Why do men think about DIY when driving

Distraction when driving can be a dangerous activity, this has been covered within a previous article and within the CPC course.  Its rather surprising to find DIY within this list of distractions but I have been guilty of day dreaming when I hear on the radio about a person winning the lottery, and by the end of the journey, I have successfully spent the winnings a dozen times over on various activities and joint business ventures.

But seriously, 15% are thinking about DIY rather than focusing on the task of driving.

How boring must your car be if you’re thinking about DIY when driving? Unless your name is ‘Handy Andy’ or Tommy Walsh, DIY should be avoided at the best of times, let alone when you’re behind the wheel.

However, according to a survey of 16,307 AA members, 15 percent of men and 9 percent of women admitted to thinking about home improvements while driving. What’s more worrying is the fact that just 11 percent of men were concerned about breaking down.

Worrying about arriving on time is the biggest distraction for men (45 percent) and women (57 percent), followed by work (34 percent overall) and planning for the future (25 percent). Money, life admin and social life are all tied on 22 percent.

And you thought ‘Hello Boys’ billboards and exotic motors were the biggest distractions when behind the wheel…

Just 30 percent of drivers said they only ever think about driving when behind the wheel, meaning two-thirds admitted to being distracted in the car.

In many ways, it has never been easier to be distracted while driving. Whether it’s a cursory glance at a mobile phone, using an aftermarket sat-nav or changing the setting on a touchscreen, there are many attention-seeking devices vying for the driver’s attention.

Throw into the mix the fact that cars are easier to drive and safer than ever before, and you have a recipe for distraction. Little wonder the government said that in 2017, there were 4,573 injury crashes where distraction was recorded as a contributory factor.

Of these, 774 were serious and a chilling 125 were fatal.

Edmund King, director of the AA Charitable Trust, said “The AA Trust has run some hard-hitting campaigns in recent years highlighting the dangers of distracted driving mobile phone use.

“But, while we can all make ourselves more aware of steps to take to minimise certain distractions, like putting mobile phones in the glove box, it is harder to switch our minds off day-to-day worries like childcare or work.

“So long as your thoughts aren’t so demanding that they overwhelm your ability to concentrate on the road then there is nothing wrong with a bit of thinking time in the car.

“Drivers can give themselves the best possible chance of keeping their concentration by making sure they are well-rested before they start a journey and take appropriate breaks on longer journeys.”

Defining the meaning of a rest period of 24-hours for tachograph purposes.

Being asked recently about the denotation of the 24-hour period, in the context of tachograph legislation. There is some guidance from the European Commission which is aimed at enforcement officials but is a useful reference point on the meaning of ‘each period of 24 hour’s.

The legislation is found in Article: 8 (2) and (5) of Regulation (EC) No. 561/2006.

In line with Article 8(2) of the Regulation a new daily rest period shall be taken within each period of 24 hours after the end of the previous rest period (regular or reduced daily or weekly rest). The next 24-hour period starts from the end of the qualifying daily or weekly rest period taken. The term ‘qualifying’ rest should be understood as a rest

period where a lawful minimum duration is accomplished within the period of 24 hours after the end of the previous qualifying rest. This qualifying rest may end later than 24 hours after the end of the previous rest if its total duration is longer than the minimum required by the legislation.

To determine the compliance with the daily resting time provisions enforcers should look into all 24-hour periods following a qualifying daily or weekly rest.

In cases where enforcers are confronted with periods of activity following a qualifying daily or weekly rest period, during which drivers do not accomplish a qualifying daily rest period, it is recommended that enforcers:

  1. divide the above-mentioned periods of activity into consecutive periods of 24 hours starting from the end of the last qualifying daily or weekly rest; and apply the rules on daily rest periods to each of these reference periods of 24 hours.
  2. Where the end of such a 24-hour period falls within the on-going rest period, which is not a qualifying rest as its lawful minimum duration has not been accomplished within the 24-hour period, but which continues into the next period of 24 hours and reaches a minimum required duration, sometime thereafter, then the calculation of the next 24 hour period shall commence when a driver ends his rest period of a total duration of at least 9/11 hours or more and resumes his daily working period.

Where a qualifying daily or weekly rest period is identified, the assessment of the next 24 hour period shall start at the end of this qualifying daily or weekly rest period taken (from the end of the relevant rest period if the rest taken is in fact longer than the required minimum period of time).

This calculation method should allow enforcers to identify and sanction all infringements of a daily rest provision committed within each period of 24 hours. The analogue calculation method should apply to drivers engaged in multi-manning, and the reference period of 24-hour period should be replaced by 30-hour period as stipulated by Article 8(5) of the Regulation.

Disclaimer: No information within this article; past / future columns shall be constured as legal advice or information.

Marijuana (cannabis) and road safety.

Many professional drivers will have their own views on Marijuana (cannabis) and its recreation usage. I had previously looked at the effects it had on mental health and the research study found that psychotic behaviour’s indents were more prevalent in young adults using this drug.

Marijuana is the most commonly used illicit drug in the United States. Its use is widespread among young people. In 2015, more than 11 million young adults ages 18 to 25 used marijuana in the past year.

Both hemp and marijuana are from the same genus and species (cannabis sativa). Marijuana is the dried leaves and flowers of the Cannabis sativa or Cannabis plant. tetrahydrocannabinol, known as THC, is responsible for many of the drug’s psychotropic (mind-altering) effects. It’s this chemical that distorts how the mind perceives the world. In other words, it is what makes you high.

