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Assessing Fitness to Drivefor commercial and private vehicle driversAustroadsLevel 9, 287 Elizabeth StreetSYDNEY NSW 2000 AustraliaPhone: 61 2 8265 3300www.austroads.com.au2016Medical standards forlicensing and clinicalmanagement guidelinesAs amended up to August 2017

Assessing Fitness to Drivefor commercial and private vehicle drivers

Help for professionalsFor guidance in assessing a patient’s fitness to drive contact your State or Territory driver licensingauthority (see Appendix 9 for details). Information is also available from the Austroads website:www.austroads.com.auAssessing Fitness to DriveFirst Published 1998Second Edition 2001Third Edition 2003Reprinted 2006Fourth Edition 2012Reprinted 2013Fifth Edition 2016Reprinted 2017 Austroads Ltd 2017This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process withoutthe prior written permission of Austroads.National Library of AustraliaCataloguing-in-Publication data:Assessing Fitness to Drive 2016 as amended up to August 2017ISBN: 978-1-925451-95-5Austroads Publication Number: AP-G56-17Design and typesetting: d fa DesignPublished by Austroads LtdLevel 9, Robell House287 Elizabeth StreetSydney NSW 2000 AustraliaPhone: 61 2 8265 3300Fax: 61 2 8265 3399Email: roads believes this publication to be correct at the time of printing and does not accept responsibility for any consequences arisingfrom the use of information herein. Readers should rely on their own skill and judgement to apply information to particular issues.Document History1 September 2016Document first published.1 August 2017Corrections relating to repaired abdominal and thoracic aneurysms to reflect agreed policy (page 51)and visual aids (page 127). Contact details updated in Appendix 9.

Assessing Fitness to Drivefor commercial and private vehicle drivers2016Medical standards for licensing andclinical management guidelinesa resource for health professionals in AustraliaAs amended up to August 2017

AustroadsAustroads is the peak organisation of Australasian road transport and traffic agencies.Austroads’ purpose is to support our member organisations to deliver an improved Australasian road transport network. To succeedin this task, we undertake leading-edge road and transport research which underpins our input to policy development and publishedguidance on the design, construction and management of the road network and its associated infrastructure.Austroads provides a collective approach that delivers value for money, encourages shared knowledge and drives consistency forroad users.Austroads is governed by a Board consisting of senior executive representatives from each of its eleven member organisations: Roads and Maritime Services New South WalesRoads Corporation VictoriaDepartment of Transport and Main Roads QueenslandMain Roads Western AustraliaDepartment of Planning, Transport and Infrastructure South AustraliaDepartment of State Growth TasmaniaDepartment of Transport Northern TerritoryTerritory and Municipal Services Directorate, Australian Capital TerritoryCommonwealth Department of Infrastructure and Regional DevelopmentAustralian Local Government AssociationNew Zealand Transport Agency.National Transport CommissionThe National Transport Commission is an inter-governmental agency charged with improving the productivity, safety and environmentalperformance of Australia’s road, rail and intermodal transport system.As an independent statutory body, the NTC develops and submits reform recommendations for approval to the Transport and InfrastructureCouncil, which comprises federal, state and territory transport, infrastructure and planning ministers.The NTC also plays an important role in implementation planning to ensure reform outcomes are realised on the ground, as well ascoordinating, monitoring, evaluating and maintaining the implementation of approved reforms.NTC’s visionAustralia’s prosperity and community liveability is enhanced by the movement of people and goods.NTC’s missionTo champion and facilitate changes that improve productivity, safety and environmental outcomes.NTC’s roleBy developing national regulatory and operational reform and implementation strategies for road, rail and intermodal transport.ivAssessing Fitness to Drive 2016

EndorsementsThese standards are endorsed by:Australasian Chapter of Addiction MedicineAustralian Diabetes SocietyAustralasian Faculty of Occupational and Environmental MedicineAustralian and New Zealand Association of NeurologistsAustralasian Sleep AssociationEpilepsy Society of AustraliaOccupational Therapy AustraliaOptometry AustraliaRoyal Australian and New Zealand College of OphthalmologistsAustralian College of Rural and Remote MedicineRoyal Australian College of PhysiciansAustralasian Faculty of Rehabilitation MedicineAssessing Fitness to Drive 2016v

