Department of Transportation Medical Reference for Examiners

By Lulu.com

This eBook provides a quick reference look-up guide to the FMCSA NRCME clinicial guidelines. Determining driver medical fitness for duty is a critical element of the FMCSA safety program. Specialists, such as cardiologists and endocrinologists, may perform additional medical evaluation, but it is the medical examiner who decides if the driver is medically qualified to drive.The FMCSA regulations are dynamic and the end user is highly encouraged to sign up on the FMCSA NRCME website to be notified on any significant changes to this regulation. AOCOPM is not responsible for any change in guidance after the release of the current version.

• Language: English
• Publisher: Lulu.com
• Release date: Sep 29, 2017
• ISBN: 9781792302091

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Acknowledgments

I would like to thank Jeffrey LeBoeuf, CAE who is the Executive Director of the American

Osteopathic College of Preventive Medicine (AOCOPM) for his encouragement of this book and

obtaining the support of the college.

I would also like to thank Dr. Dan Callan, DO,MPH,FAOCOP who is considered an expert in the new laws and regulations which guide the requirements for providers interested in doing DOT exams.  Dr. Callan has devoted numerous volunteer hours to AOCOPM and has been key in developing the core curriculum for the Department of Transportation required training courses. Additionally, Dr. Callan has been the lead for training for providers as well as a key faculty member for our twice yearly AOCOPM college meetings providing updates in this rapidly developing area.

This eBook has undergone fairly major revision in April 2022 due to the major update in the regulation which has become non-specific and sites different regulation numbers; making this reference a valuable guideline to the provider. The Provider acknowledges by using this guide that we are not held liable for any dispute. If you have questions refer to the actual regulation. Any reference to something that is required should be verified by the individual provider by referring to the actual current regulation.

General Exceptions to this Regulation

Custom Farm operation

The rules in this part, except for violation of texting or use of mobile phone while driving do not apply to a driver who drives a commercial motor vehicle controlled and operated by a person engaged in custom-harvesting operations, if the commercial motor vehicle is used to - 

Transport farm machinery, supplies, or both, to or from a farm for custom-harvesting operations on a farm; or 

Transport custom-harvested crops to storage or market.

Apiarian Industries

The rules in this part, except for violation of texting or use of mobile phone while driving do not apply to a driver who is operating a commercial motor vehicle controlled and operated by a beekeeper engaged in the seasonal transportation of bees.

Certain Farm Vehicle Drivers

The rules in this part, except for  violation of texting or use of mobile phone while driving do not apply to a farm vehicle driver except a farm vehicle driver who drives an articulated (combination) commercial motor vehicle, as defined by 4,534 kg of weight and used to transport more than 8 passengers. . For limited exemptions for farm vehicle drivers of articulated commercial motor vehicles, such as road tests maintenance of files and records and general qualification of the driver.

Covered Farm Vehicles

The rules in part 391, Subpart E - Physical Qualifications and Examinations - do not apply to drivers of covered farm vehicles, as defined in 49 CFR 390.5, which discusses need for license plates and use of vehicle.

Pipeline Welding Trucks

The rules in this part do not apply to drivers of pipeline welding trucks as defined in 49 CFR 390.38(b). This part of reg describes the welding vehicle as pick-up style truck, is equipped with a welding rig that is used in the construction or maintenance of pipelines.  It states it is exempt from: requirements relating to registration as a motor carrier, requirment relating to driver qualification, requirements of driving of a commercial motor vehicle, logs of inspection, repair, and maintenance, and hours of service of drivers.

Resolution of Conflicts of medical Evaluation

As of this edition in April 2022 the regulation states the following:

Applications. Applications for determination of a driver's medical qualifications under standards in this part will only be accepted if they conform to the requirements of this section.

Content. Applications will be accepted for consideration only if the following conditions are met.

The application should contain the name and address of the driver, motor carrier, and all physicians involved in the proceeding.

The applicant should submit proof that there is a disagreement between the physician for the driver and the physician for the motor carrier concerning the driver's qualifications.

The applicant should submit a copy of an opinion and report including results of all tests of an impartial medical specialist in the field in which the medical conflict arose

The specialist should be one agreed to by the motor carrier and the driver.

In cases where the driver refuses to agree on a specialist and the applicant is the motor carrier, the applicant should submit a statement of his/her agreement to submit the matter to an impartial medical specialist in the field, proof that he/she has requested the driver to submit to the medical specialist, and the response, if any, of the driver to

his/her request.

