that they were doing. the thing i covered were stories that were different and distinctive. kristi asked me to think about a story i mentioned. i will mention one. is that an event at the clinton white house and the former president is there and not jimmy carter. the editor said everyone knows carter and clinton didn't get along. to my surprise, president carter agreed i could interview him about it. because carter sbreed to be interviewed, president clinton agreed to be interviewed about it on the phone. i did a story about how both

southern democrats had the history fraught with tension and how it meant that president clinton didn't turn to him for advice or to do things for him that you might have expected. that's a story i remember because it was different from what everybody else was doing. i remember both things. memorable events. trying to get a story that was different from everybody else. >> the really interesting thing is you had a story idea and you talked to them about your story. >> two presidents. >> when did that stop happening? seriously. when did that stop happening? when was the last time you recalled doing something like ha? >> i have interviewed the last eight presidents.

president clinton was more likely to engage than the presidents that followed him. they intrude him before the inauguration and before the convention in 2012. with president clinton, he was a guy even during impeachment. "usa today" had the idea that father's day was coming and every section of the paper should have a cover story related to father's day. i am not defending it. bill clinton as a father, this was during the monica lewinsky scandal. nothing except his father hood.

it was a very explicit, i could not ask another question. even though in these historic times. i said i promised i would not ask about anything for father hood and if there is anything else, i'm here to listen. >> did you have that access to the president and did you call and get the president on the phone and get interviews at your initiative? >> no, we didn't. i had a few experiences with vice president bush when he was with reg land that i would get him on the phone. never with the regularity that i wanted. it's a pretty rare thing. he was very inaccessible this that type of way. he never did as far as i know, other people here who were here during that time that susan

mentioned. maybe they had a better experience than i did. i haven't tried clinton and i know he met reporters since they left. since he left. >> you did have a chance that you could if you went to where -- if he was walking to the helicopter or did a photo spread in the oval, he couldn't resist answering your questions. >> they had the questions at him and his staff went to great lengths. they would tell him before they walked out the door. don't say anything. they would say something so

provocative, he couldn't resist that. they would say he would try to meet the insult with something of his. that was a feature of the white house. he would go to camp david and leave and fly away. we would see him and try to provoke him into answering the question. reagan -- i don't have the statistics to back this up, but i have the impression that reagan was more available to the press in the oval office than his successors had been. they were there and there was also a photo op. there was always an opportunity to ask a question. whether or not he answered it was remaining to be seen. there was the opportunity and

that's one of the important things. that's something that we missed now. visiting dignitaries and people who -- i remember reagan being very antiabortion. he had antiabortion groups in a lot. as the years have gone by, that opportunity has closed. it is closing. it's the frequency of it that is not as much as it used to be. the photo opes from the oval office that were regular and my impression is that there were

with reagan, not as many news conferences with different -- and they were prime time leaderships with 60 million people. 8:00 at night. it was maybe three or four times a year. now it's more frequently than that. george herbert walker bush had so many press conferences. we didn't dread them, but it was like oh, my god, he was just here two days ago. that has diminished.

you used to go to church with president carter. being the most junior correspond ept, i was backing up my senior correspondents. part was to take notes on his sunday school lessons because he delivered the lessons. that also meant that i spent and christmas in claims so that judy and john could have time off with their families. actually it was great for a young junior correspondent to have the experience. my perspective has been refreshed just this week because

john palmer was just published posthumously. we just had a gathering in new york this sides. in looking through it, he writes that he came from being the senior foreign correspondent for nbc covering sa dat and arafat and beirut and traveling the world in africa and the congo and all over the world. when bill small came to nbc, he asked to become a domestic correspondent. they said come to washington like tomorrow. he was going to jimmy carter. one of the things he writes, as i learned my way around the carter white house, some were easy and some weren't. i found that if you wanted to,

you could ask the president if you didn't abuse the privilege. if you had something you were working on, i was working on an environmental piece and wanted to ask questions. i asked for time with the president. that gives you an idea of early on. the greatest beat as white house correspondent. that was something going on at the white house. it was enough that john said i will check it will check it out. he on a suit and ran down to the west gate and saw that there were all these limos in the west driveway. they saw there was everyone in the lower press office, stacks

of plates he describes with dried lasagna indicating they had been there for hours. he started asking around and initially one of the lower press office persons said it's something in bogota. he said i have nothing for you on it. that was enough to alert the network because we were not -- 1979. this would mean interrupting prime time programming and he knew his informal cutoff was 11:30 with the advent of the johnny carson with "the tonight show." he got a camera crew down s& he bluffed his way and described it was a classic for any

journalist, saying he gknew it had to be an international crisis and he was going to go on the air. he promised a 15-minute jump if he would not go on the air right away. no way he was going to say there a lot of cars at the white house late at night. he handed him a piece of paper and said you have two minutes to ask questions. that's all you get. he handed him the statement that in the desert, there had been a rescue mission that failed. helicopters collided and eight americans were dead. powell's eyes were tearing up. it was right before the reelection bid and he knew he

said i will call the wires now. that was the biggest scoop of his career. then they had the expanded pool. there was no pool. it was a larger expanded pool. initial initially they were late afternoon, but they discovered that if the president made

mistakes, which happened, there was no time to fix them. they moved it to prime time. they were larger and the idea was they could spin it and work it out on the morning shows and by the next evening newscast. i had one experience where i asked a question and it was classic reagan. i started to get get up to ask a question. i had to be sort of aggressively and he started to call on me and he stood in front of me. he was going to say thank you, mr. president. he said no, wait a second.

i promised andrea. steve had taken my question. i love steve. he was pointing in that direction. i asked the question about the second country. this is as it was unraveling. using the money to help support it. they were briefed on by the chief of staff. the president didn't have the answer so he denied it. at around 10 minutes to nine,

the news conference ended and minutes to 9:00, they issued a written statement that the president had erred and did not mean to say whatever, however they put it and whatever passive voice they put it in. i remember grabbing that piece of paper and tearing it to try to get it to chris before our prime time coverage. we would go the full half hour. the news conference would end and we filmed the next 25 minutes on the network with him debriefing and going around and getting in the correspondents from the hill and everywhere else. it was a big deal. he got it on right before we went off the air at 9:00. i got back to the booth feeling proud of myself that i had gotten it on in time. the phone rang and it was don. he used language i had never heart before heard before and

said he was going to get me fired. how dare i ask a question of the president of the united states. i remember that feeling in the pit of my stomach. nancy reagan had him fired, fortunately for me. the access you had to the president himself and staff members. they would roll down their windows and she would talk to them and ask them questions.

