Group of second graders, somebody whispers to the president , he stood up and he had to go. Heard, we discovered, that there was two plane crashes in new york. Lot outside bike a said stay , they right here, theyre good to speak to the pool. He did not want to scare the children but he did go into the cafeteriaas said there was a must rist attack and i return to washington. The door slammed and that the pentagon was hit. The National Transportation administration on driving it drowsy. The risk associated with sleepiness andddriving a walk and be done to address this issue. Good morning, welcome to the of the National Safety boardroom. Dangers to overcome the of Drowsy Driving. Me, dr jeff y joins collins. My thanks to all the panellist who will be giving their insight today. Driver must be awaketoconduct a vehicle safety. So Many Americans are on the road dangerously impaired by a lack of sleep. We know this is a serious problem, the current tip matesjust point at the of the iceberg. Driver tell us the contribute to 100,000 crashes annually, these are only police crashes. Some estimates put them over 1 million a year. Conservative as the mets say if are killed a ple year, other data say 5000. Due to Drowsy Driving, experts agree that the number of crashes and death is underestimated. Have a fatigue test. There is little or no Police Training in identifying drowsiness. Soft reporting is unreliable. Any resulting loss of life is preventable. It drowsy driver can be a deadly driver, even one night just losing two hours of sleep our ufficient to empower abilities, decisionmaking, ability and others can be reduced by 20 to 50 . You cannot react to the brake lights in front of us are not traffic light turning red. Fatigue alone can be deadly, it also multiplies the effects of others impairmentlike drugs, alcohol and destruction. Impairment form of may be exaggerated by a lack of sleep. Fatigue as dentified crashing in all transportation modes. Treatment of sleep disordersand scheduling policies for commercial and bus drivers. They people drive cars, operate personal vehicles. For most of us there are no hours of service or rules, we have to rely on our own experience and knowledge of fatigue. Personal experience is typically inaccurate. There was a collision at 8 30 they were driving from the hospital after 30 years of duty. Cnn said a north lane travelling against the set of traffic. She crashed against another vehicle pursuing one lane over, this vehicle was struck again by another car. One driver was fatally injured and the nurse was transported to hospital where she was she ted for her injuries, had fallen asleep. Should work night shifts for nine years and was familiar with the challenges of her schedule. The extended time since been awake contributed to have asleep at the wheel. Todays forum offers us an opportunity to concentrate on the problems of drivingand the solutions to mitigate the dangers of fatigue will talk about what we know and what we dont. Will examine medical such as obstructing sleep disorders, will hear about the challenges of young drivers, we will discuss the regular work and schedules. Even for lifesaving services, will hear about strategies to risk of Drowsy Driving. Just as importantly, will provide a public setting to examine the dangers of Drowsy Driving. For awake driving to be the expected norm. For the awareness and publication must be a law. Forum is for others, it is for nurses doctors, life osman agents, security guards driving home after the nightshift. Starting to tudent, learn this by the glow of a horn when hes going to an exam. For all of us that have ever with too little sleep. It crashed and happen in the blink of an eye. This is one step to a National Awakening of Drowsy Driving. I will turn it to my colleagues, who has done an outstanding job in organising this forum. For safety purposes please note the nearest emergency exit. To enter this and that this also emerges in those on the sides of the stage, please silence your electronic devices. Todays forum gets the heart of several topics of Drowsy Driving, will begin the introduction with the scope of the problem. Also have panels concerning nervous drivers, young advocates from the National Organisation for youth safety. After lunch, will have panels discussing health issues, in vehicle on roadway factors. Day will plan of the address countermeasures. Each panel will open with presentations by panellist and a question and answer period. Our staff and panellist, as well as the agenda, avaiilable the firm website. Early next week, presentations provided by our speakers and archive of the website will be available. Attendees are others which wish to submit written comments to include in a forum may do so until november 7. Permissions to address the must be submitted electronically. For those of you joining us in the Conference Center there are variety of lunch options, to state the escalators while floor and walk straight ahead. The agenda is available on lobby and website. We appreciate your cooperation in helping us keep our schedule during the power brakes. One note to our presenters, we will have power photos in the after the afternoon break. There will also be a group we break for lunch. Now turn to first church, mr dennis collins. When speaking please push the button of the microphone, a green light shows it is on. The first panel covers and production to the problem, a at doctor david unit for rector of the instrumental psychiatry at the university of pennsylvania. Brian tefft. You for morning, thank inviting me to this meeting. Im going to start with what terrifically dangerous to drive. The first thing to remind those listening and looking at these near as we hat as know, all animals need to sleep, he must i know exception. Sleep is an essential part of our survival and we have to do it