Scientific Reports

Fatigue Risk Management for First Responders: State of Knowledge

Abstract / Description

Objective for CSSP-2018-CP-2366

Our objective is to develop a consensus-based, evidence-informed national Standard on First Responder Workplace Fatigue Risk Management that will provide an approach to systematically prevent and manage workplace fatigue by addressing it in a strategic, coordinated approach, and as part of a broad organizational management framework.

How this milestone supports the objective for CSSP-2018-CP-2366

This milestone will contribute to the development of a Seeds Document that will be used to develop a national Standard, in accordance with CSA Groups’ accredited standards development process. This report describes the “Research and Synthesis of Evidence” phase, specifically a scoping review of peer-reviewed literature to provide current state-of-the-art scientific knowledge in first responder workplace fatigue risk management. The objective of this scoping review was to broadly identify relevant research pertaining to fatigue risk management and synthesize the research to inform aspects of risk management model known as the RACE model (recognize hazards, assess risks, implement controls, and evaluate effectiveness of controls) that will be integrated into a broader management system framework using Plan-Do-Check-Act (PDCA).
Background

First responders are at high risk of suffering from decrements in neurocognitive and physical performance related to fatigue. Such performance decrements endanger not only the personal health and safety of these responders but also the health and safety of their fellow responders and the public they serve. Fatigue may also be a precursor to adverse longer-term outcomes, such as musculoskeletal disorders, cardiovascular disease, and mental health disorders. Appropriate management, policymaking, standards, guidance, and research activities can reduce the exposure to these fatigue-related risks and hazards before they pose significant problems during emergency response operations.

Methods

We conducted a scoping review to examine the extent, range, and nature of research activity, allowing us to identify gaps in the current literature. A scoping review consists of five stages: 1) identifying the pertinent research question(s), 2) searching the relevant studies, 3) selecting studies, 4) charting the data, 5) summarizing and reporting the results. Due to the multifaceted nature of fatigue, we adopted an integrative approach focusing on cognitive fatigue (i.e., sleepiness, arousal, attention, cognitive overload/underload), physical fatigue (i.e., muscular fatigue, central/peripheral fatigue), perceptual fatigue (i.e., visual fatigue), emotional fatigue (i.e., compassion fatigue), and burnout. We were guided by the following questions:

In EMS, Firefighting, and Law Enforcement, how are hazards of fatigue identified?
In EMS, Firefighting, and Law Enforcement, how do organizations and personnel assess the risk of fatigue?
In EMS, Firefighting and Law Enforcement, what control actions or interventions are available to reduce fatigue?
In EMS, Firefighting and Law Enforcement, what are valid and reliable instruments for measuring or detecting fatigue among personnel?

General Findings

Our comprehensive literature search strategy resulted in a total of 403 relevant articles that met our inclusion criteria. We found that the focus on the type of fatigue differed between the three first responder occupations; the distribution of papers based on risk factor sub-categories and interventions also differed between occupations.

38.7% focused on firefighting, 33.3% on police, and 22.8% on EMS work, 5.2% of articles focused on a combination of the three occupations.

Cognitive fatigue most represented in EMS research (45 articles) and Police research (88 articles).

Physical fatigue most represented in firefighting research (116 articles).

Personal/social/cultural (20 articles) and work organization (17 articles) fatigue risk factors were frequently cited in EMS research. Work organization (47 articles) and personal/social/cultural (36 articles) risk factors were common in police research. There was a consistent distribution of articles representing all four risk factor sub-categories in firefighting research.

We identified potential fatigue-related outcomes into three outcome sub-categories. In both firefighting and police, physical health were most frequently identified. There was a consistent distribution of the number of articles among outcome sub-categories in EMS research.

The primary type of intervention or risk control strategy in EMS research was engineered solutions (7 articles). In firefighting, 18 articles focused on PPE and 17 articles on engineered solutions. In police research, the most frequently cited intervention was training (12 articles).

Fatigue Measurement & Risk Assessment Tools

Tools ranged from self-reported instruments and surveys to objective measures. The Maslach Burnout Inventory was the primary tool of choice when measuring burnout; Schaufeli et al.’s (2001) study recommends using both the Maslach Burnout Inventory and the Malach-Pines Burnout Measure to balance both sensitivity and specificity. Surveys instruments were common to measure cognitive fatigue, including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Chalder Fatigue Questionnaire; however, there is a lack of information on the sensitivity and specificity of these instruments. Objective measures of cognitive fatigue including heart rate, critical flicker fusion frequency, psychomotor vigilance task, oculomotor behaviour, polysomnography, and actigraphy have all been employed. These measures remain elusive in large-scale studies due to cost, practicality, and efficiency. Physical fatigue measures include heart rate as an index of physiological strain and metabolic rate, Borg’s Rating of Perceived Exertion (RPE) as a psychophysical scale for physical strain, and observational risk assessment tools to assess musculoskeletal disorder risk. Further investigations are warranted to evaluate sensitivity and specificity of these tools.

