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American Osteopathic College of Occupational and Preventive MedicineOMED 2013, Mandalay Bay Convention Center, Las VegasWednesday, October 2, 2013, Occupational Medicine Day

American Osteopathic College ofOccupational and Preventive Medicine

TRAINING SPONSOR FOR YOUR

American Osteopathic College of Occupational and Preventive Medicine

Updated: 3/13/2013

Federal Motor Carrier Safety Agency (FMCSA)National Registry Certified Medical Examiners

(NRCME)UPDATE 2013-2014

Daniel J Callan, DO/MPH,FAOCOPM, FACOFP, FASMA

[email protected]


DOT FMCSA NRCME PROGRAM CORE CURRICULUM SYLLABUSThis program has been approved for 8.5 Category 1-A AOA CME Credits .

Task Force Faculty: Dan Callan, DO, MPH&TM, FAOCOPM

Elizabeth P. Clark, DO, MPH&TM, FAOCOPM

Scott C. Jones, DO,MPH, FAOCOPM Mimms Maybe, DO,MPH, FAOCOPM

A. 8:00-10:00 a.m. An Introduction toMedical Program (2credits) Core Competencies of CME; Background, history, rationale, mission, & CME’s role Commercial Medical Examiner route to certification

CMV; driver’s responsibilities & work; CMV; driver’s identification. Obtaining, reviewing, & documenting medical history Prescription & over-the-counter medications. Medications/non-disqualifying medical conditions needing care

10:00–4:00 p.m. Clinical Medical Standards, by Body System; Medical Examination; Performing & Documenting. (2.5 credits)B. HypertensionC. RespiratoryDiseasesD. DiabetesE. Hearing

F. VisionG. Other DiseasesH. MusculoskeletalI. CardiovascularJ. Neurological

K. Psychiatry (including alcohol & drug abuse)4:00 -4:30 p.m. Panel Discussion,Questions (.5 credit)

L. Additional diagnostic tests or medical opinions, as needed (Letters)M. Obtaining medical specialist/treating physician opinion (Letters)

AOCOPM, a training organization, will stay current with FMCSA’s regulations & guidelines, provide timely, up-to-date continuous safetyeducation & training

AMERICAN OSTEOPATHIC COLLEGE OF

OCCUPATIONAL AND PREVENTIVE MEDICINE

P.O. BOX 3043Tulsa, OK 74101

WWW.AOCOPM.ORG

(800) 558-8686 ▪ (918) 561-1431-fax

Earl Miller, DO, FAOCOPM

Lance Walker, DO, MPH Robert Wanat, DO, MPH, FAOCOPM Charles Werntz, DO, MPH, FAOCOPM

GOALS & OBJECTIVES• PROVIDE EDUCATION AND TRAINING:

– To prepare DO Physicians to become trained,knowledgeable and skilled to perform FMCSAphysical evaluations, based on Regulations,Medical Standards and Recommendations.

– To ensure that ONLY Physically Qualified CMVdrivers in a Safety Sensitive Position receivea medical certificate to drive safely drive on ournations highway.

– To educate the CMV drivers on medical conditionsand medications that could lead to sudden orinsidious unrecognized incapacitation


NRCME COURSE OVERVIEW• FMCSA OVERVIEW: WHO ARE THEY/WHAT DO

THEY DO?

• LEGAL JUSTIFICATION

• CERTIFICATION PROCESS & REQUIREMENTS

• HISTORICAL PERSPECTIVE

• COURSE CONTENT

• LEARNING OBJECTIVES

• NRCME SPECIFICS

• DEFINITIONS

• COMPETENCIES• MEDICAL CERTIFICATION REQUIREMENT U/D

• OTHER RECENT & FUTURE MEDICAL ITEMS


SCHEDULE UPDATE: TODAYWHAT WE KNOW TO DATE: 09/27/2013Learning Objectives:Understand & comprehend FMCSA Medical Standards &

Federal Regs regarding & pertaining to CommercialMotor Vehicle (CMV) driver safety.

Understand Safety reasoning behind Process & Proceduralrequirements for obtaining & maintaining NRCMEstatus.

