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92 4.1 Conclusions This report provides a compendium of 16 best practices to improve sleep and reduce fatigue in the tug/towboat/barge industry. While it is beyond the scope of this project to fully develop, implement, test, and monitor the effectiveness of the proposed best practices, there is guidance on a number of pressing elements. This information could aid in the decision-making process about which practices to prioritize for implementation in order to improve sleep efficiency and reduce fatigue and fatigue-related accidents within the inland waterways. To improve sleep it will be important for all stakeholders, including policy makers, regulators, industry, labor groups, cus- tomers, and crew and their families to work together in the final development and implementation of these best practices. While the industry takes safety very seriously, a further goal could be to change the overall safety culture specifically in relation to sleep and fatigue so that there is a high value placed on sleep and that the fatigue-related risks associated with the work schedule can be managed in an appropriate manner. A major challenge is the diversity of the operations (harbor, line, seasonal, etc.) and company size (3 to 2,000 employees). Similar challenges face other transportation- related industries, such as trucking and aviation. As such, a one-size-fits-all FRMS is not pro- posed and while some prior recommendations from CEMS will ideally be considered in any FRMS, CEMS might be only one component of a well-developed FRMS program. A system in which companies used a revised/updated version of CEMS (to develop their own FRMS could be implemented on a case-by-case basis. This paradigm is currently in practice with the FAA for flight schedules that do not meet current minimum flight duty standards. Companies are able to provide an FRMS and evidence that a particular schedule does not pose a risk beyond a currently approved standard, or in this case, similar sleep duration and quality. In general, the research team suggests that any best practice be monitored and reviewed with appropriate metrics on a regular basis so that modifications and improvements can be initiated when necessary. Much like other areas of safety, such as advances in life preservers, there are new developments in the area of sleep/fatigue research all the time and so the issue of sleep and fatigue may be a moving target for implementing best practices. It is clear from this project that there needs to be clear communication between all stakeholders to determine the minimum standards, what the best way to achieve the goals of the program will be, and to determine and agree upon what could be considered the metrics for success. Based on the operations studied to date, the crew are sleeping on average similar to, or in some cases, more than population norms (McClain et al. 2014). They do, however, seem to be at greater risk for various health conditions indicated by the high prevalence of morbid obesity. The current research project has only just touched the surface of health-related issues. Future Conclusions and Suggested Research C H A P T E R 4
Conclusions and Suggested Research 93 research will also need to determine what best practices are working and which ones are not or even simply to determine whether companies are implementing programs at all. In some industries, policy makers/regulators are often required to provide the âpushâ neces- sary to get all stakeholders on board with the overall goal, in this case, to minimize risk and avoid incidents and accidents related to poor sleep. It should be noted that within the tug/towboat/ barge industry this is often not the case, as many companies are âout frontâ in that they are already addressing many of the best practices listed as part of this project. A long-term goal would be to get all companies to address these best practices in an appropriate manner for their operations. In past years, the NTSB has had addressing human fatigue on the top 10 most wanted list of important issues to tackle. At the time of this research, it is not on the list (http://www.ntsb.gov/ safety/mwl/Documents/MWL_2015_brochure.pdf), although the NTSB did include ârequir- ing medical fitness for duty.â Given the importance of health for sleep and vice versa, this is very much in line with many of the research teamâs proposed best practices (Sections 3.5.3, 3.5.6â3.5.8, 3.5.10, and 3.5.11). 4.2 Proposed Research As part of the efforts on this study, the research team spoke to a variety of individuals and groups that work in the field of fatigue management, in both the tug/towboat/barge and other transportation industries. The scope of scientific literature that reports on fatigue in the maritime sector is limited compared to other modes of transportation such as trucking, rail, and aviation. There was a general consensus from those working in the field of fatigue management in the maritime sector that there is a lot of scientifically based research that still needs to be conducted. Indeed, only limited research is being conducted, and it appears difficult to secure funding for this necessary research. It is also unclear whose role it should be to fund this type of research: regulators/policy makers, industry, or some combination? Therefore, the research team suggests that as implementation of the proposed best practices is carried out, funding for research could also be a consideration. This could take the form of the collection of outcomes within the company, as well as the collaboration of researchers outside of the industry with relevant expertise. 