Driver MedEx Report 6-07.indd

cations for Drivers

______________________

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___________________ ______________________________

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Florida School Bus Operators Medical Examination Report for Commercial Driver Fitness Determination

Any illness or injury in last 5 years?

Medication

Heart surgery (valve replacement/bypass, angioplasty,

pacemaker)

High blood pressure

Medication

Shortness of breath

Lung disease, emphysema, asthma, chronic bronchitis

Kidney disease, dialysis

Diabetes or elevated blood sugar controlled by:

diet

pills

insulin

Loss of, or altered consciousness

Fainting, dizziness

sleepiness, loud snoring

Stroke or paralysis

Spinal injury or disease

Chronic low back pain

For any

YES

List all medications (including over-the-counter medications) used regularly or recently.

invalidate the examination and my Medical Examiner’s Certi

cate.

_____________________________________________________________

Date

Testing (Medical Examiner completes Sections 3 through 7)

Applicant can recognize and distinguish among traf

c control signals and devices

Applicant meets acuity requirement only when wearing:

Monocular Vision:

____/____/____

Date of Examination

Name of Ophthalmologist or Optometrist (print)

License No./State of Issue

Signature

Corrective Lenses

HEARING

Standard: a) Must

rst perceive forced whispered voice

≥

5ft. with or without hearing aid, or b) average hearing loss in better ear

≤

Numerical readings must be provided.

ACUITY

UNCORRECTED

CORRECTED

HORIZONTAL FIELD OF VISION

Right Eye

20/

Right Eye

Left Eye

20/

Left Eye

20/

Complete next line only if vision testing is done by an ophthalmologist or optometrist.

BLOOD PRESSURE/PULSE RATE

Numerical readings must be recorded. Medical Examiner should take at least two readings to con

Blood

Systolic Diastolic

Pressure

Driver quali

ed for one year if <140/90 on initial exam.

Pulse

Regular

Rate

Irregular

Recerti

cation

6 months if <140/90

9 months if <140/90

Medical examiner should take at least 2 readings to con

rm blood pressure

Urinalysis is required.

Protein, blood, or sugar in the urine may be an indication for further testing to rule out any underlying

medical problem.

Other Testing (Describe and record):

DRIVER’S INFORMATION

Driver completes this section

Driver’s Name (Last, First, Middle)

Social Security No.

Birthdate

Age Sex

cation

Recerti

cation

___/___/___

Follow-up

___/___/___

Address

City, State, Zip Code

( )

Driver License No.

License Class

State

( )

Other

VISION

Standard: At least 20/40 acuity (Snellen) in each eye with or without correction. At least 70°

peripheral in horizontal meridian measured in each eye. The use of corrective lenses should be noted on the Medical

Examiner’s Certi

cate.

INSTRUCTIONS:

When other than the Snellen chart is used, give test results in Snellen-compared values. In recording

distance vision, use 20 feet as normal. Report visual acuity as a ratio with 20 as numerator and the smallest type read at

20 feet as denominator. If the applicant wears corrective lenses, these should be worn while visual acuity is being tested.

If the driver habitually wears contact lenses, or intends to do so while driving, suf

cient evidence of good tolerance and

adaptation to their use must be obvious. Monocular drivers are not quali

ed.

Driver completes this section, but medical examiner is encouraged to discuss with driver.

Numerical readings must be recorded.

Right Ear Left Ear

Feet

URINE SPECIMEN

PROTEIN

BLOOD

SUGAR

LABORATORY AND OTHER TEST FINDING

Numerical readings must be recorded.

Height:___________(in.) Weight:___________(lbs)

PHYSICAL EXAMINATION

Medical Examiner’s Comments on Health History

(The medical examiner must review and discuss with the driver any “yes”

*NOTE: All Florida public school bus drivers, including charter school bus drivers, must obtain a Commercial Driver’s Medical

Examination every year.

RIGHT EAR

LEFT EAR

500 Hz

1000 Hz 2000 Hz 500 Hz 1000 Hz 2000 Hz

Check if hearing aid used for tests.

Check if hearing aid

required

INSTRUCTIONS:

To convert audiometric test results from ISO to ANSI, -14dB from ISO for 500Hz, -10dB for 1,000 Hz, -8.5 dB for 2,000 Hz.

To average, add the readings for 3 frequencies tested and divide by 3.

Expiration Date

6 months

3 months

Disquali

ed from date of exam until BP is <140/90

Florida Department of Education

On initial exam

If 140 – 159/90-99

If 160 – 179/100-109

>180/110

Yes

Head/brain injuries, disorder, or illnesses

Seizures, epilepsy

Eye disorders or impaired vision (except corrective lenses)

Ear disorders, loss of hearing or balance

Heart disease or heart attack; other cardiovascular condition

Yes

Muscular disease

Liver disease

Digestive problems

Nervous or psychiatric disorders, e.g., severe depression

Medication _____________________

Yes

Sleep disorders, pauses in breathing while asleep, daytime

Missing or impaired hand, arm, foot, leg, nger, toe

Regular, frequent alcohol use

Narcotic or habit forming drug use

answer, indicate onset date, diagnosis, treating physician’s name and address, and any current limitation.

