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Commercial Truck and Bus Safety Synthesis 9 Literature Review on Health and Sponsored by the Federal Motor Carrier Fatigue Issues Associated with Safety Administration Commercial Motor Vehicle Driver Hours of Work A Synthesis of Safety Practice

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TRANSPORTATION RESEARCH BOARD EXECUTIVE COMMITTEE 2005 (Membership as of June 2005) OFFICERS Chair: John R. Njord, Executive Director, Utah DOT Vice Chair: Michael D. Meyer, Professor, School of Civil and Environmental Engineering, Georgia Institute of Technology Executive Director: Robert E. Skinner, Jr., Transportation Research Board MEMBERS MICHAEL W. BEHRENS, Executive Director, Texas DOT ALLEN D. BIEHLER, Secretary, Pennsylvania DOT LARRY L. BROWN, SR., Executive Director, Mississippi DOT DEBORAH H. BUTLER, Vice President, Customer Service, Norfolk Southern Corporation and Subsidiaries, Atlanta, GA ANNE P. CANBY, President, Surface Transportation Policy Project, Washington, DC JOHN L. CRAIG, Director, Nebraska Department of Roads DOUGLAS G. DUNCAN, President and CEO, FedEx Freight, Memphis, TN NICHOLAS J. GARBER, Professor of Civil Engineering, University of Virginia, Charlottesville ANGELA GITTENS, Consultant, Miami, FL GENEVIEVE GIULIANO, Director, Metrans Transportation Center, and Professor, School of Policy, Planning, and Development, USC, Los Angeles BERNARD S. GROSECLOSE, JR., President and CEO, South Carolina State Ports Authority SUSAN HANSON, Landry University Professor of Geography, Graduate School of Geography, Clark University JAMES R. HERTWIG, President, CSX Intermodal, Jacksonville, FL GLORIA J. JEFF, Director, Michigan DOT ADIB K. KANAFANI, Cahill Professor of Civil Engineering, University of California, Berkeley HERBERT S. LEVINSON, Principal, Herbert S. Levinson Transportation Consultant, New Haven, CT SUE MCNEIL, Director and Professor, Urban Transportation Center, University of Illinois, Chicago MICHAEL MORRIS, Director of Transportation, North Central Texas Council of Governments CAROL A. MURRAY, Commissioner, New Hampshire DOT PHILIP A. SHUCET, Commissioner, Virginia DOT MICHAEL S. TOWNES, President and CEO, Hampton Roads Transit, Hampton, VA C. MICHAEL WALTON, Ernest H. Cockrell Centennial Chair in Engineering, University of Texas, Austin LINDA S. WATSON, Executive Director, LYNX--Central Florida Regional Transportation Authority MARION C. BLAKEY, Federal Aviation Administrator, U.S.DOT (ex officio) JOSEPH H. BOARDMAN, Federal Railroad Administrator, U.S.DOT (ex officio) REBECCA M. BREWSTER, President and COO, American Transportation Research Institute, Smyrna, GA (ex officio) GEORGE BUGLIARELLO, Chancellor, Polytechnic University, and Foreign Secretary, National Academy of Engineering (ex officio) THOMAS H. COLLINS (Adm., U.S. Coast Guard), Commandant, U.S. Coast Guard (ex officio) JENNIFER L. DORN, Federal Transit Administrator, U.S.DOT (ex officio) JAMES J. EBERHARDT, Chief Scientist, Office of FreedomCAR and Vehicle Technologies, U.S. Department of Energy (ex officio) STACEY L. GERARD, Acting Deputy Administrator, Pipeline and Hazardous Materials Safety Administration, U.S.DOT (ex officio) EDWARD R. HAMBERGER, President and CEO, Association of American Railroads (ex officio) JOHN C. HORSLEY, Executive Director, American Association of State Highway and Transportation Officials (ex officio) EDWARD JOHNSON, Director, Applied Science Directorate, National Aeronautics and Space Administration (ex officio) RICK KOWALEWSKI, Deputy Director, Bureau of Transportation Statistics, U.S.DOT (ex officio) WILLIAM W. MILLAR, President, American Public Transportation Association (ex officio) MARY E. PETERS, Federal Highway Administrator, U.S.DOT (ex officio) ERIC C. PETERSON, Deputy Administrator, Research and Innovative Technology Administration, U.S.DOT (ex officio) SUZANNE RUDZINSKI, Director, Transportation and Regional Programs, U.S. Environmental Protection Agency (ex officio) JEFFREY W. RUNGE, National Highway Traffic Safety Administrator, U.S.DOT (ex officio) ANNETTE M. SANDBERG, Federal Motor Carrier Safety Administrator, U.S.DOT (ex officio) WILLIAM G. SCHUBERT, Maritime Administrator, U.S.DOT (ex officio) JEFFREY N. SHANE, Under Secretary for Policy, U.S.DOT (ex officio) CARL A. STROCK (Maj. Gen., U.S. Army), Chief of Engineers and Commanding General, U.S. Army Corps of Engineers (ex officio)