that's not something they would let happen today. >> palmer sent me out there which democrat is he trying to lobby. let john and judy know in the southwest gate who is coming in for the evening sessions in the oval room upstairs with the president. he would go with them and take the assignments from the legislative strategy. the lobby was sense to try to get the sale through the saudis. it could have been on them or anything else. that's the way the lobbying went. you had mobility. you could move around on the

grounds. >> i want to circle back and ask you to talk about your knowledge of the president and the personal interactions with the president and whether that made a significant difference in your reporting. on that point i top the go to brooks and ask about the visual element of this. were there -- did you have meaningful access to the presidents with whom you covered and think of some examples of how that happened? >> how would you define meaningful access? >> bush at his ranch. i remember that series of photos got a lot of play. >> still photography, our opportunity has fall tone three buckets. the exclusive behind the scenes. it is just defined differently.

for us, access is everything. if we don't have close physical proximity to the president or to somebody that we are doing a story on, we can't do our jobs. i tried to come up with ways to fake it. plants in the corner of the room and the empty mike. that doesn't work well. access is really everything. it's really increasingly hard especially for still photographers to get exclusive access and that sort of takes on a new meaning this this administration that we can get to later with current technology that allows the obama administration to develop their own content and access which they now send out to everybody.

with getting back to question, with bush, i remember it was probably mark knoller that i heard about three or four months into the bush administration that he had gone to the ranch and he spent 100 days out of 200. he set foot on the ranch. at that point nobody had seen what he did on the ranch and what did it look like? what his life was like. i pitched to the press secretary behind-the-scenes look at the ranch. if you are spending that much time there, we need to see what he is doing. this was before they had done any foreign heads of state visits and that sort of thing. it took about four or five months of back and forth and then one thursday afternoon i got this phone call saying what are you doing this weekend some it was boom, boom, boom.

36 hours later, i was out there on the ranch. i think in that situation, making those sorts of things work is very difficult. you need to trust. they need to know. it's a delicate dance. they need to know that or they will get totally burned. i will put a picture of him picking his nose or something. it's this delicate back and forth. the trailer where i was having video conferencing in washington.

>> what do you think is lot of by that? seriously, i'm not assuming that the answer is everything. when we talk about the president and interaction with the staff. does that produce better reporting? do you think they are reporting in the administrations that you covered was superior to what we do now and different in the way that has to do with that access? having independent access to the president and certainly an interview is independent access. that's important and that clearly happens more. that's the most frequent independent access that the press gets to the president. i think it's important for people to see. what kind of person and leader

the president is. in a way, the difference between the still photographer and tv is that i kind of come in with two cameras around my neck. things can to a certain extend unfold the way they would if i wasn't there. that has been taken over by the white house. the white house photographer and the daily -- basically the daily photo stream that goes out on flicker. those are the exclusive pictures that we see. it's very rare for independents

you might have something to the story as you read the president's body language one day. >> it was 1986. they shouted out to him that said there is a lebanese magazine that said bud mcfarland went to iran which was impossible to imagine with the take in the shape of a key and a bible. the whole thing was ridiculously ibl possible. reagan paused and said no comment. reagan is skilled at this. there is a bunch of things he

could have done. he could ignore the question. he could have said that's ridiculous and hoe said no comment. i remember the people who were there. you may have been there. we almost fell down. why did he do that? why didn't he say something? >> he said something about a middle east rag. he was disparaging. he got on the plane and we had to fly back to washington that day. nobody came back on the plane to explain why he made that remark. they sell arms to iran and it was unbelievably complicated story. it played out and hard to cover.

reagan's own version and interpretation of what happened changed and he never accepted the fact that he was trading arms for hostages and stuff. he still claimed up until his death he wasn't doing that. everybody found he was. there was all this stuff. it was a very difficult story to tell. it was just seeing him that day, the fact that he faltered and didn't give the movie star quality confident response, but instead this no comment. >> i would say, i think access to the president is so important. it's a privilege to have access to the president. i know we all feel that way when we do. the thing that causes more concern for me was with the current trend. the lack of access to senior aids and cabinet secretaries and

every every contact you have. that's a big thrill. it will be the interviewing you do with the people who are advising him and around him. that's what i look at now and i think how can we tell americans that we are giving them a 360 degree look at what's going on in the white house when the only access we have is through people in the press office. not that they are not good people, but they are not the policy makers. i remember in both the reagan and clinton white houses were incredibly messy. bush too. that's right. you could reach staffers and with the reagan team in particular, they were at war with each other. you would reach me to tell us about what baker was doing. there were ways to find out what was going on behind the scenes and not just what they wanted to feed you. that was also true of clinton

and people are now running for the white house. who ended up being able to do more? the neat controlled white house or the messy chaotic one? i would argue that the chaos of the clinton white house and the bush people and the ability of reporters to talk to people serve it well. >> why is that? why did messy result in something better? >> policy is messy and if you wait until you shape with the-point fact sheet ready to go, you missed the creation part which is important. you missed the alternative points of view the president is hearing. when you can have access to policy makers, senior aides, they are playing a game by telling you about it. maybe it should have been debated before the president gets out there. >> just to circle back, knowing the president, being out there

and having correspondence day and night has a value. on the hostage crisis, having watched him in the rose garden at seven r several events and where he was talking about the hostages and before we even dealt with the larger crisis, but the original crisis in beirut, you knew how upset he was about this. you could see it. that led you to call and find out from staff that he opened his intel briefings every day with what you know about the hostage crisis. you knew he was dasking them to do something about it. they then at the nfc were taking that as marching orders.

the most important thing to it. similarly, not having the access to staff, the control that i see being asserted by the communications people. not only on camera and going out out on the discretion, but who can be surrogates for the president. the white house most importantly is not served well by not having more senior people that they can send out whether it's on health care or gaza or now on ebola. tony is again going to do all the shows on sunday because he's the only they feel can deliver the message. one more thing, with all due respect to our commends, i was

outraged for as a news correspondent that when nina pham came in, it was only stills. if there was an editorial presence, we wouldn't use the picture. just simply would not use it. >> i'm glad you raised that point. that takes us to the second thing we want to discuss. i apologize to those of you who heart me talk about this for hours on end already, but our access project is directly related to what andrea just said. a little bit of history, last december the photographers led us, the press corps and washington media in pushes for greater access at the white house, particularly to photo access. let's give credit where it's due. the white house responded to that to some degree and that's why you start to see more stills only opportunities and also open

to more of them than we have currently gotten. as soon as that happened, the white house correspondent board realized that's a very small thing for us to be asking for in the wake of that -- we got their attention. we got the white house attention. we wanted to follow-up with something bigger and something that touches all of us and lifts all of that. that is so important. for months we have been working on this. we just talked about the gains we have made and the practices we have in place and that we value and we have written them down. they are preserved and handed down in the next administration. people have started brainstorming things that we can add to the list that will make things better and more broadly.