I certify that the above information is complete and true. I understand that inaccurate, false, or missing information may

Driver’s

Signature

showing standard red, green, and amber colors?

Telephone No.

Yes

40 dB.

b) If audiometer is used, record hearing loss in decibels.

(acc. To ANSI Z24.5-1951)

Both Eyes

rm BP.

New certi

Date of Exam

Work Tel:

Home Tel:

of Issue

HEALTH HISTORY

a) Record distance from individual at which

forced whispered voice can

rst be heard.

SPEC. GRAVITY

answers and potential hazards of medications, including over-the-counter medications, while driving.)

Average:

to meet standard.

The presence of a certain condition may not necessarily disqualify a driver, particularly if the condition is controlled adequately, is not likely to worsen, or is readily amenable to treatment. Even if a condition does not disqualify a driver, the medical

examiner may consider deferring the driver temporarily. Also, the driver should be advised to take the necessary steps to correct the condition as soon as possible, particularly if the condition, if neglected, could result in more serious illness that might

affect driving.

Check YES if there are any abnormalities. Check NO if the body system is normal. Discuss any YES answers in detail in the space below, and indicate whether it would affect the driver’s ability to operate a commercial motor vehicle safely. Enter

applicable item number before each comment. If organic disease is present, note that it has been compensated for.

See Instructions To The Medical Examiner for guidance.

including breast

examination

6. Lungs and chest, not

BODY SYSTEM

CHECK FOR:

1. General appearance Marked overweight, tremor, signs of alcoholism, problem

drinking, or drug abuse.

2. Eyes

Pupillary equality, reaction to light, accommodation, ocular

motility, ocular muscle imbalance, extraocular movement,

nystagmus, exophthalmos, strabismus uncorrected by

corrective lenses, retinopathy, cataracts, aphakia, glaucoma,

macular degeneration.

3. Ears

Middle ear disease, occlusion of external canal, perforated

eardrums.

4. Mouth and throat

Irremediable deformities likely to interfere with breathing or

swallowing.

5. Heart

Murmurs, extra sounds, enlarged heart, pacemaker.

abnormal breath sounds including wheezes or alveolar rates,

impaired respiratory function, dyspnea, cyanosis. Abnormal

ndings on physical exam may require further testing such as

pulmonary tests and/or x-ray of chest.

Abnormal chest wall expansion, abnormal respiratory rate,

YES

NO BODY SYSTEM

CHECK FOR:

7. Abdomen and viscera Enlarged liver, enlarged spleen, masses, bruits, hernia,

signi

cant abnormal wall muscle weakness.

8. Vascular system

Abnormal pulse and amplitude, carotid or arterial bruits,

varicose veins.

9. Genito-urinary system Hernias.

12. Neurological

10. Extremities – limb

impaired. Driver may be

subject to SPE certi

cate

if otherwise quali

ed.

11. Spine, other

musculoskeletal

Impaired equilibrium, coordination, or speech pattern;

paresthesia, asymmetric deep tendon re

exes, sensory or

positional abnormalities, abnormal patellar and Babinski’s

exes, ataxia.

Loss or impairment of leg, foot, toe, arm, hand, or

nger.

Perceptible limp, deformities, atrophy, weakness, paralysis,

clubbing, edema, hypotonia. Insuf

cient grasp and

prehension in upper limb to maintain steering wheel grip.

Insuf

cient mobility and strength in lower limb to operate

pedals

properly.

Previous surgery, deformities, limitation of motion,

tenderness.

YES

*COMMENTS: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Note certi

cation status here.

See Instructions To The Medical Examiner for guidance.

Meets standards in 49 CFR 391.41; quali

es for a 13-month certi

cate

Wearing corrective lenses

Skill Performance Evaluation (SPE) Certi

cate

Does not meet standards

Wearing hearing aid

Driving within an exempt intracity zone

Meets standards, but periodic evaluation required

Accompanied by a ____________________ waiver/exemption

Quali

ed by operation of 49 CFR 391.64

Due to ___________________________________________________ driver quali

ed only for:

3 months

6 months

Other ______________________ ________________________________________________

Medical Examiner’s Signature _________________________________________________________________________________________

Temporarily disquali

ed due to (condition or medication): ___________________________________ ______________________

Medical Examiner’s Name (print) ______________________________________________________________________________________

Return to medical examiner’s of

ce for follow up on _______________________________________________________________

Address _____________________________________________________________________________________________________________

If meets standards, complete a Medical Examiner’s Certi

cate according to 49 CFR 391.43(h). (Driver must carry certi

cate

Telephone __________________________________________________________________________________________________________

when operating a commercial vehicle.)

