FATIGUE RISK MANAGEMENT - Rail Safeworking Solutions

FATIGUE RISK MANAGEMENTInformation Booklet for Employees & Contractors

Effective management of fatigue-related risks is a primary concern of Metro Trains Melbourne (Metro), in order to protect the safety of our employees, customers and other stakeholders affected by our rail operations. Metro recognises that many different roles and tasks, including shift work, are needed to meet our operational requirements. Managing fatigue is a joint responsibility and requires the commitment of both Metro and its employees. A comprehensive fatigue risk management system (FRMS) has been implemented at Metro to manage the fatigue risks associated with our operations, including the provision of information about fatigue and how it can be managed.

This booklet has been designed to accompany the Fatigue Risk Management Training Program for Metro employees and contractors. It includes information about the causes and consequences of fatigue and what you can do to minimise and manage fatigue-related risks. It also contains activities to be completed during the training, which will form a personal fatigue management action plan.

INTRODUCTION

Metro Trains Melbourne 1

In fact, research has shown that after being awake for 17 hours, your performance is typically impaired to a similar level as having a blood alcohol content (BAC) of 0.05%. After being awake for 24 hours, your performance is about the same as if you had a BAC of 0.10%. And these figures are based on people who were well-rested and not already carrying a ‘sleep debt’!

One of the effects of fatigue that makes fatigue management particularly challenging is a kind of ‘blind spot’ – as you become more fatigued, you become less able to accurately identify your level of impairment – again a bit like alcohol!

But, unlike alcohol, there is currently no simple, objective test for fatigue.

OTHER WORK FACTORS THAT CONTRIBUTE TO FATIGUE

PERSONAL FACTORS THAT CONTRIBUTE TO FATIGUE

• Night shifts

• Early morning shifts

• Long shifts

• Harsh environmental factors (e.g. cold, heat, noise, wind)

• Inadequate rest breaks during a shift

• Unpredictable roster patterns

• ‘On-call’ work

• Not prioritising sleep

• Other commitments (e.g. family responsibilities, second jobs)

• Poor physical or mental health

• Using alcohol or other drugs, including some prescription medications

• Poor diet, being dehydrated and not being physically fit

• Undiagnosed or untreated sleep disorders

• Long commuting times

WHAT IS FATIGUE?

• Acute fatigue can be experienced after just one poor sleep, while chronic fatigue builds up over time when people regularly do not get enough good quality sleep.

• Another common cause of fatigue is our body clock, which controls our daily rhythms of sleepiness and alertness.

• Workload can also contribute to fatigue, with increased fatigue associated with physical or mental workloads that are either too demanding or too boring.

Both work-related and personal fatigue risk factors must be managed.

Fatigue is more than just feeling tired – it is a state of impairment, like being impaired by alcohol or other drugs. Fatigue is associated with reduced alertness and performance, and an increased risk of errors.

CAUSES OF FATIGUE

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CONSEQUENCES OF FATIGUE

If you have a 4-second microsleep while driving at 100km/h, you will have traveled 111 metres not in conscious control of your vehicle!

When fatigue reaches a critical level, sleep will force itself upon you in the form of microsleeps - brief, involuntary episodes of sleep (or lapses in attention), that can last from a fraction of a second to several minutes.

You can’t tell when you are about to have a microsleep and people often don’t even know they’ve had one because their eyes remain open.

MICROSLEEPS

Specifically, the consequences of fatigue include:

• Mood changes — you may feel more irritable and find it difficult to control your emotions. This can make you less communicative about how you are feeling, and could lead to increased risk-taking behaviours.

• Reduced alertness and mental performance — as you become more fatigued, your concentration, vigilance, information processing, judgement, decision-making and situational awareness levels decline. This can lead to you making errors/mistakes.

• Reduced physical performance — hand-eye coordination, reaction time and physical strength may decline as you become more fatigued, increasing the potential for accidents.

• Microsleeps — brief, involuntary episodes of sleep or lapses in attention.

When you are fatigued, parts of your brain will start to shut down - typically the first areas affected are those that control functions like alertness, mood and mental performance, followed by the physical effects and, eventually, microsleeps.


Drivers who cause a fatigue-related crash can be prosecuted.

