Def CMV - Wt =/> 10,001
> 8 passengers if for hire
> 15 passengers (any)
Non-discretionary conditions - MUST follow regulation standards and
... [Show More] disqualify:
Hearing
Vision
Epilepsy
Form MCSA-5850 - To maintain certification, the examiner must submit monthly with the following for all drivers examined for the month
- CMV driver's Name
- Date of birth
- Driver's license number and state
- Date of examination
- Indication of examination outcome
- Whether intrastate driver only
Recert/refresher how often? - Refresher every 5 years
Recertifcation test every 10
Who publishes guidelines? - FMCSA
Parameters tested in UA - SG, glucose, pro, blood
What's being determined by examination? - Whether the CMV driver has a fixed deficit that interferes with safe driving or a condition that may cause sudden death or incapacitation.
When is fitness for duty exam performed outside of expiration of current certification and who decides it needs to be done? - A driver whose ability to perform his/her normal duties has been impaired by a physical or mental injury or disease (391.45). The carrier decides if the driver's illness was severe enough to require recertification
The only condition for which formal medical exemption is available - Monocular vision
How long must the examiner retain copies of the examination form and card. - 3 years
When can Medical Examination Report form be revised - CANNOT be revised after final determination or after the examination has been in "determination pending" status for more than 45 days.
Medical conditions for which a certification interval has been recommended - Hypertension
Heart disease
(both one year-considered best practice)
MAY disqualify drive if: - Does not meet medical guideline recommendation
Does not meet FMCSA Medical Advisory Criteria Recommendations
Uncertain or unknown clinical course (Disqualify or limit certification until information obtained)
Unable to follow up and condition may disqualify
Until additional evaluation is completed
Can the examiner give the driver's medical examination report to the employer - Yes, with the driver's consent
What should the examiner comment on? - All findings, even if not disqualifying
Vision standard - At least 20/40 (Snellen) in each eye and together
Field of vision of 70 degrees in horizontal meridian
Eye exam should include - -Pupillary equality
-Reaction to light and accommodation
-Ocular motility
-Ocular muscle imbalance
-Extraocular movements
-Nystagmus
-Exophthalmos
Conditions that could require ophthalmology evaluation - Retinopathy
Cataracts
Aphakia
Glaucoma
Macular degeneration
Disqualifying forms of vision correction - Monovision contacts (one eye corrected for near, one eye for far)
Telescopic lenses to compensate for loss of central vision
Monocular vision WAIVER - Drivers who participated in study grandfathered, as long as they meet other medical requirements. Must be seen by opthalmologist annually and present waiver letter
Federal Vision Exemption Program - Driver sees medical examiner first and is cleared for other medical conditions, then takes examination form and certificate to ophthalmologist. After eye exam, driver sends paperwork including ophthalmologists report to FMCSA, who grants exemption. Driver must carry vision exemption and certificate card.
Vision exemption maximum recertification - 1 year
Hearing standards - Forced whisper at 5 feet, or
Average hearing loss not greater than 40 dB at 500, 1000 and 2000 Hz
Health history questions related to hearing loss - Ear disorders
Loss of hearing
Loss of balance
Dizziness
Tinnitus
Menieres
Cochlear implant
Standard used for audiometry - ANSI
Exemption for hearing impairment - Issued by FMCSA on defacto basis
Mark "Valid only with exemption" and write "hearing" in the space
Certification recommendation for acute/chronic peripheral vestibulopathy or benign positional vertigo - 2 month symptom free waiting period
Certification recommendation for uncontrolled vertigo, meniere's disease, labyrinthine fistula or nonfunctioning labyrinthes - do not certify
Ear exam findings that should be documented - Scarring of the tympanic membrane
Occlusion of the external canal
Perforated eardrums
How forced whisper test is performed - Examiner stands at examinee's side five feet away. Examinee covers other ear. EAt the end of exhalation, whispers a series of words, numbers or colors.
Examiner determines how many times test is attempted or what percentage of correct responses is adequate.
