Commercial Motor Vehicle Operators Research Articles

Challenges in Conducting Empirical Epidemiological Research with Truck and Bus Drivers in Diverse Settings in North America.

Over 6.5 million commercial vehicle drivers were operating a large truck or bus in the United States in 2020. This career often has high stress and long working hours, with few opportunities for physical activity. Previous research has linked these factors to adverse health conditions. Adverse health conditions affect not only the professional drivers’ wellbeing but potentially also commercial motor vehicle (CMV) operators’ safe driving ability and public safety for others sharing the roadway. The prevalence of health conditions with high impact on roadway safety in North American CMV drivers necessitates empirical epidemiological research to better understand and improve driver health. The paper presents four challenges in conducting epidemiological research with truck and bus drivers in North America and potential resolutions identified in past and current research. These challenges include (1) the correlation between driving performance, driving experience, and driver demographic factors; (2) the impact of medical treatment status on the relationship between health conditions and driver risk; (3) capturing accurate data in self-report data collection methods; and (4) reaching the CMV population for research. These challenges are common and influential in epidemiological research of this population, as drivers face severe health issues, health-related federal regulations, and the impact of vehicle operation on the safety of themselves and others using the roadways.

Attitudes towards Safety Regulation and Job Satisfaction in Commercial Motor Vehicle Drivers

This paper presents a study about the relationship between attitudes toward safety regulations and job satisfaction among commercial motor vehicle operators in Chile. 318 truck drivers were recruited during 2012. Results show that the principal predictor of attitudes toward safety regulations is job satisfaction, after time driving in this occupation. These findings suggest that trust in work safety is relevant for a risky profession, as the studied.

Screening for Obstructive Sleep Apnea in Commercial Drivers Using EKG-Derived Respiratory Power Index.

Obstructive sleep apnea (OSA) is common in commercial motor vehicle operators (CMVOs); however, polysomnography (PSG), the gold-standard diagnostic test, is expensive and inconvenient for screening. OSA is associated with changes in heart rate and voltage on electrocardiography (EKG). We evaluated the utility of EKG parameters in identifying CMVOs at greater risk for sleepiness-related crashes (apnea-hypopnea index [AHI] ≥ 30 events/h). In this prospective study of CMVOs, we performed EKGs with concurrent PSG, and calculated the respiratory power index (RPI) on EKG, a surrogate for AHI calculated from PSG. We evaluated the utility of two-stage predictive models using simple clinical measures (age, body mass index [BMI], neck circumference, Epworth Sleepiness Scale score, and the Multi-Variable Apnea Prediction [MVAP] score) in the first stage, followed by RPI in a subset as the second-stage. We assessed area under the receiver operating characteristic curve (AUC), sensitivity, and negative posttest probability (NPTP) for this two-stage approach and for RPI alone. The best-performing model used the MVAP, which combines BMI, age, and sex with three OSA symptoms, in the first stage, followed by RPI in the second. The model yielded an estimated (95% confidence interval) AUC of 0.883 (0.767-0.924), sensitivity of 0.917 (0.706-0.962), and NPTP of 0.034 (0.015-0.133). Predictive characteristics were similar using a model with only BMI as the first-stage screen. A two-stage model that combines BMI or the MVAP score in the first stage, with EKG in the second, had robust discriminatory power to identify severe OSA in CMVOs.

Predicting performance and safety based on driver fatigue

Fatigue causes decrements in vigilant attention and reaction time and is a major safety hazard in the trucking industry. There is a need to quantify the relationship between driver fatigue and safety in terms of operationally relevant measures. Hard-braking events are a suitable measure for this purpose as they are relatively easily observed and are correlated with collisions and near-crashes. We developed an analytic approach that predicts driver fatigue based on a biomathematical model and then estimates hard-braking events as a function of predicted fatigue, controlling for time of day to account for systematic variations in exposure (traffic density). The analysis used de-identified data from a previously published, naturalistic field study of 106 U.S. commercial motor vehicle (CMV) drivers. Data analyzed included drivers’ official duty logs, sleep patterns measured around the clock using wrist actigraphy, and continuous recording of vehicle data to capture hard-braking events. The curve relating predicted fatigue to hard-braking events showed that the frequency of hard-braking events increased as predicted fatigue levels worsened. For each increment on the fatigue scale, the frequency of hard-braking events increased by 7.8%. The results provide proof of concept for a novel approach that predicts fatigue based on drivers’ sleep patterns and estimates driving performance in terms of an operational metric related to safety. The approach can be translated to practice by CMV operators to achieve a fatigue risk profile specific to their own settings, in order to support data-driven decisions about fatigue countermeasures that cost-effectively deliver quantifiable operational benefits.

Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force.

