MODULE 1 OVERVIEW Flashcards
Hartenbaum’s Rule On Commercial Driver’s Med Eval
With the exception of the absolute regulated criteria, there is often NO absolute answer for a given diagnosis.
This Applies to all drivers with that diagnosis.
FMCSA Regulation 390.3 (d)
Relates to “ADDITIONAL REQUIREMENTS”.
The FMCSA can’t prohibit employers from requiring/enforcing more stringent criteria relating to safety of operation and employee safety & health.
Regulation 391.41
Physical Qualifications for Drivers
What Regulation Number Covers Physical Qualifications for Drivers
391.41
Regulation 391.46
Physical Qualification Standards for an individual with diabetes mellitus treated with insulin for control.
What Kind of Drivers (Intra- OR Inter- State) Require FMCSA Medical Examination
Interstate, PLUS:
- Vehicle weight of 10,001 lbs or more
- Transports 9 to 15 passengers for payment (including driver)
- Transports 16 or more passengers w/ or w/o payment (including driver)
- Transports hazardous materials in quantities that require placarding under hazardous material regs
At what vehicle weight is drug testing required for CDL?
26,001 lbs or more
Are all intra-state drivers exempt from FMCSA medical standards?
No. Some states may require intrastate drivers to meet FMCSA medical criteria.
Interstate Commerce Definition
Refers to property (not operator)
Tools and Vehicle may be considered property.
What Regulation Discusses “Who Must Be Examined”
391.45
Who Must Be Examined
Any person who has not been medically examined and certified as physically qualified to operate a commercial motor vehicle.
Any driver who has not been certified during the preceding 24 months, OR sooner if required.
What Drivers Require Med Examination q12 Months?
1) Exempt intra-city zone drivers
2) Drivers in waiver programs
3) Drivers on Insulin
4) Any Driver whose ability to perform has been impaired by a physical or mental injury or disease.
Must a Driver who is returning from an illness or injury undergo a medical examination even if his current medical certificate has not expired?
FMCSRs do NOT require examination unless the injury/illness has impaired the driver’s ability to perform normal duties.
HOWEVER, the employer/motor carrier may require one… and either way, it’s up to the MC to determine necessity of exam.
Responsibility of Employer vs Examiner
Employer’s responsibility to make sure employee is medically qualified by having them examined by examiner on the national registry.
Examiner’s responsibility to determine the employee’s medical qualification status.
Stress Factors Affecting Drivers
Environment (Ice, Snow, Rain, Altitude), Schedules (hours), Routes (terrain/traffic), Types of Cargo (bread, gasoline, electronics)
Driver’s Duties
Coupling and Uncoupling Trailers
Loading/Unloading (50-75lbs)
- Need to properly secure objects from flying off, need to evenly distribute weight
Vehicle/Trailer Inspection
Lifting, Installing, and Removing Chains/Tarps
Bending, Stooping, Crouching, Climbing
What Kind of Restrictions Can an Examiner Write on CDL?
VERY LIMITED (No MSK, No Hours, etc).
When Examining for CDL, does it only apply to the driver’s current position?
NO! This is important to keep in mind. CDL can be used at other positions requiring other duties. Just because a job may seem light and easy, doesn’t mean the next one will be. Standards must be universal
Purpose of CDME
“Medical Fitness for Duty”
Examiner must determine if driver has any condition that would result in unacceptable risk of sudden incapacitation and endanger public
Acceptable Risk
1% annual risk of sudden incapacitation / impairment is often used
Certification Reminders
Examiner must be certified / have their own registry number AND be licensed in the state where you are examining drivers. Drivers can be from out of state.
DL Number on Exam Form (Section 1 Driver Information)
Can be normal or commercial DL (mark what kind of ID was used)
Driver Health Info Key Points
DL number and ID verified (may or may not be CDL #)
Email Optional
CLP/CDL applicant/holder – Required to declare intra or inter state
Exam Date (Which Date)
Date Exam Performed (Started) … NOT date of determination or any other date, OKAY!
Can You Stop an Exam Short If you find a disqualifying condition early on?
NO. Exam must be completed once started.
AND, Determination should NOT be discussed until after entire physical exam is complete.
In Health History, What Answers are the Examiner required to comment on?
