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Safety Recommendation Details

Safety Recommendation H-18-014
Synopsis: 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.
Recommendation: TO THE MARYLAND MOTOR VEHICLE ADMINISTRATION: Assess the volume of referrals by nonphysician health-care providers and first responders (other than law enforcement) to determine whether improved outreach and adjustments to current reporting methods may increase their reporting of medically at-risk drivers.
Original recommendation transmittal letter: PDF
Overall Status: Open - Acceptable Response
Mode: Highway
Location: Chattanooga, TN, United States
Is Reiterated: No
Is Hazmat: No
Accident #: HWY17MH009
Accident Reports: Preliminary Report: HIGHWAY - HWY17MH009
Report #: SIR-18-02
Accident Date: 11/21/2016
Issue Date: 6/21/2018
Date Closed:
Addressee(s) and Addressee Status: State of Maryland, Motor Vehicle Administration (Open - Acceptable Response)

Safety Recommendation History
From: NTSB
To: State of Maryland, Motor Vehicle Administration
Date: 12/10/2018
Response: We are pleased that you completed the recommended assessment and are revising your medical reporting system to include referrals from nonphysician health-care providers and first responders. We encourage you to move forward with your plans to develop a new referral form, track submissions, and offer medical reporting training to first responders. We look forward to receiving periodic updates on your efforts. Until such actions are complete, Safety Recommendation H-18-14 is classified OPEN--ACCEPTABLE RESPONSE.

From: State of Maryland, Motor Vehicle Administration
Date: 8/28/2018
Response: -From Christine Nizer, Administrator, Maryland Department of Transportation Motor Vehicle Administration: Background: MDOT MVA encourages medical providers, emergency responders, law enforcement, family members or concerned citizens to submit referrals for drivers who have potential medical issues impacting their ability to drive safely. Response to recommendation: MDOT MVA is responding to the two elements of this recommendation. “Assess volume of referrals by nonphysician health-care providers and first responders (other than law enforcement …” MDOT MVA’s current medical referral case management systems does not currently have the coding needed to automatically report on referrals submitted by nonphysicians or first responders. However, MDOT MVA conducted a manual review of more than 600 recent medical cases sent for Medical Advisory Board review. The review found that fewer than one percent were directly submitted by nonphysician health-care providers or non-law enforcement first responders. The review did find that nonphysicians such as counselors, nurses, rehabilitation specialists or social workers frequently contributed to referrals ultimately submitted by a physician. Nonphysicians may choose this route over directly submitting a referral because they are aware of the established physician referral process. “… to determine whether improved outreach and adjustments to current reporting methods may increase their reporting of medically at-risk drivers.” MDOT MVA acknowledges that, unlike for physicians or law enforcement officers, there is currently no specific form or system for nonphysicians or first responders to make a medical referral. To better facilitate these referrals, MDOT MVA is committing to the following: a. Before September 30, 2018, MDOT MVA will change the “Voluntary Physician’s Referral” form to the “Voluntary Physician / Healthcare Provider Referral to the Maryland MVA” form and use this to accept and track referrals from nonphysicians and first responders. b. Before December 31, 2018, the agency will develop a standard Internet-based form for co-workers, family members and others to report a medical concern for any driver. c. MDOT MVA will work with the Maryland Institute for Emergency Medical Service Systems to develop training for first responses on identifying and referring at-risk drivers. This may include integration into the current automated MEDS® system.

From: NTSB
To: State of Maryland, Motor Vehicle Administration
Date: 6/21/2018
Response: The National Transportation Safety Board (NTSB) is an independent federal agency charged by Congress with investigating every civil aviation accident in the United States and significant accidents in other modes of transportation—railroad, highway, marine, and pipeline. We determine the probable cause of the accidents and issue safety recommendations aimed at preventing future accidents. In addition, we carry out special studies concerning transportation safety and coordinate the resources of the federal government and other organizations to provide assistance to victims and their family members affected by major transportation disasters. 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 Among the safety recommendations are three new recommendations issued to the Maryland Motor Vehicle Administration, which can be found on page 77 of the report. The NTSB is vitally interested in these recommendations because they are 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 them. When replying, please refer to the safety recommendations by number. We encourage you to submit your response to If it exceeds 10 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.