Federal Mtr Carrier Safety Administratin (FMCSA) Medical Examiner Handbk
Table f Cntents Intrductin... 7 Part I The Federal Mtr Carrier Safety Administratin (FMCSA)... 8 Abut the FMCSA... 8 FMCSA Missin Statement... 8 Abut the Office f Medical Prgrams... 8 The Office f Medical Prgrams Missin Statement... 8 Abut the Natinal Registry f Certified Medical Examiners... 9 The Natinal Registry f Certified Medical Examiners Missin Statement... 9 The Medical Examiner... 9 Medical Certificatin... 10 Privacy and the Medical Examinatin... 10 Medical Examinatin Reprt Frm... 10 Medical Examiner s Certificate... 11 Medical Regulatins Summary... 11 Cde f Federal Regulatins LAW... 11 Medical Standards/Advisry Criteria/Guidelines... 12 Medical Regulatins Summary Table... 12 Exemptins... 14 Imprtant Definitins... 14 Regulatin Definitins... 14 Part II - The Jb f Cmmercial Driving... 16 FMCSA Regulates Interstate Cmmercial Operatin... 16 Drivers... 16 Vehicles... 16 Truck and Bus Cmpanies... 16 State Regulatins... 17 The Driver and the Jb f Cmmercial Driving... 17 The Driver... 17 The Jb f Cmmercial Driving... 18 FMCSA Cmmercial Driving Facts and Research... 20 Office f Analysis, Research, and Technlgy... 20 Part III - Medical Examinatin Guidelines... 23 Abut 49 CFR 391.43... 23 Purpse f Interstate Cmmercial Driver Physical Examinatin... 23 Driver/Medical Examiner Relatinship... 23 Purpse f Physical Examinatin... 23 The Issue Is Risk... 23 Cnsider Safety Implicatins... 24 Page 2 f 260
Medical Examiner D's... 24 Medical Examinatin Reprt Frm - Overview... 25 Driver Infrmatin... 26 Health Histry... 27 Visin... 33 Hearing... 34 Bld Pressure/Pulse... 36 Urinalysis... 38 Physical Examinatin... 39 Determine Certificatin Status... 43 Certify... 44 Disqualify... 48 Issue Medical Examiner's Certificate... 49 Part IV - Physical Qualificatin Standards and Advisry Criteria... 51 Physical Qualificatin Standards (Regulatins) versus Advisry Criteria (Medical Guidelines)... 51 Onging Standards and Guidelines Review Prcess... 51 Abut 49 CFR 391.41... 52 Visin... 52 Visin Regulatin 49 CFR 391.41(b)(10)... 52 Health Histry and Physical Examinatin... 53 Certificatin and Dcumentatin... 56 Hearing... 59 Hearing Regulatin 49 CFR 391.41(b)(11)... 60 Health Histry and Physical Examinatin... 60 Certificatin and Dcumentatin... 62 Advisry Criteria/Guidance... 63 Hypertensin... 64 Bld Pressure (BP) Regulatins 49 CFR 391.41(b)(6) and 49 CFR 391.43(f)... 65 Health Histry and Physical Examinatin... 65 Advisry Criteria/Guidance... 67 Cardivascular... 73 Cardivascular Regulatin 49 CFR 391.41(b)(4)... 73 Health Histry and Physical Examinatin... 74 Advisry Criteria/Guidance... 75 Respiratry (b)(5)... 117 Respiratry Regulatin 49 CFR 391.41(b)(5)... 118 Health Histry and Physical Examinatin... 118 Advisry Criteria/Guidance... 120 Neurlgical (b)(7)(8)(9)... 136 Page 3 f 260
Neurlgical Regulatins 49 CFR 391.41(b)(7)(8)(9)... 137 Health Histry and Physical Examinatin... 138 Advisry Criteria/Guidance... 140 Musculskeletal (b)(1)(2)(7)... 167 Musculskeletal Regulatins 49 CFR 391.41(b)(1)(2)(7)... 167 Health Histry and Physical Examinatin... 168 Advisry Criteria/Guidance... 170 Diabetes Mellitus... 172 Diabetes Mellitus Regulatin 49 CFR 391.41(b)(3)... 173 Health Histry and Physical Examinatin... 173 Advisry Criteria/Guidance... 175 Other Diseases... 181 Other Diseases Regulatin 49 CFR 391.41(b)(9)... 182 Health Histry and Physical Examinatin... 182 Advisry Criteria/Guidance... 183 Psychlgical Disrders (b)(9)... 185 Psychlgical Regulatin 49 CFR 391.41(b)(9)... 186 Health Histry and Physical Examinatin... 186 Advisry Criteria/Guidance... 189 Drug Abuse and Alchlism... 201 Drug Abuse and Alchlism Regulatins 49 CFR 391.41(b)(12)(13)... 202 Health Histry and Physical Examinatin... 202 Abut 49 CFR 382 Alchl and Drug Rules... 204 Advisry Criteria/Guidance... 205 Medicatins/Drug Use 49 CFR 391.41(b)(12)... 208 Medicatins/Drug Use Regulatin 49 CFR 391.41(b)(12)... 208 Health Histry and Physical Examinatin... 209 Advisry Criteria/Guidance... 211 Appendix A: Medical Examinatin Reprt Frm... 213 Medical Examinatin Reprt Frm - Page 1... 213 Driver Infrmatin... 213 Health Histry... 213 Medical Examinatin Reprt Frm - Page 2... 213 Visin... 213 Hearing... 214 Bld Pressure/Pulse... 214 Urinalysis... 214 Medical Examinatin Reprt Frm - Page 3... 215 Physical Examinatin... 215 Page 4 f 260