on a daily basis. To achieve Healthy Sleepand an adequate duration so we dont have drowsiness or sleepiness during the data. This slide is just a reminder when we do not receive fall ate sleep we tend to asleep very rapidly. The graph going down on the left shows that alongour away the more rapidly will fall more rapid we a transition of sleep. On the right issues the depth and intensity of that sleep, this is an inherent part of the sleep system pretending to the need he brain from to sleep, other speakers will talk about what happens to drowsiness when you do not receive that depth of sleep. People obtain enough sleep . The only thing i say here is what we now know in our modern lifestyle is a part of the population, here on the yellow bars on the right, do not achieve even seven hours of sleep a night. Points out that once segments of the publishing and sleeping less than seven hours an increase in accident well as sleepiness as obesity, diabetes and others. There are significant healthy and critical problems with a lack of sleep. Graph on the right reminds us that part of that, a major part of why people do not get enough sleep, is work and travel. Extra time at work, extra time to get up early to get to work. May seem like normal routines they have become so problematic that they are one ng up the time though should spend sleeping. Forces us to comepress our period o a shorter during the work, week and people do a desperate effort during the weekend, that recovery is usually inadequate. Chronic sleep restriction which is how it is referred to is an inherent part of modern lifestyle for many people. That is why one of the sources of problems are. We know this is a current in the brain, many people think it is okay to drive drowsy. Is somehow has nothing to do with biology and it will yourself to overcome it. Often people away with it without crashing, so they believe it is okay and they will be safe because you have a good intention. This is just a brain scan showing that major areas of the part in blue, the frontal of the brain, the associative part of the brain. Showed changes in activityin the brain that are consistent with the brain falling asleep while we try to stay awake and drive. There is a terrific change we cannot even control, slapping ourselves in the face of chewing gum, singing or the radio would not prevent this from occurring. If it has prevented is no more than a second or two, it does have a lasting benefit. Sleep, in needs obviously you cannot sleep and drive at the same time. The hallmark features the following asleep driving is the eyelids will close. It is the muscle of our eyelids lower leaves tone. Makes our eyes blink, it also causes muscle relaxation. Come down, ids will is a truck stimulator, this is not a real experience. Asleep and the head kicks back and the eyelids close. The eyeball s, rolls back. He concedes he almost ran off the road in this stimulator. Sami people have done this in their lives that we have no trouble to recognise it. We do not appreciate how staggeringly dangerous this is. Sheer is another example other to do is click y on it and will get it going. This young lady is working on a has lance test car but she been sleep deprived. The grass down below shows you that the open time, the one on the left shows you that initially she works okay that ill go the lapses of attention in eyelide. Ease on the right, she may be bored critical work for hours. Not sleeping you enough, boredom, driving with what youre erested looking at but you can stay awake. Sleepiness is the pressure of the brain to sleep. We know that among all the test that they have been looked at, of the on and alertness numberone effects of sleepiness. Effect that more than memorising or others. Best illustrated by this heartbeat, there actually are pressing they a button. Each quick heartbeat is a fast see tion time, you can there is nothing wrong. One, u click on the top and shutter of. Here is the drowsy driver equivalent, this side of driving to is fine, as they go having these art long lapses. Down, s your eyelids youre not responding. Now youre back again, no, you go again. Click on that and look on the right, we know with the brain is but on the right you can see the instability of these response times on the sleepy driver. While the alert driver is steady as you go. Are a great risk, you really should not be behind a wheel, issued the love, get some sleep and rest. This is a great risk of driving, just because he get away with it for a mile of two does not mean you will have an uncontrolled sleep attack in the next half hour. There were becoming more and more repeated and severe. This just illustrates when you do not have these lapses. As we take slip away and move into six hours, likely would no sleep at all you see this terrific dispersion of sleep. Many more lapses and they get longer. Theyre completely unpredictable. The brain does this against your will at a time when you suddenly realise, my god, i was just awake at night just slept last period of time. You can be operating a Motor Vehicle while that happens. It takes no more than a two second laps of attention as 60 mph, with a 4 that is just t. Enough to be out of line and of road in four seconds. It takes very little from these put in great to danger. This is not as highway phenomenon, is not just a long drive. Slower driving a reaction times are occurring in people hall have not had adequate sleep in the city. They happen in washington dc. The fundraising is covering all over the metropolitan area. Know the highrisk events. This is just an illustration of of this mics drowsiness. You do not have any of these lapses from drowsiness as youre getting normal sleep at night. As a go at night without sleep those lapses increase. If you went through a second night without sleep they go even higher. The same