Audiometry requirement - Average loss of equal to/less than 40 dB at 500, 1000 and 2000 Hz
Audiometry requirement - Average loss of equal to/less than 40 dB at 500, 1000 and 2000 Hz
Cochlear implants - No specific recommendation from MEP. Do not certify if experiencing vestibular sx.
Vertigo or dizziness: do not certify if sx interfere with: - Cognitive abilities
Judgment
Attention
Concentration
Sensory or motor function
Cardiovascular physical exam should include - - Heart murmurs, extra sounds,
- Enlarged heart
- Pacemaker, implantable cardiac defibrillator
- Blood pressure and pulse (rate and rhythm) ---- Abnormal pulse and amplitude,
- Carotid or arterial bruits, varicose veins
- Additional signs of disease (e.g., edema)
- Abnormal respiratory breath sounds including wheezes and rales
Most important prognostic factor in patients with CAD - Left ventricular function
(ejection fraction 40 percent or more is the major predictor of health).
Indicators which suggest increased risk in CAD - - Severity of coronary disease
- Arrhythmias (four to six fold increased risk of
fatal ventricular arrhythmias) ]
- General health
- Age
- Angina pectoris
- Vascular disease
Recommended workload capacity for clearance with CVD - 6 METS (metabolic equivalents)
3 factors to consider when deciding certification - - The cardiovascular condition's rate of progression,
- Degree of control, and the
- Likelihood of sudden incapacitation.
MI: length of certification and waiting period - Maximum certification: 1 year
Minimum waiting period 2 months
MI: recommend certification if: - - Meets general CAD certification
recommendations
- Is asymptomatic
- Has a satisfactory ETT post MI and a biennial ETT thereafter
-Has resting left ventricular ejection fraction
(LVEF) equal to or greater than 40 percent
Angina (stable)
Recommend certification if - - Meets general CAD certification
recommendations
- Has stable angina.
- Has a satisfactory biennial exercise tolerance
test (ETT). If the ETT is inconclusive, an
imaging test may be indicated
Unstable angina
Don't certify if: - Any episodes in past 3 months
Post-CABG
Prognosis - Less risk for SCD than with medical treatment.
Most drivers can return to work
Post-CABG
Certification criteria - - Meets general CAD certification
recommendations
- Waiting period: at least three months post-
surgery to allow the sternum to heal
- Ejection fraction greater than 40 percent
- ETT (not required)
- Certification is for one year
- The driver should have an annual medical evaluation
Do not certify post-CABG if driver: - - Has a non-healed sternum
- Is symptomatic
- Has orthostatic side effects from cardiovascular medication
- Has an LVEF less than 40 percent
- Does not have cardiologist's approval for driving
When should driver get ETT post-percutaneous coronary intervention? - 6-9 mos
Certify post percutaneous coronary intervention if: - - Meets general CAD certification recommendations
- Asymptomatic
- Has no injury at the vascular access site
- Has no ischemic electrocardiogram changes
How often to recertify after percutaneous coronary intervention? - Annually
How often should driver get ETT after percutaneous coronary intervention? - Every other year
Cause of death in CHF - - Sudden death causes 10 percent to 30 percent of all deaths in individuals with HF.
- Sudden death occurs in all functional classes, but is the major cause of death in mildly symptomatic patients.
- Progressive HF is the major cause of death in those with severe symptoms.
CHF: Do NOT certify if: - - Has an EF less than 40 percent
- Has sustained ventricular tachycardia (Lasts 30 seconds or more or requires intervention
- Is symptomatic (New York Heart Association --Class II or higher)
NYHA CHF Classifications -
Supraventricular Arrhythmias : considered a cause of sudden cardiac death? - Common arrythmia, can cause LOC, but NOT considered a cause of SCD.
Supraventricular arrhythmias: tx - Meds or catheter ablation. Ablation is curative is allows discontinuation of meds.
SVT Certification - - Minimum — 1 month post-isthmus ablation for atrial flutter
- Minimum — 1 month asymptomatic/treated and the diagnosis is:
Atrioventricular nodal reentrant tachycardia
Atrioventricular reentrant tachycardia and Wolff-Parkinson-White syndrome
Atrial tachycardia:
Maximum certification is 1 year
The driver should have an annual medical examination.
