Tag Archives: fatigue

Teens and Drowsy Driving

Teens and Drowsy Driving

By Dr. Jana PriceTeenager sleeping after prepare for Exam at the Home. Focus on the Clock

Sleepiness while driving can have serious consequences. The NTSB has investigated numerous crashes in which driver drowsiness played a role. Today marks the first anniversary of one of those crashes.

On March 20, 2016, four teens were traveling home from a weekend trip to South Padre Island, Texas. At about 1:57 pm, the driver lost control of the car, crossed the center median, entered the opposing lanes of traffic, and collided with a truck-tractor semitrailer. The driver was seriously injured and her three friends died. The Board determined that that the driver’s loss of control was due to inattention resulting from her fatigue.

NTSB investigators learned that, in the 24 hours before the crash, the driver had very little opportunity for sleep—only about 5 hours on the morning of the crash.

According to the CDC, motor vehicle crashes are the leading cause of death for teens in the United States, and recent AAA Foundation for Traffic Safety research shows that one in five fatal crashes involves a drowsy driver. Other research shows that drivers aged 16 to 24 are at the greatest risk of being involved in a drowsy driving crash.

In a recent AAA Foundation study, many drivers who understood the risks of drowsy driving admitted they had, nonetheless, driven while fatigued. Specifically, the AAA survey found that 96 percent of drivers see drowsy driving as a serious threat and a completely unacceptable behavior; however, among that same group, 3 in 10 admitted to driving when they were so tired that they had a hard time keeping their eyes open.

Lack of sleep slows reaction time and makes us more susceptible to forgetting or overlooking important tasks. A few seconds is all it takes to drift out of the lane or to miss a stopped vehicle ahead.

Although it’s not always possible to predict when you will become drowsy behind the wheel, there are several steps you can take to help avoid this risk. Today, to call attention to the risk posed by driving drowsy, the NTSB is releasing a new Safety Alert, Drowsy Driving Among Young Drivers.

Jana Price, PhD, is a Senior Human Performance Investigator in NTSB’s Office of Highway Safety.

What if a Trucker Just Breaks the Rules?

By Dr. Robert Molloy

The National Transportation Safety Board (NTSB) often responds to crashes in all modes of transportation with recommendations to regulators to ensure that vehicle operators are not fatigued or impaired. In commercial trucking, for example, we have made many recommendations to prevent fatigued truckers from getting behind the wheel. There are also long-established rules about the use of impairing drugs by commercial truck drivers.

But what if a trucker just breaks the rules?

Reduce Fatugie-related Accidents Most Wanted List posterOn October 4, the NTSB met to discuss a tragic crash in Chattanooga, Tennessee, in which a tractor-trailer ran into a line of slow-moving cars at a speed of at least 78 miles per hour. This began a chain-reaction crash that killed six people and injured four others. The driver in this accident chose not to follow the hours-of-service rules and get appropriate rest before he began his trip. He also chose to use methamphetamine before getting behind the wheel. As a result, the driver was impaired by both drugs and fatigue as he approached a clearly visible work zone with slowed and stopped traffic. He deliberately ignored the rules that had been in place to prevent this very tragedy.

In such a case, what is there to learn about safety? What can be done to improve safety when a truck driver just decides to break the rules?

This question illuminates the value of a safety investigation that does not determine blame or fault, and does not conduct criminal or disciplinary proceedings. Rather, the NTSB’s sole mandate is safety. This means that we not only recommend better rules for truck drivers, but we also continue to look for ways to prevent future tragic crashes, even when a driver simply breaks the rules.

One way to prevent another crash like the one in Chattanooga is to keep such dangerous drivers away from commercial trucking. In the Chattanooga crash, we found that the driver’s employer could have used a pre-employment hair drug test to discover the driver’s history of drug use before he was hired. We also found that the state of Kentucky had a list of citations and previous collisions associated with the driver’s 5-year driving record, but his employer had only consulted the driver’s 3-year driving record in the hiring process.

In this case, we did make recommendations to the regulator, the Federal Motor Carrier Safety Administration (FMCSA), not to adopt new rules for truck drivers, but to help keep dangerous drivers that break the rules out of commercial trucking. We asked the FMCSA to disseminate information to carriers about hair drug testing. We also asked the FMCSA to specify that an employer must consider any evidence in a driver’s crash record that the driver had violated laws governing motor vehicle operation. We asked that the FMCSA evaluate motor carrier use of and perspectives on their Pre-employment Screening Program, and to collect and publish best practices for pre-employment investigations and inquiries.

In addition, we recommended that the states of Kentucky and Idaho include driver status, license expiration, driving restrictions, violations, and crashes in their 3-year driver records.