In cases where the motor carrier refuses to agree on a medical specialist, the driver should submit an opinion and test results of an impartial medical specialist, proof that he/she has requested the motor carrier to agree to submit the matter to the medical specialist and the response, if any, of the motor carrier to his/her request.

The applicant should include a statement explaining in detail why the decision of the medical specialist identified in paragraph (b)(3) of this section, is unacceptable.

The applicant should submit proof that the medical specialist mentioned in paragraph (b)(3) of this section was provided, prior to his/her determination, the medical history of the driver and an agreed-upon statement of the work the driver performs.

The applicant should submit the medical history and statement of work provided to the medical specialist under paragraph (b)(5) of this section.

The applicant should submit all medical records and statements of the physicians who have given opinions on the driver's qualifications.

The applicant should submit a description and a copy of all written and documentary evidence upon which the party making application relies in the form set out in 49 CFR 386.37.

The application should be accompanied by a statement of the driver that he/she intends to drive in interstate commerce not subject to the commercial zone exemption or a statement of the carrier that he/she has used or intends to use the driver for such work.

The applicant should submit three copies of the application and all records.

Information. FMCSA (MC-PS) may request further information from the applicant if he/she determines that a decision cannot be made on the evidence submitted. If the applicant fails to submit the information requested, FMCSA may refuse to issue a determination.

Action. Upon receiving a satisfactory application FMCSA (MC-PS) shall notify the parties (the driver, motor carrier, or any other interested party) that the application has been accepted and that a determination will be made. A copy of all evidence received shall be attached to the notice.

Reply. Any party may submit a reply to the notification within 15 days after service. Such reply should be accompanied by all evidence the party wants FMCSA (MC-PS) to consider in making his/her determination. Evidence submitted should include all medical records and test results upon which the party relies.

Parties. A party for the purposes of this section includes the motor carrier and the driver, or anyone else submitting an application.

Petitions to review, burden of proof. The driver or motor carrier may petition to review the FMCSA's determination. Such petition should be submitted in accordance with § 386.13(a) of this chapter. The burden of proof in such a proceeding is on the petitioner.

Status of driver. Once an application is submitted to FMCSA (MC-PS), the driver shall be deemed disqualified until such time as FMCSA (MC-PS) makes a determination, or until FMCSA (MC-PS) orders otherwise.

FMCSA Medical Guidelines

General Principles

Consider Safety Implications

As you conduct the physical examination to determine if the driver is medically fit to perform the job of commercial driving, you should consider:

Physical condition:

Symptoms — Does a benign underlying condition with an excellent prognosis have symptoms that interfere with the ability to drive (e.g., a benign supraventricular arrhythmia that causessyncope)?

Incapacitation — Is the onset of incapacitating symptoms so rapid that symptoms interfere with safe driving, or can the driver stop the vehicle safely before becoming incapacitated? Is the onset of incapacitating symptoms so gradual that the driver is unaware of diminished capabilities, thus adversely impacting safedriving?

Mentalcondition Cognitive — Can the driver process environmental cues rapidly and make appropriate responses, independently solve problems, and function in a dynamicenvironment ?

Behavior: Are the driver interactions appropriate, responsible, andnonviolent?

Medicaltreatment Effects — Does treatment allow the driver to perform tasks safer than withouttreatment? Side effects — Do side effects interfere with safe driving (e.g., drowsiness, dizziness, orthostatic hypotension, blurred vision, and changes in mentalstatus)?

Medical Examiner Do's

As the medical examiner, you are examining for medical fitness for duty, not diagnosing and treating personal medical conditions. Nonetheless, you have a responsibility to educate and refer the driver for further evaluation if you suspect an undiagnosed or worsening medical problem. Keep the following in mind:

DO:

Comply with FMCSA regulations.

Seek further testing/evaluations for those medical conditions of which you are unsure.

Refer the driver to his/her personal health-care provider for diagnosis and treatment of potential medical conditions discovered during your examination.

Promote public safety by educating the driver about:

Side effects caused by the use of prescription and/or over-the-counter medications.

Medication warning labels and how to read them.

The importance of seeking appropriate intervention for non-disqualifying conditions, especially those that, if neglected, could result in serious illness and possible future disqualification By signing the Medical Examination Report form, the driver:

Certifies that information is complete and true.

Acknowledges that providing inaccurate or false information or omitting information could:

Invalidate the examination and any certificate issued based on it.

Result in the levy of a civil penalty against the driver.

General Qualification of drivers -current regulation 49CFR 391.11

Responsibilities of Drivers- 49CFR 391.13

A. Health History — Medical Examiner Responsibilities

The purpose of the health history is to obtain information relevant to detecting the presence of physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a commercial motor vehicle (CMV) safely.

