Assessing fitness to drive

Assessing

ﬁtness to drive

for commercial and

private vehicle drivers

2022 EDITION

Medical standards for

licensing and clinical

management guidelines

A web version of the medical standards is available from the Austroads website: www.austroads.com.au

Help for professionals

For guidance in assessing a patient’s ﬁtness to drive contact your State or Territory driver licensing authority

(seeAppendix 9 for details). Information is also available from the Austroads website: www.austroads.com.au

Assessing Fitness to Drive

First Published 1998

Second Edition 2001

Third Edition 2003

Reprinted 2006

Fourth Edition 2012

Reprinted 2013

Fifth Edition 2016

Reprinted 2017

Sixth Edition 2022

This work is copyright. Apart from any use as

permitted under the Copyright Act 1968, no part

maybe reproduced by any process without the

priorwritten permission of Austroads.

National Library of Australia Cataloguing-in-

Publication data

Assessing Fitness to Drive 2022

ISBN: Hardcopy 978-1-922700-17-9;

PDF 978-1-922700-21-6

Austroads Publication Number: AP-G56-22

Published by Austroads Ltd

Level 9, 570 George Street

Sydney NSW 2000 Australia

Phone: +61 2 8265 3300

Email: [email protected]

www.austroads.com.au

Austroads believes this publication to be correct at the

time of printing and does not accept responsibility for

any consequences arising from the use of information

herein. Readers should rely on their own skill and

judgement to apply information to particular issues.

Assessing

ﬁtness to drive

for commercial and

private vehicle drivers

2022 EDITION

Medical standards for

licensing and clinical

management guidelines

About Austroads and the NTC

Austroads

Austroads is the collective of the Australian and

New Zealand transport agencies, representing

all levels of government. Austroads’ purpose

is to support its member organisations to

deliver an improved Australasian road transport

network. To succeed in this task, Austroads

undertakes leading-edge road and transport

research which underpins its input to policy

development and published guidance on the

design, construction and management of the

road network and its associated infrastructure.

Austroads also supports its members to achieve

consistency and improvements in the application

of registration and licensing practices, processes

and systems.

National Transport Commission

The NTC is a national land transport reform

agency that supports Australian governments to

improvesafety, productivity and environmental

outcomes, provide for future technologies and

improve regulatory eciency.

The NTC has a legislative requirement to

develop, monitor and maintain uniform or

nationally consistent regulatory and operational

arrangements for road, rail and intermodal

transport.

As a key contributor to the national

reform agenda, the NTC is accountable to

Commonwealth, state and territory ministers who

are responsible for transport and infrastructure

and make up membership of the Infrastructure

and Transport Ministers’ Meeting (ITMM). The

NTC works closely with ITMM’s advisory body,

the Infrastructure and Transport Senior Ocials’

Committee, which includes the headsof

Commonwealth, state and territory agencies.

About Austroads and the NTC

Acknowledgements

Setting these standards involved extensive

consultation across a wide range of stakeholders

including regulators, employers and health

professionals. The NTC and Austroads gratefully

acknowledge all contributors including the

members of the Advisory Group, the Medicinal

Cannabis Working Group, the project team and

consultants. In particular, the contributions of

various health professional organisations and

individual health professionals are invaluable to

the review process.

Advisory Group

Derise Cubin Access Canberra

Rebecca Wilson Access Canberra

Bill McKinley Australian Trucking Association

Dr Ramu Nachiappan Australian College of Rural and Remote Medicine

Adam Cameron Department for Infrastructure and Transport

Scott Swain Department for Infrastructure and Transport

Amie Buisman Department of Transport (WA)

Karen Webb Department of State Growth

A/Prof. Sjaan Koppel Monash University Accident Research Centre

Andreas Blahous National Heavy Vehicle Regulator

Emily Hicks Oce of Road Safety

Parik Lumb Road Safety Commission

Prof. Nigel Stocks Royal Australian College of General Practitioners

Lee Cheetham Transport for NSW

Irene Siu Transport for NSW

Yessenia Pineda-De Leon Transport and Main Roads

Fiona Morris Department of Transport (Vic)

Dr Marilyn DiStefano Department of Transport (Vic)

Dr Sanjeev Gaya Victorian Institute of Forensic Medicine

iiiii

About Austroads and the NTC Acknowledgements

Medicinal Cannabis Working Group

Dr Shruti Navathe Access Canberra

David Sutton Department for Infrastructure and Transport

Scott Swain Department for Infrastructure and Transport

Sharon Wishart Department of Transport (Vic)

Tim Umbers Department of Transport (Vic)

Amie Buisman Department of Transport (WA)

Sussan Osmond Department of Transport and Main Roads

Prof. Iain McGregor Lambert Initiative for Cannabinoid Therapeutics, USYD

Dr Tamara Nation National Institute of Integrative Medicine

A/Prof. Vicki Kotsirilos NICM, University of Western Sydney

Adelaide Jones Oce of Road Safety

Prof. Edward Ogden St Vincent’s Hospital Melbourne

Prof. Yvonne Bonomo St Vincent’s Hospital Melbourne

Sally Millward Transport for NSW

Dr Sanjeev Gaya Victorian Institute of Forensic Medicine

Contributing health professional

organisations

The following organisations contributed

substantially to the review process:

• Australian and New Zealand Association of

Neurologists

• Australian Diabetes Society

• Australasian Sleep Association

• Cardiac Society of Australia and New

Zealand

• Cognitive Dementia and Memory Service

• Epilepsy Society of Australia

• Occupational Therapy Australia

• Optometry Australia

• Orthoptics Australia

• Stroke Society of Australasia

• The Royal Australian and New Zealand

College of Ophthalmologists

• The Royal Australian and New Zealand

College of Psychiatrists.

Acknowledgements

Endorsements

These standards are endorsed by:

• Australasian Faculty of Occupational and Environmental Medicine

• Australasian Faculty of Rehabilitation Medicine

• Australasian Sleep Association

• Australian and New Zealand Association of Neurologists

• Australian College of Rural and Remote Medicine

• Australian Diabetes Society

• Cardiac Society of Australia and New Zealand

• Occupational Therapy Australia

• Royal Australian College of Physicians

Accepted Clinical Resource

Royal Australian College of General Practitioners

Legal disclaimer

These licensing standards and management

guidelines have been compiled using all

reasonable care, based on expert medical

opinion and relevant literature, and Austroads

believes them to be correct at the time of

publishing. However, neither Austroads nor

the authors accept responsibility for any

consequences arising from their application.

Health professionals should maintain an

awareness of any changes in healthcare

and health technology that may aect their

assessment of drivers. Health professionals

should also maintain an awareness of

changes in the law that may aect their legal

responsibilities.

Where there are concerns about a particular

set of circumstances relating to ethical or legal

issues, advice may be sought from the health

professional’s medical defence organisation or

legal advisor.

Other queries about the standards should be

directed to the relevant driver licensing authority.

viv

EndorsementsAcknowledgements

Foreword

In 2020, 1,106 people were killed on Australian

roads, and many tens of thousands were

hospitalised with serious injuries. The annual

economic cost of road crashes in Australia

is estimated to be $30 billion, which is

accompanied by devastating social impacts.

While many factors contribute to safety on the

road, driver health and ﬁtness to drive is an

important consideration. Drivers must meet

certain medical standards to ensure their health

status does not unduly increase their crash risk.

Assessing ﬁtness to drive is a joint publication

of Austroads and the National Transport

Commission (NTC) and details medical standards

for driver licensing purposes for use by health

professionals and driver licensing authorities.

The standards are approved by Commonwealth,

state and territory transport ministers and were

ﬁrst published in their current form in 2003. The

previous edition was published in 2016.

Since its last publication, medical, legal and

social developments have required that the

medical criteria within the guidelines are

updated to ensure they are accurate and

reﬂect current practices. To this end, the NTC

reviewed the guidelines, taking into account

feedback from stakeholders, including medical

professionals and expert consultants.

This review produced revised guidelines in

draft form, for public consultation in May 2021.

Doctors, other health professionals, members

of the public, consumer groups, commercial

operators and drivers, transport peak bodies

and governments submitted comments to the

draft guidelines.

Austroads and the NTC acknowledge the

signiﬁcant contribution of health professionals to

road safety. Health professionals, in partnership

with drivers, the road transport industry and

governments, play an essential role in keeping

all road users safe. Together we are working

towards further reducing, and eventually

eliminating, deaths and injuries from vehicle

crashes on Australian roads.

Dr Geo Allan

Chief Executive

Austroads

Dr Gillian Miles

Chief Executive Ocer and Commissioner

National Transport Commission

Foreword

Contents

A web version of the medical standards is available from the Austroads website: www.austroads.com.au

Part A. Fitness to drive principles and practices 1

1. About this publication 2

1.1. Purpose 2

1.2. Target audience 3

1.3. Scope 3

1.4. Content 4

1.5. Development and evidence base 5

2. Assessing ﬁtness to drive

–

generalguidance 7

2.1. The driving task 7

2.2. Impact of medical conditions on driving 10

2.3. Assessing and supporting functional driver capacity 21

3. Roles and responsibilities 25

3.1. Roles and responsibilities of driver licensing authorities 27

3.2. Roles and responsibilities of drivers 27

3.3. Roles and responsibilities of health professionals 28

4. Licensing and medical ﬁtness to drive 34

4.1. Medical standards for private and commercial vehicle drivers 34

4.2. Considerations for commercial vehicle licensing 35

4.3. Prescribed periodic medical examinations for particular licensing/authorisation classes 37

4.4. Conditional licences 37

4.5. Reinstatement of licences or removal or variation of licence conditions 41

5. Assessment and reporting process

–

stepby step 42

5.1. Steps in the assessment and reporting process 43

5.2. Which forms to use 50

Part B. Medical standards 54

Fitness to drive assessment 55

1. Blackouts 57

1.1. Relevance to the driving task 57

1.2. General assessment and management guidelines 57

1.3. Medical standards for licensing 58

2. Cardiovascular conditions 63

2.1. Relevance to the driving task 63

2.2. General assessment and management guidelines 63

2.3. Medical standards for licensing 71

viivi

ContentsForeword

3. Diabetes mellitus 92

3.1. Relevance to the driving task 92

3.2. General assessment and management guidelines 92

3.3. Medical standards for licensing 99

4. Hearing loss and deafness 105

4.1. Relevance to the driving task 105

4.2. General assessment and management guidelines 106

4.3. Medical standards for licensing 109

5. Musculoskeletal conditions 112

5.1. Relevance to the driving task 112

5.2. General assessment and management guidelines

114

5.3. Medical standards for licensing 117

6. Neurological conditions 120

6.1. Dementia 121

6.2. Seizures and epilepsy 128

6.3. Other neurological and neurodevelopmental conditions 152

7. Psychiatric conditions 170

7.1. Relevance to the driving task 170

7.2. General assessment and management guidelines 171

7.3. Medical standards for licensing 175

8. Sleep disorders 179

8.1. Relevance to the driving task 179

8.2. General assessment and management guidelines 179

8.3. Medical standards for licensing 185

9. Substance misuse 190

9.1. Relevance to the driving task 190

9.2. General assessment and management guidelines 193

9.3. Medical standards for licensing 196

10. Vision and eye disorders 201

10.1. Relevance to the driving task 201

10.2. General assessment and management guidelines 202

10.3. Medical standards for licensing 209

viii

Contents

Part C. Appendices 214

Appendix 1. Regulatory requirements fordriver testing 215

Appendix 2. Forms 223

Appendix 3. Legislation relating to reporting 227

Appendix 4. Drivers’ legal BAC limits 235

Appendix 5. Alcohol interlock programs 237

Appendix 6. Disabled car parking and taxiservices 241

Appendix 7. Seatbelt use 243

Appendix 8. Helmet use 245

Appendix 9. Driver licensing authoritycontacts 247

Appendix 10. Specialist driver assessors 251

ixviii

ContentsContents

PART A.

Fitness to drive

principles and practices

PART A. Fitness to drive principles and practices

1. About this publication

1.1. Purpose

Driving a motor vehicle is a complex task

involving perception, appropriate judgement,

adequate response time and appropriate

physical capability. A range of medical

conditions, disabilities and treatments may

inﬂuence these driving prerequisites. Such

impairment may adversely aect driving ability,

possibly resulting in a crash causing death

orinjury.

The primary purpose of this publication is to

increase road safety in Australia by assisting

health professionals to:

• assess the ﬁtness to drive of their patients in

a consistent and appropriate manner based

on current medical evidence

• promote the responsible behaviour of their

patients, having regard to their medical

ﬁtness

• conduct medical examinations for the

licensing of drivers as required by state and

territory driver licensing authorities

• provide information to inform decisions on

conditional licences

• recognise the extent and limits of their

professional and legal obligations with

respect to reporting ﬁtness to drive.

The publication also aims to provide guidance

to driver licensing authorities in making

licensing decisions. With these aims in mind the

publication:

• outlines clear medical requirements

for driver capability based on available

evidence and expert medical opinion

• clearly dierentiates between national

minimum standards (approved by the

Infrastructure and Transport Ministers’

Meeting) for drivers of commercial and

private vehicles

• provides general guidelines for managing

patients with respect to their ﬁtness to drive

• outlines the legal obligations for health

professionals, driver licensing authorities

and drivers

• provides a reporting template to guide

reporting to the driver licensing authority

ifrequired

• provides links to supporting and

substantiating information.

Routine use of these standards will ensure the

ﬁtness to drive of each patient is assessed in

a consistent manner. In doing so, the health

professional will not only be contributing to road

safety but may minimise medico-legal exposure

in the event that a patient is involved in a crash

or disputes a licensing decision.

This publication replaces all previous

publications containing medical standards

for private and commercial vehicle drivers

including Assessing ﬁtness to drive

2001, 2003, 2012, 2016 (and its 2017

amendment) and Medical Examinations

for Commercial Vehicle Drivers 1997.

About this publication

PART A. Fitness to drive principles and practices

1.2. Target audience

This publication is intended for use by

any health professional who is involved

in assessing a person’s ﬁtness to drive or

providing information to support ﬁtness-to-

drivedecisionsincluding:

• medical practitioners (general practitioners

and specialists)

• optometrists

• orthoptists

• occupational therapists

• psychologists

• physiotherapists

• diabetes educators

• nurse practitioners and primary health care

nurses

• case workers.

The publication is also a primary source of

requirements for driver licensing authorities in

making determinations about medical ﬁtness to

hold a driver licence.

1.3. Scope

1.3.1. Medical ﬁtness for driver

licensing

This publication is designed principally to guide

and support assessments made by health

professionals regarding ﬁtness to drive for

licensing purposes. It should be used by health

professionals when:

1. Treating any patient who holds a

driver licence whose condition may

aect their ability to drive safely.

Most adults drive, therefore a health professional

should routinely consider the impact of a

patient’s condition on their ability to drive safely.

Awareness of a patient’s occupation, licence

category (e.g. commercial, passenger vehicle)

or other driving requirements (e.g. shift work) is

also helpful.

2. Undertaking an examination at the

request of a driver licensing authority

or industry accreditation body.

Health professionals may be requested to

undertake a medical examination of a driver for

a number of reasons. This may be:

• for initial licensing of some vehicle classes

(e.g. multiple combination heavy vehicles)

• as a requirement for a conditional licence

• for assessing a person whose driving the

driver licensing authority believes may be

unsafe (i.e. ‘for cause’ examinations)

• for licence renewal of an older driver (in

certain states and territories)

• for licensing or accreditation of certain

commercial vehicle drivers (e.g. public

passenger vehicle drivers)

• as a requirement for Basic or Advanced

Fatigue Management under the National

Heavy Vehicle Accreditation Scheme (refer

to www.nhvr.gov.au).

This publication focuses on long-term health-

and disability-related conditions and their

associated functional eects that may impact

on driving. It sets out clear minimum medical

requirements for unconditional and conditional

licences that form the medical basis of decisions

made by the driver licensing authority. This

publication also provides general guidance with

respect to patient management for ﬁtness to

drive. It does not address general management

of clinical conditions unless it relates to driving.

This publication outlines two sets of medical

standards for driver licensing or authorisation:

private vehicle driver standards and commercial

vehicle driver standards.

PART A. Fitness to drive principles and practices

The standards are intended for

application to drivers who drive within the

ambit of ordinary road laws. Drivers who

are given special exemptions from these

laws, such as emergency service vehicle

drivers, should have a risk assessment

and an appropriate level of medical

standard applied by their employer. At

a minimum, they should be assessed to

thecommercial vehicle standard.

1.3.2. Short-term ﬁtness to drive

This publication does not attempt to address

the full range of health conditions that might

impact on a person’s ﬁtness to drive in the

short term. Some guidance in this regard

is included in section 2.2.3. Temporary

conditions. In most instances, the non-driving

period for short-term conditions will depend

on individualcircumstances and should be

determined by the treating health professional

based on an assessment of the condition and

the potential risks.

1.3.3. Fitness for duty

The medical standards contained in this

publication relate only to driving. They cannot

be assumed to apply to ﬁtness-for-duty

assessments (including ﬁtness for tasks such

as checking loads, conversing with passengers

andundertaking emergency procedures)

without ﬁrst undertaking a task risk assessment

that identiﬁes the range of other requirements

for aparticular job.

1.4. Content

This publication is presented in three parts.

Part A comprises general information including:

• the principles of assessing ﬁtness to drive

• speciﬁc considerations including:

− the assessment of people with multiple

medical conditions or age-related

change

− the management of temporary

conditions, progressive disorders and

undierentiated illness

− the eects of prescription and over-the-

counter drugs

− the role of practical driver assessments

and driver rehabilitation

• the roles and responsibilities of drivers,

licensing authorities and health professionals

• what standards to apply (private or

commercial) for particular driver classes

• the application of conditional licences

• the steps involved in assessing ﬁtness

todrive.

Part B comprises a series of chapters relating to

relevant medical systems/diseases. The medical

requirements for unconditional and conditional

licences are summarised in a tabulated format

to dierentiate between the requirements

for private and commercial vehicle drivers.

Additional information, including the rationale for

the standards, as well as a general assessment

and management considerations, is provided in

the supporting text of each chapter.

Part C, the appendices, comprises further

supporting information including:

• regulatory requirements for driver

assessment in each jurisdiction

• guidance on forms for the examination

process and reporting to the driver

licensingauthority

• legislation relating to driver and health

professional reporting of medical conditions

About this publication

PART A. Fitness to drive principles and practices

• legislation relating to blood alcohol, seatbelt

use, helmet use and alcohol interlocks

• contacts for services relating to disabled

parking and transport, occupational therapist

assessments and driver licensing authorities.

1.5. Development and

evidence base

The evidence that underpin the licensing criteria

and guidance are sourced from medical and

ﬁtness-to-drive studies, medical guidelines and

expert opinion. A reference list of important

studies is provided at the end of each chapter.

In addition to evidence regarding crash risk and

the eects of medical conditions on driving,

evidence has also been sought regarding best

practice approaches to driver assessment and

rehabilitation.

A key input in terms of evidence for the licensing

criteria remains the Monash University Accident

Research Centre report Inﬂuence of chronic

illness on crash involvement of motor vehicle

drivers: 3rd edition. This is an update of the

second (2010) edition of the report and provides

a comprehensive review of published studies

involving drivers of private and commercial

motor vehicles. The report investigates the

inﬂuence of selected medical conditions and

impairments on crash involvement, in the context

of condition prevalence and quality of evidence

of crash involvement.

1,2

In compiling this report, the Monash University

Accident Research Centre led an international

research consortium to compile, review and

interpret the best available evidence on each

topic. Nevertheless, for most conditions, the

report acknowledges the limited evidence

available and that the quality of evidence is

variable. In interpreting the research, there is

therefore a need to consider several sources of

potential bias including the following:

• There is a ‘healthy driver’ eect whereby

drivers with a medical condition may

recognise that they are not able to fully

control a car and may either cease driving

or restrict their driving. Their opportunity to

be in a crash is therefore reduced, and this

contributes to a lower crash risk than may

otherwise be expected.

• The deﬁnition and incidence of crashes

when driving often depends on self-

reporting, which may lead to over- or under-

reporting in some studies.

• The deﬁnition of a ‘medical condition’ is

by self-report in some studies and may not

beaccurate.

• The ‘exposure metric’ (i.e. kilometres

travelled) is often not controlled for, yet is

crucial for determining the risk of a crash.

• Sample sizes may be small and not

represent the general population of drivers.

• The control group may not be properly

matched by age and sex.

• Commercial drivers are rarely considered

as a separate cohort, and generalisations

based on evidence from private motor

vehicle drivers may not be appropriate.

• Studies rarely identify whether and how

drivers are treated/untreated – for example,

corrected vision for those with vision

impairments and hearing aids for those with

hearing impairments.

• Comorbidities may not be adjusted for

(e.g.alcohol dependence).

PART A. Fitness to drive principles and practices

The implications are that false-negative results

may occur whereby the condition appears

to have no eect or minimal eect on driving

safety. The authors acknowledge that care

should be taken in interpreting the literature

and that professional opinion plus other

relevant data should be taken into account

in determining the risks posed by medical

conditions. The authors also note that the

review focused on published peer-reviewed

literature. There was no inclusion of technical

reports, conference presentations or abstracts,

case studies, coroner reports or studies, cohort

studies (without a control group) or reviews of

consensus-based medical standards for any of

the medical conditions reviewed.

For the purposes of this publication the term

‘crash’ refers to a collision between two or

more vehicles, or any other accident or incident

involving a vehicle in which a person or animal is

killed or injured, or property is damaged.

Health professionals should also keep

themselves up to date with changes in medical

knowledge and technology that may inﬂuence

their assessment of drivers, and with legislation

that may aect the duties of the health

professional or the patient.

About this publication

PART A. Fitness to drive principles and practices

2. Assessing ﬁtness to drive

–

generalguidance

The aim of determining ﬁtness to drive is to

achieve a balance between:

• minimising any driving-related road safety

risks for the individual and the community

posed by the driver’s permanent or long-

term injury or illness,

• maintaining the driver’s lifestyle and

employment-related mobility independence.

The key question is: Is there a likelihood

the person will be unable to control the

vehicle and/or unable to act or react

to the driving environment in a safe,

consistent and timely manner?

The main considerations in making this

assessment are:

• the driving task, including the person’s

individual driving requirements and mobility

needs (refer to section 2.1. The driving task)

• the potential impacts of medical conditions,

disabilities and treatments (refer to section

2.2. Impact of medical conditions on

driving)

• the driver’s functional abilities including their

capacity to compensate and the need for

rehabilitation (refer to section 2.3. Assessing

and supporting functional driver capacity).

The general guidance provided in this section

should be considered in conjunction with the

speciﬁc criteria and management guidelines for

individual conditions outlined in Part B of this

publication.

In light of the information gathered across these

areas, the health professional may advise the

patient regarding their ﬁtness to drive and

provide advice to the driver licensing authority

(refer to section 3. Roles and responsibilities).

The threshold tolerance is much less for

commercial vehicle drivers where there is the

potential for more time on the road and more

severe consequences in the event of a crash

(refer to section 4.1. Medical standards for

private and commercial vehicle drivers). In

cases where a person may only be ﬁt to drive in

some circumstances or requires periodic review

to monitor the progression of their condition, the

health professional may advise conditions under

which driving could be performed safely (refer to

section 4.4. Conditional licences).

Detailed steps for performing the assessment

and managing the outcome are found in section

5. Assessment and reporting process – stepby

step.

2.1. The driving task

An understanding of the driving task, both

generally and for the speciﬁc driver, underpins

the assessment of ﬁtness to drive and guides

the determination of risk associated with

impairment due to ill health.

Driving is a complex instrumental activity of daily

living, characterised by a rapidly repeating cycle

in which:

• Information about the vehicle and road

environment is obtained via the visual and

auditory senses.

• The information is operated on by several

cognitive processes, which leads to

decisions about driving.

• Decisions are put into eect via the

musculoskeletal system, which acts on

the various controls to alter the vehicle in

relation to the road (refer to Figure 1).

PART A. Fitness to drive principles and practices

This repeating sequence depends on:

Sensory input

• vision

• visuospatial perception

• hearing

• proprioception

• kinesthesia

Motor function

• muscle power

• coordination

Cognitive function

• attention and concentration

• comprehension

• memory

• insight

• judgement

• decision making

• reaction time

• sensation.

Given these requirements, it follows that many

body systems need to be functional to ensure

safe and timely execution of the skills required

for driving.

Furthermore, the demands of the speciﬁc driving

task can vary considerably depending on a

range of factors including those relating to the

driver, the vehicle, the purpose of the driving

task and the road environment (Box 1). For

commercial drivers in particular these demands

can be signiﬁcant, as can be the consequences

for public safety.

Assessing health professionals should

document the individual’s driving

requirements and driving history as part

ofthe assessment process.

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

Figure 1. The driving task

Box 1. Factors aecting driving

Driving tasks occur within a dynamic system inﬂuenced by complex driver, vehicle, task,

organisational and external road environment factors including:

• the driver’s experience, training and attitude

• the driver’s physical, mental and emotional health – for example, fatigue and the eect of

substance misuse including illicit, prescription and non-prescription drugs

• the road system – for example, signs, other road users, trac characteristics and road layout

• legal requirements – for example, speed limits and blood alcohol concentration

• the natural environment – for example, night, extremes of weather and glare

• vehicle and equipment characteristics – for example, the type of vehicle, braking

performance and maintenance

• mental workload and distraction due to in-vehicle technologies (e.g. GPS, vehicle warning/

alert systems, driver assistance systems) and communication systems (hands-free phone/

email systems)

• personal requirements, trip purpose, destination, appointments, navigation tasks and time

pressures

• passengers, in-vehicle communication/entertainment devices and their potential to distract

the driver.

For commercial or heavy vehicle drivers there is a range of additional factors including:

• business requirements – for example, rosters (shifts), driver training and contractual demands

• work-related multitasking – for example, interacting with in-vehicle technologies such as a

GPS, job display screens or other communication systems

• legal requirements – for example, work diaries and licensing procedures

• vehicle issues including size, stability and load distribution

• passenger requirements/issues – for example, duty of care, communication requirements

and potential for occupational violence

• risks associated with carrying dangerous goods

• additional skills required to manage the vehicle – for example, turning and braking

• endurance/fatigue and vigilance demands associated with long periods spent on the road.

Sensory input

Musculoskeletal actions

Vehicle–road interaction

Cognitive input

PART A. Fitness to drive principles and practices

2.2. Impact of medical

conditions on driving

2.2.1. Assessing medical conditions

Reﬂecting the requirements of the driving

task (section 2.1. The driving task), the key

domains to consider when assessing the

impact of medical conditions and disabilities

ondrivingare:

• impairment of:

− sensory function (in particular, visual

acuity and visual ﬁelds but also

cutaneous, muscle and joint sensation)

− motor function (e.g. joint movements,

strength, endurance and coordination)

− cognition (e.g. attention, concentration,

memory, problem-solving skills, thought

processing, visuospatial skills, insight and

judgement)

• the risk of sudden incapacity (leading to

sudden loss of control of the vehicle).

Such impacts may be associated with a range of

medical conditions. Conditions with the potential

to cause signiﬁcant impairment and/or sudden

incapacity are the focus of this publication and

include:

• blackouts

• cardiovascular conditions

• diabetes

• hearing loss and deafness

• musculoskeletal conditions

• neurological conditions

• psychiatric conditions

• substance misuse/dependency

• sleep disorders

• vision problems.

The impairments/impacts associated with

medical conditions may be framed in a number

of ways. For example, impairments may:

• Be persistent (e.g. visual impairment) or

episodic (e.g. seizure, severe hypoglycaemic

event). Drivers with persistent impairments

can be assessed based on observations and

measures of their functional capacity. Those

with episodic impairment must be assessed

based on a risk analysis that considers the

probability and consequence of the episode,

as well as any triggering factors and whether

they can be avoided.

• Fluctuate, for example, the capacity of

people living with dementia can ﬂuctuate

both day to day and within a 24-hour period.

It is important that the assessor considers

the potential of ﬂuctuating capacity and

theimpact these factors may have on

drivingability.

• Be progressive (e.g. dementia, progressive

neurological conditions, end-organ

aects associated with diabetes) or

static (permanent disabilities), which has

implications for ongoing monitoring (refer

to section 2.2.5. Progressive conditions).

Many people with a long-term condition

or disability may have developed coping

strategies to enable safe driving (refer

to section 2.2.6. Congenital conditions,

disability and driving).

• Become introduced through use of

medications that eect cognition and

reaction time (refer to section 2.2.9. Drugs

and driving).

• Resolve with treatment (e.g. following

rehabilitation for stroke), which has

implications for reinstating of unconditional

licences (refer to section 4.5. Reinstatement

of licences or removal or variation of

licence conditions).

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

2.2.2. Conditions not covered

explicitly in this publication

This publication does not attempt to deﬁne

all clinical situations that may inﬂuence safe

driving ability.

It is accepted that other medical conditions or

combinations of conditions may also be relevant

and that it is not possible to deﬁne all clinical

situations where an individual’s overall function

would compromise public safety. A degree of

professional judgement is therefore required in

assessing ﬁtness to drive.

The examining health professional should

follow general principles when assessing

these patients including consideration of the

driving task and the potential impact of the

condition on requirements such as sensory,

motor and cognitive skills. Episodic conditions

need consideration regarding the likelihood of

recurrence. A more stringent threshold should

be applied to drivers of commercial vehicles

than to private vehicle drivers. An appropriate

period should be advised for review, depending

on the natural history of the condition.

2.2.3. Temporary conditions

This publication does not attempt to address

every condition or situation that might

temporarily aect safe driving ability.

There are a wide range of conditions that

temporarily aect the ability to drive safely.

These include conditions such as post-surgery

recovery, severe migraine or injuries to limbs.

These conditions are self-limiting and hence do

not aect licence status; therefore, the licensing

authority does not need to be informed.

The treating health professional should

provide suitable advice to such patients

about driving safely including recommended

periods of abstinence from driving, particularly

for commercial vehicle drivers. Such advice

shouldconsider the likely impact of the patient’s

condition and their speciﬁc circumstances on

the driving task as well as their speciﬁc driving

requirements. Table 1 provides guidance on

some common conditions that may temporarily

aect driving ability.

2.2.4. Undierentiated conditions

A patient may present with symptoms that could

have implications for their licence status but

where the diagnosis is not clear. Investigating

the symptoms will mean there is a period of

uncertainty before a deﬁnitive diagnosis is made

and before the licensing requirements can be

conﬁdently applied.

Each situation will need to be assessed

individually, with due consideration given to the

probability of a serious disease or long-term

injury or illness that may aect driving, and to

the circumstances in which driving is required.

However, patients presenting with symptoms

of a serious nature – for example, chest pains,

dizzy spells, blackouts or delusional states

– should be advised not to drive until their

condition can be adequately assessed. During

this interim period, in the case of private vehicle

drivers, no formal communication with the driver

licensing authority is required unless there is

signiﬁcant risk to public health (refer to section

3.3.1. Conﬁdentiality, privacy and reporting to

the driver licensing authority). After a diagnosis

is ﬁrmly established and the standards applied,

normal notiﬁcation procedures apply.

In the case of a commercial vehicle driver

presenting with symptoms of a potentially

serious nature, the driver should be advised to

stop driving and to notify the driver licensing

authority. The health professional should

consider the impact on the driver’s livelihood and

investigate the condition as quickly as possible.

PART A. Fitness to drive principles and practices

Table 1. Examples of how to manage temporary conditions

Condition and impact on driving Management guidelines

Anaesthesia and sedation

Physical and mental capacity may be impaired for some

time post anaesthesia (including general anaesthesia,

local anaesthesia and sedation). The eects of general

anaesthesia will depend on factors such as the duration

of anaesthesia, the drugs administered and the surgery

performed. The eect of local anaesthesia will depend

on dosage and the region of administration. Analgesic

and sedative use should also be considered.

In cases of recovery following surgery or procedures

under general anaesthesia, local anaesthesia or

sedation, it is the responsibility of the surgeon/dentist

and anaesthetist to advise patients not to drive until

physical and mental recovery is compatible with safe

driving.

• Following minor procedures under local anaesthesia

without sedation (e.g. dental block), driving may be

acceptable immediately after the procedure.

• Following brief surgery or procedures with short-

acting anaesthetic drugs or sedation, the patient may

be ﬁt to drive after a normal night’s sleep.

• After longer surgery or procedures requiring general

anaesthesia or sedation, it may not be safe to drive

for 24 hours or more.

Deep vein thrombosis and pulmonary embolism

While deep vein thrombosis may lead to an acute

pulmonary embolus, there is little evidence that

such an event causes crashes. Therefore there is no

licensing standard applied to either condition. Non-

driving periods are advised. If long-term anticoagulation

treatment is prescribed, the standard for anticoagulant

therapy should be applied (refer to Part B section 2.2.8.

Long-term anticoagulant therapy).

Private and commercial vehicle drivers should be

advised not to drive for at least 2 weeks following a

deep vein thrombosis and for 6 weeks following a

pulmonary embolism.

Medications or other treatments

Adaptation to new drug/medication regimens or

undergoing some treatments (e.g. radiation therapy or

haemodialysis) may require a non-driving period.

The non-driving period should be determined by the

treating health professionals based on a consideration

of the requirements of the driving task and the impact of

medications or treatments on the capacity to undertake

these tasks, including responding to emergency

situations. A practical driver assessment may be helpful

in determining ﬁtness to drive (refer to section 2.3.1.

Practical driver assessments).

Post-surgery

Surgery will aect driving ability to varying degrees

depending on the location, nature and extent of

theprocedure.

The non-driving period post-surgery should be

determined by the treating health professionals based

on a consideration of the requirements of the driving

task and the impact of the surgery on the capacity

to undertake these tasks, including responding to

emergency situations. A practical driver assessment

may be helpful in determining ﬁtness to drive (refer to

section 2.3.1. Practical driver assessments).

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

Condition and impact on driving Management guidelines

Pregnancy

Under normal circumstances pregnancy should not be

considered a barrier to driving. However, conditions that

may be associated with some pregnancies should be

considered when advising patients. These include:

• fainting or light-headedness

• hyperemesis gravidarum

• hypertension of pregnancy

• post caesarean section.

A caution regarding driving may be required depending

on the severity of symptoms and the expected eects of

medication.

Seatbelts must be worn (refer to Appendix 7. Seatbelt

use).

Temporary or short-term vision impairments

A number of conditions and treatments may impair

vision in the short term – for example, temporary

patching of an eye, use of mydriatics or other drugs

known to impair vision, or eye surgery. For long-term

vision problems, refer to Part B section 10. Vision and

eye disorders.

People whose vision is temporarily impaired by a

short-term eye condition or an eye treatment should be

advised not to drive for an appropriate period.

2.2.5. Progressive conditions

Often diagnoses of progressive conditions

are made well before there is a need to

question whether the patient remains safe to

drive (e.g. multiple sclerosis, early dementia).

However, it is important to raise issues relating

to the likely eects of these disorders on

personal independent mobility early in the

managementprocess.

The patient should be advised appropriately

where a progressive condition is diagnosed that

may result in future restrictions on driving. It is

important to give the patient as much lead time

as possible to make the lifestyle changes that

may later be required (e.g. adaptation to using

public transport and/or a motorised mobility

device). Assistance from an occupational

therapist may be valuable in such instances

(refer to Part B section 6.1. Dementia).

2.2.6. Congenital conditions,

disability and driving

Congenital conditions and long-term or

permanent disabilities may have an impact on a

person’s ability to drive safely. The physical and

cognitive implications of such conditions may

include (but are not limited to):

• diculty sustaining concentration or

switching attention between multiple

drivingtasks

• reduced cognitive and perceptual

processing speeds, including reaction times

• reduced performance in complex situations

(e.g. when there are multiple distractions)

• reduced information processing and

judgement

• diculty anticipating and responding to

other road users

• diculty controlling movement

• reduced joint range of motion and

musclestrength.

These impacts vary and many people develop

coping strategies to enable safe driving.

PART A. Fitness to drive principles and practices

Individual assessment is therefore required

based the general principles, the stability of the

disability and bodily systems that underpin any

adaptive behaviours for driving.

Legal obligations for reporting to the driver

licensing authority apply (refer to section 3.2.

Roles and responsibilities of drivers). This

may trigger the need to provide a medical

report and/or an occupational therapy driving

assessment. An occupational therapist driver

assessor can provide information about how

a condition or disability may aect driving or

learning to drive. They can also oer advice

about potential aids, vehicle modiﬁcations or

training strategies that may assist the individual.

The outcomes of the assessment may result in

the requirement of a conditional licence relating

to the driver (e.g. prosthesis must be worn) or

the vehicle (e.g. can only drive a vehicle with

certain modiﬁcations); refer to section 4.4.

Conditional licences. If the condition or disability

is assessed as static, then it is unlikely to require

periodic review.

Learning to drive

People with a disability that may impact their

ability to drive can seek the opportunity to gain

a driver licence. This opportunity is increasingly

available through the National Disability

Insurance Scheme. To ensure they receive

informed advice and reasonable opportunities

for training, it is helpful if they are trained by a

driving instructor with experience in teaching

drivers with disabilities. An initial assessment

with an occupational therapist specialised in

driver evaluation may help to identify the pre-

requisite functional capacity requirements to

realistically aspire to driving independence,

need for adaptive devices, vehicle modiﬁcations

or special driving techniques.

National Disability Insurance Scheme

There are support options to help drivers with

a disability through the National Disability

Insurance Scheme (NDIS). The NDIS provides

all Australians under the age of 65 who have

a permanent and signiﬁcant disability with

reasonable and necessary supports.

The NDIS may provide assistance with the

medical review process including obtaining a

driver licence, medical reports, occupational

therapist driving assessments, driver training and

vehicle modiﬁcations. Further information about

the support provided by the NDIS and how to

access the services can be found on the NDIS

website at www.ndis.gov.au.

2.2.7. Older drivers and age-related

changes

While advanced age in itself is not a barrier to

safe driving, age-related physical and mental

changes will eventually aect a person’s

ability to drive safely. Given the association

between health outcomes, mobility and social

connectedness, ﬁtness to drive should be

proactively managed, with the goal of enabling

older people to continue to drive for as long as it

is safe to do so.

Crash data points to some of the vulnerabilities

of older drivers, showing that they are more

likely to crash at intersections and with other

vehicles (multi-vehicle crashes). Frailty of older

drivers is also associated with higher risk of

injury and death. At the same time, safety

risks for older drivers may be mitigated by

their extensive driving experience and their

tendency to modify their driving to suit their

capabilities, including avoiding peak-hour trac,

poor weather and night driving, and driving at

slowerspeeds.

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

Management approach

A proactive approach to management of older

drivers encompasses primary, secondary and

tertiary prevention.

Discussions about mobility and driving

Talking with an older person about their driving

can be dicult, particularly if it is delayed until

the conversation is about ceasing driving.

Early conversations focused on maintenance

of driving ability in the context of their general

health, mobility needs and other activities of daily

living can help build self-awareness, enable self-

monitoring and normalise the eventual transition

to non-driving. Driver licensing authorities

provide resources to support conversations with

older drivers and their carers/families.

Active observation and screening

Routine care of the older person should

include monitoring for decline in the functions

necessary for driving, including vision, cognition

and motor/sensory functions (see below). This

is also an opportunity to pick up on ‘red ﬂags’

such as falls, memory problems, confusion,

caregiver concerns or a sudden change in social

circumstances. Annual checks, such as through

the Medicare 75 Plus health check, provide an

opportunity for screening and for considering

the overall impacts of ageing and multiple

medical conditions on driving.

Early intervention

Early identiﬁcation of functional decline can

provide opportunities to address driving

skills and capabilities in at-risk drivers. This

may involve referral for relevant assessment

and management (e.g. allied health, driver

assessment), including treatments, driving

rehabilitation, vehicle modiﬁcations and driving

restrictions (refer to section 2.3. Assessing and

supporting functional driver capacity). In cases

where an older person is not fully ﬁt to drive

in all circumstances, the health professional

may advise conditions under which driving

could be performed safely (refer to section 4.4.

Conditional licences). Referral to a geriatrician

may also assist if there is doubt about a patient’s

ﬁtness to drive or about remedial strategies.

Considering the impact of medical conditions

on driving

Most older adults have at least one chronic

medical condition. The most common conditions

include cardiovascular disease, stroke,

Parkinson’s disease, sleep disorders, cataracts,

glaucoma, musculoskeletal impairments

including arthritis, depression, dementia

and diabetes. The overall impact of multiple

conditions on driving will need to be considered

(refer to section 2.2.8. Multiple medical

conditions). A new diagnosis or change in any

condition, or an acute medical event, is a trigger

to revisit driving, so too is the addition of a new

medication or treatment. Older adults often take

multiple medications, and this is associated with

increased crash risk. Counselling regarding

medications should speciﬁcally address

potential safety concerns for driving, including

any age-associated eects such as changed

drug metabolism (refer to section 2.2.9. Drugs

and driving).

Transition to alternative means of transport

Ultimately, when a person’s functioning is no

longer compatible with safe driving, they will

need to be supported in relinquishing their

licence and seeking alternative modes of

transport. There is a role for ongoing monitoring

of health and social consequences and

compliance with advice not to drive. Caregivers

play an important role in encouraging the

older person to cease driving and to help the

individual ﬁnd alternatives.

PART A. Fitness to drive principles and practices

Assessing older drivers

Age-related physical and mental changes

vary greatly between individuals. The three

main functional areas to consider for the

assessment and routine care of older drivers are

described below. Health professionals should

be mindful that a driver may have several minor

impairments that alone may not aect driving but

when taken together may make risks associated

with driving unacceptable (refer to section 2.2.8.

Multiple medical conditions).

Some driver licensing authorities require regular

medical examination or assessment of drivers

beyond a speciﬁed age. These requirements

vary between jurisdictions and may be viewed

inAppendix 1. Regulatory requirements

fordriver testing.

Vision

Various aspects of vision may decline with

age, including acuity, visual ﬁelds and contrast

sensitivity. Eye conditions such as cataracts,

glaucoma and macular degeneration are also

more common in older people. The gradual

changes associated with ageing and the gradual

onset of eye conditions may not be noticed

by the driver. Regular eye health checks may

facilitate early detection and management for

changes in vision. Diculty driving at night and

problems with glare may be early signs of age-

related visual decline and may be investigated

in routine conversations. Driving restrictions/

conditions such as no-night driving can help

maintain safe driving, while removal of cataracts

can eectively restore vision for driving. (Refer

also to section 4.4. Conditional licences and

Part B section 10. Vision and eye disorders).

Cognition

Various aspects of cognitive processing

required for safe driving can decline with

age, including memory, working memory,

visual processing, visuospatial skills, attention

functioning, executive functioning and insight.

These impairments can aect a person’s ability

to process and respond to the complex road

environment. The impairments can vary from

day to day, which can present a challenge for

deﬁnitive assessment in relation to driving.

Dementia is a particular concern as older adults

with dementia often lack insight into theirdeﬁcits

and may be more likely to drive when it is unsafe

(refer also to Part B section 6.1. Dementia).

Motor and somatosensory function

Ageing generally results in a decline in muscle

strength and endurance, as well as reduced

ﬂexibility, range of movement and joint stability.

Musculoskeletal conditions such as arthritis

are also more prevalent in older adults. These

and other general health conditions may be

associated with chronic pain and fatigue.

Proprioception may also be an issue.

Older adults with these impairments may have

diculties getting in and out of the car, using the

seatbelt and ignition key, adjusting mirrors and

seats, steering, turning to reverse, and using foot

pedals. Adaptative equipment, some requiring

professional recommendation, is available to

support drivers experiencing pain, reduced

reach or reduced strength. Rehabilitative

therapies may improve the older driver’s

functioning and endurance (refer to section

2.3.2 Driver rehabilitation, Part B section

5. Musculoskeletal conditions).

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

More information

Reference to the Royal Australian College

of General Practitioners’ Guidelines for

preventative activities in general practice (the

‘Red Book’) and the Aged care clinical guide

(the ‘Silver Book’) may assist in assessing older

drivers.

3,4

Additional resources and references

that may support assessment are provided in

Part A, References and further reading.

5–11

2.2.8. Multiple medical conditions

Where a vehicle driver has multiple conditions

or a condition that aects multiple body systems,

there may be an additive or a compounding

detrimental eect on driving abilities – for

example in:

• congenital disabilities such as cerebral palsy,

spina biﬁda and various syndromes

• multiple trauma causing orthopaedic and

neurological injuries as well as psychiatric

sequelae

• multi-system diseases such as diabetes,

connective tissue disease, multiple sclerosis

and systemic lupus erythematosus

• dual diagnoses involving psychiatric illness

and drug or alcohol addiction

• ageing-related changes in motor, cognitive

and sensory abilities together with

degenerative disease

• chronic pain.

Although these medical standards are designed

principally around individual conditions, clinical

judgement is needed to integrate and consider

the eects on safe driving of any medical

conditions and disabilities that a patient may

present with. However, it is insucient simply

to apply the medical standards contained in

this publication for each condition separately

because a driver may have several minor

impairments that alone may not aect driving but

when taken together may make risks associated

with driving unacceptable. Therefore, it is

necessary to integrate all clinical information,

bearing in mind the additive or compounding

eect of each condition on the overall capacity

of the patient to drive safely.

Where one or more conditions are progressive,

it may be important to reduce driving exposure

and ensure ongoing monitoring of the patient

(refer to section 2.2.5. Progressive conditions).

Conditional licences that may limit the driver (e.g.

no night driving) or place requirements on the

vehicle (e.g. automatic transmission only) are an

option in these circumstances (refer to section

4.4. Conditional licences). The requirement

for periodic reviews can be included as

recommendations on driver licences.

Periodic reviews are also important for drivers

with conditions likely to be associated with

future reductions in insight and self-regulation.

If lack of insight may become an issue in the

future, it is important to advise the patient to

report the condition(s) to the driver licensing

authority. Where lack of insight already appears

to impair self-assessment and judgement,

public safety interests should prevail, and the

health professional should report the matter

directly to the driver licensing authority and, if

appropriate, seek the support of the patient’s

family members.

2.2.9. Drugs and driving

Any drug that acts on the central nervous system

has the potential to adversely aect driving

skills. Central nervous system depressants,

for example, may reduce vigilance, increase

reaction times and impair decision making

in a very similar way to alcohol. In addition,

drugs that aect behaviour may exaggerate

adverse behavioural traits and introduce risk-

takingbehaviours.

Where medication is relevant to the overall

assessment of ﬁtness to drive in managing

speciﬁc conditions such as diabetes, epilepsy

and psychiatric conditions, this is covered in

PART A. Fitness to drive principles and practices

the respective chapters. Prescribing doctors

and dispensing pharmacists do, however, need

to be mindful of the potential eects of all

prescribed and over-the-counter medicines and

to advise patients accordingly. Patients receiving

continuing long-term drug treatment should be

evaluated for their reliability in taking the drug

according to directions. They should also be

assessed for their understanding that medicines

can have undesired consequences that may

impair their ability to drive safely and this may be

unexpectedly aected by other factors such as

drug interactions.

General guidance for prescription drugs

and driving

While many drugs have eects on the central

nervous system, most, with the exception of

benzodiazepines, tend not to pose a signiﬁcantly

increased crash risk when the drugs are used

as prescribed and once the patient is stabilised

on the treatment. This may also relate to drivers

self-regulating their driving behaviour. When

advising patients and considering their general

ﬁtness to drive, whether in the short or longer

term, health professionals should consider:

• the balance between potential impairment

due to the drug and the patient’s

improvement in health on safe driving ability

• the individual response of the patient –

some people are more aected than others

• the type of licence held and the nature of

the driving task (i.e. commercial vehicle

driver assessments should be more

stringent)

• the added risks of combining two or more

drugs capable of causing impairment,

including alcohol

• the added risks of sleep deprivation on

fatigue while driving, which is particularly

relevant to commercial vehicle drivers

• the potential impact of changing medications

or changing dosage

• the cumulative eects of medications

• the presence of other medical conditions

that may combine to adversely aect

drivingability

• other factors that may exacerbate risks such

as known history of alcohol or drug misuse.

Acute alcohol and drug intoxication

Acute impairment due to alcohol or drugs

(including illicit, prescription and over-the-

counter drugs) is managed through speciﬁc

road safety legislation that prohibits driving

over a certain blood alcohol concentration

(BAC), with the presence of certain drugs in

bodily ﬂuids, or when driving is impaired by

drugs (refer to Appendix 4. Drivers’ legal

BAC limits). This may include requirements

for using alcohol interlocks, the application

of which varies between jurisdictions (refer

to Appendix 5. Alcohol interlock programs).

This is a separate consideration to long-term

medical ﬁtness to drive and licensing, therefore

speciﬁc medical requirements are not provided

in this publication. Dependency and substance

misuse, including chronic misuse of illicit,

non-prescription and prescription drugs, is a

licensing issue and standards are outlined in

Part B section 9. Substance misuse.

Further guidance for prescribing drugs of

dependence can be found in the Royal

Australian College of General Practitioners’

guide Prescribing drugs of dependence in

general practice (visit www.racgp.org.au).

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

The eects of speciﬁc drug classes

13,14

Medicinal cannabis (cannabinoids)

15–25,36,37

Medicinal cannabis refers to medically

prescribed cannabis preparations intended

for therapeutic use, including pharmaceutical

cannabis preparations with set amounts of

cannabinoids such as oils, tinctures, sprays and

other extracts. The main active components of

cannabis (medicinal or recreational) are delta-

9-tetrahydrocannabinol (THC) and cannabidiol

(CBD). THC, the psychoactive ingredient in

cannabis (including medicinal), can cause

cognitive and psychomotor impairments that

degrade the ability to drive safely including

attention and concentration deﬁcits, mild

cognitive impairment, dizziness and anxiety.

These deﬁcits can begin at low doses and are

highly individualised.

The pharmacokinetics of cannabinoids are

complex, making it dicult to predict the severity

of impairment. Other inﬂuencing factors include

the history of use, frequency of dose, ratio

of cannabinoids and route of administration

(vaporised, oral, oral-mucosal, transdermal). The

onset and duration of impairing eects can vary

signiﬁcantly between individuals. The eects can

typically last for three to six hours after inhalation

or ﬁve to eight hours after oral administration,

but may be signiﬁcantly longer for either route

of administration and should be determined

individually. Further information on the route

of administration and THC pharmacokinetic/

pharmacodynamics can be found in the TGA’s

Guidance for the use of medicinal cannabis in

Australia – overview (https://www.tga.gov.au/

publication/guidance-use-medicinal-cannabis-

australia-overview).

Based on current evidence, CBD does not

cause psychomotor or cognitive impairment or

strong psychoactive eects. CBD may produce

side eects including sedation or fatigue, which

can be more pronounced at higher doses. CBD

may interact with other prescribed medication,

potentially increasing the risk of driving

impairment. The eects of other cannabinoids

have not been systematically studied.

Managing medicinal cannabis and driving

Strategies to mitigate or manage THC

impairments include a ‘start low, go slow’

approach to treatment and administration during

periods when an individual is unlikely to drive

(e.g. at night before sleep). A period of restricted

or non-driving, generally a minimum of four

weeks, may be considered while adaptation

to medication and treatment outcomes

aredetermined.

Medicinal cannabis (THC and CBD) can

interact with other medications, impairing

the metabolism of other drugs or causing

cumulative eects such as sedation, which can

increase the road safety risk. Alcohol should

be avoided when taking medicinal cannabis

due to the signiﬁcant additive eects and the

increased risk of having a crash. CBD may eect

the metabolism of certain antiseizure drugs,

elevating plasma levels of other drugs, including

some benzodiazepines.

Assessing ﬁtness to drive

Fitness-to-drive assessments for the underlying

chronic medical condition or disability treated

with medicinal cannabis can be undertaken as

per the applicable standards. The assessment

should consider the nature of the driving task,

impairment of cognitive, visuospatial and

motor control functions from the condition

or medications, and treatment outcomes.

Conditions with speciﬁc standards, such as

seizures (Part B section 6.2. Seizures and

epilepsy) or chronic pain (Part B section 5.

Musculoskeletal conditions), may consider

medicinal cannabis under the existing criteria.

Conditions without speciﬁc criteria in Part B.

Medical standards may be assessed according

to section 2. Assessing ﬁtness to drive –

generalguidance.

PART A. Fitness to drive principles and practices

Medicinal cannabis and commercial

licenceholders

Assessments against the commercial licensing

medical standards are more stringent than the

private standards and reﬂect increased driver

exposure and the increased risk associated with

motor vehicle crashes involving these vehicles.

Sleep deprivation or fatigue while driving are

common risks among commercial vehicle

drivers. Particular attention should be paid to the

commercial vehicle driving task. Considerations

may include the vehicle type, the nature of

goods transported, the distances and roads

being travelled, the cumulative time driving over

a work period, and whether driving will occur at

night or disrupt normal sleep patterns. Impacts

of driving patterns on dosage requirements

mayalso be relevant.

Medicinal cannabis and drug driving laws

Drug driving and enforcement laws for cannabis

are established through state and territory

legislation and can vary. In general, it is against

the law for a person to drive with any amount

of THC present in their bodily ﬂuids (blood,

saliva or urine). In most states and territories

there are no exceptions to these laws, including

therapeutic use. Tasmanian law provides a

medical defence for driving with the presence of

THC in bodily ﬂuids. The medical defence only

applies if the medicinal cannabis is obtained and

administered in accordance with the Poisons

Act 1971 (Tas). It remains illegal for these patients

to drive if impaired by THC and they must still

comply with directions given by law enforcement

regarding roadside testing.

Drivers prescribed medicinal cannabis in one

jurisdiction may be treated dierently if driving in

another. The individual’s driving needs, including

interstate travel and licensing classes, should

be discussed when considering prescribing

medicinal cannabis, and it is critical to identify if

driving is required as part of their occupation.

Point-of-prescription advice regarding

medicinalcannabis and driving

The implications of drug driving regulations

and THC should be discussed at the point

of prescription and reviewed routinely with

the patient as part of good ﬁtness-to-drive

medical management. In addition to the legal

consequences, there may also be insurance

implications for patients who are convicted of

drug driving oences. CBD is not subject to

these controls and can be used while driving, so

long as treatment is free of side eects or drug

interactions that may cause impairment. Speciﬁc

information can be sourced from local driver

licensing authorities, health departments or law

enforcement agencies and should be consulted

alongside the information presented here.

Possible drug-seeking behaviour in those

directly requesting cannabis as an alternative

to, or to supplement, medicinal cannabis should

be kept in mind. Medically prescribed cannabis

is distinct from other sources of cannabis that

people may access for illicit or unregulated

medicinal purposes. These other products are

highly variable in their cannabinoid content and

can signiﬁcantly increase the road safety risk.

More information can be found in Part B section

9. Substance misuse.

Benzodiazepines

Benzodiazepines are well known to increase

the risk of a crash and are found in about 4

per cent of fatalities and 16 per cent of injured

drivers taken to hospital. In many of these cases

benzodiazepines were either abused or used

in combination with other impairing substances.

If a hypnotic is needed, a shorter acting drug is

preferred. Tolerance to the sedative eects of

the longer acting benzodiazepines used to treat

anxiety gradually reduces their adverse impact

on driving skills.

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

Antidepressants

Although antidepressants are one of the more

commonly detected drug groups in fatally

injured drivers, this tends to reﬂect their wide

use in the community. The ability to impair is

greater with sedating tricyclic antidepressants

(e.g. amitriptyline and dothiepin) than with the

less sedating serotonin and mixed reuptake

inhibitors such as ﬂuoxetine and sertraline.

However, antidepressants can reduce the

psychomotor and cognitive impairment caused

by depression and return mood towards normal.

This can improve driving performance.

Antipsychotics

This diverse class of drugs can improve

performance if substantial psychotic-related

cognitive deﬁcits are present. However, most

antipsychotics are sedating and have the

potential to adversely aect driving skills through

blocking central dopaminergic and other

receptors. Older drugs such as chlorpromazine

are very sedating due to their additional actions

on the cholinergic and histamine receptors.

Some newer drugs (clozapine, olanzapine,

quetiapine) are also sedating, while others

(aripiprazole, risperidone and ziprasidone) are

less sedating. Sedation may be a particular

problem early in treatment and at higher doses.

Opioids

27–31

Opioid analgesics are central nervous system

depressants and as such can suppress cognitive

and psychomotor responses in driving situations.

While cognitive performance is reduced early

in treatment (largely due to their sedative

eects) neuroadaptation is rapidly established.

This means that patients on a stable dose

of an opioid may not have a higher risk of a

crash. This includes patients on buprenorphine

and methadone for their opioid dependency,

providing the dose has been stabilised over

some weeks and they are not abusing other

impairing drugs. Driving at night may be a

problem due to the persistent miotic eects of

these drugs reducing peripheral vision.

Further guidance on opiate prescribing can

befoundfrom:

• the Royal Australian College of Physicians’

Prescription Opioid Policy: Improving

management of chronic non-malignant pain

and prevention of problems associated with

prescription opioid use

• the Australian and New Zealand College

of Anaesthetists and Faculty of Pain

Management’s Statement regarding the use

of opioid analgesics in patients with chronic

non-cancer pain

• the Royal Australian College of General

Practitioners’ Prescribing drugs of

dependence in general practice

28–30

• local health agency websites.

2.3. Assessing and

supporting functional

driver capacity

2.3.1. Practical driver assessments

The impact of a medical condition or multiple

conditions or disability on driving is not always

clear, so a practical driver assessment may be

useful. Such assessments are dierent from

the tests of competency to drive used with

entry-level drivers that are routinely conducted

by driver licensing authorities for licensing

purposes. These practical driver assessments

are suitable only for persistent impairments.

When is a practical driver assessment

indicated?

A practical driver assessment is designed to

assess the impact of injury, illness, disability or

the ageing process on driving skills including

judgement, decision-making skills, observation

and vehicle handling. The assessment may

also be helpful in determining the need for

special training in compensatory techniques

or vehicle modiﬁcation to assist drivers with

musculoskeletal or other disabilities.

PART A. Fitness to drive principles and practices

A health professional may request a practical

driver assessment to provide information to

supplement the clinical assessment in some

borderline cases and to assist in making

recommendations about a person’s ﬁtness to

drive. However, practical assessments have

limitations in that a patient’s condition may

ﬂuctuate (good days and bad days), and it is

not possible to create emergency situations

on the road to assess reaction time. Practical

assessments are therefore intended to inform

but not necessarily override the clinical opinion

of the examining health professional. In addition,

there are clinical situations that are clearly

unsuitable for on-road assessments such as

signiﬁcant visual impairment or signiﬁcant

cognitive impairment.

What types of assessments are

available?

There is a wide range of practical assessments

available, including o-road, on-road and driving

simulator assessments, each with strengths and

limitations. Assessments for cars, motorcycles,

buses or heavy vehicles may be conducted or

overseen by occupational therapists trained in

driver assessment or by others approved by

the particular driver licensing authority, such

as training providers for commercial vehicle

drivers. Processes for initiating and conducting

driver assessments vary between the states

and territories, and the choice of assessment

depends on resource availability, logistics, cost

and individual requirements. Generally, the

assessments may be initiated by the examining

health professional, other referrers (e.g. police,

self, family) or by the driver licensing authority.