Certificatin and Dcumentatin... 215 Appendix B: Federal Exemptin Prgrams... 217 49 CFR 381.300 What is an exemptin?... 217 Federal Visin Exemptin Prgram... 217 Qualified by Operatin f 49 CFR 391.64: "Grandfathered"... 217 Federal Diabetes Exemptin Prgram... 218 Abut the Federal Diabetes Exemptin Prgram... 218 Relevance t Driving... 219 Health Histry and Physical Examinatin... 219 Appendix C: Skill Perfrmance Evaluatin... 223 Fixed Deficit f an Extremity... 223 Appendix D: Cardivascular Recmmendatin Tables... 225 Preface... 225 ANEURYSMS... 226 AORTIC CONGENITAL HEART DISEASE... 227 AORTIC CONGENITAL HEART DISEASE (Cntinued)... 228 AORTIC REGURGITATION... 229 AORTIC STENOSIS... 230 ATRIAL SEPTAL DEFECTS... 231 ATRIAL SEPTAL DEFECTS (Cntinued)... 232 ATRIAL SEPTAL DEFECTS (Cntinued)... 233 BUNDLE BRANCH BLOCKS AND HEMIBLOCKS... 234 CARDIOMYOPATHIES AND CONGESTIVE HEART FAILURE (CHF)... 235 COMMERCIAL DRIVERS WITH KNOWN CORONARY HEART DISEASE (CHD)... 236 COMMERCIAL DRIVERS WITH KNOWN CORONARY HEART DISEASE (CHD) (Cntinued)... 237 COMMERCIAL DRIVERS WITHOUT KNOWN CORONARY HEART DISEASE (CHD)... 238 CONGENITAL HEART DISEASE... 239 CONGENITAL HEART DISEASE (Cntinued)... 240 CONGENITAL HEART DISEASE (Cntinued)... 241 CONGENITAL HEART DISEASE (Cntinued)... 242 CONGENITAL HEART DISEASE (Cntinued)... 243 HEART TRANSPLANTATION... 244 HYPERTENSION... 245 IMPLANTABLE DEFIBRILLATORS... 246 MITRAL REGURGITATION... 247 MITRAL STENOSIS... 248 PACEMAKERS... 249 PACEMAKERS (Cntinued)... 250 PACEMAKERS (Cntinued)... 251 Page 5 f 260
PERIPHERAL VASCULAR DISEASE... 252 SUPRAVENTRICULAR TACHYCARDIAS... 253 SUPRAVENTRICULAR TACHYCARDIAS (Cntinued)... 254 VALVE REPLACEMENT... 255 VALVE REPLACEMENT (Cntinued)... 256 VENOUS DISEASE... 257 VENTRICULAR ARRHYTHMIAS... 258 VENTRICULAR ARRHYTHMIAS (Cntinued)... 259 VENTRICULAR SEPTAL DEFECTS... 260 Page 6 f 260
Intrductin This handbk prvides infrmatin and guidance t the medical examiner wh perfrms the cmmercial driver medical examinatin. Determining driver medical fitness fr duty is a critical element f the FMCSA safety prgram. Specialists, such as cardilgists and endcrinlgists, may perfrm additinal medical evaluatin, but it is the medical examiner wh decides if the driver is medically qualified t drive. Page 7 f 260
Part I The Federal Mtr Carrier Safety Administratin (FMCSA) Abut the FMCSA On December 9, 1999, President Clintn signed int law the Mtr Carrier Safety Imprvement Act f 1999. This act transferred the Office f Mtr Carriers frm the Federal Highway Administratin (FHWA) t establish the Federal Mtr Carrier Safety Administratin (FMCSA). FMCSA is ne f nine U.S. Department f Transprtatin administratins. T learn mre, visit the DOT Agencies Web page at http://www.dt.gv/dotagencies.htm. FMCSA is headquartered in Washingtn, DC and emplys peple in all 50 States and the District f Clumbia. FMCSA is led by an Administratr, Deputy Administratr, and Chief Safety Officer. The Office f Medical Prgrams is lcated under the Assciate Administratr fr Plicy and Prgram Develpment. FMCSA partners and custmers are serviced by field rganizatins. The rganizatins cnsist f Field Operatins, Service Centers, and State-level mtr carrier divisin ffices. FMCSA activities cntribute t ensuring safety in mtr carrier peratins thrugh strng enfrcement f safety regulatins; targeting high-risk carriers and cmmercial mtr vehicle drivers; imprving safety infrmatin systems and cmmercial mtr vehicle technlgies; strengthening cmmercial mtr vehicle equipment and perating standards; and increasing safety awareness. FMCSA Missin Statement "The Federal Mtr Carrier Safety Administratin (FMCSA) is fcused n reducing crashes, injuries, and fatalities invlving large trucks and buses." In carrying ut its safety mandate t reduce crashes, injuries, and fatalities invlving large trucks and buses, FMCSA: Develps and enfrces data-driven regulatins that balance mtr carrier (truck and bus cmpanies) safety with industry efficiency. Harnesses safety infrmatin systems t fcus n higher-risk carriers in enfrcing safety regulatins. Targets educatinal messages t carriers, cmmercial drivers, and the public. Partners with stakehlders including Federal, State, and lcal enfrcement agencies, the mtr carrier industry, safety grups, and rganized labr n effrts t reduce bus and truck-related crashes. T learn mre abut FMCSA, visit http://www.fmcsa.dt.gv/abut/abutus.aspx. Abut the Office f Medical Prgrams The Office f Medical Prgrams Missin Statement "The missin f the Office f Medical Prgrams is t prmte the safety f America's radways thrugh the prmulgatin and implementatin f medical regulatins, guidelines and plicies that ensure cmmercial mtr vehicle drivers engaged in interstate cmmerce are physically qualified t d s." Page 8 f 260
