 I'm Dr. Michael Gibson. I'm about to give a physical examination to a commercial truck driver. The Department of Transportation requires a commercial motor vehicle driver to have a physical exam and to meet certain minimum requirements. The examining physician then signs a card which the driver must carry with him right along with his driver's license. The driver's job depends on the results of the physical exam that I'll be giving. Therefore, the truck driver, unlike another patient, will be reluctant to tell me or you if he is having some medical problems. So, I may need to do some investigating to determine the health of the individual I'm examining. It's important to understand the special physical and emotional demands of a driver's hours, schedule, and workload. When a truck driver leaves your office, he carries with him the safety of hundreds of people who travel America's highways. It's up to us to determine if the physical and emotional health of the driver can meet the challenge. Our patient's name today is Clint Blank, and he drives for Transcontinental Transport. Let's go in and start the examination. Hello, Mr. Blank. I'm Dr. Gibson. How are you today? Just fine. My name is... call me Clint. Okay, Clint, when was the last time that you saw your family doctor? It's been a year or more. Have you been having any special problems that I need to know about? No, none at all. Clint, I see here that you drive for Transcontinental Transport Company. Yeah, that's right. What kind of driving do you do? Long-haul flatbed, cross-country. There are several kinds of work schedules that the drivers you see will be facing. Turnaround or short-relay runs bring the driver back to his home terminal each night. Long-relay runs send the driver on an eight- or ten-hour trip where he stops, spends an eight-hour time off period, and then returns home. Straight through halls take the driver across country. He drives for his allotted hours and then stops to take an eight-hour time off period. For this type of hall, the driver will typically use a sleeper cab, and his work and rest periods are normally very erratic. Sleeper halls typically utilize two drivers. One sleeps while the other drives. Solo drivers sometimes use sleeper cabs to make their long-haul runs. Different types of runs produce various kinds of physical and emotional demands. A driver's life may consist of rotating work schedules, long hours at odd times of the day and night, and possibly being away from family and friends for extended periods of time. Some individuals have poor dietary and sleep habits. Things combined with the normal pressures that go with the job may hinder driver performance and affect the safety of others sharing the highway. The health of a commercial truck driver plays an important role in highway safety because the potential for fatal accidents is considerably higher when a truck is involved. There are about 5,000 fatalities related to commercial motor vehicle accidents each year. The American Automobile Association has conducted research comparing the number of fatalities when trucks collide with passenger vehicles. When a pickup truck collides with a passenger car, fatalities average 3 per 1,000 incidents. When a tractor-trailer combination collides with a car, 71 persons are killed per 1,000 incidents. When a tandem trailer collides with a passenger car, 133 persons are killed per 1,000 incidents. Clint, what kind of materials do you usually haul? Just about anything I get on my flatbed. Do you ever handle any hazardous materials? Yeah, sometimes we haul batteries and some pesticides and different chemicals. Hazardous materials present a special challenge for commercial drivers. They add a significant amount of pressure to the driver with the added risk to his own physical health and that of the public. There are guidelines for the handling of these materials, but you need to be aware your patient may be handling these items and the special safety risks that they present. Okay, Clint, put your hand over your left eye and read line number 8. D-E-F-P-O-T Vision and hearing are obviously two of the driver's most important tools. Both senses are in constant demand. Drivers must be able to read at long distances in poor light. Reflections on wet roads, looking in mirrors at odd angles all put a unique demand on driver vision. Newer cab designs with more instrumentation call for greater dependency on good peripheral vision. Drivers must also be able to hear other traffic, engine noise that would indicate a problem or hazard, and upcoming emergency vehicles. When testing vision and hearing of a commercial truck driver, you must ascertain that he or she has good distant visual acuity in each eye with or without corrective lenses, a good field of vision, and adequate hearing. The specific medical criteria for different conditions are listed on the physical examination forms. Copies of the medical criteria can also be obtained from the Federal Office of Motor Carrier Standards in Washington, D.C. The National Institute for Occupational Health and Safety has established 90 decibels as the noise level at which hearing damage may occur. Cabs of older interstate trucks typically reach noise levels exceeding 110 decibels. There are three primary concerns about hearing problems drivers face. Prolonged exposure to high noise levels could lead to permanent hearing loss. Drivers may be deprived of information vital to driving safely, and resulting fatigue could lead to hindered performance. Clen, have you had any troubles with your back? No, I haven't had any problems with my back for quite a while. Have you ever had any serious injuries? No. Have you seen any doctors for your back in the past? No. How's your back feeling today? Oh, it feels good today. Every once in a while when I wake up in the morning, it's a little bit stiff, but it's been a while since it's been like that. Pressure and strain on a truck driver's back can be great. Drivers sit for long hours behind the wheel and then lift heavy loads with practically no stretching or preparation. Drivers can also experience back and muscle pain from lifting heavy tarps, adjusting