NRCME Medical Exam Part III (ME Guidelines)

What are the 3 areas considered when looking at safety implications for the driver? Physical, Mental, and current medical treatment What aspects of physical symptoms should be considered by the medical examiner? Symptoms - does a benign underlying condition have symptoms that interfere with driving? Incapacitation - is the onset of symptoms too rapid to be considered safe? What aspects of mental symptoms should be considered by the medical examiner? Cognitive - can the driver process visual clues at an appropriate rate? Behavioral - is the driver's behavior appropriate and non-violent? What aspects of medical treatment should be considered by the medical examiner? Effects - safer on the medication than off the medication? Side effects - do they interfere with safe driving? Section one of the medical examination report is filled out by whom? who is responsible for the accuracy of this information? driver; ME Section two of the ME report is the health history. is the doctor required to discuss any portion of this section? Yes, any box that is checked "yes" must be discussed. What should the doctor ask if "head/brain injuries" is checked "yes" determine if the symptoms come in recurring episodes or if there are any residual physical, cognitive, or behavioral effects What should the doctor ask if "Seizures/epilepsy" is checked "yes" - does the patient have a dx of epilepsy? (2+ unprovoked seizures) - this is disqualifying - write down type, duration, fq, and date What should the doctor ask if "eye disorders" is checked "yes" ask about glare issues, changes in vision, dx, etc. What should the doctor ask if "ear disorders" is checked "yes" changes in hearing, ringing, balance issues, dizziness, etc. What should the doctor ask if "CVD" is checked "yes" -hx of CVD, syncope, dyspnea, CHF, angina, etc. - if s/s are present, the driver must be cleared by a cardiologist before being certified - if current dx of CVD, consult with their current physician and obtain documentation. What should the doctor ask if "heart surgery" is checked "yes" -obtain heart surgery information including pertinent operative reports. it is mandatory to get documentation from the cardiologist prior to certification. - don't certify any driver with an ICD/pacemaker What should the doctor ask if "high blood pressure" is checked "yes" make sure the medication isn't effecting the driver make sure it hasn't caused any organ damage including CVD What should the doctor ask if "musculoskeletal disease" is checked "yes" check that the disease or medication wont cause sudden incapacitating effects on the driver. What should the doctor ask if "kidney disease" is checked "yes" ask about renal failure, they cannot drive if on dialysis What should the doctor ask if "DM or elevated blood sugar" is checked "yes" Ask about tx: diet, meds, byetta, or insulin If type I DM the me must finish the exam and check "meets standard but periodic monitoring is mandatory". due to "insulin tx". one year max cert, must be accompanied by a waiver. What should the doctor ask if "missing or impaired lime/digit" is checked "yes" remember that an SPE is required for fixed deficits of the extremities. What should the doctor ask if "alcohol abuse" is checked "yes" utilize CAGE questionnaire, refer to specialist if needed What should the doctor ask if "narcotics/habit forming drugs" is checked "yes" dq driver if the driver's medication adversely impacts the ability of the driver to operate the vehicle safely. What 3 things should the doctor include when commenting on positive health hx items? 1. nature of a positive hx and effect on driving 2. discussion about medication and tx effects/side effects 3. copy any supplementary medical reports obtained What is the required distant visual acuity in each eye? 1. 20/40 snellen with or w/o corrective lenses in each eye 2. 20/40 binocular vision 3. monocular vision is automatically disqualifying What is the required visual field for drivers? field of vision of at least 70 degrees in the horizontal meridian