saturday as well as making small businesses a priority and a long-term economic plan speak what i actually agree with my honorable friend. we now see a record number of small businesses i in our count, a total increase of 760,000 over this parliament. small business saturday is an excellent event where we can boost small businesses and draw attention to the work that small businesses do. on friday will kick off this event with a small business smas they're in downing street and it's a good moment to make sure that small businesses are benefiting from all the changes we have made such as the cut in the jobs tax or businesses and charities of 2000 pounds, abolishing national interest contribution for under 21 year old with the employed them, doubling the small business regulate and cutting business taxes small businesses as well. we respect what you do in terms of creating the jobs, the welcome the prosperity that our country needs. >> thank you, mr. speaker. my constituency is the second

largest town in north was without a real station, which bring social and economic benefits to the town as we've already heard. as the prime minister is in a spending mood albeit a little bit further south, i wonder whether people help the people and give us an early christmas present with the promise of a rail station? >> i'm very happy to look with honorable lady says. what we're seeing is more railway lines open, more stations opening, and more railways electrify. i think the entire period of the last labour government electrified just 13 miles of track. and absolutely pathetic record for a government that had a 13 years to do something about it. we now have the biggest road program since the 1970s, the biggest rail investment program since the victorian, and actually under government stations, lines and electrification, that's all taking place. >> will my friend made me to help get more pledge for the

hospital quickly sent a minister to meet the magnificent the staff and possibly welsh patients who have acquired addresses in england so they can access life-saving cancer care drugs that are not a bill under the labour run welsh health secretary? >> i'm sure my although friend will welcome the 2 billion pounds for the nhs in england which the chancellor announced at the weekend. bb money to go strictly to the front line. want to see continued improvements at the hospital. there are pressures from people from wales crossing the border and wanted to use services in england and that's what it's so important that the welsh nhs has the improvements we have been talking about it in terms of getting the hospital to look carefully to what we can do to help. >> thank you, mr. speaker. cutting net migration to tens of thousands, reducing spending on buffer and eradicating the deficit by the end of this parliament, on the triple crown

of the prime minister's promises to the british people. how did it feel when you are once, twice, three times a failure? [laughter] >> i tell you how it feels to lead a government that's created 2 million private sector jobs. i will tell you how it feels to lead a government that's turned around the british economy. and i will tell you how it feels to have any come in britain that does is right around the world want to invest in. in the that is the record of this government recovering from the complete shambles and mess that he left when he was part of the previous government. >> the prime minister experienced this summer as he may well remember the congestion faced by my constituents junction nine of the motorway. and i just think the prime minister on half of the people i represent for the comprehensive package of improvements announced by the prime minister sector earlier this week? will be sure my view that my constituents can only benefit from this kind of investment because we taken the decision to

get our economy and a place that we can? >> my honorable friend is right and i know about the importance of the improvements he talks about. the fact is all of these things whether it's improving our road network, investing in our images, building new railway station to electrified railway lines, these things can only be done if you have a successful and growing economy a long-term economic plan and the demonstration that you the public finances under control. with his chancellor and with this government we have all of those things in place, and that's what we been able over the previous days to talk about improving our nhs, investing in our transport infrastructure, building the flood defenses this country need to put in place all the infrastructure whether it is ports, airports, energy, that a modern economy to in order to sustain a level of growth that can deliver the prosperity and security that the british people deserve. >> in the past four years as 5 billion pounds has been sent -- spent, around 20% of the would've gone in to the --

[inaudible] how many full-time permanent nurses would that have paid for? >> what we've got in the nhs and under this come is 1300 extra nurses, 8300 extra doctors. and because we cut the bureaucracy we have managed to remove 21,000 bureaucrats. no one wants to see extensive use of agency staff, all well-run hospital if your agency staff and more permanent staff, and that's what's happening under this government. >> order. >> here on c-span2 we will now lead the british hous house of commons as members move on to other business. you have been watching prime minister questions on and live wednesday's win part of his associate reminder you can see this week's session again sunday nights at nine these are in pacific on c-span. and for more information go to c-span.org and click on series

to get every program we have erred from the british house of commons since october 1989. we invite your comments about prime minister's questions via twitter using the hashtag pmq pmqs. >> republican senators richard burr and bob casey talked monday about how he was has just wanted to ebola and the country perverted for huge health emergency. both members of the health, education, labor and pensions committee, it's 45 minutes. >> thank you both for, with some scheduling problems. your staff worked hard to get your and we know that lame duck is going to be rather busy. we are really glad to have you today. i guess we've gone through, we were talking ourselves, one of the questions we had is, you

know, we sort of look back and 10 or 15 years ago we had a complacency in the country, that we thought public health was old and we didn't have to deal with it anymore. public health hadn't kept up come infrastructure that can do. and we had 9/11, anthrax, the legislation which was dual use, for new and emerging diseases as well as attacks. and then you came along and fill than some gaps with bipartisan legislation to originally 2006, it's got a very long name which i wrote down. the pandemic all-hazards preparation act, and it is two different acronyms. one was probably the democrat acronym and one was -- you call it poppe and then you we authorized. i like to talk a little about -- papa. bipartisan from the beginning, you've worked together. or something issues going forward. we just had something that was a

crisis that the public feel with this portion to what happened but things did not go perfectly your there's things did right, things did wrong, some like it, right? it could've been better, could have been worse. as you watch things unfold, what do you think has to be done next? >> let me just back up on something you said, that's the public health change. it did change. we wrote a new definition for public health. i would to the post-katrina, and she had a lot of events that went on that katrina was the thing that i think acknowledge for everybody, somebody has to be in charge. you can't have a bunch of people pointing fingers pic you can of folks sitting on my for somebody they thought was going to do something to actually do it. and so we resolve that as it related, at least those threats

that were material threats listed by department homeland security relative to the blueprint bob and i were working off a. i think when you look at the current threat of ebola and you ask what shook the trust of the american people, it was a total lack of communication. i think when you look back at every event that we've had in the past nine -- 12 years. community -- indication britain has been the no on number one contribute to the lack of confidence of the american people that we had a successful agenda to try to work through this. i think the administration, to their credit, though sometimes into this, realize they had to revamp totally and was in a totally different approach on the communications side. >> can congress excommunication? we had communication, those of

us were in washington during 9/11 and the aftermath and there's the anthrax, communication on that day was disastrous, right? you were here. there was always efforts to identify what you just said, communication, people have been very supportive forces have to be able to talk, public health, all that. we've had legislation and we've got conversations on communication. it was as senator burgess said, it didn't work very well. what can congress do to fix that? >> or to address at least depends on a sure there's a legislative remedy there. what we can do, richard was here in 2006 when the first pandemic all hazards bill was passed and the two of us worked together. the evolution of the policy or improvement of the policy is most what our job is. i'm certain it we will be open

to ideas how we can legislate documentation. but part of it is for any administration that has to be, not simply in the context of an ebola outbreak any kind of crisis, even if we think that the crisis was accelerated, maybe by the elections or by the attention to the issue. i believe that rests with this administration or the next administration to figure out a better way to have one person speaking for the administration. this is a difficult combination to achieve. deepened public health expense as well as someone who can communicate well. having said all that, even if we achieved a measure of perfection on communication, a lot of this is going to have to be

communication strategy at the local level. that's a whole other, it's a longer conversation, but i'm afraid unless you have, because most of the responses of the local level just like it is often on homeland security, so unless you respected figures in hundreds and hundreds of communities standing up saying these are the facts, visible going to do about what's happening, it's very difficult. and lastly i say that about local communication because whether we like it or not, washington is not all that popular today. i think it goes back, i think it's several administrations where people don't have a lot of confidence and several congresses. so the best and we can do i think is get the policy right in figure out a way to make sure that the local level, you what some people are calling validaters to get people some assurance that their committee

knows what it's doing to their community is responding and they can articulate that. >> did the cdc have too much faith in local hospitals a? >> i would say no, but in some ways we were tested substantially. but in some ways the testing didn't go to a lot of different communities in the since the only a handful of communities that had to wrestle with this. but i will tell you and i'm sure richard saw this in north going on in pennsylvania. wow, to the hospitals start drilling and practicing and really focusing. because they figure if we are next, we have to be ready. in that sense they are probably at a heightened state of alert and probably in a better preparedness posture than they were three, four months ago. >> which in large measure was the reason we did papa. we thought we had the communications problem when we designated who's in charge of statutory. the assistant secretary of emergency preparedness at hhs.

