Category Archives: Fatigue

Screening Commercial Motor Vehicle Drivers for Obstructive Sleep Apnea Can Save Lives

By Member Tom Chapman

Is it possible to have a sleep disorder and not know it? From personal experience, I can tell you the answer is yes. A few years ago, my doctor told me that I was at risk for obstructive sleep apnea (OSA), which is a sleep disorder involving episodes of airway obstruction and periods of not breathing while sleeping. OSA is not “just snoring”—it can result in fragmented sleep and subsequent daytime sleepiness. My doctor suggested I undergo a sleep study, which showed that I did indeed have OSA. The treatment I receive has made a major difference in the quality of my sleep and my overall wellness.

OSA is more common than many people think. Recent research has shown that between 6 percent and 17 percent of adults have moderate to severe OSA, and it’s particularly common among males, older individuals, and those who are overweight. Untreated OSA can lead to health problems like diabetes and heart disease, and it increases a driver’s risk of being in a crash. However, with screening and, if needed, proper treatment, that risk can be significantly reduced. A 2020 Federal Motor Carrier Safety Administration (FMCSA) study on commercial driver safety risk factors found that drivers aged 34 to 51 with treated OSA were significantly less likely to be involved in carrier-defined preventable crashes than drivers with untreated OSA.

Treating OSA improves safety, which is why “Require Medical Fitness—Screen and Treat for OSA” is on our Most Wanted List of transportation safety improvements. For more than a decade, the NTSB has recommended that the FMCSA implement a program to help identify and document treatment for commercial drivers with OSA. We also recommended that the FMCSA disseminate guidance for drivers, employers, and physicians about OSA, emphasizing that when OSA is effectively treated, drivers are routinely approved for continued medical certification.

Unfortunately, the FMCSA has not yet implemented these recommendations, and we continue to investigate crashes that could have been prevented with a more robust medical certification system. For example, we recently determined that a March 1, 2018, crash in Elmhurst, Illinois, was due to fatigue from a driver’s OSA-related sleep disorder. In that case, a large truck struck a car that had slowed due to traffic congestion. The rear-end collision initiated a chain of crashes involving two other large trucks and three more cars, killing one person and injuring five others.  

This image, taken on the day of the crash, show six of the seven vehicles involved in the March 1, 2018, Elmhurst, Illinois, multivehicle collision. (Source: WFLD-TV)

The driver of the striking truck in Elmhurst had a history of OSA and other health issues; however, he didn’t report his health history accurately to the certified medical examiner (CME) and was thus able to obtain a medical certificate. He later told investigators he believed he had recovered from OSA, but a postcrash sleep study showed that he still had a sleep disorder. Did this driver know his sleep disorder was not resolved? Regardless of what he believed, he should have accurately reported his health history, but, as we have seen in multiple investigations, drivers sometimes omit key health information during their medical review. In the Elmhurst report, the lack of a robust medical certification evaluation process to identify and screen commercial drivers at high risk for OSA contributed to the crash.  

NTSB investigators examining the damaged and burnt 2016 Kenworth truck-tractor (the Pioneer truck) involved in the March 1, 2018, Elmhurst, Illinois, multivehicle collision (Source: NTSB)

The FMCSA has not taken the steps we believe are necessary to effectively address the safety risks of OSA for all drivers. In 2016, the agency tasked its Medical Review Board (MRB) with identifying factors the agency should consider with respect to potential future rulemaking concerning OSA. In November of that year, the MRB and the FMCSA’s Motor Carrier Safety Advisory Committee (MCSAC) issued several joint recommendations that provide authoritative and useful guidance for screening commercial drivers for OSA. These recommendations also demonstrate that the large majority of drivers being screened or tested for OSA can continue to work during their evaluation (and treatment, if needed).

 Some of the conditions that the group felt merited a referral for OSA diagnostic testing included the following:

  • reporting excessive sleepiness while driving or having a crash associated with falling asleep
  • having a body mass index (BMI) greater than or equal to 40
  • having a BMI between 33 and 40 as well as 3 or more additional risk factors, such as hypertension, type 2 diabetes, loud snoring, large neck circumference, age 42 and above, or being a male or a postmenopausal female.