the president takes questions for at least once a week if not more often. they see the press at work in the oval office and wherever he is doing business. it's an opportunity for them to ask questions in an unscripted setting. those are the things that we have been pulling together to put in the document. while we have got these veterans sitting here at the table and while you are thinking about this as well, i want to and think about it yourself. we plan to work on it. which practices do you think are most important. those that existed in the past which we lot of, what matters the most in giving an independent vigorous press access at the white house? >> when they talk about the

things we have talked about here, how much staging there is. so much is staged and to the exclusion of independent photography or photo video journalism. things that have been excluded. they have delivery of a lot of content and people's impressions of the white house and developed based on what they see from a white house point of view. that puts us to decide. the white house sent an important signal with all of the leak investigations. this administration has been aggressive in their leak investigation and that resulted in a killing of sources for investigative reporters and others. it's an attitude they convey and

projected to its own officials. poem in the white house and the pentagon and the state department and beyond. it has a bad impact on what we are trying to do. i don't know how you say trying to send a signal that this administration is mory is centive to -- i have a belief in the first amendment and think this is a good thing to do independent reporting. allow the press to have more access and more insight in a way that policies are developed as you were talking about. let people have peeled back the cover ask see what's going on. >> thank you. brooks, you had thoughts when you were skusing this? >> it helps to think about things from their perspective. my guess is when we start talking about saying show us

more, we want to see the mess. instantly they are thinking this is 2o 14. and one little photo or one comment like the things we are talking about in the past will just get instantly blown up. it goes out on twitter and all over the place. the 24-hour news cycle. that's the big fear. and so we have to keep that in mind when we are crafting it. also you can't under estimate the fact that they believe that they can go directly to the public. they don't need the media to communicate to the public whether we are talking about still images, video -- i'm not saying i agree, but there a lot of people who believe they can go to the public. why should we have to filter it through the media when we can

put it out and it goes instantly all over the internet wherever we need it. >> how is that working in terms of the president's approval rating or congress or relationship with the press. >> i'm not argue. >> i understand, but i'm saying to them, is this working for you? i would argue that one of the things, it's not working for them. my big fear is this has been more restrictive and determiningous than any administration in history in terms of legal investigations and so on. they got worse and worse. whatever happens with this is the new floor for the next

administration. the ability to do our job unless we constantly fight the battle. for tackling issues in a serious way. i am worried about we have a role and we can't do it if the president and his administration don't recognize that. >> that's effective and i think where we were able to really make ground and when we said hey, at the beginning of your administration, you said this would be the most transpatient administration. this is not transparent. you are not -- this is not transparent for you guys to provide the content. i heard that got under his skin. i heard that led to changes.

what we are saying about democracy. that's an effective argument. >> being confined to the briefing room is a real issue. i know this is not going to change, but your pass would get you into the northwest gate and if you needed to see someone or some other office, you would cross the exec and go up the steps and you were wandering around. >> the story is they were walking through the office building and you saw a reporter and he said what were you doing? he is where is your escort. he said i don't have one. i have the pass. about two days later, they shut down the old office building. >> they were putting the theater seats in. it used to be big couches and

arm chairs. >> in the briefing room. >> and spi toons. then they put the theater seats in. it was september, 1981. we were moved over as a temporary press room. i remember we were all worried they were never going to let us get back and see people coming in and out. that didn't happen. we would wander back and forth and to do the stand ups. then go to the fourth floor. i remember the day sadat was killed. we were over there and it was september 1981. i was there because juty just had her baby, jeffrey. i was filling in for her maternity leave. sadat was kill and he was always

thinking of the visual and wanting to run around and get a picture. it was a competitive thing. he said get a crew, quick. get the shot of them lowering the flag over the white house. >> i grabbed a crew and we ran down four flights and ran across and got the shot of the flag being lowered in humanor of and memory of sadat. you could cover the beat by running over and getting a shot of people walking in or driving in to west exec. i know that that is not going to change given the current atmosphere, but a white house pass was your credential. once you were on the grounds, you could go to many more places. >> from the era, the first time i went to the briefing room was the end of the carter administration. couches people had thrown away from other places. it wasn't nice.

i was supposed to staff this briefing. i went and sat in one of the chairs and the man came up to me and said get out of my chair. that's how i met mark knoller. if it's not in the records, it didn't happen. >> i wanted to make one final point before we conclude this panel which i wish i made a two-hour panel because i enjoy your story telling and the great advice. they are engaged about the standards that we are drafting. they understand that in the wake of last december's conversation, we came in with a few very small asks. i understand we were not on the same page with what we asked for. you have a flavor of it earlier. each of the formats has a conflict with how we want

things. we have to work that out. we have to stand behind as a group. that will mean advocating for things that don't make a difference to you personally in your daily practice, but they do matter to the group. ironing out, for example, the difference between the photojournalists and the tv cameras is just the tip of the iceberg. that's why i want to bring one, if you are willing to come here on a saturday, i know you are willing to bring in more time. join me with the board members convening and sit down with people who are not in your media group and in different representatives of different media. put together something that we can do. i thank the contributions of the

panel. thank you. >> coming up this afternoon at 5:00 eastern, live to the atlanta council. for remarks from the director of the national u.s. council adapting to national security challenges. on capitol hill, the house begins legislative work with 4:00 eastern with debate on ten bills addressing threats from electromagnetic pulses. after 7:00, members of the congressional black caucus were scheduled to speak about the grand jury decision. they scheduled votes at 5:30 of two nominations. we spoke with the reporter for more on the congressional agenda. >> spending, immigration and taxes will dominate the final days of this session for the 113th congress and joining us here in washington is following the story for national journal.

thank you very much for being with us. >> the om ni bus issue, what does congress need to do and when? >> it's a deadline for what has been a temporary spending bill since october. the technical start of the fiscal year to keep vacancies operating. congress did not do any of the spending bills and could not agree on them. we have been relying on the temporary spending bill, but that runs out on december 11th. lawmakers are faced with where to go from there. >> this is talk of a shorter resolution being referred to as the strategy that would keep the government operating until mid-february. the reason is because republicans will have control of the house and the senate next year. >> there is talk of that. in varying degrees, the basic premises of that is that they

will have the republicans and some of the republicans in congress realizing they will control both chambers on january 3rd, the start of the new session. they are wondering why democratic majority leaders, soon to be minority leader should have a say on the spending that will last until next october. that notion is let's do another temporary 1 and the republican dominated senate and house can come up with the bill after that. republican leaders want to wipe the state clean and are referring a measure to be done now. to get congress through the whole entire next fiscal year without having to readdress it in the spring. whether they can win over the members on that is she uncertain. the other possibility is kind of a mixture of what they call a car.