that person has not been the point person of ebola. so i think the administration has got to do after action review, to to re-create the wheel? did they take a blueprint that was there? i think on any given news cycle is i different person in the administration. now there's a spokesperson but that's not the we get through a crisis like this. and in some cases to people who said two different things. but concentrated in the assistant secretary of emergency preparedness on the responsibility for the actual training that goes on continually at hospitals. i think what we've got to do is look back and say what was the training we were taking them through. we know that cdc had at least bad regulations as it related to personal protective equipment and that was transitioned very quickly. but did we communicate to the states and to the hospitals here

is th the degree of trading what you go through governors the threshold want you to get, capabilities that will be different. but we would have thought the major hospitals across the board would've gotten to a level, and i think we did have a breakdown. >> you wondered what would happen if mr. duncan had walked in a different hospital. you could've had one that was worse prepared or one that was a lot better prepared. they were false alarm cases. that was not -- there were about a dozen cases that turned out not to be ebola at the hospital recognized the warning signs and got the person in isolation. when they got on tv and said we weren't expecting ebola. we all looked at each other in the office and said, well, we were. the cdc had done a lot of drilling or talk people through it. >> you might remember early in the days of the ebola outbreak,

we actually had officials who sat on tv and said it's not going to come here. we actually brought it here from the standpoint of the doctors who were infected that we chose, but officials said you don't have to worry, it's not going to be here. >> they said they would not be an outbreak spent an outbreak your health care infrastructure we don't have to prepare. and i think that once you had one case, that all of a sudden showed up, you had a totally different tempo at every major medical facility in the country, as well as the public directions that were coming out of the cdc and hhs. >> mistakes get amplified. people pay attention when things go wrong. and when things go right people sort of don't pay as much, it's human nature. you don't legislate. that was good, let's move on. sars could've been way worse than it was. the public health protections be

taken. there is always some luck, things could be worse or better. things beyond your control because it's a disease. that the sars epidemic was a test, with an international test. it didn't get out of control. and then the flu in 2009, the luck there was a turned out not to be quite as -- it didn't kill as many people. but they were able to ramp up that. there was a mix, it wasn't as fatal or potent of iris but they also did a lot of good public health to control. so when you sort of make policy, can you say what are the lessons learned that worked them that we need to go back to? and are the steps congress needs to take to sort of say how do we do it right again? >> first thing i would say is we've got -- we don't have a lot of time for an after action report right now, but i think we're going to meet when going forward. short-term, i would say

short-term is let's use a supplement as a way to make greater investments in for example, the preparedness, hospital preparedness program, there's a gap of about 120 million up to the authorize love that i think we ought to least bring up the funny to the authorized level. >> i can happen in the next week or two? >> notwo? >> no, that would be intermediate-term. short-term, i think we should have a good debate about and then legislate or try to pass legislation as quickly as we can on the supplemental. but richard's point is well taken because this isn't just going to be well, we need more dollars here or there. we've got to take a step back and see what went right, what went wrong, and then possibly do more legislating. but there may not be a lot of legislating that's necessary. it may be a lot of what richard pointed to which is focused --

>> follow the blueprint. the blueprint. there was a tremendous amount of thought that went into. and here we are what, 12 years -- >> eight years since papa. spent we didn't have a vaccine or countermeasure for ebola. we sort of go through the litany of the 14 major threats that we had. and i think when we go the legislation, we envisioned that it would be just a constant focus of research and development. this isn't a breakdown of any structural thing. it's really a breakdown of whether there was a will to stay focused on that or whether we got distracted by source or whether we got distracted by h1n1. all of a sudden the need for vaccines, and we didn't leverage the tools that you found in papa

as successful as we should have. >> barda, it was a government tool to propel development of vaccines and therapy. >> barda was a public capital venture. it was there to be a financial partner to promising discoveries, to get into what i call the valley of death. the period where they needed external funding. you would have basic research that went to a certain level at nih, and went to to a certain level it was the responsibly of the barda to come in and say think this shows promise, we'll invest in, get across the goal line, and at the end of that process fda gets involved with its approval. we did not have an ebola vaccine or countermeasure is to the point of a handoff to barda. and i think h1n1 was a start were vaccines became more of the jurisdiction of the nih versus

barda and keep that distinction at bay. the truth is that for the current threat, bob is right and we've got to stay focused on al-qaeda vaccine, how we get a countermeasure. because i don't think we're going to successfully be able to do this through a traditional burnout zone in africa. it's absolutely crucial that we learn from this and we've got to stay on the research side but because this could be next you coming to be something a year after and the private sector could never invest the amount of money it takes to bring something to market. we have to be a partner in it. >> i asked senator burr what the initial count his initial reaction looking at what was unfolding and decent communication to be sure that? is that the first thing that went into your mind, senator casey? >> certainly one of them. i also thought at the time when

we were hearing from hospitals where they didn't have the resources they need to do. the personal protective equipment, but there's no question this is a communications challenge on a scale that you rarely encounter. part of that i think was because when it happened. when you juxtapose what happened with ebola with an election which was preheated, and people were just reacting to everything, as well as some other governmental failures throughout the year, the website, concerns about the va, you go down the list of issues. and by the time people arrived at the point into august and september and they hear about ebola and immediate attention was i think unprecedented,

dashing media attention. the predicate for that was already set up what happened over the last year. and, frankly, you go back further and say what's happened over the last 25 or 30 years. there's been a government that's taken some hits over the last generation, starting with watergate and moving forward. so to be able to say for any government, democrat or republican to stand up and say, we have this under control, don't worry, not that they said that but if that's where you start from, i think you're going to run into -- >> and anybody, i'm sure bob has been through, we have been through many tabletop exercises where you are presented with either radioactive contamination or your affected by one of the 14 natural or intentional infectious diseases. as soon as you lose the trust of the population, year and a spiral.

and i think we got to point in ebola, it was not a massive spiral, but we got to the point where the loss the trust and think we'll have to go back and pin point exactly when it was an acceptable instead, but then it becomes a struggle. in this case thank goodness we been able to contain an outbreak in the united states. >> there could be another case that comes i think the public, we would hope, now knows -- part of this there was a movie speed you have no administration official out saying we're not going to be more. you have them out saying you can expect there will be some. that is a totally different point that they've now set for the american people 4 let me add something, this goes back to an earlier question. i think if you look at the supplemental requests, whether it's for a hospital program or whether it's for cdc, writ large or whether it's nih, there's a lot in the proposal that

reflects learning and lessons in ebola treatment center in every state, if that's achievable with new funding. what richard talked about trying to move this process forward so when barda is in the midst of trying to get a countermeasure to commercialization, that that is stimulated or kicked forward. so i think there's a list of things in the supplemental which indicated the administration learned a lot. they are trying to identify how they can do better. and i also think something i wasn't as aware of without having seen it played out publicly was the interconnectedness of the relationship between cdc, state health departments, ma local public health infrastructures. i think a lot of that was tested, and i think just learning from the. i think a lot of americans were surprised to learn that cdc can't, doesn't rule by eddic.

they provide a lot of signs but a lot of this gets down to what happens at the state level and at the local level. that's where i get back to this, there to be able to communicate very well, even as we are trying to help washington communicate better. >> do you agree more money needs to go -- have an authorization law, has an appropriate. do you support the 120? is that something that will be bipartisan? >> i think will be bipartisan support but if you look at the $6 billion of emergency request, if you just take the cdc portion, 600 some billion dollars to go to their global health initiative which is a buildout of public health and countries. i would suggest strongly and i think bob would agree with me, consider it under the regular appropriations, that's a good one. the emergency appropriations housing members of the house and senate who say wait a minute, what else?

