's probably most probably typical throughout the US for those that don't have individual sleeping quarters. But that that's probably what I would say would be the best one for anybody that are is re like creating designing and developing a new station or renovating an existing station.
Absolutely. You see Anaheim, they had some stations with individual rooms, but then they had communal open bunk rooms, one big room. But they put those office partitions in, which you would have anyway in most places, because you need some privacy to get changed and do all the things that we do. So just putting those individual tones there, you've got the LED strip. You've got the tones that you can make as loud or quiet as you want. Once you get used to it, you trust it.
Basically, after a few weeks, you don't hear everyone else. I mean, I remember feeling bad because I'd wake up going, oh, that was that was a pretty good night. And then one of the other crews would be like, you mother. We had a terrible night. Four times. So, yeah, yeah. But then, you know, next shift, if you if that department wrote, you know, rotates trucks, truck assignments, then, you know, you'd you'd get a little bit heavier.
But that's the idea is, is if you're not responsible for responding, then why, why, you know, disrupt your sleep? Your sleep is already terrible, disrupted anyway. So try to mitigate that as much as possible. And that's one solution to do that pretty effectively. Yeah, absolutely. Well, you touched on it before. Sarah Jenke was talking about this, too. Again, for me, the gold national standard, I think, should be 2472.
But in addition to that conversation, I love the concept of changing the start time. If I look back again at the insanity of what I used to do for 14 years, because I always lived about an hour and a quarter from the station, I would be waking up at five in the morning, you know, and then getting all my stuff and then driving 70 miles, get to the station early so I can make sure that whoever I'm relieving doesn't get hit again. And now they're missing their kids going to school.
And when I heard her talk about it first, I was like, that is genius. If we started, for example, just throwing a time out there, not the evening. I hear that conversation, too, because that's, again, not normally coupled with a better work week. But if we went in at midday, that would mean that that responder before their shift wakes up next to their wife or husband or partner, they can have breakfast with their kids, send them off to school. Then they get in their car.
They're not fighting morning traffic. They get to the station. Now, simultaneously, the person they're waiting to relieve, they just got three, four calls after midnight. So rather than the all call waking them up at seven saying, hey, get up. We've got shift change. Get out of your bed. Now, if you want your rigs all checked out, if you need to get an extra couple hours sleep, you can. Now, finally, your relief comes at 12. You go home and now you've got the rest of the day with your family.
So talk to me about your observations at the start time, because I think coupled with a better work week, those two things together would be a force multiplier. Yeah. So first, before we get that, you mentioned the all call or the wake up tone that I don't know necessarily maybe that the history exactly behind that or why it's still being used in some departments.
But that's probably one thing that I would recommend to be eliminated, because if you have especially if it's just to swap or relieve the next group from coming in, let them sleep if they need to sleep. What's a couple more hours? And that way you're driving home or commuting home and maybe your risk of accident decreases a little bit because you've got a couple extra hours of sleep.
OK, so that aside, the shift start time that came from the research that we published of looking day by day or night by night within those two shift schedules. So the 24, 48 and the 48, 96. And basically what we found was the least amount of sleep. And this is in this small population that we looked at or sample that we looked at. The least amount of sleep occurred not at work, but at home. And it was the night before starting a new tour. So factor in their calls and whatnot.
Their least amount of sleep was at home that Sunday night, essentially. That was a little bit shocking because what I had originally thought is that that would be just a fine night, maybe a little bit of rumination or pre-work anxiety, something like that, but not surely not the least amount of sleep. So what we then looked at is on shift sleep and then the commute home, basically. And each commute day was associated with truncated sleep. So short and short and sleep.
And that was due to this particular department starting at 7 a.m. the shift start start time and end time at 7 a.m. So that got a question of if. If or before I get there, looking at their home sleep, I saw a pretty regular wake up time at about 7.30, and on one of the publications it shows exactly. So pretty consistent day one, two and three at home. And then the fourth day was like 5.30 or something like that.
So the question is, what if there was a schedule that allowed or shift start time that allowed for you to wake up or these guys to wake up at 7.30 or 7.30, for example, every day, what would that look like in terms of sleep duration of how much sleep they would they would receive and maybe sleep quality, interruption, sleep efficiency?
Because in general, sleep medicine and circadian science suggests your sleep pattern, your sleep, sleep wake cycle should be consistent throughout throughout any day. So the weekends, weekdays, etc. should be as close as consistent as possible. If that were to happen, then we suspect that sleep would improve greatly. Right now, you got to, of course, minus the calls that they get on at work.
But if they were able to go to bed and wake up at the same time, basically each day, that we hypothesize would lead to better, better outcome, better sleep and then acute and then also chronic health and performance. So we're in a department right now that that is well, that they transition shift schedules as well. And the shift start time from from I think it was eight, eight a.m. to eleven a.m. And so basically factoring in the commute. So if you ask me, like, what is the perfect time?