4.2.1 Practices Requiring Further Investigation While it is the opinion of the investigators that the practices listed in Section 3.5 are at present the best practices for mitigating the risk of fatigue and improving sleep, there is limited data to support most of these practices, i.e., there is little quantitative data to support the benefits in the tug/towboat/barge industry. Most of the evidence is either from other industries or is subjective at this time. In the next section, the research team suggests practices that could benefit from further research. These include practices recommended by the investigators in this report and practices that have been put forward by others including policy makers and regulators. 4.2.2 HOS Rules to Allow for an Uninterrupted 7 to 8 Hours of Sleep Evidence suggests that the only schedule that would allow for 7 to 8 hours of uninterrupted sleep is one that allows at least 10 hours off between consecutive shifts (depending on the time of the rest interval). Even given this extended off-duty period there are other factors that impact the amount and quality of an individualâs sleep that are not accounted for in such a simple HOS rule such as time of day, sleep disorders, stress, health, and environmental factors related to the sleep environment. HOS rules are not able to address these other factors and should therefore
94 Enhancing Sleep Efficiency on Vessels in the Tug/Towboat/Barge Industry only be used in tandem with other practices that address them. There has been some progress on the issue of time of day and sleep environment in HOS regulations, and the FAA has taken a lead in adjusting duty hour requirements based on the time of day the shift starts (FAA 117) and the type of rest facilities available. These rules are relatively new (effective January 2014) and time will tell if they have a measureable impact on safety and health. In determining the impact of any proposed changes in HOS requirements in the tug/towboat/ barge industry, it will be important for there to be direct comparisons made between various two-watch schedules (i.e., 6:6:6:6, 7:7:5:5, 8:8:4:4, and 12:12). These head-to-head studies could be either under simulation or, preferably, under real-world field conditions. Limited data sug- gest that sleep durations are not significantly different between the 6:6:6:6 square watch and a 7:5:5:7 watch (single vessel), but more extensive studies need to be performed before any defini- tive conclusion can be made about sleep obtained on various watch schedules. 4.2.3 Shift Start Times There is little data on how altering shift start times might impact sleep and fatigue. However, there is some evidence from the SAFTE/FAST modeling (Section 3.3.4) and recent research on split shifts (Jackson et al. 2014, and responses from interviews conducted with practitioners from other industries) that suggests that optimizing start times for the current schedules may be beneficial. 4.2.4 Impact of Education Programs on Improving Sleep and Safety While it is clear that education is a key component of any FRMS, not all education is created equal and not all people learn in the same way. Consideration could be given to generational learning issues and the intended audience, as there are likely to be different approaches needed for policy makers, management, crew and their families, and physicians. Research to determine whether education programs are having any tangible impact on sleep, health, behavior, atti- tudes, or safety may also be beneficial, as would programs to determine what would be the best approaches for continuing education, for example, how often should individuals have refresher training in order to maintain effectiveness? 4.2.5 FRMS There is little, if anything, published on the impact of FRMS on sleep and safety; most infor- mation comes from consultant reports that are not usually published in the scientific literature. Given the effort and cost that goes into the creation and maintenance of an FRMS, it will be important to involve researchers, economists, safety experts, and others to assess the benefits of any proposed practices in a scientific and unbiased manner. 4.2.6 Medical Examiners It is unclear whether there is a problem with the current practice of allowing any licensed medical professional to conduct licensure physical examinations. While the research team pro- posed having registered examiners, there could be research conducted to determine whether there would be any measurable benefit to determine if such a change is warranted. 4.2.7 Sleep Disorders There is a need for further research on the impact of sleep disorders, in particular OSA, in the tug/towboat/barge industry. Research could not only examine the risk of OSA in this industry
