1. Driver Medical Fitness and Fatigue Prevention Robert Ball CMIOSH, MIIRSM, MAIRSO, DipOSH

2. The scale of the problem Globally about 1.25 million people die each year on the world's roads – about 3000 deaths per day or 124 every hour. Between 20 and 50 million people sustain non-fatal injuries. Young adults aged between 15 and 44 years account for 59% of global road traffic deaths. The economic consequences of motor vehicle crashes have been estimated between 1% and 3% of the respective GNP of the world countries, reaching a total over $600 billion. * World Health Organization

3. The Scale of The Problem UAE Perspective UAE - 956 fatalities Fatality rate of 12.7 per 100,000 population. WHO 2013 report

4. Road Traffic Injuries constitute the single largest share of all type of fatalities in the period 2007 to 2011 numbering over 3,500 cases. (Source: HAAD Fatal Injuries Statistics Report – 2011) Road Traffic Injuries constitute the single largest share of all type of fatalities in the period 2007 to 2011 numbering over 3,500 cases. (Source: HAAD Fatal Injuries Statistics Report – 2011) UAE injury cause

5. Deaths by road user category - UAE Combined total 56% Commercial

6. UAE study: '1 in 20 crashes caused by sleepy drivers' NHTSA “US” fatigue results in 100,000 accidents, 71,000 injuries and 1550 deaths annually. 30 to 40% accidents involving trucks 36 % of Coach collision deaths over the last 10 years caused by Fatigue RoSPA 25% accidents resulting in deaths caused by fatigue. Fatigue crash statistics

7. Driver Fatigue

9. What is Fatigue? Fatigue is term which is used to describe a general feeling of sleepiness, being mentally or physically tired, being drained or exhausted. It reflects a level of impairment from a normal or “rested” state Yawning Eyes closing Micro sleeps Head nodding Difficulties in concentration Poor traffic lane discipline Symptoms of fatigue may include

10. Outcomes of Fatigue  Poor judgement  Slower reactions to driving events  A marked decrease in necessary driving skills  Increased likelihood of Road Traffic Collision (RTC) Crashes due to fatigue are 50 % more likely to result in death or serious injury because a driver who has fallen asleep cannot brake or swerve to reduce the impact of the crash

12. Driver Fatigue Management System

13. An integrated part of the safety management system that includes the policy, practices and procedures for identifying, managing and monitoring the risks posed to health and safety by fatigue. What Is a Fatigue Management System ?

15. Work Factors Shift Patterns Breaks and facilities Work policies and practices Vehicle type Road predictability Traffic interaction Knowledge Medical Factors Obesity Obstructive Sleep Apnoea Insomnia Medication Narcolepsy Other Sleep Disorders Lifestyle Sleeping patterns Bedroom suitability Other work Age and attitude Knowledge Alcohol DANGER Fatigue Contributors

16. In conjunction with OSHAD and other concerned SRA’s DoT produced a Code of Practice on Driver Fatigue Prevention CoP to be released with next OHSMS update

17. Fatigue Risk Management System (FRMS) Management Policy and commitment Process for fatigue risk Identification Fatigue risk education program Investigation and reporting of fatigue incidents –Controls must include – Measures for scheduling of duties Measures for employer supplied accommodation

18. Management Policy Documented commitment from senior management- –Nominate responsible person –Provide sufficient resources –Take steps to identify fatigue risk –Implement controls –Provide training –Investigate incidents

19. Assessment of Fatigue Risk HSE Fatigue Risk Index http://www.hse.gov.uk/RESEARCH/rrpdf/rr446g.pdf Proprietary tools e.g.FAID AD EHSMS RF Element 02 – Risk Management

20. HSE Fatigue Risk Indicator High Risk

21. Karolinska Sleep Scale tool

22. FAID Rostering Tool

23. Roles & Responsibilities Drivers not to drive whilst impaired (Federal Law) Not require or coerce someone to drive whilst impaired Schedulers to take into account expected delays etc. Also plan for breaks

24. Driving, Working and Rest Limits  There should be one or more breaks scheduled into a driver’s day  A driver should have at least 8 continuous hours of rest in any 24 hour period  Irregular work schedules should be minimised  Plan with duty start times to remain static or to go forwards rather than back

25. Driving, Working and Rest Limits

26. DoT Survey Results How often do you think goods vehicle drivers should take a break?

27. How long should a break during the driver's shift be? DoT Survey Results

28. Medical conditions and fatigue Conditions such as Obstructive Sleep Apnoea and Insomnia are critical to fatigue risk Prolonged fatigue has implications for an individuals health, increased risk of heart disease, impotence, high blood pressure Always require drivers to choose non drowsy medications where possible. (ask your Doctor)

29. Medical Study – Obstructive Sleep Apnea DoT currently undertaking OSA Study on Bus Drivers 100 + Drivers screened for OSA

30. Medical Fitness Standards DoT Introduced Medical Standards for School Bus drivers. –The general consultant examination –Optometry (visual acuity and color vision) –Examining blood cells and antibodies to hepatitis C –Examining the level of Glucose in blood while fasting –Examining Hemoglobin A1c –Kidney Function Examinations –Measuring hearing and ECG Requirement for driver retesting following leave periods 12 Medical Centers throughout the Emirate of Abu Dhabi

31. Monitoring and Record Keeping

32. Employers should keep records of all trips Information should be recorded relating to: Work time Breaks from driving Non-work time Existing equipment, procedures and documentation can be used

33. Incident and Improvements  Report fatigue related incidents  Investigate to determine cause  Target unsafe practices and identify any reoccurring incidents  Involve management and staff in determining corrective actions

34. Training, Instruction and Communication  Training needs to be undertaken by drivers, and all employees whose work contributes to the management of fatigue  Refresher training should be provided at regular intervals  Classroom and on the job training should be used

35. Employer supplied accommodation Provide window covering to prevent light penetration Organise shared rooms to avoid disturbance of shift conflicts Avoid cleaning and maintenance during sleep times Ensure equipment to provide the correct room temperature Reduce noise.

36. Openness Make sure you create a culture where drivers feel confident to report that they are fatigued without fear of their jobs. OR

37. DoT Guidance Documents

38. Voluntary Guidance Documents

39. Thank You