[Congressional Record Volume 146, Number 148 (Tuesday, December 5, 2000)]
[Senate]
[Pages S11559-S11561]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
FATIGUE MANAGEMENT IS KEY TO IMPROVED HIGHWAY TRUCK SAFETY
Mr. GRAMS. Mr. President, highway safety, especially concerning long-
haul
[[Page S11560]]
trucks tends to be a contentious issue. It is generally understood that
the long-haul truck driver faces a tedious and fatiguing task. Anyone
trying to get to Florida from Minnesota in one day knows that.
Government regulations on commercial truck drivers set parameters on
hours of operation in the hope necessary rest can be achieved, thus
preventing tired drivers from undertaking their critical duty. How can
a government mandate for rest produce results?
Anyone in the business knows that the Administration's proposed
regulations governing truck drivers have gone from bad to worse. We
recently passed legislation delaying the implementation of a new
proposed regulation. However, there is a solution. But first, some
background.
Prescriptive Hours of Service regulations, HOS, have been unchanged
for more than sixty years. After ten hours driving, a driver may not
drive for eight hours. A driver may not drive more than seventy hours
in eight days. Supposedly the non-driving time is intended to provide
opportunity for sleep and other necessary activities. However, long-
haul drivers may end a ten-hour driving period at a time of day when
their physiological alerting system, or body clock, will not permit
sleep. At the end of the non-driving period they may be tired but may
legally drive. In many instances, they must drive fatigued in order to
make timely delivery. There is consensus in the scientific community
that any system of prescriptive hours of service regulation will result
in drivers occasionally being prohibited from driving when they are
alert and compelled to drive when they are tired.
It has come to my attention that a logical and creative alternative
is at hand. One that offers the promise of not only improved highway
truck safety, but improvement in the life-styles of the participants--
the truck drivers--and in the efficiencies of the companies who employ
them. The alternative is in managing fatigue.
The problem of operator inattention related to sleep deprivation has
been the subject of medical, scientific and regulatory inquiry for many
years. It is the consensus of the medical and scientific communities
that the time has come to apply the knowledge gained by applying it in
real operational conditions.
That possibility is upon us. Thanks in part to the efforts of one of
my constituents, Mr. Donald G. Oren, President of Dart Transit Company
of Eagan, Minnesota, a feasibility test has been successfully
concluded. This is an exciting development.
Recently, the Safety Research Center, Bethesda, Maryland, under the
direction of its President, Tony McMahon, together with Stanford
University's Sleep Disorders Clinic and Research Center undertook a
scientific experiment. William C. Dement, M.D., Ph.D., Professor of
Psychiatry and Behavioral Sciences at the Stanford University School of
Medicine, and the director of the Stanford Sleep Disorders Clinic and
Research Center, a long-time student of and author on sleep disorders,
developed a two-phase approach to developing a solution to driver
fatigue. The first is to test and treat individuals for sleep disorders
and the second is to teach them how to manage fatigue.
Doctors and scientists researching sleep have found that drowsiness
results from sleep debt, which is cumulative. There are only two ways
to build up a sleep debt: inadequate amounts of sleep and excessively
frequent interruption of sleep as occurs in the obstructive sleep apnea
syndrome and the restless legs syndrome. According to the December 1996
Driver Fatigue and Alertness Study commissioned by the Federal Highway
Administration, the two most important factors in driver fatigue are
time of day and the amount and quality of sleep received.
At the Stanford Sleep Center, drivers from two trucking companies
were screened, treated for sleep disorders and trained in how to
recognize sleep debt and fatigue and what to do about it. On October
18, 2000, Dr. Dement announced the results of that feasibility study
involving nine drivers from Dart Transit, of Eagan, Minnesota, and Star
Transport, of Morton, Illinois. The drivers spent two separate sessions
of three days each at the sleep research facility at Stanford. Dr.
Dement's findings are that effective training will cause behavior
change and fatigue avoidance.
The next step is to develop a pilot program, which the Federal Motor
Carrier Safety Administration, FMCSA, will be asked to undertake. FMCSA
possesses the authority to conduct such a pilot program. It will be
conducted under strictly controlled exemptions to hours of service
regulations.
I am told that Clyde Hart, Acting Administrator of FMCSA, believes
the idea has merit and is willing to entertain a pilot program
proposal. The program will be undertaken by the Safety Research Center,
Bethesda, Maryland, and the Stanford Sleep Research Center. It will
begin with approximately 40 drivers each from Dart and Star. Screened,
treated and trained, they would be exempted from the hours of service
regulations (but not total hours that can be driven) to provide maximum
flexibility to the trained drivers in managing their time. These
drivers would be compared to a control group operating under current
hours of service regulations. Assuming that the operations generate
positive data, the program would be expanded to other companies.
Progress would be evaluated on an ongoing basis and at the end of the
three-year program it should be apparent that fatigue management should
be a regulatory alternative to current hours of service regulation.
This is a most welcome and exciting development. To bear out this
conclusion, I ask unanimous consent that two items be included in the
Record: Dr. Dement's remarks to the media and a recent article from
Traffic World.
