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In November 2016, the NTSB began the investigation of two crashes involving school buses. Each crash was initiated when the driver lost control of the bus. In the November 1 crash in Baltimore, Maryland, the driver was epileptic and suffered a seizure. In the November 21 crash in Chattanooga, Tennessee, the driver was speeding while using a cell phone and ran off the road. In both cases, the school bus operators were private for-hire motor carriers. Although the specific safety issues differed, the crashes shared one common factor: poor driver oversight by both the school districts and the contracted motor carriers, which resulted in unsafe operation of the school buses. Between the two crashes, 12 people died and 37 were injured. The crash investigations focused on the following safety issues: school districts’ lack of oversight of student transportation providers; poor management of unsafe school bus drivers by the motor carriers and school districts; medically unfit school bus drivers; commercial driver license fraud; occupant protection in large school buses; and the benefits of electronic stability control, automatic emergency braking, and event data recorders. The NTSB made safety recommendations to the Federal Motor Carrier Safety Administration; the National Highway Traffic Safety Administration (NHTSA); the states of Florida, Louisiana, New Jersey, and New York; 42 states, the District of Columbia, and the territory of Puerto Rico—which lack requirements for lap/shoulder belts on large school buses; the state of Maryland; the Maryland Department of Education; the Maryland Motor Vehicle Administration; five school bus transportation associations; National Express LLC; seven school bus manufacturers; five electronic health record companies; and Concentra, Inc. The report also reiterates four recommendations to NHTSA and reclassifies a recommendation to the Baltimore City Public Schools.
TO THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION: Provide explicit guidance to encourage certified medical examiners to request a complete list of current medical conditions and medications when obtaining supplemental information from a commercial driver’s treating health-care provider.
Original recommendation transmittal letter:
Open - Unacceptable Response
Chattanooga, TN, United States
Preliminary Report: HIGHWAY - HWY17MH009
Addressee(s) and Addressee Status:
FMCSA (Open - Unacceptable Response)
Safety Recommendation History
Our intent in issuing this recommendation was to provide timely and easily available guidance to CMEs to help them make decisions about driver qualification. Given that the Baltimore, Maryland, crash occurred despite the availability of existing guidance in the Code of Federal Regulations and the National Registry, which you reference in your letter, and considering that we are currently investigating additional crashes where poor CME guidance hampered the driver-qualification decision, we do not believe that your current CME guidance meets the intent of this recommendation. We urge you to reconsider your position on this recommendation and to provide the appropriate guidance. Pending such action, Safety Recommendation H-18-7 is classified OPEN--UNACCEPTABLE RESPONSE.
-From Raymond P. Martinez, Administrator: The FMCSA agrees that communication between certified medical examiners and treating healthcare clinicians is essential for medical examiners to make informed decisions about drivers' physical qualifications. Physical qualification determinations are the responsibility of certified medical examiners listed on the National Registry. Medical examiners are required to ensure that a driver is not issued a Medical Examiner's Certificate unless he or she is physically qualified. Medical examiners must be knowledgeable of the demands associated with operating a commercial motor vehicle (CMV) and should utilize this information when making a physical qualification determination. Medical examiners are entrusted to determine a driver's ability to operate a commercial motor vehicle safely and should obtain and verify information about a driver's health prior to making a physical qualification determination. The determination of a CMV driver's ability to meet the physical qualification standards should be based on a thorough review of the driver's health history, including medications they are taking, and information gained during the physical qualification examination. Before deciding whether a driver is physically qualified, medical examiners should evaluate information submitted by the driver, medical examination results, and information gained from the driver's treating healthcare clinician(s). When making physical qualification determinations, medical examiners should carefully consider the potential impact of any medications or health conditions on the driver's ability to safely operate a CMV in interstate commerce. The FMCSA has existing guidance to certified medical examiners listed on the National Registry of Certified Medical Examiners (National Registry), encouraging them to request complete and thorough information regarding current medical conditions and medication usage from treating healthcare clinicians when conducting physical qualification examinations of interstate commercial motor vehicle drivers. The guidance specifically states that medical examiners should request additional information from treating healthcare providers prior to making a physical qualification determination. This guidance is currently available on-line to Medical Examiners who are logged into the National Registry and, when first developed, was broadcast to all medical examiners on the National Registry. In addition, this guidance is part of the training curriculum and testing that must be completed before an individual can be become a certified medical examiner on the National Registry. The FMCSA relies on medical examiners to assess and certify whether a driver is physically qualified to operate a CMV through a complete medical examination in accordance with the Medical Examination Report Form, MCSA-5875, which includes collecting as much information as possible regarding the driver's health. Certifying medical examiners should consider the medical history of the driver, the driver's response to treatment, current medication regimen, the applicable regulations, current clinical best practice guidelines, and knowledge of the duties and responsibilities of commercial driving and decide on a case-by-case basis whether the driver is medically qualified to safely operate a CMV. To assist the medical examiner in making a physical qualification determination, they are advised to consult with treating healthcare providers or specialists and/or request additional medical evaluations or diagnostic tests. While federal regulations mandate that drivers provide certified medical examiners with complete and truthful information about their current health and health history on the Medical Examination Report Form, MCSA-5875, FMCSA guidance encourages medical examiners to verify the accuracy of information about a driver's health prior to intaking a physical qualification determination. One way in which medical examiners can verify the accuracy of information provided by the driver is to use the 391.41 CMV Driver Medication Form, MCSA-5895, located on FMC SA' s website, at https://www.fmcsa.dot.gov/regulations/medical/39141-cmv-drivermedication-form-mcsa-5895-optional. In addition to obtaining information regarding medications prescribed and the medical conditions being treated, this voluntary form provides treating healthcare providers with information regarding the driver's role, which can assist them in providing an opinion about a driver's ability to take medication and safely operate a CMV. The FMCSA guidance recommends certified medical examiners make it a best practice to use the information provided by the treating healthcare provider on the 391.41 CMV Driver Medication Form, to assist them in determining whether a driver can safely operate a CMV. In addition, when making a physical qualification determination, FMCSA encourages medical examiners to utilize other best practices such as requesting each driver they examine to provide a copy of their previous Medical Examination Report Form, MCSA-5875 when possible. MEs are then able to evaluate information submitted by the CMV driver, medical examination results, and information gained from the driver's treating healthcare provider(s) and carefully consider the potential impact of any medications or health conditions on the driver's ability to safely operate a CMV. The FMCSA believes the existing guidance and training are sufficient to address this safety concern and requests that the NTSB close safety recommendation H-18-007.
On May 22, 2018, the NTSB adopted its report Selective Issues in School Bus Transportation Safety: Crashes in Baltimore, Maryland, and Chattanooga, Tennessee, NTSB/SIR-18/02. The details of these investigations and the resulting safety recommendations may be found in the attached report, which can also be accessed at www.ntsb.gov. Among the safety recommendations is one new recommendation issued to the Federal Motor Carrier Safety Administration, which can be found on page 76 of the report. The NTSB is vitally interested in this recommendation because it is designed to prevent accidents and save lives. We would appreciate a response within 90 days, detailing the actions you have taken or intend to take to implement this recommendation. When replying, please refer to the safety recommendation by number. We encourage you to submit your response to firstname.lastname@example.org. If it exceeds 20 megabytes, including attachments, please e-mail us at the same address for instructions. Please do not submit both an electronic copy and a hard copy of the same response.
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