Student Outline. Improving Transportation Safety: Commercial Driver Medical Examiner Training CHAPTER 1. General FMCSA Information
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1 Student Outline CHAPTER 1 General FMCSA Information FMCSA Mission Statement / Dedicated to Safety / NRCME Important Definitions Regulations Vs. Medical Guidelines Privacy and the Medical Examination
2 13 Standards/Regulation 49 CFR Non-discretionary Standards Exemptions (see Resources tab for more information) 2 P a g e
3 CHAPTER 2 Role of Medical Examiner Who Can Be a Medical Examiner? Responsibilities of a Medical Examiner/Regulation 49 CFR Medical Certification Required for: Medical Examination Report Form (PDF) Driver Information Health History Vision Hearing Blood Pressure/Pulse Urinalysis Physical Examination Determine Certification Status Certify Disqualify Medical Examiner's Certificate (PDF) The Job of Commercial Motor Vehicle (CMV) Driver The Driver and Driver Role 3 P a g e
4 Medical Examine Requirements CHAPTER 3 Unlike regulations which are codified and have a statutory base, the recommendations in advisory 49 CFR (b) are simply guidance established to help the medical examiner determine a driver's medical qualifications pursuant to Section of the Federal Motor Carrier Safety Regulations (FMCSRs). For more information on medical advisory criteria, see Physical Qualification Standards / Health History VISION 49 CFR (b)(10) Ophthalmic Preparations Vision Tests Ophthalmic Diseases Federal Vision Exemption Program (see Resources tab for more information) 4 P a g e
5 HEARING 49 CFR (b)(11) Physical Exam Hearing Tests Otic Disease and Conditions CHAPTER 4 Measure Blood Pressure & Check Pulse (know your JNC 6 BP numbers) Essential Hypertension Stage 1 Hypertension Stage 2 Hypertension Stage 3 Hypertension Secondary Hypertension Labs/Tests 5 P a g e
6 Cardiovascular Disease See Cardiovascular Recommendation Tables (PDF in Resources Section) Anticoagulant Therapy Cardiovascular Tables Archive Aneurysms, Peripheral Vascular Disease, and Venous Disease and Treatments Abdominal Aortic Aneurysm Acute Deep Vein Thrombosis Chronic Thrombotic Venous Disease Intermittent Claudication Other Aneurysms Peripheral Vascular Disease Post-Surgical Repair of Aneurysm Pulmonary Emboli Superficial Phlebitis Thoracic Aneurysm Varicose Veins Cardiac Arrhythmias and Treatments Implantable Cardioverter-Defibrillators Pacemakers Supraventricular Arrhythmias Ventricular Arrhythmias 6 P a g e
7 Cardiovascular Tests Echocardiography Exercise Tolerance Test Coronary Heart Diseases and Treatments Acute Myocardial Infarction Angina Pectoris CHD Risk-Equivalent Multiple CHD Risk Factors Coronary Artery Bypass Grafting Heart Failure Percutaneous Coronary Intervention Congenital Heart Disease Ebstein Anomaly Heart Transplantation Syncope CHAPTER 5 RESPIRATORY Allergy Asthma Chronic Obstructive Pulmonary Disease Chronic Sleep Disorders Infectious Respiratory Diseases Acute Infectious Diseases Atypical Tuberculosis Pulmonary Tuberculosis Non-infectious Respiratory Diseases Chest Wall Deformities 7 P a g e
8 Cystic Fibrosis Pneumothorax Pulmonary Function Tests Secondary Respiratory Conditions and Underlying Disorders Chronic Sleep Disorders Cor Pulmonale Pulmonary Hypertension Sleep Disorder Tests NEUROLOGICAL Anticonvulsant Therapy Episodic Neurological Conditions Acute Seizures Structural Insult to the Brain Acute Seizures Systemic Metabolic Illness Childhood Febrile Seizures Epilepsy Headaches Single Unprovoked Seizure Vertigo and Dizziness Infections of the Central Nervous System Neuromuscular Diseases Muscular Dystrophies Progressive Neurological Conditions Central Nervous System Tumors Static Neurological Conditions Embolic and Thrombotic Strokes Intracerebral and Subarachnoid Hemorrhages Transient Ischemic Attack Traumatic Brain Injury 8 P a g e
9 MUSCULOSKELETAL Skill Performance Evaluation 49 CFR (see Resources tab for more information) Fixed Deficit of an Extremity Musculoskeletal Tests Grip Strength Tests Neuromuscular Diseases CHAPTER 6 Diabetes Mellitus Federal Diabetes Exemption Program (see Resources tab for more information) Incretin Mimetic Insulin Therapy Non-Insulin Medications 9 P a g e
10 CHAPTER 7 Psychological Disorders Antidepressant Therapy Antipsychotic Therapy Anxiolytic and Sedative Hypnotic Therapy Central Nervous System Stimulant Therapy Electroconvulsive Therapy Lithium Therapy Adult Attention Deficit Hyperactivity Disorder (AHDH) Bipolar Mood Disorder Major Depression Personality Disorders Schizophrenia and Related Psychotic Disorders Drug Abuse and Alcoholism Role of Certified Substance Abuse Professional (SAP) (See Resources tab for more information) Drug Abuse Medication Use Schedules of Controlled Substances 10 P a g e
11 CHAPTER 8 Key Points Health Counseling (See Resources tab for more information) Certification Maximum certification period is 2 years. ME can certify for less than 2 years, when: More frequent monitoring is indicated by history and/or physical examination. Medical guidance recommends a period less than 2 years. Provision of Federal exemption requires annual medical examination. Needed to ensure adequate monitoring of a medical condition that may change and be potentially disqualifying Disqualification Inform CMV driver of rationale for delaying or potentially disqualifying certification, which may include: Immediate post-operative period Vision disability (retinopathy, macular degeneration) Cardiac event (myocardial infarction, coronary insufficiency) Chronic pulmonary exacerbation (emphysema, COPD fibrosis) Uncontrolled hypertension Endocrine dysfunctions (diabetes, thyroidism) Musculoskeletal challenges (arthritis, neuromuscular disease) Neurological event (seizures, stroke, TIA) 11 P a g e
12 Sleep disorder (obstructive sleep apnea) Mental / emotional health (depression, schizophrenia) Mental health dysfunctions (depression, bipolar) NOTES 12 P a g e
13 13 P a g e
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