in fact that continues spending through next october for most of the government agencies. they could address an early spring. some anticipated by president obama through defunding or other mechanisms and the homeland security bill. >> you will see from that republican-dominated committee, a focus on what exactly president obama's administrative action might do to -- what is the less secure border practices. whether or not that's true, i'm sure it will still over into whether the executive orders are planned boy the president or simply overreached.

how they might get the spending bill and defunding mechanisms. >> how angry are they over the president's actions and how much is politics and public posturing? >> i think there is legitimate anger because it shows the latest step in the series of executive actions. that even led them to sue the president. it's another step in that direction that irritated them. specifically it's angering a good number of conservative republicans over the simple fact that lessening of the deportation rules in congress right now without congressional approval. it's kind of rubbing their faces in the fact that although they dominated the november 4th elections, this president is side stepping, or trying to anyway. >> two other issues.

rand paul, a potential 2016 presidential candidate, promising legislation dealing with the abuse of military force against isil. what can we expect on that front? well, the senators legislation would occur an authorization for military forces instead of an expiration date. but there's a notion that congress would agree to this sort of bill, this large idea in the final days of the lame duck session is a far-fetched one. but lake makers still have to sign off on a funding request. this will add to the dialogue and some of the back and forth. whether or not rand paul's legislation goes anywhere, this lame duck is unlikely. but this will just add further fire to the debate over where

exactly the pentagon training and equipment of syrian rebels and how much money should be involved in all of that. >> and finally, where is the defense authorization act at this moment? will congress move on it before the end of the year? >> the house passed a version of it earlier this year. the senate arms services committee is yet to bring its bill to the floor. but it will be addressed. before the end of the year. there's no dispute about that. how quickly can they get it to the floor in the next two weeks. >> we'll look for your reporting online. billy house, appreciate you being with us. >> you can watch the house live. the senate now live on c-span 2. mary landrieu faces bill cassidy in the final debate for the state senate seat ahead of the

runoff election. watch live coverage on c-span 2. next a look at drowsy driving. the safety administration hosted a discussion with doctors and vehicle safety advocates. this is just over an hour. >> good morning, welcome to the board room of the national transportation safety board and to awake, alert, alive, overcoming the dangers of drowsy driving. i am board member, and it is my privilege to preside over this forum today. joaning me is dr. robert mahmoud

malloy, dr. jana price and dennis collins, senior human performance investigators here at the ntsb. my thanks to all the panelists who will be providing their perspectives and expertise today. we are calling this forum awake, alert, alive because every driver must be awake and alert to operate a vehicle safely. sufficient, good, quality sleep is fundamental to alertness and human performance and yet so many americans are on the road dangerously impaired by lack of sleep. we know this is a serious, yet current estimates may only point to the tip of the iceberg. conservative numbers tell us that driver fatigue may directly contribute to over 100,000 roadway crashes annually. but these are only police reported crashes. there's some estimates that put the number of drowsy driving crashes at over a million a year. conservative estimates suggest

1,000 people are killed annually in these crashes, while other data indicate that 5,000 or 7,500 lives are lost each year due to drowsy driving. experts agree that the number of crashes and fatalities officially attributed to fatigue is grossly underestimated. there is no roadway test to determine sleepiness. state reporting practices are inconsistent and there is little or no police training in identifying drowsiness as a crash factor. self-reporting is unreliable. the one thing we do know, any resulting loss of life is tragic, needless and preventable. a drowsy driver can be a deadly driver. even one night losing just two hours of sleep is sufficient to significantly impair our abilities. attention, reaction time, decision making can all be

significantly reduced by 20 or 50% and driving in this condition, that could mean not reacting to the brake lights in front of us or not seeing the traffic light turn red. fatigue can be deadly. it multiplies the effects of other impairment that lead to crashes such as drugs and alcohol. every other form of impairment may be exacerbated. for more than 45 years, the ntsb investigations have identified fatigue as causal or finding in crashes across all transportation modes. the agency has issued more than 200 safety recommendations addressing fatigue and these have been in such diverse areas as research, education and training, vehicle technologies, treatment of sleep disorders and hours of regulations and scheduling policies for commercial and bus drivers. but 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 o of fatigue and its effects. unfortunately our personal experience, especial. ly as it relates to self-diagnosing fatigue is typically inaccurate. in january 2013 the ntsb investigated a collision involving three passenger vehicles. the collision happened at 8:40 in the morning. a nurse at a local hospital was driving home after more than 13 hours on duty. she departed her lane, crossed over the median, and entered a northbound lane traveling against the flow of traffic. her car then struck another vehicle pushing it into 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 injuries. she had fallen asleep. she had worked night shifts for nine years and was familiar with

the challenges of her schedule. and yet her inverted work schedule along with extended time since waking and this case nearly 16 hours continued and contributed to her falling asleep at the wheel. today's forum offers us an opportunity o to focus on the dangers of drowsy driving and on the countermeasures that can mitigate the measures of fatigue. e we will identify what we know and what we don't, only the most robust data on drowsy driving can lead to the most effective countermeasures. we will examine medical conditions such as obstructive sleep apnea and other sleep disorders. we'll hear about the challenges from other drivers. we'll discuss irregular work schedules and have the same people we depend on for the 24/7 modern lifestyle and even for life saving services are vulnerable to taking to the road in a fatigued state. we'll hear about countermeasures and a variety of other

strategies to reduce the risk of drowsy driving crashes. we will provide a public setting to examine the dangers of drowsy driving. to become the 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 their night shift. it's for the utility worker to fix the power lines after a storm. it's for the student startled into alertness by the blare 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 wakening about the safety risks. now i will turn to dr. jana price who has done in

outstanding job in organizing this forum. dr. price? >> thank you. 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 on the front. if you have not already done so, please silence your electronic devices. today's forum has been designed to get at the heart of several topics relative to drowsy driving. we will begin with an introduction and scope of the problem. this morning we will also have panels addressing workplace factors, concerns of novemberist drivers and we are pleased that a group of safety advocates from the national organization for youth safety will join us during the novice driver panel. after lunch we'll have panels discussing health issues and in vehicle and roadway factors. the final panel of the day will address countermeasures and

future directions. each panel will open with presentations by panel iists followed by a facilitated question and answer period led by our technical chairs. our staff and panelists bios as well as the agenda are available on the forum website. early next week presentations provided by our speakers and a video archive of the web cast will be available on our website. attendees or others who wish u to submit written comments for inclusion in the archived materials may do so until november 7th. submissions to directly address one or more of the forum topic areas and should be submitted listenically as an attached document to drowsy driving forum at ntsb.gov. there are a variety of launch options.