now there's a requirement for a level of specificity on what they're asking for and how it's going to be used. that didn't exist. they didn't have to be that greedy. >> they should have defined emergency more narrowly? >> emergency something that has to be used now to end the thre threat. on the backside of is $1.5 billion contingency fund. that's for what we did when you all of a sudden needled this thing down, it's probably a 20% contingency fund. these things were able to work out with the administration. they shouldn't have gone there, no one. >> are you talking to them and? >> i think we're in conversations and i think this can be worked out, trying to sort through what should be in the regular appropriations versus an emergency bill is going to be crucial more so on the outside than it is on the citizen. there are two things in addition to what bob said we have learned. one is we have to better

diagnostic. the fact that we are waiting 48 hours to have a confirmation of whether somebody got the bowl and we're testing it at one place and going to the cdc and testing it again. this is ridiculous. the fact we're having to build labs in western africa, and by canoe they're taking bloodwork up a river to get to a lab, technology is such that we can if we want to, we can develop a test facility, test capabilities that can be done on site. i'm convinced of that. if you look at the request for emergency money, we have to million dollars for diagnostic. this is just crazy, and i think that's where we have a leverage the private sector but the other thing gets back to what bob said about a hospital in every state that has the capabilities. what we did was we looked at the number of beds we had in the country. the number of beds was

sufficient. but when you apply what the capabilities are to discard the waste, you found where we attended, we'll have a capable to discard the waste of two patients. we have to redesign this whole thing based upon what the treatment course is for these patients. which is not the number of bed. it's what we are able to handle physically. >> we didn't know what that was like any develop high-tech country, the personal gear in the treatment was done in very much more rudimentary -- >> let's just say we were creative enough in our thinking to say, what would be encompassed if this happened? >> as you mentioned there are 14 other, or 13 other identified. are those all disease or including nuclear and bioterror? is that smallpox the? >> that's the whole basket. man-made or intentional. >> ebola, i don't want to minimize ebola. i mean, it's killing thousands

and thousands of people in africa but it is not as contagious in a developed country as the public initially feared. and we treated better when we have a handful of cases in a modern u.s. hospital or spanish or german hospital. so in terms of our people have died outside of africa, it was not the worst-case scenario that people fear. again, i'm not making light of it. i'm guessing it could have been way worse. ..

the day after the anthrax attack when we started writing legislation we find a i don't know how much since then and i think at some point we have to look and see what level of protection did it get us. how many partnerships we had with the private sector, we leverage federal assets to provide a solution to those threats. i don't think the reports are too good. at least -- we don't partner with somebody until we reaches to a threshold of what we need. we don't do a partnership just to have one. when you look at infectious disease what we would like this is a platform we are able to

handle more than one strain of ebola and possibly multiple versus a countermeasures' the only handles one strain of ebola. the question is, where is the level of research for that? have we put enough time and effort into that? >> 14 days identified, were some of them back burners and they said okay, we are going to be most worried about the three so whatever scientific or national security reasons we won't worry about six or seven of them? >> not sure it has been that stock. when you look at where we are now after this ebola challenge, when you get to these other challenges i think because of what happened we are better prepared. we got a real scare and the

system was shaken very badly or very substantially. so in terms of the sequencing, if we are faced with another challenge that could be carried in an airborne sense and could be more contagious absent this ebola chapter in worse shape. in some ways being tested on ebola prepared us to be ahead of the others. the question is will the response or the lessons learned focused on what we do wrong with ebola. >> what do we need to do? >> kind of a broad based system. >> not sure if you were here

yet. how much conversation among lawmakers, lessons learned and the federal government after s.a.r.s.? i can't remember what year it was. >> i was there. >> i don't remember what conversations took place. there were some with the agency's post. everybody performed pretty well. they were pretty lucky. >> the other question we have from twitter, and the we are talking about. and a whole movement in this country, the entire vaccine movement, is that something is

an impediment which the depopulation is supposed to get vaccinated for or the new diseases? >> there are concerns that there are always going to be populations that doesn't want to be vaccinated. every vaccine has unintended consequences based on the genetic makeup of an individual. that is to be expected. i will say this as it relates to the early testing for an ebola vaccine. the testing couldn't be more positive. we have a lot of hurdles over the next several months to be too a point probably mid 2015 and slightly sooner that you could mass-produced and begin to inoculate. >> how much on a policy level our lawmakers talking about, and

save someone's life, they have done blood transfusions, used this drug, daly had a few doses of zmack and we don't have because it is an emergency. we don't really know which of these drugs. are there policy issues that have to be bought for making sure we have clean science. >> those same questions have been asked that made the decision. and understand what their policy is going to be, the statement they are going to make and every decision has a precedent and understand why it is so difficult for the united states.

every day in this country somebody dies of cancer because the fda has not approved an experimental treatment. they might not have actually seen anything else. they have a choice between nothing and nothing. so we come from a system that puts a lot of stock and in getting to this bar before we let you take the public can't make any nikkei's. a little different when it comes to an outbreak like this. don't know what the threshold is going to be, but i am sure our normal process will be cut short as long as the test results show something positive that the end. >> the lack of progress in africa, white people didn't pay attention. then we have complete mania where the public perception and

cable coverage was a way more scared in the u.s. and now people have sort of move done. how do you maintain -- how do you get lawmakers to keep a sense of urgency when the public has moved on? particularly when money is not flowing freely in all directions on capitol hill? >> it is very difficult. washington, the issue of the moment on tuesday afternoon. a big thud and everyone is talking one vote for one new issue sometimes by wednesday afternoon it seems like it was weeks ago instead of 24 hours ago so that is a challenge because of the culture of this town. i do think the senate like any institution spends more time on particular issues so those folks

even when it is not the issue of the day will continue to work on it. i would also say as much as you raise a couple questions, what are you worried about, the next outbreak, the next challenge, do we know enough about countermeasures beyond what we learned with some other approaches, the most damage that is done or the greatest concern often is washington. washington dysfunction creates a measure of uncertainty which slows down research sometimes, opportunities are lost. the best thing we could do is make sure we are working better together because that uncertainty, you talk to richard -- talk to folks for years,

researchers need certainty. institutions need certainty. you know things are bad when the national institutes of health has a measure not just uncertainty but some damage inflicted by sequester and the few other. our diss function, i am certain that that uncertainty creates a terrible problem for addressing all these worries and a couple questions. >> before they get their questions organized we have the mic for those who want to ask a question. please identify yourself. looking at what -- looking -- classified stuff the rest of us don't know about other things we should be worried about. >> he knows more.

>> if you could just -- if you could just create one policy to fix something without worrying about 60 floats or the sequester, what would each of you if there was one measure, if you have a legislative magic wand, what would you do? >> from the standpoint of any threat? >> 14 things you have identified. watching ebola, thank god it wasn't even worse, we could learn some lessons and come out with knowledge, what would you like to see the senate do? >> i would make sure our policies in this country were such that they encourage innovation because it is innovation that is going to help us to overcome those 14 threats, the next 14 that arrives. it is innovation that is going to give the next terrorist or the next manmade threat to us,

we have to continue to be the country that innovates and innovation means you have got to make sure the math works, you have to make sure intellectual property is protected and you have to make sure there's a marketplace for them to sell to. >> i should add, we were only supposed to fix one. a constant vigilance focusing on this question. that means the who and other international institutions in places far away like liberia or sierra leone as well as what happens in accounting pennsylvania. that whole continuum of preparedness and communication, and innovation will drive the breakthroughs that gives us the

tools. >> a question over here? >> thank you, senators for coming today. what was the affect if any -- what was the effective fannie on the dod and cdc, policies? >> again. the list of communication right there. >> not to mention new york and connecticut. >> the number of hours i spend on the phone with the administration trying to convince them that they have to fix this. collectability on their part to understand that there was a problem there. and i think anybody that had been through any type of tabletop demonstration on any threats and public response would have seen that one has just probably the worst thing that could have happened.

still a policy today. we're still taking the military then come out of the region and have no contact with patients and quarantine them for 21 days and anyone else gets quarantined continues to be a problem. maybe not as high today on the public's list of concerns that they have but it is one of those things that breaks down the trust of the american people we have a system that really understands and can apply common sense. >> any questions? right here? >> this is a free shot at bob and i, take it. >> i am a health policy physician, a communications consulting. clarify something for me. my understanding of the term quarantine is somebody is in a

medical isolation type of situation whereas what the military is doing is taking people out of west africa, putting them in germany and limiting their movement, their access but they're not actually in quarantine or isolation. your point may be that that is part of the problem of communication because the policy on quarantine isn't applicable to west dod is doing in their limited movement, isolation, what ever so the two different policies for two different situations. >> nancy schneiderman. i can go to the grocery store as long as i feel like it. >> if you already made plans for that. >> a whole different issue. this just gets back to the need for somebody in charge. i can't stress this point enough. i think we all drilled it and drilled it in the administration and there's a debate about this.

