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Accident Analysis and Prevention 43 (2011) 495497

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Future directions in fatigue and safety research

Y. Ian Noy a, , William J. Horrey a , Stephen M. Popkin b , Simon Folkard c,d ,
Heidi D. Howarth b , Theodore K. Courtney a
Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, United States
John A. Volpe National Transportation Systems Center, Cambridge, MA, United States
Universit Paris Descartes, Paris, France
Swansea University, UK

a r t i c l e i n f o a b s t r a c t

Article history: Fatigue is regarded as a major contributor to workplace and highway morbidity and mortality. While
Received 4 December 2009 the scientic literature is replete with studies that can be traced back more than a hundred years, much
Accepted 10 December 2009 remains to be done to improve our knowledge of and ability to alleviate the consequences of fatigue.
Moreover, given the dramatic transformation of modern work systems due to a global and 24/7 economy,
Keywords: there is increasing urgency in improving our understanding of fatigue as a safety risk factor, its etiology
and management. As a result, a Hopkinton Conference was organized to review the state of knowledge in
the area and dene future directions for research aimed at preventing or mitigating the consequences
of fatigue. The Hopkinton Conference paradigm brings together leading experts on a key research area
to dene scientic gaps and research needs, and serves as a stimulus for further collaboration. Over the
course of several months prior to the conference, participants draft state-of-the-art reviews covering
various aspects of the research topic. In this case, ve working groups were formed, each charged with
developing collaborative manuscripts in a given topic area of interest, as follows: the Link Between
Fatigue and Safety, Demographic Issues in Fatigue, Predicting Fatigue, Technological Approaches in the
Management of Fatigue, and Organizational Factors in the Management of Fatigue. The participants then
convened for a 2 day conference at the Liberty Mutual Research Institute for Safety in Hopkinton to
review, debate, and revise the draft manuscripts; examine global issues; and discuss research priorities.
The output from this collective effort is captured in this special issue of Accident Analysis and Prevention.
2009 Elsevier Ltd. All rights reserved.

1. Introduction Physiologique du Sommeil, brought focus to the physiological

aspects of sleep. Beginning in the 1920s, Nathaniel Kleitman and
Fatigue, its causes, mechanisms and consequences, has long colleagues conducted many early investigations into sleepwake
been the topic of discourse and study. Sleep itself was discussed cycles, circadian rhythms, and the effects of sleep deprivation. Dur-
among early philosophers, including Aristotle (Edelson, 1992). The ing World War II, understanding fatigue and human (operator)
recognition and diagnosis of fatigue as a risk factor affecting health vigilance became of critical importance in high-risk environments,
and human performance in the early nineteenth century spurred such as aviation. In more recent work, especially in the domain of
physiologists, engineers, psychologists, and social reformers to transportation, the emphasis is operator drowsiness.
chart its course, nd its cure, or at least modify its effects. For an Despite the extensive literature on the topic of fatigue and
interesting perspective on the evolution of fatigue as a scientic advances in our understanding of its deleterious effect on safety,
construct, and its scientic, social and political role in the man- fatigue remains a considerable safety concern in settings such as
agement of human resources, the reader is referred to Rabinbach transportation and the workplace. For example, fatigue has been
(1990). deemed a contributing factor in as many as 20% of road vehicle
Some of the early empirical studies on fatigue date back to the crashes, though there is considerable variability in the estimates
turn of the 20th century, with Edward Thorndikes early investi- (e.g., Lyznicki et al., 1998; Horne and Reyner, 1995). A recent
gations into the phenomenon of mental fatigue (e.g., Thorndike, naturalistic driving study involving 100 instrumented cars that
1899). Later, Henri Pirons seminal work in 1913, Le Probleme monitored drivers over the course of a year found that fatigue
was a contributing factor in 12% of crashes and 10% of near-misses
(Dingus et al., 2006). Others have shown that medical interns on a
Corresponding author. Tel.: +1 508 497 0215; fax: +1 508 435 0482. traditional 24 h plus on-call schedule were 6 times more likely to
E-mail address: (Y.I. Noy). make a serious diagnostic error and 36% more likely to make a seri-

