Driving a motor vehicle is a complex task involving perception, appropriate judgement, adequate response time and appropriate physical capability. A range of medical conditions, disabilities and treatments may influence these driving prerequisites. Such impairment may adversely affect driving ability, possibly resulting in a crash causing death or injury. The primary purpose of this publication is to increase road safety in Australia by assisting health professionals to: • assess the fitness to drive of their patients in a consistent and appropriate manner based on current medical evidence • promote the responsible behaviour of their patients, having regard to their medical fitness • conduct medical examinations for the licensing of drivers as required by state and territory driver licensing authorities • provide information to inform decisions on conditional licences, and • recognise the extent and limits of their professional and legal obligations with respect to reporting fitness to drive. The publication also aims to provide guidance to driver licensing authorities in making licensing decisions. With these aims in mind the publication: • outlines clear medical requirements for driver capability based on available evidence and expert medical opinion • clearly differentiates between national minimum standards (approved by the Transport and Infrastructure Council) for drivers of commercial and private vehicles • provides general guidelines for managing patients with respect to their fitness to drive • outlines the legal obligations for health professionals, driver licensing authorities and drivers • provides a reporting template to guide reporting to the driver licensing authority if required, and • provides links to supporting and substantiating information. Routine use of these standards will ensure that the fitness to drive of each patient is assessed in a consistent manner. In doing so, the health professional will not only be contributing to road safety but may minimise medico-legal exposure in the event that a patient is involved in a crash or disputes a licensing decision. This publication is intended for use by any health professional who is involved in assessing a person’s fitness to drive or providing information to support fitness to drive decisions including: • medical practitioners (general practitioners and specialists) • optometrists • occupational therapists • psychologists • physiotherapists • diabetes educators • nurse practitioners and primary health care nurses, and • case workers. The publication is also a primary source of requirements for driver licensing authorities in making determinations about fitness to hold a driver licence. This publication is designed principally to guide and support assessments made by health professionals regarding fitness to drive for licensing purposes. It should be used by health professionals when: • Treating any patient who holds a driver licence whose condition may impact on their ability to drive safely. The majority of adults drive, thus a health professional should routinely consider the impact of a patient’s condition on their ability to drive safely. Awareness of a patient’s occupation or other driving requirements is also helpful. • Undertaking an examination at the request of a driver licensing authority or industry accreditation body. Health professionals may be requested to undertake a medical examination of a driver for a number of reasons. This may be: - for initial licensing of some vehicle classes (e.g. multiple combination heavy vehicles) - as a requirement for a conditional licence - for assessing a person whose driving the driver licensing authority believes may be unsafe (i.e. for cause examinations) - for licence renewal of an older driver (in certain states and territories) - for licensing or accreditation of certain commercial vehicle drivers (e.g. public passenger vehicle drivers) - as a requirement for Basic or Advanced Fatigue Management under the National Heavy Vehicle Accreditation Scheme (refer to <http://www.nhvr.gov.au>). This publication focuses on long-term health and disability-related conditions and their associated functional effects that may impact on driving. It sets out clear minimum medical requirements for unconditional and conditional licences that form the medical basis of decisions made by the driver licensing authority. This publication also provides general guidance with respect to patient management for fitness to drive. It does not address general management of clinical conditions unless it relates to driving. This publication outlines two sets of medical standards for driver licensing or authorisation: private vehicle driver standards and commercial vehicle driver standards. The standards are intended for application to drivers who drive within the ambit of ordinary road laws. Drivers who are given special exemptions from these laws, such as emergency service vehicle drivers, should have a risk assessment and an appropriate level of medical standard applied by the employer. At a minimum, they should be assessed to the commercial vehicle standard. This publication does not attempt to address the full range of health conditions that might impact on a person‘s fitness to drive in the short term. Some guidance in this regard is included in section 2.2.3 Temporary conditions. In most instances, the non-driving period for short-term conditions will depend on individual circumstances and should be