Category Archives: Medical Fitness

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.

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.