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1、Assessing fitness to drivefor commercial and private vehicle drivers2022 EDITION Medical standards for licensing and clinical management guidelinesA web version of the medical standards is available from the Austroads website:.auHelp for professionals For guidance in assessing a patients fitness to
2、drive contact your State or Territory driver licensing authority(seeAppendix 9 for details).Information is also available from the Austroads website:.au Assessing Fitness to Drive First Published 1998 Second Edition 2001 Third Edition 2003 Reprinted 2006 Fourth Edition 2012 Reprinted 2013 Fifth Edit
3、ion 2016 Reprinted 2017 Sixth Edition 2022 Austroads Ltd 2022 This work is copyright.Apart from any use as permitted under the Copyright Act 1968,no part maybe reproduced by any process without the priorwritten permission of Austroads.National Library of Australia Cataloguing-in-Publication dataAsse
4、ssing Fitness to Drive 2022ISBN:Hardcopy 978-1-922700-17-9;PDF 978-1-922700-21-6Austroads Publication Number:AP-G56-22 Published by Austroads Ltd Level 9,570 George Street Sydney NSW 2000 Australia Phone:+61 2 8265 3300 Email:.au .auAustroads believes this publication to be correct at the time of pr
5、inting and does not accept responsibility for any consequences arising from the use of information herein.Readers should rely on their own skill and judgement to apply information to particular issues.Assessing fitness to drivefor commercial and private vehicle drivers2022 EDITION Medical standards
6、for licensing and clinical management guidelines About Austroads and the NTCAustroadsAustroads is the collective of the Australian and New Zealand transport agencies,representing all levels of government.Austroads purpose is to support its member organisations to deliver an improved Australasian roa
7、d transport network.To succeed in this task,Austroads undertakes leading-edge road and transport research which underpins its input to policy development and published guidance on the design,construction and management of the road network and its associated infrastructure.Austroads also supports its
8、 members to achieve consistency and improvements in the application of registration and licensing practices,processes and systems.National Transport CommissionThe NTC is a national land transport reform agency that supports Australian governments to improvesafety,productivity and environmental outco
9、mes,provide for future technologies and improve regulatory efficiency.The NTC has a legislative requirement to develop,monitor and maintain uniform or nationally consistent regulatory and operational arrangements for road,rail and intermodal transport.As a key contributor to the national reform agen
10、da,the NTC is accountable to Commonwealth,state and territory ministers who are responsible for transport and infrastructure and make up membership of the Infrastructure and Transport Ministers Meeting(ITMM).The NTC works closely with ITMMs advisory body,the Infrastructure and Transport Senior Offic
11、ials Committee,which includes the headsof Commonwealth,state and territory agencies.ii About Austroads and the NTCAcknowledgementsSetting these standards involved extensive consultation across a wide range of stakeholders including regulators,employers and health professionals.The NTC and Austroads
12、gratefully acknowledge all contributors including the members of the Advisory Group,the Medicinal Cannabis Working Group,the project team and consultants.In particular,the contributions of various health professional organisations and individual health professionals are invaluable to the review proc
13、ess.Advisory GroupDerise CubinAccess CanberraRebecca WilsonAccess CanberraBill McKinleyAustralian Trucking AssociationDr Ramu NachiappanAustralian College of Rural and Remote Medicine Adam CameronDepartment for Infrastructure and TransportScott SwainDepartment for Infrastructure and TransportAmie Bu
14、ismanDepartment of Transport(WA)Karen WebbDepartment of State GrowthA/Prof.Sjaan KoppelMonash University Accident Research CentreAndreas BlahousNational Heavy Vehicle RegulatorEmily HicksOffice of Road SafetyParik LumbRoad Safety CommissionProf.Nigel StocksRoyal Australian College of General Practit
15、ionersLee CheethamTransport for NSWIrene SiuTransport for NSWYessenia Pineda-De LeonTransport and Main RoadsFiona MorrisDepartment of Transport(Vic)Dr Marilyn DiStefanoDepartment of Transport(Vic)Dr Sanjeev GayaVictorian Institute of Forensic MedicineiiiAcknowledgements Medicinal Cannabis Working Gr
16、oupDr Shruti NavatheAccess CanberraDavid SuttonDepartment for Infrastructure and TransportScott SwainDepartment for Infrastructure and TransportSharon Wishart Department of Transport(Vic)Tim UmbersDepartment of Transport(Vic)Amie BuismanDepartment of Transport(WA)Sussan OsmondDepartment of Transport
17、 and Main RoadsProf.Iain McGregorLambert Initiative for Cannabinoid Therapeutics,USYDDr Tamara NationNational Institute of Integrative MedicineA/Prof.Vicki KotsirilosNICM,University of Western SydneyAdelaide JonesOffice of Road SafetyProf.Edward Ogden St Vincents Hospital MelbourneProf.Yvonne Bonomo
18、 St Vincents Hospital MelbourneSally MillwardTransport for NSWDr Sanjeev GayaVictorian Institute of Forensic MedicineContributing health professional organisationsThe following organisations contributed substantially to the review process:Australian and New Zealand Association of Neurologists Austra
19、lian Diabetes Society Australasian Sleep Association Cardiac Society of Australia and New Zealand Cognitive Dementia and Memory Service Epilepsy Society of Australia Occupational Therapy Australia Optometry Australia Orthoptics Australia Stroke Society of Australasia The Royal Australian and New Zea
20、land College of Ophthalmologists The Royal Australian and New Zealand College of Psychiatrists.iv AcknowledgementsEndorsementsThese standards are endorsed by:Australasian Faculty of Occupational and Environmental Medicine Australasian Faculty of Rehabilitation Medicine Australasian Sleep Association
21、 Australian and New Zealand Association of Neurologists Australian College of Rural and Remote Medicine Australian Diabetes Society Cardiac Society of Australia and New Zealand Occupational Therapy Australia Royal Australian College of Physicians Accepted Clinical ResourceRoyal Australian College of
22、 General PractitionersLegal disclaimer These licensing standards and management guidelines have been compiled using all reasonable care,based on expert medical opinion and relevant literature,and Austroads believes them to be correct at the time of publishing.However,neither Austroads nor the author
23、s accept responsibility for any consequences arising from their application.Health professionals should maintain an awareness of any changes in healthcare and health technology that may affect their assessment of drivers.Health professionals should also maintain an awareness of changes in the law th
24、at may affect their legal responsibilities.Where there are concerns about a particular set of circumstances relating to ethical or legal issues,advice may be sought from the health professionals medical defence organisation or legal advisor.Other queries about the standards should be directed to the
25、 relevant driver licensing authority.v EndorsementsForewordIn 2020,1,106 people were killed on Australian roads,and many tens of thousands were hospitalised with serious injuries.The annual economic cost of road crashes in Australia is estimated to be$30 billion,which is accompanied by devastating s
26、ocial impacts.While many factors contribute to safety on the road,driver health and fitness to drive is an important consideration.Drivers must meet certain medical standards to ensure their health status does not unduly increase their crash risk.Assessing fitness to drive is a joint publication of
27、Austroads and the National Transport Commission(NTC)and details medical standards for driver licensing purposes for use by health professionals and driver licensing authorities.The standards are approved by Commonwealth,state and territory transport ministers and were first published in their curren
28、t form in 2003.The previous edition was published in 2016.Since its last publication,medical,legal and social developments have required that the medical criteria within the guidelines are updated to ensure they are accurate and reflect current practices.To this end,the NTC reviewed the guidelines,t
29、aking into account feedback from stakeholders,including medical professionals and expert consultants.This review produced revised guidelines in draft form,for public consultation in May 2021.Doctors,other health professionals,members of the public,consumer groups,commercial operators and drivers,tra
30、nsport peak bodies and governments submitted comments to the draft guidelines.Austroads and the NTC acknowledge the significant contribution of health professionals to road safety.Health professionals,in partnership with drivers,the road transport industry and governments,play an essential role in k
31、eeping all road users safe.Together we are working towards further reducing,and eventually eliminating,deaths and injuries from vehicle crashes on Australian roads.Dr Geoff Allan Chief Executive AustroadsDr Gillian Miles Chief Executive Officer and Commissioner National Transport Commissionvi Forewo
32、rdContentsA web version of the medical standards is available from the Austroads website:.auPart A.Fitness to drive principles and practices 11.About this publication 21.1.Purpose 21.2.Target audience 31.3.Scope 31.4.Content 41.5.Development and evidence base 52.Assessing fitness to drive generalgui
33、dance 72.1.The driving task 72.2.Impact of medical conditions on driving 102.3.Assessing and supporting functional driver capacity 213.Roles and responsibilities 253.1.Roles and responsibilities of driver licensing authorities 273.2.Roles and responsibilities of drivers 273.3.Roles and responsibilit
34、ies of health professionals 284.Licensing and medical fitness to drive 344.1.Medical standards for private and commercial vehicle drivers 344.2.Considerations for commercial vehicle licensing 354.3.Prescribed periodic medical examinations for particular licensing/authorisation classes 374.4.Conditio
35、nal licences 374.5.Reinstatement of licences or removal or variation of licence conditions 415.Assessment and reporting process stepby step 425.1.Steps in the assessment and reporting process 435.2.Which forms to use 50Part B.Medical standards 54Fitness to drive assessment 551.Blackouts 571.1.Releva
36、nce to the driving task 571.2.General assessment and management guidelines 571.3.Medical standards for licensing 582.Cardiovascular conditions 632.1.Relevance to the driving task 632.2.General assessment and management guidelines 632.3.Medical standards for licensing 71viiContents3.Diabetes mellitus
37、 923.1.Relevance to the driving task 923.2.General assessment and management guidelines 923.3.Medical standards for licensing 994.Hearing loss and deafness 1054.1.Relevance to the driving task 1054.2.General assessment and management guidelines 1064.3.Medical standards for licensing 1095.Musculoskel
38、etal conditions 1125.1.Relevance to the driving task 1125.2.General assessment and management guidelines2 1145.3.Medical standards for licensing 1176.Neurological conditions 1206.1.Dementia 1216.2.Seizures and epilepsy 1286.3.Other neurological and neurodevelopmental conditions 1527.Psychiatric cond
39、itions 1707.1.Relevance to the driving task 1707.2.General assessment and management guidelines 1717.3.Medical standards for licensing 1758.Sleep disorders 1798.1.Relevance to the driving task 1798.2.General assessment and management guidelines 1798.3.Medical standards for licensing 1859.Substance m
40、isuse 1909.1.Relevance to the driving task 1909.2.General assessment and management guidelines 1939.3.Medical standards for licensing 19610.Vision and eye disorders 20110.1.Relevance to the driving task 20110.2.General assessment and management guidelines 20210.3.Medical standards for licensing 209v
41、iii ContentsPart C.Appendices 214Appendix 1.Regulatory requirements fordriver testing 215Appendix 2.Forms 223Appendix 3.Legislation relating to reporting 227Appendix 4.Drivers legal BAC limits 235Appendix 5.Alcohol interlock programs 237Appendix 6.Disabled car parking and taxiservices 241Appendix 7.