T prmte safety, the Office f Medical Prgrams: Oversees the natinal medical certificatin prcess fr cmmercial mtr vehicle drivers wh perate in interstate cmmerce. Develps and implements medical regulatins, plicies, and prcedures. Oversees and supprts the Medical Review Bard in accrdance with the Federal Advisry Cmmittee Act. Develps and implements the natinal registry prgram a natinal medical examiner system and a linked natinal driver medical reprting system. Cnducts and versees the Agency's medical exemptin and certificate prgrams. Serves as the lead Federal agency fr the regulatin f cmmercial mtr vehicle driver health and safety and cnducts relevant medical research. T learn mre abut the Office f Medical Prgrams, visit http://www.fmcsa.dt.gv/rulesregulatins/tpics/medical/medical.htm. Abut the Natinal Registry f Certified Medical Examiners The Natinal Registry f Certified Medical Examiners Missin Statement "The primary missin f the Natinal Registry f Certified Medical Examiners is t imprve highway safety by prducing trained, certified medical examiners wh can effectively determine if a cmmercial mtr vehicle driver's health meets Federal Mtr Carrier Safety Administratin standards." FMCSA has begun the rulemaking prcess fr prpsing the Natinal Registry f Certified Medical Examiners (NRCME) prgram. The certified medical examiner wuld: Demnstrate an understanding f FMCSA physical qualificatin requirements and the demands f cmmercial driving, driver tasks, and the wrk envirnment. Perfrm driver certificatin examinatins in accrdance with FMCSA physical qualificatin requirements and medical guidelines. T learn mre abut the Natinal Registry f Medical Examiners, visit https://natinalregistry.fmcsa.dt.gv. The Medical Examiner The Federal Mtr Carrier Safety Regulatins identify a persn wh can be a medical examiner by tw criteria: prfessinal licensure and scpe f practice that includes perfrming physical examinatins. Medical examiner means a persn wh is licensed, certified, and/r registered, in accrdance with applicable State laws and regulatins, t perfrm physical examinatins. The term includes, but is nt limited t, dctrs f medicine and stepathy, advanced practice nurses, physician assistants and chirpractrs. When the Federal Mtr Carrier Safety Administratin (FMCSA) cmpletes the ntice-and-cmment rulemaking fr the prpsed Natinal Registry f Certified Medical Examiners, healthcare prfessinals will be required t be trained and certified and listed n a natinal registry t perfrm physical examinatins f truck and bus drivers. At this time, FMCSA des nt endrse any medical examiner Page 9 f 260
training, educatin r certificatin prgrams, and healthcare prfessinals are nt required t be listed n a registry r ther database t perfrm driver physical examinatins. Medical Certificatin Medical certificatin in accrdance with Federal Mtr Carrier Safety Administratin (FMCSA) physical qualificatin standards is required when the driver is perating a cmmercial vehicle in interstate cmmerce that: Has a cmbined grss vehicle weight r weight rating f 10,001 lbs. r mre. Is designed r used t transprt 9-15 passengers (including the driver) fr cmpensatin. Is designed r used t transprt 16 r mre passengers (including the driver) whether fr cmpensatin r nt. Transprts hazardus materials in quantities that require placarding under the hazardus materials regulatins. When a driver returns frm an illness r injury that interferes with driving ability, the driver must underg a medical examinatin even if the medical examiner's certificate has nt expired. The medical examiner is respnsible fr certifying nly drivers wh meet the physical qualificatin standards. Certificatin