CMEs need to know how to access MRB/MCSAC recommendations on OSA screening. Why? Because screening drivers for OSA—and following up with diagnostic testing and treatment, as needed—is a win-win for drivers, carriers, and the public. In 2017, we recommended that the FMCSA make the MRB/MCSAC recommendations easily accessible to CMEs to be used as guidance when evaluating commercial drivers for OSA risk. We will continue to encourage the FMCSA to implement all our open recommendations involving OSA. Until then, the MRB/MCSAC recommendations can serve as useful guidance for carriers and for the medical community.

World Day of Remembrance for Road Traffic Victims

By Nicholas Worrell, Chief, NTSB Safety Advocacy Division

Sunday, November 15, is the World Day of Remembrance for Road Traffic Victims. I’ve known many of you who have lost loved ones this way, and I’ve worked alongside many survivor advocates for years. Along with the courage and strength I’ve seen among these survivors, it’s plain to me that nobody who loses a loved one in a traffic crash needs a day of remembrance. For them, that remembrance is always there, no matter what day. The World Day of Remembrance is for the rest of us. It’s a time to reflect on these often preventable losses and work to prevent future ones from occurring. In 2020, it feels like we need this commemoration day more than ever. With the uncertainty of a global pandemic, far too many people are forgetting—or becoming numb to—the year-in, year-out toll that traffic crashes take on our country.

I was recently invited to speak on an International Road Federation panel on the topic, “Crashes: The Forgotten Pandemic.” I reminded participants of Dr. Anthony Fauci’s statement earlier this year when asked about the annual 40,000 US road deaths in America. He said that the COVID pandemic is emergent, but road crash deaths are a chronic condition.

However, although the condition is chronic, it’s not untreatable.

My talk touched on some of the ways that the road safety community is working to protect the most vulnerable road users: bicyclists, motorcyclists, and pedestrians. I also pointed out that, unlike COVID-19, the road crash pandemic strikes the young disproportionately. In fact, in the United States, from early in childhood to well into middle age, a young person is more likely to die in a motor vehicle crash than any other way.

The impact on young peoples’ lives from our acute COVID pandemic is incalculable. Students whipsaw between learning in person and on-line, with little certainty of what style comes next, and face restrictions on seeing friends. Yet, the far more pressing danger to a young person comes from the risks of speeding and of distracted, drowsy, or impaired driving. In fact, speeding crashes have increased markedly this year as the volume of traffic has decreased.

Remembrance is about honoring those we’ve lost. It’s also respecting those who, thankfully, are still with us. This World Day of Remembrance, we can respect the living and honor those lost by recommitting ourselves to practicing safe driving habits—some of which we may not have had the opportunity to use for a while. Before you get behind the wheel, make sure you’re rested and sober. Put the phone away. Don’t speed. With all the younger generations are doing to protect high‑risk loved ones from COVID, let’s do the same to lower their risk of dying in a motor vehicle crash. Let’s finally put both pandemics behind us.

Drowsy Driving Prevention Week

By Robert Molloy, PhD, Director, NTSB Office of Highway Safety

As we wrap up Drowsy Driving Prevention week, I want to remind drivers about the importance of getting adequate rest before operating their car, truck, or bus. Drowsy Driving Prevention Week (November 1–8) was established by the National Sleep Foundation to draw attention to the hazards associated with operating a motor vehicle while fatigued. The NTSB, regulators, industry, and individual drivers all play a role in reducing fatigue-related crashes.

Drowsy and fatigued driving are not new problems. According to research conducted by the AAA Foundation for Traffic Safety, every year, about one in ten crashes on our roadways involves a drowsy driver, and one in five of those crashes is fatal. “Reducing fatigue-related accidents” is on our NTSB’s Most Wanted List of transportation safety improvements because our many investigations have shown that fatigue is a significant factor in highway crashes. For example, we recently completed two investigations of commercial truck crashes, one in Boise, ID, and the second in Elmhurst, IL, in which we found that the drivers failed to stop for slowed traffic as a result of fatigue. In the Boise crash, the driver’s fatigue was related to inadequate sleep duration; in Elmhurst, it resulted from a sleeping disorder related to sleep apnea.

In preparation for Drowsy Driving Prevention Week, we hosted a webinar on Managing Commercial Motor Vehicle Driver Fatigue Risks. This joint effort between NTSB staff and industry experts from trucking and busing looked at programs companies can implement to reduce the risk of fatigued driving, and we discussed how the North American Fatigue Management Program, guidelines and materials that enable motor carriers to implement a comprehensive fatigue management program, can be an effective tool to prevent driver fatigue. You can watch the webinar online.  