42、Seatbelt use 243Appendix 8.Helmet use 245Appendix 9.Driver licensing authoritycontacts 247Appendix 10.Specialist driver assessors 251ixContentsPART A.Fitness to drive principles and practices1 PART A.Fitness to drive principles and practices11.About this publication1.1.PurposeDriving a motor vehicle
43、 is a complex task involving perception,appropriate judgement,adequate response time and appropriate physical capability.A range of medical conditions,disabilities and treatments may influence these driving prerequisites.Such impairment may adversely affect driving ability,possibly resulting in a cr
44、ash causing death orinjury.The primary purpose of this publication is to increase road safety in Australia by assisting health professionals to:assess the fitness to drive of their patients in a consistent and appropriate manner based on current medical evidence promote the responsible behaviour of
45、their patients,having regard to their medical fitness conduct medical examinations for the licensing of drivers as required by state and territory driver licensing authorities provide information to inform decisions on conditional licences recognise the extent and limits of their professional and le
46、gal obligations with respect to reporting fitness to drive.The publication also aims to provide guidance to driver licensing authorities in making licensing decisions.With these aims in mind the publication:outlines clear medical requirements for driver capability based on available evidence and exp
47、ert medical opinion clearly differentiates between national minimum standards(approved by the Infrastructure and Transport Ministers Meeting)for drivers of commercial and private vehicles provides general guidelines for managing patients with respect to their fitness to drive outlines the legal obli
48、gations for health professionals,driver licensing authorities and drivers provides a reporting template to guide reporting to the driver licensing authority ifrequired provides links to supporting and substantiating information.Routine use of these standards will ensure the fitness to drive of each
49、patient is assessed in a consistent manner.In doing so,the health professional will not only be contributing to road safety but may minimise medico-legal exposure in the event that a patient is involved in a crash or disputes a licensing decision.This publication replaces all previous publications c
50、ontaining medical standards for private and commercial vehicle drivers including Assessing fitness to drive 2001,2003,2012,2016(and its 2017 amendment)and Medical Examinations for Commercial Vehicle Drivers 1997.2About this publication1.2.Target audienceThis publication is intended for use by any he
51、alth professional who is involved in assessing a persons fitness to drive or providing information to support fitness-to-drivedecisionsincluding:medical practitioners(general practitioners and specialists)optometrists orthoptists occupational therapists psychologists physiotherapists diabetes educat
52、ors nurse practitioners and primary health care nurses case workers.The publication is also a primary source of requirements for driver licensing authorities in making determinations about medical fitness to hold a driver licence.1.3.Scope1.3.1.Medical fitness for driver licensingThis publication is
53、 designed principally to guide and support assessments made by health professionals regarding fitness to drive for licensing purposes.It should be used by health professionals when:1.Treating any patient who holds a driver licence whose condition may affect their ability to drive safely.Most adults
54、drive,therefore a health professional should routinely consider the impact of a patients condition on their ability to drive safely.Awareness of a patients occupation,licence category(mercial,passenger vehicle)or other driving requirements(e.g.shift work)is also helpful.2.Undertaking an examination
55、at the request of a driver licensing authority or industry accreditation body.Health professionals may be requested to undertake a medical examination of a driver for a number of reasons.This may be:for initial licensing of some vehicle classes(e.g.multiple combination heavy vehicles)as a requiremen
56、t for a conditional licence for assessing a person whose driving the driver licensing authority believes may be unsafe(i.e.for cause examinations)for licence renewal of an older driver(in certain states and territories)for licensing or accreditation of certain commercial vehicle drivers(e.g.public p
57、assenger vehicle drivers)as a requirement for Basic or Advanced Fatigue Management under the National Heavy Vehicle Accreditation Scheme(refer to www.nhvr.gov.au).This publication focuses on long-term health-and disability-related conditions and their associated functional effects that may impact on
58、 driving.It sets out clear minimum medical requirements for unconditional and conditional licences that form the medical basis of decisions made by the driver licensing authority.This publication also provides general guidance with respect to patient management for fitness to drive.It does not addre
59、ss general management of clinical conditions unless it relates to driving.This publication outlines two sets of medical standards for driver licensing or authorisation:private vehicle driver standards and commercial vehicle driver standards.3 PART A.Fitness to drive principles and practicesThe stand
60、ards are intended for application to drivers who drive within the ambit of ordinary road laws.Drivers who are given special exemptions from these laws,such as emergency service vehicle drivers,should have a risk assessment and an appropriate level of medical standard applied by their employer.At a m
61、inimum,they should be assessed to thecommercial vehicle standard.1.3.2.Short-term fitness to driveThis publication does not attempt to address the full range of health conditions that might impact on a persons fitness to drive in the short term.Some guidance in this regard is included in section 2.2
62、.3.Temporary conditions.In most instances,the non-driving period for short-term conditions will depend on individualcircumstances and should be determined by the treating health professional based on an assessment of the condition and the potential risks.1.3.3.Fitness for dutyThe medical standards c
63、ontained in this publication relate only to driving.They cannot be assumed to apply to fitness-for-duty assessments(including fitness for tasks such as checking loads,conversing with passengers andundertaking emergency procedures)without first undertaking a task risk assessment that identifies the r
64、ange of other requirements for aparticular job.1.4.ContentThis publication is presented in three parts.Part A comprises general information including:the principles of assessing fitness to drive specific considerations including:the assessment of people with multiple medical conditions or age-relate
65、d change the management of temporary conditions,progressive disorders and undifferentiated illness the effects of prescription and over-the-counter drugs the role of practical driver assessments and driver rehabilitation the roles and responsibilities of drivers,licensing authorities and health prof
66、essionals what standards to apply(private or commercial)for particular driver classes the application of conditional licences the steps involved in assessing fitness todrive.Part B comprises a series of chapters relating to relevant medical systems/diseases.The medical requirements for unconditional
67、 and conditional licences are summarised in a tabulated format to differentiate between the requirements for private and commercial vehicle drivers.Additional information,including the rationale for the standards,as well as a general assessment and management considerations,is provided in the suppor
68、ting text of each chapter.Part C,the appendices,comprises further supporting information including:regulatory requirements for driver assessment in each jurisdiction guidance on forms for the examination process and reporting to the driver licensingauthority legislation relating to driver and health
69、 professional reporting of medical conditions4About this publication legislation relating to blood alcohol,seatbelt use,helmet use and alcohol interlocks contacts for services relating to disabled parking and transport,occupational therapist assessments and driver licensing authorities.1.5.Developme
70、nt and evidence baseThe evidence that underpin the licensing criteria and guidance are sourced from medical and fitness-to-drive studies,medical guidelines and expert opinion.A reference list of important studies is provided at the end of each chapter.In addition to evidence regarding crash risk and
71、 the effects of medical conditions on driving,evidence has also been sought regarding best practice approaches to driver assessment and rehabilitation.A key input in terms of evidence for the licensing criteria remains the Monash University Accident Research Centre report Influence of chronic illnes
72、s on crash involvement of motor vehicle drivers:3rd edition.This is an update of the second(2010)edition of the report and provides a comprehensive review of published studies involving drivers of private and commercial motor vehicles.The report investigates the influence of selected medical conditi
73、ons and impairments on crash involvement,in the context of condition prevalence and quality of evidence of crash involvement.1,2In compiling this report,the Monash University Accident Research Centre led an international research consortium to compile,review and interpret the best available evidence
74、 on each topic.Nevertheless,for most conditions,the report acknowledges the limited evidence available and that the quality of evidence is variable.In interpreting the research,there is therefore a need to consider several sources of potential bias including the following:There is a healthy driver e
75、ffect whereby drivers with a medical condition may recognise that they are not able to fully control a car and may either cease driving or restrict their driving.Their opportunity to be in a crash is therefore reduced,and this contributes to a lower crash risk than may otherwise be expected.The defi
76、nition and incidence of crashes when driving often depends on self-reporting,which may lead to over-or under-reporting in some studies.The definition of a medical condition is by self-report in some studies and may not beaccurate.The exposure metric(i.e.kilometres travelled)is often not controlled f
77、or,yet is crucial for determining the risk of a crash.Sample sizes may be small and not represent the general population of drivers.The control group may not be properly matched by age and sex.Commercial drivers are rarely considered as a separate cohort,and generalisations based on evidence from pr
78、ivate motor vehicle drivers may not be appropriate.Studies rarely identify whether and how drivers are treated/untreated for example,corrected vision for those with vision impairments and hearing aids for those with hearing impairments.Comorbidities may not be adjusted for(e.g.alcohol dependence).5
79、PART A.Fitness to drive principles and practicesThe implications are that false-negative results may occur whereby the condition appears to have no effect or minimal effect on driving safety.The authors acknowledge that care should be taken in interpreting the literature and that professional opinio
80、n plus other relevant data should be taken into account in determining the risks posed by medical conditions.The authors also note that the review focused on published peer-reviewed literature.There was no inclusion of technical reports,conference presentations or abstracts,case studies,coroner repo
81、rts or studies,cohort studies(without a control group)or reviews of consensus-based medical standards for any of the medical conditions reviewed.For the purposes of this publication the term crash refers to a collision between two or more vehicles,or any other accident or incident involving a vehicl
