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IDENTIFYING AND MANAGING HUMAN FACTOR SPAD PRECURORS TO ADVANCE SAFETY

IDENTIFYING AND MANAGING HUMAN FACTOR SPAD PRECURORS TO ADVANCE SAFETY. Presented to International Rail Safety Conference by James McColgan Fatigue Management Solutions Ltd . October, 2005 Cape Town, SA. Employees require aptitude training, skills and knowledge They must be attentive

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IDENTIFYING AND MANAGING HUMAN FACTOR SPAD PRECURORS TO ADVANCE SAFETY

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  1. IDENTIFYING AND MANAGING HUMAN FACTOR SPAD PRECURORS TO ADVANCE SAFETY Presented to International Rail Safety Conference by James McColgan Fatigue Management Solutions Ltd. October, 2005 Cape Town, SA

  2. Employees require • aptitude • training, skills and knowledge • They must be attentive • low distraction • balanced workload Alertness: Key to Human Performance BUT Without alertness there is no performance

  3. Alertness Determinants Include: Alertness Product of: • Time of Day • Time Awake • Timing of Sleep • Sleep Regularity • Duration/Quality of Sleep • Sleep Bank Balance Alertness Influenced by: • Light • Sound • Temperature • Activity • Interest, Danger • Chemicals ©Fatigue Management Solutions, Ltd.

  4. The Key to Optimal Alertness All alertness triggers working in synch ©Fatigue Management Solutions, Ltd

  5. Employee FatigueNot a Problem or is It?Exxon Valdez Three Mile Island Chernobyl ©Fatigue Management Solutions, Ltd.

  6. Examples of Working Against the Biological Clock • Surgeons U.K. • After one night’s sleep loss: • 20% more errors • 14% longer to complete surgery • Increased stress • NHS costs? Source: Darzi Lancet Medical Journal, 1998 ©Fatigue Management Solutions, Ltd.

  7. Train Driver Micro-Sleep - Sweden Inattention due to micro-sleep events. Source: Swedish Train Driver, Torsvall & Akerstedt 1987 ©Fatigue Management Solutions, Ltd.

  8. FRA - US Railroad SPAD/Accidents # of SPAD Events Time Source: FRA (Federal Railroad Administration) ©Fatigue Management Solutions, Ltd.

  9. Impaired Alertness Decreases Driver Performance Sleep Length 700 600 4.6 hours 500 Sleep Sleep 400 Cumulative Fuel Deviation (GAL) 6.1hours 300 200 100 7.1hours (baseline) 0 -100 Run Run Run 10 Hours 10 Hours 10 Hours Source: Heavy Freight Train (12,400 tons) simulator study. Thomas et al, 1998 ©Fatigue Management Solutions, Ltd.

  10. Comparison: Industrial Error & Accident Peaks and SPAD Patterns Within few hours of shift starts 1st and 2nd days back 1st and 2nd night shifts Shift starts before 7:30 a.m. When activity very high or very low Between 2 and 6 a.m. 40% shift starts before 7:00 a.m. Peak 2-4 hrs into shift 10 to 20 times higher 1st and 2nd day back Monotony = low attentiveness Drivers report high boredom Need data World-Wide Error & Accident Peaks BR & TOC SPAD Patterns ©Fatigue Management Solutions, Ltd.

  11. Lessons Learned Railway Alertness Programs North America & UK • Regulatory Directive • Fatigue safety issue • Adopt Hours of Service • Industry Response • Apply science • Test/adopt alertness measures Calgary CANALERT 95 • Joint mgmt/union initiative • No labour relations precedent, operational or driver $ impact • Pilots: assess baselinefatigue, EEG, PAMs, logs, surveys • Implement alertness measures • Reform work/rest cycles • Nap opportunities • Barracks sleep upgrades • Cab audio/headsets • Lifestyle education drivers/families • Measure results ©Fatigue Management Solutions, Ltd.