From an individual perspective, we all need to take responsibility for our fitness to get behind the wheel, not only to protect ourselves and our passengers, but to keep other road users safe. Commercial drivers have provided heroic services to our nation during the COVID-19 pandemic; the least we can do is ensure that we aren’t putting them at risk by getting behind the wheel drowsy or fatigued.

Drowsy and fatigued driving have real-life—and death—consequences. As this week of special attention comes to an end, don’t let alert driving take a back seat.

New Hours-of-Service Rule Relaxes Critical Safety Regulations

By Vice Chairman Bruce Landsberg

Would you get tired after driving for 8 hours straight? What about after driving up to 11 hours, even with a short rest break? Suppose your vehicle weighed 80,000 pounds and was 80 feet long—would that require just a bit more alertness and finesse than the family car?

Trucks are an essential part of the supply chain, but their human drivers are just as susceptible to fatigue as the rest of us. To meet the needs of the country during this current pandemic, some trucking regulations have been relaxed to meet the unexpected, increased demand for goods and services. I understand the need to make some temporary adjustments to meet the nation’s needs; however, unfortunately during this time, the Federal Motor Carrier Safety Administration (FMCSA) also completed a 2-year effort to permanently relax hours-of-service (HOS) rules for commercial motor vehicle drivers. The new final rule puts commercial drivers—and those with whom they share the roads—at increased risk.

Fatigue is a pervasive yet preventable problem impacting transportation safety. Tackling fatigue requires a comprehensive approach focused on research, education, training, technology, sleep disorder treatment, HOS regulations, and on- and off-duty scheduling policies and practices. At the NTSB, we are troubled by the relaxed rules that ignore this approach. The FMCSA’s final rule uses terms like “safety-neutral” and “without adversely affecting safety”; and the US Department of Transportation’s press release optimistically adds that the rule will “improve” and “increase” safety. But the science doesn’t support those claims. The FMCSA euphemistically claims that the changes “enhance flexibility” so drivers can stop when they feel tired; the reality is that humans are exceedingly poor at self-assessment, especially when a paycheck is involved, and will push beyond reasonable endurance. The fact that a driver has successfully (and luckily) driven fatigued for hundreds of trips absolutely does not guarantee that the next one will have a happy ending.

The new final rule relaxes the HOS regulations in several ways.

    • It expands the short-haul exception from 100 air-miles to 150 air-miles, and increases the allowable duty day from 12 to 14 hours.
    • It expands the driving window during adverse driving conditions by up to an additional 2 hours.
    • It requires a 30-minute break after 8 hours of driving time (instead of on-duty time), and allows an on-duty/not driving period to qualify as the required break. That might include loading or unloading, which could be even more tiring than driving.
    • It modifies the sleeper berth exception to allow a driver to meet the 10-hour minimum off-duty requirement by spending at least 7—rather than at least 8— hours in the berth, and a minimum off-duty period of at least 3 hours spent inside or outside of the berth.

Bluntly speaking, the increase in allowable miles from home base for short-haul drivers is a loophole you could drive a truck through.

We understand that economics matter in this debate, and we know most drivers only get paid when the wheels are turning. But we don’t believe any dollar amount is worth a human life. And we aren’t alone in wanting to put safety first in the trucking industry—the Teamsters, who have a vested interest in full employment, recognize the value of ensuring driver safety and have also come out against these changes to the HOS rules. We should point out, too, that trucking companies that have addressed fatigue beyond simply complying with HOS regulations have experienced fewer crashes and seen fewer fatalities as a result of driver crashes. For example, after a fatigued driver caused a fatal truck crash in Cranbury, New Jersey, in 2014, Walmart Transportation introduced a fatigue management program that exceeded regulatory minimums with effective sleep management protocols. By investing in safety, proactive companies like Walmart have actually improved their bottom line.

The HOS rules are somewhat complex, but sleep science is not. Fatigue degrades a person’s ability to stay awake, alert, and attentive to the demands of safely controlling a vehicle. Humans can become fatigued under the conditions the final rule allows. Fatigue is a manageable threat to transportation safety that can be mitigated through reasonable company safety practices and individual responsibility. Understanding this, the NTSB has recommended for decades that the FMCSA tighten enforcement of fatigue regulations, implement sleep apnea screening, set science-based maximum HOS, develop sleep management programs, and deploy electronic logging devices for all commercial truck drivers.