determined by the treating health professional based on an assessment of the condition and the potential risks. The medical standards contained in this publication relate only to driving. They cannot be assumed to be applicable to fitness-for-duty assessments (including fitness for tasks such as checking loads, conversing with passengers and undertaking emergency procedures) without first undertaking a task risk assessment that identifies the range of other requirements for a particular job. This publication is presented in three parts. Part A comprises general information including: • the principles of assessing fitness to drive • specific considerations including - the assessment of people with multiple medical conditions or age-related change - the management of temporary conditions, progressive disorders and undifferentiated illness - the effects of prescription and over-the-counter drugs - the role of practical driver assessments and driver rehabilitation • the roles and responsibilities of drivers, licensing authorities and health professionals • what standards to apply (private or commercial) for particular driver classes • the application of conditional licences, and • the steps involved in assessing fitness to drive. Part B comprises a series of chapters relating to relevant medical systems/diseases. The medical requirements for unconditional and conditional licences are summarised in a tabulated to differentiate between the requirements for private and commercial vehicle drivers. Additional information, including the rationale for the standards, as well as a general assessment and management considerations, is provided in the supporting text of each chapter. Part C comprises further supporting information including: • regulatory requirements for driver assessment in each jurisdiction • guidance on forms for the examination process and reporting to the driver licensing authority • legislation relating to driver and health professional reporting of medical conditions • legislation relating to blood alcohol, seatbelt use, helmet use and alcohol interlocks, and • contacts for services relating to disabled parking and transport, occupational therapist assessments and driver licensing authorities. A key input in terms of evidence for the licensing criteria remains the Monash University Accident Research Centre (MUARC) report Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd edition.1 This is an update of the original 2004 report and provides a comprehensive review of published studies involving domestic drivers in Western countries between May 2003 and June 2009. It investigates the influence of chronic illness and impairments on driving performance and crash involvement, including condition prevalence, evidence of crash involvement and other measures of driver risk. In compiling this report, MUARC sought the best available evidence but acknowledges the quality of evidence is variable. In interpreting the research, there is therefore a need to consider a number of sources of potential bias including: • There is a ‘healthy driver’ effect whereby drivers with a medical condition may recognise that they are not able to fully control a car and may either cease driving or restrict their driving. Their opportunity to be in a crash is therefore reduced, and this contributes to a lower crash risk than may otherwise be expected. • The definition and incidence of crashes when driving often depends on self-reporting, which may lead to over- or under-reporting in some studies. • The ‘exposure metric’ (i.e. kilometres travelled) is often not controlled for, yet is crucial for determining the risk of a crash. • The definition of a ‘medical condition’ is by self-report in some studies and may not be accurate. • Sample sizes may be small and not representative of the population of drivers. • The control group may not be properly matched by age and sex. • Comorbidities may not be adjusted for, for example, alcohol dependence. The implications are that false-negative results may occur whereby the condition appears to have no effect or minimal effect on driving safety. The authors acknowledge that care should be taken in interpreting the literature and that professional opinion plus other relevant data should be taken into account in determining the risks posed by medical conditions. While the current review has not involved a further systematic review of the literature, input has been secured for the current edition of Assessing Fitness to Drive through the involvement of several expert groups and through the review of coronial cases. Where recent evidence has become available to inform refinement of licensing criteria, this has been included in the revised chapters. In addition to evidence regarding crash risk and the effects of medical conditions on driving, evidence has also been sought regarding best practice approaches to driver assessment and rehabilitation. For the purposes of this publication the term ‘crash’ refers to a collision between two or more vehicles, or any other accident or incident involving a vehicle in which a person or animal is killed or injured, or property is damaged. Health professionals should also keep themselves up to date with changes in medical knowledge and technology that may influence their assessment of drivers, and with legislation that may affect the duties of the health professional or the patient. (Author/publisher)
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