There being no objection the material was ordered to be printed in
the Record.
Remarks by William C. Dement, M.D., Ph.D., Director of the Stanford
University Sleep Disorders & Research Center
join the safe team: the point of the lance for a safer and more alert
america
At a press conference on Capitol Hill in January 1993, I
had the privilege of reporting the results of the two-year
study of Sleep in America by the National Commission on Sleep
Disorders Research. The Commission had determined that there
were two gigantic problems in our society, pervasive and
severe sleep deprivation in every component of society, and a
pandemic of undiagnosed and untreated or misdiagnosed and
mistreated sleep disorders. The Commission also emphasized
vigorously that the root cause of these problems was a total
lack of effective public and professional awareness about
sleep. Indeed, one of the most urgent recommendations of the
Commission to the U.S. Congress was to launch an effective
and broad based national awareness campaign. Sadly, this did
not happen for several reasons including the budget deficit.
During the period of the Commission study and in many of
the years since, I have learned that attempting to alleviate
the societal problems relating to sleep has a special
difficulty. The absence of prior exposure to sleep education
allows inappropriate skepticism about the facts of sleep,
retention of erroneous mythologies about sleep, and extreme
difficulty in mobilizing an adequately large community of
advocates.
In the aftermath of the failure to launch an effective
National Awareness Campaign, we have persisted in attempting
to develop an alternative strategy. The main thrust has been
to identify a much smaller community, which, if adequately
educated and trained, might be a catalyst for a larger
societal change. Efforts have been made by me and others to
educate primary care physicians, high school students,
airline personnel, railroad personnel, and a variety of other
specific groups such as Olympic athletes, shift workers, and
so on. None of the efforts to date have been adequately
successful, particularly as a catalyst.
All of this is by way of introducing what I will report in
today's conference. I believe we have the absolutely best
group from every point of view. This is not entirely new
because this group has been the focus of much attention in
recent years, a fair amount of it entirely unwonted. The
group in question is long haul truck drivers. We are here to
announce the success of a feasibility trial and the intention
to submit a fatigue management pilot program to the
administrator of the Federal Motor Carrier Safety
Administration. In summarizing the continuing lack of
effective education and awareness in America about sleep in
1993, I said that 100 or so sleep disorders centers are
islands of awareness in a vast sea of ignorance; too small in
number and too dispersed to constitute a catalytic
educational force. That situation is only slightly changed
today. There are more islands, but the vast sea of ignorance
remains.
As exemplified on the October 16, 2000, cover of US News
and World Report in an article titled, ``Sleepless in
America,'' our nation is carrying the largest sleep debt in
history. Nearly every citizen has a bigger or
[[Page S11561]]
smaller sleep debt. The question is why don't they know it.
The reasons are as follows.
Most people don't know their personal sleep requirement.
Most people know nothing about sleep debt.
Most people don't understand the function of their
circadian system (biological clock).
Most people don't know the significance of being tired all
the time.
Most people know nothing about sleep disorders.
An extremely important principle is that there are two ways
and only two ways to build up a sleep debt; inadequate
amounts of sleep and excessively frequent interruption of
sleep as occurs in the obstructive sleep apnea syndrome and
the restless legs syndrome.
Sleep scientists have known these facts for more than two
decades and have tried and tried to bring them effectively to
the attention of key communities. One would think that
learning these things would be a core part of many
professional training programs, and if nowhere else,
certainly in the transportation industry. Airline personnel
need to know the principles of fatigue management, railroad
personnel, maritime personnel, and the vast community of
automobile drivers, but we have learned in our feasibility
trial and I am now convinced, that the highest priority for
intensive professional training regarding fatigue management
should be long haul truck drivers. Of course, all drivers
must have the ability to maintain attentive alertness while
driving. However, the highest educational priority should be
bestowed upon the community of long haul truck drivers who
sit astride 40 tons of highly evolved and intricate
machinery. In other modes of transportation, attentiveness
every second is not required.
Thus, we propose a special program that involves (a)
training to behavioral change and commitment and (b)
screening for sleep disorders and ease of access for
definitive diagnosis and effective treatment. Long haul
drivers who are successful in completing this program will be
transformed by sleep debt reduction and improved personal
health, and they will become disciples seeking to recruit
their fellow truckers.
Today, instead of what we are proposing, we have
prescriptive hours of service which guarantee that there will
be times when a driver must stop driving although he or she
is fully alert. This may not be dangerous, but it is
certainly frustrating. Unfortunately, the Hours of Service
regulations also guarantee that there will be times when
dangerously fatigued truck drivers can keep driving,
sometimes for many hours. A typical scenario is that a driver
must stop at a time when clock dependent alerting will not
allow sleep. At the end of this period with very little rest,
the driver is very tired but can now go for another 10 hours.
If he chose instead to sleep, the rest period would be
extended to 16 hours and his productivity would be greatly
reduced.