AcknowledgementsSetting these standards involved extensive consultation across a wide range of stakeholders including regulators, employers and healthprofessionals. The NTC and Austroads gratefully acknowledge all contributors including the members of the Maintenance AdvisoryGroup and various working groups, and the project team and consultants. In particular, the contributions of various health professionalorganisations and individual health professionals are recognised as invaluable to the review process.Maintenance Advisory GroupAustroadsMs Cheryl RicheyDepartment of Planning, Transport and Infrastructure, South AustraliaMs Jean PhillipsDepartment of Transport and Main Roads, QueenslandMs Trudy StruberRoads and Maritime Services, New South WalesMs Mary DrewettTransport for New South WalesMs Irene SiuVicRoadsDr Marilyn Di StefanoMs Robyn SeymourAustralian College of Rural and Remote MedicineDr Ken MackeyAustralasian Faculty of Occupational and Environmental MedicineDr Bruce HockingRoyal Australian College of General PractitionersDr Nigel StocksVictorian Institute of Forensic MedicineAssociate Professor Morris OdellAustralian Trucking AssociationMs Louise BilatoMr Bill McKinleyOlder driver/multiple medical conditions working groupVicRoadsMs Fiona MorrisRoyal Australian College of General PractitionersDr Nigel StocksOccupational Therapy AustraliaDr Angela BerndtAssociate Professor Stacey GeorgeProfessor Carolyn UnsworthMonash University of Accident Research CentreAssociate Professor Judith CharltonDr Sjaan KoppelVictorian Institute of Forensic MedicineAssociate Professor Morris OdellAlzheimer’s AustraliaMs Jenny PhilippviAssessing Fitness to Drive 2016

Diabetes working groupAustralian Diabetes SocietyProfessor Stephen TwiggDiabetes AustraliaMs Renza ScibiliaAustralian Diabetes Educators AssociationMs Toni RiceMr Brett FentonAustralian College of Rural and Remote MedicineDr Ken MackeyDepartment of Planning, Transport and Infrastructure, South AustraliaMs Jean PhillipsHearing working groupConsultant audiologistDr Ross DineenDeaf AustraliaMr Kyle MiersDeaf VictoriaMs Melissa LowrieRoads and Maritime Services, New South WalesMs Mary DrewittAustralian Trucking AssociationMr Alex StojanovicVision working groupRoyal Australian and New Zealand College of OphthalmologistsDr Paul BeaumontDr Michael DelaneyMr Gerhard SchlentherUniversity of Sydney, Discipline of OrthopticsThe Hon. Research Associate Neryla JollyOptometry AustraliaMr Luke ArundelNational Transport CommissionMs Belinda IrwinMr Paul DaviesMs Tania WilsonConsultants: Project HealthDr Bruce HockingMs Fiona LandgrenAssessing Fitness to Drive 2016vii

Contributing health professional organisationsThe following organisations contributed substantially to the review process:Australian and New Zealand Association of NeurologistsAustralian Diabetes Educators AssociationAustralian Diabetes SocietyAustralasian Sleep AssociationCardiac Society of Australia and New ZealandEpilepsy Society of AustraliaOccupational Therapy AustraliaOptometry AustraliaRoyal Australian and New Zealand College of OphthalmologistsRoyal Australasian College of Physicians – Chapter of Addiction MedicineRoyal Australasian College of Physicians – Australasian Faculty of Occupational and Environmental MedicineContributing consumer health organisationsAlzheimer’s AustraliaDeaf AustraliaDeaf VictoriaDiabetes AustraliaLegal disclaimerThese licensing standards and management guidelines have been compiled using all reasonable care, based on expert medical opinionand relevant literature, and Austroads believes them to be correct at the time of printing. However, neither Austroads nor the authors acceptresponsibility for any consequences arising from their application.Health professionals should maintain an awareness of any changes in healthcare and health technology that may affect their assessmentof drivers. Health professionals should also maintain an awareness of changes in the law that may affect their legal responsibilities.Where there are concerns about a particular set of circumstances relating to ethical or legal issues, advice may be sought from the healthprofessional’s medical defence organisation or legal advisor.Other queries about the standards should be directed to the relevant driver licensing authority.viiiAssessing Fitness to Drive 2016