DEXTERITY TESTING FOR SCHOOL BUS DRIVER

(For each item , mark (X) “Yes” or “No”)

YES NO

MEDICAL EXAMINER’S CERTIFICATE

I certify that I have examined _____________________________________________ in accordance with the Federal Motor

Carrier Safety Regulations (49 CFR 391.41-49) and with knowledge of the driving duties, I

nd this person is quali

Applicant did climb and descend the front steps of a 65-passenger or larger bus without pausing ...................................................................................................................................

o o

and, if applicable, only when:

driving within an exempt intracity zone (49 CRF 391.62)

Applicant did open and close a manually operated 65-passenger or larger bus entrance door without dif

culty while seated in the driver’s seat, or from a seated position

wearing corrective lenses

got out of seat and manually opened air door and stepped down on ground .....................................................................................................................................................................

o o

accompanied by a Skill Performance Evaluation Certi

cate (SPE)

wearing hearing aid

accompanied by a _____waiver/exemption

quali

ed by operation of 49 CFR 391.64

Applicant did activate the brake pedal with the right foot in 3/4 of a second or less after removing the right foot from the throttle pedal ................................................................

o o

The information provided regarding this physical examination is true and complete. This certi

cate is valid for a

maximum period of 13 months from the date of examination unless a limited validation period is indicated. A complete

4. Applicant did move from a seated position in the driver’s seat of a 65-passenger or larger bus to the rear of the bus, open the emergency door, or use side door on rear

examination form with any attachment embodies my

ndings completely and correctly, and is on

le in my of

ce.

engine transits, and exit the bus all within 20 seconds.................................................................................................................................................................................................................

o o

Signature of Medical Examiner

Telephone

Date

Applicant did operate the driving controls using both arms simultaneously and quickly. For example, activate master panel switches or shift gears while keeping one hand

Chiropractor

on the steering wheel of a 65-passenger bus traveling 25 miles per hour. (Activity #5 is to be done last, only if all prior activities are successfully completed.) ..............................

o o

Medical Examiner’s Name (Print)

Advance

Physician

Practice

Assistant

Nurse

____________________________________________________________________________________________________

______________________________________________

Medical Examiner’s License Or Certi

cate No./Issuing State

Signature of School District Examiner

Date Examined

Signature Of Driver

Medical Certi

cate Exp. Date

Rule 6A-3.0141(9)(c) FAC, states: Successfully pass a dexterity test administered by the school district and maintain a valid Medical Examiner’s Certi

cate.

Address Of Driver

Driver’s License No.

State

ESE 479

DOE Page 1 of 2

Exp. 06/30/07

THE DRIVER’S ROLE

Responsibilities, work schedules, physical and emotional demands, and lifestyles among

commercial drivers vary by the type of driving that they do. Some of the main types of

drivers include the following: turn around or short relay (drivers return to their home base

each evening); long relay (drivers drive 8-10 hours and then have an 8-hour off-duty period);

straight through haul (cross country drivers); and team drivers (drivers share the driving by

alternating their 4-hour driving periods and 4-hour rest periods).

The following factors may be involved in a driver’s performance of duties: abrupt

schedule changes and rotating work schedules, which may result in irregular sleep patterns

and a driver beginning a trip in a fatigued condition; long hours; extended time away

49 CFR 391.41 Physical Quali

cations for Drivers

from family and friends, which may result in lack of social support; tight pickup and delivery

schedules, with irregularity in work, rest, and eating patterns; adverse road, weather and

traf

c conditions, which may cause delays and lead to hurriedly loading or unloading cargo

in order to compensate for the lost time; and environmental conditions such as excessive

vibration, noise, and extremes in temperature. Transporting passengers or hazardous

materials may add to the demands on the commercial driver.

There may be duties in addition to the driving task for which a driver is responsible and

needs to be

t. Some of these responsibilities are: coupling and uncoupling trailer(s) from

the tractor, loading and unloading trailer(s) (sometimes a driver may lift a heavy load or

unload as much as 50,000 lbs. of freight after sitting for a long period of time without any

stretching period); inspecting the operating condition of tractor and trailer(s) before,

during, and after delivery of cargo; lifting, installing, and removing heavy tire chains; and,

lifting heavy tarpaulins to cover open top trailers. The above tasks demand agility, the ability

to bend and stoop, the ability to maintain a crouching position to inspect the underside of

the vehicle, frequent entering and exiting of the cab, and the ability to climb ladders on the

tractor and/or trailer(s).

In addition, a driver must have the perceptual skills to monitor a sometimes complex

driving situation, the judgment skills to make quick decisions, when necessary, and

the manipulative skills to control an oversize steering wheel, shift gears using a manual

transmission, and maneuver a vehicle in crowded areas.

391.41 PHYSICAL QUALIFICATIONS FOR DRIVERS

(a) A person shall not drive a commercial motor vehicle unless he is physically

quali

ed to do so and, except as provided in §391.67, has on his person the

original, or a photographic copy, of a medical examiner’s certi

cate that he

is physically quali

ed to drive a commercial motor vehicle.

