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Safety Recommendation Details

Safety Recommendation H-09-016
Details
Synopsis: On July 26, 2000, the driver of a tractor-trailer travelling on Interstate 40 near Jackson, Tennessee, collided with a Tennessee Highway Patrol vehicle trailing construction vehicles, killing the state trooper inside.1 The tractor-trailer then travelled across the median and collided with a Chevrolet Blazer heading in the opposite direction, seriously injuring the driver of the Blazer. The tractor-trailer driver was 5 feet, 11 inches tall, weighed 358 pounds, and had been diagnosed with and had undergone surgery for OSA, though he had not indicated either the diagnosis or the surgery on examinations for medical certification. The NTSB found that the driver’s (unreported) OSA, his untreated hypothyroidism, or complications from either or both conditions predisposed him to impairment or incapacitation, including falling asleep at the wheel while driving. The NTSB determined that the probable cause of the accident was the driver’s incapacitation, owing to the failure of the medical certification process to detect and remove a medically unfit driver from service.
Recommendation: TO THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION: Develop and disseminate guidance for commercial drivers, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea (OSA), emphasizing that drivers who have OSA that is effectively treated are routinely approved for continued medical certification.
Original recommendation transmittal letter: PDF
Overall Status: Open - Acceptable Response
Mode: Highway
Location: Jackson, TN, United States
Is Reiterated: Yes
Is Hazmat: No
Is NPRM: No
Accident #: HWY00IH046
Accident Reports: Collision in a Work Zone on Interstate Highway 40
Report #: HAR-02-01
Accident Date: 7/26/2000
Issue Date: 10/20/2009
Date Closed:
Addressee(s) and Addressee Status: FMCSA (Open - Acceptable Response)
Keyword(s): Fatigue

Safety Recommendation History
From: NTSB
To: FMCSA
Date: 6/3/2019
Response: We are disappointed by your lack of progress on these three recommendations addressing OSA, which you say is due to restrictions placed on your agency by Public Law 113-45. To better understand your limitations, our Office of General Counsel is reviewing the law and its implications for our recommendations. Until that review is complete and we determine next steps, the status of these recommendations will not change; therefore, Safety Recommendation H-09-15 remains classified “Open—Unacceptable Response;” Safety Recommendation H-09-16 remains classified OPEN--ACCEPTABLE RESPONSE, and Safety Recommendation H-17-49 remains classified “Open—Acceptable Alternate Response.”

From: FMCSA
To: NTSB
Date: 1/18/2019
Response: -From Michael Jordan, Strategic Planning and Program Evaluation Division, Federal Motor Carrier Safety Administration: On August 8, 2018, and December 4, 2018, representatives from the Federal Motor Carrier Safety Administration (FMCSA) and National Transportation Safety Board (NTSB) met to discuss the status of 13 safety recommendations. This memorandum communicates the status updates discussed at those meetings. Source: Recommendation Letter; Obstructive Sleep Apnea (2009-10-20) Current Classification: Open - Acceptable Response Requested Classification: Open - Acceptable Response Status Update: • Please see the written update provided above for safety recommendation H-09-015. • Additionally, as NTSB is aware, the NAFMP is a voluntary, fully interactive web-based educational and training program developed to provide both truck and bus commercial vehicle drivers and carriers and others in the supply chain with an awareness of the factors contributing to fatigue and its impact on performance. Guidance on health and wellness, time management, vehicle technologies and scheduling best-practices provide effective mitigation strategies to address fatigue while maintaining a healthy and productive work/life balance. o Module 8 of the program, Driver Sleep Disorders Management, includes an extensive discussion of OSA. • FMCSA requests NTSB maintain its classification for safety recommendation H-09-016 as Open - Acceptable Response.

From: NTSB
To: FMCSA
Date: 12/6/2017
Response: Although you have authoritative and useful guidance available on screening commercial drivers for OSA, you have not yet publicized, distributed, or recommended this guidance to medical examiners; as a result, identifying and effectively treating drivers at high risk for OSA is unlikely to improve. We note that you are now moving forward with a plan to update your OSA guidance according to the current Medical Review Board recommendations. We look forward to reviewing the revised guidance. Accordingly, Safety Recommendation H-09-16 was reiterated in our report of the 2017 Palm Springs, California, motorcoach and combination vehicle collision, and remains classified OPEN--ACCEPTABLE RESPONSE.

From: NTSB
To: FMCSA
Date: 11/21/2017
Response: -From the NTSB Highway Safety Report HAR-17-04 “Motorcoach Collision With Combination Vehicle After Traffic Break on Interstate 10 Palm Springs, California, October 23, 2016.” Adopted October 31, 2017 and issued November 21, 2017: 2.4.1 Obstructive Sleep Apnea 2.4.1.1 FMCSA History. Screening, diagnosis, and treatment for OSA is critical for transportation safety. In 2009, based on several NTSB accident investigations involving operators with OSA, the NTSB issued the following two recommendations to the FMCSA: Implement a program to identify commercial drivers at high risk for obstructive sleep apnea and require that those drivers provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. (H-09-15) Develop and disseminate guidance for commercial drivers, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea (OSA), emphasizing that drivers who have OSA that is effectively treated are routinely approved for continued medical certification. (H-09-16) In 2010, the FMCSA responded that the agency was considering strengthening respiratory requirements for medical certification in response to recommendations from its Medical Review Board (MRB). Although progress since then has been slow, the agency has taken some steps toward more stringent requirements pertaining to assessing drivers’ risk for OSA. As a result, Safety Recommendations H-09-15 and -16 were classified “Open-Acceptable Response.” In January 2015, the FMCSA issued an FMCSA Bulletin to Medical Examiners and Training Organizations Regarding Obstructive Sleep Apnea for CDL medical examiners, which reiterated the qualification requirements for respiratory systems, specifically for drivers diagnosed with OSA.72 The bulletin reminded medical examiners not to certify drivers with diagnosed but untreated respiratory dysfunction. However, the bulletin did not provide any screening guidelines to identify drivers at high risk for OSA. It offered only a general statement that medical examiners should consider common OSA symptoms when assessing drivers for respiratory dysfunction. In March 2016, the FMCSA, with the Federal Railroad Administration, published an advance notice of proposed rulemaking (ANPRM) that requested information on the prevalence of OSA among commercial operators and the potential safety consequences for rail and highway operations.73 The NTSB responded by stating that the rulemaking is necessary to adequately address the need to screen, diagnose, and treat OSA among commercial operators. Additionally, the NTSB provided research evidence indicating increased crash risk for drivers with OSA (Mulgrew and others 2008, Basoglu and Tasbakan 2014). In August 2017, after reviewing the public comments, the FMCSA and the Federal Railroad Administration determined that there was insufficient information to support a rulemaking action. As a result, the agencies withdrew the rulemaking notice. 