Department of Transportation (DOT) Medical Examination

1. Department of Transportation (DOT) Medical Examination Maureen Mathews, APN, CNP OSF Occupational/Employee Health 27 February 2013

2. Who can complete the exam? Providers who have a state license which permits completion of this type of exam: • Physicians • Physician Assistants • Advanced Practice Nurses • Chiropractors

3. Final Rule of National Registry • Published in Federal Register April 2012 • Medical Examiner Requirements: • State licensure to practice • Complete FMCSA physical qualification standards • Pass FMCSA Certification Test • Refresher training 5 years, recertification testing every 10 years

4. Certification Exam • Provider training required prior to taking exam • Training can be class room, web based, self paced, or literature review • No required length of training • Proof of training

5. Certification Exam • Approved testing sites • National Registry Website – https://nationalregistry.fmcsa.dot.gov • List of certified providers, resources • Medical Examiner Handbook • Required monthly reporting of exams

6. Purpose • Primary reason for DOT license is protection of public • Some medical conditions automatically disqualify drivers • Some conditions require clearance from a specialist, such as cardiologist, etc.

7. Denial Criteria • Conditions for denial of license: • Diabetes mellitus treated with insulin – unless has exemption • Seizure disorder • Significant visual loss - exemption • Significant hearing loss • Currently taking methadone • Controlled substance/habit forming drug without script

8. Diabetes • If taking insulin, cannot be certified • If diabetes is controlled with oral (pill) medication and/or diet, may be licensed if diabetes is well controlled • Requires documentation from primary provider or endocrinologist • http://www.fmcsa.dot.gov/rules-regulations/topics/medical/exemptions.htm

9. Seizures • If diagnosis of epilepsy and recurrent seizures, may not be certified • If one seizure or loss of consciousness, may be certified if not taking medications for seizure and seizure free for 5 years or seizure free for 10 years if multiple seizures • Childhood seizures related to fever are not disqualifying • May need documentation from neurologist

10. Vision Loss • Vision must be at least 20/40 in each eye with or without correction (glasses/contacts) • Certification can be given after retested with correction • Field of vision must be at least 70 degrees in each eye (peripheral or side vision) • Color vision, must be able to recognize traffic signals (red, green, amber/yellow)

11. Hearing Loss • Must pass a whisper test in at least one ear at 5 feet • A hearing aid may be worn for test • May need an audiogram, better ear must not have average hearing loss of more than 40dB at 500, 1000, and 2000 Hz (add three decibel losses and divide by 3)

12. Possible Denial • Nine conditions MAY cause denial • Loss of hand, arm, foot, or leg • Impairment of a hand or leg • Cardiovascular disease (heart disease) • Respiratory (lung) disease • Hypertension (high blood pressure)

13. Possible Denial • MAY cause denial • Musculoskeletal, neurological, vascular diseases • Mental, nervous, organic or psychiatric disorders • Use of schedule I drugs or consciousness altering drugs • Alcoholism

14. Loss of hand, arm, foot, or leg • Loss of an appendage (as above) requires a waiver from the regional director of motor carriers

15. Impairment of a hand or leg • A defect of a limb (hand or leg) may require a waiver from an orthopedic/neurologic specialist • This might include fused or immobile knee or hip joint, partial paralysis • If a significant impairment interfering with ability to operate motor vehicle, may be disqualifying

16. Cardiovascular disease • Any heart condition which causes sudden or unexpected loss of consciousness or collapse is disqualifying • Congestive heart failure is disqualifying • Previous heart attack, chest pain, dysrhythmias (electrical problems) will probably need clearance from cardiologist

17. Respiratory disease • If symptoms of respiratory disease may need pulmonary function tests (spirometry) • Further testing and/or clearance from primary provider or pulmonologist (lung specialist) may be needed

18. Hypertension • Blood pressure (BP) ≤ 160/90 • BP >160/90, < 181/105, may have temporary certification for 3 months • If > 181/105, not certified • When BP is controlled, the certification can be issued for 1 year at a time

19. Musculoskeletal, neurological, vascular diseases • Any condition that affects the ability to safely control a motor vehicle or affect reaction times may disqualify an individual

20. Mental, nervous, organic or psychiatric disorders • Conditions that can affect thinking and reasoning may be disqualifying • May need clearance from neurologist or psychiatrist • Medications that can affect consciousness or reaction times may be disqualifying

21. Use or schedule I drugs or consciousness altering drugs • Use of schedule I drugs, or any other conscious altering substance is disqualifying (amphetamine, narcotic, other habit forming drug) • Other medications and conditions requiring regular use of medication must be consistent with safe performance of duties

22. Alcoholism • Current diagnosis, which means the physical and mental condition of the individual is not fully stabilized, regardless of time • If condition is uncertain, may need evaluation and clearance by a substance abuse counselor

23. Health Counseling • Medication side effects • Monitoring of chronic illness such as diabetes, high blood pressure • Sleep, fatigue, diet, exercise • Contacts/glasses • Hydration, absorbable glucose, self monitoring, glucose logs

24. References Hartenbaum, N. (2010). The DOT medical examination. 5th ed. OEM Press, Beverly Farms, MA Pommerenke, F., Hegmann, K., & Hartenbaum, N. (1998). DOT examinations: practical aspects and regularity review. American Family Physician.58(2): 415-426

25. QUESTIONS????