  • THC: The cannabinoid that can make you “high”—THC—has some medicinal properties. Two laboratory-made versions of THC, nabilone and dronabinol, have been approved the therapeutic properties found in cannabis to treat nausea, prevent sickness and vomiting from chemotherapy in cancer patients, and increase appetite in some patients with AIDS.
  • CBD: Another chemical in marijuana with potential therapeutic effects is called cannabidiol, or CBD. CBD doesn’t have mind-altering effects and is being studied for its possible uses as medicine. For example, CBD oil has been approved as a possible treatment for seizures in children with some severe forms of epilepsy.
  • THC and CBD: A medication with a combination of THC and CBD is available as a mouth spray for treating pain or the symptoms of multiple sclerosis.

The therapeutic properties of the cannabis are well documented but smoking a marijuana in hand-rolled cigarettes (joints) in a public location could possible land you in jail.  You need to be familiar with the different types of legalisation for medical or recreation use.

Within the UK, recreational cannabis use is still illegal but there is a movement to change this law.  Medicinal / medical use of cannabis is used under licence only.

What effect has it had on road safety?

There are some parts of the USA that cannabis is legalised. It’s been several years since recreational cannabis was made legal in some US states.

It’s not unreasonable to reflect upon this knowledge to see how reducing / removing this legalisation would work within the UK, with regards to road safety and health.

A newspaper report in April 2019, (Guardian) said what almost half of cannabis users believe it’s safe to drive when you’re high, according to a new study by PSB Research and Buzzfeed News. Perhaps unsurprisingly, those who abstain from weed, take a different view – only 14% believe someone who’s stoned can drive safely.

The dangers of driving while intoxicated have been so well established that it’s easy to assume it’s the abstainers who are right and pot-smokers are simply failing to recognize the danger they pose to themselves. But a few studies into the issue have produced a murkier picture.

It’s true that THC, the psychoactive ingredient in cannabis, can impair a person’s levels of attention and their perception of time and speed, important skills you might think for driving a car. One meta-analysis of 60 studies found that marijuana use causes impairment on every measure of safe driving, including motor-coordination, visual function and completion of complex tasks.

But a 2010 analysis published in the American Journal of Addiction found that while “cannabis and alcohol acutely impair several driving-related skills and marijuana smokers tend to compensate effectively while driving by utilizing a variety of behavioural strategies”. The authors concluded that while marijuana should, in theory, make you a worse driver, in tests it doesn’t seem to. “Cognitive studies suggest that cannabis use may lead to unsafe driving, experimental studies have suggested that it can have the opposite effect” .

However, it has been estimated that 22 million Americans (9.4% of the population) have a substance use or dependence problem. As marijuana is the most commonly used drug of abuse, having been tried by 40% of the population, and is also smoked most commonly in the age group that also has the most road traffic accidents, the contribution of marijuana smoking to road traffic accidents is concerning.

A federal report to Congress, conducted by the National Highway Traffic Safety Administration, came to similar conclusions in 2017. In one test, volunteers were given either marijuana, alcohol or both and then used a driving simulator. The researchers found that the stoned drivers were more cautious, exhibiting “reduced mean speeds, increased time driving below the speed limit and increased following distance during a car following task”, although they did find it more difficult to maintain position within a lane.

Both studies come with the caveat that the amount of THC consumed, and the user’s tolerance levels had an impact on results, with heavy smokers likely to be more greatly impaired. Cannabis users are often unaware of how much THC they have consumed – it’s easy to track the difference between one bottle of Budweiser or two, but harder to know how much THC is in each puff of a joint.

For that reason, this kind of research has only limited applicability to the bigger question of whether stoned drivers are likely to cause more accidents in the real world. Perhaps the more pertinent question is whether states where cannabis has been legalised have seen an increase in crashes and collisions.

A 2017 study found that fatal collisions have not risen in states where weed has been legalised, compared with control states where it remained criminalised. However, two further studies have shown that accidents, in general, are more common since weed became legal in certain states.

The Highway Institute found a 12.5% increase in insurance claims on collisions in Colorado following legalisation and a 9.7% increase in Washington. But using the same methodology, they found no observable increase in accidents in Oregon (the authors suggest this may be because legal cannabis use is not continuing to increase in Oregon as it is in the other two states).

Another study by the same organisation found an average increase of 5.2% in police reporting of crashes in states where cannabis is legal compared with control states.

So, it seems that further research is needed to work out the amount of weed that is dangerous and what exact effect it has on driving ability (and don’t those studies sound fun). While most studies suggest that drinking is more dangerous than smoking when it comes to driving ability, there is at least a correlation between increased cannabis use and car crashes.

professional drivers: Early diagnosis of obstructive sleep apnoea

Introduction to obstructive sleep apnoea

This briefing arose from a campaign by Unite lorry drivers in the North East of England who wanted to raise awareness about obstructive sleep apnoea (OSA) for professional drivers.

Feeling tired at work may be for a variety of reasons, not necessarily because they are suffering from OSA, and they should seek advice from their GP.

Proper and early diagnosis of any condition along with appropriate medical treatment from the NHS is essential for members’ continued health at work. Seeking medical advice is also important to ensure that professional drivers can comply with the DVSA medical standards – self-diagnosis is not a suitable option.

What is Obstructive Sleep Apnoea?

OSA is a serious. potentially life-threatening condition that is far more common than is generally understood. Obstructive sleep apnoea (OSA) is a breathing disorder characterised by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnoea. meaning “without breath”.

As we go to sleep, the muscles of the throat relax as a normal part of the sleep process. In individuals with OSA, this relaxation progresses to the point where the passage for air is partially or completely blocked, dramatically reducing or stopping airflow into the lungs.

This causes an increase in Carbon Dioxide levels and the brain responds by waking up the individual for a short while to open the air passage. Breathing begins again, but the natural sleep cycle is interrupted.