2.4.1.2 Guidance on OSA Screening. Although the NTSB has been dissatisfied with the FMCSA’s slow progress in initiating regulatory action pertaining to OSA and commercial operators, the March 2016 ANPRM represented a positive development. Consequently, the FMCSA’s recent decision to abandon the regulatory process by withdrawing the ANPRM is disappointing, particularly considering the recommendations made by the MRB and the Motor Carrier Safety Advisory Committee (MCSAC). The FMCSA had tasked the MRB in July 2016 to review all the ANPRM comments made by medical professionals and institutions and to identify those factors that the FMCSA should consider when taking the next step on the OSA rulemaking. In November 2016, the MRB and MCSAC submitted their recommendations on OSA and commercial operators to the FMCSA.75 The recommendations addressed drivers who had been diagnosed with OSA and stated that they should receive a 1-year medical certification only if they have been effectively treated for the condition. The recommendations also specified the OSA risk factors and provided detailed guidance consisting of a two-tiered set of conditions for evaluating commercial drivers. They stated that commercial drivers should be further evaluated for sleep disorders if they meet the following criteria: • Have a BMI of 40 kg/m2 or above, or • Have a BMI between 33 kg/m2 and 39 kg/m2 and meet at least 3 of 11 additional criteria, including age (42 years or above), gender (male or menopausal female), neck circumference (17 inches for males), and certain medical conditions.76 The MRB/MCSAC recommendations proposed that drivers who have not been diagnosed with OSA but who have been determined to be at risk for OSA be certified for 90 days, pending further sleep study and treatment, if required. Following an effective treatment, such drivers would be eligible for a 1-year medical certification. The NTSB considers that the MRB/MCSAC recommendations could help guide medical examiners in making decisions regarding OSA during CDL examinations. However, the FMCSA has not distributed the recommendations to certified medical examiners or made the guidance easily accessible on its website.77 The NTSB concludes that although it has authoritative and useful guidance available on screening commercial drivers for OSA, the FMCSA has not publicized, distributed, or recommended this guidance to medical examiners; as a result, identification and effective treatment of drivers at high risk for OSA is unlikely to improve. Therefore, the NTSB recommends that the FMCSA make the 2016 MRB/MCSAC recommendations on screening for OSA easily accessible to certified medical examiners, and instruct the examiners to use the recommendations as guidance when evaluating commercial drivers for OSA risk. The NTSB also reiterates the related Safety Recommendation H-09-16 to the FMCSA.

From: FMCSA
To: NTSB
Date: 9/6/2017
Response: -From Michael Jordan, Strategic Planning and Program Evaluation Division, Federal Motor Carrier Safety Administration: Report: Letter – Obstructive Sleep Apnea (2009-10-20) Current Classification: Open - Acceptable Response Requested Classification: Open - Acceptable Response • Please see the written update provided for safety recommendation H-09-015. • Additionally, per the notice of withdrawal, FMCSA will consider an update to its January 2015 “Bulletin to Medical Examiners and Training Organizations Regarding Obstructive Sleep Apnea” regarding the physical qualifications standard and related advisory criteria concerning respiratory dysfunction, specifically how the standard applies to drivers who may have OSA. The Agency would use the updated August 2016 Medical Review Board (MRB) recommendations as a basis for updating the bulletin. o On August 22-23, 2016, the MRB met in public meetings to deliberate on Medical Review Board Task 16-1 regarding public comments from medical professionals and associations on the FMCSA’s and FRA’s ANPRM on obstructive sleep apnea. o FMCSA tasked the MRB with reviewing and analyzing all ANPRM comments from medical professionals and associations and to identify factors the Agency should consider regarding making decisions about the next step in the OSA rulemaking. o FMCSA also requested that the MRB review its previous February 2012 report on OSA from the MRB and Motor Carrier Safety Advisory Committee (MCSAC). The MRB’s February 2012 recommendations formed the basis of their August 2016 recommendations. o In scenarios where medical examiners may inappropriately screen and refer drivers for diagnostic testing based on single criteria, the MRB’s 2016 recommendations provide objective criteria for identifying drivers who may be at greater risk for OSA. And, as was the case with the 2015 bulletin, the purpose of any action updating the bulletin is to ensure that medical examiners fully understand their role in screening drivers for OSA, identifying drivers at the greatest risk of having OSA, and refer only those individuals to a sleep specialist for testing. The Agency reminds medical examiners that there are no FMCSA rules or other regulatory guidance beyond what is referenced in the language above with guidelines for screening, diagnosis, and treatment of OSA in CMV drivers. Medical certification determinations for such drivers are made by the examiners based on the examiner’s medical judgment rather than a Federal regulation or requirement. • FMCSA requests NTSB maintain the classification for safety recommendation H-09-016 as “Open– Acceptable Response.”

From: NTSB
To: FMCSA
Date: 5/31/2016
Response: The National Transportation Safety Board (NTSB) has reviewed the Federal Motor Carrier Safety Administration (FMCSA)-Federal Railroad Administration (FRA) advance notice of proposed rulemaking (ANPRM) and request for public comments, “Evaluation of Safety Sensitive Personnel for Moderate-to-Severe Obstructive Sleep Apnea,” published in the Federal Register, vol. 81, no. 47 (12642), March 10, 2016. The notice requests data and information regarding screening, diagnosis, and treatment for obstructive sleep apnea (OSA) among surface transportation vehicle operators. The NTSB has found inadequately diagnosed and treated sleep disorders among operators involved in accidents in both the highway and rail modes since 2000. In the past 16 years, OSA has been included in the probable cause of eight highway and rail accidents investigated by the NTSB.1 We have made two safety recommendations to the FMCSA and three safety recommendations to the FRA on this topic.2 We are pleased that the ANPRM addresses the important issue of OSA among operators performing safety-critical tasks. Although we agree that “OSA is a critical safety issue that can affect operations in all modes of travel in the transportation industry,” we maintain that further rulemaking is necessary to adequately address the need to screen, diagnose, and treat OSA among transportation operators in safety-sensitive positions. Footnotes: 1 (a) Motorcoach Run-Off-the-Road and Collision With Vertical Highway Signpost, Interstate 95 Southbound, New York City, New York, March 21, 2011, NTSB/HAR-12/01 (Washington, DC: NTSB, 2012). (b) Truck-Tractor Semitrailer Rear-End Collision Into Passenger Vehicles on Interstate 44 Near Miami, Oklahoma, June 26, 2009, NTSB/HAR-10/02 (Washington, DC: NTSB, 2010). (c) Work Zone Collision Between a Tractor-Semitrailer and a Tennessee Highway Patrol Vehicle, Jackson, Tennessee, July 26, 2000, NTSB/HAR-02/01 (Washington, DC: NTSB, 2002). (d) Collision of Union Pacific Railroad Freight Train With BNSF Railway Freight Train Near Chaffee, Missouri, May 25, 2013, NTSB/RAR-14/02 (Washington, DC: NTSB, 2014). (e) Collision of BNSF Coal Train With the Rear End of Standing BNSF Maintenance-of-Way Equipment Train, Red Oak, Iowa, April 17, 2011, NTSB/RAR-12/02 (Washington, DC: NTSB, 2012). (f) Collision Between Two Massachusetts Bay Transportation Authority Green Line Trains, Newton, Massachusetts, May 28, 2008, NTSB/RAR-09/02 (Washington, DC: NTSB, 2009). (g) Collision of Two Canadian National/Illinois Central Railway Trains Near Clarkston, Michigan, November 15, 2001, NTSB/RAR-02/04 (Washington, DC: NTSB, 2002). (h) Maryland Transit Administration Light Rail Vehicle Accidents at the Baltimore-Washington International Airport Transit Station Near Baltimore, Maryland, February 13 and August 15, 2000, NTSB/SIR-01/02 (Washington, DC: NTSB, 2001). 2 See Safety Recommendations H-09-15 and -16 from the Jackson, Tennessee, investigation; and Safety Recommendations R-13-21 (from Head-On Collision of Two Union Pacific Railroad Freight Trains Near Goodwell, Oklahoma, June 24, 2012, NTSB/RAR-13/02 [Washington, DC: NTSB, 2013]), R-12-16 from the Red Oak, Iowa, investigation, and R-02-24 from the Clarkston, Michigan, investigation.