It is not the intent of this publication to specify

the assessment to be used in a particular

situation. Health professionals should contact

their local driver licensing authority (Appendix 9.

Driver licensing authoritycontacts) for details of

options or refer to Appendix 10. Specialist driver

assessors.

What does a practical assessment

involve?

Occupational therapy driver assessment

usually involves two components: (a) an o-

road screening and (b) an in-car practical

driver assessment. The purpose of the o-road

screening is to evaluate the nature, frequency

and requirement for driving, underlying

impairments, knowledge of road law, insight,

medical history and requirements for the

on-road test. Depending on the individual

situation, the occupational therapy driver in-car

assessment may involve evaluating:

• the need for specialised equipment or

vehicle modiﬁcations

• the driver’s ability to control the motor

vehicle truck, bus or motorcycle

• the driver’s functional status while driving

including cognitive function, physical

strength and skills, reaction time, insight

level and ability to self-monitor their driving.

Recommendations following assessment may

relate to licence status, licence conditions, the

speciﬁc vehicle modiﬁcations, rehabilitation

or retraining (refer to section 2.3.2. Driver

rehabilitation), licence conditions or restrictions

(refer to section 4.4. Conditional licences) and

reassessment.

Where can I go to get more information?

More information about occupational

therapy driver assessments can be found

in the VicRoads publication Guidelines for

Occupational therapy driver assessors, 3rd

edition, March 2018, available from the VicRoads

website at www.vicroads.vic.gov.au/licences/

health-and-driving/information-for-health-

professionals/occupational-therapist.

Refer

also to Appendix 10. Specialist driver assessors.

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

2.3.2. Driver rehabilitation

33–35

A practical driver assessment may indicate

a need for the person to participate in

a rehabilitation or retraining program. A

rehabilitation or retraining program will be

developed based on the assessment results.

It will be graded to increase the degree of

diculty or complexity in the task/environment

and may include clinic-based activities,

simulator or computer-based training, or on-

road training with a driving instructor under

the direction of an occupational therapist. It

may also include training in the use of vehicle

modiﬁcations or aids/adaptations as well as

education to develop driver awareness and

improve driving conﬁdence. There is currently

limited evidence to support the use of particular

rehabilitation or retraining strategies. Designed

and tested driving simulation activities may oer

controlled and repeatable driving conditions for

rehabilitation that are not available or limited in

on-road driving situations, allowing practice and

skills related to the behavioural, cognitive and

physical skills related to driving.

On completing the rehabilitation program, a

reassessment of the patient’s driving skills may

be made and a report sent to the driver licensing

authority with recommendations regarding driver

competency and licensing.

2.3.3. Equal employment opportunity

and discrimination

The purpose of the standards, particularly for

commercial vehicle driving, is to protect public

safety. They should not be used as a barrier to

employment per se. The system of conditional

licences aims to support employability without

compromising road safety by providing for

periodic medical review and driving conditions

as appropriate.

Commonwealth and state/territory legislation

exists to protect workers against unfair

discrimination based on disability. If a patient

suspects they are being unfairly discriminated

against based on the disability outlined on their

conditional licence, they may contact their union

or the Human Rights and Equal Opportunity

Commission, or the relevant commission in their

state or territory.

2.3.4. Information and assistance

fordrivers

Assessment by a health professional is one

piece of information taken into account by the

driver licensing authority in making a decision

about the future licensing status of a person.

The driver licensing authority may cancel,

refuse or suspend a driver licence or place

conditions on a licence. Because most people

consider a driver licence critical to continued

independence, employment and recreation,

the risk of it being withdrawn can evoke strong

emotions and reactions. Patients may become

upset, anxious, frustrated or angry, especially if

their livelihood or lifestyle is threatened (refer

to section 3.3.2. Patient–health professional

relationship).

PART A. Fitness to drive principles and practices

In cases where licensing decisions may

aect a patient’s ability to earn a living, the

health professional should demonstrate some

sensitivity in the interests of ongoing patient

health. Timely provision of medical reports is

important in this regard. Oering some direction

in developing coping strategies may help

alleviate some of the patient’s concerns or fears.

Where appropriate, the health professional

should consider direct referral rather than simply

providing sources for further information. For

example:

• Vocational assessors will assess a person’s

ability to rehabilitate, retrain and reskill for

another industry, or a new sector within the

industry.

• There may be government-funded

assistance programs to support work-based

assessments and workplace modiﬁcations

including vehicle modiﬁcations.

• Condition-speciﬁc support and advocacy

agencies may also oer advice, support

and services – for example, Diabetes

Australia, Dementia Australia, MS Australia,

Epilepsy Action Australia and the Epilepsy

Foundation.

For older drivers, early advice will help

them plan for the inevitable changes in their

independence. Some driver licensing authorities

have a range of dedicated fact sheets explaining

the impacts of ageing and common medical

conditions on driving safety: check the licensing

authority website in your state or territory.

Assessing ﬁtness to drive – generalguidance

PART A. Fitness to drive principles and practices

3. Roles and responsibilities

The roles and responsibilities of those involved

in ﬁtness-to-drive assessments and decision

making are summarised in Table 2 and

discussed in this section. The descriptions

and the relationships depicted in Figure 2 are

generalised and may vary between states/

territories in terms of legislative requirements.

For speciﬁc requirements refer to Appendix 3.

Legislation relating to reporting.

Figure 2. The relationships and interactions between the driver licensing authority, health

professional and vehicle driver

Health professionals and DLAs do

not normally communicate directly

with each other, which protects

patient conﬁdentiality. However,

with the driver’s consent, DLAs may

communicate with health professionals

when clariﬁcation or further information

is required in order to make a licensing

decision.

Driver Licencing Authority (DLA)

Health professionals and DLAs do not

normally communicate directly with

each other, which protects patient

conﬁdentiality. However, health

professionals should consider reporting

directly to the DLA in situations where

the patient continues driving despite

appropriate advice and is likely to

endanger the public.

Medical professional

The DLA

may request

drivers to have

a medical

examination.

Legislation requires drivers

with serious illnesses aecting

driving ability to inform the DLA.

Driver

Health

professionals

should advise

patients if a

medical condition,

treatment or drink

or drunk driving

behaviours impact

on their ability

to drive safely,

whether in the

short or long term.

DLA = driver licensing authority

The responsibility for issuing, renewing, suspending, refusing, cancelling or reinstating a

person’s driver licence (including a conditional licence) lies ultimately with the driver licensing

authority. Licensing decisions are based on a full consideration of relevant factors relating to the

driver’s health and driving performance record.

PART A. Fitness to drive principles and practices

Table 2. Key roles and responsibilities with respect to ﬁtness to drive

Driver Health professional Driver licensing authority

• To report to the driver

licensing authority any

long-term or permanent

injury, illness, medical

condition, disability or

treatment that may aect

their ability to drive safely.

• To respond truthfully to

questions from a health

professional about their

health status and the likely

impact on their driving

ability.

• To adhere to prescribed

medical treatment.

• To comply with

requirements of a

conditional licence as

appropriate, including

periodic medical reviews.

• For drivers who have

previously advised the

driver licensing authority

about their health and

driving, to report any

changes to their health

that could aect their

ability to drive safely as

soon as practicable. (Note:

Drivers should report as

soon as they become

aware of these new/

changed conditions –

theyshould not wait for

theperiodicreview.)

• To assess the person’s ﬁtness to

drive based on relevant clinical and

functional information and on the

relevant published medical standards.

• To advise the person about:

− the impact of their medical

condition, disability or treatment

on their ability to drive and

recommend restrictions, ongoing

monitoring, rehabilitation/training

or transitional arrangements as

required

− their responsibility to report their

condition to the driver licensing

authority if their long-term or

permanent injury or illness may

aect their ability to drive safely.

• To treat, monitor and manage the

person’s condition with ongoing

consideration of their ﬁtness to drive.

• To report to the driver licensing

authority regarding a person’s

ﬁtness to drive, including their

suitability to hold a conditional

licence, in accordance with legislated

requirements and public safety and

ethical considerations.

Note: Medical practitioners or other

clinicians do not have the legal authority

to restrict, reinstate or apply conditions

to a patient’s driver licence; this can

only be done by the relevant driver

licensingauthority.

• To make all decisions regarding

the licensing of drivers. The

driver licensing authority will

consider reports provided by

health professionals, police

and members of the public, as

well as crash involvement and

driving histories.

• To make all decisions regarding

the issue of conditional

licences. The driver licensing

authority will consider the

recommendations of health

professionals as well as other

relevant factors.

• To educate the driving public of

their responsibility to report any

long-term or permanent injury,

illness, medical condition,

disability or treatment to the

driver licensing authority if the

condition may aect their ability

to drive safely.

• To provide relevant information

resources and support for

health professionals about

driver ﬁtness assessment

andlicensing.

Brochures describing the responsibilities of patients, health professionals and licensing authorities

may be available from state and territory driver licensing authorities. Refer to Appendix 9 for contact

details. Information is also available from the Austroads website at www.austroads.com.au.

Roles and responsibilities

PART A. Fitness to drive principles and practices

3.1. Roles and

responsibilities of driver

licensing authorities

The responsibility for issuing, renewing,

suspending, refusing or cancelling a person’s

driver licence (including a conditional licence)

lies ultimately with driver licensing authorities.

Licensing decisions are individualised and are

based on a full consideration of relevant factors

relating to the driver’s:

• health

• functional capacity (including their ability to

compensate for any impairment)

• insight into their condition

• compliance with any prescribed treatment

• compliance with existing licence conditions

• driving history

• any other relevant information.

In making a licensing decision, the authority will

seek input directly from the driver and/or from

a health professional. The authority will also act

on unsolicited reports from health professionals,

the police or members of the public about a

person’s ﬁtness to drive.

Under national driving licensing arrangements

current at the time of publication, the driver

licensing authority issuing the driver licence and

the driver’s residential address should be in the

same jurisdiction.

Payment for health examinations or assessments

related to ﬁtness to drive is generally not the

responsibility of driver licensing authorities.

Each state and territory has an appeal system

for situations where drivers do not agree with

a decision made about their driver licence. The

driver licensing authority will inform drivers of

the appeal process when informing them of the

licensing decision.

Driver licensing authorities can provide health

professionals with information about:

• licensing and administrative processes

• medical aspects (while not all driver licensing

authorities have medical ocers on sta,

they are able to assist health professionals

who require guidance with particular cases)

• practical driver assessments

• legal and ethical issues (the driver

licensing authority can provide guidance

about the legislative requirements for

licensing and assessing ﬁtness to drive. For

general advice on legal or ethical issues,

health professionals should contact their

professional defence organisation).

Appendix 9 contains the contact details for

driver licensing authorities around Australia.

3.2. Roles and

responsibilities of drivers

In all states and territories, legislation requires

a driver to advise their driver licensing authority

of any long-term or permanent injury or illness,

disability or medical treatment that may aect

their safe driving ability.

At licence application and renewal, drivers can

be asked to complete a declaration regarding

their health, including whether they have

any long-term conditions such as diabetes,

epilepsy or cardiovascular disease. Based on

this information the driver licensing authority

may request a medical examination to conﬁrm

a driver’s ﬁtness to hold a driver licence. In the

case of medical examinations requested by the

driver licensing authority, drivers have a duty

to declare their health status to the examining

health professional and respond truthfully to

anyquestions for this purpose.

Drivers must also report to the driver licensing

authority when they become aware of a

health condition that may aect their ability to

drive safely. There is some variability in these

PART A. Fitness to drive principles and practices

laws between the states and territories, so

drivers and health professionals should be

aware of the speciﬁc reporting requirements

in their jurisdiction and should contact their

driver licensing authority for details of local

requirements. These laws may impose penalties

for failure to report (refer to Appendix 3.

Legislation relating to reporting).

Drivers may be liable at common law if they

continue to drive knowing that they have a

condition that is likely to adversely aect safe

driving. Drivers should be aware that there

may be long-term ﬁnancial, insurance and

legal consequences where there is failure

to report any long-term illness, disability,

medical condition or injury, or the eects of the

treatment for any of those things, to their driver

licensingauthority.

3.3. Roles and

responsibilities of health

professionals

Patients rely on health professionals to advise

them if a permanent or long-term illness,

disability, medical condition or injury, or the

eects of the treatment for any of those things

may aect their safe driving ability and whether

it should be reported to the driver licensing

authority. The health professional has an ethical

obligation, and potentially a legal one, to give

clear advice to the patient in cases where a

long-term illness, disability, medical condition

or injury, or the eects of the treatment for any

of those things, may aect safe driving ability.

Health professionals are advised to note in

the patient’s medical record the nature of

theadvicegiven.

3.3.1. Conﬁdentiality, privacy and

reporting to the driver licensing

authority

Health professionals have both an ethical and

legal duty to maintain patient conﬁdentiality.

The ethical duty is generally expressed through

codes issued by professional bodies. The

legal duty is expressed through legislative and

administrative means and includes measures

to protect personal information about a speciﬁc

individual. The duty to protect conﬁdentiality

also applies to driver licensing authorities.

The patient–professional relationship is built

on a foundation of trust. Patients disclose

highly personal and sensitive information to

health professionals because they trust that the

information will remain conﬁdential. If such trust

is broken, patients could forgo examination/

treatment or modify the information they give to

their health professional, potentially placing their

health at risk.

Although conﬁdentiality is an essential

component of the patient–professional

relationship, there are, on rare occasions,

ethically or legally justiﬁable reasons for

breaching conﬁdentiality. With respect to

assessing and reporting ﬁtness to drive, the duty

to maintain conﬁdentiality is legally qualiﬁed in

certain circumstances in order to protect public

safety. Health professionals should consider

reporting directly to the driver licensing authority

in situations where a patient is either:

• unable to appreciate the impact of

theircondition

• unable to take notice of the health

professional’s recommendations due to

cognitive impairment

• provides unreliable information on their

condition, or

• continues driving despite appropriate

adviceand is likely to endanger the public.

Roles and responsibilities

PART A. Fitness to drive principles and practices

In the Australian Capital Territory, New South

Wales, Queensland, Tasmania, Victoria and

Western Australia, statute provides that health

professionals who make such reports to driver

licensing authorities without the patient’s

consent but in good faith that a patient is unﬁt

to drive are protected from civil and criminal

liability. The Northern Territory does not currently

provide this protection (refer to Appendix 3.

Legislation relating to reporting).

In South Australia and the Northern Territory

current legislation imposes mandatory

reporting. A positive duty is imposed on health

professionals to notify the relevant authority

in writing of a belief that a driver is physically

or mentally unﬁt to drive (refer to Appendix 3.

Legislation relating to reporting).

It is preferable that any action taken in the

interests of public safety should be taken with

the consent of the patient wherever possible

and should certainly be undertaken with the

patient’s knowledge of the intended action.

The patient should be fully informed as to why

the information needs to be disclosed to the

driver licensing authority and be given the

opportunity to consider this information. Failure

to inform the patient will only exacerbate the

patient’s (and others’) mistrust in the patient–

professional relationship. It is recognised that

there might be an occasion where the health

professional feels that informing the patient of

the disclosure may place the health professional

or others at risk of violence. Under such

circumstances the health professional must

consider how to appropriately manage such a

situation (refer to section 3.3.3. Patient hostility

towards the health professional).

In making a decision to report directly to the

driver licensing authority, it may be useful for the

health professional to consider:

• the seriousness of the situation (i.e. the

immediate risks to public safely or others

both from the patient’s attitude and the

degree of risk their condition poses)

• the risks associated with disclosure without

the individual’s consent or knowledge,

balanced against the implications of non-

disclosure

• the health professional’s ethical and

professional obligations

• whether the circumstances indicate a

serious and imminent threat to the health,

lifeor safety of any person.

Considerations involving cases where there is

an immediate threat to public safety may require

the health professional to exercise their duty of

care in line with relevant professional standards

and report the driver to the driver licensing

authority or the police. This may be appropriate

in instances where there is a high risk – for

example, drivers with a history of reckless

driving, crashes or intentions to cause harm

involving motor vehicles.

Examinations requested by a driver

licensing authority

When a patient presents for a medical

examination at the request of a driver licensing

authority the situation is dierent with respect to

conﬁdentiality. The patient may present with a

form or letter from the driver licensing authority

requesting an examination for the purposes of

licence application or renewal, or as a stipulation

of a conditional licence. The completed form

should be sent directly to the driver licensing

authority, rather than returned to the driver. In

the case where an electronic medical report

form is completed, these reports will be returned

directly to the driver licensing authority.

PART A. Fitness to drive principles and practices

Privacy legislation

All health professionals and driver licensing

authorities should be aware of the National

Privacy Principles, the Health Privacy Principles

and other privacy legislation applicable

in their jurisdiction (e.g. health records

legislation) when collecting and managing

patient information and when forwarding such

information to third parties.

3.3.2. Patient–health professional

relationship

It is expected that health professionals will be

able to act objectively in assessing a patient’s

ﬁtness to drive. If this cannot be achieved – for

example, where there may be the possibility

of the patient ceasing contact or avoiding all

medical management of their condition – health

professionals should be prepared to disqualify

themselves and refer their patient to another

practitioner.

A dicult ethical situation arises in the event that

the health professional has reason to doubt the

veracity of the information provided by a patient

regarding their health, and their capacity to drive

safely. In this case health professionals could

consider the following strategies:

• contacting their professional indemnity

insurer, discussing the problem and

documenting the advice

• discussing the problem with colleagues

• referring the person for a second or

specialist opinion

• contacting the relevant driver licensing

authority and, without identifying the patient,

discussing the problem and documenting

the advice.

With these additional inputs it may be possible

to carefully discuss and reassess the situation

with the patient, taking care to document

theproceedings.

3.3.3. Patient hostility towards the

health professional

Sometimes patients feel aronted by the

possibility of restrictions to their driving or

withdrawal of their licence and may be hostile

towards their treating health professional. In

such circumstances the health professional may

elect to refer the driver to another practitioner

or may refer them directly to the driver licensing

authority without a recommendation regarding

ﬁtness to drive. Driver licensing authorities

recognise that it is their role to enforce the

laws on driver licensing and road safety and

will not place pressure on health professionals

that might needlessly expose them to risk of

harassment or intimidation.

The health professional may refer the patient to

the standards in this publication when dealing

with such situations. They may point out that

the standards are developed by the National

Transport Commission in cooperation with

professional medical, allied health associations

and road safety experts based on current

evidence and are enforced by driver licensing

authorities.

More information about managing patient–

professional hostility is available from the Royal

Australian College of General Practitioners

website at www.racgp.org.au/your-practice/

business/tools/safetyprivacy/gpsafeplace/.

Roles and responsibilities

PART A. Fitness to drive principles and practices

3.3.4. Dealing with individuals who

are not regular patients

Care should be taken when health professionals

are dealing with drivers who are not regular

patients. Some drivers may seek to deceive

health professionals about their medical history

and health status and may ‘doctor shop’ for a

desirable opinion. If a health professional has

doubts about a person’s reason for seeking a

consultation, they should consider:

• asking permission from the person to

request their medical ﬁle from their regular

health professional

• conducting a more thorough examination

of the person than would usually be

undertaken

• noting on the medical report returned to the

driver licensing authority the length of time

the patient has been known to them and

whether the health professional had access

to the full medical record/history.

3.3.5. Role of medical specialists

In most circumstances medical assessments

of drivers of either commercial or private

vehicles can be conducted by a general

practitioner. However, if doubt exists about

a patient’s ﬁtness to drive or if the patient’s

particular condition or circumstances are not

covered speciﬁcally by the standards, review

by a specialist experienced in managing the

particular condition is warranted and the

generalpractitioner should refer the patient

tosuch a specialist.

It is important that treating specialists share

their ﬁtness-to-drive assessment outcomes

with the patient’s general practitioner. This is

in recognition of the important role general

practitioners have in healthcare coordination

and monitoring of long-term health conditions

aswell as potential road safety and public

healthimplications.

In the case of commercial vehicle drivers,

theopinion of a medical specialist is generally

required for an initial recommendation and

periodic review of a conditional licence; the main

exceptions to this are set out here and in section

4.4.7. What if there is a delay before aspecialist

can be seen?.

This requirement reﬂects the higher safety

risk for commercial vehicle drivers and the

consequent importance of expert opinion. In

circumstances where access to specialists

is limited, once the initial recommendation is

made, alternative arrangements for subsequent

reviews by the general practitioner may be

made with the approval of the driver licensing

authority and with the agreement of the

specialist and the treating general practitioner.

PART A. Fitness to drive principles and practices

Box 2. Telehealth

General practitioners and patients

are encouraged to use telemedicine

technologies such as videoconferencing

to minimise any diculties associated with

seeing their regular GP or where there is

limited access to specialists.

From 30 March 2020, telehealth (video-

call) and phone consultation items

became available to all Medicare-

eligible Australians for a wide range of

consultations, subject to certain limitations.

Particularly for people in remote area

communities, this provides many patients

with easier access to specialists, without

the time and expense involved in travelling

to major cities.

These measures were introduced in

response to the COVID-19 pandemic.

A longer term telehealth model (post

31 December 2021) is currently under

development. More information about

telehealth services is available from the

Medicare website at humanservices.

gov.au/health-professionals/services/

medicare/mbs-and-telehealth.

Note: The opinion of a specialist is relevant only

to their specialty. General practitioners are in a

good position to integrate reports from various

specialists in the case of multiple disabilities

to help the driver licensing authority make a

licensing decision. An occupational physician

or an authorised health professional may

provide a similar role for drivers of commercial

vehicles and their employers. For the purposes

of this publication, the term ‘specialist’ refers

to a medical or surgical specialist other than a

general practitioner, acknowledging that Fellows

of the Royal Australian College of General

Practitioners and Fellows of the Australian

College of Rural and Remote Medicine

have specialist status under current medical

registration arrangements (refer to www.

medicalboard.gov.au).

3.3.6. Role of driver assessors and

trainers

As previously described, a practical driver

assessment (including on- or o-road

components) may be required to assess the

impact of injury, illness, disability or the ageing

process on driving skills including judgement,

decision-making skills, observation and vehicle

handling. Such assessments are particularly

useful in borderline cases where vehicle

modiﬁcations or adaptations are required and/

or where the impact of injury, illness, disability

or the ageing process on functionality is not

clear. They should be conducted by suitably

qualiﬁed occupational therapy driving assessors.

Advice regarding the availability and access to

driver assessors is available from the local driver

licensing authority and Occupational Therapy

Australia (refer also to Appendix 10. Specialist

driver assessors).

Recommendations following assessment may

relate to licence status, the need for vehicle

modiﬁcations, rehabilitation or retraining (refer

to section 2.3.2. Driver rehabilitation), licence

conditions or restrictions (refer to section 4.4.

Conditional licences) and reassessment.

Driver training and rehabilitation providers have

a role in supporting drivers to retain and regain

skills as a result of injury, disability or illness,

and to adapt to using vehicle modiﬁcations.

Training may be conducted on-road and may

be supplemented by simulator- or computer-

based training.

Roles and responsibilities

PART A. Fitness to drive principles and practices

3.3.7. Role of independent experts/

panels

Recognising that not all medical and driving

circumstances can be speciﬁcally or fully

covered in these standards, driver licensing

authorities may draw on independent expert

medical advice to inform borderline or

otherwisedicult licensing decisions.

3.3.8. Documentation

Clear documentation of the assessment results

and communication with the patient and driver

licensing authority is important. Refer to section

5.2. Which forms to use.

PART A. Fitness to drive principles and practices

4. Licensing and medical ﬁtness to drive

4.1. Medical standards

for private and

commercial vehicle

drivers

This publication outlines two sets of medical

standards for driver licensing or authorisation:

private vehicle driver standards and commercial

vehicle driver standards. The assignment of

medical standards for vehicle drivers is based

on an evaluation of the driver, passenger and

public safety risk, where:

Risk = Likelihood of the event × Severity

ofconsequences.

Commercial vehicle crashes may present

a severe threat to passengers, other road

users (including pedestrians and cyclists) and

residents adjacent to the road. Such crashes

present potential threats in terms of spillage of

chemicals, ﬁre and other signiﬁcant property

damage. On the other hand, crashes involving

private vehicle drivers are likely to have less

severe consequences.

Commercial vehicle drivers generally spend

considerable time on the road, increasing

the likelihood of a crash. They may also be

monitoring various in-vehicle communication

and work-related systems – a further factor that

increases the likelihood of a crash. Crash data

identiﬁes that commercial vehicle drivers are

more than twice as likely to be involved in a fatal

crash compared with other drivers.

To ensure that the risk to the public is similar

for private and commercial vehicle drivers, the

medical ﬁtness requirements for the commercial

vehicle driver standards must be more stringent.

This is required to reduce the risk of a crash,

as much as possible, due to long-term injuries

or illnesses. The standards in this publication

reﬂect these dierences.

Identifying which standards apply

The choice of which standards to apply

whenexamining a patient for ﬁtness to drive is

guided by both the type of vehicle (e.g. heavy

vehicle) and the purpose for which the driver is

authorised to drive (e.g. carrying passengers or

dangerous goods). Generally, the commercial

vehicle driver medical standards apply to

drivers of heavy vehicles, public passenger

vehicles or vehicles carrying dangerous goods.

A dangerous goods driver licence is required

to transport dangerous goods in an individual

receptacle with a capacity greater than 500

litres or net mass greater than 500 kilograms.

Licensing and medical ﬁtness to drive

PART A. Fitness to drive principles and practices

The private standards should be applied to:

• drivers applying for or holding a licence

class C (car), R (motorcycle) or LR (light rigid)

unless the driver is also applying for an

authority to or is already authorised to use

the vehicle for carrying public passengers

for hire or reward or for carrying dangerous

goods or, in some jurisdictions, for a

drivinginstructor

• voluntary drivers who use their private

vehicle but for a voluntary service (e.g.

wheels on meals, sta at schools who

drive students around, voluntary taxi

services for older people, L2P drivers),

unless the voluntary driving aligns with

thecommercialstandards.

The commercial standards should be applied to:

• drivers of ‘heavy vehicles’ – those holding

or applying for a licence of class MR

(medium rigid), HR (heavy rigid), HC (heavy

combination) or MC (multiple combination)

• drivers carrying public passengers for hire or

reward (bus drivers, drivers of taxis or other

ridesharing services, chaueurs, drivers of

hire cars and small buses)

• drivers carrying dangerous goods

• drivers subject to requirements for Basic

or Advanced Fatigue Management

under the National Heavy Vehicle

AccreditationStandard

• other driver categories that may also be

subject to the commercial vehicle standards

as a result of certiﬁcation requirements

of the authorising body or as required by

speciﬁc industry standards – for example,

driving instructors and members of TruckSafe.

4.2. Considerations

for commercial vehicle

licensing

The commercial vehicle driver standards

acknowledge and allow for the variability in risk

among dierent commercial vehicle drivers.

The driver licensing authority will take into

consideration the nature of the driving task as

well as the medical condition, particularly when

granting a conditional licence (refer to section

4.4. Conditional licences). For example, the

licence status of a farmer requiring a commercial

vehicle licence for the occasional use of a

heavy vehicle on their own property may be

quite dierent from that of an interstate multiple

combination vehicle driver. The examining health

professional should bear this in mind when

examining a patient and when providing advice

to the driver licensing authority.

In developing the standards, several approaches

have been adopted to manage the increased

risk associated with driving a commercial vehicle

(refer to Table 3). These approaches include

thefollowing:

• There are generally longer non-driving

periods prescribed for commercial vehicle

drivers compared with private vehicles – for

example, after a seizure or heart attack.

• There is generally a requirement that a

specialist (rather than general practitioner)

provides information regarding a conditional

licence for a commercial vehicle driver (refer

to section 4.4. Conditional licences).

• Some medical conditions may preclude a

person from driving a commercial vehicle

but they may still be eligible to hold a full or

conditional licence for a private vehicle – for

example, early dementia.

• The review period for a conditional

licence may be shorter for a commercial

vehicledriver.

PART A. Fitness to drive principles and practices

Table 3. Choice of standard according to vehicle/licence type

National licence class Applicable standard

Motorcycle (R) Motorbike or motortrike Private standards apply unless the driver

holds or is applying for an authority to carry

public passengers for hire or reward, in which

case the commercial standards apply.

Car (C) Vehicle not more than

4.5 tonnes GVM (gross

vehicular mass) and seating

up to 12 adults including the

driver

Private standards apply unless the driver:

• holds or is applying for an authority to carry

public passengers for hire or reward (e.g.

taxi driver)

• is undertaking a medical assessment as a

requirement under an accreditation scheme

• holds or is applying for an authority to hold

a dangerous goods driver licence

• holds or is applying to hold authority to

be a driving instructor (may vary between

jurisdictions).

In these cases the commercial standards apply.

Light rigid (LR) Any rigid vehicle greater

than 4.5 tonnes GVM or a

vehicle seating more than 12

adults that is not more than

8 tonnes, plus a trailer of no

more than 9 tonnes GVM

Medium rigid (MR) Any two-axle rigid vehicle

greater than 8 tonnes GVM,

plus a trailer of no more

than 9 tonnes GVM

Commercial standards apply at all times.

Heavy rigid (HR) Any rigid vehicle with 3 or

more axles greater than 8

tonnes GVM, plus a trailer of

no more than 9 tonnes GVM

Heavy combination (HC) Prime mover + single

semitrailer greater than 9

tonnes GVM and any unladen

converter dolly trailer

Multiple combination (MC) Heavy combination vehicle

with more than one trailer

Notes on national licence classes and standards:

• A person who does not meet the commercial vehicle

medical requirements may still be eligible to retain a

private vehicle driver licence. In such cases, both sets of

standards may need to be consulted.

• The driver licence authority periodic and medical

examination requirements for each licence class are

outlined in Appendix 1. Regulatory requirements

fordriver testing.

• The standards are intended for application to drivers

who drive within the ambit of ordinary road laws. Some

drivers, such as emergency service and ﬁrst responder

vehicle drivers (e.g. ambulance, ﬁre, police), are given

special exemptions from these laws. Due to the nature

of the work performed by these drivers (e.g. carrying

passengers who may be unrestrained on stretchers

or in locked vans, working shifts, under pressure) they

should have a risk assessment and an appropriate

level of medical standard applied by the employer. As a

minimum they should always be considered under the

commercial driver standard.

Licensing and medical ﬁtness to drive

PART A. Fitness to drive principles and practices

4.3. Prescribed periodic

medical examinations

for particular licensing/

authorisation classes

Some classes of driver are required to present

periodically for prescribed examinations based

on the standards as part of their licensing or

authorisation requirements.

Such requirements may vary between states and

territories and might apply, for example, to:

• drivers of vehicles that are physically dicult

to drive or require the capacity to monitor

many vehicle functions – for example,

multiple combinations

• drivers of vehicles for which the

consequences of a crash are usually serious

– for example, drivers holding a dangerous

goods driver licence or drivers of public

passenger vehicles.

There are also requirements in some states and

territories for older drivers to undergo periodic

medical assessment.

These requirements are determined and

directed by individual state and territory

driver licensing authorities and are outlined

in Appendix 1. Regulatory requirements

fordriver testing. Industry groups such as the

Australian Trucking Association and national

programs such as the Fatigue Management

Program under the National Heavy Vehicle

Accreditation Standard may also require drivers

to have periodic examinations; however,

the requirements of these programs are not

discussed speciﬁcally in this standard.

4.4. Conditional licences

4.4.1. What is a conditional licence?

A conditional licence provides a mechanism

for optimising driver and public safety while

maintaining driver independence when a driver

has a long-term or progressive health condition

or injury that may aect their ability to drive

safely. A conditional licence permits the driver to

drive in conditions that suit their capability – for

example, no night driving, only driving in familiar

areas (local area restriction) or having to wear

corrective lenses. A conditional licence identiﬁes

the need for medical treatments, vehicle

modiﬁcations or driving restrictions that would

enable the person to drive safely. It may also

specify a review period, after which the person

must undertake a medical review to establish

the status of their condition and their continued

ﬁtness to drive. A conditional licence therefore

oers an alternative to withdrawing a licence and

enables individual case-based decision making.

4.4.2. Who allocates a conditional

licence?

The ﬁnal decision regarding conditional licences

rests with the driver licensing authority (refer to

section 3.1. Roles and responsibilities of driver

licensing authorities). The decision is based

on information provided by the driver’s health

professional and on-road safety considerations.

The driver licensing authority will issue a

conditional licence to a driver with a long-term

injury or illness on the basis that any additional

road safety risk posed by the person driving is

acceptable.

PART A. Fitness to drive principles and practices

4.4.3. What is the role of the health

professional?

While the driver licensing authority makes the

ﬁnal decision about whether a driver is eligible

for a conditional licence, the health professional

provides information to assist the authority in its

decision making. The health professional should

advise the driver licensing authority of:

• which medical requirements (for an

unconditional licence) have not been met

(referring to medical criteria/thresholds

outlined in this document)

• the likely adequacy of treatments, driver

aides or vehicle modiﬁcations in optimising

driver capacity

• the plan to monitor the driver’s performance

and the medical condition, including

timeframes for review

• if appropriate, information relating to

possible licence conditions – for example,

vehicle type or licence restrictions such

as no night driving, radius restriction or

downgrading to a lower class of licence

• any other medical information that may be

relevant to the driving task.

This information is needed so the driver

licensing authority can make an informed

decision and determine what conditions will be

endorsed on the licence.

4.4.4. What sort of conditions/

restrictions may be recommended?

Examples of licence conditions, restrictions

or vehicle modiﬁcations are shown in Table

4. Examples of licence conditions that

may be required by the driver licensing

authority. These are indicative only and will

vary depending on the medical condition and

the type of licence. They include standard

conditions that will appear as codes on the

driver licence (e.g. corrective lenses, automatic

transmission, hand controls). They also include

conditions that are ‘advisory’ in nature and as

such may not appear on the actual licence

(e.g. take medication as prescribed, don’t drive

morethan a speciﬁed number of hours in any

24-hour period).

One option available to maintain a driver’s

independence despite a reduction in capacity is

to recommend that an area restriction be placed

on the licence. This eectively limits where

the person can drive and is most commonly

expressed as a kilometre radius restriction

based on their home address. Drivers should

be capable of managing usual driving demands

(e.g. negotiating intersections, giving way to

pedestrians) as required in their local area.

These licence conditions are only suitable for

drivers who can reasonably be expected to

understand and remember the limits as well as

reliably compensate for any functional declines.

The ability to respond appropriately and in a

timely manner to unexpected occurrences such

as roadworks or detours that require problem

solving should also be considered. Individuals

lacking insight or with signiﬁcant visual, memory

or cognitive-perceptual impairments are usually

not suitable candidates for a radius restriction

(e.g. refer to Part B section 6.1. Dementia).

The health professional can support a patient

in making an application for a conditional

licence by indicating the patient’s driving needs,

but the ﬁnal decision rests with the driver

licensingauthority.

Licensing and medical ﬁtness to drive

PART A. Fitness to drive principles and practices

Table 4. Examples of licence conditions that may be required by the driver licensing authority*

Examples of disability/situation Examples of licence conditions

Left leg disability Automatic transmission

Left arm disability Automatic transmission, steering aide

Short stature Built-up seat and pedals

Loss of bilateral leg function Hand-operated acceleration/brake controls

Reduced lower limb strength Power brakes required

Reduced upper limb strength Power steering required; steering aide

Short leg(s) Extended pedals

Hearing deﬁciency (commercial drivers) Hearing aid must be worn (commercial vehicles – assuming

hearing standard is met)

Deafness, both ears (commercial vehicle

driver – assuming meets speciﬁed hearing

standard)

Vehicle ﬁtted with two external rear-view mirrors and other

devices as required to assist external visual surveillance and

recognition of emergency vehicles (e.g. additional wide-angle

internal mirror, rear-view camera)

Visual acuity deﬁciency Prescribed corrective lenses must be worn

Loss of limb function Prosthesis must be worn

Degenerative medical conditions Periodic review by driver assessor

Night blindness Driving in daylight hours only

Age or medical condition-associated

impairments, forexample, attention

Driving during o-peak only; drive within a speciﬁed kilometre

radius of place of residence; in daylight hours only; no freeway

driving (local area restriction – see below for further description)

Spinal cord injury (above T12) Not to drive when the temperature is above 25°C unless the

vehicle is air-conditioned

Substance misuse (alcohol) Ignition interlock device

* These are not mandatory requirements and may be unsuitable in some circumstances.

PART A. Fitness to drive principles and practices

4.4.5. What monitoring is required

fora conditional licence?

Conditional licences should be subject to

periodic review so the medical condition,

disability or treatment, including the compliance

with treatments, can be monitored. The

frequency of formal review regarding licence

status is sometimes speciﬁed in this publication

but often is left to the judgement of the health

professional, given the variations in severity

and stability of a medical condition, disability or

treatment and the possible eects on driving.

In the course of providing advice about a

conditional licence, health professionals

shouldadvise the driver licensing authority

of the period for which a conditional licence

couldbe issued before formal review. This may

be months or years depending on the condition

in question and its progression; these reviews

dier from the ordinary follow-up consultations

that a health professional may be oering in the

course of general management.

At the time of a periodic review or during

general management of a patient’s condition,

it may become apparent that the patient

no longermeets the requirements of the

conditionallicence because their health has

deteriorated for some reason. The patient

should be advisedto inform the driver licensing

authority of their changed circumstances with

respect to ﬁtness to drive (refer to section 3.2.

Roles and responsibilities of drivers).

4.4.6. What about conditional

licences for commercial vehicle

drivers?

In addition to the examples in Table 4, the

driver licensing authority may consider issuing

a conditional commercial vehicle licence – for

example, in certain circumstances or situations

where crash risk exposure can be managed.

A case-by-case risk assessment is required

that considers relevant factors including

driver insight, stability of the health condition,

treatment compliance, nature of goods being

transported, size/complexity of the vehicle and

periodic review requirements. Examples of such

circumstances or situations may include:

• o-road driving of commercial vehicles

where licences are still required

• where driving is not the primary occupation

– for example, mechanics who need to test

drive the vehicle, primary producers who

need to get product to market and only need

to drive a couple of times a year and drivers

who need to move buses not carrying public

passengers within a bus depot or from a

nearby workshop.

In the case of commercial vehicle drivers, the

opinion of a medical specialist is generally

required for consideration of a conditional

licence – the main exceptions to this are set

out in the next paragraph and in section 4.4.7.

What if there is a delay before aspecialist can

be seen?. This requirement reﬂects the higher

safety risk for commercial vehicle drivers and the

consequent importance of expert opinion.

In areas where access to specialists may be

dicult, the driver licensing authority may agree

to a process in which:

• initial assessment and advice for the

conditional licence is provided by a

specialist

• ongoing periodic review for the conditional

licence is provided by the treating general

practitioner, with the cooperation of the

specialist.

Where appropriate, telemedicine is encouraged

to facilitate access to specialist opinion.

Licensing and medical ﬁtness to drive

PART A. Fitness to drive principles and practices

4.4.7. What if there is a delay before

aspecialist can be seen?

In the case of a commercial vehicle driver or

applicant for a commercial vehicle licence who

is assessed by a general practitioner as not

meeting the criteria to hold an unconditional

licence for one or more conditions but who

may meet the criteria to hold a conditional

licence, the driver licensing authority may permit

the person to drive, or to continue to drive, a

commercial vehicle pending assessment of the

person by an appropriate specialist(s) if:

• the person has an appointment to see

the relevant specialist(s) at the earliest

practicable opportunity

• in the opinion of the general practitioner

the condition is not, or the conditions are

not, likely to lead to acute incapacity or

loss of cognitive ability or insight before the

assessment or assessments occur.

Examples of such conditions include early

peripheral neuropathy, early rheumatoid arthritis

or diabetes treated by diet and exercise alone.

Examples of conditions that could lead to acute

incapacity or loss of concentration include

ischaemic heart disease, sleep apnoea and

blackouts (other than vasovagal).

In applying this section the driver licensing

authority may impose conditions on the licence.

4.5. Reinstatement of

licences or removal or

variation of licence

conditions

Situations may arise in which a medical

condition improves to such an extent that the

patient’s licence restriction may be reconsidered

by the driver licensing authority, resulting

in reinstatement of the licence or removal

or variation of licence conditions, including

requirements for periodic medical review.

Under such circumstances a letter or

notiﬁcation to this eect from the treating health

professional to the licensing authority (refer to

Appendix 2.2. Medical condition notiﬁcation

form) should include:

• details of the requirements now met which

were not previously met (refer to medical

criteria in this document)

• the response to treatment, interventions and/

or rehabilitation and the long-term prognosis

• the duration of improvement

• other relevant information including

consideration of the driving task (e.g. the

requirements of a person who drives

occasionally to the shops are likely to be

dierent from those of a person undertaking

extensive interstate travel or who drives

regularly as part of their employment/

voluntary work).

The driver licensing authority will consider

the request and advise the driver of their

determination; licence decisions may be

contingent on the requirement for the driver

or applicant to undertake and pass an on-road

evaluation to conﬁrm their driving abilities.

PART A. Fitness to drive principles and practices

5. Assessment and reporting process

–

stepby step

Assessing ﬁtness to drive is based on the

decision-making processes outlined in Figure 3.

Medical decision-making process for assessing

ﬁtness to drive. The nature and extent of the

examination will depend on the circumstances

and the reasons for the examination. Details of

the process and administrative requirements

are described in this section and are further

illustrated in Figure 4 and Figure 5. Note also

the further considerations outlined in section 3.

Roles and responsibilities.

Figure 3. Medical decision-making process for assessing ﬁtness to drive

Temporary condition

aecting driving

ability in the short

term

Examples: mydriatics,

general anaesthetic,

fractures

Long-term condition or disability

Examples: diabetes, cardiac, neurological, psychiatric, congenital, acquired brain

injury, cognitive impairment

Refer to requirements for licensing

Are the requirements for an unconditional licence met?

Ye s

Not sure

Fit to drive

• With no restrictions

Are the requirements

for a conditional

licence met?

Not ﬁt to drive in

short term

• Advise patient

of appropriate

temporary driving

restrictions.

• If not a licensing

issue, a report to

driver licensing

authority is not

required.

• May be a ﬁtness-

for-duty issue for

commercial vehicle

drivers – advise

driver to notify their

employer.

Fit to drive with

restrictions/

conditions on

licence

• Advise patient of

legal requirement

to notify driver

licensing authority.

• Advise/notify

driver licensing

authority directly as

appropriate (refer to

Figure 4 and Figure

5).

Not ﬁt to drive

• Advise patient of

legal requirement

to notify driver

licensing authority.

• Advise/notify

driver licensing

authority directly as

appropriate (refer to

Figure 4 and Figure

5).

Unsure of ﬁtness to

drive

• Refer to appropriate

specialist and/or

• Refer to practical

driver assessment

(section 2.3.1) and/or

• Refer to driver

licensing authority.

Assessment and reporting process – stepby step

PART A. Fitness to drive principles and practices

5.1. Steps in the

assessment and

reporting process

Step 1: Consider the type of licence

heldor applied for

The type of licence will determine whether

the commercial or private medical standards

are referred to. In the case of examinations

requested by a driver licensing authority, the

authority will identify the type of licence on the

request. In cases of assessment as part of an

ongoing therapeutic relationship, the health

professional will need to determine from the

patient what sort of driver licence or authority

they hold. Given the potential for patients to

withhold information if their mobility or livelihood

is threatened, it is helpful for health professionals

to be aware of their patients’ occupations as a

matter of course.

The health professional should refer to Table 3

to determine which standards to apply.

The medical standards for commercial vehicle

drivers are more stringent than those for drivers

of private vehicles. A person who is not eligible

for a commercial vehicle licence may still be

eligible for a private vehicle driver licence. In

such cases, both sets of standards may need to

be consulted.

Step 2: Establish relevant medical and

driving history

The nature and extent of this aspect of the

assessment will vary depending on the particular

circumstances. In the case of examinations

requested by a driver licensing authority for

the ﬁrst time, a detailed history will need to be

established including:

• whether the person has ever been found

unﬁt to drive a motor vehicle in the past, and

the reasons

• whether there is any history of epilepsy,

syncope or other conditions of impaired

consciousness including: sleep disorders;

neurological conditions; psychiatric

conditions; problems arising from alcohol

and/or drugs; diabetes; cardiovascular

conditions, especially ischaemic heart

disease; locomotor disorders; hearing or

visual problems

• whether the person has a history of motor

vehicle incidents (e.g. crashes, near misses,

driving oences, drink/drug driving)

• whether the person is taking medications

that might aect their driving ability

• the existence of other medical conditions

that, when combined, might exacerbate

any road safety risks (refer to section 2.2.8.

Multiple medical conditions)

• the degree of insight the patient has into

their ability to drive safely

• the nature of their current driving patterns

and needs – for example, how frequently

they drive, for what purposes, over what

distances and whether they travel at night.

Special examinations called ‘for cause’

examinations may be requested by the driver

licensing authority out of concern for driving

behaviour such as recurrent motor vehicle

crashes. Under such circumstances, it is

desirable that all aspects of the driver–vehicle–

road system (refer to Figure 1) be considered

– for example, fatigue factors in the case of

a commercial vehicle driver. A full medical

PART A. Fitness to drive principles and practices

history and history of any motor vehicle crashes

shouldbe taken and a complete physical

examination conducted.

While attention should be given to conditions

discussed in Part B of this publication, unusual

conditions or the eect of multiple small

disabilities aecting the driving task also warrant

consideration, investigation and, where justiﬁed,

specialist referral.

In cases of review assessments requested by

the driver licensing authority as a requirement

to maintain a conditional licence, the medical

history is likely to be well established and the

health professional may focus on the recent

status of the particular medical condition(s) and

the impacts on driving and general functionality.

In cases of assessment as part of an ongoing

therapeutic relationship, the medical history is

also likely to be well established; however, an

exploration of the person’s driving history may

be undertaken.

Step 3: Undertake a clinical examination

In the case of examinations requested by a

driver licensing authority, a comprehensive

clinical examination will generally be required;

this will involve assessing the functionality of

various body systems including physical and

cognitive functioning. The examination should

focus on determining the risk of the patient’s

involvement in a serious motor crash caused by

their inability to control the vehicle or inability

to act and react appropriately to the driving

environment.

This publication focuses on common conditions

known to aect ﬁtness to drive in the long-term

(Part B); however, it is not possible to deﬁne all

clinical situations where an individual’s overall

function would compromise public safety.

For example, where a person has a systemic

disorder or several co-occurring medical

conditions, there may be additive or cumulative

detrimental eects on judgement and overall

function (refer to section 2.2.8. Multiple medical

conditions).

Additional tests or referral to a specialist may be

required if and when clinical examination raises

the possibility of potentially signiﬁcant problems.

In cases of review assessments requested by

the driver licensing authority as a requirement

to maintain a conditional licence, the clinical

examination may focus on the status and

management of the particular medical

condition(s) while also considering other medical

issues that have developed and may impact on

driving and general functionality.

Step 4: Consider the clinical examination

results in conjunction with the patient’s

medical history, driving history and

driving needs

Upon consideration of the information available,

the health professional may draw one of a

number of conclusions about the patient’s

ﬁtness to drive:

1. The person has a temporary condition that

may aect their driving ability in the short

term but will not aect their licence status.

2. The person complies with all medical

requirements appropriate to the type of

licence held or requested.

3. The person does not meet the unconditional

licensing requirements, but medical

treatments and/or vehicle or driving

modiﬁcations may enable them to drive

safely under a conditional licence.

4. The person does not meet the medical

requirements for an unconditional or

conditional licence.

5. The health professional is in doubt about the

patient’s ﬁtness to drive.

Where doubt exists about a patient’s ﬁtness to

drive or when the patient’s particular condition or

Assessment and reporting process – stepby step

PART A. Fitness to drive principles and practices

circumstances are not covered precisely by the

standards, review by a specialist experienced in

managing the particular condition is warranted.

In cases where that specialist may still be

uncertain about the relative merits of a particular

case, a practical driver assessment is one option

that may be appropriate (refer to section 2.3.1.

Practical driver assessments). Clearance from

the driver licensing authority may be required

prior to an assessment taking place. Ultimately,

the case may need to be referred to the driver

licensing authority for evaluation.

Note: It is the driver licensing authority that

is ultimately responsible by law for making

the licensing decision. It is sucient for a

professional in such circumstances to prepare

a report for the driver licensing authority stating

the facts and their opinions clearly.

Where a condition of signiﬁcance with respect

to driving is suspected but not proven (e.g.

angina) the health professional should proceed

to investigate this. Where there is doubt about

the safety of the driver continuing to drive while

the condition is being investigated, the patient

should be advised accordingly (refer to section

2.2.4. Undierentiated conditions).

Step 5: Inform and advise the patient

Health professionals should routinely advise

patients about how their condition may impair

their ability to drive safely. As part of this

process, the patient becomes better informed

about the nature of their condition, the extent

to which they can maintain control over it, the

importance of periodic medical review and the

need for regular medication where appropriate.

In the case of temporary conditions that may

aect driving ability in the short term, the

examining health professional should provide

appropriate advice about not driving and should,

with the patient’s consent, seek support as

required from family members. Notiﬁcation to

the driver licensing authority is not required in

suchinstances.

In the case of an examination requested by a

driver licensing authority, the advisory process

is straightforward because the patient is actively

seeking an examination as part of a licence

application or renewal, or as a requirement of

a conditional licence. They will be expected to

return the report to the driver licensing authority

to complete the licensing process. Should the

patient be found not to meet the medical criteria,

the health professional will take a conciliatory

and supportive role while fully explaining

the risks posed by the patient’s condition

with respect to driving a vehicle. The health

professional should be particularly aware of the

needs of the patient whose livelihood is likely to

be aected because of the assessment ﬁndings.

There are also special considerations for dealing

with individuals who are not regular patients

(refer to section 3.3.4. Dealing with individuals

who are not regular patients).

The situation may be more challenging when

ﬁtness to drive is considered in the course

of a patient’s regular treatment and they

are found not to meet the medical criteria. In

such situations the health professional may be

seen by the patient to be making the licensing

decision even though this is not the case.

Nonetheless, where the health professional

believes that continued driving or continued

unconditional driving would likely be dangerous,

the patient should be informed of the risk to

themselves, and to others, of continuing to drive.

Where possible, it is helpful to involve a family

member or friend in this process. The driver

should be encouraged to report their condition

voluntarily to the driver licensing authority and

should be reminded of their legal obligation

todo so.

The standards in this publication should be

consulted when dealing with any such situation

since they carry an authority that is not imposed

on the driver by the health professional but by

the national consensus of the driver licensing

authorities.

PART A. Fitness to drive principles and practices

Information brochures may be available from the

driver licensing authority to support the patient

advisory process (refer to Appendix 9. Driver

licensing authoritycontacts). A range of driver

information resources are also listed in section

2.3.4. Information and assistance fordrivers.

Where patients are found not to meet the

medical criteria or when conditions or

restrictions are recommended, advice should

be provided regarding alternative means of

transport. Reference may also be made to

disabled car parking and taxi services (refer

to Appendix 6. Disabled car parking and

taxiservices).

Step 6: Report to the driver licensing

authority as appropriate

In the case of an examination requested by a

driver licensing authority, the reporting process

involves completing the relevant form provided

by the driver licensing authority via the patient.

Only information relevant to the patient’s ability

to drive should be included in the report, and it

should be signed by the examining professional.

The original of the medical report should be

provided to the patient to return to the driver

licensing authority and a copy should be kept

on ﬁle in the patient’s medical record. Since the

patient generally returns the medical report to

the driver licensing authority, there is no need

for signed consent in this regard. However, the

driver licensing authority may ask the patient to

provide signed consent for the driver licensing

authority to contact the health professional

to seek additional information about their

condition for the purposes of assessing their

ﬁtness to drive.

In the case of assessments made during

patient treatment, when encouraging patients

to self-report their condition to the driver

licensing authority, the health professional

should complete a copy of the Medical

condition notiﬁcation form (refer to Appendix

2.2. Medical condition notiﬁcation form) and

provide this to the patient to take to the driver

licensing authority. Some states and territories

may provide an online version of the medical

report for completion by health professionals.

It is recommended that the health professional

keeps a copy of the Medical condition

notiﬁcation form in the patient record. The

driver licensing authority will also accept a letter

describing the patient’s condition and the nature

of any driving restrictions recommended.

Providing a medical assessment report in an

accepted format will reduce the need for the

patient to attend on a second occasion for an

assessment requested by the driver licensing

authority. It will also reduce the time taken by

the driver licensing authority to review the case

and arrive at a decision about the patient’s driver

licence status, in turn reducing patient stress

and uncertainty.

If the health professional is aware that a patient

is continuing to drive and is likely to endanger

the public despite the health professional’s

advice and despite the driver’s own obligation

to report, reasonable measures to minimise that

danger will include notifying the driver licensing

authority. A copy of the model Medical condition

notiﬁcation form (refer to Appendix 2.2. Medical

condition notiﬁcation form) should be used

for this purpose, with additional information

provided as deemed necessary by the health

professional. The patient should be informed of

the health professional’s intent to report (refer to

section 3. Roles and responsibilities).

Cases where there is an immediate threat to

public safety may require the health professional

to exercise their duty of care in line with relevant

professional standards and report the driver to

the licensing authority or the police. This may

be appropriate in instances where there is a

high risk – for example drivers with a history of

reckless driving, crashes or intentions to cause

harm involving motor vehicles.

Assessment and reporting process – stepby step

PART A. Fitness to drive principles and practices

Step 7: Record keeping and sharing

Appropriate records need to be maintained

should the driver licensing authority require

more information. Medical specialists and others

(e.g. optometrists and occupational therapists)

should routinely, as part of best practice

patient management, share their ﬁtness-to-

drive assessments with the patient’s general

practitioner. This facilitates information sharing

and enhances review/management of long-term

health conditions and better care coordination.

The forms discussed above (refer to section 5.2.

Which forms to use) and included in Appendix

2. Forms are designed to assist with this.

Step 8: Follow-up

A health professional has no obligation to

contact the patient or driver licensing authority

to determine if the patient has reported their

condition to the driver licensing authority as

advised by the health professional. However,

it is appropriate that the health professional,

during future patient contacts, enquires about

their driving. This is particularly important for

public safety in cases where some cognitive

deterioration is detected or suspected. If the

patient continues to drive despite advice to

the contrary, the health professional should

consider notifying the driver licensing authority

as indicated above.

If the patient did not notify the driver licensing

authority and subsequently became involved

in a vehicle crash as a result of their condition/

illness, the health professional would not be

at risk unless it could be demonstrated that

they were aware of the patient’s continuing

driving and were also aware of the imminent

and serious risk (refer to section 3. Roles and

responsibilities).

PART A. Fitness to drive principles and practices

Figure 4. Conducting an examination at the request of a driver licensing authority (DLA)

DLA informs driver that licence refused and

advises right of appeal.

DLA requests report on patient’s ﬁtness to drive.

DLA provides driver with appropriate forms (medical report form) and may identify

licence type and reason for examination.

Health professional conducts examination using commercial and/or private standards.

Meets unconditional

requirements

Health professional

assesses that the patient

meets requirements for

an unconditional licence.

Health professional:

• completes the medical report in

accordance with ﬁndings

• provides original medical report

to the patient to return to the

DLA

• advises and counsels the

patient.

Meets conditional

requirements

Health professional

assesses that the

patient’s condition and

circumstances do not

meet unconditional

requirements but

may meet conditional

requirements.

Does not meet

requirements

Health professional

assesses that the

patient does not meet

medical requirements

for an unconditional or

conditional licence.

Not sure

Health professional is in

doubt.

Health professional:

• completes the medical report in

accordance with ﬁndings, noting

the:

» relevant details of the

patient’s condition

» the medical requirements

that are not met

» recommended conditions of

the licence, if appropriate,

and requirements for

ongoing monitoring and

periodic review

» recommended rehabilitation

if appropriate

• provides original medical report

to the patient to return to the

DLA

• advises and counsels the patient

accordingly

• retains a copy of the medical

report for medical ﬁle

• shares their report with the

patient’s GP to support eective

long-term management.

Health professional:

• if required, advises and counsels

the patient not to drive until

decision made by the DLA

• refers the patient to a specialist

if required

• if required, recommends/refers

the patient for a practical driver

assessment

• completes the medical report

in accordance with ﬁndings,

noting the reasons for doubt

in assessing the patient and

recommendations for further

assessment

• provides the original medical

report to the patient to return to

the DLA

• retains copy of medical report

for medical ﬁle

• shares their report with the

patient’s GP to support eective

long-term management.

Reporting to the DLA

via patient/driver

Reporting to the DLA

via patient/driver

Reporting to the DLA

via patient/driver

DLA may require a specialist

opinion or suggest a practical

driver assessment.

DLA considers medical reports, practical driver assessment (if conducted), driving record, options for rehabilitation

and retraining and other relevant information.

Licence granted

with or without restrictions or conditions

Licence not granted

or suspended/cancelled

DLA informs driver that licence issued/renewed

± restrictions/conditions.

Assessment and reporting process – stepby step

PART A. Fitness to drive principles and practices

Figure 5. Assessing and reporting on ﬁtness to drive in the course of patient treatment

Condition is diagnosed or the patient is subject to a procedure.

Health professional establishes whether the patient is a driver, motorbike or motortrike rider; establishes licence type

and conducts examination according to relevant standards (commercial and/or private standards).

Temporary

condition

Health professional

assesses condition

to temporarily aect

driving ability.

Meets

unconditional

requirements

Health professional

assesses that the

patient meets

requirements for

an unconditional

licence.

Meets

conditional

requirements

Health professional

assesses that the

patient’s condition

and circumstances

do not meet

unconditional

requirements

but may meet

conditional

requirements.

Does not meet

requirements

Health professional

assesses that the

patient does not

meet medical

requirements for

an unconditional or

conditional licence.

Not sure

Health professional

is unclear (diagnosis

and/or impact on

driving unclear)

(refer to section

2.2.4).

Health

professional:

• advises the

patient to abstain

from driving for

an appropriate

period.

Health

professional:

• if condition is

progressive,

continues

monitoring in

relation to ﬁtness

to drive in the

course of normal

treatment

• advises and

counsels

the patient

accordingly

• seeks patient

family support

where

appropriate

• maintains

appropriate

records of

examination.

Health professional:

• advises and counsels the patient about

the impact of their condition and the

need to restrict driving as appropriate

• completes Medical condition

notiﬁcation form for the patient

(Appendix 2.2) including details of

requirements not met

• recommends conditional licence and

driving restrictions if appropriate

• meets requirements for ongoing

monitoring and periodic review

• recommends rehabilitation

• provides a report to the patient and

advises them to notify the DLA

• advises the patient of their legal

obligations and implication of failure to

comply

• seeks family support for the patient if

appropriate

• retains copy of the report and other

forms for medical ﬁle

• shares their report with the patient’s

GP to support eective long-term

management.

Health professional:

• counsels the patient

and advises not to

drive until diagnosis

and impact on driving

is clear

• seeks specialist or

second opinion, or

considers referral

for practical driver

assessment

• advises the patient to

notify the DLA

• reviews to establish

deﬁnitive ﬁtness-to-

drive decision and

provides a report to

the patient to advise

the DLA

• maintains appropriate

records of examination.