June 16, 2018, Construction Zone Multivehicle Collision, in Boise, Idaho.
Postcrash photograph of vehicles under Cloverdale Road overpass; view is looking west, toward the 2019 Volvo truck that began the crash sequence of the June 16, 2018, construction zone multivehicle collision, in Boise, Idaho. (Source: Idaho State Police)

These HOS rule changes come at a time when new data show trucking fatalities increasing. Between 800 and 900 drivers lose their lives on the road each year, and the risk only begins with the truck driver. It doesn’t take much imagination to see what happens when a fatigued trucker collides with a minivan full of children, construction workers on the road, or commuters on an intercity bus. Just look at our recent investigations involving fatigued truck drivers—one in Boise, Idaho, and another in Elmhurst, Illinois. The NTSB has investigated too many preventable tragedies to remain silent on this critical issue. At a time when truck-related fatalities are increasing, how many of your family and friends are you willing to sacrifice to an exhausted trucker? We should be doing more to improve trucking safety, not relax it.

Scene views of six of the vehicles at final rest on eastbound I-290, involved in the March 1, 2018, multivehicle collision, in Elmhurst, Illinois.


Reduce Fatigue-Related Accidents is on the NTSB 2019-2020 Most Wanted List.



This July 4, Travel Safely—Don’t Put Unnecessary Strain on First Responders and Hospital Staff

By Dolline Hatchett, Director, NTSB Office of Safety Recommendations and Communications

COVID-19 has affected every American, and the NTSB has adapted to respond to the effects of the pandemic. As the agency’s Director of Safety Recommendations and Communications (SRC), I know how important it is to keep the industry, elected officials, and the advocacy community briefed on transportation safety; that’s why I decided to take advantage of this platform to try to reach as many of my fellow citizens as possible.

As we approach the July 4th weekend, with travelers expected to hit the roadways even in the midst of a pandemic, it’s important to remind the traveling public to drive safely. Motor vehicle crashes continue to constitute a chronic national health care crisis, resulting in 35,000 or more deaths and millions of injuries each year. Highway crashes create an enormous demand for medical services, year in and year out. At the same time, an emergent crisis, like COVID-19, demands those same resources, and they start to get stretched thin.

SRC works not only to inform, but also to advocate for safer personal transportation choices. Although much of the country has been shut down for the past few months, the agency continues to craft and track safety recommendations, and it’s up to my office to publicize safety advances when we close recommendations.

Throughout the lockdown, SRC has continued to facilitate communication with state and national policy makers, upon request, about transportation safety issues that are relevant to legislation they may be considering. The difference these days is that the office responds to these requests in writing, rather than in face-to-face testimony. We’ve also responded to requests from federal congressional staff to provide information on our recommendations to help them develop a surface transportation bill. And of course, we continue to make safety publications available to the public and to respond to queries about ongoing investigations.

But perhaps the most innovative response we’ve had during this pandemic is our Safety Reminder campaign, which launched just before Memorial Day with a public service announcement. This outreach was important; surprisingly, while most of the country was on lockdown leading up to Memorial Day weekend, a nationwide speeding trend emerged. We decided to proactively remind the public about safe transportation across all modes as the nation began to re-open.

I believe it’s important to re-emphasize safe road travel ahead of the July 4th weekend, especially because stay-at-home orders have eased throughout the country, and we may see even more road travelers this holiday weekend than we did over Memorial Day weekend. Despite  being away from our physical offices, SRC continues to keep the public informed of the agency’s work as we advocate for safety improvements across all modes of transportation. We’re the conduit between the technical expertise at the agency and our stakeholders—the traveling public, lawmakers, and industry—and it’s up to us to effectively communicate the vital safety improvements that come out of our investigations, reports, and studies. There’s no better time to convey that important information than now, just before a holiday weekend during which many Americans will be taking to the roads, perhaps for the first time in months.

So, before the start of the holiday weekend, when you’re picking out your mask and planning socially distant celebrations, remember how your actions behind the wheel relate to this pandemic and those directly affected by it. Don’t drive impaired. Don’t drive distracted or fatigued. Don’t speed. Whether you’re a passenger or a driver, always wear your seatbelt.

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Let’s work together to avoid further strain on our health care system; every ambulance not called, every unit of blood not transfused, every bed in an emergency department not filled because of a crash, is one more resource made available to fight our emergent crisis.