American Osteopathic College of Occupational and ... · PDF fileRecall locations CMV driver...

American Osteopathic College of Occupational and Preventive MedicineDOT FMCSA National Registry of Certified Medical Examiners Course

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Daniel J Callan, DO/MPH,FAOCOPM, FACOFP, FASMA

Medical Director, Business Health Department,Blount Memorial Hospital, Maryville, TN


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FIRST & FOREMOST: WHILE IT IS A RIGHT TO OWN PRIVATEOR COMMERCIAL MOTORVEHICLE VEHICLE; IT IS APRIVELEGE TO DRIVE THEM ON PUBLIC ROADWAYS,

SECOND, ALWAYS REMEMBER: THAT IN ANY MEDICALDECISION MAKING DELIBERATIONS TO DETERMINEPHYSICAL QUALIFICATION FOR A CDL MEDICALCERTIFICATE;= YOU MUST ALWAYS INCLUDE PSYCH, PHYSICAL &PSYCHOMOTOR COMPONENTS OF BODY (IN TOTO) &IN RELATION TO THE JOB FUNCTIONS

= YOU MUST ALWAYS CONSIDER THE EXISTENCE OFANY MEDICAL CONDITION ALONG WITH IT’S THERAPYFOR DISQUALIFYING FACTORS, SEPERATLEY &COMBINED!

Physical Qualifications & Examinations§391.45 Persons who must be medically examined & certified.Except as provided in §391.67, in accordance with §391.43 as physically

qualified (PQ) to operate CMV:(a) Any person not medically examined & certified as PQ to operate a

CMV;

(b)(1) Any driver not medically examined & certified as PQ to operate aCMV during the preceding 24 months; or

(2) Any driver authorized to operate a CMV only with an exemptintra city zone pursuant to §391.62, or only by operation of theexemption in §391.64, if such driver not been medicallyexamined & certified as PQ to drive in such zone during thepreceding 12 months;

(c) Any driver whose ability to perform their normal duties hasbeen impaired by physical or mental injury or disease.


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• DOT; U.S. Department of Transportation

• FMCSA; Federal Motor Carrier Safety Agency

• NRCME: National Registry Certified MedicalExaminers

• NTSB: National Transportation Safety Board

• CDME: Commercial Driver Medical Examiner

• CCDME: Certified CDME

• CDL: Commercial Drivers License

• CMV: Commercial Motor Vehicle

• CFR: Code of Federal Regulations

• PQ: Physically Qualified

• DQ: DisQualified

Mission:

Explain Code of Federal Regulations (CFR) are laws that must befollowed.

Recall locations CMV driver physical qualification regulationsfound in 49 CFR 391.41 Subpart E—Physicalqualifications & examinations.

Explain difference between FMCSA medical standards andmedical guidelines.

Discuss the ongoing process FMCSA uses to update current,develop new, medical fitness for duty standards &guidelines.


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What are differences between medical standards & medical guidelines?

Regulations are law. CDME must use standards found in 49 CFR391.41 to determine interstate CMV driver medical fitness forduty.

Med guidelines are based on expert review & considered best practices,& intended to assist CDME in determining driver certification.

Regulation(s) include driver physical qualification standards & CMEresponsibilities cited below:

Driver physical qualification standards are found in 49 CFR391.41.

CDME responsibilities are found in 49 CFR 391.43.

Certified Commercial Driver Medical Examiners (CCDME) will;

Assess CMV driver’s medical fitness for duty

Use Federal driver qualification standards & medical guidelines

Have an awareness of physical, cognitive & behavioral demandsassociated with the job of commercial driving.

To best of their ability, make certifications decisions that reducethe risk for crashes, injuries, & fatalities for which acontributing factor is failure of the driver to be medicallyfit for duty.


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Competencies

Training should:

Prepare CDME to appropriately apply knowledge of CMVdriverphysical qualification standards & medical guidance,

Use other FMCSA resources in performance of medical Exam. Certification test items directly assess these tasks. Include a review as a minimum CDME responsibilities for

obtaining CMV driver medical history. Use standard specific examples to introduce & reinforce cognitive

recall, application & analysis skills related to global critical tasks.