SAFETY& RISK ASSESSMENT !!!PARTS 1 & 2

FMCSA OVERVIEW


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FMCSAEpidemiology: Est. 14 Million Commercial DriversLicense (CDL)

Heavy truck drivers: 2,031,300 to 2,264,200

Bus Drivers: 691,400 to 735,300

– 7,000,000 active interstate drivers

– DOT PE annual or Biannual

Estimated:

– Current DOT providing CME over 100,000 ???

– Current annual PE load 3 to 4,000,000

– Average 45 medical exams/month/examiner

– With CDME total of 40,000 only to perform 3-4mil DOT PE/yr= Average 75/month

– Over 9 million registered trucks, 3,733 CMVA with 4,300 fatalities

– Over 843,000 registered buses, 247 CMVA with 307 fatalities


IMPACT of HUMAN FACTORS in MANMACHINE INTERFACE


MAN–MACHINE INTERFACENRCME SPECIFICS


• Drivers who operate CMVs: in Interstate commerce

– Must have a Commercial Drivers License (CDL)

– Has a Gross Vehicle Wt (GVWR) or, a Gross Combination Wt(GCWR), of 10,001 pounds or more, whichever is greater;

– Is designed or used to transport more than 8 passengers(including CMV driver) for compensation; or

– Is designed or used to transport more than 15 passengers,including CMV driver, and is not for compensation; or

– Is used to transport hazardous materials that require a placard

• Intrastate commerce : Specific State requirements for medicalcertification vary. Medical examiners should be informedregarding the State regulations that affect their practice.


WHEN IS MEDICAL CERTIFICATION REQUIRED?

WHEN IS MEDICAL CERTIFICATIONREQUIRED?

• Driver RTW from an illness or injury that interferes withdriving ability, must undergo a medical exam even ifmedical examiner’s certificate has not expired.

• CDME is responsible for certifying only drivers whomeet Physical Qualification Standards.

• Certification can not exceed 2 years, & at discretion ofthe medical examiner, may be less than 2 years.

• Federal Vision & Diabetes Exemption Programsrequire annual medical certification.


FINAL RULE FOR NRCMEHISTORY:Notice of Proposed Rule Making (NPRM) December 1st, 2008 To: Office of Secretary of Transportation: 7/28/2011 (actual)

approved by DOT Secretary LaHood September, 2011 To: Office of Management and Budget: 9/28/2011 (actual)

Office of Management and Budget Clearance: 04/10/2012 (actual)

NRCME Final Rule Federal Registry Publication: 4/20/2012

Effective Date: 05/21/2012

I Compliance Date: 05/21/2013 for companies with 50 or more driversII Compliance Date: 05/21/2014 for all drivers & all companies


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NRCME OBJECTIVES;Improve highway safety & driver health;

• Ensure CDME understand FMCSA medical standards & guidelines& how they apply to interstate CMV drivers;

• Maintain ongoing competency of CDMEs through initial training,certification, & Periodic retraining/recertification;

• Promote public confidence in quality of CDMEs who certify CMVdrivers;

• Establish an online REGISTRY list of CDMEs.


DISSEMINATION OF NATIONAL REGISTRYINFO

• FMCSA developed NRCME Web site & NRCME Listserv:

– To disseminate information including latest NRCMEdevelopments,

– To facilitate communication with program’s primarystakeholders:

• Medical professionals interested in becoming CMEs;• Certified CMEs;• Industry professionals;

• CMV drivers;• Employers;

• General public & all other interested parties.


DISSEMINATION OF NATIONAL REGISTRYINFO

NRCME Web site (http://nrcme.fmcsa.dot.gov) provides:

– Information about FMCSA regulations & otherrequirements relevant to CMV driver physical exams

– Continually updated list of certified CMEs who areauthorized by FMCSA to perform physical exams forinterstate CMVdrivers.

– Medical professionals interested in becoming CMEs &being listed on NRCME information about CMEtraining & Certification process.


NRCME WEBSITE

• Wealth of info regarding NRCME program & itsvarious components; includes;

– Medical Examiner Handbook, provides information &guidance for CMEs who perform CMVdriver medicalexamination.

– Medical Associated Best Practices

– Augment Training with info regarding their own industry’sbest medical practices.


