1
Q
DOT, CDL, & commercial motor vehicle
A
DOT: Department of Transportation
CDL: Commercial Drivers license
Commercial motor vehicle: vehicle used for commercial purposes that…(at least 1)
1. Has a weight rating of >10,000 lbs
2. Is used to transport hazardous materials
3. Can carry at least 16 passengers
Primary goal of DOT exam is public safety*
-Truck driving has 3rd highest mortality rate among common US occupations
2
Q
DOT Exam Background
A
- Qualification standards are currently set forth by the Federal Motor Carrier Safety Administration (FMCSA)
- Drivers MUST undergo a history and physical by a licensed Physician, Physician Assistant, Advanced Nurse Practitioner, DO, or Chiropractor
- Examiner bears legal liability for exam accuracy
- Maximum certificate length is 2 years
3
Q
DOT Exam: New Requirements
A
Established in 2012:
–In order to conduct these examinations, providers must complete training and subsequent testing by May 2014 to be listed on the National Registry of Certified Medical Examiners (NRCME)
4
Q
DOT Exam: History
A
- Health History (driver completes prior to arrival)
- Contains multiple questions on the driver’s PMH and current medical conditions
- Any “yes” responses require explanation - Med review
- In general, an individual can not be on a scheduled 1drug, amphetamine, narcotic, other habit-forming drug (exceptions exist), or antiseizure med
5
Q
DOT Vision Requirements
A
- demonstrate at least 20/40 visual acuity in each eye with or w/o correction
- demonstrate at least 70 degrees peripheral vision in each eye
- demonstrate ability to distinguish b/w red/green/amber colors (Ishihara test)
- can qualify w/ colorblind if distinguish traffic control signals
- demonstrate binocular vision
- use of contact lenses in 1 eye for distance & 1 eye for near vision –> disqualified
-use of corrective lenses MUST be noted on certificate*
6
Q
DOT Hearing Requirements
A
-must first perceive a whispered voice > or = 5 ft. from the provider (with or w/o a hearing aid)
OR
-demonstrate average hearing loss in the better ear < or = 40 dB at 500, 1000, and 2000 Hz
-use of a hearing aid MUST be noted on certificate*
6
Q
DOT: Blood Pressure & HR Requirements
A
Blood Pressure requirements:
- Take at least 2 BP readings to confirm*
- Reading must be < or = to 160/90 to qualify on initial exam
Pulse requirements:
-Must demonstrate a regular pulse pattern
7
Q
DOT: Physical Exam
A
Focus lies in assessing functional ability to control a large MV, move heavy cargo, load/unload vehicle etc.
- General Appearance: obesity, tremor, signs of alcohol or drug use
- Eyes: PEERLA, nystagmus, exopthalmos, retinopathy, cataracts, glaucoma, macular degeneration
- Ears: ear disease, occlusion of canal, perforated TM
- Mouth and Throat: deformities interfering w/breathing, swallowing
- Heart: murmurs, extra sounds, enlarged heart, pacemaker
- Lungs/chest: abnormal RR, abnormal breath sounds (wheezes, rales, rhonchi), dyspnea, cyanosis
- Abdomen: enlarged liver/spleen, masses, bruits, hernia, abd weakness
- Vascular: abnormal pulse, bruits, varicosities
- Genitourinary: hernias
- Spine: previous surgery, deformities, decreased ROM, tenderness
- Extremities: loss or impairment (UE and LE), limp, atrophy, weakness, paralysis, edema, insufficient grasp (upper limb), insufficient strength/ROM (lower limb)
- Neurological: impaired equilibrium/coordination/speech, asymmetric reflexes, ataxia, motor or sensory deficits
7
Q
DOT Exam: Lab Work
A
- Urinalysis to screen for diabetes (only required test for all applicants)
- Additional lab work should NOT be ordered if functional testing is normal
- Screening EKG is NOT required for asymptomatic individuals
- Resting and stress EKG’s should be done in individuals w/established heart disease or symptomatic
8
Q
DOT: Limb Impairment
A
- SPE Certification Program allows persons w/loss of foot or limb to potentially qualify w/use of prosthetic devices or equipment modifications
- additional restrictions may be placed
- driver must have current SPE certificate in vehicle
8
Q
DOT: Diabetes
A
- Previously, insulin dependent disqualified (now have exceptions)
- Non-insulin dependent can qualify if controlled & no organ damage
- Fasting plasma glucose < 140- 2 hr postprandial glucose < 200
- HA1C < 8
- Ask about hypoglycemic episodes