82、e in which a person or animal is killed or injured,or property is damaged.Health professionals should also keep themselves up to date with changes in medical knowledge and technology that may influence their assessment of drivers,and with legislation that may affect the duties of the health professi
83、onal or the patient.6About this publication2.Assessing fitness to drive generalguidanceThe aim of determining fitness to drive is to achieve a balance between:minimising any driving-related road safety risks for the individual and the community posed by the drivers permanent or long-term injury or i
84、llness,maintaining the drivers lifestyle and employment-related mobility independence.The key question is:Is there a likelihood the person will be unable to control the vehicle and/or unable to act or react to the driving environment in a safe,consistent and timely manner?The main considerations in
85、making this assessment are:the driving task,including the persons individual driving requirements and mobility needs(refer to section 2.1.The driving task)the potential impacts of medical conditions,disabilities and treatments(refer to section 2.2.Impact of medical conditions on driving)the drivers
86、functional abilities including their capacity to compensate and the need for rehabilitation(refer to section 2.3.Assessing and supporting functional driver capacity).The general guidance provided in this section should be considered in conjunction with the specific criteria and management guidelines
87、 for individual conditions outlined in Part B of this publication.In light of the information gathered across these areas,the health professional may advise the patient regarding their fitness to drive and provide advice to the driver licensing authority(refer to section 3.Roles and responsibilities
88、).The threshold tolerance is much less for commercial vehicle drivers where there is the potential for more time on the road and more severe consequences in the event of a crash(refer to section 4.1.Medical standards for private and commercial vehicle drivers).In cases where a person may only be fit
89、 to drive in some circumstances or requires periodic review to monitor the progression of their condition,the health professional may advise conditions under which driving could be performed safely(refer to section 4.4.Conditional licences).Detailed steps for performing the assessment and managing t
90、he outcome are found in section 5.Assessment and reporting process stepby step.2.1.The driving task An understanding of the driving task,both generally and for the specific driver,underpins the assessment of fitness to drive and guides the determination of risk associated with impairment due to ill
91、health.Driving is a complex instrumental activity of daily living,characterised by a rapidly repeating cycle in which:Information about the vehicle and road environment is obtained via the visual and auditory senses.The information is operated on by several cognitive processes,which leads to decisio
92、ns about driving.Decisions are put into effect via the musculoskeletal system,which acts on the various controls to alter the vehicle in relation to the road(refer to Figure 1).7 PART A.Fitness to drive principles and practicesThis repeating sequence depends on:Sensory input vision visuospatial perc
93、eption hearing proprioception kinesthesia Motor function muscle power coordinationCognitive function attention and concentration comprehension memory insight judgement decision making reaction time sensation.Given these requirements,it follows that many body systems need to be functional to ensure s
94、afe and timely execution of the skills required for driving.Furthermore,the demands of the specific driving task can vary considerably depending on a range of factors including those relating to the driver,the vehicle,the purpose of the driving task and the road environment(Box 1).For commercial dri
95、vers in particular these demands can be significant,as can be the consequences for public safety.Assessing health professionals should document the individuals driving requirements and driving history as part ofthe assessment process.8Assessing fitness to drive generalguidanceFigure 1.The driving ta
96、skBox 1.Factors affecting drivingDriving tasks occur within a dynamic system influenced by complex driver,vehicle,task,organisational and external road environment factors including:the drivers experience,training and attitude the drivers physical,mental and emotional health for example,fatigue and
97、the effect of substance misuse including illicit,prescription and non-prescription drugs the road system for example,signs,other road users,traffic characteristics and road layout legal requirements for example,speed limits and blood alcohol concentration the natural environment for example,night,ex
98、tremes of weather and glare vehicle and equipment characteristics for example,the type of vehicle,braking performance and maintenance mental workload and distraction due to in-vehicle technologies(e.g.GPS,vehicle warning/alert systems,driver assistance systems)and communication systems(hands-free ph
99、one/email systems)personal requirements,trip purpose,destination,appointments,navigation tasks and time pressures passengers,in-vehicle communication/entertainment devices and their potential to distract the driver.For commercial or heavy vehicle drivers there is a range of additional factors includ
100、ing:business requirements for example,rosters(shifts),driver training and contractual demands work-related multitasking for example,interacting with in-vehicle technologies such as a GPS,job display screens or other communication systems legal requirements for example,work diaries and licensing proc
101、edures vehicle issues including size,stability and load distribution passenger requirements/issues for example,duty of care,communication requirements and potential for occupational violence risks associated with carrying dangerous goods additional skills required to manage the vehicle for example,t
102、urning and braking endurance/fatigue and vigilance demands associated with long periods spent on the road.Sensory inputMusculoskeletal actionsVehicleroad interactionCognitive input9 PART A.Fitness to drive principles and practices2.2.Impact of medical conditions on driving 2.2.1.Assessing medical co
103、nditionsReflecting the requirements of the driving task(section 2.1.The driving task),the key domains to consider when assessing the impact of medical conditions and disabilities ondrivingare:impairment of:sensory function(in particular,visual acuity and visual fields but also cutaneous,muscle and j
104、oint sensation)motor function(e.g.joint movements,strength,endurance and coordination)cognition(e.g.attention,concentration,memory,problem-solving skills,thought processing,visuospatial skills,insight and judgement)the risk of sudden incapacity(leading to sudden loss of control of the vehicle).Such
105、impacts may be associated with a range of medical conditions.Conditions with the potential to cause significant impairment and/or sudden incapacity are the focus of this publication and include:blackouts cardiovascular conditions diabetes hearing loss and deafness musculoskeletal conditions neurolog
106、ical conditions psychiatric conditions substance misuse/dependency sleep disorders vision problems.The impairments/impacts associated with medical conditions may be framed in a number of ways.For example,impairments may:Be persistent(e.g.visual impairment)or episodic(e.g.seizure,severe hypoglycaemic
107、 event).Drivers with persistent impairments can be assessed based on observations and measures of their functional capacity.Those with episodic impairment must be assessed based on a risk analysis that considers the probability and consequence of the episode,as well as any triggering factors and whe
108、ther they can be avoided.Fluctuate,for example,the capacity of people living with dementia can fluctuate both day to day and within a 24-hour period.It is important that the assessor considers the potential of fluctuating capacity and theimpact these factors may have on drivingability.Be progressive
109、(e.g.dementia,progressive neurological conditions,end-organ affects associated with diabetes)or static(permanent disabilities),which has implications for ongoing monitoring(refer to section 2.2.5.Progressive conditions).Many people with a long-term condition or disability may have developed coping s
110、trategies to enable safe driving(refer to section 2.2.6.Congenital conditions,disability and driving).Become introduced through use of medications that effect cognition and reaction time(refer to section 2.2.9.Drugs and driving).Resolve with treatment(e.g.following rehabilitation for stroke),which h
111、as implications for reinstating of unconditional licences(refer to section 4.5.Reinstatement of licences or removal or variation of licence conditions).10Assessing fitness to drive generalguidance2.2.2.Conditions not covered explicitly in this publicationThis publication does not attempt to define a
112、ll clinical situations that may influence safe driving ability.It is accepted that other medical conditions or combinations of conditions may also be relevant and that it is not possible to define all clinical situations where an individuals overall function would compromise public safety.A degree o
113、f professional judgement is therefore required in assessing fitness to drive.The examining health professional should follow general principles when assessing these patients including consideration of the driving task and the potential impact of the condition on requirements such as sensory,motor an
114、d cognitive skills.Episodic conditions need consideration regarding the likelihood of recurrence.A more stringent threshold should be applied to drivers of commercial vehicles than to private vehicle drivers.An appropriate period should be advised for review,depending on the natural history of the c
115、ondition.2.2.3.Temporary conditionsThis publication does not attempt to address every condition or situation that might temporarily affect safe driving ability.There are a wide range of conditions that temporarily affect the ability to drive safely.These include conditions such as post-surgery recov
116、ery,severe migraine or injuries to limbs.These conditions are self-limiting and hence do not affect licence status;therefore,the licensing authority does not need to be informed.The treating health professional should provide suitable advice to such patients about driving safely including recommende
117、d periods of abstinence from driving,particularly for commercial vehicle drivers.Such advice shouldconsider the likely impact of the patients condition and their specific circumstances on the driving task as well as their specific driving requirements.Table 1 provides guidance on some common conditi
118、ons that may temporarily affect driving ability.2.2.4.Undifferentiated conditionsA patient may present with symptoms that could have implications for their licence status but where the diagnosis is not clear.Investigating the symptoms will mean there is a period of uncertainty before a definitive di
119、agnosis is made and before the licensing requirements can be confidently applied.Each situation will need to be assessed individually,with due consideration given to the probability of a serious disease or long-term injury or illness that may affect driving,and to the circumstances in which driving
120、is required.However,patients presenting with symptoms of a serious nature for example,chest pains,dizzy spells,blackouts or delusional states should be advised not to drive until their condition can be adequately assessed.During this interim period,in the case of private vehicle drivers,no formal co
121、mmunication with the driver licensing authority is required unless there is significant risk to public health(refer to section 3.3.1.Confidentiality,privacy and reporting to the driver licensing authority).After a diagnosis is firmly established and the standards applied,normal notification procedur
122、es apply.In the case of a commercial vehicle driver presenting with symptoms of a potentially serious nature,the driver should be advised to stop driving and to notify the driver licensing authority.The health professional should consider the impact on the drivers livelihood and investigate the cond
