NTSB Recommends Annual Physical Performance Testing of School Bus Drivers

Yellow school bus. Vector illustrationShortly before the holidays, the NTSB offered a blog post that included recommendations for school bus operators as a result of the investigation into a December 2017 school bus accident in Oakland, Iowa.   The tragic accident took the lives of a school bus driver and a 16 year old student when the exhaust pipe of the bus was blocked by the side of a drainage ditch. While all of the bus exits – emergency non-emergency – were operational, the report suggests that the student and driver succumbed to smoke inhalation when the student may have been attempting to help get the bus driver off of the bus.

In November 2017, the driver had visited his doctor due to complaints of pain and stated that “he could walk if he used a cane or crutches, that he experienced pain that prevented his sitting for more than 30 minutes (or standing for more than 10 minutes), and that he was sleeping less than 4 hours a night.” The school bus driver had been scheduled for a lower back surgery that would have occurred just 2 days after the fatal bus accident due to complaints of chronic lower back pain with weakness of his right leg. 

The NTSB final report notes that the school district was aware of his physical disabilities and his scheduled surgery but did not remove him from service. In addition to his physical complaints, numerous complaints about his driving performance were provided to the school district previous to the event but not documented.  However, finding number 9 concludes:

“It is likely that the bus driver’s progressive chronic back disease, which caused severe chronic pain, impaired his ability to evacuate the school bus himself or to assist the passenger to evacuate.”

The report also notes that the school district did not follow the district’s own requirements defining physical abilities of school bus drivers including appropriate fit for duty clearance of a driver that was not able to perform the required safety duties of the position.

Finding number 10 states:

“The use of physical performance tests on both a routine and as-needed basis can help identify physically unfit drivers who have a valid medical certificate but who might not be able to perform required safety duties, especially in an emergency.”

It is important to remember that a valid medical certificate does not necessarily indicate that the holder can perform the essential postural and physical demands of a specific position. The valid medical certificate only indicates that the holder meets the 4 non-discretionary standards (vision, hearing, epilepsy, diabetes mellitus) and 9 discretionary standards (hypertension, cardiovascular disease, respiratory function, loss of limb, limb impairment, neuromusculoskeletal dysfunction, mental disorders, drug use, and alcoholism) as outlined in 49 CFR 391.41.   The valid medical certificate indicates that a physician has determined them to meet the 13 standards but does not include a functional abilities test based on the essential minimum postural and physical demands of a position based on validated measurements of the required tasks.

Finding number 10 provides the basis for the following recommendation, which is directed to 44 states including New Jersey, made in the report:

“Revise your school bus driver requirements so that all drivers must pass a physical performance test on hiring and at least annually, and also whenever a driver’s physical condition changes in a manner that could affect his or her ability to physically perform school bus driver duties, including helping passengers evacuate a bus in an emergency.” (Emphasis mine)

School bus drivers perform a variety of tasks, in addition to driving the bus, that have specific postural and physical requirements, including:

  • Range of motion/strength to enter/exit the bus from the front side entrance, rear exit, or the wheel chair entrance.
  • Check roof top emergency exits (reaching to 72+ inches and applying vertical pushing and pulling forces) as part of the daily pre-drive inspection.
  • Maneuvering and securing (bending, kneeling, reaching) of wheelchairs when driving students who utilize wheelchairs.
  • The ability to bend/kneel to check under seats as well as view underneath bus.
  • The physical ability to provide assistance in seating/securing (seatbelts) for special needs students in the event that a bus aide is not provided for this task.
  • The physical ability to help move a physically incapacitated passenger from the bus in the event that the passenger needs to be moved to safety prior to the arrival of trained first responders.

Many states, including New Jersey, suffer from a shortage of school bus drivers. However, the NTSB report states:

“The NTSB is also aware that many medically certified school bus drivers with safe driving records have physical limitations that could prevent them from passing a PPT. However, the consequences of a driver not being able to evacuate a school bus or assist passengers in an emergency cannot be ignored.” (emphasis mine)

Additional recommendations by the NTSB include:

  • Appropriate fire suppression systems in the engine compartment
  • Usage of 911 emergency buttons as opposed to radioing the transportation supervisor (The driver of the bus contacted the transportation supervisor by phone after the fire started rather than calling 911.  The call to 911 was not immediately placed by the transporation staff but by the student’s mother  after the family was notified.)
  • Making sure that students, teachers, and other district employees are trained in evacuating through all of the exits, including manually operated loading doors, in the event that a bus driver becomes incapacitated.

