First published online on 15 July 2023

Transport Commission has introduced an updated set of medical standards , which came into effect in June 2022 .

This article highlights the changes in the updated standards and how they may affect the assessment of fitness to drive in a general practice setting .

Importantly , there is no change to the process of assessment , and doctors should continue to use the appropriate paperwork required in their state .

Assessing doctors must continue to review the self-declaration questionnaire and undertake more questioning and assessment where appropriate . Drivers must undergo the appropriate testing for their medical situation and the type of licence .

The standards are set out in the same way as the previous editions , with Part A providing general guidance on the driving task and assessment process , and Part B providing detailed standards for specific medical conditions .

Both parts have undergone significant revision .

General guidance updates

The new standards include improvements

to the general guidance as well as changes

to specific medical standards . The changes are summarised by Austroads ( see online resources ).

The general guidance section of Assessing Fitness to Drive ( Part A ) includes advice regarding aspects of the assessment process and provides a framework for doctors assessing more complex cases , including the ageing driver , drivers with multiple medical conditions , and relatively novel factors such as medicinal marijuana use .

The changes include updated guidance for doctors on advising patients on the impact that their medical condition may have on safety while driving and their ability to hold a driving licence .

The assessment of the ageing driver and that of the driver with multiple medical conditions have many similarities , and a thorough review is required of all applicable conditions and how they may interact with each other . The new guidance provides additional evidence regarding the safety of older drivers . It is advised that fitness to drive is routinely included in older persons ’ healthcare and screening , and that communication regarding transition to non-driving begins early and is conducted openly .

The landscape of marijuana use in Australia has changed dramatically in the last few years . The standards provide information on medicinal cannabis use as it relates to driving and include a framework for

decision-making regarding fitness to drive . It is important for any assessing doctor to understand not only the medical implication of taking medicinal cannabis , but also the relevant driving laws within the appropriate jurisdiction . A person may hold a medically appropriate driving licence while also not being allowed to drive due to laws restricting the presence of a drug in the system .

At the time of writing , it is illegal to drive with THC in your system in all states in Australia . Due to the increase in its use , the laws will be under review and may change at short notice . If you are assessing drivers who are taking medicinal cannabis , or prescribing it to your patients , then it is essential to keep up to date with any changes .

Both autism spectrum disorder and attention deficit hyperactivity disorder were considered for inclusion ; however , it was determined that the variability and severity of associated symptoms relevant to driving were too wide-ranging to allow specific licensing criteria . Assessment should be conducted on an individual basis in conjunction with any other appropriate treating specialists .

Changes to specific medical standards

It is worth noting that there are no

changes to the standards for blackouts , diabetes , hearing or sleep disorders .

Cardiovascular conditions These are relevant to driving because of the potential for sudden incapacity and symptoms that may impair the driver such as sudden onset chest pain , breathlessness or lightheadedness .

In the previous edition of the standards , it was deemed that any internal cardioverter defibrillator ( ICD ) would preclude a driver from holding a commercial licence . These standards have now been updated so that those with an ICD implanted for primary prevention may be suitable for a conditional licence , based on information from the treating cardiologist and if they meet the criteria outlined in box 1 . There is no change for patients with ICDs implanted for secondary prevention .

In the previous standards , individuals with any ventricular assist devices were not able to hold a commercial driving licence , and those with biventricular assist devices ( BiVADs ) were also unable to hold a private driving licence . The standards for commercial driving have not changed , but there are now criteria whereby a conditional private licence may be issued to a driver with a BiVAD .

Box 1 . Criteria for assessing suitability of drivers with an ICD for a commercial license ( all must apply )

• The ICD was implanted for primary prevention

• It is at least six months after the insertion of the ICD

• There are no episodes of atrial fibrillation

• There are no discharges from the defibrillator

• Interrogation of the ICD shows no evidence of anti-tachycardic pacing

• There is an ejection fraction ≥ 40 %

• There is an exercise tolerance > 90 % of the age / sex predicted exercise capacity according to the Bruce protocol or equivalent functional test protocol

• There is no evidence of severe ischaemia — that is , less than 2mm ST segment depression on an exercise test or reversible regional wall abnormality on an exercise stress echocardiogram or absence of a large defect on a stress perfusion scan

• There are minimal symptoms relevant to driving ( chest pain , palpitations , breathlessness ).

The Austroads summary of changes state that “ driver licensing authorities will support the management of this change for existing customers ”, but doctors should consider discussing these changes with any patients with these devices to see if they are affected by the new standards .

Management of congenital cardiac disease has changed a lot in recent years ,