Under the broad topic of “require medical fitness for duty,” the National Transportation Safety Board (NTSB) has identified obstructive sleep apnea diagnosis and treatment as on its “most wanted list” of safety advocacy priorities for 2015.

In its explanation, the NTSB states: “The aviation medical certification system may be the most robust, but pilots are increasingly testing positive for over-the-counter sedating medications. Moreover, although the NTSB has found that obstructive sleep apnea has been a factor in multiple accidents, all transportation modes still lack a complete screening process for this condition….In the 2013 train derailment in Bronx, New York, the engineer’s sleep apnea was undiagnosed until the week following the derailment, despite many visits for occupational and personal health care. With a change in his work patterns, the combination of the untreated sleep apnea and fatigue from his disrupted sleep schedule led to his fatigue at the time of the accident. Since 2001, the NTSB has identified obstructive sleep apnea as a factor in at least nine accidents in four transportation modes.”

To mitigate the risk related to medical fitness, the NTSB has made recommendations for a comprehensive medical certification system for safety-critical transportation personnel, including “specific historical questions and physical examination procedures to identify applicants at high risk for sleep disorders.”

Strengthening commercial trucking safety is another top priority for the NTSB in 2015, and it also involves the industry better addressing sleepiness and fatigue. The NTSB states: “Regulators have taken initial steps by maintaining science-based hours of service rules and are in the process of rulemaking mandating electronic logging devices that can help assure that drivers are adequately rested. Other important rulemaking initiatives include requirements to screen drivers for obstructive sleep apnea, other potentially impairing medical conditions, and potentially impairing drugs.”

In the topic of “implement positive train control in 2015,” the NTSB also mentions the Bronx trail derailment, this time stating, “The train’s engineer had fallen asleep and failed to slow the train from over 82 miles per hour (mph) to the maximum authorized speed of 30 mph as it entered a curve.” The NTSB posits “positive train control” (PTC) as a mandated solution will prevent tragedies such as that one. “Positive Train Control (PTC) can stop many rail accidents before they happen….Each death, each injury, and each accident that PTC could have prevented, testifies to the vital importance of implementing PTC now.”