When do patients require a Skilled Performance Exam? - ANSWER-IF they have a FIXED motor deficit of an extremity who cannot physically qualify to drive
... [Show More] that needs a full evaluation by a specialist (Not for patients with a progressive motor deficit)
**These patients must provide proof of the exam by the specialist in order to obtain certification or be given a referral letter if you think they need an exam***
What two special populations of drivers are given exemptions by the DOT? - ANSWER-1. Patients with vision disorders
2. Diabetics
***The exemption allows the grandfathering in of certain drivers who participated in vision and diabetes waiver study programs***
***Drivers can be certified as long as they meet the provisions and have the certificate with them at the time of the DOT exam***
What are your duties as a DOT examiner? - ANSWER-To detect the presence of any physical, mental, or organic conditions of such character and extent as to affect the ability of the driver to operate a CMV safely
What is the definition of Incapacitation? - ANSWER-The onset of incapacitating symptoms so rapidly that they interfere with safe driving or that the driver may be unable to safely stop the vehicle before beocming incapacitated
If the patient has any side effects of medications, can they be certified? - ANSWER-NO!! Any side effects such as drowsiness, dizziness, orthostasis, blurred vision or changes in mental status prohibit the driver from being certified
What conditions lead to AUTOMATIC DISQUALIFICATION for DOT certificates? - ANSWER-DEFIBRILLATOR
DIALYSIS
What are the VISION requirements for DOT certification? - ANSWER-1. Distant visual acuity of at least 20/40 in EACH EYE with or w/o lenses
2. Distant BINOCULAR vision of at least 20/40 in both eyes, with or w/o lenses
3. Field of vision of AT LEAST 70 DEGREES in the horizontal meridian in each eye
4. Ability to recognize/distinguish among colors of traffic signals (RED, AMBER, GREEN)
Can a driver with monocular vision obtain a DOT certificate? - ANSWER-YES, but the driver must be otherwise medically fit for duty and granted a FEDERAL VISION EXEMPTION CERTIFICATE
**Pt must return with the certificate of exemption before the DOT certificate can be given***
If a driver comes for a physical and is otherwise fit, you can disqualify them and the driver can apply for a federal vision exemption
What is MONOCULAR VISION? - ANSWER-Monocular vision occurs when the vision requirements are only met in one eye, with or without corrective lenses
***MONOCULAR VISION IS AUTOMATICALLY DISQUALIFYING***
How do you certify a driver who is in the process of applying for a Federal vision exemption? - ANSWER-YOu can certify the driver for up to 1 year, mark the accompanied by EXEMPTION checkbox and write vision so that the type of federal exemption is specified
What are the hearing requirements to obtain a DOT certificate? - ANSWER-1. Driver must first perceive a whispered voice in one ear @ no less than 5 feet (only required in 1 ear)
2. NOT have an average hearing loss in one ear >40dB at 500 Hz, 1,000 Hz and 2,000 Hz
What are the BP regulations for a person with STAGE 1 HTN (BP of 140/90-159/99)? - ANSWER-person is only certified for 1 year and if BP is >140/90 then they get 3 month cert at the 1 year recert
What are the BP regulations for a perston with STAGE 2 HTN (BP of 160/100 to 180/110? - ANSWER-Person can only get a 3 month certificate and then at recertification if the BP is less than 140/90, they can get 1 year from the date of the original exam
What are the DOT regulations for a driver with STAGE 3 HTN (BP>180/110)? - ANSWER-DRIVER IS DISQUALIFIED until the BP is <140/90
When BP is <140/90, they can only get a 6 month certificate forever
What does a urinalysis check for DOT certification? - ANSWER-Specific gravity
Proteinuria
Hematuria
Glycosuria
What should the PE rule out in every driver? - ANSWER-Presence of any current CV disease accompanied by and/or likely to cause symptoms of syncope, dyspnea, collapse or CHF
How long must a driver wait to be certified after having an AMI? - ANSWER-There is a 2 months waiting period so driver is temporarily disqualified for 2 months and can only be certified for a max of 1 year if they are Asx, tolerating meds, has a satisfactory Exercise Tolerance test has resting EF >40% and no ischemic changes on EKG
