Paying Attention to At-Risk Commercial Vehicle Operators

Details

• Personal Author:
  Collop N ; Hartenbaum N ; Phillips B ; Rosen I
• Description:
  The approach of the task force to this project was to review the existing pertinent literature, medical regulations/guidelines/standards from international organizations, and reports and recommendations from the National Transportation Safety Board and Federal Motor Carrier Safety Administration. Several experts were called on to review and write sections, and a consensus style meeting took place to review the literature and agree on recommendations. Experts included specialists in both occupational medicine and sleep medicine. The result is not an evidence-based guideline, but a consensus-type document based on the literature as it relates to this topic to date. It is also important to note that these recommendations are of this task force and do not represent official guidelines. Many of these recommendations are very similar to what exist in other countries including Canada, the United Kingdom, and Australia, all of which were reviewed by this task force. One of the many issues that the task force faced was how to measure the effectiveness of the therapy after it was initiated. Past recommendations have included these in the follow-up of these patients to assist with determining when it is "safe" for them to return to work. Several studies were reviewed that looked at a variety of measures of sleepiness, including subjective measures such as the Epworth sleepiness scale, and objective measures including the MSLT, the maintenance of wakefulness test, the Oxford Sleep Resistance Test, the psychomotor vigilance test, and driving simulators. Subjective measures are often difficult to determine in this population whose livelihood requires them to be awake and vigilant at all times. Motivation to keep their job may outweigh their honesty on subjective scores like an Epworth sleepiness scale. Moreover, objective measures have not been shown in any of the tests to specifically correlate with fitness to drive or the number of crashes. The objective tests are also subject to a number of factors that may vary from one day to the next and one patient to the next, including age, circadian rhythm, quantity and quality of prior sleep, medications, and psychological factors. Therefore, you will not find any of these specific tests recommended by the task force. Best clinical judgment is recommended when deciding about sending a CMV operator back to his job after treatment for OSA. The executive summary provides the highlights of the recommendations. It gives commercial driver medical examiners some guidelines for determining when a CMV driver deserves further evaluation for possible sleep apnea based on history and physical examination findings, but is felt to be able to continue his job during the evaluation, and also recommends conditions when a driver should be taken out of service until the appropriate diagnostic and treatment options can be performed. The executive summary discusses which treatments should be recommended, when it is felt that a CMV operator can return to work after treatment, and what type of follow-up is required. Why is this important to the readership of CHEST? It has been estimated that up to 40% of outpatient visits to the office of a community pulmonologist are for sleep-disordered breathing. Pulmonologists will often be the one screening these patients and overseeing their care. With the advent of CPAP machines that can objectively measure usage, a physician is better able to monitor patients' adherence to therapy and assist them in trouble-shooting problems. This is an important issue to everyone driving on our highways and is especially important to those of us caring for patients who may be CMV operators. [Description provided by NIOSH]
• Subjects:
  Automobiles Occupational Health Safety Transportation
• Keywords:
  Author Keywords: Commercial Drivers Continuous Positive Airway Pressure Drivers Equipment Operators Guidelines Medical Examinations Medical Screening Sleep Apnea Transportation Workers Vehicle Safety
• ISSN:
  0012-3692
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Kentucky ; Maryland ; OSHA Region 3 ; OSHA Region 4 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  130
• Issue:
  3
• NIOSHTIC Number:
  nn:20053542
• Citation:
  Chest 2006 Sep; 130(3):637-639
• Contact Point Address:
  Nancy Collop, MD, FCCP, Johns Hopkins University, Division of Pulmonary/CCM, Johns Hopkins University DOM, 1830 E Monument St, Room 555, Baltimore, MD 21205
• Email:
  ncollop@aol.com
• Federal Fiscal Year:
  2006
• Performing Organization:
  University of Pennsylvania, Philadelphia
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Chest
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:e92b87808051a360eff157ef0c78040382d4588f0ed0f7df3b6a8f4988ca6b7555cff4e5965652f991e88cd186686164d81a24f7cf05a8e9c5205033639eb51b
• Download URL:
  https://stacks.cdc.gov/view/cdc/216274/cdc_216274_DS1.pdf
• File Type:
  [PDF - 55.50 KB ]