From: NTSB
To: FMCSA
Date: 2/13/2014
Response: CC# 201301266- ANPRM Response to Federal Transit Administration: ANPRM - The National Public Transportation Safety Plan, the Public Transportation Agency Safety Plan, and the Public Transportation Safety Certification Training Program; Transit Asset Management: Although the introduction of the ANPRM states that FTA “intends to focus its initial oversight and enforcement efforts on rail transit systems’ implementation of and compliance with these requirements,” the NTSB would like to provide some additional comments with regard to transit bus safety for FTA’s future planning purposes. As was noted in the ANPRM, the NTSB held an investigative hearing on transit bus safety in March 1998, investigated several transit bus accidents, and issued a Special Investigation Report titled Transit Bus Oversight. The report noted that FTA was unable to identify conditions on buses for the traveling public or resolve any unsafe conditions due to a lack of effective safety oversight and enforcement. In addition, the NTSB questioned the utility of the safety data that was being collected on transit bus safety. Finally, the NTSB was concerned that, at the time, a comprehensive bus safety program was not available to transit agencies outside of APTA’s membership program. Based on the findings of the investigation, the NTSB issued the following safety recommendations to the US Department of Transportation: Develop and implement an oversight program to assess and ensure the safety of transit bus operations that receive Federal funding. (H-98-43) Collect accurate, timely, and sufficient data so that thorough assessments can be made relating to transit bus safety. (H-98-44) Evaluate the collected data, as part of the oversight program, to identify the underlying causes of transit bus accidents that could lead to the identification of safety deficiencies at transit agencies. (H-98-45) Develop, in cooperation with the American Public Transit Association, the Community Transportation Association of America, and the American Association of State Highway and Transportation Officials, a model comprehensive safety program(s) and provide it to all transit agencies. (H-98-46) In response, the FTA-sponsored outreach and research efforts to develop a model program for transit bus safety and security. Subsequently, the recommendations were closed with an acceptable response status by the NTSB. Moving forward, however, these recommendations must not be forgotten as data collection and evaluation is an integral component of any safety management program. It is vital that FTA continue to assess and monitor the safety of transit bus operations, including the collection of accurate, timely, and sufficient data so that thorough assessments can be made relating to transit bus safety. Likewise, it is essential that a program be maintained whereas transit bus accidents are thoroughly investigated to identify the underlying causes of crashes so that safety improvements can be implemented in a timely manner. While the NTSB is encouraged that FTA has developed a well-received bus safety program, we are concerned that the program remains completely voluntary and that FTA is unable to ensure that all bus transit agencies are positively affected. In 2013, the safety of bus operations was highlighted as a safety issue area of concern as part of the NTSB’s Most Wanted List. Over the years, the NTSB has made numerous recommendations to the motorcoach and school bus associations, manufacturers, and regulatory agencies such as the Federal Motor Carrier Safety Administration (FMCSA) and the National Highway Traffic Safety Administration (NHTSA), which the NTSB believes should be considered when establishing a robust oversight program for bus transit operations. These recommendations address safety concerns such as driver distraction, driver fatigue, medical oversight, fire safety, event data recorders, and vehicle safety equipment. FTA should refer to the NTSB safety recommendations database for additional information. The following are examples of some of the NTSB recommendations which should be considered. Driver Fatigue To FMCSA: Incorporate scientifically based fatigue mitigation strategies into the hours-of-service regulations for passenger-carrying drivers who operate during the nighttime window of circadian low. (H-12-30) Require all motor carriers to adopt a fatigue management program based on the North American Fatigue Management Program guidelines for the management of fatigue in a motor carrier operating environment. (H 10 9) Implement a program to identify commercial drivers at high risk for obstructive sleep apnea and require that those drivers provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. (H-09-15) Develop and disseminate guidance for commercial drivers, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea (OSA), emphasizing that drivers who have OSA that is effectively treated are routinely approved for continued medical certification. (H-09-16) Develop and implement a plan to deploy technologies in commercial vehicles to reduce the occurrence of fatigue-related accidents. (H 08 13)

From: NTSB
To: FMCSA
Date: 7/12/2012
Response: From the report Motorcoach Run-Off-the-Road and Collision with Vertical Highway Signpost Interstate 95 Southbound New York City, New York, March 12, 2011, adopted June 5, 2012, published July 12, 2012: The NTSB evaluated several factors to assess whether the driver was impaired by fatigue at the time of the accident, including his sleep/wake history, sleep quality, circadian factors, and health. The driver reported that, on his days off, he typically goes to bed at 8:00–9:00 p.m. and awakens at 10:00 a.m.–noon, a sleep period of 13–16 hours. The driver also reported that, on work days, he typically gets home about 9:00 a.m., at which point he goes to bed. He stated that his wake time depends on when he is next scheduled to work, which in the case of a 6:15 p.m. start time would be 4:30–5:00 p.m. Therefore, the driver’s self-reported typical sleep time during his daytime off-duty periods91 was approximately 7.5 hours. In an interview conducted 3 days after the accident, the driver reported that he slept approximately 3 hours 45 minutes on the bus before the accident trip92 and that he had slept 5 hours 30 minutes during his daytime off-duty period the day before the accident. The driver reported similar sleep patterns during the 72 hours leading to the accident, with daytime sleep periods ranging from 4 hours 30 minutes–6 hours, and nighttime naps on the bus ranging from 1 hour 45 minutes–3 hours 30 minutes. However, evidence from the driver’s cell phone and rental car records suggests that he was in the car and/or using his cell phone frequently during his self-reported daytime sleep periods over the 3 days before the accident.93 The driver’s cell phone records do not show an incoming or outgoing call or