Assessing fitness to drive - Austroads (PDF)

Assessing fitness to drive for commercial and private vehicle drivers 2022 EDITION Medical standards for licensing and clinical management guidelines  A web version of the medical standards is available from the Austroads website: www.austroads.com.au Help for professionals For guidance in assessing a patient’s fitness to drive contact your State or Territory driver licensing authority (see Appendix 9 for details). Information is also available from the Austroads website: www.austroads.com.au Assessing Fitness to Drive First Published 1998 Second Edition 2001 Third Edition 2003 Reprinted 2006 Fourth Edition 2012 Reprinted 2013 Fifth Edition 2016 Reprinted 2017 Sixth Edition 2022 © Austroads Ltd 2022 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without the prior written permission of Austroads. National Library of Australia Cataloguing-in- Publication data Assessing Fitness to Drive 2022 ISBN: Hardcopy 978-1-922700-17-9; PDF 978-1-922700-21-6 Austroads Publication Number: AP-G56-22 Published by Austroads Ltd Level 9, 570 George Street Sydney NSW 2000 Australia Phone: +61 2 8265 3300 Email: [email protected] www.austroads.com.au Austroads believes this publication to be correct at the time of printing and does not accept responsibility for any consequences arising from the use of information herein. Readers should rely on their own skill and judgement to apply information to particular issues.  Assessing fitness to drive for commercial and private vehicle drivers 2022 EDITION Medical standards for licensing and clinical management guidelines  About Austroads and the NTC Austroads Austroads is the collective of the Australian and New Zealand transport agencies, representing all levels of government. Austroads’ purpose is to support its member organisations to deliver an improved Australasian road transport network. To succeed in this task, Austroads undertakes leading-edge road and transport research which underpins its input to policy development and published guidance on the design, construction and management of the road network and its associated infrastructure. Austroads also supports its members to achieve consistency and improvements in the application of registration and licensing practices, processes and systems. National Transport Commission The NTC is a national land transport reform agency that supports Australian governments to improve safety, productivity and environmental outcomes, provide for future technologies and improve regulatory efficiency. The NTC has a legislative requirement to develop, monitor and maintain uniform or nationally consistent regulatory and operational arrangements for road, rail and intermodal transport. As a key contributor to the national reform agenda, the NTC is accountable to Commonwealth, state and territory ministers who are responsible for transport and infrastructure and make up membership of the Infrastructure and Transport Ministers’ Meeting (ITMM). The NTC works closely with ITMM’s advisory body, the Infrastructure and Transport Senior Officials’ Committee, which includes the heads of Commonwealth, state and territory agencies. ii About Austroads and the NTC  Acknowledgements Setting these standards involved extensive consultation across a wide range of stakeholders including regulators, employers and health professionals. The NTC and Austroads gratefully acknowledge all contributors including the members of the Advisory Group, the Medicinal Cannabis Working Group, the project team and consultants. In particular, the contributions of various health professional organisations and individual health professionals are invaluable to the review process. Advisory Group Derise Cubin Access Canberra Rebecca Wilson Access Canberra Bill McKinley Australian Trucking Association Dr Ramu Nachiappan Australian College of Rural and Remote Medicine Adam Cameron Department for Infrastructure and Transport Scott Swain Department for Infrastructure and Transport Amie Buisman Department of Transport (WA) Karen Webb Department of State Growth A/Prof. Sjaan Koppel Monash University Accident Research Centre Andreas Blahous National Heavy Vehicle Regulator Emily Hicks Office of Road Safety Parik Lumb Road Safety Commission Prof. Nigel Stocks Royal Australian College of General Practitioners Lee Cheetham Transport for NSW Irene Siu Transport for NSW Yessenia Pineda-De Leon Transport and Main Roads Fiona Morris Department of Transport (Vic) Dr Marilyn DiStefano Department of Transport (Vic) Dr Sanjeev Gaya Victorian Institute of Forensic Medicine iii Acknowledgements  Medicinal Cannabis Working Group Dr Shruti Navathe Access Canberra David Sutton Department for Infrastructure and Transport Scott Swain Department for Infrastructure and Transport Sharon Wishart Department of Transport (Vic) Tim Umbers Department of Transport (Vic) Amie Buisman Department of Transport (WA) Sussan Osmond Department of Transport and Main Roads Prof. Iain McGregor Lambert Initiative for Cannabinoid Therapeutics, USYD Dr Tamara Nation National Institute of Integrative Medicine A/Prof. Vicki