CDME Module 1: Overview-Hegmann KT, et.al. FMCSA’s Medical Review Board; Five years of progress in Commercial Driver Medical Examinations.

Pdf Summary

The Federal Motor Carrier Safety Administration's Medical Review Board (MRB) has been working to revise and update guidance recommendations to evaluate commercial drivers for the past five years. However, there is a lack of quality literature evaluating the risk of crash among commercial motor vehicle drivers for most medical conditions. Little literature is available for crash risk among all drivers. For select conditions such as seizure disorders, obstructive sleep apnea, and narcolepsy, there is evidence of increased crash risk among the general driving population, and evidence-based guidance is available. The MRB has developed detailed guidance for assessing commercial drivers with various disorders, but many challenges remain. <br />  <br />Commercial driving is one of the most dangerous occupations, with transportation-related fatalities accounting for a significant percentage of occupational fatalities. Approximately 20% of truck crashes are estimated to be related to one or more medical factors. The medical examinations for airline pilots are rigorous, with trained and licensed physician experts performing the evaluations. However, for commercial driver medical examinations (CDME), individuals with varying credentials have been qualified to perform these exams, resulting in lax medical oversight of the process. This lack of oversight is particularly problematic for bus drivers, where multiple fatalities can occur in a single crash. <br />  <br />In 2005, the US Congress passed legislation requiring the update of medical qualifications for commercial drivers involved in interstate commerce. This legislation established the MRB, tasked with advising the Federal Motor Carrier Safety Administration (FMCSA) on physical qualifications for commercial motor vehicle drivers. The MRB has addressed guidance for various medical conditions, including cardiovascular disorders, diabetes mellitus, obstructive sleep apnea, epilepsy, and more. The MRB has reviewed evidence reports, convened medical expert panels, and made recommendations to the FMCSA. However, there are still many topics that need to be addressed, and challenges remain in terms of standardization, qualifications for examiners, and determining appropriate screening criteria for certain conditions.

Asset Caption

JOEM 2012;54:424-430 a

Keywords

Federal Motor Carrier Safety Administration

Medical Review Board

commercial drivers

crash risk

medical conditions

evidence-based guidance

commercial driving

occupational fatalities

medical factors

commercial driver medical examinations