that the phone was in use at the time of the accident. Factoring in the driver’s use of his cell phone and rental car activity, his opportunity for sleep in the days leading to the accident would have been limited to short periods of approximately 4 hours or less.94 The normative daily sleep need for humans is 7–9 hours. Epidemiological research has shown that drivers who reported getting 5 or fewer hours of sleep in the previous 24 hours had an almost threefold increase in risk for an injury crash.95 Over multiple days of sleep deprivation, an individual incurs a “sleep debt” in which the impairing effects of sleep deprivation are compounded.96 The driver’s activity history suggested that his longest opportunity for continuous sleep during the 24-hour period preceding the accident was during the approximately 3 hours that he was on the bus (midnight–3:00 a.m.) and that his daily sleep opportunities in the days before the accident never exceeded 4 continuous hours. Therefore, the accident driver was experiencing both acute sleep loss and cumulative sleep debt at the time of the accident. The driver’s statement that he slept 13–16 hours when he had a day off further suggests that he was routinely becoming sleep deprived during his work periods. Further, the sleep quality that the driver experienced on the bus was less than optimal. Like most motorcoaches, the accident bus did not have a sleeper berth, so the driver had to recline across the seats to sleep. Circadian factors also likely influenced the driver’s sleep quantity and waking performance. Circadian factors are those factors associated with the human circadian rhythm or “biological clock,” which affects numerous biological, physiological, and performance variables. With respect to circadian factors, there are three notable issues. First, the time of day when the accident occurred—approximately 5:38 a.m.—falls during the period in the circadian cycle when self-perceived sleepiness is most pronounced and when human performance is most degraded.97 In addition, the driver’s work schedule was inverted. That is, his work periods occurred during periods when humans typically sleep, and his off-duty periods occurred during periods when humans are typically awake. Research has shown that inverted work schedules are associated with shortened sleep lengths, higher subjective wake-time sleepiness, and degraded performance. Furthermore, the driver’s self-reported sleep times followed a more traditional diurnal pattern (that is, sleeping at night and awake during the day) during his days off. The result of such dramatic change to his sleep/wake schedule would have degraded the driver’s sleep quality and quantity and led to performance impairment during waking periods. Additionally, the driver’s work schedule was rotated backward by approximately 3 hours the day before the accident. His schedule indicates that he began his work shift at 9:00 p.m. on March 8, 9, and 10, and slept from approximately 2:00–6:00 a.m. during layover periods. On March 11, the day before the accident, the driver began his work shift at 6:15 p.m., and his layover period at the casino was from 11:00 p.m.–3:00 a.m. on March 12. Although this 3-hour backward rotation is minor in comparison to the large sleep/wake rotations the driver engaged in between his work and nonwork days, such rotations have been associated with sleep reductions, as well. In written statements, several passengers stated that the driver had driven over the rumble strips numerous times during the accident trip. Additionally, three truck drivers who saw the motorcoach approximately 10–20 minutes before the accident stated that the bus was speeding and swerving. One driver stated that the bus was “zig-zagging” over the white line and that he witnessed the bus moving “deep into the breakdown lane and coming extremely close to the guardrail.” The accident driver’s repeated excursions from the roadway onto the rumble strips suggest that his alertness was degraded the entire trip. The NTSB concludes that the driver was impaired by fatigue at the time of the accident due to sleep deprivation, poor sleep quality, and circadian factors; and his lack of evasive braking or corrective steering action as the bus drifted off the roadway was consistent with fatigue-induced performance impairment. Research shows that even a healthy individual would suffer performance impairment if subjected to the sleep deprivation and circadian variation experienced by the driver in this accident. However, it is worth noting that because of his BMI and other factors, the accident driver would also have been considered at risk for obstructive sleep apnea (OSA), according to standards set by an FMCSA Medical Review Board (MRB) and by a joint task force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and National Sleep Foundation. OSA is a sleep disorder that has been associated with a significantly increased motor vehicle crash risk compared to the general driving population. In 2009, as the result of its investigation of accidents in all transportation modes, including a 2000 work zone accident, the NTSB issued the following recommendations to the FMCSA aimed at improvements in the screening, treatment, and medical certification of drivers at risk for OSA: Implement a program to identify commercial drivers at high risk for obstructive sleep apnea and require that those drivers provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. (H-09-15) Develop and disseminate guidance for commercial drivers, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea (OSA), emphasizing that drivers who have OSA that is effectively treated are routinely approved for continued medical certification. (H-09-16) These recommendations were classified “Open—Acceptable Response” pending further FMCSA action. In August 2011, the FMCSA tasked its Motor Carrier Safety Advisory Committee (MCSAC) and MRB to jointly provide information the agency should consider in developing regulatory guidance for motor carriers, CMV drivers, and medical examiners on OSA and whether drivers with this condition should be medically certified to operate CMVs in interstate commerce. MCSAC and the MRB submitted short-term recommendations to the FMCSA in December 2011 and long-term recommendations for regulatory action in February 2012. On April 20, 2012, the FMCSA published the MCSAC-MRB recommendations in the Federal Register (77 FR 23794) in a Request for Public Comments; however, on April 27, the request was withdrawn (77 FR 25226). The agency stated that the original publication was a “clerical error” and that the request for public comments would be republished later in the year. Because the FMCSA has yet to establish a program to identify commercial drivers at high risk for OSA or to provide guidance concerning the disorder, the NTSB reiterates Safety Recommendations H-09-15 and -16, which remain classified “Open—Acceptable Response.”

