1. Driven To Distraction A Review of the Driving Regulations

2. Objectives Consider our obligations with regard to fitness to drive Look at DVLA recommendations for certain medical conditions that might be encountered in the ED Get some exercise!

4. Q1. What is our initial obligation when dealing with a patient who is deemed unfit to drive? 1.Take away their car keys. 2.Tell the patient they are unfit to drive. 3.Inform the DVLA of the decision. 4.Tell the patient to inform the DVLA.

5. Q1. What is our initial obligation when dealing with a patient who is deemed unfit to drive? 1.Take away their car keys. 2.Tell the patient they are unfit to drive. 3.Inform the DVLA of the decision. 4.Tell the patient to inform the DVLA.

6. Q2. The patient says he disagrees with your opinion. Do you: 1.Shrug your shoulders and say, ‘It’s your funeral mate.’ 2.Take away their car keys. 3.Inform the DVLA. 4.Offer to arrange a second opinion.

7. Q2. The patient says he disagrees with your opinion. Do you: 1.Shrug your shoulders and say, ‘It’s your funeral mate.’ 2.Take away their car keys. 3.Inform the DVLA. 4.Offer to arrange a second opinion.

8. Q3. The patient refuses a second opinion and insists on driving home. Do you: 1.Inform the DVLA. 2.Take away their car keys. 3.Call the police. 4.Restrain the patient.

9. Q3. The patient refuses a second opinion and insists on driving home. Do you: 1.Inform the DVLA. 2.Take away their car keys. 3.Call the police. 4.Restrain the patient.

10. Case 1: 60 year old hypertensive man presents with right shoulder pain from capsulitis. An ECG has been done routinely showing LBBB. He has never had any chest pain. 1.6 months 2.4 weeks 3.No restriction 4.3 months

11. Case 1: 60 year old hypertensive man presents with right shoulder pain from capsulitis. An ECG has been done routinely showing LBBB. He has never had any chest pain. 1.6 months 2.4 weeks 3.No restriction 4.3 months

12. Case 2: 25 year old woman with history of epilepsy usually well-controlled. Attends following single seizure lasting for 5 minutes resolving spontaneously. Now fully recovered. 1.No restriction 2.1 year 3.6 months 4.3 months

13. Case 2: 25 year old woman with history of epilepsy usually well-controlled. Attends following single seizure lasting for 5 minutes resolving spontaneously. Now fully recovered. 1.No restriction 2.1 year 3.6 months 4.3 months

14. Case 3: You discover the patient outlined in Case 2 is an HGV driver. 1.10 years 2.5 years 3.1 year 4.6 months

15. Case 3: You discover the patient outlined in Case 2 is an HGV driver. 1.10 years 2.5 years 3.1 year 4.6 months

16. Case 4: 63 year old woman, no past medical history, felt hot, sweaty, dizzy while standing up in church for a hymn and suffered loss of consciousness of 3 minutes. Fully recovered, no features to suggest seizure. ECG normal. 1.1 year 2.6 months 3.1 month 4.No restriction

17. Case 4: 63 year old woman, no past medical history, felt hot, sweaty, dizzy while standing up in church for a hymn and suffered loss of consciousness of 3 minutes. Fully recovered, no features to suggest seizure. ECG normal. 1.1 year 2.6 months 3.1 month 4.No restriction

18. Case 5: Same patient as previous has a second episode of loss of consciousness 1 month later, this time while sitting down. 1.1 year 2.6 months 3.1 month 4.No restriction

19. Case 5: Same patient as previous has a second episode of loss of consciousness 1 month later, this time while sitting down. 1.1 year 2.6 months 3.1 month 4.No restriction

20. Case 6: 45 year old HGV driver has an episode of loss of consciousness while driving which lasted 5 minutes with full recovery. No obvious cause. 1.Banned for life 2.10 years 3.5 years 4.1 year

21. Case 6: 45 year old HGV driver has an episode of loss of consciousness while driving which lasted 5 minutes with full recovery. No obvious cause. 1.Banned for life 2.10 years 3.5 years 4.1 year

22. Case 7: 58 year old man fell through loft floor suffering abdominal injury. On FAST no free fluid but incidental AAA 6.8cm found. 1.No restriction 2.6 months 3.1 year 4.Banned until treated

23. Case 7: 58 year old man fell through loft floor suffering abdominal injury. On FAST no free fluid but incidental AAA 6.8cm found. 1.No restriction 2.6 months 3.1 year 4.Banned until treated

24. Case 8: 19 year old woman with first unprovoked seizure lasting 10 minutes. Fully recovered. No injury. 1.1 year 2.6 months 3.3 months 4.1 month