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COMMERCIAL TRUCK AND BUS SAFETY SYNTHESIS PROGRAM Synthesis 9 Literature Review on Health and Fatigue Issues Associated with Commercial Motor Vehicle Driver Hours of Work PETER ORRIS SUSAN BUCHANAN University of Illinois at Chicago School of Public Health Chicago, IL ALISON SMILEY DIANNE DAVIS Human Factors North, Inc. Toronto, Canada WITH DAVID DINGES University of Pennsylvania School of Medicine Philadelphia, PA GENE BERGOFFEN MaineWay Services Fryeburg, ME S UBJECT A REAS Operations and Safety Public Transit Freight Transportation Research Sponsored by the Federal Motor Carrier Safety Administration TRANSPORTATION RESEARCH BOARD WASHINGTON, D.C. 2005 www.TRB.org

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COMMERCIAL TRUCK AND BUS SAFETY SYNTHESIS PROGRAM CTBSSP SYNTHESIS 9 Safety is a principal focus of government agencies and private-sector organizations concerned with transportation. The Federal Motor Carrier Safety Administration Project MC-08 (FMCSA) was established within the Department of Transportation on January 1, 2000, pursuant to the Motor Carrier Safety Improvement Act of 1999. Formerly a part of ISSN 1544-6808 the Federal Highway Administration, the FMCSA's primary mission is to prevent commercial motor vehicle-related fatalities and injuries. Administration activities ISBN 0-309-08826-7 contribute to ensuring safety in motor carrier operations through strong enforcement of Library of Congress Control Number 2005927020 safety regulations, targeting high-risk carriers and commercial motor vehicle drivers; improving safety information systems and commercial motor vehicle technologies; 2005 Transportation Research Board strengthening commercial motor vehicle equipment and operating standards; and increasing safety awareness. To accomplish these activities, the Administration works with federal, state, and local enforcement agencies, the motor carrier industry, labor, Price $29.00 safety interest groups, and others. In addition to safety, security-related issues are also receiving significant attention in light of the terrorist events of September 11, 2001. Administrators, commercial truck and bus carriers, government regulators, and researchers often face problems for which information already exists, either in doc- umented form or as undocumented experience and practice. This information may be NOTICE fragmented, scattered, and underevaluated. As a consequence, full knowledge of what The project that is the subject of this report was a part of the Commercial Truck and has been learned about a problem may not be brought to bear on its solution. Costly Bus Safety Synthesis Program conducted by the Transportation Research Board with research findings may go unused, valuable experience may be overlooked, and due the approval of the Governing Board of the National Research Council. Such approval consideration may not be given to recommended practices for solving or alleviating the reflects the Governing Board's judgment that the program concerned is appropriate problem. with respect to both the purposes and resources of the National Research Council. There is information available on nearly every subject of concern to commercial truck The members of the technical committee selected to monitor this project and to and bus safety. Much of it derives from research or from the work of practitioners faced review this report were chosen for recognized scholarly competence and with due with problems in their day-to-day work. To provide a systematic means for assembling consideration for the balance of disciplines appropriate to the project. The opinions and and evaluating such useful information and to make it available to the commercial truck conclusions expressed or implied are those of the research agency that performed the and bus industry, the Commercial Truck and Bus Safety Synthesis Program (CTBSSP) research, and, while they have been accepted as appropriate by the technical panel, they was established by the FMCSA to undertake a series of studies to search out and are not necessarily those of the Transportation Research Board, the National Research synthesize useful knowledge from all available sources and to prepare documented Council, or the Federal Motor Carrier Safety Administration of the U.S. Department of reports on current practices in the subject areas of concern. Reports