Consensus Statement: Fatigue and accidents in transport operations

IT IS THE CONSENSUS of an international group of scientists who study human performance, safety, and prevention of accidents associated with work schedules, night activity, and inadequate sleep that: 1 The 24 h society, with around the clock operational demands in all transport modes, challenges the powerful and vital need for sleep. Sleep, alertness, and performance are fundamentally linked to the 24 h biological clock. 2 The major causes of fatigue are: (a) the time of day of the transport operation (e.g. night/early morning), (b) a long duration of wakefulness, (c) inadequate sleep, (d) pathological sleepiness (sleep apnea, etc.), (e) prolonged work hours (not necessarily operating the vehicle). 3 Fatigue (sleepiness, tiredness) is the largest identifiable and preventable cause of accidents in transport operations (between 15 and 20% of all accidents), surpassing that of alcohol or drug related incidents in all modes of transportation. Official statistics often underestimate this contribution. 4 Underestimation of the impact of fatigue can lead to the under utilization of important countermeasures. 5 Public and environmental safety, health, and productivity are compromised by fatigue and sleepiness, with substantial financial costs to individuals and society. 6 Fatigue related risk may be reduced through a variety of interventions, that include education (about sleep, the biological clock, sleep disorders, fatigue countermeasures), improved scheduling of work hours, and the judicial use of strategies and technologies. IN THE INTEREST OF SAFETY, HEALTH, AND PRODUCTIVITY, we recommend the following: • establish regulation, practice, and policy based on scientific evidence regarding fatigue, sleep, and accident risk; • share the responsibility for reducing fatigue-related risks amongst government, industry, the work force, the public, and the scientific community; • promote education on the importance of sleep, the biological clock, the adverse effects of sleep loss, sleep disorders, and the benefits of fatigue countermeasures; • develop standard reporting criteria that accurately reflect the occurrence of fatigue and sleepiness-related accidents; • implement validated fatigue management strategies, initiate research to identify new solutions, and monitor innovative programs worldwide for possible adoption; • incorporate identification of medical conditions causing sleepiness as a routine part of license examinations; • determine why the strategies designed to prevent fatigue-related accidents are not implemented and ensure that these barriers are overcome; • ensure that remuneration does not encourage unsafe work practices and is not an incentive to violate regulations; • evaluate the effects of changing policies, guidelines, and regulations on safety and the quality of working and family life. ‘Fatigue is here used as a synonym for drowsiness, sleepiness, and tiredness. ‘Transport operations’ refer to commercial operations on the road, in the air, at sea and on railways. Many of the points above are applicable to noncommercial means of transportation. Compiled by: Dr Torbjörn Åkerstedt (IPM & Karolinska institutet, Box 230, 17177 Stockholm. E-mail: torbjorn.akerstedt@ipm.ki.se). Endorsed by J. Arendt, W. Cassel, D. Dinges, L. Englund, L. Findley, S. Folkard, C. George, M. Gillberg, C. Guilleminault, M. Hack, P-O. Haraldsson, L. Hartley, J. Hetta, J. Horne, G. Kecklund, J. Krieger, U. Landström, A. Nicholson, A. Pack, D. Parkes, M. Partinen, P. Philip, L. Reyner, M. Rosekind, A. Samel, M. Spencer, J. Zulley.