take the escalators up one floor and walk straight ahead. you'll find several restaurants as well as a food court. handouts are available in the lobby and on the forum website. 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, and for the afternoon panels during the afternoon break. also there will be a group photo when we break for lunch. we'll meet right here in front. i will turn to our first technical chair 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. please bring your microphone close and press the button to turn it off when you're done speaking.

the first panel is an introduction and scope of the problem. our panelists are chief of the division of sleep and director of the unit for experimental psychiatry at the university of pennsylvania's pearlman school of medicine and brian taft, senior research associate for traffic safety. doctor? >> good morning, thank you for inviting me to speak at this important meeting. i'm 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 the slides are that as near as we know right now, all animals need to sleep and humans are no exception. sleep is an essential 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 ensure we don't have uncontrolled drowsiness and sleepiness during the daytime. next slide, please. this slide is maybe just a reminder that when we don't receive adequate sleep, we tend to fall asleep very rapidly. the graph going down on the left shows that the longer we're awake, the more rapidly we'll fall asleep and the more rapidly we'll transition into a stage of sleep where we can cannot recover even if we're alert. the graph on the right reminds us that 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 it the sleep that is essential and other speakers will talk about drowsiness and waking function when is you don't receive the depth of

sleep. next slide. why don't people obtain enough sleep? the only thing i will say here is what e we now know in our modern lifestyle is that substantial portions of the population shown here in the yellow bars on the left do not achieve even seven hours of sleep a night. the bulk of the evidence in the sleep field points to the fact that once large segments of the population are sleeping less than seven hours, we get an increase in in excessive sleepiness, accident-related sleepiness, as well as obesity, diabetes, cardiovascular problems. so there are significant safety consequences to undersleeping and yet we have large segments of the population under sleeping. the graph on the right reminds us that part of that, a major part of why people do not get adequate sleep is work and

travel. they spend extra time at work, extra time getting up early to get to work, and while those may seem like normal routine activities, they have become so problematic that they are eating up the time that one should spend sleeping and they force us to come press our sleep down into a shorter and shorter period during the workweek with then people make a desperate effort to try to recover on the weekend. but that recovery is usually inadequate. two days of extra sleep usually will not reverse repeated cycles of five days of inadequate sleep. so chronic sleep restriction is an inherent part of mods earn lifestyle in jobs for many people and that's where one of the sources of problems are. you'll hear other speakers talk about sleep disorders, et cetera. next slide, please. we know this is occurring in the

brain. many people think it's all right to drive drowsy because it's a willful event and doesn't have anything to do with biology and you can will yourself to overcome it. people get away with it without crashing, so they get the belief in their heads that it doesn't matter if you're tired. it's okay to drive. you'll be safe, you'll be careful because you'll have a good intention. but intentions won't really prevent this biology from turning on. this is just 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 in activity met bollically in the brain that are consistent with the brain falling asleep while we try to stay awake and drive. there's a terrific change we cannot easily control. and slapping your face in yourself in the face will not prevent this from occurring. and if it does prevent it, it's

no more than a second or two. it won't actually have a lasting benefit. it is not the same as sleep. the brain needs sleep. 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 that it's the muscles of our eyelids that are losing tone due to the pressure for sleep. sleepiness and drowsiness when we're 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. they will come down and this is a truck simulator. it's not a real driving experience, so we're not putting this young lady at risk. but you'll see in the virginia tech film that she's falling

asleep. and the head dips back and the eyelids close because there's loss of muscle tone. then when the eyelids opens, the eyelid rolls back and reorients in the head. 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 we don't have trouble recognizing that's what's occurring, but we don't appreciate, next slide please, we don't appreciate how dangerous this is. and here's another example in the laboratory. all we need to do is just click on this here and we'll get it going. on the left side in yellow, this young lady is working on a vigilance task, but she's been sleep deprived. on the right side she isn't sleep deprived. the graphs show you over time, the graph on the left says that initially she works okay, up go.

her lapses of attention and up go the increase in her eyelids drooping. we are measuring these by computer analysis. on the right-hand side, she may be board, but she can work for hours on end without falling asleep. so people who think that drowsy driving instead of just being bored are wrong. it's due to ewe not sleeping enough. boredom is driving when you're not interested in what you're looking at but able to stay awake. sleepiness and drowsiness is the pressure of the brain trying to force you to go to sleep while doing a vigilance task while driving. next slide please. >> we know that among all the tests that have been looked at for the effects of sleep loss attention, in particular, and alert ne alertness are the number one effects of sleep loss. by far they occur more frequently and more profoundly than the effects on memory and reasoning and many other areas. next slide, please.

and that's best illustrated. listen to these heartbeats. these are actually reaction times of people when they are fully alert and press. ing a button. each quick heartbeat is a fast reaction time. you can see there's nothing wrong. we're displaying them as heartbeats to give you the point that the brain is steady as you go here. click on the top one and shut it off and we'll click on the bottom one. here's the drowsy driver equivalent. they start off driving, they are just fine. as they go along, they start to have long lapses and you'll hear that in a minute. there's one. that's your eyelids down, you're not responding. you're not responding, you're not monitoring. now you're back again. now you're going to go again. this is the hallmark feature of sleep loss. look on the right. we know where in the brain that is, but on the right, you can see the instability of these

response times in the sleepy driver whereas the alert driver up above is steady as you go. this is the fighting sleepiness that people experience driving down the road. by the time you're doing that, you're at grave risk. you shouldn't be behind the wheel. you should pull off and get some sleep, get some rest. you should have slept adequately before you drive. you'll hear other speakers say that, but this is the grave risk of driving. 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 half hour and they will be becoming more and more repeated and more severe. next slide. this just illustrates when you have had plenty of sleep and don't have the lapses. you're really stable. but as we take sleep away and move you to six hours a night or no sleep at all for a night, you see this terrific dispersion of

increased lapsing and they are getting longer. they are completely unpredictable. if you can predict the moment you're going to fall asleep, i'll do something to correct that but you don't can't do that. . your brain does this at a time when you realize i was just awake and now i realized i just slept this last period of time. so you can't be operating a motor vehicle when that happens. next slide. it takes no more than a two-second lapse of attention at o 60 miles an hour with a 4 degree. angle of drift. there's just enough loss of steering control. let your muscles relax on the steering wheel, close your eyes for 2 seconds you can be out of lane in two seconds. and off the road in 4 seconds. so you can easily see how it takes very little of this lapse tendency to put you in grave danger. not to mention if you're in

