Remarks by Anne S. Ferro
"What DOT is doing to Crack Down on Fatigue & Sleep Apnea"
Sleep Apnea & Multimodal Transportation Conference 2011
November 9, 2011
Good afternoon, everyone. I was pleased to participate in last year's sleep apnea and trucking conference and I am proud of DOT and FMCSA's continued sponsorship and involvement and this year's spotlight on multimodal transportation safety.
Today I will talk about the steps the Department is taking to gain a better understanding in the prevention and management of fatigue and sleep apnea to ensure that we fulfill the public's expectation of safety, every trip, for every driver, every time.
At the U.S. Department of Transportation, our fundamental mission is to help Americans travel safely from one place to another. Crashes happen in the blink of an eye. So our solemn obligation – the responsibility with which the American people have entrusted us – is to prevent deadly crashes.
With me from FMCSA is Dr. Benisse Lester who is our Chief Medical Officer. You will find her participating in several sessions throughout the conference.
Also joining us are Elaine Papp, Pam Perry, Albert Alvarez, Rick Wood, Shannon Watson and Angela Ward. These folks work daily on programs, regulations and technology to reduce fatigued driving. At FMCSA, we are all about saving lives. FMCSA and the rest of the Department puts the public's safety above all else. That's what the public entrusts us to do.
Fatigue & Sleep Apnea
Among the many challenges we face are those related to fatigue and sleep apnea.
Fatigue is one of the most dangerous driver conditions leading to transportation crashes. 1 Fatigue sharply reduces a transportation workers' level of alertness and awareness of what is happening, and ultimately increases the likelihood of falling asleep at the controls of a truck, bus, train, plane or ship. Fatigue reduces a driver's perception, recognition and ability to control the vehicle. All too often, the tell-tale signs of fatigue that can cause a crash come too late to take effective action.
According to FMCSA's Large Truck Crash Causation Study, we estimate that fatigue is a factor in approximately 13 percent of all crashes involving large trucks.
Sleep apnea is an important cause of fatigue and by itself is a serious medical issue which, if diagnosed and treated, can help to ensure transportation workers can operate safely.
Both conditions are serious impediments to public safety and DOT is focusing on them like never before.
DOT Safety Council
Making all travel safer takes a larger commitment than just one or two agencies within the Department. As a result, Secretary LaHood established the DOT Safety Council two years ago to focus on this and other safety issues. The Safety Council brings together each part of DOT in addressing transportation safety as a critical national health issue.
Deputy Secretary John Porcari chairs the Council where senior leaders from our 10 operating administrations meet monthly to coordinate efforts.
One of the ways the Safety Council continues the dialogue on fatigue is through participation in events like today's conference. Because fatigue affects all modes of transportation, the Safety Council is conducting several projects focused on fatigue and hours-of-service to gain more information and a better understanding one of our toughest safety challenges.
The projects underway include:
- A study on the current use of fatigue models in the transportation community and the development of the next generation of fatigue models. This effort is being led by the Federal Railroad Administration and included a session at the Transportation Research Board Conference earlier this year. Modeling work-rest schedules and identifying patterns that contribute to fatigue would provide a tool for employers and workers to use in managing productivity and customer expectations while taking into account the real-world risks associated with scheduling demands.
- A second project will determine how to communicate to the public the importance of rest as it relates to transportation safety so that we can affect a real change in our culture. An important part of this communication campaign is to get everyone to recognize that preventing fatigue means much more than safety rules. Changing the work-rest schedules that contribute to fatigue will require much more effort than simply adhering to safety requirements. It will require a change in the safety culture and use of tools such as the next generation fatigue models. The Department plans to roll out a web site in 2012 that will communicate the scope of the fatigue problem to the public.
- A project led by the Coast Guard will develop an incident analysis framework – how are we capturing data on fatigue-related crashes across the modes? How do we determine whether fatigue is a cause of a crash, so we can gauge the extent of the problem across all modes of transportation?
- And, finally, the Federal Aviation Administration leads a project to examine how the modes are approaching their respective rulemakings concerning hours of service. We currently have the FAA, FRA and FMCSA pursuing hours of service rulemakings and this project will enable the modes to share their lessons learned and what worked for them and their industries.
Cross Modal Initiatives on Fatigue
Our efforts don't end there. Each agency is making progress on understanding the role of fatigue in its own area and is doing something about it.
FRA has a project on sleep disorders and sleep apnea. They have developed a screening tool for train crews to understand sleep and its disorders. The web site was shown at a session yesterday and will be highlighted at the session on sleep apnea in the transportation workforce immediately following this one.
