1. Update: Federal Motor Carrier Safety Administration (FMCSA) Women in Buses Council American Bus Association September 17, 2014
Elaine Papp, RN, MSN, COHN-S, FAAOHN Chief, Medical Programs Division

2. Agenda
Overview of FMCSA Medical Programs and Medical Certification Requirements
National Registry of Certified Medical Examiners
Medical Exemptions
Online tools

3. FMCSA Mission
The Federal Motor Carrier Safety Administration is focused on reducing crashes, injuries, and fatalities involving large trucks and buses.

4. Interstate or Intrastate
Defined by transportation of goods:
Interstate commerce, transports people or goods across a state line
Example -- Federal Express driver
Intrastate commerce, transports people or goods within the state
Example -- A gravel truck driver -- gravel from a quarry within a state to businesses in the same state

5. Truck and Bus Driver Statistics
3.5 million active interstate drivers
3 million CDL holders
Approx. 539,033 active interstate motor carriers

6. Large Truck and Bus Crashes
U.S. Department of Transportation (DOT) Interstate Traffic Crash Statistics 2012
Persons
Large Truck Crashes
Bus Crashes
Large Truck and Bus Crashes
All Vehicle Crashes
Fatalities
3,464
250
3,702
30,800
Injuries
73,000
12,000
85,000
1,634,000

7. Medical Program Activities
Rulemaking/Guidance Development
Research
Medical Review Board
Medical Expert Panels
Evidence Reports
Compliance Assistance
Medical Exemptions/Variances
Vision, Diabetes, Hearing, Seizure
Skill Performance Evaluation (SPE)
Agency has requested public comment on exemption applications for seizure conditions and hearing loss

8. Purpose of the Medical Certification Examination
Determine a driver's physical qualification to operate a commercial motor vehicle (CMV)
Interstate commerce
49 CFR
Med Cert/CDL Rule
Driver must provide MEC to SDLA to obtain or maintain commercial driver’s license

9. Medical Examiner Responsibilities
Knowledgeable about:
Physical and mental demands of CMV driver job duties
FMCSA regulations, including guidance
Use of medical protocols
Make medical determinations based on FMCSA regulations and advisory criteria

10. National Registry of Certified Medical Examiners (National Registry)

11. National Registry Background
New regulation - Published April 20, 2012
Requires medical examiners:
Complete training
Pass a test
Periodic training and testing
Maintain licensure
Report completed CMV driver examinations monthly
Compliance Date – May 21, 2014
All CMV drivers must use a ME on the National Registry
Medical certificates issued prior to May 21, 2014 are valid until the expiration date

12. National Registry Statistics
As of September 15, 2014
57,924 ME - registered but haven’t taken test
35,483 ME – passed test, not yet certified
34,819 ME – certified on registry
National Registry is working
Finding ME fraud
Be sure to check the National Registry for your ME’s certification
If ME not certified – driver needs a different ME

13. Regulations and Advisory Criteria
Mandatory
Advisory Criteria
Assist the Medical Examiner in making individual determination of physical fitness for driving

14. Medical Exemption Programs
Federal Diabetes Exemption Program
Federal Vision Exemption Program
Hearing Exemptions
Seizure Exemptions
Skill Performance Evaluation Certificate Program

15. Federal Diabetes Exemption Program
Exemptions for drivers who have insulin-dependent diabetes mellitus
Drivers submit application
Medical information showing their diabetes is under control
To maintain exemption, drivers submit quarterly monitoring reports
Diabetes exemption application can be found at:
or call (703)

16. Federal Vision Exemption Program
One eye does not meet the minimum vision requirements
Better eye must meet the minimum vision standard
Drivers submit application
Medical information showing driver is able to meet all other physical requirements
Experience driving with vision deficiency
Crash/violation history
Vision exemption application can be found at
or call (703)

17. Federal Hearing Exemption Program
Driver must perceive forced whisper in better ear at not less than 5 feet with or without hearing aid or no hearing loss in better in greater than 40 decibels at 500, 1,000 and 2,000 Hz with or without hearing aid
Driver may apply for an exemption by contacting the Medical Programs Division at FMCSA (202)

18. Federal Seizure Exemption Program
Disqualified from operating in interstate commerce
49 CFR (b)(8)
May be considered for exemption based on number of years:
Since last seizure, stable on anti-seizure medication, medical history
Exemption determinations are based on a case-by-case review
Driver may apply for an exemption by contacting the Medical Programs Division at FMCSA (202)

19. Skill Performance Evaluation (SPE)
Driver with loss or fixed limb impairment
Evaluation of driving skills
Driver completes application process including
Assessment and evaluation by an Orthopedic Surgeon or Physiatrist
Medical examination certification that designates he is otherwise qualified except for completion of the SPE

20. OSA Congressional action What does the Agency say about OSA?
Public Law
Signed into law October 2013
Requires Agency to develop regulation on OSA before issuing new guidance
What does the Agency say about OSA?

21. OSA Included in respiratory dysfunction regulation 49 CFR 391.41(b)(5)
Advisory criteria
Respiratory dysfunction
MRB/MCSAC Recommendations to Agency
Two-pronged approach
Interim - guidance
Long-term - rulemaking
Agency has not taken action on MRB/MCSC recommendations

22. OSA
Focus for ME
Use medical protocols/standards of clinical care to determine physical qualification
Like all other medical conditions
Consider the actual risk of sudden or gradual incapacitation
Undiagnosed OSA with risk factors
Consider issuing short-term medical card for testing and treatment
Driver diagnosed and successfully treated
Demonstrated compliance with treatment
Letter from treating clinician
CPAP recorder printout
Dental device tracking printout or other

23. Online Tools You may access the following on the the FMCSA website:
Evidence Reports
Medical Expert Panel Reports
Medical Review Board (MRB) Recommendations
Medical Examiner’s Handbook (pdf version)

24. Contact Information
Federal Motor Carrier Safety
Administration, Medical Programs Division
U.S. Department of Transportation
Washington, D.C.
Phone: (202)
Fax: (202)
Medical Programs
National Registry Website