cannt exceed 2 years, and at the discretin f the FMCSA medical examiner, may be less than 2 years. The Federal Visin and Diabetes Exemptin Prgrams require annual medical certificatin. The medical examiner's certificate expires at midnight f the day, mnth, and year written n the certificate. There is n grace perid n the expiratin. The driver must be re-examined and recertified t cntinue t drive legally. Privacy and the Medical Examinatin Regulatry requirements take precedence ver the Health Insurance Prtability and Accuntability Act (HIPAA) f 1996. There are ptential subtle interpretatins that can cause significant prblems fr the medical examiner. What infrmatin must r can be turned ver t the carrier is a legal issue, and if in dubt, the examiner shuld btain a legal pinin. Medical Examinatin Reprt Frm Althugh the Federal Mtr Carrier Safety Regulatins d nt require the medical examiner t give a cpy f the Medical Examinatin Reprt frm t the emplyer, the Federal Mtr Carrier Safety Administratin des nt prhibit emplyers frm btaining cpies f the Medical Examinatin Reprt frm. Medical examiners shuld have a release frm signed by the driver if the emplyer wishes t btain a cpy f the Medical Examinatin Reprt frm. Emplyers must cmply with applicable State and Federal laws regarding the privacy and maintenance f emplyee medical infrmatin. Fr infrmatin abut the prvisins f the Standards fr Privacy f Individually Identifiable Health Infrmatin (the Privacy Rule) cntact the U.S. Department f Health & Human Services, Office f Civil Rights at http://www.hhs.gv/cr/hipaa/. The HIPAA tll-free infrmatin line is: 1-866-627-7748. Page 10 f 260
Medical Examiner s Certificate 49 CFR 391.43(g) addresses the distributin f the medical examiner s certificate. If the medical examiner finds that the driver is physically qualified t drive a cmmercial mtr vehicle in accrdance with 391.41(b), the medical examiner shall cmplete a medical examiner s certificate and furnish ne cpy t the driver and ne cpy t the mtr carrier that emplys the driver. A release frm is nt required. The mtr carrier is required t keep a cpy f the certificate in the driver qualificatin file. The medical examiner shuld als keep a cpy f the medical examiner's certificate n file. The driver may request a replacement cpy f the certificate frm the medical examiner r get a cpy f the certificate frm the mtr carrier. T view 49 CFR 391.43(g), visit http://www.fmcsa.dt.gv/rulesregulatins/administratin/fmcsr/fmcsrruletext.aspx?reg=391.43#49cfr391.43(g) Figure 1 - Medical Examiner's Certificate Medical Regulatins Summary Cde f Federal Regulatins LAW The Cde f Federal Regulatins (CFR) is the cdificatin f the general and permanent rules published in the Federal Register by the executive departments and agencies f the Federal gvernment. It is divided int 50 titles that represent brad areas subject t Federal regulatin. Title 49 is Transprtatin. Each title is divided int chapters, which usually bear the name f the issuing agency. Chapter III f Title 49 is "Federal Mtr Carrier Safety Administratin, Department f Transprtatin." Page 11 f 260
Each chapter is further subdivided int parts that cver specific regulatry areas. Part 391 is Qualificatins f Drivers and Lnger Cmbinatin Vehicle (LCV) Driver Instructrs. Large parts may be subdivided int subparts. Subpart E f Part 391 is Physical Qualificatins and Examinatins. Parts are rganized in sectins. Citatins fr the CFRs include the title, part, and sectin numbers (e.g., 49 CFR 391.41). When the title is understd, the citatin may just include the part and sectin (e.g., 391.41). Regulatins are law and must be fllwed. Figure 2 - CFR Citatin Medical Standards/Advisry Criteria/Guidelines Standards r Federal Mtr Carrier Safety Regulatins (FMCSRs) are legal requirements fr interstate cmmercial vehicles, drivers, and mtr carriers. FMCSA prvides medical guidelines r advisry criteria t assist in the evaluatin f medical fitness t perate a cmmercial bus r truck. These guidelines are based n expert review and cnsidered best practice. The examiner may r may nt chse t use these recmmended guidelines. When the certificatin decisin des nt cnfrm t the recmmendatins, the reasn(s) fr nt fllwing the medical guidelines shuld be included in the