Austroads – Driving

When conducting a driving medical assessment, it’s crucial to evaluate a range of functional abilities and skills essential for safe driving. Here’s an outline of the key skills and abilities that should be assessed:

  1. Vision:
    1. Acuity: Ability to see details at a distance.
    2. Peripheral vision: Ability to see objects and movement outside the direct line of vision.
    3. Depth perception: Ability to judge distance and spatial relationships.
    4. Color vision: Ability to distinguish colors, particularly red, green, and amber.
    5. Night vision and glare tolerance.
  2. Hearing:
    1. Ability to hear and interpret sounds crucial for driving, like horns, sirens, and noises from the vehicle and surrounding environment.
  3. Cognitive Abilities:
    1. Attention and concentration: Ability to focus on driving tasks while ignoring distractions.
    2. Memory: Particularly short-term memory relevant to navigating and remembering driving rules.
    3. Decision-making and problem-solving skills.
    4. Reaction time: Ability to respond quickly to changing situations.
    5. Situational awareness: Understanding and interpreting traffic conditions, road signs, and the actions of other drivers and pedestrians.
  4. Psychomotor Skills:
    1. Ability to multitask, such as steering while operating other controls.
    2. Coordination and reaction time: Ability to operate the vehicle’s controls promptly and accurately.
    3. Muscle strength and range of motion: Necessary for steering, braking, accelerating, and operating controls.
    4. Flexibility: Ability to turn the head and body to view traffic, mirrors, and the vehicle’s controls.
    5. Endurance: Ability to drive for reasonable durations without fatigue impairing performance.
  5. Mental Health and Emotional Stability:
    1. Assessing for conditions like anxiety, depression, or other mental health issues that could impair driving ability.
    2. Evaluating the impact of medications on mood, alertness, and overall driving ability.
  6. General Health and Fitness:
    1. Assessing overall health conditions that may impact driving, such as heart disease, diabetes, epilepsy, or other chronic illnesses.
    2. Evaluating the impact of fatigue, pain, or discomfort on the ability to drive.
  7. Medication Use:
    1. Understanding the side effects of medications, such as drowsiness, dizziness, or impaired reflexes, and their impact on driving skills.

During the assessment, it’s also important to consider the specific demands of the individual’s driving needs, such as the type of vehicle they drive and the typical driving conditions they encounter. The assessment might involve a physical examination, vision and hearing tests, cognitive assessments, and possibly an on-road driving test. Depending on the findings, adaptations to the vehicle or restrictions on driving might be recommended.

Periodic Review

While private licence holders with no medical contions may hold an uncondional licence (up until a certain age), many people have conditional licences with fixed review periods. For example all commercial drivers are required to undergo review every 3-5 years, depending on the State or Territory, depsite the fact their licence might otherwise be viewed as unconditional.

The review periods for conditional licenses vary based on the specific conditions of the driver and the type of license, either private or commercial.

Private Licenses

For private vehicle drivers, conditional licenses are tailored to the individual’s health condition and their ability to drive safely. These licenses might include restrictions such as:

  • no night driving
  • only driving in familiar areas, or
  • wearing corrective lenses.

The review period for a conditional license is set during its issuance and requires the driver to undergo a medical review to assess their condition and continued fitness to drive. These review periods are determined on a case-by-case basis, considering the driver’s specific health situation.

Commercial Licenses

Commercial vehicle drivers are subject to stricter standards compared to private drivers. For example, drivers with certain medical conditions like vision problems, blackouts, diabetes, and others must report these conditions and may be issued a conditional license with specific restrictions. Commercial drivers, especially those holding medium rigid (MR), heavy rigid (HR), heavy combination (HC), or multiple combination (MC) licenses, are generally required to undergo medical assessments every 3-5 years, depending on the state and territory. However, if a commercial driver cannot meet these standards but can meet private standards, their license class may be temporarily changed to a private license, with the possibility of regaining the commercial license once their health improves.

In either case, the specific review period is decided based on the individual’s medical condition and the requirements of the driver licensing authority. This decision is often made in collaboration with health professionals who provide detailed information on the driver’s medical condition and ability to drive safely under certain conditions.

