One year into his 5-year term as a Member of the National Transportation Safety Board (NTSB), the Honorable Mark R. Rosekind, PhD, is drawing on all of the skills he has honed throughout his career to make progress on issues surrounding safety and fatigue. Just as the FBI, DEA, and USPS have their “Most Wanted” lists, so does the NTSB. Its list identifies areas for transportation safety improvements, focusing on the factors most relevant to preventing accidents and saving lives.
Present on that list since its inception in 1990 is fatigue. “The issue has been on the NTSB’s radar for more than 20 years,” Rosekind says. During that time, the Board has identified fatigue as playing a role in accidents in every mode of transportation, making 200 safety recommendations related to human fatigue.
As the first Board Member with an expertise in sleep science, Rosekind is in a unique position to effect even greater change in this area. But for those who have worked with him, this comes as no surprise. His entire career has been focused in some way on concerns regarding fatigue and safety, and he was recently awarded the Mark O. Hatfield Public Policy Award from the American Academy of Sleep Medicine (AASM) in recognition of this work.
His experience has included positions in the academic, government, and corporate sectors, and his efforts have resulted in useful research and successful programs that have been adopted across many industries, from transportation to health care. Now, he is able to draw on these experiences when analyzing accidents and advocating for safety.
“The part I’ve always enjoyed [about sleep science and sleep medicine] is working with real people to make a difference. While I’ve done research and work within sleep medicine areas, the bigger arena I’ve focused on has been in the area of safety in 24/7 environments where sleep and fatigue factors are relevant,” says Rosekind.
Although the topic is specific, the applications are broad and impact many types of people on multiple levels. An effort to reduce sleepiness and improve safety must involve education and action. Messages and programs must be clear, specific, consistent, persistent, and relevant.
“There are many barriers to change. You have to start by getting people educated. You’ve got to show them this is an issue that’s relevant and there is a benefit involved. And then you’ve got to be persistent because there are a lot of groups, barriers, and inertia to overcome before we can see change occur,” Rosekind says.
THE BIGGEST CHALLENGE
Mark R. Rosekind, PhD, was nominated by President Obama and confirmed by the US Senate as the 40th Member of the National Transportation Safety Board.
One of the biggest challenges to combating fatigue is a lack of knowledge regarding sleep, sleep disorders, and the negative impact fatigue can have on performance and health, a lesson Rosekind learned early from Dr William Dement. Considered the father of modern sleep medicine, William C. Dement, MD, PhD, is a professor of Psychiatry and Behavioral Science and director of the Sleep Center at the Stanford University School of Medicine who believes that education is the biggest issue facing sleep medicine today.
“Nobody seems to have an understanding of the role of sleep because it hasn’t penetrated the mainstream curriculum,” Dement says. “People need to be as smart about sleep and sleep disorders as they are about diet and exercise,” Rosekind quotes Dement from the early 1970s.
The two met at that time when Rosekind took Dement’s famous “Sleep and Dreams” course at Stanford as a sophomore undergraduate student. Dement was just then starting the first sleep clinic, and Rosekind was drawn to a new field in which so little was known and yet it represented a large portion of how humans spend their time.
“It’s an old story that still holds [true]—almost 40 years later, people are still generally ignorant about sleep, its value, and the dangers of sleep disorders,” Rosekind says. Having adopted the mantra of his mentor regarding the importance of education, Rosekind maintains it as a top priority and has contributed to efforts to extend knowledge to general and specific audiences.
EDUCATION IS KEY
While at the NASA Ames Research Center, located in Moffett Field, Calif, Rosekind directed the Fatigue Countermeasures Program and was chief of the Aviation Operations Branch in the Flight Management and Human Factors Division. In this role, he led the group that completed real-world research on aviation safety, publishing a now-famous study giving pilots planned rest in the cockpit. The team studied pilots at 41,000 feet during actual flights and showed that a 26-minute nap improved performance by 34% and alertness by 54%.1
Dr Mark R. Rosekind’s position on the National Transportation Safety Board increases his capacity to influence public policy related to fatigue.
David Dinges, PhD, chief of the Division of Sleep and Chronobiology in the Department of Psychiatry at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, worked with Rosekind at this time. “Throughout the 1990s, we conducted research evaluating alertness on the flight deck in large commercial airplanes. We studied the factors that influence pilot fatigue, ranging from understanding sleep disorders to the schedules pilots fly. We looked at ways to increase their sleep time and minimize their sleepiness and fatigue on the job, which resulted in a number of major technical reports and publications during that time,” Dinges says.
Building on his NASA research, Rosekind later developed a comprehensive fatigue management program that showed documented success in real-world operations. Rosekind was the first to demonstrate the effective results of a fatigue management program through a study conducted by his former consulting company, Alertness Solutions (founded in Cupertino, Calif, after Rosekind left NASA), in conjunction with JetBlue Airways.
“We took a group of pilots, collected a baseline, and then implemented a full program of education and alertness strategies, teaching them about sleep disorders, changing their schedules, and then again collecting in-flight measures that showed how much it improved sleep and performance during actual flight operations,” Rosekind says.