An estimated 20-30% of road fatalities and serious injuries involve fatigue (although the real figure may be much higher) and around half of all fatigue-related fatalities occur within 15km of home.

Fatigue-related crashes tend to be high speed, high impact events because the driver doesn’t engage in any avoidance behaviours like braking or swerving.

Depending on the particular facts and circumstances of an incident, potential offenses may be brought under relevant legislation including, but not limited to, offenses under sections 16, 17, 18, 22, 23, 24 and 318 of the Crimes Act 1958 (Vic), which can carry fines and up to 20 years imprisonment.

DRIVER FATIGUE

6 Fatigue Risk Management

COMMON SIGNS OF FATIGUE

MENTAL / BEHAVIOURAL SIGNS

PHYSICAL SIGNS

DRIVING PERFORMANCE

• Irritability, impatience, over-reacting or under-reacting

• Lacking motivation

• Easily distracted

• Increased risk-taking

• Poor concentration

• Difficulty making decisions

• Lapses in attention

• Start ‘seeing things’

• Waves of sleepiness

• Minor aches and pains

• Light headache

• Hungry or thirsty

• Sweaty hands

• Feeling stiff or cramped

• Lack of energy, lethargic

• Fidgeting

• Poor hand-eye coordination

• Slowed reactions

• Yawning

• Tired, sore or heavy eyes

• Blurry vision

• Slurred speech

• Microsleeps

• Not noticing a vehicle until it suddenly overtakes you

• Making fewer and/or larger steering corrections

• Not remembering the last few km’s

• Not turning off the high beam

• Missing road signs

• ‘Zoning out’

It is critical to identify your personal early warning signs of fatigue so you can implement appropriate control measures and avoid more dangerous levels of fatigue.

People often think that yawning, heavy eyes and zoning out are the first signs of fatigue – but these generally happen further down the track (by which time your performance is probably already impaired by fatigue).


THE SCIENCE OF SLEEP

Sleep is one of the cornerstones of good health, and is just as critical to your overall health and well-being as good nutrition and regular exercise. During sleep, we process information and consolidate memory, boost immune function to better fight off disease, and rebalance the vitamins and minerals in our bodies. And the quality of sleep is just as important as the amount of sleep that you get.

Some Australian Statistics

• Around 16% of Australian workers are shift workers.

• Almost a third of adults will complain of significant sleeping problems in a given year.

• Almost 90% of Australians will experience a sleep disorder at some point in our lives and for a third of these people, the sleep disorder will be severe.

• It’s estimated that less than 20% of sleep disorder cases will be recognised and treated.

• Australians are now typically sleeping around 1-1.5 hours less than we did 100 years ago.

STAGES OF SLEEP SLEEP DEBT

If you don’t get enough sleep on a regular basis, you will build up a ‘sleep debt’ - the difference between the amount of sleep you need to function well, and the amount of sleep you actually get. For example, if you need eight hours but only get six and a half hours a night, by the end of a 5-day working week you will have built up 7.5 hours of sleep debt!


STAGE 1REM

STAGE 3REM

STAGE 2REM

AWAKE

REM

STAGE 4REM

1 2 3 4 5 6 7

REM REM REM REM

Sleep position shifts

© Copyright and used with permission of FMSSA

STAGES OF SLEEP

AWAKE& ALERT

Brain waveactivity

AWAKEBUT DROWSY

STAGE 1NREM SLEEP

STAGE 2NREM SLEEP

STAGE 3NREM SLEEP

STAGE 4NREM SLEEP

REM SLEEP

© Copyright and used with permission of FMSSA

There are five stages of sleep - stages 1 to 4 NREM (non-rapid eye movement) and REM (rapid eye movement) sleep, as shown above:

• Stages 1 and 2 are light sleep - we are still somewhat aware of our surroundings and are easily woken.

• We then progress into Stages 3 and 4, which are called ‘deep sleep’ and this is critical for our physical functioning. As our sleep becomes deeper, our brain activity slows down and our muscles become more relaxed.

• We then cycle back down through the stages and enter into REM sleep, during which our brain is quite active but our muscles are essentially paralysed. REM sleep is particularly important for mental/psychological functioning.

