Illinois — After a fatal multi-vehicle crash took place on Interstate 290 in Elmhurst, Illinois in 2018, it was found that some of the circumstances were three of the 10 issues on the National Transportation Safety Board’s Most Wanted List of Transportation Safety Improvements for 2020–one being untreated obstructive sleep apnea.
On March 1st, 2018, a commercial truck-tractor and a semitrailer traveling along I-290 in Elmhurst hit a vehicle that had slowed due to traffic congestion. A chain of crashes occurred after the initial rear-end collision, which included two additional large trucks and three more automobiles. Five people were injured as a result of the seven-vehicle accident, and one was killed.
Three primary safety issues were identified by investigators: fatigue, the lack of a collision avoidance system, and medical fitness for duty. All three of these concerns are on the NTSB’s Most Wanted List.
“This crash tragically highlights the urgent need to implement the safety recommendations association with our Most Wanted List,” said Robert L. Sumwalt, NTSB chairman. “Had our safety recommendations in these areas been implemented, this crash may well have been prevented.”
The NTSB concluded that the lack of a “robust medical certification evaluation process” at a federal level to identify and treat commercial drivers for obstructive sleep apnea was one of the largest issues contributing to the fatal crash.
Investigators found that the trucker who failed to slow down in time for the traffic congestion was “likely fatigued due to an untreated sleep disorder related to obstructive sleep apnea.”
This commercial truck driver had been diagnosed with sleep apnea in 2012 after undergoing a sleep lab test following a previous hospitalization. After speaking with NTSB investigators, the trucker admitted to failing to use his continuous positive airway pressure (CPAP) device for obstructive sleep apnea treatment since his hospitalization. CPAP devices can send reports to a physician via Bluetooth when used.
The NTSB’s Most Wanted List details 10 areas of concern that act as the agency’s guidelines for immediate, necessary recommendations for action, that if put in place, would have the potential to prevent crashes and fatal accidents.
In 2009, the NTSB recommended to the Federal Motor Carrier Safety Administration that a program should be implemented that would identify and help treat commercial drivers with OSA. This concern remains on the Most Wanted List, along with other sleep apnea-related issues.
The NTSB also recommended that forward collision avoidance systems be standardized and installed in all new commercial and passenger vehicles in its 2015 special investigation report. These recommendations are still listed as some of NTSB’s Most Wanted.
“With our Most Wanted List, the NTSB has pointed the way to safer roads, rails, seas, and skies,” said Sumwalt. “But, to make that vision a reality, the recipients of our safety recommendations need to implement them.”
An FMCSA spokesman said that the agency believes “all commercial driver’s license driver medical screening examinations should be robustly performed by medical examiners.”
But, without regulated standards for these tests, the identification and treatment responsibility for obstructive sleep apnea in a driver falls on the shoulders of the medical examiner, said FMCSA medical review board member Brian Morris.
“There are some medical examiners that are quite diligent in performing the exams, and they would do the appropriate screening for sleep apnea,” said Morris. “Other medical examiners don’t focus as much on the issue.”
Still, even if sleep apnea is identified, many physicians won’t ask for a follow-up or require treatment like the CPAP, Morris explained. If untreated, the risk for sleep apnea-related issues is much higher than that of drivers at a low-risk stage.
“Right now, American Trucking Associations definitely recognizes that sleep apnea is a safety concern,” said ATA manager of safety and occupational health policy, Abigail Potter. “There is a lot of data and evidence to that effect.”
While ATA acknowledges the issue as well as FMCSA’s long-term work studying the risks at hand, ATA still says it wants FMCSA to prioritize the consideration of all cost-benefit issues before implementing a new rule, according to Potter.
“The bar for commercial drivers to get medically evaluated and certified has been raised by FMCSA over the last few years,” said Scopelitis Transportation Consulting president, David Osiecki. “Ultimately, the trucking industry and highway safety will be better served by clear guidelines that allow drivers and safety management personnel to anticipate and better plan for the medical evaluation-certification process.”