A-fib minimum waiting period - 1 month
A-fib maximum certification period - 1 year if:
- Anticoagulated adequately
- The heart rate is controlled
- There is no disqualifying underlying heart disease
- Cleared by cardiovascular specialist who understands the functions and demands of commercial driving
Is ETT a good predictor of SCD? - No
ICD-certification? - Underlying condition is usually disqualifying. High risk of recurrence.
Ventricular arrythmia-do NOT certify IF: - Recommend NOT certifying driver who:
- Is symptomatic
- Has sustained VT
- Occurs with an EF <40%
- Has hypertrophic cardiomyopathy, Long QT interval syndrome or Brugada syndrome
Annual evaluation by cardiologist
Syncope: waiting period/certification - Waiting period is at least three months.
Certification is for 1 year if the cause can be prevented or the driver is not a risk while driving or the driver is syncope free for three months and no underlying heart or neurological disease is found after evaluation.
The examiner also needs to consider if the CMV driver has pre-syncope warning or if the driver's underlying condition places him/her at an increased risk for recurrent syncope.
Certify driver with neurocardiogenic syncope with a pacemaker? - NO-remains at risk
Murmur: no evaluation needed if: - No evaluation is recommended if the murmur is: - Midsystolic and grade 2 or less
- No symptoms
- No clinical findings
- Venous hum
Murmur: evaluation needed if: - Evaluation is recommended if the murmur is:
- Early Systolic
- Midsystolic grade 3 or more
- Late systolic
- Holosystolic
- Midsystolic murmur grade 2 or less with symptoms or other signs of cardiac disease
- Diastolic
- Continuous murmur
- Systolic Grade 1+ or 2 with S/S of heart disease
Mild Mitral Stenosis (MVA >1.6 cm2 ): cert/recert? - Certification: Yes, if asymptomatic.
Re-certification: Annual.
Echo every 3 to 5 years and for reevaluation in drivers with known MS and changing symptoms or signs.
Moderate Mitral Stenosis (MVA 1.0 to 1.6 cm2): cert/recert? - Certification: yes if assymptomatic
Recertification: Annual.
Recommend annual exam by a cardiologist. If asymptomatic, echo every 2 years and in drivers with known MS and changing symptoms or signs
Severe mitral stenosis (MVA < 1.0 cm): cert/recert? - Certification: NO if:
- NYHA Class II or higher;
- Atrial fibrillation;
- History of systemic embolism
- Pulmonary artery pressure >50% of systemic pressure;
- Inability to exercise for >6 Mets on Bruce protocol (Stage II)
Recertification:
YES if:
- At least 4 weeks post percutaneous balloon mitral valvotomy; or
- At least 3 months post-surgical commissurotomy;
- Annual; clearance by cardiologist annually
Mild mitral regurgitation: cert/recert? - Cert if:
- Asymptomatic;
- Normal LV size and function;*
- Normal PAP.
Recert:
- Annual
- Annual echo not necessary.
Moderate mitral regurgitation: cert/recert? - Certification: Yes if
- Asymptomatic;
- Normal LV size and function;
- Normal PAP.
Recertification:
- Annual
- Annual echo
Severe mitral regurgitation: cert/recert? - Certify:
YES, if asymptomatic.
YES, if postop: at least 3 months post-surgery, asymptomatic and cleared by cardiologist.
NO if:
- Symptomatic: dyspnea, orthopnea, fatigue, PND
- Inability to achieve > 6 METS on Bruce protocol;
- Ruptured chordae or flail leaflet;
- Atrial fibrillation
- LV dysfunction: LVEF < 60%; LVESD > 45mm LVEDD > 70MM
- Thromboembolism;
- PAP> 50% of systolic arterial pressure;
Recert
- Asymptomatic patient should see cardiologist every 6 to 12 months to assess for symptoms or development of asymptomatic LV dysfunction --- Echo every 6-12 months.
- ETT may be helpful to assess symptoms [Show Less]