123、ition as quickly as possible.11 PART A.Fitness to drive principles and practicesTable 1.Examples of how to manage temporary conditionsCondition and impact on drivingManagement guidelinesAnaesthesia and sedation3Physical and mental capacity may be impaired for some time post anaesthesia(including gen
124、eral anaesthesia,local anaesthesia and sedation).The effects of general anaesthesia will depend on factors such as the duration of anaesthesia,the drugs administered and the surgery performed.The effect of local anaesthesia will depend on dosage and the region of administration.Analgesic and sedativ
125、e use should also be considered.In cases of recovery following surgery or procedures under general anaesthesia,local anaesthesia or sedation,it is the responsibility of the surgeon/dentist and anaesthetist to advise patients not to drive until physical and mental recovery is compatible with safe dri
126、ving.Following minor procedures under local anaesthesia without sedation(e.g.dental block),driving may be acceptable immediately after the procedure.Following brief surgery or procedures with short-acting anaesthetic drugs or sedation,the patient may be fit to drive after a normal nights sleep.After
127、 longer surgery or procedures requiring general anaesthesia or sedation,it may not be safe to drive for 24 hours or more.Deep vein thrombosis and pulmonary embolismWhile deep vein thrombosis may lead to an acute pulmonary embolus,there is little evidence that such an event causes crashes.Therefore t
128、here is no licensing standard applied to either condition.Non-driving periods are advised.If long-term anticoagulation treatment is prescribed,the standard for anticoagulant therapy should be applied(refer to Part B section 2.2.8.Long-term anticoagulant therapy).Private and commercial vehicle driver
129、s should be advised not to drive for at least 2 weeks following a deep vein thrombosis and for 6 weeks following a pulmonary embolism.Medications or other treatmentsAdaptation to new drug/medication regimens or undergoing some treatments(e.g.radiation therapy or haemodialysis)may require a non-drivi
130、ng period.The non-driving period should be determined by the treating health professionals based on a consideration of the requirements of the driving task and the impact of medications or treatments on the capacity to undertake these tasks,including responding to emergency situations.A practical dr
131、iver assessment may be helpful in determining fitness to drive(refer to section 2.3.1.Practical driver assessments).Post-surgerySurgery will affect driving ability to varying degrees depending on the location,nature and extent of theprocedure.The non-driving period post-surgery should be determined
132、by the treating health professionals based on a consideration of the requirements of the driving task and the impact of the surgery on the capacity to undertake these tasks,including responding to emergency situations.A practical driver assessment may be helpful in determining fitness to drive(refer
133、 to section 2.3.1.Practical driver assessments).12Assessing fitness to drive generalguidanceCondition and impact on drivingManagement guidelinesPregnancyUnder normal circumstances pregnancy should not be considered a barrier to driving.However,conditions that may be associated with some pregnancies
134、should be considered when advising patients.These include:fainting or light-headedness hyperemesis gravidarum hypertension of pregnancy post caesarean section.A caution regarding driving may be required depending on the severity of symptoms and the expected effects of medication.Seatbelts must be wo
135、rn(refer to Appendix 7.Seatbelt use).Temporary or short-term vision impairmentsA number of conditions and treatments may impair vision in the short term for example,temporary patching of an eye,use of mydriatics or other drugs known to impair vision,or eye surgery.For long-term vision problems,refer
136、 to Part B section 10.Vision and eye disorders.People whose vision is temporarily impaired by a short-term eye condition or an eye treatment should be advised not to drive for an appropriate period.2.2.5.Progressive conditionsOften diagnoses of progressive conditions are made well before there is a
137、need to question whether the patient remains safe to drive(e.g.multiple sclerosis,early dementia).However,it is important to raise issues relating to the likely effects of these disorders on personal independent mobility early in the managementprocess.The patient should be advised appropriately wher
138、e a progressive condition is diagnosed that may result in future restrictions on driving.It is important to give the patient as much lead time as possible to make the lifestyle changes that may later be required(e.g.adaptation to using public transport and/or a motorised mobility device).Assistance
139、from an occupational therapist may be valuable in such instances(refer to Part B section 6.1.Dementia).2.2.6.Congenital conditions,disability and drivingCongenital conditions and long-term or permanent disabilities may have an impact on a persons ability to drive safely.The physical and cognitive im
140、plications of such conditions may include(but are not limited to):difficulty sustaining concentration or switching attention between multiple drivingtasks reduced cognitive and perceptual processing speeds,including reaction times reduced performance in complex situations(e.g.when there are multiple
141、 distractions)reduced information processing and judgement difficulty anticipating and responding to other road users difficulty controlling movement reduced joint range of motion and musclestrength.These impacts vary and many people develop coping strategies to enable safe driving.13 PART A.Fitness
142、 to drive principles and practicesIndividual assessment is therefore required based the general principles,the stability of the disability and bodily systems that underpin any adaptive behaviours for driving.Legal obligations for reporting to the driver licensing authority apply(refer to section 3.2
143、.Roles and responsibilities of drivers).This may trigger the need to provide a medical report and/or an occupational therapy driving assessment.An occupational therapist driver assessor can provide information about how a condition or disability may affect driving or learning to drive.They can also
144、offer advice about potential aids,vehicle modifications or training strategies that may assist the individual.The outcomes of the assessment may result in the requirement of a conditional licence relating to the driver(e.g.prosthesis must be worn)or the vehicle(e.g.can only drive a vehicle with cert
145、ain modifications);refer to section 4.4.Conditional licences.If the condition or disability is assessed as static,then it is unlikely to require periodic review.Learning to drivePeople with a disability that may impact their ability to drive can seek the opportunity to gain a driver licence.This opp
146、ortunity is increasingly available through the National Disability Insurance Scheme.To ensure they receive informed advice and reasonable opportunities for training,it is helpful if they are trained by a driving instructor with experience in teaching drivers with disabilities.An initial assessment w
147、ith an occupational therapist specialised in driver evaluation may help to identify the pre-requisite functional capacity requirements to realistically aspire to driving independence,need for adaptive devices,vehicle modifications or special driving techniques.National Disability Insurance SchemeThe
148、re are support options to help drivers with a disability through the National Disability Insurance Scheme(NDIS).The NDIS provides all Australians under the age of 65 who have a permanent and significant disability with reasonable and necessary supports.The NDIS may provide assistance with the medica
149、l review process including obtaining a driver licence,medical reports,occupational therapist driving assessments,driver training and vehicle modifications.Further information about the support provided by the NDIS and how to access the services can be found on the NDIS website at www.ndis.gov.au.2.2
150、.7.Older drivers and age-related changesWhile advanced age in itself is not a barrier to safe driving,age-related physical and mental changes will eventually affect a persons ability to drive safely.Given the association between health outcomes,mobility and social connectedness,fitness to drive shou
151、ld be proactively managed,with the goal of enabling older people to continue to drive for as long as it is safe to do so.Crash data points to some of the vulnerabilities of older drivers,showing that they are more likely to crash at intersections and with other vehicles(multi-vehicle crashes).Frailt
152、y of older drivers is also associated with higher risk of injury and death.At the same time,safety risks for older drivers may be mitigated by their extensive driving experience and their tendency to modify their driving to suit their capabilities,including avoiding peak-hour traffic,poor weather an
153、d night driving,and driving at slowerspeeds.14Assessing fitness to drive generalguidanceManagement approachA proactive approach to management of older drivers encompasses primary,secondary and tertiary prevention.Discussions about mobility and drivingTalking with an older person about their driving
154、can be difficult,particularly if it is delayed until the conversation is about ceasing driving.Early conversations focused on maintenance of driving ability in the context of their general health,mobility needs and other activities of daily living can help build self-awareness,enable self-monitoring
155、 and normalise the eventual transition to non-driving.Driver licensing authorities provide resources to support conversations with older drivers and their carers/families.Active observation and screeningRoutine care of the older person should include monitoring for decline in the functions necessary
156、 for driving,including vision,cognition and motor/sensory functions(see below).This is also an opportunity to pick up on red flags such as falls,memory problems,confusion,caregiver concerns or a sudden change in social circumstances.Annual checks,such as through the Medicare 75 Plus health check,pro
157、vide an opportunity for screening and for considering the overall impacts of ageing and multiple medical conditions on driving.Early interventionEarly identification of functional decline can provide opportunities to address driving skills and capabilities in at-risk drivers.This may involve referra
158、l for relevant assessment and management(e.g.allied health,driver assessment),including treatments,driving rehabilitation,vehicle modifications and driving restrictions(refer to section 2.3.Assessing and supporting functional driver capacity).In cases where an older person is not fully fit to drive
159、in all circumstances,the health professional may advise conditions under which driving could be performed safely(refer to section 4.4.Conditional licences).Referral to a geriatrician may also assist if there is doubt about a patients fitness to drive or about remedial strategies.Considering the impa
160、ct of medical conditions on drivingMost older adults have at least one chronic medical condition.The most common conditions include cardiovascular disease,stroke,Parkinsons disease,sleep disorders,cataracts,glaucoma,musculoskeletal impairments including arthritis,depression,dementia and diabetes.The
161、 overall impact of multiple conditions on driving will need to be considered(refer to section 2.2.8.Multiple medical conditions).A new diagnosis or change in any condition,or an acute medical event,is a trigger to revisit driving,so too is the addition of a new medication or treatment.Older adults o
162、ften take multiple medications,and this is associated with increased crash risk.Counselling regarding medications should specifically address potential safety concerns for driving,including any age-associated effects such as changed drug metabolism(refer to section 2.2.9.Drugs and driving).Transitio
