CompChoice Review the purpose of the DOT physical Review the - PowerPoint PPT Presentation

Darin Gregory, MD CompChoice

Review the purpose of the DOT physical Review the components of the DOT physical Discuss controversial topics regarding DOT physicals

Large truck fatalities and crashes have increased (by 3% in 2018) This is the highest level in 30 years Motor vehicular deaths decreasing (decreased by 1%) 40% of truck occupants killed were not wearing seatbelts Freight on roadways also increasing/ multifactorial NHTSA facts

 Develops and enforces data-driven regulations that balance motor carrier (truck and bus companies) safety with efficiency  Harnesses safety information systems to focus on higher risk carriers in enforcing the safety regulations  Targets educational messages to carriers, commercial drivers, and the public  Partners with federal, state, and local enforcement agencies, the motor carrier industry, safety groups, and organized labor on efforts to reduce bus and truck-related crashes

 Initial criteria for commercial drivers in 1939 was “Good physical and mental health; good eyesight; adequate hearing; no addiction to narcotic drugs and no excessive use of alcoholic beverages or liquors ”.  Physical exams were not required by the then Interstate Commerce Commission until 1954.  DOT was created in 1967 and issued more specific qualification standards.

 The Federal Motor Carrier Safety Administration (FMCSA) was established within the Department of Transportation on January 1, 2000, pursuant to the Motor Carrier Safety Improvement Act of 1999 (49 U.S.C. 113).  Prior to establishment of the NRCME (National Registry of Certified Medical Examiners), any licensed healthcare clinician could perform exam. There were no training requirements or demonstration of competence to perform exams. On May 21, 2014 that all changed.

Driver had severe CHF and end-stage renal failure. He had been released from two jobs and was rejected by another potential employer for positive drug tests. Because of the circumstances leading to this accident, the Safety Board focused its investigation and part of a subsequent public hearing on two specific areas: the medical certification of commercial drivers and drug testing procedures used for commercial vehicle operations.

 Operation of a CMV in interstate commerce that:  Has a combined gross vehicle weight 10,001 pounds or more  Is designed or used to transport more than 8 passengers (including the driver) for compensation  Is designed or used to transport more than 15 passengers (including the driver)  Transports hazardous materials in quantities requiring placarding under hazardous materials regulations

The probable cause, according to the NTSB, of this accident was the Volvo truck driver's fatigue, caused by the combined effects of acute sleep loss, circadian disruption associated with his shift work schedule, and mild sleep apnea, which resulted in the driver's failure to react to slowing and stopped traffic ahead by applying the brakes or performing any evasive maneuver to avoid colliding with the traffic queue.

Release must be signed by the driver if employer requests a copy of the Medical Examination Report Form (long form) Employers must keep health information private Medical Examiner’s Certificate (card) is provided to the employer without a release

Most issues involve health history and medications Physical exam picks up issues such as heart murmurs and weakness Often diagnose HTN and diabetes mellitus

 Must be “redone” if the driver’s abilities to perform his or her normal duties has been impaired by physical or mental injury or disease even if it has not expired  Expires at midnight on the date on the card with no grace period

 Has not been officially updated and released since 2014  260 pages of content  FMCSA provides medical guidance through advisory criteria, bulletins and FAQs  Based on expert reviews and best practices  Guidance is not legally binding but helps to apply regulation standards  Decisions may require referrals and treating provider statements as well as medical record review  Preliminary updated handbook is available for review and it is less than 80 pages

Specific, mandatory training (approximately 12 hours) Pass a standard examination (120 questions over 2 hours) Refresher training and re-examination periodically Removal of non- compliant examiners

 Licensed, certified and/or registered in accordance with state laws to perform physical examinations  Must register and certify with FMCSA  Participate in educational program related to DOT physicals  Pass an examination to receive certification  Maintain up to date records on FMCSA site (report by midnight of the following day)

 Research has indicated that being awake for 18 hours is comparable to having a blood alcohol concentration (BAC) of 0.08 percent, which is legally intoxicated and leaves you at equal risk for a crash.  A 2005 study suggests that three out of every four CMV drivers report having experienced at least one type of driving error as a result of drowsiness.  On October 16, 2005 at 2 a.m., a 23-year-old CMV driver fell asleep behind the wheel, causing him to enter a ditch and eventually roll his truck over on both west-bound lanes of Interstate 94. Minutes later, a charter bus carrying a school band crashed into the truck killing 5 and injuring 29 others. As a result of the crash, the CMV driver was charged with 5 counts of homicide by negligent operation of a vehicle and 29 counts of reckless driving that caused great bodily harm.

Odds of an accident with untreated driver with OSA are 243% higher than a driver without OSA CPAP decreases risk to the same level as drivers without OSA Sleepiness decreases in 2 days and driving simulator performance increases in 2-7 days Drivers not meeting CPAP compliance have a 5 fold increase in crashes compared to those who do

CMV truck crashes cost between $304,500- $7,000,000 Aggressive OSA screening and treatment saves trucking companies approximately $19,000,000 per 1000 drivers annually according to the Journal of Clinical Sleep Medicine

More comfortable for many users Tubing behind head instead of in front

Driver need not fall asleep Compromised decision making Reduced short-term memory Reduced vigilance Increased impulsivity/risk taking Prolonged reaction time

 Cost  Sleep Study- $500- $3000, important to “shop around”  CPAP machine- $500-$3500, depends on accessories and functions  Approximately 80% of confirmed OSA patients deny any symptoms  OSA usually does not cause individuals to wake up enough to experience symptoms at the time of apnea/ hypopnea  Concerns about receiving a 1 year card  Finding a comfortable mask

THC Cocaine Amphetamines/methamp hetamine/MDA PCP Opiates and opioids including codeine, hydrocodone, hydromorphone, morphine, oxycodone, oxymorphone, heroin

Pre-employment Random (consortium) Post-accident Return to duty Follow-up for substance abuse issue

Impartial and independent gatekeeper Provide quality assurance Determine if there is a legitimate medical explanation Investigate problems No doctor-patient relationship Protect confidentiality Fitness for duty (safety issue)

Driver receives instructions from certified collector 45 mL of urine must be provided in reasonable time frame (3-4 minutes in restroom) Maximum of 3 hours to provide a specimen

Temperature out of range (not 90-100 degrees F) or signs of adulteration next sample is directly observed (not a violation of their rights) Split sample sent to lab for certification MRO verifies result

 Objective disqualifiers for:  Vision  Hearing  Epilepsy  Diabetes Mellitus

VISION HEARING  Monocular vision  Medical record review  Now possess a license to drive a  Driving record review over the CMV last 3 years  Operated CMV accident free with vision deficit last 3 years  Ophthalmologist or optometrist exam in the last 3 months  Adequate horizontal field of view  Safe to operate CMV

EPILEPSY IDDM  8 years seizure free on or off  Now a packet filled out by medications with stable treating physician treatment for 2 years  Reviewed by certified medical  If single seizure, 4 years seizure examiner free with stable treatment for 2  Must have 3 months of blood years glucose readings electronically  Single provoked seizure depends downloadable on cause and is reviewed by the  HgbA1c within 3 months FMCSA  End organ damage  All require 3 year driving history documentation and review and physician statement

Not-Excepted Excepted  Subject to DMV medical and  Subject to federal medical and vision requirements vision requirements  Employee of a government or  Must provide medical examiner’s political subdivision certificate (card) to DMV  Custom harvester  21 years old  Bee keeper  Private motor carrier of passengers used for non-business purposes (churches, private schools etc.)  18 years old and above criteria