From: NTSB
To: FMCSA
Date: 3/3/2011
Response: Notation 8286: Carrier Safety Administration (FMCSA) notice of proposed rulemaking (NPRM) titled “Hours of Service of Drivers,” which was published at 75 Federal Register (FR) 82170 on December 29, 2010. The notice proposes to revise the regulations for hours of service (HOS) for drivers of property-carrying commercial motor vehicles (CMV). Background of HOS Rule The NTSB has a long history of making recommendations to reduce the likelihood of fatigue-related highway accidents, including recommendations concerning HOS, electronic on board recorders (EOBR), obstructive sleep apnea (OSA), fatigue education and training, vehicle- and environment-based countermeasures, and fatigue risk management programs. With respect to HOS, in 1995, the NTSB issued Safety Recommendation H-95-1, which urged the Federal Highway Administration (FHWA) to require sufficient rest provisions to enable drivers to obtain at least 8 continuous hours of sleep. At the same time, the NTSB issued Safety Recommendation H-95-2, which asked the FHWA to eliminate the provision that allowed drivers to split the required 8 hours off duty into two separate periods, so that drivers would have the opportunity to obtain 8 continuous hours of sleep. Both of these recommendations were added to the NTSB Most Wanted List of Transportation Safety Improvements (Most Wanted List) in 1995. On May 11, 1999, the NTSB classified both recommendations “Closed—Unacceptable Action/Superseded” and issued Safety Recommendation H-99-19, which asked the FMCSA to do the following: Establish within 2 years scientifically based hours-of-service regulations that set limits on hours of service, provide predictable work and rest schedules, and consider circadian rhythms and human sleep and rest requirements. At a minimum, and as recommended by the National Transportation Safety Board in 1995, the revised regulations should also (a) require sufficient rest provisions to enable drivers to obtain at least 8 continuous hours of sleep after driving for 10 hours or being on duty for 15 hours, and (b) eliminate 49 Code of Federal Regulations 395.1 paragraph (h), which allows drivers with sleeper berth equipment to cumulate the 8 hours off-duty time in two separate periods. (H-99-19) On April 28, 2003, the FMCSA promulgated a final rule (68 FR 22455) for CMV drivers that extended the driving time from 10 to 11 hours but limited the driving window to 14 consecutive hours after coming on duty. The daily off-duty period requirement was extended from 8 to 10 hours. Although the maximum weekly limits were not changed, drivers were allowed to restart the calculation of weekly hours by taking an off-duty break of 34 consecutive hours (termed the “34-hour restart” provision). Based on this new rule, the NTSB classified Safety Recommendation H-99-19 “Closed—Acceptable Alternate Action” at a Board Meeting on November 18, 2003. In a letter to the FMCSA dated February 23, 2004, the NTSB commended the FMCSA for revising the HOS regulations for truck drivers for the first time in more than 60 years and stated that, although the sleeper berth provision was not eliminated as requested, the revision met the main objectives of the safety recommendation. On July 16, 2004, the U.S. Court of Appeals for the District of Columbia Circuit (DC Circuit) vacated the 2003 rule, stating that the FMCSA “failed to consider the impact of the rules on the health of drivers, a factor that the agency must consider under its organic statute.” Subsequently, Congress directed that the 2003 regulations remain in force until the effective date of a new final rule or until September 30, 2005, whichever occurred first. On January 24, 2005, the FMCSA issued an NPRM on CMV driver HOS published at 70 FR 3339. On March 10, 2005, the NTSB responded to this NPRM by first acknowledging the FMCSA’s efforts to develop a rule based on current scientific research on fatigue. Additionally, the NTSB’s comments on the proposed rule reiterated concerns about issues that were not addressed by the 2003 rulemaking. Specifically, the NTSB urged the FMCSA to eliminate provisions or exemptions that would permit a daily sleep period for drivers of less than 8 continuous hours. The NTSB also highlighted the continuing need for tamper-proof EOBRs to assist in the enforcement of HOS regulations. On August 25, 2005, the FMCSA published a revised final rule, which, while similar to the 2003 rule, also revised the sleeper berth provision to require at least 8 consecutive hours in the sleeper berth. Drivers using the sleeper berth provision were required to take an additional 2 hours either off duty or in the sleeper berth. The 2005 rule also provided an exception for CMV drivers who operate within 150 air miles of their work-reporting location and who drive CMVs that do not require a commercial driver’s license (CDL). The rule permitted such drivers to extend the driving window and on-duty time to 16 hours twice a week. Based on additional legal challenges to the 2005 rule, on July 24, 2007, the DC Circuit vacated provisions of the 2005 rule that involved the 11-hour driving limit and the 34-hour restart provision. Subsequently, the FMCSA published an interim final rule on December 17, 2007, and a final rule on November 19, 2008, which repromulgated both the 11-hour driving limit and the 34-hour restart provision and provided the full regulatory evaluation and an explanation of the agency’s methodology in support of its rationale. In 2009, a new petition was filed with the DC Circuit challenging the 2008 rule, and a settlement was reached whereby the petition would be held in abeyance pending the publication of a revised final rule by July 26, 2011. Proposed HOS Rule Revisions The NTSB understands that the subject NPRM proposes to make several changes to the current HOS rule, as summarized in the table on page 4 of this letter. The NTSB supports those provisions of the proposed rule that are scientifically based and would reduce continuous duty or driving time, encourage break-taking, promote nighttime sleep, and foster scheduling patterns that are predictable and consistent with the normal human diurnal circadian rhythm, because extended periods of time awake and time on task, as well as inverted or rotating schedules, have been associated with fatigue-related performance decrements and increased accident risk. By limiting on-duty time to 13 hours and consecutive driving time without breaks to 7 hours, and by choosing to reduce the 11-hour maximum driving time to 10 hours, the FMCSA will reduce continuous time on task and increase rest periods for some drivers. Additionally, limiting how often drivers may use the restart provision and requiring that the 34-hour restart interval include two periods between midnight and 6 a.m. should have the effect of increasing the amount of sleep that drivers receive during the restart period and may encourage drivers to adopt schedules that are more diurnally oriented. Table. Summary of changes to the current HOS rule proposed in the December 29, 2010, NPRM issued by the FMCSA. Provision Current Rule Proposed Rule Daily off-duty period 10 consecutive hours No change Daily driving window For most drivers, 14 consecutive hours (may continue on duty/not driving after 14 hours); "Regional" drivers allowed one 16-hour period "weekly," but release from duty required after 16 hours; Non-CDL drivers within 150 miles of work reporting location allowed two 16 hour periods "weekly" (may continue on duty/not driving after 16 hours) For all property-carrying CMV drivers (unless excepted): • 14 consecutive hours with release from duty required at end of driving window; • 16 consecutive hours no more than twice "weekly," with release from duty required at end of driving window Maximum on-duty time within driving window Normally 14 hours; 16 hours once per week for "regional" drivers; 16 hours twice per week for non-CDL drivers within 150 miles of work-reporting location 13 hours* Maximum driving within driving window 11 hours 10 or 11 hours (both being considered) Maximum consecutive driving No limit May drive only if it has been 7 hours or less since last off-duty period of at least 30 minutes* Weekly on-duty maximum 60 hours in 7 days or 70 hours in 8 days No change Weekly restart May restart weekly limits after at least 34 hours off duty 34-hour restart retained but may only be used once per week and must include two off-duty periods between midnight and 6 a.m. Sleeper berth exception May split off duty into two periods: one period must be at least 8 consecutive hours in sleeper berth; the other, at least 2 hours in sleeper berth or off duty (shorter period does not extend the driving window) No change, but apply same new driving, on duty, and duty-period limits as proposed for non-sleeper-berth drivers Definition of “on duty” Includes any time in CMV except in sleeper berth Does not include any time resting in a parked CMV; In a moving CMV, does not include up to 2 hours in passenger seat immediately before or after 8 consecutive hours in sleeper berth Oilfield exemption “Waiting time” for certain