Transcript Department of Transportation (DOT) Medical

Department of Transportation (DOT)
Medical Examination
Maureen Mathews, APN, CNP
OSF Occupational/Employee Health
27 February 2013
Who can complete the exam?
Providers who have a state license which
permits completion of this type of exam:
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Physicians
Physician Assistants
Advanced Practice Nurses
Chiropractors
Final Rule of National Registry
• Published in Federal Register April 2012
• Medical Examiner Requirements:
– State licensure to practice
– Complete FMCSA physical qualification
standards
– Pass FMCSA Certification Test
– Refresher training 5 years, recertification
testing every 10 years
Certification Exam
• Provider training required prior to taking
exam
• Training can be class room, web based,
self paced, or literature review
• No required length of training
• Proof of training
Certification Exam
• Approved testing sites
• National Registry Website –
https://nationalregistry.fmcsa.dot.gov
• List of certified providers, resources
• Medical Examiner Handbook
• Required monthly reporting of exams
Purpose
• Primary reason for DOT license is protection of
public
• Some medical conditions automatically
disqualify drivers
• Some conditions require clearance from a
specialist, such as cardiologist, etc.
Denial Criteria
• Conditions for denial of license:
– Diabetes mellitus treated with insulin – unless has
exemption
– Seizure disorder
– Significant visual loss - exemption
– Significant hearing loss
– Currently taking methadone
– Controlled substance/habit forming drug without script
Diabetes
• If taking insulin, cannot be certified
• If diabetes is controlled with oral (pill) medication
and/or diet, may be licensed if diabetes is well
controlled
• Requires documentation from primary provider
or endocrinologist
• http://www.fmcsa.dot.gov/rulesregulations/topics/medical/exemptions.htm
Seizures
• If diagnosis of epilepsy and recurrent seizures,
may not be certified
• If one seizure or loss of consciousness, may be
certified if not taking medications for seizure and
seizure free for 5 years or seizure free for 10
years if multiple seizures
• Childhood seizures related to fever are not
disqualifying
• May need documentation from neurologist
Vision Loss
• Vision must be at least 20/40 in each eye with or
without correction (glasses/contacts)
• Certification can be given after retested with
correction
• Field of vision must be at least 70 degrees in
each eye (peripheral or side vision)
• Color vision, must be able to recognize traffic
signals (red, green, amber/yellow)
Hearing Loss
• Must pass a whisper test in at least one ear at 5
feet
• A hearing aid may be worn for test
• May need an audiogram, better ear must not
have average hearing loss of more than 40dB at
500, 1000, and 2000 Hz (add three decibel
losses and divide by 3)
Possible Denial
• Nine conditions MAY cause denial
– Loss of hand, arm, foot, or leg
– Impairment of a hand or leg
– Cardiovascular disease (heart disease)
– Respiratory (lung) disease
– Hypertension (high blood pressure)
Possible Denial
• MAY cause denial
– Musculoskeletal, neurological, vascular
diseases
– Mental, nervous, organic or psychiatric
disorders
– Use of schedule I drugs or consciousness
altering drugs
– Alcoholism
Loss of hand, arm, foot, or leg
• Loss of an appendage (as above) requires
a waiver from the regional director of
motor carriers
Impairment of a hand or leg
• A defect of a limb (hand or leg) may require a
waiver from an orthopedic/neurologic specialist
• This might include fused or immobile knee or hip
joint, partial paralysis
• If a significant impairment interfering with ability
to operate motor vehicle, may be disqualifying
Cardiovascular disease
• Any heart condition which causes sudden or
unexpected loss of consciousness or collapse is
disqualifying
• Congestive heart failure is disqualifying
• Previous heart attack, chest pain, dysrhythmias
(electrical problems) will probably need
clearance from cardiologist
Respiratory disease
• If symptoms of respiratory disease may need
pulmonary function tests (spirometry)
• Further testing and/or clearance from primary
provider or pulmonologist (lung specialist) may
be needed
Hypertension
• Blood pressure (BP) ≤ 160/90
• BP >160/90, < 181/105, may have temporary
certification for 3 months
• If > 181/105, not certified
• When BP is controlled, the certification can be
issued for 1 year at a time
Musculoskeletal, neurological, vascular
diseases
• Any condition that affects the ability to safely
control a motor vehicle or affect reaction times
may disqualify an individual
Mental, nervous, organic or psychiatric
disorders
• Conditions that can affect thinking and
reasoning may be disqualifying
• May need clearance from neurologist or
psychiatrist
• Medications that can affect consciousness or
reaction times may be disqualifying
Use or schedule I drugs or
consciousness altering drugs
• Use of schedule I drugs, or any other conscious
altering substance is disqualifying
(amphetamine, narcotic, other habit forming
drug)
• Other medications and conditions requiring
regular use of medication must be consistent
with safe performance of duties
Alcoholism
• Current diagnosis, which means the physical
and mental condition of the individual is not fully
stabilized, regardless of time
• If condition is uncertain, may need evaluation
and clearance by a substance abuse counselor
Health Counseling
• Medication side effects
• Monitoring of chronic illness such as
diabetes, high blood pressure
• Sleep, fatigue, diet, exercise
• Contacts/glasses
• Hydration, absorbable glucose, self
monitoring, glucose logs
References
Hartenbaum, N. (2010). The DOT medical examination. 5th ed. OEM Press,
Beverly Farms, MA
Pommerenke, F., Hegmann, K., & Hartenbaum, N. (1998). DOT examinations:
practical aspects and regularity review. American Family Physician. 58(2):
415-426
QUESTIONS????