The American Academy of Sleep Medicine Sleep and Transportation Safety Awareness Task Force responded to the Federal Motor Carrier Safety Administration and Federal Railroad Administration Advance Notice of Proposed Rulemaking and request for public comments regarding the evaluation of safety-sensitive personnel for moderate-to-severe obstructive sleep apnea (OSA). The following document represents this response. The most salient points provided in our comments are that (1) moderate-to-severe OSA is common among commercial motor vehicle operators (CMVOs) and contributes to an increased risk of crashes; (2) objective screening methods are available and preferred for identifying at-risk drivers, with the most commonly used indicator being body mass index; (3) treatment in the form of continuous positive airway pressure (CPAP) is effective and reduces crashes; (4) CPAP is economically viable; (5) guidelines are available to assist medical examiners in determining whether CMVOs with moderate-to-severe OSA should continue to work without restrictions, with conditional certification, or be disqualified from operating commercial motor vehicles.

Commercial Motor Vehicle Driver Obstructive Sleep Apnea Screening and Treatment in the United States: An Update and Recommendation Overview.

No regulatory mandate exists in the United States (U.S.) for comprehensive obstructive sleep apnea (OSA) risk assessment and stratification for commercial motor vehicle (CMV) drivers. Current Federal Motor Carrier Safety Administration (FMCSA) requirements are outdated and depend largely on subjective report, a less reliable strategy in an occupational setting. Without FMCSA standards, sleep specialists, occupational medical examiners and employers rely on a collection of medical consensus recommendations to establish standards of care. These recommendations advise OSA risk assessment through a combination of focused medical history, physical examination, questionnaires, and accident history, which increase OSA detection compared to current FMCSA standards. For those diagnosed with OSA, consensus-based risk stratification helps identify CMV drivers who may benefit from OSA treatment and establish minimum standards for assessing treatment efficacy and adherence. Unfortunately no consolidated recommendation exists; rather, publications span medical and governmental literature in a patchwork fashion that no longer fully reflect current practice due to subsequent advances in OSA diagnosis, treatment, and technology. Based on searches of medical literature, internet materials, and reference lists from existing publications, an overview and discussion of key published recommendations regarding OSA assessment and treatment in CMV operators is provided. Suggestions for incorporating these recommendations into clinical sleep medicine practice in the U.S. are presented. The challenge for sleep specialists is maintaining the delicate balance between recommendations impacting standard of care and associated medico-legal impact with stakeholder interests from medical, regulatory, industry and public perspectives while providing high quality and efficient care.

Sleep Apnea Evaluation of Commercial Motor Vehicle Operators.

Sleep Apnea Evaluation of Commercial Motor Vehicle Operators.

American College of Occupational and Environmental Medicine's Occupational and Environmental Medicine Competencies-2014: ACOEM OEM Competencies Task Force*.

The preventive medicine foundation of occupational medicine impacts all the different practice areas of OEM, whether it involves preventing illness related to a hazardous exposure, treating injury due to an employee health condition, or addressing unnecessary work disability after an occupational injury. The OEM physicians are required to effectivelyinteractwithawiderangeofother professionals and provide guidance not only to patients but also to other clinicians and occupational health nurses, employers, safety and industrial hygiene professionals, human resource managers, attorneys, labor unions, and public health care professionals. In these interactions,OEMphysiciansshouldfollowa strict code of ethics related to matters of confidentiality and potential conflicts of interest. Detailed guidance in this area is provided in ACOEM Code of Ethics. 16 Effective communication in OEM includes risk communication, patient education, workforce education, development of policy and guidance documents, and medical/legal document preparation. Physicians practicing OEM typically

Response to “Hits and Misses

Response to “Hits and Misses

Portable diagnostic devices for identifying obstructive sleep apnea among commercial motor vehicle drivers: considerations and unanswered questions.

Obstructive sleep apnea (OSA), a syndrome defined by breathing abnormalities during sleep, can lead to fatigue and excessive daytime sleepiness (EDS) with an increased risk of motor vehicle crashes. Identifying commercial motor vehicle operators with unrecognized OSA is a major public health priority. Portable monitors (PMs) are being actively marketed to trucking firms as potentially lower-cost and more accessible alternatives to the reference standard of in-laboratory polysomnography (PSG) in the diagnosis of OSA among commercial motor vehicle operators. Several factors regarding PMs remain uncertain in this unique patient population: their sensitivity and specificity; the cost-benefit ratio of the PMs versus PSG; potential barriers from human factors; and evolving technologic advancement. Human factors that alter test accuracy are a major concern among commercial drivers motivated to gain/maintain employment. Current available data using PMs as a diagnostic tool among CMV operators indicate relatively high data loss and high loss to follow-up. Loss to follow-up has also been an issue using PSG in commercial motor vehicle operators. Furthermore, PM testing and PM results interpretation protocols may have no sleep specialist oversight, and sometimes minimal physician oversight and involvement. Additional studies comparing unattended and unmonitored PMs directly against full in-laboratory PSG are needed to provide evidence for their efficacy among commercial motor vehicle operators.

