Good morning! Thank you for that kind introduction and thank you for the opportunity to speak at this important conference. I am very glad to be here with all of you, leaders in industry, advocacy, education, law enforcement, government, and many other areas of transportation. I also am happy to be back in the beautiful state of Maine. I grew up in Texas, but I have great affection for this state. I have spent many happy weeks on vacation here in the summer. I also remember when a friend from Maine held her wedding here complete with a lobster bake, and, long before I was at the NTSB (National Transportation Safety Board), I served for many years on the advisory board of a Maine non-profit organization. Also, as Commissioner Dave Bernhardt knows, I was just in Maine earlier this year at the Spring Meeting for AASHTO (American Association of State Highway and Transportation Officials), which the Commissioner currently chairs.
Maine is full of history and the three organizations that are hosting this conference reflect that. The State of Maine’s Highway Office is over 100 years old. In 1913, the Maine State Legislature created the three-member Maine State Highway Commission and charged it with the ambitious task of building a “system of connected main highways throughout the state” -- and you have to remember, this was with only 12 employees at the time! The MBTA (Maine Better Transportation Association) was founded to advocate for a multi-modal safe and efficient transportation network…in 1939! Also, although I am not sure exactly when the Maine Section was started, the American Society of Civil Engineers is the nation’s oldest engineering society, established in 1852. Even this very conference is 67 years old – congratulations!
The NTSB, as it exists today, is not as old as any of these organizations. In fact, we are not as old as this conference! We were established first as part of the Air Commerce Act of 1926 as part of the Commerce Department, but it was not until 1967 that the NTSB was designated as an independent entity, so we are exactly 50 years old this year.
At the NTSB, we work hard on safety for all modes of transportation, but like you, we know that more people die on the roads, by far, than in any other mode. So, today, I will focus primarily on highway safety, but I also will touch on the other modes as well, since I work in all modes and I know there are people here, who also are interested in rail and aviation safety.
Today, I first would like to give you a brief overview of the NTSB so that you know us a little better, learn about our values and what we do, and, I hope, use the results of our investigations to continue advancing safety here in Maine. I also will tell you about our Most Wanted List, and some of our other work, in hopes that you will be encouraged to call on us if we can ever be of help to you in your work to save lives and prevent injuries. I will be here for the entire conference, so I look forward to hearing the other presentations and talking with as many of you as possible.
The NTSB is a unique federal agency because we are independent of all other government agencies. We are charged with investigating transportation accidents. You may hear about us most often when we rush to the scene of disasters all over the country during a Go Team Launch. I dressed up for you today, but at the scene of an accident, we wear our trademark dark blue uniforms with our logo and large yellow letters spelling out NTSB on the back. You will see us at the scene of transportation disasters of all types - aviation, highway, maritime, rail, as well as pipeline and hazardous materials. During my time at the NTSB, I have been to launches in Philadelphia and Hoboken, NJ, for train accidents; to Akron, OH, for a business jet that crashed into an apartment building; to Jacksonville, FL, for the El Faro cargo ship lost in Hurricane Joaquin, this last accident, sadly with several mariners from Maine aboard. Wherever there has been an accident, we get there as fast as we can so we can collect data before it disappears. As one doctor I know says, we are like infectious disease outbreak investigation teams, except what we are investigating is an outbreak of kinetic energy instead of a disease. We get as much information as we can to make recommendations to prevent the next “outbreak.” We also are mandated by Congress to provide assistance to the families of victims of a transportation disaster, a less well-known but very important part of our work.
Those on-scene investigations are a key part of our work – that is why we are on call 24-hours a day, 365 days a year. Once we have finished our on-scene work, our work continues back at our state-of-the-art labs. The final result of an investigation is a very thorough report covering every aspect of an accident and including a probable cause and safety recommendations designed to prevent that type of accident from happening again. Before I get any disapproving looks; yes, I used the word “accident”. Although the term “accident” is now not used in highway safety, we still use the term for our investigations because, under the federal statute that created the NTSB, we are charged by Congress with investigating every civil aviation accident – as well as significant accidents in other modes. As many of you know, “accident” is a term of art in aviation. It also underscores the fact that we investigate unintentional occurrences – we leave the criminal investigations to the FBI (Federal Bureau of Investigations).
