New Hope in Fighting Fatigue as a Cause of Work Injury

Michelle Hopkins

Hard time functioning

Fatigue is more than momentary tiredness. It is a condition of physical, mental, and emotional weariness, and it can result from multiple factors including time awake, time of day, workload, prolonged anxiety, harsh environment, and sleep deprivation. Employees with fatigue lack the capacity and energy to do their work. They are vulnerable to dangerous errors and injuries, slow reaction time, and reduced alertness. Most often, they are unable to bounce back after a good night’s sleep. In fact, fatigue often comes with an inability to go to sleep, unlike sleepiness.1,2

Fatigue is serious, with a cost to the economy estimated at $400 billion annually.3 From seven to 45 percent of employees have work-related fatigue, depending on the measurement instrument used. When employees in safety-sensitive industries are fatigued, the risk expands to the public. “Fatigue accounts for about 20 to 30 percent of all road accidents and 5 to 15 percent of fatal road accidents,” researchers have concluded.4 In addition to energy, alertness, and reaction time, an employee’s concentration, motor function, memory and information processing, communication, mood, and motivation are all affected, making an employer’s workforce a shadow of what it should be.

But there is new hope on the horizon as technology innovations – such as “smart” personal protective equipment (PPE) and intelligent vehicles that issue a fatigue warning to the driver – are gaining more traction. Newly energized interest in fatigue and technology-based solutions is seen as a silver lining of the COVID-19 pandemic. A global market analysis says COVID-19 will spur accelerated growth in smart PPE, and projects market growth of $2.55 billion from 2020 to 2024.5

Fatigue increases injury risk

Fatigue is not just a problem behind the wheel of a moving vehicle. All employees with sleep problems have a 1.62 times higher risk of being injured than other employees, based on a meta-analysis of 27 studies with 268,332 participants.6

Recently, the National Safety Council (NSC) began encouraging employers to add fatigue to their definition of “workplace impairment” in company policies and procedures. (Substance use is a more traditionally recognized impairment factor.)7 Survey results revealed at the virtual 2021 National Safety Council Safety Congress and Expo show that approximately 77 percent of employers are currently concerned about the impact fatigue has on workforce fitness for duty.8

The NSC released a major report on fatigue in 2018, called, “Fatigue in Safety-Critical Industries: Impact, Risks, and Recommendations.” The report enumerated several of the leading risk factors in work-related fatigue.9 They included:

  • Shift work – night shifts, early morning, rotating and irregular shifts, disruption of the body clock
  • Long weeks – working more than 50 hours per week
  • No rest breaks during the shift
  • Quick shift returns – employees need at least 12 hours between shifts
  • High-risk hours – working at night, working in the morning, working infrequently
  • Sleep loss – getting less than 7 to 9 hours of sleep
  • Long shifts – working 10 or more consecutive hours
  • Demanding jobs – work that requires sustained attention or is physically or cognitively demanding
  • Long commutes – driving more than 30 minutes each way

These factors are important considerations in highly physical and/or safety-sensitive industries, such as oil and gas extraction, construction, transportation, and manufacturing. Let’s look at leading fatigue drivers in each of these industries.

Long commutes in the oil and gas industry

A National Institute for Occupational Safety and Health (NIOSH) fact sheet describes an all-too-common reality in this industry: “Oil and gas workers drive long distances from their homes, lodging sites, and equipment yards to reach well sites that are often in remote areas. The combination of long trips with long shifts can result in fatigue. Fatigued driving is a major cause of crashes in this industry. Crashes are the leading cause of death for oil and gas extraction workers.”10

Oil and Gas Industry Safety, an eBook produced by Industrial Safety and Hygiene News, supports the conclusion that many of the industry’s vehicle accidents are fatigue-related when it says, “A NIOSH study found that 56 percent of fatal traffic accidents among oil workers involved only one vehicle.11

A jolt of caffeine or a rush of wind on the face cannot force alertness. Employees need at least nine hours of sleep each day and time for rest and relaxation, NIOSH says.12

Driving at hours that don’t align with the body’s natural circadian rhythms of sleep/wakefulness, monotonous driving or routines, length of time awake, and certain medications and health conditions increase the risk of fatigued driving, according to NIOSH.13

In construction, demanding work and fast-paced projects lead to fatigue

The need to repair and modernize infrastructure in the United States is a leading policy issue in 2021. The new infrastructure plan is expected to boost construction activity but it could boost employee fatigue, as well. Frequently, highway construction projects run on compressed schedules so they can be completed rapidly to limit interference to traffic and communities. Such schedules may create high-stress environments for construction employees, who may work extended work shifts through the night. This can produce both cognitive fatigue from long periods of mental concentration and focus, as well as muscle fatigue from repetitive use of certain muscle groups.14 Of course, fast-paced project deadlines contribute to these same fatigue risks in commercial and residential building construction.