Driver vs. manager perceptions of commonly used safety practices in commercial motor vehicle operations

This research investigated the perceptions of Commercial Motor Vehicle Operators and Safety Professionals regarding 35 commonly implemented practices used to improve operating safety. Several differences were found in how drivers of different backgrounds rated various practices, and between the drivers and safety managers. These differences were found to be persistent even when combined with measures of safety performance and experience. Managers tended to overvalue (relative to drivers) practices related to hiring, while drivers tended to overvalue (relative to managers) practices related to company support and reward systems. Motor Carriers, insurers, and regulators could consider areas of agreement with respect to high value practices as actionable for increased investment of resources. At the same time, resources allocated toward areas of low perceived value could be reduced.

Health Behavior and Accident Risk: Obesity is Associated with the Future Risk of Heavy Truck Crashes Among Newly Recruited Commercial Drivers

This study estimates the dose-response relationship between Body Mass Index (BMI) and crash risk in commercial motor vehicle operators. Intake data was collected on 744 new truck drivers who were training for their commercial driver's licenses at a school operated by the cooperating trucking firm during the first two-week phase of instruction. Drivers were then followed prospectively on the job using the firm's operational data for two years, or until employment separation, whichever came first. Multivariate Poisson regression and Cox proportional hazards models were used to estimate the relationship between crash risk and BMI, controlling for exposure using miles driven, trip segments, and job type. Results from the Poisson regression indicated that the risk ratio (RR) for all crashes was significantly higher for drivers in the obesity Class II and Class III categories: RR= 1.6, confidence interval 1.2-2.1 and RR= 1.49, confidence interval 1.12-1.99, respectively. Similarly, the multivariate Cox Proportional Hazard model results showed that crash risk was significantly higher for obesity class II (BMI 35 to 40; RR = 1.35, P =0.06) when compared to normal BMI (BMI 18.5 to

A multi‐dimensional construct of commercial motor vehicle operators' attitudes toward safety regulations

PurposeThe purpose of this paper is to develop a measurement scale to assess over‐the‐road commercial motor vehicle operators' attitudes toward safety regulations.Design/methodology/approachA literature review of the current USA motor carrier safety literature and general safety literature is conducted to determine the existence of a construct and measurement scale suitable for assessing truck drivers' attitudes toward regulations. As no existing construct is found, a new construct needs to be developed. A rigorous construct development process is conducted to establish the content domain, reliability, and validity of a new construct to measure truck drivers' regulatory attitudes.FindingsThe results of this paper shows a reliable and valid construct to measure truck drivers' perceptions of the general attitude, effectiveness, and enforcement of safety regulations.Research limitations/implicationsThis effort is the initial construct development process and use of the construct in theory testing studies is necessary.Practical implicationsThe regulatory attitude construct is developed in support of a larger investigation into the behavioral aspects of truck driver safety. The broader study seeks to inform theory and practice as to how the trucking industry's regulatory environment influences truck drivers' safety‐related decisions and behaviors. By identifying the impact of the regulatory environment, safety program managers should be able to direct their educational and training efforts to influence factors that will result in better decisions and safer driving behaviors.Originality/valueThis construct development process marks the first attempt to comprehensively measure truck drivers' attitudes toward safety regulations.

Truckers with OSA, Should They Be Driving?

Truckers with OSA, Should They Be Driving?

Sleep Apnea and Commercial Motor Vehicle Operators:

Obstructive sleep apnea (OSA) has been demonstrated to significantly increase safety and health risks. Medical research has shown that OSA is a significant cause of motor vehicle crashes (resulting in a two- to sevenfold increased risk) and increases the possibility of an individual developing significant health problems such as hypertension, stroke, ischemic heart disease, and mood disorders. Studies suggest that commercial motor vehicle (CMV) operators have a higher prevalence of OSA than the general population. U.S. federal statute requires CMV drivers to undergo medical qualification examinations at least every 2 years—the federal medical standard that deals with OSA is section 49 CFR 391.41(b)(5) of the Federal Motor Carrier Safety Regulations. This section states that the driver must have “no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.” Recently, the Federal Motor Carrier Safety Administration (FMCSA) changed the medical examination reporting form to include a question that asks a driver whether he or she has a sleep disorder, pauses in breathing while asleep, daytime sleepiness, or loud snoring. So far, the only guidance available from FMCSA on the diagnosis and treatment of OSA in CMV drivers was issued in 1991, the result of a report from a conference sponsored by the Federal Highway Administration. However, in the past 15 years, there has been a tremendous increase in the scientific and clinical knowledge regarding the diagnosis and treatment of OSA. This new information is not reflected in the current FMCSA guidance and has created challenging and, at times, conflicting approaches to managing OSA in commercial drivers. Because public safety has always been of the highest priority when determining acceptable risk in relation to medical conditions in CMV drivers (this differs significantly from the usual approach in clinical medicine), it is well accepted that when assessing risk of accidents due to a medical condition, CMV drivers are held to a higher medical standard than the general population. Given the public safety risks associated with OSA, its prevalence in the CMV driver population, and the fact that the guidance on OSA diagnosis and management is 15 years old, the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation convened a Task Force to address this important safety and medical risk in CMV drivers. The Task Force pursued the following activities: 1) review the existing scientific literature related to the diagnosis and management of OSA; 2) review the medical standards and guidelines related to OSA from U.S. Department of Transportation agencies and equivalent international groups; 3) review other relevant reports and recommendations from the National Transportation Safety Board, FMCSA, and others; 4) draft a preliminary document of findings; 5) develop recommendations related to screening, diagnosis, treatment, return to work, and follow up; and 6) address other relevant topics such as compliance, duration of certification, and research needs. This report of the Task Force provides the detailed findings of the extensive reviews conducted of documents from diverse resources on many relevant topics. The detailed reviews address the following areas: 1) definition of sleep apnea; 2) current regulations, recommendations, and guidelines; 3) identification of patients at risk for sleep apnea and diagnosis; 4) objective assessment of sleepiness and performance; 5) identification of CMV drivers with sleep apnea who are at high risk for crashes; 6) management of sleep apnea in the CMV driver; 7) practical considerations; and 8) additional research questions. Findings formed the foundation for consensus recommendations regarding the diagnosis and management of OSA in commercial drivers. The information presented in the eight sections are not summarized here, but rather provided in detail with references in the report. The recommendation categories focus on the following: Screening; Diagnosis; Treatment; Compliance and efficacy; Return to work after treatment for OSA; and Follow up. The tables included in this article provide an overview of these recommendations. However, the Task Force recommends that the commercial driver medical examiner (CDME) evaluate each driver individually and make a judgment about his or her fitness for duty based on specific criteria, including those listed in the tables in this article. These criteria cannot predict every situation faced by the examiner, and the final judgment belongs to the CDME. Additional testing is optional, based on clinical judgment, to document absence of excessive somnolence.Table: Screening Recommendation for Commercial Drivers With Possible or Probable Sleep ApneaTable: Recommendation Regarding the Evaluation for Fitness-for-Duty for Commercial Drivers With Possible or Probable Sleep Apnea

Sleep Apnea and Commercial Motor Vehicle Operators: Statement From the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation

Sleep Apnea and Commercial Motor Vehicle Operators: Statement From the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation

Sleep Apnea and Commercial Motor Vehicle Operators:

Sleep Apnea and Commercial Motor Vehicle Operators:

Temporal separation and self-rating of alertness as indicators of driver fatigue in commercial motor vehicle operators.

This on-road field investigation employed, for the first time, a completely automated trigger-based data collection system capable of evaluating driver performance in an extended-duration real-world commercial motor vehicle environment. The study examined the use of self-assessment of fatigue (Karolinska Sleepiness Scale) and temporal separation (minimum time to collision, minimum headway, and mean headway) as indicators of driver fatigue. Without exception, the correlation analyses for both the self-rating of alertness and temporal separation yielded models low in associative ability; neither metric was found to be a valid indicator of driver fatigue. In addition, based upon the data collected for this research, preliminary evidence suggests that driver fatigue onset within a real-world driving environment does not appear to follow the standard progression of events associated with the onset of fatigue within a simulated driving environment. Application of this research includes the development of an on-board driver performance/fatigue monitoring system that could potentially assist drivers in identifying the onset of fatigue.

Auditory Icons as Impending Collision System Warning Signals in Commercial Motor Vehicles

This simulator-based study examined the use of conventional auditory warnings (tonal, non-verbal sounds) and auditory icons (representational, non-verbal sounds), alone and in combination with a dash-mounted visual display to warn commercial motor vehicle operators of impending front-to-rear and side collision situations. Driver performance was measured in the simulated driving task via brake response time in the front-to-rear collision scenarios and via a count of accident occurrence in the side collision scenarios. For both front-to-rear and side collision scenarios, auditory icons elicited significantly improved driver performance over conventional auditory warnings. Driver performance improved when collision warning information was presented through multiple modalities.