[Federal Register Volume 69, Number 190 (Friday, October 1, 2004)]
[Notices]
[Pages 58995-58996]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-22025]


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DEPARTMENT OF TRANSPORTATION

Federal Railroad Administration


Notice of Safety Advisory 2004-04; Effect of Sleep Disorders on 
Safety of Railroad Operations

AGENCY: Federal Railroad Administration (FRA), DOT.

ACTION: Notice of Safety Advisory.

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SUMMARY: FRA is issuing Safety Advisory 2004-04 to alert the railroad 
community, and especially those employees occupying safety-sensitive 
positions, to the danger associated with degradation of performance 
resulting from sleep disorders that are undiagnosed or not successfully 
treated. Alertness (vigilance) and unimpaired cognitive functions are 
important to the safety of railroad operations. Of particular concern 
to FRA are those employees who dispatch or operate trains or who 
inspect and maintain signal systems. Many of these employees work 
unpredictable schedules and long hours, making it difficult for them to 
achieve adequate rest even if otherwise healthy. This advisory contains 
suggested measures that railroads and employees should utilize to 
prevent work-related errors and on-the-job accidents as a result of 
sleep disorders.

FOR FURTHER INFORMATION CONTACT: A. Scott Kaye, Office of Safety, RRS-
4, Mail Stop 25, Federal Railroad Administration, U.S. Department of 
Transportation, 1120 Vermont Avenue, NW., Washington, DC 20590. 
Telephone 202-493-6303.

SUPPLEMENTARY INFORMATION:

Factual Background

    On November 15, 2001, Canadian National Railway Company/Illinois 
Central Railroad Company (CN/IC) southbound Train 533 and northbound 
Train 243 collided near Clarkston, Michigan. Both crewmembers of Train 
243 were fatally injured, and both crewmembers of Train 533 sustained 
serious injuries. The track and equipment damaged in the accident was 
valued at approximately $1.4 million. The National Transportation 
Safety Board (NTSB) determined that the probable cause of the accident 
was crewmembers' fatigue, which was primarily due to the engineer's 
untreated, and the conductor's insufficiently treated, obstructive 
sleep apnea. NTSB Report No. RAR/02/04. Sleep apnea is a sleep disorder 
characterized by cessations of breathing during sleep, and therefore 
partial awakenings during a sleep period.
    Sleep disorders represent a serious health problem in American 
society and a significant economic concern. Moreover, untreated sleep 
disorders can result in impaired work performance, including possible 
loss of alertness and situational awareness, which could in turn 
present an imminent threat to transportation safety. In general terms, 
sleep disorders range from fairly common disorders, such as insomnia 
(the inability to initiate or maintain sleep) to relatively rare sleep 
disorders such as narcolepsy (inappropriate and uncontrollable sleep 
episodes). Railroad employees who typically work on-call are especially 
vulnerable to sleep disorders such as circadian rhythm disorders,\1\ 
and shift work sleep disorder,\2\ a relatively recent addition to sleep 
disorders listed in the Diagnostic and Statistical Manual of Mental 
Disorders published in 1994 by the American Psychiatric Association 
(better known as the DSM IV), which cuts across all types of shift work 
jobs. Studies of on-call work schedules that lead to alterations in the 
timing or duration of sleep and the sleep-wake cycle have also been 
shown to lead to significant sleep and circadian rhythm disturbances in 
railroad workers.\3\
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    \1\ Elshaug, A. Reid, K. and Damson, D. 1998, The circadian 
effects of irregular work schedules on sleep. In W.P. Colquhoun 
(ed.), Aspects of Human Efficiency (London: English Universities), 
273-282.
    \2\ 2004, National Sleep Foundation Workshop on Shift Work Sleep 
Disorder, March 4-5, Washington, DC.
    \3\ Pilcher, J. and Coplen, M. 2000, Work/Rest Cycles in 
railroad operations: effects of shorter than 24-hour shift work 
schedules and on-call schedules on sleep. Ergonomics, Vol. 43, No. 
5, 573-588.
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    One of the more common sleep disorders is sleep apnea, affecting as 
many as 18 million Americans. Researchers estimate that the prevalence 
of sleep apnea in the general population is between 8-12%, depending on 
the measure used (mild, moderate or severe). Some researchers have also 
estimated the prevalence of severe sleep apnea in the general 
population between 3-5%, about 90% of whom are still undiagnosed, 
clearly demonstrating a significant problem. Obstructive sleep apnea, 
circadian rhythm disorders, and rotating shifts, have been found to be 
significant predictors of work-related accidents.\4\ Although severe 
sleep apnea is considered one of the more debilitating sleep disorders 
and is a significant risk factor for on-the-job accidents, it is also 
one of the most easily diagnosed and treated of all sleep disorders.
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    \4\ Ohayton, M, Lermoine, P., Arnaud-Briant, V., and Dreyfus, 
M., 2002, Prevalence and consequences of sleep disorders in a shift 
worker population. Journal of Psychosomatic Research, 53, 577-583.
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    According to the National Sleep Foundation, untreated sleep 
disorder sufferers are three times more likely to have automobile 
accidents. The National Highway Traffic Safety Administration estimates 
that more than 100,000 auto crashes annually may be fatigue-related. 
These incidents result in an estimated 1,500 deaths and tens of 
thousands of injuries and lasting disabilities. Sleep disorders also 
tend to be more prevalent in an aging population. The average age for a 
railroad operating employee is now approaching 50.
    While the impact of sleep disorders is unique to each individual 
and can be related to a variety of other factors and medical conditions 
such as obesity, depression, age and gender, evidence is clear that 
significant risks exist for those with undiagnosed and untreated sleep 
disorders. Some of these risks include excessive daytime sleepiness, 
greater risk of cardiovascular disease, memory loss, and increased risk 
of accidents to name a few. For these and other reasons, the NTSB has 
been concerned about the impact of sleep disorders and other medical 
conditions on railroad safety.
    Following its investigation into the collision near Clarkston, 
Michigan, the NTSB issued three recommendations to FRA:


[[Page 58996]]


    ``Develop a standard medical examination form that includes 
questions regarding sleep problems and requires that the form be 
used, pursuant to 49 CFR part 240, to determine the medical fitness 
of locomotive engineers; the form should also be available for use 
to determine the medical fitness of other employees in safety-
sensitive positions.'' (R-02-24).
    ``Require that any medical condition that could incapacitate, or 
seriously impair the performance of, an employee in a safety-
sensitive position be reported to the railroad in a timely manner.'' 
(R-02-25).
    ``Require that, when a railroad becomes aware that an employee 
in a safety-sensitive position has a potentially incapacitating or 
performance-impairing medical condition, the railroad prohibit that 
employee from performing any safety-sensitive duties until the 
railroad's designated physician determines that the employee can 
continue to work safely in a safety-sensitive position.'' (R-02-26).

    FRA agrees with the safety concerns as expressed by the NTSB. This 
Safety Advisory, which has been developed after consultation with 
industry parties participating in the North American Rail Alertness 
Partnership, is an initial step in addressing the concerns identified 
by the NTSB.
    However, in evaluating the recommendations, FRA has noted the 
importance of addressing these needs within a proper framework of 
accountability, scientific credibility, professional discipline, and 
fairness. Further, FRA notes that conditions that could threaten 
employee fitness for duty are not limited to sleep disorders. 
Accordingly, in the fall of 2003, FRA awarded a contract for a 
comprehensive study to determine the need for, and options for 
implementing, medical standards for railroad employees in safety-
critical occupations. Upon receipt of a final report from that study, 
FRA will evaluate the appropriate framework for addressing in greater 
detail the NTSB's recommendations.
    While FRA has regulations that address the fitness of employees, 
the regulations are limited to hearing and vision requirements for 
locomotive engineers (49 CFR part 240) and the control of alcohol/drug 
use (49 CFR part 219). FRA also enforces the hours of service law (49 
U.S.C. 21101-21108), which specifies the maximum hours of duty and 
minimum periods of release for certain safety-critical employees.\5\
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    \5\ The hours of service law is an important defense against 
excessively long hours of work. However, it was enacted prior to 
completion of the major body of fatigue research. Although FRA may 
not vary the terms of the statute, FRA is empowered to authorize 
pilot projects directed at fatigue mitigation upon joint petition of 
the railroad and employees affected. FRA continues to encourage 
development of approaches to fatigue prevention and mitigation, 
especially with regard to providing predictable work schedules that 
do not induce fatigue and that offer ample opportunity for rest.
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Need for Action Now

