DVLA Fitness to Drive

1. DVLA Fitness to Drive Bryndon Eve and Claire Jennings

2. DVLA Philosophy • In the interests of road safety, those who suffer from a medical condition likely to cause a sudden disabling event at the wheel or who are unable to safely control their vehicle from any other cause, should not drive.

3. License Categories • Group 1 • Motor cars and motor cycles. • Group 2 • Large lorries and buses.

4. Questions? • Why do the DVLA set stricter guidelines for group 2 drivers? (2 reasons) • What can I do in a car that the new run-through trainees can’t? • Are the DVLA ageist?

5. Special Categories • Emergency services and Taxis • Seat belt exemption • Patients that won’t inform the DVLA • Driving after surgery • What are the post op considerations?

6. Post op considerations recovery from the surgical procedure, • recovery from anaesthesia , • The distracting effect of pain, • impairment due to analgesia (sedation and cognitive impairment), • physical restrictions due to the surgery, underlying condition, or other co-morbid conditions

7. Contact details • Tel: 01792 782337 (Medical Professionals Only) • Email: medadviser@dvla.gsi.gov.uk (Medical Professionals Only) • Patient enquiries have to be in written form only.

8. Neurology • Bryndon is so excited to pass his driving test that he has a seizure! It is witnessed by his medical friends. • Through his contacts at the HGH he sees a neurologist and gets an EEG and brain scan – both are normal. • What are you going to recommend re driving?

9. Epilepsy and Provoked seizures • Epilepsy – no driving for 1 year after a seizure. • Need to tell the DVLA regarding provoked seizures but dealt with on an individual basis.

10. Provoked Seizures • • eclamptic seizures • • reflex anoxic seizures • • an immediate seizure (within seconds) at the time of a head injury • • seizure in first week following a head injury, which is not associated with any damage on CT scanning, nor with post traumatic amnesia of longer than 30 minutes • • at the time of a stroke/TIA or within the ensuing 24 hours • • during intracranial surgery or in the ensuing 24 hours. • Seizures occurring during an acute exacerbation of multiple sclerosis or migraine

11. Fainting / Giddiness • Rules on fainting • When are you not allowed to drive after a faint. • Mr Jerry Attrick comes to you feeling “giddy” He drives to see his daughter and do his shopping every day – this is his lifeline. Do you need to tell the DVLA.

12. CVA / TIA • Can’t drive for 1 month after a stroke • Can’t drive for 3 months if you have multiple TIAs over a “short period of time”

13. Cardiovascular • Angina – who needs to tell the DVLA • 60yr old lady with an exercise tolerance of 20m on multiple medications • 65year old man, no regular meds, good ET, but needed to take his GTN spray when overcome with emotion at daughter’s wedding reception.

14. Heart attacks • Primary angioplasty • Thrombolysis • Presents too late to have either – but then goes on to have a CABG

15. Cardiovascular • AAA – 6.5cm and you can’t drive! • All other CV disorders, eg congenital heart disease, HF, PVD, WPW.... • No restrictions but follow initial DVLA philosophy.

16. Diabetes • Diet controlled • Tablet controlled • Vision • Hypoglycaemia • Temporary treatment with insulin <3/12 • Gestational and post MI

17. IDDM • Inform the DVLA • Licenses will be issued for 1, 2 or 3 years depending on individual case. • Vision • Neuropathy • Hypoglycaemia • PVD

18. IDDM Advice • Drivers with insulin treated diabetes are advised to take the following precautions: • • Do not drive if you feel hypoglycaemic or if your blood glucose is less than 4.0 mmol/l. • • If hypoglycaemia develops while driving stop the vehicle as soon as possible in a safe location, switch off the engine, remove the keys from the ignition and move from the drivers seat. • • Do not resume driving until 45 minutes after blood glucose has returned to normal. It takes up to 45 minutes for the brain to fully recover. • • Always keep an emergency supply of fast-acting carbohydrate such as glucose tablets or sweets within easy reach in the vehicle.

19. Continued.... • • Carry your glucose meter and blood glucose strips with you. Check blood glucose before driving (even on short journeys) and test regularly (every 2 hours) on long journeys. If blood glucose is 5.0mmol/l or less, take a snack before driving. • • Carry personal identification indicating that you have diabetes in case of injury in a road traffic accident. • • Particular care should be taken during changes of insulin regimens, changes of lifestyle, exercise, travel and pregnancy. • • Take regular meals, snacks and rest periods on long journeys. Always avoid alcohol.