drivers at oilfields (which is off duty but does not extend 14 hour duty period) must be recorded and available to the FMCSA, but no method or details are specified for recordkeeping “Waiting time” for certain drivers at oilfields must be shown on record of duty status or electronic equivalent as off duty and identified by annotations in “remarks” or a separate line added to “grid” *Provision is not applicable to non-CDL drivers operating within 150 air miles of work-reporting location. The NTSB acknowledges the challenges associated with establishing HOS regulations that promote safety and driver health while still providing drivers and operators sufficient flexibility to make scheduling decisions and carry out operations in a competitive manner. Although many drivers do not have schedules that extend to the regulatory limits, as the NPRM notes, some carriers have elected to incorporate maximum on-duty periods into their supply chain planning. This fact shows that some carriers will routinely schedule drivers to the regulatory limits. Because some carriers will inevitably incorporate the minimum rest periods and maximum duty periods into their standard operating practices, in the absence of scientific data, the NTSB encourages the FMCSA to select conservative thresholds to protect the safety and health of drivers, as well as the safety of the traveling public. The NTSB commends the FMCSA for acknowledging in this NPRM that there are insufficient scientific data to support a specific maximum driving time and for particularly requesting data from stakeholders to address this issue. The NTSB has continually and consistently recommended scientifically based HOS regulations. In the absence of relevant scientific data, a conservative maximum driving period is warranted. For these reasons, the NTSB supports reducing the 11-hour maximum driving period within the driving window to a 10-hour maximum, unless or until relevant scientific data justify a departure from this limit. The NTSB has significant reservations about several of the other proposed rule changes. Although allowing the driving window to be extended to 16 hours up to 2 days per week may not lead to an increase in duty or driving hours, it is likely to lead to a forward schedule rotation and may, therefore, adversely affect drivers’ circadian rhythms and sleep quality. Further, the NTSB is strongly opposed to special provisions providing exemptions to certain HOS requirements, such as those the proposed rule applies to passenger-carrying CMVs, oilfield operations, and various other groups. Such exemptions are likely to lead to increased risk for the exempted population and the driving public. NTSB Fatigue Recommendations As stated above, the NTSB supports those provisions of the proposed HOS rule that are likely to reduce driver fatigue. Nevertheless, the NTSB notes that, although driver scheduling is a foundational factor in reducing driver fatigue, an improved HOS rule alone cannot solve the problem of fatigue-related crashes. The NTSB believes several additional issues must be addressed concerning driver fatigue and safety. In recent years, the NTSB has made recommendations to the FMCSA concerning additional actions that can reduce the likelihood drivers will have fatigue-related crashes. Such actions include the following: • Requiring the use of EOBRs for monitoring and assessing HOS compliance; • Reducing the incidence of drivers with undetected, or untreated, OSA; • Developing and employing in-vehicle technologies to reduce the occurrence of fatigue-related accidents; • Providing education about fatigue and fatigue countermeasures; and • Requiring motor carriers to adopt fatigue management programs. Because we believe these actions are vital in addressing the risks posed by driver fatigue, we would like to highlight the relevant open NTSB recommendations to the FMCSA in these areas. Electronic On-Board Recorders. EOBRs have the potential to efficiently and accurately collect and verify HOS information for all drivers, establish the proper incentives and a level playing field for compliance with HOS requirements, and, ultimately, make our highways safer. For more than 30 years, the NTSB has advocated the use of in-vehicle recording devices to improve highway safety. The first NTSB recommendation urging mandatory use of on-board recorders resulted from our 1990 safety study on Fatigue, Alcohol, Other Drugs, and Medical Factors in Fatal-to-the-Driver Heavy Truck Crashes, which concluded that on-board recording devices could provide a tamper-proof mechanism to enforce HOS regulations. More recently, as a result of the NTSB investigation of a 2004 multiple-vehicle accident near Chelsea, Michigan, which resulted in one fatality, the NTSB issued Safety Recommendations H-07-41 and -42 to the FMCSA on December 17, 2007. The recommendations call on the FMCSA to take the following actions: Require all interstate commercial vehicle carriers to use electronic on-board recorders that collect and maintain data concerning driver hours of service in a valid, accurate, and secure manner under all circumstances, including accident conditions, to enable the carriers and their regulators to monitor and assess hours of-service compliance. (H-07-41) As an interim measure and until industrywide use of electronic on-board recorders is mandated, as recommended in Safety Recommendation H-07-41, prevent log tampering and submission of false paper logs by requiring motor carriers to create and maintain audit control systems that include, at a minimum, the retention of all original and corrected paper logs and the use of bound and sequentially numbered logs. (H-07-42) In January 2007, the FMCSA published an NPRM proposing to require motor carriers with a “demonstrated history of serious noncompliance with hours-of-service rules” to be subject to mandatory installation of EOBRs meeting proposed standards of accuracy, validity, and security. In response, the NTSB asserted that, because of deficiencies in the compliance review program, the FMCSA did not have the resources or processes necessary to identify all carriers and drivers that are pattern violators of HOS regulations. The NTSB reiterated its long-held position that the only way by which EOBRs can effectively stem HOS violations is to mandate their installation and use by all operators subject to HOS regulations. On April 5, 2010, the FMCSA issued a final rule (75 FR 17209) that required EOBRs only for those motor carriers found during compliance reviews to have a 10 percent (or higher) violation rate for HOS regulations. In the final rule, the FMCSA acknowledged that many responses to the 2007 NPRM stated the limited scope of the rule would keep it from making a meaningful difference in highway safety. Consequently, the FMCSA committed to exploring a broader EOBR mandate in a new rulemaking process. Safety Recommendations H-07-41 and -42 are currently classified “Open—Unacceptable Response” because the FMCSA has not yet mandated the use of EOBRs by all motor carriers. Under the framework we envision, HOS regulations will be refined and, of necessity, more detailed; there will continue to be temptations for companies and drivers to evade the rules to gain economic advantage over their competitors, or they may inadvertently violate the rules due to the complexity of the regulatory scheme; and, accordingly, enforcement will remain a challenge for state and federal officials. EOBRs can provide readily accessible, objective, and convincing information to maintain the integrity of the new HOS rule. The NTSB is aware that the FMCSA issued an NPRM concerning EOBRs on February 1, 2011. The NTSB is currently reviewing the NPRM and anticipates providing comments to the FMCSA. Obstructive Sleep Apnea. OSA is a condition in which an individual’s airway becomes obstructed while sleeping, typically resulting in hypoxia at night, interruptions in breathing lasting several seconds at a time, loud snoring, and nonrestful sleep. Individuals with the disorder are frequently unaware of the condition and may have extreme daytime sleepiness. OSA is associated with significant cognitive and psychomotor deficits, which are at least partially reversible with appropriate treatment. Such deficits are particularly problematic during commercial highway operations where immediate and appropriate responses to external stimuli are often essential to safety. Accident rates have been shown to be considerably higher in drivers with OSA than in those without the disorder, with one case-control study demonstrating a more than six-fold higher risk of traffic accidents in drivers with OSA, after controlling for other possible confounding factors. On October 20, 2009, the NTSB recommended that the FMCSA do the following: Implement a program to identify commercial drivers at high risk for obstructive sleep apnea and require that those drivers provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. (H-09-15) Develop and disseminate guidance for commercial drivers, employers, and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea (OSA), emphasizing that drivers who have OSA that