from this endeavor Transportation. constitute the CTBSSP Synthesis series, which collects and assembles the various forms of information into single concise documents pertaining to specific commercial truck Each report is reviewed and accepted for publication by the technical panel according to and bus safety problems or sets of closely related problems procedures established and monitored by the Transportation Research Board Executive Committee and the Governing Board of the National Research Council. The CTBSSP, administered by the Transportation Research Board, began in early 2002 in support of the FMCSA's safety research programs. The program initiates three To save time and money in disseminating the research findings, the report is essentially to four synthesis studies annually that address concerns in the area of commercial truck the original text as submitted by the research agency. This report has not been fully and bus safety. A synthesis report is a document that summarizes existing practice in a edited by TRB. specific technical area based typically on a literature search and a survey of relevant organizations (e.g., state DOTs, enforcement agencies, commercial truck and bus com- panies, or other organizations appropriate for the specific topic). The primary users of the syntheses are practitioners who work on issues or problems using diverse approaches in their individual settings. The program is modeled after the successful synthesis programs currently operated as part of the National Cooperative Highway Research Program (NCHRP) and the Transit Cooperative Research Program (TCRP). This synthesis series reports on various practices, making recommendations where appropriate. Each document is a compendium of the best knowledge available on mea- sures found to be successful in resolving specific problems. To develop these synthe- ses in a comprehensive manner and to ensure inclusion of significant knowledge, avail- Published reports of the able information assembled from numerous sources, including a large number of relevant organizations, is analyzed. COMMERCIAL TRUCK AND BUS SAFETY SYNTHESIS PROGRAM For each topic, the project objectives are (1) to locate and assemble documented infor- mation (2) to learn what practice has been used for solving or alleviating problems; (3) are available from: to identify all ongoing research; (4) to learn what problems remain largely unsolved; and Transportation Research Board (5) to organize, evaluate, and document the useful information that is acquired. Each Business Office synthesis is an immediately useful document that records practices that were acceptable 500 Fifth Street, NW within the limitations of the knowledge available at the time of its preparation. Washington, DC 20001 The CTBSSP is governed by a Program Oversight Panel consisting of individuals knowledgeable in the area of commercial truck and bus safety from a number of and can be ordered through the Internet at: perspectives--commercial truck and bus carriers, key industry trade associations, state http://www.national-academies.org/trb/bookstore regulatory agencies, safety organizations, academia, and related federal agencies. Major Printed in the United States of America responsibilities of the panel are to (1) provide general oversight of the CTBSSP and its procedures, (2) annually select synthesis topics, (3) refine synthesis scopes, (4) select researchers to prepare each synthesis, (5) review products, and (6) make publication recommendations. Each year, potential synthesis topics are solicited through a broad industry-wide Note: The Transportation Research Board of the National Academies, the process. Based on the topics received, the Program Oversight Panel selects new synthesis National Research Council, and the Federal Motor Carrier Safety Administration topics based on the level of funding provided by the FMCSA. In late 2002, the Program do not endorse products or manufacturers. Trade or manufacturers' names Oversight Panel selected two task-order contractor teams through a competitive process appear herein solely because they are considered essential to the object of this to conduct syntheses for Fiscal Years 2003 through 2005. report.