close traffic trying to stop in time, one of my messages is going to be this isn't just highway. this isn't just the long drive. drowsy driving, slowed reaction times are occurring in people who haven't had adequate sleep in the city. they are occurring in density traffic. the studies done by the federal government have shown within the washington, d.c. area when they instrument cars, they found droz siness occurring all over the area. we know these are high risk occurring even in crowded traffic. this is just an illustration of the dynamics of the drowsiness and what you see in the upper graph is that you don't have the lapses of drowsiness when getting normal sleep at night on the left. as you go a night without sleep, the lapses increase. if you went a second night without sleep, they go even

higher. the same thing happens if you're only getting four or five or even six hours of sleep a night they get progressively worse day after day. down below you can can see that segment of the night from midnight to 8:00 or 9:00 a.m. and can see the high rate of motor vehicle crashes related to falling asleep. at that time you can see they ramp up at that time. now it doesn't mean you're safe in the middle of the day if you haven't slept the night before. you can absolutely have a drowsy driving crash at any time of day, but this just shows the dynamic from one study done in north carolina of people falling asleep and you're at a particularly high danger risk through the night and especially in the morning. people think they are safe because the sun is up. that won't protect you. light is not powerful enough to override this pressure from sleep. and shift workers we know have a very high rate of crashes, but they are by means not the only

group. the elderly can have them in the middle of the afternoon. next slide, please. the studies done on the left and the right, the left shows that the less sleep you get. every night, the more lapsing you have every day. they are going up. so 4 versus 6 versus 8, versus no sleep. on the right is how people felt about sleepiness. next slide. in the middle graph here is that the bottom graph is performance is lapsing and getting worse linearly across time, but our sense of how we're doing is not changing. this means you can't tell how dangerous you are driving. you need to pay attention to your behavior. if you are actually suddenly discovering your head is falling over, your eyes are closing uncontrol bli, you just almost

drifted out of lane, you need to get off the road. there isn't you need 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. and the best way to go here is prevention. don't get out on the road sleep deprived. get. adequate sleep before you bet get on the road and plan your trip effectively to ensure you take adequate breaks. next slide. this just makes the point that even when we work at night and are awake during the daytime, even eight hours or trying to sleep eight hours in the daytime and stay awake at night, we're at a greater risk for lapses of attention because we're awake at biological night and that puts pressure on the brain to go. to sleep. we're programmed to sleep then. there's no safety here in what time. you're the a risk whenever

you're awake at night. these functions are important to recall too. sup good performance. down is bad. the lines show you that's time on task, over ten minutes, how your performance is deteriorating 37. what's on the red in the left o or whether you have obstructed sleep apnea in the middle or whether the red line on the right, you're an airline pilot and flying at night. you have a lower level of performance. if you get adequate sleep, if you get treated for apnea, if you fly in the daytime, you can perform better. it is these functions that are so dangerous with -- this is the time on task problem with driving. you can rapidly deteriorate. you can start out feeling fully alert in minutes be struggling to stay awake. people often can't understand how that is. the brain cannot do a vigilance

task. will demonstrate that to you immediately. next slide please. these tasks are very dangerous. they have a rate of alcohol. very serious injuries. because the driver does not correct answer. you fall asleep and you're not completely asleep, but you exit the roadway and don't engage in a corrective action to avoid hitting the pole or the truck or the tree or rolling the vehicle. as a result they have a high degree of bodily injury. almost equivalent of high blood alcohol levels. next slide please. here's the good news. this is a study from walter reid. they are going to e restrict people to three hours a night for a week in the laboratory to look at what happens. but before that, one group got seven hours time in bed at night and one got ten hours. the more you sleep ahead of t e time, the better you can tolerate the effects of any restriction that's on your sleep

period being forced to get up to care for a baby or driving to work. you have to get your sleep is the bottom line. you have to treat sleep as a high priority item in your life every day to prevent these cumulative sleep depths that pose risks for driving. next slide please. really there are seven messages. i'm going to end on this. the brain is the organ of behavior and needs healthy sleep of adequate daily duration to prevent drowsy driving. there's no question about it. thousands of studies support this statement. it is unequivocal. we know it in medicine and science and we have to penetrate this message to the public and to everybody who drives whether professionally or just driving to pick up children or whatever. next slide please. when sleep is inadequate, the brain has a slower response and it unpredictably lapses into microsleeps that result in the waxing and waning of attention, slowed reaction times and these

pose a very serious crash risk. next slide. as sleepiness increases, lapses get more frequent and long er i duration and there's increasing loss of muscle tone in the hands, eyelids that contribute to an ever greater driving risk. in other words, once you start having this attack driving, it's not going to get any better unless you get off the road, get some sleep or take some other kind of countermeasure, which will be discussed today. next please. as sleepiness related lapses of attention of only two seconds is enough to result in you being completely off the road, out of lane. so it takes very little to have a catastrophe u. such crashes often involve bodily injury that's very severe or fatality because there's little corrective action by the sleepy driver. next. the slowed reaction times even

without frequent lapses of attention can cause problems in congested traffic. so really if you're not falling asleep f you're sleepy in the morning and drive, you can have slowed reaction times that will get you in trouble. next. and 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's essential that people do not drive when they have not slept sufficiently to maintain alertness. what this means is you plan your driving place based on who has slept the most and is most fit. and if you absolutely must drive overnight, having someone else with you to watch you, i always say have someone watching you and don't let everybody go to sleep because the driver will go to sleep. i think that's my final message. thank you very much.

>> thank you. our next speaker for this panel is mr. tuft. >> thank you, mr. collins. i have been asked today to talk about the prevalence and impact of drowsy driving on the road and 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 o of drivers actually falling asleep while driving as well as drivers who are highly fatigued, yet not asleep and also be talking about studies of actual motor vehicle crashes that estimate the number and proportion of crashes involving fatigue and drowsiness. next slide please. so in national surveys that have been done by the national

highway traffic safety administration, the centers for disease control and prevention and the aaa for traffic safety, the motoring public has been asked whether they have fallen asleep or nodded all while they were driving and consistently all of these studies find that about 2 out of 5 americans report having fallen asleep while they were driving at some point in their life. and consistently across any study that's looked at this, about 11% report 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. and these statistics are even likely to be underreported because studies have shown that a person has to be asleep for on average two to four minutes before they are more likely than

not to realize, yes, i was just asleep. so these are likely underestimates of the frequency with which people fall asleep at the wheel. and in addition to that, the aaa foundation every year in a survey that we do of driving behaviors and drivers' attitudes, we asked people in the past 30 days, how often have you driven when you were so tired you had a hard time keeping your eyes open. 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 or regularly. next slide please. in terms of the toll of drowsiness in motor vehicle crashes, the most recent official statistics published by the national traffic highway

safety administration show 2.4% of fatal crashes, 2% of injury crashes, and 1.3% of all crashes involve a drowsy driver and that's based on data from 2009. next slide please. however, the statistics that these are based on are wrougt with a number of limitations that result in their likely being substantial underestimates of the scope of the problem. first, we don't have a fatiguelyzer. it's hard for people to assess 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 might not realize or might