20. Psychiatric Disorders • It is the relationship of symptoms to driving that is of importance. • If condition is managed in primary care – prob don’t need to inform DVLA. • Psychosis and Mania – 3/12 • Depression – can’t drive if suicidal / poor concentration / behavioural component.

21. Alcohol Misuse • What advice would you give to the following patients about driving? • 29 Year old publican drinks around 80 units per week thinks he doesn’t have a drink problem. He says he drinks to relax and never before driving. His GGT and MCV are mildly elevated. - 45 year old woman who is a self-confessed alcoholic. She drinks around 90 units per week and often drinks in the morning.

22. Alcohol Misuse & Dependence • Misuse defined as ‘ a state caused by alcohol consumption which leads to behavioural disturbance, related disease or other consequence likely to cause harm to the patient/family/society either now or in the future. May or may not involve dependence. • ‘Misuse of ETOH’- persistent misuse confirmed by medical enquiry &/or abnormal blood markers otherwise unexplained. Requires licence revocation/refusal for a minimum 6 months until abstinence or controlled drinking has been attained leading to normalisation of blood markers. • Alcohol Dependency- Revocation or refusal until 1 year of abstinence attained and blood markers normalised. Restoration of licence will need satisfactory medical reports from GP +/- independent DVLA assessment. • Seizure related to drug or alcohol misuse – Licence revoked or refused for 1 year. Multiple seizures needs consideration under epilepsy regulations. Restoration needs satisfactory medical reports +/- independent DVLA assessment. • Alcohol related disorders e.g. neuropsychiatric impairment, psychosis, driving should cease until recovery.

23. Drug Misuse • What advice would you give to the following patient about driving? - 24 year old man who smokes cannabis every day. On further discussion he says he never smokes before driving.

24. Drug Misuse & Dependence • Cannabis, amphetamines, LSD – 6 months free of persistent use or dependency +/- independent assessment and urine analysis. • Heroin, morphine, methadone, cocaine, benzodiazepine misuse – 1 year free of use + independent DVLA assessment +/- consultant report. May be licenced if on supervised methadone programme.

25. Visual Disorders • Read in good light (+glasses) number plate at 20 m. (~ 6/10 Snellen but see below) • Monocular vision- ok if can meet requirement in good eye and no visual field defect. • Cataracts- be aware of glare preventing meeting requirement. • Visual field defect – Driving must cease unless meets requirements in appendix. • Diplopia- driving must cease unless controlled by glasses or patch. • Color Blindness- no restrictions • Blepharospasm- needs consultant report ? severity

26. Renal Disorders • Chronic renal failure on dialysis or CAPD: • no restrictions unless significant symptoms e.g. dizziness attacks, psychomotor or congnitive impairment. May then be refused. All other renal disorders have no restrictions.

27. Respiratory Disorders • Obstructive sleep anpoea, cough syncope – driving must cease until satisfactory control of symptoms confirmed by medical opinion. • Cough syncope – driving must cease until liability to attacks is controlled, confirmed by medical opinion. • COPD, Asthma – need not be informed unless attacks of dizziness, fainting or LOC.

28. Cancer • For all tumours, fitness to drive depends upon: - risk of seizure (related to cerebral secondaries)

29. AGE • No bar to driving! • DVLA needs confirmation at age 70 that no medical disability is present. • 3 year licence issued subject to satisfactory completion of questions on form. • Older drivers and their relatives should review their suitability to drive with regard to their loss of memory, impairment of concentration and reaction time and possible loss of confidence.

30. Impairment of Cognitive Function • post- stroke, head injury, early dementia: • No single marker or assessment tool • Ability to cope with day to day activities a good yardstick. • Consider in car assessment.

31. Disabled Drivers • Chronic Neurological Disorders • MS • PD • Motor neuron disease • Peripheral neuropathy • Permanent limb disabilities: • Amputees • Hemiplegia/CP • Ank Spondilitis • Severe arthritis Consider vehicle modification and assessment via disabled drivers assessment centre.

32. Refer to: • www.dft.gov.uk/dvla/medical/ataglance.aspx ‘At a glance guide to the current Medical Standards of Fitness to Drive issued by Drivers Medical Group DVLA, Swansea. September 2009.’ • www.mobility-centres.org.uk