In the case of a tragic crash like the one that happened in Chattanooga, it is for other appropriate authorities to pursue punishment. Our findings and recommendations reflect our mission to improve safety.

NTSB 2016 Most Wanted List issue image for End Substance Impairment in Transportation, image collage of drugs, alcohol, vehicles and dead end signOur Most Wanted List of safety improvements includes ending impairment in transportation and reducing fatigue-related accidents. One way to make progress toward these goals is to ensure that truck drivers with a demonstrable pattern of unsafe behavior are filtered out of the transportation system before their behavior results in tragedy.

Dr. Robert Molloy is the Director of the NTSB Office of Highway Safety.

A Wake-Up Call for Employers and Employees

By Jana Price

Poster encouraging drivers to get enough rest and not drive drowsyMy brother is a district sales manager who sells manufacturing supplies to companies across Wisconsin. He spends about 75 percent of his work time in his car, traveling on sales calls throughout the state, often driving 5 hours for a 2-hour sales visit before driving back home. Because he drives a company car, his employer pays for his insurance and gas. When I asked him what types of driving safety training or policies his company has, he told me that the driving safety policy is clear: No texting or hand-held phone use while driving, and always wear seat belts.

“But what about drowsy driving?” I asked him. No policies, no training, even though he spends as much time on the road as many interstate truck drivers.

Drowsy driving is a serious problem. According to a study conducted by the AAA Foundation for Traffic Safety, one in five fatal crashes involves a drowsy driver. As an accident investigator at the National Transportation Safety Board, I have spent a good part of my career investigating crashes that could have been prevented if drivers made better choices to stay alert, and if employers had proactive strategies to prevent drowsy driving. All of us need sleep, and none of us—even the most experienced drivers—is immune to the consequences of getting behind the wheel while drowsy. In the blink of an eye, your car can drift off the road, risking your life and the lives of those around you.

This week is Drive Safely Work Week, sponsored by the Network of Employers for Traffic Safety, and one of this year’s central themes is the importance of sleep to ensure that employees stay healthy and safe. To prevent drowsy driving and increase safety, companies can establish fatigue management programs, which can include setting maximum work times and minimum rest hours to ensure that workers have sufficient time for sleep, educating workers about the importance of sleep for health and safety, providing screening and treatment for sleep disorders, and encouraging drivers to report sleep, fatigue, or workload problems.

Even if your company doesn’t have a fatigue management program, there are steps you can take to stay safe and alert while driving. Aim for 8 hours of sleep every night; avoid driving during early morning hours when the brain is wired for sleep; get checked for sleep disorders, especially if you are drowsy during waking hours; and if you feel drowsy while driving, get off the road and stay safe.

I am thankful that my brother’s company has paid for hotel rooms the handful of times he felt he was too tired to drive home. But employers and workers can—and must—do more to ensure that drivers are alert and safe for every trip.

Jana Price, PhD, is a Senior Human Performance Investigator in the NTSB Office of Highway Safety.

Don’t be that Driver! – Drive Safely Through Work Zones

By Pete Kotowski

National Work Zone Awareness Week posterSpring marks the start of road construction season. It is a time when motorists face lane closures, speed reductions, and road workers and equipment operating close to moving traffic. If drivers are inattentive road work can result in crashes that kill or injure road workers and motorists.

National Work Zone Awareness Week is April 11-15 —a time to recognize the hazards of traveling in and around work zones. The NTSB has a long history of promoting work zone safety. I recall the agency conducting a safety study in 1988, involving the investigation of more than 40 work zone accidents. In 1992, we completed the study, Highway Work Zone Safety, which contained safety recommendations to the Federal Highway Administration to address commercial motor vehicles traveling in work zones. We also issued recommendations to enhance speed compliance and traffic control within work zones following the investigation of a 1990 crash in West Virginia.

The number of deaths occurring in highway work zones has been declining. Work zone crashes and fatal work zone crashes have decreased in recent years because of improvements in advanced warning technologies, better traffic control devices, lighting enhancements and improved monitoring of work zone traffic. But more work remains to be done, particularly in regards to commercial vehicles traveling within work zones and so the NTSB continues its efforts to make work zones safer. While commercial vehicles account for only 4.5 percent of all registered vehicles in the United States, they are involved in 11.2 percent of all fatal accidents and 28 percent of all fatal work zone crashes.