Having OSA means that a person can stop breathing for periods when asleep. These interruptions (apnoea). which last for 10 seconds or more, occur when the airway narrows so much that it closes. These stops breathing, and the brain reacts by briefly waking up, causing the airways to re-open and breathing to restart.

The individual is usually unaware of this awakening and this process can be repeated up to several hundred times during the night. Proper restful sleep becomes impossible, resulting in sleepiness and impairment of daytime function. Early recognition and treatment of OSA is important.

The excessive sleepiness associated with OSA impairs quality of life and places people at increased risk of road traffic and other accidents.

It may also be associated with irregular heartbeat, high blood pressure, heart attack and stroke, impairment of cognitive function and mood and personality disorders.

Who suffers from Obstructive Sleep Apnoea

Apnoea occurs in all age groups and both men and women; although it is more common in middle aged men. OSA affects an estimated 4% of the male and one percent of the female middle-aged population.

Recent research has suggested that the disorder is much more prevalent in the transport industry. A 2005 study found that 16% of HGV drivers in the study has OSA and a corresponding increased risk of accidents.  

Other studies found that drivers with OSA have a 2 to 13-fold increase in accident rates. The risk of an accident for an OSA sufferer appears to be greatly increased. Further studies show that approximately 33% of OSA sufferers have had an accident in the past 5 years, with 19%-27% of OSA patients admitting to falling asleep at the wheel. UK research estimated that 20% of all motorway accidents are caused by sleepiness.

If untreated, OSA is a major threat to nightly rest. People most likely to have or develop OSA include those who snore loudly, are overweight, have high blood pressure, or have a physical abnormality in the nose, throat, or other parts of the upper airway. If left untreated or undiagnosed the results can be tragic.

Stimulants (like coffee) taken to counter the effects of tiredness but is not a substitute for sleep. The regular use of stimulants by individuals may be a clue to the existence of an underlying sleep disorder. Ingestion of alcohol, sleeping pills, or smoking, can exacerbate OSA.

What are the signs and symptoms of Obstructive Sleep Apnoea?

If you. or someone you know, snores nightly and has one or more of the following signs or symptoms. OSA may be the cause (though there may also be other reasons).

Common signs and symptoms of OSA include:

  • Excessive daytime sleepiness
  • Nightly snoring interrupted by pauses in breathing
  • Falling asleep when you shouldn’t – at work, while driving, etc.
  • Loss of energy, fatigue
  • Choking and gasping during sleep
  • Restless sleep
  • High blood pressure
  • Neck size greater than 17″ in men, 16″ in women
  • Being overweight
  • Depression
  • Having trouble concentrating
  • Irritability
  • Forgetfulness

Risk Factors for Obstructive Sleep Apnoea

  1. Some studies have shown that a family history of OSA increases the risk of OSA two to four times.
  2. Being overweight is a risk factor for OSA, though not all individuals with OSA are overweight.
  3. OSA is more likely to occur in men over 40 than in women, but it can affect people of all ages.
  4. Abnormalities of the structure of the upper airway contribute to OSA.
  5. OSA may be more common amongst certain ethnic groups (African, Mexican, Aborigines)
  6. Smoking and alcohol use increase the risk of OSA.
Treatments for Obstructive Sleep Apnoea

Treatment can include:

Lifestyle changes – weight reduction and reduction of alcohol consumption

Oral appliances

In a small number of cases surgery may have a place if there is a definite anatomical cause though a variety of treatments are available.

Continuous Positive Airway Pressure (CPAP) therapy is the most common and effective treatment for OSA. The individual wears a mask over the nose or mouth during sleep and gentle pressure from a quiet air blower forces air through the nasal passages.

The CPAP machine adds gentle pressure to the air as it is breathed in. This prevents the airway from collapsing and stops obstruction during sleep.

Your Next Step

Restful sleep is required for a normal healthy life Daily wakefulness should be effortless and free from unintended sleep episodes. Excessive sleepiness is far more common than often realised and can be dangerous.

If you or someone close to you regularly shows the signs of excessive sleepiness, or complains of constantly feeling tired

get help from your GP. OSA can be simply screened, diagnosed and treated. 

Treatment of OSA is effective, affordable and uncomplicated.


This article only provides general information about OSA Individuals should contact their GP for medical advice about OSA and the NHS treatment which is available.

Sources of further information

Loughborough Sleep Research Centre/Awake www.awakeltd.info/

National Institute for Health and Care Excellence (NICE) guidance on CPAP and OSA www.nice.org.uk

Unite Health and Safety Unit. Direct Line: 020 7611 2596 e-mail: [email protected]


Len McCluskey, General Secretary Unite House. 128 Theobalds Road

London WC1X8TN

Roadside Eye-Catchers Drive Motorists To Distraction

UK drivers are putting themselves at risk because they struggle to keep their eyes on the road.

Roadside objects such as billboards, flashing signs and Christmas decorations cause a third of motorists (32 percent) to lose concentration while behind the wheel.

With 41 percent of these drivers confessing to being distracted for up to 5 seconds – which equates to driving 15 car lengths at 30mph – two and a half times, the stopping distance needed at this speed.

At 60mph, this means drivers would find themselves traveling at least the length of a football pitch without their full concentration on the road.

Overall roadside distractions are pulling the attention of 83 per cent of UK drivers away from the roads, Privilege finds.

And its male drivers who are most affected as one in five (22 percent) confess to being captivated by scantily-clad women on adverts, compared to just one in ten female drivers by semi-naked male models (11 percent).

As public spaces become cluttered with illuminating and moving visuals, 26 percent of British drivers have been distracted by huge advertising hoardings, a fifth (21 percent) by the new vehicle activated signs and 17 percent by Christmas lights and decorations.

