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LITERATURE REVIEW ON HEALTH AND FATIGUE ISSUES ASSOCIATED WITH COMMERCIAL MOTOR VEHICLE DRIVER HOURS OF SERVICE Part II: Review of References Related to Public Comments SUMMARY Since 1995, the U.S. Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA) [formerly FHWA's Office of Motor Carriers] actively con- ducted a concentrated program of research, study, and industry outreach education on commercial driver alertness, fatigue, health and wellness. There was much open pub- lic discussion, deliberation, and negotiation over the public rulemaking process from 1996 to 2003. In May 2003, FMCSA issued new Hours of Service (HOS) rules for com- mercial truck drivers with a planned implementation date in January 2004. After sub- stantial amounts of training and preparation by government and the trucking industry, those new HOS rules went into effect January 4, 2004. The January 2004 revised HOS rules extended allowable driving time to 11 hours and reduced overall driver work hours to 14 before requiring a 10-hour break. The old HOS rules limited commercial truck driving to 10 hours and allowed drivers to work 15 hours before taking a mandatory 8-hour break. Public Citizen challenged those HOS rules in a lawsuit, alleging that the new HOS did not properly account for commercial driver health concerns. Responding to that lawsuit, in July 2004, the U.S. Court of Appeals for the Washington District of Colum- bia Circuit ruled that DOT's FMCSA did not consider truck drivers' health in the revised HOS rules. FMCSA requested the federal court to stay its order and to keep the current, revised HOS rules in effect until FMCSA could present its case again or could prepare a new set of HOS rules. As one part of its efforts to reply to the Court of Appeals ruling on HOS, the FMCSA requested independent technical assistance from a third-party research team to sum- marize the scientific and technical literature on commercial vehicle operator health, wellness, fatigue, and performance, as they might be related to the hours a person works or to the structure of the work schedule (e.g., on-duty/off-duty cycles, sleep time, etc.).

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120 MaineWay Services was assigned the task of literature review by the Transportation Research Board (TRB). This synthesis was completed and submitted to TRB for review and publication. OBJECTIVE OF SUPPLEMENTAL REVIEW On January 24, 2005, FMCSA published in the Federal Register (70 FR 3339) a Notice of Proposed Rulemaking (NPRM) regarding HOS of commercial motor vehi- cle (CMV) drivers. In that NPRM, FMCSA announced its intention to review and reconsider the regulations on HOS of drivers published on April 28, 2003, and amended on September 30, 2003. In the docket to this January 24, 2005, NPRM, FMCSA re- filed the same Regulatory Impact Analysis (RIA), or comprehensive analysis of eco- nomic benefits and costs of the proposed rule, as was filed in the docket for the April 2003 final rule. Within the responses to this request for comments on this announcement were some 266 references to studies, articles, and literature relating to the health and fatigue effects of the HOS regulations. To assess the significance and relevance of these references, the MaineWay Services research team was asked to review the studies, articles, and lit- erature and provide analyses of those references it deemed relevant to the health and fatigue effects of the existing regulations. RESEARCH TEAM The research team consisted of the following members: Health Effects Panel Peter Orris, MD, MPH Professor of Occupational and Environmental Health Sciences, University of Illi- nois School of Public Health, Cook County Hospital Director of Occupational Health Services Institute, Great Lakes Center for Occu- pational and Environmental Safety and Health, University of Illinois Chief of Service, Occupational and Environmental Medicine, University of Illi- nois at Chicago Hospital and Medical Center President, Medical Staff, Cook County Hospital Secretary/Treasurer, Journal of Public Health Policy Member of Medical Advisory Committee of International Brotherhood of Teamsters Author of multiple publications relating to public health topics and reviewer and participant in editorial boards of a range of professional journals related to pub- lic health topics Susan Buchanan, MD, MPH Interim Program Director, Occupational Medicine Residency, UIC College of Medicine Author, several publications relating to Occupational Health Reviewer, American Journal of Industrial Medicine, 2004

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121 Health Effects Panel Members Leslie Stayner, PhD. Professor and Director, Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health Served as Chief of Risk Evaluation branch, National Institute for Occupational Safety and Health, Education and Information Division, and in several other career positions relating to risk evaluation Contributing Editor to Journal of Industrial Medicine, and involved in a wide range of professional activities relating to industrial health Eric Garshick, MD, MOH Assistant Professor of Medicine, VA Boston Healthcare System, Channing Lab- oratory, Brigham and Women's Hospital, Harvard Medical School Served as Advisor, World Health Organization; International Program on Chem- ical Safety, Environmental Health Criteria for Diesel Fuel and Exhaust Emis- sions, Geneva Switzerland Served as Consultant, U.S. EPA Science Advisory Board, Clean Air Scientific Advisory Committee Diesel Emissions Health Document William Marras, PhD. Co-Director, Institute of Ergonomics, Ohio State University Professor, Department of Physical Medicine, Biomedical Engineering Center, Ohio State University Associate Editor, Human Factors Natalie Hartenbaum, MD, MPH President and Chief Medical Officer of OccuMedix, Inc. Adjunct Assistant Professor of Emergency Medicine/Occupational Medicine at the University of Pennsylvania Editor-in-Chief of CDME (Commercial Driver Medical Examiner) Review Fatigue Effects Panel Alison Smiley, PhD. President of Human Factors North, Inc., a Toronto-based human factors and engi- neering consulting company; and a Canadian Certified Professional Ergonomist (CCPE) 30 years experience in measurement of human performance, and human factors consulting, specializing in driver behavior, transportation safety, and shift work Senior specialist in assessment of work-rest schedules, shift work, hours of work and worker rest for transportation industries (railways, coast guard and marine vessels, trucking, etc.) and for nuclear power plant and manufacturing operations Project manager for several Transport Canada projects involving literature review and development of experimental protocols related to fatigue and minimum recov- ery periods for CMV drivers Forensic consultant with expertise on car and truck driver fatigue and shift- scheduling issues Consultant to both Canadian and U.S. governing bodies on trucking industry hours of service regulations

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122 Dianne Davis, M.Eng. Associate Consultant, Human Factors North, Inc. Over 10 years experience conducting human factors analyses in a variety of dif- ferent domains such as the safety of driver examination tests, the study of fatigue and truck driving, way-finding, and the design of medical mobile devices and online shipping tools ORGANIZATION AND PRESENTATION OF PART II: REVIEW OF REFERENCES RELATED TO PUBLIC COMMENTS This supplemental references review is presented in two sections: Health Effects and Fatigue Effects. The Health Effects section has the following subsections: Executive Summary Process and Methodology Review of References Reference Summaries The Fatigue Effects section has the following subsections: Selection Criteria Executive Summary Reference Summaries Note: The sections are presented in a format prescribed by the FMCSA HOS Regu- latory Review Team subsequent to the publication of the initial statement of work.