9
Q
DOT: CV Disease
A
- Current CV disease accompanied by or likely to cause sxs of syncope, dyspnea, collapse, or CHF should be disqualified
- Can make exception -> cardiologist eval
- Must undergo resting & stress EKG
- CABG, pacemakers, & Coumadin do not disqualify
10
Q
DOT: HTN
A
- BP 161-180/91-104 –> qualify x 3 mos
- BP < or = to 160 and/or 90 w/in 3 mos –> then qualify x 1 year (document Rx, BP control)
- BP > 180 and/or 104 –> disqualified until reduced to then qualify x 3 mos
- BP < or = 160 and/or 90 w/in 3 mos –> qualify x 6 mos (document Rx, BP control)
11
Q
DOT: Respiratory Dysfunction
A
-If any conditions suspected that are not controlled and could interfere with oxygen exchange (i.e.-COPD, chronic asthma, TB, sleep apnea etc.) –> REFER for additional testing
12
Q
DOT: Epilepsy
A
- Any pt with a hx of epilepsy, current diagnosis of epilepsy, or taking antiseizure medication –> disqualified
- If sudden LOC or sz of unknown cause which did not require antiseizure med –> 6 month waiting period/neuro exam. If neuro exam normal and driver is not prescribed antiseizure meds –> qualified
- If LOC or sz resulted from known medical condition –> defer until fully recovered
13
Q
DOT: Mental Disorders
A
- Individuals highly susceptible to frequent or severe episodes of emotional instability (schizophrenia, psychoses, paranoia, anxiety, depression etc.) –> consider disqualification
- Adverse effects and interactions of psychotropic meds should also be reviewed
14
Q
DOT: MS, Neuromuscular, or Vascular DZ
A
Rheumatic, Orthopedic, Muscular, Neuromuscular or Vascular Disease:
-Once individual has been diagnosed w/ one of the above conditions, the examiner must consider the following…
1. severity (loss of sensation or strength)
2. degree of limited ROM
3. likelihood of progressive limitation
4. likelihood of sudden incapacitation
If severe functional impairment –> disqualified
15
Q
DOT: Drug Use
A
- Disqualifying medications: Schedule 1, amphetamines, narcotics, any other habit-forming drugs
- Exception…driver may use an above med if prescribed by licensed provider familiar w/pt’s hx/duties and has been told it will not interfere w/safe driving
- Exception excludes methadone (disqualified no matter what)
- drug screening not required, but if + test pt must be free from use or complete drug rehab before recertification*–can make pt certify for < 2 years if desired
16
Q
DOT: Alcoholism
A
- Disqualified if not stable, sober, or current abuse –> send pt to tx
- Pt can be recertified once sober (no specific time limit)
17
Q
DOT: Legal Aspects
A
- Upon completion the Provider records the final results including:
- qualification or disqualification status
- duration of certification
- waiver status
- accommodations
- Providers must clearly document and make decisions based on objective data
- Completed DOT form must be kept on file
- Driver must sign certificate confirming accuracy
- Confidentiality is maintained
- Driver is given the certificate (if qualified)
- Employers can request to obtain copies of the full DOT form –> providers should obtain a signed release from the patient
- The Americans With Disabilities Act does not override safety requirements under federal law
18
Q
DOT: Drug Use
A
- Disqualifying medications: Schedule 1, amphetamines, narcotics, any other habit-forming drugs
- Exception…driver may use an above med if prescribed by licensed provider familiar w/pt’s hx/duties and has been told it will not interfere w/safe driving
- Exception excludes methadone (disqualified no matter what)
- drug screening not required, but if + test pt must be free from use or complete drug rehab before recertification*–can make pt certify for < 2 years if desired
19
Q
DOT: Alcoholism
A
- Disqualified if not stable, sober, or current abuse –> send pt to tx
- Pt can be recertified once sober (no specific time limit)
20
Q
DOT: Legal Aspects
A
- Upon completion the Provider records the final results including:
- qualification or disqualification status
- duration of certification
- waiver status
- accommodations
- Providers must clearly document and make decisions based on objective data
- Completed DOT form must be kept on file
- Driver must sign certificate confirming accuracy
- Confidentiality is maintained