I led an investigation of a 2014 work zone crash in Cranbury, New Jersey, involving a commercial motor vehicle (which the media dubbed “the Tracy Morgan” crash). Our investigation found that the commercial vehicle was speeding in a nighttime work zone when it encountered slow-moving traffic in advance of a lane closure. The fatigued driver failed to perceive the slowing traffic until it was too late to do anything. The commercial vehicle struck the rear of a limo van, and this impact began a chain-reaction collision involving four other vehicles. One of the limo van occupants died, and nine other people were injured in the crash.

The NTSB made safety recommendations to mitigate commercial vehicle involvement in work zone crashes, calling for the implementation of traffic control strategies and devices to reduce crash events involving heavy commercial vehicles.  The recommendations also addressed fatigue management programs and occupant protection improvements. Promoting collision avoidance technologies and addressing fatigue and occupant protection safety are all issues on the NTSB’s Most Wanted List of transportation safety improvements.

Work zones are becoming safer because of the use of new technologies and more efficient traffic management. However, until we make more headway against the over-involvement of commercial vehicles in fatal work zone crashes, the road construction season will remain a dangerous time, requiring motorists to be especially attentive to the driving task.

Pete Kotowski is a Senior Accident Investigator in the NTSB’s Office of Highway Safety.

Helping Build a Nation of Safe, Healthy Communities

By Dr. Mary Pat McKay

National Public health Week posterAs an Emergency Physician, it’s been my duty to break bad news to friends and family members who have raced to the emergency department after hearing that their loved one was in a motor vehicle crash. When I start speaking, their faces reflect a mix of hope and fear, but then grim, irrevocable grief dawns with the realization that their loved one died in the crash.

Although it was always there in the back of my mind, I left out the part where their loved one’s death was entirely preventable.

Today marks the start of Public Health Week, when the American Public Health Association brings together communities across the nation to recognize past public health contributions and to highlight present public health challenges.

There is no public health challenge more pressing than our nation’s epidemic of motor vehicle crash deaths. Public health is not only about disease outbreaks, contaminated drinking water, diet, exercise, or smoking cessation. It is also about preventing injuries and deaths in motor vehicle crashes, a leading cause of death for all Americans – and the leading cause of death for Americans from ages 5 to 24.

More than 30,000 of us die every year because of a motor vehicle crash.

According to the Centers for Disease Control and Prevention (CDC), more than 2.5 million Americans went to the emergency department —and nearly 200,000 were then hospitalized—for crash injuries in 2012.

In addition to the human suffering associated with hospitalization, disability, and lost productivity, there is a significant economic impact. According to the National Highway Traffic Safety Administration, the economic cost of crash deaths and injuries in 2010 was more than $240 billion.

The numbers are still being counted, but motor vehicle crashes – and the deaths and injuries resulting from them – are increasing, with an increase of more than 10 percent expected for 2015. That’s potentially 3,000 more unnecessary deaths. I think that’s unacceptable and it makes it even more critical to focus on using proven interventions.

The same public health perspective that can eliminate a disease can one day eliminate our epidemic of crash deaths. Just as the solution to preventing many communicable diseases is washing your hands, there are equally simple and easy ways that you can personally prevent the epidemic of motor vehicle crash deaths and injuries.

First, wear your seat belt. On every ride, in every vehicle, no matter where you are sitting.

Using a seat belt is the easiest and simplest way to help prevent deaths and injuries when crashes happen.

The next way you can personally prevent motor vehicle crash deaths and injuries is by preventing the accident itself. Every year, the NTSB issues its Most Wanted List of transportation safety improvements. This year’s list features many of the behaviors that cause motor vehicle crashes—distraction, impairment, and fatigue – three behaviors you control.

Let me ask you a few questions. It’s all right, remember, I’m a doctor.

Have you ever fought sleep while behind the wheel of an automobile? How often have you gotten behind the wheel when you’ve been drinking? Do you take cell phone calls while driving? Do you know texting while driving is dangerous but do it anyway “because you’re so good at it”?

The fact is when you’re behind the wheel you need to be alert, awake, and attentive. Looking away for as little as two seconds puts you – and those around you – at risk of becoming a statistic.

Let me write you a few free prescriptions that just might save your life, or somebody else’s:

  • Don’t get behind the wheel if you’ve been drinking, no matter how much or how little.
  • When you’re driving, leave the phone alone, hands free calls included, and
  • No texting and driving. Ever. If you need to take or place a call, send a Tweet, reply to a text or check an email, pull over to a safe location, stop and park your vehicle, and then hammer out those 140 characters.

Advances in medicine have made diseases that killed millions a distant memory instead of a continuing reality. Treating the epidemic of crash related injuries and fatalities as the public health emergency that it is can help build a nation of safe, healthy communities. Take this doctor’s advice, and follow this prescription – the life you save may be your own.