habits if youre only getting four or five or six hours. Get progressively worse everyday. Below using a segment and you can see the higher rate of related hicle crashes to falling asleep. It does not mean you are safe middle of the day if you are not slept the day before. You can have a crush at any time of the day, but this to the dynamic from one study in North Carolina of people falling asleep in a particular high risk in the night and the morning. Enough to t powerful override the pressure of sleep. Age g adult males until the of mid40s. In the udy done lavatory. On the right is how people felt about the sleepiness. What you should see, please that,and the middle graph is performances are getting worse across time. But our sense of how we are doing is not changing. This means you cannot actually the whole dangers you are, year to Pay Attention to your behaviour. If you are just discovering your hip is falling over, your eyes are closing uncontrollably, you need to get off the road. You dont need to slap yourself get the radio on, you to get off the road. One talent is, can you do safely in most highways . Best is prevention, do not get road with bad sleep. Effectively to make sure. This just makes the point that even when we work at night and are awake in the daytime is all were getting eight hours, we are a greater risk for the lapses of sleep. There is no safety here depending on the time. When you work you are risk whenever you have inadequate sleep. Are three ee here different graphs. What you can see is whether youre a sleep deprived whether have an obstructive sleep, where the red line on the right, youre an Airline Pilot and your flank at night you have a lower Level Performance would deteriorate more rapidly. If you play a bit you can perform better. Time on task problem with driving, you can rapidly deteriorate. Understand how that is, the brain cannot do that last task when it has not had adequate sleep. There are very serious injuries because the driver does not action, you fall asleep so you no longer monitoring. You dont engage in the corrective action. Is the good news, this is study from walter reed. Were going to restrict people to 3 night at the lavatory. Before that, the more you sleep ahead of time the more you can tolerate the effects of any restrictions on your sleep period being forced to get up middle of the night, to pick up a baby or to go to work. Treat sleep as a viable item in your life. Really, there are seven messages im sending on this, of brain is the organ behaviour and needs Healthy Sleep to prevent Drowsy Driving. There is no question about it, hasnt of studies support this statement. It is unequivocal and we have to penetrate this message to the public and everybody who drives, whether professionally going to pick up children. The sleep goes into microscopes and create slower reaction times and these pose a very serious threat. Sleepiness increase letters get frequent and longer duration. Not going to get any better and less get off the sleep or take of cancer can measure. Two seconds ses of is enough in resulting due being completely out of line. It is very little here to have a catastrophe. Such crashes often involve injury, fidelity very severe. Even with her frigate letters of attention it can cause problems and congested traffic, eeven if youre not frankly falling asleep, if youre sleeping the morning that all gay controls in the afternoon. Unable to people are judge people. It is essential and people do not bribe they have not slept enough hours. You should plan drivingbased hoover slid the most, if you absolutely must drive overnight you ng somebody else with not let you and to the ody asleep because driver will go to sleep. That is it from me. Our next speaker for this channel be brian tefft. I have been asked today to talk about the impact of road ht are driving on the and traffic crashes. I will be talking about recent driving on to drowsy the road, both in terms of drivers actually falling asleep as well ey are driving as drivers who are highly fatigued and not asleep. Also be talking aboutstudies of actual motorvehicle crashes that is proportion of crashes. In National Surveys that have national by the highway administration. The motoran public have been asked whether survey respond, if they fall asleep or not at why they were driving. Consistently all of the studies find that about 2 5 americans report having fallen asleep while they were drivingat some point in their lives. Persistently at anything has at this, around 11 admit to having doing so in the last year. Around 4 agree that they have fallen asleep at the wheel in the last 30 days. They are likely to be studies orted because have shown that a person has to 2 to 4 ep for average minutes before there are more likely than not. The e are underestimates of the people. We do driving behaviours and driving attitudes, we had people and we asked them whilst the latter you had a hard time keeping your eyes open. More than a quarter of american drivers consistently report having done that list was in the past monthand 2 reported probably often or regularly. Famous official study shows that around 2. 4 of fatal of its injury 1. 