dcumentatin. Medical Regulatins Summary Table The medical examiner shuld be familiar with the regulatins listed in the fllwing table: Regulatin Descriptin 49 CFR 391.41 Describes the physical qualificatin requirements fr drivers. The 13 standards are used t determine driver medical fitness fr duty. Fur f the standards: visin, hearing, epilepsy, and diabetes mellitus have bjective disqualifiers that d nt depend n medical examiner clinical interpretatin. These standards are the "nn-discretinary" standards. Fr the ther nine "discretinary" standards, the medical examiner makes a clinical judgment in accrdance with the physical qualificatin requirements fr driver certificatin. Page 12 f 260
49 CFR 391.43 Describes the respnsibilities f the medical examiner, including general instructins fr perfrming the medical examinatin, a descriptin f driver tasks and wrk envirnment, medical advisry criteria, the sample Medical Examinatin Reprt frm, and the medical examiner's certificate. 49 CFR 391.45 Identifies wh must have the cmmercial mtr vehicle (CMV) driver physical examinatin. 49 CFR 391.47 Describes the prcess fr cnflict reslutin when there is a disagreement between the primary care prvider fr the driver and the medical examiner fr the mtr carrier cncerning driver qualificatins. 49 CFR 391.49 Describes the Skill Perfrmance Evaluatin (SPE) Certificatin Prgram, which is an alternative physical qualificatin standard fr the driver with a fixed musculskeletal deficit f an extremity wh cannt physically qualify t drive under 391.41(b)(1) r (b)(2). The driver must be therwise qualified t drive a CMV and meet the prvisins f the alternate standard. The first prgram t address fixed musculskeletal deficits was created and administered by the Interstate Cmmerce Cmmissin (ICC) in 1964 and was knwn as the Handicapped Driver Waiver Prgram. Fr mre infrmatin, see Skill Perfrmance Evaluatin Certificatin Prgram (SPE) Histry at http://www.fmcsa.dt.gv/rules-regulatins/tpics/medical/spe-histry.htm. 49 CFR 391.62 Describes limited exemptins fr intra-city zne drivers. 49 CFR 391.64 Describes grandfathering fr certain drivers wh participated in visin and diabetes waiver study prgrams. These drivers may be certified as lng as they cntinue t meet the prvisins utlined in 49 CFR 391.64 and cntinue t meet all ther qualificatin standards. 49 CFR 390 Includes general infrmatin and definitins. 49 CFR 40 Includes regulatins fr medical review fficers and substance abuse prfessinals, including drug and alchl testing prcedures. Table 1 - Medical Regulatins Summary Table T view the regulatins in the Medical Regulatins Summary Table, visit: http://www.fmcsa.dt.gv/rulesregulatins/administratin/fmcsr/fmcsrguide.aspx?sectin_type=a. Page 13 f 260
Exemptins An exemptin prvides temprary regulatry relief frm ne r mre f the FMCSRs fr cmmercial drivers. Relief frm a regulatin is fr 2 years and may be renewed. Currently, FMCSA has tw medical Driver Exemptin Prgrams: Federal Visin Exemptin Prgram (1998). Diabetes Exemptin Prgram (September 2003). The medical examiner cannt issue an exemptin. The rle f the medical examiner is t determine if the driver is "therwise qualified." As part f the applicatin prcedure, the driver must btain a medical examinatin, whereby the medical examiner determines whether the driver is "therwise qualified" if accmpanied by the Federal visin r diabetes exemptin. Bth Federal exemptins require the driver t have an annual medical examinatin fr maintenance and renewal f the exemptin. There currently are n FMCSA medical waiver prgrams. Imprtant Definitins Regulatin Definitins The medical examiner shuld becme familiar with frequently used terms in the cntext f the Federal Mtr Carrier Safety Regulatins and the medical examiner rle. Select terms frm 49 CFR 390.5 and 49 CFR 40 fllw. Definitins frm Regulatin 49 CFR 390.5 Cmmercial Mtr Vehicle: Cmmercial mtr vehicle means any self-prpelled r twed mtr vehicle used n a highway in interstate cmmerce t transprt passengers r prperty when the vehicle: Driver: 1. Has a grss vehicle weight rating r grss cmbinatin weight rating, r grss vehicle weight r grss cmbinatin weight, f 4,536 kg (10,001 punds) r mre, whichever is greater; r 2. Is designed r used t transprt mre than 8 passengers (including the