Commercial Motor Vehicle Driver Fatigue, Long-Term Health, and Highway Safety Research Needs (2016) / Chapter Skim
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8 Fatigue and Health and Wellness
8 Fatigue and Health and Wellness
Pages 131-152
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From page 131... ...
devices, and medical examination policy for drivers regarding OSA. Next, the chapter reviews non-OSA medical conditions among CMV drivers and the linkages between lifestyle factors and drivers' health.
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From page 132... ...
work shifts have been associ ated with poorer performance on clinical tasks, and increased risks of serious medical errors, preventable adverse events, self-inflicted percu taneous injuries, and motor vehicle crashes among resident physicians.
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MEDICAL CERTIFICATION OF THE HEALTH OF CMV DRIVERS An unhealthy driver behind the wheel of a commercial motor vehicle compromises the safety of the driver and general public. To address this issue, the Federal Motor Carrier Safety Administration (FMCSA)
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From page 134... ...
The Medical Examiner Handbook was removed from the FMCSA website in early 2015 for update, although most examiners still use it as a resource. Examiners can also refer to recommendations of the Medical Expert Panel on Obstructive Sleep Apnea and the Medical Review Board (MRB)
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Increased Risk of Crashes for Commercial Motor Vehicle Drivers with OSA A substantial research literature supports the conclusion that severe OSA -- that is, OSA with an AHI over 30 -- is associated with increased crash risk for the nonprofessional driver. Some of the major contributors to this literature include Aldrich (1989)
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From page 136... ...
is that as "a group, drivers with OSA are at an increased risk for a motor vehicle crash when compared with comparable drivers who do not have the disorder even though a precise estimate of the magnitude of this increased risk could not be determined." An argument might be made that definitive proof of an elevated crash risk among CMV drivers with OSA of a given hypopnea level can come only from a randomized controlled trial examining whether untreated OSA is associated with a higher risk of crashing. Such a study, however, is not feasible; it would also be unethical.
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5 Presentation by Don Osterberg, Schneider National to the Panel on Research Methodologies and Statistical Approaches to Understanding Driver Fatigue Factors in Motor Carrier Safety and Driver Health in Washington, D.C., on May 28, 2014.
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. Medical Examination Policy Regarding OSA FMCSA's current medical examination policy for CMV drivers states, "A person is physically qualified to drive a motor vehicle if that person has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a motor vehicle safely." Thus if the medical examiner detects a respiratory dysfunction that in any way is likely to interfere with the driver's ability to control and drive a commercial motor vehicle safely, the driver must
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From page 139... ...
They recommended further that drivers with OSA who were medically qualified to drive commercial motor vehicles be reevaluated annually by means of sleep studies or MSLT. The 1991 conference report was not widely disseminated, and the majority of medical examiners likely were unaware of its existence.
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(Williams et al., 2011) , FMCSA's Medical Expert Panel on Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety (MEP)
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The NRCME Medical Examiner Sample Training Handbook (National Registry of Certified Medical Examiners, 2012) noted that training programs could teach material beyond the Medical Examiner Handbook, provided they clearly highlighted that the material was not endorsed by FMCSA, and that examiners could use more current guidance than that issued by FMCSA in making certification determinations.
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Conclusion 4: It is apparent that medical examiners who certify com mercial motor vehicle drivers are not consistent in understanding and applying current best practice to identify drivers who may be at risk of moderate to severe obstructive sleep apnea. Many examiners therefore 10 American College of Occupational and Environmental Medicine (ACOEM)
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Nonetheless, this section summarizes the evidence that is required for diagnosis of other medical conditions based on the FMCSA Medical Examiner Handbook. Hypertension Hypertension -- elevated systolic or diastolic blood pressure -- is a risk factor for cardiovascular disease, peripheral vascular disease, and chronic renal insufficiency.
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Details on cardiovascular problems and the increased risk for truck drivers can be found in FMCSA (2002) and the references included therein.
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Conclusion 5: Substantial data gaps limit understanding of factors that impact the health and wellness of commercial motor vehicle drivers. Closing these gaps would aid greatly in developing a better understand ing of drivers' current status and long-term prospects with respect to health and wellness.
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Conclusion 6: Many commercial motor vehicle drivers work/live with occupational pressures that adversely affect health. Given the impact of various aspects of the lifestyle of CMV driving, it is important to develop a better understanding of what aspects of that lifestyle are associated with negative health outcomes.
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From page 147... ...
Absent longitudinal data collection, it is extremely difficult to understand how health outcomes change over time and how such changes occur in the absence or presence of various lifestyle modifications. Conclusion 7: Insufficient data are available on the prevalence of sleep insufficiency, economic pressures, diet, and exercise habits for the popu lation of commercial motor vehicle drivers.
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From page 148... ...
These three carriers have integrated driver fatigue management into their health and wellness programs. Returns on investment in successful health and wellness programs include such benefits as improved employee morale and driver retention rates; enhanced corporate culture and reputation; decreased clinic visits and costs; improved insurance premium rates; and, importantly, decreased accidents and injuries, and therefore also improved safety records (Krueger, 2012)
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• Customers -- pickup/delivery times, transit times, expectations (improve scheduling times) • Medical examiners -- nature of work, sleep apnea (better detect sleep disorders)
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To this end, the agency has conducted extensive education and outreach; held forums on the topics; and carried out extensive research on driver fatigue and performance in conjunction with cooperative, enlightened truck and bus carriers. In terms of continuously addressing driver fatigue management, FMCSA developed and sponsored (with industry)
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how the variety of fatigue management and health and wellness management programs available have been designed, (2) whether drivers/employers actually adhere to these programs, and (3)
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