Accident Analysis and Prevention 43 (2011) 495497

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Accident Analysis and Prevention

journal homepage: www.elsevier.com/locate/aap

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
a
Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, United States
b
John A. Volpe National Transportation Systems Center, Cambridge, MA, United States
c
Universit Paris Descartes, Paris, France
d
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
Fatigue
and management. As a result, a Hopkinton Conference was organized to review the state of knowledge in
Safety
the area and dene future directions for research aimed at preventing or mitigating the consequences
Transportation
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

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

0001-4575/$ see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.aap.2009.12.017
496 Y.I. Noy et al. / Accident Analysis and Prevention 43 (2011) 495497
ous medical error than interns on a restricted duty cycle (Landrigan
et al., 2004; Lockley et al., 2004). Meanwhile, a 20 year longitudi-
nal study of Swedish workers found that workers who reported
difculties sleeping were almost twice as likely to die from a work-
related injury (Akerstedt et al., 2002).
While these statistics are compelling, the true extent of the
problem of fatigue in transportation and other settings is unknown.
It is clear, however, that even by conservative estimates the conse-
quences are enormous. Moreover, it is clear that there are still gaps
in our knowledge and in our ability to offset the adverse effects of
fatigue through the management of fatigue or other countermea-
sures. To this end, a Hopkinton Conference was organized with two
principle goals: (1) to identify the critical gaps in our understanding
of fatigue and its consequences on transportation and work safety,
and (2) to outline and propose future research aimed at addressing
these gaps.
2. Hopkinton Conference on fatigue and safety
On November 1314, 2008, the Liberty Mutual Research Insti-
tute for Safety, located in Hopkinton, MA, USA, hosted a 2 day
international conference entitled Future Directions in Fatigue
and Safety Research. The conference was organized by scientists
at the Liberty Mutual Research Institute for Safety, the John A.
Volpe National Transportation Systems Center, the Universit Paris
Descartes and Swansea University. An international group of nearly
30 researchers in medicine, public health, engineering, ergonomics
and other disciplines was invited to participate, representing more
than 25 institutions from Australia, Finland, France, Germany, Italy,
New Zealand, Sweden, the UK, and the USA. This Hopkinton Confer-
ence is the fourth in a series, each addressing an important area for
occupational safety, including injury epidemiology (Courtney et al.,
1997), slips, trips and falls (Courtney et al., 2001), and improving
return-to-work research (Pransky et al., 2005).
In mid-2008, participants were invited for the current con-
ference and subsequently organized into issue-focused working
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,
demographic issues in fatigue, predicting fatigue, technological
approaches in fatigue management, and organizational factors in
fatigue management. The working groups, under the direction of a
group-appointed chairperson, worked for several months to pro-
duce manuscripts for presentation, discussion and critique at the
conference.
At the meeting in November 2008, each group in turn presented
their work in progress and was then rebutted by another working
group which also provided an a priori review of the presenting
groups manuscript. This was followed by an open discussion of the
issues, limitations and recommendations for improvement. Subse-
quent to the conference, each manuscript was also further reviewed
by two or more external reviewers who were not part of the pro-
gram. The collective output from this group effort is captured in
this special issue of Accident Analysis and Prevention.
3. Denition of fatigue
Since the introduction of the construct of fatigue, a succinct
and universally-accepted denition has been elusive, mostly due
to difculties arising from its non-specic etiology, individual dif-
ferences in susceptibility and adaptations, and lack of consensus
regarding its measurement. The term, fatigue, can be traced to
the medical literature where it was associated with the deleteri-
ous effects of overwork. In 1875, George Poore provided an initial
framework for fatigue, distinguishing between general and local
as well as between chronic and acute fatigue (Rabinbach, 1990).
Subsequent studies of fatigue investigated anatomical and physio-
logical pathways. Fatigue has similarly been described in relation to
its adverse effects on cognitive functioning as well as to emotional
disposition. It has been described by various authors in terms of
a physical and moral disorder that results in a disruption of func-
tion, a breakdown of body and mind, an impairment of the will, and
complete exhaustion (Rabinbach, 1990).
It is clear from what has been stated above that fatigue is a
multi-dimensional construct and its effects on cognitive and task
performance along with risk and safety are complex. On the sur-
face, it would appear to be an intuitively obvious concept familiar
to all of us and easily understood. Yet, there exist a plethora of def-
initions that vary largely according to the needs of the author or
the particular issue being addressed. However, despite denitional
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
self-evident to researchers, regulators and safety professionals for
decades.
During the conference and in subsequent correspondence, there
was considerable and energetic debate over a denition of fatigue
for the conference monograph. Among the many issues raised were
whether fatigue is a process, a condition, or a hypothetical con-
