Driver Medicals- a Guideline to safety in declaring Fitness for work
May 27th, 2019
Legislation and Standards applicable:
The National Road Traffic Act and Regulations 12 of 1996.
Driven machinery Regulations (GNR 145, 18/02/2005) of the Occupational Health and Safety Act 85 of 1993
SASOM : National Standard for Drivers, code 8-14 and forklifts.
It is a great responsibility to decide whether a driver/ operator is fit for his job. As an occupational health nurse, who has to declare this person fit, the following guidelines can be used.
A thorough history must be taken of the driver. This includes medical, surgical, mental health history. Focus on the diseases that can cause altered state of conciousness, eg. epilepsy, narcolepsy, insomnia, stress, alcoholism, drug use, diabetes, brain injuries etc. Illness such as chronic backache etc can lead to use of painkillers, which can cause drowsiness.
TESTS to be performed:
- Vision: Aquity- far and near. Colourvision, depth perception
- Audio: Audiometry. Whisper test
- Urine tests for SG, Protein, blood, sugar and PH, Ketones
- Physical examinantion:
- General appearance: overweight, tremors, gait and posture
- Eyes: pupil equality, reaction to light, accommodation, ocular motility, ocular imbalance, extra ocular movements, nystagmus, exophthalmos, cataracts, glaucoma, ocular pressure.
- Ears:Scarring or perforation of tympanic membrane, wax impaction, foreign bodies in canal.
- Mouth and throat: Deformities causing breathing and swallowing problems.
- Heart: murmers, extra sounds, enlarged heart, pacemaker
- Lungs and chest: abnormal chest wall expansion, rate, depth and speed, breathing sounds, cyanosis
- JACCOL: Jaundice, anaemia, clubbing, cyanosis, oedema and lymphadenopathy
- Abdomen and viscera: enlarged liver, spleen, masses, bruits, hernia, significant abdominal wall weekness.
- Vascular system: abnormal pulse rate, rhytm and speed, carotid or arterial bruits, raised JVP, varicose veins, haemorrhoids
- Genito urinary: hydrocele, hernias
- Extremities: absence of limbs, deformities, weakness, paralysis, insufficient grasp with hands, feet deformed to use in pedal control.
- Spine, musculoskeletal: surgery, deformity and weakness.
- Neurologigal: Balance, coordination, speech, tendon reflexes, sensory or positional abnormalities, abnormal babinski or patellar reflexes, trigger fingers, ataxia, flexion and extension, climbing stairs, tremors.
- Diabetics must get ECG, HBA1c,
- Alcoholics must get a GGT, FBC, AST, ALT
- Drug testing for THC, METH. AMPH, COC, OPI,BARB.
PHYSICAL QUALIFICATION FOR DRIVERS:
The task of the driver includes the following activities, which should be taken in account when a medical examination is performed:
- Sitting for extended time
- long hours work
- separation from significant others causing stress
- shift and rotation work- night and day shifts disturb equilibrium
- physical activities eg. pick up, lift, carry, move
- coupling/ uncoupling trailers etc.
- bending in unusual position
- climbing ladders and working above 1.8m
- Noise, vibration, extreme temperatures
- Stress due to transporting people and hazardous chemicals.
- Mental challenges to make quick decisions, problem solve, manipulate the steering wheel, shift gears and maneuver the vehicle in crowded areas.
THE PHYSICAL REQUIREMENTS FOR A DRIVER:
- all extremities can be used effectively
- No impairment of hand/ fingers in grasping the steering wheel
- No insulin dependent diabetes mellitus, unless stabilized
- No current incidence of heart attack, angina, thrombosis, heart failure, fainting, tightness of chest or collapse.
- No respiratory condition that can interfere with driving and control of vehicle.
- No current clinical uncontrolled hypertension.
- No neurological problems, arthritis that disables, or muscular disease that prevents sitting, standing and moving as per job requirements.
- No mental, nervous, organic, psychiatric or functional disease.
- Distant vision of 4/6 (Snellen) and above, peripheral vision fields of 70 degrees, recognition of green and red and amber ( ishiara test pass).
- Hearing loss of not more than 40dB at 500, 1000 and 2000Hz.
- Does not use any substance- drug/ alcohol and medication that cause drowsiness.
- Has no clinical diagnosis of alcoholism.
- BMI must be below 40.
- Previous stroke or dementia must be referred to OHMP.
- Random HGT must not exceed 12 mmol/l
- HBA1c must not exceed 11%
- Lungfunction: FVC < 50%, FEV1 <50% MUST be evaluated by OHMP
- Chronic conditions must be followed up 3 monthly. A driver who is a diabetic should preferably have a glucometer with him to monitor his HGT.
- Negative drugtest.
IF any abnormality is found, the driver must be referred and examined by the OHMP.
ACKNOWLEGEMENT to Dr Greg Kiew, OHMP SASOM