this was somebody in charge. this is about a person that made the pieces move and communicate what everything -- what was going to happen. i can only tell you the faces change that do the weekly breached. but the process of consultation on what they're going to do remains the same. that is why you have two policies that are selling consistent on isolation and quarantine. one that the military adopts and one that the cdc adopts. if there is one responsibility to communicate and to administrate the organizational basket you don't have those

inconsistencies. >> the person who the public is focusing on, after 30 years. >> you have tom friedman and love them all to death so they necessarily are the ones you want on tv. >> you do have a designated secretary for preparedness and response. >> the administration -- >> she was -- a military background too. >> what the doctor pointed out, part of communicating is having the right terminology that everyone agrees to and the finding terms and another part

of this is standardizing the things, and 50 states 50 ebola responses, 50. >> things themselves. >> standardization. >> the d a d versus the cdc, the governors and that wasn't purely republicans or democrats. it was a cacophony of state policy. is that hhs's job to say sit down and do that. >> it was difficult in the midst of it. it was a vacuum people are filling. might have been right or wrong. folks at the local level. and those who are going on,

washington, keep hearing different things. >> this never happened and shall trust breaks down. everything goes up to this point. and the message changed and my public was outraged so i have to play over. you wouldn't be fair if you had a consistent approach to it from the beginning. let me just say this. you can have a consistent approach here and an approach in west africa that evolves based upon how the diseases fair, totally different places. >> the public reaction, this history of complex reasons for

distrust of government and the of va, questioned people's minds, but the gap between what a large segment of the public thought versus the science that is not in dispute that you understand, a very big gap. how do you -- how do you get over something like that if there is something more contagious and more frightening and maybe not more frightening but something that is a bigger medical threat with that inability to clamp down fiers and not create -- how do public officials look at that gap and will you worry about a bigger version? i didn't articulate that very well. >> remember congress isn't simply about legislating but communicating. and what the facts are.

but the administration, any administration has to figure out a way to constantly repeat what the science is telling us not just in rebuttal, not just when people are doubting, there has to be a constant repetition of what science is telling us. if you don't do that others will fill lloyd with some science and some stuff that doesn't make a lot of sense. >> time to wrap up the conversation. thanks for taking time to talk with us and share your insight and thank you to everyone who attended today and for watching us on the line, a big thank-you to cbs held for partnering with us on this important event and the whole -- have a great day and look forward to seeing you at the next political event. [applause]

>> coming up, a house committee looks at defective car airbags manufactured by the toccata corp. and a senior official at the corporation along with representatives of toyota, honda and bmw. you can see it live at 10:00 a.m. eastern and later live coverage of the foreign policy initiative forum held in washington d.c.. we will hear from senator ted cruz in louisiana governor bobby jindal as well as experts on the middle east and russia. saturday night live on c-span3. >> according to aaa drunken-driving is responsible for 100,000 traffic accidents every year. national transportation safety board hosted a summit to look at the problem. concluded medical and safety

experts. >> good morning. welcome to the board room of the national transportation safety board to awake and alert live, overcoming the dangers of drowsy driving. i am board member of mark rose, kind. joining me is dr. robert malloy of the office of highway safety, dr. gina price and mr. dennis collins, performance investigators at the and in heaven. my thanks to the panelists will provide considerable expertise today.

we are calling this awake alert alive because every driver must be awake and alert to operate a vehicle safely. americans on the road impaired by lack of sleep but this is only the tip of the iceberg. conservative numbers tell us driver fatigue made directly contribute to 100,000 roadway crashes annually but these are only police reported crashes. there are some estimates that put the number of drowsy driving crashes at over a million year. conservative estimates suggest 1,000 people killed annually in these crashes while other data indicates that 5,004 as many as 7500 lives are lost each year due to drowsy driving. experts agreed the number of crashes and fatalities officially attributed to fatigue

is grossly underestimated. there is no roadway test to determine sleepiness. we do not have the fatigueolizer as we have a breathalyzer. the reporting practices are inconsistent and there's little or no police training in identifying drowsiness as a crash factor. self reporting is unreliable. one thing we do know is any resulting loss of life is tragic, needless and preventable. a drowsy driver can be a dead the driver. one night losing two hours of sleep is significant to impair our abilities. reaction time, decisionsmaking could be significantly reduced by 20% to 50% and driving in this condition to the brake lights in front of us. fatigued alone can be deadly. and the adverse effect of other

forms of impairment that lead to crashes such as drugs, alcohol and distraction. other forms of impairment may be exacerbated when basic requirements for sleep is disrupted. for years the ntsb investigation identified fatigue is causal, contributory or finding crash is moving across transportation modes. the agency has issued 200 safety recognitions for safety fatigue in diverse areas as research, education and training, vehicle technologies, a treatment of disorders and hours of regulation and scheduling policies for commercial bus drivers. most people drive cars. they operate personal vehicles. for most of us there are no hours of service or rest rules. we have to rely on our own experience for knowledge and fatigue and its effects. our personal experience especially as it relates to self diagnosing fatigue is typically

inaccurate. in january of 2013 the ntsb investigated a collision of three passenger vehicles. the collision happened at 8:30 in the morning, and a nurse at a local hospital was driving home after 13 hours, she departed a lane, crossed over the median and entered a northbound lane against flow of traffic. the car struck another vehicle, pushing at one lane over. this vehicle was struck again from behind by another car. one driver was fatally injured and the nurse was transported to a hospital where she was treated for her in juries. she had fallen asleep. she had worked in the shift for nine years and was familiar with the challenges of her schedule and yet her in third work schedule along with her extended time since waking and in this case nearly 16 hours continued and contributed to her falling asleep at the wheel. today's for authorizes us to

talk about drowsy driving. and to mitigate the dangers of fatigue. we identified what we know and what we don't. only the most robust data on drowsy driving and lead to the most effective countermeasures. we examine medical conditions that lead to fatigue. and other sleep disorders. we hear about the challenge by the novice drivers, we will discuss regular work schedules and the same people we depend on for 24/7 modern life style and even life-saving services are vulnerable to taking to the road in a fatigue state. we will hear about on road countermeasures and a variety of other strategies to reduce the risk of drowsy driving crashedes. perhaps just as importantly, we will provide a public setting to examine the dangers of drowsy driving. for awake and alert driving become expected norm, public awareness and education must play a prominent preventive

role. this forum is for all of us. it is for nurses, doctors, law-enforcement officers and security guards driving home after the night shift, the utility workers driving into the night to fix power lines after a storm, for the student, startled into alertness by the glare of a horn as he drives home from an exam. it is for any of us who have ever driven with too little sleep. a crash can happen literally in the blink of an eye. it is our hope that this forum is one step toward a national waking about this he risks of drowsy driving. now i will turn into dr. price along with her collie says the net outstanding job organizing this forum. dr. price. >> most kind. for safety purposes please note the nearest emergency exit. you can use the rear doors you came through, to enter the conference center.

there's also a set of emergency doors unneeded side of the stage upfront, if you have not already done so, use your -- silence your electronic devices. today's for his been designed to get at the heart of several topics relative to drowsy driving. we will begin with an introduction and discussion of the scope of the problem. this morning we also have panelists addressing workplace factors, concerns of novice drivers, and these that a group of young roadway safety advocates from the national organization for use safety join us during the novice driver panel. after lunch we will have panels' discussing health issues and in vehicles and roadways. the final panel of the day will address countermeasures and future directions. each panel will open with presentations by analysts followed by a facilitated question and answer period led by our ntsb tactical chairs. our staff and panelists bios as well as the agenda are available on the forum web site, www.

ntsb.gov/drowsydriving. early next week presentations provided by our speakers and the video archive of the web cast will be available on our web site. attendees or others who wish to submit written comments for inclusion in the forums may do so until november 7th. submissions to directly address one or more of the forum topic areas should be submitted electronically as an attached document to drowsy driving forums@ntsb.gov. those joining us in our conference center there are a variety of the adoptions in the plaza. take the escalator up 1 floor and walk straight ahead. you will find several restaurants and a food court. handouts for the agenda are available in the lobby and the forum web site. because we have a full agenda we appreciate your cooperation in helping us keep on schedule during panels and breaks.