No report submitted to the DLA

If the patient is unable to appreciate the impact of their condition or to take notice

of the health professional’s recommendations due to cognitive impairment or if

driving continues despite above measures and is likely to endanger the public,

consider reporting directly to the DLA while informing the patient.

Reporting to

the DLA via

patient/driver

DLA may seek

independent advice

Reporting to DLA via health professional

DLA considers medical reports, practical driver assessment (if conducted), driving record, options for rehabilitation

and retraining and other relevant information.

DLA informs driver of licence status and advises of right of appeal as applicable.

PART A. Fitness to drive principles and practices

5.2. Which forms to use

5.2.1. When conducting an

assessment at the request of a

driverlicensing authority

When conducting an assessment at the request

of a driver licensing authority, the key form is the

medical report. This form is the mechanism for

communication between the health professional

and the driver licensing authority about the

patient’s ﬁtness (or otherwise) to drive, albeit via

the patient/driver. It should be completed with

details of any medical requirements not met

as well as details of recommended restrictions

and monitoring requirements for a conditional

licence. For privacy reasons, only medical

information relevant to the patient’s ﬁtness to

drive should be included on this form.

The local driver licensing authority will provide

a blank report to the patient, who will present

it to their health professional for completion

and signing. Some driver licensing authorities

insert personal details on their medical report

forms before them issuing to a driver. In these

circumstances, drivers can only obtain the

form by attending a motor registry branch

or by calling the authority’s contact centre.

Electronic forms are also available from some

driver licence agencies and can be accessed

online or through some practice management

software systems. The completed form is

returned to the driver for forwarding to the driver

licensing authority. The forms used by each

state or territory dier in certain administrative

aspects but should contain the key elements

described in Appendix 2. Forms. Some states

or territories may provide an electronic or online

version of the medical report for completion by

healthprofessionals.

5.2.2. When assessing ﬁtness

to drive in the course of patient

treatment

If in the course of treatment it is considered

that a patient’s condition may aect their

ability to drive safely, the health professional

should, in the ﬁrst instance, encourage the

patient to report their condition to the driver

licensing authority. A standard form, Medical

condition notiﬁcation form, has been produced

to facilitate this process. Refer to Appendix

2.2. Medical condition notiﬁcation form or

visit www.austroads.com.au. If necessary, the

health professional may feel obliged to make a

report directly to the driver licensing authority

using a copy of this form. Most driver licensing

authorities will also accept a letter from the

treating practitioner or specialist. Please ensure

adequate driver identifying details are included

(e.g. driver full name, address, date of birth).

Note that such reporting is not required for

temporary conditions. Such conditions do

not have an impact on licence status (refer to

section 2.2.3. Temporary conditions), but the

patient should be advised not to drive until the

temporary situation is resolved.

Assessment and reporting process – stepby step

PART A. Fitness to drive principles and practices

References and further reading

1. Charlton, J. L. & Monash University Accident

Research Centre. Inﬂuence of chronic

illness on crash involvement of motor

vehicle drivers. (Monash University Accident

Research Centre, 2010).

2. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

3. Australian and New Zealand College

of Anaesthetists. Guideline for the

perioperative care of patients selected

forday stay procedures. (2018).

4. Royal Australian College of General

Practitioners. RACGP aged care clinical

guide (Silver Book). (2021).

5. Royal Australian College of General

Practitioners. Guidelines for preventive

activities in general practice (Red Book),

9thedition. (2016).

6. Wallis, K. A., Matthews, J. & Spurling, G. K.

Assessing ﬁtness to drive in older people:

the need for an evidence-based toolkit

in general practice. Medical Journal of

Australia 212, 396-398.e1 (2020).

7. Pomidor, A. et al. Clinician’s guide to

assessing and counseling older drivers.

(The American Geriatrics Society, 2019).

8. Falkenstein, M., Karthaus, M. & Brüne-Cohrs,

U. Age-related diseases and driving safety.

Geriatrics (Switzerland) vol. 5 1–28 (2020).

9. Allan, C., Coxon, K., Bundy, A., Peattie,

L. & Keay, L. DriveSafe and DriveAware

assessment tools are a measure of driving-

related function and predicts self-reported

restriction for older drivers. Journal of

Applied Gerontology 35, 583–600 (2016).

10. Unsworth, C., Pallant, J., Russel, K. & Odell,

M. OT–DORA Battery: Occupational therapy

driver o-road assessment battery. (AOTA

Press, 2011).

11. Hines, A. & Bundy, A. C. Predicting driving

ability using DriveSafe and DriveAware

in people with cognitive impairments: a

replication study. Australian Occupational

Therapy Journal 61, 224–229 (2014).

12. Unsworth, C. A. et al. Development of a

standardised occupational therapy – driver

o-road assessment battery to assess

older and/or functionally impaired drivers.

Australian Occupational Therapy Journal

59, 23–36 (2012).

13. Parekh, V. Psychoactive drugs and driving.

Australian Prescriber 42, 182–185 (2019).

14. EMCDDA. Drug use, impaired driving and

trac accidents - 2nd edition. (European

Monitoring Centre for Drugs and Drug

Addiction, 2014).

15. Arkell, T. R. et al. Eect of cannabidiol

and Δ9-tetrahydrocannabinol on driving

performance: a randomized clinical trial.

JAMA 324, 2177–2186 (2020).

16. RACGP. Use of medical cannabis products.

Position statement (2019).

17. Hartman, R. L. & Huestis, M. A. Cannabis

eects on driving skills. Clinical Chemistry

vol. 59 478–492 (2013).

PART A. Fitness to drive principles and practices

18. Ramaekers, J. G. Driving under the inﬂuence

of cannabis an increasing public health

concern. JAMA 319, 1433–1434 (2018).

19. Arnold, J. C., Nation, T. & McGregor, I. S.

Prescribing medicinal cannabis. Australian

Prescriber 43, 152–159 (2020).

20. Bosker, W. M. et al. Medicinal Δ

9-tetrahydrocannabinol (dronabinol)

impairs on-the-road driving performance of

occasional and heavy cannabis users but

is not detected in Standard Field Sobriety

Tests. Addiction 107, 1837–1844 (2012).

21. Chesney, E. et al. Adverse eects of

cannabidiol: a systematic review and

meta-analysis of randomized clinical trials.

Neuropsychopharmacology 45, 1799–1806

(2020).

22. Broyd, S. J., van Hell, H. H., Beale, C., Yücel,

M. & Solowij, N. Acute and chronic eects

of cannabinoids on human cognition – a

systematic review. Biological Psychiatry vol.

79 557–567 (2016).

23. TGA. Guidance for the use of medicinal

cannabis in Australia Overview. (2017).

24. TGA. Safety of low dose cannabidiol.

(2020).

25. McCartney, D., Arkell, T. R., Irwin, C.

& McGregor, I. S. Determining the

magnitude and duration of acute Δ9-

tetrahydrocannabinol (Δ9-THC)-induced

driving and cognitive impairment: a

systematic and meta-analytic review.

Neuroscience & Biobehavioral Reviews 126,

(2021).

26. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part B:

Benzodiazepines. (2015).

27. Royal Australian College of Physicians.

Prescription opioid policy – improving

management of chronic non-malignant pain

and prevention of problems associated with

prescription opioid use. (2009).

28. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part C1:

Opioids. (2017).

29. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part C2:

The role of opioids in pain management.

(2017).

30. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part A:

Clinical governance framework. (2015).

31. Australian and New Zealand College of

Anaesthetists. Faculty of Pain Management:

Statement regarding the use of opioid

analgesics in patients with chronic non-

cancer pain. (2020).

32. Di Stefano, M. & Ross, P. VicRoads

Guidelines for occupational therapy driver

assessors, 3rd edition, Melbourne, Australia:

Roads Corporation Victoria (2018).

33. Golisz, K. Occupational therapy

interventions to improve driving

performance in older adults: a systematic

review. American Journal of Occupational

Therapy vol. 68 662–669 (2014).

34. Unsworth, C. A. & Baker, A. Driver

rehabilitation: a systematic review of the

types and eectiveness of interventions

used by occupational therapists to improve

on-road ﬁtness-to-drive. Accident Analysis

and Prevention 71, 106–114 (2014).

Assessment and reporting process – stepby step

PART A. Fitness to drive principles and practices

35. Classen, S. & Brooks, J. Driving simulators

for occupational therapy screening,

assessment, and intervention. Occupational

Therapy in Health Care 28, 154–162 (2014).

36. Spindle, T. R., et al. Acute eects of smoked

and vaporized cannabis in healthy adults

who infrequently use cannabis: a crossover

trial. JAMA Network Open, vol. 1 7, e184841.

(2018).

37. Vandrey, R., et al. Pharmacokinetic proﬁle

of oral cannabis in humans: blood and

oral ﬂuid disposition and relation to

pharmacodynamic outcomes. Journal of

Analytical Toxicology, vol. 41 2, 83–99.

(2017).

PART A. Fitness to drive principles and practices

PART B.

Medical

standards

PART A. Fitness to drive principles and practices PART B. Medical Standards

Fitness to drive assessment

Fitness to drive decision-making process and key assessment considerations

Temporary condition

aecting driving

ability in the short

term

Long-term condition, disability or treatment aecting drivingability

Are the requirements for an unconditional licence met?

Ye s

Not sure

Fit to drive

Are the requirements for a

conditional licence met?

Unﬁt to drive in

short term

Fit to drive with

restrictions/

conditions on licence

Not ﬁt to drive

Unsure of ﬁtness to

drive

Key assessment steps and questions

; Establish the medical and driving history and consider the licence type

• Note on the medical report if consulting with a person for the ﬁrst time without access to their

clinical history

; Undertake a clinical examination and consider the results, patient history and driving needs

• Could fatigued driving exacerbate the person’s condition or medications?

• Are there comorbidities that individually or additively impair driving ability?

• Does the person rely on other body systems for adaptation or compensation? Have these been

assessed?

; Inform and advise the patient of their ﬁtness to drive and any driving restrictions

• Is the patient capable of understanding, retaining or complying with this advice?

• For progressive conditions, plan for the potential impacts on future driving ability

; Report to the driver licensing authority as appropriate

• Check the legal requirements for reporting with the local driver licensing authority

• Consider reporting to the driver licensing authority if the person continues driving despite

appropriate advice and is likely to endanger the public

; Record keeping, sharing and follow-up

• Document the advice in the person’s patient ﬁle

• Has your advice been shared with the patient’s referring GP and/or other treating physicians?

PART B. Medical standards

Assessment and licensing responsibilities, obligations and considerations

DRIVER HEALTH PROFESSIONAL DRIVER LICENSING AUTHORITY

Responsible for meeting licensing

obligations and managing their

health conditions

Assesses driving ﬁtness by:

• evaluating conditions against

the medical standards

• providing advice to the driver on

their ﬁtness to drive

Makes the ﬁnal licensing decision

based on:

• private and commercial

licensing standards

• medical advice and driver

information

Licensing obligations

• Follow licensing requirements,

including licence conditions or

driving restrictions

• Report health changes within a

reasonable timeframe

• Follow medical advice

• Provide accurate information

to health professionals and the

driver licensing authority

Medical and physical conditions

aecting driving

• Temporary conditions

• Substance misuse and

intoxication

• Chronic illness and conditions

• Disabilities

• Age-related changes

• Multiple medical conditions

• Medications and other

treatments

Medical advice and driver

information

• Advice from medical

professionals

• Advice from independent

medical panels

• Recommendations for licence

conditions

• Periodic medical review

• Driving history

Health professional’s advice

• Supports drivers to understand

the impact of their condition and

meet their licensing obligations

• Supports driver licensing

authority make ﬁnal decision

Driver licensing decision

• Issue

• Renew

• Apply a condition

• Suspend

• Cancel

Further information

• The driving task and assessing medical conditions refer to Part A section 2. Assessing

ﬁtness to drive – generalguidance

• Roles, responsibilities and reporting options refer to Part A section 3. Roles and

responsibilities

• Driver licensing standards and conditional licensing refer to Part A section 4. Licensing and

medical ﬁtness to drive

• Step-by-step guidance to performing an assessment refer to Part A section 5. Assessment

and reporting process – stepby step

Assessment and reporting process – stepby step

PART B. Medical standards

1. Blackouts

1.1. Relevance to the

driving task

For the purposes of this standard, the term

‘blackout’ means a transient impairment or

loss of consciousness. Loss of consciousness

is clearly incompatible with safe driving.

The evidence for crash risk associated with

various causes of blackout is discussed in

the relevant chapters. This chapter provides

guidance regarding the general management

of blackouts,with cross-reference to relevant

chapters as per Figure 6. Management of

blackouts and driving.

1.2. General assessment

and management

guidelines

1.2.1. General considerations

1–4

Blackouts may occur due to a range of

mechanisms including:

• vasovagal syncope or ‘faint’, which accounts

for more than 50 per cent of blackouts and

may be due to factors such as hot weather,

emotion or venepuncture but may also be

due to more serious causes that may recur

• syncope due to other cardiovascular causes

such as structural heart disease, arrhythmias

or vascular disease

• epileptic seizure, which accounts for less

than 10 per cent of blackouts

• other causes including metabolic causes

(e.g. hypoglycaemia), drug intoxication or a

sleep disorder.

Determination of the mechanism of a blackout

may be straightforward based on history,

investigations and specialist referral, and the

person may be managed as per the appropriate

chapter. Alternatively, it may require extensive

cardiovascular and neurological investigations

and referral to several specialists. People should

be advised not to drive until the mechanism is

ascertained and the corresponding standard met.

Some drivers may attribute a crash or driving

mishap to a ‘blackout’ to excuse an event

that occurred for some other reason such as

inattention or distraction (e.g. a mobile phone

conversation). There will also be a small

proportion of cases in which a clear cause

cannot be established.

1.2.2. Vasovagal syncope

The most common cause of transient loss of

consciousness is vasovagal syncope (‘fainting’).

Where this has been triggered by a well-deﬁned

provoking factor or a situation that is unlikely

to recur while driving (e.g. prolonged standing,

venepuncture or emotional situation), it is not

necessary to restrict driving. However, vasovagal

syncope may also result from other causes

that are not so benign. In such cases, ﬁtness

to drive should be assessed according to the

cardiovascular conditions standards for syncope

(refer to section 2. Cardiovascular conditions).

1.2.3. Blackouts due to medical

causes not covered in the standards

If the cause of the blackout is determined

to be a medical condition not covered in

the standards, then ﬁrst principles regarding

ﬁtness to drive should be applied (refer to

Part A section 2. Assessing ﬁtness to drive

– generalguidance). Considerations include

the likelihood of recurrence of blackout and

the treatability of the condition as well as the

nature of the driving task. There should also be

an appropriate review period. A more stringent

approach should be considered for commercial

vehicle drivers.

PART B. Medical standards

1.2.4. Blackouts of undetermined

mechanism

If, despite extensive investigation, the

mechanism of a blackout cannot be determined,

ﬁtness to drive should be assessed according

to section 1.3. Medical standards for licensing.

The standards for blackout of undetermined

mechanism are similar to those for seizure.

1.3. Medical standards

for licensing

Requirements for unconditional and conditional

licences are outlined in the following tables.

Health professionals should familiarise

themselves with the information in this chapter

and the tabulated standards before assessing a

person’s ﬁtness to drive.

Where a ﬁrm diagnosis has been made, the

standard appropriate to the condition should

be referred to in this publication (refer to Figure

6. Management of blackouts and driving). For

blackouts due to medical causes not covered

in the standard, refer to ﬁrst principles (refer to

Part A section 2. Assessing ﬁtness to drive –

generalguidance). For blackouts where, after

investigation, it is not possible to diagnose one

of the conditions covered elsewhere in this

publication, refer to the table for blackouts of

uncertain nature over the page.

Figure 6. Management of blackouts and driving

Blackout

(may be while driving or in other circumstances)

Advise not to drive until the corresponding standard is met:

history, investigations, referral (as needed)

Syncope

Epilepsy/

seizure

Hypogly-

caemic event

Drug or

alcohol

misuse

Sleep

disorders

Other

Undeter-

mined

Refer to

section

6.2.

Seizures

and

epilepsy

Refer to

section 3.

Diabetes

mellitus

Refer to

section

8. Sleep

disorders

Refer to

General

guidance:

Part A,

section 2

Refer to the

table entry

on blackouts

of uncertain

nature

Refer to

section 9.

Substance

misuse

Vasovagal with cause unlikely

to occur when driving

Other causes

Fit to drive

Refer to section 2.

Cardiovascular conditions

Blackouts

PART B. Medical standards

Medical standards for licensing

–

blackouts of uncertain nature

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition in

Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Blackouts –

episode(s)

or impaired

consciousness

– of uncertain

nature

A person should not drive for 6

months following a single blackout of

undetermined nature.

A person should not drive for 12 months

following two or more blackouts of

undetermined nature separated by a 24-

hour period.

A person is not ﬁt to hold an unconditional

licence:

• if the person has experienced blackouts

that cannot be diagnosed as syncope,

seizure or another condition.

If there has been a single blackout or more

than one blackout within a 24-hour period,

a conditional licence may be considered

by the driver licensing authority subject to

at least annual review, taking into account

information provided by the treating doctor

as to whether the following criterion is met:

• there have been no further blackouts for

at least 6 months.

If there have been two or more blackouts

separated by at least 24 hours, a

conditional licence may be considered by

the driver licensing authority subject to at

least annual review, taking into account

information provided by the treating doctor

as to whether the following criterion is met:

• there have been no further blackouts for

at least 12 months.

A person should not drive for 5

years following a single blackout of

undetermined nature.

A person should not drive for 10 years

following two or more blackouts of

undetermined nature separated by a 24-

hour period.

A person is not ﬁt to hold an unconditional

licence:

• if the person has experienced blackouts

that cannot be diagnosed as syncope,

seizure or another condition.

If there has been a single blackout or more

than one blackout within a 24-hour period,

a conditional licence may be considered

by the driver licensing authority subject to

at least annual review, taking into account

information provided by an appropriate

specialist as to whether the following

criterion is met:

• there have been no further blackouts for

at least 5 years.

If there have been two or more blackouts

separated by at least 24 hours, a

conditional licence may be considered by

the driver licensing authority subject to at

least annual review, taking into account

information provided by an appropriate

specialist as to whether the following

criterion is met:

• there have been no further blackouts for

at least 10 years.

PART B. Medical standards

Medical standards for licensing

–

blackouts of uncertain nature

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition in

Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Exceptional cases Where a person with one or more blackouts

of undetermined mechanism does not

meet the standards above for a conditional

licence but may, in the opinion of the

treating specialist, be safe to drive, a

conditional licence may be considered by

the driver licensing authority, subject to at

least annual review:

• if the driver licensing authority, after

considering information provided by the

treating specialist(s), considers that the

risk of a crash caused by a blackout is

acceptably low.

Where a person with one or more blackouts

of undetermined mechanism does not

meet the standards above for a conditional

licence but may, in the opinion of the

treating specialist, be safe to drive, a

conditional licence may be considered by

the driver licensing authority, subject to at

least annual review:

• if the driver licensing authority, after

considering information provided by the

treating specialist(s), considers that the

risk of a crash caused by a blackout is

acceptably low.

Blackouts

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

PART B. Medical standards

References and further reading

1. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

2. Chee, J. N. et al. A systematic review of the

risk of motor vehicle collision in patients with

syncope. Canadian Journal of Cardiology

37, 151–161 (2021).

3. Shen, W. K. et al. 2017 ACC/AHA/

HRS guideline for the evaluation and

management of patients with syncope:

A report of the American College of

Cardiology/American Heart Association task

force on clinical practice guidelines and the

Heart Rhythm Society. Circulation 136, e60–

e122 (2017).

4. Sorajja, D. et al. Syncope while driving.

Clinical characteristics, causes, and

prognosis. Circulation 120, 928–934 (2009).

5. Moya, A. et al. Guidelines for the diagnosis

and management of syncope (version

2009). European Heart Journal 30, 2631–

2671 (2009).

6. Tan, V. H., Ritchie, D., Maxey, C. & Sheldon,

R. Prospective assessment of the risk of

vasovagal syncope during driving. JACC:

Clinical Electrophysiology 2, 203–208

(2016).

Blackouts

PART B. Medical standards

2. Cardiovascular conditions

2.1. Relevance to the

driving task

2.1.1. Eects of cardiovascular

conditions on driving

Cardiovascular conditions may aect the ability

to drive safely due to sudden incapacity such

as from a heart attack or arrhythmia. They may

also aect concentration and the ability to

control a vehicle due to the onset of chest pain,

palpitations or breathlessness.

Cardiovascular conditions may also have end-

organ eects such as on the brain (stroke),

the extremities and the eyes. The relevant

chapters should be referred to for advice on the

assessment and requirements for these eects

(refer to section 6. Neurological conditions and

section 10. Vision and eye disorders).

2.1.2. Eects on the heart

A further problem in those who have established

ischaemic heart disease is that situations

experienced while driving may lead to a faster

heart rate and ﬂuctuation in blood pressure,

which could trigger angina or even infarction.

2.1.3. Evidence of crash risk

1,2

Evidence suggests that people who have severe

and even fatal heart attacks while driving may

have enough warning to slow down or stop

before losing consciousness, since less than half

of such attacks result in property damage and

injury. However, sometimes no warning occurs

or a warning sign is misinterpreted or ignored,

and this may result in severe injury or death

to the driver and other road users. The quality

of available evidence is variable and there

are a number of sources of potential bias, so

drawing clear conclusions is not always possible

(refer toPart A section 1.5. Development and

evidence base).

2.2. General assessment

and management

guidelines

–

2.2.1. Non-driving periods

A number of cardiovascular incidents and

procedures aect short-term driving capacity as

well as long-term licensing status – for example,

acute myocardial infarction and cardiac surgery.

Such situations present an obvious driving

risk that cannot be addressed by the licensing

process in the short term. The person should

be advised not to drive for the appropriate

period, as shown in Table 5. Suggested non-

driving periods after cardiovascular events or

procedures.

The variation in non-driving periods reﬂects the

varying eects of these conditions and is based

on expert opinion. These non-driving periods

are minimum advisory periods only and are

not enforceable by the licensing process. The

recommendations regarding long-term licence

status (including conditional licences) should be

considered once the condition has stabilised

and driving capacity can be assessed as per the

licensing standards outlined in this chapter.

2.2.2. Ischaemic heart disease

In people with ischaemic heart disease, the

severity rather than the mere presence of

ischaemic heart disease should be the primary

consideration in assessing ﬁtness to drive.

PART B. Medical standards

Health professionals should consider any

symptoms of sucient severity to be a risk

while driving. Those who have had a previous

myocardial infarction or similar event are at

greater risk of recurrence than the normal

population, so cardiac history is an important

consideration. An electrocardiogram (ECG)

should be performed if clinically indicated.

Exercise testing

The Bruce protocol or equivalent is

recommended for formal exercise testing.

Where a patient is not capable of performing

a treadmill test due to a medical condition,

for example osteoarthritis of the knee, an

equivalent stress test may be used. Nomograms

for assessing functional capacity are shown in

Figure 7 and Figure 8.

Suspected angina pectoris

Where chest pains of uncertain origin are

reported, every attempt should be made

to reach a diagnosis. In the meantime, the

person should be advised to restrict their

driving until their licence status is determined,

particularly in the case of commercial vehicle

drivers. If the tests are positive or the person

remains symptomatic and requires antianginal

medication to control symptoms, the

requirements listed for proven angina pectoris

apply (refer to page 73).

Risk factors

Multiple risk factors interact in the development

of ischaemic heart disease and stroke.

These factors include age, gender, blood

pressure, smoking, total cholesterol:HDL ratio,

diabetes and ECG evidence of left ventricular

hypertrophy. The combined eect of these

factors on risk of cardiovascular disease may be

calculated using the Australian Cardiovascular

Risk Charts (an electronic calculator is available

at www.cvdcheck.org.au).

Routine screening for these risk factors is not

required for licensing purposes, except where

speciﬁed for certain commercial vehicle drivers

as part of their additional accreditation or

endorsement requirements. However, when

a risk factor such as high blood pressure is

being managed, it is good practice to assess

other risk factors and to calculate overall risk.

This risk assessment may be helpful additional

information in determining ﬁtness to drive,

especially for commercial vehicle drivers (refer

also to section 2.2.3. High blood pressure).

Cardiovascular conditions

PART B. Medical standards

Table 5. Suggested non-driving periods after cardiovascular events or procedures

Event/procedure Minimum non-driving

period (advisory)

–

private vehicle drivers

Minimum non-driving period

(advisory)

–

commercial

vehicle drivers

Ischaemic heart disease

Acute myocardial infarction 2 weeks 4 weeks

Percutaneous coronary intervention – for

example, for angioplasty

2 days 4 weeks

Coronary artery bypass grafts 4 weeks 3 months

Disorders of rate, rhythm and conduction

Cardiac arrest 6 months 6 months

Implantable cardioverter deﬁbrillator

(ICD) insertion

6 months after cardiac

arrest

6 months for primary prevention

Not applicable for secondary

prevention

Generator change of an ICD 2 weeks 2 weeks for primary prevention

Not applicable for secondary

prevention

ICD therapy associated with symptoms

of haemodynamic compromise

4 weeks Not applicable

Cardiac pacemaker insertion 2 weeks 4 weeks

Vascular disease

Aneurysm repair 4 weeks 3 months

Valvular replacement (including

treatment with MitraClips and

transcutaneous aortic valve replacement)

4 weeks 3 months

PART B. Medical standards

Event/procedure Minimum non-driving

period (advisory)

–

private vehicle drivers

Minimum non-driving period

(advisory)

–

commercial

vehicle drivers

Other

Deep vein thrombosis 2 weeks 2 weeks

Heart/lung transplant 6 weeks 3 months

Ventricular assist device 3 months Not applicable

Pulmonary embolism 6 weeks 6 weeks

Syncope (due to cardiovascular causes) 4 weeks 3 months

2.2.3. High blood pressure

The cut-o blood pressure values at which

a person is considered unﬁt to hold an

unconditional licence do not reﬂect usual goals

for managing hypertension. Rather, they reﬂect

levels that are likely to be associated with

sudden incapacity due to neurological events

(e.g. stroke). The cut-o points are based on

expert opinion.

It is a general requirement that conditional

licences for commercial vehicle drivers are

issued by the driver licensing authority based

on the advice of an appropriate medical

specialist and that these drivers are reviewed

periodically by the specialist to determine

their ongoing ﬁtness to drive (refer to Part A

section 4.4. Conditional licences). In the case

of high blood pressure, ongoing ﬁtness to

drive may be assessed by the treating general

practitioner, provided this is mutually agreed by

the specialist and the general practitioner. The

initial recommendation of a conditional licence

must, however, be based on the opinion of

thespecialist.

2.2.4. Cardiac surgery (open chest)

Cardiac surgery may be performed for various

reasons including valve replacement, excision of

atrial myxoma and correction of septal defects.

In some cases this is curative of the underlying

disorder and so will not aect licence status

for private or commercial vehicle drivers (refer

also to Table 5. Suggested non-driving periods

after cardiovascular events or procedures). In

other cases, the condition may not be stabilised,

and the eect on driving safety and hence on

licence status needs to be individually assessed.

All cardiac surgery patients should be advised

regarding safety of driving in the short term as

for any other post-surgery patient (e.g. taking

into account the limitation of chest and shoulder

movements after sternotomy).

2.2.5. Disorders of rate, rhythm or

conduction

People with recurrent arrhythmias causing

syncope or pre-syncope are usually not ﬁt to

drive. A conditional licence may be considered

after appropriate treatment and an event-free

non-driving period (refer to Table 5. Suggested

non-driving periods after cardiovascular events

or procedures).

Cardiovascular conditions

PART B. Medical standards

2.2.6. Implantable cardioverter

deﬁbrillators

6,7

People ﬁtted with an implantable cardioverter

deﬁbrillator (ICD) have a risk of sudden

incapacity, which poses a crash risk. The risk

is mainly a consequence of the underlying

condition; however, there is also a risk of

inappropriate discharge of the device (i.e. when

there is no ventricular arrhythmia). This risk

is considered unacceptable for commercial

vehicle drivers to hold an unconditional licence.

A conditional commercial licence may be

considered by the driver licensing authority on

the advice of a specialist in electrophysiology

based on the nature of the driving tasks and

criteria outlined in the medical standards

table when the device is inserted for primary

prevention. A person is not ﬁt to hold a

conditional commercial licence when the ICD is

inserted for secondary prevention.

2.2.7. Aneurysms

Thoracic aortic aneurysms are largely

asymptomatic until a sudden and catastrophic

event occurs, such as rupture or dissection.

Such events are rapidly fatal in a large

proportion of patients. Risk varies with the

type and size of aneurysm. The standard is set

more stringently for atherosclerotic aneurysms

or aneurysms associated with bicuspid aortic

valve, compared with aneurysms associated

with genetic aortopathy, including Marfan’s,

Turner’s and Ehlers-Danlos syndromes, and

familialaortopathy.

2.2.8. Long-term anticoagulant

therapy

Long-term anticoagulant therapy may be used to

lessen the risk of emboli in disorders of cardiac

rhythm, following valve replacement, for deep

venous thrombosis and other similar conditions.

If not adequately controlled, there is a risk of

bleeding that, in the case of an intracranial

bleed, may acutely aect driving. People on

private vehicle licences may drive without

licence restriction and without reporting to the

driver licensing authority if the treating doctor

considers anticoagulation is maintained at the

appropriate level for the underlying condition.

Commercial vehicle drivers do not meet the

requirements for an unconditional licence and

may drive only with a conditional licence.

2.2.9. Deep vein thrombosis and

pulmonary embolism

While deep vein thrombosis (DVT) may lead to

an acute pulmonary embolus (PE), there is little

evidence that such an event causes crashes.

Therefore, no standard applies for either DVT

or PE, although non-driving periods are advised

(refer to Table 5. Suggested non-driving periods

after cardiovascular events or procedures).

If long-term anticoagulation treatment is

prescribed, the standard for anticoagulant

therapy should be applied (refer to section

2.2.8. Long-term anticoagulant therapy).

2.2.10. Syncope

2,9–11

If an episode of syncope is vasovagal in

nature with a clear-cut precipitating factor

(such as venesection), and the situation is

unlikely to occur while driving, the person may

generally resume driving within 24 hours. With

syncope due to other cardiovascular causes,

an appropriate non-driving period should be

advised (at least four weeks for private vehicle

drivers and at least three months for commercial

vehicle drivers), after which time their ongoing

ﬁtness to drive should be assessed (refer to

page 89). In cases where it is not possible to

determine an episode of loss of consciousness

is due to syncope or some other cause, refer

to section 1.2.4. Blackouts of undetermined

mechanism.

PART B. Medical standards

2.2.11. Ventricular assist devices

12–14

A ventricular assist device (VAD) is an

electromechanical circulatory device used to

partially or completely replace the function of

a failing heart. Some VADs are intended for

short-term use, typically for patients recovering

from heart attacks or heart surgery. Others are

intended for long-term use (months to years and

in some cases for life), typically for heart failure.

They carry a small risk of stroke or device failure.

The driver licensing authority may consider a

conditional licence for a private driver with a

LVAD or BiVAD, but not for commercial drivers.

As part of ongoing recovery, patients should

undergo a rehabilitation program to ensure

conﬁdence in using the equipment.

People with very severe heart failure may have

persisting cognitive or neurological impairment

and warrant a practical driving assessment

(refer to Part A section 2.3.1. Practical driver

assessments).

2.2.12. Congenital disorders

The impact of congenital heart disorders on

driving safety relates to the eects of the

congenital lesion on systemic ventricular

function and complicating arrhythmias.

Pacemakers and ICDs are employed in the

management of some individuals with congenital

heart disease. People on private vehicle

licences may drive without licence restriction

and without reporting to the driver licensing

authority if they have uncomplicated congenital

heart disease with no or minimal haemodynamic

eect (e.g. pulmonary stenosis, atrial septal

defect, small ventricular septal defect, bicuspid

aortic valve, patent ductus arteriosus or mild

coarctation of the aorta), and there are no or

minimal symptoms (chest pain, palpitations,

breathlessness).

The relevant sections on atrial ﬁbrillation,

paroxysmal arrhythmias, implantable

cardioverter deﬁbrillators, cardiac pacemaker

and heart failure may also apply to drivers with

complex congenital heart disease.

Cardiovascular conditions

PART B. Medical standards

Figure 7. Bruce protocol nomogram for men

SEDENTARY

-20

-10

ACTIVE

-20

-10

FUNCTIONAL AEROBIC IMPAIRMENT %

AGE

MINUTES OF DURATION (Multistage Treadmill Test)

LEV.

SEC.

MEN

900

840

780

720

660

600

540

480

420

360

300

240

180

120

III

MEN

Reproduced with permission Department of Cardiology, School of Medicine, University of Washington.

PART B. Medical standards

Figure 8. Bruce protocol nomogram for women

SEDENTARY

-20

-10

AGE

MINUTES OF DURATION (Multistage Treadmill Test)

LEV.

SEC.

WOMEN

900

840

780

720

660

600

540

480

420

360

300

240

180

120

III

FUNCTIONAL AEROBIC IMPAIRMENT %

ACTIVE

-20

-10

WOMEN

Reproduced with permission

Department of Cardiology, School of Medicine, University of Washington.

Cardiovascular conditions

PART B. Medical standards

2.3. Medical standards

for licensing

2.3.1. Medical criteria

Requirements for unconditional and conditional

licences are outlined in the following tables.

Health professionals should familiarise

themselves with the information in this chapter

and the tabulated standards before assessing a

person’s ﬁtness to drive.

The standards for medical conditions in the

tables on page 72 to page 89 cover:

• ischaemic heart disease

− acute myocardial infarction

− angina

− coronary artery bypass grafting

− percutaneous coronary intervention

• disorders of rate, rhythm or conduction

− atrial ﬁbrillation

− arrhythmia

− cardiac arrest

− cardiac pacemaker

− implantable cardioverter deﬁbrillator

− ECG changes

• vascular disease

− aneurysms

− deep vein thrombosis

− pulmonary embolism

− valvular heart disease

• myocardial diseases

− dilated cardiomyopathy

− hypertrophic cardiomyopathy

• other conditions and treatments

− anticoagulant therapy

− congenital disorders

− heart failure

− heart transplant

− ventricular assist devices

− hypertension

− stroke

− syncope.

2.3.2. Conditional licences and

periodic review

Because many cardiac conditions are stabilised

and not cured, periodic review is recommended.

In general, the review interval should be

a minimum of 12 months unless otherwise

recommended by the treating doctor/specialist,

taking into consideration the licence type (e.g.

commercial versus private vehicle), other health

risk factors and how well the underlying illness is

managed.

Where a condition has been eectively treated

and there is minimal risk of recurrence, the driver

may apply for reinstatement of an unconditional

licence on the advice of the treating doctor

or specialist (in the case of a commercial

vehicle driver). Refer to Part A section 4.5.

Reinstatement of licences or removal or

variation of licence conditions.

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Ischaemic heart disease

Acute

myocardial

infarction

(AMI)

Refer also

to coronary

artery bypass

grafting

and to

percutaneous

coronary

intervention.

The person should not drive for at least 2

weeks after an AMI.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had an AMI.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• it is at least 2 weeks after an

uncomplicated AMI; and

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

Fitness thereafter should be assessed in

terms of general convalescence.

The person should not drive for at least 4

weeks after anAMI.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had an AMI.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• it is at least 4 weeks after an

uncomplicated AMI; and

• there is a satisfactory response to

treatment; and

• there is an exercise tolerance ≥ 90%

of the age/sex predicted exercise

capacity according to the Bruce protocol

or equivalent functional exercise test

protocol;and

• there is no evidence of severe ischaemia

– that is, less than 2 mm ST segment

depression on an exercise ECG or a

reversible regional wall abnormality on

an exercise stress echocardiogram or

absence of a large defect on a stress

perfusion scan; and

• there is an ejection fraction ≥ 40%; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid

vehicles or motorcycles

unless carrying public

passengers or requiring a

dangerous goods driver

licence – refer to deﬁnition

in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a

dangerous goods driver licence – refer to deﬁnition in Table 3)

Angina A person with angina,

which is usually absent

on mild exertion, and

who is compliant with

treatment may drive

without licence restriction

and without notiﬁcation

to the driver licensing

authority, subject to

periodic monitoring.

A person is not ﬁt to hold

an unconditional licence:

• if the person is subject

to angina pectoris

at rest or on minimal

exertion despite

medical therapy, or

has unstable angina.

A conditional licence

may be considered

by the driver licensing

authority subject to

periodic review, taking

into account the nature

of the driving task and

information provided by

the treating specialist as

to whether the following

criteria are met:

• there is a satisfactory

response to treatment;

and

• there are minimal

symptoms relevant

to driving (chest

pain, palpitations,

breathlessness).

A person is not ﬁt to hold an unconditional licence:

• if the person is subject to angina pectoris.

A conditional licence may be considered by the driver licensing authority

subject to annual review, taking into account the nature of the driving

task and information provided by the treating specialist as to whether

the following criteria are met:

• either or both:

− there is an exercise tolerance ≥ 90% of the age/sex predicted

exercise capacity according to the Bruce protocol or equivalent

functional exercise test protocol;

− a resting or stress echocardiogram or a myocardial perfusion

study, or both, show no evidence of ischaemia; and

• there are minimal symptoms relevant to driving (chest pain,

palpitations, breathlessness).

If myocardial ischaemia is demonstrated, a coronary angiogram may

be oered.

A conditional licence may be considered, subject to annual review, if

the following criterion is met:

• the coronary angiogram (invasive or CT) shows lumen diameter

reduction < 70% in a major coronary branch, and < 50% in the left

main coronary artery.

If the result of the angiogram shows a lumen diameter reduction of

≥70% in a major coronary branch and < 50% in the left main coronary

artery (or if an angiogram is not conducted), a conditional licence may

be considered, subject to annual review, if the following criteria are met:

• there is an exercise tolerance ≥ 90% of the age/sex predicted

exercise capacity according to the Bruce protocol or equivalent

functional exercise test protocol; and

• there is no evidence of severe ischaemia – that is, less than 2 mm

ST segment depression on an exercise ECG or a reversible regional

wall abnormality on an exercise stress echocardiogram or absence

of a large defect on a stress perfusion scan; and

• there is an ejection fraction ≥ 40%; and

• there are minimal symptoms relevant to driving (chest pain,

palpitations, breathlessness).

The above criteria also apply if an angiogram is not conducted.

Where surgery or percutaneous coronary intervention is undertaken to

relieve the angina, the requirements listed in the table apply.

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Coronary

artery bypass

grafting

(CABG)

The person should not drive for at least 4

weeks after CABG.

A person is not ﬁt to hold an unconditional

licence:

• if the person requires or has had CABG.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• it is at least 4 weeks after CABG; and

• there is satisfactory response to treatment;

and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); and

• there is minimal residual musculoskeletal

pain after the chest surgery.

The person should not drive for at least 3

months after CABG.

A person is not ﬁt to hold an unconditional

licence:

• if the person requires or has had CABG.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• it is at least 3 months after CABG; and

• there is a satisfactory response to

treatment; and

• there is an exercise tolerance ≥ 90% of

the age/sex predicted exercise capacity

according to the Bruce protocol or

equivalent functional exercise test protocol;

and

• there is no evidence of severe ischaemia

– that is, less than 2 mm ST segment

depression on an exercise ECG or a

reversible regional wall abnormality on

an exercise stress echocardiogram or

absence of a large defect on a stress

perfusion scan; and

• there is an ejection fraction ≥ 40%; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); and

• there is minimal residual musculoskeletal

pain after the chest surgery.

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Percutaneous

coronary

intervention

(PCI)

(e.g.

angioplasty/

stent)

The person should not drive for at least 2

days after the PCI.

A person is not ﬁt to hold an unconditional

licence:

• if the person requires or has had a PCI.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• there was no AMI immediately before or

after the PCI; and

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

The person should not drive for at least 4

weeks after the PCI.

A person is not ﬁt to hold an unconditional

licence:

• if the person requires or has had a PCI.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• it is at least 4 weeks after the PCI; and

• there is a satisfactory response to

treatment; and

• there is an exercise tolerance ≥ 90% of

the age/sex predicted exercise capacity

according to the Bruce protocol or

equivalent functional exercise test protocol;

and

• there is no evidence of severe ischaemia

– that is, less than 2 mm ST segment

depression on an exercise ECG or a

reversible regional wall abnormality on

an exercise stress echocardiogram or

absence of a large defect on a stress

perfusion scan; and

• there is an ejection fraction ≥ 40%; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Disorders of rate, rhythm and conduction

Atrial

ﬁbrillation

The non-driving period will depend on the

method of treatment – see below.

A person is not ﬁt to hold an unconditional

licence:

• if an episode of ﬁbrillation results in

syncope or incapacitating symptoms.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

The person should not drive for:

• at least 1 week following PCI;

• at least 1 week following initiation of

successful medical treatment;

• an appropriate time following open chest

surgery.

The non-driving period will depend on the

method of treatment – see below.

A person is not ﬁt to hold an unconditional

licence:

• if the person has a history of recurrent or

persistent arrhythmia that may result in

syncope or incapacitating symptoms.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); and

• appropriate follow-up has been arranged.

The person should not drive for:

• at least 4 weeks following PCI;

• at least 4 weeks following initiation of

successful medical treatment;

• at least 3 months following open chest

surgery.

If the person is taking anticoagulants refer to

‘anticoagulant therapy’.

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Paroxysmal

arrhythmias

(e.g.

supraventricular

tachycardia,

atrial ﬂutter,

idiopathic

ventricular

tachycardia)

A person is not ﬁt to hold an unconditional

licence:

• if there was near or deﬁnite collapse.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review*, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• there is a satisfactory response to

treatment; and

• there are normal haemodynamic

responses at a moderate level of exercise;

and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

* Where the condition is considered to be

cured, the requirement for periodic review

may be waived.

The non-driving period is at least 4 weeks.

A person is not ﬁt to hold an unconditional

licence:

• if there was near or deﬁnite collapse.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review*, taking into account the

nature of the driving task and information

provided by the treating specialist as to

whether the following criteria are met:

• there is a satisfactory response to

treatment; and

• there are normal haemodynamic

responses at a moderate level of exercise;

and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

The person should not drive for:

• at least 4 weeks following PCI;

• at least 4 weeks following initiation of

successful medical treatment.

* Where the condition is considered to be

cured, the requirement for periodic review

may be waived.

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Cardiac

arrest

The person should not drive for at least 6

months following a cardiac arrest.

Limited exceptions apply – see below*.

A person is not ﬁt to hold an unconditional

licence:

• if the person has suered a cardiac arrest.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• it is at least 6 months after the arrest; and

• the cause of the cardiac arrest and

response to treatment has been

considered; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

* A shorter non-driving period may be

considered subject to specialist assessment

if the cardiac arrest has occurred within 48

hours of an acute myocardial infarction, or if

the arrhythmia causing the cardiac arrest has

been addressed by radio frequency ablation

surgery or by pacemaker implantation.

The person should not drive for at least 6

months following a cardiac arrest.

A person is not ﬁt to hold an unconditional

licence:

• if the person has suered a cardiac arrest.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• it is at least 6 months after the arrest; and

• a reversible cause is identiﬁed and

recurrence is unlikely; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Cardiac

pacemaker

Refer also to

‘implantable

cardioverter

deﬁbrillator’ if

appropriate.

The person should not drive for at least 2

weeks after a pacemaker is inserted.

A person is not ﬁt to hold an unconditional

licence:

• if a cardiac pacemaker is required or has

been implanted or replaced.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• it is at least 2 weeks after insertion of the

cardiac pacemaker; and

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

The person should not drive for at least 4

weeks after a pacemaker is inserted.

A person is not ﬁt to hold an unconditional

licence:

• if a cardiac pacemaker is required or has

been implanted or replaced.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• it is at least 4 weeks after insertion of the

cardiac pacemaker; and

• the relative risks of pacemaker dysfunction

have been considered; and

• there are normal haemodynamic

responses at a moderate level of exercise;

and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Implantable

cardioverter

deﬁbrillator

(ICD)

The non-driving period will depend on the

reason for ICD implantation – see below.

A person is not ﬁt to hold an unconditional

licence:

• if the person requires or has had an ICD

implanted for ventricular arrhythmias.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating specialist as to

whether the following criteria are met:

• the ICD has been implanted for an episode

of cardiac arrest and the person has been

asymptomatic for 6 months; or

• the ICD has been prophylactically

implanted for at least 2 weeks; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

A person should not drive:

• for 2 weeks after a generator change of

an ICD;

• for at least 4 weeks after appropriate ICD

therapy associated with symptoms of

haemodynamic compromise (if syncopal,

refer to ‘syncope’).

The person should not drive for at least 6

months after the ICD is implanted.

A person is not ﬁt to hold an unconditional

licence or a conditional licence:

• if the ICD was implanted to manage

ventricular arrhythmias (secondary

prevention).

A conditional licence may be considered

by the driver licensing authority subject to

annual review, taking into account the nature

of the driving tasks and information provided

by the treating specialist* as to whether the

following criteria are met:

• the ICD was implanted for primary

prevention; and

• it is at least 6 months after the insertion of

the ICD; and

• there are no episodes of atrial ﬁbrillation;

and

• there are no discharges from the

deﬁbrillator; and

• interrogation of the ICD shows no evidence

of anti-tachycardic pacing; and

• there is an ejection fraction ≥ 40%; and

• there is an exercise tolerance > 90% of

the age/sex predicted exercise capacity

according to the Bruce protocol or

equivalent functional test protocol; and

• there is no evidence of severe ischaemia

– that is, less than 2mm ST segment

depression on an exercise test or

reversible regional wall abnormality on

an exercise stress echocardiogram or

absence of a large defect on a stress

perfusion scan; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

* The initial assessment is to be performed by

the treating electrophysiologist.

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

ECG changes

Strain

patterns,

bundle

branch

blocks, heart

block, etc.

Refer also

to ‘cardiac

pacemaker’.

The person should not drive for at least 2

weeks following initiation of treatment.

A person is not ﬁt to hold an unconditional

licence:

• if the conduction defect is causing

symptoms.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• the condition has been treated

procedurally or medically for at least 2

weeks; and

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

* Where the condition is considered to be

cured, the requirement for periodic review

may be waived.

The person should not drive for at least 3

months following initiation of treatment.

A person is not ﬁt to hold an unconditional

licence:

• if the person has an electrocardiographic

abnormality – for example, left bundle

branch block, right bundle branch block,

pre-excitation, prolonged QT interval

or changes suggestive of myocardial

ischaemia or previous myocardial

infarction.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• all of the following:

− the condition has been treated

procedurally or medically for at least 3

months; and

− there is a satisfactory response to

treatment; and

− there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); or

• follow-up investigation has excluded

underlying cardiac disease.

* Where the condition is considered to be

cured, the requirement for periodic review

may be waived.

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Vascular disease

Aneurysms

– abdominal

and thoracic

The person should not drive for at least 4

weeks after repair.

A person is not ﬁt to hold an unconditional

licence:

• if the person has an unrepaired aortic

aneurysm – thoracic or abdominal.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating specialist as to

whether the following criteria are met:

• both:

− it is at least 4 weeks after repair; and

− the response to treatment is

satisfactory, according to the treating

vascular surgeon;

• or

− in the case of atherosclerotic aneurysm

or aneurysm associated with the

bicuspid aortic valve, the aneurysm

diameter is less than 55 mm; or

− the diameter is less than 50 mm for all

other aneurysms.

The person should not drive for at least 3

months after repair.

A person is not ﬁt to hold an unconditional

licence:

• if the person has an unrepaired aortic

aneurysm – thoracic or abdominal.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• both:

− it is at least 3 months after repair; and

− the response to treatment is

satisfactory, according to the treating

vascular surgeon;

• or

− in the case of atherosclerotic aneurysm

or aneurysm associated with the

bicuspid aortic valve, the aneurysm

diameter is less than 55 mm; or

− the diameter is less than 50 mm for all

other aneurysms.

Deep vein

thrombosis

(DVT)

There are no licensing criteria for DVT.

For advisory non-driving period following

DVT refer to Table 5. Suggested non-driving

periods after cardiovascular events or

procedures.

For long-term anticoagulation refer to Table

5. Suggested non-driving periods after

cardiovascular events or procedures. Refer

also to section 2.2.8 in the text.

There are no licensing criteria for DVT.

For advisory non-driving period following

DVT refer to Table 5. Suggested non-driving

periods after cardiovascular events or

procedures.

For long-term anticoagulation refer to Table

5. Suggested non-driving periods after

cardiovascular events or procedures. Refer

also to section 2.2.8 in the text.

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition

in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles

or requiring a dangerous goods driver licence – refer

to deﬁnition in Table 3)

Pulmonary

embolism

(PE)

There are no licensing criteria for PE.

For advisory non-driving period

following PE refer to Table 5.

Suggested non-driving periods after

cardiovascular events or procedures.

For long-term anticoagulation refer

to Table 5. Suggested non-driving

periods after cardiovascular events

or procedures. Refer also to section

2.2.8.

There are no licensing criteria for PE.

For advisory non-driving period following PE refer

to Table 5. Suggested non-driving periods after

cardiovascular events or procedures.

For long-term anticoagulation refer to Table 5.

Suggested non-driving periods after cardiovascular

events or procedures. Refer also to section 2.2.8.

Valvular heart

disease

(including

treatment with

MitraClips,

tricuspid clips,

transcutaneous

aortic valve

replacement

and

transcutaneous

pulmonary

valve

replacement)

The person should not drive for at

least 4 weeks following valve repair.

A person is not ﬁt to hold an

unconditional licence:

• if the person has symptoms on

moderate exertion.

A conditional licence may be

considered by the driver licensing

authority subject to periodic review,

taking into account the nature of the

driving task and information provided

by the treating doctor as to whether

the following criteria are met:

• there is a satisfactory response to

treatment; and

• there are minimal symptoms

relevant to driving (chest pain,

palpitations, breathlessness); and

• there is minimal residual

musculoskeletal pain after chest

surgery, if required.

The person should not drive for at least 4 weeks

following valve repair.

A person is not ﬁt to hold an unconditional licence:

• if the person has any history or evidence of

valve disease, with or without surgical repair

or replacement, associated with symptoms

or a history of embolism, arrhythmia, cardiac

enlargement, abnormal ECG or high blood

pressure; or

• if the person is taking anticoagulants (a conditional

licence may be issued subject to the requirements

speciﬁed in Table 5. Suggested non-driving

periods after cardiovascular events or

procedures in relation to anticoagulant therapy).

A conditional licence may be considered by the

driver licensing authority subject to annual review,

taking into account the nature of the driving task and

information provided by the treating specialist as to

whether the following criteria are met:

• the person’s cardiological assessment shows

valvular disease of no haemodynamic signiﬁcance;

• all of the following:

− it is 3 months following surgery and there is no

evidence of valvular dysfunction; and

− there are minimal symptoms relevant to driving

(chest pain, palpitations, breathlessness); and

− there is minimal residual musculoskeletal pain

after chest surgery.

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or

requiring a dangerous goods driver licence – refer to

deﬁnition in Table 3)

Other cardiovascular diseases

Anticoagulant

therapy

A person on a private vehicle

licence may drive without restriction

and without reporting to the driver

licensing authority, pending periodic

review, if:

• anticoagulation is maintained at

the appropriate degree for the

underlying condition.

A person is not ﬁt to hold an unconditional licence:

• if the person is on long-term anticoagulant therapy.

A conditional licence may be considered by the driver

licensing authority subject to annual review, taking into

account the nature of the driving task and information

provided by the treating specialist as to whether the

following criterion is met:

• anticoagulation is maintained at the appropriate

degree for the underlying condition.

Congenital

disorders

Refer also

to ‘heart

failure’, ‘atrial

ﬁbrillation’,

‘paroxysmal

arrhythmias’,

‘cardiac

pacemaker’

and ‘ICD’.

A person may drive without

restriction and without reporting to

the driver licensing authority if they

have uncomplicated congenital

heart disease and there are no

or minimal symptoms relevant to

driving.

A person should not drive for a

period of at least 4 weeks after

surgery to correct a congenital

lesion.

The person should not drive

for at least 2 weeks following a

percutaneous procedure to treat a

congenital lesion.

A person is not ﬁt to hold an

unconditional licence:

• if the person has a complicated

congenital heart disorder.

A conditional licence may be

considered by the driver licensing

authority subject to periodic review,

taking into account the nature of

the driving task and information

provided by the treating specialist

as to whether the following criterion

is met:

• there are minimal symptoms

relevant to driving (chest pain,

palpitations, breathlessness).

A person should not drive for at least 3 months

following surgical treatment for congenital heart

disease.

A person should not drive for 4 weeks following a

percutaneous intervention for congenital heart disease.

A person is not ﬁt to hold an unconditional licence:

• if the person has a complicated congenital heart

disorder.

A conditional licence may be considered by the driver

licensing authority subject to annual review taking

into account the nature of the driving task and the

information provided by the treating specialist as to

whether the following criteria are met:

• there are minimal symptoms relevant to driving

(chest pain, palpitations, breathlessness); and

• the ejection fraction of the systemic ventricle is

greater than 40%; and

• there is a minor congenital disorder of no

haemodynamic signiﬁcance such as pulmonary

stenosis, atrial septal defect, small ventricular septal

defect, bicuspid aortic valve, patent ductus arteriosus

or mild coarctation of the aorta; or

• there has been surgical/percutaneous correction of

the congenital lesion including atrial septal defect,

ventricular septal defect, patent ductus arteriosus,

coarctation, pulmonary stenosis, total correction of

tetralogy of Fallot, or total correction of transposition

of the great arteries, and there are no or minimal

symptoms.

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Dilated

cardiomyopathy

A person is not ﬁt to hold an unconditional

licence:

• if the person has a dilated cardiomyopathy.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); and

• the person is not subject to arrhythmias.

Cardiologist assessment is recommended for

complex presentations.

A person is not ﬁt to hold and unconditional

licence:

• if the person has a dilated cardiomyopathy.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• there is an ejection fraction ≥ 40%; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); and

• the person is not subject to arrhythmias.

Hypertrophic

cardiomyopathy

(HCM)

A person is not ﬁt to hold an unconditional

licence:

• if the person has HCM.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating specialist as to

whether the following criteria are met:

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness); and

• the person is not subject to arrhythmias or

syncope.

A person is not ﬁt to hold an unconditional

licence:

• if the person has HCM.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• the left ventricular ejection fraction ≥ 40%;

and

• there is an exercise tolerance ≥ 90% of

the age/sex predicted exercise capacity

according to the Bruce protocol or

equivalent functional exercise test protocol;

and

• there is an absence of: a history

of syncope; severe left ventricular

hypertrophy; a family history of sudden

death; or ventricular arrhythmia on Holter

testing; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition

in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Heart failure

Refer also to

‘ventricular

assist

devices’.

A person is not ﬁt to hold an

unconditional licence:

• if symptoms arise on moderate

exertion.

A conditional licence may be

considered by the driver licensing

authority subject to periodic review,

taking into account the nature of the

driving task and information provided by

the treating doctor as to whether the

following criteria are met:

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

A person is not ﬁt to hold an unconditional licence:

• if the person has heart failure.

A conditional licence may be considered by the

driver licensing authority subject to annual review,

taking into account the nature of the driving task

and information provided by the treating specialist

as to whether the following criteria are met:

• there is a satisfactory response to treatment; and

• there is an exercise tolerance ≥ 90% of the age/

sex predicted exercise capacity according to the

Bruce protocol or equivalent functional exercise

test protocol; and

• there is an ejection fraction ≥ 40%; and

• the underlying cause of the heart failure is

considered; and

• there are minimal symptoms relevant to driving

(chest pain, palpitations, breathlessness).

Heart

transplant

The person should not drive for at least

6 weeks post transplant.

A person is not ﬁt to hold an

unconditional licence:

• if the person requires or has had a

heart or heart/lung transplant.

A conditional licence may be

considered by the driver licensing

authority subject to periodic review,

taking into account the nature of the

driving task and information provided by

the treating specialist as to whether the

following criteria are met:

• it is at least 6 weeks after transplant;

and

• there is a satisfactory response to

treatment; and

• there are minimal symptoms relevant

to driving (chest pain, palpitations,

breathlessness).

The person should not drive for at least 3 months

post transplant.

A person is not ﬁt to hold an unconditional licence:

• if the person requires or has had a heart or

heart/lung transplant.

A conditional licence may be considered by the

driver licensing authority subject to annual review,

taking into account the nature of the driving task

and information provided by the treating specialist

as to whether the following criteria are met:

• it is at least 3 months after transplant; and

• there is a satisfactory response to treatment; and

• there is an exercise tolerance ≥ 90% of the age/

sex predicted exercise capacity according to the

Bruce protocol or equivalent functional exercise

test protocol; and

• there are minimal symptoms relevant to driving

(chest pain, palpitations, breathlessness).

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Ventricular

assist

devices

(LVAD,

BiVAD)

A person should not drive for at least 3

months following insertion of a ventricular

assist device.

A person is not ﬁt to hold an unconditional

licence:

• if the person requires an LVAD or BiVAD.

A conditional licence may be considered

by the driver licensing authority subject to

6-monthly review, taking into account the

nature of the driving task and information

provided by the treating specialist as to

whether the following criteria are met:

• the device has been in situ for at least

3 months and there have been no

equipment problems during the preceding

2 weeks; and

• anticoagulation is stable as per this

standard; and

• the medical condition is stable and

satisfactorily controlled, and there are

minimal symptoms relevant to driving

(chest pain, palpitations, breathlessness);

and

• the person is conﬁdent in relation to all

LVAD or BiVAD equipment.

Where there is concern of cognitive or

neurological impairment, a practical driver

assessment should be conducted (refer

to Part A section 2.3.1. Practical driver

assessments).

A person is not ﬁt to hold an unconditional

licence or a conditional licence:

• if the person requires a VAD of any type or

an artiﬁcial heart.

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Hypertension A person is not ﬁt to hold an unconditional

licence:

• if the person has blood pressure

consistently > 200 systolic or > 110 diastolic

(treated or untreated).

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• the blood pressure is well controlled; and

• there are no side eects from the

medication that will impair safe driving; and

• there is no evidence of damage to target

organs relevant to driving.

A person is not ﬁt to hold an unconditional

licence:

• if the person has blood pressure

consistently > 170 systolic or > 100 diastolic

(treated or untreated).

A conditional licence may be considered

by the driver licensing authority subject to

annual review, taking into account the nature

of the driving task and information provided

by the treating specialist* as to whether the

following criteria are met:

• the person is treated with antihypertensive

therapy and eective control of

hypertension is achieved over a 4-week

follow-up period; and

• there are no side eects from the

medication that will impair safe driving; and

• there is no evidence of damage to target

organs relevant to driving.

* Ongoing ﬁtness to drive for commercial

vehicle drivers may be assessed by the

treating GP provided this is mutually agreed

by the specialist, GP and driver licensing

authority. The initial granting of a conditional

licence must, however, be based on

information provided by the specialist.

Stroke

Refer to section 6. Neurological conditions. Refer to section 6. Neurological conditions.

Cardiovascular conditions

PART B. Medical standards

Medical standards for licensing

–

cardiovascular conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Syncope

Refer also

to section 1.

