Work-Related Road Safety Fitness to Drive Dr Jamie Dow Medical Advisor on Road Safety Société de l’assurance automobile du Québec CARSP Halifax, NS 6 June 2016 © Société de l'assurance automobile du Québec, 2013

Conflicts of interest I have no conflicts of interest to declare I am a full-time, salaried employee of the Société de l’assurance automobile du Québec. I receive no revenue from commercial enterprises.

Fitness to Drive Certain medical conditions affect crash risk Epilepsy Relative risk 1.42 Substance abuse Relative risk 1.32 Psychiatric conditions Relative risk 1.32 Respiratory conditions Relative risk 1.21 Epilepsy + musculoskeletal Relative risk 1.93 Psychiatric + sleep disorder Relative risk 1.85 Source: Dow, Gaudet, Turmel 2013

Multiple meidcal conditions # of conditions Male Female 1.00 1 1.14 1.26 2 1.27 1.48 3 1.36 1.69 4 or more 1.38 1.84 Relative risk of a crash according to the presence of medical conditions known to influence driver fitness NB: Male: Female RR = 1 : 0.6 Source: Dow, Gaudet 2016

Fitness versus wellness Driver fitness evaluates the person’s state of health and its effects upon how a person can drive or the possibility of an adverse, medically-related incident occurring at the wheel Wellness programmes seek to install a healthy lifestyle (smoking cessation, physical activity, nutrition) Fitness + Wellness = Healthier Person

Fitness + Wellness A good wellness programme can render the person with a medical condition better able to drive safely. It can help the person to compensate for a medical condition that would otherwise affect driver fitness. Many medical conditions are the result of inactivity and poor nutrition. For example: Lack of physical activity can contribute to obesity which is a factor in diabetes, sleep disorders and cardiovascular conditions

Professional drivers Medical standards for drivers are stricter than those for private drivers Why? More hours on the road Inflexible work schedules Long hours Requirement to observe a schedule Cannot pull over and rest whenever they feel like it. Consequences of a crash

Diabetes A Canadian professional driver with insulin-treated diabetes cannot drive his vehicle in the US (Condition W) Diabetes requires a regular daily schedule Regular meals, regular sleep, regular monitoring of blood sugar, stopping if hypoglycemia, managing the condition Does that sound like the average day for a long-distance truck or bus driver? Consequently, a diabetic Class 1 - 4 driver treated with insulin must demonstrate stable diabetes and good comprehension of the disease before being allowed to drive in Canada Explications et commentaires sur chaque point.

Sleep disorders Obstructive sleep apnea (OSA) Probably more prevalent in Class 1 – 3 drivers, many of whom have predisposing factors – obesity, male, 40+, sedentary lifestyle Fatigue + OSA = big problem Lifestyle changes can help resolve both problems Real incidence of OSA and its effects are unknown Most studies of OSA in the trucking industry have a selection bias OSA is the default cause of crashes in many investigations

Conclusion Medical fitness to drive and wellness are not the same There is an interaction between the driver’s health and wellness programmes that is beneficial for all concerned Wellness programmes may not make you healthy but they can make you healthier The healthier you are the better you will perform no matter what your job may be.

Questions? jamie.dow@saaq.gouv.qc.ca (418) 528-4984