Review and discuss with the driver any Yes answers

For each Yes answer:

Ask about history, diagnosis, treatment, and response totreatment.

Explore underlying cause, precipitating events, and other pertinentfacts.

Obtain additional tests or consultations, as necessary, to adequately assess the medical fitness of thedriver.

Review and discuss driver response to treatment and medications currently or recently used, including over-the-counter medications, and discuss any potential effects and side effects that may interfere with driving. As needed, you should also educate the driver regarding drug interactions with other prescription and nonprescription drugs andalcohol.

Write all information on the Medical Examination Reportform.

Additional questions include:

Symptoms that interfere with safe driving becauseof:

Frequency?

Duration?

Severity?

Rapidonset?

Limitations that interfere with safe driving becauseof:

Degree of limitationpresent?

Likelihood of progressivelimitation?

Medications that when used have effects and side effects that interfere with driving ability, such as:

Visualdisturbances.

Drowsiness.

Hypotension.

Behavioralchanges.

In addition to the guidance provided in the section above, directions specific to each category in Column 1 for each Yes answer are listed below. Feel free to ask other questions to help you gather sufficient information to make your qualification/disqualification decision.

Any illness or injury in the last 5 years

A driver should report any condition for which he/she is currently under treatment. The driver is also asked to report any illness/injury he/she has sustained within the last 5 years, whether or not currently under treatment.

Head/brain injuries, disorders, or illnesses

Ask questions that help you determine if the driver has recurring episodes of illness or any residual physical, cognitive, or behavioral effects that interfere with the ability to safely operate a CMV.

Seizures, epilepsy

REMEMBER: According to regulation, a driver with an established medical history or clinical diagnosis of epilepsy does not meet qualification standards and cannot be certified.

Eye disorders or impaired vision (except corrective lenses)

Ask about changes in vision, diagnosis of eye disorder, and diagnoses commonly associated with secondary eye changes that interfere with driving. Complaints of glare or near-crashes are driver responses that may be the first warning signs of an eye disorder that interferes with safe driving.

REMEMBER: The requirements for vision screening are regulatory.

Ear disorders, loss of hearing or balance

Ask about changes in hearing, ringing in the ears, difficulties with balance, or dizziness. Loss of balance while performing nondriving tasks can lead to serious injury of the driver.

REMEMBER: The requirements for screening for hearing loss are regulatory.

Heart disease or acute myocardial infarction, other cardiovascular conditions: Ask about history and symptoms of cardiovascular disease (CVD), syncope, dyspnea, congestive heart failure, angina, etc.

NOTE: If the driver reports symptoms consistent with undiagnosed CVD, you should refer the driver to a specialist for further evaluation prior to certification. If a driver reports current CVD, consult with the driver health care provider and obtain documentation prior to certification.

Heart surgery

Ask about history of heart surgery, bypass, valve replacement, pacemaker, angioplasty, and whether the driver has an implantable cardioverter defibrillator (ICD). Obtain heart surgery information, including such pertinent operative reports as copies of the original cardiac catheterization report,stress tests, worksheets, and original tracings, as needed, to adequately assess medical fitness for duty.

NOTE: If a driver gives a Yes answer to the question regarding heart surgery, obtain documentation from the cardiologist before certifying. Also, FMCSA medical guidelines recommend not to certify the driver who has an ICD, due to risk of syncope and gradual or sudden incapacitation while driving a CMV. This includes a dual pacemaker/ICD, even if the ICD has not been activated.

High blood pressure

Ask about the history, diagnosis, and treatment of hypertension. In addition, talk with the driver about his/her response to prescribed medications.

Hypertension alone is unlikely to cause sudden collapse. The likelihood increases, however, when there is target organ damage, particularly cerebral vascular disease. Recommending specific therapy is beyond the scope of the physical examination. As a medical examiner, though, you are concerned with the blood pressure response to treatment, and whether the driver is free of any effects or side effects that could impair job performance.

Muscular disease

Ask the driver about history, diagnosis, and treatment of musculoskeletal conditions, such as rheumatic, arthritic, orthopedic, and neuromuscular diseases. Does the diagnosis indicate that the driver is at risk for sudden, incapacitating episodes of muscle weakness, ataxia, paresthesia, hypotonia, or pain? Does the diagnosis indicate a degenerative process that over time will restrict movements and eventually interfere with the ability to safely operate a CMV?

NOTE: In addition to driving, CMV driver duties include such rigorous activity as coupling and uncoupling trailers, loading and unloading