Each sleep cycle lasts for around 90 minutes, with the cycles changing throughout the sleep period. We get most of our deep sleep in the first third and most of our REM in the last third.


THE BODY CLOCK AND SHIFT WORK

Working at night can be challenging because humans are designed to be awake and alert during the day, and to sleep at night.

• Our ability to sleep and our alertness while awake varies across the 24-hour period and these daily (“circadian”) rhythms are controlled by the body clock, which is located in the brain.

• There are circadian rhythms in physical functions (e.g. body temperature, digestion and hormones) as well as mental and physical performance.

• Our alertness and performance typically hit their lowest point, and sleepiness peaks, at the time of lowest body temperature - around 03:00-05:00h for most people.

POST-LUNCH DIP It is also quite normal for people to experience a slump in alertness in the early to mid-afternoon - the ‘post-lunch dip’ or ‘siesta time’. This can be a high risk time for fatigue, particularly if you are carrying a sleep debt.

SHIFT WORK• Shift workers often need to be awake and alert when their body clock is

telling them it’s time to sleep, and need to sleep during the day when their body is geared to be awake and active.

• Daytime sleep is typically shorter and lighter, with shift workers averaging 1-2 hours less sleep per day than day workers. Across work days, this can lead to a sleep debt, making shift workers more susceptible to fatigue.

• Shift work increases the risk of workplace incidents, crashes while driving home after night shifts, and longer-term physical and mental health problems.

There are differences in the amount of sleep people need to function well - the average is between 7 and 9 hours, but some people need less sleep, while others require more.

There are also differences in the timing of the body clock, with some people being naturally night ‘owls’ while others are morning ‘larks’. Night owls tend to have less trouble shifting the timing of their sleep-wake

schedules to cope with shift work, while morning larks find it more difficult.

Recent research has also found differences in people’s vulnerability to fatigue as a result of sleep deprivation, with some individuals being more resistant to fatigue than others.

INDIVIDUAL DIFFERENCES IN SLEEP NEEDS AND THE BODY CLOCK


EMPLOYERS RESPONSIBILITIES Your employer has a primary duty of care to provide and maintain a safe working environment, including:

ROLES AND RESPONSIBILITIES FOR MANAGING FATIGUE

Managing fatigue is a joint responsibility and requires the commitment of both Metro and its employees.

WORKERS’ RESPONSIBILITIES

• Identifying and managing fatigue-related risks

• Taking reasonable steps to ensure adequate resources to minimise fatigue risks

• Developing rosters that provide safe hours of work and adequate rest opportunities

• Monitoring actual hours of work

• Providing clear guidelines, education and training on how to identify and manage risks associated with fatigue.

You have a responsibility to:

• Take reasonable care of your own health and safety.

• Understand fatigue and how to manage it.

• Present for work fit for duty and not impaired by fatigue.

• Inform your supervisor if you think you may be impaired by fatigue.

• Not accept overtime or undertake safety critical tasks (including driving) if you are likely to be impaired by fatigue.

• Report any incident or near miss that may involve fatigue.


This procedure describes the Metro processes for managing fatigue-related risks and applies to all Metro employees and contractors.

MTM FATIGUE RISK MANAGEMENT PROCEDURE

It details the specific roles and responsibilities for workers, supervisors and managers, and the processes to be utilised to manage fatigue-related risks. Please ensure that you are familiar with the requirements of this procedure and your responsibilities for complying with these requirements.

Each area of MTM has also developed a local Fatigue Risk Management Plan, which sits under the MTM Fatigue Risk Management Procedure.

More information on these plans will be provided by your Supervisor or Manager after this training course.


When fully rested, you should be feeling alert, energetic and engaged.

You may still have good energy and feel focused to perform your tasks well, however, you are not feeling as chipper.

Small yawns may signal that you are tiring, and you have difficulty concentrating, and your mood is low.

You may be fighting sleep when you are highly fatigued, with long yawns, head nods and microsleeps.

When you are tired you may make mistakes or errors, be irritable and start yawning more.

KEEP YOURSELF WELL RESTED

You should develop good sleep habits, keep well hydrated, limit caffeine, maintain a healthy and varied diet and keep active.