(b)

A person is physically quali

ed to drive a motor vehicle if that person:

(1) Has no loss of a foot, a leg, a hand, or an arm, or has been granted a Skill

Performance Evaluation (SPE) Certi

cate (formerly Limb Waiver Program)

pursuant to §391.49;

(2) Has no impairment of: (i) A hand or

nger which interferes with prehension

or power grasping; or (ii) An arm, foot, or leg which interferes with the

ability to perform normal tasks associated with operating a commercial

motor vehicle; or any other signi

cant limb defect or limitation which

interferes with the ability to perform normal tasks associated with operating

a commercial motor vehicle; or has been granted an SPE Certi

cate

pursuant to §391.49;

(3) Has no established medical history or clinical diagnosis of diabetes mellitus

currently requiring insulin for control;

(4) Has no current clinical diagnosis of myocardial infarction, angina pectoris,

coronary insuf

ciency, thrombosis, or any other cardiovascular disease of

a variety known to be accompanied by syncope, dyspnea, collapse, or

congestive cardiac failure;

(5) Has no established medical history or clinical diagnosis of a respiratory

dysfunction likely to interfere with the ability to control and drive a commercial

motor vehicle safely;

(6) Has no current clinical diagnosis of high blood pressure likely to interfere with his

ability to operate a commercial motor vehicle safely;

(7) Has no established medical history or clinical diagnosis of rheumatic, arthritic,

orthopedic, muscular, neuromuscular, or vascular disease which interferes with

his ability to control and operate a commercial motor vehicle safely;

(8) Has no established medical history or clinical diagnosis of epilepsy or any other condition

which is likely to cause loss of consciousness or any loss of ability to control a commercial

motor vehicle;

(9) Has no mental, nervous, organic, or functional disease or psychiatric disorder likely to

interfere with his ability to drive a commercial motor vehicle safely;

(10) Has distant visual acuity of a least 20/40 (Snellen) in each eye without corrective lenses

or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses,

distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective

lenses,

eld of vision of at least 70 degrees in the horizontal meridian in each eye, and

the ability to recognize the colors of traf

c signals and devices showing standard red,

green and amber;

(11) First perceives a forced whispered voice in the better ear not less than 5 feet with or

without the use of a hearing aid, or, if tested by use of an audiometric device, does not

have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000

Hz and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated

to American National Standard (formerly ASA Standard) Z24.5-1951;

(12) (i) Does not use a controlled substance identi

ed in 21 CFR 1308.11 Schedule I, an

amphetamine, a narcotic, or any other habit-forming drug. (ii) Exception: A driver

may use such a substance or drug, if the substance or drug is prescribed by a licensed

medical practitioner who:

(A) Is familiar with the driver’s medical history and assigned duties; and (B) Has advised

the driver that the prescribed substance or drug will not adversely affect the driver’s

ability to safely operate a commercial motor vehicle; and

(13) Has no current clinical diagnosis of alcoholism.

INSTRUCTIONS TO THE MEDICAL EXAMINER

General Information

The purpose of this examination is to determine a driver’s physical quali

cation to operate

a commercial motor vehicle (CMV) in interstate commerce according to the requirements

in 49 CFR 391.41-49. Therefore, the medical examiner must be knowledgeable of these

requirements and guidelines developed by the FMCSA to assist the medical examiner in

making the quali

cation determination. The medical examiner should be familiar with the

driver’s responsibilities and work environment and is referred to the section on the form, The

Driver’s Role.

In addition to reviewing the Health History section with the driver and conducting the

physical examination, the medical examiner should discuss common prescriptions and

over-the-counter medications while driving. Educate driver to read warning labels on all

medications. History of certain conditions may be cause for rejection, particularly if required

by regulation, or may indicate the need for additional laboratory tests or more stringent

examination perhaps by a medical specialist. These decisions are usually made by the

medical examiner in light of the driver’s job responsibilities, work schedule and potential for

the condition to render the driver unsafe.

Medical conditions should be recorded even if they are not cause for denial, and they

should be discussed with the driver to encourage appropriate remedial care. This advice is

especially needed when a condition, if neglected, could develop into a serious illness that

could affect driving.

If the medical examiner determines that the driver is

t to drive and is also able to

perform non-driving responsibilities as may be required, the medical examiner signs the

medical certi

cate which the driver must carry with his/her license. The certi

cate must be

dated. Under current regulations, the certi

cate is valid for one year, unless the driver has a

medical condition that does not prohibit driving but does require more frequent monitoring.

In such situations, the medical certi

cate should be issued for a shorter length of time. The

physical examination should be done carefully and at least as complete as is indicated by

the attached form. Contact the FMCSA at (202) 366-1790 for further information (a vision

exemption, qualifying drivers under 49 CFR 391.64, etc.).

Interpretation of Medical Standards

Since the issuance of the regulations for physical quali

cations of commercial drivers,

the Federal Motor Carrier Safety Administration (FMCSA) has published recommendations

called Advisory Criteria to help medical examiners in determining whether a driver meets

the physical quali

cations for commercial driving. These recommendations have been

condensed to provide information to medical examiners that (1) is directly relevant to the

physical examination and (2) is not already included in the medical examination form. The

speci

c regulation is printed in italics and its reference by section is highlighted.