Dr. Mark Young, an expert in transport ergonomics at Brunel University, said:

“While we currently know a lot of more about in-vehicle distractions such as mobile phones than external distractors, there is a growing body of concern about the lack of any coherent strategy for arranging roadside furniture.

“Drivers’ visual workload varies through the course of a journey, and at crucial times – negotiating a difficult roundabout, for example, there is a small but significant risk of distraction from novel stimuli like advertising. In fact, this risk is probably underestimated, and we need to do more research on the possibility of excluding non-essential information when the driver is already busy dealing with the road.”

Ian Parker, Managing Director of Privilege Insurance, said:“It appears that the development of new technologies, products, and advertising techniques is getting in the way of road safety. The implications of the increase in eye-catching roadside objects such as illuminating signs have not been monitored until today. Privilege is providing motorists with tips on how to concentrate while driving amid the increase in distracting objects.”

To help drivers focus on the roads, relevant signs and drive as safely as possible, Privilege is providing drivers with the following tips and advice:

Try to take notice only of official signs and notices which are crucial for driving. Try saying them out loud as you pass them if it helps make you concentrate on them. If someone asks you what the last sign was, you should be able to tell them.

Constantly scan the road environment for other potential hazards. Don’t let your vision wander off from the beaten track.

When you are stationary try to keep your gaze on the traffic in front – or any road signals. Listen to mid-paced music to relieve boredom, rather than allow your concentration to wander to roadside distractions.

Driven to Distraction

“Each day in the United States, approximately 9 people are killed and more than 1,000 injured in crashes that are reported to involve a distracted driver”.

What Is Distracted Driving?

Distracted driving is any activity that diverts attention from driving, including talking or texting on your phone, eating and drinking, talking to people in your vehicle, fiddling with the stereo, entertainment or navigation system—anything that takes your attention away from the task of safe driving.

Another frequent question is whether talking on the phone is really any more dangerous than putting on mascara, shaving, or reading a map while driving — all things we’ve seen drivers do. I reply that indeed, any activity that distracts a driver visually or cognitively increases the risk of an accident. (And for clinicians, that includes dictating.) It’s just that cell-phone use is far more widespread than these other activities. But none of them is safe.

Texting is the most alarming distraction. Sending or reading a text takes your eyes off the road for 5 seconds. At 55 mph, that’s like driving the length of an entire football field with your eyes closed.

The statistics are chilling. In 2011 (the last year with complete statistics), 3,331 people were killed in motor vehicle crashes involving a distracted driver, and nearly 400,000 were injured within the USA The National Highway Traffic Safety Administration estimates that distracted driving accounts for about one in five crashes in which someone was injured.

You cannot drive safely unless the task of driving has your full attention. Any non-driving activity you engage in is a potential distraction and increases your risk of crashing.

There are three major types of distraction: visual distraction (taking your eyes off the road), manual distraction (taking your hands off the wheel), and cognitive distraction (taking your mind off the complex task of driving).

Imagine the scene: three young women are traveling in a car. It is a sunny morning, traffic is light, and all are wearing their seat belts and are not intoxicated. They are talking about a friend — “You like him, don’t you?”

It is happy, benign teenager chatter. Then the driver decides to include that other friend in the conversation. While steering, she sends him a short text message on her cell phone.

Suddenly, the car swerves into oncoming traffic and metal hits metal at high speed. Bodies are thrown. Glass breaks. Blood splatters. When the car finally comes to a stop, only the driver is conscious. Her screams speak of not only the agony of her injuries but also the realization that she has just killed her two friends — by texting.

This scene appears in a British public service announcement. The video above is horrifying to watch, but although it is obviously staged, the scenario is hardly a fiction: driving while distracted — by talking or texting — increases the likelihood of accident and injury. And some of these accidents kill people.

Although it is difficult to assess the absolute increase in the risk of collision attributable to driver distraction, one study showed that talking on a cell phone while driving posed a risk four times that faced by undistracted drivers and on a par with that of driving while intoxicated.

Another study showed that texting while driving might confer a risk of collision 23 times that of driving while undistracted. Although there are many possible distractions for drivers, more than 275 million Americans own cell phones, and 81% of them talk on those phones while driving. The adverse consequences have reached epidemic proportions.

Current data suggest that each year, at least 1.6 million traffic accidents (28% of all crashes) in the United States are caused by drivers talking on cell phones or texting.  Talking on the phone causes many more accidents than texting, simply because millions of more drivers talk than text; moreover, using a hands-free device does not make talking on the phone any safer.

according to the National Safety Council:

  • Drivers talking on handheld or hands-free cell phones are four times as likely to be involved in a car crash.
  • People talking on cell phones while driving are involved in 21% of all traffic crashes in the U.S.

In addition, hands-free devices do not eliminate the danger of cell phone use during driving.

Acknowledging these risks, all but 11 states have passed laws regarding cell-phone use while driving. And the U.S. government is concerned: in January 2010, the secretary of transportation and the National Safety Council announced the creation of FocusDriven, an organization devoted to reducing the prevalence of distracted driving. The Department of Transportation has also launched a Web site, www.distraction.gov.

At the medical school and academic practice where I teach, students and residents routinely query patients about habits associated with harm, asking about the use of helmets, seat belts, condoms, cigarettes, alcohol, and drugs.

There is little solid evidence that asking these screening questions has any benefit. But we continue to ask them — as I believe we should. And as technology evolves, our questions must be updated in keeping with the risks: it’s time for us to ask patients about driving and distraction.

Although no direct correlation can be made, we know that counselling patients about dangerous behaviours can have powerful consequences. According to the U.S. Preventive Services Task Force, even 3 minutes spent discussing the risks of tobacco use increases the likelihood that a patient will quit smoking.