2 involves drowsy driver. That data from 2009. Their likely being substantial underestimate of the problem. First, we do not have a fatigue difficult t is very for police man to know whether the driver was drowsy or not. The driver who is alert and and are hand andable to talk about may not be willing that mit to the police there were drowsy. Again, when is to be out to the are minutes when they likely to realise. In the case of the more severe finishing d crashes in his casualties, it is very difficult for the police to entertain what happened. Another more subtleaand more insidious limitation of this that in many states before and Police Officer use happened in a at crash. That contain a series of a driver es to know if was drowsy, iimpaired by angry, if he was emotional, distracted, etc. Officer with an indicate if it ever was drowsy would be by checking a box. They would not check the address box. But fortunately, this creates in interpreting the data. The way that it would be driver was not e weight would be indicated that we dont know if the driver was drowsy or not, it is an empty box. I will be talking about if you that have l studies greater depth at data to estimate the number that involves driver drowsiness. Study will talk if the 100 car by the virginia institute. Instrumented900 vehicles in the in the rea, mostly virginia with legal cameras and other Data Collection equipment. Bells for a period of 12 to 30 months. When researchers manually reviewed if it is from crashes and request that always occurred, looking at the signatures of drowsiness. The eyelid dropping, the were able to estimate the level of thousands of drivers and estimated that of the crashes in involves moderate to severe driver drowsiness. The bulk of the driver is done into the race is not connected. Another study that took a totally different approach to by s problem was the study doctor james stutts. They gathered a sample of a crash in North Carolina, where the researchers was a reasonable entertainment and whether the driver was known to be drowsy are known not to be drowsy. This dad and others, they develop and statistical model that the likelihood of the driver being drowsy. The researchers applied this data from fatal clashes that happened nationwide. The estimated that as many as 15 of drivers in fatal crashes were drowsy. They call this and not conservative estimate. The national statisticshows of fatal crashes involve Drowsy Driving, these it 50 and they considered a conservative estimate. Another study is the national Motor Vehicle crash survey, this is a study that used multidisciplinary areas to investigate a look at the written factors of 5000 crashes nationwide. Some of them were severe enough that the emergency medical assistance was dispatched to the scene. This study has if early assessment of private fatigue. This does not include the report from the police but anybody from the drivers as well as the drivers families and employers and others, whether they were fatigued at the time of the crash. The sleep habits, the work schedule, medications they were taking. Side of the video proof. One important limitation of this study is that it only looks at crashes that happened between 6 am in midnight. If you are study crashes midnight and 6 am way as you make the same price driving is significantly this study, excluding the parts were Drowsy Driving is not included, some of them were actually asleep at the time of the crash and an 5 of them were despite the bin asleep, there were judged to be fatigued. A third of crashes, around 29 were unable to assess whether a driver was fatigued or not. For aggregating this dad are the crashes, it was suggested as many as 2 involve a driver and an actually asleep additional 10 involves a actually o was not sleep but fatigued. This is only out of the 60 of crashes. The last of the old talk about did for my y that i employer. This was a study that used the national Highway Safety administration, crashworthiness that the system which is a in which crashes motor vehicl. Look at that data from 79 to 2000 made was surprised the 47,997 crashes which involved 80,000 vehicles. Fatigued, youre distracted or other by investigators that interview drivers and in this study the estimated that 2 of the were actually drowsy, however, researchers also not able to 5 were assess if he was drowsy or not. This devastation be the driver not being drowsy and the investigators not being able to make a determination as important. Because of this i was able to use an statistical methodto proportion of the drivers. He likely was drowsy and just amputation is a message in which to build a model they use that those related to the probability that investigators are not able to make a determination. Using this model, they identify either were and drivers drowsiness is actually now on, the most similar to the cases that youre looking at you make a random draw from distribution of this data. They know it is estimated in cases where investigators were not able to assess. That by the way if the message that the national highway and since ction has used 2001. Driver lly, in 45 cases drowsiness was unknown. 7 of the crashes involved at least one drowsy driver. Among the most severe crashes, those in which an occupant was hospitalised as a result of the injuries sustained in the crash much estimate that is as present they were drowsy, 13 involved try the driver. Terms of fatal crashes, we estimated 12 of drivers involved in those pressures were drowsy. A 17 involved at least one drowsy driver. Based on the number of people year that would implyconservatively over the 5000 people are killed every year by crashes. Of comments and observations, these studies collectively, there is no the le study can provide definitive answer, however, there is this reasonable convergence across multiple studies that the proportion involving a drowsy driver is much higher as reflected in the official national statistic. See uple of the trends we in this data. Of the e representative smaller samples. Were also seen other studies best entertainment and drowsiness goes to the plant interviews and they have the highest proportion of crashes. Finally, although it is probably unrealistic to expect of id entertainment drowsiness in better than collected by Police Officers scene of the t the crash. On the pad in front it is really important to be able to distinguish between crashes where the investigator is determined that the driver was not drowsy versus crashes where they cannot make a determination. A distinction that is missing. To summarise, 2 5 drivers report having fallen asleep at one point in their lives. 