163、n to alternative means of transportUltimately,when a persons functioning is no longer compatible with safe driving,they will need to be supported in relinquishing their licence and seeking alternative modes of transport.There is a role for ongoing monitoring of health and social consequences and com
164、pliance with advice not to drive.Caregivers play an important role in encouraging the older person to cease driving and to help the individual find alternatives.15 PART A.Fitness to drive principles and practicesAssessing older driversAge-related physical and mental changes vary greatly between indi
165、viduals.The three main functional areas to consider for the assessment and routine care of older drivers are described below.Health professionals should be mindful that a driver may have several minor impairments that alone may not affect driving but when taken together may make risks associated wit
166、h driving unacceptable(refer to section 2.2.8.Multiple medical conditions).Some driver licensing authorities require regular medical examination or assessment of drivers beyond a specified age.These requirements vary between jurisdictions and may be viewed inAppendix 1.Regulatory requirements fordri
167、ver testing.VisionVarious aspects of vision may decline with age,including acuity,visual fields and contrast sensitivity.Eye conditions such as cataracts,glaucoma and macular degeneration are also more common in older people.The gradual changes associated with ageing and the gradual onset of eye con
168、ditions may not be noticed by the driver.Regular eye health checks may facilitate early detection and management for changes in vision.Difficulty driving at night and problems with glare may be early signs of age-related visual decline and may be investigated in routine conversations.Driving restric
169、tions/conditions such as no-night driving can help maintain safe driving,while removal of cataracts can effectively restore vision for driving.(Refer also to section 4.4.Conditional licences and Part B section 10.Vision and eye disorders).CognitionVarious aspects of cognitive processing required for
170、 safe driving can decline with age,including memory,working memory,visual processing,visuospatial skills,attention functioning,executive functioning and insight.These impairments can affect a persons ability to process and respond to the complex road environment.The impairments can vary from day to
171、day,which can present a challenge for definitive assessment in relation to driving.Dementia is a particular concern as older adults with dementia often lack insight into theirdeficits and may be more likely to drive when it is unsafe(refer also to Part B section 6.1.Dementia).Motor and somatosensory
172、 functionAgeing generally results in a decline in muscle strength and endurance,as well as reduced flexibility,range of movement and joint stability.Musculoskeletal conditions such as arthritis are also more prevalent in older adults.These and other general health conditions may be associated with c
173、hronic pain and fatigue.Proprioception may also be an issue.Older adults with these impairments may have difficulties getting in and out of the car,using the seatbelt and ignition key,adjusting mirrors and seats,steering,turning to reverse,and using foot pedals.Adaptative equipment,some requiring pr
174、ofessional recommendation,is available to support drivers experiencing pain,reduced reach or reduced strength.Rehabilitative therapies may improve the older drivers functioning and endurance(refer to section 2.3.2 Driver rehabilitation,Part B section 5.Musculoskeletal conditions).16Assessing fitness
175、 to drive generalguidanceMore informationReference to the Royal Australian College of General Practitioners Guidelines for preventative activities in general practice(the Red Book)and the Aged care clinical guide(the Silver Book)may assist in assessing older drivers.3,4 Additional resources and refe
176、rences that may support assessment are provided in Part A,References and further reading.5112.2.8.Multiple medical conditionsWhere a vehicle driver has multiple conditions or a condition that affects multiple body systems,there may be an additive or a compounding detrimental effect on driving abilit
177、ies for example in:congenital disabilities such as cerebral palsy,spina bifida and various syndromes multiple trauma causing orthopaedic and neurological injuries as well as psychiatric sequelae multi-system diseases such as diabetes,connective tissue disease,multiple sclerosis and systemic lupus er
178、ythematosus dual diagnoses involving psychiatric illness and drug or alcohol addiction ageing-related changes in motor,cognitive and sensory abilities together with degenerative disease chronic pain.Although these medical standards are designed principally around individual conditions,clinical judge
179、ment is needed to integrate and consider the effects on safe driving of any medical conditions and disabilities that a patient may present with.However,it is insufficient simply to apply the medical standards contained in this publication for each condition separately because a driver may have sever
180、al minor impairments that alone may not affect driving but when taken together may make risks associated with driving unacceptable.Therefore,it is necessary to integrate all clinical information,bearing in mind the additive or compounding effect of each condition on the overall capacity of the patie
181、nt to drive safely.Where one or more conditions are progressive,it may be important to reduce driving exposure and ensure ongoing monitoring of the patient(refer to section 2.2.5.Progressive conditions).Conditional licences that may limit the driver(e.g.no night driving)or place requirements on the
182、vehicle(e.g.automatic transmission only)are an option in these circumstances(refer to section 4.4.Conditional licences).The requirement for periodic reviews can be included as recommendations on driver licences.Periodic reviews are also important for drivers with conditions likely to be associated w
183、ith future reductions in insight and self-regulation.If lack of insight may become an issue in the future,it is important to advise the patient to report the condition(s)to the driver licensing authority.Where lack of insight already appears to impair self-assessment and judgement,public safety inte
184、rests should prevail,and the health professional should report the matter directly to the driver licensing authority and,if appropriate,seek the support of the patients family members.2.2.9.Drugs and drivingAny drug that acts on the central nervous system has the potential to adversely affect drivin
185、g skills.Central nervous system depressants,for example,may reduce vigilance,increase reaction times and impair decision making in a very similar way to alcohol.In addition,drugs that affect behaviour may exaggerate adverse behavioural traits and introduce risk-takingbehaviours.Where medication is r
186、elevant to the overall assessment of fitness to drive in managing specific conditions such as diabetes,epilepsy and psychiatric conditions,this is covered in 17 PART A.Fitness to drive principles and practicesthe respective chapters.Prescribing doctors and dispensing pharmacists do,however,need to b
187、e mindful of the potential effects of all prescribed and over-the-counter medicines and to advise patients accordingly.Patients receiving continuing long-term drug treatment should be evaluated for their reliability in taking the drug according to directions.They should also be assessed for their un
188、derstanding that medicines can have undesired consequences that may impair their ability to drive safely and this may be unexpectedly affected by other factors such as drug interactions.General guidance for prescription drugs and drivingWhile many drugs have effects on the central nervous system,mos
189、t,with the exception of benzodiazepines,tend not to pose a significantly increased crash risk when the drugs are used as prescribed and once the patient is stabilised on the treatment.This may also relate to drivers self-regulating their driving behaviour.When advising patients and considering their
190、 general fitness to drive,whether in the short or longer term,health professionals should consider:the balance between potential impairment due to the drug and the patients improvement in health on safe driving ability the individual response of the patient some people are more affected than others
191、the type of licence held and the nature of the driving task(mercial vehicle driver assessments should be more stringent)the added risks of combining two or more drugs capable of causing impairment,including alcohol the added risks of sleep deprivation on fatigue while driving,which is particularly r
192、elevant to commercial vehicle drivers the potential impact of changing medications or changing dosage the cumulative effects of medications the presence of other medical conditions that may combine to adversely affect drivingability other factors that may exacerbate risks such as known history of al
193、cohol or drug misuse.Acute alcohol and drug intoxicationAcute impairment due to alcohol or drugs(including illicit,prescription and over-the-counter drugs)is managed through specific road safety legislation that prohibits driving over a certain blood alcohol concentration(BAC),with the presence of c
194、ertain drugs in bodily fluids,or when driving is impaired by drugs(refer to Appendix 4.Drivers legal BAC limits).This may include requirements for using alcohol interlocks,the application of which varies between jurisdictions(refer to Appendix 5.Alcohol interlock programs).This is a separate conside
195、ration to long-term medical fitness to drive and licensing,therefore specific medical requirements are not provided in this publication.Dependency and substance misuse,including chronic misuse of illicit,non-prescription and prescription drugs,is a licensing issue and standards are outlined in Part
196、B section 9.Substance misuse.Further guidance for prescribing drugs of dependence can be found in the Royal Australian College of General Practitioners guide Prescribing drugs of dependence in general practice(visit www.racgp.org.au).18Assessing fitness to drive generalguidanceThe effects of specifi
197、c drug classes13,14 Medicinal cannabis(cannabinoids)1525,36,37Medicinal cannabis refers to medically prescribed cannabis preparations intended for therapeutic use,including pharmaceutical cannabis preparations with set amounts of cannabinoids such as oils,tinctures,sprays and other extracts.The main
198、 active components of cannabis(medicinal or recreational)are delta-9-tetrahydrocannabinol(THC)and cannabidiol(CBD).THC,the psychoactive ingredient in cannabis(including medicinal),can cause cognitive and psychomotor impairments that degrade the ability to drive safely including attention and concent
199、ration deficits,mild cognitive impairment,dizziness and anxiety.These deficits can begin at low doses and are highly individualised.The pharmacokinetics of cannabinoids are complex,making it difficult to predict the severity of impairment.Other influencing factors include the history of use,frequenc
200、y of dose,ratio of cannabinoids and route of administration(vaporised,oral,oral-mucosal,transdermal).The onset and duration of impairing effects can vary significantly between individuals.The effects can typically last for three to six hours after inhalation or five to eight hours after oral adminis
201、tration,but may be significantly longer for either route of administration and should be determined individually.Further information on the route of administration and THC pharmacokinetic/pharmacodynamics can be found in the TGAs Guidance for the use of medicinal cannabis in Australia overview(https
202、:/www.tga.gov.au/publication/guidance-use-medicinal-cannabis-australia-overview).Based on current evidence,CBD does not cause psychomotor or cognitive impairment or strong psychoactive effects.CBD may produce side effects including sedation or fatigue,which can be more pronounced at higher doses.CBD
203、 may interact with other prescribed medication,potentially increasing the risk of driving impairment.The effects of other cannabinoids have not been systematically studied.Managing medicinal cannabis and driving Strategies to mitigate or manage THC impairments include a start low,go slow approach to
