Medical standards for drivers
Manitoba Public Insurance assesses medical fitness to drive based on the Medical Standards for Drivers published by the Canadian Council of Motor Transport Administrators (CCMTA). The standards were developed by medical advisors (physicians) and driver licensing administrators from Canadian provinces and territories, and establish basic medical qualifications for drivers with medical conditions that may impact their ability to drive safely.
These standards were recently reformatted and updated in 2013. Traditionally, CCMTA medical standards largely reflected a diagnostic model. In terms of an evidentiary basis, the standards reflected the consensus opinion of practicing physicians.
In this model, authorities are moving toward a functional approach to driver fitness. This means assessing the impact of a medical condition on the functions necessary for driving. The functions necessary for driving are generally cognitive, motor, and sensory.
CCMTA’s new publication has increased its emphasis on using research evidence, where it exists, as the basis of its driver fitness standards. Each medical condition in included because the best available evidence shows that the medical condition causes impairment of one or more of the functions necessary for driving, or has been associated with an elevated risk of crash or impaired driving performance.
CCMTA physicians and health care professionals used many documents and medical expertise in preparing the medical standards including medical specialty associations, and the Canadian Medical Association. Physicians and optometrists are encouraged to review these standards when assessing and making recommendations regarding their patient’s medical fitness for driving.
In addition to the Medical Standards for Drivers, provincial jurisdictions use assessment guidelines to determine how particular conditions or combination of conditions may affect an individual’s ability to drive safely.
The functions necessary for driving are cognitive, sensory (vision, touch) and motor (physical). Driving is a complex perceptual-motor skill that usually takes place in a complex environment requiring the functions to operate together. Since the combination of medical conditions is exhaustive, Medical Compliance and Assessments staff often analyze medical information specific to the types of impairments and the potential effect on driving functions.
The types of impairment resulting from medical conditions can be classified as persistent or episodic and the effect of each on driving ability is assessed differently.
With episodic impairments, the event is sporadic, unpredictable and lasts for a short time. Episodic impairments do not have any ongoing measurable, testable or observable impacts on the functional ability to drive. Examples of episodic impairments include but are not limited to:
- myocardial infarctions
- transient ischemic attacks
- hypoglycemic reactions
- blackouts or fainting spells due to transitory illnesses
When the medical event occurs, there is no question that the individual is not competent to drive and may be incapacitated. Determining driver fitness for episodic impairments therefore focuses on medical assessments and the likelihood the event will recur. Generally the Medical Standards for episodic impairments reflect medical research and/or consensus medical opinions to assist in driving decisions. In most cases, drivers who experience episodic impairments are monitored by their physicians and driving privileges are suspended until such time as the condition has cleared (completely or for an established period of time), or has been stabilized. Drivers with episodic impairments do not require functional driving assessments because there are no ongoing, measureable effects on driving other than when the event occurs, which cannot be predicted.
Persistent impairments, such as cognitive and motor deficits resulting from a stroke, are relatively stable and enduring. Drivers with medical conditions that have persistent impairments generally require a functional assessment, in addition to a medical assessment, to determine fitness to drive. Examples of medical conditions that may require a functional assessment include but are not limited to:
- cognitive deficits – no dementia
- multiple medical conditions
- multiple sclerosis
- Parkinson’s disease
- head injury
- vision deficits
Functional assessments measure the effect of persistent impairments on an individual’s ability to drive. They involve observing or measuring the functions required for driving and can reveal subtle, persistent impairments that may go undetected during a physician’s in-office examination. Functional assessments may include DriveABLE assessments, assessments conducted by the Driver Assessment and Management Program (DAMP) , other evaluations conducted by Manitoba Public Insurance, or a combination of these assessments.
Multiple medical conditions
The Medical Standards for Drivers each focus on a single medical condition and are written as if the driver had only one medical condition. While the standards for each medical condition may indicate the driver is fit to drive, the cumulative effect of those conditions may make the driver unfit to drive. In situations where a driver’s medical fitness to drive is unclear, a functional assessment is the most useful tool to determine driver fitness.