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Important EU Document on Driver Fitness

The European Commission and its unit for Road Safety, DG MOVE, Unit C2 has recently published a new report that contains important aspects of medical driver fitness issues. It can be found on http://bookshop.europa.eu/is-bin/INTERSHOP.enfinity/WFS/EU-Bookshop-Site/en_GB/-/EUR/ViewPublication-Start?PublicationKey=MI0417247 and is free to download.

It is a systematic quality assessment of papers and a review of the best scientific evidence of effectiveness for different approaches to training, testing and graduated licensing for Category B (car) drivers, graduated licensing for higher motorcycle categories, driving instructor competencies, and requirements on medical fitness to drive (including its relevance for older drivers). The primary focus of the reviews was on road safety outcomes.

The review was produced with international cooperation and the institutions included are Transport Research Laboratory (UK), SWOV (Netherlands), BASt (Germany) Monash University (Australia) and Loughborough University (UK). A short summary by Lars Englund can be found below.

There is an executive summary where the most important recommendations from the EU are summarized. When it comes to medical driver fitness some points are stressed: 

  1. On-road testing should not be used to assess medical driver fitness.
  2. Off-road testing is recommended but more scientific research is needed to find more and better such instruments. It is said that the lack of a validated off-road screening tools has led to use of on-road assessments that have questionable validity and are potentially dangerous for clients and assessors.
  3. A common and standardised method for screening to assess driver fitness for group 1 license holders (personal cars) should be produced for all member states.
  4. Educational programs on driver fitness issues for general practitioners should be introduced.
  5. Programs and methods to help unfit drivers (or persons in their surroundings) to realize themselves when it is time to terminate their driving should be produced.
  6. The member states should use restricted licensing for persons who are limited by medical conditions.

 The screening procedure

“A standardized screening process ensures that there is a consistent approach to assessing medical fitness to drive across Member States, optimizing safe driving and reducing opportunities of licensing inconsistencies in Europe.

Current best practice suggests the following: (i) referral by a General Practitioner to a specific traffic medicine centre, (ii) assessment of fitness to drive using validated off-road screening tools with acceptable sensitivity and specificity measures, (iii) referral to expert medical advisory boards for final assessment by expert medical advisors, and (iv) an appropriate appeal process by the individual for disputed claims.”

Education programmes for general practitioners

“General Practitioners are for the most part willing to be the primary point of call for initiating an assessment of a person’s fitness to drive. However, they often acknowledge the lack of specific assessment criteria to use and some feel uneasy about making the assessment, especially around unsafe driver functions. It is recommended therefore, that educational programs for GPs be established to assist in this process.”

Self-Regulation Materials

“While it is a difficult task for people with questionable fitness to drive, especially those with severe dementia, to decide to stop driving at an appropriate time nevertheless many elderly and medically challenged drivers do seek out information on self-assessing their own driving abilities. Family members of these individuals also require such materials to help them in deciding whether to initiate an assessment process.

There are best practice examples of brochures, test procedures and online courses that could be made available or used to assist individuals and family members. “

Conditional and restricted licences

“Restricted and/or conditional licences are intended to minimize crash exposure and risk (only marginal if applied in low traffic conditions). Authorities need to balance this increase in crash risk with health and social needs of the individual and the restrictions should be regularly reviewed (at least yearly).”

Future research

 “It is recommended that further research be commissioned in three key areas, which will provide much needed evidence to support the implementation of a consistent approach in the assessment of a person’s fitness to drive namely:

a. Undertake research to develop an effective and transparent screening protocol for possible use across Europe in testing the functional capabilities of someone suspected of being an unfit driver of a Class B vehicle.
b. Undertake research to develop evidence-based guidelines for GPs across all Member States to use in assessing a person’s fitness to drive.

c. Undertake research to develop and evaluate educational programs for GPs that are both effective and accepted by medical practitioners. “

 

Summarized April 12, 2017 by Lars Englund, Immediate Past President and Executive Director of Driver Fitness Issues in ITMA

The International Traffic and Medicine Association