Fatigue & Outcome Relationships in First Responder Occupations
We identified 22 papers that linked risk factors, fatigue type, and outcome. Cognitive fatigue was cited as the most acknowledged type of fatigue linked to health (injury, accident risk, musculoskeletal disorders, cardiovascular disease), wellness (depression, anxiety, dissatisfaction), and work performance. Increasing fatigue generally led to adverse outcomes, however 15 of the retained articles were cross-sectional studies, limiting our interpretation of causality.

Fatigue Management Interventions Identified in First Responder Occupations

We identified interventions and controls based on the Hierarchy of Controls (NIOSH, 2015). In all three occupations, training was the most common type of intervention to mitigate burnout. PPE and engineering controls were most common in combating physical fatigue. There was a stronger focus on administrative and training controls to reduce cognitive fatigue. No single intervention was supported by overwhelming evidence, but we found limited support for stretcher design, predictive capacity testing, self-contained breathing apparatus (SCBA) design (material and shape), and mindfulness-based resilience training. Articles indicate that changes to protective clothing, to reduce physical demands and fatigue, were not effective solutions in firefighting work.

Conclusion

The scoping review provides insight towards the extent, impact, and management of fatigue based on a broad range of fatigue types for first responder occupations. Categorizing by fatigue type might be useful in targeting appropriate controls and focus future research investigations. In all three occupations, burnout, cognitive fatigue, and physical fatigue were associated with adverse health and performance effects; these results highlight the importance of managing fatigue, of any type, to prevent longer term outcomes. Although a range of measurement tools have been identified in the peer-reviewed literature, future investigations are needed to identify tools specific to first responder occupations and information on the sensitivity and specificity of these instruments. No single interventions were supported by overwhelming evidence; high quality research, including randomized control trials, may help identify and inform effective risk mitigation strategies for first responders.

