Dr. Tara Worron, DC p 630.554 - Illinois DOT Medical …illinoisdotmedicalexam.com/.../illinoisdot/pdf/Dr.Tara-midwest.pdf · Dr. Tara Worron, DC p 630.554.9323 Worron Family Chiropractic

Dr. Tara Worron, DC

p 630.554.9323

Worron Family Chiropractic

1144 Douglas Rd

Oswego IL 60543

IllinoisDOTMedicalExam.com

http://www.illinoisdotmedicalexam.com/

Updates on the new DOT exam, certified medical examiners, why the

change happened and what it means for you

What to expect at your exam

Hypertension … one of the biggest reasons for a reduced certification time.

Current regulations and guidelines surrounding Sleep Apnea

How do you know you need a Sleep Apnea test?

Comfortable, confident and know being treated fairly

National Registry of Certified Medical Examiners (NRCME) - otherwise known as the National Registry had an effective date of May 21, 2012 and a compliance date of May 21, 2014

So, effective May of last year, Medical Examiners had to meet new requirements in order to perform and sign off on a DOT exam

1. Maintain a valid State license

2. Complete an Accredited Training program

3. Pass the National Registry Certification Test

4. Complete periodic re-training (every 5 years)

5. Complete re-certification testing (every 10 years)

Dr. Tara Worron 630.554.9323

www.IllinoisDOTMedicalExam.com

Federal Motor Carrier Safety Administration (FMCSA) - will monitor and audit performed medical examinations for errors and omissions

• Was established on January 1, 2000

• It is one of nine DOT administrations

• It is focused on reducing crashes, injuries and fatalities

involving large trucks & buses



Mission Statements

National Registry of Certified Medical Examiners (NRCME)

"To improve highway safety by producing trained, certified medical examiners who can

effectively determine if a CMV drivers health meets the FMCSA standards.“

Federal Motor Carrier Safety Administration (FMCSA)

"To promote safety of America's highways through pro-regulation and implementation of

medical regulations, guidelines and policies that ensure CMV drivers engaged in

interstate commerce are physically qualified to do so."

Dr. Tara Worron

"To be your advocate between the NRCME & FMCSA and get you certified."

Severity of injury in an accident is relative to velocity change.

2x weight = 6 fold increased risk



When is a Medical Certificate Required?

Before first operating a Commercial Motor Vehicle

(CMV). Drivers who are attending driving school have a

commercial learners permit.

At least every 2 years, or more frequent as determined

at the discretion of your Medical Examiner.

Whenever the driver's ability to perform his or her normal

duties have been impaired by a physical or mental injury

or disease.



Medical Standards

• These are Codified

Federal Regulations (CFR)

that are laws and must

be followed

Medical Guidelines

• These assist in the evaluation

of drivers and are based on

expert review and

considered "best practice"

• * These are up to the

discretion of the Medical

Examiner



Examples of Medical Standards & Medical Guidelines

Medical Standard

Code 49 CFR 391.4 (b) (5)

This code states that a person is physically qualified to drive a commercial motor vehicle if that person has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with their ability to control and drive a commercial motor vehicle safely.

Medical Guideline

Do not certify a driver when they have a diagnosis of Myasthenia Gravis (MG)

Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." -National Institute of Neurological Disorders and Stroke

* When the certification decision does not conform with the guidelines, the reason must be noted on the medical exam form and the driver can be certified

* Medical examiner discretion always wins out.

Dr. Tara Worron 630.554.9323 www.IllinoisDOTMedicalExam.com

Disqualifications

The medical examiner can use their discretion in all areas

of the exam, however there are 4 regulations that must be

followed. The examiner must disqualify the driver who fails

to meet the physical qualification requirements cited in the

regulations for:

1. Vision parameters (unless accompanied by an exemption)

2. Diabetes requiring insulin (unless accompanied by an exemption)

3. Hearing loss

4. Epilepsy



Exemptions

An exemption provides a temporary regulatory relief from one or more regulations for commercial drivers.

Two Federal medical Driver Exemption Programs are:

1. Vision Exemption Program

2. Diabetes Exemption Program

www.IlliniosDOTMedicalExam.com

www.fmcsa.dot.gov

* The Medical Examiner CANNOT issue the exemption for you.


http://www.fmcsa.dot.gov/

* The medical examiner can start the exemption program application by first

determining if the driver is otherwise medically qualified except for monocular vision or

the use of insulin.

* Copy of your medical exams, employment history, driving experience and motor

vehicle records must be submitted with the application.

* 180 days of receipt

Vision Exemption Program

• Allows some drivers with

monocular vision to drive

Diabetes Exemption Program

• Allows some drivers with diabetes mellitus who uses insulin replacement to drive.

• Diabetes Mellitus is a chronic disease in which there are high levels of sugar in the blood/urine.


All exemption programs are for drivers who intend

to operate CMVs in interstate commerce as the

FMCSA does not have statutory authority to grant

exemptions from states’ intrastate requirements.