(Competencies identified within this module are considered globalcompetencies because they either apply to every certificationexamination or they apply to most if not all qualificationstandards.)

Identify, Query, & Note issues in CMV driver’s medical recordand/or health history, which WILL include:

o Verify ID of CMV drivero Ensure CMV driver signs health history statemento Specifics regarding any affirmative history responseso Any illness, surgery, injury in last five yearso Any other hospitalizations or surgerieso Any recent changes in health statuso Any medical conditions or current complaintso Any incidents of disability / physical limitationso Limitations placed during prior FMCSA emanationso Current OTC/prescription medications/supplements, potential

side effects, be potentially disqualifyingo Other conditions that could impair a driver’s ability to safely

function


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NOTE: Critical task stems for following competencies describeminimum expectations for CDME to obtain sufficient medicalevaluation data to determine CMV driver’s health & documentancillary information; including;

History & Physical Examination,

Lab,

Imaging,

Consultation

.

The detail tasks, are listed in specific standards module ofcompetencies.

Ensure CMV driver properly clothed for physical examination

Record height/weight, BMI note if CMV driver is over orunderweight

Note all interfering conditions;Examine eyes, ears, nose, mouth/throat, note conditions that interfere

with seeing, hearing, breathing, speaking, or swallowingExamine neck & spine ROMExamine heart/lungs, chest, thorax, excluding breasts,Examine abdomenExamine extremitiesExamine neurological status & mental statusExamine peripheral vascular systemExamine urine & note specific gravity, protein, blood, & glucose


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Health Education Counseling

NOTE: Following critical tasks are global tasks.

CDME provide CMV driver with appropriate explanation,advice, information, & decision rationale.

Body system specific tasks/examples are also includedin corresponding module competency lists.

Explain to CMV driver consequences of non-compliance withcare plan for, medical conditions that they have beenadvised for periodic monitoring with PCP.

Advise a CMV driver:o Regarding side effects/interactions of medications/supplements

(narcotics, anticoagulants, psychotropics) including acquiredOTC (antihistamines, cold & cough meds) could negatively affecttheir driving

o Fatigue, lack of sleep, undesirable diet, emotional conditions, stress, &other illnesses can affect safe driving

o Contact lenses they should carry a pair of glasses while driving

o Hearing aids they should possess a spare power source for device whiledriving

o Deep vein thrombosis event of risks associated with inactivity whiledriving & interventions TO prevent another thrombotic event


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Advise a CMV driver:

DM about blood glucose monitoring frequencies & minimumthreshold while driving

DM exemption, they should:o Possess a rapidly absorbable form of glucose while

drivingo Self-monitor blood glucose one hour before driving &

at least once every 4 hours while driving

o Comply with each condition of their exemption

o Plan to submit blood glucose monitoring logs for eachannual recertification

Inform CMV driver of rationale for delaying or potentiallydisqualifying certification, which may include:

o Immediate post-operative periodo Vision disability (retinopathy, macular degeneration)o Cardiac event (myocardial infarction, coronary insufficiency)o Chronic pulmonary exacerbation (emphysema, COPD fibrosis)o Uncontrolled hypertensiono Endocrine dysfunctions (diabetes, thyroidism)o Musculoskeletal challenges (arthritis, neuromuscular disease)o Neurological event (seizures, stroke, TIA)o Sleep disorder (obstructive sleep apnea)o Mental / emotional health (depression, schizophrenia)o Mental health dysfunctions (depression, bipolar)


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Consider a CMV driver’s ability to:

o Couple & uncouple trailers from a tractoro Load or unload several thousand pounds of freighto Install & remove tire chainso Manipulate & secure tarpaulins that cover open trailero Move one’s own body through space while climbing ladders;

bending, stooping, crouching; entering & exiting the cabo Manipulate an oversized steering wheelo Shift through several gears using a manual transmissiono Perform precision prehension & power graspingo Use arms, feet, & legs during CMV operation

Review Skill Performance Evaluation (SPE) cases

Consider a CMV driver’s cognitive ability to:o Plan a travel routeo Inspect operating condition of a tractor and/or trailero Monitor & adjust to a complex driving situationo Maneuver through crowded areaso Quickly alter the course of vehicle to avoid trouble