Blackouts.

The person can resume driving within 24

hours if the episode was vasovagal in nature

with a clear-cut precipitating factor (e.g.

venesection) and the situation is unlikely

to occur while driving. The driver licensing

authority should not be notiﬁed.

The person should not drive for at least

4 weeks after syncope due to other

cardiovascular causes.

A person is not ﬁt to hold an unconditional

licence:

• if the condition is severe enough to cause

episodes of loss of consciousness without

warning.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to whether

the following criteria are met:

• the underlying cause has been identiﬁed;

and

• satisfactory treatment has been instituted;

and

• the person has been symptom-free for at

least 4 weeks.

The person can resume driving within 24

hours if the episode was vasovagal in nature

with a clear-cut precipitating factor (e.g.

venesection) and the situation is unlikely

to occur while driving. The driver licensing

authority should not be notiﬁed.

The person should not drive for at least

3 months after syncope due to other

cardiovascular causes.

A person is not ﬁt to hold an unconditional

licence:

• if the condition is severe enough to cause

episodes of loss of consciousness without

warning.

A conditional licence may be considered by

the driver licensing authority subject to annual

review, taking into account the nature of the

driving task and information provided by the

treating specialist as to whether the following

criteria are met:

• the underlying cause has been identiﬁed;

and

• satisfactory treatment has been instituted;

and

• the person has been symptom-free for

3months.

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

Cardiovascular conditions

PART B. Medical standards

References and further reading

1. Charlton, J. L. & Monash University Accident

Research Centre. Inﬂuence of chronic

illness on crash involvement of motor

vehicle drivers. (Monash University, Accident

Research Centre, 2010).

2. Chee, J. N. et al. A systematic review of the

risk of motor vehicle collision in patients with

syncope. Canadian Journal of Cardiology

37, 151–161 (2021).

3. European Working Group on Driving and

Cardiovascular Disease. New standards for

driving and cardiovascular diseases. (2013).

4. Canadian Medical Association. CMA driver’s

guide: determining medical ﬁtness to

operate motor vehicles. (Joule, 2017).

5. Atherton, J. J. et al. National Heart

Foundation of Australia and Cardiac Society

of Australia and New Zealand: guidelines for

the prevention, detection, and management

of heart failure in Australia 2018. Heart Lung

and Circulation 27, 1123–1208 (2018).

6. Lovibond, S. W., Odell, M. & Mariani, J. A.

Driving with cardiac devices in Australia.

Does a review of recent evidence prompt

a change in guidelines? Internal Medicine

Journal 50, 271–277 (2020).

7. Watanabe, E., Abe, H. & Watanabe,

S. Driving restrictions in patients with

implantable cardioverter deﬁbrillators and

pacemakers. Journal of Arrhythmia 33,

594–601 (2017).

8. Boodhwani, M. et al. Canadian

Cardiovascular Society position statement

on the management of thoracic aortic

disease. Canadian Journal of Cardiology

30, 577–589 (2014).

9. Tan, V. H., Ritchie, D., Maxey, C. & Sheldon,

R. Prospective assessment of the risk of

vasovagal syncope during driving. JACC:

Clinical Electrophysiology 2, 203–208

(2016).

10. Shen, W. K. et al. 2017 ACC/AHA/

HRS guideline for the evaluation and

management of patients with syncope:

a report of the American College of

Cardiology/American Heart Association task

force on clinical practice guidelines and the

Heart Rhythm Society. Circulation 136, e60–

e122 (2017).

11. Moya, A. et al. Guidelines for the diagnosis

and management of syncope (version

2009). European Heart Journal 30, 2631–

2671 (2009).

12. Hanke, J. S. et al. Driving after left ventricular

assist device implantation. Artiﬁcial Organs

42, 695–699 (2018).

13. Slaughter, M. S. et al. Advanced heart failure

treated with continuous-ﬂow left ventricular

assist device. New England Journal of

Medicine 361, 2241–2251 (2009).

14. Singhvi, A. & Trachtenberg, B. Left

ventricular assist devices 101: shared care

for general cardiologists and primary care.

Journal of Clinical Medicine 8, 1720 (2019).

PART B. Medical standards

3. Diabetes mellitus

Refer also to section 2. Cardiovascular

conditions, section 8. Sleep disorders and

section 10. Vision and eye disorders.

3.1. Relevance to the

driving task

3.1.1. Eects of diabetes on driving

1–3

Diabetes may aect a person’s ability to drive,

either through a ‘severe hypoglycaemic event’

or from end-organ eects on relevant functions,

including eects on vision, the heart and the

peripheral nerves and vasculature of the

extremities, particularly the feet. In people with

type 2 diabetes, sleep apnoea is also more

common (refer to section 8. Sleep disorders).

The main hazard in people with insulin-treated

diabetes is the unexpected occurrence of

hypoglycaemia.

3.1.2. Evidence of crash risk

1,4–7

There is a small but appreciable increase

in motor vehicle crash risk for drivers with

diabetes. The potential eects of hypoglycaemia

are of most concern to road safety. However,

ﬁndings point to a higher risk among those with

a history of severe hypoglycaemia. There is also

evidence that ‘tighter control’, as measured by

the HbA1c, may be associated with increased

crash risk.

3.2. General assessment

and management

guidelines

General management of diabetes in relation

to ﬁtness to drive is summarised in Figure 10.

Note, for the purpose of the diabetes standard,

appropriate specialist means an endocrinologist

or consultant physician specialising in diabetes.

For general guidance on diabetes management

refer to relevant best practice guidelines

(e.g. Royal Australasian College of General

Practitioners’ Management of type 2 diabetes: a

handbook for general practice

or the National

Health and Medical Research Council’s National

evidence based clinical care guidelines for type

1 diabetes for children, adolescents and adults

3.2.1. Hypoglycaemia

Deﬁnition: severe hypoglycaemic

event

6,8,9

For the purposes of this document, a ‘severe

hypoglycaemic event’ is deﬁned as an event of

hypoglycaemia of sucient severity such that

the person is unable to treat the hypoglycaemia

themselves and so requires someone else to

administer treatment. It includes hypoglycaemia

causing loss of consciousness or seizure. It can

occur during driving or at any other time of the

day or night. A severe hypoglycaemic event is

particularly relevant to driving because it aects

Diabetes mellitus

PART B. Medical standards

brain function and may cause impairment of

perception, motor skills or consciousness. It

may also cause abnormal behaviour. A severe

hypoglycaemic event is to be distinguished

from mild hypoglycaemic events, the latter with

symptoms such as sweating, tremulousness,

hunger and tingling around the mouth, which

are common occurrences in the life of a person

with diabetes treated with insulin and some

hypoglycaemic agents.

Potential causes

Hypoglycaemia may be caused by many

factors including non-adherence or alteration

to medication, unexpected exertion, alcohol

intake or irregular meals. Meal regularity and

variability in medication administration may

be important considerations for long-distance

commercial driving or for drivers operating

on shifts. Impairment of consciousness and

judgement can develop rapidly and result in loss

of control of a vehicle. Excessively tight control

may contribute to hypoglycaemia.

Advice to drivers

The driver should be advised not to drive if a

severe hypoglycaemic event is experienced

while driving or at any other time, until they have

been cleared to drive by a medical practitioner.

The driver should also be advised to take

appropriate precautionary steps to help avoid a

severe hypoglycaemic event – for example, by:

• complying with general medical review

requirements as requested by their general

practitioner or specialist

• not driving if either their blood glucose is

at or less than 5 mmol/L or if, while wearing

a continuous or ﬂash glucose monitor,

the predicted glucose level is showing

downward trends into the hypoglycaemia

range (measured when the vehicle is parked)

• wearing a continuous or ﬂash glucose

monitor, preferably with an active

hypoglycaemia alert or alarm

• not driving for more than two hours without

considering having a snack

• not delaying or missing a main meal

• self-monitoring blood glucose levels before

driving and every two hours during a

journey, as reasonably practical

• carrying adequate glucose in the vehicle for

self-treatment

• treating mild hypoglycaemia if symptoms

occur while driving including:

− safely steering the vehicle to the side of

the road

− turning o the engine and removing the

keys from the ignition

− self-treating the low blood glucose

− checking the blood glucose levels 15

minutes or more after the hypoglycaemia

has been treated and ensuring it is above

5 mmol/L

− not recommencing driving until feeling

well and until at least 30 minutes after the

blood glucose is above 5 mmol/L.

PART B. Medical standards

Non-driving period after a ‘severe

hypoglycaemic event’

If a severe hypoglycaemic event occurs (as

deﬁned in section 3.2.1. Hypoglycaemia), the

person should not drive for a signiﬁcant period

of time and will need to be urgently assessed.

The minimum period of time before returning

to drive is generally six weeks because it often

takes many weeks for patterns of glucose

control and behaviour to be re-established and

for any temporary ‘impaired hypoglycaemia

awareness’ to resolve (see below). The non-

driving period will depend on factors such

as identifying the reason for the episode, the

specialist’s opinion and the type of motor vehicle

licence. The specialist’s recommendation for

returning to driving should be based on the

patient’s behaviour and objective measures of

glycaemic control (documented blood glucose)

over a reasonable interval.

Impaired hypoglycaemic awareness

–

Impaired hypoglycaemic awareness exists when

a person does not regularly sense the usual

early warning symptoms of mild hypoglycaemia

such as sweating, tremulousness, hunger,

tingling around the mouth, palpitations and

headache. It markedly increases the risk of a

severe hypoglycaemic event occurring and is

therefore a risk for road safety. Rates of severe

hypoglycaemia may be up to seven times higher

compared with those who retain hypoglycaemia

awareness. Impaired hypoglycaemia awareness

occurs in 20–25 per cent of people with type

1 diabetes and about 10 per cent of those with

type 2 diabetes. Prevalence is higher in older

people and in those with a longer duration

ofdiabetes.

Impaired hypoglycaemic awareness may be

screened for using the Clarke questionnaire

(refer to Figure 9. Clarke hypoglycaemia

awareness survey), which may be particularly

useful for people with insulin-treated diabetes of

longer duration (more than 10 years), or following

a severe hypoglycaemic event or after a crash.

The use of devices such as continuous or ﬂash

glucose monitors do not replace the need for a

person to be able to sense the warning signs of

hypoglycaemia or to compensate for impaired

hypoglycaemia awareness.

When impaired hypoglycaemia awareness

develops in a person who has experienced a

severe hypoglycaemic event, it may improve

in the subsequent weeks and months if further

hypoglycaemia can be avoided.

A person with persistent impaired

hypoglycaemia awareness should be under

the regular care of a medical practitioner with

expert knowledge in managing diabetes (e.g.

an endocrinologist or diabetes specialist), who

should be involved in assessing their ﬁtness

to drive. As reﬂected in the standards table on

page 101, any driver who has a persistent

impaired hypoglycaemia awareness is generally

not ﬁt to drive unless their ability to experience

early warning symptoms returns or they have

an eective management strategy for lack of

early warning symptoms. For private drivers, a

conditional licence may be considered by the

driver licensing authority, taking into account

the opinion of an appropriate specialist, the

nature and extent of the driving involved and

thedriver’s self-care behaviours.

Diabetes mellitus

PART B. Medical standards

In managing impaired hypoglycaemia

awareness, the medical practitioner should focus

on aspects of the person’s self-care to minimise

a severe hypoglycaemic event occurring while

driving, including steps described above (Advice

to drivers). In addition, self-care behaviours that

help to minimise severe hypoglycaemic events

in general should be a major ongoing focus of

regular diabetes care. This requires attention

by both the medical practitioner and the person

with diabetes to diet and exercise approaches,

insulin regimens and blood glucose testing

protocols.

3.2.2. Acute hyperglycaemia

While acute hyperglycaemia may aect some

aspects of brain function, there is not enough

evidence to determine the regular eects on

driving performance and related crash risk. Each

person with diabetes should be counselled

about managing their diabetes during days

when they are unwell and should be advised

not to drive if they are acutely unwell with

metabolically unstable diabetes.

3.2.3. Comorbidities and end-organ

complications

1–3,8,9

Assessment and management of comorbidities

is an important aspect of managing people with

diabetes with respect to their ﬁtness to drive.

This should be part of routine review as per

recommended practice and may include, but is

not limited to, the following.

Vision

Refer to section 10. Vision and eye disorders.

Visual acuity should be tested annually. Retinal

screening should be undertaken every second

year if there is no retinopathy, or more frequently

if at high risk. Visual ﬁeld testing is not required

unless clinically indicated.

7,8

Neuropathy and foot care

While it can be dicult to be prescriptive

about neuropathy in the context of driving, it is

important that the severity of the condition is

assessed. Adequate sensation and movement

for the operation of foot controls is required

(refer to section 6. Neurological conditions and

section 5. Musculoskeletal conditions).

Sleep apnoea

Sleep apnoea is a common comorbidity

aecting many people with type 2 diabetes and

has substantial implications for road safety. The

treating health professional should be alert to

potential signs (e.g. BMI greater than 35) and

symptoms, and apply the Epworth Sleepiness

Scale as appropriate (refer to section 8. Sleep

disorders).

Cardiovascular

There are no diabetes-speciﬁc medical

standards for cardiovascular risk factors and

driver licensing. Consistent with good medical

practice, people with diabetes should have their

cardiovascular risk factors periodically assessed

and treated as required (refer to section 2.

Cardiovascular conditions).

PART B. Medical standards

3.2.4. Gestational diabetes mellitus

The standards in this chapter apply to diabetes

mellitus as a chronic condition. The self-limiting

condition known as gestational diabetes

mellitus does not aect licensing. However,

consideration should be given to short-term

ﬁtness to drive in women with gestational

diabetes mellitus treated with insulin, although

severe hypoglycaemia in this condition is rare.

Aected women should be counselled to

recognise symptoms and to restrict driving when

symptoms occur.

Diabetes mellitus

PART B. Medical standards

Figure 9. Clarke hypoglycaemia awareness survey

Patient Survey

The survey is useful to administer to assess hypoglycaemia

awareness including for people who have been on insulin

formany years after a severe hypoglycaemic event

followinga crash.

1. Check the category that best describes you:

(check one only)

I always have symptoms when my

blood sugar is low (A).

I sometimes have symptoms when my

blood sugar is low (R).

I no longer have symptoms when my

blood sugar is low (R).

2. Have you lost some of the symptoms that used to

occurwhen your blood sugar was low?

Yes (R) No (A)

3. In the past six months, how often have you had moderate hypoglycaemia episodes? (episodes

where you might feel confused, disoriented or lethargic and were unable to treat yourself)

Never (A) Once a month (R)

Once or twice (R) More than once a month (R)

Every other month (R)

4. In the past year, how often have you had severe hypoglycaemic episodes?

(episodes where you were unconscious or had a seizure and needed glucagon or

intravenousglucose)

Never (A) 3 times (R) 7 times (R) 10 times (R)

1 time (R) 5 times (R) 8 times (R) 11 times (R)

2 times (R) 6 times (R) 9 times (R) 12 or more times (U)

Scoring

• Four or more ‘R’ responses

implies reduced awareness.

• For questions 5 and 6,

one ‘R’ response is given

if the answer to question 5

is less than the answer to

question6.

• ‘A’ responses imply

awareness.

• ‘U’ response (12 or more

severe hypoglycaemic

episodes in the last

12 months) indicates

unawareness.

PART B. Medical standards

5. How often in the last month have you had readings less than 3.8 mmol/L with symptoms?

Never (A) 2 to 3 times/week

1 to 3 times 4 to 5 times/week

1 time/week Almost daily

6. How often in the last month have you had readings less than 3.8 mmol/L without any symptoms?

Never 2 to 3 times/week

1 to 3 times 4 to 5 times/week

1 time/week Almost daily

(R = answer to 5 is less than answer to 6, A = answer to 6 is greater than answer to 5)

7. How low does your blood sugar need to go before you feel symptoms?

3.3–3.8 mmol/L (A) 2.2–2.7 mmol/L (R)

2.7–3.3 mmol/L (A) Less than 2.2 mmol/L (R)

8. To what extent can you tell by your symptoms that your blood sugar is low?

Never (R) Often (A)

Rarely (R) Always (A)

Sometimes (R)

Note: Units of measure have been converted from mg/dl to mmol/L as per

http://www.onlineconversion.com/blood_sugar.htm

Diabetes mellitus

PART B. Medical standards

3.3. Medical standards

for licensing

Medical requirements for unconditional and

conditional licences are outlined in the table

on page 101. Health professionals should

familiarise themselves with the information in

this chapter and the tabulated standards before

assessing a person’s ﬁtness to drive.

3.3.1. Diabetes treated by glucose-

lowering agents other than insulin for

private drivers

Private vehicle drivers treated by glucose-

lowering agents other than insulin may generally

drive without licence restriction (i.e. on an

unconditional licence) but should be required

by the driver licensing authority to have ﬁve-

yearlyreviews.

3.3.2. Recommendation and

review of conditional licences for

commercial vehicle drivers

It is a general requirement that conditional

licences for commercial vehicle drivers are

issued by the driver licensing authority based on

advice from an appropriate medical specialist

(endocrinologist or consultant physician

specialising in diabetes) and that these drivers

are reviewed periodically by the specialist to

determine their ongoing ﬁtness to drive (refer

to Part A section 4.4. Conditional licences). For

commercial drivers receiving insulin treatment, at

least three months of blood glucose monitoring

records should be reviewed in assessing ﬁtness

to drive.

Commercial vehicle drivers treated by glucose-

lowering agents other than insulin must have

at least an annual review by an appropriate

specialist to monitor the progression of their

condition. However, in the case of type 2

diabetes managed by metformin alone, ongoing

ﬁtness to drive may be assessed by the treating

general practitioner by mutual agreement with

the specialist. The initial recommendation of

a conditional licence must be based on the

opinion of an endocrinologist or consultant

physician specialising in diabetes.

In areas where access to specialists may be

dicult, the driver licensing authority may agree

to a process in which:

• initial assessment and advice for the

conditional licence is provided by a

specialist (endocrinologist or consultant

physician specialising in diabetes)

• ongoing periodic review for the conditional

licence is provided by the treating general

practitioner, with the cooperation of the

specialist.

Where appropriate and available, the use

of telemedicine technologies such as

videoconferencing is encouraged as a means of

facilitating access to specialist opinion (refer to

Part A section 3.3.5. Role of medical specialists).

PART B. Medical standards

Figure 10. Management of diabetes and driving

Treated with insulin

Person with diabetes

Controlled by diet

and exercise alone

Private and

commercial

Driver not

required to

notify the

DLA between

licence

renewals

No licence

restriction

or review

required

Is glucose-

lowering

medication

required?

Treated with glucose-lowering agent other than insulin

Private Commercial

Refer to specialist

for advice about conditional licence

Driver notiﬁes

the DLA as

required

Driver notiﬁes the DLA

Treat by metformin

alone

Treat by other

agents

No conditional

licence

required*

Five-yearly

review for

licensing

(treating doctor)

Annual review for

licensing (treating

doctor)

Annual review for

licensing (specialist

)

If access to specialist

is dicult refer 3.3

• Severe hypoglycaemic event – refer 3.2.1

• Impaired hypoglycaemia awareness – refer 3.2.1

• Acute hyperglycaemia – refer 3.2.2

• Comorbidities and end-organ complications – refer 3.2.3

Is insulin required?

Assess comorbidities: vision, heart, limbs, sleep apnoea Manage as per relevant chapter

Private Commercial

Treating doctor

provides advice about

conditional licence

Refer to specialist

for advice about

conditional licence

Driver notiﬁes the

DLA

Driver notiﬁes the

DLA

Annual review for

licensing (treating

doctor)

Annual review for

licensing (specialist

)

If access to specialist

is dicult refer 3.3

• Severe hypoglycaemic event – refer 3.2.1

• Impaired hypoglycaemia awareness – refer 3.2.1

• Acute hyperglycaemia – refer 3.2.2

• Comorbidities and end-organ complications – refer 3.2.3

* Check individual state and territory requirements (refer to

Appendix 9 for contacts)

# Endocrinologist or consultant physician specialising in diabetes

100

Diabetes mellitus

PART B. Medical standards

Medical standards for licensing

–

diabetes mellitus

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Diabetes

controlled

by diet and

exercise

alone

A person with diabetes treated by diet and

exercise alone may drive without licence

restriction. They should be reviewed by their

treating doctor periodically regarding the

progression of their diabetes.

A person with diabetes treated by diet and

exercise alone may drive without licence

restriction. They should he reviewed by their

treating doctor periodically regarding the

progression of their diabetes.

Diabetes

treated by

glucose-

lowering

agents other

than insulin

For deﬁnition

and

management

of a ‘severe

hypoglycaemic

event’ refer to

section 3.2.1

A person is not ﬁt to hold an unconditional

licence:

• if the person has end-organ complications

that may aect driving, as per this

publication; or

• the person has had a recent ‘severe

hypoglycaemic event’.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into consideration

the nature of the driving task and information

provided by the treating doctor on whether

the following criteria are met:

• any end-organ eects are satisfactorily

treated, with reference to the standards in

this publication; and

• the person is following a treatment

regimen that minimises the risk of

hypoglycaemia; and

• the person experiences early warning

symptoms (awareness) of hypoglycaemia

or has a documented management plan

for lack of early warning symptoms; and

• any recent ‘severe hypoglycaemic

event’ has been satisfactorily treated,

with reference to the standards in this

publication (refer to section 3.2.1).

For private drivers who do not meet the

above criteria, a conditional licence may

be considered by the driver licensing

authority, taking into account the opinion of

an endocrinologist or consultant physician

specialising in diabetes and subject to

regular specialist review.

A person is not ﬁt to hold an unconditional

licence:

• if the person has non–insulin treated

diabetes mellitus and is being treated with

glucose-lowering agents other than insulin.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into consideration

the nature of the driving task and information

provided by an endocrinologist or consultant

physician specialising in diabetes* on whether

the following criteria are met:

• there is no recent history of a ‘severe

hypoglycaemic event’ as assessed by the

specialist; and

• the person experiences early warning

symptoms (awareness) of hypoglycaemia;

and

• the person is following a treatment regimen

that minimises the risk of hypoglycaemia;

and

• there is an absence of end-organ

eects that may aect driving as per this

publication.

* For a commercial driver with type 2 diabetes

who is being treated with metformin alone, the

annual review for a conditional licence may

be undertaken by the driver’s treating doctor

upon mutual agreement of the treating doctor,

specialist and driver licensing authority. The

initial granting of a conditional licence must,

however, be based on information provided by

the specialist.

101

PART B. Medical standards

Medical standards for licensing

–

diabetes mellitus

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public passengers

or requiring a dangerous goods driver licence

– refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Insulin-

treated

diabetes

(except

gestational

diabetes)

For deﬁnition

and

management

of a ‘severe

hypoglycaemic

event’ refer to

section 3.2.1

A person is not ﬁt to hold an unconditional

licence:

• if the person has insulin-treated diabetes.

A conditional licence may be considered

by the driver licensing authority subject

to at least 2-yearly review, taking into

consideration the nature of the driving task

and information provided by the treating

doctor on whether the following criteria are

met:

• there is no recent history of a ‘severe

hypoglycaemic event’; and

• the person is following a treatment

regimen that minimises the risk of

hypoglycaemia; and

• the person experiences early warning

symptoms (awareness) of hypoglycaemia

(refer to section 3.2.1) or has a

documented management plan for lack of

early warning symptoms; and

• there are no end-organ eects that may

aect driving as per this publication.

For private drivers who do not meet the

above criteria, a conditional licence may

be considered by the driver licensing

authority, taking into account the opinion of

an endocrinologist or consultant physician

specialising in diabetes and subject to

regular specialist review.

A person is not ﬁt to hold an unconditional

licence:

• if the person has insulin-treated diabetes.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into consideration

the nature of the driving task and information

provided by an endocrinologist or consultant

physician specialising in diabetes on whether

the following criteria are met:

• there is no recent history (generally at least

6 weeks) of a ‘severe hypoglycaemic event’

as assessed by the specialist; and

• the person is following a treatment regimen

that minimises the risk of hypoglycaemia;

and

• the person experiences early warning

symptoms (awareness) of hypoglycaemia

(refer to section 3.2.1); and

• there are no end-organ eects that may

aect driving as per this publication.

102

Diabetes mellitus

101

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

103

PART B. Medical standards

References and further reading

1. Second European Working Group on

Diabetes and Driving. (2005).

2. Houlden, R. L. et al. Diabetes and Driving:

2015 Canadian Diabetes Association

Updated Recommendations for Private and

Commercial Drivers. Canadian Journal of

Diabetes vol. 39 347–353 (2015).

3. American Diabetes Association. Diabetes

and driving – position statement. Diabetes

Care 37, S97–S103 (2014).

4. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021).

5. Skurtveit, S. et al. Road trac accident risk

in patients with diabetes mellitus receiving

blood glucose-lowering drugs. Prospective

follow-up study. Diabetic Medicine 26,

404–408 (2009).

6. Cox, D. J. et al. Driving mishaps among

individuals with type 1 diabetes: a

prospective study. Diabetes Care 32,

2177–2180 (2009).

7. Redelmeier, D. A., Kenshole, A. B. & Ray, J.

G. Motor vehicle crashes in diabetic patients

with tight glycemic control: a population-

based case control analysis. PLoS

Medicine6, (2009).

8. Royal Australian College of General

Practitioners. Management of type 2

diabetes: a handbook for general practice.

(2020).

9. Australian Type 1 Diabetes Guidelines

Expert Advisory Group. National evidence-

based clinical care guidelines for type 1

diabetes in children, adolecents, and adults.

(Australian Government Department of

Health and Ageing, 2011).

10. Clarke, W. L. et al. Reduced awareness

of hypoglycemia in adults with IDDM:

a prospective study of hypoglycemic

frequency and associated symptoms.

Diabetes Care 18, 517–522 (1995).

11. Høi-Hansen, T., Pedersen-Bjergaard,

U. & Thorsteinsson, B. Classiﬁcation of

hypoglycemia awareness in people with

type 1 diabetes in clinical practice. Journal

ofDiabetes and its Complications 24,

392–397 (2010).

12. Geddes, J., Wright, R. J., Zammitt, N. N.,

Deary, I. J. & Frier, B. M. An evaluation of

methods of assessing impaired awareness

of hypoglycemia in type 1 diabetes.

Diabetes Care 30, 1868–1870 (2007).

13. Schopman, J. E., Geddes, J. & Frier, B.

M. Prevalence of impaired awareness

of hypoglycaemia and frequency of

hypoglycaemia in insulin-treated type 2

diabetes. Diabetes Research and Clinical

Practice 87, 64–68 (2010).

14. Geddes, J., Schopman, J. E., Zammitt, N.

N. & Frier, B. M. Prevalence of impaired

awareness of hypoglycaemia in adults

with type 1 diabetes. Diabetic Medicine 25,

501–504 (2008).

104

Diabetes mellitus

103

PART B. Medical standards

4. Hearing loss and deafness

Refer also to Part B section 5. Musculoskeletal

conditions and section 10. Vision and eye

disorders.

This section deals with ﬁtness to drive in relation

to hearing loss and deafness. Hearing loss

and deafness may be well compensated for

when driving by relying on vision, attention

and physical mobility to adequately scan the

driving environment. Hearing loss and deafness

may coexist with other impairments that could

compromise these adaptive capabilities, such

as visual, mobility and cognitive impairment,

particularly in older people. For guidance in

assessing multiple medical conditions refer to

Part A 2.2.8. Multiple medical conditions.

4.1. Relevance to the

driving task

4.1.1. Eect of hearing loss on

driving

1–7

The evidence base regarding hearing loss and

driving safely is limited; however, the analysis

of the small number of quality studies report

that hearing loss has no eect on motor vehicle

crash risk.

It may be that a loss of hearing is

well compensated for since most people who

are hard of hearing are aware of their disability

and therefore tend to be more cautious and rely

more on visual cues and other sensations such

as vibrations. Functional hearing is used in the

driving task to:

• sense alarms, notiﬁcations and other

auditory cues in the driving environment (e.g.

railway crossings, ﬁrst responder sirens)

• sense auditory cues on the state and

position of the vehicle from vehicle

technology systems (e.g. alarms, warning

systems using sound alerts)

• compensate for comorbidities or general

reduction in functional abilities that

may impair driving (e.g. slower reaction

times, reduced neck rotation due to

musculoskeletal changes)

• assist in maintaining general vigilance,

alertness and arousal.

4.1.2. Considerations for commercial

vehicle drivers

8,9

While driving ability per se might not be aected

by a hearing loss, responsiveness to critical

events is an important safety consideration for

drivers of commercial vehicles. These drivers

therefore require the capacity to ensure safety

and the capacity to respond to environmental

situations that may involve sirens, rail crossings

and emergency signals as well as conditions

of the vehicle and roads. It may be challenging

to rely solely on vision to compensate for a

signiﬁcant hearing loss in a commercial vehicle.

The internal commercial vehicle cabin can

place additional attentional, workload and visual

demands on drivers for undertaking tasks such

as checking multiple displays or monitors and

using communication systems. These additional

tasks reduce capacity to compensate for a lack

of hearing by relying on vision to monitor the

external environment.

105

PART B. Medical standards

4.2. General assessment

and management

guidelines

4.2.1. Commercial vehicle drivers

Only drivers of commercial vehicles are

required to meet a hearing standard for the

reasons outlined above. The following hearing

assessment applies to all forms of hearing loss

including congenital and childhood hearing

loss, and hearing loss acquired in later years.

The process is summarised in Figure 11.

Management of hearing loss in commercial

vehicle drivers.

• Compliance with the standard should be

clinically assessed initially by the treating

doctor, audiologist* or audiometrist**. If

there is doubt about the person’s hearing,

audiometry should be performed by an ear,

nose and throat (ENT) specialist, audiologist*

or audiometrist**. The person need not

undergo audiometry if their hearing is

satisfactory.

• If on audiometry the person has unaided

hearing loss greater than or equal to 40

dB in the better ear (averaged over the

frequencies 0.5, 1, 2 and 3 KHz), they do not

meet the criteria for an unconditional licence.

• If the standard is able to be met with a

hearing aid, the driver licensing authority

may consider a conditional licence, subject

to periodic assessment of hearing, the use

of the hearing aid whilst driving and of the

hearing aids set at a frequency advised

by the ENT specialist, audiologist* or

audiometrist**. Stable conditions may not

require periodic review.

• If the standard is not able to be met with

a hearing aid, this does not disqualify the

person from driving. They should be oered

individualised assessment to determine their

eligibility for a conditional licence. This may

comprise assessment by an ENT specialist

or audiologist* including consideration of:

− the person’s medical history – for

example, childhood deafness may have

led to good adaptation

− the person’s driving record before and

since the hearing loss

− the nature of the driving task – for

example, the type of vehicle (e.g. truck,

bus), roads and distances to be travelled

− the ergonomics of the driving cab – for

example, assistive devices such as

mirrors and a GPS

− concomitant medical conditions such as

vision impairment or cognitive impairment

− practical driver assessment if required

(refer to Part A section 2.3.1. Practical

driver assessments). The report may

advise on assistive technologies as a

licence condition.

The driver licensing authority may consider a

conditional licence based on the information

received. Periodic review may include medical

review and/or a practical driver assessment at

the discretion of the driver licensing authority.

The health professional should advise on the

frequency of review as determined by the

natural history of the condition. Stable conditions

may not require periodic review.

In some cases, noise ampliﬁcation from wearing

hearing aids may lead to driver distraction

and may warrant individualised assessment as

above to determine ﬁtness to drive without the

hearing aid.

106

Hearing loss and deafness

105

PART B. Medical standards

4.2.2. Private vehicle drivers

While hearing loss will not preclude driving a

private car, people with hearing loss should

be advised regarding their loss and their

limited ability to hear warning signals. Assistive

technologies such as hearing aids, sensors and/

or physical equipment such as additional mirrors

might also be used upon consideration of the

needs of the individual driver. Occupational

therapist driving assessors can assist with

identifying vehicle aides.

* For the purposes of this document an

audiologist is a person accredited as such by

Audiology Australia (refer to www.audiology.asn.

au ) or the Australian College of Audiology (refer

to www.acaud.org).

** For the purposes of this document, an

audiometrist is a person accredited as such by

the Australian College of Audiology (refer to

www.acaud.org) or the Hearing Aid Audiology

Society of Australia (refer to www.haasa.org.au).

107

PART B. Medical standards

Figure 11. Management of hearing loss in commercial vehicle drivers

Assess hearing clinically

Possible hearing loss?

Conduct audiometry

Hearing loss > 40 dB in better

ear averaged over 0.5, 1, 2 &

3 kHz

Standard is able to be met

with hearing aid?*

Individual assessment

Eligible for an

unconditionallicence

Eligible for a

conditionallicence

Unﬁt to hold a

commercial vehicle

licence

Periodic review of

hearing and hearing

aids (if applicable)

Stable

hearing loss?

Periodic review may

not be required

* In some cases noise ampliﬁcation as a result of wearing hearing aids may lead to driver distraction and may warrant

individualised assessment to determine ﬁtness to drive without the hearing aid (refer to section 4.2.1).

Ye s

No Ye s

Ye s

Pass

Fail

Ye s

108

Hearing loss and deafness

107

PART B. Medical standards

4.3. Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table.

Medical standards for licensing

–

hearing

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles

or requiring a dangerous goods driver licence –

refer to deﬁnition in Table 3)

Hearing loss There is no hearing standard for private

vehicle drivers.

Refer to 4.2. General assessment and

management guidelines.

Compliance with the standard should be clinically

assessed initially. If the initial clinical assessment

indicates possible hearing loss, the person should

be referred for audiometry.

A person is not ﬁt to hold an unconditional licence:

• if the person has unaided hearing loss ≥ 40 dB

in the better ear (averaged over the frequencies

0.5, 1, 2 and 3 KHz).

A conditional licence may be considered by the

driver licensing authority subject to periodic review*,

taking into account the nature of the driving task

and information provided by an ENT specialist or

audiologist**, as to whether:

• the standard is able to be met with a hearing

aid***.

If the standard is not able to be met with a hearing

aid, further individualised assessment should be

oered.

A conditional licence may be considered by the

driver licensing authority subject to periodic review*,

taking into account:

• the nature of the driving task; and

• information provided by an ENT specialist or

audiologist**; and

• the results of a practical driver assessment if

required.

* Stable conditions may not require periodic review.

** Refer to section 4.2. General assessment and

management guidelines.

*** In some cases, noise ampliﬁcation as a result of

wearing hearing aids may lead to driver distraction

and may warrant individualised assessment to

determine ﬁtness to drive without the hearing aid

(refer to 4.2. General assessment and management

guidelines).

109

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

110

Hearing loss and deafness

109

PART B. Medical standards

References and further reading

1. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021).

2. Green, K. A., McGwin, G. & Owsley, C.

Associations between visual, hearing, and

dual sensory impairments and history of

motor vehicle collision involvement of older

drivers. Journal of the American Geriatrics

Society 61, 252–257 (2013).

3. McCloskey, L. W., Koepsell, T. D., Wolf, M.

E. & Buchner, D. M. Motor vehicle collision

injuries and sensory impairments of older

drivers. Age and Ageing 23, 267–273

(1994).

4. Picard, M. et al. Could driving safety be

compromised by noise exposure at work

and noise-induced hearing loss? Trac

Injury Prevention 9, 489–499 (2008).

5. Dow, J., Gaudet, M. & Turmel, E. Crash rates

of Quebec drivers with medical conditions.

Annals of advances in automotive medicine.

Association for the Advancement of

Automotive Medicine. Annual Scientiﬁc

Conference 57, 57–66 (2013).

6. Vivoda, J. M. et al. The Inﬂuence of

Hearing Impairment on Driving Avoidance

Among a Large Cohort of Older Drivers.

Journal of Applied Gerontology (2021)

doi:10.1177/0733464821999223.

7. Australian Transport Safety Bureau. Level

crossing collision between The Ghan

Passenger Train (1AD8) and a Road-Train

Truck: ATSB Transport Safety Investigation

Report 2006/015. (Australian Transport

Safety Bureau, 2008).

8. Songer, T. et al. Hearing disorders and

commercial motor vehicle operators (Final

Report FHWA-MC-93-004. (1992).

9. Campbell, J. et al. Human factors design

guidance for driver-vehicle interfaces

(Report No. DOT HS 812 360). www.nhtsa.

gov (2016).

111

PART B. Medical standards

5. Musculoskeletal conditions

Refer also to Part A section 2.2.7. Older drivers

and age-related changes and 2.2.9. Drugs

and driving; Part B section 6. Neurological

conditions and section 10. Vision and eye

disorders.

This section deals with ﬁtness to drive in relation

to a variety of musculoskeletal conditions and

disabilities that may result in chronic pain,

muscle weakness, joint stiness, sensory

loss or loss of limbs. Speciﬁc neuromuscular

conditions, such as multiple sclerosis, are

addressed under section 6. Neurological

conditions. Musculoskeletal conditions are also

likely to coexist with other impairments, such as

visual and cognitive impairment, particularly in

older people. For guidance in assessing older

drivers and multiple medical conditions refer

to Part A section 2.2.7. Older drivers and age-

related changes and 2.2.8. Multiple medical

conditions).

5.1. Relevance to the

driving task

5.1.1. Eects of musculoskeletal

conditions on driving

To safely operate a motor a vehicle, drivers

must be able to execute and coordinate many

complex muscular movements requiring

adequate range of movement, sensation,

coordination and power of the upper and lower

limbs (refer Figure 12):

• The upper limbs are required to steer and to

operate gears/transmission and secondary

vehicle controls.

• The lower limbs are required to operate the

foot controls.

• The ability to rotate the head is important for

scanning the environment including when

reversing.

• General postural stability and endurance is

also required.

• Entering and leaving the vehicle also

requires a degree of strength and ﬂexibility.

There is a close link between these

requirements and the cognitive and decision-

making requirements of the driving task.

Speciﬁc requirements will vary depending on

the vehicle and the driving task. Commercial

vehicles vary considerably in terms of cabin

access and design, vehicle controls and

ergonomics, and the commercial driving task

can be physically demanding in terms of the

vehicle operation as well as the duration of

driving. The needs of motorcyclists also dier

due to the type of controls and the overall

driving task, as well as requirements for balance

and agility.

112

Musculoskeletal conditions

111

PART B. Medical standards

Figure 12. General functional requirements for driving motor vehicles (excluding motorcycles)

Able to move upper limb(s) with

sucient range of movement,

sensation, coordination and

power to achieve required

movements to:

• operate ignition

• hold and turn steering wheel

• operate secondary vehicle

controls consistently (e.g.

indicators)

• operate gear lever and hand

brake (if needed).

Upper limb(s)

Able to maintain attention,

concentration, decision making,

responsiveness and insight

needed for driving-related tasks.

Cognitive function

Able to stabilise head and

rotate neck to achieve required

movements to:

• turn head to both sides to scan

road and view mirrors

• turn head for reversing.

Neck movements

Able to maintain posture and

move spine so as to support

positions of head, upper and

lower limbs needed for driving-

related tasks.

Back movements

Able to move lower limb/s with

sucient range of movement,

sensation, coordination and

power to operate foot controls.

Lower limb(s)

The features of modern vehicles, such as

digital controls, reversing cameras, automatic

transmission, power steering and adjustable

seats, accommodate a range of impairments.

Adaptive equipment can also be installed (e.g.

hand-operated controls) that enable many

drivers with impairments to operate vehicles

safely (refer to Table 6).

Chronic impairment of musculoskeletal functions

may arise from numerous disorders and trauma

(e.g. amputations, arthritis, ankylosis, deformities

and chronic lower back pain). Issues related

to muscle tone, spasm, sitting tolerance and

endurance, as well as the eects of medications,

may also need to be considered (refer to Part A

section 2.2.9. Drugs and driving).

Acute and chronic pain associated with

musculoskeletal conditions may also impact the

cognitive aspects of driving, with evidence that

it aects attention and concentration, as well

as emotional responses. This is an important

consideration for the overall management

of drivers with musculoskeletal conditions

(refer to section 5.2. General assessment and

management guidelines).

It is possible to drive safely with quite severe

functional impairment; however, driver insight

into functional limitations, stability of the

condition and compensatory body movements

or vehicle devices to overcome deﬁcits are

usually required (refer to section 5.2. General

assessment and management guidelines).

113

PART B. Medical standards

5.1.2. Evidence of crash risk

There is limited published data on the risk

of a crash or loss of control of a vehicle due

to musculoskeletal disorders. While several

studies describe driving diculties experienced

by people with physical impairment aecting

the musculoskeletal system, the evidence

suggests there is only a slightly increased

risk of crash associated with these disorders.

This may be attributed to the driver’s ability to

compensate for physical impairments while

driving or, as for various other conditions, it may

be due to self-limiting of driving by people with

theseconditions.

5.2. General assessment

and management

guidelines

5.2.1. Clinical assessment

Given the variability in vehicles and driving tasks,

driver assessment should be individualised and

based on their deﬁned functional requirements,

together with the associated impacts of their

condition and treatment.

The clinical assessment aims to identify whether

a driver’s condition is likely to result in diculty

undertaking the driving task and whether and

how they might be supported to drive safely.

Several factors need to be considered:

• the person’s driving and mobility

requirements

• the person’s functional capacity relative to

the driving task

− muscle strength

− ﬂexibility

− endurance

− sensory abilities (sensation,

proprioception, kinaesthesia)

• the presence of pain that may impede

concentration, attention or movement

• the potential impairment from

prescriptionmedications balanced against

the patient’s improvement in function and

health more generally

• the likely progression of the condition/disability

• the person’s current use of adaptive

strategies and equipment, including impacts

on functionality and outcomes such as

endurance on the driving task

• the impact of comorbidities and age-

relatedchange.

5.2.2. Chronic pain associated with

musculoskeletal conditions

Assessment and management of chronic pain

should consider the functional and cognitive

impacts on driving. This includes whether

pain or pain treatments (refer to Part A section

2.2.9. Drugs and driving) are likely to aect

attention, concentration or decision making, or

the person’s ability to respond appropriately

in the driving environment. The functional and

cognitive impacts may ﬂuctuate.

Fitness to drive will depend on the demands

of the driving task and whether these can be

managed or modiﬁed. It will also depend on

self-management and compensatory strategies

and the driver’s insight into the impact of their

chronic pain. A practical driver assessment may

assist in some cases to evaluate the impact of

chronic pain on driving (refer to Part A section

2.3.1. Practical driver assessments).

5.2.3. Functional and practical

assessment

In addition to a clinical examination, a functional

assessment and/or practical driver assessment

may be required to assess functional limitations

and identify requirements for vehicle adaptation

or personal restrictions (refer to Table 6 for

examples).

4,5

Processes for initiating and conducting driver

assessments vary between the states and

territories. Practical assessments may be

114

Musculoskeletal conditions

113

PART B. Medical standards

conducted by occupational therapists or others

approved by the driver licensing authority

(refer to Part A section 2.3.1. Practical driver

assessments). The assessments may be initiated

by the examining health professional or by the

driver licensing authority. Recommendations

following assessment may relate to:

• licence status

• the need for rehabilitation or retraining

• licence conditions such as vehicle

modiﬁcation or personal restrictions

• requirements for reassessment.

If a person installs or upgrades a vehicle

modiﬁcation, reassessment is generally only

required if a dierent class of device will be

used. The device classes include:

• hand-operated brake and accelerator lever

controls, requiring a steering aid

• hand-operated brake and accelerator controls,

maintaining two hands on the steering wheel

• pedal modiﬁcations, maintaining operation

by the lower limbs (e.g. left foot accelerator,

pedal extensions)

• steering aids

• secondary control modiﬁcations (e.g. park

brake, gear selector).

Information about the options for practical

driver assessment in the relevant state or

territory can be obtained by contacting the local

driver licensing authority (Appendix 9. Driver

licensing authoritycontacts). For information

about occupational therapists qualiﬁed in driver

assessment, contact Occupational Therapy

Australia (refer to Appendix 9. Driver licensing

authoritycontacts).

In the case of a driver seeking a conditional

commercial vehicle licence, the person will have

to initially demonstrate proﬁciency in driving a

light vehicle (car) before being assessed in a

commercial vehicle. For the commercial vehicle

licence, an on-road driver assessment will need

to be undertaken in the commercial vehicle and

with modiﬁcations if required. This assessment

should be conducted as required by the driver

licensing authority.

Motorcyclists with a musculoskeletal disability

will require a practical driver assessment

(refer to Part A section 2.3.1. Practical driver

assessments).

Table 6. Examples of vehicle modiﬁcations and personal restrictions relevant to

musculoskeletal disorders*

Example of disability/situation Examples of licence conditions (vehicle modiﬁcation or

personal restrictions)

Left leg disability Automatic transmission

Left arm disability Automatic transmission and steering aid

Short stature Built-up seat and pedals

Loss of leg function Hand-operated controls

Loss of right leg function Left foot accelerator

Reduced upper limb strength Power steering only

Short leg(s) Extended pedals

Loss of limb function or limb-deﬁcient Prosthesis required

* These are not mandatory requirements and may be unsuitable in some circumstances.

115

PART B. Medical standards

5.2.4. Congenital or non-progressive

conditions

Drivers who have conditions of a non-

progressive nature (e.g. congenital loss

or incapacity of a limb) require a medical

assessment for the ﬁrst issue of a licence.

Periodic review is not usually required if the

condition is static and there are no comorbidities

impacting on ﬁtness to drive.

5.2.5. Use of prosthetic devices

Prosthetic devices are an alternative to vehicle

modiﬁcation and may be suitable for people

who are learning to drive or returning to driving

after a signiﬁcant injury. These devices should

be recommended by an occupational therapist

specialising in the area, with conﬁrmation that:

• the prosthesis manufacturer has not

speciﬁed that the prosthesis is unsuitable

fordriving

• the person has demonstrated:

− the ability to drive safely while using

the prosthesis, including maintaining

uninterrupted observation of the road

(i.e. not needing to visually check the

prosthesis’ position)

− adequate strength and endurance to

maintain prosthetic use while driving

• the therapist has assessed appropriate

sensation (superﬁcial and proprioception) in

the stump and remaining limb

• the therapist has conﬁdence in the ﬁt of the

prosthesis

• the prosthesis-vehicle control interfaces

have been evaluated and addressed (e.g.

upper limb prostheses may require a suitably

designed steering aid if used to maintain

steering control).

Periodic review may not be required where the

driver’s health is stable and there are no other

medical conditions that may impair driving.

5.2.6. Short-term musculoskeletal

conditions

People with severe musculoskeletal pain and/

or reduced mobility associated with short-term

conditions such as injury or surgery should

be advised not to drive for the duration of

their treatment. Return to driving should be

determined by the treating doctor and is not

a licensing issue. Considerations include the

impact of pharmacological treatments (refer to

Part A section 2.2.9. Drugs and driving) and

non-pharmacological treatments such as soft

collarsorbraces.

Some loss of neck movement is allowable

if the vehicle is ﬁtted with adequate internal

and externally mounted mirrors or cameras,

and provided the driver meets the visual

standards for driving and has no cognitive or

insight limitations that might aect adopting

compensatory strategies.

The opinion of an occupational therapy driver

assessor may be obtained if there is ongoing

limitation of function.

Guidance for managing short-term conditions

is included in Part A section 2.2.3. Temporary

conditions.

116

Musculoskeletal conditions

115

PART B. Medical standards

5.3. Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table.

Medical standards for licensing

–

musculoskeletal conditions

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Musculoskeletal

disorders

(including chronic

pain, muscle

weakness,

arthritis)

A person is not ﬁt to hold an unconditional

licence:

• if the driver’s ability to perform the

required driving activities (refer to section

5.2.1. Clinical assessment and Figure 12)

is inadequate.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor on:

− the stability of the condition; and

− the beneﬁt of treatments, prostheses

or other devices (see footnote below);

− medications that may impair capacity

for safe driving (refer to Part A section

2.2.9. Drugs and driving)

• a practical driver assessment if required*;

and

• any modiﬁcation to the vehicle.

* Motorcyclists with a musculoskeletal

disability will require a practical driver

assessment (refer to Part A section 2.3.1.

Practical driver assessments).

A person is not ﬁt to hold an unconditional

licence:

• if the driver’s ability to perform the

required driving activities (refer to section

5.2.1. Clinical assessment and Figure 12)

is inadequate.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor on:

− the stability of the condition; and

− the beneﬁt of treatments, prostheses

or other devices (see footnote below);

− medications that may impair capacity

for safe driving (refer to Part A section

2.2.9. Drugs and driving)

• the results of a practical driver

assessment*; and

• any modiﬁcation to the vehicle.

* All commercial vehicle drivers with a

musculoskeletal disability will require a

practical driver assessment (refer to Part A

section 2.3.1. Practical driver assessments).

Note: The evaluation of the eectiveness of prostheses and the speciﬁcation of appropriate modiﬁcations to vehicle controls

is a specialist area. It is recommended that the person be referred to an occupational therapist specialising in the area and

that the report from that professional be made available to the driver licensing authority (refer to Appendix 10. Specialist

driver assessors).

117

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

118

Musculoskeletal conditions

117

PART B. Medical standards

References and further reading

1. Charlton, J. L. & Monash University Accident

Research Centre. Inﬂuence of chronic

illness on crash involvement of motor

vehicle drivers. (Monash University, Accident

Research Centre, 2010).

2. Di Stefano, M. & Ross, P. VicRoads

Guidelines for occupational therapy driver

assessors, 3rd edition, Melbourne, Australia:

Roads Corporation Victoria (2018)

3. Vaezipour, A. et al. The impact of chronic

pain on driving behaviour: a systematic

review. Pain (2021) doi:10.1097/j.pain.

4. Di Stefano, M., Stuckey, R., Kinsman,

N. & Lavender, K. Vehicle modiﬁcation

prescription: Australian occupational therapy

consensus-based guidelines. American

Journal of Occupational Therapy 73, (2019).

5. Di Stefano, M. Stuckey, R. & Kinsman,

N. Understanding characteristics and

experiences of drivers using vehicle

modiﬁcations. American Journal of

Occupational Therapy 73, (2019).

119

PART B. Medical standards

6. Neurological conditions

Safe driving is a demanding task that requires

a number of intact neurological functions

including:

• visuospatial perception

• insight

• judgement

• attention and concentration

• comprehension

• reaction time

• memory

• sensation

• muscle power (refer to section

5. Musculoskeletal conditions)

• coordination

• vision (refer to section 10. Vision and eye

disorders).

Impairment of any of these capacities may

be caused by neurological disorders and

therefore aect safe driving ability. In addition

to these deﬁcits, some neurological conditions

produceseizures.

This chapter provides guidance and medical

criteria for the following conditions:

• dementia (refer to section 6.1)

• seizures and epilepsy (refer to section 6.2)

• other neurological conditions including (refer

to section 6.3):

− aneurysms

− cerebral palsy

− head injury

− neuromuscular conditions

− Parkinson’s disease

− multiple sclerosis

− Ménière’s disease

− stroke

− transient ischaemic attacks

− subarachnoid haemorrhage

− space-occupying lesions including brain

tumours

− other neurodevelopmental conditions.

The focus of this chapter is on long-term or

progressive disorders aecting driving ability

and licensing status. Some guidance (advisory

only) is provided regarding short-term ﬁtness

to drive – for example, following a head injury.

Refer also to Part A section 2.2.3. Temporary

conditions.

Where people experience musculoskeletal,

visual or psychological symptoms, the relevant

standards should also be considered. Refer to

section 5. Musculoskeletal conditions, section

7. Psychiatric conditions and section 10. Vision

and eye disorders.

120

Neurological conditions

119

PART B. Medical standards

6.1. Dementia

Refer also to Part A section 2.2.7. Older drivers

and age-related changes and section 2.2.8.

Multiple medical conditions.

Dementia is a syndrome due to a disease of

the brain, usually of a chronic or progressive

nature, in which there is disturbance of one

ormore cognitive functions beyond what

might be expected from normal ageing. It

can aect memory, thinking, orientation,

comprehension, calculation, learning capacity,

language and judgement. Consciousness is

not clouded. Theimpairments are commonly

accompanied,and occasionally preceded,

by deterioration in emotional control, social

behaviour or motivation.

Disease pathology without cognitive impairment

can be seen in preclinical dementia, while

a slight but noticeable decline in some

cognitive functions may indicate mild cognitive

impairment (MCI) or prodromal dementia.

Alzheimer’s disease is the most common form

of dementia and may contribute to 60–70

per cent of cases. Other major forms include

vascular dementia, dementia with Lewy bodies,

and a group of diseases that contribute to

frontotemporaldementia.

The estimated proportion of the general

population aged 60 or older with dementia

at a given time is between 5 and 8 per cent.

Although age is the strongest known risk factor

for dementia, it is not an inevitable consequence

of ageing. Further, dementia does not

exclusively aect older people – young-onset

dementia (deﬁned as the onset of symptoms

before the age of 65 years) accounts for up to 9

per cent of cases.

6.1.1. Relevance to the driving task

Eects of dementia on driving

Dementia is characterised by signiﬁcant loss

of cognitive abilities such as memory capacity,

psychomotor abilities, attention, visuospatial

functions, insight and executive functions.

Dementia may aect driving ability in several

ways including:

• errors with navigation, including forgetting

routes and getting lost in familiar

surroundings

• limited concentration or ‘gaps’ in attention,

such as failing to see or respond to ‘stop’

signs

• errors in judgement, including misjudging

the distance between cars and misjudging

the speed of other cars

• confusion when making choices – for

example, diculty choosing between the

accelerator or brake pedals in stressful

situations

• poor decision making or problem solving,

including failure to give way appropriately at

intersections and inappropriate stopping in

trac

• poor insight and denial of deﬁcits

• slowed reaction time, including failure to

respond in a timely fashion to instructions

from passengers

• poor hand–eye coordination.

Other causes of ﬂuctuating cognitive impairment

or delirium, such as hepatic, renal or respiratory

failure, do not usually have an impact on licence

status and may be managed in the short term

according to general principles (refer to Part

A section 2. Assessing ﬁtness to drive –

generalguidance).

121

PART B. Medical standards

Evidence of crash risk

2,3

Dementia syndrome and symptoms are

associated with a moderately high risk of

collision compared with matched controls.

However, the evidence does not suggest that

all people with dementia symptoms should have

their licences revoked or restricted. Throughout

all stages of their condition, drivers require

regular monitoring regarding progression of

the disease. While for some drivers the crash

risk is minimised because they choose, or

are persuaded by their family, to voluntarily

cease driving, others with signiﬁcant cognitive

decline and limited insight may require careful

management and support in this regard, as

discussed below.

6.1.2. General assessment and

management guidelines

Preclinical dementia

Preclinical dementia is increasingly being

identiﬁed using modern diagnostic techniques.

The dementia-related pathology is diagnosed

in advance of the clinical manifestations of

dementia itself, including symptoms that impair

driving (e.g. preclinical Alzheimer’s disease). A

person diagnosed in this manner, who has no

clinically signiﬁcant symptoms of dementia, can

be considered ﬁt to drive. Health professional

review may be appropriate to monitor

disease progression and development of

dementiasymptoms.

Mild cognitive impairment

5–7

MCI, which incorporates the prodromal stage

of dementia, causes a slight but measurable

decline in cognitive abilities. The cognitive

changes are noticeable to the person and to

family members and friends but generally do not

aect the person’s ability to carry out everyday

activities. Driving studies examining the eects

of MCI found limited evidence of increased

driving error rates, concluding that MCI does

not signiﬁcantly impair driving. Where there is

impairment across multiple cognitive domains

such as visuospatial, attention and executive

functions, it may be appropriate to consider

the driver’s ﬁtness to drive and perform an

assessment as outlinedbelow.

Dementia assessment

Due to the progressive and irreversible nature

of the condition, people with a diagnosis of

dementia will eventually be a risk to themselves

and others when driving. The level of impairment

varies widely – each person will experience a

dierent pattern and timing of impairment as

their condition progresses, and some people

may not need to stop driving immediately.

Individual assessment and regular review are

therefore important, although it is dicult to

predict the point at which a person will no longer

be safe to drive.

A combination of medical assessment (including

specialist assessment as required) and o-road

and on-road practical assessments appears

to give the best indication of driving ability.

For further information about practical driver

assessments refer to Part A section 2.3.1.

Practical driver assessments.

The following points may assist in assessing a

person:

• Driving history. Have they been involved

in any driving incidents? Have they been

referred for assessment by the police or a

driver licensing authority?

• Vision. Can they see things coming straight

at them or from the sides? (refer to section

10. Vision and eye disorders)

• Hearing. Can they hear the sound of

approaching cars, car horns and sirens?

• Reaction time. Can they turn, stop or speed

up their car quickly?

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Neurological conditions

121

PART B. Medical standards

• Problem solving. Do they become upset

and confused when more than one thing

happens at the same time?

• Coordination. Have they become clumsy

and started to walk dierently because their

coordination is aected?

• Praxis. Do they have diculty using their

hands and feet when asked to follow motor

instructions?

• Alertness and perception. Are they aware

and understand what is happening around

them? Do they experience hallucinations or

delusions?

• Insight. Are they aware of the eects of their

dementia? Is there denial?

• Other aspects of driving performance.

− Can they tell the dierence between left

and right?

− Do they become anxious or confused on

familiar routes?

− Can they comprehend road signs?

− Can they respond to verbal instructions?

− Do they understand the dierence

between ‘stop’ and ‘go’ lights?

− Are they able to stay in the correct lane?

− Can they read a road map and follow

detour routes?

− Has their mood changed when driving?

(Some previously calm drivers may

become anxious, panicked, angry or

aggressive.)

− Are they conﬁdent when driving?

Because of the lack of insight and variable

memory abilities associated with most dementia

syndromes, the person may minimise or deny

any diculties with driving. Relatives may be a

useful source of information regarding overall

coping and driving skills. They may comment

about the occurrence of minor crashes, or

whether they are happy to be driven by the

person with dementia. Referral for a practical

driving assessment may be warranted where

sucient concern or uncertainty remains

regarding the degree of impact of the cognitive

impairments (refer to Part A section 2.3.1.

Practical driver assessments).

Transition from driving

Licence restrictions, such as limitation of driving

within a certain distance from a driver’s home,

may be considered by the driver licensing

authority (refer to section 6.1.3. Medical

standards for licensing). Community mobility

assessment and planning with reference to

cessation of driving may include family support,

accessing local public transport or using

community buses, and providing information

about taxi and other community transport

services available for people with disabilities.

Anumber of resources are available to support

the transition. Speciﬁc information resources are

available from Dementia Australia for drivers with

dementia and their family/carers.

Failure to comply with advice or licence

restriction

People may continue to drive despite being

advised they are unsafe, and despite their

licence being restricted or revoked. This

may be because of denial, memory loss or

loss of insight. Discussions with the person’s

family/carers may be helpful, and alternative

transportation can be explored. Where the

person is judged to be an imminent threat to

safety, all states and territories provide indemnity

for health professionals and other members

of the public who notify the driver licensing

authority of at-risk drivers; the driver licensing

authority will then take the necessary steps.

123

PART B. Medical standards

6.1.3. Medical standards for licensing

Requirements for unconditional and conditional

licences are outlined in the following table.