In August, FRA published a final rule to limit the number of consecutive hours passenger railroad workers can be on the job. FRA issued this rule to reduce risk and improve safety in the railroad industry, and for the first time, differentiated between freight and passenger service.
The Federal Transit Administration is in the final stages of developing an on-line course focused on understanding fatigue for public transit employees. This course will be made available as early the first of the year.
It will give transit employees the knowledge they need to identify warning signs of fatigue and sleep disorders such as sleep apnea.
The Federal Aviation Administration continues to push for pilot flight and duty time changes. The rule is in its final stages. FAA is working to get the rule out as soon as possible. FAA remains committed to ensuring that airline pilots are fit and rested when they report for duty.
The Federal Highway Administration is working with states to construct safety edges on America's roadsides. This simple innovation sets the outside edge of new or resurfaced pavement at 30 degrees, helping fatigued drivers who have strayed from the road to more safely re-enter traffic. And rumble strips are getting all drivers attention.
Across the modes, we are taking a vigilant approach to safety and fatigue in particular.
At FMCSA, we understand that fatigue and sleep apnea is complex with no easy solutions. That is why we rely on a mix of research, regulations, enforcement, grants to states and public outreach to save lives by reducing crashes involving large trucks and buses.
Earlier this year, we developed a Sleep Apnea spot-light page on our web site, complete with tools and resources directed to both drivers and carriers. This page gives visitors a one-stop place to highlight the problem of sleep disorders and commercial motor vehicle safety.
For the first-time ever, FMCSA is holding a joint session on December 7 of our Medical Review Board and the Motor Carrier Advisory Committee to address how FMCSA will explore how FMCSA might move forward in our approach to fatigue and sleep apnea and to recommend what direction those decisions that will take us.
Everything from regulatory guidance based on current regulations to the cost-effectiveness of current screening methods will be discussed. The meeting is open to the public – please check the FMCSA or MCSAC web sites for an announcement with more details of the December 7 meeting.
Current FMCSA Research
As I said earlier, fatigue is estimated to be a factor in 13 percent of all truck crashes1 and it is one of the most dangerous conditions for drivers of large trucks.2
That is why we have undertaken several studies to better understand sleep apnea.
A May 2002 study found that almost one-third of truck and bus drivers tested have mild to severe sleep apnea. The prevalence of sleep apnea is impacted by short sleep duration or six hours or less per night of sleep.
A 2004 report assessed the risks of commercial motor vehicle crashes due to sleep apnea. The study found that age and BMI or Body Mass Index – are the two major factors linked to the frequency of sleep apnea. The study also found a significant relationship between severe sleep apnea and severe crashes – those that cause multiple injuries and require vehicles to be towed from the scene.
Drivers with severe sleep apnea were 4.6 times more likely to be involved in a severe crash in the seven-year period than drivers who did not have sleep apnea.
Another study evaluated the effects of putting into place fatigue management programs in trucking companies. The study found that adherence to sleep apnea treatment greatly varied among the study sites. We learned that you can't just focus on the screening of sleep apnea; you must also be concerned with the compliance of sleep apnea treatment.
FMCSA recognizes the need for studies to gain a better understanding of detention or waiting times in the trucking industry and the safety impacts that can occur as a result of long detention times.
Studying the relationship between driver compensation and safety is also on our near term agenda. In addition, we are looking to advance the state-of-the-art of fatigue models by developing a fatigue model that takes into account individual differences that provide a better prediction of individual driver performance.
We are studying whether certain individuals are more vulnerable to fatigue than others and then based on what we learn, a set of best practices for carriers will be developed to match drivers vulnerable to fatigue with more appropriate work schedules.
All of this work takes us steps closer to identifying and addressing safety problems resulting from work hours and fatigue. Our goal is to develop and implement solutions in order to save lives – because this will make a difference in safety on our roads.
Are we there yet? Are we as safe as we want to be? No, we are not. But we are moving forward.
We are making progress on our understanding of fatigue and what we are leaning is turning into highly effective life saving rules and other programs and initiatives that will help to eliminate serious and tragic crashes.
At DOT, our number one priority is to put safety first in order to save lives.
We won't rest until America's skies, roadways, railways and waterways are the safest they can possibly be. We are committed to working with you to do the same. Thank you all.
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1 - Paper presented by Dr. Ralph Craft at the First International Conference on Driver Distraction and Inattention, Gothenberg, Sweden, September 2009.