Context matters. When a doctor raises an issue while providing overall preventive care, the message is different from that conveyed by a public service announcement nestled between ads for chips and beer or a printed warning on a product box.

Recently, I have added a question about driving and distraction to my annual patient review of health and safety. I begin with the customary seat-belt question.

Then I ask, “Do you text while you drive?”

Although I’m concerned about both texting and talking, most people are aware of the risks associated with texting, and many judges it more harshly. If a patient admits to texting while driving, I share my knowledge and concerns. Many patients who do not text while driving voice opinions about its dangers, giving me an opening to note that talking on the phone while driving causes more accidents than texting. 

Although I can share published data and often recommend that patients view the video described above, I find it more powerful simply to say that driving while distracted is roughly equivalent to driving drunk — a statement that captures both the inherent risks and the implied immorality.

Amy N. Ship, M.D. ask patients whether they could reduce or abstain from cell-phone use while driving. As with any plan for behaviour modification, we need to understand the circumstances surrounding the activity.

Many people have become accustomed to the diversion of talking on the phone while driving, and we’re all susceptible to the allure of a new message or call. If patients tell me that occasionally they receive “important” phone calls they don’t want to miss, we discuss what that means in the context of the risks. We talk about alternatives, including pulling over to make or take calls. 

I remind them that we all managed without mobile phones until recently and encourage them to return to the practices of the pre–cell-phone era.

Inattention blindness

Psychology faculty members Jason Watson, Ph.D., and David Strayer, Ph.D., used a video that was created for earlier inattention blindness research featured in the 2010 book The Invisible Gorilla by Christopher Chabris, Ph.D.

The video depicts six actors passing a basketball, and viewers are asked to count the number of passes. Many people are so intent on counting that they fail to see a person in a gorilla suit stroll across the scene, stop briefly to thump its chest and then walk off.

This experiment reveals two things: that we are missing a lot of what goes on around us, and that we have no idea that we are missing so much.

According to previous University of Utah research, only 2.5 percent of individuals can drive and talk on a cell phone without impairment. And Strayer has conducted studies showing that inattention blindness explains why motorists can fail to see something right in front of them – like a stop light turning green – because they are distracted by the conversation, and how motorists using cell phones impede traffic and increase their risk of traffic accidents.

What can drivers do if they want to fill the resulting void?

They can listen to the radio or a CD? 

They can pay attention to what they’re doing and their surroundings, rather than attempt to multitask. We talk about practical solutions. I tell them about a driver who killed a woman while talking on his phone but couldn’t restrain himself even after that horror. He now puts his phone in the trunk of his car before he gets behind the wheel. I talk about creating such a system for eliminating the risk.

Although I’ve encountered less resistance from patients than I’d anticipated, many do have questions. Most commonly, they ask why talking on the phone, even with a hands-free device, is more dangerous than talking to a passenger in their car.

There are several reasons: first is the obvious risk associated with trying to manoeuvre a phone, but cognitive studies have also shown that we are unable to multitask and that neurons are diverted differently depending on whether we are talking on the phone or talking to a passenger. 

When patients aren’t convinced, I ask them,

 “How would you feel if the surgeon removing your appendix talked on the phone — hands free, of course — while operating?”

This hypothetical captures the essence of the problem — the challenge of concentrating fully on the task at hand while engaged in a phone conversation.

In 1959, before seat belts were standard equipment in cars, my father — a surgeon who was an active member of Physicians for Automotive Safety in its infancy and had seen the terrible consequences of motor vehicle accidents — had airplane seat belts installed in our family Studebaker.

Vehicular safety was thus part of my education before I was in grade school. Fifty-plus years later, laws enforce seat-belt use in nearly every state, and deaths from motor vehicle accidents have decreased markedly. 

Just as we’ve moved beyond Studebakers, it’s time for us to update our model of preventive care. Primary care doctors are uniquely positioned to teach and influence patients; we should not squander that power.

A question about driving and distraction is as central to the preventive care we provide as the other questions we ask. Not to ask — and not to educate our patients and reduce their risk — is to place in harm’s way those we hope to heal.

UK Penalties Law

You can get 6 penalty points and a £200 fine if you use a hand-held phone when driving. You’ll also lose your licence if you passed your driving test in the last 2 years.

You can get 3 penalty points if you don’t have a full view of the road and traffic ahead or proper control of the vehicle.

You can also be taken to court where you can:


June 10, 2010N Engl J Med 2010; 362:2145-2147






Maintaining truck and trailer fridge units

Maintaining truck and trailer fridge units has become a lot more challenging in recent years, thanks to the impact of environmental legislation, reports Steve Banner.  The European Union’s latest regulations on fluorinated greenhouse gases (EU 517/2014), in force since January 2015, means that all refrigeration systems on trucks and trailers must be inspected annually for leaks by an F-gas certified technician, says Carrier Transicold northern Europe managing director Scott Dargan.

The risk of the escape of refrigerant must be minimised because of its global warming potential. “Leak test results must be recorded and traceable,” says Thermo King UK sales manager Steve Williams.  “If a leak is found, then it has to be fixed, and the system must be re-tested to ensure that it is tight.” Ignore leaks and you are driving up your costs as well as breaking regulations and harming the environment, Dargan warns.

Since July 2017, technicians must be qualified to work on refrigeration systems for trucks greater than 3.5 tonnes gvw and on trailers, just as those working on light commercial vehicles are. A certification body is Logic Certification and training suppliers include the Institute of the Motor Industry and https://is.gd/miquli) and ABC {https:// is.gd/viwuqu}.