Interstate = trade, traffic or transport involving the crossing of a State boundary

Intrastate = trade, traffic or transport within a single State

Updated: January 21, 2015

Components of the physical exam

General appearance

Eyes

Ears

Mouth & Throat

Heart * HTN

Lungs & Chest * Sleep Apnea

Abdomen & Viscera

Genito-urinary System

Extremities

Spine & other musculoskeletal

Neurological

General Appearance

Abnormalities with posture, limps or tremors

Overall appearance, demeanor and responses to questions

Markedly overweight

Signs of drug abuse

Signs of current alcohol abuse

Issue with balance

Eyes

Pupils equally reactive to light

Abnormal eyemovements

Looking for imbalances, irregular movements

Cataracts

Ears

We will be looking in your ears

Scarring of the tympanic membrane

Anything blocking the external canal

Perforated ear drums

Essentially we are looking for anything that would account for hearing loss or a

disturbance in balance

Meniere’s Disease (disorder of the inner ear that can affect hearing and

balance and be associated with severe & unpredictable bouts of dizziness and

hearing loss) can significantly interfere with driving and task performance

Surgery? Possible but few guarantee no hearing loss

Effective April 1, 2014 the FMCSA is reviewing this issue in relation to certification

Mouth & Throat

Deformities likely to interfere with breathing or swallowing

Heart

Heart must be examined for murmurs, extra sounds, enlargement and a

pacemaker or implantable defibrillator

Legs evaluated for pitting edema & other signs of cardiac disease

Essentially the examiner is looking for any abnormalities that indicate the

driver has current heart disease accompanied by and/or likely to cause

symptoms of

shortness of breath

Sudden loss of consciousness

Collapse

Heart failure

And if there is a condition, can it be corrected, stabilized, managed and well

tolerated with Rx and/or surgery

Hypertension BP 139/89 or lower 2 year certificate

140/90 - 159/99 Stage 1 Hypertension 1 year certificate (see example) & done annually thereafter Rechecks should be ≤ 139/89. If 140/90-159/99, certification may be extended one time for 3 months

160/100 - 170/109 Stage 2 Hypertension one time 3 month certificate (gives you time to decrease BP) if ≤ 139/89 on the recheck, get a certification for one year from the date of the original exam certified annually thereafter

180/110 Stage 3 Hypertension cannot certify even temporarily If ≤ 139/89 on the recheck, done every 6 months thereafter

* Annual recertification is expected if the medical examiner does not know the severity of HTN prior to treatment


Lungs & Chest

Chest wall expansion

Abnormal breathing rates

Abnormal chest sounds (wheezing)

Bluish discoloration of the skin resulting from inadequate oxygenation

of the blood

Essentially looking for the presence of an underlying lung condition

Abdomen

Enlarged liver / spleen

Masses

Hernias

Significant abdominal wall muscle weakess

Vascular System

Abnormal pulses

Carotid bruits (noise caused by turbulent blood flow in the carotid artery)

Varicose veins

Genito-urinary System

Example: Hernias

These can cause the driver discomfort

Want to be certain if there is one, that they do not interfere with the drivers

ability to operate a CMV safely

Also, a driver that has not provided a urine sample cannot be certified

Extremities – Limb impairment

Looking for deficits of the arms and legs caused by loss, impairment

or deformity

Examples

Can the driver demonstrate sufficient grasp and use of their arms to

maintain steering wheel grip

Does the driver have sufficient mobility and strength in their legs to

operate pedals properly

* May be subject to Skill Performance Evaluation

Spine & Other Musculoskeletal

Evaluated for previous surgeries, deformities, limitations in movement and

tenderness.

Looking to see if the driver has a diagnosis or signs of a condition known to be

associated with acute episodes of:

Muscle weakness

Poor muscle coordination

Abnormal sensations

Decreased muscle tone

Pain

Neurological

Impairments of equilibrium, coordination and speech

Looking to see if the driver has ataxia

Ataxia: is a lack of muscle coordination that can affect speech, eye movements and the ability to swallow, pick up objects and other voluntary movements that you would see in:

Multiple Sclerosis

Head Injuries

Alcohol abuse

Stroke

Tumors

Infections

The DOT exam is basically looking for …

Any abnormal finding/s that would suggest a

condition that might interfere with the safe

operation of a vehicle

* Medical Examiner Discretion

FMCSA just released a bulletin to Medical

Examiners and Training Organizations regarding

Obstructive Sleep Apnea

The FMCSA just put out a the new bulletin to remind healthcare professionals

“of the current physical qualifications standard and advisory criteria

concerning the respiratory system, specifically how the requirements apply to

drivers that may have obstructive sleep apnea (OSA)”

The FMCSA’s physical qualifications standard prohibit individuals from

receiving a medical examiners’ certificate to operate commercial motor

vehicles in interstate commerce if they have an “established medical history or

clinical diagnosis of a respiratory dysfunction likely to interfere with his or her

ability to control and drive a commercial motor vehicle safely” 49 CFR 391.4

(b)(5)

• OSA is considered a respiratory disorder

• But this determination needs to be based upon the severity of the case

• Medical examiner discretion applies

What is Obstructive Sleep Apnea (OSA)?