25. Case 8: 19 year old woman with first unprovoked seizure lasting 10 minutes. Fully recovered. No injury. 1.1 year 2.6 months 3.3 months 4.1 month

26. Case 9: 45 year old woman presenting with single episode of presumed cough syncope. 1.No restriction (on cough sweets??) 2.1 year 3.6 months 4.4 weeks

27. Case 9: 45 year old woman presenting with single episode of presumed cough syncope. 1.No restriction (on cough sweets??) 2.1 year 3.6 months 4.4 weeks

28. Case 10: 56 year old man presents with a 3 day history of left homonymous hemianopia which is found to be due to a CVA. No other neurological deficit. 1.Banned for life 2.5 years 3.1 year 4.6 months

29. Case 10: 56 year old man presents with a 3 day history of left homonymous hemianopia which is found to be due to a CVA. No other neurological deficit. 1.Banned for life 2.5 years 3.1 year 4.6 months

30. Case 11: GP sends in a 32 year old man with mildly deranged LFTs, thrombocytopenia and macrocytosis. On questioning he admits to drinking half litre of vodka per day for 6 months. He never has the shakes. 1.1 year 2.6 months 3.1 month 4.No restriction

31. Case 11: GP sends in a 32 year old man with mildly deranged LFTs, thromboctopenia and macrocytosis. On questioning he admits to drinking half litre of vodka per day for 6 months. He never has the shakes. 1.1 year 2.6 months 3.1 month 4.No restriction

32. Case 12: 24 year old paramedic is newly diagnosed with diabetes mellitus and is started on insulin. 1.Banned for life 2.6 months 3.1 month 4.Banned until condition stable

33. Case 12: 24 year old paramedic is newly diagnosed with diabetes mellitus and is started on insulin. 1.Banned for life 2.6 months 3.1 month 4.Banned until condition stable

34. Case 13: 22 year old woman admits to withdrawal symptoms when trying to kick a 2 year ketamine habit. 1.No restriction 2.1 year 3.6 months 4.As soon as drug free

35. Case 13: 22 year old woman admits to withdrawal symptoms when trying to kick a 2 year ketamine habit. 1.No restriction 2.1 year 3.6 months 4.As soon as drug free

36. Case 14: 48 year old HGV driver has fully recovered from TIA with right hemiparesis. Normal ECG. 1.5 years 2.1 year 3.6 months 4.3 months

37. Case 14: 48 year old HGV driver has fully recovered from TIA with right hemiparesis. Normal ECG. 1.5 years 2.1 year 3.6 months 4.3 months

38. Case 15: 20 year old man presents 2 days after an assault with persisting headache, blurred vision. A CT head shows some left frontal contusions not requiring any treatment. 1.No restriction 2.4 weeks 3.3 months 4.6 months

39. Case 15: 20 year old man presents 2 days after an assault with persisting headache, blurred vision. A CT head shows some left frontal contusions not requiring any treatment. 1.No restriction 2.4 weeks 3.3 months 4.6 months

40. Case 17: 34 year old diabetic attends with hypoglycaemic episode requiring her husband to administer Hypostop. 1.No restriction 2.4 weeks 3.3 months 4.1 year

41. Case 17: 34 year old diabetic attends with hypoglycaemic episode requiring her husband to administer Hypostop. 1.No restriction 2.4 weeks 3.3 months 4.1 year

42. Case 18: Same woman presents 1 month later with further episode of hypoglycaemia requiring husband to administer Hypostop. 1.No restriction 2.4 weeks 3.3 months 4.1 year

43. Case 18: Same woman presents 1 month later with further episode of hypoglycaemia requiring husband to administer Hypostop. 1.No restriction 2.4 weeks 3.3 months 4.1 year

44. Case 19: 66 year old man with implantable defibrillator for 2 years. It has delivered a single shock and the patient is well on arrival in ED. ECG now shows normal sinus rhythm. 1.Banned for life 2.1 year 3.6 months 4.1 month

45. Case 19: 66 year old man with implantable defibrillator for 2 years. It has delivered a single shock and the patient is well on arrival in ED. ECG now shows normal sinus rhythm. 1.Banned for life 2.1 year 3.6 months 4.1 month

46. Case 20: 52 year old HGV driver is in withdrawal. He admits to drinking 2 litres of White Lightning a day. 1.Banned for life 2.10 years 3.3 years 4.1 year

47. Case 20: 52 year old HGV driver is in withdrawal. He admits to drinking 2 litres of White Lightning a day. 1.Banned for life 2.10 years 3.3 years 4.1 year

48. Questions?

49. Summary Legal and ethical obligations with regard to fitness to drive Looked at several cases and the relevant DVLA advice Got a dead arm