Driving Change: Insights from the 2024 Lifesavers Conference

Anthony Lam, NTSB Transportation Safety Specialist, Office of Safety Recommendations and Communications

Attendees stepped into the world of road safety innovation and collaboration at last week’s Lifesavers Conference 2024 in Denver, Colorado. Each year, experts, advocates, and policymakers convene at Lifesavers to tackle pressing issues shaping the future of safer roadways. From combating impaired driving to ensuring equitable access to cutting-edge vehicle technology, NTSB staff presented and moderated a variety of workshops that offered invaluable insights and strategies for creating a safer tomorrow.

NTSB staff at 2024 Lifesavers Conference exhibit booth

NTSB Transportation Research Analyst Dr. Ryan Smith’s presentation, “The Oral Fluids Factor: Roadside & Evidential Testing to Reduce Drug-impaired Driving,” shed light on the rising interest in using oral fluid testing in roadside and evidential testing for drug impairment. With the landscape of cannabis legalization evolving and concerns about drugged driving escalating, the timing couldn’t be more crucial. Attendees gained insights into the nuances between preliminary and evidential testing, the mechanics of roadside testing, and the outcomes from states already implementing oral fluid testing. Discussions encompassed emerging challenges such as detecting novel drugs, ongoing research, and legal hurdles faced by states.

In 2022, we released a safety research report titled, Alcohol, Other Drug, and Multiple Drug Use Among Drivers, which found oral fluid is a valuable—but underused—biological specimen for detecting drug use by drivers. The report also recommended states modify their impaired-driving laws, if they have not already, to allow for oral fluid drug testing. Smith pointed this out in his presentation, adding, “It [oral fluid testing] can play a key role in supporting the enforcement of impaired-driving laws.”

Dr. Ryan Smith, Transportation Research Analyst, Office of Research and Engineering

Smith also organized and moderated the session, “Brave New World in Cannabis Detection,” which brought together leading-edge researchers in the field of cannabis detection. Cannabis impairment is a critical issue, and researchers discussed novel ways that cannabis use can be detected in drivers. In his opening remarks, Smith stated: “More than half of the US population now lives in a state where cannabis has been legalized. Recent NTSB research demonstrates the high prevalence of cannabis use among drivers, second in prevalence only to alcohol. Effective methods for detecting signs of cannabis impairment are critical for getting impaired drivers off our nation’s roadways.”

NTSB Office of Highway Safety Program Manager Ellen Lee gave a presentation on the dangers of speeding titled, “Not so Fast & Furious – Channeling Our Energy to Prevent Speed-related Fatalities,” which highlighted the urgent need to address speed-related fatalities through a comprehensive approach. Lee talked about the NTSB’s recent recommendations from our investigation of a crash in North Las Vegas, Nevada, where speeding and speeding recidivism were key.

Ellen Lee, Program Manager, Office of Highway Safety

Lee emphasized our findings that the driver in the crash was impaired and had received seven recent speeding offenses in the 5 years before the crash. “Despite repeated law enforcement actions, the driver’s record was inaccurate (showing only one speeding violation) and local courts treated this driver as a new offender for each violation,” Lee said.

Drawing from NTSB crash investigations and real-world examples, attendees learned about effective countermeasures and community engagement strategies. From leveraging data insights to advocating for vehicle safety technologies and infrastructure enhancements, the workshop underscored the importance of collaboration to curb excessive speed and protect lives on the road.

NTSB Safety Advocate Leah Walton moderated a thought-provoking discussion in her session, “A Safe System Approach to Address Impaired Driving” exploring where and how impaired driving fits into the five pillars of the Safe System Approach. Walton and her panel explored the multifaceted challenges posed by impaired driving, particularly concerning polysubstance impairment. Attendees gained a deeper understanding of the prevalence and risks associated with this behavior, along with potential policy interventions and enforcement strategies.

Leah Walton, Safety Advocate, Office of Safety Recommendations and Communications

In Walton’s opening remarks, she emphasized, “We cannot have a safe system while impaired driving is killing over 13,000 people a year. To achieve zero fatalities, we must expand our view of impaired-driving prevention through the Safe System lens.” With an emphasis on partnership-building at both the state and national levels, the workshop provided a roadmap for stakeholders to tackle impaired driving head-on and enhance road safety.

Stephanie Shaw, NTSB Management Analysis Officer, moderated the session, “Safety for All: How Vehicle Technology Addresses Underserved Populations.” Exploring design considerations, benefits, and challenges, attendees learned ways to extend these advancements to underserved populations. Shaw emphasized the importance of building a system that guarantees safe transportation for all who use it, regardless of socioeconomic status or mode of travel, whether it be personal vehicle, bike, walking, rolling, hailing a rideshare or an autonomous shuttle service, or taking public transportation. This sentiment encapsulated the overarching theme of inclusivity and accessibility discussed throughout the workshop.

Stephanie Shaw, Management Analysis Officer, Office of Railroad, Pipeline, and Hazardous Materials Investigations

The Lifesavers Conference serves as a catalyst for meaningful dialogue and collaboration in advancing road safety initiatives. By harnessing innovation, data-driven approaches, and community engagement, attendees are empowered to drive tangible change and create safer roads for everyone. We hope to continue these important dialogues at next year’s Lifesavers Conference in Long Beach, California!