not remember that they were asleep. one has to be out for two to four minutes when they are more likely than not to realize they were sleeping. in the case of the more severe crashes and crashes resulting in fatalities, the driver may be unconscious or deceased and it's in such cases it's very difficult for the police to ascertain what happened. and another more subtle and more insidious 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, impaired by alcohol, whether they were angry, emotional, distracted, et cete cetera. and the way an officer would

indicate that a driver was drowsy is by checking the box. if a driver was not drowsy and they know that, they simply would not check the drowsy box. unfntly, this kraetss a problem in interpreting the data after the fact because the way that it would be indicated that a driver was not drowsy and the way that it would be indicated that we don't know whether the driver was drowsy the same, empty box. next slide please. i'll be talking about a few special studies that have looked in greater depth at at data on specific examples of motor vehicle crash os to estimate the proportion and number that involve driver drowsiness. next slide please. so the first study i'll talk about is one that was alluded to. thfl the 100 car study by the

virginia tech transportation institute. in that study that 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 for a period of 12 to 13 months. and with researchers manually reviewing video from crashes in that occurred looking at the signatures of drowsiness that was noted in the video, the slack and the face, the eyelids drooping, researchers were able to estimate the level of drowsiness in drivers and estimated that 22 to 24% of the crashes in the near 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. another study that took a totally different approach to this problem was a study by colleagues at the university of north carolina. and in this study, the researchers gatt. erred a sample of police reported crashes from the state of north carolina where the researchers believed there was reasonable ascertainment of whether the driver was known to be drowsy or not to be drowsy. based on these data in the police reports, they developed a statistical mod tole predict the likeliness that a driver was drowsy based on the characteristics of the driver and the crash included in the police reports. . then the researchers aspplied this model to data from fatal crashes that occurred nationwide

in years 2001 to 2003. when they did so, they estimated that as many as 15% of drivers in fatal crashes were drowsy. in the author's own words, they called this a conservative estimate. again, the national statistics suggest that about 2% of fatal crashes involve a drowsy driver. the authors of this study estimated 15% and labeled that a conservative estimate. next slide please. another study that gives us more insight into the prevalence of does drowsiness in crashes is the national motor vehicle crash causation survey done by the national highway safety traffic administration. this is a study that used teams of crash investigators to look at the causes and contributing factors of a sample of 5,470 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 a fairly in-depth 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 the time of the crash, their recent and long-term sleep habits, their work schedule, medications that they were taking, et cetera. and this is aside from the video based evidence probably some of the strongest ascertainment we have of drowsy driving in traffic crashes. one important limitation of this study, though, that this study only looked at crashes that occurred between 6:00 a.m. and

midnight. this did not investigate crashes between midnight and 6:00 a.m. when, as you might assume, drowsy driving is significantly more prevalent. next slide please. so in this study, again, excludeing the hours when drowsy driving crashes are most likely to be known to occur, the researchers found that 2% of drivers involved in these cra crashes were actually asleep at the time of the crash and 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 inging a gra gaiting this to crashes, this would suggest that 3% of all crashes involve a driver who was actually asleep

and an additional 10% involved a driver who was not actually asleep but fatigued. this is only out of the 60% of crashes where researchers could ascertain that for all drivers. next slide please. and the last study i will talk about is a study that i did for my employer, the aaa foundation in 2012. and this was a study that used the national highway automotive sampling system crash worthiness system which is a sample of crashes in which a motor vehicle is towed away from the scene. and i looked at data from 19d 99 to 2008 and this 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. in this study, they estimated that 2% of the drivers were actually drowsy. however, researchers also reported that 45% of cases they were not able to assess whether the driver was drowsy or not. and the distinction between the driver not being drowsy and the investigators not being able to make a determination is important. because of this, i was able to use a statistical method of multiple amputation to estimate the proportion of the drivers where investigators couldn't make a determination who likely were drowsy and amputation is a method in which you build a model using data that are

related to the probability that a driver will be drowsy or the probability that investigators aren't able to make a determination and using this model, identify other cases in the data where driver's drowsiness is actually known that are the most similar to the cases that you're looking at and 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. and that, by. the way, is a method that the national highway traffic safety administration has used since 2001 to estimate the 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 one drowsy 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. 17% of fatal crashes involved at least one drowsy driver. based on the number of people killed in crashes each year, that would imply conservativively 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 is that no study can provide the definitive answer. there is reasonable convergence across multiple studies that the proportion of crashes involving a drowsy driver is much higher than is reflected in the official national statistics. and a couple trends we see in these data is although the studies with the best ascerta ascertainment of driver drowsiness are also admittedly base. ed on some of the less representative samples of drivers and of crashes, we also see that the studies with the best ascertainment of drowsiness, those with the in-depth interviews, those with the actual video data of crashes e estimate by far the highest proportion of crashes involving drowsiness. and finally although it's

probably unrealistic to expect solid ascertainment of drowsiness in data that are 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's really important to be able to distinguish between crashes where the investigators determined that the driver was not drowsy versus crashes in which they cannot make a determination. right now that's a distinction that's absent from most of the data that we have. next slide, please. so to summarize, surveys consistently show 2 out of 5 drivers report having fallen asleep while driving at some point in their life u. 11% of drivers report doing that in the past year. 4% of drivers report doing that in the past month. that's consistent across multiple studies by a different organizations done over the span of a decade.

for all the reasons we talked about that's probably still a significant underestimate of the prevalence of drowsy drivers on the road. official statistics estimate that 1 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 the low end 7%. on the high end, 24% of crashes involving drowsy driving as a cause or a contributing factor. 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. in your presentation, you were

very clear that there are severe safety and health consequences to operating fatigued and it's not something that can be affected by will, with clear physical affects. you also mentioned some things that were not effective in combatting fatigue. i'm wondering if you could tell us in simple, general term what is is effective in combatting fatigue. >> the primary countermeasure is adequate sleep. i made a specific point of saying healthy sleep, and you'll hear other speakers talk about what healthy and unhealthy sleep is. but also sleep of adequate duration and sleep that is oc r occurring not too far before the driving episode. in other words, sleeping adequately one night and two days later drive iing 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 s a substitute for sleep. it's not a chemical sleep. it's just simply forcing areas of your brain to use it metap r metaphorically speaking, 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 have just published a review on this, once the pressure for sleep is very high, once you have chronically underslept and have a high sleep pressure, caffeine cannot stop it. it cannot stop sleep or drowsiness. and it also doesn't last a day. you take a cup of coffee, it depends on how much caffeine is in the coffee, what the dose is, what your sensitivity is to it.