Conclusions and Suggested Research 95 but also the benefits for addressing this health and safety concern, including not only the benefits to the individual but the benefits to the companies and the community as a whole. This could be approached in several ways: one would be to examine the impact in other industries such as aviation where there is a rule, or another would be to further examine cases within the trucking and/or the tug/towboat/barge industries were companies already have programs, even though there is no rule requiring them to do so. 4.2.8 Other Considerations Even if crew are obtaining sufficient sleep, there are still factors related to the work schedule and operations, such as working away from home and during the nighttime (circadian low of alertness) that should be considered in relation to overall health, well-being, and safety. Com- pared to other transportation sectors, there appears to be much less turnover in crew, which makes it particularly important for maintaining the health and well-being of crew over their careers, which could provide savings in healthcare and lost work time. Given this, it could be beneficial for companies to monitor the health of their workers over their careers. One aspect of the inland waterway industry that is important to take into consideration is that schedules are in general very regular. Unless there are some unforeseen circumstances, schedules remain fairly static. This allows management and crew to plan accordingly. For instance, when there are unforeseen circumstances and a crew member works longer than planned or misses a sleep episode; basic policies and procedures would ideally be in place to mitigate the risks associ- ated with these events. Another relatively unique aspect of the schedules used in this industry is the number of days worked without a full 24+ hours off. This practice is most common in industries where travel to and from the work place is challenging, for example, maritime, remote mining, or offshore oil rigs. Each of these environments provides its own challenges and benefits in regard to optimizing schedules and balancing work and rest. While the use of 14- to 28-day rotations are common for some sectors of the tug/towboat/barge industry, the 12:12 schedule is also used and on this schedule, crew typically sleep at home daily. There is a need to monitor sleep and the buildup of fatigue while on these 12:12 schedules, particularly in the context of seasonal work where there is a benefit for both companies and crew to work as much as possible in the limited time avail- able. The research team did some modeling of these schedules and the findings are presented in Section 3.3.4. It is also important not to jump to the conclusion that this type of schedule is automatically of higher risk than other split schedules where crew work for 30 consecutive days, since 30 days on a night shift might allow for greater circadian adaptation and therefore better sleep during the day and less fatigue during work. The research team suggests the need for fur- ther research on the impact of this type of schedule in the tug/towboat/barge industry. 4.2.9 New Technologies An area for future development is likely to be the use of modern self-monitoring and cloud- based technologies that are now available for tracking physical activity, sleep, and fatigue. These technologies could be used to provide feedback to crew members about the status of their fatigue level and measures that should be taken to reduce and eliminate fatigue. 4.2.10 Why Are Some Practices Not Included? There are other possible practices that were considered but that are not included in this compendium.
96 Enhancing Sleep Efficiency on Vessels in the Tug/Towboat/Barge Industry There is a multitude of other new technologies available to monitor fatigue/alertness or administer bright light, etc. While many of these technologies show promise, there is not neces- sarily a clear consensus on whether most of these devices/technologies are effective in improving sleep and reducing risk. Because of this, the research team has not included them in the best practices. This does not mean, however, that in the future with sufficient data that these tech- nologies will not prove to be beneficial. Nor should this report deter companies from trying new technologies, but rather they should understand that they should not ârelyâ on these devices to safeguard them from the effects of poor sleep or remove the underlying causes of poor sleep. 4.3 Concluding Remarks The best practices put forward in this report synthesize the findings of the research conducted by the research team in the tug/towboat/barge industry over the past 7 years and their broad experience in other areas of sleep and circadian research. While they are comprehensive, there is still considerable work required to bring them to practice within the tug/towboat/barge industry and to determine which best practices significantly improve sleep and reduce fatigue.