Carrier Transicold’s UK training academy can help trainees obtain a City & Guilds F-gas qualification, which is valid for five years. Its programme has been accredited by the Society of Operations Engineers (the umbrella organisation for the IRTE) as a continuing professional development course.

 Many systems still use the now-outmoded R404A gas as a refrigerant, Dargan points out. However, its production is gradually being wound down because it is an HFC hydrofluorocarbon – with a global warming potential of above 2,500 times that of CO2, and the F-gas regulation imposes a reducing limit on the amount of fluorinated greenhouse gas that can be sold in the EU. 

So, its price is rising steeply, says Dargan. “It’s gone up by 800% since January 2017 and the cost is likely to go stratospheric this year,” he predicts. “At present, it’s around £60/kg, but it could go to £200. Our systems typically hold 5kg, but there are other systems around that may contain 10kg to 11kg and have an annual leakage rate of around 15% to 20%,” he contends. That is a lot of expensive refrigerant to lose.

Dargan says that diesel-powered systems should usually be serviced twice a year – a view shared by Thermo King’s Williams. “What we’re talking about is one major service that takes three or four hours and one interim service that takes 90 minutes to two hours,” he says.

The former is likely to involve changing the oil and filter and replacing drive belts, too, if necessary. The latter is primarily dedicated to checking and adjustment, but both services will include ensuring that there are no refrigerant leaks.

“One thing we advise engineers to do is check the state of the straps that hold the diesel tank in place,” remarks Norman Highnam, contracts director at Thermo King dealer Marshall Fleet Solutions.

Jobs such as swapping oil filters can be handled by any suitably trained workshop technician, says Williams, but anything that involves refrigerant should be left to a specialist, he contends.

“General workshop technicians can do some of this work, but it’s not really in their mindset,” reckons Highnam. “It takes them outside their comfort zone.”  

A specialist fridge engineer can obtain a lot of information on how the system is performing, and any faults that may have arisen, by interrogating its microprocessors, says Williams. “Remember, too, that you can also look at what has been recorded by the load area’s temperature data logger,” he adds. Telematics systems also help operators monitor systems, remotely.

“By preference, the truck or trailer should be brought into a workshop, but in the UK this doesn’t often happen,” Dargan observes. “Instead, the engineer usually has to go out to the vehicle in a service van.”

Highnam reports that 98% of Marshall’s work is carried out on site, and that this work is increasingly covered by a repair and maintenance agreement.

Site visits may mean working outdoors in an operator’s yard, but the vehicle may have to be brought under cover if there is a problem with a refrigerant circuit. “If the ambient temperature isn’t above 15°C, then you may get an ingress of moisture,” Dargan points out. That can combine with the refrigerant to form an acidic solution that will eat away compressor components.

At the very least, a workshop should have a wheeled gantry available for the engineer to use. Accessing fridge units -nose-mounted units on trailers, for example – can be problematic because of how high they are from the ground.

Falls from height in the workplace can lead to heavy fines for employers, thanks to fresh guidelines introduced by the Sentencing Council on 1 February 2016. That same year saw Volvo fined £900,000 after a technician at one of its dealerships was seriously injured in a fall from a ladder.


In many cases, the engineer may have no option but to use a ladder and a safety harness, especially in an emergency service when a fridge unit has failed on a fully-laden vehicle. However, they will not be expected to do so if they believe the conditions are unsafe, Dargan stresses. Williams insists: “Nor should major repairs be conducted by a technician up a ladder.”

What about cab-top aerofoils, which often used to impede access to nose-mounted units on rigids? Dargan explains that this problem has largely gone away. Now, he says, “they can be tilted so they don’t get in the way”.

Working at heights is clearly far less of an issue if the engineer is maintaining a 3.5-tonne van with a direct-drive fridge unit. Although they are not powered by their own diesel engine, they too require periodic servicing, says Highnam.

 “We’re usually talking two visits a year, although some operators try to push it to once a year,” he says. “There are fewer long hose runs, so in that respect maintenance is easier, but direct drives can be pernickety because [they are] in effect a very large air-conditioning system.”

Other technology developments are further changing the status quo. For example, some of the different and hopefully more environmentally friendly approaches to transport refrigeration are likely to result in changes to maintenance requirements.

For example, powered by a hydraulic pump driven by the truck’s engine, fridge systems from Swedish manufacturer Hultsteins, which are available in a variety of configurations, are said to cost 50% less to maintain than its diesel-fired equivalent, with CO2 emissions down by at least 98%.

However, Williams warns that the claims made of new systems always need real-life substantiation. “It’s not always easy to know what will happen in practice,” he states; a point fleet engineers may care to bear in mind.


Qualification requirements for F-gas technicians (2017)  Safe access during plant inspection (SAFed, 2016) – Working at height for mobile plant (SAFed, 2016)

Do we have a booze / drink problem

Every company policy state that if you drink on the road your job will be terminated. Also, if any alcohol is found in your truck by your company your employment will also be terminated. Most of the major transport companies also have a mandate that all drivers involved in a road traffic accident will need to take a compulsorily drug and alcohol test. The consumption of alcohol is prevalent amongst professional drivers and stress has been linked to the increase in consumption. 

Many drivers do not appreciate that they are still over the legal limit during the following day. However, a current documentary by Radio and TV presenter Adrian Chiles highlighted the long-term damage alcohol has on your health.

A current documentary included Proofessor Roger Williams from the Institute of Hepatology at King’s College Hospital in South London, has given his life to medicine and is widely revered as the “Sir Alex Ferguson of the medical establishment”, and his driving passion is to dispel our blasé attitudes to casual, excess drinking and face up to its real cost.