FEDERAL MOTOR CARRIER SAFETY REGULATIONS ADVISORY CRITERIA

Loss of Limb

§ 391.41(b)(1)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no loss of a foot, leg, hand or an arm, or has been granted a Skill Performance Evaluation

(SPE) Certi

cate pursuant to Section 391.49.

Limb Impairment

§ 391.41(b)(2)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no impairment of: (i) A hand or

nger which interferes with prehension or power

grasping; or (ii) An arm, foot, or leg which interferes with the ability to perform normal tasks

associated with operating a commercial motor vehicle; or (iii) Any other signi

cant limb

defect or limitation which interferes with the ability to perform normal tasks associated

with operating a commercial motor vehicle; or (iv) Has been granted a Skill Performance

Evaluation Certi

cate pursuant to Section 391.49

A person who suffers loss of a foot, leg, hand or arm or whose limb impairment in any

way interferes with the safe performance of normal tasks associated with operating a

commercial motor vehicle is subject to the Skill Performance Evaluation (SPE) Certi

cation

Program pursuant to section 391.49, assuming the person is otherwise quali

ed.

With the advancement of technology, medical aids and equipment modi

cations

have been developed to compensate for certain disabilities. The SPE Certi

cation Program

(formerly the Limb Waiver Program) was designed to allow persons with the loss of a foot

or limb or with functional impairment to qualify under the Federal Motor Carrier Safety

Regulation (FMCSRs) by use of prosthetic devices or equipment modi

cations which enable

them to safely operate a commercial motor vehicle. Since there are no medical aids

equivalent to the original body or limb, certain risks are still present, and thus restrictions may

be included on individual SPE certi

cates when a State Director for the FMCSA determines

they are necessary to be consistent with safety and public interest.

If the driver is found otherwise medically quali

ed (391.41(b)(3) through (13), the

medical examiner must check on the medical certi

cate that the driver is quali

ed only

if accompanied by an SPE certi

cate. The driver and the employing motor carrier are

subject to appropriate penalty if the driver operates a motor vehicle in interstate or foreign

commerce without a current SPE certi

cate for his/her physical disability.

Diabetes

§ 391.41(b)(3)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring

insulin for control.

Diabetes mellitus is a disease which, on occasion, can result in a loss of consciousness or

disorientation in time and space. Individuals who require insulin for control have conditions

which can get out of control by the use of too much or too little insulin, or food intake

not consistent with the insulin dosage. Incapacitation may occur from symptoms of

hyperglycemic or hypoglycemic reactions (drowsiness, semiconsciousness, diabetic coma

or insulin shock).

The administration of insulin is, within itself, a complicated process requiring insulin,

syringe, needle, alcohol sponge and a sterile technique. Factors related to long-haul

commercial motor vehicle operations, such as fatigue, lack of sleep, poor diet, emotional

conditions, stress, and concomitant illness, compound the diabetic problem. Thus, because

of these inherent dangers, the FMCSA has consistently held that a diabetic who uses insulin

for control does not meet the minimum physical requirements of the FMCSRs.

Hypoglycemic drugs, taken orally, are sometimes prescribed for diabetic individuals to

help stimulate natural body production of insulin. If the condition can be controlled by

the use of oral medication and diet, then an individual may be quali

ed under the present

rule.

(See Conference Report on Diabetic Disorders and Commercial Drivers and Insulin-Using

Commercial Motor Vehicle Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

Cardiovascular Condition

§ 391.41(b)(4)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary

insuf

ciency, thrombosis or any other cardiovascular disease of a variety known to be

accompanied by syncope, dyspnea, collapse or congestive cardiac failure.

The term “has no current clinical diagnosis of” is speci

cally designed to encompass:

“a clinical diagnosis of”

(1) a current cardiovascular condition, or (2) a cardiovascular

condition which has not fully stabilized regardless of the time limit. The term

“known to be

accompanied by”

is de

ned to include:

a clinical diagnosis

of a cardiovascular disease

(1) which is accompanied by symptoms of syncope, dyspnea, collapse or congestive

cardiac failure; and/or (2) which is likely to cause syncope, dyspnea, collapse or congestive

cardiac failure.

It is the intent of the FMCSRs to render unquali

ed a driver who has a current

cardiovascular disease which is accompanied by and/or likely to cause symptoms of

syncope, syspnea, collapse, or congestive cardiac failure. However, the subjective decision

of whether the nature and severity of an individual’s condition will likely cause symptoms

of cardiovascular insuf

ciency is on an individual basis and quali

cation rests with the

medical examiner and the motor carrier. In those cases where there is an occurrence of

cardiovascular insuf

ciency (myocardial infarction, thrombosis, etc.), it is suggested before

a driver is certi

ed that he or she have a normal resting and stress electrocardiogram (ECG),

no residual complications and no physical limitations, and is taking no medication likely to

interfere with safe driving.