FMCSA MEDICAL EXAMINERHANDBOOK

• Home Page

• Part I - General FMCSA Information

• Part II - The Job of Commercial Driving

• Part III - Medical Examination Guidelines

• Part IV - Physical Qualification Standards– Guidance/Advisory Criteria — ALL SYSTEMS

– Guidance/Advisory Criteria — Medication

– Guidance/Advisory Criteria — Testing

– Guidance/Advisory Criteria — Treatments


HOW DO I BECOME A CERTIFIED CDME?

Established IAW final rule published by FMCSA in FederalRegister on April 20, 2012,

• To become a CCMExaminer you must:– Be licensed, certified, or registered in accordance with

applicable State laws & regulations to perform physicalexaminations,(MD, DO, PA, APN, & DC).

– Complete required training– Register on NRCME WEBSITE & receive a unique

identification number– Pass Medical Examiner certification test (PSI only contract)– Report results of driver exams monthly via national registry

system (Part I) Electronic by COB each day (Part II)– Submit to periodic monitoring and audits (started)

– Maintain certification by completing periodic training every 5

yrs (online) & recertify by passing certification exam Q10 yrs


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HOW DO I TRAIN?• ON NRCME WEBSITE: Find Complete Guide to Medical

Examiner Certification of November 1, 2012

• Find a training organization that meets following requirements:

– Accredited by a nationally recognized medical profession

accrediting organization to provide continuing educationCredit/Units

– Meets current core curriculum specifications established by

FMCSA for medical examiner training

– Provides training participants with proof of participation

– Provides FMCSA POC information to training participants


NATIONAL ACCREDITING ORGANIZATIONS• Accreditation Council for Continuing Medical Education (ACCME)

American College of Occupational & Environmental Medicine(ACOEM)

American Medical Association (AMA)

• American Osteopathic Association (AOA)American Osteopathic College of Occupational & PreventiveMedicine (AOCOPM)

• Accreditation Review Commission on Education for thePhysician Assistant, Inc. (ARC-PA)

• National Commission Certification of Physician Assistants (NCCPA)American Academy of Physician Assistants (AAPA)American Academy of Nurse Practitioners (AANP)American Association of Occupational Health Nurses (AAOHN)American Nurses Credentialing Center (ANCC)Colleges & universities accredited by U.S. Department of Education

Office of Postsecondary EducationProviders of Approved Continuing Education (PACE)


TRAINING PROVIDER REQUIREMENTS• Listing on the Web site is voluntary & does not constitute

endorsement by FMCSA.

• Verification of Training Participants:

– To ensure integrity of NRCME training & certification program,training providers must verify identification for alltraining participants prior to issuing a certificate ofcompletion (participation).

– Training organizations providing online or web-based trainingmust include a page where the training participant can verify &confirm their identity prior to printing a certificate.

• NOTE: ME candidate can attend a training program accredited byany medical profession accrediting organization (physician cancomplete a training program accredited by a nursepractitioner accrediting organization).


I’M TRAINED – WHERE DO I GO TO BE

TESTED?• Find a test delivery organization that has been approved by FMCSA

(only PSI at this time), PSI has 260 test centers throughout US.To locate a test center near you, please visit the National Registrywebsite at https://nationalregistry.fmcsa.dot.gov.

• To register to take the exam you must access PSI website athttps://candidate.psiexams.com/

• At Testing Center: prepare to provide your identification (a photoID, your medical credential or license, & your training certificate)to test delivery organization & take the electronic computerizedtest

Pass the test & receive a FMCSA Medical Examiner certificationcredential valid for 10 years, listed on NRCME website(@6 wks)


NRCME CERTIFICATION TEST:As of August 20, 2012 NRCME will issue Unique ID number with

application for testing. If successful at passing certificationexam this will remain your CDME # to be used on allofficial documents.

Computerized test composed of questions from expanding pool;- will consist 120 multiple choice questions.

- 100 questions are graded,- 20 are being evaluated for use in future certification exams- Pass/Fail report will be available immediately at testing site.

- Test has 2 hour time limit.- Coats, cell-phones, electronic devices & written materials will

not be allowed in the testing area, with video monitoringduring test.