Gary Vee, ROI, and workplace safety

In a recent podcast, Gary Vaynerchuk talked about Return on Investment (ROI) and the fact that ROI isn’t necessarily driven by what is spent but “is predicated on how good you are at it”.

This is so important in the area of occupational health and safety. Often, companies will purchase equipment with the best of intentions in mind – make the job easier for the employees and reduce the potential risk of injuries. But what happens once the equipment is installed and the trainers leave? This is an issue more often than not, on initiatives large and small.

Several years ago, I was doing an ergonomic walkthrough at a large retail grocery store. Towards the end of the visit, we were standing near the check out lanes. As we were talking, I noticed that one cashier was fairly tall – a little over 6 feet – but the cashier next to him was an older woman who was just a little over 5 feet. A few minutes before, the safety manager had explained that they had purchased adjustable monitors for the cashiers to be able to see the items that had been rung up. As I was looking at these cashiers, I noticed that both had their monitors set to exactly the same height. Despite the best efforts of the employer to provide equipment to make the job easier and safer, the employees weren’t using it. They did not adjust the monitor heights.

While filling out consent forms for a fit for duty functional capacity evaluation, a recent claimant repositioned himself in a chair in the lobby of our office that allowed me to see his feet. I noticed that one foot was in a walking boot. This was an unexpected piece of information. As I asked him about the walking boot, I learned that he had been working modified duty in the boot which was for treatment for a significant medical issue related to his foot. Both the condition and the walking boot required a quick call to the employer who he had not told about the walking boot. This employer provides safety shoes for their employees as it is a safety requirement for the position. Due to the fact that the walking boot was black as were the issued safety shoes, nobody had noticed the walking boot. A quick routine check of PPE when supervisors meet with employees throughout the day/week would have resolved this issue which could have resulted in greater medical issues for the employee.

For any project, whether it is a safety initiative such as safety equipment or equipment modifications or programs such as post-offer pre-employment or return to work testing, it all comes down to how good you are the program that you are putting in place. This requires constantly paying attention to how the program is running. Are supervisors making sure that employees are following safety guidelines? Are you making sure that your post-offer physical ability testing or return to work programs are based on accurate job descriptions? When developing a new safety initiative, make sure that you include follow-up and oversight in your planning to ensure that you get the ROI that you are expecting.

**  For those looking for the specific podcast, it is the December 4, 2019 episode entitled “You’re Not Going To Know Where To Start”

 

What Should We Do Wednesday – 10/9/19

In the past, I have covered different incidents that point out how things could be done differently under the guise of “What Not To Do Wednesday” blog posts.  This morning, I read an article that was written after the safe resolution of a training flight that included a mechanical failure.  In “Elevator Failure at 4,500 Feet”, instructor pilot Rich Wyeroski recounts a flight in which the elevator on the horizontal stabilizer had a malfunction while the plane was in flight.  Wyeroski provides a solid recounting of the steps that he took to safely bring the plane down after the student pilot reported difficulty with the controls.  In the article, he states that his reason for writing the article is a concern that this incident, particular to Cessna 150 airplanes built between 1959 and 1970, could occur again without a hardware modification to upgrade the elevator hardware to the same standard as Cessna 152 planes as well as some Cessna 150 planes that were later.     He also discusses the importance of training to deal with potential emergencies such as this to ensure that pilots:

“Always try and stay calm during an emergency. Don’t do anything until you assess the situation and then react slowly. (The only time I would deviate from the above recommendation is if the aircraft is on fire!)”

Wyeroski, who is not only an experienced pilot, instructor pilot, and instructor for A&P mechanics, gave a great breakdown on how the flight was handled and possible solutions.  But, my reason for bringing up this aviation article was the comments section.  Some of the comments argued that a pre-flight inspection should have caught this and that a request for planes to have the attachment system for the elevators in the older Cessna 150 models is a little too much for something that happens rarely.

The thought process of those who stated that it should have been caught in the pre-flight inspection really stuck with me when I was reading the article.  Several people did note that it would be easy to miss (either by a lack of a thorough pre-flight inspection or by seeming ok during the pre-flight but loosening in flight).  The author noted in a comment that no issues were noted during pre-flight or during a recent annual inspection.