Health professionals should familiarise

themselves with the information in this chapter

and the tabulated standards before assessing a

person’s ﬁtness to drive.

Due to the progressive nature of dementia

and the need for frequent review, a person

diagnosed with this condition may not hold

an unconditional licence for either a private or

commercial vehicle. Private vehicle drivers may

be considered for a conditional licence subject

to medical opinion and practical assessment as

required. The practical assessment is generally

appropriate for borderline cases where the

impact on driving is unclear. Commercial vehicle

drivers require specialist assessment including

a practical driver assessment (refer to Part A

section 2.3.1. Practical driver assessments).

One option available to maintain a driver’s

independence despite a reduction in capacity

is to recommend that an area restriction be

placed on the licence. This eectively limits

where the person can drive and is most

expressed as a kilometre radius restriction

based on their home address. Drivers should

be capable of managing usual driving demands

(e.g. negotiating intersections, giving way to

pedestrians) as required in their local area.

These licence conditions are only suitable for

drivers who can reasonably be expected to

understand and remember the limits as well as

reliably compensate for any functional declines.

The ability to respond appropriately and in

a timely manner to unexpected occurrences

such as roadworks or detours that require

problem solving should also be considered.

People lacking insight or with signiﬁcant visual,

memory or cognitive-perceptual impairments

are therefore usually not suitable candidates

for a radius restriction. When advising such a

restriction it is also important to remember the

following:

• A driver may not always appreciate the

meaning or extent of a speciﬁed number of

kilometres from home.

• Potential hazards such as pedestrians,

intersections, roadworks, bad weather and

detours can still exist in familiar streets close

to home and can be a source of confusion.

• A driver licence is a legal document that

demonstrates that a driver has satisﬁed

the driver licensing authority that they are

ﬁt to use the road system as it exists – this

means they must be competent to deal with

unexpected and hazardous situations, even

when limited to driving close to home.

• Restrictions to speciﬁed routes are not

practicable and should not be advised.

Drivers with a diagnosis of dementia will

generally not meet the commercial standards.

In some situations a conditional licence may

be considered by the driver licensing authority

subject to careful assessment by an appropriate

specialist. Commercial vehicle drivers must

also be subject to a practical driver assessment

(refer to Part A section 2.3.1. Practical driver

assessments).

124

Neurological conditions

123

PART B. Medical standards

Medical standards for licensing

–

dementia and other cognitive impairment

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Dementia A person is not ﬁt to hold an unconditional

licence:

• if the person has a diagnosis of dementia*.

A conditional licence may be considered by

the driver licensing authority subject to at least

annual review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor regarding the level of impairment

of any of the following: visuospatial

perception, insight, judgement, attention,

comprehension, reaction time or memory

and the likely impact on driving ability; and

• the results of a practical driver assessment

if required (refer to Part A section 2.3.1.

Practical driver assessments).

The opinion of an appropriate specialist may

also be considered.

* This does not include preclinical or

prodromal/MCI stages of the disease unless

impairments are present as described in

section 6.1.2. General assessment and

management guidelines.

A person is not ﬁt to hold an unconditional

licence:

• if the person has a diagnosis of dementia*.

A conditional licence may be considered by

the driver licensing authority subject to at least

annual review, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the level of impairment

of any of the following: visuospatial

perception, insight, judgement, attention,

comprehension, reaction time or memory

and the likely impact on driving ability; and

• the results of a practical driver

assessment**.

* This does not include preclinical or

prodromal/MCI stages of the disease unless

impairments are present as described in

section 6.1.2. General assessment and

management guidelines.

** All commercial vehicle drivers will require

a practical driver assessment (refer to Part A

section 2.3.1. Practical driver assessments).

125

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

126

Neurological conditions

125

PART B. Medical standards

References and further reading

1. Rapoport, M. J. et al. An international

approach to enhancing a national guideline

on driving and dementia. Current Psychiatry

Reports vol. 20 (2018).

2. Chee, J. N. et al. Update on the risk of motor

vehicle collision or driving impairment with

dementia: a collaborative international

systematic review and meta-analysis.

American Journal of Geriatric Psychiatry vol.

25 1376–1390 (2017).

3. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

4. Dubois, B. et al. Preclinical Alzheimer’s

disease: Deﬁnition, natural history, and

diagnostic criteria. Alzheimer’s and

Dementia vol. 12 292–323 (2016).

5. Hird, M. A. et al. Investigating simulated

driving errors in amnestic single- and

multiple-domain mild cognitive impairment.

Journal of Alzheimer’s Disease 56, 447–

452 (2017).

6. Eramudugolla, R., Huque, M. H., Wood, J.

& Anstey, K. J. On-road behavior in older

drivers with mild cognitive impairment.

Journal of the American Medical Directors

Association 22, 399-405.e1 (2020).

7. Anstey, K. J. et al. Assessment of driving

safety in older adults with mild cognitive

impairment. Journal of Alzheimer’s Disease

57, 1197–1205 (2017).

8. Australian and New Zealand Society for

Geriatric Medicine. Australian and New

Zealand Society for Geriatric Medicine

Position Statement No. 11 Driving and

Dementia. (2009).

127

PART B. Medical standards

6.2. Seizures and epilepsy

Refer also to section 1. Blackouts and section

2. Cardiovascular conditions.

6.2.1. Relevance to the driving task

Eects of seizures on driving

1–3

Seizures vary considerably, some being

purely subjective experiences – for example,

some focal seizures – but most involve some

impairment of consciousness (e.g. absence

and focal impaired awareness seizures) or

loss of voluntary control of the limbs (e.g. focal

motor and focal impaired awareness seizures).

Convulsive (tonic–clonic) seizures may be

generalised from onset or have a focal onset.

Seizures associated with loss of awareness,

even if brief or subtle, or loss of motor control,

have the potential to impair the ability to control

a motor vehicle.

Evidence of crash risk

4–6

Most studies have reported an elevated crash

risk among drivers with epilepsy, but the size of

the risk varies considerably across the studies.

These studies have found that people with

epilepsy are twice as likely to be involved in a

motor vehicle crash compared with the general

driving population. More recent studies have

found that drivers who do not take antiseizure

medication as prescribed are at an increased

risk for experiencing a crash.

6.2.2. General assessment and

management guideline

7,8

Epilepsy refers to the tendency to experience

recurrent seizures. Not all people who

experience a seizure have epilepsy.

Epilepsy is a common disorder with a cumulative

incidence of 2 per cent of the population, with

0.5 per cent aected and taking medication

at any one time. Most cases respond well to

treatment, with a terminal remission rate of

80 per cent or more. The majority suer few

seizures in a lifetime, and about half will have no

further seizures in the ﬁrst one or two years after

starting treatment. Some people with epilepsy

may eventually cease medication. For others,

surgery may be beneﬁcial.

In general, responsible people with well-

managed epilepsy (as demonstrated by an

appropriate seizure-free period and compliance

with treatment and other recommendations) may

be considered by the driver licensing authority

to be ﬁt to drive a private vehicle. Conditional

licences rely on individual responsibility for

management of the condition, including

compliance with treatment, in conjunction

with the support of a health professional and

regularreview.

Commercial vehicle driving exposes the driver

and the public to a relatively greater risk

because of the increased time spent at the

wheel, as well as the generally greater potential

for injury from motor vehicle crashes due to the

greater size or weight of commercial vehicles,

or large numbers of passengers carried. For this

reason, the acceptable risk of a seizure-related

crash for commercial driving is much less, and

the requirements applied are much stricter;

in addition, sleep deprivation is a common

provoking factor in epilepsy and may be

experienced in long-distance transport driving

and amongst drivers doing shift work.

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Neurological conditions

127

PART B. Medical standards

It is good medical practice for any person with

initial seizures to be referred to a specialist,

where available, for accurate diagnosis of the

speciﬁc epilepsy syndrome so that appropriate

treatment is instituted and all the risks

associated with epilepsy, including driving, can

be explained.

With regard to licensing, the treating doctor

or general practitioner may liaise with the

driver licensing authority about whether the

criteria are met for driving a private vehicle, but

only a specialist may do so for a commercial

vehicledriver.

Use of electroencephalograms (EEG)

9,10

Electroencephalography is an important tool

in diagnosing epilepsy. In people who have

had one or more seizures, it has a limited but

valuable role in predicting seizure recurrence.

It may also be used to identify subtle episodes

in which awareness may be impaired. Because

there is a wide range of clinical situations, with

varying utility of EEG, it does not form part

of the driving standards except for the initial

ﬁtness assessment of commercial drivers. When

epileptiform abnormalities that may represent

subtle seizures (e.g. generalised spike-wave

bursts lasting longer than three seconds, or

photoparoxysmal response) are found on the

EEG of those who meet the standard to hold

a conditional (or unconditional) licence, their

ﬁtness should be assessed on a case-by-case

basis. This may require more detailed testing.

Advice to licence holders

All licence holders should be advised of the

following general principles for safety when

driving:

• The person must continue to take antiseizure

medication regularly as recommended.

• The person should ensure they get

adequate sleep and not drive when sleep-

deprived.

• The person should avoid circumstances,

or the use of substances (e.g. excessive

alcohol), that are known to increase the

riskof seizures.

It is good medical practice for any person

with epilepsy to be reviewed periodically.

Patients who are licence holders should also

be monitored regarding their response to

treatment and compliance with the general

advice for safety when driving. Drivers of private

vehicles who hold a conditional licence should

be reviewed at least annually by their treating

doctor (unless experiencing an extended

seizure-free period – see The default standard

on page 130). Commercial vehicle drivers

should be reviewed at least annually by a

specialist regarding any conditional licence that

has been issued.

Refusal of medical advice

Some people with epilepsy choose not to

follow medical advice, including the taking of

antiseizure medicine and avoidance (where

possible) of factors that may provoke seizures.

If a patient refuses to follow a treating doctor’s

recommendation, the patient should be

assessed as not ﬁt to drive. The treating doctor

may consider reporting this information to the

driver licensing authority so it can be considered

in the event that another doctor certiﬁes the

person as ﬁt to drive without therapy. Further

guidance on managing patients who refuse

to follow medical advice can be found in Part

A section 3.3.1. Conﬁdentiality, privacy and

reporting to the driver licensing authority.

Refer also to Medication noncompliance and

Uncertain or unreliable history in this section.

Concurrent conditions

Where epilepsy is associated with other

impairments or conditions, the relevant

sections covering those disorders should

alsobeconsulted.

129

PART B. Medical standards

Other conditions with risk of seizure

Seizures can occur in association with many

brain disorders. Some of these disorders

may also impair safe driving because of an

associated neurological deﬁcit. Both the

occurrence of seizures, as well as the eect

of any neurological deﬁcit, must be taken

into account when determining ﬁtness to

drive. Managing acute symptomatic seizures

caused by a transient brain disorder or a

metabolic disturbance (e.g. encephalitis,

hyponatraemia, head injury or drug or alcohol

withdrawal) is covered on page 141. Refer

also to section 6.3. Other neurological

and neurodevelopmental conditions for

seizures associated with a head injury and

intracranialsurgery.

Loss of consciousness due to other

causes

In cases where it is not possible to be certain

that loss of consciousness is due to a seizure

or some other cause, refer to section 1.2.4.

Blackouts of undetermined mechanism.

6.2.3. Medical standards for licensing

Given the considerable variation in seizures

and their potential impact on safe driving, a

hierarchy of standards has been developed that

provides a logical and fair basis for decision

making regarding licensing (see also Figure

13. Overview of management of a driver with

seizures). This hierarchy comprises:

• a default standard, applicable to all cases of

seizure, unless reductions are allowed (refer

below and to the table on page 138)

• reductions for speciﬁc types of epilepsy

or speciﬁc circumstances, including an

allowance for exceptional circumstances

upon the advice of a specialist in epilepsy

(refer below and to the table on page 139).

In addition, advice is provided on a number

of dicult management issues relating to safe

driving for people with seizures and epilepsy

(refer below and to the table on page 146).

The default standard (all cases)

The ‘default standard’ is the standard that

applies to all drivers who have had a seizure

unless their situation matches one of a

number of deﬁned situations listed in the table

and described below. These situations are

associated with a lower risk of a seizure-related

crash and therefore driving may be resumed

after a shorter period of seizure freedom than

required under the default standard. However,

the need to adhere to medical advice and at

least annual review still apply. If a seizure has

caused a crash within the preceding 12 months,

the required period of seizure freedom may

not be reduced below that required under the

default standard. If antiseizure medication is to

be withdrawn, the person should not drive (refer

to table for details).

If a driver who is taking antiseizure medication

has experienced an extended seizure-free

period (more than 10 years for private drivers,

and more than 20 years for commercial drivers)

the driver licensing authority may consider

reduced review requirements (at least once

every three years) based on advice from the

treating doctor or specialist.

130

Neurological conditions

129

PART B. Medical standards

Figure 13. Overview of management of a driver with seizures

Seizure(s)

Private driver Commercial driver

GP or specialist assessment

Specialist assessment

Are there factors that reduce the crash risk?

• Childhood seizures

• First seizure

• Acute symptomatic seizures

• Epilepsy treated for the ﬁrst time

• ‘Safe’ seizures

• Sleep-only seizures

• Previously well-controlled seizures

• Exceptional case

Are there factors that reduce the crash risk?

• Childhood seizures

• First seizure

• Acute symptomatic seizures

• Exceptional case

1-year minimum non-

driving period

Refer table

(page 139)

10-year minimum non-

driving period

Refer table

(page 139)

Conditional licence

Management factors

• Surgery

• Noncompliance with management

• Withdrawal of antiseizure medication

• Reduction of antiseizure medication

• Seizure causing crash

• Resumption of full licence

No NoYe s Ye s

131

PART B. Medical standards

Variations to the default standard

There are several situations in which a variation

from the default standard may be considered by

the driver licensing authority to allow an earlier

return to driving. These are listed below and

discussed on subsequent pages:

• seizures in childhood

• ﬁrst seizure

• epilepsy treated for the ﬁrst time

• acute symptomatic seizures

• ‘safe’ seizures

• seizures only in sleep

• seizures in a person previously well

controlled

• exceptional circumstances.

In most cases, exceptions to the default standard

will be considered only for private vehicle

drivers. A reduction in restrictions for commercial

vehicle drivers will generally only be granted

after considering information provided by a

specialist with expertise in epilepsy.

If a person has experienced a crash as a result

of a seizure, the default non-driving seizure-free

period applies, even if the situation matches one

of those above.

In addition to the reduction for particular

circumstances or seizure types, there is also

an allowance for ‘exceptional cases’ in which

a conditional licence may be considered for

private or commercial vehicle drivers on the

recommendation of a medical specialist with

speciﬁc expertise in epilepsy. This enables

individualisation of licensing for cases where the

person does not meet the standard but may be

safe to drive.

Licensing of drivers with a history of childhood

febrile seizures or benign epilepsy syndrome of

childhood

In some speciﬁc childhood epilepsy syndromes,

seizures usually cease before the minimum age

of driving. The driver may hold an unconditional

licence if no seizures have occurred after the

age of 11 years. If a seizure has occurred after 11

years of age, the default standard applies unless

the situation matches one of those in this section

(Variations to the default standard).

The ﬁrst seizure (of any type)

11–13

The occurrence of a ﬁrst seizure warrants

medical specialist assessment, where available.

Approximately half of all people experiencing

their ﬁrst seizure will never have another

seizure, while half will have further seizures (i.e.

epilepsy). The risk of recurrence falls with time.

Driving may be resumed after sucient time

has passed without further seizures (with or

without medication) to allow the risk to reach an

acceptably low level (refer to the table on page

139). If a second seizure occurs (except on the

same day as the ﬁrst), the risk of recurrence is

much higher. The standard for Epilepsy treated

for the ﬁrst time will then apply (refer to page

139 and to Figure 14).

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Neurological conditions

131

PART B. Medical standards

Figure 14. Epilepsy treated for the ﬁrst time

Epilepsy treated for the ﬁrst time

(deﬁned as treatment with antiepileptic medication

commenced for the ﬁrst time within the last 18 months)

Commercial vehicle driver?

Treatment started more

than 6 months ago?

Reassess after at least 6

months of treatment

Any seizures?

Seizures were

only in the ﬁrst

6 months after

starting treatment?

May return to driving on a

conditional licence 6 months

after last seizure

Default standard

(minimum 1-year non-driving

seizure-free period)

Default standard (minimum

10-year non-driving seizure-free

period)

Ye s

133

PART B. Medical standards

Epilepsy treated for the ﬁrst time

14,15

The risk of recurrent seizures in people starting

treatment for epilepsy is suciently low to allow

driving to resume earlier than required under

the default standard. For the purpose of these

standards, epilepsy treated for the ﬁrst time

means that treatment was started for the ﬁrst

time within the preceding 18 months.

When treatment with an antiseizure drug is

started in a previously untreated person, enough

time should pass to establish that the drug

is eective before driving is recommenced.

However, eectiveness cannot be established

until the person reaches an appropriate dose.

For example, if a drug is being gradually

introduced over three weeks and a seizure

occurs in the second week, it would be

premature to declare the drug ineective. The

standard allows seizures to occur within the

ﬁrst six months after starting treatment without

lengthening the required seizure-free period.

However, if seizures occur more than six months

after starting therapy, a longer seizure-free

period is required (refer to table for details). For

commercial drivers, the default standard applies.

For example, if a patient has a seizure three

months after starting therapy, they may be ﬁt to

drive six months after the most recent seizure

(nine months after starting therapy). However, if a

person experiences a seizure eight months after

starting therapy, the default standard applies and

they may not be ﬁt to drive until 12 months after

the most recent seizure.

If the patient has received no treatment in the

last ﬁve years or more, resumption of treatment is

managed as if treated for the ﬁrst time (asabove).

Acute symptomatic seizures

16,17

Acute symptomatic seizures are caused by a

transient brain disorder or metabolic disturbance

(e.g. encephalitis, hyponatraemia, head injury

or drug or alcohol withdrawal) in patients

without previous epilepsy. Acute symptomatic

seizures can be followed by further seizures

weeks, months or years after the transient brain

disorder resolves. This may occur because of

permanent changes to the brain caused by

the process underlying the acute symptomatic

seizures (e.g. seizures may return years after a

resolved episode of encephalitis) or because

the transient brain disorder has recurred (e.g.

benzodiazepinewithdrawal).

People who have experienced a seizure only

during and because of a transient brain disorder

or metabolic disturbance should not drive for a

sucient period to allow the risk of recurrence

to fall to an acceptably low level (refer to table

for details). Return to driving for commercial

vehicle drivers requires input from an epilepsy

specialist. The risk of seizure recurrence varies

greatly, depending on the cause.

If seizures occur after the causative acute

illness has resolved, whether or not due to a

second transient brain disorder or metabolic

disturbance, the acute symptomatic seizures

standard no longer applies. For example, if

a person has a seizure during an episode of

encephalitis and then, after recovering from the

encephalitis, has another seizure and begins

treatment, the standard for epilepsy treated

for the ﬁrst time applies. Similarly, if a person

experiences seizures during two separate

episodes of benzodiazepine withdrawal, the

default standard applies.

The management of late post-traumatic epilepsy

is discussed in section 6.3.1. under Head injury.

‘Safe’ seizures (including prolonged aura)

Some seizures do not impair consciousness or

the ability to control a motor vehicle; however,

this must be well established without exceptions

and corroborated by reliable witnesses or video-

EEG recording because people may believe

their consciousness is unimpaired when it is not.

For example, some ‘auras’ are associated with

impaired consciousness that the person does

not perceive. Isolated infrequent myoclonic

jerks (without impaired awareness) may be

134

Neurological conditions

133

PART B. Medical standards

considered safe in the context of no seizures of

any other type for more than 12 months.

For private vehicle drivers, where seizures occur

only at a particular time of day (e.g. in the ﬁrst

hour after waking), a conditional licence, which

limits driving to certain hours or circumstances,

may be acceptable. This applies only to private

vehicle drivers.

Seizures may begin with a subjective sensation

(the ‘aura’) that precedes impairment of

consciousness. If this lasts long enough, the

driver may have time to stop the vehicle.

However, this can only be relied upon when

this pattern has been well established without

exceptions and corroborated by witnesses

or video-EEG monitoring. Furthermore, it

may be impossible to stop immediately and

safely because of trac conditions. Even if the

person is able to stop the vehicle before the

seizure, they may then be in a confused state

and not appreciate the danger of resuming

their journey. For these reasons, such seizures

can be considered safe only in exceptional

circumstances and must be considered by

the driver licensing authority on a case-by-

case basis. See Exceptional cases in the text

andtable.

Any seizures that involve confusion/vagueness,

automatisms, diculty speaking or emotional

features or memory loss are not considered

safeseizures.

Sleep-only seizures

Some seizures occur only during sleep and

hence are not a hazard to driving. In people

who have never had a seizure while awake but

who have an established pattern of seizures

exclusively during sleep, the risk of subsequent

seizures while awake is suciently low to allow

private driving, despite continuing seizures while

asleep. In people with an established pattern

of sleep-only seizures but a history of previous

seizures while awake, the risk of further seizures

while awake is higher. Therefore, a longer period

of sleep-only seizures is required before driving

by this group than in those who have never

had a seizure while awake. This applies only to

private vehicle drivers.

Seizure in a person whose epilepsy has been

previously ‘well controlled’

Where a single seizure occurs after a long

period (deﬁned in these standards as at least

12 months) without seizures, the risk of further

seizures is suciently low that driving can be

resumed after a shorter period than when the

epilepsy has not been as well controlled. The

duration of the non-driving seizure-free period

depends on whether a provoking factor was

identiﬁed and can be reliably avoided (refer

below). This applies only to private vehicle

drivers who are already under treatment.

In people with epilepsy, their seizures are

often provoked by factors such as missed

doses of antiseizure medication, over-the-

counter medications, alcohol or acute illnesses.

If the provoking factor is avoided, the risk

of subsequent seizures may be suciently

low to allow private driving to resume after a

shorter seizure-free period than following an

unprovoked seizure. However, this applies only

if the epilepsy has been well controlled until the

provoked seizure (refer to previous point). Some

provocative factors (e.g. sleep deprivation),

unless severe, cannot be reliably avoided.

For the purpose of these standards, sleep

deprivation is not considered a provoking factor.

Refer also to Medication noncompliance on the

next page.

Exceptional cases

Where a medical specialist who is experienced

in managing epilepsy considers that a person

with seizures or epilepsy does not meet

the standards for a conditional licence but

nonetheless may be safe to drive, a conditional

licence may be considered if the driver licensing

authority, after considering clinical information

provided by the treating medical specialist,

135

PART B. Medical standards

considers that the risk of a crash caused by a

seizure is acceptably low.

Other factors that may inﬂuence

licensingstatus

Several other factors may inﬂuence the

management of epilepsy in regard to driving and

licensing. These include:

• epilepsy treated by surgery

• medication noncompliance

• uncertain or unreliable history

• cessation of antiseizure medication

• a seizure causing a crash

• resumption of an unconditional licence.

These issues are discussed below and criteria

are outlined in the table on page 146.

Epilepsy treated by surgery

Resection of epileptogenic brain tissue may

eliminate seizures completely, allowing

safe driving after a suitable seizure-free

period. The vision standard may also apply

if there is a residual visual ﬁeld defect. If

medication is withdrawn, refer to Withdrawal

or dose reduction of one or more antiseizure

medications opposite.

Medication noncompliance

Compliance with medical advice regarding

medication intake is a requirement for

conditional licensing. Where the treating doctor

suspects noncompliance, they may recommend

to the driver licensing authority that the licence

be granted on the condition that periodic

drug-level monitoring is conducted. Where a

person without a history of noncompliance with

medication experiences a seizure because of

a missed dose and there were no seizures in

the 12 months leading up to that seizure, the

situation can be considered a provoked seizure

(refer to the standard for Seizure in a person

whose epilepsy has been previously well

controlled above).

Uncertain or unreliable history

Some people with epilepsy are unable to

reliably report the occurrence of seizures

because their awareness is impaired by their

seizure. Some others deliberately fail to report

seizures. In both situations, the person may

report that no seizures have occurred, when, in

fact, they have, and the person is unﬁt to drive.

Corroboration by people in regular contact

with the person may decrease any uncertainty.

Where uncertainty remains, the driver licensing

authority can be informed (refer to Part A section

3.3.1. Conﬁdentiality, privacy and reporting to

the driver licensing authority).

Withdrawal or dose reduction of one or more

antiseizure medications

In people who have had no seizures while

taking antiseizure medication over a suitable

period, the specialist may attempt a withdrawal

of all antiseizure medication, a reduction in the

number of medications or a reduction in dose.

The medication may also be changed because

of side eects or potential side eects (e.g.

teratogenicity). The person should not drive for

the full period of withdrawal or dose change

and for three months thereafter. However, if

the dose is being reduced only because of

current dose-related side eects and is unlikely

to result in a seizure, driving may continue. The

person will already be on a conditional licence,

therefore notifying the driver licensing authority

is not required. Patients who do not adhere to

the prescribed dose should be reminded that

compliance is a condition of their licence.

For commercial vehicle drivers, if antiseizure

medication is to be withdrawn, the person will

no longer meet the criteria to hold a conditional

licence. This also applies to a reduction in dose

of antiseizure medication except if the dose

reduction is due only to the presence of dose-

related side eects (refer to page 146). Driving

may continue despite withdrawal of antiseizure

medication only after consideration by the driver

licensing authority under the Exceptional cases

136

Neurological conditions

135

PART B. Medical standards

standard (e.g. where antiepileptic therapy has

been started in a patient without seizures).

Seizure causing a crash or loss of control

ofavehicle

Not all seizures carry the same risk of causing

a crash or lack of control of a vehicle. People

who have lost control of a vehicle as a result of

a seizure are likely to have a higher crash risk.

If a person who has lost control of a vehicle

or experienced a crash due to a seizure, the

default seizure-free non-driving period applies,

even if they fall into one of the categories that

allow a reduction.

Psychogenic nonepileptic seizures

Some transient episodes of impaired

consciousness, awareness, or motor control

resemble epileptic seizures or syncope,

yet have a psychological cause. These

episodes are usually termed psychogenic

nonepileptic seizures (PNES), although they are

sometimes known as dissociative, functional

or pseudoseizures. Refer to section 7.2.9.

Psychogenic nonepileptic seizures.

Resumption of an unconditional licence

Where a person has had no seizures for at

least ﬁve years and has taken no antiseizure

medication for at least the preceding 12 months,

the driver licensing authority may consider

granting an unconditional licence. This does not

apply to commercial vehicle drivers.

The resumption of an unconditional private or

commercial licence may be considered in some

instances of ﬁrst seizure or acute symptomatic

seizures – refer to these entries in the table).

Medical standards for licensing – seizures and epilepsy

Requirements for unconditional and conditional licences are outlined in the following table.

Step 1: Read ‘All cases’. This applies to all people with seizures.

Step 2: Look through the list of situations in the left-hand column of the Possible reductions in

the non-driving seizure-free periods for a conditional licence table to see if the person matches

one of these situations.

Step 3. Look through the left-hand column of the Other factors that may inﬂuence licence

status table to see if the person matches one of these situations.

Depending on the situation, the driver licensing authority may consider a conditional licence

after a shorter (reduced) seizure-free period.

Note

People are not eligible for a reduction if they have had a motor vehicle crash or lost control

ofavehicle due to a seizure.

If withdrawal of all antiseizure medication is planned, refer to the relevant section of the table.

The longer non-driving period applies if the situation is covered by more than one standard.

137

PART B. Medical standards

All cases: default standard

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

All cases (default

standard)

Applies to all

people who have

experienced a

seizure.

Exceptions may

be considered

only if the situation

matches one of

those listed in the

tables that follow.

A person cannot hold an unconditional

licence:

• if the person has experienced a

seizure.

A conditional licence may be

considered by the driver licensing

authority subject to at least annual

review*, taking into account

information provided by the treating

doctor as to whether the following

criteria are met:

• there have been no seizures for at

least 12 months**; and

• the person follows medical advice,

including adherence to medication

if prescribed or recommended.

* If a driver undergoing treatment

for epilepsy has experienced an

extended seizure-free period (more

than 10 years) the driver licensing

authority may consider reduced review

requirements based on independent

specialist advice (refer to section 3.3.7.

Role of independent experts/panels).

** Shorter seizure-free periods may

be considered by the driver licensing

authority if the person’s situation

matches one of those in the tables that

follow.

A person cannot hold an unconditional licence:

• if the person has experienced a seizure.

A conditional licence may be considered by

the driver licensing authority subject to at least

annual review*, taking into account information

provided by a specialist in epilepsy as to

whether the following criteria are met:

• there have been no seizures for at least 10

years**; and

• an EEG conducted in the last 6 months has

shown no epileptiform activity and no other

EEG conducted in the last 12 months has

shown epileptiform activity***; and

• the person follows medical advice, including

adherence to medication if prescribed or

recommended.

* If a driver undergoing treatment for epilepsy

has experienced an extended seizure-

free period (more than 20 years) the driver

licensing authority may consider reduced

review requirements based on independent

specialist advice (refer to section 3.3.7. Role of

independent experts/panels).

** Shorter seizure-free periods may be

considered by the driver licensing authority if

the person’s situation matches one of those in

the tables that follow.

*** This is only required for initial granting of the

conditional licence and not for annual review.

138

Neurological conditions

137

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

History of a

benign seizure

or epilepsy

syndrome

usually limited to

childhood

(e.g. febrile

seizures, benign

focal epilepsy,

childhood

absence epilepsy)

A history of a benign seizure or

epilepsy syndrome usually limited

to childhood does not disqualify the

person from holding an unconditional

licence, as long as there have been no

seizures after 11 years of age.

If a seizure has occurred after 11 years

of age, the default standard (refer

above) applies unless the situation

matches one of those listed below.

A history of a benign seizure or epilepsy

syndrome usually limited to childhood does

not disqualify the person from holding an

unconditional licence, as long as there have

been no seizures after 11 years of age.

If a seizure has occurred after 11 years of age,

the default standard (refer above) applies unless

the situation matches one of those listed below.

First seizure (of

any type)

The person

must report their

condition to the

driver licensing

authority.

Note: Two or

more seizures

in a 24-period

are considered a

single seizure.

A conditional licence may be

considered by the driver licensing

authority subject to at least annual

review, taking into account information

provided by the treating doctor as to

whether the following criterion is met:

• there have been no further seizures

(with or without medication) for at

least 6 months.

Resumption of an unconditional

licence may be considered by the

driver licensing authority, taking into

account information provided by the

treating doctor as to whether the

following criteria are met:

• antiseizure medication has not been

prescribed in the past 12 months;

and

• there have been no seizures for at

least 2 years.

A conditional licence may be considered by

the driver licensing authority subject to at least

annual review, taking into account information

provided by a specialist in epilepsy as to

whether the following criteria are met:

• there have been no seizures for at least 5

years (with or without medication); and

• an EEG conducted in the last 6 months has

shown no epileptiform activity and no other

EEG conducted in the last 12 months has

shown epileptiform activity*.

Resumption of an unconditional licence may

be considered by the driver licensing authority,

taking into account information provided by

a specialist in epilepsy as to whether the

following criteria are met:

• antiseizure medication has not been

prescribed in the past 12 months; and

• there have been no seizures for at least 10

years; and

• an EEG conducted in the last 6 months has

shown no epileptiform activity and no other

EEG conducted in the last 12 months has

shown epileptiform activity.

* This is only required for initial granting of the

conditional licence and not for annual review.

139

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Epilepsy treated

for the ﬁrst time

This applies when

antiepileptic

treatment has

been started for

the ﬁrst time within

the preceding 18

months.

See Figure 14.

Epilepsy treated

for the ﬁrst time.

A conditional licence may be

considered by the driver licensing

authority subject to at least annual

review, taking into account information

provided by the treating doctor as to

whether the following criteria are met:

• the person has been treated for at

least 6 months; and

• there have been no seizures in the

preceding 6 months; and

• if any seizures occurred after the

start of treatment, they happened

only in the ﬁrst 6 months after

starting treatment and not in the last

6 months; and

• the person follows medical advice,

including adherence to medication.

There is no reduction. The default standard

applies.

140

Neurological conditions

139

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Acute

symptomatic

seizures

Seizures occurring

only during

a temporary

brain disorder

or metabolic

disturbance in a

person without

previous seizures.

This includes

head injuries

and withdrawal

from drugs or

alcohol. This is

not the same as

provoked seizures

in a person with

epilepsy.

A conditional licence may be

considered by the driver licensing

authority subject to at least annual

review, taking into account information

provided by the treating doctor as to

whether the following criterion is met:

• there have been no further seizures

for at least 6 months.

If there have been two or more

separate transient disorders causing

acute symptomatic seizures, the

default standard applies.

Resumption of an unconditional

licence may be considered by the

driver licensing authority, taking into

account information provided by the

treating doctor as to whether the

following criteria are met:

• antiseizure medication has not been

prescribed in the past 12 months;

and

• there have been no seizures for at

least 2 years.

A conditional licence may be considered by

the driver licensing authority subject to at least

annual review, taking into account information

provided by a specialist in epilepsy as to

whether the following criteria are met:

• there have been no further seizures for at

least 12 months; and

• an EEG conducted in the last 6 months has

shown no epileptiform activity and no other

EEG conducted in the last 12 months has

shown epileptiform activity*.

If there have been two or more separate

transient disorders causing acute symptomatic

seizures, the default standard applies.

Resumption of an unconditional licence may

be considered by the driver licensing authority,

taking into account information provided by

a specialist in epilepsy as to whether the

following criteria are met:

• antiseizure medication has not been

prescribed in the past 12 months; and

• there have been no seizures for at least 10

years; and

• an EEG conducted in the last 6 months has

shown no epileptiform activity and no other

EEG conducted in the last 12 months has

shown epileptiform activity.

* This is only required for initial granting of the

conditional licence and not for annual review.

141

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

‘Safe’ seizures

These are deﬁned

as seizures that do

not impair driving

ability (see text

page 134).

Normal

responsiveness

must have been

tested by reliable

witnesses or

during video EEG.

Isolated infrequent

myoclonic jerks

(without impaired

awareness) may

be considered

safe in the context

of no seizures of

any other type

for more than 12

months.

A conditional licence may be

considered by the driver licensing

authority subject to at least annual

review, taking into account information

provided by the treating doctor as to

whether the following criteria are met:

• ‘safe’ seizures have been present

for at least 2 years; and

• there have been no seizures of

other type for at least 2 years; and

• the person follows medical advice,

including adherence to medication

if prescribed.

If the above criteria are not met, the

default standard applies.

There is no reduction. The default standard

applies.

142

Neurological conditions

141

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Sleep-only

seizures

(seizures occurring

only during sleep)

A conditional licence may be

considered by the driver licensing

authority, despite continuing seizures

only during sleep and subject to

at least annual review, taking into

account information provided by the

treating doctor as to whether the

following criteria are met:

• there have been no previous

seizures while awake; and

• the ﬁrst sleep-only seizure was at

least 12 months ago; and

• the person follows medical advice,

including adherence to medication

if prescribed;

• there have been previous seizures

while awake but not in the

preceding 2 years; and

• sleep-only seizures have been

occurring for at least 2 years; and

• the person follows medical advice,

including adherence to medication

if prescribed.

If the above criteria are not met, the

default standard applies.

There is no reduction. The default standard

applies.

143

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Seizures in a

person under

treatment whose

epilepsy was

previously well

controlled

‘Well controlled’ is

deﬁned as: there

were no seizures

during the 12

months leading up

to the last seizure.

A conditional licence may be

considered by the driver licensing

authority subject to at least annual

review, taking into account information

provided by the treating doctor as to

whether the following criteria are met:

• the seizure was caused by an

identiﬁed provoking factor*; and

• the provoking factor can be reliably

avoided; and

• the provoking factor has not caused

previous seizures; and

• there have been no seizures for at

least 4 weeks; and

• the person follows medical advice,

including adherence to medication

(periodic serum drug-level

measurements may be required)

and avoidance of provoking factors;

• no cause for the seizure was

identiﬁed; and

• there have been no seizures for at

least 3 months; and

• the person follows medical advice,

including adherence to medication.

If the person has experienced one or

more seizures during the 12 months

leading up to the last seizure, there is

no reduction and the default standard

applies.

* Sleep deprivation is not considered a

provoking factor for the purpose of the

standards.

There is no reduction. The default standard

applies.

144

Neurological conditions

143

PART B. Medical standards

Possible reductions in the non-driving seizure-free periods for a conditional licence

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Exceptional cases Where a medical specialist

experienced in managing epilepsy

considers that a person with seizures

or epilepsy does not meet the

standards above for a conditional

licence but may be safe to drive, a

conditional licence may be considered

by the driver licensing authority,

subject to at least annual review:

• if the driver licensing authority, after

considering information provided

by a specialist experienced in

managing epilepsy, considers that

the risk of a crash caused by a

seizure is acceptably low; and

• if the person follows medical advice,

including adherence to medication

if prescribed or recommended.

Where a specialist in epilepsy considers that a

person with seizures or epilepsy does not meet

the standards above for a conditional licence

but may be safe to drive, a conditional licence

may be considered by the driver licensing

authority, subject to at least annual review:

• if the driver licensing authority, after

considering information provided by a

specialist experienced in managing epilepsy,

considers that the risk of a crash caused by a

seizure is acceptably low; and

• if the person follows medical advice,

including adherence to medication if

prescribed or recommended.

145

PART B. Medical standards

Other factors that may inﬂuence licence status

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition in

Table 3)

Commercial standards

(Drivers of heavy vehicles, public

passenger vehicles or requiring a

dangerous goods driver licence – refer to

deﬁnition in Table 3)

Epilepsy treated

by surgery

(where the primary

goal of surgery is

the elimination of

epilepsy)

A conditional licence may be considered

by the driver licensing authority subject to

at least annual review, taking into account

information provided by the treating doctor

as to whether the following criterion is met:

• there have been no seizures for at least

12 months following surgery; and

• the person follows medical advice with

respect to medication adherence.

The vision standard may also apply if there

is a visual ﬁeld defect.

If medication is withdrawn, refer to Planned

withdrawal of all antiseizure medication

below.

A conditional licence may be considered

by the driver licensing authority subject to

at least annual review, taking into account

information provided by a specialist in

epilepsy as to whether the following criteria

are met:

• there have been no seizures for at least

10 years; and

• an EEG conducted in the last 6 months

has shown no epileptiform activity and

no other EEG conducted in the last 12

months has shown epileptiform activity*;

and

• the person follows medical advice with

respect to medication adherence.

The vision standard may also apply if there

is a visual ﬁeld defect.

If any antiseizure medication is to be

withdrawn, the person will no longer meet

the criteria to hold a conditional licence.

* This is only required for initial granting of

the conditional licence and not for annual

review.

Refusal of

medical advice

or medication

noncompliance

Refer to the text on page 129 and page

136.

Refer to the text on page 129 and page

136.

Unreliable or

doubtful clinical

information

If the treating doctor doubts the reliability

of the relevant clinical information (e.g.

unreported seizures, likely due to the

person not recognising the occurrence

of seizures or deliberately not reporting

seizures), the person is not ﬁt to drive.

Refer to page 136.

If the specialist in epilepsy doubts the

reliability of the relevant clinical information

(e.g. unreported seizures, likely due to the

person not recognising the occurrence

of seizures or deliberately not reporting

seizures), the person is not ﬁt to drive.

Refer to page 136

146

Neurological conditions

145

PART B. Medical standards

Other factors that may inﬂuence licence status

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition in

Table 3)

Commercial standards

(Drivers of heavy vehicles, public

passenger vehicles or requiring a

dangerous goods driver licence – refer to

deﬁnition in Table 3)

Planned

withdrawal of

antiseizure

medication in

a person who

satisﬁes the

standard to hold

a conditional

licence

The person should not drive:

• during the period in which the dose is

being tapered; and

• for 3 months after the last dose*.

If seizures recur, the driver licensing

authority may allow the person to resume

driving on a conditional licence subject to

at least annual review, taking into account

information provided by the treating doctor

as to whether the following criteria are met:

• the previously eective medication

regimen is resumed; and

• there have been no seizures for 4

weeks after resuming the medication

regimen; and

• the person follows medical advice,

including adherence to medication.

If seizures do not recur, the person may

become eligible for an unconditional

licence (refer to Resumption of

unconditional licence below).

* If a drug is being withdrawn as part of a

switch from one drug to another (e.g. to

reduce teratogenic risk), the 3-month non-

driving period still applies.

If antiseizure medication is to be withdrawn,

the person will no longer meet the criteria

to hold a conditional licence. Driving

may continue only after consideration by

the driver licensing authority under the

Exceptional cases standard page 135.

147

PART B. Medical standards

Other factors that may inﬂuence licence status

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition in

Table 3)

Commercial standards

(Drivers of heavy vehicles, public

passenger vehicles or requiring a

dangerous goods driver licence – refer to

deﬁnition in Table 3)

Recommended

reduction in

dosage of

antiseizure

medication in

a person who

satisﬁes the

standard to hold

a conditional

licence

Driving may continue:

• if the dose reduction is due only to the

presence of current dose-related side

eects and is unlikely to aect seizure

control; or

• if the dose is being reduced after an

increase due to a temporary situation

that has now resolved (e.g. pregnancy)

to the dose that was eective before the

increase.

In circumstances other than above, the

person should not drive:

• during the period in which the dose

reduction is being made; and

• for 3 months after completing the dose

reduction.

If seizures recur, the driver licensing

authority may allow the person to resume

driving on a conditional licence subject to

at least annual review, taking into account

information provided by the treating doctor

as to whether the following criteria are met:

• the previously eective medication dose

is resumed; and

• there have been no seizures for 4

weeks after resuming the previously

eective dose; and

• the person follows medical advice,

including adherence to medication.

Driving may continue:

• if the dose reduction is due only to

the presence of current dose-related

side eects and is unlikely to result in a

seizure; or

• if the dose is being reduced after an

increase due to a temporary situation

that has now resolved (e.g. pregnancy)

to the dose that was eective before the

increase.

In circumstances other than the above, the

person will no longer meet the criteria to

hold a conditional licence.

Seizure causing a

crash

If a person has experienced a crash or has

lost control of the vehicle as a result of

a seizure, the default seizure-free non-

driving period applies, even if they fall into

one of the seizure categories that allow a

reduction.

If a person has experienced a crash or has

lost control of the vehicle as a result of

a seizure, the default seizure-free non-

driving period applies, even if they fall into

one of the seizure categories that allow a

reduction.

Psychogenic

nonepileptic

seizures

Refer to section 7.2.9. Psychogenic

nonepileptic seizures.

Refer to section 7.2.9. Psychogenic

nonepileptic seizures.

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147

PART B. Medical standards

Other factors that may inﬂuence licence status

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition in

Table 3)

Commercial standards

(Drivers of heavy vehicles, public

passenger vehicles or requiring a

dangerous goods driver licence – refer to

deﬁnition in Table 3)

Resumption of

unconditional

licence

Unless outlined in the possible reductions

above (see ﬁrst seizure or acute

symptomatic seizure), the driver licensing

authority may consider granting an

unconditional licence, taking into account

information provided by the treating doctor

as to whether the following criteria are met:

• the person has had no seizures for at

least 5 years; and

• the person has taken no antiseizure

medication for at least the preceding 12

months.

Unless outlined in the possible reductions

above (see ﬁrst seizure or acute

symptomatic seizure), resumption of an

unconditional commercial licence will not

be considered.

Refer to the text on page 137.

149

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

150

Neurological conditions

149

PART B. Medical standards

References and further reading

1. Fisher, R. S. et al. Epilepsy and driving: an

international perspective. Epilepsia 35,

675–684 (1994).

2. Second European Working Group on

Epilepsy and Driving. Epilepsy and driving in

Europe. (2005).

3. Chen, W. C. et al. Epilepsy and driving:

potential impact of transient impaired

consciousness. Epilepsy and Behavior 30,

50–57 (2014).

4. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

5. Xu, Y. et al. Prevalence of driving and trac

accidents among people with seizures: a

systematic review. Neuroepidemiology 53,

1–12 (2019).

6. Hansotia, P. & Broste, S. K. The eect of

epilepsy or diabetes mellitus on the risk of

automobile accidents. New England Journal

of Medicine 324, 22–26 (1991).

7. Xu, Y. et al. Who is driving and whoisproneto

have trac accidents? A systematic reviewand

meta-analysis among people withseizures.

Epilepsy and Behavior 94, 252–257 (2019).

8. Engel, J., Fisher, R. S., Krauss, G. L.,

Krumholz, A. & Quigg, M. S. Expert panel

recommendations: seizure disorders and

commercial motor vehicle driver safety

medical expert panel members. (2007).

9. Nirkko, A. C. et al. Virtual car accidents of

epilepsy patients, interictal epileptic activity,

and medication. Epilepsia 57, 832–840 (2016).

10. Cohen, E. et al. Realistic driving simulation

during generalized epileptiform discharges

to identify electroencephalographic features

related to motor vehicle safety: feasibility

and pilot study. Epilepsia 61, 19–28 (2020).

11. Lawn, N., Chan, J., Lee, J. & Dunne, J. Is the

ﬁrst seizure epilepsy? And when? Epilepsia

56, 1425–1431 (2015).

12. Brown, J. W. L., Lawn, N. D., Lee, J. & Dunne,

J. W. When is it safe to return to driving

following ﬁrst-ever seizure? Journal of

Neurology, Neurosurgery and Psychiatry

86, 60–64 (2015).

13. Krumholz, A. et al. Evidence-based guideline:

management of an unprovoked ﬁrst seizure

in adults. Neurology 84, 1705–1713 (2015).

14. Brodie, M. J., Perucca, E., Ryvlin, P., Ben-

Menachem, E. & Meencke, H. J. Comparison

of levetiracetam and controlled-release

carbamazepine in newly diagnosed

epilepsy. Neurology 68, 402–408 (2007).

15. Marson, A. et al. Immediate versus deferred

antiepileptic drug treatment for early

epilepsy and single seizures: a randomised

controlled trial. Lancet 365, 2007–2013 (2005).

16. Leung, H., Man, C. B. L., Hui, A. C. F., Kwan,

P. & Wong, K. S. Prognosticating acute

symptomatic seizures using two dierent

seizure outcomes. Epilepsia 51, 1570–1579

(2010).

17. Beghi, E. et al. Recommendation for a

deﬁnition of acute symptomatic seizure.

Epilepsia 51, 671–675 (2010).

18. Asadi-Pooya, A. A. et al. Driving a motor

vehicle and psychogenic nonepileptic

seizures: ILAE Report by the Task Force

on Psychogenic Nonepileptic Seizures.

Epilepsia Open 5, 371–385 (2020).

151

PART B. Medical standards

6.3. Other neurological and neurodevelopmental

conditions

6.3.1. General assessment and management guidelines

People with neurological conditions should be examined to determine the impact on the functions

required for safe driving as listed below. If the health professional is concerned about a person’s

ability to drive safely, the person may be referred for a driver assessment or for appropriate allied

health assessment (Box 3) (refer also to Appendix 10. Specialist driver assessors).

Box 3. Checklist for neurological disorders

If the answer is YES to any of the following questions, the person may be unﬁt to drive and

warrants further assessment.

1. Are there signiﬁcant impairments of any of the following?

• Visuospatial perception

• Insight

• Judgement

• Attention and concentration

• Comprehension

• Reaction time

• Memory

• Sensation

• Muscle power

• Coordination

2. Are the visual ﬁelds abnormal? (refer to section 10. Vision and eye disorders)

3. Have there been one or more seizures? (refer to section 6.2. Seizures and epilepsy)

Some neurological conditions are progressive, while others are static. In the case of static

conditions in those who are ﬁt to drive, the requirement for periodic review may be waived.

Aneurysms (unruptured intracranial

aneurysms and other vascular

malformations)

The risk of sudden severe haemorrhage

from most unruptured intracranial aneurysms

and vascular malformations is low enough

to allow unrestricted driving for private

vehicle drivers. However, the person should

not drive if they are at high risk of sudden

symptomatic haemorrhage (e.g. giant [> 15 mm]

aneurysms). Cavernomas frequently produce

small asymptomatic haemorrhages that do not

impair driving ability. However, if they produce

a neurological deﬁcit, the person should be

assessed to determine if any of the functions

listed above are impaired. Commercial vehicle

drivers should be individually assessed for

suitability for a conditional licence.

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Neurological conditions

151

PART B. Medical standards

If treated surgically, the advice regarding

intracranial surgery applies (refer below). If the

person has had a seizure, the seizures and

epilepsy standards also apply (refer to section

6.2. Seizures and epilepsy).

Cerebral palsy

Cerebral palsy may impair driving ability

because of diculty with motor control or if it

is associated with intellectual impairment. A

practical driver assessment may be required

(refer to Part A section 2.3.1. Practical driver

assessments). As the disorder is usually static,

periodic review is not normally required.

Head injury

2–6

A head injury will only aect driver licensing

if it results in chronic impairment or seizures.

However, any person who has had a traumatic

injury causing loss of consciousness should not

drive for a minimum of 24 hours, and the eects

on functions listed above should be monitored.

This is advisory and not a licensing matter.

Minor head injuries involving a loss of

consciousness of less than one minute with no

complications do not usually result in any long-

term impairment. Similarly, immediate seizures

that occur within 24 hours of a head injury are

not considered to be epilepsy but part of the

acute process.

More signiﬁcant head injuries may impair any

of the neurological functions listed in Box 3

and can impair long-term driving ability. There

may be focal neurological injury aecting

motor or sensory tracts as well as the cranial

nerves. Also, personality or behavioural

changes may aect judgement and tolerance

and be associated with a psychiatric disorder

such as depression or post-traumatic stress

disorder. Clinical, neuropsychological or

practical driver assessments may be helpful

in determining ﬁtness to drive (refer to Part A

section 2.3.1. Practical driver assessments).

Comorbidities such as drug or alcohol misuse

and musculoskeletal injuries may also need to

be considered (refer to section 9. Substance

misuse and section 5. Musculoskeletal

conditions).

Neurological recovery from a traumatic brain

injury may occur over a long period, and some

people who are initially unﬁt may recover

suciently over many months such that driving

can eventually be resumed.

Risk of post-traumatic epilepsy

People with depressed skull fractures, traumatic

intracranial haematoma or severe traumatic brain

injury are at increased risk of epilepsy, especially

in the ﬁrst year. Commercial drivers therefore

should not drive for 12 months after the injury

and require a conditional licence. Private driving

may continue, provided the person otherwise

meets the standard to drive (refer to Head injury

in table). If one or more seizures have occurred,

the symptomatic seizures standard applies. Post-

traumatic epilepsy should be distinguished from

immediate post-traumatic (acute symptomatic)

seizures occurring within 24 hours of a head

injury, which are considered part of the acute

process (refer to Acute symptomatic seizures,

page 134).

Intracranial surgery (advisory only; non-

driving periods may be varied by the

neurosurgeon)

Non-driving periods are advised to allow for the

risk of seizures occurring after certain types of

intracranial surgery. Following supratentorial

surgery or surgery requiring retraction of the

cerebral hemispheres, the person generally

should not drive a private vehicle for six

months or a commercial vehicle for 12 months.

Notiﬁcation to the driver licensing authority is

not required. There is no speciﬁc restriction after

infratentorial or trans-sphenoidal surgery.

If one or more seizures occur, the standards for

seizures and epilepsy apply (refer to section

153

PART B. Medical standards

6.2. Seizures and epilepsy), and the driver

should notify the driver licensing authority.

Similarly, if there is long-term impairment of any

of the functions listed in Box 3, ﬁtness to drive

will need to be assessed (refer to section 6.3.

Other neurological and neurodevelopmental

conditions).

Ménière’s disease

Ménière’s disease may be accompanied by

acute vertigo, which can aect driving. However,

attacks are usually accompanied by a prodrome

of fullness in the ear, which gives sucient

warning to cease driving. Drivers, particularly

commercial vehicle drivers, warrant individual

assessment by an ENT specialist regarding

their ability to respond in a timely manner to an

attack. Such commercial drivers need also to

meet the hearing standard (refer to section

4. Hearing loss and deafness).

Multiple sclerosis

Multiple sclerosis may produce a wide range

of neurological deﬁcits that may be temporary

or permanent. Possible deﬁcits that may impair

safe driving include all of those listed in Box 3.

Disease-modifying therapies are available that

can slow or halt the progression of disability with

long periods of stability without impairment for

safe driving. Vehicle modiﬁcations may assist

with some of the listed impairments; the advice

of an occupational therapist may be helpful in

this regard (refer to Part A section 2.3.1. Practical

driver assessments).

Neuromuscular disorders

Neuromuscular disorders include diseases

of the peripheral nerves, muscles or

neuromuscular junction. Peripheral neuropathy

may impair driving due to diculties with

sensation (particularly proprioception) or from

severe weakness. Disorders of the muscles or

neuromuscular junction may also interfere with

the ability to control a vehicle. A practical driver

assessment may be required (refer to Part A

section 2.3.1. Practical driver assessments).

Parkinson’s disease

8–10

Parkinson’s disease is a common, progressive

disease that may aect driving in advanced

stages

due to its motor manifestations

(bradykinesia and rigidity) or cognitive

impairments (deﬁcits in executive function and

memory and visuospatial diculties).

There may

also be disturbances of sleep, with episodes of

sleepiness when driving. When assessing the

response to treatment, the response over the

whole dose cycle should be taken into account

(e.g. in patients with motor ﬂuctuations, it would

not be appropriate to assesses ﬁtness to drive

only on the basis of the best ‘on’ response).

Most patients with severe ﬂuctuations will be

unﬁt to drive. A practical driver assessment

may be required (refer to Part A section 2.3.1.

Practical driver assessments).

Stroke (cerebral infarction or

intracerebral haemorrhage)

11–13

Stroke may impair driving ability either because

of the long-term neurological deﬁcit it produces

or because of the risk of a recurrent stroke or

transient ischaemic attack (TIA) at the wheel of a

vehicle (refer over the page).

Stroke and TIA rarely produce loss of

consciousness; it is very uncommon for

undiagnosed strokes or TIAs to result in motor

vehicle crashes. When they do, it is usually due

to an unrecognised visual ﬁeld deﬁcit.

It is common for a person to experience fatigue

and impairments in concentration and attention

after a stroke, even in those with no persisting

neurological deﬁcits. These eects are normally

temporary. The eects may temporarily impair

the ability to perform the driving task, particularly

for commercial vehicle drivers. For this reason,

154

Neurological conditions

153

PART B. Medical standards

aminimum non-driving period applies to all

drivers after a stroke (at least four weeks for

private drivers and at least three months for

commercial drivers).

Functionally signiﬁcant symptoms or

neurological deﬁcits that are persistent after

a stroke can aect activities of daily living

including driving. For drivers with these deﬁcits,

subsequent driving ﬁtness will depend on the

extent of impairment of the functions listed in

Box 3 and the likely impact on driving ability. A

practical driver assessment may be required

(refer to Part A section 2.3.1. Practical driver

assessments). While many people with mild

stroke are independent in many activities of

daily living, they may have ongoing aphasia

(comprehension of written and spoken

language), which may impact on their ﬁtness

to drive. The musculoskeletal and vision

standards may also apply (refer to sections 5.

Musculoskeletal conditions and 10. Vision and

eye disorders). If the person has had a seizure,

the seizures and epilepsy standards also apply

(refer to section 6.2. Seizures and epilepsy).

Private drivers without signiﬁcant impairment

(with respect to driving) of the functions listed

in Box 3, may resume driving after the non-

driving period without further medical review

or licence restrictions. This also applies to

patients assessed and discharged early from

specialist care within the four weeks following

a stroke, either as an inpatient or outpatient. If

the person requires post-stroke rehabilitation

their functional deﬁcits may indicate impacts

on driving capacity. Documentation of the

assessment should be provided at discharge,

which includes details of the driver’s licence,

indicate that they have not suered any

permanent neurological deﬁcits that will impact

driving, and that they are ﬁt to drive at the end

ofthe non-driving period.

Some private drivers may require a conditional

licence depending on the nature of the

impairment. Conditions on the licence can

include requirements for vehicle modiﬁcations,

local area driving only, no night driving, or no

freeway driving (refer to Part A section 4.4.

Conditional licences). Periodic review is not

normally required as these impairments are

usually static. Reference should be made to the

review requirements if musculoskeletal, vision

or seizure standards apply (refer to sections 5.

Musculoskeletal conditions, 10. Vision and eye

disorders and 6.2. Seizures and epilepsy).

If symptoms or deﬁcits improve, the driver

licensing authority may consider removing the

requirement for licence conditions (refer to Part

A section 4.5. Reinstatement of licences or

removal or variation of licence conditions).

Treatable causes of stroke (e.g. high blood

pressure, atrial ﬁbrillation or carotid stenosis)

should be managed with reference to this

standard. Patients should be encouraged to

comply with stroke prevention therapy.

Transient ischaemic attack (advisory)

11,12,14

TIAs can be single or recurrent and may be

followed by a stroke. Included under this

deﬁnition are patients who may have minor

infarction on neuroimaging but who have fully

resolved symptoms and a normal neurological

examination within a 24-hour period. TIAs may

impair driving ability if they occur at the wheel of

a motor vehicle. However, because a TIA almost

never produces loss of consciousness, it is an

extremely uncommon cause of crashes. The risk

of a subsequent stroke with modern medical

therapy is about 5 per cent in the ﬁrst year and

about half of that risk occurs in the ﬁrst week. In

view of the low risk of a TIA or stroke aecting

driving, private vehicle drivers should not drive

for two weeks, and commercial vehicle drivers

should not drive for four weeks after a TIA. A

conditional licence is not required because

there is no long-term impairment (refer to Part A

section 2.2.3. Temporary conditions).

155

PART B. Medical standards

Subarachnoid haemorrhage

Driving should be restricted if the person has

had a subarachnoid haemorrhage. Aneurysmal

subarachnoid haemorrhage has a high chance

of associated neurological injury and high rates

of post-subarachnoid haemorrhage seizures.

For such patients, a conditional licence may be

considered after a minimum three-month non-

driving period for private vehicle drivers and

after at least six months for commercial vehicle

drivers, taking into account the presence of

neurological disabilities as described in Box 3.

The vision standard may apply (refer to section

10. Vision and eye disorders). If the person has

had one or more seizures, the seizures and

epilepsy standards also apply (refer to section

6.2. Seizures and epilepsy). If a craniotomy

has been performed, the advice for intracranial

surgery also applies (refer to page 153). A

practical driver assessment may be considered

(refer to Part A section 2.3.1. Practical driver

assessments).

Minor non-aneurysmal subarachnoid

haemorrhage restricted to the cerebral

convexity is associated with a range of

underlying neurovascular conditions (e.g.

cerebral amyloid angiopathy and reversible

cerebral vasoconstriction syndrome) with

diering symptom associations and risks. For

such patients, assessment of ﬁtness will depend

on the underlying aetiologyand presence of

neurological impairments as described in Box 3.

The vision standard may apply (refer to section

10. Vision and eye disorders). If the person has

had one or more seizures, the seizures and

epilepsy standards also apply (refer to section

6.2. Seizures and epilepsy). If a craniotomy

has been performed, the advice for intracranial

surgery also applies (refer to page 153). A

practical driver assessment may be considered

(refer to Part A section 2.3.1. Practical driver

assessment).