***For the initial certification exam following an MI, an in-hospital post-MI echo showing LV EF>40% is sufficient***
What LV EF is required after an MI for a patient to obtain DOT certificate? - ANSWER-LV EF>40%
What conditions disqualify a patient after an MI? - ANSWER--Rest angina or change in anginal patterns
-ischemic changes on rest EKG
-intolerance to cardio meds
How long must a driver wait after having a CABG before they can be certified? - ANSWER-3 months
How often is an Exercise Tolerance Test required for a patient after having an AMI vs a CABG? - ANSWER-ETT every 2 years after an MI
ETT every year after a CABG
Can a driver with an implantable defibrillator qualify for a DOT certificate? - ANSWER-NO!!! because these pts have risk of syncope if it fires
Can a driver with a pacemaker qualify for a DOT certificate? - ANSWER-YES
What is the max amount of time that a driver on Anticoagulant therapy be certified? - ANSWER-1 year
***can only be certified if the driver is stabilized for at least 1 month, provides a copy of INR results at the exam and has at least monthly INR monitoring with documentation***
What is required from a driver with a prior history of DVT before he/she can obtain DOT certification? - ANSWER-Recent ultrasound showing resolution of DVT
What type of documentation is required from a pt on Xarelto or Pradaxa requesting a DOT certificate? - ANSWER-A letter from the treating Cardiologist stating that the patient is clear to drive
***Driver can only be certified for 1 year***
What is the required waiting period for a patient that has a history of seizures/epilepsy? - ANSWER-10 years off of anticonvulsant meds and w/o any seizures
What is the maximum time that an alcoholic patient can be certified? - ANSWER-2 years
***no recommended time frame for alcoholism waiting period, driver can be certified as long as they have no residual disqualifying physical impairment, completed counseling or no current disqualifying alcohol-related d/o's***
What is required for a driver with a history of drug abuse to be certified? - ANSWER-1. Driver must be evaluated by a SAP (Substance Abuse Person)
2. Comply with recommended rehab
3. Have a negative return-to-duty drug test
What drugs prohibit you from giving a driver a DOT certificate? - ANSWER--Use of schedule 1 controlled substances (Amphetamines, Narcotics)
-Any habit forming drug
-Methadone (reason for Rx is irrelevant)
-Marijuana (even if it's legal in that state)
Can a driver with DM who uses insulin be certified? - ANSWER-NO!! INsulin use is an automatic disqualifier unless the pt has a DM exemption letter/paperwork from an Endocrinologist
What is the definition of a severe Hypoglycemic reaction by the Federal Motor Carrier Safety Administration (FMCSA)? - ANSWER-Any reaction that results in:
-SEIZURE
-LOC
-Need of assistance from another person
-Period of impaired cognition that occurs w/o warning
***If a driver on insulin has had any such events in the past 12 mos, he can NOT be certified***
What is the waiting period for a driver that is on insulin therapy? - ANSWER--Must wait at least 1 month for a driver that was previously diagnosed and has just recently added insulin to the treatment regimen
-Must wait at least 2 MONTHS for a driver that was just diagnosed and was never on any Tx for DM (b/c it takes longer to get pt under control)
What is the max amount of time that a driver on insulin therapy can receive a DOT certificate? - ANSWER-1 year
What conditions prevent a driver with diabetes from being certified? - ANSWER--History of Severe hypoglycemic rxn in the past 1 yr
-2+ severe hypoglycemic reactions in the last 5 years
-loss of position sense
-loss of pedal sensation
-resting tachy
-orthostasis
-peripheral neuropathy
Any driver on oral hypoglycemic meds for DM can only be certified for how long? - ANSWER-1 year
***You need a letter from endocrinologist stating pt's DM is under good control and pt is not on any meds that can cause hypoglycemia, dizziness, orthostasis
For which population of drivers is a skilled performance exam appropriate? - ANSWER-Only for drivers with fixed deficits of the EXTREMITIES (not the neck or torso)