Consider general health and wellness factors such as:o Adverse health effects associated with rotating work schedules &

irregular sleep patternso Long-term effects of fatigue associated with extended work hours

without breakso Risk factors associated with common dietary choices available to

driverso Stressors likely associated with extended time away from a Driver’s

social support system


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Consider general health & wellness factors such aso Short- and long-term health effects of stress from tight pickup &

delivery scheduleso Irregular work, rest, & eating patterns / dietary choiceso Adverse road, weather, & traffic conditionso Exposure to temperature extremes, vibration, & noiseo Transporting passengers or hazardous products

Integrate FMCSA medical advisory criteria and guidelines:regarding a driver’s condition into the risk assessment

Support the rationale for using FMCSA guidelines that have not beenpublished in regulations yet.

Consider for documented conditions:

Rate of progression, Degree of control, Likelihood of gradual or sudden incapacitation, examples include:

o Cardiovascular

o Neurologic

o Respiratory

o Musculoskeletal


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Apply Certification Medical Standards to:Physically Qualify (PQ) orPhysically Disqualify (DQ)

CMVdriverDQ any CMV driver who:o Currently taking methadone or any Schedule I uses a controlled

substance including a narcotic, amphetamine, or another habit-forming drug without a prescription from the treating physician

o Current clinical diagnosis of alcoholism,DQ any CMV driver when:o Evidence shows a condition exists that will likely interfere with the

safe operation of a CMV, include sufficient supporting opinions& information from specialists

Document reason(s) for DQ and/or referralAdvise a CMV driver of reasons for a disqualification decision &what the CMV driver could do to become qualified

Certify any driver: appropriate interval (3, 6, 9, 12 or 24m)Indicate certification status, which may require;o Waiver / exemption, which CDME Identifieso Wearing corrective lenseso Wearing a hearing aido Skill Performance Evaluation Certificate

Advise any driver certified with limited interval to return forrecertification with appropriate documentation for their condition

Complete medical examination report & medical certificate/cardensure:o Use of currently required examination formo Form includes CDME’s name, examination date, office address, &

telephone numbero Driver signs the medical certificate/card


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Rules & Regulations:At the completion of training and Certification,o CCDME must be aware of following Federal regulations,o Have an awareness of how they relate to driver certification.o Recall regulation that cites driver PQ Medical Standards & regulation

that cites medical examiner responsibilities.

Subpart A— General applicability & definitions §390.5 Definitions

Subpart E— Physical qualifications & examinations emphasize

o 49 CFR 391.41 Physical qualifications for drivers

o 49 CFR 391.43 Medical examination; certificate of physicalqualification

Subpart G—Limited exemptions, emphasize:

o 49 CFR 391.62 Limited exemptions for intra-city zone drivers

o 49 CFR 391.64 Grandfathering for certain drivers participatingin vision & diabetes waiver study programs

o 49 CFR Part 40 DOT Procedures for Drug and Alcohol Testing

o 49 CFR Part 381 Waivers/Exemptions/Pilot Programs

o 21 USC Sec. 812 U.S. Drug Enforcement Administration


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Regulation Guidance:

FMCSA Medical Examiner Handbook:

Part I—General FMCSA Information

Part II—The Job of Commercial Driving

Part III—Medical Examination Guidelines

Part IV—Physical Qualification Standards - particularly:

o Regulations Versus Medical Guidelines (Guidance)

o Ongoing standards and guidelines Review Process

FMCSA Content Sources

Related FMCSA Web Site Resources:

FMCSA Medical Programs

Driver Exemption Programs

Skill Performance Evaluation (SPE)

About FMCSA

Medical Examination Form (PDF)


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Topic 1: Background, rationale, mission, goals of FMCSA CDME’s rolein reducing crashes, injuries, & fatalities involving CMVs.

Background:Identify FMCSA as 1 of 9 administrations established within

U.S. Department of Transportation (DOT) agencies.

Identify Office of Medical Programs as a key FMCSA CMVdriver safety program.

Recall that NRCME is under direction of Office of MedicalPrograms.

Give an example of documenting the reason(s) for acertification decision that does not conform withguidelines.