driver) fr cmpensatin; r 3. Is designed r used t transprt mre than 15 passengers, including the driver, and is nt used t transprt passengers fr cmpensatin; r 4. Is used in transprting material fund by the Secretary f Transprtatin t be hazardus under 49 U.S.C. 5103 and transprted in a quantity requiring placarding under regulatins prescribed by the Secretary under 49 CFR, subtitle B, chapter I, subchapter C. Driver means any persn wh perates any cmmercial mtr vehicle. Interstate Cmmerce: Interstate cmmerce means trade, traffic, r transprtatin in the United States: 1. Between a place in a State and a place utside f such State (including a place utside f the United States); Page 14 f 260
2. Between tw places in a State thrugh anther State r a place utside f the United States; r 3. Between tw places in a State as part f trade, traffic, r transprtatin riginating r terminating utside the State r the United States. Intrastate Cmmerce: Intrastate cmmerce means any trade, traffic, r transprtatin in any State which is nt described in the term "interstate cmmerce." Medical Examiner: Medical examiner means a persn wh is licensed, certified, and/r registered, in accrdance with applicable State laws and regulatins, t perfrm physical examinatins. The term includes, but is nt limited t, dctrs f medicine and stepathy, advanced practice nurses, physician assistants and chirpractrs. Mtr Carrier: Mtr carrier means a fr-hire mtr carrier r a private mtr carrier. The term includes a mtr carrier's agents, fficers, and representatives as well as emplyees respnsible fr the hiring, supervising, training, assigning, r dispatching f drivers and emplyees cncerned with the installatin, inspectin, and maintenance f mtr vehicle equipment and/r accessries. Fr purpses f subchapter B, this definitin includes the terms "emplyer" and "exempt mtr carrier." Fr additinal definitins frm 49 CFR 390.5, visit http://www.fmcsa.dt.gv/rulesregulatins/administratin/fmcsr/fmcsrruletext.asp?rule_tc=759§in=390.5§in_tc=1739. 49 CFR 40.3 - What D the Terms Used in This Regulatin Mean? The Omnibus Transprtatin Emplyee Testing Act f 1991 requires drug and alchl testing f safetysensitive transprtatin emplyees in aviatin, trucking, railrads, mass transit, pipelines, and ther transprtatin industries. The Department f Transprtatin (DOT) publishes rules n wh must cnduct drug and alchl tests, hw t cnduct thse tests, and what prcedures t use when testing. There are times when a medical examiner may have interactins with healthcare prfessinals wh perfrm services in the drug and alchl testing prgram. Medical Review Officer (MRO): A persn wh is a licensed physician and wh is respnsible fr receiving and reviewing labratry results generated by an emplyer drug testing prgram and evaluating medical explanatins fr certain drug test results. Substance Abuse Prfessinal (SAP): A persn wh evaluates emplyees wh have vilated DOT drug and alchl regulatins and makes recmmendatins cncerning educatin, treatment, fllw-up testing, and aftercare. Fr additinal definitins frm 49 CFR 40, visit http://www.dt.gv/st/dapc/new_docs/part40.html?prc. Page 15 f 260
Part II - The Jb f Cmmercial Driving FMCSA Regulates Interstate Cmmercial Operatin The Federal Mtr Carrier Safety Administratin (FMCSA) regulates interstate cmmercial peratins, including the drivers, the trucks and buses the drivers perate, the mtr carrier, and the transprtatin f hazardus materials in a quantity requiring placards. A safety risk in any ne r mre f these cmmercial peratins cmpnents can endanger the safety and health f the public. Drivers Apprximately 6 t 7 millin cmmercial mtr vehicle (CMV) drivers are required by law t cmply with FMCSA physical qualificatin standards. Thus, an estimated 3 t 4 millin physical examinatins must be perfrmed annually, with the demand increasing every year. In additin t medical fitness fr duty certificatin, ther regulatins affecting the CMV driver include drug and alchl testing, recrd keeping, hurs f service, and mre. Vehicles CMVs include trucks and buses subject t regulatins gverning inspectin, repair, and maintenance. Truck and Bus Cmpanies Mtr carriers, bth fr-hire and private, must cmply with FCMSA regulatins gverning their drivers and minimum levels f financial respnsibility. In the