Health and Wellness Programs for Commercial Drivers (2007)

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TRANSPORTAT ION RESEARCH BOARD WASHINGTON, D.C. 2007 www.TRB.org C O M M E R C I A L T R U C K A N D B U S S A F E T Y S Y N T H E S I S P R O G R A M CTBSSP SYNTHESIS 15 Research sponsored by the Federal Motor Carrier Safety Administration Subject Areas Operations and Safety • Freight Transportation Health and Wellness Programs for Commercial Drivers Gerald P. Krueger KRUEGER ERGONOMICS CONSULTANTS Alexandria, VA Rebecca M. Brewster A N D Virginia R. Dick AMERICAN TRANSPORTATION RESEARCH INSTITUTE Alexandria, VA Robert E. Inderbitzen REI SAFETY SERVICES, LLC Vonore, TN Loren Staplin TRANSANALYTICS Kulpsville, PA

COMMERCIAL TRUCK AND BUS SAFETY SYNTHESIS PROGRAM Safety is a principal focus of government agencies and private-sector organiza- tions concerned with transportation. The Federal Motor Carrier Safety Administra- tion (FMCSA) was established within the Department of Transportation on January 1, 2000, pursuant to the Motor Carrier Safety Improvement Act of 1999. Formerly a part of the Federal Highway Administration, the FMCSA’s primary mission is to prevent commercial motor vehicle-related fatalities and injuries. Administration activities contribute to ensuring safety in motor carrier operations through strong enforcement of safety regulations, targeting high-risk carriers and commercial motor vehicle drivers; improving safety information systems and commercial motor vehicle technologies; strengthening commercial motor vehicle equipment and operating stan- dards; and increasing safety awareness. To accomplish these activities, the Adminis- tration works with federal, state, and local enforcement agencies, the motor carrier industry, labor, safety interest groups, and others. In addition to safety, security- related issues are also receiving significant attention in light of the terrorist events of September 11, 2001. Administrators, commercial truck and bus carriers, government regulators, and researchers often face problems for which information already exists, either in docu- mented form or as undocumented experience and practice. This information may be fragmented, scattered, and underevaluated. As a consequence, full knowledge of what has been learned about a problem may not be brought to bear on its solution. Costly research findings may go unused, valuable experience may be overlooked, and due consideration may not be given to recommended practices for solving or alle- viating the problem. There is information available on nearly every subject of concern to commercial truck and bus safety. Much of it derives from research or from the work of practitioners faced with problems in their day-to-day work. To provide a systematic means for assem- bling and evaluating such useful information and to make it available to the com- mercial truck and bus industry, the Commercial Truck and Bus Safety Synthesis Pro- gram (CTBSSP) was established by the FMCSA to undertake a series of studies to search out and synthesize useful knowledge from all available sources and to prepare documented reports on current practices in the subject areas of concern. Reports from this endeavor constitute the CTBSSP Synthesis series, which collects and assembles the various forms of information into single concise documents pertaining to specific commercial truck and bus safety problems or sets of closely related problems The CTBSSP, administered by the Transportation Research Board, began in early 2002 in support of the FMCSA’s safety research programs. The program initiates three to four synthesis studies annually that address concerns in the area of commercial truck and bus safety. A synthesis report is a document that summarizes existing prac- tice in a specific technical area based typically on a literature search and a survey of rel- evant organizations (e.g., state DOTs, enforcement agencies, commercial truck and bus companies, or other organizations appropriate for the specific topic). The pri- mary users of the syntheses are practitioners who work on issues or problems using diverse approaches in their individual settings. The program is modeled after the successful synthesis programs currently operated as part of the National Cooperative Highway Research Program (NCHRP) and the Transit Cooperative Research Pro- gram (TCRP). This synthesis series reports on various practices, making recommendations where appropriate. Each document is a compendium of the best knowledge available on measures found to be successful in resolving specific problems. To develop these syn- theses in a comprehensive manner and to ensure inclusion of significant knowledge, available information assembled from numerous sources, including a large number of relevant organizations, is analyzed. For each topic, the project objectives are (1) to locate and assemble documented information (2) to learn what practice has been used for solving or alleviating prob- lems; (3) to identify all ongoing research; (4) to learn what problems remain largely unsolved; and (5) to organize, evaluate, and document the useful information that is acquired. Each synthesis is an immediately useful document that records practices that were acceptable within the limitations of the knowledge available at the time of its preparation. The CTBSSP is governed by a Program Oversight Panel consisting of individuals knowledgeable in the area of commercial truck and bus safety from a number of perspectives—commercial truck and bus carriers, key industry trade associations, state regulatory agencies, safety organizations, academia, and related federal agencies. Major responsibilities of the panel are to (1) provide general oversight of the CTBSSP and its procedures, (2) annually select synthesis topics, (3) refine synthesis scopes, (4) select researchers to prepare each synthesis, (5) review products, and (6) make publi- cation recommendations. Each year, potential synthesis topics are solicited through a broad industry-wide process. Based on the topics received, the Program Oversight Panel selects new synthesis topics based on the level of funding provided by the FMCSA. In late 2002, the Program Oversight Panel selected two task-order contractor teams through a competitive process to conduct syntheses for Fiscal Years 2003 through 2005. CTBSSP SYNTHESIS 15 Project MC-16 ISSN 1544-6808 ISBN: 978-0-309-09887-8 Library of Congress Control Number 2007928897 © 2007 Transportation Research Board COPYRIGHT PERMISSION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, FAA, FHWA, FMCSA, FTA, or Transit Development Corporation endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. NOTICE The project that is the subject of this report was a part of the Commercial Truck and Bus Safety Synthesis Program conducted by the Transportation Research Board with the approval of the Governing Board of the National Research Council. Such approval reflects the Governing Board’s judgment that the program concerned is appropriate with respect to both the purposes and resources of the National Research Council. The members of the technical committee selected to monitor this project and to review this report were chosen for recognized scholarly competence and with due consideration for the balance of disciplines appropriate to the project. The opinions and conclusions expressed or implied are those of the research agency that performed the research, and, while they have been accepted as appropriate by the technical panel, they are not necessarily those of the Transportation Research Board, the National Research Council, or the Federal Motor Carrier Safety Administration of the U.S. Department of Transportation. Each report is reviewed and accepted for publication by the technical panel according to procedures established and monitored by the Transportation Research Board Executive Committee and the Governing Board of the National Research Council. The Transportation Research Board, the National Research Council, and the Federal Motor Carrier Safety Administration (sponsor of the Commercial Truck and Bus Safety Synthesis Program) do not endorse products or manufacturers. Trade or manufacturers’ names appear herein solely because they are considered essential to the clarity and completeness of the project reporting. Published reports of the COMMERCIAL TRUCK AND BUS SAFETY SYNTHESIS PROGRAM are available from: Transportation Research Board Business Office 500 Fifth Street, NW Washington, DC 20001 and can be ordered through the Internet at: http://www.national-academies.org/trb/bookstore Printed in the United States of America

