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Safety Recommendation Details

Safety Recommendation R-14-073
Details
Synopsis: During the time period between May 2013 and March 2014, the National Transportation Safety Board (NTSB) launched investigative teams to five significant accidents on the Metro-North Railroad (Metro-North): (1) the May 17, 2013, derailment and subsequent collision in Bridgeport, Connecticut; (2) the May 28, 2013, employee fatality in West Haven, Connecticut; (3) the July 18, 2013, CSX derailment on Metro-North tracks in The Bronx, New York; (4) the December 1, 2013, derailment in The Bronx, New York; and (5) the March 10, 2014, employee fatality in Manhattan, New York. In combination, these accidents resulted in 6 fatalities, 126 injuries and more than $28 million in damages. The continued safe operation of Metro-North is vital to New York City and the tri-state area of New York, New Jersey, and Connecticut. As the NTSB investigations progressed, it became apparent that several organizational factors issues were involved in the accidents. The November 2013 NTSB investigative hearing on the Bridgeport and West Haven accidents (the NTSB hearing) explored the role of Metro-North and the Federal Railroad Administration (FRA) organizational factors in these accidents. The NTSB was not alone in observing that organizational factors were relevant to the series of Metro-North accidents. Subsequent actions by the FRA, which conducted a focused audit, and the Metropolitan Transportation Authority (MTA), which formed a Blue Ribbon Panel (BRP) to review safety and created an MTA Board Safety Committee to monitor safety, have reinforced the need to examine both the role of Metro-North and FRA organizational factors in relation to these five accidents. This special investigation report discusses all five of the recent Metro-North accidents investigated by the NTSB, examines some of the common elements of these accidents, and addresses the steps that Metro-North, the MTA, and the FRA have taken as a result of these investigations. The report also highlights lessons learned and provides recommendations to Metro-North, MTA, and several other entities to improve railroad safety on Metro-North and elsewhere.
Recommendation: TO THE AMERICAN ACADEMY OF FAMILY PHYSICIANS: Enhance initial and ongoing training to ensure that Board-certified physicians in Family Medicine can successfully identify risk factors for, evaluate, and effectively treat obstructive sleep apnea among their patients. (R-14-73)
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Action
Mode: Railroad
Location: United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA14SS005
Accident Reports:
Report #: SIR-14-04
Accident Date: 4/2/2014
Issue Date: 11/24/2014
Date Closed: 5/9/2018
Addressee(s) and Addressee Status: American Academy of Family Physicians (Closed - Acceptable Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: American Academy of Family Physicians
Date: 5/9/2018
Response: We note that, since 2014, the AAFP has conducted 37 live continuing medication education activities, implemented eight self-study packages, and produced one monograph, one audio program, and three journal articles that incorporate education on OSA. Further, we note that your curriculum guidelines (CGs) for family medicine residency training include two CGs with recommendations regarding OSA. Because these products adequately address OSA risk factors, evaluation, and treatment, Safety Recommendation R-14-73 is classified CLOSED--ACCEPTABLE ACTION. Thank you for taking these actions to ensure that Board-certified physicians in family medicine can successfully identify the risk factors for, evaluate, and treat OSA.

From: American Academy of Family Physicians
To: NTSB
Date: 3/13/2018
Response: -From Douglas E. Henley, MD, FAAFP, Executive Vice President and CEO: This is in response to your March 5 letter regarding five accident investigations involving the Metro-North Railroad specifically related to NTSB’s Safety Recommendation R-14-73: “Enhance initial and ongoing training to ensure that Board-certified physicians in family medicine can successfully identify risk factors for, evaluate, and effectively treat obstructive sleep apnea among their patients.” Since 2014, the AAFP has conducted 37 live CME activities; implemented eight enduring self-study packages; created one monograph, one audio program and three American Family Physician journal articles that incorporate education on sleep apnea. Search results for some of the articles can be referenced below: September 1, 2016 – Diagnosis and Treatment of Obstructive Sleep Apnea in Adults https://www.aafp.org/afp/2016/0901/p355.html January 24, 2017 – Obstructive Sleep Apnea in Adults – Clinical Preventive Service Recommendation https://www.aafp.org/patient-care/clinical-recommendations/all/sleep-apnea.html July 15, 2017 – U.S. Preventive Services Task Force: Screening for Obstructive Sleep Apnea in Adults https://www.aafp.org/afp/2017/0715/od1.html The AAFP produces curriculum guidelines (CGs) for family medicine residency training. Our CGs on Care of the Older Adult, and Care of the Critically Ill Adult both include recommendations regarding education on sleep apnea. Unfortunately, we could not determine the reason for the delayed response to your request for this information, and hope this will suffice as an adequate reply to your inquiry.

From: NTSB
To: American Academy of Family Physicians
Date: 3/5/2018
Response: We have not received any information from you regarding the AAFP’s activities to satisfy this recommendation. On November 8, 2017, we used the general e-mail address on your website (aafp@aafp.org) in an effort to obtain an update. Ms. Bellinda K. Schoof, Director, Health of the Public and Science Division, replied that you were not aware of receiving this recommendation in 2014 and asked that we send more background information. On November 13, 2017, we e-mailed Ms. Schoof copies of our November 24, 2014, letter and of our report on the Metro-North Railroad accidents. We have not received any further information about your action to satisfy this recommendation since then, despite our January 3, 2018, request for information. We normally expect that action to satisfy our recommendations should be completed within 3 to 5 years after they are issued. Safety Recommendation R-14-73, currently classified OPEN--AWAIT RESPONSE, is now over 3 years old, and we have not been able to learn of any activities that you have completed or planned to satisfy the recommendation. Please update us at regarding your actions to address Safety Recommendation R-14-73.