Bulletin to Medical Examiners, Operation Safe Driver, Updates

Bulletin to Medical Examiners

Clarifies Handling of Sleep Apnea

There are currently no direct federal regulations regarding the diagnosis and treatment of Obstructive Sleep Apnea (OSA). To date FMCSA has relied on the following regulatory language:

§ 391.41(b)(5)

Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.

According to the most recent bulletin issued to medical examiners: “If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy.” This type of guidance has been the driving force behind the diagnosis and treatment of OSA for years.

There is certainly nothing wrong with diagnosing and treating a medical problem, especially if it is likely to impair the driver’s ability to control a commercial motor vehicle. The problem is that there are no clear–cut guidelines and each Medical Examiner is free to use their judgement.

Two different medical facilities could examine the same driver and yet reach differing conclusions. In fact there are even differences of opinion on what criteria or symptoms should trigger a test for OSA. There has been much discussion about Body Mass Index and the role it plays and whether or not that can/should be the sole indicator.

The industry has been vocal about setting standards and last year Congress mandated that FMCSA formalize standards for OSA through the rulemaking process. The advantage to this approach is that there will be a clearly defined standard and the industry will have input.

In the meantime you should keep in mind the following information from the recent bulletin:

Screening: With regard to identifying drivers with undiagnosed OSA, FMCSA’s regulations and advisory criteria do not include screening guidelines. Medical examiners should consider common OSA symptoms such as loud snoring, witnessed apneas, or sleepiness during the major wake periods, as well as risk factors, and consider multiple risk factors such as body mass index (BMI), neck size, involvement in a single-vehicle crash, etc.

Diagnosis: Methods of diagnosis include in–laboratory polysomnography, at–home polysomnography, or other limited channel ambulatory testing devices which ensure chain of custody. (Editor’s note: For a test completed at a clinic the subject is observed thus establishing chain of custody. For the at-home test the subject is not observed so an alternative method establishing chain of custody should be used. There are no published guidelines for this)

Treatment: OSA is a treatable condition, and drivers with moderate-to-severe OSA can manage the condition effectively to reduce the risk of drowsy driving. Treatment options range from weight loss to dental appliances to Continuous Positive Airway Pressure (CPAP) therapy, and combinations of these treatments. The Agency’s regulations and advisory criteria do not include recommendations for treatments for OSA and FMCSA believes the issue of treatment is best left to the treating healthcare professional and the driver.

Operation Safe Driver

Also Targets Non–Commercial

The results from CVSA’s Operation Safe Driver mobilization week have been released. The data comes from the campaign which was conducted October 19 – 25, 2014. During that time period over 4,000 law enforcement officials pulled over 59,080 vehicles, both commercial and passenger vehicles, and conducted outreach events at high schools, state capitals, state fairs, truck rodeos, sporting events and other locations.

Top five warnings & tickets for CMV drivers:

Top five warnings & tickets for non-CMV drivers:

As with many other enforcement actions this program takes a targeted approach and focuses on problem driver behaviors. Officers found that non-commercial motor vehicle drivers speed significantly more so than commercial motor vehicle drivers and they were issued a warning or citation for speeding 52.3 percent of the time, versus 5.8 percent for CMV drivers.

During the 2014 campaign, Federal and State safety investigators also used data from CSA to target motor carriers for on–site interventions. As a result, 193 compliance Investigations were conducted during Operation Safe Driver 2014, and 23 percent of the motor carriers investigated received proposed Unsatisfactory Safety Ratings, while another 53 percent received proposed Conditional Safety Ratings. In addition, 46 percent of the investigations resulted in enforcement actions.

Updates

Restart Study Contractor Chosen

FMCSA has chosen Virginia Tech’s Transportation Institute to conduct a study on the 34–hour restart rule. Last year’s temporary suspension of two restart provisions carried the caveat that FMCSA study the effect on driver safety. The study will involve 250 drivers and is expected to be completed by the end of September.

Final ELD Rule Due In November

FMCSA expects that the Electronic Logging Devices final rule will be published in November with an effective date two years later. The final rule will establish technical specifications, harassment protection provisions, and the requirements for supporting documents.

Guidance on Training Requirements

FMCSA has a 26 member committee studying training requirements for new commercial vehicle drivers. The committee’s recommendations will become part of FMCSA’s proposed training rule which should be published later this year.

Pay/Safety Relationship

FMCSA is planning on gathering information from motor carriers to study what if any affects driver compensation has on safety. The information will come from the owners of motor carriers as well as safety and operations employees. FMCSA will randomly select carriers and use an online questionnaire to obtain the information.

Learn More About Our Services