3.1 Employer Programs

Overall Effectiveness Concerns: This countermeasure has not been systematically examined. There are insufficient evaluation data available to conclude that the countermeasure is effective.

Drowsy driving is closely related to a person’s employment. In 2008 the National Sleep Foundation conducted a survey of 1,000 U.S. residents who were employed full time. Those who work 50 or more hours per week were three times as likely to report driving drowsy on a weekly basis compared to those who work 30 to 40 hours per week (Swanson et al., 2012).

Shift workers are one employment group at high risk for drowsy-driving crashes. Shift workers include people who work long or irregular hours or who work at night, including many LEOs (Stutts et al., 2005, Strategy D6). Another at-risk group for drowsy driving crashes is medical interns, who frequently work extended shifts of 24 hours or more. Barger et al. (2005) collected monthly reports from 2,737 interns. Interns were 2.3 times more likely to report a crash and 5.9 times more likely to report a near miss after an extended shift than a shorter shift. Each extended shift in a month increased the monthly risk of a crash during the commute from work by 16%. In one driving simulator study, anesthesiology residents were found to have significant increases in reaction times, attention lapses, impairments in speed and lane position maintenance, and increased risk of collisions after six consecutive night shifts (Huffmyer et al., 2016).

Other shift workers such are commercial drivers and drivers in emergency medical services (EMS) are also vulnerable to drowsiness-related driving impairments. One study of 96 truck drivers found that safety critical driving events were associated with a sleep pattern of shorter sleep duration, less sleep between 1 a.m. to 5 a.m., and sleep in the early stages of the non-work period preceding the work-related driving (Chen et al., 2016).

The effect of scheduled naps on alleviating fatigue in EMS personnel was studied in a review and meta-analysis of 13 articles (Martin-Gill, Barger, et al., 2018). Though direct measures of driving were not included, general measures of acute fatigue and performance on the psychomotor vigilance test were studied. Nap durations in 12 articles varied from 15 minutes to 2 hours; one study did not include duration. Among fatigue related outcomes, naps had a moderate significant effect on both end-of-shift sleepiness and difference between start- and end-of-shift sleepiness. Effects on reaction times were not statistically significant (Martin-Gill, Barger, et al., 2018). This study of napping as a countermeasure was part of a larger Fatigue in EMS Project by NHTSA that was aimed at providing evidence-based guidelines to manage fatigue in EMS personnel. Other recommendations by a NHTSA expert panel in this project include the use of sleepiness survey instruments to measure and monitor fatigue, access to caffeine as a countermeasure (although they cautioned against excessive caffeine consumption), and education and training of EMS personnel to prevent and mitigate fatigue-related risks (Patterson, Higgins, et al., 2018; Martin-Gill, Higgins, et al., 2018). The authors performed a systematic review of existing survey instruments for measuring fatigue and concluded that currently there exists limited evidence of instrument reliability and validity (Patterson, Weaver, et al., 2018).

There are many ways States can work with employers to address drowsy driving. In general, work culture, adherence to hours of service rules, and employer-provided interventions and education can help address drowsy driving. The National Sleep Foundation provides material for publicizing the Drowsy Driving Prevention Week and information on managing shift work schedules (www.sleepfoundation.org/shift-work/content/tips-help-manage-your-shift-work-schedule). NHTSA and the National Center on Sleep Disorders Research have produced a comprehensive workplace education program for shift workers. It includes information on sleep habits in general and drowsy driving in particular. Program material that includes a video, posters, brochures for workers and their families, tip cards, a PowerPoint training session, and an administrator’s guide are available at https://icsw.nhtsa.gov/people/injury/drowsy_­driving1/human/drows_driving/. Employer programs can also include medical condition testing/education. See Section 3.2 for more information about medical conditions, medications, and drowsy driving.

Use: How many employers use the NHTSA/NCSDR program is not known.

Effectiveness: The NHTSA/NCSDR program was tested by more than 20 U.S. companies and was well received by workers and management. It has not been evaluated further (Stutts et al., 2005, Strategy D3). No other employer drowsy driving program has been evaluated.

Costs: Since a comprehensive program is available at no cost, program costs will consist only of material production and employer time for training.

Time to implement: An employer program can be implemented within 3 months.

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