is effectively treated are routinely approved for continued medical certification. (H-09-16) In a letter dated February 1, 2010, the FMCSA noted it was in the process of developing medical examiner, employer, and driver guidance on sleep disorders, including OSA. The letter also described several other actions the agency had taken or was planning to take, including sponsoring a National Sleep Apnea and Trucking Conference, developing a chapter in its on-line medical examiner handbook to include guidance on sleep disorders, providing a revised medical examination report form to include items specific to the assessment of sleep disorders, developing a best practices guide on medical certification of drivers with OSA, and possibly conducting rulemaking to strengthen the pulmonary/respiratory requirements for driver medical qualification to include sleep disorders. Pending completion of the described efforts and implementation of the recommended program, guidance, and requirement, the NTSB classified Safety Recommendations H-09-15 and -16 “Open—Acceptable Response” on July 20, 2010. In-Vehicle Technologies. In-vehicle fatigue-related technologies are designed to monitor driver behaviors, such as eyelid closure or head position, or vehicle actions, such as steering wheel input or lane drift. In its report on a 2005 accident in Osseo, Wisconsin, which involved the rollover of a truck-tractor semitrailer combination unit and a motorcoach’s collision with the truck wreckage, and which resulted in five fatalities, the NTSB found that technologies to detect fatigue might have prevented or mitigated the severity of the fatigue-related rollover, had the truck been so equipped. Because technologies to detect fatigue could make fatigued drivers more aware of their condition, the NTSB recommended that the FMCSA do the following: Develop and implement a plan to deploy technologies in commercial vehicles to reduce the occurrence of fatigue-related accidents. (H-08-13) On May 11, 2009, the FMCSA responded to this recommendation and indicated that the development of an advanced drowsy driver warning system was underway, and the program would move into principal research and prototype development in 2009. The FMCSA projected this phase would last 2 years, after which a commercialization decision would be made. However, the FMCSA also stated it was unaware of any available technology that commercial drivers could use for both day and night driving. The NTSB responded that although no products were available commercially that could be used effectively both day and night, the agency’s recently published review of activities underway to develop unobtrusive, in-vehicle, real-time, drowsy driver detection and alertness systems discussed at least five separate systems capable of functioning under a variety of conditions. Therefore, on October 2, 2009, the NTSB classified Safety Recommendation H-08-13 “Open—Unacceptable Response.” The NTSB subsequently reiterated Safety Recommendation H-08-13 in its report on a 2009 truck tractor semitrailer rear end collision into passenger vehicles that took place in Miami, Oklahoma, and resulted in 10 fatalities. The NTSB continues to believe in-vehicle technologies can reduce the incidence and seriousness of fatigue-related accidents and urges the FMCSA to move forward with a plan to deploy such technologies in commercial vehicles. Fatigue Education and Information. The provision by the FMCSA of new and updated information on sleep, fatigue, and alertness, based on contemporary scientific research, is essential to ensuring commercial drivers have the necessary guidance to enable them to be well rested and remain alert when operating their vehicles. Since the 1980s, the NTSB has called on the U.S. Department of Transportation (DOT) and its modal agencies to develop and disseminate educational materials for transportation industry personnel concerning fatigue risks and countermeasures. In the mid-1990s, the FHWA Office of Motor Carriers coordinated with several other agencies to produce materials and sponsor meetings to educate drivers and others about fatigue. During its investigation of the 2009 Miami, Oklahoma, accident, the NTSB reviewed some of the existing FMCSA fatigue-related training materials. The NTSB determined that, although the fatigue training materials available to truck drivers provided some valuable guidelines, some of the information was outdated, and the available guidance video concerning fatigue did not include vital information pertaining to current HOS regulations and risk factors for OSA. Because updating the information provided to truck drivers about fatigue and fatigue countermeasures, HOS, and OSA could help reduce accidents, the NTSB issued Safety Recommendation H-10-8, which asks the FMCSA to do the following: Create educational materials that provide current information on fatigue and fatigue countermeasures and make the materials available in different formats, including updating and redistributing your truck-driver-focused driver fatigue video; make the video available electronically for quicker dissemination; and implement a plan to regularly update the educational materials and the video with the latest scientific information and to regularly redistribute them. (H-10-8) The NTSB is awaiting a response to this recommendation. Fatigue Management Programs. Although employee education about fatigue is extremely valuable, it alone is insufficient to constitute an adequate fatigue management program, which should involve all aspects of a carrier’s operation. A fatigue management program is a system designed to take a comprehensive, tailored approach to the issue of fatigue within an industry or a workplace and address it in an operational environment. Typically, a fatigue management program incorporates individual program-focused efforts to help manage fatigue. For example, it might include policies and practices addressing scheduling and attendance; employee education, medical screening, and treatment; personal responsibility during nonwork periods; task/workload issues; rest environments; and commuting and/or napping. There should also be an overall organizational strategy for implementing, supervising, and evaluating the plan. Many motor carriers have developed and put into action their own fatigue management programs, although the extent and nature of the plans vary widely. On February 2, 2009, the NTSB issued Safety Recommendation H-08-14 as a result of the Osseo, Wisconsin, accident investigation, and on October 21, 2010, the NTSB issued Safety Recommendation H-10-9 as a result of the Miami, Oklahoma, accident investigation. The recommendations asked the FMCSA to take the following actions: Develop and use a methodology that will continually assess the effectiveness of the fatigue management plans implemented by motor carriers, including their ability to improve sleep and alertness, mitigate performance errors, and prevent incidents and accidents. (H-08-14) Require all motor carriers to adopt a fatigue management program based on the North American Fatigue Management Program guidelines for the management of fatigue in a motor carrier operating environment. (H-10-9) The NTSB is aware that, since 1999, the FMCSA has been involved in the North American Fatigue Management Program (NAFMP) initiative, which is a four-phase cooperative program including participants from the U.S. and Canadian transportation industries, as well as government organizations. In the first phase, researchers identified fatigue management plan requirements targeted toward drivers, dispatchers, and company managers. In phase 2, educational, training, and assessment materials were designed for a field test. In phase 3, researchers conducted a field operational test that included an evaluation of the effectiveness of the NAFMP compared to current industry practices. The FMCSA has informed the NTSB it is reviewing the report on the field test to determine whether to continue to the final phase of the project, which would include developing a deployment strategy for the NAFMP. The NTSB has encouraged the FMCSA to move forward with the completion and deployment of the final phase and has urged the agency to include in the program a methodology to continually assess the effectiveness of the plans implemented by motor carriers. Based on this information, on October 2, 2009, the NTSB classified Safety Recommendation H-08-14 “Open—Acceptable Response.” Safety Recommendation H-10-9 is currently classified “Open—Await Response.” Summary In developing the proposed rule, the FMCSA has considered current scientific findings concerning fatigue, and many of its provisions affecting driver scheduling and associated factors have the potential to reduce driver fatigue and fatigue-related CMV accidents. However, the NTSB remains concerned that the FMCSA is not aggressively pursuing other fatigue reduction and mitigation opportunities concerning EOBRs, OSA, in-vehicle technologies, fatigue education, and fatigue management programs. The NTSB appreciates the opportunity to comment on this NPRM addressing the revision of HOS regulations.