- Driver is given the certificate (if qualified)
- Employers can request to obtain copies of the full DOT form –> providers should obtain a signed release from the patient
- The Americans With Disabilities Act does not override safety requirements under federal law
21
Q
DOT Exam: Lab Work
A
- Urinalysis to screen for diabetes (only required test for all applicants)
- Additional lab work should NOT be ordered if functional testing is normal
- Screening EKG is NOT required for asymptomatic individuals
- Resting and stress EKG’s should be done in individuals w/established heart disease or symptomatic
22
DOT: Limb Impairment
- SPE Certification Program allows persons w/loss of foot or limb to potentially qualify w/use of prosthetic devices or equipment modifications
- additional restrictions may be placed
- driver must have current SPE certificate in vehicle
23
DOT: Diabetes
- Previously, insulin dependent disqualified (now have exceptions)
- Non-insulin dependent can qualify if controlled & no organ damage
- Fasting plasma glucose < 140
- 2 hr postprandial glucose < 200
- HA1C < 8
- Ask about hypoglycemic episodes
24
DOT: CV Disease
- Current CV disease accompanied by or likely to cause sxs of syncope, dyspnea, collapse, or CHF should be disqualified
* Can make exception -> cardiologist eval
- Must undergo resting & stress EKG
- CABG, pacemakers, & Coumadin do not disqualify
25
DOT: HTN
- BP 161-180/91-104 --> qualify x 3 mos
- BP < or = to 160 and/or 90 w/in 3 mos --> then qualify x 1 year (document Rx, BP control)
- BP > 180 and/or 104 --> *disqualified* until reduced to then qualify x 3 mos
- BP < or = 160 and/or 90 w/in 3 mos --> qualify x 6 mos (document Rx, BP control)
26
DOT: Respiratory Dysfunction
-If any conditions suspected that are not controlled and could interfere with oxygen exchange (i.e.-COPD, chronic asthma, TB, sleep apnea etc.) --> REFER for additional testing
27
DOT: Epilepsy
- Any pt with a hx of epilepsy, current diagnosis of epilepsy, or taking antiseizure medication --> disqualified
- If sudden LOC or sz of unknown cause which did not require antiseizure med --> 6 month waiting period/neuro exam. If neuro exam normal and driver is not prescribed antiseizure meds --> qualified
- If LOC or sz resulted from known medical condition --> defer until fully recovered
28
DOT: Mental Disorders
- Individuals highly susceptible to frequent or severe episodes of emotional instability (schizophrenia, psychoses, paranoia, anxiety, depression etc.) --> consider disqualification
- Adverse effects and interactions of psychotropic meds should also be reviewed
29
DOT: MS, Neuromuscular, or Vascular DZ
Rheumatic, Orthopedic, Muscular, Neuromuscular or Vascular Disease:
-Once individual has been diagnosed w/ one of the above conditions, the examiner must consider the following…
1. severity (loss of sensation or strength)
2. degree of limited ROM
3. likelihood of progressive limitation
4. likelihood of sudden incapacitation
If severe functional impairment --> disqualified
30
DOT: Drug Use
- Disqualifying medications: Schedule 1, amphetamines, narcotics, any other habit-forming drugs
- *Exception*…driver may use an above med if prescribed by licensed provider familiar w/pt’s hx/duties and has been told it will not interfere w/safe driving
- Exception excludes methadone (disqualified no matter what)
* drug screening not required, but if + test pt must be free from use or complete drug rehab before recertification*--can make pt certify for < 2 years if desired
31
DOT: Alcoholism
- Disqualified if not stable, sober, or current abuse --> send pt to tx
- Pt can be recertified once sober (no specific time limit)
32
DOT: Legal Aspects
- Upon completion the Provider records the final results including:
- qualification or disqualification status
- duration of certification
- waiver status
- accommodations
- Providers must clearly document and make decisions based on objective data
- Completed DOT form must be kept on file
- Driver must sign certificate confirming accuracy
- Confidentiality is maintained
- Driver is given the certificate (if qualified)
- Employers can request to obtain copies of the full DOT form --> providers should obtain a signed release from the patient
- The Americans With Disabilities Act does not override safety requirements under federal law