0001-4575/$ see front matter 2009 Elsevier Ltd. All rights reserved.
496 Y.I. Noy et al. / Accident Analysis and Prevention 43 (2011) 495497

ous medical error than interns on a restricted duty cycle (Landrigan as well as between chronic and acute fatigue (Rabinbach, 1990).
et al., 2004; Lockley et al., 2004). Meanwhile, a 20 year longitudi- Subsequent studies of fatigue investigated anatomical and physio-
nal study of Swedish workers found that workers who reported logical pathways. Fatigue has similarly been described in relation to
difculties sleeping were almost twice as likely to die from a work- its adverse effects on cognitive functioning as well as to emotional
related injury (Akerstedt et al., 2002). disposition. It has been described by various authors in terms of
While these statistics are compelling, the true extent of the a physical and moral disorder that results in a disruption of func-
problem of fatigue in transportation and other settings is unknown. tion, a breakdown of body and mind, an impairment of the will, and
It is clear, however, that even by conservative estimates the conse- complete exhaustion (Rabinbach, 1990).
quences are enormous. Moreover, it is clear that there are still gaps It is clear from what has been stated above that fatigue is a
in our knowledge and in our ability to offset the adverse effects of multi-dimensional construct and its effects on cognitive and task
fatigue through the management of fatigue or other countermea- performance along with risk and safety are complex. On the sur-
sures. To this end, a Hopkinton Conference was organized with two face, it would appear to be an intuitively obvious concept familiar
principle goals: (1) to identify the critical gaps in our understanding to all of us and easily understood. Yet, there exist a plethora of def-
of fatigue and its consequences on transportation and work safety, initions that vary largely according to the needs of the author or
and (2) to outline and propose future research aimed at addressing the particular issue being addressed. However, despite denitional
these gaps. ambiguity, its intuitive conceptualization and signicant capacity
to explain the link between work schedules, sleepwake behaviour,
cognitive and task performance, as well as risk and safety, have been
2. Hopkinton Conference on fatigue and safety
self-evident to researchers, regulators and safety professionals for
On November 1314, 2008, the Liberty Mutual Research Insti-
During the conference and in subsequent correspondence, there
tute for Safety, located in Hopkinton, MA, USA, hosted a 2 day
was considerable and energetic debate over a denition of fatigue
international conference entitled Future Directions in Fatigue
for the conference monograph. Among the many issues raised were
and Safety Research. The conference was organized by scientists
whether fatigue is a process, a condition, or a hypothetical con-
at the Liberty Mutual Research Institute for Safety, the John A.
struct which may give rise to impaired performance. For example,
Volpe National Transportation Systems Center, the Universit Paris
does fatigue necessarily result in impaired performance and to
Descartes and Swansea University. An international group of nearly
what extent can motivation protect against the effects of fatigue?
30 researchers in medicine, public health, engineering, ergonomics
Is sleepiness a form of fatigue, or something quite different? Some
and other disciplines was invited to participate, representing more
viewed fatigue as a biological drive for sleep while others viewed it
than 25 institutions from Australia, Finland, France, Germany, Italy,
more broadly as a drive for recuperation. Yet others were not per-
New Zealand, Sweden, the UK, and the USA. This Hopkinton Confer-
suaded that it necessarily manifests as a biological drive at all. While
ence is the fourth in a series, each addressing an important area for
clearly there was a common understanding among the participants
occupational safety, including injury epidemiology (Courtney et al.,
about what fatigue is, it was less clear that the group could settle
1997), slips, trips and falls (Courtney et al., 2001), and improving
on a precise denition. As a result, it was decided that rather than
return-to-work research (Pransky et al., 2005).
imposing an overarching denition of fatigue across the groups
In mid-2008, participants were invited for the current con-
each of the ve working groups would adopt a denition that best
ference and subsequently organized into issue-focused working
suited the needs of their manuscript.
groups. Five different groups were formed, aligned with differ-