From: NTSB
To: FMCSA
Date: 9/30/2010
Response: Notation 8248: The National Transportation Safety Board (NTSB) has reviewed the Federal Motor Carrier Safety Administration’s (FMCSA) Announcement of Public Listening Session and Request for Comment, which was published at 75 Federal Register 53015 on August 30, 2010. The notice announced that the FMCSA planned to hold a public listening session to solicit input on key challenges facing the motor carrier industry, issues facing stakeholders, and concerns that should be considered by the agency in developing its next 5-year Strategic Plan. NTSB staff attended the listening session and provided the FMCSA with a list of open recommendations that have been issued to the FMCSA. The FMCSA also invited written comments, suggestions, and recommendations from all individuals and organizations regarding the FMCSA’s mission, vision, and strategic objectives (goals) for the plan. This letter provides a more detailed history of the currently open recommendations the NTSB has made to the FMCSA (attached), a summary of the key safety issues the FMCSA should address to improve truck and bus safety as presented during the NTSB’s April 28, 2010, testimony before the U.S. Senate Committee on Commerce, Science, and Transportation, Subcommittee on Surface Transportation and Merchant Marine Infrastructure, Safety, and Security (attached), and responds to the questions most relevant to the NTSB’s mission for which the FMCSA is seeking input. Question 2. How can the FMCSA have a greater impact in the reduction of injuries and loss of life on our nation’s highways? The NTSB currently has 51 open recommendations that were issued to the FMCSA with the intent to improve safety on our highways. The implementation of these recommendations would allow the FMCSA to have both an immediate and lasting impact on reducing loss on our highways. We continue to believe that a plan to implement the recommendations on the NTSB’s Federal Most Wanted List of Transportation Safety Improvements (MWL) would significantly contribute to transportation safety. Question 5. How can the FMCSA balance driver-focused, vehicle-focused, motor carrier- focused compliance, interventions, and enforcement to achieve its safety mission? The NTSB has recommended that the FMCSA change the “balance” of its motor carrier oversight since 1999. The two most important factors related to safe motor carrier operations are the condition of the vehicles and the performance of the drivers. Current rules prevent the FMCSA from putting carriers out of service with an unsatisfactory rating in only one of the 6 rated factors. They must be unsatisfactory in at least 2 factors. In other words, they could be unsatisfactory in either the vehicle or driver areas and still be allowed to operate. The NTSB believes that an unsatisfactory in either category should be sufficient cause to place a carrier out of service. The NTSB recommended that the FMCSA do something relatively simple: change the safety fitness rating methodology so that adverse vehicle- or driver performance-based data alone would be sufficient to result in an overall “unsatisfactory” rating for a carrier. To date, the FMCSA has not acted on this recommendation. As a result, the NTSB added this recommendation to our Most Wanted List of Transportation Safety Improvements. The NTSB has been encouraged that the FMCSA is developing the CSA 2010 Initiative to include a greater emphasis on vehicle and driver safety. However, the NTSB is disappointed that the FMCSA did not make the incremental changes to the current safety system necessary to make either driver or vehicle deficiencies sufficient to affect the safety rating of a carrier. As such, the NTSB believes the FMCSA’s strategic plan should recognize the importance of getting carriers with unsafe drivers or unsafe vehicles off the road. Question 8. What technological changes could positively impact highway safety? The NTSB has recommended numerous technological improvements to both the FMCSA and the National Highway Traffic Safety Administration (NHTSA). Two technologies, forward collision warning systems (FCWs) and electronic onboard recording systems (EOBRs), are currently on the NTSB’s Federal MWL. Both of these technologies have been available for the last decade and could have improved highway safety. More recently, the NTSB has recommended to NHTSA technologies for driver fatigue detection, stability control for buses, event data recording, and lane departure warning for buses. The implementation of these recommendations would significantly improve highway safety. Question 9. How will technology affect driver behavior? Well designed technology can improve driver performance. Current research by the FMCSA on vehicle based collision warning systems found improved driver performance as a result of technology. However, technology not designed for use in vehicles, such as cell phones, can distract the driver from the road. That is why the NTSB supported the FMCSA’s ban on texting. Further, the NTSB has included restricting bus drivers from using a cell phone on its Federal MWL. The NTSB appreciates the opportunity to comment on this notice addressing concerns that should be considered in developing the FMCSA’s 5-year Strategic Plan. Many of the issues discussed here have been around for decades, and much is left to be done to improve highway safety. Prompt action is needed so that the trucks and buses that surround us on the nation’s highways are safely designed, maintained, and operated. We look forward to working with FMCSA in the near future to address the concerns presented in these comments.

From: NTSB
To: FMCSA
Date: 7/20/2010
Response: The NTSB is pleased that FMCSA supports this recommendation and is in the process of developing medical examiner, employer, and driver guidance on sleep disorders, including OSA. We are also pleased that FMCSA, together with the American Sleep Apnea Association, the ATA, and others, sponsored a National Sleep Apnea & Trucking Conference in Baltimore, Maryland, on May 12,2010, and that FMCSA has taken and planned additional initiatives to satisfy Safety Recommendation H-09-16. Pending completion of the efforts you described to develop and disseminate the recommended guidance, Safety Recommendation H-09-16 is classified OPEN – ACCEPTABLE RESPONSE. The NTSB notes that your letter provided several specific dates of anticipated progress on this important issue and that, by the end of 2010, FMCSA anticipates completion of (1) a chapter in its on-line medical examiner handbook to include guidance on sleep disorders, (2) a revised medical examination report form (including items specific to the assessment of sleep disorders), and (3) a best practices guide on medical certification of drivers with OSA. Please keep us informed of any changes in the anticipated completion dates and of progress regarding rulemaking on your MRB recommendations.

From: FMCSA
To: NTSB
Date: 2/1/2010
Response: Letter Mail Controlled 2/3/2010 1:09:28 PM MC# 2100039 - From Anne S. Ferro, Administrator: Concur. The FMSCA agrees that medical examiners and all parties involved in the driver medical certification decision should screen for sleep apnea and ensure that drivers meet the current respiratory requirements. The FMCSA is developing medical examiner, employer, and driver guidance on sleep disorders and commercial driving, to include information about obstructive sleep apnea. The new FMSCA on-line Medical Examiner Handbook will include a regulation/ guidance chapter on the respiratory requirements, CFR 391.41 (b)(5), to include sleep disorders (May 2010) (http://nrcme.fmsca.dot.gov/MEhandbook.htm). The FMSCA has a partnership with American College of Occupational and Environmental Medicine (ACOEM) that supports out work in promulgating guidelines for commercial driver medical examiners. The 2010 FMCSA ACOEM Medical Fellow will study validation of alternative treatments for drivers with sleep apnea (e.g. portable sleep monitors), to be completed in 2010. The FMCSA intends to publish clinical guidance to accompany each medical regulation change upon completion of the notice and comment rulemaking process. Finally, FMCSA is cosponsoring a national meeting on Sleep Apnea and the Commercial Driver to be held in May 2010. The Agency is committed to improving education and training for motor carrier professional to produce safer drivers and carriers, improve safety of commercial motor vehicles, advance safety through information-based initiatives, and improve security through safety initiatives. The FMCSA looks forward to working with NTSB to address obstructive sleep apnea and respectfully requests that NTSB classify safety recommendations H-09-15 and H-09-16 as “Open-Acceptable Response.” We share the NTSB’s goal of improving motor carrier safety and believe the actions described above are responsive to the safety recommendations.