ACCESSIBLE SKILLED TRADES: INCLUSIVE AND ACCESSIBLE SKILLED TRADES EMPLOYMENT FOR PEOPLE WITH DISABILITIES

Introduction Skilled trades are fundamental to the functioning and growth of Canada’s economy. Workers in trades occupations build infrastructure, maintain essential services, and support industries ranging from construction and manufacturing to transportation and service sec tors. The skilled trades may represent a promising pathway toward equitable employment outcomes for persons with disabilities. Skilled trades careers can provide stable employment, strong earnings potential, and opportunities for advancement. Despite this potential, persons with disabilities remain underrepresented in skilled trades occupations. Research across sectors has documented discrimination in hiring practices, limited opportunities for advancement, and insufficient knowledge among employers regarding disability accommodation. Individuals with disabilities frequently report encountering stigma, aesthetic bias, and skepticism about their productivity or qualifications. In skilled trades environments, these barriers are often amplified by the nature of work tasks and workplace cultures. Trades workplaces often prioritize physical performance, technical skill, and productivity, which can shape assumptions about workers’ abilities and influence access to opportunities. This report addresses knowledge gaps by examining accessibility in skilled trades from multiple complementary perspectives: workers, employers, and previous scientific studies. The projects presented in this report explore employer readiness to accommodate workers with disabilities, the availability of assistive devices, technologies and workplace support solutions, and the lived experiences of persons with disabilities navigating skilled trades employment pathways. Studies contained in this report employ complementary mixed-methods, including phenomenological interviewing, surveys, scoping reviews and environmental scans. Collectively, these findings have direct implications for the development of accessibility standards that reflect the operational, cultural, and safety realities of skilled trades environments. Summary of Findings The research in this report converges on a clear message: persons with disabilities are a significant, underutilized talent pool for Canada’s skilled trades, yet face layered structural, cultural, training, and equipment barriers. Practical, scalable solutions, particularly in training design, PPE and procurement, accommodation pathways, and employer readiness, can meaningfully improve sector entry, safety, and retention. Participation & Risk Persons with disabilities represent about 20% of apprenticeship populations, but remain underrepresented in the broader trades workforce and advancement pathways, across a variety of sources. Apprentices with disabilities reported lower occupational health and safety knowledge, higher likelihood of severe injury, and more chronic and short-term pain, suggesting a preventable gap in training efficacy and workplace controls. Structural & Cultural Barriers Structural obstacles, such as administrative complexity, inconsistent accommodation processes, and certification challenges, limit both access and progression within trades. Cultural dynamics, especially stigma, “old boys’ club” norms, and misconceptions about visible and nonvisible disabilities, shape whether workers disclose, request support, or remain in skilled trades careers. Although participants bring strengths (e.g., problem solving, hyperfocus), deficit-based assumptions often over-shadowed these assets. Disclosure is strategic: workers weigh safety, trust, and anticipated stigma, highlighting the need for transparent, psychologically safe pathways to share their disability. Training & Learning Preferences Hands-on learning was broadly preferred. Apprentices with disabilities consistently recommend accommodations across three themes: learning style, resources, and physical accommodations. PPE Design PPE issues cluster around fit, function, comfort, and sensory load. Poorly designed or ill-fitting PPE can compound disability-related needs and create compatibility conflicts with assistive devices. Employer Readiness & Accommodations Many companies reported being insufficiently prepared to accommodate several impairment types; readiness was lowest for vision and mobility impairments. Construction firms were less prepared than other sectors to accommodate mobility and hearing impairments. Company size matters. Larger organizations showed greater preparedness for mobility and learning-related accommodations, suggesting a resource and capacity gradient. Assistive Technologies & Workplace Solutions Evidence scans show a disproportionate focus on physical impairments, with limited solutions for vision, hearing, and cognitive, needs, where many employers felt least prepared Employers’ awareness and integration of assistive technologies into disability management remain uneven; alignment between solutions and trade-specific tasks or functional demands is critical for adoption and impact. Implications and Next Steps Across all recommendations, a consistent theme emerges: without trade-specific standards, implementation becomes discretionary, inconsistent, and vulnerable to dilution. Employers may struggle to interpret their obligations, workers may experience uneven access to supports, and accountability mechanisms may remain weak. Therefore, trade specific standardization is not merely desirable; it is essential to achieving the objectives of accessibility legislation and ensuring that standards result in real, measurable change in skilled trades workplaces. Conclusions These findings underscore an urgent need to move beyond generalized approaches to accessibility and toward standards that reflect the unique cultures, tasks, and safety realities of skilled trades work. Persistent cultural exclusion, inconsistent employment practices, complex disclosure dynamics, and uneven accommodation access reveal systems that remain misaligned with the lived experiences of workers with disabilities. By applying these findings to standards, Accessibility Standards Canada has a critical opportunity to lead this shift by advancing trade-specific accessibility standards that translate high-level principles into actionable, practical guidance. Without such specificity, implementation risks being fragmented and ineffective. With it, Canada can meaningfully expand equitable participation in the skilled trades, strengthen workforce resilience, and build inclusive trades systems capable of meeting the country’s future social and economic needs. View French Publication

Scientific Reports 2025

The Level of Perceived Occupational Health and Safety Knowledge in Skilled Trades Apprentices: Impact, Influencing factors, and Learning Preferences