Rationale:List entities; FMCSA regulates, including: drivers, vehicles, & motor

carriers.Discuss why; regulation is needed to protect public safety, which may

include describing why crashes involving a CMV can becatastrophic;

Rational includes:o Greater risk of injury & fatalities to individuals in smaller vehicles.

o Risk to environment & persons when crashes involve hazardousmaterials.

o Some CMV carry many members of the public.

o The economic cost of these crashes is exceedingly high.


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Mission:Discuss the missions of FMCSA & NRCME.

Review FMCSA strategies to achieve goals including:

o Develops & enforces data-driven regulations that

balance motor carrier (truck/bus company) safetywith industry efficiency.

o Employs safety information systems to focus on higher-

risk carriers in enforcing safety regulations.Targetseducational messages to carriers, CMV drivers, &public.

o Partners with stakeholders, including Federal, State, and

local enforcement agencies, the motor carrierindustry, safety groups, & organized labor in effortsto reduce bus/truck crashes.

Mission:

List FMCSA Medical Programs responsibilities; including to:o Oversee national medical certification process for CMVdrivers who operate in interstate commerce.o Develop/implement medical regulations, policies, andprocedures.o Oversee & support the Medical Review Board inaccordance with Federal Advisory Committee Act.o Develop/Implement NRCME & a linked national CMVdriver medical reporting system.o Conduct/Oversee Agency’s medical exemption and

certificate programs.o Serve as lead Federal Agency for regulation of CMVdriver health, safety & conduct relevant medicalresearch.


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Recall purpose of the Federal CMV driver physicalexamination.

Differentiate between goals of CDME & goals ofPCP or specialist provider.

Recall who is responsible for determination of CMVdriver medical certification status.

Topic 2: Familiarization with responsibilities & work environmentof CMV operation.

Safety Considerations:Factors that Contribute to Job-related Stress:

Identify CMV driving factors that contribute to commercialdriving job-related stress, including:o Route, scheduling, and traffic environment stresses.

o Road, traffic, weather, & night time driving.

o Vehicle size, noise, vibration, & sleeper environment.

o Types of cargo (e.g., hazardous or passenger).


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Driver Responsibilities:

Identify duties, in addition to driving task, for which adriver is responsible & needs to be medically fit forduty, including:o Coupling & uncoupling trailer(s) from the tractor.

o Loading & unloading trailer(s).

o Inspecting operating condition of tractor and/or trailer(s)before, during & after delivery of cargo.

o Lifting, installing, & removing heavy tire chains.

o Lifting heavy tarpaulins to cover open top trailers.

About the Job of Commercial Driving

Driver Population:

Discuss that driver population exhibits same characteristicsprevalent in the general population, including;o age distribution of work forceo age-related medical conditions.

Discuss health risks associated with aging/obesity Including:o High risk for chronic disease.o Increased risk for fixed deficits.o Increased risk for gradual or sudden incapacitation.o Increased likelihood of comorbidity.


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Safety Considerations:Identify & Discuss CMV driver job-related safety implicationconsidered when making Certification Determination, including:o Severity of physical condition DQing because:

o Symptoms, even if medically benign, interfere with abilityto drive?

o Onset of symptoms may be so fast driver may be unableto stop vehicle safely before becomingincapacitated?

o Onset of symptoms may be so gradual driver is unawareof diminished ability to operate a CMV safely.

o Presence of mental/physiological condition DQ because itinterferes with:

Cognitive abilities used to process environmental cuesrapidly & make appropriate responses?

Safety Considerations:o Problem solving skills used to function independently of direct

supervision in a new environment or in the event of anemergency?

o Behavioral inhibitors that suppress inappropriate, irresponsible, orpossibly violent actions?

Is the use of a medical treatment:o PQing because it controls a physical &/or mental condition

allowing CMV driver to perform tasks more safely than withouttreatment?

o DQing because effects, even if medically optimal interfere with safedriving?

o DQing because the side effects interfere with safe driving?


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Topic 3: Obtaining, reviewing, & documenting driver medical history,including prescription/over-the-counter (OTC) medications.

Health History: Obtaining;

Reference Medical Examination Report form health history asminimum guideline for obtaining driver history used to determinemedical fitness for duty.

Discuss importance of obtaining accurate/complete driver health history.

