Medical driving restrictions for EMS?

[emtannie]

I saw this on EMSResponder today, and was a little surprised that this EMT was allowed to drive the ambulance with his medical history of narcolepsy and epilepsy. Although I know people who have both, and do drive, they also have some restrictions on their licenses. I suspect the fact that he had just come off a 24 hour shift and was starting another shift with a different service contributed as well, as well as the texting while driving (AARRGGHHHH).

Are there driving restrictions at your service? Just curious how a staff member like this would have been handled elsewhere - would he have been allowed to drive, given his medical hx?

http://www.emsresponder.com/article/article.jsp?id=11577&siteSection=1

Reported by Sara Dorsey

Story by wsmv.com

NASHVILLE, Tenn. --

New information released on Monday suggests that a Franklin firefighter's medical history may have been a factor that resulted in a fatal interstate crash in October.

Franklin firefighter David Cline was killed when the ambulance he was driving rear ended a Tennessee Department of Transportation truck.

The patient he was transporting, Sue Bly, also died in the crash.

A report released late Monday afternoon shows Cline had a history of seizures.

After speaking to Cline's widow, crash investigators learned that Cline had been diagnosed with narcolepsy and epilepsy and was prescribed medications for both.

Cline had just finished a 24-hour shift at the Franklin Fire Department on Oct. 22 when he began a shift with the privately run Rural Metro Ambulance Service.

He was transporting Bly, who had just received dialysis treatment, back to her home when he rear ended the TDOT truck, which was parked on the shoulder of Interstate 65 near the Wedgewood Avenue exit.

According to toxicology reports, Cline had a high level of amphetamines in his system, likely caused by the Adderall he took for narcolepsy. But the toxicology report didn't show any traces of the drug he took for epilepsy in Cline's system.

The report also shows that Cline had a similar crash in 1999, where he swerved off the road after having a seizure. His license was suspended after that crash and reinstated in 2000.

A co-worker at the Franklin Fire Department also told investigators that Cline had a seizure three or four years ago.

A check of phone records also revealed Cline was sending or receiving text messages at the time of the crash.

However, investigators believe given Cline's medical history that some type of medical condition is to blame for the wreck.

According to the Department of Safety's Web site, a person has to be seizure free for a full year to get a license and also must get a doctor's permission if you are on controlled medications.

Edited December 31, 2009 by emtannie

[JakeEMTP]

Tragic. Condolences to both families.

To answer your question, the FF in question would not be hired by us do his medical hx. Although he takes medication for his conditions, he would still be ineligible for employment. The risk factor is to high. The nature of our profession requires that one stay mentally alert. Driving an emergency vehicle is different than driving a car. We need to be better than the average motorist. Saying that, if there is a possibility that an EMS provider could have a epileptic seizure either on a call or whilst driving is to great a risk to take.

I don't even want to start the texting/cell phone thingy. My BP is still elevated from the San Antonio FD thread!

Our Medical Director is looking at regulating the number of hours a provider can work consecutively. 36 hours straight would not be allowed under his new rules if he has his way. Since it is his medical license, it is likely to come about.

Edited December 31, 2009 by JakeEMTP

[flight-lp]

Yeah, epic fail...............

Shouldn't have been driving with his history and, if he was still alive, should be fully liable for negligence from not taking his medications as prescribed. Shame on Rural Metro and that FD.

[JPINFV]

California requires ambulance drivers to meet the same physical standards as commercial vehicle drivers. As such, a "medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a [vehicle]" is an automatic failure of the physical exam.

Edited December 31, 2009 by JPINFV

[FireMedic65]

PA is the same way. You have to meet certain medical requirements to operate a vehicle. As for narcolepsy and epilepsy, as long as they under control, there is no harm. That being said, if you DO have an episode of one or the other, your license is supposed to be revoked. Regardless of if you were operating a vehicle at the time or not. I don't recall the time frame of how long they take the license away, but it's not a short period.

Really crappy this happened though.

[rock_shoes]

Everyone working for BCAS must have a class 4 driver’s license in order to operate any ambulance. A class 4 in BC is a type of commercial driver’s license specific to the operation of ambulances, taxis, limousines, etc.. Obtaining and keeping a class 4 requires passing a physical exam every 5 year period (at a random time), and it is impossible to pass said exam with a condition like epilepsy. It's a tragic event that should never have occurred.

[Kiwiology]

We used to have a Class E license for emergency vehicles which was the same medical standard as a CDL (required for heavy vehicles, taxis and tow trucks). This was the same as the green DOT medical card California requires for it's ambulance endorsment.