204、 treatment and administration during periods when an individual is unlikely to drive(e.g.at night before sleep).A period of restricted or non-driving,generally a minimum of four weeks,may be considered while adaptation to medication and treatment outcomes aredetermined.Medicinal cannabis(THC and CBD
205、)can interact with other medications,impairing the metabolism of other drugs or causing cumulative effects such as sedation,which can increase the road safety risk.Alcohol should be avoided when taking medicinal cannabis due to the significant additive effects and the increased risk of having a cras
206、h.CBD may effect the metabolism of certain antiseizure drugs,elevating plasma levels of other drugs,including some benzodiazepines.Assessing fitness to driveFitness-to-drive assessments for the underlying chronic medical condition or disability treated with medicinal cannabis can be undertaken as pe
207、r the applicable standards.The assessment should consider the nature of the driving task,impairment of cognitive,visuospatial and motor control functions from the condition or medications,and treatment outcomes.Conditions with specific standards,such as seizures(Part B section 6.2.Seizures and epile
208、psy)or chronic pain(Part B section 5.Musculoskeletal conditions),may consider medicinal cannabis under the existing criteria.Conditions without specific criteria in Part B.Medical standards may be assessed according to section 2.Assessing fitness to drive generalguidance.19 PART A.Fitness to drive p
209、rinciples and practicesMedicinal cannabis and commercial licenceholdersAssessments against the commercial licensing medical standards are more stringent than the private standards and reflect increased driver exposure and the increased risk associated with motor vehicle crashes involving these vehic
210、les.Sleep deprivation or fatigue while driving are common risks among commercial vehicle drivers.Particular attention should be paid to the commercial vehicle driving task.Considerations may include the vehicle type,the nature of goods transported,the distances and roads being travelled,the cumulati
211、ve time driving over a work period,and whether driving will occur at night or disrupt normal sleep patterns.Impacts of driving patterns on dosage requirements mayalso be relevant.Medicinal cannabis and drug driving lawsDrug driving and enforcement laws for cannabis are established through state and
212、territory legislation and can vary.In general,it is against the law for a person to drive with any amount of THC present in their bodily fluids(blood,saliva or urine).In most states and territories there are no exceptions to these laws,including therapeutic use.Tasmanian law provides a medical defen
213、ce for driving with the presence of THC in bodily fluids.The medical defence only applies if the medicinal cannabis is obtained and administered in accordance with the Poisons Act 1971(Tas).It remains illegal for these patients to drive if impaired by THC and they must still comply with directions g
214、iven by law enforcement regarding roadside testing.Drivers prescribed medicinal cannabis in one jurisdiction may be treated differently if driving in another.The individuals driving needs,including interstate travel and licensing classes,should be discussed when considering prescribing medicinal can
215、nabis,and it is critical to identify if driving is required as part of their occupation.Point-of-prescription advice regarding medicinalcannabis and drivingThe implications of drug driving regulations and THC should be discussed at the point of prescription and reviewed routinely with the patient as
216、 part of good fitness-to-drive medical management.In addition to the legal consequences,there may also be insurance implications for patients who are convicted of drug driving offences.CBD is not subject to these controls and can be used while driving,so long as treatment is free of side effects or
217、drug interactions that may cause impairment.Specific information can be sourced from local driver licensing authorities,health departments or law enforcement agencies and should be consulted alongside the information presented here.Possible drug-seeking behaviour in those directly requesting cannabi
218、s as an alternative to,or to supplement,medicinal cannabis should be kept in mind.Medically prescribed cannabis is distinct from other sources of cannabis that people may access for illicit or unregulated medicinal purposes.These other products are highly variable in their cannabinoid content and ca
219、n significantly increase the road safety risk.More information can be found in Part B section 9.Substance misuse.Benzodiazepines26Benzodiazepines are well known to increase the risk of a crash and are found in about 4 per cent of fatalities and 16 per cent of injured drivers taken to hospital.In man
220、y of these cases benzodiazepines were either abused or used in combination with other impairing substances.If a hypnotic is needed,a shorter acting drug is preferred.Tolerance to the sedative effects of the longer acting benzodiazepines used to treat anxiety gradually reduces their adverse impact on
221、 driving skills.20Assessing fitness to drive generalguidanceAntidepressantsAlthough antidepressants are one of the more commonly detected drug groups in fatally injured drivers,this tends to reflect their wide use in the community.The ability to impair is greater with sedating tricyclic antidepressa
222、nts(e.g.amitriptyline and dothiepin)than with the less sedating serotonin and mixed reuptake inhibitors such as fluoxetine and sertraline.However,antidepressants can reduce the psychomotor and cognitive impairment caused by depression and return mood towards normal.This can improve driving performan
223、ce.AntipsychoticsThis diverse class of drugs can improve performance if substantial psychotic-related cognitive deficits are present.However,most antipsychotics are sedating and have the potential to adversely affect driving skills through blocking central dopaminergic and other receptors.Older drug
224、s such as chlorpromazine are very sedating due to their additional actions on the cholinergic and histamine receptors.Some newer drugs(clozapine,olanzapine,quetiapine)are also sedating,while others(aripiprazole,risperidone and ziprasidone)are less sedating.Sedation may be a particular problem early
225、in treatment and at higher doses.Opioids2731Opioid analgesics are central nervous system depressants and as such can suppress cognitive and psychomotor responses in driving situations.While cognitive performance is reduced early in treatment(largely due to their sedative effects)neuroadaptation is r
226、apidly established.This means that patients on a stable dose of an opioid may not have a higher risk of a crash.This includes patients on buprenorphine and methadone for their opioid dependency,providing the dose has been stabilised over some weeks and they are not abusing other impairing drugs.Driv
227、ing at night may be a problem due to the persistent miotic effects of these drugs reducing peripheral vision.Further guidance on opiate prescribing can befoundfrom:the Royal Australian College of Physicians Prescription Opioid Policy:Improving management of chronic non-malignant pain and prevention
228、of problems associated with prescription opioid use27 the Australian and New Zealand College of Anaesthetists and Faculty of Pain Managements Statement regarding the use of opioid analgesics in patients with chronic non-cancer pain31 the Royal Australian College of General Practitioners Prescribing
229、drugs of dependence in general practice2830 local health agency websites.2.3.Assessing and supporting functional driver capacity 2.3.1.Practical driver assessmentsThe impact of a medical condition or multiple conditions or disability on driving is not always clear,so a practical driver assessment ma
230、y be useful.Such assessments are different from the tests of competency to drive used with entry-level drivers that are routinely conducted by driver licensing authorities for licensing purposes.These practical driver assessments are suitable only for persistent impairments.When is a practical drive
231、r assessment indicated?A practical driver assessment is designed to assess the impact of injury,illness,disability or the ageing process on driving skills including judgement,decision-making skills,observation and vehicle handling.The assessment may also be helpful in determining the need for specia
232、l training in compensatory techniques or vehicle modification to assist drivers with musculoskeletal or other disabilities.21 PART A.Fitness to drive principles and practicesA health professional may request a practical driver assessment to provide information to supplement the clinical assessment i
233、n some borderline cases and to assist in making recommendations about a persons fitness to drive.However,practical assessments have limitations in that a patients condition may fluctuate(good days and bad days),and it is not possible to create emergency situations on the road to assess reaction time
234、.Practical assessments are therefore intended to inform but not necessarily override the clinical opinion of the examining health professional.In addition,there are clinical situations that are clearly unsuitable for on-road assessments such as significant visual impairment or significant cognitive
235、impairment.What types of assessments are available?There is a wide range of practical assessments available,including off-road,on-road and driving simulator assessments,each with strengths and limitations.Assessments for cars,motorcycles,buses or heavy vehicles may be conducted or overseen by occupa
236、tional therapists trained in driver assessment or by others approved by the particular driver licensing authority,such as training providers for commercial vehicle drivers.Processes for initiating and conducting driver assessments vary between the states and territories,and the choice of assessment
237、depends on resource availability,logistics,cost and individual requirements.Generally,the assessments may be initiated by the examining health professional,other referrers(e.g.police,self,family)or by the driver licensing authority.It is not the intent of this publication to specify the assessment t
238、o be used in a particular situation.Health professionals should contact their local driver licensing authority(Appendix 9.Driver licensing authoritycontacts)for details of options or refer to Appendix 10.Specialist driver assessors.What does a practical assessment involve?Occupational therapy driver
239、 assessment usually involves two components:(a)an off-road screening and(b)an in-car practical driver assessment.The purpose of the off-road screening is to evaluate the nature,frequency and requirement for driving,underlying impairments,knowledge of road law,insight,medical history and requirements
240、 for the on-road test.Depending on the individual situation,the occupational therapy driver in-car assessment may involve evaluating:the need for specialised equipment or vehicle modifications the drivers ability to control the motor vehicle truck,bus or motorcycle the drivers functional status whil
241、e driving including cognitive function,physical strength and skills,reaction time,insight level and ability to self-monitor their driving.Recommendations following assessment may relate to licence status,licence conditions,the specific vehicle modifications,rehabilitation or retraining(refer to sect
242、ion 2.3.2.Driver rehabilitation),licence conditions or restrictions(refer to section 4.4.Conditional licences)and reassessment.Where can I go to get more information?More information about occupational therapy driver assessments can be found in the VicRoads publication Guidelines for Occupational th
243、erapy driver assessors,3rd edition,March 2018,available from the VicRoads website at www.vicroads.vic.gov.au/licences/health-and-driving/information-for-health-professionals/occupational-therapist.32 Refer also to Appendix 10.Specialist driver assessors.22Assessing fitness to drive generalguidance2.