Health History: ObtainingRecall driver is to:

o Complete Medical Examination Report form DriverInformation & Health History sections.

o Disclose (if known), onset date, diagnosis, treating physician'sname & address, and/or any current limitation for positivehistory.

o List all current or recently used medication, including OTCdrugs & supplements.

Explain by signing Medical Examination Report form CMV drivercertifies that the information provided is complete & true, & alsocertify that they understands that inaccurate, false ormisleading information may invalidate examination &medical examiner's certificate.

A civil penalty may also be levied against the driver under:49 U.S.C. 521(b)(2)(b), either for making a false statement of forconcealing a disqualifying condition.


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Reviewing:Recall CDME or examiner trained assistive staff should:

o Verify identity of driver, using at least 1 government issuedphoto identification form (CDL).

o Confirm identification form information & medical recorddriver information match.

Discuss purpose of reviewing driver health history to assist indetermination medical fitness for duty.

Give examples of why negative history might be inaccurate(driver erroneously applied "last 5 years“ time frame to allhealth history questions or was unaware that a same-day,minimally invasive procedure is surgery).

Reviewing:Recall CDME must review & discuss:

o Any health history ―all yes answers.o Potential for medication effects or side effects that

interfere with safe driving.Discuss why CDME should ask about symptoms of diseases to evaluate

the ability to drive safely & effectively on function & relevanthistory rather than relying solely on history of diagnosis.

Discuss importance of ensuring medication history discloses:o If effects of medication contribute to ability to drive safely.o If the effects or side effects of medication interfere with

ability to drive safely.o Increased risk for sudden or unperceived interference

with Ability (INCAPACITATION) to drive safelyresulting from:


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Health History

Reviewing:

Discuss importance of ensuring medication history discloses:Drug interactions with another drug, food, and/or supplement.

o Synergistic effects from a combination of prescription and/orOTC medications.

o Reactions to new medication or one with a narrow therapeuticrange.

o Reactions to single late or missed dose of a medication.

Ensure that CMV driver has completed both sections, signed, & datedthe Medical Examination Report form.

When appropriate, request specific report details as treating provider maynot be familiar with CMV driver physical qualificationrequirements:

o Request medical details (dates, treatment effects and/or sideeffects, test results, etc.) identified by regulation and/orrecommendations.

o Ensure appropriate medical information release forms areprovided when required.

o Include supporting documentation with Medical Examinationreport form.


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Fully document health history review, which includes:

o Noting discussions of medication effects and/or sideeffects that can interfere with driving.

o Identifying when history indicates additional tests orevaluation are required to make a certificationdecision.

o Explaining if health history is cause fordisqualification.

Performing:Recall: Medical Examination Report form describes minimum physical

examination required for determining driver certification.Discuss: CDME responsibility to adequately assess medically fit for duty

may require additional driver testing and/or medicalevaluation by PCP and/or specialist provider.

Identify: 4 tests required as a part of every driver certification &recertification examination:

o Visiono Hearingo Blood Pressure/Pulseo Urinalysis (dipstick)

Review the body systems listed in physical exam section, noting thatcheck for lists are minimum examination requirements.

Discuss implications of general exam (CDME must be able in inspect forscars, therefore driver must disrobe).


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ReviewingRecall all abnormal findings are to be noted.Distinguish between disqualifying/non-disqualifying

abnormalities.Discuss rationale for why CDME may choose to temporarily

disqualify, including:o Obtain additional testing or evaluation.o Conform with recommended waiting periods

(post-surgical minimum recovery, newlystarted on medication or treatment).

Discuss importance of ascertaining affect of a condition ortreatment on the CMV driver’s ability to operate a CMVsafely.

Discuss CDME responsibility to distinguish between optimalmedical treatment, prognosis, & risk to public safety.

Documenting:

Review Medical Examination Report form instruction for documentingphysical examination.

Recall that all abnormal findings must be documented.

Recall that noting the affect on driving ability is required.

Give examples of noting that organic disease has or has not beencompensated for adequately for driver certification.


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Additional Diagnostic Tests & Medical ExpertOpinion

Topic 5: Performing, obtaining, & documenting additional diagnostictests or medical opinion from a medical specialist or treatingphysician.

