FMCSA and Commercial Driving Exam Preparation

FMCSA History and Structure

  • US Department of Transportation (USDOT) regulates interstate commerce.
  • Motor Carrier Safety Improvement Act of 1999:
    • Created the Federal Motor Carrier Safety Administration (FMCSA).
    • Moved the Office of Motor Carriers from the Federal Highway Administration to the FMCSA.
  • FMCSA Structure:
    • One of nine administrations within the DOT.
  • FMCSA Activities Focused On:
    • Enforcing safety regulations.
    • Targeting high-risk carriers and commercial motor vehicle (CMV) drivers.
    • Improving safety information systems and CMV technologies.
    • Strengthening CMV equipment and operating standards.
    • Increasing safety awareness.
  • FMCSA Mission Statement:
    • Reducing crashes, injuries, and fatalities involving large trucks and buses.

FMCSA's Safety Mandate

  • Core Activities:
    • Developing and enforcing data-driven regulations for safety and industry efficiency.
    • Using safety information systems to focus on high-risk carriers.
    • Targeting educational messages:
      • Carriers.
      • Commercial drivers.
      • The public.
    • Partnerships with stakeholders:
      • Federal, state, and local enforcement agencies.
      • Motor carrier industry.
      • Safety groups.
      • Organized labor.
  • FMCSA Office of Medical Programs:
    • Lead federal agency for CMV driver health and safety regulation.
  • Office of Medical Programs Mission:
    • Promoting roadway safety through medical regulations, guidelines, and policies.
    • Ensuring CMV drivers in interstate commerce are physically qualified.
  • Responsibilities of the Office of Medical Programs:
    • Overseeing national medical certification for interstate CMV drivers.
    • Developing and implementing medical regulations, policies, and procedures.
    • Overseeing and supporting the Medical Review Board (MRB).
    • Developing and implementing:
      • National Registry Program.
      • National Medical Examiner System.
      • LINK National Driver Medical Reporting System.
    • Conducting and overseeing medical exemption and certificate programs.
    • Serving as the lead federal agency for CMV driver health and safety.
    • Conducting relevant medical research.

Origin of CMV Driver Certification Requirements

  • Proximate Cause:
    • 1999 bus crash in New Orleans (Mother's Day).
      • 22 passengers killed.
      • 15 passengers and the driver suffered serious injuries.
  • National Transportation Safety Board (NTSB) Investigation:
    • Driver should not have been medically certified due to disqualifying conditions:
      • Renal failure.
      • Heart failure.
    • Failure to prevent medically unqualified drivers was a systemic issue.
  • Establishment of National Registry of Certified Medical Examiners:
    • Established on April 20, 2012.
    • Since May 14, 2014, only certified medical examiners can legally certify CMV drivers.
  • NRCME Mission Statement:
    • Improve highway safety by training and certifying medical examiners.
    • Ensure medical examiners can effectively determine if a CMV driver's health meets FMCSA standards.
  • Certified Medical Examiners Must:
    • Demonstrate understanding of FMCSA physical qualification requirements and the demands of commercial driving.
    • Perform driver certification examinations according to FMCSA requirements and guidelines.
  • Definition of Medical Examiner:
    • A person licensed under applicable state laws and regulations to perform physical examinations, including:
      • Doctors of medicine and osteopathy.
      • Advanced practice nurses.
      • Physician assistants.
      • Chiropractors.

FMCSA Research and Analysis

  • FMCSA Office of Analysis, Research and Technology (ART):
    • Provides analytical reports on trends, costs, fatalities, and injuries in large truck and bus crashes.
    • Identifies factors contributing to crashes.
    • Develops effective countermeasures to reduce crash occurrence and severity.
    • Prepares economic and environmental analyses for FMCSA rulemakings.
    • Ensures motor carrier regulation changes are based on sound data and analysis.

Federal Regulations

  • Code of Federal Regulations (CFR):
    • Divided into 50 titles covering broad areas of federal regulation.
  • Federal Motor Carrier Safety Regulations (FMCSR):
    • Legal requirements for interstate commercial vehicles, drivers, and motor carriers.
    • Title 49 of the CFR:
      • Deals with transportation.
      • Chapter three: Federal Motor Carrier Safety Administration, Department of Transportation.
  • 49 CFR Part 391:
    • Describes the qualification of drivers.
    • 49 CFR 391.41: Commercial motor vehicle driver physical qualifications.
      • Outlines 13 standards for medical certification.
      • Criteria to determine a driver's medical fitness for duty.