People do not talk about values very much these days, but it is our values at the NTSB that set us apart and help us advance our safety mission. Some of our most deeply held values are independence, credibility, and transparency.
We are an independent agency and we have five independent board members, like myself, who are nominated by the President and confirmed by the Senate for a certain term of office, so our terms are not tied to Administrations or elections. We do not report to anyone – not the U.S. Department of Transportation (DOT) or any other federal agency – so we can make recommendations to anyone. We always perform our analyses alone - completely independent of any other agencies and organizations.
Unlike many government agencies, the NTSB does not have regulatory authority, so it is our reputation that allows us to advance safety recommendations. We maintain our credibility by conducting very thorough investigations that touch on every single aspect of an accident from engineering to human performance to the weather. We are fortunate that communities welcome us during some of their most difficult times because we are considered to wear the “white hats” since we are there to help them find out what happened and prevent it from happening to other communities.
As for transparency, all of our meetings and deliberations are done in the public eye under the Government in the Sunshine Act, so they are open to the public as well as webcast online. As you can see if you watch our televised meetings, as Board Members, we sometimes do not agree – but that is part of the beauty and strength of the NTSB. We debate publicly, not for any political gain, but in order to come to the best resolution for the sake of safety.
Board Members like myself are not political in the traditional sense, but by law, NTSB is bipartisan since no more than 3 of the 5 board members can be nominated by the same party – but we never let politics get in the way of safety. This philosophy of collegiality for the sake of a good cause is strong among the current NTSB Board Members and we all fiercely protect our values of independence, credibility, and transparency.
Ultimately, our work results in products that contain recommendations to advance safety including – accident reports, safety studies, and special investigative reports. We deliberate, we make decisions, and by-law, we vote on all items in public, during our sunshine meetings. In fact, we are so transparent that you will never see more than 2 Board Members together at a time discussing an investigation unless we are doing so publicly, and it is televised! Federal agencies, states, and territories have used our recommendations to make progress on issues such as: airport design, air traffic control procedures, maritime vessel traffic systems, rail car design, training and equipment for operators in all modes, event data recorders, fatigue, road design, setting standards for signage, just to name a few.
Although we have no regulatory authority, our good reputation has enabled us to successfully set and track targets for the benefit of safety. We have issued over 14,000 safety recommendations to over 2,300 recipients over the years –in all modes of transportation. In fact, about 80% of our recommendations have been adopted. Although we have a good track record of having our recommendations adopted, we also do not give up on targets that are not achieved. Some recommendations take years or even decades, especially if they must pass individually in all 50 states or require federal rulemaking. We also are sometimes criticized, even vilified, for our efforts. But that does not stop us.
Most Wanted List
One of our tools is the NTSB’s Most Wanted List. For over 25 years, the NTSB has chosen ten issues - covering all modes of transportation - that represent safety challenges; challenges which have a strong chance of being advanced if given some good hard pushes. These 10 areas are: Impairment, Occupant Protection, Data Recorders, Vehicle Crash Avoidance Systems, Distraction, Medical Fitness for Duty, Fatigue, Loss of Control in General Aviation, Rail Transit Safety, and Safe Transport of Hazardous Materials. I thought I would touch briefly on a few of the areas covered by the NTSB that might be of interest, some of which are not on the Most Wanted List, but I hope you will not hesitate to get in touch with me if you would like more information on any of these areas. I also am including the email of my colleague John Brown on the last contact slide since his name is much easier than mine to spell!
I saw pedestrian safety as a panel topic so I wanted to be sure to let you know that we hosted a Pedestrian Safety Forum last year, which I chaired, with top experts speaking on diverse solutions – from infrastructure to vehicle design – to help keep these vulnerable road users safe. You can find all the presentations on our website.
We are now in the midst of our first-ever set of investigations into pedestrian fatalities. It does pose a challenge for us, however, because pedestrian deaths usually do not generate large pieces of evidence that we are used to gathering such as you would find at the scene of plane and train accidents. We do get there as soon as possible, as always, and our investigators are using additional, more agile investigative tools like Go Pro cameras.