IF YOU FEEL YOURSELF HEADING TOWARDS FATIGUE

Talk to your Supervisor to discuss ways to decrease your fatigue level, such as job/task rotation, buddying up or taking an extra break. Continue to monitor your fatigue levels.

IF YOU ARE HIGHLY FATIGUED

STOP! Do not continue high risk / safety critical work and advise your Supervisor immediately. You should also keep an eye out for signs of fatigue in your colleagues. When people get to the point of being highly fatigued, they may become incapable of recognising it.

LONG TERM ACTIONS

• Prioritise and plan your sleep times in advance

• Ensure your bedroom is well set up

• Keep yourself in good physical shape (exercise most days of the week)

• Speak to your Medical Practitioner about your ongoing fatigue symptoms

• For information on how to incorporate balanced nutrition, physical activity and relaxation techniques, please contact healthandwellness@ metrotrains.com.au

• For further information about fatigue risk management, please contact [email protected]

HOW FATIGUED ARE YOU?

It is essential to learn to recognise your own early signs of fatigue, so that you can implement appropriate control measures before it builds to more dangerous levels.

MANAGING YOUR FATIGUE

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CAFFEINECaffeine is a stimulant and can increase your alertness in the short term — but it can also affect your sleep later on. There are some general tips for using caffeine as a fatigue counter measure:

STAY HYDRATED

Dehydration reduces your energy levels and slows you down, which can make you feel sleepy. Working in hot environments, in air conditioning, or at night can make you more dehydrated, as can some foods and drinks (e.g. caffeine, soft drinks, and salty foods).

• Don’t use caffeine unless you need it — it will then have more of an effect.

• Only have caffeine in the first half of your day so it doesn’t disturb your next sleep.

• It takes around 30-60 minutes for the effects to kick in.

• If you typically consume large amounts of caffeine, the effects won’t last as long.

• If tired before or during driving, try the ‘coffee nap’ — pull over, drink caffeine, and have a powernap. Caffeine will increase your alertness short-term. However, it will only be more effective if only used when necessary.

FOODS TO INCREASE ALERTNESSSome foods can increase our alertness, while others can increase fatigue:

HIGH PROTEIN/LOW FAT

• These foods may increase alertness - better when combined with vegetables and not carbohydrates.

• You may feel the effect after around 30 minutes and find that it’s more noticeable if you are fatigued, rather than when you are already alert.

• These foods provide an even blood sugar level, which will help to maintain alertness and are therefore good snacks while at work.

CARBOHYDRATES

• Simple carbohydrates may give you a quick ‘sugar hit’ - followed by a ‘crash’ as your blood sugar levels crash rapidly.

• Complex or unrefined carbohydrates are a better choice, as they are processed slowly, keeping your energy levels even.

Good examples of high protein, low fat and complex carbohydrate meals include:

• Omelette (add your favourite vegetables, fish, meats or cheese)

• Grilled chicken or salmon salad

• Chilli con carne

• Wholegrain tuna sandwich

• Chicken stir-fry and brown rice

• Brown rice sushi


BEWARE OF MEDICATIONS

Many prescribed and over-the-counter medications can cause drowsiness and impair your ability to operate heavy machinery or drive safely (e.g. some antihistamines, pain killers, antidepressants and anti-anxiety drugs). These medications may also interact with other drugs (including alcohol) and can exacerbate fatigue.

A drug is defined as any substance, when consumed or used by a person, deprives that person temporarily or permanently of any of his or her normal mental or physical faculties. This may include prescription or over the counter medicines.

Metro Trains requires all persons entering and/or carrying out work at Metro controlled premises to be free from the influence of drugs and alcohol while at work.

Drug Information Card for Rail Safety Work

It is an offence under the RSNL for rail safety workers to undertake rail safety work while impaired by a drug. The Regulator (ONRSR) does conduct its own random testing program. An employee or contractor could be fined by ONRSR up to a maximum of $10,000. The RSNL provides a definition of a drug, however, more broadly it is any substance (other than alcohol) that, when consumed or used by a person, deprives that person (temporarily or permanently) of any of his or her normal mental or physical faculties. This may include prescription or over the counter medicines.

An information card for rail safety workers to present to doctors, pharmacists, or any other health practitioner prescribing or dispensing medication.