Federal Mtr Carrier Safety Regulatins (FMCSR), the term "mtr carrier" refers t: Agents fr mtr carriers. Officers. Representatives. Emplyees respnsible fr the hiring, supervising, training, assigning, and dispatching f drivers. Emplyees cncerned with the installatin, inspectin, and maintenance f mtr vehicle equipment and accessries. Emplyer. Exempt mtr carrier. Mtr carriers are respnsible fr ensuring that the driver meets the general qualificatin requirements f 49 CFR 391.11. The driver must: Be at least 21 years ld. Speak and read English well enugh t: Cnverse with the general public. Understand highway/traffic signals. Respnd t fficial questins. Make legible entries n reprts. Be capable f safely perating the CMV. Page 16 f 260
Have a current Medical Examiner s Certificate n file. Have nly ne valid CMV peratr s license. Have prvided the mtr carrier with required backgrund and vilatins infrmatin. Nt be subject t disqualificatin t drive a CMV under the rules in 49 CFR 391.15. Have successfully cmpleted a driver s rad test r equivalent. Cmmercial driver medical fitness fr duty recrds must include all Federal physical qualificatin requirements fund n the Medical Examinatin Reprt frm. Truck and bus cmpanies may als have additinal medical requirements, such as a minimum lifting capability. The driver culd fail a mtr carrier pre-emplyment driver certificatin examinatin and still meet the Federal physical qualificatin requirements fr certificatin and issuance f a Medical Examiner's Certificate. Stat Regulatins States regulate intrastate cmmerce and cmmercial drivers wh are nt subject t Federal regulatins. They are required, at a minimum, t adpt Federal physical qualificatin requirements and may even have additinal, different, r mre stringent requirements. Medical examiners are respnsible fr knwing the driver regulatins fr the State r States in which they practice. The Driver and the Jb f Cmmercial Driving The Driver Driver Certificatin 49 CFR 391 Qualificatins f drivers and lnger cmbinatin vehicle (LCV) driver instructrs establishes the minimum qualificatins fr persns wh drive a CMV. There are seven subparts. As a medical examiner, yu shuld be knwledgeable regarding the physical qualificatin requirements f the driver specified in Subpart E Physical qualificatins and examinatins. Yu are respnsible fr ensuring that nly the driver wh meets the Federal physical qualificatin requirements is issued a Medical Examiner s Certificate. When yu issue a Medical Examiner s Certificate, yu are certifying that the driver is medically fit fr duty and can perfrm the driver rle that is described in the Medical Examinatin Frm. Yu may certify the driver fr a maximum f 2 years. Yu may als, at any time, certify the driver fr less than 2 years when examinatin indicates mre frequent mnitring is required t ensure medical fitness fr duty. The driver is respnsible fr maintaining medical certificatin and carrying the Medical Examiner s Certificate while perating a CMV. The Average Driver The driver ppulatin exhibits characteristics similar t the general ppulatin, including an aging wrk frce. Aging means a higher risk exists fr chrnic diseases, fixed deficits, gradual r sudden incapacitatin, and the likelihd f cmrbidity. All f these can interfere with the ability t drive safely, thus endangering the safety and health f the driver and the public. The prfile f the average truck r bus driver: Male. Mre than 40 years f age. Page 17 f 260
Sedentary. Overweight. Smker. Pr eating habits. The medical prfile: Less healthy than the average persn. Mre than tw medical cnditins. Cardivascular disease prevalent. The Jb f Cmmercial Driving Stress Factrs Assciated with Cmmercial Driving Many factrs cntribute t making cmmercial driving a stressful ccupatin. Types f rutes Turn-arund r shrt relay rutes allw the driver t return hme each evening. A lng relay rute requires driving 9 t 11 hurs, fllwed by at least a 10-hur, ff-duty perid. Several days may elapse befre the driver returns hme. With a straight thrugh haul r crss-cuntry rute, the driver may spend a mnth n the rad, dispatched frm ne lad t the next. The driver usually sleeps in the truck and returns hme fr nly 4 r 5 days befre leaving fr anther extended perid n the rad. In team peratin, drivers