Introduction Canada’s skilled trades shortage has negatively impacted organizations and consumers and has cost billions of dollars from healthcare expenditure and productivity loss. This issue is compounded by the high risk of disabling injury to workers in the skilled trades, particularly apprentices. While occupational health and safety (OHS) training may improve health and safety outcomes in theory, we must emphasize the appropriate delivery of OHS content to better suit skilled trades apprentices. It may be possible to maximize the impact of OHS training by first understanding how apprentices perceive their current training. The findings presented in this study improves on the current understanding of the potential links between a skilled trades apprentice’s perceptions and preferences of their OHS training, and their injury outcomes. Through effective delivery of OHS training, including considerations of apprentice preferences, we may be able to maximize the retention of health and safety information and contribute towards the development of a safer workforce. Objectives We aim to explore the relationships between a skilled trades apprentice's perception of their OHS knowledge and their self-reported physical and cognitive demands. This report also aims to explore the relationship between a skilled trades apprentice's self-reported functional limitations and their knowledge acquisition. Finally, we seek a better understanding of an apprentice’s preferred delivery method when learning about OHS. Key Findings An apprentice with a lower self-perception of their OHS knowledge was also more likely to report a negative OHS outcome. Inexperienced apprentices that have a lower self perceived knowledge in their OHS training were also more likely to report that they had sustained an injury over a 12-month period. There were also relationships between an apprentice’s self-perceived knowledge of health and safety, and the self-reporting of feeling burned out and overwhelmed. The program release type, age, and level of an apprentice influenced their perceived OHS confidence and subsequent relationship with injury and pain self reporting. Day release apprentices were 1.5 times more likely to self-report an injury, while younger apprentices perceived themselves as more confident than older apprentices but were twice as likely to self-report an injury. Older apprentices, while less likely to self-report an injury, were 1.24 times more likely to report non-injury related body pain. There was a greater self-reporting of cognitive functional limitations compared to physical functional limitations (e.g. walking). While apprentices with these functional limitations overall perceived that they were unaffected by them, trends indicated that these apprentices perceived themselves as less likely to be able to manage their own safety, and the safety of their coworkers. This may indicate that apprentices with functional limitations may not be fully aware of the underlying impacts of their functional limitations on their work ability, including their ability to implement their OHS training. Hands-on training was overwhelmingly preferred by apprentices as a means of improving the retention of information and improving the situational awareness that would otherwise be underdeveloped through traditional classroom lectures. A combination of receiving foundational OHS training through their apprenticeship training and workplace specific OHS training from the employer may improve an apprentice’s ability to identify and manage OHS hazards. Practical Implications We may be able to improve an apprentice’s OSH outcomes by improving their confidence in their OSH training. However, a confident apprentice is not necessarily a safe apprentice, as that confidence must be proportional to their OHS knowledge. Apprentices will benefit from receiving hands-on OHS training that is directly aligned with the most relevant workplace hazards. This requires that the apprentice receive not only foundational OHS knowledge in the classroom, but also more specific, situationally relevant training from their employer. If implemented correctly, OHS training may facilitate a reduction in workplace injuries and MSD development through the application of well-retained and relevant OHS knowledge.

Scientific Reports 2025

Landscape of Experiential Learning Technologies for Teaching Occupational Health and Safety in Skilled Trades

Background and Objective Injuries and illnesses among skilled trades professions accounted for over 25% of all workers’ compensation claims in Ontario between 2015 and 2020. Ensuring that skilled trade professionals are equipped with the relevant occupational safety and health (OSH) knowledge, skills, and abilities is critical in mitigating occupational risks and reducing injuries. Low engagement during OSH training has been the primary reason for low retention of OSH-related knowledge; thus, skilled trade professionals and trainees must receive effective and engaging OSH training to ensure that the knowledge is learned, retained, and applied. Experiential learning technologies (ELTs) (e.g., immersive virtual reality (VR) experiences, simulators, and interactive and serious games) can increase engagement, and knowledge and skills retention when compared to traditional classroom PowerPoint lectures. Given that ELTs may be a powerful tool for teaching OSH, we aim to build an ELT toolbox to support OSH training in the skilled trades. As a first step in developing an ELT toolbox, we conducted an environmental scan to better understand the existing OSH-related ELTs that are commercially available for trainees and professionals working in the skilled trades. Methods A systematic web-based search was performed to obtain existing commercially available OSH-related ELTs for the skilled trades; snowballing technique was applied to identify additional results. Key information was extracted from each relevant ELT, including the description of the ELT and its intended occupation, the tasks performed in the ELT, and the OSH topics taught. Software developers who only offered customized ELT solutions were also documented. Key Findings ➢ 288 off-the-shelf OSH-related ELTs for skilled trade occupations were identified. Over 50 complimentary ELTs (nearly 20%) can be delivered via highly accessible platforms such as desktops or smartphones. ➢ 85 unique off-the-shelf ELT developers/distributors were identified. 65% of the off-the-shelf ELT developers’/distributors’ headquarters were in the USA; 11% were in Canada. More ELTs need to be developed in Canada or have options to be customized to Canadian safety laws and regulations. ➢ 10 different types of delivery mechanisms for OSH-related ELTs emerged. Most of the ELTs are delivered through VR headsets, meaning that, if trainees have access to a VR headset, they can access a vast library of OSH-related ELTs. ➢ 96 unique topic areas were identified. Thirteen topics were relevant to general skilled trades, 3 were relevant to the service sector, 3 for the automotive sector, 32 for the industrial sector, and 45 for the construction sector. Many of the ELTs identified were relevant to acute injury prevention while few focused on the chronic and long-term consequences of hazardous exposures. ELTs designed for trade-specific occupations (n=192) often focused on the safe work processes and practices of a given task (e.g., painting, welding, machine operations, gas leak inspection) with the integration of OSH concepts. ➢ 42 software developers who only offered customized ELT solutions were identified.