244、3.2.Driver rehabilitation3335 A practical driver assessment may indicate a need for the person to participate in a rehabilitation or retraining program.A rehabilitation or retraining program will be developed based on the assessment results.It will be graded to increase the degree of difficulty or c
245、omplexity in the task/environment and may include clinic-based activities,simulator or computer-based training,or on-road training with a driving instructor under the direction of an occupational therapist.It may also include training in the use of vehicle modifications or aids/adaptations as well a
246、s education to develop driver awareness and improve driving confidence.There is currently limited evidence to support the use of particular rehabilitation or retraining strategies.Designed and tested driving simulation activities may offer controlled and repeatable driving conditions for rehabilitat
247、ion that are not available or limited in on-road driving situations,allowing practice and skills related to the behavioural,cognitive and physical skills related to driving.On completing the rehabilitation program,a reassessment of the patients driving skills may be made and a report sent to the dri
248、ver licensing authority with recommendations regarding driver competency and licensing.2.3.3.Equal employment opportunity and discriminationThe purpose of the standards,particularly for commercial vehicle driving,is to protect public safety.They should not be used as a barrier to employment per se.T
249、he system of conditional licences aims to support employability without compromising road safety by providing for periodic medical review and driving conditions as appropriate.Commonwealth and state/territory legislation exists to protect workers against unfair discrimination based on disability.If
250、a patient suspects they are being unfairly discriminated against based on the disability outlined on their conditional licence,they may contact their union or the Human Rights and Equal Opportunity Commission,or the relevant commission in their state or territory.2.3.4.Information and assistance for
251、driversAssessment by a health professional is one piece of information taken into account by the driver licensing authority in making a decision about the future licensing status of a person.The driver licensing authority may cancel,refuse or suspend a driver licence or place conditions on a licence
252、.Because most people consider a driver licence critical to continued independence,employment and recreation,the risk of it being withdrawn can evoke strong emotions and reactions.Patients may become upset,anxious,frustrated or angry,especially if their livelihood or lifestyle is threatened(refer to
253、section 3.3.2.Patienthealth professional relationship).23 PART A.Fitness to drive principles and practicesIn cases where licensing decisions may affect a patients ability to earn a living,the health professional should demonstrate some sensitivity in the interests of ongoing patient health.Timely pr
254、ovision of medical reports is important in this regard.Offering some direction in developing coping strategies may help alleviate some of the patients concerns or fears.Where appropriate,the health professional should consider direct referral rather than simply providing sources for further informat
255、ion.For example:Vocational assessors will assess a persons ability to rehabilitate,retrain and reskill for another industry,or a new sector within the industry.There may be government-funded assistance programs to support work-based assessments and workplace modifications including vehicle modificat
256、ions.Condition-specific support and advocacy agencies may also offer advice,support and services for example,Diabetes Australia,Dementia Australia,MS Australia,Epilepsy Action Australia and the Epilepsy Foundation.For older drivers,early advice will help them plan for the inevitable changes in their
257、 independence.Some driver licensing authorities have a range of dedicated fact sheets explaining the impacts of ageing and common medical conditions on driving safety:check the licensing authority website in your state or territory.24Assessing fitness to drive generalguidance3.Roles and responsibili
258、tiesThe roles and responsibilities of those involved in fitness-to-drive assessments and decision making are summarised in Table 2 and discussed in this section.The descriptions and the relationships depicted in Figure 2 are generalised and may vary between states/territories in terms of legislative
259、 requirements.For specific requirements refer to Appendix 3.Legislation relating to reporting.Figure 2.The relationships and interactions between the driver licensing authority,health professional and vehicle driverHealth professionals and DLAs do not normally communicate directly with each other,wh
260、ich protects patient confidentiality.However,with the drivers consent,DLAs may communicate with health professionals when clarification or further information is required in order to make a licensing decision.Driver Licencing Authority(DLA)Health professionals and DLAs do not normally communicate di
261、rectly with each other,which protects patient confidentiality.However,health professionals should consider reporting directly to the DLA in situations where the patient continues driving despite appropriate advice and is likely to endanger the public.Medical professionalThe DLA may request drivers t
262、o have a medical examination.Legislation requires drivers with serious illnesses affecting driving ability to inform the DLA.DriverHealth professionals should advise patients if a medical condition,treatment or drink or drunk driving behaviours impact on their ability to drive safely,whether in the
263、short or long term.DLA=driver licensing authorityThe responsibility for issuing,renewing,suspending,refusing,cancelling or reinstating a persons driver licence(including a conditional licence)lies ultimately with the driver licensing authority.Licensing decisions are based on a full consideration of
264、 relevant factors relating to the drivers health and driving performance record.25 PART A.Fitness to drive principles and practicesTable 2.Key roles and responsibilities with respect to fitness to driveDriverHealth professionalDriver licensing authority To report to the driver licensing authority an
265、y long-term or permanent injury,illness,medical condition,disability or treatment that may affect their ability to drive safely.To respond truthfully to questions from a health professional about their health status and the likely impact on their driving ability.To adhere to prescribed medical treat
266、ment.To comply with requirements of a conditional licence as appropriate,including periodic medical reviews.For drivers who have previously advised the driver licensing authority about their health and driving,to report any changes to their health that could affect their ability to drive safely as s
267、oon as practicable.(Note:Drivers should report as soon as they become aware of these new/changed conditions theyshould not wait for theperiodicreview.)To assess the persons fitness to drive based on relevant clinical and functional information and on the relevant published medical standards.To advis
268、e the person about:the impact of their medical condition,disability or treatment on their ability to drive and recommend restrictions,ongoing monitoring,rehabilitation/training or transitional arrangements as required their responsibility to report their condition to the driver licensing authority i
269、f their long-term or permanent injury or illness may affect their ability to drive safely.To treat,monitor and manage the persons condition with ongoing consideration of their fitness to drive.To report to the driver licensing authority regarding a persons fitness to drive,including their suitabilit
270、y to hold a conditional licence,in accordance with legislated requirements and public safety and ethical considerations.Note:Medical practitioners or other clinicians do not have the legal authority to restrict,reinstate or apply conditions to a patients driver licence;this can only be done by the r
271、elevant driver licensingauthority.To make all decisions regarding the licensing of drivers.The driver licensing authority will consider reports provided by health professionals,police and members of the public,as well as crash involvement and driving histories.To make all decisions regarding the iss
272、ue of conditional licences.The driver licensing authority will consider the recommendations of health professionals as well as other relevant factors.To educate the driving public of their responsibility to report any long-term or permanent injury,illness,medical condition,disability or treatment to
273、 the driver licensing authority if the condition may affect their ability to drive safely.To provide relevant information resources and support for health professionals about driver fitness assessment andlicensing.Brochures describing the responsibilities of patients,health professionals and licensi
274、ng authorities may be available from state and territory driver licensing authorities.Refer to Appendix 9 for contact details.Information is also available from the Austroads website at .au.26Roles and responsibilities3.1.Roles and responsibilities of driver licensing authoritiesThe responsibility f
275、or issuing,renewing,suspending,refusing or cancelling a persons driver licence(including a conditional licence)lies ultimately with driver licensing authorities.Licensing decisions are individualised and are based on a full consideration of relevant factors relating to the drivers:health functional
276、capacity(including their ability to compensate for any impairment)insight into their condition compliance with any prescribed treatment compliance with existing licence conditions driving history any other relevant information.In making a licensing decision,the authority will seek input directly fro
277、m the driver and/or from a health professional.The authority will also act on unsolicited reports from health professionals,the police or members of the public about a persons fitness to drive.Under national driving licensing arrangements current at the time of publication,the driver licensing autho
278、rity issuing the driver licence and the drivers residential address should be in the same jurisdiction.Payment for health examinations or assessments related to fitness to drive is generally not the responsibility of driver licensing authorities.Each state and territory has an appeal system for situ
279、ations where drivers do not agree with a decision made about their driver licence.The driver licensing authority will inform drivers of the appeal process when informing them of the licensing decision.Driver licensing authorities can provide health professionals with information about:licensing and
280、administrative processes medical aspects(while not all driver licensing authorities have medical officers on staff,they are able to assist health professionals who require guidance with particular cases)practical driver assessments legal and ethical issues(the driver licensing authority can provide
281、guidance about the legislative requirements for licensing and assessing fitness to drive.For general advice on legal or ethical issues,health professionals should contact their professional defence organisation).Appendix 9 contains the contact details for driver licensing authorities around Australi
282、a.3.2.Roles and responsibilities of driversIn all states and territories,legislation requires a driver to advise their driver licensing authority of any long-term or permanent injury or illness,disability or medical treatment that may affect their safe driving ability.At licence application and rene
283、wal,drivers can be asked to complete a declaration regarding their health,including whether they have any long-term conditions such as diabetes,epilepsy or cardiovascular disease.Based on this information the driver licensing authority may request a medical examination to confirm a drivers fitness t
284、o hold a driver licence.In the case of medical examinations requested by the driver licensing authority,drivers have a duty to declare their health status to the examining health professional and respond truthfully to anyquestions for this purpose.Drivers must also report to the driver licensing aut
285、hority when they become aware of a health condition that may affect their ability to drive safely.There is some variability in these 27 PART A.Fitness to drive principles and practiceslaws between the states and territories,so drivers and health professionals should be aware of the specific reportin
286、g requirements in their jurisdiction and should contact their driver licensing authority for details of local requirements.These laws may impose penalties for failure to report(refer to Appendix 3.Legislation relating to reporting).Drivers may be liable at common law if they continue to drive knowin
287、g that they have a condition that is likely to adversely affect safe driving.Drivers should be aware that there may be long-term financial,insurance and legal consequences where there is failure to report any long-term illness,disability,medical condition or injury,or the effects of the treatment fo
288、r any of those things,to their driver licensingauthority.3.3.Roles and responsibilities of health professionalsPatients rely on health professionals to advise them if a permanent or long-term illness,disability,medical condition or injury,or the effects of the treatment for any of those things may a