CRP STAFF FOR CTBSSP SYNTHESIS 15 Christopher W. Jenks, Director, Cooperative Research Programs Crawford F. Jencks, Deputy Director, Cooperative Research Programs Eileen P. Delaney, Director of Publications Kami Cabral, Editor CTBSSP OVERSIGHT PANEL Stephen Campbell, Commercial Vehicle Safety Alliance, Washington, DC (Chair) Thomas M. Corsi, University of Maryland, College Park, MD Nicholas J. Garber, University of Virginia, Charlottesville, VA Alex Guariento, Greyhound Lines, Inc., Dallas, TX Scott Madar, ORC Worldwide, Washington, DC James W. McFarlin, ABF Freight System, Inc., Fort Smith, AR David Osiecki, American Trucking Associations, Alexandria, VA John Siebert, Owner-Operator Independent Drivers Association, Grain Valley, MO Larry F. Sutherland, HNTB Corporation, Columbus, OH R. Greer Woodruff, J. B. Hunt Transport, Inc., Lowell, AR Albert Alvarez, FMCSA Liaison Martin Walker, FMCSA Liaison William Mahorney, FHWA Liaison David Smith, FHWA Liaison Christopher Zeilinger, CTAA Liaison Greg Hull, APTA Liaison Leo Penne, AASHTO Liaison Charles Niessner, TRB Liaison Richard Pain, TRB Liaison AUTHOR ACKNOWLEDGMENTS The research team expresses appreciation to Dr. Peter Orris, MD, MPH, FACP, FACOEM, of the Divi- sion of Occupational Medicine at the John H. Stroger, Jr., Hospital of Cook County, Chicago, Illinois, for his medical technical review of this report. The team also expresses appreciation for the mentorship, the numerous review comments, and the sug- gestions for improvements made by Albert Alvarez of the Federal Motor Carrier Safety Administration. C O O P E R A T I V E R E S E A R C H P R O G R A M S