Coronary artery bypass surgery and pacemaker implantation are remedial procedures

and thus, not unqualifying. Coumadin is a medical treatment which can improve the health

and safety of the driver and should not, by its use, medically disqualify the commercial driver.

The emphasis should be on the underlying medical condition(s) which require treatment

and the general health of the driver. The FMCSA should be contacted at (202) 366-1790 for

additional recommendations regarding the physical quali

cation of drivers on coumadin.

(See Conference on Cardiac Disorders and Commercial Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

ESE 479

General Information

The purpose of this examination is to determine a driver’s physical quali

cation to operate

a commercial motor vehicle (CMV) in interstate commerce according to the requirements

in 49 CFR 391.41-49. Therefore, the medical examiner must be knowledgeable of these

requirements and guidelines developed by the Federal Motor Carrier Safety Administration

(FMCSA) to assist the medical examiner in making the quali

cation determination. The

medical examiner should be familiar with the driver’s responsibilities and work environment

and is referred to the section on the form, “The Driver’s Role.”

In addition to reviewing the “Health History” section with the driver and conducting the

physical examination, the medical examiner should discuss common prescriptions and over-

the-counter medications used while driving. Educate driver to read warning labels on all

medications. History of certain conditions may be cause for rejection, particularly if required

by regulation, or may indicate the need for additional laboratory tests or more stringent

examination, perhaps by a medical specialist. These decisions are usually made by the

medical examiner in light of the driver’s job responsibilities, work schedule, and potential for

the condition to render the driver unsafe.

Medical conditions should be recorded even if they are not cause for denial, and they

should be discussed with the driver to encourage appropriate remedial care. This advice is

especially needed when a condition, if neglected, could develop into a serious illness that

could affect driving.

If the medical examiner determines that the driver is

t to drive and is also able to

perform non-driving responsibilities as may be required, the medical examiner signs the

medical certi

cate that the driver must carry with his/her license. The certi

cate must be

dated. Under current regulations, the certi

cate is valid for one year, unless the driver has a

medical condition that does not prohibit driving but does require more frequent monitoring.

In such situations, the medical certi

cate should be issued for a shorter length of time. The

physical examination should be done carefully and at least as completely as is indicated

by the attached form. Contact the FMCSA at (202) 366-1790 for further information (a vision

exemption, qualifying drivers under 49 CFR 391.64, etc.).

Interpretation of Medical Standards

Since the issuance of the regulations for physical quali

cations of commercial drivers,

the FMCSA has published recommendations called Advisory Criteria to help medical

examiners in determining whether a driver meets the physical quali

cations for commercial

driving. These recommendations have been condensed to provide information to medical

examiners that (1) is directly relevant to the physical examination and (2) is not already

included in the medical examination form. The speci

c regulation is printed in italics and its

reference by section is highlighted.

FEDERAL MOTOR CARRIER SAFETY REGULATIONS ADVISORY CRITERIA

Loss of Limb

§ 391.41(b)(1)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no loss of a foot, leg, hand or an arm, or has been granted a Skill Performance Evaluation

(SPE) Certi

cate pursuant to Section 391.49.

Limb Impairment

§ 391.41(b)(2)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no impairment of: (i) A hand or

nger which interferes with prehension or power

grasping; or (ii) An arm, foot, or leg which interferes with the ability to perform normal tasks

associated with operating a commercial motor vehicle; or (iii) Any other signi

cant limb

defect or limitation which interferes with the ability to perform normal tasks associated

with operating a commercial motor vehicle; or (iv) Has been granted a Skill Performance

Evaluation Certi

cate pursuant to Section 391.49

A person who suffers loss of a foot, leg, hand or arm or whose limb impairment in any

way interferes with the safe performance of normal tasks associated with operating a

commercial motor vehicle is subject to the Skill Performance Evaluation (SPE) Certi

cation

Program pursuant to section 391.49, assuming the person is otherwise quali

ed.

With the advancement of technology, medical aids and equipment modi

cations

have been developed to compensate for certain disabilities. The SPE Certi

cation Program

(formerly the Limb Waiver Program) was designed to allow persons with the loss of a foot

or limb or with functional impairment to qualify under the Federal Motor Carrier Safety

Regulation (FMCSRs) by use of prosthetic devices or equipment modi

cations which enable

them to safely operate a commercial motor vehicle. Since there are no medical aids

equivalent to the original body or limb, certain risks are still present, and thus restrictions may

be included on individual SPE certi

cates when a State Director for the FMCSA determines

they are necessary to be consistent with safety and public interest.

If the driver is found otherwise medically quali

ed (391.41(b)(3) through (13), the

medical examiner must check on the medical certi

cate that the driver is quali

ed only

if accompanied by an SPE certi

cate. The driver and the employing motor carrier are

subject to appropriate penalty if the driver operates a motor vehicle in interstate or foreign

commerce without a current SPE certi

cate for his/her physical disability.

Diabetes

§ 391.41(b)(3),

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring

insulin for control.