Most recently, we published a study this year on speeding which has been getting quite a bit of attention. You can download the entire study online and, if you have any more detailed questions about our speeding study, I can put you in touch with the lead authors.
Of course, at the NTSB, we always have recognized the importance of good infrastructure to safety. Safer roads, safer cars, and safer people – each is vital to reaching zero deaths, but we cannot forget that infrastructure forms the basic foundation for road safety.
As we work on the behavioral side of prevention to make safety recommendations to prevent high-risk drivers from getting behind the wheel, we never forget that we also must have safe roads; roads that are forgiving of the mistakes that we, as humans, will make. I do not think I need to tell any of you that forgiving roads help reduce death and injury should a crash occur.
I will never forget an investigation we completed a few years ago of a truck-tractor semitrailer that crossed over a median and crashed into a bus filled with members of a college women’s softball team in Davis, Oklahoma. Our investigation revealed that the truck driver was impaired on synthetic drugs, the occupants were not wearing their seatbelts, and there were no crashworthiness standards for a bus of that size. We also found that the Oklahoma Department of Transportation had done the right thing – they had conducted a risk assessment of that highway and were planning to install median barriers at that location, perhaps even within the year. Median cable barriers might have prevented those 4 deaths and 13 injuries. It was sad that the median barriers could not save those college students, but they are saving lives now, every day, as we speak, by preventing crossover crashes. This investigation reminds me of the importance of what many of you do every day - implementing infrastructure solutions as fast as possible, in order to save lives.
Just last week, the NTSB held a public board meeting about a 2016 crash in St. Mark’s, Florida, between a bus carrying agricultural workers and a truck at an intersection. As a result of the collision and post crash fire, the truck driver and three bus passengers died. The bus driver and 29 passengers sustained injuries of varying severity.
In public health, and increasingly in highway safety, it is widely acknowledged that interventions designed to protect the most vulnerable, at-risk populations often protect all people. For example, highway professionals have found that interventions implemented to reduce deaths and injuries among older people, who are more likely to die when involved in a crash, have also prevented deaths and injuries among road users of all ages. The new recommendations in this report demonstrate that improving safety for the most vulnerable improves safety for all of us. This report focuses on an often-overlooked population, agricultural workers. The recommendations will help these workers, but ultimately it will help all travelers, reach their destinations safely.
As in our Speeding Study, this St. Marks report highlights road design. Our report cites a 2010 study, conducted in Minnesota and Iowa (by Srinivasan, Baek, and Council), that found a 39% reduction in fatal and incapacitating injuries at intersections with transverse rumble strips. A simple road design change, such as installation of rumble strips, could have prevented or mitigated this terrible crash. Federal government agencies and highway organizations can, and should, foster these types of best practices in which jurisdictions take a systemic, data-driven approach to identifying locations that could benefit from roadway engineering countermeasures in order to reduce intersection crashes. Also, as with our speeding study, roadway intersection design is another area in which states, cities, and other jurisdictions may work to prevent deaths and injuries at a more local level. These types of interventions will serve to protect not only vulnerable road users, like the agricultural workers in this crash, but they will ultimately better protect everyone.
The NTSB has a long history of supporting evidence-based approaches to risk assessment. Work zone safety, pedestrian safety, and the important use of barriers are some of our highway priorities. Like you, we are committed to supporting safe infrastructure, so we can prevent terrible crashes like the ones in Davis, OK, and St. Mark’s, FL from ever happening again.
Speaking of vulnerable populations like older road users, a little over 10 years ago, I was appointed by President George W. Bush (yes, I have been appointed by both President Bush and President Obama – safety really is bipartisan!) as an advisor to the White House Conference on Aging and two of the top 50 priorities chosen by senior delegates from every state – right up there with health and finances – were related to transportation. The two issues that seniors from across our nation voted for were: (1) increasing safe transportation options for seniors who could no longer drive and (2) finding ways to keep seniors safely driving longer. In fact, I was appointed to this White House advisory committee with a Maine native, Katherine Freund of Independent Transportation Network or ITN America, a national organization founded in Maine that is the first of its kind to address the priority of increasing transportation options by providing dignified transportation to seniors through volunteer drivers. I just heard ITN America is about to reach its one millionth ride mark and is now expanding to rural communities such as York, Boothbay, Bowdoinham, and they are looking for two more. That is part of the innovative and see-a-problem-and-get-to-solving-it spirit I always associate with Maine!
