Skill Performance Evaluation Certificate Application Form (Page 22 of 25) in pdf

on maximal or near-maximal doses of 2-3 pharmacologic agents.

accompanied by" is designed to include a clinical diagnosis

(See Conference on Pulmonary/Respiratory Disorders

Some causes of secondary hypertension may be amenable to surgical

of a cardiovascular disease (1) which is accompanied by

and Commercial Drivers at:

symptoms of syncope, dyspnea, collapse or congestive

intervention or specific pharmacologic disease.

cardiac failure; and/or (2) which is likely to cause syncope,

(See Cardiovascular Advisory Panel Guidelines for the Medical

dyspnea, collapse or congestive cardiac failure.

Hypertension

Examination of Commercial Motor Vehicle Drivers at:

It is the intent of the FMCSRs to render unqualified, a

§391.41(b)(6)

)

A person is physically qualified to drive a commercial motor

driver who has a current cardiovascular disease which is

vehicle if that person:

accompanied by and/or likely to cause symptoms of

Rheumatic, Arthritic, Orthopedic, Muscular,

syncope, dyspnea, collapse, or congestive cardiac failure.

Has no current clinical diagnosis of high blood pressure

Neuromuscular or Vascular Disease §391.41(b)(7)

However, the subjective decision of whether the nature and

likely to interfere with ability to operate a commercial motor

A person is physically qualified to drive a commercial motor vehicle if

severity of an individual's condition will likely cause

vehicle safely.

Hypertension alone is unlikely to cause sudden collapse;

that person:

symptoms of cardiovascular insufficiency is on an individual

however, the likelihood increases when target organ

Has no established medical history or clinical diagnosis of rheumatic,

basis and qualification rests with the medical examiner and

damage, particularly cerebral vascular disease, is present.

the motor carrier. In those cases where there is an

arthritic, orthopedic, muscular, neuromuscular or vascular disease which

This regulatory criteria is based on FMCSA's

occurrence of cardiovascular insufficiency (myocardial

interferes with the ability to control and operate a commercial motor

Cardiovascular Advisory Guidelines for the Examination of

infarction, thrombosis, etc.), it is suggested before a driver

vehicle safely.

CMV Drivers, which used the Sixth Report of the Joint

is certified that he or she have a normal resting and stress

Certain diseases are known to have acute episodes of transient

National Committee on Detection, Evaluation, and

electrocardiogram (ECG), no residual complications and no

Treatment of High Blood Pressure (1997).

physical limitations, and is taking no medication likely to

muscle weakness, poor muscular coordination (ataxia), abnormal

Stage 1 hypertension corresponds to a systolic BP of

interfere with safe driving.

sensations (paresthesia), decreased muscular tone (hypotonia), visual

140-159 mmHg and/or a diastolic BP of 90-99 mmHg. The

Coronary artery bypass surgery and pacemaker

disturbances and pain which may be suddenly incapacitating. With

driver with a BP in this range is at low risk for

implantation are remedial procedures and thus, not

each recurring episode, these symptoms may become more

hypertension-related acute incapacitation and may be

unqualifying. Implantable cardioverter defibrillators are

pronounced and remain for longer periods of time. Other diseases

medically certified to drive for a one-year period.

disqualifying due to risk of syncope. Coumadin is a

Certification examinations should be done annually

have more insidious onsets and display symptoms of muscle wasting

medical treatment which can improve the health and safety

thereafter and should be at or less than 140/90. If less than

of the driver and should not, by its use, medically disqualify

(atrophy), swelling and paresthesia which may not suddenly

160/100, certification may be extended one time for 3

the commercial driver. The emphasis should be on the

incapacitate a person but may restrict his/her movements and

months.

underlying medical condition(s) which require treatment and

eventually interfere with the ability to safely operate a motor vehicle. In

A blood pressure of 160-179 systolic and/or 100-109

the general health of the driver. The FMCSA should be

many instances these diseases are degenerative in nature or may

diastolic is considered Stage 2 hypertension, and the driver

contacted at (202) 366-1790 for additional

result in deterioration of the involved area.

is not necessarily unqualified during evaluation and

recommendations regarding the physical qualification of

institution of treatment. The driver is given a one time

drivers on coumadin.

Once the individual has been diagnosed as having a rheumatic,

certification of three months to reduce his or her blood

(See Cardiovasular Advisory Panel Guidelines for the

arthritic, orthopedic, muscular, neuromuscular or vascular disease,

pressure to less than or equal to 140/90. A blood pressure

Medical examination of Commercial Motor Vehicle Drivers

then he/she has an established history of that disease. The physician,

in this range is an absolute indication for anti-hypertensive

at: )

when examining an individual, should consider the following: (1) the

drug therapy. Provided treatment is well tolerated and the

nature and severity of the individual's condition (such as sensory loss

driver demonstrates a BP value of 140/90 or less, he or she

Respiratory Dysfunction

may be certified for one year from date of the initial exam.

or loss of strength); (2) the degree of limitation present (such as range

§391.41(b)(5)

The driver is certified annually thereafter.

A person is physically qualified to drive a commercial motor

of motion); (3) the likelihood of progressive limitation (not always

A blood pressure at or greater than 180 (systolic) and

vehicle if that person:

present initially but may manifest itself over time); and (4) the likelihood

110 (diastolic) is considered Stage 3, high risk for an acute

Has no established medical history or clinical diagnosis of a

of sudden incapacitation. If severe functional impairment exists, the

BP-related event. The driver may not be qualified, even

respiratory dysfunction likely to interfere with ability to

driver does not qualify. In cases where more frequent monitoring is

temporarily, until reduced to 140/90 or less and treatment is

control and drive a commercial motor vehicle safely.

well tolerated. The driver may be certified for 6 months and

required, a certificate for a shorter period of time may be issued. (See

Since a driver must be alert at all times, any change in

biannually (every 6 months) thereafter if at recheck BP is

his or her mental state is in direct conflict with highway

Conference on Neurological Disorders and Commercial Drivers at:

140/90 or less.

safety. Even the slightest impairment in respiratory function

)

Annual recertification is recommended if the medical

under emergency conditions (when greater oxygen supply

examiner does not know the severity of hypertension prior

is necessary for performance) may be detrimental to safe

to treatment.

driving.

An elevated blood pressure finding should be confirmed

There are many conditions that interfere with oxygen

by at least two subsequent measurements on different

exchange and may result in incapacitation, including

days.

emphysema, chronic asthma, carcinoma, tuberculosis,

Treatment includes nonpharmacologic and

chronic bronchitis and sleep apnea. If the medical

pharmacologic modalities as well as counseling to reduce

examiner detects a respiratory dysfunction, that in any way

other risk factors. Most antihypertensive medications also

is likely to interfere with the driver's ability to safely control

have side effects, the importance of which must be judged

and drive a commercial motor vehicle, the driver must be

on an individual basis. Individuals must be alerted to the

referred to a specialist for further evaluation and therapy.

hazards of these medications while driving. Side effects of

Anticoagulation therapy for deep vein thrombosis and/or

somnolence or syncope are particulary undesirable in

pulmonary thromboembolism is not unqualifying once

commercial drivers.

optimum dose is achieved, provided lower extremity venous

Secondary hypertension is based on the above stages.

examinations remain normal and the treating physician

gives a favorable recommendation.

Evaluation is warranted if patient is persistently hypertensive

Skill Performance Evaluation Certificate Application Form Page 22

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