It is a respiratory disorder characterized by a reduction or cessation (no

breathing) during sleep

During sleep, OSA blocks the airway and prevents you from breathing up to

dozens of times per hour and can often wake you up

Time in bed DOES NOT EQUAL hours of sleep

8 hours of sleep with OSA can be less refreshing than 4 hours of ordinary,

uninterrupted sleep

Needs to be coupled with symptoms

According to the recent FMCSA bulletin, it was found that OSA patients were

more likely to unintentionally swerve and strike objects. Both are serious and

dangerous reactions.

Sleep Apnea Symptoms

• Waking up with a very sore or dry throat

• Loud snoring

• Occasionally waking up with a choking or gasping sensation

• Sleepiness or lack of energy during the day

• Morning headaches

• Restless sleep

• Forgetfulness, mood changes, and a decreased interest in sex

• Recurrent awakenings or insomnia

* OSA could therefore lead to unpredictable & sudden incapacitation like falling asleep at the wheel, contributing to the potential for crashes, injuries and fatalities



Sleep Apnea

In addition to cognitive dysfunction (sleepiness, fatigue), if left untreated, dramatically increases your risk for …

o Stroke

o Heart Disease

o Diabetes

o Obesity



Which of these can make sleep apnea worse? o Sleeping pills

o Alcohol

o Tobacco

o All of the above

How is sleep apnea diagnosed?

* The Epworth scale is widely used in the field of sleep medicine as a subjective

measure of a your sleepiness.

* It is now given to every driver who walks into our office for a DOT exam and

has significantly reduced the need for additional sleep studies. S

Dr. Tara Worron 630.554.9323 www. IllinoisDOTMedicalExam.com

SCORES

Value of your responses on the 8 questions are added up

Score is based on a scale of 0-24:

0 - 7 unlikely you are abnormally sleepy

8-9 average amount of daytime sleepiness

10-15 may be excessively sleepy

may want to consider further seeking medical attention

16-24 you are excessively sleepy

you should consider seeking medical attention


FMCSA’s physical qualifications standards

& advisory criteria in the recent bulletin

They do not provide OSA screening, diagnosis or treatment

guidelines for medical examiners

Believes the issue of treatment is best left to the treating

healthcare professional & the driver

Medical examiners are therefore left to exercise their medical judgment and expertise in determining:

If a driver exhibits risk factors for OSA

If additional information is needed before making a decision

on issuing a certificate

If a medical certificate is issued, what is the duration

The Agency does not require that these drivers be

considered unfit to continue their driving, only that

the medical examiner make a determination

whether they need to be evaluated and if

warranted, demonstrate they are managing their

OSA to reduce the risk of drowsy driving.

Things that also need to be considered:

Loud snoring, witnessed apneas, sleepiness during the major wake periods as

well as risk factors like body mass index (BMI), involvement in a single-vehicle

crash and neck size.

How does neck size effect sleep?

Fat deposits crowd the airway making it more likely to:

• partially collapse leading to snoring

• completely close off leading to sleep apnea

• large tonsils, adenoids and even tongues contribute to airway restriction

Risk factor if circumference > 17" for men

> 16" for women

* used in the right context, it may be additional evidence suggesting the need for further evaluation


Home Sleep Apnea Test When a sleep study is needed you have options

• Current breakthrough in technology lets you do the sleep study in the privacy and comfort of your own home

• Satisfies DOT regulation

• $500 (compared to the average lab fee $3,000)

• Includes the report



The most common treatment for sleep apnea is a Continuous Positive Airway Pressure machine (CPAP). How does it work? Blows air to keep the airways open during sleep

Chantix Side Effects 1. Nausea (and in rare cases vomiting)

2. Vivid, strange or unusual dreams

3. Constipation

4. Feeling sleepy

5. May be linked with a small increase in risk for *heart problems, including but not limited to heart attacks

*Disclaimer: Shortness of breath, chest pain or pressure, calf pain when walking, sudden onset of weakness, numbness or difficulty speaking


In closing …

Understand that the DOT exam is designed to keep you

and the public safe

Be comfortable with what to expect at the exam

Supply the Medical Examiner with pertinent medical data

before you go for your exam (conditions / Rx)

Find a facility that you trust

Find a facility that does not have a vested interest in you

needing advanced testing or monitoring

Find a facility that is efficient, offers truck parking and gives

you a great exam at a fair price

Dr. Tara Worron, DC

p 630.554.9323

Worron Family Chiropractic

1144 Douglas Rd

Oswego IL 60543

IllinoisDOTMedicalExam.com


Dr. Tara Worron, DC p 630.554 - Illinois DOT Medical …illinoisdotmedicalexam.com/.../illinoisdot/pdf/Dr.Tara-midwest.pdf · Dr. Tara Worron, DC p 630.554.9323 Worron Family Chiropractic

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