Kotsirilos NICM, University of Western Sydney Adelaide Jones Office of Road Safety Prof. Edward Ogden St Vincent’s Hospital Melbourne Prof. Yvonne Bonomo St Vincent’s Hospital Melbourne Sally Millward Transport for NSW Dr Sanjeev Gaya Victorian Institute of Forensic Medicine Contributing health professional organisations The following organisations contributed substantially to the review process: • Australian and New Zealand Association of Neurologists • Australian Diabetes Society • Australasian Sleep Association • Cardiac Society of Australia and New Zealand • Cognitive Dementia and Memory Service • Epilepsy Society of Australia • Occupational Therapy Australia • Optometry Australia • Orthoptics Australia • Stroke Society of Australasia • The Royal Australian and New Zealand College of Ophthalmologists • The Royal Australian and New Zealand College of Psychiatrists. iv Acknowledgements  Endorsements These standards are endorsed by: • Australasian Faculty of Occupational and Environmental Medicine • Australasian Faculty of Rehabilitation Medicine • Australasian Sleep Association • Australian and New Zealand Association of Neurologists • Australian College of Rural and Remote Medicine • Australian Diabetes Society • Cardiac Society of Australia and New Zealand • Occupational Therapy Australia • Royal Australian College of Physicians Accepted Clinical Resource Royal Australian College of General Practitioners Legal disclaimer These licensing standards and management guidelines have been compiled using all reasonable care, based on expert medical opinion and relevant literature, and Austroads believes them to be correct at the time of publishing. However, neither Austroads nor the authors accept responsibility for any consequences arising from their application. Health professionals should maintain an awareness of any changes in healthcare and health technology that may affect their assessment of drivers. Health professionals should also maintain an awareness of changes in the law that may affect their legal responsibilities. Where there are concerns about a particular set of circumstances relating to ethical or legal issues, advice may be sought from the health professional’s medical defence organisation or legal advisor. Other queries about the standards should be directed to the relevant driver licensing authority. v Endorsements  Foreword In 2020, 1,106 people were killed on Australian roads, and many tens of thousands were hospitalised with serious injuries. The annual economic cost of road crashes in Australia is estimated to be $30 billion, which is accompanied by devastating social impacts. While many factors contribute to safety on the road, driver health and fitness to drive is an important consideration. Drivers must meet certain medical standards to ensure their health status does not unduly increase their crash risk. Assessing fitness to drive is a joint publication of Austroads and the National Transport Commission (NTC) and details medical standards for driver licensing purposes for use by health professionals and driver licensing authorities. The standards are approved by Commonwealth, state and territory transport ministers and were first published in their current form in 2003. The previous edition was published in 2016. Since its last publication, medical, legal and social developments have required that the medical criteria within the guidelines are updated to ensure they are accurate and reflect current practices. To this end, the NTC reviewed the guidelines, taking into account feedback from stakeholders, including medical professionals and expert consultants. This review produced revised guidelines in draft form, for public consultation in May 2021. Doctors, other health professionals, members of the public, consumer groups, commercial operators and drivers, transport peak bodies and governments submitted comments to the draft guidelines. Austroads and the NTC acknowledge the significant contribution of health professionals to road safety. Health professionals, in partnership with drivers, the road transport industry and governments, play an essential role in keeping all road users safe. Together we are working towards further reducing, and eventually eliminating, deaths and injuries from vehicle crashes on Australian roads. Dr Geoff Allan Chief Executive Austroads Dr Gillian Miles Chief Executive Officer and Commissioner National Transport Commission vi Foreword  Contents A web version of the medical standards is available from the Austroads website: www.austroads.com.au Part A. Fitness to drive principles and practices 1 1. About this publication 2 1.1. Purpose 2 1.2. Target audience 3 1.3. Scope 3 1.4. Content 4 1.5. Development and evidence base 5 2. Assessing fitness to drive – general guidance 7 2.1. The driving task 7 2.2. Impact of medical conditions on driving 10 2.3. Assessing and supporting functional driver capacity 21 3. Roles and responsibilities 25 3.1. Roles and responsibilities of driver licensing authorities 27 3.2. Roles and responsibilities of drivers 27 3.3. Roles and responsibilities of health professionals 