FMCSA MEDICAL EXAMINER CERTIFICATION

– Comply with administrative requirements including:

• submission of monthly reports, (part 1) electronic COB (Part II)

• periodic monitoring/auditing,

• responding promptly to requests for records from enforcementpersonnel.

• All medical certificates issued on or after May 21, 2014, must beissued by CMEs who are listed on National Registry.

Training Maintenance: Periodic and Recertification

– intended to keep CMEs current with latest FMCSA information.

– FMCSA may develop & offer online periodic training to CMEs.

– More specific information about periodic training will bedisseminated via NRCME Web site & listserv.


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PERIODIC & RECERTIFICATION• Periodic Training must be completed Q 5 yrs , prerequisite to taking

recertification exam 10th yr.• Completing Recertification restarts recertification cycle for next 10

yrs.To ensure uninterrupted certification status, CCME must complete

training requirements & pass certification test within calendar yrprior to certification expiration date.

• If successful recertification is not completed within that time frame:– CME’s certification expires,– CME is no longer certified to perform medical examinations but

CME’s name & contact information are still displayed onNational Registry Web site.

NOTE: FMCSA does not recognize physical examinationsperformed by CME after their certification has expired.


TIPS TO REMEMBER

FIRST & FOREMOST: WHILE IT IS A RIGHT TO OWN PRIVATE ORCOMMERCIAL MOTOR VEHICLE; IT IS A PRIVILEGE TO DRIVE THEMON PUBLIC ROADWAYS,

SECOND, ALWAYS REMEMBER: THAT IN ANY MEDICAL DECISIONMAKING DELIBERATIONSTO DETERMINE PHYSICAL QUALIFICATIONFOR A CDL MEDICAL CERTIFICATE (SAFETY SENSITIVE POSITION);

= YOU MUST ALWAYS INCLUDE PSYCH, PHYSICAL & PSYCHOMOTORCOMPONENTS OF BODY (IN TOTO) & IN RELATION TO THE JOBFUNCTIONS

= YOU MUST ALWAYS CONSIDER THE EXISTENCE OF ANY MEDICALCONDITION ALONG WITH IT’S THERAPY FOR DISQUALIFYINGFACTORS, SEPARATELY & COMBINED!


DOT FMCSA

Driving: (SAFETY SENSITIVE POSITION)

Complicated psychomotor performance activity that dependson fine coordination between sensory & motor systems.

Many health conditions that exist have potential to impairperception, cognition (including alertness, attitude to risk, &

recall) and/or motor function (psychomotor) & resulting inless safe driving.

REMEMBER IT IS ALL ABOUT SAFETY!!!!


Older Workers Who Drive Top Traffic Death List:

• Older employees who drive for a living are three times more likelyto die in an accident than younger workers

• U.S. CDC&P’S, Aug. 21, 2013 Center for Motor Vehicle Safety at

CDC’s NIOSH.

• Driving safety: shared responsibility between employers & workers.

• Older workers; drive as part of their job have significantly highertraffic death rates than younger workers.

• Risk for older drivers begins to increase 55Y/O, & then increases

much more at 65 & older.

• Workers aged 65 & older have traffic-related deaths @ 3/100k people,triple rate of workers aged 18 to 54,

• Risk cuts across all industries & occupations & not restricted to

workers employed in typical transportation occupations, truckdriver or delivery driver.

• Employers can do to assist & accommodate older drivers to stay safe.

What is a CMV?

American Osteopathic College of Occupational and PreventiveMedicine

Updated: March 8, 2013

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CORE CURRICULUM SPECIFICATIONSOverview of CMV Driving: ability to use all senses TO focus &limit distractors;

• Job Responsibilities: Physical & Emotional demands

• Lifestyle among CMV drivers vary by type of BUS orTractor- Trailer “RIG” driven

• “HOOK & DROP” long haul, over the road

• Sleep in OWN bed every night

• Work schedules: (HOS)– Irregular work & rest cycles– Eating patterns– Dietary choices– Time away from social support


ESSENTIAL “JOB FUNCTIONS” RA• CMV DRIVER DUTIES & RESPONSIBILITIES:

Inspect operating condition of a tractor/trailer/bus– Trip Pre-Inspection & Periodic (climb, stretch, reach)

