[Congressional Record (Bound Edition), Volume 146 (2000), Part 18]
[Senate]
[Pages 26274-26276]
[From the U.S. 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 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

[[Page 26275]]

     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 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

[[Page 26276]]

     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.

                          ____________________