People used to ask me, back when I was about 30 years old, why I was so interested in working on safety for older road users when I was so young. I usually said, well, it is for selfish reasons because I want to be an older road user myself one day! But really, we all know that what is good for seniors (such as improvements in signage, lighting, countdown signals, roadway infrastructure designed for the safety of both pedestrians and vehicles) is good for all of us. Once again, when we protect the most vulnerable, we protect everyone.
I happen to be the first Board Member with a background in public health and injury prevention, rather than pure aviation. Because of that, in my first Go Team launch to an aviation accident in Ohio, I did what anyone would do, I overprepared and learned all the technical details. I learned everything I could about the aircraft, a Hawker 700A business jet that crashed on descent to an airport, destroying 2 apartment buildings and killing all 9 people aboard. I learned how an aircraft enters into aerodynamic stall and the standard operating procedures for this type of aircraft. I wanted to know everything, so I could explain every technical detail accurately to the families and the community, a community that was in shock because an airplane plowed right into their neighborhood and burst into flames, killing all people aboard. I will never forget the sight of people sitting on their porches just a few houses down as we walked through the blackened and flattened area where the Hawker crashed. I also wanted to make sure I was ready for the large and noisy press corps that day.
After that accident, I received a nice, handwritten letter addressed simply to “the lady at the NTSB”. It was one of the first letters I ever received at the NTSB and it was from a member of that Ohio community. She was an older lady who, seemingly unimpressed with my technical recall about the aircraft, wrote instead to thank me for taking the time to explain clearly what happened to the community! She said although she had not met me, she watched the news avidly because she lived close by and felt I showed compassion towards the community. That letter reminded me (once again) that while it is vital to learn all the technical details, I should not forget the people who are affected by tragedy, like this lady who took the time to write a message to me, and how important it is to tell the story clearly to them.
Because of NTSB’s detailed investigations, it may seem that our work is largely technical and mechanical, but like you, my 400 colleagues at the NTSB and I never forget that the true purpose of our work is to serve people. These stories help us remember that. Part of our work is to assist people who have been affected by a transportation disaster - victims and families of victims. As a Board Member, I talk with family members at the scene and I consider that part of my job a great responsibility and a great privilege. Survivors and family members share their stories with me and I carry those stories with me whenever I speak about our safety recommendations.
One person I will never forget is a woman who was seriously injured in a train accident and wrote me a letter. Eight people died and 185 were hospitalized when an Amtrak train that was speeding derailed at a curve over 2 years ago in Philadelphia. I received her letter not long after our public board meeting on that accident. I was not feeling particularly happy at the time because I had not managed to convince my fellow board members to vote with me, so I had cast a lone dissenting vote. I felt that the lack of positive train control, or PTC, a system that would have slowed the train and prevented the accident, should have been listed as a primary probable cause, rather than only listing the engineer’s mistake in speeding as the main cause. From the public health perspective, I felt PTC was like a vaccine, everyone knew they should have it and everyone knew it would have prevented the disease or, in this case, the accident.
So I was very frustrated – and somewhat mad at myself that I could not convince anyone else to vote with me! Then I received the letter. She identified herself as one of the passengers and proceeded to describe the horrific way she had been injured when the train derailed, saying that her life had changed forever. She ended by saying she hoped that PTC would prevent future crashes and even took the time to thank me for my efforts and to tell me not to give up because people like her were counting on us. She said not to forget about people like her, people who were injured for the rest of their lives because PTC had not been fully implemented, something the NTSB has been recommending for decades. This woman’s letter reminded me of the many, many injuries in addition to the deaths that occur in an accident and it also reminded me that the work we all do – the work that those of you in this room do to prevent injuries and deaths – is more often a marathon, rather than a sprint.