Traffic Safety Through a Public Health Lens

By Sophia Peerzada, Safety Advocate

On March 28th, I moderated a webinar titled “Traffic Safety Through a Public Health Lens.” This joint effort between the NTSB and the American Public Health Association (APHA) ahead of National Public Health Week highlighted traffic safety as a public health issue.

This topic is very important to me as a transportation safety advocate with a degree in public health. When I was studying for my Master of Public Health degree at the University of South Florida, I was the only student in my program (that I knew of) who was interested in traffic safety. I was motivated by the Tampa Bay region’s regrettably high rates of traffic-related fatalities, and the perceptible imbalance of safety interventions along socioeconomic lines. I also knew the statistics nationwide: each year, 43,000 people die on US roadways. I thought, of course this is a public health issue—people are getting hurt and dying on our roads each day!  

Since joining the NTSB in November 2023, I have had the pleasure of meeting folks who bring a public health mindset to transportation safety. In fact, the NTSB itself plays a significant role in public health by identifying transportation safety issues and issuing recommendations to make travel safer for the public.

Prior to the webinar, I connected with former NTSB Vice Chair T. Bella Dinh-Zarr, who notably referred to traffic fatalities as an “epidemic on wheels.” Of course, I was thrilled when Dr. Dinh-Zarr and public health colleagues Dr. Kathleen Carlson, Dr. David Ederer, and Dr. Mighty Fine agreed to be panelists on this first-of-its-kind webinar.

Each panelist brought an invaluable perspective to the conversation.

Dr. Carlson, a professor of epidemiology at the Oregon Health and Science University-Portland State University School of Public Health and core investigator at the Portland VA, opened the event with a review of injury epidemiology. She explained that “public health takes a scientific approach to a public health problem” as it seeks to identify the problem’s cause and develop strategies for preventing it from happening again.

Dr. Ederer, an epidemiologist at the CDC’s Physical Activity and Health Branch, followed with a presentation on the Safe Systems Pyramid and how public health principles can be applied to engineering. His presentation underscored the need to apply traffic safety interventions systematically to improve population health.

Dr. Dinh-Zarr, Senior Advisor at FIA Foundation and the Traffic Injury Research Foundation, built upon Dr. Carlson’s and Dr. Ederer’s presentations by providing concrete examples of how the public health lens has been applied to traffic safety efforts. She highlighted the NTSB’s investigation process as an example of taking a public health approach to preventing the recurrence of traffic-related injuries and fatalities.

Finally, Dr. Fine, associate executive director of the APHA’s Division of Public Health Policy & Practice, rounded out the panel by emphasizing the need to apply a health equity perspective to all traffic safety efforts. He urged traffic safety practitioners to ensure that interventions are inclusive, accessible, and culturally relevant.

Overall, it was a wonderful and much-needed discussion that I am certain each attendee walked away from having learned something new. Dr. Ederer said it best in his presentation: “Public health is a way of describing and solving problems.” Given that, I think all of us in the traffic safety space are public health practitioners.

You can view the full webinar recording here: https://youtu.be/DMNxSFNANeI?si=FDR2BhF6vZXdJDut..

Honor Traffic Victims with Action

By Chair Jennifer Homendy

50 million deaths. Hundreds of millions of injuries.

That’s the worldwide cost of traffic violence, in human terms. It’s difficult to comprehend fully, which is why the World Day of Remembrance for Road Traffic Victims is so meaningful.

This annual observance provides a time to reflect on the real people behind the statistics: mothers, fathers, sons, daughters, grandparents, aunts, uncles, cousins, colleagues, best friends, and neighbors.

It’s a time to support those who’ve lost a loved one to the public health crisis on our roads.

And it’s a time to act, starting with NTSB recommendations.

Lessons from Tragedy

Since last year’s World Day of Remembrance, the NTSB has made 26 new recommendations to improve road safety. All remain open.

Where did these recommendations come from? They are the result of rigorous NTSB investigations into devastating crashes, outlined below. Each one is a lesson from tragedy, which is why we don’t rest until a recommendation is implemented.

At the NTSB, we believe the most meaningful thing we can do for victims of traffic violence is to advocate for our safety recommendations.

In other words: we choose to honor the victims with action.

Here are just some of the victims we’re remembering today — along with the recommended safety improvements to best honor their memory. 

Today we remember two people who were killed and seven who were injured in a Belton, SC, crash between an SUV and a bus carrying disabled passengers. The actions we demand on their behalf include the following:

• Ban nonemergency use of portable electronic devices, like cellphones, for all drivers.  
• Recruit cellphone manufacturers in the fight against distracted driving; they should automatically disable distracting functions when a vehicle is in motion.
• Provide annual safety training for people employed to transport wheelchair users.  
• Develop a side-impact protection standard for new, medium-size buses, regardless of weight — and require compliance.