28 4. Licensing and medical fitness to drive 34 4.1. Medical standards for private and commercial vehicle drivers 34 4.2. Considerations for commercial vehicle licensing 35 4.3. Prescribed periodic medical examinations for particular licensing/authorisation classes 37 4.4. Conditional licences 37 4.5. Reinstatement of licences or removal or variation of licence conditions 41 5. Assessment and reporting process – step by step 42 5.1. Steps in the assessment and reporting process 43 5.2. Which forms to use 50 Part B. Medical standards 54 Fitness to drive assessment 55 1. Blackouts 57 1.1. Relevance to the driving task 57 1.2. General assessment and management guidelines 57 1.3. Medical standards for licensing 58 2. Cardiovascular conditions 63 2.1. Relevance to the driving task 63 2.2. General assessment and management guidelines 63 2.3. Medical standards for licensing 71 vii Contents  3. Diabetes mellitus 92 3.1. Relevance to the driving task 92 3.2. General assessment and management guidelines 92 3.3. Medical standards for licensing 99 4. Hearing loss and deafness 105 4.1. Relevance to the driving task 105 4.2. General assessment and management guidelines 106 4.3. Medical standards for licensing 109 5. Musculoskeletal conditions 112 5.1. Relevance to the driving task 112 5.2. General assessment and management guidelines2 114 5.3. Medical standards for licensing 117 6. Neurological conditions 120 6.1. Dementia 121 6.2. Seizures and epilepsy 128 6.3. Other neurological and neurodevelopmental conditions 152 7. Psychiatric conditions 170 7.1. Relevance to the driving task 170 7.2. General assessment and management guidelines 171 7.3. Medical standards for licensing 175 8. Sleep disorders 179 8.1. Relevance to the driving task 179 8.2. General assessment and management guidelines 179 8.3. Medical standards for licensing 185 9. Substance misuse 190 9.1. Relevance to the driving task 190 9.2. General assessment and management guidelines 193 9.3. Medical standards for licensing 196 10. Vision and eye disorders 201 10.1. Relevance to the driving task 201 10.2. General assessment and management guidelines 202 10.3. Medical standards for licensing 209 viii Contents  Part C. Appendices 214 Appendix 1. Regulatory requirements for driver testing 215 Appendix 2. Forms 223 Appendix 3. Legislation relating to reporting 227 Appendix 4. Drivers’ legal BAC limits 235 Appendix 5. Alcohol interlock programs 237 Appendix 6. Disabled car parking and taxi services 241 Appendix 7. Seatbelt use 243 Appendix 8. Helmet use 245 Appendix 9. Driver licensing authority contacts 247 Appendix 10. Specialist driver assessors 251 ix Contents  PART A. Fitness to drive principles and practices 1 PART A. Fitness to drive principles and practices 1  1. About this publication 1.1. Purpose 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 • 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 Infrastructure and Transport Ministers’ Meeting) 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 • provides links to supporting and substantiating information. Routine use of these standards will ensure 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 replaces all previous publications containing medical standards for private and commercial vehicle drivers including Assessing fitness to drive 2001, 2003, 2012, 2016 (and its 2017 amendment) and Medical Examinations for Commercial Vehicle Drivers 1997. 2 About this publication  1.2. Target audience 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 • orthoptists • occupational therapists • psychologists • physiotherapists • diabetes educators • nurse practitioners and primary health care nurses • case workers. The publication is also a primary source of requirements for driver licensing authorities in making determinations about medical fitness to hold a driver licence. 1.3. Scope 1.3.1. Medical fitness for driver licensing 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: 1. Treating any patient who holds a driver licence whose condition may affect their ability to drive safely. Most adults drive, therefore 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, licence category (e.g. commercial, passenger vehicle) or other driving requirements (e.g. shift work) is also helpful. 2. 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 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. 3 PART A. Fitness to drive principles and practices  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 their employer. At a minimum, they should be assessed to the commercial vehicle standard. 1.3.2. Short-term fitness to drive 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. 1.3.3. Fitness for duty The medical standards contained in this publication relate only to driving. They cannot be assumed to apply 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. 1.4. Content 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 • 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 format 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, the appendices, 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 4 About this publication