Diabetes mellitus is a disease which, on occasion, can result in a loss of consciousness or

disorientation in time and space. Individuals who require insulin for control have conditions

which can get out of control by the use of too much or too little insulin, or food intake

not consistent with the insulin dosage. Incapacitation may occur from symptoms of

hyperglycemic or hypoglycemic reactions (drowsiness, semiconsciousness, diabetic coma

or insulin shock).

The administration of insulin is, within itself, a complicated process requiring insulin, syringe,

needle, alcohol sponge and a sterile technique. Factors related to long-haul commercial

motor vehicle operations, such as fatigue, lack of sleep, poor diet, emotional conditions,

stress, and concomitant illness, compound the diabetic problem. Because of these inherent

dangers, the FMCSA has consistently held that a diabetic who uses insulin for control does

not meet the minimum physical requirements of the FMCSRs.

Hypoglycemic drugs, taken orally, are sometimes prescribed for diabetic individuals to

help stimulate natural body production of insulin. If the condition can be controlled by

the use of oral medication and diet, then an individual may be quali

ed under the present

rule.

(See Conference Report on Diabetic Disorders and Commercial Drivers and Insulin-Using

Commercial Motor Vehicle Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

Cardiovascular Condition

§ 391.41(b)(4)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary

insuf

ciency, thrombosis or any other cardiovascular disease of a variety known to be

accompanied by syncope, dyspnea, collapse or congestive cardiac failure.

The term “has no current clinical diagnosis of” is speci

cally designed to encompass;

(1) a current cardiovascular condition; or (2) a cardiovascular condition which has not fully

stabilized regardless of the time limit. The term

“known to be accompanied by”

is de

ned

to include:

a clinical diagnosis

of a cardiovascular disease (1) which is accompanied by

symptoms of syncope, dyspnea, collapse or congestive cardiac failure; and/or (2) which is

likely to cause syncope, dyspnea, collapse or congestive cardiac failure.

It is the intent of the FMCSRs to render unquali

ed, a driver who has a current

cardiovascular disease which is accompanied by and/or likely to cause symptoms of

syncope, syspnea, collapse, or congestive cardiac failure. However, the subjective decision

of whether the nature and severity of an individual’s condition will likely cause symptoms

of cardiovascular insuf

ciency is on an individual basis and quali

cation rests with the

medical examiner and the motor carrier. In those cases where there is an occurrence of

cardiovascular insuf

ciency (myocardial infarction, thrombosis, etc.), it is suggested before

a driver is certi

ed that he or she have a normal resting and stress electrocardiogram (ECG),

no residual complications, no physical limitations, and is taking no medication likely to

interfere with safe driving.

Coronary artery bypass surgery and pacemaker implantation are remedial procedures

and thus, not unqualifying. Implantable cardioverter de

brillators are disqualifying due to

risk of syncope. Coumadin is a medical treatment which can improve the health and safety

of the driver and should not, by its use, medically disqualify the commercial driver. The

emphasis should be on the underlying medical condition(s) which require treatment and

the general health of the driver. The FMCSA should be contacted at (202) 366-1790 for

additional recommendations regarding the physical quali

cation of drivers on coumadin.

(See Conference on Cardiac Disorders and Commercial Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

DOE Page 2 of 2

Respiratory Dysfunction

§ 391.41(b)(5)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to

interfere with the ability to control and drive a commercial motor vehicle safely.

Since a driver must be alert at all times, any change in his or her mental state is in direct

con

ict with highway safety. Even the slightest impairment in respiratory function under

emergency conditions (when greater oxygen supply is necessary for performance) may

be detrimental to safe driving.

There are many conditions that interfere with oxygen exchange and may result in

incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic

bronchitis and sleep apnea. If the medical examiner detects a respiratory dysfunction

that in any way is likely to interfere with the driver’s ability to safety control and drive a

commercial motor vehicle, the driver must be referred to a specialist for further evaluation

and therapy. Anticoagulation therapy for deep vein thrombosis and/or pulmonary

thromboembolism is not unqualifying once optimum dose is achieved, provided lower

extremity venous examinations remain normal and the treating physician gives a favorable

recommendation.

(See Conference on Pulmonary/Respiratory Disorder and Commercial Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

Hypertension

§ 391.41(b)(6)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no current clinical diagnosis of high blood pressure likely to interfere with the ability to

operate a commercial motor vehicle safely.

Hypertension alone is unlikely to cause sudden collapse; however, the likelihood increases

when target organ damage, particularly cerebral vascular disease is present. This advisory

criteria is based on FMCSA’s Cardiovascular Advisory Guidelines for the Examination of CMV

Drivers, which used the Sixth Report of the Joint National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure (1997).

Stage 1

hypertension corresponds to a systolic BP of 140-159 mmHg and/or a diastolic BP of

90-99 mmHg. The driver with a BP in this range is at low risk for hypertension-related acute

incapacitation and may be medically certi

ed to drive for a six-month period. Provided

treatment is well tolerated and the driver demonstrates a BP value of less than 140/90, he or

she may be certi

ed for six months from the date of second exam.

