Author: Dr. David Thorpe, President of Pass My Physical
Truck drivers are no different than everyone else within the general population within our country. They suffer many of the same types of medical conditions and other problems. That said, due to the lifestyle and stress associated with their work, they are at greater risk for suffering certain medical problems and events. This is very true as it relates to truck drivers and heart attacks.
In the general population more than 3 million heart attacks occur each year. According to FMCSA statistics, truck drivers suffer from cardiovascular (heart and blood flow problems) disease at a higher rate than what exists in the general population. Let’s face it, the driver population is aging, is overweight, smokes and eats poorly. Additionally tight pickup and delivery schedules and long times away from family while on the road add to the stress that truck drivers have. All of these things increase the risk for truck drivers to have heart problems. Many of whom end up having some type of cardiac (heart) event, most typically a heart attack.
HEART ATTACKS AND FMCSA REGULATIONS
The FMCSA has had guidance in place for drivers that suffer a heart attack since the 1990’s. Since they were adopted they have changed very little. Basically, drivers that survive a heart attack have a number of requirements that they must meet before they can return to work:
- They must complete a 2 month waiting period before they can return. All waiting periods are designed to allow a driver enough time to fully recover while at the same time limiting the possibility of him/her suffering another heart attack or any complications. Interestingly, some cardiologists will provide a return to work for a driver earlier than the 2 month waiting period. How would this effect the drivers RTW you may ask. The answer is simple…….the driver must wait the entire 2 months before they can return to work regardless of what the cardiologist will say.
- Medical clearance is however still required to return to work from the cardiologist following completion of the required waiting period. The clearance must be written and it must state that the driver can return to work (it is preferable for them to stipulate that they may return to driving a commercial motor vehicle specifically) without restrictions. Always remember, there is no light duty allowed for a truck driver!
- The driver must also tolerate treatment (medications or cardiovascular therapy), have no electrocardiogram ischemic (lack of blood supply) changes, and be asymptomatic.
- Medical testing is also required to return to work. The driver must have an acceptable echocardiogram demonstrating a LVEF (Left Ventricular Ejection Fraction) of 40% or greater. They also need an acceptable Exercise Tolerance Test (ETT) (6 METS or greater).
HOW LONG CAN A DRIVER BE CERTIFIED FOR?
After the driver returns to work, they can be certified for up to 1 year. Certification will be annual thereafter and will never return to a 2 year certification interval. Additionally, the driver will require the following for each recertification:
- Medical clearance from a cardiologist (not the PCP) every year is required before the driver can be certified.
- Every two years, the driver is required to also have an acceptable exercises tolerance test (minimum of 6 METS).
- The certification interval is 1 year as mentioned.
MEDICAL EXAMINER DECISION MAKING
What is required following an event (a heart attack) has been discussed already within this post. The medical examiner would not be able to vary from these requirements regardless of what the cardiologist would say. That includes the waiting period, required clearance and testing needed for the driver to return to driving.
If the driver comes in without clearance or testing information following a heart attack, the medical examiner has no alternative but to either postpone the exam or disqualify the driver until they obtain the information. If they disqualify the driver the medical examiner would then be required to perform an entirely new exam when the driver returns with the required information. It would be better to postpone the exam in my opinion and instruct the driver on what they would need to obtain prior to having the exam.
Regarding recertification exams, options for medical examiners can vary based on how a driver comes in for their exam. The ideal situation would be for the driver to come in prepared with clearances and testing results. If the medical examiners exam is otherwise normal, then the driver that comes in prepared can be certified for a period of 1 year.
The medical examiner would have a couple of choices however if the driver comes in unprepared with required clearances and testing. The options would include:
- Using determination pending. This would be appropriate for the driver that has some time left on their medical certification card (up to 45 days) and if the rest of the drivers history and exam findings would allow for certication. The CME would therefore be able to postpone a final certification decision until the driver has met all of the requirements. This would not work well for drivers that have very little time on their current card as they would not be able to drive if their card is expired.
- The CME could also choose to provide a shortened certification if they feel the driver is healthy enough to drive so that they could obtain the required clearances and testing information. Typically this would be for 3 months. When the driver returns with the needed information the medical examiner would be required to perform a new exam on the driver however. The certification decision would not extend the current 3 month card, but the certification decision would be either to disqualify the driver (typically you would not run into this as your previous exam was essentially benign), or certify the driver for 1 year (if they meet all FMCSA requirements) from the date of the NEW exam.
GOOD NEWS FOR DRIVERS MOTOR CARRIERS AND MEDICAL EXAMINERS
Pass My Physical offers free driver mobile apps that can connect with medical examiners around the country. These mobile apps can be downloaded onto any smart device and allow the driver to fill out and store their exam form and transfer it to any medical examiner. The app also reminds the driver about recert exams beginning at 3 months from the exam and informs the driver as to what is needed for their exam based on their answers to the 32 questions listed on the exam form itself. Finally, it offers them clearance letters for FREE that inform treated providers of all requirements needed for certification. All they need do is review and sign the form if the driver meets all requirements.
This results in fewer delays and less stress for all stakeholders. Drivers that come in prepared should be able to be certified on the spot as long as the rest of their history and exam findings are normal.
For benefit for drivers is that they never have to fill out their exam form again (the app reminds them to update their information periodically), and they will have less hassels and suffer fewer delays relating to their required DOT examination.
Motor carriers benefit by adding a greater number of hours-of-service to their fleets. Based on FMCSA, ATRI and ATA statistics, each motor carrier should add anywhere from 350 to 650 HOS for every 100 driver exams. Additionally, if the medical examiner is using one of our electronic health records they will be able to obtain driver certification cards and HIPAA compliant exam forms either from the driver or the medical examiner through secure portals. No more waiting for driver to hand deliver forms or requesting faxes from medical examiners. Information is transferred automatically and efficiently.
Lastly, medical examiners using one of our products will have access to drivers completed exam forms automatically transferred already completed directly into their system. The driver also comes in prepared and ready for their exam. All this saves time, and allows medical examiners and staff more time and less hassles.