Note that commercial standards apply to both car and light rigid (LR) licences if the person:

  • holds or is applying for an authority to carry public passengers for hire or reward (e.g. taxi driver, school bus driver)
  • holds or is applying for an authority to hold a dangerous goods driver licence
  • holds or is applying to hold authority to be a driving instructor

Vision

  1. Visual Acuity
    1. Uncorrected
      • Private: One eye at least 6/12 is fit to hold unconditional licence
      • Commercial: Better eye at least 6/9 and worse eye at least 6/18 fit to hold unconditional licence
    2. Corrected
      • Private: One eye at least 6/12 is fit to hold conditional licence
      • Commercial: Better eye at least 6/9 and worse eye at least 6/18 fit to hold conditional licence
      • Condition: Glasses must be worn for driving
  2. Visual Field Loss:
    • Private Standards: A person is not fit to hold an unconditional licence if the binocular visual field does not have a horizontal extent of at least 110 degrees within 10 degrees above and below the horizontal midline, or if there is significant visual field loss. A conditional licence may be considered subject to annual review.
    • Commercial Standards: A person is not fit to hold an unconditional licence if they have any visual field defect. A conditional licence may be considered subject to annual review, with specific criteria including a binocular visual field extent of at least 140 degrees.
  3. Cataract Surgery:
    • The specific review periods post-cataract surgery are not detailed in the Austroads standards. However, individuals are generally advised not to drive immediately following the surgery until cleared by their health professional, considering factors like recovery from the procedure and effectiveness of vision correction.
  4. Macular Degeneration:
    • While specific review periods for macular degeneration are not explicitly mentioned in the Austroads guidelines, the standard practice is to assess the individual’s fitness to drive based on their level of vision loss and its impact on driving safety. Those with significant vision loss may not be able to safely drive and might need to consider alternative transportation options.

Hearing

  • Private: no standard
  • Commercial: must have best ear over > -40dB at 500, 1k, 2k, 3k Hz

Vascular Disease

  1. Acute Myocardial Infarction (AMI):
    • Private Standards: A minimum non-driving period of 2 weeks post-AMI. A conditional licence may be considered after this period, subject to periodic review.
    • Commercial Standards: A minimum non-driving period of 4 weeks post-AMI. A conditional licence may be considered after this period, subject to annual review.
  2. Percutaneous Coronary Intervention (PCI):
    • Private Standards: A minimum non-driving period of 2 days post-PCI.
    • Commercial Standards: A minimum non-driving period of 4 weeks post-PCI.
  3. Coronary Artery Bypass Grafting (CABG):
    • Private Standards: A minimum non-driving period of 4 weeks post-CABG. A conditional licence may be considered after this period, subject to periodic review.
    • Commercial Standards: A minimum non-driving period of 3 months post-CABG. A conditional licence may be considered after this period, subject to annual review.
  4. Cerebrovascular Accident (CVA):
    • The specific review periods and restrictions for CVA are not explicitly mentioned in the sources, but they would typically be assessed based on the individual’s recovery and ability to meet the medical standards for licensing.

Diabetes

  • Private License
    • Oral Medication: Generally, drivers can drive without restrictions but are subject to five-yearly reviews.
    • Insulin: Drivers must undergo an annual review. They may be subject to certain restrictions or conditions based on individual assessment.
  • Commercial License
    • Must see a specialist
    • Oral Medication must undergo an annual review (can be with GP if only on Metformin)
    • Insulin Generally, insulin-treated drivers may face restrictions or may not be eligible for a commercial license, depending on individual circumstances and risk assessments.
  • Hypoglycaemia
    • 6 week non driving period following severe hypoglycaemia
    • Should not drive until cleared by a medical practitioner
    • Should take precautions ie
      • not drive if BSL < 5,
      • not drive for more than 2 hours without having a snack

Obstructive Sleep Apnoea

  • Private: Conditional licence is allowed subject to annual review (can be by GP)
    • If the person complies with treatment
      • CPAP at least 4 hours a night, 5 days a week; and
    • If the response to treatment is satisfactory
      • ie low Epworth Sleepiness Scale Score (ie not > 10)
  • Commercial: The standards are more stringent due to the higher level of driving responsibility.
    • Drivers must demonstrate effective management of their condition and
    • And re subject to specialist medical review to ensure their ability to drive safely.
    • And must comply with treatment
      • CPAP at least 4 hours a night, 5 days a week; and
    • And the response to treatment is satisfactory
      • ie low Epworth Sleepiness Scale Score (ie not > 10)

Neurological

  1. Seizures
    • First Seizure
      • Private: 6-month seizure-free period
      • Commercial: 5-year seizure-free period
    • Recurrent Seizure
      • Private: 1-year seizure-free period
      • Commercial: 10-year seizure-free period
    • Review period:
      • Private: annual until 10 years seizure free, then 3 yearly
      • Commercial: annual until 20 years seizure free, then 3 yearly
  2. Dementia:
    • Driving may not be allowed if cognitive impairment is significant. Decisions are made on a case-by-case basis, considering the impact on driving ability.
    • Regular reviews by a health professional are necessary to assess fitness to drive so only a conditional licence can be granted.
    • This may include restrictions on night driving and familiar areas only.
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