one note to our presenters about breaks. we will have panel photos in the morning, panels for the morning, during the morning break in the afternoon panels during the afternoon break. also there will be a group photo of all panelists when we break for lunch, we will be here in front of the dais. i will now turn to our first technical chair, denis collins, to introduce the first panel. mr. collins. >> thank you, dr. price. presenters, when speaking please push the button on the microphone. a green light indicates the microphone is on. bring your microphone close and press the button and turn it off when you are done speaking. the first panel covers and introduction on the scope of the problem. our panelists are dr. dinges david ant director of the unit for experimental psychiatry at the university of pennsylvania's perlman school of medicine and brian task, senior research associate at the aaa foundation

for traffic safety. >> good morning. thank you, most kind for inviting me to speak at this important meeting. i am going to begin by setting the stage for the biological effects of drowsiness that make it so terrifically dangerous when we drive. next slide please. the first thing to remind those listening and looking at these slides are that as near as we know right now all animals need to sleep and humans are no exception. sleep is any central part of our health and survival. we have to do it on a daily basis and we have to achieve healthy sleep and we need sleep that is of adequate duration to insure the we don't have an controlled drowsiness and sleepiness during the day time. next slide please. this slide is a reminder that when we don't receive adequate

sleep we tend to fall asleep very rapidly. the graph going down shows the longer we are awake the more rapidly we will fall asleep and the more rapidly we will transition into a stage of sleep where we cannot recovery even if we are alerted. the graph on the right reminds us the depth and intensity of that sleep is an inherent part of the sleep system attempting to recover the brain from the terrific need for sleep and to give in this league that is essentials in other speakers will talk about what happens to drowsiness and waking functions when you don't receive the depth of sleep. next slide. why don't people obtain enough sleep? this is the only thing i will say here, we now know in our modern life style that substantial portions of the population shown in the yellow

bars on the left. the bulk of the evidence points to the fact that once large segments of the population are sleeping less than 7 hours, we get an increase in excess of sleepiness, accident related sleepiness as well as obesity, diabetes, cardiovascular problems. there are significant safety and health consequences to chronically undersleeping yet we have large segments of the population under sleeping. the graph on the right reminds us that part of that, why people don't get out of -- adequate sleep is work and travel. they spend extra time at work, extra time getting up early to get to work and those seem like a normal routine activities, they have become so problematic they are eating up the time that

one should spend sleeping and force us to compress our sleeve down into a shorter and shorter period during the workweek and people make a desperate effort to try to recover on the weekend but that recovery is usually inadequate, two days of extra sleep will not reverse repeated cycles of five days of inadequate sleep. chronic sleep restriction which is how it is referred to is an inherent part of modern life style land jobs for many people and that is one of the sources of problems. you will hear this speakers talk about sleep disorders. next slide please. we know that this is occurring in the brain. many think it is ok to drive drowsy because it is a willful event, that somehow doesn't have anything to do with biology and you can will yourself to overcome it. often people get away with it without crashing, they get the belief in their heads that it doesn't matter if you are tired, is ok to drive, the save and

careful because you have a good intention but intentions won't as we know won't prevent this biology from turning on. this is a brain scan showing that major areas of the brain in blue, the frontal part of the brain, the associative parts of the brain in the upper back part of the brain, the central core of the brain are all showing changes inactivity, metabolic we in the brain that are consistent with the brain falling asleep with are trying to stay awake and drive. there's a terrific change going on the we cannot easily control and swapping yourself in the face or turning the radio up or chewing gum or singing will not prevent this from occurring. if it does prevent it, it is no more than a second or two. it won't have a lasting benefit. it is not the same as we. the brain needs leak. obviously you can't sleep and drive at the same time. next slide please. with you click on this video?

one of the hallmark features of the falling asleep/driving is that the eyelids will close. we all know this but we don't understand it is the muscles of our eyelids that are abusing tone due to the pressure for sleet. sleepiness and drowsiness when we are driving not only makes our brain blink on and off and not pay attention but it also causes muscle relaxation including the muscles of the eyelids so the eyelids will come down. this is a truck simulator, not a real driving experience so we are not putting this young lady at risk but you will see that she is falling asleep and the head steps back and the eyelids closed because there is loss of muscle tone and when the i did opens the eyeball rolls back and reorients in the head and that will happen in a second. you can see she almost ran off the road in the simulator. this is what we all know.

drowsy driving is. so many people have done it in their lives. we don't have any trouble recognizing that is what is occurring but -- next slide -- we don't appreciate how staggeringly dangerous this is. here is another example in the laboratory. all we need to do is click on this year and we will get it going. on the left side in yellow this young lady is working on a vigilance task but she has been sleep deprived. on the right side she is working on a vigilance task and she isn't sleep deprived of in the grass down below, show you that overtime the graph on the left says that initially she works ok but as soon as we sleep deprived her, halfway along the graph up go her lapses of attention and up goes the increase in her eyelids drooping. we are measuring these by computer analysis. on the right hand side she made the board that she can work for hours on end without falling asleep. people who think drowsy driving

is due to being bored when you drive for bad scenery are wrong. it is due to you not sleeping enough. boredom is driving when you are not interested in what you are looking at but you are able to stay awake. sleepiness and drowsiness is the pressure of the brain trying to force you to go to sleep when you have vigilance tass called driving. and attention in particular and alertness are the number one effective sleet loss. by far they occur more frequently and more profoundly than the effect on memory and reasoning and many other areas. next slide please. that is best illustrated by this complicated slide. listen to these heartbeat. they are not hard these, these are reaction times of people when they are fully alert and pressing a button so each heartbeat is a fast reaction

time. and just to give you the point that the brain is steady as you go here. click on the top one again and shut it off and click on the bottom one. okay, now, here is the drowsy driver equivalent. they start driving fine. has they go along if they have long lapses and you will hear that in a minute. there is one. that is your eyelids down. you are not responding but you are not responding, you are not monitoring, now you are back again, now you're going to go again. this is a hallmark featureless the loss. click on that and look at the right. we know where in the brain that is done on the right you see the instability of these response times in the sleepy driver whereas the other driver up above on the right is steady as you go. this is that fighting sleepiness people experience driving down the road. by the time you are doing that you are at grave risk. you shouldn't be behind the wheel. you should pull off, you should

get some sleep, get some rest, should have slept adequately before you are driving and you'll hear other speakers and me say that but this is the grave risks, just because you get away with it for a mile or two doesn't mean you won't have an uncontrolled sleep attack in the next minute or the next half hour they will be becoming more repeated and more severe. next slide. this just illustrates when you have plenty of sleep you don't have these lapses and when you do their very short so you are really stable but as we take sleep away and move you to six hours a night or four hours a light or no sleep at all for a night. you see this terrific dispersion of increased lapsing. many more lapses and they're getting longer. they are completely unpredictable. if you could predict the moment you fall asleep you might argue i will do something to correct that but you cannot do that. the brain does is against your will at the time when you suddenly realize oh my god i was

just awake. i realize i just slept is less period of time. you can't be operating a motor vehicle, you are just begging for a crash, next slide. it takes no more than at two second laps of attention at 60 miles an hour with a 4 degree angle of drift, that is just enough loss of steering control, let your muscles relax on the steering wheel, close your eyes for two seconds, you can be completely out of lean in two second set off the road in four seconds. you can easily see how it takes very little of this lapse tendency, these my chrises to put you in grave danger. not to mention a few are in close traffic trying to stop in time and one of my messages is going to be this isn't just highway phenomena in. this isn't just the long drive. drowsy driving, slow reaction time is are occurring in people who haven't had adequate sleep in the city. they are occurring in density

traffic. studies done by the federal government had shown within the washington d.c. area when they -- cars find drowsing is occurring all over the metropolitan area. these are high risk events occurring in crowded traffic. next slide. this is an illustration of the dynamics of this drowsiness and what you see in the upper graph is you don't have any of these labss from ground drowsiness in the way you get normal sleep at night on the left. as you go a night without sleep those lapss increase. if you go second night without sleep they go even higher. the same thing happens if you are only getting four, five or six hours of sleep a night. they get progressively worse day after day. down below you can see that segment from midnight to 9 a m and you can see the high rate of motor vehicle crashes related to falling asleep.