Dr.Mary Pat McKay is the NTSB Chief Medical Officer.

Rail Workers: Deadly Tired…but Still Working

By Georgetta Gregory

The rail business is an industry full of tired, stressed workers. It is an epidemic.

I know this first-hand because, before coming to the NTSB several years ago, I spent more than 30 years working in the freight railroad industry. While freight railroad managers and crews count on reliable schedules to make their shipments and make their customers happy, there is no routine schedule for the hundreds of thousands of crewmembers employed in this business. As a result, many railroad workers are literally walking and working in their sleep.

I was one of them.

One of my last jobs before coming to the NTSB was as a trainmaster for a major freight railroad. My duties included safely seeing the arrival and departure of trains in and out of terminals in California. I spent a large majority of my time reviewing train schedules and communicating with train personnel of arriving and departing trains. I coordinated the efforts of nearly 300 crewmembers, including yardmasters, dispatchers and engineers, to execute the transportation plan on my territory. Additionally, I was responsible for making sure all the work was done safely and in accordance with rules and regulations.

The job was very stressful and required long hours. It wasn’t unusual for me to work 80 hours a week. I often worked overnight, evenings, weekends and long hours.

Over time, I became chronically fatigued. I gained weight and began to lose my memory and other cognitive abilities. I had no routine schedule for sleep, because I worked irregular hours that were counter to my circadian rhythms. Eventually, I began to make mistakes at work and in my personal life – potentially dangerous ones.

Noting how my work and home life was suffering, I went to a sleep specialist. The doctor determined that I was fatigued at a dangerous level – to the point where the state of California took my driver’s license. Ironically, while I could no longer drive a car, I was still expected to carry out the meticulous details associated with managing rail yards.

I warned my bosses, but there was little help or response. I made suggestions for improvements, including encouraging the railroad to provide better lineups and opportunities for rest, but I felt unsupported and became concerned for the safety of my crews. Eventually, I left the railroad and began a new career.

My story is not unusual. And when I came to the NTSB as Chief of the Railroad Division, I quickly learned that the NTSB also realized the dangers of fatigue in the railroad business. As a result of our investigations in recent years, we have issued more than 25 recommendations related to managing fatigue—all still open, needing to be addressed.

Wreckage of BNSF train, including lead locomotive of striking train, at Red Oak, Iowa.
Wreckage of BNSF train, including lead locomotive of striking train, at Red Oak, Iowa.

One accident, in particular, involving a freight train perhaps best highlights the danger the NTSB is attempting to eradicate. In April 2011, an eastbound BNSF Railway (BNSF) coal train traveling about 23 mph, collided with the rear end of a standing BNSF maintenance-of-way equipment train near Red Oak, Iowa. The collision resulted in the derailment of 2 locomotives and 12 cars. The lead locomotive’s modular crew cab was detached, partially crushed, and involved in a subsequent diesel fuel fire. Both crewmembers on the striking train were fatally injured.

We determined that the probable cause of the accident was the failure of the crew of the striking train to comply with the signal indication requiring them to operate in accordance with restricted speed requirements and stop short of the standing train because they had fallen asleep due to fatigue resulting from their irregular work schedules and their medical conditions.

As a result of that accident, we recommended that the railway require all employees and managers who perform or supervise safety-critical tasks to complete fatigue training on an annual basis and document when they have received this training, and that they medically screen employees in safety-sensitive positions for sleep apnea and other sleep disorders.

Both the conductor and the engineer had worked irregular schedules for several weeks leading up to the accident. During this time, work start times often varied significantly from day to day for both crewmembers. Changing work start and end times can make achieving adequate sleep more difficult, because irregular work schedules tend to disrupt a person’s normal circadian rhythms and sleep patterns, which in turn can lead to chronic fatigue.

Metro North Train 8808 scene
Scene of the derailment of Metro North Train 8808.

More recently, we investigated an accident in New York where a Metro North Railroad locomotive engineer was operating a train with undiagnosed severe obstructive sleep apnea (OSA). The train, on its way toward Grand Central Station in New York, New York, had 115 passengers on board. The engineer headed into a curve with a 30 mph speed limit traveling at 82 mph, resulting in a derailment. Sixty-one people were injured, and 4 passengers died.

The engineer experienced a dramatic work schedule change less than 2 weeks before the accident, with his wake/sleep cycle shifting about 12 hours. Previously, he had complained of fatigue but had not been tested or treated for sleep apnea. After the accident he had a sleep evaluation that identified excessive daytime sleepiness and underwent a sleep study resulting in a diagnosis of severe OSA. Following the study, he was treated successfully for OSA within 30 days of the diagnosis.

