In 2005 the National Transport Commission (NTC) in association with key stakeholders, such as Austroads and the AMA, conducted an interim review of the driver medical standards Assessing Fitness to Drive 2003. The next review is scheduled for completion in late 2008.

Why driver medical standards?
What is the purpose of the standards?
When did the standards come into effect?
Where do I get a copy of the standards?
Who do I speak to for advice about assessment of a particular patient?
Who produced/endorsed the standards?
What are my legal and ethical responsibilities?
What are some of the key points of the latest standards?
How does Assessing Fitness to Drive 2003 affect my practice?
How do the standards affect my patients?
How do the standards affect commercial vehicle drivers?
Which standards (private or commercial) should be applied?
Are there educational services to support health professionals in assessing fitness to drive?
Where can I access patient support material?

Why driver medical standards?

The driver medical standards Assessing Fitness to Drive 2003 facilitate management of drivers in relation to their health.

The latest publication combines private and commercial vehicle medical standards into one document for greater clarity and replaces the two previous publications: the National Road Transport Commissions Medical Examinations of Commercial Vehicle Drivers (1997) and Austroads' Assessing Fitness to Drive (2001) for private vehicle drivers.

The publication provides clear medical standards for licensing of drivers, differentiating between the more stringent requirements for commercial vehicle drivers and those for drivers of private vehicles. It also outlines general guidelines to assist health professionals in managing and advising patients and includes:

• a clear statement of responsibilities for patients/drivers and licensing authorities with respect to the licensing process
• a discussion of legal and ethical considerations, including State and Territory requirements
• guidance with respect to the role of conditional licences as well as the management of temporary illnesses and undifferentiated illnesses
• flow charts summarising the examination requirements and decision making processes
• template forms for patient questionnaires and examination records.

Assessing Fitness to Drive 2003 reflects current medical knowledge and the current transport environment. It also reflects requirements in terms of privacy and anti-discrimination.

What is the purpose of the standards?

The purpose of Assessing Fitness to Drive 2003 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 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
• make recommendations regarding conditional licences
• recognise the extent and limits of their professional and legal obligations with respect to reporting fitness to drive.

When did the latest standards come into effect?

Assessing Fitness to Drive 2003 became effective in the Australian Capital Territory, New South Wales, South Australia and Tasmania from 1 October 2003. In all other states and the Northern Territory, the publication was effective upon receipt. On and after these dates all recommendations made with respect to driver licensing should be based on this edition.

Where do I get a copy of the standards?

From the Austroads website (in Adobe Acrobat PDF format), or in hard copy from your state or territory driver licensing authority.

Who do I speak to for advice about assessment of a particular patient?

The driver licensing authority in your state or territory - contact details

Who produced/endorsed the standards?

The standards were produced through an extensive consultation process involving medical specialists and general practitioners, as well as all State and Territory licensing authorities, the transport industry and unions. The process was overseen the National Transport Commission and Austroads.

The standards are endorsed by the Australian Medical Association, the Royal Australian College of General Practitioners, the Royal Australasian College of Physicians and numerous specialist medical organisations.

What are some of the key points of the latest standards?

One easy reference
An important development in the standards is combining the requirements for private and commercial vehicle drivers into one document. As well as being of significant practical benefit, combination of the standards helps to highlight the difference in risk assessment for the two major classes of licence.

Conditional licences
Conditional licences have long been a feature of the licensing system and allow for continued driving as long as certain conditions or restrictions are met, such as regular review by the health professional, corrective lenses etc. Conditional licences provide scope for patients with well managed conditions to continue driving while maintaining the required safety standards through appropriate treatment and review.

Conditional licences for commercial vehicle drivers
Conditional licences have also been a longstanding feature of the commercial licensing system. The revised standards ensure clearer and more consistent application of conditional licences for commercial vehicle drivers and reflect recent advances in medical diagnosis and treatment. The standards also require specialist opinion be sought for recommendations for conditional licences, reflecting the higher risk of this driver category.

Privacy considerations
The standards emphasise the importance of compliance with privacy legislation, particularly with respect to the communication between health professionals and driver licensing authorities. Health professionals are required to only communicate information relevant to the person’s ability to drive - all other medical information must be retained by the professional. Such information is generally communicated via the patient (rather than directly to the driver licensing authority), which protects patient confidentiality.

Medical criteria
Most chapters have undergone significant refinement in order to distinguish between the commercial and private standards, to ensure clarity for examining health professionals and to ensure consistency with current medical knowledge.

Vision standard
Based on the absence of road safety evidence regarding a negative effect of red-deficient vision, and the significant engineering solutions now addressing this issue, the standard for red colour vision for commercial vehicle drivers has been omitted.

HIV/AIDS standard
Advances in treatment for HIV/AIDS has resulted in a substantial reduction in neurological sequelae, substantially reducing the risks for driving. The standard for drivers of both private and commercial vehicles has therefore been amended.