at that time you conceive a ramp up at that time. it doesn't mean you are safe in the middle of the day if you haven't slept the night before. you can have a drowsy driving crash at any time of day but this just shows the dynamic from one study in north carolina of people falling asleep and you are out at a particularly high dangerous through the night and especially in the morning often after the sun is that people think they are safe because the sun is up, that won't protect you. a light is not powerful enough to override this pressure for sleet from being awake at night. shift workers have a very high rate of these crashes but they are not the only group in society that had these crashes. young adult males do up to the age in their mid 40s at a higher rate. they already and have them in the middle of the afternoon which is often when they will fall asleep. next slide please. studies done in the laboratory shown on the left and right, the left shows the less sleep you

get every night, the more lapss you have every day. they're going to. four vs. six vs. eight vs. no sleep. on the right are how people felt about their sleepiness and what you should seek, click on that please, what you should see in the middle graph is the bottom graph, performances waxing is getting worse linear the across time and but our sense of how we are doing is not changing. this means you cannot tell how dangerous you are driving. you need to pay attention to your behavior. if you are actually suddenly discovering your head swelling of her or your eyes closing and control of the just almost drifted out of lane, you need to get off the road. not unique to slap yourself or turn the radio on, you need to get off the road. one challenge we face in this country is can you do that safely in most highways, etc.. the best way to go is

prevention. don't get out on the road sleep deprived. get adequate sleep before you get on the road ends plan your trip effectively to shore you take adequate breaks etc.. next slide. this makes the point that even when we work at night and are awakened the daytime even when we get eight hours are trying to sleep eight hours in the daytime or stay awake at night we are at greater risk for these lapses of attention because we are awake at biological night and that puts enormous pressure on the brain to go asleep. there is no safety year in what time of day you were coarsely. you are at risk whenever you don't get adequate sleep and whenever you are awake at night. next slide please. these functions are important to recall too. there are three graphs, good performance, down is bad. the lines show you time on task over ten minutes, how your performance is deteriorating and what you see is wet your sleep deprived on the left or whether

you have obstructed sleep apnea and treated in the middle, or whether the red line on the right, you are an airline pilot flying at night, you have a lower level of performance and deteriorate more rapidly. if you get adequate sleep, get treated for sleep apnea, fly in the daytime, you can perform better. they're so dangerous -- this is the time on task problem was driving. you can rapidly deteriorated. and people can't understand how that is. and it is a vigilance task when it hasn't had adequate sleep and i will demonstrate that immediately. next slide please. these tasks are very dangerous. they have a mentality really that about all. serious injuries because the driver does not correct action. you fall asleep and you are not completely asleep but you are no

longer monitoring, you exit the roadway, you don't engage in corrective action to avoid hitting the poll or the truck or the tree or rolling the vehicle and as a result they have a high degree of bodily injury. almost equivalent to that of high blood alcohol levels. here is the good news. a study from walter reed, they will restrict people to three hours a night in a laboratory to look at what happens but before that one group got 7 hours in bed at night and one got 10 hours. the more you sleep better times the better you can tolerate the effects of any restrictions that is on your sleep period being forced to get up in the middle of the night to care for a baby or get up early to drive to work. you have to get your sleep is the bottom line and you have to treat sleep as a high priority item in your life every day to prevent these cumulative sleep deaths that pose these risks for drowsy driving.

next slide please. there are seven messages. i will end on this. the brain is the organ of behavior and the brain needs healthy sleep of adequate daily duration to prevent drowsy driving. no question about it, thousands of studies support this statement. is unequivocal. we know in medicine and science and we got to penetrate this message to the public, to everybody who drives, to pick up children or whatever. next slide please. wins the bees in at the brain as a slow response and unpredictably lapses into microsleep that result in a waxing and waning of attention, slowed reaction times and these pose a very serious crash risk. they get more frequent and long in duration there is increasing loss of muscle tone in their hands, the eyelids, that contribute to an effort greater

risk. once you start having this attack writing it won't get any better unless you get off the road, get some sleep or take some other kind of counter measure which will be discussed today. next please. as sleepiness related lapses of the attention of only two seconds is enough to result in you being completely off the road, out of lane, it takes very little fear, and they often involve bottle the injury that is very severe or fatality because there is very little corrective action in a timely manner by the sleepy drivers. next. the slow reaction times even without frequent lapses of attention can cause problems in congested traffic so really if you are not frankly falling asleep, if you are sleeping in the morning and you drive you can have slowed reaction times in dense traffic that will get you in trouble. finally, since people are

frequently unable to judge their vulnerability to drowsy driving even when they are lapsing repeatedly they think they are okay. it is essential people do not drive when they have not slowed sufficiently to maintain alertness. this means you playing your driving based on who has led the most and is most fit. if you absolutely must drive overnight, having someone watch you, have someone watching you and don't let everybody go to sleep because the driver will go to sleep. that is my final message. next slide, i think that is it. thank you very much. >> thank you. our next speaker for this panel is mr. tuft of the aaa foundation for traffic safety. >> thank you, i have been today to talk about the prevalence and

impact of drowsy driving on the road ended in traffic crashes. next slide please. so in this presentation i will be talking about recent research into the prevalence of drowsy drivers on the road both in terms of driver is actually falling asleep when they are driving as well as drivers who are highly fatigue yet not asleep and also talking about studies of actual motive vehicle crashes that estimate the number and proportion of crashes involving fatigue and drowsiness. so in national surveys that have been done by the national traffic's highway safety administration, the centers for disease control and prevention and the aaa foundation for traffic safety the motoring public has been asked whether surveyed response when did they have fallen asleep or not off while they are driving and so

consistently all these studies find that about two of five americans report having fallen asleep while they are driving and at some point in their life. consistently across any study that has looked at this, even present greek port having done so within the past year and approximately 4% of american drivers report having fallen asleep at the wheel within the past 30 days. the statistics are likely to be underreported because studies have shown a person has to be asleep for on average two to four minutes before they are more likely than not to realize i was just asleep. so these are unlikely underestimates of the frequency with which people actually fallen asleep at the wheel. in addition to that the aaa foundation every year in a

survey that we do of driving behavior is an drivers's attitudes we ask people in the past 30 days how often have you driven when you were so tired you have a hard time keeping your eyes open and in response to that question more than a quarter of american drivers consistently report having done that at least once in the past month and 2% report having done that fairly often regularly. next slide please. in terms of the toll of drowsiness in motor vehicle crashes the most recent official statistics published by the national trier hectic -- pat highway traffic safety administration show 4% of fatal crashes, 2% crashes resulting in injuries and 1.3% of all crashes involve a drowsy driver involved in data from 2009.

however, the statistics that these are based on show a number of limitations that result in their likely being substantial underestimates of the scope of the problem. as a member rosekind said we don't have the fatigueolyzer. is difficult for police to arrive at the scene of a crash whether a driver was drowsy or not. a driver who is alert and awake and unharmed and able to talk about what happened may not be willing to admit to the police that they were drowsy and that contributed to the crash. they may not realize or might not remember is that they were asleep. one has to be out for two to four minutes before they are more likely than not to realize they were sleeping. in the case of the more severe crashes resulting in fatalities

would driver may be unconscious for disease -- deceased, and in such cases is difficult for the police to ascertain what happened. another, more subtle and more in serious limitation of these data are that in many states, the forms that police officers use to indicate what happened in a crash, they contain a simple series of check boxes to indicate whether a driver was perhaps drowsy, in care by alcohol, whether they were angry, emotional, distracted, etc. etc.. the way an officer would indicate a driver is drowsy is by checking the box. if a driver was not drowsy and they know that, they simply would not check the drowsy box. unfortunately, this creates a problem in interpreting the data after the fact because the way

that it would be indicated that a driver is not drowsy and the way it would be indicated that we don't know whether the driver was drowsy or not is exactly the same, an empty box. next slide please. i will be talking about a few special studies that have looked in greater depth at data on specific samples of motor vehicle crashes to estimate the proportion and the number that involve driver drowsiness. next slide please. the first study i will talk about is one that dr. dinges eluded to. the naturalistic driving study by the virginia tech transportation institute and in that study day instrumented 109 vehicles in the d.c. metro area mostly in northern virginia with in vehicle cameras and other data collection equipment and monitored these drivers 4 period of 12 to 13 months and with

researchers many will be reviewing video from crashes and near crashes that occurred, looking at the signatures of drowsiness the doctor dinges noted in his presentation, the eyelids drooping, researchers were able to estimate the level of drowsiness of drivers and they estimated that 22 to 24% of the crashes and new crashes in this study involved moderate to severe driver drowsiness and again this was a study in the d.c. metro area where the bulk of the driving was done in circumstances that aren't typically associated with frequent drowsiness. next slide please. and other studies that took a totally different approach to this problem was a study by dr. jean stepson colleagues in the

university of north carolina and in this study the researchers gathered a sample of police reported crashes from the state of north carolina where the researchers believed there was reasonable ascertain meant whether the driver was known to be drowsy or known not to be drowsy. ..