share the driving by alternating 5-hur driving perids with 5-hur rest perids. Schedules Abrupt schedule changes and rtating wrk schedules may result in irregular sleep patterns and a driver beginning a trip already fatigued. Tight pickup-and-delivery schedules require bth day and night driving. Failure t meet schedules may result in a financial lss fr the driver. Lng hurs and extended time away frm family and friends may result in a lack f scial supprt. Envirnment The driver may be expsed t excessive vehicle nise, vibratin, and extremes in temperature. The driver may encunter adverse rad, weather, and traffic cnditins that cause unavidable delays. Types f carg The driver f a bus is respnsible fr passenger safety. Transprting passengers als demands effective scial skills. Lss f r shifting carg while driving can result in serius accidents. Transprting hazardus materials, including explsives, flammables, and txics, increases the risk f injury and prperty damage extending beynd the accident site. Driving and Other Tasks Stay alert when driving This demands sustained mental alertness and physical endurance that is nt cmprmised by fatigue r sudden, incapacitating symptms. Required cgnitive skills include prblem slving, cmmunicatin, judgment, and apprpriate behavir in bth nrmal and emergency situatins. Driving requires the ability t judge the maximum speed at which vehicle cntrl can be maintained under changing traffic, rad, and weather cnditins. Page 18 f 260
Use side mirrrs Mirrrs n bth sides f the vehicle are used t mnitr traffic that can mve int the blind spt f the driver. Mirrrs are als used in backing up trucks t lading and unlading areas. Sufficient lateral cervical mbility is needed fr effective use f side mirrrs. Cntrl steering wheel Steering wheels f large trucks and buses are versized. The act f steering can be simulated by ffering resistance, while having the driver imitate the mtin pattern necessary t turn a 24-inch steering wheel. Manipulate dashbard switches and cntrls Large trucks and buses are cmplex vehicles with multiple dashbards, switches, and knbs. Use f these cmpnents requires adequate reach, prehensin, and tuch sensatin in hands and fingers. Shift gears The manual transmissin f a large truck may have mre than 20 gears. This requires the driver t repeatedly perfrm reciprcal mvements f bth legs crdinated with right arm and hand mvements. Enter and exit vehicle The driver may have t enter and exit the vehicle similar t the same way an individual climbs a ladder: by maintaining three pints f cntact fr safety. Full verhead extensin may be required t reach the hand hlds. Hip angle and knee flexin may bth have t exceed 90. Cupling and uncupling the trailers Multiple sub-tasks are perfrmed in the prcess f cupling and uncupling the trailer, including raising and lwering the trailer supprts, cnnecting air lines and electrical cables, and checking the height f the trailer kingpin. Physical demands include grip strength, upper bdy strength, range f mtin, balance, and flexibility. Page 19 f 260
Lad, secure, and unlad carg Federal Mtr Carrier Safety Administratin (FMCSA) guidelines d nt specify the number f punds a driver must be able t lift. Hwever, the Centers fr Disease Cntrl and Preventin (CDC) table f General Physical Activities Defined by Level f Intensity lists "lading and unlading a truck" as an example f a vigrus activity that requires the individual t exert greater than 6.0 metablic equivalents (MET) in perfrmance f the activity. Perfrm vehicle checks Grip strength, upper and lwer bdy strength, range f mtin, balance, and flexibility are required t inspect the engine, brakes, and carg. Visin and hearing are used t identify and interpret changes in vehicle perfrmance. FMCSA Cmmercial Driving Facts and Research Office f Analysis, Research, and Technlgy The Federal Mtr Carrier Safety Administratin (FMCSA) Office f Analysis, Research, and Technlgy (ART) prvides the transprtatin industry and the public with analytical reprts n trends, csts, fatalities, and injuries in large truck and bus crashes. ART research and data help identify factrs that cntribute t crashes. FMCSA uses this infrmatin t develp effective cuntermeasures that will reduce the ccurrence and severity f crashes. Page 20 f 260