That's going to be, you know, it depends on the department because you the idea is not to spend two hours in in rush hour traffic commuting. And so now you're just you're you're you're spending more time in traffic versus just waking up early. That's that's you want to try to work around those those particular numbers. But it's whatever time will allow you to get to work and then also wake up that consistent across the day. So we haven't got the results yet on the follow up.
We're we're about to start the follow up process here. But yes, shift start time, I would suspect that that may be equal or greater importance than the actual shift schedule. Now, that's just speculation based on what I've kind of thought about it. But I'm really eager to see this compared to an early morning shift start time, especially those that don't live in the same city or have to commute a great distance to to the fire department.
It would also probably help greatly like those that are on the Kelly schedule. I call the Kelly's the three fours, the on off on off on and in for four days off that nine day tour where they basically go through five days of commuting and commuting before they have some time at home. So those five days got to be just just terrible in terms of sleep duration and then waking up early to to commute back and forth those those those days.
Next question is whether or not a AM or PM start time is maybe a little bit better. That still needs to be kind of teased out in research. And but what I would question is whether or not like that historically. We get a lot more calls during the evening or early evening hours.
So if we're starting an ending and more so that the ending part ending at our busiest time in the day, does that lead to a little bit more of increased accident injury on on the fire ground or in in the response to to emergencies that that that remains a very important question. And so we don't have data yet on that.
Well, I think what's interesting is that when I'm new to this conversation and I love the fact that this is yet another innovation and it's it's free, like you could do it tomorrow in your department for zero dollars. But yeah, but if you think about it again, the evening, because I see some people are we're doing seven p.m. now instead of seven a.m. So you have you're now putting yourself in traffic.
You're now driving home in the dark, especially in winter, you know, these are, as you said, a safety factors. And I remember Alison Brager has been on a couple of times. She come on again. And I remember telling me a story and it was the the guys running special forces selection in the North Carolina mountains and it was the cadre, not not the the people trying to get in. They would run this selection course.
They would be seat deprived and they would drive off the side of a mountain on the way home after running the cadre and get killed or horrendously injured. So, like you said, the the safety of the person getting to work and then getting home from work is all part of this equation as well, which is why you mentioned 11. I think that's that's the perfect like 1112 ish. Most places, even if you're a bit in L.A. I used to live in California for a few years.
And, you know, once you try and navigate traffic at 10 a.m., it's going to be a much different experience than, you know, 7 a.m. So I think that is the sweet spot to me because you leave in the daylight, you drive home in the daylight, you're missing both of the rush hours. You've got enough time to sleep if you've been at the station or stay with your
family until it's time to go. So that to me and again, this is just my perspective, that seems to be the happy medium, the middle part that seems to satisfy all the requirements. Yep. Yeah, I think it's going to come down to the department and the jurisdiction that they're around. So the the idea, I think that so far that I've kind of come up with is not to have too far where they're just kind of not not going to say, you know, someone's just going to be sitting around waiting to go to work.
But you don't want to create a place where maybe now they go out and do a bunch of other stuff before before their work, right, essentially wasting time because no one wants to do that. So if you can have it where it's an ideal, where you wake up with your normal time, have your have your morning, drop off your drop off the kids at work, because basically that's what you're doing on the nights of one through three.
So whatever you do during those nights or mornings, you know, you could do that on your your your your workday in the in the morning and then go go to work. So that will probably be more of a, you know, specific department question and they can run their own study to look at where a person I live, the traffic patterns and so forth, be a pretty easy question to to to answer and what you said at the very beginning, it's it's free.
That's that's one that can have a direct, like immediate effect on sleep for the better. And it's and it's free. So even if a department wanted to pilot that for a week or even with one station, they could do it, you know, have a have a survey go out and see some satisfaction stuff and family satisfaction as well and then implement it at a larger scale. It'd be it'd be a very easy, direct evidence for that department to make an evidence based decision.
Absolutely. All right. I want to hit one more area. Then we'll go to some closing questions. We've talked about start times and shift patterns and some other things. Naps talk to me about the firefighter, the importance of Naps and then the the culture of allowing for Naps. Because, again, I've worked for departments that were totally fine with it. And I've worked for departments where the safety captain would come in with a tick and see if anyone had been watching the television.
You know what I mean? So the whole gamut. So talk to me about your perspective on that. Yeah. And I have seen or been in departments for research that have like no policies whatsoever. You can even be in bed any time that you're not on a call or training. And there's departments that have very formal, rigid sleep and napping policies. Naps in general. Well, in general, firefighters don't get good sleep. So I don't think it would be beneficial to withhold Naps.