  12. Alertness Measures - Provide Multiple Benefits Alertness 15-30 % improvement in alertness Crew Absence 56-60% reduction in absenteeism Safety 1 million accident-free & injury-free miles Operating Costs $100 million per annum - regulatory freedom 17 to 68% reduction in non-productive crew payments Sleep Health 56 % improvement - sleep duration, 65% quality 93% reduction stress, 28%GI symptoms Result: Improved performance, quality and safety ©Fatigue Management Solutions, Ltd.

  13. 1996-7 British Rail Thameslink Driver Alertness Program • 95-96 BR Wide Assessment • Freight, intercity, commuter & regional drivers • Work design, conditions, lifestyle & railway culture • 96-97 Thameslink Alertness Program • 110 mph commuter ops to/thru London • Joint mgmt/union support & task team • Cost neutral • No IR precedent • PAMS, logs, surveys, cab rides • 90% survey response • Developed customised fatigue countermeasures Bedford . London . Brighton. ©Fatigue Management Solutions, Ltd.

  14. Drivers - Self-Reported Sleep Duration Hours needed to feel alert & well rested (%) Total sleep in 24 hrs when: Moving from late to early starts (%) Working on a late start (%)

  15. ©Fatigue Management Solutions, Ltd.

  16. Thameslink Output • Napping/quiet room • Recliner chair • Darkened area • Sound insulation Only 40% napped on breaks Concern discipline for napping Napping Areas • Sleep design & needs • Adapting to shiftwork • Diet, exercise, social issues Shiftwork Education Drivers & Spouses, Managers 90%+ interested in learning about shiftwork adaptation ©Fatigue Management Solutions, Ltd.

  17. Thameslink Output (Cont’d) • Seating, arm rests • Air fans, cut consoles • Bottled water, face wipes 87% rated cab comfort/heating poor 73% rated induced weariness 92% poor ventilation 82% restricted leg movement Cab (Work Environment) Improvements` • Short breaks, 5-10 minutes • Walk, snack, tea/coffee 72% routine monotony 66% high boredom 75% isolation Diagram Breaks • Luton based drivers book off option @ Luton 30% Luton based Remote Booking Off Duty ©Fatigue Management Solutions, Ltd.

  18. FATIGUE OUTPUT TRAIN CANCELLATIONS, CUSTOMER SERVICE Reduced Customer Satisfaction Poor Mood Attitude HIGH CHRONIC FATIGUE Reduced Revenues Increased Train Delays & Cancellations Increased Absenteeism Impact the Bottom Line Increased Hiring & Training Costs Increased Operating Costs ©Fatigue Management Solutions, Ltd.

  19. SPAD Management Through Driver Performance • DRIVERS ADVISE • Tiredness • Monotony, Boredom • Loss Concentration • Distraction • Cab Environment ,i.e. heat, limited movement • RAILWAYS APPLY • Candidate Screening • Training/License Renewals • Defensive Driving • Alcohol/ Drug Policy • Fitness Duty Testing • Conduct SPAD Investigations • Signal Changes Impact Reduces: Alertness, Attentiveness, & Concentration Driver Performance SPAD Potential Increases ©Fatigue Management Solutions, Ltd.

  20. Design SPAD investigation - systematic questions on alertness/attentiveness Train investigators in human alertness issues Focus investigation into a problem solving exercise (root causes analysis) Educate drivers and management on alertness issues - include signallers & regulators Alertness enhancing rosters, ARC modelling Napping policies Cab design/mods for alertness Objective duty fitness testing Conduct SPAD data analysis accident patterns/alertness 2 Steps - Target Human Factors & Create a Systematic SPAD Management Program I. Reactive (Post SPAD) II. Pro-Active (SPAD Prevention) Create A Human-Based Vigilance System ©Fatigue Management Solutions, Ltd.

  21. Alertness Program Elements Work & Rest Scheduling Practices Workplace Countermeasures Management Education Promote Alertness Lifestyle Education Strategies Operating Practices Human Centred Policies ©Fatigue Management Solutions, Ltd.

  22. Thank you for your time James McColgan Managing Director Fatigue Management Solutions Ltd Tel +1 403 617 0604 Fax +1 403 264 9218 E-mail keepalert@iprimus.ca www.fatiguesolutions.ca

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