The US National Highway Traffic Safety Administration (NHTSA) reports more than 4,000 non-fatal and 1,550 fatal crashes each year are attributed to sleep-deprived drivers.
The North American Fatigue Management Program (FMP) involving the Federal Motor Carrier Administration (FMCSA), the Alberta and Quebec governments, Transport Canada, the Alberta Motor Transport Association, CTA and the American Transportation Research Institute (ATRI) claims that roughly 15% of road accidents involving heavy vehicles are linked to fatigue.
A contributing factor to driver fatigue is sleep disorders. One disorder currently receiving considerable attention is Obstructive Sleep Apnea (OSA), characterized by obstructed breathing during sleep which results in disrupted sleep and sleep deprivation in turn causing drowsiness and increasing the risk of sleep episodes behind the wheel.
The Canadian Medical Association’s Physician’s Guide for Determining Medical Fitness to Operate a Motor Vehicle states: “The relative risk for motor vehicle crashes for patients with symptomatic OSA is about two to three times that of control groups. In severe cases of OSA, the risk of a motor vehicle crash may be increased as much as 10-fold.”
OSA is also linked to hypertension, forms of diabetes and heart disease. The good news is that OSA is detectable and treatable. This is not only a safety issue, but a quality of life issue as well. Commercial driver medical standards in Canada and the US do not specifically require physicians to test for OSA during physical examinations. They simply recommend that if a physician feels there is further need of testing, it should be conducted. However, it increasingly appears that the FMCSA may be moving towards the introduction of mandatory testing of commercial drivers for OSA.
In 2008, a Medical Expert Panel recommended that FMCSA make substantial changes to the current guidelines. The FMCSA’s Medical Review Board recommended mandatory OSA screening for commercial drivers with a Body Mass Index (BMI) over 30.While a proposed rule-making has not been published, more and more observers feel it is just a matter of time.
A study conducted by the Harvard School of Public Health, the Boston University School of Medicine and the Cambridge Health Alliance, funded in part by FMCSA, and published in the March 2009 Journal of Occupational and Environmental Medicine, also recommends mandatory OSA screening of truck drivers. It concluded OSA increases the risk of falling asleep at the wheel on the order of two to seven times. It found obesity to be a strong predictor of OSA (people with a BMI of greater than 29 are at 10 times the risk of having OSA).
Of course truck drivers are not the only people that can suffer from OSA, but the study estimates as many as 2.4 million to 3.9 million of the 14 million licensed commercial drivers in the US could have the disorder. In addition to US regulators, insurers and carriers on both sides of the border are starting to take the issue more seriously. More carriers are now taking steps to increase driver awareness of OSA and the treatments available.
The North American FMP is developing educational and training materials, workshops, certification, protocols, etc., which will contain some information on OSA.
Preliminary results from a research project into the effects of an FMP on fatigue suggest drivers with OSA respond positively to screening and treatment, if they follow up. The drivers (who were from both Canada and the US) experienced improved sleep quality and reported less fatigue. This is a good start, but much more will likely be required to meet a US mandate.
There are a lot of questions that need to be answered. What will be required in terms of testing? Which current devices will be acceptable under the US rules? The FMCSA’s medical expert panel indicates a strong preference for full in-laboratory sleep study. What will be considered acceptable treatment? The medical expert panel recommends against the use of dental appliances.
Who will pay the costs not covered by provincial or private health insurance for testing and treatment? Is the medical system able to cope with an increased demand for testing? How will drivers react? How can we be assured that they will follow up on diagnoses and treatment?
Another huge question is what will Canada do?
What we need, CTA believes, is a Canadian policy and program on OSA testing for commercial drivers in order to achieve reciprocal recognition from the US. This would enable Canadian carriers and drivers to comply with the US mandate and ensure that the necessary infrastructure and policies are in place in Canada to deal with OSA testing. Otherwise the Canadian industry could once again be facing the situation where its drivers may not be able to operate into and out of the US. Whether it’s OSA, EOBRs, environmental regulation or safety technology, Canada cannot and should not simply be a policy-taker. But, we have to start today.
-David Bradley is president of the OTA and CEO of the CTA.
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