Without Wyeroski’s recount, this near fatal flight would not be a learning experience except for those who dig through NTSB case files.OLYMPUS DIGITAL CAMERA

One of the problems in safety and workers compensation is that all too often, only the incidents that cause injuries are reported/recorded and potentially used to effect some level of change within a worksite.  Sometimes, it is because only the people involved know about the incident because of not being required to report/record or even check in with occupational health.  But these “near misses” are important to take the time and look into more deeply.  Many times, the lessons learned from a “near miss incident”  can provide the information necessary to change either policies/procedures and or change/adjust equipment to prevent future incidents.  Wyeroski even notes in the comments that one lesson that he learned from this incident was to contact Air Traffic Control rather than the local Unicom operator to make sure that the Fire Department was ready and at the runway when he landed (apparently, the Unicom operator was unable to get the fire department to understand the urgency of the request and the risk of a fatal crash).

Photo by Adrian Pingstone, Wikimedia Commons

 

Friday Five – 8/2/19

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

Diane Gyi et al. have created a new anthropometry data set for plus sized workers.  With increasing obesity levels, this new dataset is very important as many of the original data sets  that were utilized were based on measurements of military personnel.  A course from The Back School on ergonomics for plus sized workers was a good reminder for me that this category requires some different ergonomic considerations because there are some different biomechanical needs when setting up or correcting workstations.  It was also a good reminder that this category is not necessarily about obesity – the plus sized worker category includes anyone that is outside of the normative data sets, regardless of the reason why they fall outside of the normative data.  (When I originally took the course, it reminded me of The Incredibles when Bob tries to become a non-super hero, stuffing himself into the small car or into his cubicle at work).

Dominique Larouche et al. look at the issue of safe handling techniques for paramedics when transferring patients from stair chairs to stretchers.  One of the interesting points is that they believe that training needs to be oriented more towards the ability to adapt work techniques based on the environment and on the work teammates.

Joshua Zheng Rui Ting et al. investigated the effect of an ergonomics/exercise intervention compared to an ergonomics/health promotion intervention on workability levels in the office worker population.   For the general population, there was no significant difference in results.  But for a subgroup of office workers who reported neck pain (greater than 3/10 at start of study), the ergonomics and exercise intervention group demonstrated trending improvements in workability when compared to the ergonomics/health promotion group, if they completed at least 70% of the exercise sessions.

Peter Love et al. dealt with the difficulties in establishing operational guidelines for construction safety when the information on injuries is not readily available to use to set best practice guidelines.

Kaitlin Gallagher et al. noted that walking breaks can help to reduce low back pain that is induced by prolonged standing.   Walking and moving is something that I have been an advocate of for a long time.  Walking is not only great to break up prolonged postures (sitting or standing) but the overall movement is helpful for preventing other health issues as well.

 

What Not To Do Wednesday – 5/24/17

Some days, what not to do is right in front of you.  When I was walking from the parking lot into the building, I noticed the ladder leaning against the building to access the roof.  The first thing that jumped out at me was the fact that the top of the ladder was extended just barely beyond the top edge of the wall.  It was not anywhere close to the minimum 3 feet that it should have extended past the access point between the ladder and the roof.

I went inside and grabbed my business partner to point out the ladder, but also to show him the new NIOSH Ladder Safety App.  It’s a simple but useful app that I’ve used out in the field on a couple of previous occasions to document fixed ladders on a worksite.  The nice thing about it is that it has a measuring tool that can tell you whether a ladder is placed at too shallow an angle, the appropriate angle, or too steep an angle.  When I placed my phone on the ladder, the ladder was at too shallow an angle – 72 degrees.  The shallow angle placement of the ladder is compounded by the fact that the feet of the ladder are placed on a downward sloping section of pavement.  Between the shallow angle, sloped pavement, and lack of ladder extension beyond the access point, this is a catastrophe waiting to happen.

Correcting these mistakes is a simple fix:

  • Extend the ladder further – there is still plenty of extension left in this ladder.
  • Check the angle of the ladder to make sure that it isn’t too shallow or too steep.  The NIOSH Ladder Safety App is free and easy to use.  Almost everyone has a smart phone so there is no excuse not to use the app.

