******************************************************************************
"Lessons Learned" is a series of drop-in articles prepared by the NTSB for use 
in publications of other organizations.  An index of articles is available at
http://www.ntsb.gov/events/journalist/lessons/lessons.htm
07/2005
******************************************************************************


Lessons Learned from Accident Investigations

Training Needed to Evaluate Medical Conditions and Ability to Drive Safely

Healthcare professionals need improved awareness and training on the adverse 
impact serious medical conditions and medications have on many of the nation's drivers, 
according to a report by the National Transportation Safety Board (NTSB).

Dozens of people have been killed and injured in accidents in which the NTSB 
found drivers with serious medical conditions or those who took prescription medicines 
that impaired their driving. One of the worst was a motorcoach accident in New Orleans 
in 1999 that claimed 22 lives. 

Nearly 200 million Americans are licensed to drive, and many of them have 
serious medical conditions that may impair the basic functions -- vision, cognition and 
motor skills -- that are necessary to drive safely.  However there is no required training 
for medical students regarding how to handle -- identify, rehabilitate, refer, counsel, and 
report -- driving impairment due to medical conditions.  Licensed physicians likewise are 
not required to receive such training, and no State requires any continuing education in 
the area of assessing and counseling medically impaired drivers.

The NTSB's recommendations, based on the results of a public hearing on 
Medical Oversight of Noncommercial Drivers in March 2003 and a report in November 
2004, include the implementation of course requirements for students in medical and 
osteopathic schools regarding assessment and counseling of such drivers and the 
inclusion of a course on the topic in required continuing medical education (CME).

The Safety Board notes an example of the type of tool that can assist physicians in 
making determinations, recommendations, and referrals regarding their patients' 
conditions and their effects on driving: The Physician's Guide to Assessing and 
Counseling Older Drivers, published in 2003 through collaboration between the 
American Medical Association (AMA) and the National Highway Traffic Safety 
Administration (NHTSA).  Though it references "older drivers" in the title, it is designed 
to help physicians treating medical conditions that may affect driving at any age. The 
Guide is approved for CME credits.  The AMA, with support from NHTSA, has 
developed a training program based on the Physician's Guide.

 The Physicians' Guide is available for free in print or electronic format from 
NHTSA at http://www.nhtsa.dot.gov/people/injury/olddrive/OlderDriversBook/ or the 
AMA at http://www.ama-assn.org/ama/pub/category/10791.html  The complete NTSB 
report is available at http://www.ntsb.gov/publictn/2004/SIR0401.htm