2010 BC Guide in Determining Fitness to Drive

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Attention-Deficit/Hyperactivity Disorder (Axis I)The pattern of deficits in adults with ADHD is similar to that in children and adolescents. Oneof the primary cognitive functions that may be affected is the ability to sustain attention,particularly when performing demanding cognitive tasks. In addition to attentional impairments,individuals with ADHD often experience other cognitive deficits such as difficulties with: planning and forethought flexibility problem solving working memory, and response inhibition.Symptoms of ADHD referenced in the DSM-IV-TR that may be relevant to driving include:Inattention often fails to give close attention to details or makes careless mistakes in school work, work,or other activities often has difficulty sustaining attention in tasks or play activities often is easily distracted by extraneous stimuli.Hyperactivity-impulsivity often is “on the go” or acts as if “driven by a motor” often has difficulty awaiting his or her turn.Schizophrenia (Axis I)Neuropsychological deficits associated with Schizophrenia may impact driving. The degree offunctional impairment associated with schizophrenia varies between the acute and residualphases of the disorder. Neuropsychological functions that may be impaired include: attention executive function spatial abilities memory, and motor and tactile dexterity.Personality disorders (Axis II)The characteristics of personality disorders most likely to affect driving include: affectivity (e.g. aggression, frustration, anger) interpersonal functioning (e.g. failure to conform to social norms, reckless disregard for thesafety of others), and poor impulse control.234
Suicidal ideationSuicidal ideation is an important consideration regarding drivers with psychiatric disordersbecause of the risk of traffic suicide.Pharmacological treatmentIn addition to the direct effects of psychiatric disorders on functional ability to drive, the impactof pharmacological treatment is an important consideration when assessing drivers. The effectsof drug treatment are considered in Chapter 29, Psychotropic Drugs.ConditionType of drivingimpairment andassessmentapproachPrimaryfunctionalabilityaffectedAssessment toolsPersistentImpairment:FunctionalassessmentCognitivePsychomotorDriver’s MedicalExamination ReportSpecialist’s reportICBC road testMood disordersAnxiety disordersADHDSchizophreniaCognitive screening toolssuch as; MOCA, MMSE,SIMARD-MD, Trails Aor BDriveABLE assessmentFunctional assessment byan occupational therapistor driver rehabilitationspecialistEpisodicimpairment:Medical assessment– likelihood ofimpairmentCognitivePsychomotorDriver’s MedicalExamination ReportSpecialist’s reportPersonality disordersPersistentImpairment:FunctionalassessmentAffectiveDriver’s MedicalExamination ReportSpecialist’s reportEpisodicimpairment:AffectiveDriver’s MedicalExamination Report235
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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
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Chapter 6: Assessment Policies and
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6.2 Assessments will only be reques
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6.4 Requesting specialist assessmen
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Policy6.5.1 If a case manager or ad
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Persistent and episodic impairments
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further assessment. Drivers who sco
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6.9.4 A case manager or adjudicator
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ASSESSMENT PROCEDURESCase manager o
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A driver fitness determination is a
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Policy rationaleBecause individuals
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7.5.3 Generally, an individual whos
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7.6.2 In particular, the case manag
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7.8.3 Whether an individual can com
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in order to be fit to drive, the ca
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has the judgment and willingness to
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Policy7.11.1 If a case manager or a
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(e) the medical condition results i
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7.12 Communicating a decisionPolicy
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7.13 Determination proceduresThe fo
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During the reconsideration, the adj
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8.3 Reconsideration proceduresThe f
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Chapter 9:Introduction to the Medic
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9.4 Medical condition chapter templ
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Private and commercial drivers who
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Chapter 11: Diabetes - Hypoglycemia
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PercentFigure 1 - Prevalence of Dia
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neuropathy, nephropathy, cardiovasc
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11.8 Private drivers with diabetes
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11.9 Commercial drivers with diabet
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RestrictionsRe-assessmentguidelines
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Policy rationaleSevere hypoglycemia
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11.12 Private drivers who have pers
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11.13 Commercial drivers who have a
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11.14 Commercial drivers who have a
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11.15 Commercial drivers who have p
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PART B - HYPOGLYCEMIA11a. Has the p
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Produce my glycemic log for my doct
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Deep-vein thrombosisDeep-vein throm
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Aneurysms less than 5 cm in diamete
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GUIDELINES12.6 Private and commerci
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12.7 Private drivers who have an an
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12.9 Commercial drivers who have an
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Chapter 13: Musculoskeletal Conditi
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ConditionType of drivingimpairment
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ConditionsRestrictionsRe-assessment
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14.3 Chronic renal disease and adve
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14.8 Private drivers with end-stage
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14.10 Private and commercial driver
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Level ofImpairmentMildlyImpairedMod
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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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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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Page 197 and 198: 17.25 Private and commercial driver
Page 199 and 200: 17.27 Private drivers with atrioven
Page 201 and 202: 17.28 Commercial drivers with atrio
Page 203 and 204: 17.29 Private drivers with permanen
Page 205 and 206: 17.31 Private drivers who have decl
Page 207 and 208: 17.33 Private drivers where ICD the
Page 209 and 210: 17.35 Commercial drivers who have d
Page 211 and 212: 17.37 Commercial drivers with inher
Page 213 and 214: 17.39 Commercial drivers with medic
Page 215 and 216: 17.41 Private drivers with surgical
Page 217 and 218: 17.43 Private drivers with mitral v
Page 219 and 220: 17.45 Private drivers with congesti
Page 221 and 222: 17.46 Commercial drivers with conge
Page 223 and 224: 17.47 Private drivers with left ven
Page 225 and 226: 17.49 Private drivers with a heart
Page 227 and 228: 17.51 Private drivers with hypertro
Page 229 and 230: 17.53 SyncopeSee the guidelines in
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Page 233 and 234: Chapter 18: Hearing LossBACKGROUND1
Page 235 and 236: GUIDELINES18.6 Private drivers with
Page 237 and 238: equirement for commercial drivers i
Page 239 and 240: PLEASE COMPLETE THE FOLLOWING: YES
Page 241 and 242: this manual. Axis IV addresses exte
Page 243 and 244: Negative symptoms are characterized
Page 245 and 246: Schizophrenia (Axis I)Schizophrenia
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Page 251 and 252: GUIDELINES19.6 Private and commerci
Page 253 and 254: Chapter 20: Cerebrovascular Disease
Page 255 and 256: Cerebrovascular accidentCVAs are th
Page 257 and 258: ConditionType of drivingimpairment
Page 259 and 260: GUIDELINES20.6 Private and commerci
Page 261 and 262: Re-assessmentguidelinesPolicy ratio
Page 263 and 264: 20.9 Private drivers who have had s
Page 265 and 266: 20.10 Commercial drivers who have h
Page 267 and 268: Visual field impairment refers to a
Page 269 and 270: Right homonymous hemianopiaBinasal
Page 271 and 272: An example of the effects of diabet
Page 273 and 274: Retinitis pigmentosaRetinitis pigme
Page 275 and 276: GlaucomaApproximately 67 million pe
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Page 281 and 282: Policy rationaleretinopathy dependi
Page 283 and 284: Policy rationaleIndividuals with be
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Page 289 and 290: 21.13 Commercial drivers with a los
Page 291 and 292: 21.15 Private and commercial driver
Page 293 and 294: 21.17 Visual field impairmentsTypes
Page 295 and 296: 21.18 Examination of visual functio
Page 297 and 298: 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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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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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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