Sometimes the story is about someone who was not affected, someone who just reminds people of a face behind the numbers. That was the case in Utah.
At the NTSB, we are sometimes criticized for our safety recommendations. We are not usually criticized by the public – who seem to understand our mission, but rather, by groups that are misinformed and worry unnecessarily that they might lose profits if a safety recommendation is implemented. Nowhere has that been more evident than with our recommendations related to impaired driving.
Ten thousand people. As we all know, that is how many people die every year due to alcohol-impaired driving in our nation. The NTSB has made many different recommendations in this area. We have recommended reducing the illegal per se BAC (blood alcohol concentration) limit for all drivers; conducting high-visibility enforcement of impaired driving laws; incorporating passive alcohol-sensing technology into enforcement efforts; expanding the use of in-vehicle devices to prevent operation by an impaired driver; and DUI (driving under the influence) courts and other programs to reduce recidivism by repeat offenders.
We made all these recommendations 4 years ago as part of our Reaching Zero study, but we get the most criticism for our recommendation for states to reduce their illegal per se to .05 BAC or lower. This is despite the fact that about 100 countries around the world already have a .05 or lower BAC law and there have been dozens of studies demonstrating that such a law would reduce the number of impaired driving crashes.
I always try to be optimistic, but even I was surprised earlier this year when, against high odds and during a short legislative session of 45 days, the State of Utah passed the first .05 BAC law in the United States. Utah and Oregon passed the first .08 law also.
How did it happen? In part, because people in Utah requested safety information and the NTSB was able to provide it. When Utah legislators reached out to me early on, we provided unbiased information, and I testified twice in their state legislature. We told them that in countries with a .05 BAC law, people consume more alcohol per capita and yet were less likely to die from impaired driving. We told them that a .05 BAC law is a broad deterrent that decreases the number of impaired drivers on the road at all BAC levels – high and low – so amazingly, it also reduces the number of high BAC drivers (yes, those well over .05 BAC), who are involved in the most crashes, from getting behind the wheel. We showed them studies demonstrating that even at a .05 BAC, people have problems with coordination, vision, and steering. When people called me names like “neo-prohibitionist”, we told them that a .05 BAC law was not about drinking at all – it simply helps people to separate their drinking from their driving. We told them it meant people should “Choose One: Drink or Drive”! We also told them that a law could save 1,790 lives nationwide every year.
Opponents of the .05 law used scare tactics and spread misinformation through expensive full-page ads in many newspapers. These ads contradicted information from NTSB, NHTSA (National Highway Traffic Safety Administration), the CDC (Centers for Disease Control and Prevention), and many other sources. Yet these ads told a compelling story, a false story, but a compelling story nonetheless. Opponents tried to mislead Utah residents with a story about innocent people getting put in jail after having one drink with dinner. I have to admit, they were clever and had catchy slogans like “Arrive on vacation, leave on probation.”
We provided stacks of information and studies and statistics, all of which legislators and the governor appreciated. I thought surely the statistic of saving 1,790 lives a year would be all they would need. But no, in the end, although our statistics helped, it was the power of the story that prevailed. My first op ed was full of numbers but my second op ed, which was very well received, described my brother, a doctor, who often visited Utah with his family to snowboard and said he did not want to get hit by drunk drivers. I wrote that by passing a .05 BAC law, they would be taking the first step to saving 1,790 lives nationwide, and I thanked them for protecting their families - and mine. I cannot tell you how many comments I received about “the story about my brother”! Supporters of .05 BAC also showed up at hearings to tell their story, often citing NTSB information.
The NTSB is not here to engage misguided opponents of safety in a public fight (as much as I love a good fight for a good cause). We are here – as an objective source - to provide solid, accurate, independent safety information for people to make informed decisions. These personal stories help people understand that information and remember it. I know that each state has its own unique political climate, but as state leaders and employers, you have the power to influence many people to do the right thing for the benefit of safety. Utah was the first to pass a .08 BAC law also, a law that has saved over 26,000 American lives, including many in Maine. A .05 law could save many more. When the time is right, the NTSB will be here, ready to assist you in your efforts to prevent crashes caused by drinking and driving.
