2010 BC Guide in Determining Fitness to Drive

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Factors that may be associated with hypoglycemia unawareness include older age, duration ofdiabetes, presence of autonomic neuropathy, species of insulin, degree of metabolic control, andnumber of hypoglycemic events.11.3 Diabetes and adverse driving outcomesAlthough there is some variability in results of research on drivers with diabetes, there is clearevidence to show that both private and commercial drivers with diabetes are at an increased riskof motor vehicle crashes.It has been shown that diabetes treatment modality is an important consideration indetermination of risk for drivers. Study results consistently indicate that individuals takinginsulin have an elevated risk of crashes. Some studies have also shown an elevated risk of crashfor drivers with type 2 diabetes who are treated with a combination of oral antihyperglycemics(secretagogues and non-secretagogues). Those treated by diet alone or with a single oralantihyperglycemic agent have shown no elevated risk of crash.A relationship between hypoglycemia and crashes has also been found. Despite a lack of datafrom studies of large samples of people with diabetes, a number of small studies have shown arelationship between hypoglycemic reactions and motor vehicle crashes.While research has established clear links between diabetes, hypoglycemia and motor vehiclecrashes, the variable results of these studies indicate that decisions about driving should be basedon assessment of individual medical history and circumstances including: treatment modality incidence of hypoglycemia incidence of hypoglycemia unawareness, and presence of chronic complications of diabetes.11.4 Effect of diabetes and hypoglycemia on functional ability to driveFor individuals with diabetes, both acute and chronic complications of the disease may affectfitness to drive.Hyperglycemia may cause blurred vision, confusion, and eventually diabetic coma. For thepurposes of this manual, these are considered transient impairments.The neuroglycopenic symptoms associated with severe hypoglycemia can significantly impairthe sensory, motor, and cognitive functions required for driving. There are studies that suggestthat mild hypoglycemia may also impair these functions.While it is clear that the risk of hypoglycemia is an important consideration when assessing thefitness of drivers with diabetes, research indicates that the chronic complications of diabetes aremore likely to be responsible for impaired fitness to drive than episodic incidents ofhypoglycemia. Over time, people with diabetes often develop co-morbidities caused by theirprolonged exposure to hyperglycemia. These complications of diabetes include retinopathy,88
neuropathy, nephropathy, cardiovascular disease, and peripheral vascular disease. Therefore, theeffect of chronic complications always must be considered when assessing fitness to drive forpeople with diabetes.ConditionType of drivingimpairment andassessment approachPrimary functionalability affectedAssessment toolsSeverehypoglycemiaEpisodic impairment:Medical assessment –likelihood of impairmentAll – suddenincapacitationDriver’s MedicalExamination ReportDoctor’s MedicalReport Re DiabeticDriverDriver’s DiabetesQuestionnaire11.5 CompensationAs severe hypoglycemia is an episodic impairment, a driver cannot compensate.89
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Ministry of Public Safety and Solic
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AcknowledgmentsResearcherBonnie M.
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Table of Contents (click on any ite
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11.7 Private and commercial drivers
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BACKGROUND ........................
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PART 1:BACKGROUND1
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Appendix 2: Excerpts from the MVA t
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Chapter 2: The Driver Fitness Progr
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for the exercise of discretion by O
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1. SCREENINGA driver disclosesa med
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2.3 Roles and responsibilitiesOSMV
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Medical practitionersMedical practi
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Chapter 3:Driver Fitness Program Pr
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Because of these limitations, OSMV
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Example: the temporary storage of i
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Motor functions (including sensorim
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an individual with poor contrast se
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3.5 Best informationDriver fitness
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Chapter 4: Introduction to the Poli
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3. DETERMINATIONFrom2. AssessmentAn
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Once identified, a DMER is mailed t
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5.3 Screening aging driversDefiniti
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5.5 Transient impairmentsDefinition
Page 51 and 52: Chapter 6: Assessment Policies and
Page 53 and 54: 6.2 Assessments will only be reques
Page 55 and 56: 6.4 Requesting specialist assessmen
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Page 59 and 60: Persistent and episodic impairments
Page 61 and 62: further assessment. Drivers who sco
Page 63 and 64: 6.9.4 A case manager or adjudicator
Page 65 and 66: ASSESSMENT PROCEDURESCase manager o
Page 67 and 68: A driver fitness determination is a
Page 69 and 70: Policy rationaleBecause individuals
Page 71 and 72: 7.5.3 Generally, an individual whos
Page 73 and 74: 7.6.2 In particular, the case manag
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Page 77 and 78: in order to be fit to drive, the ca
Page 79 and 80: has the judgment and willingness to
Page 81 and 82: Policy7.11.1 If a case manager or a
Page 83 and 84: (e) the medical condition results i
Page 85 and 86: 7.12 Communicating a decisionPolicy
Page 87 and 88: 7.13 Determination proceduresThe fo
Page 89 and 90: During the reconsideration, the adj
Page 91 and 92: 8.3 Reconsideration proceduresThe f
Page 93 and 94: Chapter 9:Introduction to the Medic
Page 95 and 96: 9.4 Medical condition chapter templ
Page 97 and 98: Private and commercial drivers who
Page 99 and 100: Chapter 11: Diabetes - Hypoglycemia
Page 101: PercentFigure 1 - Prevalence of Dia
Page 105 and 106: 11.7 Private and commercial drivers
Page 107 and 108: 11.8 Private drivers with diabetes
Page 109 and 110: 11.9 Commercial drivers with diabet
Page 111 and 112: RestrictionsRe-assessmentguidelines
Page 113 and 114: Policy rationaleSevere hypoglycemia
Page 115 and 116: 11.12 Private drivers who have pers
Page 117 and 118: 11.13 Commercial drivers who have a
Page 119 and 120: 11.14 Commercial drivers who have a
Page 121 and 122: 11.15 Commercial drivers who have p
Page 123 and 124: PART B - HYPOGLYCEMIA11a. Has the p
Page 125 and 126: Produce my glycemic log for my doct
Page 127 and 128: Deep-vein thrombosisDeep-vein throm
Page 129 and 130: Aneurysms less than 5 cm in diamete
Page 131 and 132: GUIDELINES12.6 Private and commerci
Page 133 and 134: 12.7 Private drivers who have an an
Page 135 and 136: 12.9 Commercial drivers who have an
Page 137 and 138: Chapter 13: Musculoskeletal Conditi
Page 139 and 140: ConditionType of drivingimpairment
Page 143 and 144: ConditionsRestrictionsRe-assessment
Page 145 and 146: 14.3 Chronic renal disease and adve
Page 149 and 150: 14.8 Private drivers with end-stage
Page 151 and 152: 14.10 Private and commercial driver
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Level ofImpairmentMildlyImpairedMod
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GUIDELINES15.6 Private and commerci
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15.8 Commercial drivers with modera
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15.10 Commercial drivers with sever
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Policy rationaleDrivers who require
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Chapter 16: Vestibular DisordersBAC
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One study identified that 32.5% of
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ConditionType ofdrivingimpairmentan
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Re-assessmentguidelinesPolicy ratio
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16.10 Private and commercial driver
