PubMed · 14158688
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J A THOMSON, J A BOYLE, D R TILSTON, R G DAVIS. 1964-07-11. PRISONS 1963.. https://pubmed.ncbi.nlm.nih.gov/14158688/
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Sleep-disordered breathing and excessive sleepiness may be more common in commercial vehicle drivers than in the general population. The relative importance of factors causing excessive sleepiness and accidents in this population remains unclear. We measured the prevalence of excessive sleepiness and sleep-disordered breathing and assessed accident risk factors in 2,342 respondents to a questionnaire distributed to a random sample of 3,268 Australian commercial vehicle drivers and another 161 drivers among 244 invited to undergo polysomnography. More than half (59.6%) of drivers had sleep-disordered breathing and 15.8% had obstructive sleep apnea syndrome. Twenty-four percent of drivers had excessive sleepiness. Increasing sleepiness was related to an increased accident risk. The sleepiest 5% of drivers on the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire had an increased risk of an accident (odds ratio [OR] 1.91, p = 0.02 and OR 2.23, p < 0.01, respectively) and multiple accidents (OR 2.67, p < 0.01 and OR 2.39, p = 0.01), adjusted for established risk factors. There was an increased accident risk with narcotic analgesic use (OR 2.40, p < 0.01) and antihistamine use (OR 3.44, p = 0.04). Chronic excessive sleepiness and sleep-disordered breathing are common in Australian commercial vehicle drivers. Accident risk was related to increasing chronic sleepiness and antihistamine and narcotic analgesic use.
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Historically, safety has been subjected to a fragmented approach. In the past, every department has had its own responsibility towards safety, focusing either on working conditions, internal safety, external safety, rescue and emergency, public order or security. They each issued policy documents, which in their time were leading statements for elaboration and regulation. They also addressed safety issues with tools of various nature, often specifically developed within their domain. Due to a series of major accidents and disasters, the focus of attention is shifting from complying with quantitative risk standards towards intervention in primary operational processes, coping with systemic deficiencies and a more integrated assessment of safety in its societal context. In The Netherlands recognition of the importance of independent investigations has led to an expansion of this philosophy from the transport sector to other sectors. The philosophy now covers transport, industry, defense, natural disaster, environment and health and other major occurrences such as explosions, fires, and collapse of buildings or structures. In 2003 a multi-sector covering law will establish an independent safety board in The Netherlands. At a European level, mandatory investigation agencies are recognized as indispensable safety instruments for aviation, railways and the maritime sector, for which EU Directives are in place or being progressed [Transport accident and incident investigation in the European Union, European Transport Safety Council, ISBN 90-76024-10-3, Brussel, 2001]. Due to a series of major events, attention has been drawn to the consequences of disasters, highlighting the involvement of rescue and emergency services. They also have become subjected to investigative efforts, which in return, puts demands on investigation methodology. This paper comments on an evolutionary development in safety thinking and of safety boards, highlighting some consequences for strategic perspectives in a further development of independent accident investigation.