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and the outcomes of surgical procedures and the functional capacity of affected patients are much improved .
The updated standards for congenital cardiac disease reflect these changes and provide more guidance on non-driving periods after surgery . They also contain clear criteria for what recovery and outcomes are needed for both private and commercial licensing .
Neurological conditions
• Seizures and epilepsy There are a number of changes , clarifications and additional descriptions of concepts in this section .
There has been no change to the default standards , whereby a private driver is required to have a seizure-free period of at least 12 months , and a commercial driver a period of 10 years .
The updated standards note that doctors are often reliant on patient self-reporting to determine seizure history , and that there may be times when the doctor has concerns about the reliability of this self-report . This may be the result of patient awareness of seizures being impaired by the seizure itself , or deliberate failure to report . There are now new criteria to enable the examining doctor or epilepsy specialist to assess the person as unfit to drive , if the history is considered uncertain or unreliable .
Additional guidance has been provided regarding safe seizures , the resumption of an unconditional licence after a first seizure , or triggered acute symptomatic seizure , as well as situations where a reduction in antiepileptic dosage is being considered .
The update has also clarified the situations in which an EEG is required for the
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Visual acuity assessment has also been clarified in the new standards .
granting of a conditional license for commercial
drivers . Medical standards have been added for psychogenic nonepileptic seizures in the chapter on psychiatric conditions . Individuals with seizure-like activity may be assessed under the ‘ Seizures and epilepsy ’, ‘ Blackouts of undetermined mechanism ’, or the ‘ Psychogenic nonepileptic seizures ’ sections . It is imperative that the examining doctor has a good understanding of the diagnosis in order to assess the situation appropriately .
If you are assessing drivers who are taking medicinal cannabis , it is essential to keep up to date with changes .
• Dementia and cognitive impairment The updated standards note that , in general , a person with dementia may not hold an unconditional private or commercial licence , but they may hold a conditional license subject to periodic review .
It is acknowledged that dementia is now often diagnosed at an earlier , and sometimes pre-clinical , stage . The new standards
thus exclude pre-clinical or prodromal dementia from the requirement for a conditional license , unless there are clinically significant symptoms .
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• Other neurological conditions When assessing an individual for a private license after a stroke , if they have been cleared to drive by a relevant specialist physician within four weeks of the stroke , they may continue to drive on their |
existing licence . This assumes there is documentation confirming that they have not sustained any permanent neurological deficits that would impact driving .
There have been reports that this provision has caused some confusion to date . It aids interpretation to note that , as a baseline , a stroke patient with persistent functional deficits will require neurological assessment and a conditional licence . However , if the patient is discharged from treating specialist care within four weeks and meets the criteria for the absence of significant functional symptoms as defined in the standards , they can resume driving without restriction on their license and without the need for ongoing stroke specialist review .
The section on stroke also includes updates regarding conditional licensing and the requirements for periodic assessment .
Substance misuse The major change in this area relates to the need for ongoing addiction specialist review requirements for individuals with substance misuse disorders . The updated standards clarify that periodic review of individuals with stable conditions may be undertaken by a general practitioner ( in place of an addiction specialist review ), if there has been an initial addiction specialist review , and all health professionals involved in the individual ’ s management agree to the subsequent review arrangement .
Vision and eye disorders There have been changes or clarifications to a number of aspects of this section . This includes monocular vision , diplopia and visual fields assessment . Visual
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acuity assessment has also been clarified , and while acuity requirements remain unchanged , it is now noted that orthokeratology ( corneal reshaping contact lens wear ) may be an option for meeting the requirements .
In most circumstances , the assessment of vision and eye disorders requires formal optometry or ophthalmology review .
Conclusion
There have been a number of changes to continue to improve and update the standards for assessing fitness to drive in line with current evidence . Doctors who undertake these assessments regularly should review the changes and ensure that they have a good understanding of their impacts .
Doctors who occasionally assess their patients should make sure that they have a good understanding of the document and how to use it .
In complex situations , or where the doctor is concerned that their involvement in assessment may impact the therapeutic relationship , there are a number of avenues available for assistance . These include referral to a relevant specialist for the specific medical condition , or involvement of an occupational physician ( particularly for commercial , work-related driving tasks ).
References on request from kate . kelso @ adg . com . au
Online resource
• austroads . com . au / publications / assessing-fitness-to-drive / ap-g56
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