Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 4
4
METHODOLOGY AND APPROACH be usable in practice in select commercial transportation
applications.
Literature Review
The literature review presented here is of the narrative
This synthesis provides a narrative review and description
type. It describes and appraises previous work, but does not
of much of what is known from the scientific literature
specify methods by which any particular studies cited were
about psychoactive chemicals that some commercial drivers
identified, selected, and/or evaluated. Many of the citations
at times ingest, and reports on the known and probable
are from scientific peer-reviewed journals. Many textbook
effects of such chemicals on operator performance, safety,
chapters cited were written by leading scientists in their fields,
and health. These substances include many prescription
whose knowledge of decades of their own and their peers'
and self-administered medications, sleep-inducing hypnotics,
published works lends credibility to their synopsis on select
wakefulness-promoting stimulants, and a large number
topics. The choice of which articles to cite in this narrative
of products best labeled as dietary and nutritional supple-
review was largely determined by the synthesis team's judg-
ments, many of which contain psychoactive agents and are
ment that a particular reference explicated the points being
readily available over the counter in grocery and drug
made or provided an alternative or clarifying viewpoint that the
stores and at convenience stores located at fueling rest stops
reader can seek out to suit his or her own interest in the topic.
along the U.S. highways. Reports identified and reviewed
This review does not appraise all available research that may
included:
be relevant to a particular topic, but it does attempt to focus
on key points and findings while citing numerous additional
· Scientific journal articles presenting results of experi- identified published studies in an extensive web-only Refer-
ments involving psychoactive substances and equipment ence section (Appendix D), plus a web-only Bibliography
operator performance, as well as laboratory studies (Appendix E) of citations that are useful, but not directly
of generic performance and skill tests having a direct cited in the text.
relationship to driving behavior (i.e., studies of drug
effects on reaction time, psychomotor tracking, vigilance, This narrative presents an overview and some discussion of
judgment, decision making, and so on); previous experimental and analytical works, selected because
· Occupational health and safety reports pertaining directly they explain effects of psychoactive chemicals (drugs,
to chemical substance use by transportation operators medications, supplements, and so on) on operator performance,
(commercial drivers, aviators, and others) and their particularly drug effects on psychomotor tracking, reaction
performance; time, judgment, and decision-making performance--all
· Rules and advisory guidelines from FMCSA published directly related to driving performance. The review suggests
and available for use by the public and by CDMEs; current gaps in knowledge on these topics. The information
· Documents in the widely dispersed government- contained in the review can assist in developing a rationale for
sponsored technical report literature, especially those of proposing new research that still remains to be accomplished.
federal research organizations such as the U.S. military It also may be used to scope the types of interventions avail-
medical research and civil aeromedical research labora- able to be included in more thorough analyses of the issues
tories, the National Institutes of Health research institutes, raised in the problem statements described earlier.
and public health centers (e.g., National Institute of
Drug Abuse); and
· A variety of professional scientific publications, text- Bibliography of References Cited
book chapters, committee reports, symposia proceedings, and Additional Literature
position papers, and others that are largely produced
During the extensive search for, review, and critique of
outside the refereed journal literature.
numerous scientific references for this synthesis, it became
apparent that a great number of reports on psychoactive drugs
Also provided as Appendix B is a brief analytical review and chemicals and performance are available (some previous
of the medical and performance research that supports the review articles examined cite dozens, even hundreds of
current operational policy statements of the several U.S. studies). Many of the reports identified here appear directly
military services, each of which permits selective, limited- related to the task at hand, whereas many others only provide
time, operational use of psychoactive chemical substances to additional background or are only tangentially related. In
be taken by military personnel under highly controlled military both cases, the articles and reports are widely scattered. The
circumstances. Such state-of-the-art/practice research portends references (web-only Appendix D) contain all of those citations
the potential, but with significant accompanying cautions, for actually cited in this report. It was deemed appropriate to
employing psychoactive chemicals for operational fatigue provide at least a bibliographic listing of related citations in
countermeasures in other work settings. It also anticipates the belief that presenting them together in a single listing
discussion of whether such chemical substances would ever might save other researchers significant search time when
OCR for page 5
5
looking for additional publications pertinent to these topics. Survey of Commercial Carrier Policies
The Bibliography (web-only Appendix E) lists those citations on Driver Use of Chemical Substances
determined to be sufficiently related to effects of psycho-
active substances on performance and health to warrant A structured interview questionnaire for use by CMV stake-
including, that are not specifically mentioned in the text, but holders (predominately truck carrier fleet managers, safety
that could provide additional background. advocates, and other company officials) was administered to
elicit key information about current policies, applications,
and programs involving the use, or restriction of use, of
Survey of Medical Examiners Performing psychoactive chemical substances by commercial drivers.
Commercial Driver Medical Examinations The survey questionnaire asked specific questions about fleet
managers' knowledge base, and about current company
The synthesis team distributed a survey questionnaire about policies regarding driver use of stimulants, hypnotics, and
medications and drugs to a small convenience sample of nutritional supplements. The survey was sufficiently open-
23 medical providers who administer CDMEs to commer- ended to gather information about experiences with current
cial drivers seeking medical qualification and certification to approaches, procedures, and safety policies in place, to identify
drive commercial vehicles. The questionnaire was administered problems, and to elicit proposed solutions regarding the use
in two western geographical regions of the United States: of chemical substances in the commercial transportation
15 medical examiner responses were obtained in a Salt Lake industries. Survey questions were specifically designed to
City, Utah, survey; and 8 medical examiners were surveyed cover the scope and objectives outlined previously. The
in Reno, Nevada. survey questionnaire for motor carrier company officials
was distributed by members of the American Transportation
The questionnaire asked these medical examiners about: Research Institute (ATRI) to (1) the American Trucking
Associations (ATA) Safety and Loss Prevention Management
· Their anticipated certification decisions regarding chem- Council, (2) a Health and Wellness working group within
ical substances identified while performing medical that council, and (3) several wellness clinics located at travel
qualification exams of CMV drivers, centers that target over-the-road drivers. The participants
· Their role in providing medical advice about driver consisted of safety and human resource personnel within the
alertness and combating fatigue, trucking industry, including motor carriers and allied profes-
· Their advice on the use of and identifiable hazards sionals (e.g., motorcoach companies and health and wellness
associated with ingesting chemical substances in the clinics). Motor carrier representatives were invited to partic-
workplace, and ipate by e-mail, which included an Internet link on ATRI's
· Advice they might or might not give to CMV drivers website where respondents could gain access to the online
and to their employers. version of the Chemical Effects Survey.
In particular, providers were asked about the certification There were 31 company responses. These companies
actions and information resources relied on in making driver employed a range of from 10 to a maximum of 6,200 drivers,
certification decisions. The survey questions asked of med- with a company average of more than 800 drivers. Most
ical examiners also solicited suggestions for improvements respondents were truck carrier firms. The survey also netted
in the administration and conduct of occupational medicine responses from one commercial driver training company and
and CDME practices concerning use of chemical substances by one charter bus company. The specific questions posed in the
drivers, and about the health and safety implications attached survey are depicted in the context of the presentation of the
thereto. A summary of the questionnaire results is presented in results along with summary statistics for the surveys, and are
chapter six of this synthesis report. described in chapter seven of this report.