Notes for employeesRail Safety National Law (RSNL)

If you are unsure if your medication may have an impact on your ability to work safely, please contact your Manager.

For further information, contact the Health and Productivity Team [email protected]

J002403 Drug Info Pocket Card Mar 16 ƒ.indd 1-3 15/08/2016 1:31 pm

Ensure that you ask your doctor or pharmacist about the possible side effects of any medications you are taking or considering using. If the side effects include possible drowsiness, fatigue or reduced performance, ask about alternatives.

If you are unsure if your medication may impact your ability to work safely, refer to Metro’s Drug Information Card for Rail Safety Work, or speak with your Supervisor or Manager. Alternatively, contact the Health & Productivity Team on healthandwellness@ metrotrains.com.au


INCREASE PHYSICAL ACTIVITYStretching, walking around, mild exercise or changing position can help increase your alertness temporarily.

SAFE COMMUTINGDriving to and from work can be a high risk time for fatigue, especially after night shifts, long shifts and overnight.

• Car pool where possible.

• Take a 20-30 minute powernap, but allow at least 15 minutes after waking before driving to minimise the risk of sleep inertia (grogginess or confusion upon waking - worse when you’ve woken from deeper sleep).

• Have a caffeinated drink about 30 minutes before driving –but keep in mind this could affect your next sleep period.

• Pull over and take a break if necessary. Get out of your car, walk around, or take a powernap if possible! Getting home 15-20 minutes later is better than not getting home at all!

The most effective way to reduce your risk of fatigue is to get enough good quality sleep!


• Make sleep a priority — use the time you have available for sleep and make sure the people you live with know when you need to be sleeping.

• Good health and fitness will help your sleep and help fend off fatigue – look out for signs of sleep disorders.

• Sleep as late as possible on the day of your first night shift.

• Have a nap in the mid-afternoon to ‘top up’ your sleep while working nights.

LIMIT CAFFEINE

BEDROOM

IMPROVING YOUR SLEEP

• Keep your bedroom dark and quiet - ear plugs, an eye mask or block-out curtains can be useful. A constant “white noise” from an air conditioner or a fan can help to mask other noises.

• The temperature should be comfortable, which for most people is 18-24°C.

• Your mattress, pillow and bedding should be comfortable.

• Don’t have any technology in the bedroom (e.g. TV, iPads, smart phones and computers).

• Don’t look at the clock!

• Caffeine takes about 24 hours to be flushed out of your system.

• It can make falling asleep more difficult.

• Caffeine will disturb the quality of your sleep.

• Caffeine will increase the need to urinate during sleep time.

LIMIT ALCOHOL• Alcohol can disturb the quality

of your sleep, even if it helps you get to sleep quicker.

• Alcohol can result in early wakings.

• Alcohol will also increase the need to urinate during sleep time.

HEALTHY DIET AND REGULAR EXERCISEDIET

• Regular mealtimes help keep your body clock in check.

• Don’t eat a large meal within 2-3 hours of going to bed.

• Avoid fatty, fried foods before bed – they can disturb the quality of your sleep.

• Don’t go to bed hungry.

EXERCISE

• Regular exercise is generally associated with better quality sleep.

• Have a relaxing routine in the hour before bed.

• But avoid vigorous exercise in the few hours before bed as this can make it harder to fall asleep.


HAVE A RELAXING ROUTINE IN THE HOUR BEFORE BED• Keep the lights low and undertake a

quiet, relaxing activity (e.g. reading, TV, relaxation technique) – ideally not in your bedroom.

• No computers, smart phones or iPads – the blue light emitted from these devices can make it harder to go to sleep.

TRAIN YOUR BODY AND MIND THAT BED IS FOR SLEEPING• The bed and bedroom should

only be used for sleep and intimate activity.

• Go to bed when feeling sleepy – don’t try to go to bed too early.

• If you are having trouble sleeping, get up and go into another room, keep the lights low and do something quiet and relaxing, and try again when you’re feeling calm and sleepy.

SLEEP DISORDERS

INSOMNIA

Sleep disorders are changes in sleeping patterns or habits. Signs and symptoms of sleep disorders include excessive daytime sleepiness, irregular breathing or increased movement during sleep, difficulty sleeping, and abnormal sleep behaviors.

