Medical aspects of fitness to drive a guide for medical practitioners

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When driving may resume or may occur An individual may be fit to drive three months after coronary artery bypass surgery, subject to a specialist assessment, if: • there is no evidence of myocardial ischaemia on adequate stress (exercise or pharmacological) testing (electrocardiographic, echocardiographic or scintigraphic), or • there is evidence of minimal myocardial ischaemia at a moderate or high level of stress, but at angiography there is complete revascularisation. The Agency may impose licence conditions for regular medical assessment, eg annual reviews. The Agency may consider individuals with evidence of minimal myocardial ischaemia and/or with incomplete revascularisation at angiography, if there is a supporting specialist opinion. 3.1.5 Coronary angioplasty When driving may resume or may occur An individual may be fit to drive four weeks after coronary angioplasty if: • angioplasty was not associated with acute myocardial infarction (immediately prior to, during or after angioplasty) and there is no evidence of myocardial ischaemia on adequate stress (exercise or pharmacological) testing (electrocardiographic, echocardiographic or scintigraphic), or • there is evidence of minimal myocardial ischaemia at a moderate or high level of stress, but at angiography there is complete revascularisation. The Agency may impose licence conditions for regular medical assessment, eg annual reviews. The Agency may consider individuals with evidence of minimal myocardial ischaemia and/or with incomplete revascularisation at angiography, if there is a supporting specialist opinion. The period of convalescence after coronary angioplasty will vary according to symptoms, the extent of disease prior to angioplasty, the efficacy and complications of angioplasty, functional capacity and evidence of reversible myocardial ischaemia after angioplasty. The timing of fitness to drive after coronary angioplasty should be assessed in the context of convalescence generally. Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or a D, F, R, T or W endorsement (see appendix 3) When driving should cease Individuals should not drive for at least two days after coronary angioplasty. Individuals with complications arising from coronary angioplasty, which may impair their ability to drive safely, should not drive until given medical clearance. When driving may resume or may occur An individual may be fit to drive two days after coronary angioplasty if angioplasty was not associated with acute myocardial infarction (immediately prior to, during or after angioplasty) or other significant complications. Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement When driving should cease Individuals should not drive for at least four weeks after coronary angioplasty. Individuals with complications arising from coronary angioplasty, which may impair their ability to drive safely, should not drive. The Agency may require regular review because of the possibility of in‐stent restenosis occurring over this time. 46 3. Cardiovascular conditions | Medical aspects of fitness to drive | NZTA July 2009 July 2009 NZTA | Medical aspects of fitness to drive | 3. Cardiovascular conditions 47
3.2 Severe hypertension Treatment for hypertension aims to maintain a sitting blood pressure equal to or less than 140mm Hg systolic and equal to or less than 90mm Hg diastolic. Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or a D, F, R, T or W endorsement (see appendix 3) When driving should cease Individuals for whom treatment causes symptomatic postural hypotension or impaired alertness should not drive until these effects have been satisfactorily remedied. When driving may resume or may occur An individual may be fit to drive unless either of the following applies (and provided there is no other condition that would render the individual unfit to drive): • treatment causes symptomatic postural hypotension, or • treatment causes impaired alertness. Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement When driving should cease An individual is normally considered unfit to drive if: • the sitting blood pressure is consistently equal to or greater than 200mm Hg systolic, or equal to or greater than 110mm Hg diastolic, or • treatment causes symptomatic postural hypotension or impaired alertness, or • there is end‐organ damage (cardiac, cerebral, retinal or renal) that would otherwise render the individual unfit to drive. 3.3 Arrhythmias and conduction abnormalities Individuals with recurrent or persistent arrhythmias causing presyncope or syncope are normally considered unfit to drive. Fitness to drive may be assessed after effective treatment and an appropriate symptom‐free interval. 3.3.1 Cardiac arrest Cardiac arrest may occur secondary to bradycardia or asystole, ventricular tachycardia or fibrillation, or if cardiac output is reduced in association with other arrhythmias. Driving should be resumed only when the underlying cause(s) of cardiac arrest have been effectively treated and the individual has remained asymptomatic for an adequate period. Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or a D, F, R, T or W endorsement (see appendix 3) When driving should cease An individual should not drive for at least two months following a cardiac arrest. When driving may resume or may occur An individual may be fit to drive two months after a cardiac arrest, subject to a specialist assessment and provided there is no other condition that would render the individual unfit to drive. Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement When driving should cease An individual is normally considered permanently unfit to drive, unless: • cardiac arrest had occurred within two days of acute myocardial infarction, and the individual subsequently did not have inducible ventricular tachycardia at electrophysiological study, and there was no other condition that would render the individual unfit to drive, or • cardiac arrest had been associated with an arrhythmia that was subsequently cured by surgery or catheter ablation, and the individual subsequently did not have inducible ventricular tachycardia at electrophysiological study, and there was no other condition that would render the individual unfit to drive, or • cardiac arrest had been associated with factors that could be avoided in the future, and there was no other condition that would render the individual unfit to drive. In the circumstances listed above, fitness to drive may be assessed following a symptom‐free interval of at least three months after cardiac arrest. Specialist assessment is required before an individual returns to driving. The Agency may impose licence conditions for regular medical assessment, eg annual cardiologist reviews. 48 3. Cardiovascular conditions | Medical aspects of fitness to drive | NZTA July 2009 July 2009 NZTA | Medical aspects of fitness to drive | 3. Cardiovascular conditions 49
Page 1 and 2: Medical aspects Publication title o
Page 3 and 4: Foreword The NZ Transport Agency an
Page 5 and 6: 10. Miscellaneous conditions 109 10
Page 7 and 8: 1. General matters This section cov
Page 9 and 10: The extent of the examination The e
Page 11 and 12: 1.5 Second opinions and dealing wit
Page 13 and 14: Medical condition Class 1 or class
Page 15 and 16: 2.2 Blackouts of unknown cause (exc
Page 17 and 18: Medical standards for individuals a
Page 19 and 20: neurologist’s report is provided
Page 21 and 22: 2.8 Dementia and other cognitive im
Page 23 and 24: 2.10 2.10.1 Structural intracranial
Page 25 and 26: Medical condition Class 1 or class
Page 27: 3.1.2 Angina pectoris (suspected) M
Page 31 and 32: 3.3.4 Pacemaker 3.3.5 Automatic imp
Page 33 and 34: 3.5 Cardiac failure and cardiomyopa
Page 35 and 36: 3.9 Other cardiovascular disease 3.
Page 37 and 38: Factors for medical practitioners t
Page 39 and 40: 4.1 Type 1 diabetes Individuals in
Page 41 and 42: Introduction Specific neuromuscular
Page 43 and 44: 6. Visual standards Summary table T
Page 45 and 46: Dealing with individuals who are un
Page 47 and 48: 6.3 Visual fields For safe driving,
Page 49 and 50: 6.7 Night blindness Individuals who
Page 51 and 52: Introduction There is very little e
Page 53 and 54: Legal obligations on medical practi
Page 55 and 56: Psychotropic medication can tempora
Page 59 and 60: Medical standards for individuals a
Page 61 and 62: When driving should cease Driving s
Page 65 and 66: 12. Driving after surgery The table
Page 67 and 68: 14. Temporary driving impairments A
Page 69 and 70: Appendix 1. Section 18 of the Land
Page 71 and 72: Table B. Graduated driver licensing
Page 73 and 74: Appendix 6. Example letter for noti
Page 75: References American Optometric Asso

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