Personally, I have wanted to carry out this type of
intensive training with targeted personnel for more than 10
years. In 1990 and 91, we completed a study of 200 drivers
and found that 75% of them had obstructive sleep apnea and
that in interviews of more than 600, 82% said the signal to
stop driving was ``falling asleep.'' Now, two visionary
companies, Dart and Star, have stepped forward and have
supported such a program with their own resources. We have
completed a feasibility study with nine drivers and in my
more than 30 years as an educator, this was one of the best
teaching experiences we have ever had. Initially, I was
uncertain that we could accomplish the desired result in this
community. I insisted on an adequate opportunity, which
consisted of an initial three full days of education and
training together with sleep disorders screening, diagnosis,
and most importantly, treatment. Then three full days of
additional education, review, and evaluation one month later.
In brief, at the second session we learned that the prior
training and screening had been successful beyond our wildest
dreams. The fatigue of this group was greatly reduced; the
success of CPAP treatment had a double impact because spouses
experienced great relief. Finally, I believe that our initial
group of drivers is now completely safe, feel much better,
and have substantially improved cardiovascular health. They
are the vanguard of a new breed of long haul trucker, and on
their own initiative, they have named themselves ``The SAFE
TEAM'' which stands for Sleep and Fatigue Experienced
Truckers Educating America's Motorcarriers. I also believe
that long-haul truckers will be the vanguard of educating our
entire society.
We are ready and eager to go forward with a formal pilot
project and will seek approval of the Office of Federal Motor
Carrier Safety Administration. We will put in place
technology to monitor SAFE TEAM drivers and to insure that
waiver of hours of service and the essential flexibility is
not abused. I see no likelihood of the latter because of the
commitment of these drivers to safety, but political issues
make it necessary.
The intense interaction of the Stanford group which
includes SleepQuest and the School of Sleep Medicine as
partners in the Stanford University Center of Excellence, the
Safety Research Institute, and above all, the pioneering
group of drivers revealed and clarified what will surely
become the theme of the pilot project and beyond. Fatigue
management education is the missing piece in the training of
professional drivers. This is why the sleep training was
embraced by the drivers and their companies and why we can
predict that it will eventually be enthusiastically embraced
throughout the entire long haul trucking industry.
____
[From Traffic World, Oct. 30, 2000]
Enlightened Self-Interest
(By Frank N. Wilmer)
pilot program would teach fatigue management, permit drivers to set
their own work-rest cycles
When the shipment absolutely positively has to be there on
time, perhaps the truck driver should take a nap. That's the
opinion of Stanford University sleep scientist William Dement
and safety consultant and former Federal Highway
Administration chief counsel Anthony McMahon. They say
drivers properly trained in fatigue management are more
productive, more alert and safer. They also make more
informed decisions on when to drive and when to rest than
bureaucrats who prescribe a one-size-fits-all model.
Dement and McMahon intend to ask the Federal Motor Carrier
Safety Administration to authorize a three-year pilot program
under which prescriptive hours-of-service regulations would
be scrapped temporarily in favor of enlightened self-interest
by up to 80 drivers who successfully complete Dement's
fatigue-management course. Where federal regulations now
mandate a relatively inflexible driving schedule, the Dement-
McMahon proposal would permit drivers to determine, within
limits, when they are alert and able to drive safely.
The drivers' dispatchers as well as members of the drivers'
families also would receive fatigue management training and
drive time behind the wheel would be monitored
electronically. McMahon said the pilot program, whose details
would be fleshed out in collaboration with the FMCSA, likely
would limit drivers to the same maximum 70 hours of driving
time within eight consecutive days as now exist. But drivers
would have greater flexibility to devise how they accumulate
those 70 hours of driving time.
The proposed pilot program would involve Dart Transit of
Eagan, Minn., which utilizes owner-operators, and Star
Transport of Moton, Ill., which employs its own drivers. Dart
CEO Glenn Werry and Star CEO Donald Oren have pledged to pay
the costs of the pilot program, said McMahon.
``The experience at Stanford proves to me we can create a
cadre of drivers who understand how sleep really works and
will use new knowledge to drive more safely, reduce the
dangers to themselves and others and improve their quality of
life on and off the road,'' said Dement, a medical doctor who
also holds a Ph.D. in neurophysiology.
The Dement-McMahon proposal is the first entrepreneurial
approach to what has become a furious battle between the
FMCSA and the trucking industry on how to revise arguably
outdated safety regulations that prescribe the maximum number
of hours commercial drivers may be behind the wheel.
An April FMCSA reform proposal would limit daily driving
time to 12 hours, mandate 10 continuous hours of daily rest,
prescribe up to four workday breaks totaling two hours and
prohibit drivers from being behind the wheel for up to 56
consecutive hours each seven-day period even if it stranded
them at truck stops.
The American Trucking Associations, which estimates the
FMCSA's proposed hours-of-service revision could increase
universities cloning the training program, said Dement.
Dart's Oren, who already sent some drivers through Dement's
fatigue management course, said they previously ``didn't
worry'' about how they spent their time before getting behind
the wheel, but now ensure they do not have alertness-
depriving ``sleep debt'' before driving. ``It has become a
way of life for them.'' said Oren.
FMCSA Acting Deputy Administrator Clyde Hart and ATA
President Walter McCormick each told Traffic World they
hadn't seen the proposal and thus could not comment.
____________________