Tuesday, March 23, 2021

Standardised Screening Test to Medically Assess All Drivers Called for by Safety Group

European Wide Statistics Clearly Show a Need for Improvement
Shipping News Feature

EUROPE – The standards utilised to assess the fitness of drivers have come under severe criticism from the European Transport Safety Council (ETSC) in a new report it has published. The report examines the current state of play in European countries regarding the assessment of medical fitness to drive, with reference to current EU rules. The EU is currently reviewing the Directive on driver licensing and a revised legal proposal is expected in 2022.

The points made in the report, readable in full here, make perfect sense and considers that the current starting point for many EU countries is still age-based assessment despite the fact that studies have concluded that specific medical conditions, substance abuse, mental disorders, epilepsy and diabetes are more important factors than age when it comes to medical fitness to drive.

Whilst the EU claims a harmonised medical policy for HGV and bus drivers, ETSC says that across the board the evidence is that mandatory age-based screening of older drivers has not been shown to be effective in preventing severe collisions. It even extrapolates this to infer that there may even be a negative safety impact, as older drivers with revoked licences due to poor health become vulnerable road users.

ETSC is recommending that national governments should make wider use of conditional licences to allow those who may be at slight risk to continue to drive under certain circumstances. A lack of good data on the role played by medical conditions and disorders in road collisions is also cited as a significant problem, according to the report authors. Pan-European in-depth collision investigation data could help but currently only a small number of countries systematically collect such data.

One important exception is Finland, where every fatal collision is followed-up with an in-depth investigation. Between 2014 and 2018, Finnish investigators attributed the cause of a fatal collision to driver illness in 16% of cases. Cardiovascular diseases were the most common risk factor where disease was known to have been an immediate contributor to the collision. Of the 141 fatal collisions known to have been caused by the illness of the driver, between 2014-18, 119 were due to heart disease or hypertension.

Many of the countries surveyed require some form of medical check when first applying for a licence to drive a car, beyond the sight test required by the EU rules. But there are vast differences in how these checks are carried out among the different countries. The medical test required when acquiring a licence for the first time can vary from a self-assessment form filled out and signed by the applicant, to a medical examination carried out by a family doctor or undertaken by a specialist doctor or centre.

ETSC is recommending that the EU and national governments should consider adopting a standardised screening process based on international best practice for use across all Member States. Medical fitness to drive is a matter of judgement as well as science, but the levels of training or guidance provided to those assessing medical fitness to drive in European countries vary substantially.

ETSC says a clear set of guidelines issued to those assessing medical fitness to drive is known to have a positive effect and it recommends stressing the role of General Practitioners (GPs) as the primary point of call for identifying those who may be at-risk. ETSC is also calling on national governments to develop and mandate evidence-based training programmes, which have been shown to be effective and are accepted in particular by family doctors.

Current EU rules explicitly rule-out the issuing of driving licences to people who are alcohol dependent. While this may sound sensible because 25% of all road deaths in the EU are estimated to be alcohol related, drink-driving offenders and alcohol-dependent people can end up ignoring driving bans and getting behind the wheel anyway. For alcohol-dependent people, the current EU rules effectively block access to one of the most effective tools for preventing repeat drink-driving offences: alcohol interlock rehabilitation programmes.

Regular readers will know we have extolled the virtues of the devices for the past decade yet no positive European wide measures have been adopted. The devices enable drink-driving offenders to drive as long as their vehicle is fitted with a device that prevents them from driving after consuming too much alcohol. ETSC says EU rules should allow for alcohol-dependent people to be included in alcohol interlock programmes and carry on driving under these restrictions.

When it comes to driving under the influence of medication, less is known about the effects of a variety of drugs than for alcohol. ETSC recommends applying the existing EU ‘DRUID’ categorisation for labelling relevant medicines and stressing the role doctors can play in advising their patients on the impact of prescription medicines on driving.

Photo: Courtesy Cambridgeshire Police.