ForewordIn 2015, 12091 people were killed on Australian roads, and many tens of thousands hospitalised with serious injuries. The annualeconomic cost of road crashes in Australia is estimated to be 27 billion, which is accompanied by devastating social impacts.While many factors contribute to safety on the road, driver health and fitness to drive is an important consideration. Drivers mustmeet certain medical standards to ensure their health status does not unduly increase their crash risk.Assessing Fitness to Drive is a joint publication of Austroads and the National Transport Commission (NTC) and details medicalstandards for driver licensing purposes for use by health professionals and driver licensing authorities. The standards are approvedby Commonwealth, state and territory transport ministers, and were first published in their current form in 2003. The last edition waspublished in 2012.Since the last publication medical, legal and social developments have required that the medical criteria within the guidelines are updatedto ensure they are accurate and reflect current practices. To this end, the NTC reviewed the guidelines, taking into account feedback fromstakeholders, including medical professionals and expert consultants.This review produced revised guidelines in draft form, for public consultation in October 2015. Doctors, other health professionals,members of the public, consumer groups, commercial operators and drivers, transport peak bodies, transport unions and governmentssubmitted comments to the draft guidelines.This edition of Assessing Fitness to Drive is the result of this extensive consultation process.The Transport and Infrastructure Council approved this edition of the guidelines in June 2016. Medical organisations listed on page v havealso endorsed these guidelines.Austroads and the NTC acknowledge the significant contribution of health professionals to road safety. Health professionals in partnershipwith drivers, the road transport industry and governments play an essential role in keeping all road users safe. Together we are workingtowards further reducing, and eventually eliminating, deaths and injuries from vehicle crashes on Australian roads.Peter Duncan AMChair, AustroadsDavid Anderson PSMChairman, National Transport Commission1. Bureau of Infrastructure, Transport and Regional Economics. 2015. Road deaths Australia. Commonwealth of g/rda/files/RDA Dec 2015.pdf (accessed 28 Jan 2016)Assessing Fitness to Drive 2016ix

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ContentsPart A: General information11.About this publication31.1Purpose31.2Target audience31.3Scope31.4Content41.5Development and evidence base52.3.4.5.Principles of assessing fitness to drive62.1The driving task62.2Medical conditions and driving72.3Assessing and supporting functional driver capacity12Roles and responsibilities153.1Roles and responsibilities of driver licensing authority163.2Roles and responsibilities of drivers173.3Roles and responsibilities of health professionals17Licensing and medical fitness to drive204.1Medical standards for private and commercial vehicle drivers204.2Considerations for commercial vehicle licensing204.3Prescribed periodic medical examinations for particular licensing/authorisation classes224.4Conditional licences224.5Reinstatement of licences or removal or variation of licence conditions25Assessment and reporting process – step by step265.1Which forms to use295.2Steps in the assessment and reporting process29Part B: Medical standards331.Blackouts351.1Relevance to the driving task351.2General assessment and management guidelines351.3Medical standards for licensing352.Cardiovascular conditions392.1Relevance to the driving task392.2General assessment and management guidelines392.3Medical standards for licensing44Assessing Fitness to Drive 2016xi

3.4.5.6.7.8.9.Diabetes mellitus593.1Relevance to the driving task593.2General assessment and management guidelines593.3Medical standards for licensing62Hearing loss and deafness674.1Relevance to the driving task674.2General assessment and management guidelines674.3Medical standards for licensing69Musculoskeletal conditions715.1Relevance to the driving task715.2General assessment and management guidelines715.3Medical standards for licensing74Neurological conditions766.1Dementia766.2Seizures and epilepsy836.3Other neurological and neurodevelopmental conditions97Psychiatric conditions1077.1Relevance to the driving task1077.2General assessment and management guidelines1087.3Medical standards for licensing110Sleep disorders1128.1Relevance to the driving task1128.2General assessment and