Discretionary vs. Nondiscretionary Standards

  • Nondiscretionary Criteria:
    • Hearing, vision, and epilepsy.
    • Drivers must meet hearing and vision criteria.
    • Drivers cannot have a diagnosis of epilepsy.
  • Insulin Use:
    • Previously nondiscretionary and disqualifying.
    • Federal diabetes exemption waiver was the only way for insulin-treated drivers to be allowed to drive.
    • Effective November 2018, new FMCSA regulation allows medical examiners to certify drivers with insulin-treated diabetes.
  • Remaining FMCSA Criteria (Guidance):
    • Based on expert review and considered best practice but are not legally binding.
    • Examiners may deviate, but reasons should be documented.

Pertinent Regulations for Medical Examiners

  • 49 CFR 391.43:
    • Responsibilities of the medical examiner:
      • General instructions for performing the medical examination.
      • Description of driver tasks and work environment.
      • Medical advisory criteria.
      • Sample medical examination report form.
      • Medical examiner certificate.
  • 49 CFR 391.45:
    • Identifies who must have the commercial motor vehicle driver physical examination.
  • 49 CFR 391.47:
    • Process for conflict resolution when there is a disagreement between the driver's primary care provider and the medical examiner.
  • 49 CFR 391.49:
    • Skilled Performance Evaluation Certification Program.
      • Allows drivers with loss or impairment of an extremity to obtain a waiver.
  • 49 CFR 391.64:
    • Grandfathering for drivers who participated in vision and diabetes waiver study programs.
  • 49 CFR 40:
    • Regulations for medical review officers and substance abuse professionals, including drug and alcohol testing procedures.

FMCSA Updates to Regulations and Guidelines

  • Process:
    • Expert analyses from federal data and other relevant data sources.
    • Formulation of questions related to specific medical conditions and their impact on driving safely.
    • Development of a report containing a systematic review of evidence-based scientific literature.
    • Appointment of a medical expert panel:
      • Composed of subject matter experts.
      • Reviews the evidence report.
      • Issues recommendations to the FMCSA.
  • Medical Review Board (MRB):
    • Meets three to four times each year.
    • Independently reviews the evidence report, the medical expert panel opinion, and related information.
    • Proposes recommendations to the FMCSA.
  • FMCSA Considerations When Deciding Guidelines:
    • Evidence reports.
    • Medical expert panel opinion.
    • Medical Review Board recommendations.
    • Feasibility.
    • Economic impact on carriers and drivers.
    • Legal implications.

Important Definitions

  • Commercial Motor Vehicle (CMV):
    • Self-propelled or towed motor vehicle used on a highway in interstate commerce to transport passengers or property when the vehicle:
      • Has a combined gross vehicle weight or weight rating of ≥\geq 10,001 pounds.
      • Is designed or used to transport > 8 passengers (including the driver) for compensation.
      • Is designed or used to transport > 15 passengers (including the driver), whether for compensation or not.
      • Transports hazardous materials in quantities requiring placards.
  • Driver:
    • Any person who operates a commercial motor vehicle.
  • Interstate Commerce:
    • Trade, traffic, or transportation:
      • Between a place in a state and a place outside of such state (including outside the U.S.).
      • Between two places in a state through another state or a place outside of the U.S.
      • Between two places in a state as part of trade, traffic, or transportation originating or terminating outside the state or the U.S.
  • Medical Examiner:
    • A person who is licensed, certified, and/or registered in accordance with applicable state laws and regulations to perform physical examinations.
    • Includes doctors of medicine and osteopathy, advanced practice nurses, physician assistants, and chiropractors.
  • Motor Carrier:
    • A for-hire motor carrier or a private motor carrier.
    • Includes a motor carrier's agents, officers, and representatives as well as employees responsible for the hiring, supervising, training, assigning, or dispatching of drivers and employees concerned with the installation, inspection, and maintenance of motor vehicle equipment and accessories.
    • This definition includes the terms employer and exempt motor carrier.