What I would say is use Naps responsibly and appropriately. And so timing is important because if you take it basically a big nap at say seven o'clock in the night, that's likely going to disrupt your sleep during your main sleep at night. It probably lead to a greater sleep latency. So the time it takes you to fall asleep. And so you basically be tossing and turning into bed.
If you do that quite often, that's probably going to lead into some bad habits that's going to disrupt your sleep chronically. So timing is important. And then also timing in regards to nap duration. So something that is a very quick, like a catnap or sufficient enough where you pass through the stages of sleep and you're not going to wake up in the deep, deep stage of sleep. That's a little bit more tricky because you don't know when calls are going to come in.
But say if you had that guaranteed 90 minutes, that's typically the time it takes someone to progress through all the cycles of sleep. You can have one cycle of sleep and have the benefits of that restorative nap. But if you need a nap, that means there are symptoms and you're sleepy. And so if you're sleepy, you're at increased risk for injury or accident.
So that should probably be acknowledged and maybe breaking that stigma that if you're tired or you need a nap, that means you're tired and you're under the influence of a little bit of sleep deprivation. So and that's understandable based on calls and shift start times. And so the solution or the bandaid would be a nap. The more permanent solution is kind of what we talked about, maybe shift schedules and shift start time for a department.
I can't remember if I talked about this when we were chatting on the phone, but I had a guy on recently, Jim Poole, who is the CEO of Newcom. And you see ALM, an amazing technology used to be, I've said the story many times on here, but very long story, very short, an incredible neuroscientist, one of the most brilliant people we've had in the States in modern times, spent years trying to figure out the frequency the brain was at during different emotional states.
He figured it out and then figured after another 10 years how to actually get the brain to go into those states. And he created this machine and you put the headphones on and the eye mask and you listen to music, but underneath are these neuro acoustic beats. And it's incredible. But it was only ever in like the Navy SEALs team room and NFL locker rooms and high performers that could afford this machine. Well, smartphones got so incredibly advanced that now it's an app. Any of us can use it.
And I'm I know if you can see, I don't wear wearables. I'm not a big kind of easy button kind of a guy. So I didn't go into this thinking, oh, this is going to be amazing. And hand on my heart is one of the most incredible things. And they have one called Powernap, which is only 20 minutes. And when you put yourself through that and you'll feel yourself almost sink into the ground, it's the bizarre feeling. Time just flies by. But it gives you the equivalent of a couple of hours sleep.
And what I think is beautiful about it, obviously, you could do that in a station in the middle of a shift, but to punctuate the shift before that drive home, having done maybe something horrific during the night with some minivan full of kids or something to be able to say, all right, shift is over. I'm going back into father, husband, whatever mode. That is another incredible tour. A lot of people haven't heard about it, but it's amazing.
And it does give this kind of restorative sleep element as well. And there's longer programs. So when you get home, you can't actually get to sleep. You can set that for an hour and it will take you on a basically an involuntary version of a kind of sleep. So even if your mind is spinning, it's still you don't have a choice. You're going for that ride anyway. And then an hour later, you're like, well, I felt like that was five minutes and now you've had this effect.
So that's an amazing technology that people need to know about. Interesting. Yeah, I am not familiar with that, but I will definitely look at it. Because, like you said, especially if it helps you unwind. Because I mean, I have data that shows when they get back from a call or it probably depends on the type of call that one particular participant had two hours sleep latency, they were tossed and turning for two hours to try to get back to sleep, and that was just after one call.
And so if you have two of those, I mean, that could just be further. And so when during this typical eight hour period, now half of it is just tossing and turning, and so that could definitely lead into some serious issues. So anything that helps wind down and relax and go into a quick sleep versus either a nap or actual sleep could be a huge benefit. I'll have to check it out.
But I was just going to also mention for that sleep, the FEMA sleep deprivation report, part of the early career grant that I have right now, we will be having a lot of. Guidance for for departments and they'll have various levels from fire administration to health and safety officer, station officer, and the of course, the individual firefighter.
So concepts of such as the maps and having a little bit more formal guidance on that with with backed by research and hopefully data will see or it'll be kind of a first guidance report for firefighters in terms of optimizing and improving sleep health. Beautiful. Well, before I go to the closing questions, you and I are going to be in Orlando and I'm going to get this right, the Florida Fire Chiefs Conference. And we're there with the safety and the Florida Safety and Wellness Collaborative.
I think I've got that right. So we're going to be doing a panel on 24 72 with three of my guests that are all here have either gone to it or about to go to it in Pasco County's case. So talk to me about that conference and let people know what we'll be doing. Yeah, so I will have a presentation based on all my research that I've done so far on sleep, it kind of give you a or the audience a state of science sleep update.