• Insomnia is the most common sleep disorder – it includes difficulty falling asleep, staying asleep, or waking too early.

• First step, try the above steps to improving your sleep.

• If your sleeping problems continue, visit your GP and discuss other options. You can ask for a referral to a Sleep Specialist.


OBSTRUCTIVE SLEEP APNOEA (OSA) RESTLESS LEGS SYNDROME (RLS) AND PERIODIC LIMB MOVEMENTS OF SLEEP (PLMS)

TREATMENT FOR OSA

TREATMENT FOR RLS AND PLMS

• Around 3-5% of people have OSA – it is more common in males, people with nose or throat problems, and those aged over 40.

• Signs of OSA include loud snoring, episodes of not breathing, waking with a headache and/or dry mouth, and excessive daytime sleepiness.

• RLS and PLMS are related conditions - RLS occurs while you are awake and PLMS occur while you are sleeping. Around 80% of those with RLS will also have PLMS.

• RLS is often described as an uncomfortable, itchy, “creepy crawling” feeling, which is only relieved by moving the legs.

• PLMS is associated with regular frequent jerks of the limbs (typically the legs and/or feet) while you are asleep.

• It is critical to visit your GP if you think you may have OSA.

• In some milder cases, losing weight, giving up smoking and cutting back alcohol can help.

• The most effective treatment is Continuous Positive Airway Pressure (CPAP).

• Cut back caffeine, nicotine and alcohol.

• Leg massages, hot baths, heat pads and/or ice packs can help in mild cases.

• Moderate exercise during the day can help -although intense exercise can make it worse.

• Magnesium and/or iron supplements can help.

• Medication prescribed by a sleep specialist.

Useful websites

Australasian Sleep Association (ASA): www.sleep.org.au

Sleep Health Foundation (SHF): www.sleephealthfoundation.org.au


SLEEPING PILLS

• Sleeping pills should only be used on the advice of your GP – make sure you understand the possible short and long term effects.

• Typically they help people to fall asleep, rather than staying asleep.

• Sleeping pills should never be used with alcohol or other drugs.

• If you use sleeping pills regularly, you become less sensitive to their effects, you can become dependent on them, and may experience withdrawal effects (like insomnia and anxiety) if you try to stop taking them.

• It is best to only use sleeping pills occasionally.

Remember, Metro Trains requires all persons entering and/or carrying out work at Metro controlled premises to be free from the influence of drugs and alcohol while at work. Please discuss your role with your medical practitioner, and raise any concerns you may have about prescribed medication with your Manager or Supervisor. If you have any further queries regarding medications, please email [email protected]

Use the following activities to better understand your own fatigue risk factors, and to develop your own personal fatigue management action plan.

ACTIVITY 1IDENTIFY YOUR RISK FACTORS FOR FATIGUE

• List three work-related and three non-work related fatigue risk factors you have experienced while working at Metro:

• What strategies have you tried to address these?

ACTIVITIES PERSONAL FATIGUE MANAGEMENT ACTION PLAN


ACTIVITY 2IDENTIFY YOUR OWN WARNING SIGNS FOR FATIGUE

• List your own early warning signs of fatigue:

• List your own later warning signs of fatigue:

ACTIVITY 3IDENTIFY YOUR OWN SLEEP PROFILE

• How much sleep do you think you need to be at your best?

• Do you think you are a night owl, a morning person, or neither?

• How much sleep do you actually get, on average:

» On work days?

» On different shifts?

» On days off/holidays?

• Is there a difference between work days and days off?

• If so, can you feel the difference in terms of your fatigue and alertness?

ACTIVITY 4IDENTIFY FATIGUE CONTROL MEASURES

• What are 3 techniques you currently use to increase your alertness or minimise your fatigue risk while at work or commuting?

1.

2.

3.

• List 3 additional techniques you could try.

1.

2.

3.

ACTIVITY 5PLEDGE TO IMPROVE YOUR SLEEP

• Using the responses from the previous activities, pledge to do three things to improve your sleep and level of fatigue.

1.

2.

3.


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FATIGUE RISK MANAGEMENT - Rail Safeworking Solutions