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

• n 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

• n two specific areas: the

medical certification of commercial drivers and drug testing procedures used for commercial vehicle

• perations.

• 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

• n 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

• thers. As a result of the crash, the CMV driver was charged with 5 counts
• f 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,

• xymorphone, 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

• f adulteration next

sample is directly

• bserved (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

• Monocular vision
• Now possess a license to drive a

CMV

• 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

HEARING

• Medical record review
• Driving record review over the

last 3 years

EPILEPSY

• 8 years seizure free on or off

medications with stable treatment for 2 years

• If single seizure, 4 years seizure

free with stable treatment for 2 years

• Single provoked seizure depends
• n cause and is reviewed by the

FMCSA

• All require 3 year driving history

and physician statement IDDM

• Now a packet filled out by

treating physician

• Reviewed by certified medical

examiner

• Must have 3 months of blood

glucose readings electronically downloadable

• HgbA1c within 3 months
• End organ damage

documentation and review

Not-Excepted

• Subject to federal medical and

vision requirements

• Must provide medical examiner’s

certificate (card) to DMV

• 21 years old

Excepted

• Subject to DMV medical and

vision requirements

• Employee of a government or

political subdivision

• Custom harvester
• Bee keeper
• Private motor carrier of

passengers used for non-business purposes (churches, private schools etc.)

• 18 years old and above criteria

Non-Excepted

• Subject to federal medical and

vision requirements

• Must carry MEC (medical

examiner’s certificate)

• Not required to provide MEC to

the DMV

• 18 years old

Excepted

• Subject to DMV medical and

vision requirements

• Held a NE CDL prior to 7/30/1996
• Employee of government or

political subdivision

• Custom harvester
• Bee keeper
• Private motor carrier of passengers

for non-business purposes

• 18 years old

Online database giving employers real-time information about CDL and CLP holders drug and alcohol violations January 6, 2020 Manual inquiries with previous employers until 2023 to cover previous 3 years Changes no existing requirements

MROs report violations Drivers consent online when full query required SAPs report when driver is eligible for return to duty (RTD) process Employers and consortium/TPAs report positives, results of RTD and follow-up testing

$1.25 flat rate for all queries (bundles do not decrease per query cost) If limited query positive you will need to conduct a full query within 24 hours or driver is removed from

• perating a CMV/ SSF

(safety-sensitive functions) Violation with no negative RTD driver is removed from

• perating CMV/SSF

• Often hear it was “not made a requirement or law”
• 49 CFR 391.41- (Driver) has no established medical history or

clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely;

• Recommendations and guidance are not legally binding

BUT…

• Help to support the application of standards
• Developed by expert groups/ task forces and are generally consistent

with best practices

• Must be filled out accurately and completely

by driver

• False or inaccurate information or omitting

information could:

• Invalidate the examination and any certification issued

based on it

• Result in civil or criminal penalties against the driver
• Expose the driver to liability should he/she be involved in an

accident

• THC is federally illegal
• CBD oil comes from hemp with less than 0.3% THC
• Examiners may require non-DOT drug test from

drivers admitting to CBD oil use

• CBD oil may be “contaminated” with THC and would

lead to driver disqualification

We have drivers take an instant urine test for THC while at the clinic If refused, they don’t pass Cost is $25 from the patient Getting the test done later would decrease validity

Continue to encourage drivers to avoid marijuana/CBD oil Use CPAP and bring as many months of reporting as they have Realize that we want all drivers to pass but there are rules to follow The Drug and Alcohol Clearinghouse will probably not roll out smoothly but will be a helpful resource at some point