Category Archives: Medical Fitness

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.

Returning to Travel with Safety on the Mind

By Nicholas Worrell, Chief, Office of Safety Advocacy

Normally this time of year, the transportation safety advocacy world would be buzzing with annual calendared campaigns, like these more well-known ones in the highway safety world:

• Global Youth Traffic Safety Month
• Motorcycle Awareness Month
• 100 Deadliest Days of Summer
• NHTSA’s “Click it or Ticket” seatbelt enforcement campaign

As the weather gets warmer, students learning to drive, fly or even operate a boat would gather for educational awareness-raising events or training seminars and conferences. Driver-educators and safety advocates would be working to pour their hearts and souls into reaching teen drivers on stages around the country, hoping to convince some to avoid the bad choices that would put them at higher risk of traffic crashes. Flight schools would be gearing up for the busy summer flying months, and the US Coast Guard and other organizations would be prepping for summer safety on our waterways.

But it is different this year. This year, the country is in large part sheltering in place because of a global public health pandemic.

In terms of traffic safety, the dark cloud might have a silver lining. The Los Angeles Times reports that crash incidences have reduced by half due to the virus; however, Streetsblog.org questions whether this silver lining in the form of reduced numbers of crashes will come with another dark cloud in the form of higher rates of crashes. We will have to wait for the statistics to be compiled a year or more from now to get a clearer picture. Although advocacy messages no longer reach students face-to-face, young people have less freedom—and reason—to drive. Will those two factors cancel each other out? Will drivers of all ages remember to drive sober and without distractions? Only time will tell.

General aviation continues to operate, though in a slightly more limited fashion, but we at the NTSB continue to investigate crashes. Boaters have not been out, due to shutdowns and weather, but with summer coming, things will change.

The big question I find myself pondering is, what will transportation safety look like once we are all able to move about freely again?

I like to think that Abraham Lincoln was right when he said that the best way to predict your future is to create it. I wonder about the new normal that we could strive to achieve in transportation safety on the other side of this pandemic. I also find myself worrying about re-emergence shock on the highways.

I recall from my time in the Marine Corps that when we’d return from duty on ship for an extended period without driving, traffic safety advocates would come on board to remind us what we would be facing returning home. That type of reminder would be helpful now after this long period of reduced driving. Have our skills gotten rusty? Will our road awareness be slow to return?

A potential benefit that could come from this pandemic, though, is that many of us have become much more mindful of how our behavior affects others. Will our mindfulness stay with us when we head back out on the roads, or jump back into our cockpits, or warm up our boats?

The present crisis knocked us out of our 24/7, “go-go-go” lifestyle suddenly and shockingly. Now, it is finally sinking in that returning to that normal will not happen soon or suddenly; rather, it will happen step by step. How can we rebuild transportation safety in our new normal? Tens of thousands of lives are lost on our roads every year. For too long, we have accepted this as normal. Perhaps this pandemic will wake us up to the fact that it does not have to be this way.

The step to transitioning back to our new normal will be to remember all the little safety lessons that might not have been front-of-mind these last few weeks or months. Returning to safe driving, flying, and other transportation operations will require renewed focus. To help us return to safe operations, the NTSB and other transportation organizations will launch the #SafetyReminder campaign with a Twitter chat @NTSB, May 21, 2020, at 12pm EDT.  You can join the conversation by mentioning @NTSB in your tweets to questions and comments or simply follow the conversation using #SafetyReminder.

SafetyReminder Announcement 1

I encourage you to follow the campaign and brush up on some of the things you may have forgotten before we all get back out on the road. When it comes to transportation safety, we really are all in this together.

Ensuring Transportation Safety, Even During a Crisis

By Member Jennifer L. Homendy

For the past few weeks, I’ve woken up every morning to a text message from the Virginia Railway Express (VRE) updating riders on its continued service and modified schedule. It’s hard not to think of all the VRE and Amtrak locomotive engineers and conductors that I’ve come to recognize (or know by name—Hi, Willie and Samantha!) over the years, and how dedicated they are to continuing to serve the public during this national emergency. You and your colleagues across the country are heroes. Thank you for all you do.

The safety of transportation workers across all modes is extremely important especially during times of crisis. Our nation’s transportation workforce is essential to getting critical goods to states and local communities and to ensuring that those serving on the frontlines of this pandemic, like medical personnel, grocery store employees, and other essential personnel, are able to continue the fight against COVID-19. Without all of them, we’d be in a much more dire situation. Still, we need to make sure that the transportation workers who are putting their lives at risk daily to make deliveries or get people to work are also safe. That not only means providing them with necessary personal protective gear, but also ensuring any regulatory waivers do not jeopardize their safety or the safety of others.

Since the start of this national emergency, many transportation entities facing staffing shortages due to illness and the need to quarantine have requested emergency relief from certain safety regulations. These entities cite concerns about their ability to deliver critical goods and materials necessary for the country’s welfare while meeting regulatory requirements for inspections, training, and maintenance, to name a few. Although regulatory relief from certain requirements may be necessary during this difficult time, I urge the US Department of Transportation (DOT) to carefully review each request and put measures in place to ensure that the safety of transportation workers, and all others who must travel, remains a priority.

We are all being challenged in ways that we could not have imagined a month ago. People are staying safe by traveling only when absolutely necessary and maintaining a safe social distance from others. Those in the transportation industry are also doing what they can to stay safe while continuing to do the important work of moving the people and goods that keep our nation pushing forward during this crisis.

It’s important that any regulatory relief the DOT determines is appropriate is only temporary. This crisis can seem overwhelming, but as a nation, we will prevail. It’s important that when our lives start to take the path back to “normal,” safety regulations—many of which the NTSB has long advocated for following tragic crashes—are reinstituted. Temporary measures to address a crisis should not become the new normal. An efficient transportation network is key to our nation’s success during this challenging time, but we must not forget the importance of ensuring the safety of transportation workers and the traveling public both now and in the future.