none of it will last in your bloodstream probably more than three to four hours at most. and then you're faced with the problem of what do you do now if you're still drowsy. it won't substitute for sleep. you're going to have to sleep. it won't keep you going indefinitely, but it is probably the most common way that people attempt to cope with sleepiness when they have to drive. it's just a limited countermeasure. that's 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 in a minute if you haven't had adequate sleep and are drowsy due to that. so alas the options are limited. there are medical options, but i will leave that to the physician who is 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 an individual difference have and what problems does that pose to you as a researcher? >> 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 are a minority of the population. and we're not even sure it's 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

and if that goes on chronically, everyone will become impaired. and even if you don't feel it and this is a key point, it does mean you're not, in fact, experiencing drowsiness, lapses in attention, and so the only way to be safe and certain is get adequate sleep. >> you cited 2009 data as the last official data. and i'm wondering if you have had had a chance to look at anything that might be more recent. and if so, could comment briefly on what it shows. >> right, 23009 was the -- data from 2009 is the last data that has been cited in official publications by the national highway traffic safety administration. however, those data are -- those

statistics are based on data that are collected annually and presently are 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? is there a general trend and if so what direction is it heading? >> well, in the official statistics, there doesn't seem to be much of a general trend. if anything, the proportion in the official statistics may have decreased slightly in recent years. however, as i talked about in my presentation, i believe those

are such a vast underestimate that i would not look to the data published in those sources for evidence of a trend or lack thereof. in the study that i conducted looking at data from 1999 through 2008, this is based on a sample of about 5,000 crashes each year that were investigated in more depth and in those data, there wasn't evidence of an increasing or decreasing trend in the proportion of the crashes that involved drowsiness. i would note that in recent years as we all know the raw number of crashes in injuries and deaths in crashes nationwide each year has decreased and that is a good thing. however, i don't believe that there's any evidence based on the best available data that the

problem is increasing or decreasing in the share of all crashes. so if we use the most conservative estimate we had across any of the more solid studies of the proportion of crashes that involve drowsy drivers and apply that to 2012 data, we'd still estimate that over 5,000 people were killed in crashes that involved a drowsy driver. >> you also mentioned in r your presentation multiple amputation. and that they have used it to look at alcohol impaired driving. i'm wondering if they could use the same technique on their data to look at fatigue-related crashes, and if so or if not, what would your opinion be on that? >> i believe it could be done, but i would only do that with a couple of the data from a couple

of the studies that i referred to in my presentation. 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 of whether a driver is drowsy and critically to the use of amputation they distinguish whether the driver was known to be attentive or whether they were known to be drowsy or whether they could not make a determinati determination. in the data that are published annually their fatality analysis reporting system and their general estimate system, the data on driver u 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 simply couldn't tell whether the driver was drowsy or not. there is 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 crash where is 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 one-third of the time 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 the notion of the prevalence changing here. there's no question that the introduction of shoulder rumble strips, of air bags, 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's evidence they've reduced drowsy driving. in other words, the message is to don't engage in the behavior to begin with, and i think what they've done is try to alert people from catastrophic run off the road, but it's 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 are at great 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, we don't make a concerted effort to make sleep the priority, in addition to all the other things 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. and operating a motor vehicle. >> thank you. dr. price? >> thank you. i have just one question for dr. dinges. you talked about banking sleep, or recovery sleep. if a person is acutely sleep deprived, how much 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's not as easy to answer as i would like it to be based on evidence. but the estimates -- we've been stud thing for the national institutes of helts and other agencies, as has other labs. it appears that the old belief that you can make it all up in one night is not supported by the evidence. 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 the sleepiness or contributing to it. medical conditions, et cetera. >> thank you. dr. moore? >> i have a question for mr. tefft. with regard to the data as we talk about, people generally having -- being more drowsy in general and you talk about the people reporting that they've 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 drowsy driving and the risks? >> it honestly doesn't appear that they do. we have looked at that in surveys by the aaa foundation. and in those surveys we asked people how much of a threat they perceive other drivers, driving while they're sleepy, are to

their own personal safety, as well as whether 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, a large majority of people report that they consider it a very serious threat to their own personal safety, that other drowsy drivers are out there. and are 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 that they couldn't keep area eyes open. and a small minority. but still that translates to a large number of people report doing that fairly often or regularly. >> thank you. dr. rosekind? >> mr. tefft, i'll ask 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, just if we're trying to characterize the scope of the problem, annually how many drowsy driving crashes, how many lives are lost, how many injuries? >> based on the most conservative estimates of the prevalence, the most recent statistics on the number of crashes, 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 in 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. the second thing is, you identify a variety of different

shortcomings in the methodological proemapproaches. if you had a program that involved these, what would that program look like? >> ideally, 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 national highway traffic administration's crash 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 in-vehicle 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 in the 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 into 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 a reasonably sized sample, at least i'd say 3,000 to 5,000 severe crashes annually, that would put us far, far ahead of where we are now in

terms of what we know about drowsy driving, and being able to monitor are deaths. >> thank you. dr. dinges, why do you think we have this disconnect between the science between what we know about sleep loss and societal behaviors? what do you think the basis is? >> one of the bases of it is we are used to being drowsy, used to falling asleep, and no one thinks that's unusual. just as years ago no one thought it was odd that someone snore vd loudly when they slept, and that just seemed like normal behavior, and now you hear from physicians from apnea and whatnot is not normal, and poses significant health risks. this touches on the point of what would you do about it. we need to show people drivers

driving drowsy, that naturalistic observation study done in northern virginia by d.o.t. in the washington area was shocking when "60 minutes" showed some of those videos. it frightens you when you see it. and i don't think we have materially shown people how dangerous this is. and once you see what the cameras are seeing, that the driver's heads are nodding and he's moving out of lane, you get the message and you get it loud and clear. years ago, when i was in australia, and they had mounted significant campaigns around public advertisements on this showing graphic fall-asleep crashes, involving families and truck drivers and individuals alone, i brought some of those back, and the response that i got was those are too frightening for the american people. but in fact, i think we do need

some shock here and awe. we need to show the truth about drowsiness. it's not funny. it's not cute. it's not willfully overcome. we have to show that this is an incredibly dangerous thing to do. just as we now realize driving with alcohol in your system is dangerous to do. driving without seat belts was dangerous to do. we need to do the same thing with drowsiness and show what it is. an extremely risky behavior. it should not be normal or normalized. it should not be permitted or allowed. >> that would be a perfect ending to this panel. but i'm going to use just one last minute if you would tell us what do you think, briefly, regarding safety is the biggest scientific challenge that's still out there? not in all the science, but related to the safety of drowsy driving. >> truthfully, i think it's inadequate areas for people to get off the road and take a