Performing:Distinguish between testing/evaluation to diagnose/treat CMV driver &

testing/evaluation to determine medical fitness for duty & toprotect public safety.

Give examples of examination finding that may indicate need foradditional testing and/or evaluation, such as:o An abnormal urinalysis.o An occurrence of cardiovascular insufficiency.o Abnormal affect at examination.o Recently prescribed treatment/medication.

Give examples of additional tests examiner might perform, such as:Random blood glucose, Pulse Oximetry.

Obtaining:Additional tests the examiner might require, such as:

o Arterial blood gas analysis (ABG).o Stress exercise tolerance test (ETT).o Sleep studies.o Drug test.

Distinguish between role of consulted HCP to adequately assess CMVdriver health & medical examiner role to determine medicalfitness for duty.

Additional evaluations CDME might require, such as:o Report of effectiveness of procedure, surgery, or treatment.o Evaluation of medication effects and/or side effects.o Results of cognitive and/or behavioral evaluation.o Evaluation of completion/success of rehabilitation program


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Documenting:Recall test results & consulting provider reports to be included with

Medical Examination Report form.Discuss advantages of providing appropriate documentation to increase

likelihood of obtaining adequate evaluation report information,including:o Copy of Medical Examination Report form, including CMV

driver role.o Medical release form.o Copy or list of applicable regulation and/or medical guidelines

assessment criteria.o Medical examiner contact information.

Recall medical clearance to drive from consulting provider is an opinionwith which CDME may or may not concur.CDME makes qualification decision.

Documenting:

Discuss rationale for FMCSA reliance on CDME’s to determine drivercertification, including CDME knows:

o Driver physical qualification requirements.

o Physical, mental, & behavioral demands of commercial driving.

o Driver is certified for driver’s role, not specific job descriptionwhich may be less demanding.

o Limitations of CDME role (cannot limit driving to daylighthours, etc.).


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Topic 6: Informing/educating CMV driver about medications & non-disqualifying medical conditions that require remedial care.

Medications:Recall potential effects/risks associated with use of medication &

supplements should be discussed with CMV driver & mayinclude:o Id possible side effects, interaction, and/or synergistic affects

that interfere with driving ability.o Advising driver read warning labels on all medications.o Recommend driver carry extra medication when driving so that

doses are not missed due to trip delays.o Recommend driver have a method for refilling prescription

when driving.o Educating driver that effectiveness of medications can be

affected by improper storage, including exposure to light,heat, cold, and moisture.

Non-disqualifying Medical Conditions:

Recall potential risks to driver & public safety associated with job ofCMV driving should be discussed with CMV driver.

Discuss rationale for delaying or potentially disqualifying driver & mayinclude:o Recommended waiting periods.o Presence of or unacceptable risk for occurrence of

disqualifying symptom.o Presence of or unacceptable risk for disqualifying effect of

medication or treatment.

Recall that option of applying for a Federal exemption should bediscussed with otherwise medically qualified CMV driver withmonocular vision or diabetes mellitus who uses insulin.


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Topic 7: Determining CMV driver certification outcome & period forwhich certification should be valid.

Recall FMCSA relies on CDME to assess/determine when a person ismedically fit to operate CMV in interstate commerce.

Recall CDME who signs Medical Examination Report form is CDMEaccountable for driver certification decision.

Discuss fundamental issue of risk to public safety for determiningdriver certification. Does CMV driver have condition/treatmentthat:o Interferes with ability of CMV driver to safely operate CMV.o Poses an unacceptable risk for gradual or sudden

incapacitation.

Recall CDME must determine for each Certification/recertification examination whether or not driver ismedically:

o Qualified (PQ) for CMV driving & will be certified &issued CDME’s certificate.

o Unqualified (DQ) for CMV Diving & will not becertified.


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Certification Outcome & Period:Discuss fundamental issue when deciding certification period is the

probability of an event occurring within certain period of time.

Recall For Interstate CMV driver medical certification:o Maximum certification period is 2 years.o CDME can certify for less than 2 years, when:o More frequent monitoring is indicated by history and/or

physical examination.o Medical guidance recommends a period less than 2 years.o Provision of Federal exemption requires annual medical

examination.o Needed to ensure adequate monitoring of a medical condition

that may change and be potentially DQ disqualifying.