A speech made a few weeks ago by the Secretary of State for Health, Matt Hancock read:

‘For 95 per cent of people, the alcohol we drink is perfectly safe and normal. I like a pint or the odd glass of wine, and I know I speak for most of my audience and certainly the vast majority of my colleagues, too.’

We must also need to point out that alcohol plays an important role in the lifestyles of European citizens and cultures of European countries. Alcohol is also an important driving force behind the European economy that creates jobs, generates fiscal revenues and contributes to the UK and EU economy by around €9 billion annually through trade (Anderson & Baumberg 2006)

WHAT riled Professor Williams was that first sentence? For while the Health Secretary may think 95% of alcohol consumption is safe, Professor Williams and fellow experts on the influential Lancet Standing Commission on Liver Disease in the UK do not.

They are committed to lobbying the Government and public health policy makers to act, especially on the availability of cheap drink.

The NHS recommends that adults drink no more than 14 units each week — that’s 14 single shots of spirit or six pints of beer or a bottle and a half of wine.

But about a third of drinkers consume more than this, which is enough to significantly damage their health, particularly their liver.

The reporter used to be a bit of a drinker, often knocking back six pints of Guinness a day. In an average week, I’d consume around 50 units, although that number was known to double.

I did my best to downplay and told himself everyone likes a drink. (But that’s not true, since about 17 per cent of adults don’t drink at all and 70 per cent of those who do stick to the 14-unit guidelines.) The only days I drank nothing focus on extreme cases, and so the rest of us look at the classic ‘alcoholic’ slumped in a shop doorway, and say to ourselves: ‘Oh, that’s not me!

Therefore, I have no problem.

I am fine.’

Well, I know now that we aren’t fine. Today, as someone who still likes to drink, nothing when he was broadcasting in the evening. He needed an actual reason to abstain for even one day.  His drinking habits go back a long way. At university, if anyone I liked had said they didn’t drink, well, I probably wouldn’t have ended up being friends with them.

And as a lifelong West Bromwich Albion fan, going to a match meant having a few drinks with mates — one or two or countless — beforehand.

I believe the word ‘alcoholic’ is outdated, but I’ve come to realise that I was undoubtedly depend­ent on alcohol to some extent.

And if I am, then thousands of others are, too. They are drinkers like me, quietly putting it away without, superficially, doing any great harm — when, actually, we could do ourselves some real good by drinking significantly less.

I believe that all the coverage of alcohol misuse and abuse fails to tackle this problem. It tends to focus on extreme cases, and so the rest of us look at the classic ‘alcoholic’ slumped in a shop door­way, and say to ourselves: ‘Oh, that’s not me! Therefore, I have no problem. I am fine.’

Well, I know now that we aren’t fine. Today, as someone who still likes to drink, nothing would give me more pleasure than to tell you that the 14-unit figure is a load of nonsense.

But I can’t do that. Over the past months, I’ve applied my (admit­tedly unscientific) mind to a vast amount of evidence, and it is clear that the folks in white coats speak the truth: drinking more than 14 units a week is bad for you.

To suggest otherwise is about as daft as claiming that smoking isn’t harmful.

To be fair to Matt Hancock, he’s right when he points out that the group most at risk of alcohol-related health problems is the 5% of drinkers who put away more than 50 units a week (for women, who are more suscep­tible to damage caused by alcohol, it’s 35 units). Indeed, this group consumes about a third of all the alcohol drunk in the UK.

But look at it another way and you discover that nearly half of all alcohol is consumed by the 8.5 million drinkers like me who knock back between 14 and 50 units a week.

More than one million hospital admissions annually are the result of alcohol-related disorders, and it costs the NHS £3.5 billion a year.

Alcohol is the biggest risk factor for death in men under 60. 

And terrifyingly, with the frequency of deaths from liver disease and hospital admissions increasing year on year, logic dictates that must include many of those drinking between 14 and 50 units a week. From all I have learned about full­blown liver disease, the symptoms are horrific and the end ghastly.

Just as worrying is the demon­strated link between drinking arid the increased risk of common cancers of the breast and bowel. All of this becomes even more alarm­ing when you realise — as I did when making the documentary for the BBC — that it’s very easy to drink 50 units a week if you drink something every day and then throw in a couple of big nights out.

At a friend’s 40th birthday cele­bration last year, I drank four pints of Guinness, four bottles of beer, a glass of champagne and five glasses of wine. Even a quiet night out — what I, in my ignorance, thought of as a non-drinking night with a mate — would be two pints of Guinness each and perhaps a bottle of wine between us.

Even with that degree of regular boozing, the symptoms can be silent. Liver disease often doesn’t show itself until it’s too late to easily treat.

Routine blood tests showed my liver function was normal, but for the documentary I had a fibroscan which is a type of ultrasound that assesses the hardness of the liver. That told a different story.

My liver is fatty, which is bad, and there are signs of fibrosis caused by a large amount of scar tissue — both undoubtedly linked to my drinking. In short, last year I found I was well on the way to having potentially fatal liver disease.

The liver specialist I saw said: ‘You can’t go on like this’ — and he was right.

For you, it’s not a choice between living a good, long life or a good, slightly shorter life, he added; it’s about making your declining years as bearable as possible. And drinking too much before you get there isn’t going to help.

Ironically, my biggest concern is getting to old age without having ruined my innards so much that I can’t enjoy a drink to ease me through my twilight years.

So, I’ve cut down on my drinking, though it’s not been easy. In fact, I wonder whether it’s easier to stop completely rather than to try to moderate what you drink. If you stop completely, you have only one decision to make, hard though it is. But you know where you stand, and so does everyone else.

If you’re merely moderating, there are dozens of decisions to make every week. When do I drink?

