Keeping Commercial Traffic on the Road

The National Registry of Certified Medical Examiners (NRCME) was created to establish a system in which all examiners consistently apply FMCSA regulations for driver fitness when providing DOT physicals. The overall goal is to ensure Commercial Motor Vehicle (CMV) driver health and reduce the overall number and severity of highway crashes involving commercial motor vehicles.

NRCME medical examiners play a critical role in highway safety by ensuring that only qualified drivers receive a medical certificate allowing them to operate CMVs. NRCME contributes to highway safety in a few important ways:

• Sets the Standards for Medical Fitness. NRCME establishes the standards that provide examiners with a framework to ensure CMV drivers are physically and mentally capable of safely operating vehicles.

• Provides DOT Driver Physicals. NRCME certified medical examiners provide required DOT physicals to CMV drivers. As a certified medical examiner, you will assess drivers’ medical conditions, vision, hearing, and other factors that impair a driver’s ability to operate their vehicle safely. By detecting and addressing these issues, you help prevent accidents that may be caused by drivers experiencing a medical emergency while behind the wheel.

• Keeps Examiners Informed. Medical examiners are required to complete an approved training program prior to sitting for the FMCSA exam every 10 years. This recertification process ensures that all examiners providing DOT physicals possess the same knowledge and comply with the medical standards as required by the NRCME.

Maximize Your Impact as a DOT Certified Medical Examiner

As a certified NRCME examiner, you take on the important task of ensuring the health and safety of commercial drivers. Here are some tips to excel in this role:

• Stay Up-to-Date with the Latest Regulations. Regulations, guidelines, and medical standards change periodically. Staying updated with the latest FMCSA regulations concerning commercial driver fitness and medical standards is a critical component of your role as a medical examiner. Make sure to familiarize yourself with the FMCSA handbook and keep an eye out for updates.

• Preparation Goes A Long Way. Spend a little time preparing for the DOT physicals you conduct. Prepare the required DOT Medical Examination Report Form (MCSA-5875) and any tools needed to conduct a thorough physical.

• Take a History Lesson. Carefully review the driver’s medical history, including any previous medical conditions, surgeries, medications, or treatments. Determine if any medical conditions would exclude them from operating a CMV.

• Be Thorough. Perform a comprehensive physical examination according to the FMCSA guidelines. Assess the driver’s vision, hearing, blood pressure, cardiovascular health, respiratory health, and overall physical condition. Remember, the more thorough your examination, the more certain you can be that the driver is physically and mentally healthy enough to operate a CMV.

• Handle with Care. Not all examinations will be straightforward. Some drivers may have complex medical conditions or may have conditions that require further treatment from their physician before qualifying to operate a CMV. Remember, their livelihood depends on passing the physical exam, so be sure you approach these more difficult cases with patience, empathy, and a commitment to their health and safety.

• Assess Health Issues. If any health issues are identified during the examination, provide guidance to the driver for necessary follow-up actions. Remember: you cannot treat these health issues during the driver’s physical appointment, but you can make recommendations for further evaluation or

The Most Important CMV Driver Health Related Issues

Commercial Motor Vehicle (CMV) drivers pose a potential safety risk to other drivers and their passengers for a variety of reasons.

For starters, the size and weight of large commercial vehicles such as tractor-trailers and buses mean they are more likely to result in severe damage and injuries in the event of a collision with a smaller vehicle. Large commercial motor vehicles (CMVs) also have limited maneuverability and require additional time to accelerate, decelerate, and change lanes.

CMVs have large blind spots — “no-zones” — where the driver’s visibility is either extremely limited or nonexistent, increasing the risk of collisions when changing lanes or turning, particularly at high speed.

In addition to the risk posed by the vehicles themselves, there are also risks associated with CMV drivers, as they may have some medical conditions that pose additional, and serious, risk factors. Undiagnosed or unmanaged medical conditions create safety risks for drivers and others while they are on the road.

As a medical examiner, these are some of the conditions you should pay attention to when giving a DOT physical:

• Cardiovascular Diseases or Events: Conditions like hypertension or coronary artery disease could lead to cardiovascular events such as heart attacks or strokes. Should one of these events occur while driving, the driver’s ability to maintain control of the vehicle is severely impaired, and could pose a significant risk to the driver and others on the road.

• Diabetes: Fluctuations in blood sugar levels associated with diabetes can lead to symptoms such as dizziness, confusion, weakness, or even loss of consciousness, all of which can affect the driver’s ability to operate a vehicle safely.

• Sleep Disorders: Conditions such as obstructive sleep apnea (OSA) and narcolepsy can cause excessive daytime sleepiness, fatigue, and impaired cognitive function. Driver fatigue is a big problem as they face long hours of driving, irregular schedules, and demanding transit and delivery deadlines imposed by their employers. Fatigued drivers may be more prone to slower reaction times and lapses in attention, increasing the risk of accidents.

• Vision and hearing disorders: Visual impairments can limit a driver’s ability to see hazards, signs, or other vehicles on the road, increasing the risk of accidents. Similarly, hearing impairments can limit a driver’s ability to hear warning signals, sirens, or other auditory cues while driving.

• Neurological disorders: Conditions such as epilepsy, Parkinson’s disease, or peripheral neuropathy can affect motor coordination, balance, and cognitive function, leading to difficulties maintaining control of the vehicle, maintaining lane position, or reacting quickly and appropriately to traffic signals and hazards.

Why is CMV driver health important?

On May 9, 1999, 22 people were killed in the deadliest vehicle crash in Louisiana history. The crash occurred when a bus carrying residents of a retirement home veered off Interstate 610 on its way to Mississippi Gulf Coast casinos.

According to the crash investigation report by the National Transportation Safety Board (NTSB), the driver’s history of medical conditions and hospitalizations were ruled to be a factor in the crash. Though the driver did hold a medical certificate, the physician who conducted his DOT physical exam explained that, at the time, there was only a limited one-page list of guidelines for carrying out driver physicals.[i]

While this single – traffic related incident was not the sole impetus for the creation of the National Registry of Certified Medical Examiners (NRCME), it proved that there was a clear need to provide medical examiners a standardized system for assessing driver health.

Here are some additional statistics on crash information from 2021, reported by the Federal Motor Carrier Safety Association (FMCSA):

• Approximately 494,000 police reported crashes involved large trucks. Of these, there were 5,149 fatal crashes and 110,000 crashes that resulted in injuries.

• 37% of all fatal crashes and 24% of all injury crashes involving large trucks occurred at night, between 6:00 pm and 6:00 am.

• On average, there were 1.12 fatalities in fatal crashes involving large trucks. 83% of these fatalities were not occupants of the large CMV vehicle/truck.[ii]

Data regarding the total number of crashes involving drivers with serious medical conditions is not available through the FMCSA, however, information from individual crash investigations by the NTSB indicates that improper medical certification of CMV drivers who had disqualifying medical conditions

directly contributed to fatal and injury crashes. NRCME ensures that medical examiners possess the knowledge necessary to accurately assess driver medical fitness.

Ready to Contribute to Highway Safety?

If your NRCME recertification date is approaching, or if you want to get certified for the first time, Oakstone’s NRCME Plus Examiner Training System® is the place to start. It’s the most comprehensive, most user-friendly, and highly efficient training program available. By completing the training program, you’ll learn everything you need to know to pass the FMCSA exam and provide these critical DOT physicals to CMV drivers in your area.

[i] https://www.ntsb.gov/investigations/AccidentReports/Reports/HAR0101.pdf

[ii] https://www.fmcsa.dot.gov/safety/data-and-statistics/large-truck-and-bus-crash-facts