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Individuals who have undergone valv
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Episodic impairmentThe potential ep
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GUIDELINES17.6 Policy rationaleThes
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17.9 Commercial drivers with corona
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17.11 Private drivers who have had
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17.15 Private drivers who have vent
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17.19 Private drivers who have sust
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17.21 Commercial drivers who have s
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17.27 Private drivers with atrioven
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17.28 Commercial drivers with atrio
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17.29 Private drivers with permanen
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17.31 Private drivers who have decl
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17.33 Private drivers where ICD the
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17.35 Commercial drivers who have d
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17.37 Commercial drivers with inher
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17.39 Commercial drivers with medic
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17.41 Private drivers with surgical
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17.43 Private drivers with mitral v
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17.45 Private drivers with congesti
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17.46 Commercial drivers with conge
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17.47 Private drivers with left ven
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17.49 Private drivers with a heart
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17.51 Private drivers with hypertro
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17.53 SyncopeSee the guidelines in
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Stable coronary syndromes - waiting
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Chapter 18: Hearing LossBACKGROUND1
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GUIDELINES18.6 Private drivers with
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equirement for commercial drivers i
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PLEASE COMPLETE THE FOLLOWING: YES
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this manual. Axis IV addresses exte
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Negative symptoms are characterized
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Schizophrenia (Axis I)Schizophrenia
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19.4 Effect of psychiatric disorder
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Suicidal ideationSuicidal ideation
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Chapter 20: Cerebrovascular Disease
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Cerebrovascular accidentCVAs are th
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ConditionType of drivingimpairment
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20.9 Private drivers who have had s
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20.10 Commercial drivers who have h
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Visual field impairment refers to a
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Right homonymous hemianopiaBinasal
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An example of the effects of diabet
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Retinitis pigmentosaRetinitis pigme
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GlaucomaApproximately 67 million pe
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indicates that wait times of 6 mont
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Although telescopic spectacles, hem
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Policy rationaleretinopathy dependi
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Policy rationaleIndividuals with be
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Re-assessmentguidelines cont’dPol
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Re-assessmentguidelines cont’dPol
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21.13 Commercial drivers with a los
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21.17 Visual field impairmentsTypes
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21.18 Examination of visual functio
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VISUAL FIELD TEST (VFT)For drivers
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To the Driver:Under section 29 of t
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Please note:Goldman, Esterman and H
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Cardiac syncopeCardiac syncope refe
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22.7 Private drivers who have had a
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22.9 Private drivers with recurrent
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22.11 Commercial drivers who have h
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22.13 Commercial drivers with recur
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Chapter 23: Seizures and EpilepsyBA
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abnormal numbnesstingling and a cra
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23.10 Private drivers with single u
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23.12 Private drivers with epilepsy
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23.18 Commercial drivers with epile
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Level of disabilityor worsening of
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Parkinson’s diseaseThere is a sma
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ConditionsRestrictionsRe-assessment
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25.2 Prevalence and incidence of tr
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Chapter 26: Intracranial TumoursBAC
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Some examples of compensatory mecha
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i. aphasia (language disturbance)ii
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27.2 Prevalence and incidence of co
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27.4 Effect of cognitive impairment
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Chapter 28: Sleep DisordersBACKGROU
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An immediate reduction in daytime s
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28.5 CompensationIndividuals with s
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OSMV determinationguidelines cont
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ConditionsRestrictionsRe-assessment
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Policy rationaleThe general approac
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Chapter 29: Prescription and Over-T
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Examples of newer antihistamines in
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Stimulants (for ADHD)Examples of st
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AntiepilepticsIn general, individua
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Sedating EffectLowModerateHighTCAsd
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dizziness, andblurred or double vis
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30.2 Effect of general debility and
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Appendix 1: Glossary of TermsCommer
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Medical assessmentis any kind of as
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Transient impairmentmeans a tempora
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must cause to be issued to the appl
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(ii) cancel the person's driver's l
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Appendix 3: Aging DriversAbout agin
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Percentadults. The survey also foun
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Appendix 4: Licence ClassesThe tabl
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Appendix 5: Drafting and Approval P
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drivers, this means that BC commerc
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2010 BC Guide in Determining Fitness to Drive

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