• Open Hood• Check fluids• Inspect tires, including “tire billy” for inner tires• Inspect vehicle (walk around) Periodic• Placard their load (may include climbing onto trailer)

• Loading & Unloading their truck of thousands pounds freight– Move one’s own body through space while climbing ladders;

bending, stooping, crouching; entering & exiting the Cab,Trailer

– Use arms, feet, & legs during CMV operation• Perform precision prehension & power grasping

– Securing the load (CLIMBING),Manipulate & Secure tarpsthat cover open trailers (gravel, coal, sand, or trash)


JOB

OR

POSITION

DESCRIPTION

ESSENTIAL “JOB FUNCTIONS” RA– Ratchet straps– Load Bars– Nailing boards to floor– Tarping a load

• Couple & uncouple trailers from a tractor• Crank trailer wheels up/down (usually rusty)– Go under trailer to pull “unhook” pin– Fuel vehicle– Climb into the cab– Actually drive the vehicle

• Requires two hands & two feet• Manual transmission– Left foot – clutch– Right Foot – Gas and Brake– Left Hand – Steering Wheel– Right Hand – Gear Shift (often 10-12 gears)


ESSENTIAL “JOB FUNCTIONS” RAEMERGENCY Activities:

Install & remove snow chains on vehicle (weigh up to 80 lbs)Place triangles 100 and 250 feet behind disabled truck

For Bus drivers assist passengers or lift children out of the bus

Hours of Service (HOS) limits of driving: 11 hours wheel, 15hours on-duty

• Minimum hours “off duty” before RTW/Max hours in a Week• “Team” driving, 6 hrs on, 6 hrs off for up to about 10 days• Sleep locations:

–Motel–Truck stop–In cab–In sleeper–At home


ESSENTIAL “JOB FUNCTIONS” RASUMMARY: Consider general health & wellness factors such as:

o Short- & long-term health effects of stress from tight pickup &delivery schedules

o Irregular work, rest, & eating patterns / dietary choiceso Adverse road, weather, & traffic conditionso Exposure to temperature extremes, vibration, & noise

o Transporting passengers or hazardous products

Integrate FMCSA medical advisory criteria & guidelines: regardinga driver’s condition into risk assessment (RA)

Support the rationale for using FMCSA guidelines that have not beenpublished in regulations yet.

Skill Performance Evaluation (SPE) cases


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ESSENTIAL “JOB FUNCTIONS” RA

Consider driver’s Cognitive Ability to: Prepare Bill of Ladingo Receive dispatch for a load, Plan a travel route, Complete

manifest, shipping papers Log Bookso Monitor & adjust to complex driving situationso Maneuver through crowded areaso Quickly alter the course of vehicle to avoid trouble

Consider General Health & Wellness factors such as:o Adverse effects associated with rotating work schedules &

irregular sleep patternso Long-term effects of fatigue associated with extended work

hours without breakso Risk factors associated with common dietary choices available

to driverso Stressors likely associated with extended time away from

social support system (family, home)


SUMMARY: Driver Duties

• Prepare Bill of Lading

• Plan Route

• Pre-trip vehicle inspection

• Hitch and unhitch trailer

• Secure Load

• Drive Vehicle

• Monitor traffic and Road Conditions

• Maintain driver time logs

• Communicate with “dispatch”

American Osteopathic College of Occupational and PreventiveMedicine

Climb into Cab and Drive

Pre-trip vehicle inspection

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WE WANT YOU TO DRIVE---SAFELY


INITIAL (Part 1) Status• CDMEs required to:

Bundle & Forward completed Medical Exam Data to FMCSAClearing House, each month,

• Possess & use an electronic form of communication to receiveupdates to medical exam,

NRCME training, & changes in FMCSA policy.WEBSITE/LISTSERV

• Proposed: (Part 2) (within first 3 yrs begin 05/21/2014)electronically transmit to Chief Medical Examiner, Driver name& numerical identifier for any completed Med Exam RPT(certified or not) with CDME Medical Certificate, on newsummary form MCSA-5850 (CMV Driver MedicalExamination RPT)

• Provide copies of Med Exam RPTS & Med Certificates, Within 48hrs, to FMCSA or authorized Federal/State and/or local lawenforcement personnel.