next slide please. and, another study that gives us more insight into the prevalence of drowsiness in crashes is the national motor vehicle crash causation survey done by the national highway traffic safety administration. this is a study that used multidisciplinary teams of crash investigators to look at the causes and contributing factors of a sample of 5470 crashes nationwide in the years 2005 to 2007 that were severe enough that emergency medical services were dispatched to the scene. and this study had, had fairly indepth assessment of driver fatigue. this involved not only police reports of drowsy driving but interviews by the investigators

with the drivers, as well as the driver's families, their employers and others about whether they were fatigued at time of the crash, their recent as well as long-term sleep habits, work schedule, medications they were taking, et cetera. and, and this is aside from the video-based evidence, probably some of the strongest ascertainment we have lousy driving in traffic crashes. -- draws sy driving. one of the important limitations of study, this only looked at crashes that occurred between 6:00 a.m. and midnight. the study did not investigate crashes that occurred between midnight and 6:00 a.m. when you might assume drowsy drive something significantly more prevalent. next slide please. in this study, again, excluding the hours when drowsy driving crashes are known to be most

likely to occur, the researchers found that 2% of drivers involved in these crashes were actually asleep at the time of the crash and an additional 5% of them were, despite not being asleep, they were judged to be fatigued. and in nearly a third of crashes, in 29%, they were unable to assess whether a driver was fatigued or not. so, so aggregating this driver level data to crashes, this would suggest that as many as 3% of all crashes involved a driver who was actually asleep and an additional 10% involved a driver who was, who was not actually asleep but fatigued. and this is only out of the 60% of the crashes where researchers could ascertain that for all drivers. next slide, please. the last study i will talk about is a study that did for my

employer, the aaa foundation, in 2012 and this was a study that that used the national highway traffic safety at administration's national automotive sampling system, crash worthiness data system which is a sample of crashes which a motor vehicle is towed away from the scene. i looked at data from 1999 to 2008 and it is comprised 47,597 crashes which involved over 80,000 vehicles and drivers in total and in these data drivers attentiveness, whether they were paying attention, whether they were distracted or whether they were fatigued was assessed again not only from police reports but by investigators who interviewed drivers and in this study they estimated that 2% of the drivers were actually drowsy. however, researchers also

reported that 45, in 45% of cases they were not able to assess whether the driver was drowsy or not. the distinction between the driver not being drowsy and the investigators not being able to make determination is important. because of this, i was able to use a statistical method of multiple imputation to estimate the proportion of drivers where investigators couldn't make a determination, who likely were drowsy. and just briefly, imputation is a method in which, in which you build a model using data that are, are related to probability that a driver will be drowsy or the probability that investigators aren't able to make a determination and, using, using this model, investigate, identify, other cases in the data where drivers drowsiness is actually known, that are the

most similar to the cases that you're looking at, then you make a random draw from the distribution of these data where drowsiness is known to estimate the drowsiness in cases where investigators were not able to assess. next slide, please. that by the way, is a method that the highway traffic safety administration has used since 2001 to estimated proportion of fatal crashes that involve alcohol. so in this study, again, originally, in 45% of cases driver drowsiness was unknown. so i estimate based on these data that 4% of drivers in all crashes were drowsy and 7% of the crashes involved at least wondrous sy driver. and among the more severe crashes, those in which an occupant was hospitalized as a result of injuries sustained in the crash, i estimate that as many as 8% of the drivers were

drowsy and 13% of these crashes involved a drowsy driver. in terms of fatal crashes i estimate that 12% of drivers involved in fatal crashes were drowsy. and 17% of fatal crashes involved at least wondrous sy driver. based on the, based on the number of people killed in crashes each year, that would imply conservatively, that over 5,000 people each year are killed in crashes involving a drowsy driver. next slide please. so, a couple of comments and observations, on these studies collectively, no single study can provide the definitive answer, however there is reasonable convergence across multiple studies that the proportion of crashes involving a drowsy driver is much higher than is reflected in, in the

official national statistics. and a couple of trend we see in these data are that, although the studies with the best ascertainment of driver drowsiness are also admittedly based on some of the less representative drivers and of crashes, we also see with the studies with best ascertainment of drowsiness, those with best interviews and actually video data of crashes estimate by far the highest proportion of crashes involving drowsiness. finally although it is probably unrealistic to expect solid ascertainment of drowsiness in data collected by police officers who arrive at the scene of a crash several minutes after it's already happened, however, on the data front it is really important to be able to distinguish between crashes

where the investigators determined that the driver was not drowsy versus crashes in which they can not make a determination and right now that is a distinction that is absent from most of the data that we have. next slide, please. so to summarize, surveys consistently show that as many as two out of five drivers report having fallen asleep while they were driving at some point in their life. 11% of drivers report doing that in the past year. 4% of drivers report doing that in the past month. that is consistent across multiple studies, by different organizations, done over the span of a decade and for all the reasons we talked about, that's probably still a significant underestimate of the prevalence of drowsy driverses on the road. and official statistics estimate one to 2% of crashes involve drowsy driving. again that is likely a substantial underestimate.

the studies with the best data and the best research methods consistently show a much higher prevalence of drowsy driving with, on the low end 7%, on the high-end as many as 24% of crashes involving drowsy driving as a cause or a contributing factor and, and the data tends to suggest that the prevalence is on the high-end of that range in the most severe crashes. thank you. >> thank you, mr. teft. dr. dinges, in your presentation you were very clear that there are very severe safety and health consequences to operating fatigued and it is not something that can be affected by will, with clear physical effects. you mentioned some things not effective in combating fatigue. i wonder if you can tell us in

simple and general terms what is effective in combating fatigue. >> well the primary counter measure is adequate sleep and i made a specific point of saying healthy sleep and you will hear other speakers talk about what healthy and unhealthy sleep is. but also, sleep of adequate duration and sleep that is occurring not too far before the driving episode. in other words sleeping adequately one night and two days later, driving with inadequate sleep wouldn't work. the other, most commonly used way of coping with drowsiness is caffeinated beverages. there is evidence that caffeine can promote alertness, but, no drug, and that includes caffeine, is a substitute for sleep. it is not a chemical sleep. it is just simply forcing areas of your brain to use it

metaphorically speaking, forcing areas of your brain to be more alert, blocking some molecules that produce sleep in the brain but it can't block all of them. if the sleep pressure is too high, and we just published a review in nutrition reviews on this, once the pressure for sleep is very high, once you've chronically underslept and not getting adequate sleep and have high sleep pressure caffeine can not stop it. it can not stop sleep from intruding and can not stop drowsiness. it does not last a day. take a cup of coffee, depends how much caffeine is in the coffee, what the dose is, what your sensitivity is to it, but nothing will last in your bloodstream probably three to four hours at the most. you are faced with the problem what do you do if you're still driving. it won't substitute for sleep. you will have to sleep. and it won't keep you going

indefinitely. but it is the most, problem i let most common way that people attempt to cope with sleepiness when they have to drive. it is just a very limited counter measure. that is the primary one. stopping and exercising, taking a break, is helpful but it won't substitute for sleep either and you can be sleepy back on the road again back in a minute if you haven't had adequate sleep and are drowsy due to that. alas the options are quite limited. there are medical options but i will leave that to the physicians who will speak about how you treat specific disorders. what are the medical implications. >> i'm also wondering if you could speak briefly on the nature of individual differences with respect to fatigue and sleep. what effect would a person's individual differences have and what problems does that pose to you as a researcher?

>> well, there are individual differences in how rapidly people will become impaired from sleep loss but everyone becomes impaired. it just takes some people longer than others. scientifically we don't understand the basis for it but those people who take longer to get impaired are not the majority. they're the minority of the population. and we're not even sure that they're always, it is always the same for them. we don't understand what it is that makes them, excuse me, less vulnerable to sleep loss at one time than another. but once you're awake too long, if that goes on chronically, everyone will become impaired. and even if you don't feel it, and this is a key point, it doesn't mean you're not in fact experiencing drowsiness, lapses inattention. and so the only way to be safe and certain is get adequate

sleep. >> mr. teft, you cited 2009 data as nhtsa's last official data and i'm wondering if you had a chance to look at anything that might be more recent and if so could comment briefly what it shows? >> right. the 2009, the data from 2009 are the last data that have been cited in official publications by the national highway traffic safety administration as their estimates of the prevalence of drowsy driving. however those data are, those statistics are based on data that are collected annually and presently available through 2012 and the most recent data which i have looked at from 2012 show that 1.6% of drivers involved in fatal crashes in 2012 were

