Fitness to Drive

For commercial and private vehicle drivers March 2012

Health professionals have an ethical obligation and potentially a legal one to give clear advice to the patient in cases where illness of injury may affect safe driving ability.
You should note in the medical record the nature of advice given.

"There are rare occasions in wheich there are ethically and legally justifiable reasons for breaching patient confidentiality." The duty to maintain confidentially is legally qualified in certain circumstances in order to protect public safety.

Consider directly reporting to the driver licencing authority whether the patient is:

• unable to appreciate the impact of their condition
• unable to take notice of the health professional's recommendations due to cognitive impairment
• continues driving despite appropriate advice and is likely to endanger the public

It is preferrable if any action taken is done so with patient consent....and if not consent then at least their knowledge of the intended action.

If there are concerns about hostility then patients can be referred directly to the driver licencing authority without a recommendation re fitness to drive.

1. GPs must advise the patient if a medical condition is going to impact on the patient's ability to drive safely.
2. Drivers are required by law to let the DLA (driver licencing authority) know if they have a serious condition which may affect their driving.
3. The DLA will then let the driver know if they need a medical examination by the GP.

If your patient doesn't seem to keen to advise the DLA, it may be wise to gently remind them that there can be long term financial and legal consequinces from not reporting a medical condition which might affect their driving ability. The driver's insurance may also not cover them anymore.

blackouts
aim is to determine cause of blackouts
if it is a "one-off" event such as a faint (or vaso-vagal) after an episode of dehydration then there is no need to notify the DLA.
blackouts with unknown cause (not syncope, not seizure etc) driver cannot hold unconditional licence. If the balackout(s) occur in a 24 hr period, and there are no further blackouts for 6 months (5 years for commercial standard) then DLA will consider a conditional licence (reviewed yearly).

cardiac event/ procedures

• After most cardiac events (such as an acute MI, a valve replacement) there is a 2 to 6 week non driving period.
• After an AMI a private driver is unable to hold an unconditional licence.
• It is NOT possible to hold a commercial vehicle licence and have an implantable defibrilator (a conditional licence is needed for a standard pace-maker).
• A patient on warfarin may hold an unrestricted private licence but commercial vehicle drivers are restricted to a conditional licence.
• A private driver with well controlled angina does not need a restricted licence but a commercial vehicle driver needs a conditional licence (and this must be issued by a specialist)
• after a cardiac arrest there is a 6 month non driving period before a conditional licence can be considered. This period may be shortened but requires a specialist assessment.
• private licence: BP must not be over 200 systolic or over 110 diastolic for an unconditional licence. Commercial licence: BP must not be over 170 s or over 100 d. or the patient requires specialist assessment.

A patient is unable to hold a commercial licence if they have

• an ICD (an implantable cardioverter defribrilator) for ventricular arrhythmias

Diabetes
Provide advice about regulating BGLs and sensible eating to all drivers.

• It is recommended that patients do not drive for a minimum of 6 weeks following a severe hypogylcaemic episode.
• provate vehicle drivers can hold an unrestricted licence (with 5 yearly review) if they are managed by medications other than insulin
• A commercial vehicle driver who has diabetes which is well controlled on metformin alone must have an initial assessment by a specialist endocrinologist. After this, if the specialist agrees, the GP can provide the following yearly medical assessments.
• A private vehicle driver with insulin controlled diabetes needs 2 yearly review and a conditional licence.
• A commercial vehicle driver on insulin needs a yearly review by an endocrinologist
• Any driver who has diabetes controlled by diet and exercise alone can hold an unrestricted licence (commercial or private)

Hearing Loss
There are no hearing standards for private drivers
A commercial driver is unable to hold an unconditional licence if they have unaided hearing loss greater than or equal to 40 db in the good ear. An ENT specialist is required to advise about suitability for a conditional licence.



A specialist (not a GP) must be the one to provide information re a conditional licence for a commercial vehicle driver