This synthesis will be useful to federal and state agencies, commercial truck and bus operators, and others interested in improving commercial vehicle safety. The synthesis pro- vides a state of the practice of commercial driver health and wellness programs. It provides a review of literature on truck and motorcoach driver health issues, highlighting the chief health risks facing commercial drivers; presents an analytical review of literature associat- ing crash causation with functional impairments affecting abilities of commercial motor vehicle drivers to drive safely; describes elements of employee health and wellness programs that could apply to commercial drivers; provides the results of a survey of trucking and motorcoach companies who have already implemented employee health and wellness pro- grams and documents the components that are presently being offered to their drivers; and offers several case studies of successful employee health and wellness programs in the truck and motorbus industries, focusing on the elements that appear to work effectively. Administrators, commercial truck and bus carriers, government regulators, and researchers often face problems for which information already exists, either in documented form or as undocumented experience and practice. This information may be fragmented, scattered, and underevaluated. As a consequence, full knowledge of what has been learned about a problem may not be brought to bear on its solution. Costly research findings may go unused, valuable experience may be overlooked, and due consideration may not be given to recommended practices for solving or alleviating the problem. There is information available on nearly every subject of concern to commercial truck and bus safety. Much of it derives from research or from the work of practitioners faced with problems in their day-to-day jobs. To provide a systematic means for assembling and eval- uating such useful information and to make it available to the commercial truck and bus industry, the Commercial Truck and Bus Safety Synthesis Program (CTBSSP) was estab- lished by the Federal Motor Carrier Safety Administration (FMCSA) to undertake a series of studies to search out and synthesize useful knowledge from all available sources and to prepare documented reports on current practices in the subject areas of concern. Reports from this endeavor constitute the CTBSSP Synthesis series, which collects and assembles information into single concise documents pertaining to specific commercial truck and bus safety problems. The CTBSSP, administered by the Transportation Research Board, was authorized in late 2001 and began in 2002 in support of the FMCSA’s safety research programs. The program initiates several synthesis studies annually that address issues in the area of commercial truck and bus safety. A synthesis report is a document that summarizes existing practice in a spe- cific technical area based typically on a literature search and a survey of relevant organizations F O R E W O R D By Christopher W. Jenks Director, Cooperative Research Programs Transportation Research Board

(e.g., state DOTs, enforcement agencies, commercial truck and bus companies, or other orga- nizations appropriate for the specific topic). The primary users of the syntheses are practi- tioners who work on issues or problems using diverse approaches in their individual settings. This synthesis series reports on various practices; each document is a compendium of the best knowledge available on measures found to be successful in resolving specific problems. To develop these syntheses in a comprehensive manner and to ensure inclusion of signifi- cant knowledge, available information assembled from numerous sources is analyzed. For each topic, the project objectives are (1) to locate and assemble documented infor- mation; (2) to learn what practices have been used for solving or alleviating problems; (3) to identify relevant, ongoing research; (4) to learn what problems remain largely unsolved; and (5) to organize, evaluate, and document the useful information that is acquired. Each synthesis is an immediately useful document that records practices that were acceptable within the limitations of the knowledge available at the time of its preparation.

C O N T E N T S 1 Summary 2 Chapter 1 Introduction 2 1.1 Background 3 1.2 Objectives and Scope 3 1.3 Methodology and Approach of This Synthesis 5 Chapter 2 Review of the Literature 5 2.1 Commercial Driving Affects Driver Health 5 2.2 Federal Regulations for Qualification, Fitness, and Suitability to Drive 6 2.3 FMCSA Initiatives Regarding Physical Qualification Standards 7 2.4 Most Common Health and Fitness Risks for Commercial Drivers 9 2.5 Health Issues That May Affect Commercial Driver Safety 13 2.6 Additional Driver Health Conditions That May Affect Driving Safety 19 2.7 Medical Conditions, Functional Impairment, and Fitness to Drive 22 2.8 Corporate Employee Health and Wellness Programs 31 Chapter 3 Health and Wellness Surveys 31 3.1 Truck and Bus Industry Survey Results: Experiences with Employee Health and Wellness Programs 32 3.2 Trucking Industry Manager Survey Results 36 3.3 Driver Survey Results 39 3.4 Key Survey Findings 40 Chapter 4 Health and Wellness Program Case Studies 40 4.1 Case Study: Schneider National, Inc. 41 4.2 Case Study: Trucks, Inc. 42 4.3 Case Study: JB Hunt, Inc. 42 4.4 Case Study: Waste Management, Inc. 43 4.5 Case Study: Greyhound Lines, Inc. (Amalgamated Transit Union National Local 1700 Health and Welfare Plan) 45 Chapter 5 Failure of Employee Wellness Programs 47 Chapter 6 Conclusions and Discussion 49 Chapter 7 Suggestions for Future Research 51 References 56 Bibliography of Additional Readings 60 Appendix A Manager Survey 73 Appendix B Driver Survey

79 Appendix C Truckload Carriers Association Audio Teleconference on Driver Health 80 Appendix D OSHA’s Web-Based Assistance on Safety and Health Topics