believed to be drowsy or fatigued at the time of the crash. >> what would you say is the general trend for the drowsy driving data? let me back up. is there a general trend and if so, which direction is it heading? >> well, in the, in the official statistics there doesn't seem to be much of a general trend. if anything the proportion in the statistics may have decreased slightly in several years. as i talked about in my presentation i believe those are such a vast underestimate i would not look to the data published in those sources for evidence of a trend or lack there of. in the study that i conducted looking at data from 1999

through 2008, this is based on sample of about 5,000 crashes each year investigated in more depth. in those data, there wasn't evidence of an increasing or decreasing trend in the proportion of the crashes that, that involved drowsiness. i would note that in recent years, as we all know, the, the raw number of crashes and injuries and deaths in crashes nationwide each year has decreased and that is a good thing. however, i don't believe that there is any evidence based on the best available data that the problem is, is increasing or decreasing as a share of all crashes. so, if we look, if we used the most conservative estimate we had across any of the, any of the more solid studies of the proportion of crashes that involved drowsy drivers and apply that to 2012 data, we

would still estimate that over 5,000 people were killed in crashes that involved a drowsy driver. >> you also mentioned in your presentation multiple imputation. that nhtsa looked at it to look at alcohol-impaired driving. i'm wondering if nhtsa could use the same technique to look at fatigue-related crashes? if so and if not, what would your opinion be on that? >> well i believe it could be done but, i would only, i would only do that with, with a couple of the data from a couple of the studies that i referred to in my presentations. the national motor vehicle crash causation survey and the national automotive sampling system crash worthiness data system because in both of those studies researchers, independent of the police make an

independent determination whether a driver is drowsy and critically to the use of imputation they distinguish between whether the driver was known to be attentive or whether they were known to be drowsy or whether they could not make a determination. in the, in the data that are published annually by the national highway traffic safety administration their fatality analysis reporting system and their general estimate system, the data on driver drowsiness there is only based on data from reports completed in the field by police officers and they, in most cases i don't believe they make a determination between, a distinction between whether a driver was known to be attentive or whether, whether they simply couldn't tell whether the driver was drowsy or not. there is actually an indication in the data of whether there were no contributing factors

apparent or whether the driver's condition at the time of the crash was unknown. however, the proportion in which they indicate that the driver's condition was unknown is implausibly low, even among crashes in which only one vehicle was involved in the crash, there was only one occupant, the driver, in the vehicle and the driver was already deceased by the time the police arrived. even in those crashes they only report that the driver's condition was unknown about 1/3 of the time and in more than 60% of the cases they report no contributing factors apparent. and i'm not sure how one could arrive at that determination when the only person involved in the crash is already deceased by the time you arrive to investigate. >> i wanted to comment on the, the notion of, you know, is the prevalence changing here. there is no question that the introduction of shoulder rumble

strips, of airbags, et cetera, might have made it safer or less likely to be lethal for someone who drives drowsy but it is unclear to me that there is evidence they have reduced drowsy driving. in other words the message is, to don't engage in the behavior to begin with. and i think what they have done is try to alert people from catastrophic run off the road but it is not clear to me that we have the evidence to suggest they have really prevented drowsy driving. and the risk factor here is the impaired driver from drowsiness. if we don't have a concerted effort to teach children adolescents grave risk in this area, and i'm sure we'll hear about that, shift workers and the average person who pushes themselves very hard and doesn't get adequate sleep, if we don't make concerted effort to make sleep the priority in addition to all of the other things that we can do with roadways and

motor vehicles to help protect drivers we are in effect not dealing with the core source of the problem here and that is inadequate sleep operating a motor vehicle. >> thank you. dr. price? >> thank you. i have just one question for dr. dinges. dr. dinges you talked about banking sleep or recovery sleep. if a person is chronically or acutely sleep deprived, how much time does it take for a person to sleep to pay that sleep back? if they have enough sleep, are they then safe to perform after that? >> thank you for the question. it is not as easy to answer as i would like it to be based on evidence but the estimates, we've been studying this for the national institutes of health and other agencies as have other labs. it appears that the old belief you can make it all up in one

night is not supported by the evidence. we can't, that, that belief came about by only allowing one night of sleep and people looked fine the next day, so they let them go home. when you keep them in the laboratory and you study how they function, how safe they are, you realize that in fact it takes more nights of steady sleep to get you back, of longer sleep. it would be vastly better to not get sleep deprived than to attempt to recover from it. and i realize that's a harsh message for the public that has gotten used to sleep deprivation but the fact of the matter is, prevention is the best way to go here. recovery takes longer. and it can take longer if you have other conditions that are causing sleepiness or contributing to it, medical conditions, et cetera. >> thank you. dr. mali loy. >> i have a question for mr. teft, regarding to the data as we talk about, people

generally having, being more drowsy in general and you talk about the people reporting that they have driven while drowsy, have surveys looked at people's attitudes as far as the risks of driving drowsy and if so, do people make that link between their louse drowsy driving and the risks? >> it honestly doesn't appear that they do. we have looked at that in surveys by the aaa foundation in those surveys we asked people how much of a threat they perceive other drivers driving while they are sleepily to their own personal safety as well as they consider it acceptable for a driver to drive when they're so tired that they have a hard time keeping their eyes open and consistently large majority of people report that they consider a very serious threat to their own personal safety, that other drowsy drivers are out there.

that, and, almost unanimously, consider it completely unacceptable for a driver to drive when they're so tired, yet, again, over a quarter of them consistently report having driven in the past 30 days when they were so tired they couldn't keep their eyes open, and a small minority but still that translates to still a large number of people report doing that fairly often or regularly. >> thank you. dr. rosekind? >> mr. teft, i'm asking you the hardest question first. ready? in your understanding of all the data and limitations, et cetera, give me the numbers. so pick whatever year you want and don't say the data suggests. if we're trying to characterize the scope of the problem annually, how many drive drowsy driving crashes, how many lives lost, how many injuries? >> based on the most conservative estimates of prevalence that consider

credible and most recent statistics on number of crashes and injuries and deaths in the united states annually i think conservatively at least 400,000 police reported crashes each year involve drowsy driving as at least a contributing factor. over 100,000 i would estimate, approximately 115,000 crashes resulting in injuries involved drowsy driving and, at least 5,000 people are killed each year in crashes involving a drowsy driver. >> great. thank you very much for being so direct about that. with all the caveats acknowledged. second thing is you identified a variety of different shortcomings in the different methodological approaches. if you were going to create a program that more accurately was more able to define this problem in a ongoing manner, what would that program look like? >> ideally, if, if every vehicle on the road or at least a large

sample on an ongoing basis were equipped with sophisticated in-vehicle data collection equipment, including cameras, that would give us a great deal of insight into many of the causes and contributing factors in crashes, including of course drowsiness. short of that, what i would really like to see is in the, in the national highway traffic safety administration crash worthiness data system which i believe is the only current, ongoing, annual data collection system that has the means to make a reasonable determination of whether a driver was drowsy and whether fatigue contributed to a crash, not in the same depth as invehicle cameras could but much, much better than simple investigation of police reports. if that data collection system were to be beefed up in size and number of investigations done

each year, and if a little bit more depth of investigation was added, analogous perhaps to the national motor vehicle crash causation survey which was a one-time effort done in 2005 to 2007, if that level of investigation again interviewing not only the driver but their families, their employers, really trying to gain insight what this driver's life was like and what state this driver was in at the time of the crash, if that were done with reasonably sized sample, at least, i'd say 3 to 5,000 severe crashes annually, that would put us, far, far, ahead where we are now in terms of what we know about drowsy driving and being able to monitor trend. >> great, thank you. dr. dinges, why do you think we have this disconnect between the science about what we know regarding sleep and sleep loss, et cetera and our societal attitudes and behaviors?

what do you think are the basis for that significant disconnect? >> well one of the base sis of it, we have become used to being sleep deprived, used to being drowsy and used to falling asleep and no one thinks that is unusual. just as years ago no one thought it was odd someone snored very loudly when they slept and that seemed like normal behavior as you now here from physicians regarding apnea, that is not normal and in fact poses significant health risks. this really touches on the point about what would you do about it for me. we need to show people, drivers driving drowsy, that. >> we'll leave this program here. you can see the rest of it anytime on our website, c-span.org. in a moment we'll bring you live coverage of the u.s. senate. lawmakers today voting at 10:00 this morning on confirmations to the equal opportunity employment commission. also procedural votes on several

judicial nominations. another round of votes is expected at 5:30 eastern today, off the floor, senators continue working on a bill that would fund the federal government beyond next thursday. and now to live coverage of the u.s. senate here on c-span2.