What is the problem?
Undiagnosed and untreated obstructive sleep apnea (OSA)—and the
fatigue that results from it—continues to be deadly on our railways.
Train operators and other personnel in safety-sensitive positions
must be medically fit to operate their trains safely, yet many suffer
from inadequately treated OSA.
OSA is a chronic disease in which patients experience episodes of
airway obstruction while sleeping, often resulting in fragmented
sleep and subsequent daytime sleepiness and fatigue. OSA is more
prevalent in train operators than in the general population because
railroaders are more likely to be male, older, and obese.
OSA often goes undiagnosed in the transportation environment,
which increases the risk that personnel will suffer from fatigue and
perform their duties in an unsafe manner.
The absence of regulations in the railroad industry focused on
screening for, diagnosing, and ensuring adequate OSA treatment
means that employers may be unaware of their employees’ impairing
medical conditions or medication use. What’s more, the industry does
not require employees in safety-sensitive positions to be medically
evaluated beyond basic vision and hearing testing. This means that
we will continue to investigate derailments and collisions resulting
from inadequate treatment of OSA and other medical conditions.
What can be done?
In February 2019, NTSB determined the following:
Rail workers in safety-sensitive positions must be effectively
screened, diagnosed, and treated for OSA. Sleepy employees
introduce safety risks on our railways. When treated, OSA is not a
medically disqualifying condition for transportation operators in
safety-sensitive positions.
To address the problem of OSA, the following
actions should be taken:
Operators/Industry
- Medically screen employees in safety-sensitive positions for
sleep apnea and other sleep disorders.
- Collaborate to develop a model national labor agreement that
supports effective programs for addressing sleep disorders and other
medical conditions among safety-sensitive train-operating personnel.
- Develop and implement protocols to routinely screen and fully
evaluate employees in safety-sensitive positions for sleep disorders,
and ensure that such disorders are adequately addressed, if
diagnosed.
- Add any diagnosed sleep disorder to the list of medical conditions
that employees in safety-sensitive positions must report. When
reported, periodically evaluate the employee to ensure the condition
is appropriately treated and the employee is fit for duty.
Regulatory Agencies
- Provide guidance to operators, transit authorities, and physicians
to help them identify and treat individuals at high risk for OSA and
other sleep disorders.
- Enhance medical standards by identifying a list of medical
conditions that disqualify employees for safety-sensitive positions
because of their condition’s potential to negatively affect rail safety.
- Require more frequent medical certification exams for employees
in safety-sensitive positions who have chronic conditions that may
impair their job performance.
- Require railroads to medically screen employees in safety-sensitive
positions for sleep apnea and other sleep disorders.
- Require railroads to systematically identify and evaluate the
safety of medical conditions and medication use among employees
in safety-sensitive positions.
- Develop medical certification regulations for employees in safety-sensitive
positions that include, at a minimum, a complete medical
history (including specific screening for sleep disorders, a review
of current medications, and a thorough physical examination),
standard testing protocols across the industry, and central oversight
of certification decisions for employees who fail initial testing.
Consider requiring that medical exams be performed by those with
specific training and certification in evaluating medication use and
health issues related to occupational safety on railroads.
Medical Community
- Ensure that board-certified physicians in internal and family
medicine have enhanced and ongoing training that allows them to
successfully identify risk factors for, evaluate, and treat OSA in their
patients.
Rail Workers
- Work with your health care providers to ensure your medical
conditions are adequately treated and that you are fit for duty.
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