Space-occupying lesions including brain

tumours

15,16

Brain tumours and other space-occupying

lesions (e.g. abscesses, chronic subdural

haematomas, cysticercosis) may cause diverse

eects depending on their location and type.

They may impair any of the neurological

functions listed in Box 3. If the person has had

one or more seizures, the seizures and epilepsy

standards also apply (refer to section 6.2.

Seizures and epilepsy). If a craniotomy has been

performed, the advice regarding intracranial

surgery also applies (refer to page 153).

156

Neurological conditions

155

PART B. Medical standards

Other neurological conditions including

autism spectrum disorder and other

developmental and intellectual

disabilities

17–21

The impact of other neurological conditions

including autism spectrum disorder (ASD) and

developmental and intellectual disability should

be assessed individually. A practical driver

assessment may be required. If the degree

of impairment is static, periodic review is not

usually required.

People with ASD can have dierences in

social communication and interaction, with

restricted and repetitive patterns of behaviour,

interest and activities. Although evidence from

driving studies are limited, drivers with ASD

may drive dierently from people without ASD.

Shortcomings in tactical driving skills have been

observed, while rule-following aspects of driving

are improved. There is considerable dierence

in the range and severity of ASD symptoms,

so assessment should focus on these and the

signiﬁcance of likely functional eects, rather

than an ASD diagnosis. People with ASD may

have diculty with:

• managing attention and distraction

• understanding non-verbal communication

from other drivers

• planning and organisation of the driving task

and adapting to unexpected change

• sensory sensitivities (e.g. glare and sound)

• emotional regulation and input overload

• repetitive behaviours such as rocking or

hand ﬂapping.

6.3.2. Medical standards for licensing

Requirements for unconditional and conditional

licences are outlined in the following table.

The standards for medical conditions in the table

on page 158 (in alphabetical order) cover:

• aneurysms (unruptured intracranial

aneurysms and other vascular malformations)

• cerebral palsy

• head injury

• intracranial surgery

• Ménière’s disease

• multiple sclerosis

• neuromuscular conditions

• other neurological conditions

• Parkinson’s disease

• stroke

• transient ischaemic attacks

• space-occupying lesions including brain

tumours

• subarachnoid haemorrhage.

157

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Aneurysms

(unruptured

intracranial

aneurysms)

and other

vascular

malformations

of the brain

Refer also to

subarachnoid

haemorrhage.

A person is not ﬁt to hold an unconditional

licence:

• if the person has an unruptured

intracranial aneurysm or other vascular

malformation at high risk of major

symptomatic haemorrhage.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by an appropriate specialist

regarding:

• the response to treatment.

If treated surgically, the intracranial surgery

advice applies.

If the person has had a seizure, the seizure

and epilepsy standards apply (refer to

section 6.2. Seizures and epilepsy).

A person is not ﬁt to hold an unconditional

licence:

• if the person has an unruptured

intracranial aneurysm or other vascular

malformation.

A conditional licence may be considered

by the driver licensing authority subject

to annual review, taking into account the

nature of the driving task and information

provided by an appropriate specialist

regarding:

• the risk of major symptomatic

haemorrhage; and

• the response to treatment.

If treated surgically, the intracranial surgery

advice applies.

If the person has had a seizure, the seizure

and epilepsy standards apply (refer to

section 6.2. Seizures and epilepsy).

158

Neurological conditions

157

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Cerebral palsy

Refer also to

neuromuscular

and/or other

neurological

conditions.

A person is not ﬁt to hold an unconditional

licence:

• if the person has cerebral palsy producing

signiﬁcant impairment of any of the

following: visuospatial perception, insight,

judgement, attention, comprehension,

reaction time, sensation, muscle power,

coordination, vision (including visual

ﬁelds).

A conditional licence may be considered

by the driver licensing authority, taking into

account:

• the nature of the driving task; and

• information provided by the treating

doctor regarding the likely impact of the

neurological impairment on driving ability;

and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments); and

• the need for vehicle modiﬁcations.

Periodic review is not required if the

condition is static.

A person is not ﬁt to hold an unconditional

licence:

• if the person has cerebral palsy producing

signiﬁcant impairment of any of the

following: visuospatial perception, insight,

judgement, attention, comprehension,

reaction time, sensation, muscle power,

coordination, vision (including visual

ﬁelds).

A conditional licence may be considered

by the driver licensing authority, taking into

account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the likely impact of

the neurological impairment on driving

ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments); and

• the need for vehicle modiﬁcations.

Periodic review is not required if the

condition is static.

159

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to deﬁnition

in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Head injury

Refer also to

intracranial

surgery (below).

A person should not drive for at least 24

hours following a head injury causing loss

of consciousness.

A person is not ﬁt to hold an

unconditional licence:

• if the person has had a head injury

producing signiﬁcant impairment

of any of the following: visuospatial

perception, insight, judgement,

attention, comprehension, reaction

time, memory, sensation, muscle

power, coordination or vision (including

visual ﬁelds).

A conditional licence may be considered

by the driver licensing authority, taking

into account:

• the nature of the driving task; and

• information provided by the treating

doctor regarding the likely impact of

the neurological impairment on driving

ability and the presence of other

disabilities that may impair driving as

per this publication; and

• the results of neuropsychological

testing if indicated; and

• the results of a practical driver

assessment if required.

Periodic review is not required if the

condition is static.

If a seizure has occurred, refer to section

6.2. Seizures and epilepsy.

A person should not drive for at least 24

hours following a head injury causing loss of

consciousness.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had a head injury producing

signiﬁcant impairment of any of the following:

visuospatial perception, insight, judgement,

attention, comprehension, reaction

time, memory, sensation, muscle power,

coordination or vision (including visual ﬁelds).

A conditional licence may be considered by the

driver licensing authority, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the likely impact of the

neurological impairment on driving ability and

the presence of other disabilities that may

impair driving as per this publication; and

• the results of neuropsychological testing if

indicated; and

• the results of a practical driver assessment if

required.

Periodic review is not required if the condition is

static.

A person is not ﬁt to hold an unconditional

licence:

• if they have a high risk of post-traumatic

epilepsy (penetrating brain injury, brain

contusion, subdural haematoma, loss of

consciousness/alteration of consciousness or

post-traumatic amnesia greater than 24 hours).

A conditional licence may be considered by

the driver licensing authority subject to at least

annual review, taking into account information

provided by the treating doctor as to whether

the following criterion is met:

• the person has had no seizures for at least 12

months.

If a seizure has occurred, refer to section 6.2.

Seizures and epilepsy.

160

Neurological conditions

159

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Intracranial

surgery

(advisory only)

A person should not drive for 6 months

following supratentorial surgery or retraction

of the cerebral hemispheres.

If there are seizures or long-term

neurological deﬁcits, refer to section

6.2. Seizures and epilepsy.

A person should not drive for 12 months

following supratentorial surgery or retraction

of the cerebral hemispheres.

If there are seizures or long-term

neurological deﬁcits, refer to section

6.2. Seizures and epilepsy.

Ménière’s

disease

Refer to section 6.3.1. General assessment

and management guidelines.

A person requires individualised assessment

by an ENT specialist.

Multiple

sclerosis

A person is not ﬁt to hold an unconditional

licence:

• if the person has multiple sclerosis and

signiﬁcant impairment of any of the

following: visuospatial perception, insight,

judgement, attention, comprehension,

reaction time, memory, sensation, muscle

power, coordination or vision (including

visual ﬁelds).

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor regarding the likely impact of the

neurological impairment on driving ability;

and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments); and

• the need for vehicle modiﬁcation.

A person is not ﬁt to hold an unconditional

licence:

• if the person has multiple sclerosis.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the level of

impairment of any of the following:

visuospatial perception, insight,

judgement, attention, comprehension,

reaction time, memory, sensation, muscle

power, coordination, vision (including

visual ﬁelds) and the likely impact on

driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments); and

• the need for vehicle modiﬁcation.

161

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Neuromuscular

conditions

(peripheral

neuropathy,

muscular

dystrophy, etc.)

A person is not ﬁt to hold an unconditional

licence:

• if the person has peripheral neuropathy,

muscular dystrophy or any other

neuromuscular disorder that signiﬁcantly

impairs muscle power, sensation or

coordination.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor regarding the likely impact of the

impairment on driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments); and

• the need for vehicle modiﬁcation.

A person is not ﬁt to hold an unconditional

licence:

• if the person has peripheral neuropathy,

muscular dystrophy or any other

neuromuscular disorder that signiﬁcantly

impairs muscle power, sensation or

coordination.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the likely impact of

the impairment on driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments); and

• the need for vehicle modiﬁcation.

Parkinson’s

disease

A person is not ﬁt to hold an unconditional

licence:

• if the person has Parkinson’s disease with

signiﬁcant impairment of movement or

reaction time or the onset of dementia.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor regarding the likely impact of the

neurological impairment on driving ability

and the response to treatment; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

A person is not ﬁt to hold an unconditional

licence.

• if the person has Parkinson’s disease.

A conditional licence may be considered

by the driver licensing authority subject to at

least annual review, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the likely impact of

the neurological impairment on driving

ability and the response to treatment; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

162

Neurological conditions

161

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or motorcycles

unless carrying public passengers or requiring a

dangerous goods driver licence – refer to deﬁnition

in Table 3)

Commercial standards

(Drivers of heavy vehicles, public

passenger vehicles or requiring a

dangerous goods driver licence –

refer to deﬁnition in Table 3)

Stroke

(cerebral

infarction or

intracerebral

haemorrhage)

A person should not drive for at least 4 weeks

following a stroke.

Treatable causes of stroke should be identiﬁed and

managed with reference to this standard.

A person may resume driving without licence

restriction or further review, after at least 4 weeks,

if:

• the person has no neurological deﬁcit or only

minor residual symptoms that do not cause

functionally signiﬁcant impairment relevant to the

safe execution of driving of any of the following:

visuospatial perception, insight, judgement,

attention, comprehension, reaction time,

memory, sensation, muscle power, coordination

or vision (including visual ﬁelds).

The person does not require reassessment in

relation to licensing if they meet the above criteria

when discharged from specialist care within 4

weeks of the stroke. If the person requires post-

stroke rehabilitation their functional deﬁcits may

indicate impacts on driving capacity.

Where a person has persistent functionally

signiﬁcant symptoms or deﬁcits relevant to the safe

execution of driving, the driver licensing authority

may consider a return to driving on a conditional

licence, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist regarding the level of impairment of

any of the following: visuospatial perception,

insight, judgement, attention, comprehension,

reaction time, memory, sensation, muscle power,

coordination or vision (including visual ﬁelds) and

the likely impact on driving ability; and

• the results of a practical driver assessment if

required (refer to Part A section 2.3.1. Practical

driver assessments).

Periodic review is not usually required if the

condition is static. Refer to the review requirements

in sections 5. Musculoskeletal conditions, 6.2.

Seizures and epilepsy and 10. Vision and eye

disorders if these standards apply.

A person should not drive for at least 3

months following a stroke.

Treatable causes of stroke should be

identiﬁed and managed with reference

to this standard.

A person is not ﬁt to hold an

unconditional licence:

• if the person has had a stroke.

A conditional licence may be

considered by the driver licensing

authority after at least 3 months and

subject to at least annual review,

taking into account:

• the nature of the driving task; and

• information provided by an

appropriate specialist regarding

the level of impairment of any of the

following: visuospatial perception,

insight, judgement, attention,

comprehension, reaction time,

memory, sensation, muscle power,

coordination or vision (including

visual ﬁelds) and the likely impact

on driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

163

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Transient

ischaemic

attack

(advisory only)

A person should not drive for at least 2

weeks following a TIA.

A conditional licence is not required.

A person should not drive for at least 4

weeks following a TIA.

A conditional licence is not required.

Space-

occupying

lesions

(including brain

tumours)

Refer also to

intracranial

surgery.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had a space-occupying

lesion that results in signiﬁcant impairment

of any of the following: visuospatial

perception, insight, judgement, attention,

comprehension, reaction time, memory,

sensation, muscle power, coordination or

vision (including visual ﬁelds).

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor about the likely impact of the

neurological impairment on driving ability;

and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

If seizures occur, the standards for seizures

and epilepsy apply (refer to section 6.2.

Seizures and epilepsy).

If surgically treated, the advice for intracranial

surgery applies.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had a space-occupying

lesion.

A conditional licence may be considered

by the driver licensing authority subject to

annual review, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist about the level of impairment

of any of the following: visuospatial

perception, insight, judgement, attention,

comprehension, reaction time, memory,

sensation, muscle power, coordination

or vision (including visual ﬁelds) and the

likely impact on driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

If seizures occur, the standards for seizures

and epilepsy apply (refer to section 6.2.

Seizures and epilepsy).

If surgically treated, the advice for intracranial

surgery applies.

164

Neurological conditions

163

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Subarachnoid

haemorrhage

Refer also to

aneurysms.

A person should not drive for at least 3

months after a subarachnoid haemorrhage*.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had a subarachnoid

haemorrhage*.

A conditional licence may be considered by

the driver licensing authority after 3 months

and subject to periodic review, taking into

account:

• the nature of the driving task; and

• information provided by the treating

doctor about the level of impairment

of any of the following: visuospatial

perception, insight, judgement, attention,

comprehension, reaction time, memory,

sensation, muscle power, coordination

or vision (including visual ﬁelds) and the

likely impact on driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

* This does not include a minor non-

aneurysmal subarachnoid haemorrhage

restricted to the cerebral convexity unless

impairments are present – refer to

page 156.

A person should not drive for at least 6

months after a subarachnoid haemorrhage*.

A person is not ﬁt to hold an unconditional

licence:

• if the person has had a subarachnoid

haemorrhage*.

A conditional licence may be considered by

the driver licensing authority after 6 months

and subject to periodic review, taking into

account:

• the nature of the driving task; and

• information provided by an appropriate

specialist about the level of impairment

of any of the following: visuospatial

perception, insight, judgement, attention,

comprehension, reaction time, memory,

sensation, muscle power, coordination

or vision (including visual ﬁelds) and the

likely impact on driving ability; and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

* This does not include a minor non-

aneurysmal subarachnoid haemorrhage

restricted to the cerebral convexity unless

impairments are present – refer to

page 156.

165

PART B. Medical standards

Medical standards for licensing

–

neurological conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Other

neurological

conditions

(e.g. autism

spectrum

disorder, other

developmental

and intellectual

disabilities)

A person is not ﬁt to hold an unconditional

licence:

• if the person has a neurological disorder

that signiﬁcantly impairs any of the

following: visuospatial perception,

insight, judgement, behaviour, attention,

comprehension, reaction time, memory,

sensation, muscle power, coordination

and vision (including visual ﬁelds).

A conditional licence may be considered

by the driver licensing authority subject to

periodic review*, taking into account:

• the nature of the driving task; and

• information provided by the treating

doctor about the likely impact of the

neurological impairment on driving ability;

and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

* Periodic review may not be necessary if the

condition is static.

A person is not ﬁt to hold an unconditional

licence:

• if the person has a neurological disorder

that signiﬁcantly impairs any of the

following: visuospatial perception,

insight, judgement, behaviour, attention,

comprehension, reaction time, memory,

sensation, muscle power, coordination

and vision (including visual ﬁelds).

A conditional licence may be considered

by the driver licensing authority subject to

periodic review*, taking into account:

• the nature of the driving task; and

• information provided by an appropriate

specialist about the likely impact of the

neurological impairment on driving ability;

and

• the results of a practical driver

assessment if required (refer to

Part A section 2.3.1. Practical driver

assessments).

* Periodic review may not be necessary if the

condition is static.

166

Neurological conditions

165

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

167

PART B. Medical standards

References and further reading

1. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

2. Annegers, J. F., Hauser, W. A., Coan, S. P. &

Rocca, W. A. A population-based study of

seizures after traumatic brain injuries. New

England Journal of Medicine 338, 20–24

(1998).

3. Christensen, J. et al. Long-term risk of

epilepsy after traumatic brain injury in

children and young adults: a population-

based cohort study. The Lancet 373, 1105–

1110 (2009).

4. Baker, A., Unsworth, C. A. & Lannin, N. A.

Fitness-to-drive after mild traumatic brain

injury: mapping the time trajectory of

recovery in the acute stages post injury.

Accident Analysis and Prevention 79,

50–55 (2015).

5. Chee, J. N. et al. Risk of motor vehicle

collision or driving impairment after

traumatic brain injury: a collaborative

international systematic review and

meta-analysis. Journal of Head Trauma

Rehabilitation 34, E27–E38 (2019).

6. Hawley, C. A. Return to driving after head

injury. Journal of Neurology Neurosurgery

and Psychiatry 70, 761–766 (2001).

7. Giovannoni, G. et al. Brain health: time

matters in multiple sclerosis. Multiple

Sclerosis and Related Disorders 9, S5–S48

(2016).

8. Heikkilä, V. M., Turkka, J., Korpelainen, J.,

Kallanranta, T. & Summala, H. Decreased

driving ability in people with Parkinson’s

disease. Journal of Neurology Neurosurgery

and Psychiatry 64, 325–330 (1998).

9. Wood, J. M., Worringham, C., Kerr, G., Mallon,

K. & Silburn, P. Quantitative assessment of

driving performance in Parkinson’s disease.

Journal of Neurology, Neurosurgery and

Psychiatry 76, 176–180 (2005).

10. Classen, S. Consensus statements on

driving in people with Parkinson’s disease.

Occupational Therapy in Health Care 28,

140–147 (2014).

11. Rapoport, M. J. et al. A systematic review

of the risk of motor vehicle collision after

stroke or transient ischemic attack. Topics in

Stroke Rehabilitation 26, 226–235 (2019).

12. Shahjouei, S. et al. A 5-decade analysis of

incidence trends of ischemic stroke after

transient ischemic attack: a systematic

review and meta-analysis. JAMA Neurology

(2020) doi:10.1001/jamaneurol.2020.3627.

13. Mohan, K. M. et al. Risk and cumulative risk

of stroke recurrence: a systematic review

and meta-analysis. Stroke 42, 1489–1494

(2011).

14. Lioutas, V. A. et al. Incidence of transient

ischemic attack and association with long-

term risk of stroke. JAMA: Journal of the

American Medical Association 325, 373–

381 (2021).

15. Kerkhof, M. & Vecht, C. J. Seizure

characteristics and prognostic factors of

gliomas. Epilepsia 54, 12–17 (2013).

168

Neurological conditions

167

PART B. Medical standards

16. Mansur, A. et al. Driving habits and

behaviors of patients with brain tumors: a

self-report, cognitive and driving simulation

study. Scientiﬁc Reports 8, 4635 (2018).

17. Chee, D. Y., Lee, H. C., Patomella, A. H.

& Falkmer, T. Driving behaviour proﬁle of

drivers with autism spectrum disorder (ASD).

Journal of Autism and Developmental

Disorders 47, 2658–2670 (2017).

18. Brooks, J. et al. Training the motor aspects

of pre-driving skills of young adults with and

without autism spectrum disorder. Journal

of Autism and Developmental Disorders 46,

2408–2426 (2016).

19. Lindsay, S. Systematic review of factors

aecting driving and motor vehicle

transportation among people with

autism spectrum disorder. Disability and

Rehabilitation 39, 837–846 (2017).

20. Wilson, N. J., Lee, H. C., Vaz, S., Vindin,

P. & Cordier, R. Scoping review of the

driving behaviour of and driver training

programs for people on the autism

spectrum. Behavioural Neurology (2018) doi:

10.1155/2018/6842306

21. Cox, N. B., Reeve, R. E., Cox, S. M. & Cox,

D. J. Brief report: Driving and young adults

with ASD – parents’ experiences. Journal of

Autism and Developmental Disorders 42,

2257–2262 (2012).

169

PART B. Medical standards

7. Psychiatric conditions

Refer also to section 6. Neurological conditions

and section 9. Substance misuse.

Psychiatric conditions encompass a range of

cognitive, emotional and behavioural conditions

such as schizophrenia, depression, anxiety

disorders and personality disorders. They

also include dementia and substance abuse

conditions, which are addressed elsewhere in

the standards (refer to section 6.1. Dementia and

section 9. Substance misuse).

7.1. Relevance to the

driving task

7.1.1. Eects of psychiatric conditions

on driving

1–4

Psychiatric conditions may be associated

with disturbances of behaviour, cognitive

abilities and perception and therefore have

the potential to aect driving ability. They

do, however, dier considerably in their

aetiology, symptoms and severity, and may be

occasional or persistent. The impact of mental

illness also varies depending on a person’s

social circumstances, occupation and coping

strategies. Assessment of ﬁtness to drive must

therefore be individualised and should rely on

an evaluation of the speciﬁc pattern of illness

and potential impairments as well as severity,

rather than the diagnosis per se. The range of

potential impairments for various conditions is

describedbelow.

People with schizophrenia may have

impairments across many domains of cognitive

function including:

• reduced ability to sustain concentration

orattention

• reduced cognitive and perceptual

processing speeds including reaction time

• reduced ability to perform in complex

conditions – for example, when there are

multiple distractions

• perceptual abnormalities – for example,

hallucinations that distract attention or are

preoccupying

• delusional beliefs that interfere with driving –

for example, persecutory beliefs may include

being followed and result in erratic driving,

or grandiose beliefs may result in extreme

risk taking.

People with bipolar aective condition may

demonstrate:

• depression and suicidal ideation

• mania or hypomania, with impaired

judgement about driving skill and associated

recklessness

• delusional beliefs that directly aect driving.

People with depression may demonstrate:

• disturbances in attention, information

processing and judgement, including

reduced ability to anticipate

• psychomotor retardation and reduced

reaction times

• sleep disturbances and fatigue

• suicidal ideation that may manifest in

reckless driving.

People with anxiety conditions (including post-

traumatic stress disorder) may:

• be preoccupied or distractible

• experience panic attacks or obsessional

behaviours that may impair driving.

People with personality conditions may be:

• aggressive or impulsive

• resentful of authority or reckless.

170

Psychiatric conditions

169

PART B. Medical standards

People with attention-deﬁcit/hyperactivity

disorder may:

• be more prone to angry aggressive and risky

driving behaviour

• have diculty in planning, organising and

prioritising tasks

• have diculty in sustaining or shifting focus

• have diculty managing frustration,

modulating emotions and self-regulation.

These impairments are dicult to determine

because impairment diers at various phases

of the illness and may vary markedly between

individuals. The impairments described above

are particularly important for commercial vehicle

drivers.

7.1.2. Evidence of crash risk

1,3,4

There is limited evidence about the impact of

psychiatric illness on crash risk. Some studies

have shown that drivers with psychiatric illness

have an increased crash risk compared with

drivers without psychiatric illness. There is also

speciﬁc evidence for increased risk among

those with schizophrenia and personality

conditions. The evidence suggests a modestly

elevated risk for people with low levels of

impairment; however, it is possible that people

with higher levels of impairment self-regulate

their driving or drive more slowly and cautiously,

therefore reducing their risk.

7.1.3. Impairments associated with

medication

Medications prescribed for treating psychiatric

conditions may impair driving performance.

There is, however, little evidence that

medication, if taken as prescribed, contributes

to crashes; in fact, it may even help reduce the

risk of a crash (refer to Part A section 2.2.9.

Drugs and driving). Numerous psychotropic

medications have been shown to impair

perception, vigilance and psychomotor

skills. Many medications can produce side

eects such as sedation, lethargy, impaired

psychomotor function and sleep disturbance.

Benzodiazepines have especially been

shown to impair vision, attention, information

processing, memory, motor coordination and

combined-skill tasks. Tolerance to the sedating

eects may develop after the ﬁrst few weeks,

although other cognitive impairments may

persist. The assessment of medication eects

should be individualised and rely upon self-

report, observation, clinical assessment and

collateral information to determine if particular

medications might aect driving. If a person is

prescribed stimulants (e.g. dexamphetamine) for

treating attention-deﬁcit/hyperactivity disorder,

this should be stated in the advice provided to

the driver licensing authority.

Health professionals should have heightened

concern when sedative medications are

prescribed but should also consider the need to

treat psychiatric conditions eectively. Refer also

to section 9. Substance misuse.

7.2. General assessment

and management

guidelines

2,6,7

7.2.1. General considerations

In assessing the impact of mental illness on

the ability to drive safely, the focus should be

on assessing the severity and signiﬁcance of

likely functional eects, rather than the simple

diagnosis of a mental illness. Information

relevant to the assessment may be gained from

case workers and others involved in the ongoing

management of the person. The review period

should be tailored to the likely prognosis or

pattern of progression of the condition in an

individual. Commercial vehicle licences warrant

greater concern and a lower threshold for

intervention.

171

PART B. Medical standards

Mild mental illness does not usually have a

signiﬁcant impact on functioning. Moderate

levels of mental illness commonly aect

functioning, but many people will be able

to manage usual activities, often with some

modiﬁcation. Severe mental illness often impairs

multiple domains of functioning, and it is this

category that is most likely to aect the functions

and abilities required for safe driving. A person’s

medication requirements should not be used as

the only measure of disease severity.

Contraindications to driving

A person seen or reported to have any of the

following problems can be advised not to drive

until the condition has been evaluated and

treated:

• condition relapses sucient to impair

perceptions, mood or thinking

• lack of insight or lack of cooperation with

treatment

• an intent to use a vehicle to cause self-harm

• an intent to use a vehicle to harm others.

7.2.2. Reporting patients

If a patient appears unwilling or unable to accept

advice about restricting their driving, the health

professional should consider if it is appropriate

to report directly to the driver licensing authority

and, if so, determine how best such a notiﬁcation

can be made while continuing to engage the

person in treatment that is beneﬁcial to them.

It may also be appropriate to notify the police

cases where there is an immediate threat

to public safety or high risk – for example,

drivers with a history of reckless driving,

crashes or intentions to cause harm involving

motor vehicles. Refer to Part A section 3.3.1.

Conﬁdentiality, privacy and reporting to the

driver licensing authority and Appendix 3.2.

Legislation relating to reporting by health

professionals.

7.2.3. Mental state examination

The mental state examination can be usefully

applied in identifying the following areas of

impairment that may aect ﬁtness to drive:

• Appearance. Appearance is suggestive

of general functioning (e.g. attention to

personal hygiene, grooming, sedation,

indications of substance use).

• Attitude. This may, for example, be

described as cooperative, uncooperative,

hostile, guarded or suspicious. While

subjective, it helps to evaluate the quality

of information gained in the rest of the

assessment and may reﬂect personality

attributes.

• Behaviour. This may include observation of

speciﬁc behaviours or general functioning

including ability to function in normal work

and social environments.

• Mood and aect. This includes elevated

mood (increase in risk taking) and low mood

(suicidal ideation, particularly if past attempts,

current ideation or future plans involve

driving vehicles). Suicide involving motor

vehicles is relatively common.

• Thought form, stream and content. This

relates to the logic, quantity, ﬂow and subject

of thoughts that may be aected by mania,

depression, schizophrenia or dementia.

Delusions with speciﬁc related content may

have an impact on driving ability.

• Perception. This relates to the presence of

disturbances, such as hallucinations, that

may interfere with attention or concentration,

or may inﬂuence behaviour.

• Cognition. This relates to alertness,

orientation, attention, memory, visuospatial

functioning, language functions and

executive functions. Evidence from formal

testing, screening tests and observations

related to adaptive functioning may be

sought to determine if a psychiatric disorder

is associated with deﬁcits in these areas that

are relevant to driving.

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Psychiatric conditions

171

PART B. Medical standards

• Insight. Insight relates to self-awareness of

the eects of the condition on behaviour and

thinking. Assessment requires an exploration

of the person’s awareness of the nature and

impacts of their condition and has major

implications for management.

• Judgement. The person’s ability to make

sound and responsible decisions has

obvious implications for road safety. As

judgement may vary, it should not be

assessed in a single consultation.

7.2.4. Treatment

The eects of prescribed medication should also

be considered for the individual including:

• how medication may help to control or

overcome aspects of the condition that may

aect driving safety

• what medication side eects may aect

driving ability including risk of sedation,

impaired reaction time, impaired motor skills,

blurred vision, hypotension and dizziness.

Alternative treatments including ‘talking

therapies’ may be useful as an alternative or

supplement to medication and lessen the risk

of medication aecting driving. The health

professional could advise non-driving periods to

allow time for the patient to adjust to medication

and for the health professional to evaluate

the patient’s response and their adherence to

treatments. Refer to Part A section 2.2.9. Drugs

and driving for further guidance to consider

the eects of prescribed medication when

performing an assessment.

7.2.5. Comorbidities

People with a psychiatric condition and

substance misuse (section 9. Substance misuse)

or chronic pain (section 5. Musculoskeletal

conditions) comorbidities may be at higher risk

and warrant careful consideration.

The assessment should identify the potential

relevance of:

• problematic alcohol consumption

• use of illicit substances

• chronic pain

• prescription drug abuse (e.g. increased use

of benzodiazepines, sedatives or painkillers).

7.2.6. Insight

The presence or absence of insight has

implications for management.

• The person with insight may recognise when

they are unwell and self-limit their driving.

• Limited insight may be associated with

reduced awareness or deﬁcits and may

result in markedly impaired judgement or

self-appraisal.

• The person might exhibit signiﬁcantly

impaired insight and appear unwilling to

accept advice about restricting their driving.

7.2.7. Acute psychotic episodes

A person suering an acute episode of mental

illness (e.g. psychosis, moderate–severe

depression or mania) may pose a signiﬁcant

risk. The health professional should advise a

person in this situation not to drive until their

condition has stabilised and a decision can be

made about their future licence status. This

is particularly relevant to commercial vehicle

drivers.

7.2.8. Severe chronic conditions

A person with a severe chronic or relapsing

psychiatric condition needs to be assessed

for the eect of the illness on impairment and

the skills needed to drive and the impairments

that may arise. This may include a clinical

assessment (e.g. neuropsychological) and may

also include an on-road driving assessment

(refer to Part A section 2.3.1. Practical driver

assessments).

173

PART B. Medical standards

7.2.9. Psychogenic nonepileptic

seizures

8,9

Some transient episodes of apparently impaired

consciousness, awareness or motor control

resemble epileptic seizures or syncope,

yet have a psychological cause. These

episodes are usually termed psychogenic

nonepileptic seizures (PNES), although they are

sometimes known as dissociative, functional

or pseudoseizures. Most patients diagnosed

with PNES self-report loss of responsiveness

or loss of awareness that may place them

at an increased risk of causing a motor

vehicleaccident.

The safety risk is suciently low after a three-

month period, with no further psychogenic

seizures, to allow a return to driving. People with

active PNES should generally not be allowed to

drive if they lose awareness or responsiveness

with their psychogenic seizures, have a history

of seizure related injuries, or if the semiology

suggests that ability to drive would be impaired

during a psychogenic seizure.

People with active PNES may be considered

for driving under the private standards after 12

months if PNES only occurs when the person

could not be driving or after exposure to

speciﬁc triggers that cannot be encountered

when driving. This must be well established

without exceptions and corroborated by

reliablewitnesses.

Diagnosis of PNES must establish that such

episodes are psychogenic only. This may require

recording an episode with video or video-EEG.

Approximately 20 per cent of people with PNES

have a history of epilepsy. In such patients, it is

important to distinguish between the two types

of attack and to establish whether an epileptic

seizure has occurred. The seizure and epilepsy

standards may apply in these cases (refer to

section 6.2. Seizures and epilepsy). If there is

uncertainty regarding the type of attack, the

blackouts of uncertain mechanism (refer to

section 1. Blackouts) standards may apply. If

more than one standard applies, the longer non-

driving period prevails.

It is good medical practice for any person

with initial PNES to be referred to a specialist,

where available, for accurate diagnosis so that

appropriate treatment is instituted and all the

risks associated with PNES, including driving,

can be explained.

With regard to licensing, the treating doctor/

general practitioner may liaise with the driver

licensing authority about whether the criteria

are met for driving a private vehicle, but

only aspecialist may do so for a commercial

vehicledriver.

7.2.10. Personality disorders

Some people with a personality disorder may

display aggressive, irresponsible or erratic

behaviour and could beneﬁt from psychiatric

interventions. Their licence status may also need

to be managed through administrative, police or

legal channels.

7.2.11. Post-traumatic stress disorder

Post-traumatic stress disorder may arise

following motor vehicle crashes. Return to safe,

competent driving may be assisted by therapy

such as cognitive behaviour therapy and by

driving rehabilitation courses.

7.2.12. Other psychiatric conditions

Specialist advice may need to be sought for

drivers who have a psychiatric condition not

covered here.

Where a psychiatric condition is associated with

epilepsy or illicit drug use, the relevant section

should also be referenced.

174

Psychiatric conditions

173

PART B. Medical standards

7.3. Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table.

Medical standards for licensing

–

psychiatric conditions

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Psychiatric

conditions

(e.g.

schizophrenia,

bipolar aective

condition,

depression,

anxiety

conditions, and

personality

conditions)

Refer also to

section 7.1.1.

Eects of

psychiatric

conditions on

driving.

A person is not ﬁt to hold an unconditional

licence:

• if the person has a chronic psychiatric

condition of such severity that it is likely to

impair insight, behaviour, cognitive ability

or perception required for safe driving.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to

whether the following criteria are met:

• the condition is well controlled and the

person complies with treatment over a

substantial period; and

• the person has insight into the potential

eects of their condition on safe driving;

and

• there are no adverse medication eects

that may impair their capacity for safe

driving (also refer to Part A section 2.2.9.

Drugs and driving); and

• the impact of comorbidities has been

considered (e.g. substance abuse).

A person is not ﬁt to hold an unconditional

licence:

• if the person has a chronic psychiatric

condition of such severity that is likely

to impair behaviour, cognitive ability or

perception required for safe driving.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by a psychiatrist* as to whether the

following criteria are met:

• the condition is well controlled and the

person complies with treatment over a

substantial period; and

• the person has insight into the potential

eects of their condition on safe driving;

and

• there are no adverse medication eects

that may impair their capacity for safe

driving (also refer to Part A section 2.2.9.

Drugs and driving); and

• the impact of comorbidities has been

considered (e.g. substance abuse).

* Where the treating psychiatrist considers

a driver’s condition to be stable, well

managed, and the driver has good insight,

the driver licensing authority may agree to

ongoing periodic review by the person’s

regular GP on mutual agreement of all

practitioners concerned. The initial allocation

of a conditional licence must, however, be

based on an assessment and information

provided by the psychiatrist.

175

PART B. Medical standards

Medical standards for licensing

–

psychiatric conditions

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Psychogenic

nonepileptic

seizures

Refer also to

section 6.2.

Seizures and

epilepsy

A person is not ﬁt to hold an unconditional

licence:

• if the person has experienced a

psychogenic seizure.

A conditional licence may be considered

by the driver licensing authority subject

to periodic review, taking into account

information provided by the treating doctor

as to whether the following criteria are met:

• seizures are identiﬁed as psychogenic

only with no epileptic seizures*; and

• there have been no further psychogenic

seizures for at least 3 months

• the situational context or the semiology

has been stable for at least 12 months

and the psychogenic seizures

− have not caused a loss of awareness

or responsiveness; and

− have not resulted in injury; and

− would not disrupt the driving task

• could not occur when a person is driving;

and

• only occur in response to triggers that will

not be encountered whilst driving.

* The seizure and epilepsy standards also

apply in cases where there is co-existent

epilepsy (refer to section 6.2. Seizures

and epilepsy). If psychogenic and epileptic

seizures cannot be dierentiated, the

Blackouts of uncertain mechanism standards

apply (refer to section 1.2.4. Blackouts of

undetermined mechanism). If more than

one standard applies, the standard with the

longer non-driving period prevails.

A person is not ﬁt to hold an unconditional

licence:

• if the person has experienced a

psychogenic seizure.

A conditional licence may be considered

by the driver licensing authority subject to

at least annual review, taking into account

information provided by the treating

neurologist or psychiatrist as to whether the

following criteria are met:

• seizures are identiﬁed as psychogenic

only with no epileptic seizures*; and

• there have been no further psychogenic

seizures for at least 3 months.

* The seizure and epilepsy standards also

apply in cases where there is co-existent

epilepsy (refer to section 6.2. Seizures

and epilepsy). If psychogenic and epileptic

seizures cannot be dierentiated, the

Blackouts of uncertain mechanism standards

apply (refer to section 1.2.4. Blackouts of

undetermined mechanism). If more than

one standard applies, the standard with the

longer non-driving period prevails.

176

Psychiatric conditions

175

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

177

PART B. Medical standards

References and further reading

1. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

2. American Psychiatric Association. Position

statement on the role of psychiatrists in

assessing driving ability. (2016).

3. Unsworth, C. A., Baker, A. M., So, M. H.,

Harries, P. & O’Neill, D. A systematic review

of evidence for ﬁtness-to-drive among

people with the mental health conditions

of schizophrenia, stress/anxiety disorder,

depression, personality disorder and

obsessive compulsive disorder. BMC

Psychiatry 17, (2017).

4. Charlton, J. L. & Monash University Accident

Research Centre. Inﬂuence of chronic

illness on crash involvement of motor

vehicle drivers. (Monash University, Accident

Research Centre, 2010).

5. Parekh, V. Psychoactive drugs and driving.

Australian Prescriber 42, 182–185 (2019).

6. North Western Mental Health. Guidelines

for mental health professionals to assist

consumers with safe driving. www.vicroads.

vic.gov.au (2017).

7. Canadian Medical Association. CMA driver’s

guide: determining medical ﬁtness to

operate motor vehicles. (Joule, 2017).

8. Asadi-Pooya, A. A. & Sperling, M. R.

Epidemiology of psychogenic nonepileptic

seizures. Epilepsy and Behavior 46, 60–65

(2015).

9. Asadi-Pooya, A. A. et al. Driving a motor

vehicle and psychogenic nonepileptic

seizures: ILAE Report by the Task Force

on Psychogenic Nonepileptic Seizures.

Epilepsia Open 5, 371–385 (2020).

178

Psychiatric conditions

177

PART B. Medical standards

8. Sleep disorders

Refer also to section 1. Blackouts.

8.1. Relevance to the

driving task

8.1.1. Evidence of crash risk

Studies have shown an increased rate of motor

vehicle crashes of between two and seven times

that of among control subjects in those with

sleep apnoea. Studies have also demonstrated

increased objectively measured sleepiness

while driving (electro-encephalography and eye

closure measurements) and impaired driving-

simulator performance in people with conﬁrmed

sleep apnoea. This performance impairment

is similar to that seen due to illegal alcohol

impairment or sleep deprivation. Drivers with

severe sleep-disordered breathing (respiratory

disturbance index > 34) may have a higher

rate of crashes than those with a less severe

sleepdisorder.

Those with narcolepsy perform worse on

simulated driving tasks and are more likely to

have vehicle crashes than control subjects.

8.1.2. Impact of treatment on

crashrisk

2–5

Treating obstructive sleep apnoea (OSA) with

nasal continuous positive airways pressure

(CPAP) has been shown to reduce daytime

sleepiness and reduce the risk of crashes to

the same level as controls. CPAP has also been

shown to improve driving-simulator performance

to the same levels as the control group. When

used to treat OSA, mandibular advancement

splints reduce daytime sleepiness and improve

vigilance; however, studies have not been

performed to assess whether they reduce motor

vehicle crash rates.

8.2. General assessment

and management

guidelines

8.2.1. General considerations

6–10

Excessive daytime sleepiness, which manifests

itself as a tendency to doze at inappropriate

times when intending to stay awake, can arise

from many causes and is associated with

an increased risk of motor vehicle crashes.

It is important to distinguish sleepiness (the

tendency to fall asleep) from fatigue or tiredness

that is not associated with a tendency to fall

asleep. Many chronic illnesses cause fatigue

without increased sleepiness.

Increased sleepiness during the daytime in

otherwise normal people may be due to prior

sleep deprivation (restricting the time for sleep),

poor sleep hygiene habits, irregular sleep–

wake schedules or the inﬂuence of sedative

medications, including alcohol. Insucient sleep

(less than ﬁve hours) prior to driving is strongly

related to motor vehicle crash risk. Excessive

daytime sleepiness may also result from a

range of medical sleep disorders including the

sleep apnoea syndromes (OSA, central sleep

apnoea and nocturnal hypoventilation), periodic

limb movement disorder, circadian rhythm

disturbances (e.g. advanced or delayed sleep

phase syndrome), some forms of insomnia and

narcolepsy.

Unexplained episodes of ‘sleepiness’ may also

require consideration of the several causes of

blackouts (refer to section 1. Blackouts).

179

PART B. Medical standards

8.2.2. Identifying and managing

people at high crash risk

4,10,11

Until the disorder is investigated, treated

eectively and licence status determined,

people should be advised to avoid or limit

driving if they are sleepy, and not to drive if

they are at high risk, particularly in the case of

commercial vehicle drivers. High-risk people

include:

• those who experience moderate to severe

excessive daytime sleepiness

• those with a history of frequent self-reported

sleepiness while driving

• those who have had a motor vehicle crash

caused by inattention or sleepiness.

People with these high-risk features have a

signiﬁcantly increased risk of sleepiness-related

motor vehicle crashes. These people should

be referred to a sleep disorders specialist,

particularly in the case of commercial vehicle

drivers. Driving limitations may include avoiding

driving at night and after consuming alcohol

or sedative drugs, and limiting continuous

driving (e.g. to between 15 minutes and two

hours depending on symptoms) until eective

treatment is implemented (refer to section 8.2.5.

Advice to patients).

8.2.3. Sleep apnoea

10,12–15

Deﬁnitions and prevalence

Diagnosed sleep apnoea has been reported in

8.3 per cent of Australian adults, 12.9 per cent of

men and 3.7 per cent of women. Approximately

3 per cent of adults have diagnosed sleep

apnoea and excessive daytime sleepiness,

indicating a signiﬁcant tendency to doze

o in various situations during the daytime,

including when driving. Sleep apnoea syndrome

(excessive daytime sleepiness in combination

with sleep apnoea on overnight monitoring)

is present in 2 per cent of women and 4 per

cent of men. Some studies suggest a higher

prevalence in transport drivers.

OSA involves repetitive obstruction to the upper

airway during sleep, caused by relaxation of the

dilator muscles of the pharynx and tongue and/

or narrowing of the upper airway, resulting in

cessation (apnoea) or reduction (hypopnoea) of

breathing.

Central sleep apnoea refers to a similar pattern

of cyclic apnoea or hypopnoeas caused by

oscillating instability of respiratory neural

drive, and not due to upper airways factors.

This condition is less common than OSA and

is associated with cardiac or neurological

conditions. It may also be idiopathic.

Hypoventilation associated with chronic

obstructive pulmonary disease or chronic

neuromuscular conditions may also interfere

with sleep quality, causing excessive sleepiness.

Sleep apnoea assessment

Evaluating sleep apnoea includes a clinical

assessment of the likelihood of sleep apnoea

followed by overnight monitoring (sleep study) to

identify sleep apnoea and its severity, as well as

assessing sleepiness based on subjective and

sometimes objective tools.

Clinical and physical features

12,16

Clinical features can have a high predictive

value for a subsequent diagnosis of OSA via

a sleep study. Criteria of signiﬁcant concern

include:

• BMI ≥ 40 kg/m2

• BMI ≥ 35 kg/m2 and either

− hypertension requiring ≥ 2 medications

for control, or

− type 2 diabetes

• sleepiness-related crash or accident, o-

road deviation, or rear-ending another

vehicle by report or observation

• excessive sleepiness during the major

wakeperiod.

180

Sleep disorders

179

PART B. Medical standards

Other clinical features include:

• habitual snoring during sleep

• witnessed apnoeic events (often in bed

by a spouse/partner) or falling asleep

inappropriately (particularly during non-

stimulating activities such as watching

television, sitting reading, travelling in a car,

when talking with someone)

• feeling tired despite adequate time in bed.

Poor memory and concentration, morning

headaches and insomnia may also be

presenting features. The condition is more

common in men and with increasing age. Other

physical features commonly include a thick

neck (>42 cm in men, >41 cm in women) and a

narrow oedematous (‘crowded’) oropharynx.

The presence of type 2 diabetes and dicult-

to-control high blood pressure should also

increase the suspicion of sleep apnoea.

However, the condition may be present without

these features.

The STOP-BANG, OSA-50, and Berlin

Questionnaire are clinical screening tools with

demonstrated predictive value for subsequent

diagnosis of sleep apnoea. Using these

questionnaires may assist in the decision to refer

for further sleep studies. For general guidance

on sleep studies, refer to relevant best practice

guidelines (e.g. Australasian Sleep Association’s

Guidelines for sleep studies in adults,

available

at www.sleep.org.au).

Sleep studies, referral and management

17,18

People in whom sleep apnoea, chronic

excessive sleepiness or another medical sleep

disorder is suspected should be referred to a

specialist sleep physician for further assessment,

investigation with overnight polysomnography

(either in the laboratory or home) and

management. Home sleep studies are widely

available with Medicare reimbursed direct

referrals oered for patients who have a high

score on sleep apnoea and daytime sleepiness

screening questionnaires (e.g. ≥ 3 on STOP-

Bang and Epworth Sleepiness Scale score ≥ 8).

Referral to a sleep specialist should also be

considered for any person who has unexplained

daytime sleepiness while driving, or who has

been involved in a motor vehicle crash that may

have been caused by sleepiness.

Non-driving or restricted driving periods can

be considered while assessing the response

to treatment and may be determined on a

case-by-case basis. Examples of restrictions

that can be considered include limiting driving

duration (e.g. from 30 minutes with graduated

increasing times) or no night driving (11PM–

7AM). For commercial vehicle drivers, this is

assessed by a sleep specialist considering the

improvement in sleepiness and the related

driving risk. The ecacy of treatment should

bedocumentedwith:

• minimal adherence to treatment

• eectiveness of treatment

• resolution of sleepiness.

A person found to be positive for moderate

to severe OSA on polysomnography, but who

denies symptoms and declines treatment, may

be oered a Maintenance of Wakefulness Test

(MWT) (the MWT should include a drug screen

and apply a 40-minute protocol). For those with

a normal MWT, the driver licensing authority

may consider a conditional licence without OSA

treatment subject to review in one year.

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PART B. Medical standards

Subjective measures of sleepiness

19–21

Determining excessive daytime sleepiness

is a clinical decision, which may be assisted

with clinical tools. Tools such as the Epworth

Sleepiness Scale (ESS) or other validated

questionnaires can be used as subjective

measures of excessive daytime sleepiness while

recognising that the ESS is neither sensitive nor

speciﬁc in the diagnosis of OSA. Such tests rely

on honest completion by the driver, and there

is evidence that incorrect reporting may occur

in some cases. The tools are therefore just one

aspect of the comprehensive assessment.

The responses to eight questions for the

ESS (refer to Figure 15. Epworth Sleepiness

Scale questions) relating to the likelihood of

falling asleep in certain situations are scored

and summed. A score of 0–10 is within the

normal range, 11–15 indicates mild-moderate

daytime sleepiness, and a score of 16–24

indicates moderate to severe excessive daytime

sleepiness and may be associated with an

increased risk of motor vehicle crashes.

A history of frequent self-reported sleepiness

while driving or motor vehicle crashes caused

by sleepiness also indicates a high risk of motor

vehicle crashes.

Figure 15. Epworth Sleepiness Scale questions

Epworth Sleepiness Scale questions

How likely are you to doze o or fall asleep in the following situations?

Scored 0–3, where:

0 = never

1 = light chance

2 = moderate chance

3 = high chance of dozing

Situation Score

1. Sitting and reading

2. Watching TV

3. Sitting, inactive in a public space (e.g. a theatre or meeting)

4. As a passanger in a car for an hour without a break

5. Lying down to rest in the afternoon when circumstances permit

6. Sitting and talking to someone

7. Sitting quietly after a lunch without alcohol

8. In a car, while stopped for a few minutes in the trac

Total score:

It may be used by individual doctors without permission, but its use on a commercial basis mustbe negotiated.

182

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181

PART B. Medical standards

Objective measures of sleepiness

Objective measures include the MWT. Excessive

sleepiness on the MWT suggests impaired

driving performance.

Screening tools that combine questions and

physical measurements (e.g. the Multivariate

Apnoea Prediction Questionnaire) have been

evaluated for screening people for sleep

disorders in a clinical setting. Their ecacy for

screening large general populations remains

under evaluation.

Commercial vehicle drivers

Commercial vehicle drivers who are diagnosed

with sleep apnoea and require treatment

must have an annual review by a sleep

specialist to ensure adequate treatment is

maintained. For drivers who are treated with

CPAP, it is recommended that they use CPAP

machines with a usage meter to allow objective

assessment and recording of treatment

compliance. Minimally acceptable adherence

with treatment is deﬁned as four hours or more

per day of use on 70 per cent or more of days.

An assessment of sleepiness should be made,

and an objective measurement of sleepiness

should be considered (MWT), particularly if there

is a concern about persisting sleepiness or

treatment compliance.

8.2.4. Narcolepsy

23–25

Narcolepsy is present in 0.05 per cent of the

population and usually starts in the second

or third decade of life. Suerers present with

excessive sleepiness and can have periods of

sleep with little or no warning of sleep onset.

Other symptoms include cataplexy, sleep

paralysis and vivid hypnagogic hallucinations.

Inadequate warning of oncoming sleep and

cataplexy put drivers at high risk.

There is a subgroup of people who are

excessively sleepy but do not have all the

diagnostic features of narcolepsy. In addition,

some people may have other central disorders

of hypersomnolence such as idiopathic

hypersomnia. For drivers with idiopathic

hypersomnia or sleepiness due to other central

disorders of hypersomnolence, refer to the

medical standards for Sleep apnoea syndrome,

excessive sleepiness, and other sleep disorders

on page 185.

Diagnosis of narcolepsy is made on the

combination of clinical features. A multiple

sleep latency test (MSLT) is conducted, with

a diagnostic sleep study on the prior night

to exclude other sleep disorders and aid

interpretation of the MSLT.

Drivers suspected of having narcolepsy should

be referred to a sleep specialist or neurologist

for assessment (including an MSLT) and

management.

Sleepiness in narcolepsy can usually be

managed eectively with scheduled naps and

stimulant medication. Additional treatment for

cataplexy may be required. Commercial vehicle

drivers on a conditional licence should have a

review at least annually by their specialist.

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PART B. Medical standards

8.2.5. Advice to patients

All patients suspected of having sleep apnoea

or other sleep disorders should be warned

about the potential eect on road safety.

General advice may include:

• minimising unnecessary driving

• minimising driving at times when they would

normally be asleep

• allowing adequate time for sleep and

avoiding driving after having missed a large

portion of their normal sleep

• avoiding alcohol and sedative medications

• avoiding using over-the-counter or other

non-prescribed substances for maintaining

wakefulness

• ensuring prescribed treatments are taken as

required

• resting and limiting driving if they are sleepy

• heeding the advice of a passenger that the

driver is dozing o.

It is the responsibility of the driver to avoid

driving if they are sleepy, comply with treatment,

maintain their treatment device, attend review

appointments and honestly report their condition

to their treating physician.

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183

PART B. Medical standards

8.3. Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table.

Medical standards for licensing

–

sleep disorders

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Sleep apnoea,

excessive

sleepiness and

other sleep

disorders

(e.g. all sleep

apnoea,

idiopathic

hypersomnia

and other central

disorders of

hypersomnolence)

Refer also to

narcolepsy.

A person is not ﬁt to hold an unconditional

licence:

• if the person has an established sleep

apnoea syndrome (sleep apnoea on a

diagnostic sleep study and moderate to

severe excessive daytime sleepiness*); or

• if the person has frequent self-reported*

episodes of sleepiness or drowsiness

while driving; or

• if the person has had motor vehicle

crash(es) caused by inattention or

sleepiness; or

• if the person, in the opinion of the treating

doctor, represents a signiﬁcant driving

risk as a result of a sleep disorder.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by the treating doctor as to

whether the following criteria are met:

• the person complies with treatment; and

• the response to treatment is satisfactory.

* The treating doctor should not rely solely

on subjective measures of sleepiness such

as the Epworth Sleepiness Scale to rule out

sleep apnoea. Refer to section 8.2.3. Sleep

apnoea.

A person is not ﬁt to hold an unconditional

licence:

• if the person has an established sleep

apnoea syndrome (sleep apnoea on a

diagnostic sleep study and moderate to

severe excessive daytime sleepiness*); or

• if the person has frequent self-reported*

episodes of sleepiness or drowsiness

while driving; or

• if the person has had motor vehicle

crash(es) caused by inattention or

sleepiness; or

• if the person, in the opinion of the treating

doctor, represents a signiﬁcant driving

risk as a result of a sleep disorder.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by a specialist in sleep disorders

as to whether the following criteria are met:

• the person complies with treatment; and

• the response to treatment is satisfactory.

* The treating doctor should not rely solely

on subjective measures of sleepiness such

as the Epworth Sleepiness Scale to rule out

sleep apnoea. Refer to section 8.2.3. Sleep

apnoea.

185

PART B. Medical standards

Medical standards for licensing

–

sleep disorders

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Narcolepsy A person is not ﬁt to hold an unconditional

licence:

• if narcolepsy is conﬁrmed.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review, taking into account the

nature of the driving task and information

provided by a specialist in sleep disorders

on the response to treatment.

A person is not ﬁt to hold an unconditional

licence:

• if narcolepsy is conﬁrmed.

A conditional licence may be considered

by the driver licensing authority subject to

at least annual review, taking into account

the nature of the driving task and information

provided by a specialist in sleep disorders

as to whether the following criteria are met:

• cataplexy has not been a feature in the

past; and

• medication is taken regularly; and

• there has been an absence of symptoms

for 6 months; and

• normal sleep latency present on MWT (on

or o medication).

186

Sleep disorders

185

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

187

PART B. Medical standards

References and further reading

1. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

2. George, C. F. P. Reduction in motor vehicle

collisions following treatment of sleep

apnoea with nasal CPAP. Thorax 56, 508–

512 (2001).

3. Karimi, M., Hedner, J., Häbel, H., Nerman,

O. & Grote, L. Sleep apnea related risk

of motor vehicle accidents is reduced

by continuous positive airway pressure:

Swedish trac accident registry data.

Sleep38, 341–349 (2015).

4. Komada, Y. et al. Elevated risk of motor

vehicle accident for male drivers with

obstructive sleep apnea syndrome in the

tokyo metropolitan area. Tohoku Journal of

Experimental Medicine 219, 11–16 (2009).

5. Mehta, A., Qian, J., Petocz, P., Ali

Darendeliler, M. & Cistulli, P. A. A

randomized, controlled study of a

mandibular advancement splint for

obstructive sleep apnea. American Journal

of Respiratory and Critical Care Medicine

163, 1457–1461 (2001).

6. Findley, L. J. et al. Driving simulator

performance in patients with sleep apnea.

American Review of Respiratory Disease

140, 529–530 (1989).

7. Masa, J. F. et al. Habitually sleepy drivers

have a high frequency of automobile

crashes associated with respiratory

disorders during sleep. American Journal of

Respiratory and Critical Care Medicine 162,

1407–1412 (2000).

8. Howard, M. E. et al. Sleepiness, sleep-

disordered breathing, and accident risk

factors in commercial vehicle drivers.

American Journal of Respiratory and Critical

Care Medicine 170, 1014–1021 (2004).

9. Turkington, P. M., Sircar, M., Allgar, V.

& Elliott, M. W. Relationship between

obstructive sleep apnoea, driving simulator

performance, and risk of road trac

accidents. Thorax 56, 800–805 (2001).

10. Ayas, N. et al. Obstructive sleep apnea and

driving: A Canadian Thoracic Society and

Canadian Sleep Society position paper.

Canadian Respiratory Journal 21, 114–123

(2014).

11. Vakulin, A. et al. Eects of alcohol and sleep

restriction on simulated driving performance

in untreated patients with obstructive sleep

apnea. Annals of Internal Medicine 151,

447–455 (2009).

12. Gurubhagavatula, I. et al. Management of

obstructive sleep apnea in commercial

motor vehicle operators: recommendations

of the AASM sleep and transportation safety

awareness task force. Journal of Clinical

Sleep Medicine 13, 745–758 (2017).

13. Sarkissian, L., Kitipornchai, L., Cistulli, P. &

Mackay, S. G. An update on the current

management of adult obstructive sleep

apnoea. Australian Journal of General

Practice 48, 182–186 (2019).

14. Adams, R. J. et al. Sleep health of Australian

adults in 2016: results of the 2016 Sleep

Health Foundation national survey.

SleepHealth 3, 35–42 (2017).

188

Sleep disorders

187

PART B. Medical standards

15. Appleton, S. L. et al. Prevalence and

comorbidity of sleep conditions in Australian

adults: 2016 Sleep Health Foundation

national survey. Sleep Health 4, 13–19 (2018).

16. Colquhoun, C. P. & Casolin, A. Impact of

rail medical standard on obstructive sleep

apnoea prevalence. Occupational Medicine

66, 62–68 (2016).

17. Douglas, J. A. et al. Guidelines for sleep

studies in adults – a position statement of

the Australasian Sleep Association. Sleep

Medicine vol. 36 S2–S22 (2017).

18. Strohl, K. P. et al. An ocial American

Thoracic Society clinical practice guideline:

sleep apnea, seepiness, and driving risk in

noncommercial drivers. American Journal of

Respiratory and Critical Care Medicine 187,

(2013).

19. Lloberes, P. et al. Self-reported sleepiness

while driving as a risk factor for trac

accidents in patients with obstructive sleep

apnoea syndrome and in non-apnoeic

snorers. Respiratory Medicine 94, 971–976

(2000).

20. Farney, R. J., Walker, B. S., Farney, R. M.,

Snow, G. L. & Walker, J. M. The STOP-Bang

equivalent model and prediction of severity

of obstructive sleep apnea: relation to

polysomnographic measurements of the

apnea/hypopnea index. Journal of Clinical

Sleep Medicine 7, 459–465 (2011).

21. Sharwood, L. N. et al. Assessing sleepiness

and sleep disorders in Australian long-

distance commercial vehicle drivers: Self-

report versus an ‘at home’ monitoring

device. Sleep 35, 469–475 (2012).

22. Philip, P. et al. Maintenance of Wakefulness

Test scores and driving performance

in sleep disorder patients and controls.

International Journal of Psychophysiology

89, 195–202 (2013).

23. Philip, P. et al. Sleep disorders and

accidental risk in a large group of regular

registered highway drivers. Sleep Medicine

11, 973–979 (2010).

24. Pizza, F. et al. Car crashes and central

disorders of hypersomnolence: a French

study. PLoS One 10, e0129386 (2015).

25. Aldrich, M. S. Automobile Accidents in

Patients with Sleep Disorders. Sleep 12,

487–494 (1989).

189

PART B. Medical standards

9. Substance misuse

(including alcohol, illicit drugs and prescription

drug misuse)

This chapter focuses mainly on regular heavy

use of, and dependence on, alcohol and other

substances (including illicit and prescription

or over-the-counter drugs). The standards for

licensing do not address acute intoxication,

which is subject to drink/drug driving laws

(refer to Appendix 4. Drivers’ legal BAC limits)

or to policies regarding random drug and

alcohol testing within workplaces. However, it is

possible for a long-term dependent person to

be impaired due to both chronic use and recent

consumption, and these risks are factors in

considering the ﬁtness to drive of such people.

