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  • Medical Fitness to Drive in the Transportation Industry and the Impact on Public Safety: Recommended Actions

    Introduction

    Driving is considered a basic activity of daily living for most Americans, and in many cases is a job requirement, but not every driver is a safe driver. Certain individuals, because they have medical conditions that may impair their physical skills, alertness, and/or decision-making abilities, pose a public safety risk and should not operate vehicles, moving equipment, or other heavy machinery. In order to protect the public, all vehicle/equipment operators in the transportation industry — and commercial motor vehicle (CMV) drivers in particular — need to be physically qualified to drive.

    Challenges

    Making sure that individuals who operate vehicles as part of their job responsibilities are medically fit can be challenging. This is due to the fact that there is a lack of uniform reporting laws and protections from liability for reporting unsafe drivers, and because medical fitness-for-duty programs in the transportation industry vary greatly. For example, many individuals who operate CMVs as part of their occupational responsibilities are covered under Federal Motor Carrier Safety Administration (FMCSA) regulations, a system that provides regulations and guidelines, but at the current time has no training requirements or program oversight. Other CMV drivers are subject to state medical standards which — in most cases — are similar to the federal standards although waivers, grandfather programs, or exemptions are more common-place. The Federal Railroad Administration’s (FRA’s) medical standards/regulations cover only locomotive engineers and conductors  for vision (including color vision) and hearing under 49 CFR Part 40. In addition, operators of other forms of local transportation (e.g., transit vehicles, buses, trolleys, etc.) are often not covered under any medical criteria. School bus drivers are generally required to meet specific medical criteria that are set by individual states. In addition, a large number of workers who drive as a part of their jobs are not required to meet any criteria other than that they must hold a valid driver’s license.

    Recommended Actions

    To address these issues and to make sure that all individuals who operate vehicles as part of their job responsibilities are medically fit, the American College of Occupational and Environmental Medicine (ACOEM) urges medical providers, employers, employees, and federal and state officials to take the following actions:

    Medical Providers

    • Occupational physicians and other occupational health providers who are responsible for determining the fitness for duty of those employees who handle vehicles or other similar equipment must understand the safety risks involved in operating a motor vehicle and the role that they, as health care providers, play in protecting the public from unsafe drivers.
    • Providers should be well versed on the relevant rules (e.g., FRA, FMCSA, state bus driving regulations) overseeing a patient’s/driver’s occupation.
    • Providers should consider a patient’s diagnosis(es), treatment, adverse effects, mental state, and functional abilities/impairments in determining fitness for duty. They should also consider the job requirements and whether the patient/driver meets those requirements.
    • Personal health care providers must recognize the public safety risks that exist when they clear individuals who have a medical condition that could potentially impair their ability to safely operate a vehicle. Health care providers should ask their patients whether they operate a vehicle or other similar equipment as part of their job responsibilities. In a situation where the personal health care professional is uncertain of the patient’s ability to safely operate a particular vehicle, or unsure of the regulations involved, he or she should consult with a physician knowledgeable in such matters.
    • Health care professionals need to be aware — and utilize — existing guidelines, recommendations, and resources that are available to aid providers and employers. These resources include — but are not limited to — FMCSA’s Medical Examiner Handbook,1 the Federal Transit Administration’s Prescription and Over-the-Counter Medications Tool Kit,2 and the American Medical Association’s Physician's Guide to Assessing and Counseling Older Drivers.3

    Employers

    • Employers should be aware that motor vehicle crashes are the leading cause of occupational fatalities.
    • Employers must understand their responsibility in ensuring that all employees who operate a motor vehicle can do so safely, and make certain that those who have a medical condition which may present a danger to others are appropriately evaluated by medical personnel with an understanding of the medical condition and the public safety risks.
    • Employers should think about establishing a program to address these safety-related issues.
    • Employers should consider having workers with potentially impairing conditions monitored, including having independent medical examinations performed as needed.

    Employees

    • Employees must understand the impact their health has on their ability to safely operate vehicles at work.
    • Employees must inform their treating and examining health care professional if they operate a vehicle requiring a commercial driver’s license, or any other vehicle or heavy machinery.
    • Employees must accurately inform their treating and examining health care professional of pertinent medical history, mental impairments, medications, adverse effects of treatment(s), and symptoms in a timely manner.
    • Employees with temporary medical conditions or who are taking medications that prevent safe operation of a motor vehicle should discuss the situation with their health care provider or their employer and not drive when safe driving cannot be assured.

    Federal and/or State Officials

    • Officials should assure that information on the effects of medical conditions and medication on safe operation of vehicles and equipment at work is evaluated and communicated to appropriate parties.
    • State and federal legislatures should provide immunity from liability for physicians and other providers for good faith reporting of drivers and other transportation operators whose medical conditions may place them and others at risk of substantial harm.
    • Federal officials should ensure that the National Registry of Certified Medical Examiners is implemented and maintained so that only physicians and other health care providers qualified to perform commercial driver medical examinations are allowed to do so.

    Conclusion

    Preventing employees from placing themselves or others at risk of harm due to an inability to perform their job tasks safely is a joint responsibility of employers, employees, government entities, and — as an integral component of most occupational and environmental medicine physician’s practice whether in the private, corporate, or academic setting – medical providers. To protect both drivers and the public, ACOEM urges providers, employers, employees, federal and state officials, and all others involved in the transportation industry to adopt these actions to help ensure the medical fitness of all individuals who operate motor vehicles as part of their work responsibility.

    References 

    1. U.S. Department of Transportation. Federal Motor Carrier Safety Administration (FMCSA) Medical Examiner Handbook. Available at http://nrcme.fmcsa.dot.gov/mehandbook/MEhandbook.aspx.
    2. U.S. Department of Transportation. Federal Transit Administration Prescription and Over-the-Counter Medications Tool Kit. Washington, DC; 2011. Available at http://transit-safety.volpe.dot.gov/publications/substance/RxOTC/RxOTC_Sept2011.pdf.
    3. American Medical Association. Physician's Guide to Assessing and Counseling Older Drivers. Available at www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety/assessing-counseling-older-drivers.page?.

    Acknowledgements

    This document was prepared by Natalie Hartenbaum, MD, FACOEM, and Dan Janiga, MD, FACOEM, on behalf to the ACOEM Transportation Section. The document was peer reviewed by members of the Transportation Section; the authors wish to thank Drs. Karl Auerbach and Kurt Hegmann for their contributions. The document was also reviewed by the Committee on Policy, Procedures, and Public Positions. It was approved by the ACOEM Board of Directors on April 28, 2012. ACOEM requires all substantive contributors to its documents to disclose any potential competing interests, which are carefully considered. ACOEM emphasizes that the judgments expressed herein represents the best available evidence at the time of publication and shall be considered the position of ACOEM and not the individual opinions of contributing authors.

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