    The FRA and NTSB have investigated numerous human factor accidents 
that were the result of errors caused by loss of alertness or loss of 
situational awareness. While there are no existing data to justify the 
inference that undetected or untreated sleep disorders were a causal 
factor, several factors, including the Clarkston, Michigan collision, 
data extrapolated from other modes of transportation, and the 
prevalence of sleep disorders within the general population, clearly 
demonstrate that there is a threat to railroad operations from 
undiagnosed or incompletely treated sleep disorders.
    This threat exists, not only in train operations, train 
dispatching, and signal maintenance, but also in the operation of motor 
vehicles, on-track equipment, and other machinery. Approximately 35% of 
all train accidents reported to FRA are attributed to human factors, of 
which fatigue, and more particularly, sleep disorders, play an 
undetermined role. Most employee casualties in train incidents and non-
train incidents also involve a human factor component.

Recommended Actions

    Therefore, FRA recommends that railroads and representatives of 
employees, working together, take the following actions to promote the 
fitness of employees in safety-sensitive positions:
    (1) Establish training and educational programs to inform employees 
of the potential for performance impairment as a result of fatigue, 
sleep loss, sleep deprivation, inadequate sleep quality, and working at 
odd hours, and document when employees have received the training. 
Incorporate elements that encourage self-assessment, peer-to-peer 
communication, and co-worker identification accompanied by policies 
consistent with these recommendations.
    (2) Ensure that employees' medical examinations include assessment 
and screening for possible sleep disorders and other associated medical 
conditions (including use of appropriate checklists and records). 
Develop standardized screening tools, or a good practices guide, for 
the diagnosis, referral and treatment of sleep disorders (especially 
sleep apnea) and other related medical conditions to be used by company 
paid or recommended physicians during routine medical examinations; and 
provide an appropriate list of certified sleep disorder centers and 
related specialists for referral when necessary.
    (3) Develop and implement rules that request employees in safety-
sensitive positions to voluntarily report any sleep disorder that could 
incapacitate, or seriously impair, their performance.
    (4) Develop and implement policies such that, when a railroad 
becomes aware that an employee in a safety-sensitive position has an 
incapacitating or performance-impairing medical condition related to 
sleep, the railroad prohibits that employee from performing any safety-
sensitive duties until that medical condition appropriately responds to 
treatment.
    (5) Implement policies, procedures, and any necessary agreements 
to--
    (a) Promote self-reporting of sleep-related medical conditions by 
protecting the medical confidentiality of that information and 
protecting the employment relationship, provided that the employee 
complies with the recommended course of treatment;
    (b) Encourage employees with diagnosed sleep disorders to 
participate in recommended evaluation and treatment; and
    (c) Establish dispute resolution mechanisms that rapidly resolve 
any issues regarding the current fitness of employees who have reported 
sleep-related medical conditions and have cooperated in evaluation and 
prescribed treatment.
    FRA acknowledges that some of the above recommendations may have 
already been institutionalized in one form or another by various 
segments of the industry; in this case, FRA suggests a review of 
current policies and procedures for relevancy.
    FRA believes that the recommendations set forth above, if 
implemented by industry parties, could advance the successful 
management of sleep disorders. Taken together with the results of FRA's 
broader study of potentially impairing medical conditions, lessons 
learned could provide a sound foundation for more formal action by 
industry, government, or both.

    Issued in Washington, DC, on September 21, 2004.
Grady C. Cothen, Jr.,
Acting Associate Administrator for Safety.
[FR Doc. 04-22025 Filed 9-30-04; 8:45 am]
BILLING CODE 4910-06-P