We should honor the victims of the Pennsylvania Turnpike crash that injured 50 people and killed five others — including a nine-year-old child — by taking the following actions:

• Develop performance standards for advanced speed-limiting technology, connected-vehicle technology, and collision-avoidance systems — and require their use on new vehicles, as appropriate.
• Require newly manufactured heavy vehicles to have onboard video event recorders.
• Deploy connected-vehicle technology nationwide.
• Take a comprehensive approach to eliminate speeding. Among other measures, this means thinking long and hard about the 85th percentile approach and using speed safety cameras, which includes working to remove restrictions against them. 

Here’s what we must do to honor the three people who were killed and the 18 who were injured when a bus overturned in Pala Mesa, California:

• Require all new buses to meet a roof strength standard.
• Sponsor research into safe tire tread depths for commercial vehicles.
• Require seat belt use.

The best way to remember the victims of the Decatur, Tennessee, school bus crash that injured 14 people and killed two people, including a 7-year-old child, is to take the following steps:

• Make lap-shoulder belts mandatory in new school buses.
• Require lane-departure prevention systems on heavy vehicles.

And what about the nine people who died in a head-on crash in Avenal, California, on New Year’s Day — seven of whom were children? We must implement the following NTSB recommendations in their memory:

• Require alcohol-detection systems in all new vehicles to prevent alcohol-impaired driving.
• Encourage vehicle manufacturers to combat alcohol-impaired driving by accelerating progress on advanced impaired driving prevention technology and finding new ways to use existing technology, like driver monitoring systems.
• Incentivize vehicle manufacturers and consumers to adopt intelligent speed adaptation (ISA) systems. One way to achieve this is to include ISA in the New Car Assessment Program. Notably, ISA became mandatory in July 2022 for all new models of vehicles introduced in the European Union.
• Develop a common standard of practice for drug toxicology testing by state officials.

Remember. Support. Act.

Even as we advocate for our safety recommendations, more crashes are occurring daily — which means more investigations. The work continues.

And yet, we cannot let the magnitude of the road safety crisis deter us.

We must keep fighting for zero, which is only possible through a Safe System Approach. 

We must fight for road users around the world who deserve to be safe.

We must fight for those whose lives are forever changed by traffic violence.

We must fight for those who are no longer here to fight for themselves.

For all these people and more, the NTSB will keep fighting. And so will I.

World Day of Remembrance for Road Traffic Victims

By Chair Jennifer Homendy

November 21 is the World Day of Remembrance for Road Traffic Victims. It is a day to honor the 1.3 million lives lost each year around the world in motor vehicle crashes.

Today, I urge everyone to take a moment to remember all those who have lost loved ones in crashes, as millions have done around the world since 1995. Here in the United States, traffic deaths are up 18 percent over the first half of 2020. We are on pace to lose 40,000 Americans this year alone.

My thoughts are with all who have lost loved ones, but especially those I’ve met who lost loved ones in crashes that the NTSB has investigated, and the survivor advocates I’ve gotten to know over the years.

We need to remember these numbers are people from our communities. They are lives lost: mothers, fathers, or children suddenly, permanently gone; brothers and sisters absent from holiday gatherings; friends missing from a baby shower. We record our losses in data tables, but we feel them at the dinner table, and in the graduations, weddings, and birthdays never celebrated.

At a November 10 virtual roundtable on the need for our nation to transition to a Safe System approach, I called for a moment of silence in advance of the World Day of Remembrance. I said then that, for the NTSB, the toughest part of our job is facing family members after a tragedy, explaining that their loved one’s death was 100 percent preventable and that we’ve issued recommendations which, if acted upon, would have prevented the crash and the loss of their loved one.

Then I said that we need a paradigm shift in how we address this ever-growing public health crisis.

For 26 years now, the world has memorialized the victims of motor vehicle crashes, and we have been right to remember them. No loss should be forgotten. But these are unnecessary losses. They must not be remembered only in words.

They deserve and demand action now.

They demand to be remembered with road treatments, traffic calming measures, engineering speed assessments, road safety laws, and other investments that will result in safe roads and safe speeds on those roads.

They demand to be remembered with the manufacture of safe vehicles that should come standard with better technology for avoiding collisions, including collisions with pedestrians, bicyclists, and motorcyclists.

They must be remembered with vehicle sizes and shapes that are less likely to result in the pedestrian and bicyclist deaths that we have seen so often.

They demand to be remembered with ignition interlocks for all impaired drivers, in the development of in-vehicle alcohol detection technology, and in fair and just traffic law enforcement.

They demand to be memorialized with increased investments in alternative modes of transportation, like public transit, which will reduce crashes on our roads, in newly changed laws to improve road safety, and in the enforcement of existing laws.

But most of all, these victims should be remembered as what they were: flesh and blood. Human. Vulnerable.

Put that image at the center of all the other aspects of our roads, and you’ll see the road as we must in order to finally make it safe. Don’t think of numbers, think of people. Put them at the center of every decision about our road system. That’s the paradigm shift that we need—to make our many layers of traffic hazards into layers of traffic protection, so that when crashes happen, nobody pays for it with their life.

This Day of Remembrance, let’s remember that the candle we light to remember victims is more than just a memorial; it’s a light showing the way to a safer tomorrow.

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.