The NTSB issued safety recommendation to the Metro-North Railroad to revise its medical protocols for employees in safety-sensitive positions to include specific protocols on sleep disorders, including OSA.

We have issued numerous recommendations to the Federal Railroad Administration, as well, requiring it to develop medical certification regulations for employees in safety-sensitive positions that include, at a minimum, a complete medical history that includes specific screening for sleep apnea and other sleep disorders, a review of current medications, and a thorough physical exam. If such a recommendation had been implemented at the railroad for which I worked, my fatigue most likely would have been caught earlier and mistakes avoided.

(Note: As I was writing this blog, I was heartened to hear that, on March 8, the FRA announced it was seeking public input on the impacts of screening, evaluating and treating rail workers for obstructive sleep apnea.)

And while the railroads and the federal regulators are responsible for addressing this epidemic, so too must railroad workers recognize the dangers of working while fatigued. Yet many are compelled to make money and want to stay ready to react at any hour of the day to avoid missing the opportunity to get paid. To a certain extent, I understand this. And that’s why we must also work with labor unions to address this issue and provide workers the opportunity for sleep, while still allowing them the opportunity to get a paycheck and progress in their careers.

Fatigue in transportation is such a significant concern for the NTSB that it has put “Reduce Fatigue-Related Accidents” on its Most Wanted List of transportation safety improvements. It is not just an issue in rail, but an issue in all modes of transportation that must be addressed.

As a former railroad worker and now as a supervisor of railroad accident investigators, I can tell you we still have a long way to go to address this issue. Doing so will require the joint efforts of the regulator, the operator, and the employee. These efforts must be undertaken, because we can’t keep running down this dangerous track.

Georgetta Gregory is chief of NTSB’s Railroad Division.

Wake Up, America!

By Jeffrey Marcus

Reduce Fatugie-related Accidents Most Wanted List posterOn February 29, 2016, the scientific journal Injury Prevention published “Fatigue in Transportation: NTSB Investigations and Safety Recommendations,” which I co-authored with former NTSB Board Member (and fatigue expert) Dr. Mark Rosekind. We reviewed all recent major NTSB investigations in all modes of transportation for the presence of fatigue in accidents.

Bottom line: fatigue was present in 20 percent of them as a probable cause, a contributing factor, or a finding. The presence of fatigue varied among the modes of transportation, ranging from 40 percent of highway investigations to 4 percent of marine investigations.

And this is after 109 years of federal government action to mitigate the risk of fatigue in transportation. Congress passed the Hours of Service Act on March 4, 1907. Fatigue regulations have been continually reviewed and revised as we learn more about the impact of fatigue; as recently as January 12, 2012, the FAA published a final rule substantially revising and improving the fatigue regulations governing commercial aviation.

However, the NTSB continues to see fatigue in transportation tragedies and incidents in investigations in all modes of transportation. Accordingly, we have issued safety recommendations to help prevent recurrences. Since the NTSB issued its first fatigue recommendation in 1972, we have issued 205 separate fatigue-specific recommendations.

Dr. Rosekind and I divide these recommendations into seven subject categories. We list the number of recommendations in each category, both overall and by transportation mode. We also analyze the types of organizations that received the recommendations, whether the recommended actions have been taken, and the NTSB’s evaluation of whether the actions taken satisfied a given recommendation.

Of the seven subject categories, scheduling policies and practices account for 40% of all fatigue recommendations. Other subject categories included Education/Raising Awareness; Organizational Strategies; Medical issues affecting sleep; Vehicle and Environmental Strategies and Technologies; Research and Evaluation; and Fatigue Management Plans.

Overall, 54 percent of NTSB fatigue safety recommendations were issued to federal agencies, but this percentage varied among modes, with 86 percent of all aviation fatigue recommendations being issued to federal agencies, and only 30 percent of rail recommendations issued to these agencies. Other types of organizations receiving recommendations included transportation operators (both government and private companies), labor unions, and professional associations.

In the more than 40 years since our first fatigue recommendation, the scientific knowledge related to fatigue, sleep, circadian rhythms and sleep disorders has grown enormously, and there has been a parallel increase in investigators’ recognition of fatigue as a causal or contributory factor. In addition, investigative techniques (such as collection of a 72-hour history) are now standard components of major investigations. These advancements in science, recognition, and investigative techniques have resulted in fatigue findings that previously might not have been identified.

The more we know about fatigue, the more clearly we learn that proper sleep is foundational to all human functioning – including in the operation of vehicles in transportation.

Jeffrey Marcus is a Transportation Safety Specialist in the Office of Safety Recommendations & Communications