***SPE cannot be used as an alternative standard for deficits caused by progressive diseases such as MS***
What is the waiting period during which a driver with depression must be temporarily disqualified? - ANSWER-6 months symptom free following a non-psychotic major depression unaccompanied by suicidal behavior
1 year symptom free following a MAJOR/SEVERE depressive episode, suicide attempt or manic episode
***Depressed pts can only be certified for 1 yr***
What is the minimum waiting period for any driver with a history of stroke? - ANSWER-At least 1 year for any pt that has no risk of seizures (vascular lesions in the cerebellum or brainstem)
At least 5 years for a pt with stroke related to seizure risk (cortical or subcortical lesions)
***Driver must be cleared by neuro; Max certification for a pt that has had a stroke is 1 yr***
What are the requirements for obtaining a Sleep Apnea referral for DOT drivers? - ANSWER-Hypertension
BMI >35 % and Neck Circumference >17in in M and >16in in F
How long is the waiting period for sleep apnea drivers? - ANSWER-At least 1 month after starting CPAP (so pt must be temporarily disqualified for at least 1 mo after starting)
At least 3 months symptom free after surgery tx
***Max certification for 1 year***
Can a driver with a pacemaker be certified under the DOT and what are the regulations? - ANSWER-Only certify if:
-Documented fully functioning pacemaker
-documented completed pacemaker check
-no disqualifying underlying dz
***Any pt with a combination Defibrillator/Pacemaker CANNOT be certified***
What are the size requirements of a AAA that allow a driver to be certified? - ANSWER-AAA<4 cm with no symptoms = driver can be certified
AAA>4cm<5cm needs surgical clearance from a cardiovascular specialist to verify low risk of rupture
AAA>5cm CANNOT BE CERTIFIED
AAA that increases more than 0.5cm during 6 months CANNOT be certified, regardless of size (pt very high risk for rupture)
***Any pts with symptoms of AAA CANNOT be certified regardless of AAA size***
What waiting period is required for a patient with a pacemaker? - ANSWER-At least 1 month temporary disqualification of a driver with minor dz such as SA node dysfunction or AV block
At least 3 month temporary disqualification for a driver with an underlying dz such as neurocardiogenic syncope or hypersensitive carotid sinus with syncope
How long can a pt with Diabetes be certified if the Diabetes is well controlled? - ANSWER-In general 1 year certification is safest
-Pt will need annual evaluation of vision, neuro fxn, cardio dz and HTN
Who sets the qualification standards for the DOT exam? - ANSWER-Federal Motor Carrier Safety Administration (FMCSA)
What does CDL stand for? - ANSWER-Commercial Driver's License (any motor vehicle used for commercial purposes that has a weight >10,000 lbs, is used to transport hazardous materials or can carry at least 16 passengers)
What are the vision requirements of DOT testing? - ANSWER-At least 20/40 visual acuity in each eye with or w/o correction
At least 70 degrees peripheral vision in each eye
Ability to distinguish between red/green/amber colors (Ishihara test)
Must demonstrate BINOCULAR VISION
*always note use of corrective lenses on the test
What is the name of the test to assess for color blindness - ANSWER-Ishihara Test
What are the hearing requirements for DOT testing? - ANSWER-Must first perceive whispered voice greater than or equal to 5 ft from the provider (WITH OR WITHOUT A HEARING AID)
Demonstrates average hearing loss in the better ear greater than or equal to 40dB at 500, 1,000 and 2,000 Hz
*Use of hearing aid must be noted on certificate
What is the purpose of the urinalysis used for all DOT applicants? - ANSWER-To screen for Diabetes
How do you deal with limb impairment? - ANSWER-SPE Certification program allows persons with loss of foot or limb to potentially qualify with use of prosthetic devices or equipment modifications
*Driver must have current SPE certificate in behicle
What are the restrictions placed on Diabetics by the DOT? - ANSWER-Only NON-INSULIN dependent diabetics can qualify if the disease is controlled by diet and oral meds AND