With an emphasis on sleep, sleep disorders, and strategies for ensuring adequate sleep, the program eventually evolved into an education and training program applicable across industries, including other modes of transportation and settings such as health care and law enforcement.
THE BAR IS RISING
While focused on safety-sensitive 24/7 work environments, research shows that education and fatigue management can result in better alertness, improved performance, and, subsequently, greater safety. At the NTSB, Rosekind has greater leverage with which he can deliver that message and potentially influence public policy and behavior.
Rosekind was nominated by President Obama and confirmed by the US Senate as the 40th Member of the Board, a full-time position based in Washington, DC. “As a Member of the NTSB, Dr Rosekind is now in a position to inform investigations into accidents using his knowledge of the science that underlies sleep and alertness, training people who are not sleep experts to understand the criticality of sleep and bringing that message to a larger policy audience in Washington,” Dinges says.
As a Member of the National Transportation Safety Board, Mark R. Rosekind, PhD, is part of the team that makes recommendations to the FAA regarding pilot fatigue. Here, Rosekind is pictured with an orange flight recorder, commonly referred to as a “black box.”
The NTSB is charged with determining the probable cause of transportation accidents and making recommendations to prevent their recurrence. The Board’s purview covers all modes of transportation, including aviation, highway, marine, pipeline, rail, and hazardous materials accidents. Since its creation in 1967, the Board has investigated more than 130,000 accidents and made more than 13,000 safety recommendations, of which 82% have been accepted.
“It’s exciting [to be on the Board] because the NTSB makes recommendations at very high levels. I’m not here to be a fatigue expert but as a Board Member addressing all modes of transportation and all the issues we face. But how can I leverage my expertise to ‘raise the bar’ in relation to fatigue issues that come before the Board?” Rosekind asks.
“Raising the bar” is a directive from NTSB Board Chairman Deborah Hersman, who challenges each of the Board Members to do just that wherever possible. Rosekind notes the bar regarding fatigue is already high at the Board, where he has seen a concerted effort over many years to improve what is already a world-leading agency. “Our professional investigators continue to get better and better at identifying fatigue issues in an accident, and our recommendations over the past year break the status quo,” Rosekind says.
One of those with a big potential impact is a recommendation made to the FAA to review and revise its policy on pilots and the use of sleeping pills for insomnia. If history is any indication, recommendations related to fatigue will continue to be issued by the Board over the coming years.
RELEVANCE IS KEY
The best way to take advantage of these opportunities, according to Rosekind, is to highlight relevance along with education (and persistence). “While getting people educated is important, it’s not enough. You’ve got to show the relevance of paying attention to sleep,” Rosekind says.
This means using data and strategies that are applicable to the specific industry or individual. If it’s an operational group, Rosekind focuses on safety; if it’s physicians, his angle is health; for other groups, it may be about performance or productivity. Once people understand the relevance and potential benefit, support is easier to garner.
Rosekind applies the same philosophy to sleep medicine physicians, who, he believes, are agents of change in this evolution. To help them see the relevance, he asks them, during presentations, to consider what their patients do outside the doctor’s office. Does knowing that the patient flies a jet or operates a semi impact the physician’s strategy for treatment and compliance? How should it?
Physicians, in turn, can ask those same questions of their patients and educate the public about the importance of sleep. “Every contact that a sleep medicine physician has with a patient, their family, or the public is a chance to raise the level of education and appreciation for the relevance of these issues. Because the field has grown, there are many more opportunities to get this information out there,” Rosekind says, citing consults with individual patients and visits to children’s schools as examples.
THE PRESSURE IS ON
As Rosekind gets people both internal and external to the field to consider some of the harder questions, his influence on public policy expands. This work caught the eye of the Nominating Committee and Board of Directors of the AASM, who awarded Rosekind its Mark O. Hatfield Public Policy Award this year. The award honors individuals in the field of sleep medicine who have worked to develop public policy that positively affects the healthy sleep of all Americans.
The Nominating Committee accepts nominations and the association’s Board of Directors approves the recipients.
“Rosekind is a great spokesperson for the field and was recognized for advocating for sleep medicine and raising the level of consciousness with regard to the importance of sleep,” says Nancy Collop, MD, AASM president and director of the Emory Sleep Center at the Emory University School of Medicine in Atlanta.
Most sleep experts agree: we are a tired society. As technology makes the world seem to spin faster, we are likely to become more tired. Without proper education about the importance of adequate sleep, fatigue will continue to be a serious safety issue. But, with the first sleep scientist as a Board Member at the NTSB, a smart focus on safety, education, effective recommendations, and persistent efforts creates the opportunity for good sleep to make travel safer for everyone.
Renee Diiulio is a freelance writer based in Manhattan Beach, Calif. She can be reached at [email protected].
REFERENCE
- Rosekind MR, Graeber RC, Dinges DF, et al. Crew Factors in Flight Operations IX: Effects of Planned Cockpit Rest on Crew Performance and Alertness in Long Haul Operations (NASA Technical Memorandum 108839). Moffett Field, Calif: NASA Ames Research Center; 1994.