And so everything that we've done from here and then maybe some highlights of the current projects that we have ongoing as well as some preliminary data for for those projects, then shortly after there, I believe we will get into our panel discussion. And so as James mentioned, we'll have a panel of some excellent individuals and be moderated by you. So I'm looking forward to those questions and participating to a lively conversation. Absolutely. And that will be recorded.
I made sure that it was going to be video so that we can share it with everyone. It's not there. Excellent. Brilliant. All right. Well, the first of the closing questions, is there a book or other books that you love to recommend? It can be related to our discussion today or completely unrelated. Any particular books for maybe the curious firefighter, whoever, any books? OK, I generally don't read like like fiction, nonfiction, like, like, you know, fun books.
I may be more of the on the nerd side. I read textbooks. So that's that's my area. But if those that are interested in like sleep and heavy sleep, the centrals of sleep practices and sleep medicine textbooks are are they're they're thick, they're dense, they're heavy, but they have a lot of information. If you want something a little bit more lighthearted fun. And I think you've recommended this book before, but it's by, you know, Matthew Walker, Why We Sleep. That's a that's a great book.
It's it's it's funny and it kind of mixes the serious with the jokes and drives that point point across. Beautiful. What about films and documentaries? Films right now, I'm into scary movies or horror movies with the the upcoming, you know, Halloween holiday, always big into Halloween and horror movies. I don't have any particular favorites. I really just like a lot and various types of horror movies.
So I don't I don't think I have any any particular one to recommend, though I though I am curious about the new Beetlejuice coming out. So I went to see it the other day. It was good. Oh, did you? Yeah. Good. That's a good throwback. What about do you like the the kind of ghosty ones like the Japanese ones or are you more of a slasher person? I do like the slasher jump scares are are I think X good. I mean, more of the you know, the kind of probably the corny, scary movies, I guess. Gotcha.
All right. Well, then the next question, is there a person that you recommend to come on this podcast as a guest to speak to the first responders, military and associated professionals of the world? Hmm. Actually, I think it'd be kind of cool maybe to do a duo with Sarah and I going back and forth, that'd be a question. If not, I think you've had Sarah Jenke on your on your show before. Right. Yeah. No, but I'm doing that now.
Actually, I'm getting Alison Brager and Rachel Markwell done such as Alison's the army sleep expert and Rachel's the Navy's. So they're coming on together. So that's a new thing that I've started doing now is bringing two guests on together. So we'll definitely do that down the road. Oh, neat. Yeah. Or do a whole panel on sleep. That'd be that'd be kind of interesting as well.
Absolutely. Brilliant. All right. Well, then the very last question, before we make sure where people can find you and the studies, what do you do to decompress? I like so I have a dog. He's a he's a Siberian Husky German Shepherd. So we like to walk. I roll a blade with them, bike ride with them. A lot of stuff outdoors. And right now is. I'd say probably that if there's a perfect time in Oklahoma to be outdoors, like now is the is the time our fall last probably two weeks.
And so I think we're right in the middle of it. So anything outdoors I like to do to help decompress and get out of house, especially as a remote employee, it getting out and experiencing the outdoors is important. How far are you from Tulsa? About an hour and 15 minutes and same with the city. So we're right in basically right in the middle. Brilliant, because I'm actually running a marathon. I forget what it's called now. Route 66 marathon.
There's a previous guest of mine who was a paramedic and her EMT partner tried to murder her, which is terrifying. And she survived the murder attempt. He shot her and he beat her and it was horrendous. But she does five K's and she's done some marathons. And a lot of it will be in the chair. But I've never run a marathon before. And she asked me if I'd run with her. So I'm going to be there in November. So I'm curious about the weather. I'm going to be experiencing taking Bonnie.
Oh, well, if it blows from the south, it's going to be warm. If it comes from Kansas, it's going to be cold. That's the best advice I can give you. But you mentioned Tulsa. Tulsa is where that's the department for my early career study, which will be starting probably in January. OK, excellent. All right. Well, then for people listening, if they want to reach out to you or if they want to read some of the studies or go to the website that you created, where are the best places online?
Yeah. So if you want any of the research studies, you could probably find them online. But if you can't, you just just email me. I'm pretty quick at getting back. So it's Joel Billings at ERAU.edu. I do have a website called FDSleep.com. So firedepartment.sleep.com. And that has an offer just a bunch of research and literature that I've been unable to find some updates on studies because I get quite a few interests and inquiries from people.
So I try to put it all together for people that want to learn a little bit more about sleep and what you can do to improve sleep. Brilliant. Well, I want to thank you so much. It's been such an interesting conversation, a very different perspective. I mean, Sarah obviously was in a firefighter family. You actually wore the uniform for a while and now you both find yourself in the research space.
So I want to thank you so much for being so generous with your time and coming on the Behind the Shield podcast today. Oh, not a problem. Glad to be here. And this is my first podcast ever. So I hope I delivered.