Diabetes
The restrictions on commercial drivers who are insulin dependent diabetic have been eased in light of developments in new insulins and modes of administration which have lead to increased stability of control.

Sleep disorders
Sleep disorders are increasingly recognised as an important contributor to road crashes, but diagnosis is not always easy. To assist in this regard the Epworth Sleepiness Scale has been incorporated into the patient questionnaire, a tool for doctors which is included in the latest publication.

What are my legal and ethical responsibilities?

Assessing Fitness to Drive 2003 clearly outlines the responsibilities of drivers, examining health professionals and licensing authorities.

All States and Territories in Australia have laws about reporting health conditions that might affect a person’s ability to drive safely. These laws have been created to protect public safety.

The laws require drivers to report to the driver licensing authority if they have any permanent or long-term illness that is likely to affect their ability to drive safely.

As the relationship between patient and health professional is confidential, the health professional will not normally communicate directly with the driver licensing authority. They will provide the patient with advice about their ability to drive safely as well as a letter, or report, to take to the authority (except in South Australia and the Northern Territory, where legislation currently requires the health professional to report directly to the licensing authority if they are concerned about the impact of the patient’s health on their ability to drive safely).

Health professionals also have an obligation to public safety, so if a health professional believes a patient is not heeding advice to cease driving, the health professional may report directly to the driver licensing authority.

If you have questions pertaining to your legal and ethical positioning as a health professional you may wish to contact your local medical defence organisation (MDO) or seek legal advice.

How does Assessing Fitness to Drive 2003 affect my practice?

The clarity of the standards facilitates assessment of fitness to drive by health professionals and ensures greater consistency in such assessments. It is not anticipated that the standards will impact on health professionals’ workload in undertaking assessments.

How do the standards affect my patients?

Patients must ensure they do not drive if they have a condition that is likely to affect their ability to drive safely, and they must report such conditions to the driver licensing authority.

The standards reflect developments in medical science and improvements in diagnosis and treatment of various health conditions.

They therefore provide scope for drivers with well-managed health conditions to continue to drive safely. The clearer and more consistent use of conditional licences means that drivers can benefit from such developments in treatment while sharing responsibility for their ongoing fitness to drive.

How do the standards affect commercial drivers?

Overall the standards provide greater clarity with respect to the use of conditional licences. For commercial drivers this means there are few blanket exclusions for health conditions and there is scope for drivers to continue operating on a conditional licence provided the condition is well controlled and reviewed regularly.

The standards require that an appropriate medical specialist (not a GP) make such recommendations regarding conditional licences for commercial vehicle drivers. This is in recognition of the increased risk associated with driving a commercial vehicle.

A key message for commercial drivers is that they seek medical advice about any health problem they might have, since early and effective management is likely to extend their driving career – not shorten it.

In addition to the general issue of conditional licences, a number of specific changes have occurred in the commercial driver standards.

The omission of the requirement for red colour vision is one example. Those applying for a commercial vehicle licence are no longer required to demonstrate normal red colour vision. This reflects the significant engineering developments to enhance the differentiation of traffic lights by people with colour deficient vision. It also reflects the lack of evidence connecting red colour deficiency with increased road accidents.

Which standards (private or commercial) should be applied?

Assessing Fitness to Drive 2003 contains two sets of medical standards – private vehicle driver standards and commercial vehicle driver standards.

The choice of which standards to apply when examining a patient for fitness to drive is guided by both the type of vehicle and the purpose for which the driver is authorised to drive.

The private standards should be applied to:

• Drivers applying for, or holding, a license class C (Car), R (Motorcycle) or LR (Light Rigid), unless the driver is also applying for an authority, or is already authorised, to use the vehicle for carrying public passengers for hire or reward, or for the carriage of bulk dangerous goods, or in some jurisdictions for a driver instructor’s license.

The commercial standards should be applied to:

• Drivers of 'heavy vehicles' i.e. those holding or applying for a licence of class MR (Medium Rigid), HR (Heavy Rigid), HC (Heavy Combination) or MC (Multi-combination, refer table 1).
  
• Drivers applying for an authority or already authorised to carry public passengers for hire or reward (bus drivers, taxi drivers, chauffeurs, drivers of hire cars and small buses etc).
  
• Drivers applying for an authority or already authorised to carry bulk dangerous goods.

Note: A person who does not meet the commercial vehicle medical criteria may still be eligible to retain a private vehicle driver licence. In such cases, both sets of standards may need to be consulted.
The Austroads website features information for drivers, as well as fact sheets, which can be downloaded and printed. Brochures are also available from each State and Territory licensing authority.

Are there educational services to support health professionals in assessing fitness to drive?

An online educational program has been developed for assessing fitness to drive by GP Education Australia. The service is accessible to all health professionals.

The program is accredited by the RACGP and attracts CPE points for participating general practitioners. CPE accreditation for other health professionals can be arranged through the relevant professional colleges.

Where can I access patient support material?

Download a fact sheet or obtain a brochure from your State or Territory licensing authority.