Certification Outcome & Period:

Discuss CDME authority to indicate CMV driver is medically PQ"onlywhen" in compliance with one or more of 6 requirements printedon the medical examiner's certificate:

o Wearing corrective lenses.o Wearing hearing aid.o Accompanied by a___ waiver/exemption. (Federal

vision or diabetes exemptions).o Driving within an exempt intracity zone (49 CFR

391.62).o Accompanied by a Skill Performance Evaluation (SPE)

certificate.o Qualified by operation of 49 CFR 391.64.


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Topic 8: FMCSA reporting & documentation requirements.Documenting Certification Status:Compare Medical Exam Report form certification status & CDME’s

certification to ID minimum requirements for documentingcertification decision.

o Note that both status & CDME’s certificate have list of6 certification modifications CDME may impose.

o Show relationship between exam date, statuscertification period, CDME's certificate expirationdate.

Discuss importance of Medical Exam Report form status &CDME’s certificate being accurate, complete & reflecting thesame certification decision.

Recall there is no issuance of CDME’s certificate to CMV Driver who isnot medically qualified (DQ).

Review 49 CFR 391.43 (g)(h) requirements for completion/distributionof CDME's certificate.

Reporting:

Discuss minimum requirements for retention of CMV drivermedical records.

Discuss national registry listing requirement for CDME toreport monthly interstate CMV driver physicalexaminations including months when no examinationswere performed.

Discuss requirements to produce records when requested byFMCSA or designated representative as part ofinvestigation of CMV crashes.


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Self-checks are stem & key example resource for developingknowledge mastery learning strategies, such as:discussion,drill & practice,pre- & post-topic comprehension assessment interactions.

Use of self-check content is optional.

Stems and Keys:Stem: What is purpose of Interstate CMV driver physical examination?

Key: purpose of CMV driver physical exam to detect presence ofphysical, mental, or organic conditions of such character & extentas to affect driver ability to operate a CMV safely.This examination is for public safety determination & considered

by FMCSA to be a “medical fitness for duty" exam.

Stem: What is the mission of the FMCSA?

Key: "The FMCSA is focused on reducing crashes, injuries, &fatalities involving large trucks & buses.“

Stem: Who and what does FMCSA regulate?

Key: The FMCSA regulates interstate commercial operation,including driver, vehicle, motor carrier, & transport ofhazardous materials.


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Stem: Give examples of CMV driver stress factors.

Key: Stress factors may include:

Interruption of normal sleep, exercise, & eating patternsAccess to social support networks resulting in fatigue, obesity,

and/or alienation of affection.Environment that may have excessive vibration, noise, &

extremes temperature, and/or adverse road or trafficconditions can interfere with CMV driver ability torecognize a driving hazard, cause temporary orpermanent physical damage to sensory perceptionor affect driver behavior.

Increased potential for injury & fatalities should there be acrash when driver is responsible for passengersafety or hazardous cargo.

Stem: What are differences between medical standards & medicalguidelines?

Key: Regulations are law. CDME must use standards found in 49 CFR391.41 to determine interstate CMV driver medical fitness forduty. Med guidelines are based on expert review & consideredbest practices, & intended to assist CDME in determining drivercertification.

Stem: In which regulation(s) are driver physical qualification standards& CME responsibilities cited?

Key: Driver physical qualification standards are found in 49 CFR391.41.CDME responsibilities are found in 49 CFR 391.43.


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Stem: What objective tests & measurements are required aspart of driver physical exam.

Key: Driver:Height and weight.Vision.Hearing.Blood pressure and pulse.Urinalysis (dipstick) for specific gravity,

protein, blood, and glucose.

Stem: What are possible outcomes of CMV driver physicalexam?

Key: Certification (PQ) OR Disqualification (DQ)

Stem: What date is used to determine CDME’s certificateexpiration

Key: Date noted on CDME report form; day physical examwas started.


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Documentation ApplicationStem: What is CDME certificate expiration date for following drivers?

Driver A – Exam 4/16/2011 – Meets standards in 49 CFR 391.41;qualifies for 2 yr certificate.

Driver B – Exam 4/16/2011 – Meets standards, but periodic monitoringrequired due to hypertension – driver qualified 1 yr.