struct which may give rise to impaired performance. For example,
does fatigue necessarily result in impaired performance and to
what extent can motivation protect against the effects of fatigue?
Is sleepiness a form of fatigue, or something quite different? Some
viewed fatigue as a biological drive for sleep while others viewed it
more broadly as a drive for recuperation. Yet others were not per-
suaded that it necessarily manifests as a biological drive at all. While
clearly there was a common understanding among the participants
about what fatigue is, it was less clear that the group could settle
on a precise denition. As a result, it was decided that rather than
imposing an overarching denition of fatigue across the groups
each of the ve working groups would adopt a denition that best
suited the needs of their manuscript.
4. Issue areas in fatigue and safety research
While fatigue is generally accepted as a public safety concern,
the involvement of fatigue in single adverse safety outcomes does
not necessarily reect a causal relationship. In the rst paper of this
special issue, Williamson et al. (2011) explore The link between
fatigue and safety. In their review, they examine the relationship
between three major sources of fatigue (sleep homeostasis factors,
circadian inuences, nature of task effects) and several safety out-
comes. They highlight knowledge gaps and opportunities for future
research.
In the next two papers, the second working group reviews
the extant literature on demographic issues and individual differ-
ences in fatigue and safety. The rst paper, Demographic factors,
fatigue, and driving accidents: An examination of the published lit-
erature (Di Milia et al., 2011), explores the association between
many demographic variables (e.g., age, gender, income, ethnicity)
and fatigue and accident risk. This review also traces the inuence
and interaction with work. In a second paper, Sleep disorders, medi-
cal conditions, and road accident risk, Smolensky et al. (2011) discuss
the role of various chronic medical conditions and sleep disorders
in drowsy driving and trafc crashes.
In the fourth paper of this special issue, Modelling fatigue and
the use of fatigue models in work settings, Dawson et al. (2011) dis-
cuss the various theoretical models of sleep and circadian rhythms
aimed at predicting fatigue. They also outline how fatigue models
are applied in eld settings by organizations and regulators. Finally,
 Y.I. Noy et al. / Accident Analysis and Prevention 43 (2011) 495497
they discuss the future of these models, making recommendations
on the most appropriate ways to use and regulate the current gen-
eration of models. Finally they make a series of recommendations
on how these models might be modied in order to improve fatigue
risk management.
In the fth paper, Balkin et al. (2011) review issues surrounding
the application of technological approaches to fatigue manage-
ment (The challenges and opportunities of technological approaches
to fatigue management). Unlike the regulatory and organizational
approaches described by Gander et al., these technologies tend to
focus on the individual driver, operator or worker. The authors
review different existing technologies, outline the characteristics
of an ideal system, and describe and discuss many issues related
to the human interaction with these devices, including user accep-
tance and compliance.
In their paper, Fatigue risk management: Organizational factors
at the regulatory and industry/company level, Gander et al. (2011)
describe and discuss fatigue risk management systems (FRMS) in
the transportation industry. They chart the evolution of regula-
tory frameworks towards multi-dimensional FRMS, in which the
locus of responsibility for safety is shifted away from regulators and
towards companies and individuals. They further discuss impor-
tant considerations and potential threats in implementing FRMS,
including safety and organizational culture, as well as current and
future shortages in skilled labor.
The nal paper, Research needs and opportunities for reducing
the adverse safety consequences of fatigue (Horrey et al., 2011), dis-
tills and synthesizes some of the key issues raised in the working
groups papers as well as those raised through discussions and
interactions during and following the Hopkinton Conference. Build-
ing on the knowledge presented in the other papers in the special
issue, this paper identies the salient issues regarding the needs
and opportunities in the study of fatigue and safety.
5. Conclusion
The impetus for this special issue of Accident Analysis and
Prevention is the realization that there are critical gaps in our under-
standing of the causes and consequences of fatigue as well as
strategies for mitigating the potentially adverse effects associated
with fatigue. Moreover, there is a shared belief that these gaps can
be addressed through focused scientic research. The principal aim
of this issue is to seek innovative directions that will lead to better
approaches to managing this major source of social and economic
losses. The conference Organizing Committee fervently hopes that
the outcome of this Hopkinton Conference will inspire and motivate
new research efforts that will lead to dramatic reductions in loss
and human suffering.
Acknowledgements
The ultimate success of any such venture depends on the hard
work of people behind the scenes. We are grateful for the efforts and
497
support of many staff members from the Liberty Mutual Research
Institute for Safetyin particular, Margaret (Peg) Rothwell and
Debra Larnis. We also wish to thank each of our conference par-
ticipants and their respective institutions for their time, effort, and
commitment to the conference process. Finally, we are grateful to
Drew Dawson, Ann Williamson, Glenn Pransky, Wen-Ruey Chang,
and Margaret Rothwell for helpful comments on an earlier draft of
this introduction.
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