11 recognised in that in the last year, 4 recognised the net in the last month. That is consistent by multiple studies and different organisations. For the reasons we spoke about still significant under estimate of the problem of drunken drivers. Involve of crashes Drowsy Driving. That is a substantial study with te, the data so much higher case. And the highend it is as many as 24 of crashes i involved with Drowsy Driving. Tends to suggest on t it is on the high end the most severe crashes. Thank you. This is not something they can be affected by will, you also mentioned some things that were not affected in combating fatigue. And wondering if you could tell us in simple general terms, is effective in combating in fatigue. I made a specific point about Healthy Sleep. You will hear about what is Healthy Sleep. It is occurring not too far before the driving episode, one night dequately and then driving two days after sleep would not work. There is a commonsense that caffeine does alert you, by a ts not forget that is substitute for sleep. Of t is just forcing errors to be more alert, molecules that produce sleep. If the sleep pressure is too high, when you have chronically and have a high sleep pressure, catherine cannot stop it. It cannot stop drowsiness. It also doesnt last a day, you take a couple of coffee and depends how much caffeine, what what your or sensitivity is. Last more than three or four hours at most. To have to sleep, keep you going indefinitely but it is probably way the people attempt to cope with sleepiness when they have to drive. It is just a very limited countermeasure. Stopping and exercising, stopping and taking a break is not ful but it will substitute for sleep. Here are options pretty limited. I will leave the medical options to the physicians. I am also wondering if you could speak briefly on the nature of individual differences with respect to fatigue and sleep. What effect have a personal what problem d does that oppose the User Research . Everybody becomes impaired, it just takes some people longer than others. Scientifically we do not the basis for it, those people that take longer to be impaired and not the majority, they are a minority. Sure that they are always the same for them. We do not understand what it isthat makes them less vulnerable to sleep loss. Once you are awake too long everybody will become impaired. Do not feel it, and this is a key point, it does not mean youre not suffering inattention lapses. Wondering if and you had a chance to see anything that had been released more recently . Is a lesson data that said in official publications. Drowsy stimates for driving, those sstatistics are based on data is collected and presently are available to 2012. The most recently from 2012 shows that 1. 6 of drivers involved in fatal crashes in were believed to be drowsy or fatigued. What would you say is a the drowsy nd for driving data . In the official statistics there doesnt seem to be much if anything trend, the proportion of the official statistics may have decreased slightly in recent years. However, as i talked about in such a entation, that is vast underestimate that i would published in data those sources for evidence of a trend. I conducted that from 1999 to a 5000 with a sample of crashes each year, in the day that there was no evidence of increasing or decreasing trend in the proportion of crashes that involved drowsiness. In recent years, the raw number injuries and d deaths, nationwide, each year has decreased and that is a good thing. There r, i do not think is any evidence that drowsiness is increasing or decreasing. If we use the most conservative estimate that we have across any of the more solid studies of the proportion of crashes that involved Drowsy Driving apply that to 2012 data, whistle estimate than over 5000 people were killed in crashes that involved Drowsy Driving. Mentioned in your presentation, to look at alcohol for impairing driving. I am wondering if they could use the same technique on that at fatigue related crashes, if not what was your opinion be on that . It could be done, but i would only do that with a couple of the data from some studies that i referred to on my presentation. Both of those n studies researchers, of the police determination they distinguish if the driver was known to be attentive or if he was knowing to be drowsy. In data that is published annually the fatality analysis reporting system and the estimate system, the day on Drowsy Driving is only based on reports done on the field by Police Officers. In most cases i believe they do not make a distinction between knowing to be they could r whether not tell if he was drowsy or not. There is actually an indication were no ataif there contributing factors or whether the drivers condition at the the crash was unknown. The proportion in which they indicate his situation was even among low, crashes were, only one vehicle involved only one occupant and the driver was already deceased by the time they arrived. Even in those crashes, the only report that the drivers condition was unknown and one third of the time. Is 60 of the cases they contribute no factors. I want to comment on the notion of a prevalence changing. There is no question that the introduction of rumble strips and airbags might have made it safer or less likely to be lethal for somebody who drives drowsy. But it is unclear to me that there is evidence they have reduced Drowsy Driving. The message is do not engage in that behavior to begin with. And i think what they have done is try to other people from catastrophic runoff of the road. It is not clear to me that we have the evidence to suggest that they have really prevented Drowsy Driving, and the