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished schol- ars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. On the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and techni- cal matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Acad- emy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achieve- ments of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, on its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Acad- emy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both the Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. William A. Wulf are chair and vice chair, respectively, of the National Research Council. The Transportation Research Board is a division of the National Research Council, which serves the National Academy of Sciences and the National Academy of Engineering. The Board's mission is to promote innovation and progress in transportation through research. In an objective and interdisciplinary setting, the Board facilitates the sharing of information on transportation practice and policy by researchers and practitioners; stimulates research and offers research management services that promote technical excellence; provides expert advice on transportation policy and programs; and disseminates research results broadly and encourages their implementation. The Board's varied activities annually engage more than 5,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. www.TRB.org www.national-academies.org

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COOPERATIVE RESEARCH PROGRAMS STAFF FOR CTBSSP SYNTHESIS 9 ROBERT J. REILLY, Director, Cooperative Research Programs CHRISTOPHER W. JENKS, Manager, Commercial Truck and Bus Safety Synthesis Program EILEEN P. DELANEY, Director of Publications KAMI CABRAL, Associate Editor COMMERCIAL TRUCK AND BUS SAFETY SYNTHESIS PROGRAM OVERSIGHT PANEL STEPHEN CAMPBELL, Commercial Vehicle Safety Alliance, Washington, DC (Chair) REBECCA M. BREWSTER, American Transportation Research Institute, Smyrna, GA KENNETH CAMPBELL, Oak Ridge National Laboratory, Oak Ridge, TN THOMAS M. CORSI, University of Maryland, College Park DENNISON COTTRELL, New York State DOT NICHOLAS J. GARBER, University of Virginia, Charlottesville ALEX GUARIENTO, Greyhound Lines, Inc., Dallas, TX SCOTT MADAR, International Brotherhood of Teamsters, Washington, DC WILLIAM MAHORNEY, American Bus Association, Washington, DC JAMES W. McFARLIN, ABF Freight System, Inc., Fort Smith, AR WILLIAM C. ROGERS, Motor Freight Carriers Association, Washington, DC JOHN SIEBERT, Owner-Operator Independent Drivers Association, Grain Valley, MO LARRY F. SUTHERLAND, HNTB Consultants, Columbus, OH DAVID K. WILLIS, Texas A&M University, College Station DAVID SMITH, FHWA Liaison ALBERT ALVAREZ, FMCSA Liaison DOUG McKELVEY, FMCSA Liaison MARTIN WALKER, FMCSA Liaison GREG HULL, APTA Liaison MICHELE McMURTRY, NTSB Liaison LEO PENNE, AASHTO Liaison CHRISTOPHER ZEILINGER, CTAA Liaison CHARLES NIESSNER, TRB Liaison RICHARD PAIN, TRB Liaison

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This synthesis will be useful to commercial vehicle operators, federal and state FOREWORD agencies, and others interested in improving commercial vehicle safety. The report pro- By Christopher W. Jenks vides a review of literature relevant to health and fatigue issues associated with com- CTBSSP Manager mercial vehicle driver hours of service. This literature review was specifically Transportation Research requested by the Federal Motor Carrier Safety Administration (FMCSA) to provide Board information related to their issuance of Hours of Service regulations in January 2004. Soon after the issuance of these regulations, a lawsuit was filed challenging the regu- lations. As a result of this lawsuit, a federal court ordered the new regulations to stay in effect while the FMCSA reviewed the regulations and presented its case in support of the regulations and/or prepared a new set of agreed upon Hours of Service regula- tions. To assist the FMCSA in conducting its review, the CTBSSP was asked to con- duct a two-part literature review of relevant material. Part I contains a general litera- ture review of the health and fatigue issues associated with commercial vehicle driver hours of service. For fatigue issues, the focus is on research that occurred after the Hours of Service regulations were published, as a literature review was performed to support these regulations. The literature review relating to health issues is more exten- sive, and covers studies conducted from 1975 to the present. Part II contains a litera- ture review of references