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COMMERCIAL DRIVER MEDICAL EXAM

COMMERCIAL DRIVER MEDICAL EXAM. Registration and Certification Michael Weiss, MD, MPH, FACOEM. CDL Exam. To detect the presence of any physical, mental or organic conditions of such a character and extent as to affect the ability of the driver to operate a CMV safely

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COMMERCIAL DRIVER MEDICAL EXAM

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  1. COMMERCIAL DRIVER MEDICAL EXAM Registration and Certification Michael Weiss, MD, MPH, FACOEM

  2. CDL Exam • To detect the presence of any physical, mental or organic conditions of such a character and extent as to affect the ability of the driver to operate a CMV safely • To establish whether a driver has a disease, disorder or injury resulting in a higher than acceptable likelihood of sudden incapacitation or death over the duration of the medical certificate • Privately administered based on DOT regs

  3. Let’s Change It! 1999 Motor Carrier Safety Improvement Act - Created Federal Motor Carrier Safety Administration. • Any “medical practitioner” to registered and certified practitioners • Standardizing practice with regulation and “best practice” guidelines • Linking state drivers’ licensing to medical certification • Computerizing records- moving potential forgery to data entry and transfer

  4. Covered Drivers • Interstate commerce of property, cargo, tools or vehicles • >10,000 lbs • Compensated transport 9-15 passengers • Any transport >15 passengers • Placarded hazardous material transport

  5. Exempted Drivers • Government employees • School Buses • Emergency • Medical transport- living or dead • Private, non-business • Agriculture • Farmers • Bee keepers • Migrant workers

  6. When exam is required • If not medically examined and qualified during preceding 24 months • If not currently medically qualified • If ability to perform normal duties has been impaired by physical or mental injury or disease • New exam if returning from illness or injury interfering with driving ability

  7. Who can be a Medical Examiner • Person licensed, certified and registered by a State to perform physical exams (includes but not limited to: MD, DO, PA, NP and DC) • Trained, certified and listed on national registry by May 21, 2014

  8. Medical Examiners Must Be • Knowledgeable of the physical and mental demands of operating a CMV • Requirements of the regulations and advisory criteria • Proficient in the use of and use medical protocols to adequately perform the medical exam

  9. Job of CMV Driver • Route type • Schedule • Environment • Type of cargo • Attention • Use of side mirrors • Steering Wheel • Dash controls • Shifting (>20 gears) • Enter and exit vehicle • Coupling and uncoupling • Load, secure and unload cargo • Vehicle inspections

  10. Typical CMV Driver • Male • >40 years • Sedentary • Overweight • Smoker • Poor eating habits • Less healthy, more than 2 medical (often CVD)

  11. Examiner Duties • Verify form • Positive history: Onset, diagnosis, contacts, limits and meds • Detailed history, exam, tests and consultations • Assess potential severity, rapidity of onset, progression, vision, drowsiness, hypotension or behavior changes • Document, explain decision, • Limitation (other than time) or deferral not allowed

  12. Thirteen Standards Four Non-discretionary • Vision: 20/40 each eye and binocular, 70 degree fields and Red/Green/Amber • Hearing: 5 ft whisper or audiometry 40 dB • Diabetes • Seizures Waivers and Exemptions

  13. Thirteen Standards Nine discretionary: Clinical Judgment of Examiner • Cardiovascular disease • Respiratory dysfunction • High blood pressure • Orthopedic or neuromuscular disorder • Mental health • Habit forming or Schedule 1 drugs • Alcoholism • Loss of grasping or prehension • Loss of extremity or part: • Skills Performance Evaluation

  14. “Guidelines” • Medical Expert Panel Reports • Medical Review Board Recommendations • Motor Carrier Safety Advisory Committee • Medical Literature • Medical Examiner Handbook

  15. Examples: Chronic Sleep Disorder • 1 month after starting CPAP • 3 months after surgical treatment • Max Certification 1 year if successful and compliant treatment • Yearly testing with MSL or Maintenance of Wakefulness • Not if: • Hypoxemic at rest • Untreated symptoms • Narcolepsy • Primary alveolar hypoventilation • Idiopathic CNS hypersomnolance • RLS with EDS

  16. FAA • Examine applicants to determine whether or not they meet the standards for issuance of an airman medical certificate • May issue, deny or defer a medical certificate • Delegated authority by FAA based on need and FAA training program • Standards updated by FAA CAMI • Free required conferences and on line training • Supportive monitoring of providers

  17. Pandora’s Truck • 35 million CMV drivers • 99.9 % of commerce depends on trucks • System disruption? • Increased cost! • Increased liability! • HIPPA and ADA compliance? • Increased litigation? • Increased safety?

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