ent topic areas as dened by the organizing committee a priori.
These topic areas included; the link between fatigue and safety,
4. Issue areas in fatigue and safety research
demographic issues in fatigue, predicting fatigue, technological
approaches in fatigue management, and organizational factors in
While fatigue is generally accepted as a public safety concern,
fatigue management. The working groups, under the direction of a
the involvement of fatigue in single adverse safety outcomes does
group-appointed chairperson, worked for several months to pro-
not necessarily reect a causal relationship. In the rst paper of this
duce manuscripts for presentation, discussion and critique at the
special issue, Williamson et al. (2011) explore The link between
fatigue and safety. In their review, they examine the relationship
At the meeting in November 2008, each group in turn presented
between three major sources of fatigue (sleep homeostasis factors,
their work in progress and was then rebutted by another working
circadian inuences, nature of task effects) and several safety out-
group which also provided an a priori review of the presenting
comes. They highlight knowledge gaps and opportunities for future
groups manuscript. This was followed by an open discussion of the
issues, limitations and recommendations for improvement. Subse-
In the next two papers, the second working group reviews
quent to the conference, each manuscript was also further reviewed
the extant literature on demographic issues and individual differ-
by two or more external reviewers who were not part of the pro-
ences in fatigue and safety. The rst paper, Demographic factors,
gram. The collective output from this group effort is captured in
fatigue, and driving accidents: An examination of the published lit-
this special issue of Accident Analysis and Prevention.
erature (Di Milia et al., 2011), explores the association between
many demographic variables (e.g., age, gender, income, ethnicity)
3. Denition of fatigue and fatigue and accident risk. This review also traces the inuence
and interaction with work. In a second paper, Sleep disorders, medi-
Since the introduction of the construct of fatigue, a succinct cal conditions, and road accident risk, Smolensky et al. (2011) discuss
and universally-accepted denition has been elusive, mostly due the role of various chronic medical conditions and sleep disorders
to difculties arising from its non-specic etiology, individual dif- in drowsy driving and trafc crashes.
ferences in susceptibility and adaptations, and lack of consensus In the fourth paper of this special issue, Modelling fatigue and
regarding its measurement. The term, fatigue, can be traced to the use of fatigue models in work settings, Dawson et al. (2011) dis-
the medical literature where it was associated with the deleteri- cuss the various theoretical models of sleep and circadian rhythms
ous effects of overwork. In 1875, George Poore provided an initial aimed at predicting fatigue. They also outline how fatigue models
framework for fatigue, distinguishing between general and local are applied in eld settings by organizations and regulators. Finally,
Y.I. Noy et al. / Accident Analysis and Prevention 43 (2011) 495497 497

they discuss the future of these models, making recommendations support of many staff members from the Liberty Mutual Research
on the most appropriate ways to use and regulate the current gen- Institute for Safetyin particular, Margaret (Peg) Rothwell and
eration of models. Finally they make a series of recommendations Debra Larnis. We also wish to thank each of our conference par-
on how these models might be modied in order to improve fatigue ticipants and their respective institutions for their time, effort, and
risk management. commitment to the conference process. Finally, we are grateful to
In the fth paper, Balkin et al. (2011) review issues surrounding Drew Dawson, Ann Williamson, Glenn Pransky, Wen-Ruey Chang,
the application of technological approaches to fatigue manage- and Margaret Rothwell for helpful comments on an earlier draft of
ment (The challenges and opportunities of technological approaches this introduction.
to fatigue management). Unlike the regulatory and organizational
approaches described by Gander et al., these technologies tend to References
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In their paper, Fatigue risk management: Organizational factors Courtney, T.K., Burdorf, A., Sorock, G.S., Herrick, R.F., 1997. Methodological
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The ultimate success of any such venture depends on the hard 43, 498515.
work of people behind the scenes. We are grateful for the efforts and