Update: Federal Motor Carrier Safety Administration (FMCSA)

Women in Buses CouncilAmerican Bus Association

September 17, 2014

Elaine Papp, RN, MSN, COHN-S, FAAOHNChief, Medical Programs Division

Agenda

Overview of FMCSA Medical Programs and Medical Certification Requirements

National Registry of Certified Medical Examiners Medical Exemptions Online tools

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FMCSA Mission

The Federal Motor Carrier Safety Administration is focused on reducing crashes, injuries, and fatalities involving large trucks and buses.

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Interstate or Intrastate

Defined by transportation of goods: Interstate commerce, transports people or goods across a state

line Example -- Federal Express driver

Intrastate commerce, transports people or goods within the state Example -- A gravel truck driver -- gravel from a quarry within a state to

businesses in the same state

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Truck and Bus Driver Statistics

3.5 million active interstate drivers 3 million CDL holders

Approx. 539,033 active interstate motor carriers

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U.S. Department of Transportation (DOT)Interstate Traffic Crash Statistics 2012

Persons Large Truck

Crashes

Bus Crashes

Large Truck

and Bus Crashes

All Vehicle Crashes

Fatalities 3,464 250 3,702 30,800

Injuries 73,000 12,000 85,000 1,634,000

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Medical Program Activities Rulemaking/Guidance Development Research

Medical Review Board Medical Expert Panels Evidence Reports

Compliance Assistance Medical Exemptions/Variances

Vision, Diabetes, Hearing, Seizure Skill Performance Evaluation (SPE) Agency has requested public comment on exemption

applications for seizure conditions and hearing loss 7

Purpose of the Medical Certification Examination

Determine a driver's physical qualification to operate a commercial motor vehicle (CMV) Interstate commerce 49 CFR 391.41-49

Med Cert/CDL Rule Driver must provide MEC to SDLA to

obtain or maintain commercial driver’s license

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Medical Examiner Responsibilities

Knowledgeable about: Physical and mental demands of CMV driver job duties FMCSA regulations, including guidance

Use of medical protocols Make medical determinations based on FMCSA

regulations and advisory criteria

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National Registry of Certified MedicalExaminers (National Registry)

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National Registry Background New regulation - Published April 20, 2012 Requires medical examiners:

Complete training Pass a test Periodic training and testing Maintain licensure Report completed CMV driver examinations monthly

Compliance Date – May 21, 2014 All CMV drivers must use a ME on the National Registry Medical certificates issued prior to May 21, 2014 are valid until

the expiration date11

National Registry Statistics

As of September 15, 2014■ 57,924 ME - registered but haven’t taken test

35,483 ME – passed test, not yet certified 34,819 ME – certified on registry

■ National Registry is working Finding ME fraud

■ Be sure to check the National Registry for your ME’s certification

■ If ME not certified – driver needs a different ME

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Regulations and Advisory Criteria

Regulations Mandatory

Advisory Criteria Assist the Medical Examiner in making individual

determination of physical fitness for driving

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Medical Exemption Programs

Federal Diabetes Exemption Program Federal Vision Exemption Program Hearing Exemptions Seizure Exemptions Skill Performance Evaluation Certificate Program

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Federal Diabetes Exemption Program

Exemptions for drivers who have insulin-dependent diabetes mellitus

Drivers submit application Medical information showing their diabetes is under control

To maintain exemption, drivers submit quarterly monitoring reports

Diabetes exemption application can be found at:https://www.fmcsa.dot.gov/rules-regulations/topics/medical/exemptions.htm or call (703) 448-3094

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Federal Vision Exemption Program One eye does not meet the minimum vision requirements Better eye must meet the minimum vision standard Drivers submit application

Medical information showing driver is able to meet all other physical requirements

Experience driving with vision deficiency Crash/violation history Vision exemption application can be found at

https://www.fmcsa.dot.gov/rules-regulations/topics/medical/exemptions.htm or call (703) 448-3094

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Federal Hearing Exemption Program

Driver must perceive forced whisper in better ear at not less than 5 feet with or without hearing aid or no hearing loss in better in greater than 40 decibels at 500, 1,000 and 2,000 Hz with or without hearing aid

Driver may apply for an exemption by contacting the Medical Programs Division at FMCSA (202) 366-4001

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Federal Seizure Exemption Program Disqualified from operating in interstate commerce 49 CFR 391.41(b)(8) May be considered for exemption based on number of

years: Since last seizure, stable on anti-seizure medication, medical

history Exemption determinations are based on a case-by-case

review Driver may apply for an exemption by contacting the

Medical Programs Division at FMCSA (202) 366-4001

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Skill Performance Evaluation (SPE)

Driver with loss or fixed limb impairment Evaluation of driving skills Driver completes application process including

Assessment and evaluation by an Orthopedic Surgeon or Physiatrist

Medical examination certification that designates he is otherwise qualified except for completion of the SPE

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OSA

Congressional action Public Law 113-45

■ Signed into law October 2013 Requires Agency to develop regulation on

OSA before issuing new guidance

■ What does the Agency say about OSA?

OSA Included in respiratory dysfunction

regulation 49 CFR 391.41(b)(5) Advisory criteria

Respiratory dysfunction MRB/MCSAC Recommendations to

Agency Two-pronged approach

Interim - guidance Long-term - rulemaking

Agency has not taken action on MRB/MCSC recommendations

OSA

■ Focus for ME Use medical protocols/standards of clinical

care to determine physical qualification■ Like all other medical conditions

Consider the actual risk of sudden or gradual incapacitation

Undiagnosed OSA with risk factors■ Consider issuing short-term medical card for

testing and treatment Driver diagnosed and successfully treated

■ Demonstrated compliance with treatment Letter from treating clinician CPAP recorder printout Dental device tracking printout or other

Online Tools

You may access the following on the the FMCSA website: Evidence Reports Medical Expert Panel Reports Medical Review Board (MRB) Recommendations Medical Examiner’s Handbook (pdf version)

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Contact InformationFederal Motor Carrier SafetyAdministration, Medical Programs DivisionU.S. Department of TransportationWashington, D.C.

E-mail: fmcsamedical@dot.govPhone: (202) 366-4001Fax: (202) 366-8842

Medical Programswww.fmcsa.dot.gov/rules-regulations/topics/medical/medical.htm

National Registry Websitewww.nationalregistry.fmcsa.dot.gov

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