How much do I drink?

Will this friend or that friend be annoyed if I don’t drink with them?

The list goes on and on.

But I’m proud to say that I’ve managed it. And, for me, the key to it has been counting units. Believe me, I know how hard it is to bring yourself to do this, and I resisted for a while.

I find the Drink Less phone app easiest to use (other apps are available). It allows you to input your alcohol intake throughout the day and projects it onto a graph. The effect on me was immediate.

I’ve discovered that once you’re counting units, you can work out which drinks you really want, or need or will enjoy.

I reckon if you put every drink I’ve ever consumed in a row, it would stretch for nearly four miles. But, to be honest, I think I’ve only really appreciated a third of them. The rest were completely unneces­sary, and now I’ve got a dodgy liver for my trouble. What an idiot!

Nowadays, when I go to the pub, I order what the Germans call beer sour: half a beer and half a soda water in the same glass.

That’s been a game changer for me. It gives you a pint to hold and the taste isn’t dramatically different. More importantly, it’s half the units. I’ve also started drinking alcohol-free versions of the drinks I like, and there’s plenty of good stuff out there.

So how do I feel in my new guise as a ‘moderating drinker’?

Well, I’m a bit lighter, a bit calmer, a bit healthier and, what I do drink, I enjoy more.

The biggest changes I’ve noticed, however, are psychological. The pressure we put on each other to drink is absurd. Alcohol is the only drug you must apologise for not taking. I’ve sworn a solemn oath no longer to be pressured into drinking by anyone, and nor will I pressure anyone else.

But neither will I pressure any­one into drinking less. If you enjoy every drop, crack on —just if you’re aware that more than 14 units a week puts your health at risk. Don’t beat yourself up if you can’t get down to that number. I still really struggle, but every unit I don’t drink helps.

If you’re regularly drinking much more than that — say 40 units a week — my strongest advice is to ask your GP to send you for a fibro-scan. I know how lucky I am. I got the wake-up call I needed. Now, I want to wake-up others.

And if I ever need further encouragement, I can always call upon the image of Professor Williams slumped at his desk in despair, knowing better than anyone what too much booze is doing to us — and determined to do something about it.

Smart tachographs: what you need to know

JUNE 2019 will see the biggest change in tachograph regulation in more than 12 years – the mandatory introduction of ‘smart tachographs’ in all new vehicles. With many improvements, such as satellite positioning data and increased security, the new devices are

designed to foster greater compliance with the drivers’ hours rules by making it more difficult to tamper with the devices; they may also reduce administrative processes.

The most important new feature is the introduction of satellite positioning data. The new devices will take a GPS reading at the start and end of duty and every three hours of accumulated driving.

This will expand the enforcement role of tachographs to establishment rules, such as cabotage, in addition monitoring compliance with the drivers’ hours rules. Other security features include a new Intelligent Transport Systems (ITS) interface; sealing requirements; and Dedicated Short Range Communications (DSRC).

To facilitate targeted roadside checks, the DSRC will enable authorities to access tachograph data while the vehicle is in motion. This will be used for targeting processes and to address only most the severe infringements.

It cannot be used for automated fines and if no issues are detected, the authorities must delete the data within three hours. The regulation does not require enforcement agencies to have the equipment required to read the signal until 2034; and as far as the FTA is aware, the DVSA does not see this capability as a priority.

It may be a different story in mainland Europe – other member states may wish to install this capability as soon as possible.

As smart tachographs will be mandatory in new vehicles alone, it is down to dealerships to ensure they are fitted at the point of sale; there is no retrofit requirement for domestic operators.

Any vehicles crossing international borders must have a smart tachograph retrofitted by June 2034, but it is unlikely many vehicles in current circulation would remain active by this time.

That said, several MEPs have realised they have allowed a rather long lead time and are looking to bring any retrofit date forward by at least 10 years.

The DVLA has confirmed all new driver and company cards issued from early 2019 will be fully compatible and able to hold the new fields of data collected by the devices.

 These cards will still work with the older tachographs; current cards will also be compatible with the smart tachographs. But it’s not so simple with workshop cards; for calibration purposes, tachograph centres must a hold a smart-compatible card. All workshop cards in Great Britain are re-issued 1 April 2019 and are valid for one year.  

While the statutory introduction date for the new devices is 15 June 2019, tachograph manufacturers expect to have them in vehicles in 2019, so workshops will need to have been issued their new cards in time for this.

FTA is currently in talks with the DVLA to ensure they are taking appropriate steps to address this.

Smuggler Hides Asylum Seekers In Back Of Refrigerated Truck

A gang ringleader has been jailed for smuggling hundreds of migrants, including children, into Britain inside refrigerated lorries.   Alket Dauti, a UK-based Albanian, worked with corrupt lorry drivers to bring people into the country illegally via the Channel ports.

He was arrested in June at his home in Penge, south-east London, as part of a joint UK-Belgian investigation into organised crime.  

The 31-year-old was convicted in his absence by a court in Belgium last month and has now been sent there to serve his ten year sentence and also been fined £625,000.

Two other men, described as his ‘lieu­tenants’, were Sentenced to eight years each and await extradition. Belgian prosecutors believe the gang made hun­dreds of attempts to smuggle migrants into the UK.

Only some were stopped by the Border Force. The National Crime Agency’s Andrea Wilson said: ‘Dauti treated desperate migrants as commodities he could make money from. He was perfectly happy to risk their lives on incredibly danger­ous journeys in the backs of lorries.’

She added: ‘Through our close work­ing with the Belgian Federal Police and prosecutors, we have taken out a sig­nificant organised crime group involved in bringing migrants to the UK illegally. Dauti was head of that group.’

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