• New CDME MER & MEC be used by 05/21/2014,

REPORTING PROCESS(Part II)(2) CMV Driver Medical Examination Results Data:

• EVERY calendar month, (BY COB PART 2) CME required tocomplete & Electronically transmit to FMCSA Form MCSA–5850,

CMV Driver Medical Exam Results, with following informationabout each CMV driver

• Part 2: Data will be submitted electronically via a secure FMCSA-designated Web site (VIA CDME INDIVIDUAL NRCMEACCOUNT#).

• IOT continue to be listed on & to continue participation in NRCME,CMEs comply with this requirements.

• CMEs who examine drivers who operate only intrastate commercemay report those driver examination results on form & check thebox for ‘‘Intrastate Only’’,

• Data will be used to provide information to State & local enforcementofficials on ME performance & driver physical qualifications .

The Way Ahead (Part2):

• Requires: on a monthly basis CDMEs INITIALLY SUBMIT ALIST (Paper via USPS, FAX or electronically) that contain thefollowing data points:

– Driver Name– Driver’s FMCSA numerical identifier

– Date of the examination– Whether the person was found to be medically PQ, medically DQ

or temporarily DQ.– Date of expiration on CMV Medical Certificate, if applicable.

– CDME’s medical examination certificate shall be substantiallyin accordance with the NEW form (see following)

Existing PE forms 649-F (6045) may be used until current printedsupplies are depleted or until MAY 21, 2016, whichever occursfirst.

Part 2: BY COB DAY OF EXAM: CDMEs, electronicallytransmit to FMCSA Chief Medical Examiner, including DAYSwhen no examinations were performed.

Electronic On-Line FMCSA Form MCSA–5850Enter your CMV Driver Exam Results on the form below.

• *Required Field

• CMV Driver Name and Address

– Last Name*

– First Name*

– Middle Name

– Suffix

• Driver's License Information

– State*

– License Number*

– Date of Birth*

– CDL* Yes/No

• Intrastate Only

Electronic On-Line FMCSA Form MCSA–5850Enter your CMV Driver Exam Results on the form below.

• Examination Information– Examination Date*– Examination Result*

– Examiner's Medical Certificate Expiration Date*

• Restrictions and Variances– Wearing corrective lenses– Wearing hearing aid

– Accompanied by waiver/exemption– Explain if "other"– Driving within an except intracity zone (49 CFR 391.62)

– Accompanied by Skilled Performance Evaluation Certificate(SPE)

– Qualified by operation of 49 CFR 391.64– Update to previously transmitted exam

• *Required Fields

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REPORTING PROCESS(3) Medical Examination Reports & ME’s Certificates:

NRCME Rule requires CME to maintain (3yrs) & provide copies ofMER & CDME’s certificates documents to authorized reps,special agents, or investigators of FMCSA or authorized State orlocal enforcement agency reps; contain driver’s SS#, date ofbirth, driver license number, health & medical information.

IOT determine CDME compliance with FMCSA medicalstandards & guidelines in performing CMV driver med exam.

• Failure to comply with FMCSA medical standards & guidelines mayresult in removal from the NRCME. CDME’s certificates provideadditional documentation to:

– Determine compliance with FMCSA by linking the CDME toboth medical examination & the driver medicalcertification decision.

– Determine compliance by ensuring certification decisionmatches information in medical examination & that thecertificate is completed correctly.

REPORTING PROCESS(4) Frequency: FMCSA further estimates that each

respondent would provide:

CDMV driver examination data at Close OfBusiness Day of Exam (COBDOE)

REALTIME.

Average of approximately 20,000 CMEs will apply totake certification test annually for first 2 yrs ofNRCME implementation.

• In-Toto: projected that 40,000 certified CDMEs will beneeded to perform AND FILE 4,623,000 ME’scertificates/year

Summary: Part 2 of NRCME• FMCSA announced proposed rule to allow state & federal

enforcement officials to easily share & view most current &accurate information about CMV driver's medical

certification status. EFFECTIVE DATE 3 YRS AFTERFINAL RULE!!!