More information about acute intoxication

and driving can be found on driver licensing

authoritywebsites.

Chronic misuse of alcohol and other substances

can lead to a syndrome of dependence,

characterised by several of the following features:

• tolerance, as deﬁned by either a need

for markedly increased amounts of the

substance to achieve intoxication or desired

eect, or a markedly diminished eect

with continued use of the same amount of

substance

• withdrawal, as manifested by either the

characteristic withdrawal syndrome for the

substance, or the same (or a closely related)

substance is taken to relieve or avoid

withdrawal symptoms

• the substance is often taken in larger

amounts or over a longer period than was

intended

• there is a persistent desire or unsuccessful

eorts to cut down or control substance use

• a great deal of time is spent in activities to

obtain the substance, use the substance or

recover from its eects

• important social, occupational or recreational

activities are given up or reduced because

of substance use

• the substance use is continued despite

knowledge of having a persistent or

recurrent physical or psychological

problem that is likely to have been caused

or exacerbated by the substance (e.g.

continued drinking despite recognition

that an ulcer was made worse by alcohol

consumption).

9.1. Relevance to the

driving task

9.1.1. Eects of long-term alcohol use

and other substance use on driving

1–8

Alcohol

In Australia, the 12-month prevalence of

alcohol use disorders in 2016 was 6.1 per cent

for men and 2.7 per cent for women. Alcohol

dependence had a prevalence of 2.2 per

cent for men and 0.8 per cent for women.

Chronic heavy alcohol use carries a real risk

of neurocognitive deﬁcits relevant to driving

capability including:

• short-term memory and learning

impairments, which become more evident as

the diculty of the task increases

• impaired perceptual-motor speed

• impaired visual search and scanning

strategies

• deﬁcits in executive functions such as

mental ﬂexibility and problem-solving skills;

planning, organising and prioritising tasks;

focusing attention, sustaining focus and

shifting focus from one task to another;

ﬁltering out distractions; monitoring and

regulating self-action; or impulsivity.

190

Substance misuse

189

PART B. Medical standards

Long-term heavy alcohol use is also associated

with various end-organ pathologies that

may aect the ability to drive – for example,

Wernicke-Korsako syndrome or peripheral

neuropathies experienced as numbness or

paresthesia of the hands or feet. In the event

of end-organ eects relevant to driving, the

appropriate requirements should be applied as

set out elsewhere in this publication.

Alcohol-dependent people may experience

a withdrawal syndrome on cessation or

signiﬁcant reduction of intake, which carries

some risk of generalised seizure (refer to Acute

symptomatic seizures, page 134 and page

141),confusional states and hallucinations.

Other substances

Substances (prescribed, over-the-counter and

illicit) are misused for their intoxicating, sedative

or euphoric eects. Drivers under the inﬂuence

of these drugs are more likely to behave in a

manner incompatible with safe driving. This

may involve, but not be limited to, risk taking,

aggression, feelings of invulnerability, narrowed

attention, altered arousal states and poor

judgement.

Illicit substances are a heterogeneous group.

Chronic eects of their use vary and are not

as well understood as those of alcohol. Some

evidence suggests cognitive impairment is

associated with chronic stimulant, opioid and

benzodiazepine use. Illicit substance users

may be at risk of brain injury through hypoxic

overdose, trauma or chronic illness.

End-organ damage, including cardiac,

neurological and hepatic damage, may be

associated with some forms of illicit substance

use, particularly injection drug use. Cocaine and

other stimulant misuse have been linked with

cardiovascular pathology. In the event of end-

organ eects relevant to driving, the appropriate

requirements should be applied as set out

elsewhere in this publication.

Withdrawal seizures may occur (refer to

Acutesymptomatic seizures, page 134 and

page 141).

9.1.2. Evidence of crash risk

1,6,9–21

Alcohol

The relationship between raised alcohol levels

and crash risk is well established, and it has

been estimated that driving while intoxicated

contributes to 30–50 per cent of fatal crashes,

15–35 per cent of crashes involving injury and 10

per cent of crashes not involving injury.

Increasing levels of intoxication result in

disproportionate increases in the risk of a motor

vehicle crash. The ﬁrst case-controlled study of

collision risk showed that with a blood alcohol

concentration (BAC) of 0.05 per cent (g/100 mL),

a driver was twice as likely to be involved in a

collision as someone with no alcohol; at 0.10

per cent a driver has ﬁve times the relative risk;

and at 0.20, there is a 25 times greater risk of a

collision.

Less experienced drivers have alcohol-related

crashes at lower BACs than more experienced

drivers. For example, a study of single-vehicle

fatal collisions showed that a male driverin the

ﬁrst ﬁve years of driving is 17 times more likely to

have a fatal collision if their BAC is 0.05–0.079

and risk increases exponentially with BAC. This

supports zero BAC for probationary drivers as

mandated in our graduated licensing system.

In the case of commercial vehicle drivers,

‘zero’ BAC is also mandated (refer to Appendix

4. Drivers’ legal BAC limits). Inexperienced

drivers need to be educated about the real risks

associated with drinking and driving.

People with alcohol dependency have

approximately twice the risk of crash

involvement as controls, possibly because they

are more likely to drive while intoxicated despite

prior convictions for drink driving.

191

PART B. Medical standards

Drugs

There is limited evidence regarding crash risk

and drug dependency. Approximately 13 per

cent of fatal crashes are attributed to drug

use. The risk is ampliﬁed with alcohol–drug

and impairing drug–drug combinations. In

an Australian study examining the odds of

culpability associated with use of impairing

drugs in injured drivers, one or more illicit

drug present, but no alcohol, increased the

odds of culpability 10-fold, while drivers with

any impairing drug (but no alcohol) increased

the odds 8.2-fold. The two most common illicit

drugs detected were methylamphetamine

and THC. Common impairing drugs included

illicit drugs as well as benzodiazepines and

sedating antihistamines. The most frequent

substance combinations included alcohol with

THC, alcohol with a benzodiazepine, alcohol

with methylamphetamine, and THC with

methylamphetamine.

Amphetamine-type stimulants

10,11,16,21

Australian studies report amphetamine-type

stimulants in 7.1 per cent of all fatal road crashes

and a 14-fold increase in the odds of culpability

for collisions causing injury. Low doses of

stimulants improve reaction time and reduce

fatigue but at a cost of poor road position, loss

of attention to peripheral information, erratic

driving, weaving, speeding, drifting o the road,

increased risk taking and high-speed collisions.

Cannabis

5,10,13,14,22–24

Cannabis use can lead to dependence

syndrome, with well-documented withdrawal

symptoms including restlessness, insomnia,

anxiety, aggression, anorexia, muscle tremor

and autonomic eects. Adult lifetime prevalence

rates suggest that 9 per cent of cannabis users

develop cannabis dependence, with higher

rates in young people. Cannabis is the most

common substance after alcohol for which

admission for detoxiﬁcation is sought.

Acute cannabis consumption is associated with

increased road trauma. Australian studies have

found the presence of cannabis (THC) in 11.1 per

cent of all drivers injured in a road accident and

13.1 per cent of road fatalities. Chronic cannabis

use is associated with cognitive decline, and

the implications for safe driving should be

carefullyassessed.

On-road assessment may be required to

determine ﬁtness to drive. Practitioners

should be aware of the potential use of illicit

and prescription medicinal cannabis and the

cumulative impairment to drive safely. For

information on prescription medicinal cannabis,

refer to Part A section 2.2.9. Drugs and driving.

Sedating drugs

10,11,17,25,26

This is a heterogeneous group that includes all

the drugs that cause mental clouding, sleepiness

and poor responsiveness to the environment.

It includes the benzodiazepines, sedating

antihistamines, sedating antidepressants and

narcotic analgesics. There is speciﬁc data on

driving risk for some substances and none for

others. Practitioners should be aware of the

implications of their prescribing on the ability of

patients to drive safely.

There is an increased risk of personal injury

crashes among drivers using anti-anxiety drugs

compared with the rest of the population.

The risk is exacerbated by alcohol and other

sedatives. There is a hangover eect, and a

small dose of any sedative the following day can

potentiate the eect. A meta-analysis of more

than 500 studies showed that the degree of

impairment of driving skill was directly related to

the serum level of each substance. In Australian

studies benzodiazepines were found in 8.2

per cent of fatalities and 12 per cent of injured

drivers. In a culpability study of drivers taken to

hospital for treatment after a collision, 100 per

cent of drivers who had a benzodiazepine at any

level with alcohol at any level were responsible

for the collision.

192

Substance misuse

191

PART B. Medical standards

9.1.3. Eects of alcohol or drugs on

other diseases

People who are frequently intoxicated and who

also suer from certain other medical conditions

are often unable to give their other medical

problems the careful attention required, which

has implications for safe driving.

Epilepsy

Many people with epilepsy are quite likely to

have a seizure if they miss their prescribed

medication even for a day or two, particularly

when this omission is combined with inadequate

rest, emotional turmoil, irregular meals and

alcohol or other substances. Patients under

treatment for any kind of epilepsy are not ﬁt

to drive any class of motor vehicle if they are

frequently intoxicated.

Diabetes

People with insulin-dependent diabetes have

a special problem when they are frequently

intoxicated. Not only may they forget to inject

their insulin at the proper time and in the proper

quantity but also their food intake can get out of

balance with the insulin dosage. This may result

in a hypoglycaemic reaction or the slow onset of

a diabetic coma.

9.2. General assessment

and management

guidelines

9.2.1. General considerations

Chronic misuse of drugs is incompatible

with safe vehicle driving. Careful individual

assessment must be made of drivers who

misuse alcohol or other substances (prescribed

or illicit). Substance misuse may not be conﬁned

to a single drug class, and people may use

multiple substances in combination. In addition,

people who misuse substances may change

from one substance to another. Occasional

use of these drugs also requires very careful

assessment. In particular, the health professional

should be satisﬁed that the use of these drugs is

not going to aect a commercial vehicle driver in

the performance of their duties.

During clinical assessment, patients may

understate or deny substance use for fear of

consequences of disclosure. The acute and

chronic cognitive eects of some substance

use also contribute to diculty in obtaining an

accurate history and identiﬁcation of substance

use. Assessment should therefore incorporate a

range of indicators of substance use in addition

to self-report, including objective assessments.

Urine drug screens, oral ﬂuid testing and blood

testing provide objective evidence of recent

drug use but may only give a limited historical

context. Hair testing can provide a longitudinal

detection window measured in months through

which to assess remission.

193

PART B. Medical standards

Secondary opinion from an appropriate

specialist, such as an addiction medicine

specialist or addiction psychiatrist, may be

necessary. Further assessments and/or

objective evidence from biological monitoring

(e.g. supervised drug screening) by the

treating doctor may be indicated, including

relevant investigations, particularly in the case

of commercial vehicle drivers. In particular,

people with substance use disorder and mental

illness, acquired brain injury or chronic pain

comorbidities may have a level of complexity

requiring specialist assessment. On-road

practical driving assessments may assist in some

cases to determine ﬁtness to drive.

9.2.2. Alcohol dependence

Screening tests may be useful for assessing

alcohol dependence and other substance

use disorders. For example, the Alcohol Use

Disorders Identiﬁcation Test (AUDIT) may be

used to screen for alcohol dependence (refer

to Figure 16). The total maximum score is 40.

A score of eight or more indicates a strong

likelihood of hazardous or harmful alcohol

consumption. Referral to an appropriate

specialist, such as an addiction medicine

specialist or addiction psychiatrist, should

be considered, particularly in the case of

commercial vehicle drivers. The AUDIT relies

on accurate responses to the questionnaire

and should be interpreted in the context of a

global assessment that includes other clinical

evidence. For more information about the

AUDIT questionnaire, refer to https://www.who.

int/publications/i/item/audit-the-alcohol-use-

disorders-identiﬁcation-test-guidelines-for-use-

in-primary-health-care.

Alcohol ignition interlocks are devices that

prevent a car starting if the driver has been

drinking. All states and territories have alcohol

interlock programs where a driver who has been

convicted of speciﬁed drink-driving oences

is subject to a licence condition that they only

drive a motor vehicle with an alcohol interlock

ﬁtted. An alcohol interlock condition may be

ordered by a court as part of the sentencing

or the licence restoration process, or imposed

by the driver licensing authority in some

circumstances. Interlocks may also be used

voluntarily by drivers who are found to have

alcohol dependence. A zero BAC condition can

be set independently of an interlock condition

or continue at the conclusion of an interlock

program. Programs vary between the states and

territories. For more information see Appendix

5. Alcohol interlock programs.

194

Substance misuse

193

PART B. Medical standards

Figure 16. The Alcohol Use Disorders Identiﬁcation Test (AUDIT) questionnaire

The Alcohol Use Disorders Identiﬁcation Test (AUDIT) questionnaire

Please tick the answer that is correct for you.

Scoring:

(0) (1) (2) (3) (4)

1. How often do you have a drink containing alcohol?

Never

(Skip to Q9)

Monthly or less 2 to 4 times a

month

2 to 3 times a

week

4 or more times

a week

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

1 or 2 3 or 4 5 or 6 7, 8 or 9 10 or more

3. How often do you have six or more drinks on one occasion?

Never Less than

monthly

Monthly Weekly Daily or almost

daily

4. How often during the last year have you found you were not able to stop drinking once you had started?

Never Less than

monthly

Monthly Weekly Daily or almost

daily

5. How often during the last year have you failed to do what was normally expected from you because of drinking?

Never Less than

monthly

Monthly Weekly Daily or almost

daily

6. How often during the last year have you needed a ﬁrst drink in the morning to get yourself going after a heavy

drinking session?

Never Less than

monthly

Monthly Weekly Daily or almost

daily

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

Never Less than

monthly

Monthly Weekly Daily or almost

daily

8. How often during the last year have you been unable to remember what happened the night before because

you had been drinking?

Never Less than

monthly

Monthly Weekly Daily or almost

daily

9. Have you or someone else been injured as a result of your drinking?

No Yes, but not in the last year Yes, during the last year

10. Has a relative or friend or a doctor or other healthcare worker been concerned about your drinking or suggested

you cut down?

No Yes, but not in the last year Yes, during the last year

195

PART B. Medical standards

9.2.3. Opioid dependence

29–32

Opioid dependency includes patients taking

opioid medication for chronic pain. People

on stable doses of opioid analgesics for

chronic pain management and people taking

buprenorphine or methadone for their opioid

dependency may not have a higher risk of a

crash than the general population, providing the

dose has been stabilised over some weeks and

they are not abusing other impairing drugs.

The risk of impairment due to unsanctioned use

of opioids or other sedatives is a consideration.

Short-acting opioids, particularly parenteral

forms, may cause ﬂuctuation in blood levels

of opioids, which would be expected to be

incompatible with safe driving. People using

these agents should be referred for assessment

by an appropriate specialist such as an addiction

medicine specialist, addiction psychiatrist or pain

medicine specialist.

Further guidance on opiate prescribing can be

found from:

• the Royal Australian College of Physicians’

Prescription Opioid Policy: Improving

management of chronic non-malignant pain

and prevention of problems associated with

prescription opioid use

• the Australian and New Zealand College

of Anaesthetists and Faculty of Pain

Management’s Statement regarding the use

of opioid analgesics in patients with chronic

non-cancer pain

• the Royal Australian College of General

Practitioners’ Prescribing drugs of

dependence in general practice

29–31

• local health agency websites.

9.2.4. Non-cooperation in cessation

of driving

Should the person continue to drive despite

advice to the contrary, the health professional

should consider the risk posed to other road

users and take reasonable measures to

minimise that risk, including notifying the driver

licensing authority. This is particularly relevant

for commercial vehicle drivers. Refer to Part

A section 3.3.1. Conﬁdentiality, privacy and

reporting to the driver licensing authority and

Appendix 3.2. Legislation relating to reporting

by health professionals. Refer to information

about alcohol interlock programs section 9.9.2.

9.3. Medical standards

for licensing

Requirements for unconditional and conditional

licences are outlined in the following table.

Health professionals should familiarise

themselves with the information in this chapter

and the tabulated standards before assessing a

person’s ﬁtness to drive.

In providing information to the driver licensing

authority about the suitability of a driver for a

conditional licence, the health professional will

need to consider the driver’s substance use

history, response to treatment and their level

of insight. For example, in the case of patients

with more severe substance use problems who

have had previous high rates of relapse and

ﬂuctuation in stabilisation, a longer non-driving

period and/or the use of an alcohol interlock

should be considered before granting a

conditional licence. Similarly, a strong response

to treatment and well-documented abstinence

and recovery may enable provision of a

conditional licence after the minimum period.

Remission by self-report can be unreliable and

may be conﬁrmed by biological monitoring for

presence of drugs.

196

Substance misuse

195

PART B. Medical standards

Medical standards for licensing

–

alcohol and other substance use disorders

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous

goods driver licence – refer to

deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods driver

licence – refer to deﬁnition in Table 3)

Substance use

disorder

(For withdrawal

seizures refer to

acute symptomatic

seizures on page

134 and page

141)

A person is not ﬁt to hold an

unconditional licence:

• if there is an alcohol use disorder

such as alcohol dependence or

heavy frequent alcohol use; or

• if there is a substance use disorder

such as substance dependence or

other substance use that is likely to

impair safe driving.

A conditional licence may be

considered by the driver licensing

authority subject to periodic review,

taking into account the nature of the

driving task and information provided

by the treating doctor as to whether

the following criteria are met:

• the person is involved in a treatment

program and has been in remission*

for at least 1 month; and

• there is an absence of cognitive

impairments relevant to driving; and

• there is an absence of end-organ

eects that impact on driving

(as described elsewhere in this

publication).

The person is not ﬁt to drive until they

meet the criteria for a conditional

licence.

* Remission is attained when there

is abstinence from use of impairing

substance(s) or where substance

use has reduced in frequency to the

point where it is unlikely to cause

impairment. Remission by self-report

can be unreliable and may be

conﬁrmed by biological monitoring for

the presence of drugs.

An alcohol interlock may form part of

the approach to managing driving for

alcohol-dependent people (refer to

section 9.2.2. Alcohol dependence

and Appendix 5).

A person is not ﬁt to hold an unconditional

licence:

• if there is an alcohol use disorder such as

alcohol dependence or heavy frequent

alcohol use; or

• if there is a substance use disorder such as

substance dependence or other substance

use that is likely to impair safe driving.

A conditional licence may be considered by

the driver licensing authority subject to periodic

review, taking into account the nature of the

driving task and information provided by an

appropriate specialist (such as an addiction

medicine specialist or addiction psychiatrist)*

as to whether the following criteria are met:

• the person is involved in a treatment program

and has been in remission** for at least 3

months; and

• there is an absence of cognitive impairments

relevant to driving; and

• there is absence of end-organ eects that

impact on driving (as described elsewhere in

this publication).

The person is not ﬁt to drive until they meet the

criteria for a conditional licence.

* Where the treating specialist considers a

driver’s condition to be stable, well managed,

and the driver has good insight, the driver

licensing authority may agree to ongoing

periodic review by the person’s regular GP

on mutual agreement of all practitioners

concerned. The initial allocation of a conditional

licence must, however, be based on an

assessment and information provided by the

specialist.

** Remission is attained when there is

abstinence from use of impairing substance(s)

or where substance use has reduced in

frequency to the point where it is unlikely to

cause impairment. Remission by self-report

can be unreliable and may be conﬁrmed by

biological monitoring for the presence of drugs.

197

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

198

Substance misuse

197

PART B. Medical standards

References and further reading

1. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021)

2. Panenka, W. J. et al. Methamphetamine

use: a comprehensive review of molecular,

preclinical and clinical ﬁndings. Drug and

Alcohol Dependence vol. 129 167–179 (2013).

3. Brust, J. C. M. Neurologic complications of

illicit drug abuse. CONTINUUM: Lifelong

Learning in Neurology vol. 20 642–656

(2014).

4. Frishman, W. H., del Vecchio, A., Sanal, S.

& Ismail, A. Cardiovascular manifestations

of substance abuse: Part 2: Alcohol,

amphetamines, heroin, cannabis, and

caeine. Heart Disease vol. 5 253–271 (2003).

5. Broyd, S. J., van Hell, H. H., Beale, C., Yücel,

M. & Solowij, N. Acute and chronic eects

of cannabinoids on human cognition – a

systematic review. Biological Psychiatry vol.

79 557–567 (2016).

6. EMCDDA. Drug use, impaired driving and

trac accidents – 2nd edition. European

Monitoring Centre for Drugs and Drug

Addiction http://bookshop.europa.eu (2014)

doi:10.2810/26821.

7. Parekh, V. Psychoactive drugs and driving.

Australian Prescriber 42, 182–185 (2019).

8. Garrisson, H., Scholey, A., Ogden, E.

& Benson, S. The eects of alcohol

intoxication on cognitive functions critical

for driving: a systematic review. Accident

Analysis and Prevention 154, (2021).

9. Drummer, O. H. Epidemiology and trac

safety: culpability studies. In Drugs, Driving

and Trac Safety 93–106 (Birkhäuser Basel,

2009). doi:10.1007/978-3-7643-9923-8_7.

10. Drummer, O. H. et al. Odds of culpability

associated with use of impairing drugs in

injured drivers in Victoria, Australia. Accident

Analysis and Prevention 135, 105389

(2020).

11. Schumann, J. et al. The prevalence of

alcohol and other drugs in fatal road

crashes in Victoria, Australia. Accident

Analysis and Prevention 153, (2021).

12. Elvik, R. Risk of road accident associated

with the use of drugs: a systematic review

and meta-analysis of evidence from

epidemiological studies. Accident Analysis

and Prevention 60, 254–267 (2013).

13. Rogeberg, O. A meta-analysis of the crash

risk of cannabis-positive drivers in culpability

studies: avoiding interpretational bias.

Accident Analysis and Prevention 123,

69–78 (2019).

14. Hartman, R. L. & Huestis, M. A. Cannabis

eects on driving skills. Clinical Chemistry

59 478–492 (2013).

15. Drummer, O. H. & Yap, S. The involvement of

prescribed drugs in road trauma. Forensic

Science International 265, 17–21 (2016).

16. Silber, B. Y. et al. The eects of

dexamphetamine on simulated driving

performance. Psychopharmacology 179,

536–543 (2005).

17. Berghaus, G. et al. Meta-analysis of

empirical studies concerning the eects

of medicines and illegal drugs including

pharmacokinetics on safe driving. Druid

(2011).

199

PART B. Medical standards

18. Schnabel, E., Hargutt, V. & Krüger, H.-

P. Meta-analysis of empirical studies

concerning the eects of alcohol on safe

driving. Druid (2010).

19. Zador, P. L. Alcohol-related relative risk of

fatal driver injuries in relation to driver age

and sex. Journal of Studies on Alcohol 52,

302–310 (1991).

20. Borkenstein, R., Crowther, R. & Shumate,

R. The role of the drinking driver in trac

accidents. Blutalkohol 11, 1–131 (1974).

21. Stough, C. et al. The acute eects of

3,4-methylenedioxymethamphetamine and

methamphetamine on driving: a simulator

study. Accident Analysis and Prevention 45,

493–497 (2012).

22. Ashton, C. H. Pharmacology and eects of

cannabis: a brief review. British Journal of

Psychiatry 178 101–106 (2001).

23. Coey, C. et al. Cannabis dependence

in young adults: an Australian population

study. Addiction 97, 187–194 (2002).

24. Ramaekers, J. G. Driving under the inﬂuence

of cannabis an increasing public health

concern. Journal of the American Medical

Association 319 1433–1434 (2018).

25. Seppala, K., Korttila, K., Hakkinen, S. &

Linnoila, M. Residual eects and skills

related to driving after a single oral

administration of diazepam, medazepam

or lorazepam. British Journal of Clinical

Pharmacology 3, 831–841 (1976).

26. Skegg, D. C. G., Richards, S. M. & Doll, R.

Minor tranquillisers and road accidents.

British Medical Journal 1, 917–919 (1979).

27. Ogden, E. J. D. et al. When should the

driver with a history of substance misuse

be allowed to return to the wheel? A

review of the substance misuse section of

the Australian national guidelines. Internal

Medicine Journal 48, 908–915 (2018).

28. Bush, K., Kivlahan, D. R., McDonell, M. B.,

Fihn, S. D. & Bradley, K. A. The AUDIT

alcohol consumption questions (AUDIT-C):

an eective brief screening test for problem

drinking. Archives of Internal Medicine 158,

1789–1795 (1998).

29. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part C1:

Opioids. www.racgp.org.au (2017).

30. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part C2:

The role of opioids in pain management.

(2017).

31. Royal Australian College of General

Practitioners. Prescribing drugs of

dependence in general practice, Part A:

Clinical governance framework. (2015).

32. Royal Australian College of Physicians.

Prescription Opioid Policy: improving

management of chronic non-malignant pain

and prevention of problems associated with

prescription opioid use. (2009).

33. Australian and New Zealand College of

Anaesthetists. Faculty of Pain Management:

Statement regarding the use of opioid

analgesics in patients with chronic non-

cancer pain. (2020).

200

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199

PART B. Medical standards

10. Vision and eye disorders

This chapter focuses on the assessment

methods, medical criteria and management

approach for the two main aspects of vision –

visual acuity and visual ﬁelds. It should be read

in conjunction with other chapters where those

conditions may aect vision (e.g, neurological

conditions (section 6.3. Other neurological

and neurodevelopmental conditions), diabetes

(section 3. Diabetes mellitus) and with Part A

section 2.2.7. Older drivers and age-related

changes.

10.1. Relevance to the

driving task

10.1.1. Eects of vision and eye

disorders on driving

1–6

Good vision, including visual acuity and visual

ﬁelds, is essential to operating a motor vehicle.

Any marked loss of visual acuity or visual ﬁelds

will diminish the person’s ability to drive safely,

including their ability to detect another vehicle,

pedestrians or warning signs. It may also

increase the time for a person to perceive and

react to a potentially hazardous situation.

Peripheral or side vision assists the driver to be

aware of the total driving environment and is

particularly important in certain common driving

tasks, such as merging into a trac stream or

changing lanes, and in detecting pedestrians

and vehicles to the side of the line of vision.

Vision defects can develop slowly, and drivers

may be unaware of their reduced abilities,

particularly in relation to peripheral vision.

10.1.2. Evidence of crash risk

1–3,7,8,15,16

The evidence is incomplete regarding visual

ﬁelds and visual acuity and crash risk. This is

likely due to the many methodological reasons

outlined in Part A of this publication (refer to Part

A section 1.5. Development and evidence base).

Identifying the degree to which reduced visual

acuity increases motor vehicle crash risk is

challenging. The evidence for visual acuity

impairment is generally limited to drivers whose

visual acuity already meets licensing standards,

limiting the ability to determine whether

alternative cut-points are more appropriate.

While it is generally agreed that adequate visual

ﬁelds are important for safe driving, the actual

cut-o value that should be set remains unclear.

Most research suggests there is no association

between crash risk and colour vision. While

there is evidence that people with red-colour-

deﬁcient vision have diculty in detecting

red lights and stopping in laboratory and on-

road testing, signiﬁcant improvements in road

engineering mean that people with red-colour

deﬁciency may largely compensate for their

deﬁciency while driving.

201

PART B. Medical standards

10.2. General assessment

and management

guidelines

Decline in vision is associated with normal

ageing and is therefore an important

consideration for ﬁtness to drive in the general

care of older people, along with consideration

of cognition and sensory-motor function (refer

to Part A section 2.2.7. Older drivers and age-

related changes).

Progressive eye conditions such as cataracts,

glaucoma and macular degeneration are also

more common in older people. Once diagnosed,

these conditions require regular monitoring in

relation to driving, including through conditional

licences as appropriate (refer to section

10.2.4. Progressive eye conditions). Regular

monitoring is also required for conditions such

as diabetes to screen for and manage end-

organ eects (retinopathy) (refer to section 3.2.3.

Comorbidities and end-organ complications).

For drivers with neurological conditions such as

stroke, vision is one of a number of functional

outcomes that will be addressed as part of

an overall assessment of ﬁtness to drive, and

ﬁndings will need to be integrated as part of

this overall assessment (refer to section 6.3.

Other neurological and neurodevelopmental

conditions).

10.2.1. Visual acuity

3–6

For the purposes of this publication, visual acuity

is deﬁned as a person’s clarity of vision with

or without glasses or contact lenses. Where a

person does not meet the visual acuity standard

at initial assessment, they may be referred

for further assessment by an optometrist or

ophthalmologist.

Assessment method

Visual acuity should be measured for each eye

separately and without optical correction. If

optical correction is needed, vision should be

retested with appropriate corrective lenses. For

use of orthokeratology lenses to correct visual

acuity, refer to section 10.2.7. Orthokeratology

therapy.

Acuity should be tested using a standard

visual acuity chart (Snellen or LogMAR chart

or equivalent) with ﬁve letters on the 6/12 line.

Standard charts should be placed six metres

from the person tested; otherwise, a reverse

chart can be used and viewed through a

mirror from a distance of three metres. Other

calibrated charts can be used at a minimum

distance of three metres. More than two errors

in reading the letters of any line is regarded as

a failure to read that line. Refer to Figure 17 for a

management ﬂow chart.

In the case of a private vehicle driver, if

the person’s visual acuity is just below that

required by the standard but the person is

otherwise alert, has normal reaction times and

good physical coordination, an optometrist or

ophthalmologist can recommend the granting

of a conditional licence. The use of contrast

sensitivity or other specialised tests may help

in the assessment. However, a driver licence

will not be issued when visual acuity in the

better eye is worse than 6/24 for private

vehicledrivers.

There is also some ﬂexibility for commercial

vehicle drivers depending on the driving task,

providing the visual acuity in the driver’s better

eye (with or without corrective lenses) is 6/9

orbetter.

Restrictions on driving (conditional licence)

may be advised; for example, where glare is

a marked problem, no-night driving may be

recommended. Refer to Part A section 4.4.

Conditional licences.

202

Vision and eye disorders

201

PART B. Medical standards

Figure 17. Visual acuity requirements for private and commercial vehicle drivers

Private

• With one or both eyes at least

6/12

Commercial

• Better eye at least 6/9

• Worse eye at least 6/18

Uncorrected visual acuity (without glasses)

Refer to optomertrist or ophthalmologist

for clinical assessment with regard to

driving task (also refer to 10.2.1)

Ye s

Fit to hold an unconditional

licence

Not ﬁt to hold an unconditional or

conditional licence

Fit to hold a conditional licence

Private – better eye at least 6/24

Commercial – better eye at least

6/9 (refer to 10.2.1)

Private

• With one or both eyes at least

6/12

Commercial

• Better eye at least 6/9

• Worse eye at least 6/18

Corrected visual acuity (with glasses)

203

PART B. Medical standards

10.2.2. Visual ﬁelds

3–6,8–13

For the purposes of this publication, visual

ﬁelds are deﬁned as a measure of the extent

of peripheral (side) vision. Normal visual ﬁeld is:

60 degrees nasally, 100 degrees temporally, 75

degrees inferiorly and 60 degrees superiorly.

The binocular ﬁeld extends the horizontal extent

from 160 to 200 degrees, with the central 120

degrees overlapping and providing the potential

for stereopsis.

Visual ﬁelds may be reduced due to a range

of neurological conditions (e.g. stroke, multiple

sclerosis) as well by ocular diseases (e.g.

glaucoma), or injuries, resulting in hemionopia,

quadrantanopia or monocularity.

Peripheral vision assists the driver to be aware

of the total driving environment. Once alerted,

the central fovea area is moved to identify

the importance of the information. Therefore,

peripheral vision loss that is incomplete will

still allow awareness; this includes small areas

of loss and patchy loss. Additionally, aected

drivers can adapt to the defect by scanning

regularly and eectively and can have good

awareness. Patients with visual ﬁeld defects

who have full intellectual/cognitive capacity

are more able to adapt, but those with such

impairments will have decreased awareness and

are therefore not safe to drive.

A longstanding ﬁeld defect, such as from

childhood, may lead to visual adaptation. Such

defects need to be assessed by an optometrist

or ophthalmologist for a conditional licence

to be considered. They should be managed

as an exceptional case to the standard, with

consideration for duration and evidence of visual

adaptation, whether the location of the defect is

an area that may already be blocked by the car

door on the passenger side (i.e. the inferior ﬁeld

on the left side without central ﬁeld loss), driver

safety record and the nature of the driving task.

Assessment method

If there is no clinical indication of a visual ﬁeld

impairment or a progressive eye condition,

then it is satisfactory to screen for defect by

confrontation. Confrontation is an inexact test.

Any person who has, or is suspected of having,

a visual ﬁeld defect should have a formal

perimetry-based assessment.

Monocular automated static perimetry is the

minimum baseline standard for visual ﬁeld

assessments. If monocular automated static

perimetry shows no visual ﬁeld defect, this

information is sucient to conﬁrm that the

standard is met.

Subjects with any signiﬁcant ﬁeld defect or a

progressive eye condition require a binocular

Esterman visual ﬁeld for assessment. This is

classically done on a Humphrey visual ﬁeld

analyser, but any machine that can be shown

to be equivalent is accepted (e.g. Medmont

binocular VF printed o in level map mode).

The treating optometrist or ophthalmologist

can determine whether it is appropriate for the

person to wear their normal corrective lenses

while undergoing testing. Fixation monitoring

must be performed and recorded on the test.

Alternative devices must have the ability to

monitor ﬁxation and to stimulate the same

spots as the standard binocular Esterman. For

an Esterman binocular chart to be considered

reliable for licensing, the false-positive score

must be no more than 20 per cent.

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Vision and eye disorders

203

PART B. Medical standards

Horizontal extent of the visual ﬁeld

In the case of a private vehicle driver, if the

horizontal extension of a person’s visual ﬁelds

are less than 110 degrees but greater or equal to

90 degrees, an optometrist or ophthalmologist

may support the granting of a conditional

licence by the driver licensing authority. The

extent is measured on the Esterman from the

last seen point to the next seen point. There

is no ﬂexibility in this regard for commercial

vehicledrivers.

A single cluster of up to three adjoining missed

points, unattached to any other area of defect,

lying on or across the horizontal meridian will

be disregarded when assessing the horizontal

extension of the visual ﬁeld. A vertical defect

of only a single point width but of any length,

unattached to any other area of defect, that

touches or cuts through the horizontal meridian

may be disregarded. There should be no

signiﬁcant defect in the binocular ﬁeld that

encroaches within 20 degrees of ﬁxation above

or below the horizontal meridian. This means

that homonymous or bitemporal defects that

come close to ﬁxation, whether hemianopic or

quadrantanopic, are not normally accepted as

safe for driving.

Central ﬁeld loss

Scattered single missed points or a single

cluster of up to three adjoining points is

acceptable central ﬁeld loss for a person to

hold an unconditional licence. A signiﬁcant or

unacceptable central ﬁeld loss is deﬁned as

any of the following:

• a cluster of four or more adjoining points

that is either completely or partly within the

central 20-degree area

• loss consisting of both a single cluster of

three adjoining missed points up to and

including 20 degrees from ﬁxation, and any

additional separate missed point(s) within the

central 20-degree area

• any central loss that is an extension of

a hemianopia or quadrantanopia of size

greater than three missed points.

Methods of measuring visual ﬁelds are limited in

their ability to resemble the demands of the real-

world driving environment where drivers are free

to move their eyes as required and must sustain

their visual function in variable conditions.

Additional factors to be considered by the driver

licensing authority in assessing patients with

defects in visual ﬁelds therefore include, but are

not limited to, the following:

• kinetic ﬁelds conducted on a Goldman

• binocular Esterman visual ﬁelds conducted

without ﬁxation monitoring, often referred to

as a roving Esterman (two consecutive tests

must be performed with no more than one

false-positive allowed) – the test should be

in the numeric ﬁeld format when it is printed

out or sent for an opinion

• contrast sensitivity and glare susceptibility

• medical history; duration and prognosis;

if the condition is progressive; rate of

progression/deterioration; eectiveness of

treatment/management

• driving record before and since the

occurrence of the defect

• the nature of the driving task – for example,

type of vehicle (truck, bus, etc.), roads

and distances to be travelled concomitant

medical conditions such as cognitive

impairment or impaired rotation of the neck.

There is no ﬂexibility in this regard for

commercial vehicle drivers.

Monocular vision (one-eyed driver)

Monocular drivers have a reduction of visual

ﬁelds due to the nose obstructing the medial

visual ﬁeld. They also have no stereoscopic

vision and may have other deﬁcits in

visualfunctions.

205

PART B. Medical standards

For private vehicle drivers, a conditional licence

may be considered by the driver licensing

authority if the horizontal visual ﬁeld is 110

degrees and the visual acuity is satisfactory in

the better eye. People with monocular vision are

generally not ﬁt to drive a commercial vehicle.

A conditional licence may be considered by the

driver licensing authority if the horizontal visual

ﬁeld is 140 degrees, the visual acuity in the

better eye is satisfactory, there is no other visual

ﬁeld loss that is likely to impede driving and an

ophthalmologist/optometrist assesses that the

person may be safe to drive after consideration

of the above factors. The better eye must be

reviewed at least every two years.

If monocular automated static perimetry is

undertaken on patients without symptoms, family

history or risk factors for visual ﬁeld loss, and

shows no indication of any visual ﬁeld concerns,

this information may be sucient to conﬁrm

that the standard is met. If monocular testing

suggests a ﬁeld defect, or if the patient has a

progressive eye condition, and/or the patient

has any other symptoms or signs that indicate

a ﬁeld defect, then binocular testing should be

conducted using the Esterman binocular ﬁeld

test or an Esterman-equivalent test. Alternative

devices must have the ability to monitor ﬁxation

and to stimulate the same spots as the standard

binocular Esterman.

Sudden loss of unilateral vision

A person who has lost an eye or most of the

vision in an eye on a long-term basis has to

adapt to their new visual circumstances and

re-establish depth perception. They should

therefore be advised not to drive for an

appropriate period after the onset of their

sudden loss of vision (usually three months).

They should notify the driver licensing authority

and be assessed according to the relevant

visual ﬁeld standard.

10.2.3. Diplopia

People suering from all but minor forms of

diplopia are generally not ﬁt to drive. Any person

who reports or is suspected of experiencing

diplopia within 20 degrees from central ﬁxation

should be referred for assessment by an

optometrist or ophthalmologist. For diplopia

managed with an occluder, a three-month non-

driving period applies in order to re-establish

depth perception.

10.2.4. Progressive eye conditions

The patient should be advised appropriately

when a progressive eye condition is diagnosed

that may result in future restrictions on driving.

It is important to give the patient as much

lead time as possible to prepare for changes

that may later be required (e.g. adaptation to

alternate transport and/or engaging blindness

and low vision services). Refer to Part A section

2.2.6. Congenital conditions, disability and

driving and 2.2.7. Older drivers and age-related

changes.

People with progressive eye conditions such as

cataract, glaucoma, optic neuropathy, diabetic

retinopathy, macular degeneration or retinitis

pigmentosa should be monitored regularly

and should be advised in advance about the

potential future impact on their driving ability.

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Vision and eye disorders

205

PART B. Medical standards

10.2.5. Congenital and acquired

nystagmus

Nystagmus may reduce visual acuity. Drivers

with nystagmus must meet the visual acuity

standard. Any underlying condition must be

fully assessed to ensure there is no other issue

that relates to ﬁtness to drive. Those who have

congenital nystagmus may have developed

coping strategies that are compatible with safe

driving and should be individually assessed by

an appropriate specialist.

10.2.6. Colour vision

There is not a colour vision standard for

drivers, either private or commercial. Doctors,

optometrists and ophthalmologist should,

however, advise drivers who have a signiﬁcant

colour vision deﬁciency about how this may

aect their responsiveness to signal lights and

the need to adapt their driving accordingly.

Note, this standard applies only to driving within

normal road rules and conditions. A standard

requiring colour vision may be justiﬁed based on

risk assessment for particular driving tasks.

10.2.7. Orthokeratology therapy

Orthokeratology involves the therapeutic use

of rigid gas-permeable contact lenses worn

overnight to reshape the cornea of the eye. This

provides eective correction of visual refractive

error (once the lenses are removed) that can

last at least a full day. The therapeutic eect

is temporary and so the lenses must be worn

regularly to maintain the best visual outcomes.

A conditional licence can be considered

for private and commercial vehicle drivers

provided the visual acuity standard is met

with orthokeratology therapy and the lenses

are worn as recommended by an optometrist

or ophthalmologist. The driver may drive

without their normal correcting lenses (e.g.

glasses or contact lens) provided that the

visual acuity standard is maintained with the

support of orthokeratology therapy. If the driver

cannot meet or maintain the standard using

orthokeratology therapy, they must drive with

correcting lenses that enable them to meet the

standard.

10.2.8. Telescopic lenses (bioptic

telescopes)

The driver licensing authority may refuse

a licence if the visual acuity standards

are not met without the use of a bioptic

telescope (refer to section 10.2.1. Visual

acuity). People seeking to use a bioptic

device for driving should ﬁrst contact

their driver licensing authority and check

whether these devices are an accepted

means to meet the standards. Refer to

Appendix 9 for driver licensing authority

contact details.

Bioptic telescopes are devices used to

compensate for reduced visual acuity. They

are miniature telescopes typically mounted on

the upper part of a person’s glasses. Bioptics

are used momentarily and intermittently when

driving, the majority of which occurs at the

corrected visual acuity provided by the person’s

glasses. The person drops their chin slightly to

view through the telescope for magniﬁcation,

then lifts their chin to view through their standard

corrective lens.

At present, there is insucient information

from human factors and safety research of

drivers using these devices to set standards

for bioptics. As such, and due to the increased

risk associated with commercial vehicle driving

(refer to Part A section 4.1. Medical standards

for private and commercial vehicle drivers),

these devices should not be used to meet the

visual acuity standards for commercial vehicles.

For private vehicle drivers, the driver licensing

authority may consider information from an

207

PART B. Medical standards

assessment performed by an ophthalmologist or

optometrist when making its licensing decision.

10.2.9. Practical driver assessments

A practical driver assessment is not considered

to be a safe or reliable method of assessing

the eects of disorders of vision on driving,

especially the visual ﬁelds, because the driver’s

response to emergency situations or various

environmental conditions cannot be determined.

Information about adaptation to visual ﬁeld

defects can be gained from visual ﬁeld tests

such as the Esterman.

A practical driver assessment may be helpful

in assessing the ability to process visual

information (refer to Part A section 2.3.1.

Practical driver assessments).

10.2.10. Exceptional cases

In unusual circumstances, cases may be referred

by the driver licensing authority for further

medical specialist opinion (refer to Part A section

3.3.7. Role of independent experts/panels).

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Vision and eye disorders

207

PART B. Medical standards

10.3. Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following tables.

Medical standards for licensing

–

vision and eye disorders

Health professionals should familiarise themselves with the information in this chapter and the tabulated

standards before assessing a person’s ﬁtness to drive.

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Visual acuity

Refer to section

10.2.1. Visual

acuity and

Figure 17.

A person is not ﬁt to hold an unconditional

licence:

• if the person’s uncorrected visual acuity in

the better eye or with both eyes together

is worse than 6/12.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review if the standard is met with

corrective lenses*.

Some discretion is allowed in application of

the standard by the treating optometrist or

ophthalmologist. However, a driver licence

will not be issued when visual acuity in the

better eye is worse than 6/24.

* Refer to section 10.2.7. Orthokeratology

therapy for information on meeting the

standard using orthokeratology therapy.

A person is not ﬁt to hold an unconditional

licence:

• if the person’s uncorrected visual acuity is

worse than 6/9 in the better eye; or

• if the person’s uncorrected visual acuity is

worse than 6/18 in either eye.

A conditional licence may be considered

by the driver licensing authority subject to

periodic review if the standard is met with

corrective lenses*.

If the person’s vision is worse than 6/18 in

the worse eye, a conditional licence may be

considered by the driver licensing authority

subject to periodic review, provided the

visual acuity in the better eye is 6/9 (with or

without corrective lenses*) according to the

treating optometrist or ophthalmologist.

The driver licensing authority will take into

account:

• the nature of the driving task; and

• the nature of any underlying disorder; and

• any other restriction advised by the

optometrist or ophthalmologist.

* Refer to section 10.2.7. Orthokeratology

therapy for information on meeting the

standard using orthokeratology therapy.

209

PART B. Medical standards

Medical standards for licensing

–

vision and eye disorders

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Visual ﬁelds

Refer to section

10.2.2. Visual

ﬁelds.

A person is not ﬁt to hold an unconditional

licence:

• if the binocular visual ﬁeld does not have

a horizontal extent of at least 110 degrees

within 10 degrees above and below the

horizontal midline; or

• if there is any signiﬁcant visual ﬁeld

loss (scotoma) within a central radius

of 20 degrees of the foveal ﬁxation or

other scotoma likely to impede driving

performance; or

• if there is any signiﬁcant visual ﬁeld loss

(scotoma) with more than four contiguous

spots within a 20-degree radius from

ﬁxation.

A conditional licence may be considered

by the driver licensing authority subject

to annual review, taking into account the

nature of the driving task and information

provided by the treating optometrist or

ophthalmologist.

A person is not ﬁt to hold an unconditional

licence:

• if the person has any visual ﬁeld defect.

A conditional licence may be considered

by the driver licensing authority subject

to annual review, taking into account the

nature of the driving task and information

provided by the treating optometrist or

ophthalmologist as to whether the following

criteria are met:

• the binocular visual ﬁeld has an extent of

at least 140 degrees within 10 degrees

above and below the horizontal midline;

and

• the person has no signiﬁcant visual

ﬁeld loss (scotoma, hemianopia,

quadrantanopia) that is likely to impede

driving performance; and

• the visual ﬁeld loss is static and unlikely to

progress rapidly.

Monocular

vision

Refer to section

10.2.2. Visual

ﬁelds.

A person is not ﬁt to hold an unconditional

licence:

• if the person is monocular.

A conditional licence may be considered

by the driver licensing authority subject to

2-yearly review, taking into account the

nature of the driving task and information

provided by the treating optometrist or

ophthalmologist as to whether the following

criteria are met:

• the visual acuity in the remaining eye is

6/12 or better, with or without correction;

and

• the visual ﬁeld in the remaining eye has

a horizontal extent of at least 110 degrees

within 10 degrees above and below the

horizontal midline.

A person is not ﬁt to hold an unconditional

licence:

• if the person is monocular.

A conditional licence may be considered

by the driver licensing authority subject to

2-yearly review, taking into account the

nature of the driving task and information

provided by the treating optometrist or

ophthalmologist, as to whether the following

criteria are met:

• the visual acuity in the remaining eye is

6/9 or better, with or without correction;

and

• the visual ﬁeld in the remaining eye has a

horizontal extent of at least 140 degrees

within 10 degrees above and below the

horizontal midline; and

• there is no other signiﬁcant visual ﬁeld

loss that is likely to impede driving

performance.

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209

PART B. Medical standards

Medical standards for licensing

–

vision and eye disorders

Condition Private standards

(Drivers of cars, light rigid vehicles or

motorcycles unless carrying public

passengers or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger

vehicles or requiring a dangerous goods

driver licence – refer to deﬁnition in Table 3)

Diplopia

Refer to section

10.2.3. Diplopia.

A person is not ﬁt to hold an unconditional

licence:

• if the person experiences any diplopia

(other than physiological diplopia) within

20 degrees from central ﬁxation.

A conditional licence may be considered

by the driver licensing authority subject

to annual review, taking into account the

nature of the driving task and information

provided by the treating optometrist or

ophthalmologist as to whether the following

criteria are met:

• the condition is managed satisfactorily

with corrective lenses or an occluder; and

• the person meets other criteria as per this

section, including visual ﬁelds.

The following licence condition may apply

if corrective lenses or an occluder prevents

the occurrence of diplopia:

• Corrective lenses or an occluder must be

worn while driving. A 3-month non-driving

period applies for use of occluders, in

order to re-establish depth perception.

A person is not ﬁt to hold an unconditional

licence or a conditional licence:

• if the person experiences any diplopia

(other than physiological diplopia) within

20 degrees from central ﬁxation.

211

PART B. Medical standards

IMPORTANT: The medical standards and management guidelines contained in this chapter

should be read in conjunction with the general information contained in Part A of this

publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing,

suspending or cancelling a person’s driver

licence (including a conditional licence) lies

ultimately with the driver licensing authority.

Licensing decisions are based on a full

consideration of relevant factors relating to

health and driving performance.

Conditional licences

For a conditional licence to be issued, the

health professional must provide to the

driver licensing authority details of the

medical criteria not met, evidence of the

medical criteria met, as well as the proposed

conditions and monitoring requirements.

The presence of other medical conditions

While a person may meet individual disease

criteria, concurrent medical conditions

may combine to aect ﬁtness to drive –

for example, hearing, visual or cognitive

impairment (refer to Part A section 2.2.7.

Older drivers and age-related changes and

section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into

consideration the nature of the driving task

as well as the medical condition, particularly

when granting a conditional licence. For

example, the licence status of a farmer

requiring a commercial vehicle licence for

the occasional use of a heavy vehicle may

be quite dierent from that of an interstate

multiple combination vehicle driver. The

examining health professional should bear

this in mind when examining a person

and when providing advice to the driver

licensing authority.

Reporting responsibilities

Patients should be made aware of the

eects of their condition on driving and

should be advised of their legal obligation

to notify the driver licensing authority where

driving is likely to be aected. The health

professional may themselves advise the

driver licensing authority as the situation

requires (refer to section 3.3 and step 6).

212

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211

PART B. Medical standards

References and further reading

1. Wood, J. M. Aging, driving and vision.

Clinical and Experimental Optometry 85,

214–220 (2002).

2. Owsley, C., Wood, J. M. & McGwin, G. A

roadmap for interpreting the literature on

vision and driving. Survey of Ophthalmology

60, 250–262 (2015).

3. Wood, J. M. & Black, A. A. Ocular disease

and driving. Clinical and Experimental

Optometry 99, 395–401 (2016).

4. Delaey, J. & Colenbrander, A. Visual

standards: vision requirements for driving

safety with emphasis on individual

assessment. http://www.icoph.org/

downloads/visionfordriving.pdf (2006).

5. van Rijn, L. & Members of the Eyesight

Working Group to the European Driving

Licence Committee. New standards for

the visual functions of drivers: report of the

Eyesight Working Group. (2005).

6. Owsley, C. & McGwin, G. Vision and driving.

Vision Research 50, 2348–2361 (2010).

7. Charlton, J.L., Di Stefano, M., Dow, J.,

Rapoport, M.J., O’Neill, D., Odell, M.,

Darzins, P., & Koppel, S. Inﬂuence of

chronic Illness on crash involvement of

motor vehicle drivers: 3rd edition. Monash

University Accident Research Centre

Reports 353. Melbourne, Australia: Monash

University Accident Research Centre. (2021).

8. Wood, J. M., Black, A. A., Anstey, K. J. &

Horswill, M. S. Hazard perception in older

drivers with eye disease. Translational

Vision Science & Technology 10, 31 (2021).

9. McGwin, G., Wood, J., Huisingh, C.

& Owsley, C. Motor vehicle collision

involvement among persons with

hemianopia and quadrantanopia. Geriatrics

(Switzerland) 1, (2016).

10. Sample, P. A. et al. Imaging and Perimetry

Society standards and guidelines.

Optometry and Vision Science 88, 4–7 (2011).

11. Wood, J. M., Lacherez, P. F. & Anstey, K.

J. Not all older adults have insight into

their driving abilities: evidence from an

on-road assessment and implications for

policy. Journals of Gerontology – Series A

Biological Sciences and Medical Sciences

68, 559–566 (2013).

12. Bohensky, M., Charlton, J., Odell, M. &

Keee, J. Implications of vision testing

for older driver licensing. Trac Injury

Prevention 9, 304–313 (2008).

13. McKnight, A. J., Shinar, D. & Hilburn, B.

The visual and driving performance of

monocular and binocular heavy-duty truck

drivers. Accident Analysis & Prevention 23,

225–237 (1991).

14. Bullimore, M. A. & Johnson, L. A. Overnight

orthokeratology. Contact Lens and Anterior

Eye 43, 322–332 (2020).

15. Wood, J.M. et al. Impact of vision disorders

and vision impairment on motor vehicle

crash risk and on-road driving performance:

A systematic review. Acta Ophthalmol doi:

10.1111/aos.14908 (2021)

16. Swain, T.A. et al. Naturalistic driving

techniques and association of visual

risk factors with at-fault crashes and

near crashes by older drivers with vision

impairment. JAMA Ophthalmol 139, 639-

645 (2021)

213213

PART B. Medical standards

PART C.

Appendices

213213

PART B. Medical standards

214

PART C. Appendices

Appendix 1. Regulatory requirements

fordriver testing

Drivers in most states and territories must

make a medical self-declaration in relation to

their ﬁtness to drive at licence application and

renewal. The information obtained may result

in a requirement for a medical assessment

or refusal of the application. In addition, each

state and territory has speciﬁc requirements for

medical examinations or road testing, depending

on the driver’s age or the type of vehicle being

driven, such as heavy vehicles, public passenger

vehicles and dangerous goods vehicles. There

are also speciﬁc requirements for drivers and

operating a vehicle as a driver instructor. Note

that various agencies are involved in overseeing

the requirements for dierent vehicle types,

and these agencies generally cooperate in this

regard to support road safety.

Note: All review requirements may be amended

on medical advice or on self-declaration or at

the request of the licensing authority. Refer to

your state or territory driver licensing authority

or other responsible agency for current

requirements (see Appendix 9. Driver licensing

authoritycontacts).

Commercial vehicle drivers accredited under

Basic Fatigue Management (BFM) and Advanced

Fatigue Management (AFM) have additional

medical assessment requirements. Under

these schemes, medical examinations are to

be conducted, as a minimum, once every three

years for drivers aged 49 or under, and yearly

for drivers aged 50 or over and must assess

sleep disorders.

Note: Not all states/territories participate in these

fatigue management schemes (currently the

Australian Capital Territory, Northern Territory

and Western Australia do not participate).

State or

territory

Vision test Medical assessment Road test

Australian

Capital

Territory

Private vehicle drivers

A vision test for all drivers on

initial licence; at ages 50, 60,

65, 70 and 75, and annually

thereafter.

A medical assessment for all

licence classes at age 75 years,

and annually thereafter.

No prescribed period,

orage.

Commercial vehicle drivers

Heavy vehicle drivers (class MR

and above): a vision test on initial

application; when upgrading to

medium rigid (class MR); at ages

50, 60, 65, 70, 75 and annually

thereafter.

Heavy vehicle drivers (class

MR and above): a commercial

medical assessment at age 75

years and annually thereafter.

Heavy vehicle drivers

(class MR and above):

an initial test on

application or when

upgrading to MR class

or above. No prescribed

period or age thereafter,

unless declared or

reported.

215

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

Australian

Capital

Territory

(cont’d)

Commercial vehicle drivers

Public passenger vehicle

drivers (H, M, T, W, D): a vision

test on initial application, then

5-yearly to age 70, then annually

thereafter. Public passenger

vehicle drivers (O): a vision

test on initial application, then

annually thereafter. In all cases

additional or more frequent health

assessments may be required if a

condition is reported.

Public passenger vehicle drivers

(H, M, T, W, D): a commercial

medical assessment on initial

application, then ﬁve- yearly

to age 70, then annually

thereafter. Public passenger

vehicle drivers (O): a commercial

medical assessment on initial

application, then annually

thereafter. In all cases,

additional or more frequent

health assessments may

be required if a condition is

reported.

Public passenger

vehicle drivers (H, M, O,

T, W, D): at age 70 and

annually thereafter.

Dangerous goods vehicle drivers:

a vision test on initial application,

then every 5 years.

Dangerous goods vehicle

drivers: a commercial

medical assessment on initial

application, then every 5 years.

Dangerous goods

vehicle drivers: no

special requirements.

Driving instructors: a vision test

on initial application, then every

5 years.

Driving instructors: a commercial

medical assessment on initial

application, then every 5 years.

Driving instructors: no

prescribed period or

age after initial test for

licensing.

New

South

Wales

Private vehicle drivers

Vision test for all drivers on initial

application.

All car and rider licence holders

under 45 years of age have an

eyesight test every 10 years.

All car and rider licence holders

45 years of age or older have an

eyesight test every 5 years.

Drivers 75 years or older require

an annual eyesighttest.

Medical assessment for all

licence classes at age 75 years

and annually thereafter.

Road test required

every 2 years for all car

drivers (class C) and

drivers of motorcycles

(class R) from 85 years

of age.

Annual driving test for

heavy vehicle drivers

with a light rigid (LR) to

heavy combination (HC)

from 80 years of age.

A road test may be

required as a result

of a doctor’s or police

recommendation.

Commercial vehicle drivers

Vision test for all drivers on initial

application.

Medical assessment for all

licence classes at 75 years of

age and annually thereafter.

Annual road test

required for heavy

vehicle drivers (LR, MR,

HR and HC) from 80

years of age.

216

Regulatory requirements fordriver testing

215

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

New

South

Wales

(cont’d)

Commercial vehicle drivers

Multiple combination vehicle (road

train) drivers (class MC): vision test

with medical assessment on initial

application and then at age 21

and every 10 years up to age 40,

then every 5 years until age 60,

then every 2 years until age 70;

annually thereafter.

Multiple combination vehicle

(road train) drivers (class MC):

medical assessment on initial

application and then at age 21

and every 10 years up to age

40, then every 5 years until age

60, then every 2 years until age

70; annually thereafter.

Multiple combination

vehicle (road train)

drivers (class MC): road

test at 70 years and

annually thereafter.

Public passenger vehicle drivers

(buses): vision test on initial

application and then every 3

years until the age of 60 years;

annually thereafter.

Public passenger vehicle drivers

(buses): medical assessment

on initial application and then

every 3 years until the age of 60

years; annually thereafter.

Public passenger

vehicle drivers (buses):

road test at age 80

years.

Dangerous good vehicle drivers:

vision test on initial application,

then every 5years.

Dangerous goods vehicle

drivers: medical assessment on

initial application, then every 5

years.

Dangerous goods

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Driving instructors: vision test on

initial application; thereafter in line

with driver licence class held.

Driving instructors: medical

assessment on initial

application; thereafter in line

with driver licence class held.

Driving instructors:

on initial application;

thereafter in line

with driver licence

classheld.

Northern

Territory

Private vehicle drivers

Vision test for all drivers on initial

application.

Medical assessment only when

condition notiﬁed by a health

professional or driver.

Road test only when

recommended by a

health professional.

Commercial vehicle drivers

Vision test on initial application. Medical assessment only when

a condition is reported by a

health professional or driver.

Only if recommended

by a health professional.

Public passenger vehicle drivers:

as above.

Public passenger vehicle

drivers: medical assessment on

initial application, then 5-yearly

or sooner if a condition is

reported.

Public passenger

vehicle drivers: road test

only if recommended by

a health professional.

217

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

Northern

Territory

(cont’d)

Commercial vehicle drivers

Dangerous good vehicle drivers:

vision test on initial application,

then every 5 years.

Dangerous goods vehicle

drivers: medical assessment on

initial application, then 5-yearly

thereafter.

Dangerous goods

vehicle drivers: no

speciﬁc requirements.