289、ffect their safe driving ability and whether it should be reported to the driver licensing authority.The health professional has an ethical obligation,and potentially a legal one,to give clear advice to the patient in cases where a long-term illness,disability,medical condition or injury,or the effe
290、cts of the treatment for any of those things,may affect safe driving ability.Health professionals are advised to note in the patients medical record the nature of theadvicegiven.3.3.1.Confidentiality,privacy and reporting to the driver licensing authorityHealth professionals have both an ethical and
291、 legal duty to maintain patient confidentiality.The ethical duty is generally expressed through codes issued by professional bodies.The legal duty is expressed through legislative and administrative means and includes measures to protect personal information about a specific individual.The duty to p
292、rotect confidentiality also applies to driver licensing authorities.The patientprofessional relationship is built on a foundation of trust.Patients disclose highly personal and sensitive information to health professionals because they trust that the information will remain confidential.If such trus
293、t is broken,patients could forgo examination/treatment or modify the information they give to their health professional,potentially placing their health at risk.Although confidentiality is an essential component of the patientprofessional relationship,there are,on rare occasions,ethically or legally
294、 justifiable reasons for breaching confidentiality.With respect to assessing and reporting fitness to drive,the duty to maintain confidentiality is legally qualified in certain circumstances in order to protect public safety.Health professionals should consider reporting directly to the driver licen
295、sing authority in situations where a patient is either:unable to appreciate the impact of theircondition unable to take notice of the health professionals recommendations due to cognitive impairment provides unreliable information on their condition,or continues driving despite appropriate adviceand
296、 is likely to endanger the public.28Roles and responsibilitiesIn the Australian Capital Territory,New South Wales,Queensland,Tasmania,Victoria and Western Australia,statute provides that health professionals who make such reports to driver licensing authorities without the patients consent but in go
297、od faith that a patient is unfit to drive are protected from civil and criminal liability.The Northern Territory does not currently provide this protection(refer to Appendix 3.Legislation relating to reporting).In South Australia and the Northern Territory current legislation imposes mandatory repor
298、ting.A positive duty is imposed on health professionals to notify the relevant authority in writing of a belief that a driver is physically or mentally unfit to drive(refer to Appendix 3.Legislation relating to reporting).It is preferable that any action taken in the interests of public safety shoul
299、d be taken with the consent of the patient wherever possible and should certainly be undertaken with the patients knowledge of the intended action.The patient should be fully informed as to why the information needs to be disclosed to the driver licensing authority and be given the opportunity to co
300、nsider this information.Failure to inform the patient will only exacerbate the patients(and others)mistrust in the patientprofessional relationship.It is recognised that there might be an occasion where the health professional feels that informing the patient of the disclosure may place the health p
301、rofessional or others at risk of violence.Under such circumstances the health professional must consider how to appropriately manage such a situation(refer to section 3.3.3.Patient hostility towards the health professional).In making a decision to report directly to the driver licensing authority,it
302、 may be useful for the health professional to consider:the seriousness of the situation(i.e.the immediate risks to public safely or others both from the patients attitude and the degree of risk their condition poses)the risks associated with disclosure without the individuals consent or knowledge,ba
303、lanced against the implications of non-disclosure the health professionals ethical and professional obligations whether the circumstances indicate a serious and imminent threat to the health,lifeor safety of any person.Considerations involving cases where there is an immediate threat to public safet
304、y may require the health professional to exercise their duty of care in line with relevant professional standards and report the driver to the driver licensing authority or the police.This may be appropriate in instances where there is a high risk for example,drivers with a history of reckless drivi
305、ng,crashes or intentions to cause harm involving motor vehicles.Examinations requested by a driver licensing authorityWhen a patient presents for a medical examination at the request of a driver licensing authority the situation is different with respect to confidentiality.The patient may present wi
306、th a form or letter from the driver licensing authority requesting an examination for the purposes of licence application or renewal,or as a stipulation of a conditional licence.The completed form should be sent directly to the driver licensing authority,rather than returned to the driver.In the cas
307、e where an electronic medical report form is completed,these reports will be returned directly to the driver licensing authority.29 PART A.Fitness to drive principles and practicesPrivacy legislationAll health professionals and driver licensing authorities should be aware of the National Privacy Pri
308、nciples,the Health Privacy Principles and other privacy legislation applicable in their jurisdiction(e.g.health records legislation)when collecting and managing patient information and when forwarding such information to third parties.3.3.2.Patienthealth professional relationshipIt is expected that
309、health professionals will be able to act objectively in assessing a patients fitness to drive.If this cannot be achieved for example,where there may be the possibility of the patient ceasing contact or avoiding all medical management of their condition health professionals should be prepared to disq
310、ualify themselves and refer their patient to another practitioner.A difficult ethical situation arises in the event that the health professional has reason to doubt the veracity of the information provided by a patient regarding their health,and their capacity to drive safely.In this case health pro
311、fessionals could consider the following strategies:contacting their professional indemnity insurer,discussing the problem and documenting the advice discussing the problem with colleagues referring the person for a second or specialist opinion contacting the relevant driver licensing authority and,w
312、ithout identifying the patient,discussing the problem and documenting the advice.With these additional inputs it may be possible to carefully discuss and reassess the situation with the patient,taking care to document theproceedings.3.3.3.Patient hostility towards the health professionalSometimes pa
313、tients feel affronted by the possibility of restrictions to their driving or withdrawal of their licence and may be hostile towards their treating health professional.In such circumstances the health professional may elect to refer the driver to another practitioner or may refer them directly to the
314、 driver licensing authority without a recommendation regarding fitness to drive.Driver licensing authorities recognise that it is their role to enforce the laws on driver licensing and road safety and will not place pressure on health professionals that might needlessly expose them to risk of harass
315、ment or intimidation.The health professional may refer the patient to the standards in this publication when dealing with such situations.They may point out that the standards are developed by the National Transport Commission in cooperation with professional medical,allied health associations and r
316、oad safety experts based on current evidence and are enforced by driver licensing authorities.More information about managing patientprofessional hostility is available from the Royal Australian College of General Practitioners website at www.racgp.org.au/your-practice/business/tools/safetyprivacy/g
317、psafeplace/.30Roles and responsibilities3.3.4.Dealing with individuals who are not regular patientsCare should be taken when health professionals are dealing with drivers who are not regular patients.Some drivers may seek to deceive health professionals about their medical history and health status
318、and may doctor shop for a desirable opinion.If a health professional has doubts about a persons reason for seeking a consultation,they should consider:asking permission from the person to request their medical file from their regular health professional conducting a more thorough examination of the
319、person than would usually be undertaken noting on the medical report returned to the driver licensing authority the length of time the patient has been known to them and whether the health professional had access to the full medical record/history.3.3.5.Role of medical specialistsIn most circumstanc
320、es medical assessments of drivers of either commercial or private vehicles can be conducted by a general practitioner.However,if doubt exists about a patients fitness to drive or if the patients particular condition or circumstances are not covered specifically by the standards,review by a specialis
321、t experienced in managing the particular condition is warranted and the generalpractitioner should refer the patient tosuch a specialist.It is important that treating specialists share their fitness-to-drive assessment outcomes with the patients general practitioner.This is in recognition of the imp
322、ortant role general practitioners have in healthcare coordination and monitoring of long-term health conditions aswell as potential road safety and public healthimplications.In the case of commercial vehicle drivers,theopinion of a medical specialist is generally required for an initial recommendati
323、on and periodic review of a conditional licence;the main exceptions to this are set out here and in section 4.4.7.What if there is a delay before aspecialist can be seen?.This requirement reflects the higher safety risk for commercial vehicle drivers and the consequent importance of expert opinion.I
324、n circumstances where access to specialists is limited,once the initial recommendation is made,alternative arrangements for subsequent reviews by the general practitioner may be made with the approval of the driver licensing authority and with the agreement of the specialist and the treating general
325、 practitioner.31 PART A.Fitness to drive principles and practicesBox 2.TelehealthGeneral practitioners and patients are encouraged to use telemedicine technologies such as videoconferencing to minimise any difficulties associated with seeing their regular GP or where there is limited access to speci
326、alists.From 30 March 2020,telehealth(video-call)and phone consultation items became available to all Medicare-eligible Australians for a wide range of consultations,subject to certain limitations.Particularly for people in remote area communities,this provides many patients with easier access to spe
327、cialists,without the time and expense involved in travelling to major cities.These measures were introduced in response to the COVID-19 pandemic.A longer term telehealth model(post 31 December 2021)is currently under development.More information about telehealth services is available from the Medica
328、re website at humanservices.gov.au/health-professionals/services/medicare/mbs-and-telehealth.Note:The opinion of a specialist is relevant only to their specialty.General practitioners are in a good position to integrate reports from various specialists in the case of multiple disabilities to help th
329、e driver licensing authority make a licensing decision.An occupational physician or an authorised health professional may provide a similar role for drivers of commercial vehicles and their employers.For the purposes of this publication,the term specialist refers to a medical or surgical specialist
330、other than a general practitioner,acknowledging that Fellows of the Royal Australian College of General Practitioners and Fellows of the Australian College of Rural and Remote Medicine have specialist status under current medical registration arrangements(refer to www.medicalboard.gov.au).3.3.6.Role
331、 of driver assessors and trainersAs previously described,a practical driver assessment(including on-or off-road components)may be required to assess the impact of injury,illness,disability or the ageing process on driving skills including judgement,decision-making skills,observation and vehicle hand
332、ling.Such assessments are particularly useful in borderline cases where vehicle modifications or adaptations are required and/or where the impact of injury,illness,disability or the ageing process on functionality is not clear.They should be conducted by suitably qualified occupational therapy drivi
333、ng assessors.Advice regarding the availability and access to driver assessors is available from the local driver licensing authority and Occupational Therapy Australia(refer also to Appendix 10.Specialist driver assessors).Recommendations following assessment may relate to licence status,the need for vehicle modifications,rehabilitation or retraining(refer to section 2.3.2.Driver rehabilitation),l