no evidence of organ damage
What is the definition of controlled Diabetes? - ANSWER-Fasting plasma glucose < 140
2 hour post-prandial glucose <200
HgbA1C <8
*Ask all patients about hypoglycemic episodes
What are the restrictions/guidelines for applicants with Cardiovascular dz? - ANSWER-Current CV disease that is accompanied by or likely to cuase any symptoms of SYNCOPE, DYSPNEA, COLLAPSE OR CHF SHOULD BE DISQUALIFIED
*Always obtain eval by a Cardiologist
-If pt has established CV disease, they must undergo a resting and stress EKG
*CABG, pacemakers, Coumadin or NOT disqualifying so refer to Cardiologist for clearance
What is the HTN Algorithm - ANSWER-BP 161-180/91-100 can be qualified for 3 months. IF the BP is then less than or equal to 160/90 within the 3 months then qualify for 1 year from date of initial exam with documented Rx and BP control
BP >180/104 is disqualified until reduced to <180/104 then driver can be qualified for 3 months. If the BP is <160/90 in 3 months, the driver can be qualified for 6 months with documented Rx and BP control
What are the restrictions on applicants with history of epilepsy/seizures? - ANSWER-Any pt with a hx of epilepsy, current diagnosis of epilepsy or taking antiseizure meds is DISQUALIFIED
-If a patient has a suddent LOC or seizure of unknown cause that did not require anti-seizure meds then there is a 6 month waiting period with neurologic clearance. If Neuro does not prescribe pt with anti-seizure meds, pt can then be cleared
Vision - ANSWER-Use of contact lenses in 1 eye for distance and 1 eye for near vision means driver must be disqualified
-If visual acuity is normal only while wearing corrective lenses, then the patient must wear them in order to qualify
What medications are disqualifying according to the DOT? - ANSWER-Schedule 1 meds such as Heroine, Marijuana, Amphetamines, Narcotics or any other habit-forming drugs
(Exception is only if the driver was prescribed the med by a doctor familiar with the patient's history, duties and has been told it will not interfere with safe driving)
Hypertension Stage 1 - ANSWER-BP between 140/90 and 159/99
One year certification
Hypertension Stage 2 - ANSWER-BP between 160/100 and 179/109
Three month cert first time, then one year from original cert date if controlled
Stage 3 HTN - ANSWER-BP greater than 180 or 110 is a disqualify. Pt may be certified every 6 months if the BP is less than 140/90
Is Audiometry required? - ANSWER-No, not if the applicant can pass the forced whisper test in at least one ear
What is the highest acceptable A1C? - ANSWER-10
What is the maximum certification for someone with DM? - ANSWER-1 year
What is the maximum allowable AAA size? - ANSWER-5 cm
How often must drivers with OSA be tested? - ANSWER-Yearly
What is the maximum certification period that can be allowed for a patient on an anticoagulant? - ANSWER-1 year for Cardiac anticoagulant, disqualified for BRAIN
What is the waiting period after starting CPAP? - ANSWER-1 month
What is the maximum recertification for drivers with OSA? - ANSWER-1 year
What is the minimum compliance with CPAP machines required by drivers? - ANSWER-4 hours a day on 70% of days
How long must a driver stop driving after an MI? - ANSWER-2 months
-Driver needs an Echo with EF>40% and ETT
How long must a driver stop driving after a CABG? - ANSWER-3 months to allow for full sternal healing
Can a driver taking medical marijuana be given a DOT card? - ANSWER-NO, per the FMCSA it is against the rules
What is the criteria for a patient to return to work after having a STENT placed? - ANSWER-Exam and approval letter from treating Cardiologist
Asymptomatic
ETT 3-6 months post PCI (Stent placement)
Annual medical exam
Negative ETT at least every other year
Is hematuria a disqualifying medical disorder? - ANSWER-No, you can certify the patient, but you must document a referral to the patients PCP or specialist for further workup
Proteinuria - ANSWER-This is a sign of renal dysfunction
Always document referral to Nephrologist
Can a driver who needs a Diabetes or vision exemption be certified? - ANSWER-No! They are disqualified until they obtain the exemptio [Show Less]