Ambulance is now covered under Class 1 (standard light vehicle) and is subject to "Private" medical standards, which have significantly more leeway for exemptions and waivers.

A "P" (passenger) endorsement, which is subject to CDL medical standards, is not required for Ambulance as the cost and process of obtaining one is seen as prohibitive and a disincentive for volunteer recruitment (it costs around $500 for said endorsement, which a 5 yearly cost).

Just because one legally holds the required license to drive an ambulance doesn't mean the employer will let them, it would be at their discretion.

The Fire Service require Class 2 or 4 for thier trucks because of the weight (anything over 4,500kg or 10,000lb requires a Class 2 and anything over 15,000kg or 33,000lbs requires Class 4). Both these are subject to commercial medical standards.

Edited January 1, 2010 by kiwimedic

[rock_shoes]

We used to have a Class E license for emergency vehicles which was the same medical standard as a CDL (required for heavy vehicles, taxis and tow trucks)

Why was it dropped? That sounds like a step in the right direction to me. One step better would have been requiring people to attend an emergency vehicle operations program prior to obtaining a Class E license.

Ambulance is now covered under Class 1 (standard light vehicle) and is subject to "Private" medical standards, which have significantly more leeway for exemptions and waivers.

What an unfortunate step backwards. I’m used to seeing better from our friends in the really “deep south”.

A "P" (passenger) endorsement, which is subject to CDL medical standards, is not required for Ambulance as the cost and process of obtaining one is not legally required and seen as prohibitive and a disincentive for volunteer recruitment (it costs around $500 for said endorsement, which a 5 yearly cost).

I fail to see any negative in requiring the passenger endorsement. It would decrease the likelihood of a medically unfit person driving and serve as a “whacker filter” all at once.

[Kiwiology]

Why was it dropped? That sounds like a step in the right direction to me. One step better would have been requiring people to attend an emergency vehicle operations program prior to obtaining a Class E license.

The Class E license was obtained by holding a Class B (car) license and passing a CDL medical, like your class 4 (or Class F in Ontario) or the green DOT CDL card required in California.

It was dropped in 1999 when we introduced photo driver licenses and moved from 15-20 types of licenses down to 6 classes. The new classes are based upon weight and not vehicle type. Because an ambulance weighs under 4,500kg it is considered a Class 1 vehicle which is subject to "private" medical standards.

I fail to see any negative in requiring the passenger endorsement. It would decrease the likelihood of a medically unfit person driving and serve as a “whacker filter” all at once.

A passenger endorsment requires passing the full Class 1 practical license test (unless sat within the last 5 years), a CDL medical (the same standard taxi, tow truck and heavy tractor-trailer or commercial vehicle drivers must pass) and a police check. They are not hard but the cost is extremely prohibitive ($500 up front to obtain and then again every five years to renew) and it is not a cost the ambulance service is prepared to meet for every volunteer ambo because it would cost literally over a million dollars.

If I had my way, we would reinstate the P endorsement requirement for ambulance.

[rock_shoes]

The Class E license was obtained by holding a Class B (car) license and passing a CDL medical, like your class 4 (or Class F in Ontario) or the green DOT CDL card required in California.

That’s almost the identical process. I did have to pass another drivers exam and pre-trip inspection to obtain a class 4.

It was dropped in 1999 when we introduced photo driver licenses and moved from 15-20 types of licenses down to 6 classes. The new classes are based upon weight and not vehicle type. Because an ambulance weighs under 4,500kg it is considered a Class 1 vehicle which is subject to "private" medical standards.

Wow. No wonder you guys re-vamped the licensing system. Our system is kind of a hybrid involving both weight and vehicle type.

A passenger endorsment requires passing the full Class 1 practical license test (unless sat within the last 5 years), a CDL medical (the same standard taxi, tow truck and heavy tractor-trailer or commercial vehicle drivers must pass) and a police check. They are not hard but the cost is extremely prohibitive ($500 up front to obtain and then again every five years to renew) and it is not a cost the ambulance service is prepared to meet for every volunteer ambo because it would cost literally over a million dollars.

If I had my way, we would reinstate the P endorsement requirement for ambulance.

Do they actually have to drive a bus or tractor with trailer, air-brakes, etc. or is it just another drivers test? I agree that you don’t need to be licensed to operate a tractor-trailer unit to drive an ambulance.

Edited January 3, 2010 by rock_shoes