What Not To Do Wednesday – 3/15/17

A recent article in The Daily Meal focused on bad kitchen hygiene habits that can be observed by watching most of the television shows featuring celebrity chefs.  These habits include unsafe handling of meats and vegetables, lack of personal protective equipment (gloves), and unsafe techniques for tasting food while cooking.  The article points out that a reminder during the show about safe techniques could go along way to prevent unsafe and unhealthy techniques being used for cooks at home.  A “Don’t Do What I Do” reminder, if you will.

The celebrity food shows are not the only media in which poor or unsafe techniques are shown.

chip on top step of ladder

I hate to pick on Fixer Upper (it’s a favorite show in our home) as Chip’s goofiness is always the source of a few laughs.  But, this morning as my kids were watching a rerun, I heard him discuss some issues with the roof of a house that they were renovating.  When the word “ladder” came across the speaker of the television, I knew that I needed to take a quick peak.  I grabbed a quick picture with my cell phone as I saw them pull out the sketchy wooden A-frame ladder which was well below the roof line of the house.  Not only did Chip stand on the top step of the ladder with not great holding by his wife, he used this top step as a launching point to climb on to the roof.

In defense of Fixer Upper, almost every home improvement/home repair show on HGTV and DIY features moments just like this one – whether it is with ladders, saws, hammers, etc.  As Joanna Fantozzi of The Daily Meal pointed out in her article, a quick reminder of safety principles could go along way towards better safety practices of homeowners as they are attempting to do home renovations and repairs.

While This Old House may not be as fun and glitzy as its HGTV relatives, they include a lot of safety information as they take on different tasks on the show.

Ladder accidents cause nearly 500,000 injuries per year and the rate of ladder injuries has been increasing every year.  A significant portion of these injuries are not work related and occur at home.

There are several simple solutions to reducing the number of ladder related injuries:

  • Use the right type of ladder.
    • Use wood or fiberglass ladders when dealing with electricity.
    • Make sure that the ladder is of sufficient height for the task being performed.
    • Make sure that the ladder has a sufficient strength rating for the weight of the user and and tools/materials that are being carried or used.
  • Make sure that the ladder is in good shape.
    • If the ladder is worn or damaged, make sure that the ladder is repaired to manufacturer standards or replaced.
  • Make sure that you are using the ladder properly.
    • Maintain 3 points of contact when climbing.
    • Don’t reach out of your base of support.
    • When necessary, climb down, move the ladder, and climb again.
  • Make sure that you use proper ladder placement.
    • Place ladder on firm, even ground.
    • Use an assistant/helper to support the base of the ladder to prevent slipping.
    • Don’t place the ladder in front of doors that have not been secured.

One last suggestion comes from a recent paper in Injury by Ackland et al.  In their review of admissions to intensive care units due to ladder related injuries, they recommend that ladder users wear helmets to reduce the risk of traumatic brain injuries in the event of a fall from a ladder.  They note that this is especially important in home based environments as typical worksite occupational health and safety regulations are not in effect.

 

 

Friday Five – 3/10/17

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product.

The news media this morning had several stories noting that beginning in July medical residents may work consecutively from 16 hours to 24 hours.  Interestingly, there were many medical residents that were in favor of this change.   Taking this change to resident’s shifts and the upcoming changing of the clocks for Daylight Saving Time, this Friday Five is focused on shift work.

Some residents looked forward to the increased hours as a way of reducing mid-case handoff of ER cases due to hitting the 16 hour mark.  A research letter by Charlie Wray, DO et al. in JAMA looked at handoff policies for residents at hospitals as implemenation of these practices, despite guidelines, is left to each hospital to implement.

A study published last year investigated the effect of hours per week worked by an admitting resident on patient outcomes.  It found that individuals admitted by residents working 80+ hours per week had longer hospital stays and more ICU transfers than those admitted by residents working less than 80 hours per week.  However, there did not appear to be a relationship between hours worked and 30 day readmission rates or in-hospital mortality rates.

Fernando and Roswell looked at the work performed during nursing shifts and noted that the types of work and volume of work performed varied through a 24 hour work cycle.  They note that the scheduling of shifts needs to take type of work and work volume into account.