Driver C – Exam 4/16/2011 – Disqualified due to not having results ofpost-CABG stress test for review.4/25/2011 – Return to medical examiner’s office with test

results (attached) – driver qualified 1 yr.Driver D – Exam 4/16/2011 – Disqualified due to diagnosis of benign

positional vertigo 3/15/2011 – Return to medicalexaminer’s office for Certification Exam on 5/20/2011.

Note asymptomatic since 3/11/2011 but periodic– driver qualified 2 yrs.

Key:Driver A – Expiration date 4/16/2013 (2 yrs from date of PE)Driver B – Expiration date 4/16/2012 (1 yr from date of PE).Driver C – Expiration date 4/16/2012 (1 yr from date physical exam

was started, not follow-up date when driver returned withtest results needed to complete physical exam).

Driver D – Expiration date 5/20/2013 (Time & conditions of waitingperiods should be completed before considering driver forcertification.

CDME DQ CMV Driver, explaining that 2 month, symptom-freewaiting period must elapse. CDME performed a completephysical exam, including starting a new Medical ExamReport form, on 5/20/2011 & determined CMV Drivercould be certified for 2 yrs. Expiration date is 2 yrs from datethe exam was performed.


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Objective of clinical scenario to reinforce application of FMCSAregulations/guidance in clinical setting to effectively performCMV driver physical exam.

Use of example cases are optional. When used, the scenario can be usedas a whole or in part to develop learning strategies, such asvignettes, role plays, simulations, & group discussion.

Remember all FMCSA CDME test items assess knowledge acquiredthrough training in context of CDME performance of criticaltasks.

Format used to present medical facts for scenarios is based on dataCDME records on Medical Examination Report form.

Medical Examination Report Form — Ms. Karen Anderson

Ms. Anderson—Recertification Examination

Sex: Female | Age: 42 | Height: 67" | Weight: 172 lbs.

Health History: Yes response(s): None.

Medication(s): None.

Health History Comments:

Reports negative health history. Denies any current or recent prescriptionmedication or supplement use other than taking one-a-daymultivitamin formulated for women.


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Vision:Uncorrected Acuity: Rt. Eye: 20/20 Lt. Eye: 20/30 Both: 20/20Horizontal Field of Vision: Rt. Eye: 80° Lt. Eye: 80°Meets standard only when wearing: corrective lenses? NoColor: Can distinguish red, green, and amber colors? YesMonocular Vision? No

Hearing:Hearing aid used for test? NoHearing aid required to meet standard? NoWhisper test: Rt. Ear: 5 Feet Lt. Ear: 5 FeetAudiometric test hearing loss average: Rt. Ear: N/A Lt. Ear: N/ABlood Pressure/Pulse: BP-134/88 P-80 & RegularUrinalysisSP. GR.: 1.020 | Protein: 1+ | Blood: 4+ | Glucose: NegHemoglobin: 12.4

Physical Examination Comments: Currently on 4th day of menses withheavy bleeding. CMV Driver denies any change in alertnessaffecting driving ability. Advised her to consult PCP or GYNspecialist for evaluation of excessive bleeding that might lead toanemia which could cause her to tire easily, increasing her riskfor unsafe driving.

Stems and Keys:Best Outcome

Stem: What is the certification decision in this scenario?

Key: Certify Ms. Anderson for 2 years. She has no DQ health history orphysical examination abnormalities


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Health History Documentation:

Stem: Even though Ms. Anderson reported a negative health history,what important information did CDME ask about IN reviewingher health history?

Key: CME asked about medication usage, including supplements,which many drivers may not report because they do not considerthem medications & are unaware of medical implications of theuse of supplements.

Required Test Documentation

Stem: Which reported test result did CDME Obtain based onphysical examination findings & not as part of the requiredtesting?

Key: Hemoglobin.

Physical Examination Comments:

Stem: Do you think the comment adequately documents findings?Justify your answer.

Key: CDME correctly noted body system in which there was anabnormal finding. The note reflects inquiry as to affect on drivingability & is also supported by hemoglobin test results.CDME also documented advice for medical follow up for acondition that could worsen & interfere with safe operation ofa CMV.

Date post:	13-Feb-2018
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