that were cited in response to a related FMCSA Notice of Pro- posed Rulemaking. In both Parts I and II, the literature reviews summarize the literature without drawing any conclusions as to how they specifically relate to the FMCSA Hours of Service regulations. Any conclusions in this area are left to the FMCSA and others. Administrators, commercial truck and bus carriers, government regulators, and researchers often face problems for which information already exists, either in docu- mented form or as undocumented experience and practice. This information may be fragmented, scattered, and underevaluated. As a consequence, full knowledge of what has been learned about a problem may not be brought to bear on its solution. Costly research findings may go unused, valuable experience may be overlooked, and due con- sideration may not be given to recommended practices for solving or alleviating the problem. There is information available on nearly every subject of concern to commercial truck and bus safety. Much of it derives from research or from the work of practition- ers faced with problems in their day-to-day jobs. To provide a systematic means for assembling and evaluating such useful information and to make it available to the com- mercial truck and bus industry, the Commercial Truck and Bus Safety Synthesis Pro- gram (CTBSSP) was established by the Federal Motor Carrier Safety Administration (FMCSA) to undertake a series of studies to search out and synthesize useful knowl- edge from all available sources and to prepare documented reports on current practices

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in the subject areas of concern. Reports from this endeavor constitute the CTBSSP Syn- thesis series, which collects and assembles information into single concise documents pertaining to specific commercial truck and bus safety problems. The CTBSSP, administered by the Transportation Research Board, was authorized in late 2001 and began in 2002 in support of the FMCSA's safety research programs. The program initiates three to four synthesis studies annually that address issues in the area of commercial truck and bus safety. A synthesis report is a document that sum- marizes existing practice in a specific technical area based typically on a literature search and a survey of relevant organizations (e.g., state DOTs, enforcement agencies, commercial truck and bus companies, or other organizations appropriate for the spe- cific topic). The primary users of the syntheses are practitioners who work on issues or problems using diverse approaches in their individual settings. This synthesis series reports on various practices; each document is a compendium of the best knowledge available on measures found to be successful in resolving spe- cific problems. To develop these syntheses in a comprehensive manner and to ensure inclusion of significant knowledge, available information assembled from numerous sources is analyzed. For each topic, the project objectives are (1) to locate and assemble documented information (2) to learn what practice has been used for solving or alleviating prob- lems; (3) to identify all ongoing research; (4) to learn what problems remain largely unsolved; and (5) to organize, evaluate, and document the useful information that is acquired. Each synthesis is an immediately useful document that records practices that were acceptable within the limitations of the knowledge available at the time of its preparation.

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CONTENTS PART I General Literature Review 3 SUMMARY 8 LITERATURE REVIEW--HEALTH Executive Summary, 8 Process and Methodology, 9 Selection Criteria, 9 Review of Primary Sources, 10 Article Summaries, 13 Summary of Findings of Literature, 49 Bibliography of Primary and Secondary Sources, 49 52 LITERATURE REVIEW--FATIGUE Process and Methodology, 52 Selection Criteria, 52 Article Summaries, 55 Summary of Findings of Literature, 92 Research Limitations, 93 Complete Primary Sources and Abstracts, 93 Secondary Sources, 99 115 APPENDIX A Project Statement of Work PART II Review of References Related to Public Comments 119 SUMMARY 123 HEALTH EFFECTS REFERENCES REVIEW Executive Summary, 123 Process and Methodology, 123 Review of References, 123 Reference Summaries, 125 140 FATIGUE EFFECTS REFERENCES REVIEW Selection Criteria, 140 Executive Summary, 140 Reference Summaries, 146