Drug and Alcohol Testing

  • Regulation 49 CFR 40:
    • Outlines the regulations for medical review officers and drug and alcohol testing procedures.
  • Omnibus Transportation Employee Testing Act of 1991:
    • Requires drug and alcohol testing of safety-sensitive transportation employees in aviation, trucking, railroads, mass transit, pipelines, and other transportation duties.
  • DOT Rules:
    • Who must conduct drug and alcohol tests.
    • How to conduct those tests.
    • What procedures to use when testing.
  • Medical Review Officer (MRO):
    • A licensed physician who receives and reviews laboratory results from an employer's drug testing program.
    • Evaluates medical explanations for certain drug test results.
  • Substance Abuse Professional (SAP):
    • A person who evaluates employees who have violated DOT drug and alcohol regulations.
    • Makes recommendations concerning education, treatment, follow-up testing, and aftercare.

Job of Commercial Driving

  • FMCSA Regulates:
    • Interstate commercial operations, including:
      • Drivers.
      • Trucks and buses.
      • Motor carriers.
      • Transportation of hazardous materials (in placard-requiring quantities).
    • A safety risk in any of these components can endanger public safety and health.
  • Driver Compliance:
    • Approximately 6-7 million CMV drivers must comply with FMCSA physical qualification standards.
    • Estimated 3-4 million physical examinations are performed annually.
  • Other Regulations Affecting CMV Drivers:
    • Drug and alcohol testing.
    • Record keeping.
    • Hours of service.
  • Motor Carrier Responsibilities:
    • Comply with FMCSA regulations governing their drivers and minimum levels of financial responsibility.
    • Motor carrier definition includes agents, officers, representatives, employees responsible for hiring, supervising, training, assigning, and dispatching drivers.
  • Driver General Qualification Requirements (49 CFR 391.11):
    • Be at least 21 years old.
    • Speak and read English well enough to converse with the general public and understand highway and traffic signals.
    • Make legible entries on reports.
    • Be capable of safely operating the CMV.
    • Have a current medical examiner certificate on file.
    • Have only one valid commercial motor vehicle operator's license.
    • Provide the motor carrier with required background and violations information.
    • Not be subject to disqualification to drive a CMV under the rules in 49 CFR 391.15.
    • Successfully complete a driver's road test or equivalent.
  • Medical Fitness for Duty Records Must Include:
    • All federal physical qualification requirements found on the medical examination report form.
  • Additional Motor Carrier Requirements:
    • Truck and bus companies may have additional medical requirements, such as a minimum lifting capability.
  • State Regulations:
    • Regulate interstate commerce and commercial drivers not subject to federal regulations.
    • Must adopt federal physical qualification requirements at a minimum.
    • May have additional, different, or more stringent requirements.
    • Medical examiners are responsible for knowing the driver regulations for their state or the states in which they practice.

CMV Driver Population Characteristics

  • Demographics:
    • Similar to the general population but with an aging workforce.
  • Risks Associated with Aging:
    • Higher risk for chronic diseases, fixed deficits, gradual or sudden incapacitation, and comorbidity.
    • These can interfere with the ability to drive safely.
  • Average Truck or Bus Driver Profile:
    • Male over 40 years of age.
    • Sedentary, overweight, a smoker, and has poor eating habits.
    • Less healthy than the average person and has more than two medical conditions.
    • Cardiovascular disease is prevalent.

Stressful Aspects of Commercial Driving

  • Types of Routes:
    • Turnaround routes (return home each evening).
    • Long relay routes (9-11 hours driving, 10-hour off-duty period, several days before returning home).
    • Straight-through haul or cross-country routes (month on the road, 4-5 days at home before leaving again).
    • Team operation (drivers alternate 5-hour driving periods with 5-hour rest periods).
  • Schedules:
    • Abrupt schedule changes and rotating work schedules.
    • Irregular sleep patterns and fatigue.
    • Tight pickup and delivery schedules requiring both day and night driving.
    • Failure to meet schedules may result in financial losses.
    • Long hours and extended time away from family and friends lead to lack of social support.
  • Environment:
    • Excessive vehicle noise, vibration, and extremes in temperature.
    • Adverse road, weather, and traffic conditions causing unavoidable delays.
  • Types of Cargo:
    • Bus drivers are responsible for passenger safety, which requires effective social skills.
    • Loss of or shifting cargo while driving can result in serious accidents.
    • Transporting hazardous materials increases the risk of injury and property damage.