Two older studies looked at the incidence of work related injuries following onset of Daylight Saving Time.  A study of American mine workers found an increase in injuries on the Monday following the start of DST and a decrease in total sleep for that night by 40 minutes.  A Canadian study found no statistical relationship between injuries and the onset of DST.

Interestingly,  researchers found that the rate of ischemic strokes increases during the first two days after the onset of daylight saving time.

 

What Not To Do Wednesday – 2/22/17

This What Not To Do Wednesday is a little bit different.  I recently came across an article about an OSHA investigation into the death of a mountain climbing guide in Wyoming.

Typically, people think of OSHA and workplace safety as a construction or manufacturing issue and don’t realize that the involvement of OSHA is much further reaching.  In the past, OSHA has looked into the death of a marine mammal trainer at Sea World after an orca attacked a trainer as well as ski resorts after a ski director was killed in an avalanche.  OSHA also became involved in a recent case of a researcher in Montana who was killed by a grizzly bear.  OSHA noted that the researcher did not have anti-bear devices when he left to go into the field and that his employer did not have a check-in/check-out procedure to make sure that employees were properly equipped.

In the case of the climbing guide, OSHA looked into details surrounding a failure of a specific piece of safety equipment that failed as the climbing guide was attempting to retrieve a descending device.  OSHA acknowledged that the item was a piece of personally owned gear and that the actual failure was a knot tied by the guide.  Exum Mountain Guides agreed to perform formal annual inspections of both company and personal gear as part of their safety changes due to this case.  It was acknowledged that the failure of the knot was not Exum’s responsibility and that it isn’t practical for Exum to double check every knot tied by its employees.  OSHA also acknowledged that the guide was highly experienced.

The important thing to remember is that if there is a risk of injury to your employees, you need to have a safety plan to minimize or mitigate those risks – even if it is the potential of attacks by bears, whales, avalanches, or personal equipment failure.

 

What Not To Do Wednesday – 2/10/17

I’m posting on Friday because Wednesday was a little busy with weather preparations for Winter Storm Niko.  But, the delay dropped us a great WNTDW topic.

Fortunately, all reports indicate that this cheerleader is ok and does not have significant injuries.

Cheerleading is a demanding and occasionally dangerous activity with a lot of falls.  The what not to do portion hits three times within this video.

Admittedly, all videos of this event have a small break in the video between the fall and the cheerleader being carried out.  However, the first WNTD occurs when a member of the coaching staff chooses to carry the injured cheerleader from the court.  This cheerleader fell on her back and struck her head against the floor.  She should have been checked by the medical staff.

The coaching staff member then chose to run/walk at a very fast pace while carrying someone who has been injured.  Again, with a potential head and back injury, this is a definite WNTD.

Finally, because the person was moving fast while carrying the cheerleader, he was unable to see that his path was not clear which caused him to trip, fall, and drop the injured cheerleader.

Each of these WNTD’s could have been prevented by making sure that all staff members were instructed and trained on emergency procedures in the event of an injury.  With the potential head, neck, and back injuries, this cheerleader should have left the court on a stretcher/backboard – not carried by hand.

Friday Five – 2/2/17

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product.

A lot of money and time has been put into exoskeletons for assisting soldiers, laborers, and individuals who have had strokes or spinal cord injuries.  This is an area that I plan on revisiting in future posts.  For now, a company called suitX has introduced a modular line of exoskeletons for assisting with specific work related tasks and body parts.

Whenever there is a change of administrations, regardless of whether there is a change in party, there are revisions to previous rules and regulations.  This National Law Review piece takes a quick look at areas of potential changes at OSHA.

Becker’s Healthcare Review has five great tips for designing an intergenerational workspace in hospital settings.

Not so much ergonomics but a question of productivity and efficiency on the Monday after the Super Bowl.  Kraft Foods is suggesting the day after should be a holiday  with an anticipated 16.5 million workers may call out sick to recover from festivities the day before.  This is an interesting question when talking about presenteeism vs. absenteeism.  How much work is actually lost with people discussing the game and the commercials when they come to work the next day?

When I was taking a tour of our local police department with my son’s Cub Scout den, my son asked the officer who gave the tour about a poster in the squad room.  The poster had a police cruiser that had been in an accident and had a slogan reminding officers that car accidents cause more line of duty deaths than some of the other more media noticed causes.  I found this article with 5 real world tips that police officers can use to make their vehicle safer for today’s tour of duty.