Published In

BMJ Public Health

Document Type

Article

Publication Date

8-2-2025

Subjects

Work -- Psychological aspects -- Firefighters

Abstract

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.

Rights

Copyright (c) 2025 The Authors

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

DOI

10.1136/bmjph-2024-002427

Persistent Identifier

https://archives.pdx.edu/ds/psu/44067

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