Fit for Duty?

We all go to work when we are tired. We might need an extra cup of coffee or tea on those days (or a Red Bull, I suppose) but we can get our work done, albeit a bit more slowly or less efficiently. For those of us with office jobs, it might mean having to read an email a few times to understand it completely or being a little less engaged in a conference call or staff meeting.Tiredness, however, can be a serious problem in the transportation environment – especially when it’s brought on by an underlying sleep or medical problem.Requiring medical fitness for duty was on the National Transportation Safety Board’s Top 10 so-called Most Wanted List for 2015. Sounds simple enough but in reality is it? Some pilots, vessel and train operators are not medically fit to operate vehicles. Those suffering from impairing medical disorders should not be at the controls unless they receive medical treatment that mitigates the risk to the public.NTSB said the medical certification processes for safety critical personnel vary widely across modes of transportation. Although the NTSB has found that obstructive sleep apnea has been a factor in multiple accidents, transportation modes often still lack a complete screening process for this condition.In a 2013 train derailment in the Bronx, the engineer’s sleep apnea was undiagnosed until the week following the derailment, despite many visits for occupational and personal health care. With a change in his work patterns, the combination of the untreated sleep apnea and fatigue from his disrupted sleep schedule led to his fatigue at the time of the accident.In March 2014, a CTA Blue Line train struck a barrier and went airborne, landing atop an escalator at Chicago’s O’Hare airport station. The woman operating the Chicago commuter train that derailed and injured more than 30 people admitted she fell asleep before the accident and only woke up on impact. She said she had dozed off before and overshot a station. It’s still unclear what role an underlying condition or changing work schedule played in that accident.Since 2001, the NTSB has identified obstructive sleep apnea as a factor in at least nine accidents in four transportation modes, and recommended that the Federal Railroad Administration require all railroads to screen for and treat sleep apnea more than a decade ago.The Wisconsin Sleep Cohort Study, a longitudinal study of cardiopulmonary sleep disorders among middle-aged working adults, estimated that 2 percent of women and 4 percent of men have sleep apnea. According to the Wisconsin study, 9 percent of women and 24 percent of men have undiagnosed sleep-disordered breathing, a condition that in some people results in excessive daytime sleepiness.In mid-December, MTA Metro-North Railroad selected a health care company to provide medical testing and evaluation services for a seven-month pilot project focusing on obstructive sleep apnea and locomotive engineers. The railroad developed the pilot in tandem with Long Island Rail Road and New York City Transit, which will be closely following its results. All 410 Metro-North engineers and about 20 engineers in training will undergo an initial screening by the railroad’s Occupational Health Services Department based on industry best practices. Those locomotive engineers recommended for additional screening will be referred to a contractor that specializes in sleep disorders.The vendor will provide training and test equipment for an at-home, overnight sleep test. In the morning, the engineer will use a prepaid mailer and send the test device back to the vendor. Test data will be analyzed and, if needed, employees will be referred to a sleep specialist for additional testing and/or treatment.Last month, U.S. Sen. Charles E. Schumer (D-N.Y.) charged that the MTA still does not have a specific plan to test and treat Long Island Rail Road engineers for sleep disorders, like sleep apnea, and urged that the MTA quickly expand its Metro-North pilot program to include LIRR engineers.“A light rail crash in Boston prompted the MTA to start testing New York City’s subway engineers for dangerous sleep disorders and then, a Metro-North crash prompted the testing of Metro-North engineers; it shouldn’t take a Long Island Rail Road crash for the MTA to test and treat LIRR engineers for sleep disorders, like sleep apnea,” said Senator Schumer. “Time and again, NTSB has made common-sense recommendations that transit agencies have taken far too long to implement in a comprehensive way. There should be no delay in starting a pilot program for testing LIRR engineers who may suffer from obstructive sleep apnea syndrome, which could put thousands of daily commuters at risk if undetected.”I don’t often agree with the New York Senator, but I’ve agreed with him at least twice in the last few weeks – once on sleep apnea testing for railroad workers and the other on his new legislation to provide more funds to improve engineering, education and enforcement at railroad grade crossings.---By Kathy Keeney
Kathy Keeney is Publisher of the Rail Group. The granddaughter of a railroader, she has been writing about railroads for nearly 30 years. She is a past president of The League of Railway Industry Women and served on the board of directors for the American Short Line and Regional Railroad Association and for the Washington Chapter of WTS.