What is the issue?
When safety-critical personnel, such as public vehicle operators, have untreated medical conditions that prevent them from doing their jobs effectively, people can be seriously injured or die. In fact, they have done so in many accidents investigated by the NTSB. Requiring medical fitness for duty can prevent the accidents leading to these and other tragic outcomes.
In two train accidents—one in 1996 in Secaucus, New Jersey, and one in 2012 in Goodwell, Oklahoma—the engineers lacked the ability to see and interpret wayside signals due to deficient color vision. In a July 2002 aviation accident, a FedEx Boeing 727 flew into the ground while approaching the Tallahassee, Florida, airport because the flying pilot had a severe color vision deficiency which made it difficult for him to correctly identify the color of the airport’s PAPI lights that were warning that the flight was too low.
In 2013, in the Bronx, New York, an engineer operated his train at 82 miles per hour into a curve with a speed restriction of 30 miles per hour. The train derailed, killing four and injuring 61. Undiagnosed sleep apnea affected the engineer’s physical condition at the time of the accident. A week following the accident, his condition was diagnosed and subsequently successfully treated—but it was already too late.
It has long been recognized that untreated or undiagnosed medical conditions pose a safety risk to the traveling public. However, medical certification for safety-critical personnel varies across the modes of transportation.
For instance, medical certifications for railroad engineers are renewed every three years, and they cover only vision and hearing standards. The U.S. Coast Guard requires commercial ship captains to get comprehensive medical exams at regular intervals, but relies on mariners to self-report medical conditions and medication use.
For commercial drivers, the Federal Motor Carrier Safety Administration recently has required training and certification for health care providers who perform medical examinations. However, there is no mechanism to ensure recommended guidelines are followed. Moreover, chiropractors and other healthcare professionals with no experience prescribing medications are considered acceptable medical examiners.
The aviation medical certification system may be the most robust, but pilots are increasingly testing positive for over-the-counter sedating medications.
Moreover, although the NTSB has found that obstructive sleep apnea has been a factor in multiple accidents, most transportation modes still lack a complete screening process for this condition.
What can be done?
The NTSB has made recommendations for a comprehensive medical certification system for safety-critical transportation personnel that includes these features:
- a complete medical history of the applicant, taken at prescribed intervals, that includes medications, conditions, and treatments as well as a physical examination;
- specific historical questions and physical examination procedures to identify applicants at high risk for sleep disorders;
- identification of specific conditions, treatments, and medications that initially disqualify applicants for duty, with certification contingent on further testing (specific to each condition);
- explicit and uniform processes and criteria for determining when the applicant has a treated, but otherwise disqualifying, condition;
- certificates that are good only for a limited time for applicants with conditions that are currently stable but known to be likely to deteriorate, to ensure appropriate retesting;
- medical examiners who:
- are licensed or registered to both perform examinations and prescribe medication in a given state;
- are specifically trained and certified to perform medical certification exams; and
- have ready access to information regarding disqualifying conditions that require further evaluation.
- a review system for medical examiners’ work product(s) with both the information and capacity to identify and correct errors and substandard performance;
- the capacity to prevent applicants who have been deferred or denied certification from finding another provider who will certify them;
- a process for dealing with conditions which could impair safety and are diagnosed between certification exams; and
- guidance for medical providers that should be used when the provider believes a medical condition disqualifies an individual for duty.
The goal is simple: ensure safety-critical professionals are medically fit for duty before they operate a vehicle.