A blood pressure of 160-179 systolic and/or 100-109 diastolic is considered

Stage 2

hypertension,

and the driver is not necessarily unquali

ed during evaluation and institution of treatment. The

driver is given a one time certi

cation of three months to reduce his or her blood pressure to

less than 140/90. A blood pressure in this range is an absolute indication for antihypertensive

drug therapy. Provided treatment is well tolerated and the driver demonstrates a BP value

of less than 140/90, he or she may be certi

ed for nine months from the date of the second

exam.

A blood pressure at or greater than 180 (systolic) and 110 (diastolic) is considered

Stage 3

high risk for an acute BP-related event. The driver may

not

be quali

ed, even temporarily, until

reduced to less than 140/90 and treatment is well tolerated. The driver may be certi

ed for 6

months and biannually (every 6 months) thereafter if at recheck BP is less than 140/90.

An elevated blood pressure

nding should be con

rmed by at least two subsequent

measurements on different days.

Treatment includes non-pharmacologic and pharmacologic modalities as well as counseling

to reduce other risk factors. Most antihypertensive medications also have side effects, the

importance of which must be judged on an individual basis. Individuals must be alerted to

the hazards of these medications while driving. Side effects of somnolence or syncope are

particularly undesirable in commercial drivers.

Secondary hypertension is based on the above stages.

Evaluation is warranted if patient is persistently hypertensive on maximal or near-

maximal doses of 2-3 pharmacologic agents. Some causes of secondary hypertension

may

amenable

surgical

intervention

speci

c pharmacologic therapy.

(See Cardiovascular Advisory Panel Guidelines for the Medical Examination of

Commercial Motor Vehicle Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease

§ 391.41(b)(7)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of a rheumatic, arthritic, orthopedic,

muscular, neuromuscular or vascular disease which interferes with the ability to control and

operate a commercial motor vehicle safely.

Certain diseases are known to have acute episodes of transient muscle weakness, poor

muscular coordination (ataxia), abnormal sensations (paresthesia), decreased muscular

tone (hypotonia), visual disturbances and pain which may be suddenly incapacitating.

With each recurring episode, these symptoms may become more pronounced and remain

for longer periods of time. Other diseases have more insidious onsets and display symptoms

of muscle wasting (atrophy), swelling and paresthesia which may not suddenly incapacitate

a person but may restrict his/her movements and eventually interfere with the ability to

safely operate a motor vehicle. In many instances these diseases are degenerative in

nature or may result in deterioration of the involved area.

Once the individual has been diagnosed as having a rheumatic, arthritic,

orthopedic, muscular, neuromuscular or vascular disease, then he/she has an

established history of that disease. The physician, when examining an individual,

should consider the following: (1) the nature and severity of the individual’s condition

(such as sensory loss or loss of strength); (2) the degree of limitation present (such as

range of motion); (3) the likelihood of progressive limitation (not always present initially

but may manifest itself over time); and (4) the likelihood of sudden incapacitation. If

severe functional impairment exists, the driver does not qualify. In cases where more

frequent monitoring is required, a certi

cate for a shorter time period may be issued.

(See Conference on Neurological Disorders and Commercial Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)

Epilepsy

§ 391.41(b)(8)

A person is physically quali

ed to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of epilepsy or any other condition

which is likely to cause loss of consciousness or any loss of ability to control a motor

vehicle.

Epilepsy is a chronic functional disease characterized by seizures or episodes that occur

without warning, resulting in loss of voluntary control which may lead to loss of consciousness

and/or seizures. Therefore, the following drivers cannot be quali

ed: (1) a driver who has a

medical history of epilepsy; (2) a driver who has a current clinical diagnosis of epilepsy; or

(3) a driver who is taking antiseizure medication.

If an individual has had a sudden episode of a nonepileptic seizure or loss of

consciousness of unknown cause which did not require antiseizure medication, the decision

as to whether that person’s condition will likely cause loss of consciousness or loss of ability

to control a motor vehicle is made on an individual basis by the medical examiner in

consultation with the treating physician. Before certi

cation is considered, it is suggested

that a 6-month waiting period elapse from the time of the episode. Following the waiting

period, it is suggested that the individual have a complete neurological examination. If the

results of the examination are negative and antiseizure medication is not required, then the

driver may be quali

ed.

In those individual cases where a driver has a seizure or an episode of loss of

consciousness that resulted from a known medical condition (e.g., drug reaction, high

temperature, acute infectious disease, dehydration or acute metabolic disturbance),

certi

cation should be deferred until the driver has fully recovered from that condition, has

no existing residual complications, and is not taking antiseizure medication. Drivers with

a history of epilepsy/seizures off antiseizure medication and seizure-free for 10 years may

be quali

ed to operate a CMV in interstate commerce. Interstate drivers with a history

of a single unprovoked seizure may be quali

ed to drive a CMV in interstate commerce if

seizure-free and off antiseizure medication for a 5-year period or more.

(See Conference on Neurological Disorders and Commercial Drivers at:

http://www.fmcsa.dot.gov/rulesregs/medreports.htm

)