“Demanding jobs” was the leading reason for fatigue cited by 77 percent of construction employees in the NSC survey in 2018. This was followed by high-risk hours and long commutes (each, 46 percent).15 Other contributors to fatigue were very hot or cold working conditions, extreme concentration needed, such as to operate heavy equipment, poor sleep quality, unhealthy eating habits, substance use, and certain medications.

Fatigue, a high-visibility concern in transportation

Ninety-seven percent of employers in the transportation industry are concerned about fatigue as a safety risk. This level of awareness is higher than in any other safety-critical industry, according to the NSC report in 2018.16

“With more Americans reporting being sleep deprived over the past three decades, and with fatigue implicated in 20 percent or more of transportation accidents, identifying and mitigating the risk of fatigue in transportation operators is more important than ever,” says Anne-Marie Puricelli, MD, JD, national medical director of transportation for Concentra.17,18

In 2020, a fleet operator launched a program using the Trucking Fatigue Meter, a technology funded by the Federal Motor Carrier Safety Administration (FMCSA), designed to give drivers feedback on their fatigue status in near real-time. A 32 percent increase in driver fatigue was observed, which the fleet operator attributed to a coincident action: In response to demands of the COVID-19 pandemic, the FMCSA had relaxed hours of service (HOS) regulations in transportation.19

Employees in transportation listed their three top fatigue-related concerns as demanding jobs (86 percent), high-risk hours (64 percent), and sleep loss (48 percent) in the 2018 NSC Report on Fatigue.

Fatigue mounts with manufacturing job demands

The pandemic rapidly accelerated operations in some manufacturing businesses, while also causing widespread layoffs in others and subsequently shifting workload to the remaining employees – all without an ability to gradually and effectively manage workload demands. The result was long hours and employee fatigue.20

In the 2018 NSC Report on Fatigue, manufacturing employees said demanding jobs led to fatigue most often (86 percent), followed distantly by sleep loss (46 percent), and high-risk hours (45 percent).

A call to action for employers

As business operations begin to return to normal, it’s not safe to assume employee fatigue will recede as a work-related safety concern or that fatigued employees will be able to solve the problem on their own.

“Although sleep is part of the triad of wellness (along with exercise and nutrition), talking about sleep is not part of the routine conversation between a physician and patient. Fewer than one percent of the histories taken by (family) doctors during routine exams even include a mention of sleep,” says Maja Jurisic, MD, vice president, Concentra medical director, strategic accounts.21 However, occupational medicine is different. Occupational health care professionals spend their days immersed in the effects of work on health and the effects of health on work. They are well aware of the role fatigue plays in work performance and workforce health.

Get started with Concentra occupational health care.

1   Medical Definition of Fatigue. MedicineNet.    
2   Sadeghniiat-Haghighi K, Yazdi Z. Fatigue management in the workplace. Industrial Psychiatry Journal. 2015; 24(1):12-17.
3   Address Employee Fatigue Immediately. The Campbell Institute of the National Safety Council.. 
4   Sadeghniiat-Haghighi K.  
5   Analysis of COVID-19 Impact – Smart Personal Protective Equipment Market 2020-2024 – Focus on Worker’s Safety to Boost Growth. Technavio. July 8, 2020.  
6   Uehli K, Mehta AJ, Miedinger D, et al. Sleep problems and work injuries: a systematic review and meta-analysis. Sleep medicine reviews. 2014; 18(1): 61-73.  
7   NSC Expands Definition of Workplace Impairment. Electrical Contractor. March 2021.     
8   Don’t ignore safety risks of on-the-job fatigue: NSC. Business Insurance. March 4, 2021. 
9   Fatigue in Safety-Critical Industries: Impact, Risks, and Recommendations. National Safety Council. 2018. NSC Report on Fatigue
10  Fact Sheet. Oil and Gas Workers: How to Prevent Fatigued Driving at Work. National Institute of Occupational Safety and Health.  
11  Oil and Gas Industry Safety. Industrial Safety & Hygiene News.
12  Oil and Gas Industry Safety. Industrial Safety & Hygiene News.
13  Oil and Gas Industry Safety. Industrial Safety & Hygiene News. 
14  Worker Fatigue: Managing Concerns in Rapid Renewal Highway Construction Projects. Electronic Library of Construction Occupational Safety and Health. 2010. 
15  Fatigue in Safety-Critical Industries. NSC Report on Fatigue
16  Fatigue in Safety-Critical Industries. NSC Report on Fatigue
17  Insufficient sleep is a public health epidemic. American Sleep Apnea Association. /   
18  Reduce Fatigue-Related Accidents. National Transportation Safety Board.  
19  FMCSA helps bankroll Trucking Fatigue Meter. Trucking Truth. September 2, 2020.  
20  Workplace Fatigue in Manufacturing: Best Practices for Minimizing Risk. Shiftboard.  
21  Effects of Shift Work: The Danger of Not Getting Enough Sleep. January 20, 2017.