Latest posts by Michael Morgenstern, MD (see all)
Is there information (studies, data, etc.) available for estimating the future consequences resulting from individuals with OSA occupying safety sensitive transportation positions in the absence of new restrictions?
According to the Federal Railway Administration (FRA) Office of Safety Analysis, there were 11,233 train incidents including 1,856 accidents and 1,314 derailments in 2015, resulting in 821 lives lost. Among commuter trains, 1453 passengers were injured and 17 were killed. The FRA has identified human factors to be the biggest problem, responsible as a primary cause 39% of the time. 1 The majority of human factors are likely to be fatigue related, based on a five-year study of main-track train collisions by the FRA which found 30 percent of collisions to be related to fatigue. 2 Of note, the term “fatigue” is routinely used by federal agencies such as the National Transportation Safety Board (NTSB) to describe what sleep specialists call excessive “sleepiness.” 3
The greatest cost of railway accidents are the lives lost, but the direct and indirect financial costs of railway accidents are projected to be in the billions. The Department of Transportation’s Pipeline and Hazardous Materials Safety Administration, looking only at a subset of trains carrying ethanol or crude oil, project that these trains will derail 10 times per year on average over the next two decades, resulting in $4 billion in damages.4 These projections rely on data from prior catastrophes including the Lac-Mégantic accident in the Canadian province of Quebec, which killed 46 individuals and had costs estimated around $2.7 billion. Some make the case that these projections could be severely underestimated.5 For example, railroad companies have frequently cited a 2006 damage assessment report by the American Academy of Actuaries for the President’s Working Group on Financial Markets to estimate damages of an oil tanker explosion in a more densely populated area. Using the closest analogy, a truck bomb explosion would result in damages of $3 billion near Des Moines, $8.8 billion in San Francisco, and $11.8 billion near New York City. Despite debate over estimates, these cost projections only represents a fraction of the costs of the total number of railway accidents.
The Metro-North Passenger Train Derailment
On December 1st, 2013 shortly after 7:19 AM, a passenger train derailed in the Bronx, NY, killing 4, injuring 61 and causing $9 million in property damage.6 As of December 2015 an additional $38 million dollars in lawsuits had been settled.7 A single accident might also indirectly impact the contribution to GDP from workers traveling on a route that is temporarily disabled. An article in Fortune Magazine published after an Amtrak passenger derailment on May 13, 2015 cited company officials who estimated that a single day of lost service could cost $100 million to affected businesses and consumers. 8
Does any organization track the number of historical motor carrier or train accidents caused by OSA?
The NTSB issues accident reports following the investigation of train accidents in the United States. This data often explores prior medical records, often reporting on accidents that are caused by OSA. However, this data may underestimate OSA incidence due to cases of undiagnosed OSA.
- Fortune Magazine. What’s the economic impact of the Amtrak crash? May 2015. (Link)
- Epstein, Lawrence J., et al. “Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.” J Clin Sleep Med3 (2009): 263-276. (Link)
- Kales, Stefanos N., and Madeleine G. Straubel. “Obstructive sleep apnea in North American commercial drivers.” Industrial health1 (2014): 13-24. (Link)
- Johns, Murray W. “Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard.” Journal of sleep research1 (2000): 5-11. (Link)
- Pizza, Fabio, et al. “Daytime sleepiness and driving performance in patients with obstructive sleep apnea: comparison of the MSLT, the MWT, and a simulated driving task.” Sleep3 (2009): 382. (Link)
- Vakulin, Andrew, et al. “Individual variability and predictors of driving simulator impairment in patients with obstructive sleep apnea.” J Clin Sleep Med6 (2014): 647-55. (Link)
- Dorrian, Jillian, et al. “Simulated train driving: Fatigue, self-awareness and cognitive disengagement.” Applied ergonomics2 (2007): 155-166. (Link)
- Sagaspe, Patricia, et al. “Maintenance of wakefulness test as a predictor of driving performance in patients with untreated obstructive sleep apnea.”SLEEP (2007): 327. (Link)