Yes and Not Sure responses
Required Exam Testing (5)
1) BP & Pulse
2) Height/Weight (NOT BMI)
3) UA
4) Visual Acuity
5) Hearing (Whisper Test OR Audiometric Testing)
*Others MAY be done (EKG, BMI, Audiogram, PFT’s, TTE, Sleep Study, Imaging, Etc.)
What can an examiner use BMI to determine?
BMI 40+ can be used to suggest OSA screening.
Audiometric Testing in Hz?
Both Ears, 500-1000-2000 Hz
Visual Acuity Points
Do NOT have to perform with BOTH corrective and uncorrected lenses (just one or the other)
May send to Optometrist/Eye doctor to complete that portion of the exam
Medical Examiner Determination (Federal vs State)
Only have to pick one. Federal covers both, but they may meet INTRA state if they meet state requirements. Some states haven’t adopted fed regs
*NO “Determination Pending” Status for Intrastate Exams
Examiner Determination Options (Federal)
- Does NOT meet standards
- Meets Standards (2 year certification)
- Meets Standards (but more frequent exams, than 2 years… days, months, etc)
- Determination Pending (must fu in 45 days or less)
- Incomplete Exam
Who Must examiner inform when Driver disqualified?
The Driver, and FMCSA
Federal Vision Exemption Recertification Time Period
1 year (or less per examiner discretion)
When Does A Med Exam Certificate Expire?
At midnight on day/month and year written on certificate.
NO GRACE PERIOD
When Does an Incomplete Exam Happen?
When Driver decides to stop
this is NOT to avoid determination (as determination should NOT be mentioned until the exam is totally complete).
Determination Pending Points
Follow Up Must Occur within 45 days or less
The Amended Report Date becomes the date of expiration (not the original date of exam when determination pending started)
The Driver can still Drive - ONLY IF they have a current active medical certificate while their new one is pending.
Information Needed Scenario
Examiner CAN certify for 30-60-90 days if they feel driver is safe (like just don’t have recent A1C but their CDL expires in 1 day)
Driver may NOT drive more than 1 day if CDL expires in 1 day AND examiner lists determination pending status
Does the date of the exam appear on the Examiner Certificate?
NO. Only the date the certificate is signed and the Expiration of the Medical Examiners Certificate (NOT the Examiners NRCME certificate expiration)
Visual Qualifications
20/40 in each eye without lenses
at least 70 degrees horizontal meridian in each eye
ability to recognize colors of traffic signals (red, green, amber)
Hearing Qualifications
Hear whisper at no less than 5 feet with/without hearing aid in at least one ear
Does not have average hearing loss greater than 40 decibels at 500-1000-2000 Hz with or without hearing aid
Controlled Substance Qualifications
Doesn’t use Schedule 1 drugs (like amphetamines / narcotics) UNLESS prescribed AND has letter/advisement that medication wont interfere with driving
Alcohol Qualifications
No Clinical Dx of Alcoholism or you’ll be disqualified
Can Examiners Grant Exemptions?
NO
Do FMCSA Regulations Dictate Who Pays for Exams?
No. Silent on anything financial. That’s up to employee/employers.
What happens if examiner certificate is lost or damaged?
Driver may request copy from examiner or carrier.
If previous examiner is gone, the new one can provide photo copy, sign a replacement, or require new exam altogether
Resolution of Conflicts of Med Exam
Disqualified until decision is made by Director of Motor Carrier Research and Standards (which makes decision based on impartial specialist agreed to by carrier/driver)
HIPPA and Exam Documents
Employer allowed to have Examiner Certificate (But NOT the medical long form unless HIPPA signed and agreed upon)
Difference between Medical Standards & Advisory Criteria & Guidelines?
Standards MUST be followed, no room for discretion.
(Vision, Hearing, Epilepsy, Insulin Use)
Advisory and Guidelines help assist decision making. Does not have to follow them, but should document why they aren’t.
Can the FMCSA grant exemptions for intrastate drivers?!
NOPE. Only inter-state
What Does the FMCSA Regulate?
INTER-State commercial ops (driver, vehicle, motor carrier & transport of hazardous material).
Not in charge of states processes (even if they’ve adopted fed requirements).
Where are regulations of driver physical qualifications found?
391.41
Where are regulations of med examiner responsibilities found?
391.43
Possible Outcomes of Driver’s Physical Examination
Qualified, Not Qualified, Determination Pending, Incomplete
