health

Temperatures are high across the country, and even potentially dangerous for some truck drivers.

As truckers work to deliver goods throughout the nation, some areas are seeing temperatures as high as 100 degrees during the extreme heat waves taking place this year. Some truckers may not be able to acclimate their bodies to high humidity and temperatures quickly enough during these heat waves, which can be detrimental.

“There’s a fine line drivers must walk between moving freight within the allotted transit times and avoiding heat-related illness during heat waves,” explained Trinity Healthcare owner and medical director, Dr. John Abraham.

Trinity serves as Prime Inc. truckload carrier’s wellness provider, and Prime Inc. works to keep truckers as healthy and safe as possible by educating them on the importance of hydration and urging them to drink plenty of water while they’re on the road.

“When temperatures spike, the primary concern is about the amount of fluid and water that’s in the driver’s system,” said Abraham. “Heat exhaustion and dehydration can cause organ failure and can even lead to death if allowed to go too far.”

Additionally, drivers should focus on the heat index in the area in which they’re driving for a more accurate understanding of weather conditions, as the heat index considers humidity and temperature alike, Abraham added.

“The higher the heat index, the hotter the weather feels,” he said. “That’s because, with the higher humidity, the higher moisture content in the air doesn’t allow sweat to evaporate and cool the skin.”

According to Abraham, as a driver acclimates to hot temperatures, his or her body will become more tolerant and sweat around two to three more liters every hour to expel heat. If the body is unable to properly rid itself of excessive heat, the driver may experience heat exhaustion.

The key, of course, is to stay hydrated with water, as opposed to energy drinks that often contain high amounts of caffeine or sugar, added president of Rolling Strong, Stephen Kane. A hydrating beverage should provide the minerals a driver’s body might lose when sweating in high temperatures.

“Because once you start to become dehydrated, it’s really tough to get back [to being hydrated],” Kane noted.

One’s body temperature also rises quickly when metabolizing large or unhealthy meals, so truckers should do their best to avoid fast food and instead bring lighter meals on the road that are rich in vitamins and minerals. Additionally, sufficient rest is especially helpful for a driver’s body to be able to handle high heat levels, so Kane recommends that drivers understand how much sleep they need for their bodies to perform at their best while on the road.

Wellness and health programs dedicated to truck drivers, like Rolling Strong, have a lot of tips for drivers to stay hydrated and cool while working. Rolling Stone suggests drivers keep coolers in their cabs filled with water bottles and other health drinks, as well as with fruit, cucumber, or other healthy, hydrating snacks to munch on while they drive or take a break.

“Having been dehydrated when I served in the military…[I] had to be taken to the hospital and have an IV put in my arm and two liters of saline solution pumped into me because I got dehydrated,” said Sage Truck Driving School instructor and trucker, Scott Douglas. “I know from experience just how fast [dehydration] can hit you and how bad the results can be when it finally hits you,” he said.

Some signs of heat exhaustion or dehydration can include headaches, nausea, dry mouth, dizziness, or confusion, and drivers should immediately stop operating their vehicles when experiencing any of these symptoms and reach out to their dispatchers, Trinity Healthcare’s Abraham noted. Drivers who tend to drink caffeinated beverages like coffee or soda to stay awake and alert while on the road should counterbalance those drinks with their equivalent amount in water. This amount of water intake should also be in addition to the recommended intake of 90 ounces of water per day for women and 125 ounces of water per day for men.

Following complaints from the Federal Motor Carrier Safety Administration’s own medical review board, the FMCSA will be making efforts to boost accessibility in regards to obstructive sleep apnea information for the medical experts conducting medical exams for truck drivers and assessing their ability to perform their jobs safely and efficiently.

A group of medical professionals on the agency’s medical review board have urged FMCSA leaders to link apnea-related information within the FMCSA’s medical examiners handbook, and made clear this necessary during last month’s virtual meeting. The current 250-page handbook was taken off FMCSA’s website six years ago and still requires major updates–which was, consequently, the main focus of May’s virtual meeting.

Because some medical examiners, as well as FMCSA, have hesitated to push the issue of sleep apnea and the knowledge surrounding it on truck drivers, the medical board’s physicians have even stressed that the overarching subject of sleep apnea has become far too “political.” As of now, FMCSA has not released any particular regulatory guidance on when a trucker at risk for apnea should be required to participate in a sleep lab study to better evaluate the actual risks at hand.

A big player in this issue is Congress’ 2013 legislation that has prohibited any official regulatory guidance in regards to a medical examiner’s ability to diagnose truck drivers who may be at risk for sleep apnea before undergoing the strenuous process for rule-making.

Referring to the attempt to bring back to light the sleep apnea problem in 2016 for regulatory apnea guidance through an Advance Notice of Proposed Rulemaking along with the Federal Railroad Administration, FMCSA’s associate administrator for policy, Larry Minor, noted during the virtual meeting that sleep apnea in truckers has become a “nearly nuclear” topic. FMCSA declared the currently-in-place fatigue risk management-related safety programs “are the appropriate avenues to address OSA” in 2017, and the Advance Notice of Proposed Rulemaking was withdrawn at that time. As of now, FMCSA has held on to the claim that apnea is not directly related to potential accidents, as determined by the present evidence.

FMCSA will, however, add further information about apnea to its examiner’s handbook and will indeed include a link and references to previous discussions and diagnosis recommendations, as well as treatment possibilities, from the medical review board. The agency still does not plan to issue any particular rule-making guidance on the topic, though.

Additionally, FMCSA has stated it does understand the worries regarding the potential risks related to a commercial trucker’s health and safety when it comes to moderate to severe obstructive sleep apnea.

“Drivers with untreated moderate to severe OSA are at increased risk of being fatigued while driving–regardless of the amount of off-duty time prior to the beginning of the work shift,” said FMCSA in a statement. “The agency believes all medical examiners on the National Registry of Certified Medical Examiners should be aware of the OSA risk factors so that drivers exhibiting such conditions are referred to a sleep specialist for evaluation.”

Even though this may sound promising, FMCSA maintains that the evidence needed for any potential rule-making is not yet present. The agency says it also “does not have sufficient data or information to support issuing a Notice of Proposed Rulemaking to establish requirements for mandatory OSA testing and treatment,” according to its statement.

Because of this lack of data, “we’re still not clear why it’s obstructive sleep apnea [acting as a major issue] more than anything else,” Minor explained during the meeting. He also added that there are currently no regulations mandating that an examiner screens “each and every driver that comes in for OSA, and we don’t have any regulatory criteria that says you must send him out for an OSA [sleep] test.”

Many medical professionals are saying this process should be much more of a no-brainer than it is during out to be.

“The board put a lot of effort in coming up with guidelines for sleep apnea that included a menu of symptoms and signs by which you could screen people, and then get sleep studies to look for the presence of sleep apnea,” said physician and review board member, Brian Morris. “The special interest groups stepped in and kind of torpedoed the whole process.”

One big roadblock in the way of these guidelines? Out-of-pocket costs for truckers.

“Drivers commonly don’t want to be screened for apnea because they may have to pay for sleep studies, which can cost more than $1,000,” noted Morris, who also serves as OccMed’s corporate director of medical surveillance in Boston.