Since we will hear more about automation today, I also wanted to briefly share with you the NTSB’s recent – and first – investigation into a crash involving a level 2 automated vehicle. In May of last year, a 2015 Tesla Model S, was traveling eastbound on a divided highway near Williston, Florida. A truck traveling westbound was making a left turn across the eastbound lanes. The Tesla’s automation did not detect – nor was it designed to detect – the crossing vehicle. The Tesla struck the side of the semitrailer, then crossed underneath, shearing off the car’s roof. Sadly, the car driver died. The NTSB determined the probable cause was the truck driver’s failure to yield the right of way, combined with the car driver’s inattention due to overreliance on vehicle automation. A contributing factor was the vehicle’s operational design, which permitted prolonged disengagement from the driving task.
This crash reminds us that, even as we encourage game-changing, cutting-edge technology like automated vehicles, we must remember to remind everyone to keep safety at the forefront, something which you all know too well.
Your engineering and technical work gives you legitimacy and power behind what you say. But stories can help show your humanity so people will remember why you do your work. I know it is a fine line between providing information and advocacy, a line that some of you cannot cross, but real-life stories also are information. Information that people will remember. Stories give power to the data to overcome incorrect and misleading information. It is hard for us to believe sometimes, but the public needs us to present the data and tell the story. It is important for us to speak up, even for interventions we thought were long accepted like infrastructure and seatbelt laws. In fact, just last month, I was in Massachusetts where they are, once again, debating a primary seat belt law. Data alone and the story alone cannot do it, but together, they can be a more powerful force than the sum of their parts.
At the NTSB, we make safety recommendations that are feasible and practical, and doable. Yet, like your state priority issues, that does not mean they cannot also be inspiring and ambitious. Our safety recommendations allow us to imagine what the world would be like if our work is as effective as it can be. They allow us to imagine a world where no one dies because they were not properly restrained, a world where we know that our cars, trains, and airplanes will warn us or protect us if we make a mistake, where our roads are designed to be forgiving of human error or even warn us before we make a mistake, a world where no one gets behind the wheel when impaired by alcohol or drugs or distraction. They allow us to imagine a world where we can send our loved ones to school or work and know they will come home safely.
You are the transportation leaders in Maine and you are shaping the future of transportation safety here. You are doing something good and noble; helping people get to where they need to go, and do so safely. You are already doing so much in your daily work, as a law enforcement officer, an engineer, a planner, government employee, or other transportation leader. If you are here, you ARE a leader. So please do not forget to tell YOUR STORY about the importance of SAFETY to all aspects of transportation … you can bring life to the cold hard facts. It is difficult to fight an epidemic that happens every day, across Maine, one or two at a time. But the people of Maine are a strong and tenacious and innovative group and, together, I am confident you can do it. We at the NTSB are here to help you.
I would love nothing more than to come back to Maine to prevent a tragedy rather than to investigate one. All you have to do is ask. All of the NTSB’s information on investigations, studies, and recommendations, in fact, everything we do is available publicly. I look forward to hearing from you.
I love good quotes and, since I am from Texas, I have to give a quote from a Texan. President Lyndon Baines Johnson said:
“There are no problems we cannot solve together, and very few that we can solve by ourselves.” - Lyndon B. Johnson
That is what you are doing here today – working together on a complex set of issues that will ultimately save lives. It will take time and it will not be easy, but the people of Maine have never shied away from a challenge. So in closing, I would like to end with the words of a very well-known Maine native, which I think can be interpreted in many ways. I like to take it to mean that we must work and build today a solid base in order to ensure a safe and secure future, in transportation and in life. Henry Wadsworth Longfellow wrote:
Build today, then strong and sure,
With a firm and ample base;
And ascending and secure.
Shall tomorrow find its place.
- Henry Wadsworth Longfellow (of Maine)
Thank you again for inviting me to speak. Please come find to me during the conference or contact me afterwards. I would really like to hear from you. Thank you for your commitment to safety and have a great conference.