• Require CME performing CMV driver physical exam use newlydeveloped MER & MEC forms.

• Required to electronically report to FMCSA results of allcompleted CMV drivers' physical exams, includingresults of any exam where driver was found NPQ, by COBon day of exam using new form.

• FMCSA would make MEC information for interstate CDLholders available to SDLA only as part of integration of themedical certification & CDL issuance & renewalprocess.

Summary CDME Required to:• Complete CMV Driver MER Results Form (NEW MCSA–

5850), via their individual password- protected NRCMEweb account.

• Include results of driver exam found to be:– Physically Qualified, (PQ)

– Not Physically Qualified (NPQ = DQ)– Indicate that determination was pending,

– IF driver determined to be NPQ, all previous certificatesissued to driver would be deemed invalid.

• Transmit all information from MEC electronically from NRCMEsystem, to SDLAs, (into CDLIS) for CLP/CDL holders only,next business day after receipt.

• Transmit to SDLAs information about MEC for CDL/CLP driversthat have been invalidated because subsequent exam

found driver is NPQ.• SDLAs would then record driver’s status on CDLIS driver

record as ‘‘not certified’’ and begin process of downgradingCDL.

NEW OSA & Mallampati Score• RISK ASSESSMENT TO INCLUDE

• Small or recessed jaw

• Small airway (Mallampati Scale scoreof Class 3 or 4)

• Neck size > 17 inches (male), 16inches (female)

• EXAM PROCESS;– Assess tonsil and tonsillar fossa visibility

View pharynx with mouth open at restNo phonationNo protrusion of Tongue

Scoring:Class 1: Entire tonsil clearly visibleClass 2: Upper half of tonsil fossa visibleClass 3: Soft and Hard Palate clearly visibleClass 4: Only Hard Palate visible

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NEW MER Form, MCSA–5875

• Make info collected on driver health history more comprehensive,streamline format, strengthen efficiency of frequently used

clinical processes & tools for performing driver physical exams

• Expand CME determination section, add statement for CMESignature, add NRCME Number, add section for amending CME

determination.

• No longer include info about driver’s role, a listing of physicalqualification standards for drivers, detailed instructions for

performing exam, & medical advisory criteria, WILL bepublished in FMCSA Guidance Documents & covered in trainingrequired for CME to be listed on the NRCME.


• Expand CME determination section by eliminating‘‘Temporarily Disqualified’’ option & adding‘‘Pending Determination’’ option to defer decisiontemporarily for up to 45 days, if the CME requiresadditional info to make determination of whetherdriver was Qualified.

• Add place for CME to amend certification decision ifdriver did not require completely new exam.FMCSA would consider any CMV Driver MERForm, MCSA–5850, displaying a ‘‘Pending

Determination’’ status as incomplete exam.

NEW MER FORM, MCSA–5875

• Information will be submitted & stored only inNRCME system.

• If dispositionof pending exam is not updated byCME before 45 day expiration date, FMCSAwouldnotify CME & driver in writing that theexam is no longer valid & driver is required to bereexamined.

• FMCSA will retain invalidated examination info inthe NRCME Registry System.


• Current MER (Oct 2000) last revised Feb. 22, 2012.

• FMCSA NPRM MAY 10, 2013: 49 CFR Parts 383,384 and 391

• Medical Examiner’s Certification Integration

Eliminates advisory criteria (guidance) contained incurrent MER Form that has been sometimesmisinterpreted when applying regulatory standards.

CME can make more accurate decisions regarding thephysical qualificationof CMV drivers.

NEW MER MCSA–5875

• No longer include:

– Info on CMV drivers role,

– Instructions to the CME

– Statement for CME to review medications

– Now 38 numbered items under Health History

– Any illness or injury in past 5 yrs now in #32 “otherhealth conditions not described above”.

• Questions added on: “ever had sleep study, spent a night inhospital, had a broken bone, High Cholesterol, ever orcurrent use of tobacco, illegal substances in past 2 yrs,or failed a drug test”

• Testing section include Neck Circumference & BMI

• Attestation statement at end of form for CME sig and info.

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NEW MEC Form MCSA–5876 END RESULT:HEALTHY & SAFE DRIVER

Discussion and Questions
