Medical Fitness for Duty: NTSB Most Wanted List

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Each year, the National Transportation Safety Board (NTSB) issues their list of areas where safety can be improved. So what does “Medical Fitness for Duty” mean? This may not sound familiar, but essentially, this covers medical certification for public vehicle operators – including commercial pilots, railroad engineers, commercial drivers, and commercial ship captains.

Are there regulations to ensure that safety-critical personnel such as public vehicle operators are medically fit for duty?  Yes, but they can and should be improved.

The topic — “Require Medical Fitness for Duty” — is one of those areas that we sometimes assume is carefully, consistently and comprehensively regulated. Unfortunately, tragic events in transportation prove that we can do better.

  • The NTSB notes two train crashes that highlight this problem. In both examples, the engineers lacked the ability to see and interpret signals due to deficient color vision.
  • In 2002, a FedEx Boeing 727 flew into the ground because the pilot had a severe color vision deficiency. The deficiency made it difficult for him to correctly identify the color of approach lights warning that the aircraft was too low.
  • In 2013, an engineer operated his train at 82 mph in a 30 mph curve, killing four and injuring sixty-one. After the incident, his condition of sleep apnea was diagnosed and successfully treated.

According to the NTSB, “it has long been recognized that untreated or undiagnosed medical conditions pose a safety risk to the traveling public. However, medical certification for safety personnel varies across the modes of transportation.”

  • Medical certifications for railroad engineers are renewed every three years, but only cover vision and hearing standards.
  • The U.S. Coast Guard requires commercial captains to get comprehensive medical exams at regular intervals, but relies on mariners to self-report medical conditions.
  • The Federal Motor Carrier Safety Administration recently has required training and certification for health care providers who perform examinations, but there is no process to make sure that the recommended guidelines are followed. Healthcare providers who may not have any experience in prescribing medications are considered acceptable medical examiners.
  • Federal Aviation Regulations (FARs), promulgated by the FAA, define perhaps the strongest medical certification system, but the NTSB noted that “pilots are increasingly testing positive for over-the-counter sedating medications.”
  • The NTSB stated that it has found that sleep apnea has been a factor in multiple accidents, but most transportation modes still lack a complete screening process for this condition.

The positive news is that the NTSB has made recommendations for a comprehensive medical certification system for safety-critical transportation that affects all of us every day. They include reasonable, common sense suggestions to enhance safety.

This article is not meant to be a criticism of any specific group of those involved in safety critical transportation jobs. Most of those engaged in safety critical transportation perform their work safely. Rather, this is meant to raise awareness of an area that is very important for the public and those involved in safety critical transportation – medical fitness for duty.

The NTSB framed the issue well, “The goal is simple: ensure safety-critical professionals are medically fit for duty before they operate a vehicle.”

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