Driving instructors: asabove. Driving instructors: medical

assessment on initial

application, then 5-yearly or

sooner if a condition is reported.

Driving instructors:

road test only if

recommended by a

health professional.

Queensland

Private vehicle drivers

A vision test, performed by a

health professional, and a medical

certiﬁcate verifying the outcome

of the test is required if the

applicant declares a vision or eye

disorder or if required by the chief

executive.

Vision tests are not performed by

departmentalsta.

A person must obtain, carry

and drive in accordance with a

current medical certiﬁcate if:

• they have a mental or

physical incapacity that may

aect their ability to drive

safely; or

• they are 75 years of age or

older.

Currency of the medical

certiﬁcate is determined by the

health professional. Medical

certiﬁcates issued to drivers 75

years or older have a maximum

validity of 1 year.

Road test required on

application.

Commercial vehicle drivers

Heavy vehicle drivers: a vision test,

performed by a health professional,

and a medical certiﬁcate verifying

the outcome of the test is required

if the applicant declares a vision or

eye disorder or if required by the

chief executive.

Vision tests are not performed by

departmental sta.

Heavy vehicle drivers: a person

must obtain, carry and drive

in accordance with a current

medial certiﬁcate if:

• they have a mental or

physical incapacity that may

aect their ability to drive

safely; or

• they are 75 years of age or

older.

Currency of the medical

certiﬁcate is determined by the

health professional. Medical

certiﬁcates issued to drivers 75

years or older have a maximum

validity of 1 year.

Heavy vehicle drivers:

road test required on

application.

218

Regulatory requirements fordriver testing

217

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

Queensland

(cont’d)

Public passenger vehicle drivers: a

vision test, performed by a health

professional, is required every 5

years (as part of the prescribed

medical assessment), or more

frequently if required by a health

professional.

Vision tests are not performed by

departmental sta.

Public passenger vehicle

drivers: a medical assessment is

required every 5 years, or more

frequently if required by a health

professional.

A driver 75 years of age or older

is required to obtain, carry and

drive in accordance with a current

medical certiﬁcate.

Public passenger

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Dangerous good vehicle drivers: a

vision test, performed by a health

professional, is required on initial

application, then every 3 years

as part of the prescribed medical

assessment), or more frequently if

required by a health professional.

Vision tests are not performed by

departmental sta.

Dangerous goods vehicle drivers:

a medical assessment is required

on initial application, then every

3 years, or more frequently if

required by a health professional.

A driver 75 years of age or older

is required to obtain, carry and

drive in accordance with a current

medical certiﬁcate.

Dangerous goods

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Driving instructors: no vision test

required unless the applicant

declares a vision or eye disorder or

if required by the chief executive.

Vision tests are not performed by

departmental sta.

Driving instructors: no medical

assessment required unless the

person has a mental or physical

incapacity that may aect their

ability to drive safely.

A driver 75 years of age or older

is required to obtain, carry and

drive in accordance with a current

medical certiﬁcate.

Driving instructors: no

prescribed period or

age, unless declared or

reported.

South

Australia

Private vehicle drivers

Vision test yearly from 70 years of

age for holders of licence classes

other than C or if declared or

reported.

Medical assessment required

yearly from 70 years of age for

holders of licence classes other

than C.

Road test annually

from age 85 for licence

classes other than C.

219

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

South

Australia

(cont’d)

Commercial vehicle drivers

Heavy vehicle drivers: vision

test annually from 70 years of

age or with prescribed medical

examinations.

Heavy vehicle drivers: medical

assessment annually from 70

years of age for all licence

holders unless prescribed

otherwise (refer below).

Multiple combination vehicle

drivers (class MC) operating

south of Port Augusta: medical

assessment every 3 years up to

49 years of age, then annually.

Heavy vehicle drivers:

road test annually from

age 85.

Public passenger vehicle

drivers: vision test with medical

assessment every 3 years up

to age 70 years, then annually

thereafter.

Public passenger vehicle

drivers: medical assessment

every 3 years up to age 70

years, then annually thereafter.

Public passenger

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Dangerous good vehicle drivers:

vision test on initial application,

then every 3 years.

Dangerous goods vehicle

drivers: medical assessment on

initial application, then every 3

years.

Dangerous goods

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Driving instructors: vision test on

licence application and renewal.

Driving instructors: medical

assessment on licence

application and renewal.

Driving instructors: no

prescribed period or

age, unless declared or

reported.

Tasmania

Private vehicle drivers

Vision test required on initial

application.

No prescribed period or age

but may occur if a medical

condition or concern is declared

or reported.

No prescribed period

or age but may occur if

a medical condition or

concern is declared or

reported.

Commercial vehicle drivers

Multiple combination vehicle

drivers (class MC): vision test

required on initial application (as

part of medical assessment).

Multiple combination vehicle

drivers (class MC): medical

assessment on initial

application.

Heavy vehicle drivers:

road test or training

course on initial

application; no tests/

courses are required

thereafter.

220

Regulatory requirements fordriver testing

219

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

Tasmania

(cont’d)

Commercial vehicle drivers

Public passenger vehicle drivers:

vision test on initial application and

then as part of required medical

assessments (refer to next column).

Public passenger vehicle drivers

(Ancillary Certiﬁcate Public

Passenger Vehicles): medical

assessment on initial application,

then every 3 years up to age 65,

then annually.

(ACPPVs are further categorised:

taxi or other).

Public passenger

vehicle drivers (ACPPV):

no prescribed period or

age, unless declared or

reported.

(ACPPVs are further

categorised: taxi or

other).

Dangerous goods vehicle drivers:

vision test on initial application,

then every licence renewal period.

Dangerous goods vehicle drivers:

medical assessment on initial

application, then every licence

renewal period.

Dangerous goods

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Driving instructors: vision test on

initial application and then as part

of required medical assessments

(refer to next column).

Driving instructors: medical

assessment on initial application,

then every 3 years until age 65

years, then annually.

Driving instructors:

training course on initial

application.

Victoria

Private vehicle drivers

Vision test for all drivers on initial

application and subsequently if a

concern is declared or reported.

No prescribed period or age

but may occur if a concern is

declared or reported.

No prescribed period or

age but may occur if a

concern is declared or

reported.

Commercial vehicle drivers

Heavy vehicle drivers: vision test

on initial application. Otherwise no

speciﬁed period, unless declared

or reported.

Heavy vehicle drivers: no

prescribed period or age, unless

declared or reported.

Heavy vehicle drivers:

no prescribed period or

age, unless declared or

reported.

Public passenger vehicle drivers

(taxis, bus): vision test with medical

assessment every 3 years unless

a medical practitioner advises

shorter review periods. If a driver

is changed from a 3-year to a

12-month accreditation, ongoing

annual review is generally required.

Public passenger vehicle drivers

(taxis, bus): medical assessment

every 3 years unless a medical

practitioner advises shorter

review periods. If a driver is

changed from a 3-year to a

12-month accreditation, ongoing

annual review is generally

required.

Public passenger

vehicle drivers (taxis,

bus): no prescribed

period or age, unless

declared or reported.

Dangerous good vehicle drivers:

vision test on initial application,

then every 5 years.

Dangerous goods vehicle drivers:

medical assessment on initial

application, then every 5 years.

Dangerous goods

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

221

PART C. Appendices

State or

territory

Vision test Medical assessment Road test

Victoria

(cont’d)

Commercial vehicle drivers

Driving instructors: vision test on

licence application then every 3

years unless a medical practitioner

advises shorter review periods. If a

driver is changed from a 3-year to

a 12-month accreditation, ongoing

annual review is generally required.

Driving instructors: medical

assessment on application then

every 3 years unless a medical

practitioner advises shorter

review periods. If a driver is

changed from a 3-year to a

12-month accreditation, ongoing

annual review is generally

required.

Driving instructors: no

prescribed period or

age, unless declared or

reported.

Western

Australia

Private vehicle drivers

Vision test required on initial

application then yearly from

80 years of age (as part of

required medical assessment),

or as required depending on the

condition declared or reported.

Annually from 80 years of age,

unless a medical condition

requires an earlier assessment.

Road test annually

from age 85 for licence

classes other than C

and R, unless a medical

condition requires an

earlier assessment.

Commercial vehicle drivers

Heavy vehicle drivers (class MR

and above): vision test required on

initial application then yearly from

80 years of age (as part of required

medical assessment) or as required

depending on the condition

declared or reported.

Heavy vehicle drivers (class MR

and above): annually from 80

years of age, unless a medical

condition requires an earlier

assessment.

Heavy vehicle drivers

(class MR and above):

road test at 85 years

of age, then annually

unless a medical

condition requires an

earlier assessment.

Public passenger vehicle drivers:

vision test on initial application

and then when applying for an

additional class, then every 5 years

until age 45, then every 2 years

until age 65, then annually.

Public passenger vehicle drivers:

medical assessment on initial

application, then every 5 years.

Public passenger

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Dangerous good vehicle drivers:

vision test on initial application,

then every 5 years.

Dangerous goods vehicle drivers:

medical assessment on initial

application, then every 5 years.

Dangerous goods

vehicle drivers: no

prescribed period or

age, unless declared or

reported.

Driving instructors: vision test

on initial application and when

applying for an additional class,

then every 5 years until age 45,

then every 2 years until age 65,

then annually from age 65.

Driving instructors: medical

assessment on initial

application, then every 5 years.

Driving instructors:

practical driving and

instructional technique

assessment every 3

years unless exempted.

222

Regulatory requirements fordriver testing

221

PART C. Appendices

Appendix 2. Forms

Appendix 2.1. Medical report form

The driver licensing authority has a legal

responsibility to ensure all drivers have

the appropriate skills and ability, and are

medically ﬁt to hold a driver licence. To meet

this responsibility, legislation gives the driver

licensing authority the authority to ask any motor

vehicle licence holder or applicant to provide

medical evidence of their suitability to drive and/

or to undergo a driver assessment.

This is facilitated by a medical report. The

relevant driver licensing authority provides

the medical report form to the driver, who

will present it to the health professional for

completion at the time of the examination. This

form is the key communication between health

professionals and driver licensing authorities.

It should be completed with details of any

medical criteria not met, as well as details

of recommended conditions and monitoring

requirements for a conditional licence. Medical

information that is not relevant to the patient’s

ﬁtness to drive should not be included on this

form for privacy reasons.

The forms used by each state or territory

vary; however, they will generally include the

information outlined below. Electronic and online

forms are now available in certain states and

territories. For more information contact your

local driver licensing authority (refer to Appendix

9. Driver licensing authoritycontacts).

Information required in a medical report form

Driver details:

• name, date of birth and contact details

(postal address, phone number)

• consent for the driver licensing authority to

contact the health professional for further

information relevant to the person’s ﬁtness to

drive (inclusions and wording will depend on

jurisdiction)

• licence details (to guide the health

professional in selecting the appropriate

standard for assessment – private or

commercial).

Health professional details:

• date of examination

• health professional’s name and contact

details

• physical or digital signature of examining

health professional or health professional

identity validation for online electronic

medical reports.

Assessment of ﬁtness to drive – the health

professional records the following:

• whether they were familiar with the driver’s

medical history prior to the examination

• which standards (private/commercial) were

applied in the examination

• whether the driver meets or does not meet

the criteria for an unconditional licence

(noting criteria that are not met and other

relevant medical details)

• whether the driver meets or does not meet

the criteria for a conditional licence, noting:

− criteria that are not met and other

relevant medical details

− proposed restrictions to the person’s

licence (if appropriate)

223

PART C. Appendices

− suggestions for management and

periodic review intervals (conditional

licence)

• whether the driver requires additional

assessment including:

− specialist assessment (specify type)

− practical driving assessment (specify

type)

− occupational therapist assessment

• whether the driver’s condition has now

improved so as to meet criteria for a

conditional or unconditional licence noting:

− criteria previously not met

− response to treatment and prognosis

− duration of improvement

• other relevant information including

consideration of the driving task.

Other information contained within the form:

• legal information

• instructions to:

− the driver/applicant

− the health professional

• information about:

− occupational therapy driver assessments

− driver licensing authority driver

assessments.

Appendix 2.2. Medical condition

notiﬁcation form

If, in the course of treatment, a patient’s

condition is found to aect their ability to drive

safely, the health professional should, in the

ﬁrst instance, encourage the patient to report

their condition to the driver licensing authority.

A standard form, Medical condition notiﬁcation

form, has been produced to facilitate this

process. The health professional completes the

form, explains the circumstances to the patient

and asks the patient to forward the form to the

driver licensing authority. Most driver licensing

authorities will also accept a letter from the

treating practitioner or specialist. The letter

should, however, include the details laid out in

the form to enable the driver licensing authority

to make a decision.

If necessary, the health professional may feel

obliged to make a report directly to the driver

licensing authority using a copy of this form

(refer to section 3.3 and step 6). Even when

making a report directly to the driver licensing

authority, the health professional should inform

the patient that they are doing so.

224

Forms

223

PART C. Appendices

Medical Condition Notiﬁcation Form

To :

[Add the address of your local driver licensing authority from Appendix 9: Driver licensing

authority contacts in Assessing ﬁtness to drive 2022.]

Patient details [please print]:

Title: Surname:

Given names:

Full address:

Date of birth: __ __ / __ __ / __ __ __ __ Licence no.:

Health professional’s details [please print]:

Reporting professional’s name:

Professional’s address:

Phone: Email:

Date of examination: __ __ / __ __ / __ __ __ __ Signature:

Assessment of ﬁtness to drive – report

I have examined the patient (whose name, address and date of birth are set out above) in

accordance with the relevant National Medical Standards (private or commercial) as set out in

Assessing ﬁtness to drive, 2022.

Private vehicle standards Commercial vehicle standards

I have known/treated the patient since (insert date): __ __ / __ __ / __ __ __ __

225

PART C. Appendices

In my opinion and in accordance with standards in Assessing ﬁtness to drive, the person who is the

subject of this report:

Meets the medical criteria to hold an unconditional licence

Does not meet the medical criteria to hold an unconditional licence but may meet the medical

criteria to hold a conditional licence

Does not meet the medical criteria to hold an unconditional or conditional licence

Has had an improvement in their medical condition such that they meet the criteria for an

unconditional or conditional licence

Requires further examination

Please provide information to support this assessment.

Please describe the nature of the condition and provide information to support consideration of the

licensing decision, including information used to evaluate against the medical criteria, consideration

of the driving task, or recommendations for further examination:

If applicable, please describe any recommended licence conditions or restrictions relating to the

driver’s medical condition including requirements for periodic review (e.g. annual review), vehicle

modiﬁcations, corrective lenses or restricted daytime driving, etc:

For conditions that have improved, please provide details of: the criteria previously not met; the

response to treatment and prognosis; duration of improvement; and other relevant information

including consideration of the driving task:

Further comments on medical condition(s) aecting safe driving are attached

226

Forms

225

PART C. Appendices

Appendix 3. Legislation relating to reporting

Appendix 3.1. Legislation relating to reporting bydrivers

State or

Territory

Legislation Discretionary reporting

Australian

Capital

Territory

Road Transport

(Driver

Licensing)

Regulation

2000, r. 77

(2), (3)

If a person who is the holder of a driver licence suers any permanent or long-

term illness, injury or incapacity that may impair his or her ability to drive safely,

the person must tell the road transport authority as soon as practicable (but

within seven days). Maximum penalty: 20 penalty units.

It is a defence to the prosecution of a person for an oence against this section

if the person establishes:

a. that the person was unaware that his or her ability to drive safely had been

impaired, or

b. that the person had another reasonable excuse for contravening the sub-

section.

New

South

Wales

Road Transport

(Driver

Licensing)

Regulation

2017, c. 122 (4)

The holder of a driver licence must, as soon as practicable, notify the road

transport authority of any permanent or long-term injury or illness that may impair

his or her ability to drive safely.

Northern

Territory

Motor Vehicles

Act 1949, s.

11(3)

If a person who is licensed to drive a motor vehicle is suering from a physical

or mental incapacity that may aect his or her ability to drive a motor vehicle with

safety to the public, the person or his or her personal representative, they must

notify the registrar of the nature of the incapacity in terms of unﬁtness.

Queensland Transport

Operations

(Road Use

Management –

Driver Licensing)

Regulation 2010,

rr. 50, 51

A person is not eligible for the grant or renewal of a Queensland driver licence

if the chief executive reasonably believes the person has a mental or physical

incapacity that is likely to adversely aect the person’s ability to drive safely.

However, the person is eligible for the grant or renewal of a Queensland driver

licence if the chief executive reasonably believes that, by stating conditions on

the licence, the person’s incapacity is not likely to adversely aect the person’s

ability to drive safely.

Transport

Operations

(Passenger

Transport)

Regulation

2005, r. 40A

The holder of a Queensland driver licence must give notice to the chief

executive if they develop any permanent or long-term mental or physical

incapacity, or there is any permanent or long-term increase in, or other

aggravation of, a mental or physical incapacity that is likely to aect the holder’s

ability to drive safely.

More speciﬁcally, there is a standard for drivers of public passenger vehicles:

An authorised driver must:

a. notify the chief executive if there is a change in the driver’s medical

condition that makes the driver continuously unﬁt to safely operate a motor

vehicle for more than one month

b. within ﬁve years after the issue of the last medical certiﬁcate given to the

chief executive, give the chief executive a fresh medical certiﬁcate.

227

PART C. Appendices

State or

Territory

Legislation Discretionary reporting

South

Australia

Motor Vehicles

Act 1959, s.

98AAF

The holder of a licence or learner’s permit who, during the term of the licence

or permit, suers any illness or injury that may impair his or her competence to

drive a motor vehicle without danger to the public must, within a reasonable time

after the occurrence of the illness or injury, notify the registrar in writing of that

fact. Maximum penalty: $750

Tasmania Vehicle and

Trac (Driver

Licensing

and Vehicle

Registration)

Regulations

2021, rr. 45(1),

45(2)

The holder of a driver licence must, as soon as practicable, notify the registrar of:

a. any permanent or long-term injury or illness that may impair his or her ability

to drive safely, or

b. any deterioration of physical or mental condition (including a deterioration of

eyesight) that may impair his or her ability to drive safely, or

c. any other factor related to physical or mental health that may impair his or

her ability to drive safely.

Penalty: Fine not exceeding 10 penalty units.

Unless the registrar requires written notiﬁcation, the notiﬁcation need not be in

writing.

Victoria Road Safety

(Drivers)

Regulations

2019, r. 68(2)

The holder of a driver licence or permit or any person exempted from holding

a driver licence or permit under section 18(1)(a) of the Act must, as soon

as practicable, notify the Secretary and any other relevant agency of any

permanent or long-term illness, disability, medical condition or injury, or the

eects of the treatment for any of those things, that may impair his or her ability

to drive safely.

228

Legislation relating to reporting

227

PART C. Appendices

State or

Territory

Legislation Discretionary reporting

Western

Australia

Road Trac

(Authorisation

to Drive)

Regulations

2014, r. 64

Duty to reveal things that might impair ability:

1. In this regulation –

driving impairment of the person means any permanent or long-term

mental or physical condition (which may include a dependence on drugs

or alcohol) that is likely to, or treatment for which is likely to, impair the

person’s ability to control a motor vehicle either –

a. in all circumstances; or

b. except under certain conditions or subject to certain limitations; or

c. unless measures are taken to overcome the impairment.

2. A person applying for the grant of a learner’s permit or a driver licence,

other than by way of renewal must, when applying, inform the CEO of any

driving impairment of the person.

Penalty: 10 PU.

Modiﬁed penalty: 1 PU.

3. If a person who holds a learner’s permit or a driver licence becomes

aected by any driving impairment of the person of which the person has

not already informed the CEO, the person must, as soon as practicable, to

inform the CEO in writing of the impairment.

Penalty: 10 PU

Modiﬁed penalty: 1 PU

4. If a person who has informed the CEO of a driving impairment of the person

becomes aected by an increase in the extent of the impairment to a

degree that is substantially dierent from that of which the CEO was most

recently informed the person must, as soon as practicable, inform the CEO

in writing of the development.

Penalty: 10 PU

Modiﬁed penalty: 1 PU

5. If a person who has informed the CEO of a driving impairment of the person

later informs the CEO that the person has ceased to be aected by the

impairment but subsequently becomes again aected by it the person must,

as soon as practicable, inform the CEO in writing of the development.

Penalty: 10 PU.

Modiﬁed penalty: 1 PU.

229

PART C. Appendices

Appendix 3.2. Legislation relating to reporting by health professionals

Jurisdiction and

legislation

Applies to Discretionary reporting Mandatory reporting

Australian Capital

Territory

Road Transport

(General) Act 1999, ss.

230 (3)

(4)

Road Transport (Driver

Licensing) Act 1999,

s. 28

Road Transport (Driver

Licensing) Regulation

2000, rr. 15, 15A, 69,

70 and 78

An individual

carrying out a certain

test or examination

(i.e. medical

practitioners,

optometrists,

occupational

therapists,

physiotherapists)

An individual

An individual is not civilly or

criminally liable for carrying

out a test or examination in

accordance with the regulation

made under the Road

Transport (Driver Licensing)

Act 1999 and expressing to

the road transport authority, in

good faith, an opinion formed

because of having carried out

the test or examination.

An individual is not civilly or

criminally liable for reporting

to the road transport authority,

in good faith, information that

discloses or suggests that

someone else is or may be

unﬁt to drive or that it may be

dangerous to allow someone

else to hold, to be issued or to

have renewed, a driver licence

or a variation of a driver

licence.

There is no mandatory

reporting requirement

for practitioners.

New South Wales

Road Transport Act

2013, ss. 275 (3)

& (4)

Road Transport Act

2013, Schedule 1

Road Transport (Driver

Licensing) Regulation

2017, c. 60

An individual

carrying out a certain

test or examination

(i.e. medical

practitioners,

optometrists,

occupational

therapists,

physiotherapists)

An individual

An individual does not

incur civil or criminal liability

for carrying out a test or

examination in accordance

with statutory rules made

for the purposes of driver

licensing and expressing to

the authority in good faith an

opinion formed as a result of

having carried out the test or

examination.

An individual does not incur

civil or criminal liability for

reporting to the authority, in

good faith, information that

discloses or suggests that

another person is or may be

unﬁt to drive or that it may be

dangerous to allow another

person to hold, to be issued

or to have renewed, a driver

licence or a variation of a

driver licence.

There is no mandatory

reporting requirement

for practitioners.

230

Legislation relating to reporting

229

PART C. Appendices

Jurisdiction and

legislation

Applies to Discretionary reporting Mandatory reporting

Northern Territory

Motor Vehicles Act

1949, s. 11

A registered person

means a medical

practitioner, an

optometrist, an

occupational

therapist or a

physiotherapist who

is registered under

the applicable Acts

Not covered in legislation. If a registered person

reasonably believes

that a person they have

examined is licensed to

drive a motor vehicle

and is physically or

mentally incapable or

driving a motor vehicle

with safety to the

public or is physically

or mentally unﬁt to be

licensed, the registered

person must notify the

registrar in writing of

the person’s name and

address and the nature

of the incapacity or

unﬁtness.

Queensland

Transport Operations

(Road Use

Management) Act

1995, s. 142

A person registered

under the Health

Practitioner

Regulation National

Law to practise

in the medical

profession, other

than as a student

A health professional is not

liable, civilly or under an

administrative process, for

giving information in good faith

to the chief executive about

a person’s medical ﬁtness to

hold, or to continue to hold, a

Queensland driver licence.

Without limiting this, in a civil

proceeding for defamation,

a health professional has a

defence of absolute privilege

for publishing the information.

Additionally, if the health

professional would otherwise

be required to maintain

conﬁdentiality about the

information under an Act, oath,

rule of law or practice, the

health professional does not

contravene the Act, oath, rule

of law or practice by disclosing

the information and is not

liable to disciplinary action for

disclosing the information.

There is no mandatory

reporting requirement

for practitioners.

231

PART C. Appendices

Jurisdiction and

legislation

Applies to Discretionary reporting Mandatory reporting

South Australia

Motor Vehicles Act

1959, s. 148

A legally qualiﬁed

medical practitioner,

a registered optician

or a registered

physiotherapist

Not covered in legislation. Where a legally qualiﬁed

medical practitioner,

a registered optician

or a registered

physiotherapist has

reasonable cause to

believe that a person

whom they have

examined holds a driver

licence or a learner

permit and that person is

suering from a physical

or mental illness,

disability or deﬁciency

such that, if the person

drove a motor vehicle,

they would be likely to

endanger the public,

then the medical

practitioner, registered

optician or registered

physiotherapist is under

a duty to inform the

registrar in writing of

the name and address

of that person, and of

the nature of the illness,

disability or deﬁciency

from which the person is

believed to be suering.

Where a medical

practitioner, registered

optician or registered

physiotherapist furnishes

such information to the

registrar, they must notify

the person to whom

the information relates

of that fact and of the

nature of the information

furnished.

No civil or criminal

liability is incurred in

carrying out the duty

imposed.

232

Legislation relating to reporting

231

PART C. Appendices

Jurisdiction and

legislation

Applies to Discretionary reporting Mandatory reporting

Tasmania

Vehicle and Trac Act

1999, ss. 63 (2), 56

Vehicle and Trac Act

1999, s. 63 (1)

A person A person incurs no civil or

criminal liability for reporting to

the registrar, in good faith, the

results of a test or examination

carried out under the Act or

an opinion formed as a result

of conducting such a test or

examination.

Section 56 deals with tests and

examinations of drivers.

A person incurs no civil or

criminal liability for reporting to

the registrar, in good faith, that

another person may be unﬁt to

drive a motor vehicle.

There is no mandatory

reporting requirement

for practitioners.

Victoria

Road Safety Act 1986,

s. 27 (4)

Road Safety (Drivers)

Regulations 2019, r. 69

A person carrying

out a test

under s. 27 (i.e.

registered medical

practitioners,

optometrists,

occupational

therapists and other

people authorised in

writing by VicRoads)

A person who

expresses an

opinion to VicRoads

formed as a result of

the test

No action may be taken

against a person who carries

out a test to determine if a

person is unﬁt to drive or if it is

dangerous for that person to

drive) and who expresses to

VicRoads an opinion formed

by that person as a result of

the test.

No action may be taken

against a person who, in good

faith, reports to VicRoads any

information that discloses

or suggests that a person is

unﬁt to drive or that it may be

dangerous to allow that person

to hold or to be granted a

driver licence, a driver licence

variation or a learner permit.

There is no mandatory

reporting requirement

for practitioners.

233

PART C. Appendices

Jurisdiction and

legislation

Applies to Discretionary reporting Mandatory reporting

Western Australia

Road Trac

(Administration) Act

2008, s. 136

A person People expressing an opinion

to the Director General formed

as a result of carrying out a

test or examination under

the provisions of the Act are

protected from liability when

acting in good faith.

An action in tort does not lie

against a person, and a person

is not to be prosecuted for an

oence, for reporting to the

CEO, in good faith, information

that discloses or suggests that:

• another person is or may be

unﬁt to drive, or

• it may be dangerous to:

− allow another person to

hold a driver licence or

learner’s permit, or

− grant a driver licence

or learner’s permit to

another person, or

− vary or not to vary,

another person’s driver

licence or learner

permit.

There is no mandatory

reporting requirement

for practitioners.

234

Legislation relating to reporting

233

PART C. Appendices

Appendix 4. Drivers’ legal BAC limits

Appendix 4.1. Summary of state and territory laws on BAC and driving

State/territory Drivers of cars and light trucks,

motorcycle riders

Drivers of trucks, taxis, buses and

private hire cars

Australian Capital

Territory

The legal BAC limit applying to learner,

provisional and probationary drivers, drivers

classed as ‘special drivers’ and restricted

licence holders is zero BAC.

The legal limit for drivers of cars, trucks and

buses (excluding public vehicles) up to 15

tonnes gross vehicle mass (GVM) and riders

of motorcycles who hold a full licence (gold)

is below 0.05 BAC.

The legal BAC limit applying to drivers

of heavy motor vehicles exceeding 15

tonnes GVM, dangerous goods vehicles,

public vehicles (taxis, buses, rideshare,

and private hire cars) and Commonwealth

chaueur cars is zero BAC.

New South Wales A zero BAC limit applies to all learner

licence holders, provisional P1 licence

holders, provisional P2 licence holders and

interlock licence holders. For drivers not

listed elsewhere it is 0.05 BAC.

For drivers of trucks over 13.9 tonnes GVM,

all drivers of public passenger vehicles

within the meaning of the Passenger

Transport Act 1990 and drivers of any

vehicles carrying dangerous goods or

radioactive substances it is 0.02 BAC.

Northern Territory For unlicensed and learner drivers,

provisional licence holders, drivers under

25 with less than 3 years’ experience it is

zero BAC. For drivers not listed elsewhere it

is 0.05 BAC.

For drivers of vehicles over 15 tonnes

GVM, public passenger vehicles,

dangerous goods vehicles, vehicles with

people unrestrained in an open load

space and vehicles carrying more than 12

people; and for driving instructors while

instructing, licensed drivers under the age

of 25 who have been licensed for less than

3 years it is zero BAC. For drivers not listed

elsewhere it is 0.05 BAC.

Queensland For learner licence holders, probationary

licence holders, provisional licence holders,

class RE licence holders for the ﬁrst year

of holding a motorbike licence, restricted

licence holders, licence holders subject to

a 79E order, interlock drivers, driver trainers

while giving driver training and unlicensed

drivers it is zero BAC. For drivers not listed

elsewhere it is 0.05 BAC.

For drivers of trucks, public passenger

vehicles, articulated motor vehicles,

B-doubles, road trains, vehicles carrying

placard load of dangerous goods, tow

trucks and pilot or escort vehicles it is zero

BAC. For drivers not listed elsewhere it is

0.05 BAC.

South Australia For learner permit holders and provisional

and probationary licence holders it is zero

BAC. For drivers not listed elsewhere it is

0.05 BAC. Note that unlicensed drivers are

also subject to zero BAC.

For drivers of vehicles over 15 tonnes

GVM, prime movers with an unladen mass

less than 4 tonnes, taxis, buses, licensed

chaueured vehicles and vehicles carrying

dangerous goods it is zero BAC.

235

PART C. Appendices

State/territory Drivers of cars and light trucks,

motorcycle riders

Drivers of trucks, taxis, buses and

private hire cars

Tasmania For unlicensed and learner drivers,

provisional licence holders, people

convicted of causing death driving a motor

vehicle, or reckless or negligent driving,

people with three of more drink-driving

convictions in 10 years it is zero BAC. For

drivers not listed elsewhere it is 0.05 BAC.

For drivers of all public passenger vehicles

(e.g. buses, taxis) and vehicles exceeding

4.5 tonnes GVM it is zero BAC.

Victoria

Further

information:

https://www.

vicroads.vic.

gov.au/licences/

demerit-points-

and-oences/

drink-and-drug-

driving-oences/

drink-driving-

oences

A zero BAC applies to the following groups

of drivers:

• car and motorcycle learner and

probationary drivers

• people who get their licence or permit

back after being disqualiﬁed from driving

(this applies for 3 years from that date)

• people who have an interlock condition

on their licence

• professional driving instructors

• motorcyclists in the ﬁrst 3 years of

holding a licence

• drivers with a Z condition on their

licence.

A 0.05 BAC applies for other drivers

Any driver/rider licensed following a drink-

driving oence has a zero BAC condition on

their licence for a period of 3 years (or if the

period of their interlock condition is longer,

it is whichever is greater) and must install an

alcohol interlock prior to licensing.

A zero BAC applies to the following groups

of drivers:

• drivers of vehicles over 15 tonnes GVM

• all taxi and bus drivers

• some emergency vehicle drivers.

Western Australia A zero BAC applies to the following groups

of drivers:

• novice drivers

• holders of extraordinary licences

• recently disqualiﬁed drivers.

A 0.05 BAC applies for other drivers.

A zero BAC applies to the following groups

of drivers:

• vehicles exceeding 22.5 tonne gross

combination mass (GCM)

• vehicles carrying dangerous goods

(when such goods are being carried)

• buses (while carrying passengers where

the vehicle is equipped to carry more

than 12 adults including the driver)

• small charter vehicles (when carrying

passengers for hire or reward)

• taxis (when carrying passengers for hire

or reward).

A 0.05 BAC applies for other drivers.

236

Drivers’ legal BAC limits

235

PART C. Appendices

Appendix 5. Alcohol interlock programs

Appendix 5.1. Summary of state and territory laws on alcohol interlocks

and driving

State/territory Summary of law

Australian Capital

Territory

The Australian Capital Territory’s alcohol interlock program began on 17 June 2014.

High-risk drinkdriving oenders (high range and habitual drinkdriving oenders) must

participate in the ACT alcohol interlock program as a mandatory condition of relicensing.

For these high-risk oenders, participation in the program may include a court-ordered

therapeutic component as well as a requirement to only drive a vehicle ﬁtted with

an interlock device. All high-risk oenders are required to undergo a pre-sentence

assessment by the Court Alcohol and Drug Assessment Service.

Voluntary participation is an option for other drink-driving oenders, who may reduce

their total disqualiﬁcation period by agreeing to participate in, and comply with, an

alcohol interlock program. These oenders may elect to apply for a probationary

licence, which will be issued subject to an interlock condition, at any time during their

disqualiﬁcation period.

High-risk oenders who obtain an exemption from participating in the scheme must

complete their full disqualiﬁcation period before applying for a probationary licence.

Exemptions are available only where special circumstances exist.

There is a 6 month minimum program participation period, with program participants

required to demonstrate a continuous period of 3 months’ compliance with the interlock

program (i.e. no alcohol detected in the person’s breath samples) and compliance with

any treatment order before the interlock condition may be removed.

More information can be found on the ACT Road Transport Authority website at http://

www.rego.act.gov.au/licence/act-road-rules,-laws-and-publications/alcohol-ignition-

interlock-program.

237

PART C. Appendices

State/territory Summary of law

New South Wales Drivers convicted of serious drink driving oences are restricted to driving vehicles with

alcohol interlock devices for a period of time when they return to driving.

High-range, mid-range, repeat driving under the inﬂuence of alcohol and all combined

drink and drug driving oenders must participate in the program (the blood alcohol

content is zero) unless the court makes an interlock exemption order. The requirements

apply to speciﬁc oences declared ‘alcohol related major oences’ in s. 211 of the Road

Transport Act 2013.

Interlock orders may also be made by a court if a person is convicted of dangerous

driving oences as prescribed in s. 52A of the Crimes Act 1900 where the oence

involved the presence of alcohol.

The licence holder must meet mandatory alcohol Interlock licence conditions, in addition

to other conditions that may apply to the licence, and must not drive a motor vehicle with

a placard load within the meaning of the Dangerous Goods (Road and Rail Transport)

Regulation 2014.

At the end of a court-ordered interlock period, Transport for NSW may refer interlock

licence holders to a medical professional for assessment under the Assessing ﬁtness to

drive guidelines if interlock data indicate that further medical assessment for substance

misuse may be required. Based on the recommendation of a medical professional,

Transport for NSW can extend the interlock condition for a further 6 months. At the end

of this period, these drivers must undertake another ﬁtness-to-drive assessment before

they complete the program.

More information can be found on the Transport for NSW website at https://roads-

waterways.transport.nsw.gov.au/roads/demerits-oences/drug-alcohol/interlock-

program.html.

Northern Territory The Northern Territory’s Alcohol Interlock Program was introduced in 2009.

The program applies to repeat drink-drivers convicted of a relevant oence on a second

and subsequent occasion including: driving with a high-range blood alcohol content

(BAC of 0.15 per cent or greater); driving with a medium-range blood alcohol content

(BAC of 0.08 per cent or greater, but less than 0.15 per cent); driving under the inﬂuence

of alcohol or both alcohol and a drug; failing to provide a sucient sample of breath for

a breath analysis; failing to give a sample of blood for analysis; or driving with alcohol in

the blood if the driver is subject to a zero alcohol limit.

The program is a period of driving under conditions, which include the requirement

to drive a vehicle ﬁtted with an alcohol ignition lock (AIL). The court may, in addition to

disqualifying a person from driving for a mandatory period, order an AIL period ranging

from 6 months to 3 years.

When the mandatory disqualiﬁcation period ends, a person can apply for an AIL licence

and have an AIL device installed by an approved supplier or, if they opt not to drive,

serve out the court-imposed AIL period as an additional disqualiﬁcation period.

To obtain an AIL licence a person must have held a driver licence other than a learner

licence within the previous 5 years and completed the drink-driver education course

relevant to the oence.

More information can be found on the Northern Territory website at https://nt.gov.au/

driving/driving-oences-and-penalties/alcohol-ignition-lock-order/introduction.

238

Alcohol interlock programs

237

PART C. Appendices

State/territory Summary of law

Queensland Drink-drivers who are convicted of driving while over the alcohol limit, driving under the

inﬂuence of alcohol, failing to provide a breath specimen for analysis, dangerous driving

when adversely aected by alcohol, or two or more drink-driving oences of any kind

within a 5 year period are subject to Queensland’s Alcohol Ignition Interlock Program.

Drivers subject to the program must comply with the no-alcohol limit at all times when

driving and only drive a vehicle that has been nominated to the department and ﬁtted

with an approved interlock.

To complete the program a person must hold a valid licence with an ‘I’ (interlock)

condition and have an approved interlock installed in a nominated vehicle for a minimum

period of 1 year. If a person chooses not to have an approved interlock installed, they are

not allowed to drive for 2 years from the end of their disqualiﬁcation period for the drink-

driving oence. Exemptions are available only where special circumstances exist.

More information can be found on the Queensland Government website at https://www.

qld.gov.au/transport/safety/road-safety/drink-driving/penalties/interlocks/index.html.

South Australia TheMandatory Alcohol Interlock Scheme (MAIS) began in South Australia in 2009. This

scheme is administered by the Registrar of Motor Vehicles under s. 81E of the Motor

Vehicles Act 1959.

All people who commit a serious drinkdriving oence are liable to the scheme on

returning to driving after completing the court-imposed disqualiﬁcation period. A serious

drinkdriving oence is deﬁned as: a second or subsequent oence, within a period of 5

years, of driving with a BAC at or above 0.08; driving with a BAC at or above 0.15; driving

under the inﬂuence of an intoxicating liquor; or refusing to provide a sample of breath or

blood for the purpose of alcohol testing.

The conditions apply for a period equal to the disqualiﬁcation period ordered by the

Magistrates’ Court plus any immediate loss of licence suspension issued by South

Australia Police, to a maximum of 3 years. The MAIS requires the person to nominate

a vehicle(s) that he/she will drive for the period the conditions apply and to have an

alcohol interlock device ﬁtted to the vehicle(s). The personmust notoperate any other

vehicles.

Exemptions are available only where special circumstances exist.

Licence holders who are assessed by an approved assessment clinic as dependent

on alcohol can make an application to the Registrar of Motor Vehicles for a licence

subject to an interlock condition. If approved the person is granted a licence subject to

the interlock condition; this condition can only be removed where the licence holder is

assessed by an approved assessment clinic as non-dependent on alcohol. If the person

does not agree to the interlock condition, they are refused the issue of a licence until

they are assessed as non-dependent.

More information can be found on the South Australian Department of Planning,

Transport and Infrastructure website at http://www.dpti.sa.gov.au/towardszerotogether/

Safer_behaviours/alcohol_drink_driving2/mandatory_interlock_scheme_faqs.

239

PART C. Appendices

State/territory Summary of law

Tasmania Drivers convicted of drinkdriving oences are subject to Tasmania’s Mandatory Alcohol

Interlock Program (MAIP). The scheme is administered by the Registrar of Motor Vehicles

under the Vehicle and Trac (Driver Licensing and Vehicle Registration) Regulations

2021.

The program applies to drivers convicted of: a drinkdriving oence recording a BAC of

0.15 or more; two or more drink-driving oences in a 5 year period; driving under the

inﬂuence of liquor; or failing to provide a breath/blood specimen for analysis.

Participants serve a disqualiﬁcation period and then are required to have an interlock

installed in a nominated vehicle at the conclusion of their disqualiﬁcation and before

their driver licence can be issued/reissued.

Tasmania’s program runs for a minimum of 15 months consisting of a 9 month ‘learning

period’ and a 6 month ‘demonstration period’.

There are limited grounds for exemption to participating in the Tasmanian MAIP.

More information can be found on the Tasmanian Department of State Growth website at

http://www.transport.tas.gov.au/licensing/oences/interlocks.

Victoria As of 30 April 2018, all drivers committing a drinkdriving oence will lose their licence,

be required to complete a behaviour change program and ﬁt an alcohol interlock to their

vehicle before licensing.

More information can be found on the VicRoads website at https://www.vicroads.vic.gov.

au/licences/demerit-points-and-oences/drink-and-drug-driving-oences.

Western Australia From October 2016, high-end and repeat drink-drivers who commit oences will

be subject to Western Australia’s Alcohol Interlock Program under the Road Trac

Amendment (Alcohol Interlocks and Other Matters) Act 2015.

Oences include ﬁrst-time driving under the inﬂuence of alcohol oences; ﬁrst-time

failure to provide breath, blood or urine sample oences; ﬁrst-time dangerous driving

causing death, bodily harm or grievous bodily harm oences where the oender is

under the inﬂuence of alcohol to such an extent as to be incapable of having proper

control of a vehicle; and second or subsequent drink-driving oences of any kind within

a 5 year period.

Drivers convicted of alcohol-related oences on seeking authorisation to drive will have

their licence endorsed with an interlock condition restricting their driving to vehicles

ﬁtted with an approved alcohol interlock device.

The period a driver is required to have an interlock installed in their vehicle is referred to

as the ‘restricted driving period’. The disqualiﬁcation imposed by the courts and the type

of licence granted to a person will determine the length of the restricted driving.

The program includes support by means of an alcohol assessment, a treatment

component and extension of time on the interlock device for those who don’t comply.

More information can be found on the Western Australian Road Safety Commission

website at https://www.rsc.wa.gov.au/Documents/Law-Changes/rsc-alcohol-interlocks-

fact-sheet.aspx.

240

Alcohol interlock programs

239

PART C. Appendices

Appendix 6. Disabled car parking and

taxiservices

People suering substantial levels of disability may be eligible for disabled parking permits and

discount taxi fares. The practitioner should direct enquiries to the contacts shown below. Taxi

subsidies may be available only to those physically unable to use public transport.

Appendix 6.1. Contacts for transport assistance for people with disabilities

State/territory Disabled parking permits Taxi services

Australian Capital

Territory

Access Canberra

PO Box 582

Dickson ACT 2602

13 22 81

[email protected].au

www.accesscanberra.act.gov.au

ACT Taxi Subsidy Scheme

ACT Revenue Oce

PO Box 293

Civic Square ACT 2608

(02) 6207 0028

revenue.act.gov.au

[email protected].au

New South Wales Service NSW

13 22 13

www.service.nsw.gov.au

[email protected].gov.au

Taxi Transport Subsidy Scheme

Locked Bag 5067

Parramatta NSW 2124

1800 623 724

Northern Territory Contact your local council. Commercial Passenger Vehicles

Department of Infrastructure, Planning and

Logistics

GPO Box 2520

Darwin NT 0801

(08) 8924 7229

nt.gov.au

cpv[email protected].au

Queensland Disabled Parking

Department of Transport and Main Roads

PO Box 673

Fortitude Valley QLD 4006

13 23 80

Taxi Subsidy Scheme

TransLink Division

Department of Transport and Main Roads

PO Box 13347

Brisbane QLD 4003

1300 134 755

241

PART C. Appendices

State/territory Disabled parking permits Taxi services

South Australia Department for Infrastructure and Transport

GPO Box 1533

Adelaide SA 5001

13 10 84

Public Transport Division

Department for Infrastructure and Transport

GPO Box 1533

Adelaide SA 5001

(08) 8204 8169

Tasmania Transport Access Scheme

Department of State Growth

GPO Box 1242

Hobart TAS 7001

1300 135 513

Transport Access Scheme

Department of State Growth

GPO Box 1242

Hobart TAS 7001

1300 135 513

Victoria Contact your local council. Commercial Passenger Vehicles Victoria

GPO Box 1716

Melbourne VIC 3001

1800 638 802 (toll-free for ﬁxed

landlinesonly)

+61 3 8683 0768 (international callers)

www.cpv.vic.gov.au

contact@cpv.vic.gov.au

Western Australia ACROD

PO Box 184

Northbridge WA 6865

(08) 9242 5544 (Monday–Friday,

9AM–4PM)

www.app.org.au

[email protected]

Taxi Users Subsidy Scheme

Department of Transport

GPO Box C102

Perth WA 6839

1300 660 147

242

Disabled car parking and taxiservices

241

PART C. Appendices

Appendix 7. Seatbelt use

The use of seatbelts is compulsory in Australia

for drivers of all motor vehicles. This includes

drivers of trucks and buses but excludes taxi

drivers in New South Wales and Queensland

(while carrying passengers). It has been reported

that unrestrained occupants are more than three

times more likely to be killed in the event of a

crash than those who wear seatbelts.

The granting of an exemption from the use

of seatbelts places a person’s safety at

considerable risk. For a person who is otherwise

medically ﬁt to drive, there are very few

circumstances in which a medical condition will

render a person unable to wear a seatbelt.

Requests relating to seatbelt exemptions

Individuals may request a medical certiﬁcate

recommending or granting exemption

(depending on the state or territory); however,

exemptions based on most medical grounds are

considered invalid. Health professionals are

discouraged from providing letters stating that

the use of a seatbelt is not required.

In conditions such as obesity, health

professionals should advise the patient to have

the seatbelt modiﬁed and an inertia seatbelt

ﬁtted. In conditions in which there are scars

to the chest or abdomen (i.e. post surgery/

injury), the patient should be advised about

the use of padding to prevent any problems

ofseatbeltirritation.

It must be stressed that exemptions due to

any medical condition should be an extremely

rare exception to the uniformity of a rule that

enforces the legal obligation of a driver to wear

a seatbelt if ﬁt to drive.

Medical certiﬁcate regarding exemption

If a health professional recommends or

grants (depending on state or territory law) an

exemption, they must accept responsibility for

granting the exemption. In order to comply

with the requirements of the driver licensing

authority, a certiﬁcate of exemption (or

recommendation for exemption) should be

issued in the following manner:

• The certiﬁcate must be dated and issued

on the practitioner’s letterhead (except in

Queensland and Tasmania, refer below).

• The certiﬁcate must state the name, address,

sex and date of birth of the person for whom

the exemption is requested.

• The certiﬁcate must state the reason for

which the exemption is requested.

• The date the exemption expires must be

clearly stated. It should not exceed one

year from the date of issue of the certiﬁcate

except for musculoskeletal conditions or

deformities of a permanent nature. The

certiﬁcate may not be legally valid without

this date.

• In Victoria a registered medical practitioner

must issue the certiﬁcate stating that,

because of medical unﬁtness or physical

disability, it is impractical, undesirable

or inexpedient that the person wears a

seatbelt. Any conditions stated in the

certiﬁcate must be complied with.

The certiﬁcate (a) must be carried by the

person or the driver of the vehicle whenever

they are travelling in a car, (b) must clearly

display a date of issue and (c) will expire

after 12 months.

243

PART C. Appendices

• In Queensland an approved exemption

certiﬁcate (form F2690) may be completed

by the practitioner. Seatbelt exemption

certiﬁcates in Queensland must only be

issued for a maximum period of 12 months.

Contact details are listed in Appendix 9.

Driver licensing authoritycontacts.

• In Tasmania a medical certiﬁcate issued by

a medical practitioner exempting the person

from wearing a seatbelt must be carried. See

the website at www.transport.tas.gov.au/

licensing/exemptions for further information.

Contact details are listed in Appendix 9:

Driver licensing authority contacts.

• In the Northern Territory a medical

recommendation that clearly indicates that

these guidelines have been referred to in

reaching the exemption recommendation is

required. All such recommendations should

be sent to the Registrar of Motor Vehicles.

Contact details are in Appendix 9. Driver

licensing authoritycontacts.

• Inform the patient that the certiﬁcate must

be carried when travelling in motor vehicles

without using a seatbelt and must be shown

to police and authorised ocers when

requested.

• All health professionals and licensing

authorities should keep a record of all

exemptions granted or recommended and

document the reasons for exemption in case

litigation occurs.

Appendix 7.1. Medical exemptions

The table below suggests guidelines for possible exemptions.

Seatbelt exemptions

Condition Exemption

Ileostomies and colostomies No exemption. In normal circumstances, a properly worn seatbelt should not

interfere with external devices. An occupational therapist can advise on seatbelt

adjustments in other cases.

Musculoskeletal conditions

and deformities

Exemption possible for passengers only, depending on the exact nature of the

condition.

Obesity Modiﬁcation of restraint advised. If not feasible, an exemption is possible.

Pacemakers No exemption. If the pacemaker receives a direct compression force from a

seatbelt, the device should be checked for malfunction.

Physical disability No exemption. Advise patient about correct ﬁtting.

Pregnancy No exemption. Advise patient about correct ﬁtting.

Psychological conditions No exemption. Claustrophobia from seatbelt use can be overcome; if the condition

is severe, refer the patient to a specialist.

Scars and wounds No exemption. Advise the patient about the use of protective padding.

244

Seatbelt use

243

PART C. Appendices

Appendix 8. Helmet use

It is compulsory for motorcyclists to wear

helmets in Australia. Legislation does not allow

for exemptions in New South Wales, Victoria,

South Australia, Queensland and the Australian

Capital Territory. In the Northern Territory,

legislation does not permit an exemption on

medical grounds. Exemptions are possible

in other states only under extremely rare

conditions and should be strongly discouraged.

Health professionals are urged to point out to

patients the risk of severe disability or death

compared with the relatively small advantages of

an exemption from wearing a motorcycle helmet.

It is also compulsory for bicyclists to wear

helmets in Australia. In those states or territories

where exemptions are possible, applications

should be strongly discouraged in view of the

greater risk of injury and death. The table below

shows the laws on exemption from wearing

bicycle helmets by state and territory.

Appendix 8.1. State and territory laws on exemptions from wearing bicycle

or motorcycle helmets

State/territory Motorcycle helmets Bicycle helmets

Australian Capital

Territory

No exemptions No exemptions

New South Wales No exemptions No exemptions

Northern Territory No medical exemptions Bicycle helmets are not necessary for people who have

attained the age of 17 years and who ride in a public place,

on a footpath, shared path or cycle path (if separated from

the roadway by a barrier) or in an area declared exempt by

the transport minister.

Queensland No exemptions A person is exempt from wearing a bicycle helmet if the

person is carrying a current doctor’s certiﬁcate stating that,

for a stated period the person cannot wear a bicycle helmet

for medical reasons, or because of a physical characteristic

of the person, it would be unreasonable to require them to

wear a bicycle helmet.

A person is exempt if they are a member of a religious group

and they are wearing a type of headdress customarily worn

by members of the group and the wearing of the headdress

makes it impractical for them to wear a bicycle helmet.

245

PART C. Appendices

State/territory Motorcycle helmets Bicycle helmets

South Australia No exemptions Exemptions for Sikh religion only

Tasmania No exemptions May be considered on medical grounds at discretion of the

Transport Commission.

Email: [email protected].gov.au

Victoria No exemptions Exemptions possible on religious or medical grounds

Western Australia No new motorcycle

helmet exemption

applications are granted;

however, legislation

allows exemptions

granted on or before

30 November 2000

to be renewed prior to

expiry, at the discretion

of the Department of

Transport with supporting

evidence from a medical

practitioner.

Exemption on medical or religious grounds. A medical

certiﬁcate from a GP is required; however, issue is at the

discretion of the Department of Transport with supporting

evidence from a medical practitioner.

246

Helmet use

245

PART C. Appendices

Appendix 9. Driver licensing

authoritycontacts

Appendix 9.1. State or general contact details for health professional enquiries

State/territory General contact details including for

heavy vehicle licensing

Health professional enquiries

Australian Capital

Territory

Access Canberra

13 22 81

[email protected].au

www.accesscanberra.act.gov.au

Access Canberra

13 22 81

[email protected].au

www.accesscanberra.act.gov.au

New South Wales Transport for NSW

Locked Bag 928

North Sydney NSW 2059

13 22 13

[email protected].gov.au

www.rms.nsw.gov.au

Licence Review Unit

Transport for NSW

Locked Bag 14

Grafton NSW 2460

(02) 6640 2821

[email protected].gov.au

Northern Territory Motor Vehicle Registry

GPO Box 530

Darwin NT 0801

1300 654 628 / (08) 8999 3111

mvr[email protected].au

nt.gov.au

Motor Vehicle Registry

GPO Box 530

Darwin NT 0801

1300 654 628 / (08) 8999 3111

mvr[email protected].au

nt.gov.au

Queensland Department of Transport and Main Roads

GPO Box 2451

Brisbane QLD 4001

(07) 13 23 80

lavr@tmr.qld.gov.au

www.tmr.qld.gov.au

Department of Transport and Main Roads

Locked Bag 2000

Red Hill Rockhampton QLD 4701

1300 753 627

MCR@tmr.qld.gov.au

www.tmr.qld.gov.au

247

PART C. Appendices

State/territory General contact details including for

heavy vehicle licensing

Health professional enquiries

South Australia Department for Infrastructure and Transport

GPO Box 1533

Adelaide SA 5001

13 10 84

DIT.enquiriesadministrator@sa.gov.au

www.sa.gov.au

Manager – Licence Regulation

Department for Infrastructure and Transport

Locked Bag 700 GPO

Adelaide SA 5001

(08) 8204 1946

Tasmania Department of State Growth

GPO Box 1002

Hobart TAS 7001

1300 135 513

[email protected].gov.au

www.transport.tas.gov.au

Driver Licensing Unit

Registration and Licensing Services

Department of State Growth

GPO Box 1002

Hobart TAS 7001

(03) 6166 4887

Victoria VicRoads Medical Review

PO Box 2504

Kew VIC 3101

13 11 71

medicalreview@roads.vic.gov.au

www.vicroads.vic.gov.au/licences/health-

and-driving

VicRoads Medical Review

PO Box 2504

Kew VIC 3101

(03) 8391 3224

medicalreview@roads.vic.gov.au

www.vicroads.vic.gov.au/licences/health-

and-driving

Western Australia Driver Services

Department of Transport

GPO Box R1290

Perth WA 6844

1300 852 722

driverservices@transport.wa.gov.au

www.transport.wa.gov.au

Driver Services

Department of Transport

GPO Box R1290

Perth WA 6844

1300 852 722

driverservices@transport.wa.gov.au

www.transport.wa.gov.au

248

Driver licensing authoritycontacts

247

PART C. Appendices

Appendix 9.2. Public passenger vehicle driver licensing and dangerous

goods vehicle driver licensing enquiries

State/territory Public passenger vehicle driver

licensing enquiries

Dangerous goods vehicle driver licensing

enquiries

Australian Capital

Territory

Access Canberra

13 22 81

[email protected].au

www.accesscanberra.act.gov.au

Dangerous Goods Transport WorkSafe ACT

GPO Box 158

Canberra ACT 2601

(02) 6207 3000

New South Wales Enrolment Processing Unit

Transport for NSW

Locked Bag 5310

Parramatta NSW 2150

1800 227 774

Department of Conservation and Environment

PO Box A290

Sydney South NSW 1232

13 15 55 / (02) 9995 5555

Northern Territory Commercial Passenger Vehicles

Department of Infrastructure,

Planning and Logistics

GPO Box 2520

Darwin NT 0801

(08) 8924 7580

cpv[email protected].au

NT WorkSafe

Department of Business

GPO Box 3200

Darwin NT 0801

1800 019 115

Queensland Operator Accreditation and

Authorisation Team

Department of Transport and Main

Roads

PO Box 673

Fortitude Valley QLD 4006

(07) 3338 4994

PTStandards@tmr.qld.gov.au

Industry Accreditation and Licensing Team

Department of Transport and Main Roads

PO Box 673

Fortitude Valley QLD 4006

(07) 3066 2995

dgu@tmr.qld.gov.au

249

PART C. Appendices

State/territory Public passenger vehicle driver

licensing enquiries

Dangerous goods vehicle driver licensing

enquiries

South Australia Accreditation and Licensing Centre

Department for Infrastructure and

Transport

PO Box 9

Marleston BC SA 5033

(08) 7109 8117

SafeWork SA

Attorney-General’s Department

GPO Box 465

Adelaide SA 5001

1300 365 255

Tasmania Driver Licensing Unit

Registration and Licensing Services

Department of State Growth

GPO Box 1002

Hobart TAS 7001

(03) 6166 4887

WorkSafe Tasmania

PO Box 56

Rosny Park TAS 7018

1300 366 322 (in Tasmania) / (03) 6166 4600

wstinfo@justice.tas.gov.au

Victoria Commercial Passenger Vehicles

Victoria

GPO Box 1716

Melbourne VIC 3001

1800 638 802 (toll-free for ﬁxed

landlines only)

contact@cpv.vic.gov.au

cpv.vic.gov.au

WorkSafe Victoria

Advisory Service

GPO Box 4293

Melbourne VIC 3001

1300 852 562

licensing@worksafe.vic.gov.au

http://www.worksafe.vic.gov.au/safety-and-

prevention/licensing/worksafe-licence-types-

and-fees/application-for-a-dangerous-goods-

driver-licence

Western Australia Driver Services

Department of Transport

GPO Box R1290

Perth WA 6844

1300 852 722

driverservices@transport.wa.gov.au

www.transport.wa.gov.au

Department of Consumer and Employment

Protection, Resources and Safety Division

100 Plain Street

East Perth WA 6004

(08) 9222 3333

250

Driver licensing authoritycontacts

249

PART C. Appendices

Appendix 10. Specialist driver assessors

Appendix 10.1. Contact for occupational therapist specialist driver

assessors

Region Organisation Contact

Australian Capital

Territory

Driver Assessment and Rehabilitation

Program (Canberra Hospital)

1300 682 878

New South Wales Occupational Therapy Australia 1300 682 878

Northern Territory Occupational Therapy Australia 1300 682 878

Queensland Occupational Therapy Australia 1300 682 878

South Australia Occupational Therapy Australia 1300 682 878

Tasmania Occupational Therapy Australia 1300 682 878

Victoria VicRoads maintains a current list of

occupational therapy driving assessors

who operate throughout Victoria. The list is

located on this page:

https://www.vicroads.vic.gov.au/licences/

health-and-driving/information-for-health-

professionals/occupational-therapist

Occupational therapy driving assessors can

also be located via the ‘Find an OT’ page

on the Occupational Therapy Australia

Victoria webpage:

https://www.otaus.com.au/ﬁnd-an-ot

VicRoads Medical Review

PO Box 2504

Kew VIC 3101

(03) 8391 3226 or VicRoads on 13 11 71 (TTY

13 36 77, Speak and Listen 1300 555 727)

medicalreview@roads.vic.gov.au

vicroads.vic.gov.au

Occupational Therapy Australia – Victoria

5/340 Gore Street

Fitzroy VIC 3065

1300 682 878

otaus.com.au/contact

Western Australia Occupational Therapy Australia 1300 682 878

Occupational Therapy Australia has a listing of occupational therapists qualiﬁed in driver assessment. Visit the

Occupational Therapy Australia website at www.otaus.com.au.

251

PART C. Appendices

251

PART C. Appendices