Tasks of Commercial Driving

  • Staying Alert While Driving:
    • Demands sustained mental alertness and physical endurance.
    • Should not be compromised by fatigue or sudden incapacitating symptoms.
  • Cognitive Skills Required:
    • Problem-solving.
    • Communication.
    • Judgment.
    • Appropriate behavior in normal and emergency situations.
  • Driving Requires:
    • The ability to judge the maximum speed at which vehicle control can be maintained under changing conditions.
  • Use of Side Mirrors:
    • Monitor traffic that can move into the driver's blind spot.
    • Used in backing up trucks to loading and unloading areas.
    • Requires sufficient lateral cervical mobility for effective use.
  • Control of the Steering Wheel:
    • Large trucks and buses have oversized steering wheels.
    • Active steering can be simulated by offering resistance while having the driver imitate the motion pattern necessary to turn a 24-inch steering wheel.
  • Manipulation of Dashboard Switches and Controls:
    • Large trucks and buses are complex vehicles with multiple dashboards, switches, and knobs.
    • Requires adequate reach, prehension, and touch sensation in hands and fingers.
  • Shifting Gears:
    • Manual transmissions may have more than 20 gears.
    • Requires repetitive reciprocal movements of both legs coordinated with right arm and hand movements.
  • Entering and Exiting the Vehicle:
    • Similar to climbing a ladder, requiring three points of contact.
    • Full overhead extension may be required to reach the handholds.
    • Hip angle and knee flexion may have to exceed 90 degrees.
  • Coupling and Uncoupling Trailers:
    • Multiple subtasks, including raising and lowering trailer supports, connecting air lines and electrical cables, and checking trailer kingpin height.
    • Requires grip strength, upper body strength, range of motion, balance, and flexibility.
  • Load, Secure and Unload Cargo:
    • FMCSA guidelines do not specify the number of pounds a driver must be able to lift.
    • CDC defines loading/unloading a truck as vigorous activity that requires > 6 metabolic equivalents.
  • Perform Vehicle Checks:
    • Requires grip strength, upper and lower body strength, range of motion, balance, and flexibility to inspect the engine, brakes, and cargo.
    • Vision and hearing are used to identify and interpret changes in vehicle performance.

Physics of Crashes Involving Large Trucks

  • FMCSA Goal:
    • Lower the rate of crashes, injuries, and fatalities involving large trucks and buses.
  • Outcomes of Crashes:
    • When a fatal crash involves at least one truck, occupants of passenger vehicles are more likely to sustain serious injury or die.
  • Basic Physics Principles:
    • Injury severity equals relative velocity change.
    • The greater the mass, the less relative velocity change.
    • Crash of a vehicle having twice the mass of the lighter vehicle equals a sixfold risk of death to persons in the lighter vehicle.
  • Weight Comparisons:
    • SUV: approximately 4,000 pounds.
    • Loaded semi-truck: approximately 80,000 pounds.
    • The truck has 20 times the mass of the SUV.

Safety Implications of Disease

  • Considerations for Examiners:
    • High rate of illness in the commercial driver population.
    • Safety implications of existing disease processes or their treatments on the ability to drive.
  • Disqualifying Physical Conditions:
    • Symptoms, even if medically benign, interfere with driving ability.
    • Example: Supraventricular tachycardia (often benign) can be disqualifying if it results in near syncope.
    • The onset of symptoms may be so fast that the driver is unable to stop the vehicle safely before becoming incapacitated.
    • The onset of symptoms may be so gradual that the driver is unaware of diminished ability to operate a commercial motor vehicle safely.
  • Mental or Physiological Conditions:
    • May be disqualifying if it interferes with:
      • Cognitive abilities used to process environmental cues rapidly and make appropriate responses.
      • Problem-solving skills used to function independently in a new environment or in an emergency.
      • Behavioral inhibitors that suppress inappropriate, irresponsible, or possibly violent actions.
  • Medical Treatment Considerations:
    • Is the use of a medical treatment qualifying because it controls a physical or mental condition, allowing the driver to perform tasks more safely than without the treatment?
    • Disqualifying because the effects, even if medically optimal, interfere with safe driving?
    • Disqualifying because the side effects interfere with safe driving?