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LITERATURE REVIEW ON HEALTH AND FATIGUE ISSUES ASSOCIATED WITH COMMERCIAL MOTOR VEHICLE DRIVER HOURS OF SERVICE 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 program of research, study, and industry outreach and education on commer- cial motor vehicle (CMV) driver alertness, fatigue, health, and wellness. There was much open public 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 CMV drivers with a planned implementation date of 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 hr and cut overall driver work to 14 hr before requiring a 10-hr break. The old HOS rules lim- ited CMV driving to 10 hr, and allowed drivers to work 15 hr before taking a manda- tory 8-hr break. Public Citizen challenged those HOS rules in a lawsuit, alleging that the new HOS did not properly account for CMV driver health concerns. Responding to that lawsuit, in July 2004, the U.S. Court of Appeals for the Washington, D.C., Circuit ruled that DOT's FMCSA did not follow a congressional mandate to consider truck drivers' health in the revised HOS rules. FMCSA requested the federal court to stay its order and keep the current, revised HOS rules in effect until FMCSA can re-present its case or prepare a new set of HOS rules. As one part of its efforts to reply to the Court of Appeals ruling on HOS, FMCSA requested the independent technical assistance from a third-party research team. FMCSA asked MaineWay Services to summarize the scientific and technical literature on CMV operator health, wellness, fatigue, and performance, as they relate to the hours a person works, or to the structure of the work schedule (e.g., on-duty/off-duty cycles, sleep time, etc.). The MaineWay Services research team was assigned the task of literature review. This synthesis is designed to provide information to FMCSA on existing literature in this subject area.

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4 OBJECTIVES AND SCOPE This synthesis responds to the statement of work (see Appendix A): to review the scientific and technical literature in two topical areas related to HOS: (1) driver health and (2) driver fatigue. Driver Health. The synthesis reviews and summarizes available information in the sci- entific and technical literature concerning HOS and CMV operator health. The purpose of the literature review was to provide information that clearly discusses in a scientific, experimental, quantitative, or qualitative way, the relationship between the hours a per- son works or the structure of the work schedule (e.g., on-duty/off-duty cycles, sleep time, etc.) and the impact on some medical conditions of concern to truck drivers. The literature review summarizes the characteristics and methodology of each study, so that each study's approach can be clearly understood and compared with other studies. Driver Fatigue. The synthesis reviews and summarizes available information in the scientific and technical literature concerning HOS and CMV operator performance and fatigue, especially as they pertain to driver health. The purpose of this facet of the lit- erature review is to provide information that clearly summarizes in a scientific, exper- imental, qualitative, and quantitative way the relationship between the hours a person works, drives, and the structure of the work schedule (on-duty/off-duty cycles, time on task, especially time in continuous driving, sleep time, etc.) and the impact of CMV driver fatigue and performance. The literature review summarizes the characteristics and methodology of each study, so that each study's approach can be clearly under- stood and compared with other studies. SELECTION OF AND PARTICIPATION OF KEY PERSONNEL ON THE PROJECT Following award of the contract for this research, Gene Bergoffen, Principal, MaineWay Services, appointed two technical panels, one on driver health and the other on driver fatigue. Mr. Bergoffen served as the project executive administrator and senior advisor, with the assistance of Gerald P. Krueger, PhD., as the senior technical advisor. After consultation with the FMCSA, Peter Orris, MD, MPH, was appointed as technical advisor and panel leader for the health literature review and Alison Smiley, PhD., was appointed as technical advisor and as the panel leader for the fatigue literature review. The background of the key project personnel is included in the following section. Dr. Orris was assisted by Dr. Susan Buchanan. To provide additional peer input and advice in the health literature review, Dr. Orris elicited panel member participation from four additional experts listed in the Health Panel Members section. Ms. Smiley was assisted by Dianne Davis. To provide further input and advice in the fatigue liter- ature review, Ms. Smiley elicited panel member participation from two additional experts listed in the Fatigue Panel Members section. KEY PERSONNEL Project Administration Gene Bergoffen, MaineWay Services, Project Administrator and Senior Advisor Currently the Principal of MaineWay Services, a transportation research and con- sulting firm in Fryeburg, Maine

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5 Eight years as President and CEO, National Private Truck Council Co-investigator and co-author of CTBSSP Synthesis 1, "Effective Commercial Truck and Bus Safety Management Techniques" Leader of MaineWay Services Task Order Team for several CTBSSP Synthesis Projects; principal investigator of CTBSSP Synthesis 8, "Commercial Motor Vehicle Driver Safety Belt Usage" Broad experience in project management stemming from the organization of the Private Fleet Management Institute and including a number of research projects conducted when employed by Science Applications International Corporation Gerald P. Krueger, PhD, Wexford Group International, Senior Technical Advisor Highly experienced engineering psychologist and human factors specialist (36 years) and a Certified Professional Ergonomist (CPE) Recognized authority on sustained performance of aviators, heavy equipment operators, and of CMV driver fatigue, factors relating to driver wellness and health, and occupational and environmental medicine research Co-investigator on two truck driver simulator studies and one large field study on CMV truck driver alertness and fatigue issues Principal developer of two FMCSA and American Trucking Associations' (ATA) train-the-trainer courses: Mastering Alertness and Managing Commercial Driver Fatigue; and Gettin' in Gear Wellness, Health and Fitness for Commercial Drivers Co-investigator and co-author for CTBSSP Synthesis 7, "Motorcoach Industry Hours of Service and Fatigue Management Techniques." Co-investigator and principal ergonomist on CTBSSP Synthesis 8, "Commercial Motor Vehicle Driver Safety Belt Usage" Health 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, University of Illi- nois at Chicago College of Medicine Author, several publications relating to Occupational Health Reviewer, American Journal of Industrial Medicine, 2004

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6 Health 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 Laboratory, 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 Panel Alison Smiley, PhD. President of Human Factors North, Inc., a Toronto-based human factors and engineering consulting company; and a Canadian Certified Professional Ergono- mist (CCPE) 30 years experience in measurement of human performance, and human fac- tors 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 recovery 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 HOS regulations

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7 Dianne Davis, M.Eng Associate Consultant, Human Factors North, Inc. More than 10 years experience conducting human factors analyses in a variety of different 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 Fatigue Panel Members Mark Rosekind, PhD. President and Chief Scientist, Alertness Solutions, Cupertino, California Served as Research Scientist and Team Leader, Fatigue Countermeasures Pro- gram, Aviation Safety Research Branch, Flight Management and Human Fac- tors Division, NASA Ames Research Center Richard Hanowski, PhD. Leader, Truck and Bus Safety Group, Virginia Tech Transportation Institute Experience includes transportation human factors with both heavy and light vehicles, laboratory and field testing, real-time automobile and heavy vehicle simulation, advanced system development and testing, design guideline devel- opment, and human performance evaluation ORGANIZATION AND PRESENTATION OF PART I: GENERAL LITERATURE REVIEW The literature review is presented in two sections: Health and Fatigue. The health literature review has the following subsections: Executive summary, Process and methodology, Selection criteria, Review of primary sources, Article summaries, Summary of findings of literature, and Bibliography of primary and secondary sources. The fatigue literature review has the following subsections: Process and methodology, Selection criteria, Article summaries, Summary of findings of literature, Research limitations, Complete primary sources and abstracts, and Secondary sources. Appendix A of the synthesis presents the initial FMCSA prescribed statement of work. As called for in this statement, the team consulted with FMCSA on the ultimate make-up of the two literature review panels and on all other elements of the synthesis. Two briefings of the FMCSA staff were conducted during the course of the study to gain feedback on methodology, scope, and initial findings.