load straps or carrying and mounting heavy snow chains. There is a high incidence of premature degenerative deformities of the spinal column among line haul truck drivers than in some other occupations. One of the main problems that cause these spinal problems in truck drivers is vibration. Vibration in the 3 to 7 Hertz range can produce chest pain, balance problems, hinder the ability to sit erect and cause physical fatigue. Truck cabs typically vibrate at a frequency of up to 20 Hertz. This rate of vibration is 3 to 5 times higher than a typical city bus. Truck drivers are also under considerable stress. They sometimes run under very tight pickup and delivery schedules. The driver may be forced to deal with poor weather and slippery roads. In Seattle, there are reports of excessive amounts of snow and extremely heavy winds. Snow quality pass is closed to all vehicles except those with snow chains aboard. Poor road conditions slow down the driver and provide for very tense driving conditions. The driver must be concerned with the safety of his co-driver, other road users and the load he's carrying. Abrupt duty hour changes and the added pressure of a load of hazardous materials can also cause a great deal of driver stress. Clint, were you aware that your blood pressure was slightly high? Yes, yes I was. Are you taking anything to bring it down? Yeah, they're sitting over there on the counter, brought them in. I see. Are you having any side effects from these? Yeah, they make me sleepy so when I'm driving I don't take them. Otherwise I do. Have you discussed these side effects with your doctor, Clint? No, I haven't. I don't get home often enough to get in and see the doctor on a regular basis. Well you know these medicines can cause such side effects such as sleepiness and drowsiness but there are other medications that you could take where you wouldn't have this kind of problem. I'm wondering if you'd mind if I talk to your doctor about switching you to one of these medicines, see what he'd think and we maybe could avoid some of these side effects that have been such a problem. Yeah, that'd be fine with me. You know it is important that we keep this blood pressure under control because if it raises too high you're going to have your driving privileges restricted. Also it's important that you keep your blood pressure under control to avoid future problems such as heart disease and as you grow older. I wonder when I talk to your doctor if you'd mind if I get your old records also so I can review that to help to determine your fitness for duty. Yeah, I can get the records for you or sign something so that you can get them from me. Now were there any other medical problems that you had in the past or that your doctor's treating you that I would need to know about? No, none at all. One other thing that's important to control your blood pressure is your diet. What kind of diet do you eat while you're out on the road? Well I try to eat a couple meals a day but it's kind of hard to do and there are different times of the day and everything and truck stop food is not the greatest in the world. One of the biggest handicaps truck drivers face is eating the right foods. Commercial truck drivers have a much higher incidence of peptic ulcers than most other occupations. Drivers must also be aware that their diet can cause hypoglycemic or hyperglycemic reactions. These reactions do affect driver performance. Being on a low fat, low cholesterol, high fiber diet is not impossible but it is very difficult. Only a few truck stop restaurants offer more fresh food and less starch and fat. Exposure to exhaust fumes may also cause food to be poorly digested leading to gas pains and nausea. Medication, diet and exercise are all important in controlling your high blood pressure clamp. Now I just got off the phone talking with your doctor and he agrees that we ought to try switching you to a different blood pressure medicine that should make you less drowsy. Now I'm going to start you on this medicine today and then in a couple of weeks I want you to be seen by your family doctor to get checked again and be sure it's going to be working for you. Now as far as the diet I want you to avoid a lot of greasy foods, get plenty of exercise and avoid the foods that are high in sodium. Let's check your reflexes here now. Good reaction time is an essential part of a driver's performance. Quick reactions when braking, shifting and steering can avoid accidents and potentially save lives. Firm grasp of the wheel and upper body and arm strength are also important to a driver's ability to safely handle his vehicle. Glenn I'd like to take a minute to talk to you about alcohol. How much and how often do you drink alcohol? Oh I'll have a beer or two every once in a while but not very often. Do you ever use alcohol when you're driving? Oh no absolutely not. Well I'm sure that you know that use of alcohol or any controlled substance while you're driving is grounds for suspension of your license. If that happened you'd have a heck of a time getting another driving job. Yeah I'm well aware of that and I don't touch the stuff when I got to drive. The lifestyle and schedule of most truck drivers throws their sleep patterns into complete disarray. When their circadian rhythms are disrupted as when a driver's day and night schedule switches a state of stress is produced. As you know this stress can result in impairment of physical health, emotional and behavior problems, sleep difficulties, altered responses to medication, and decrements in work performance. The battle to stay alert during the low part of the circadian rhythm prompts some drivers to use illegal amphetamines, narcotics, and or other habit forming drugs. The effects of illegal drugs and alcohol on a driver's reaction time, management and control of his vehicle are obvious. Drug and alcohol abuse among truck drivers can be a dangerous problem for drivers who abuse these substances. It's important to be alert to the physical indicators that would tip you off to drug use and alcoholism. Then I think in general things look pretty good but before I sign your card I'd like to review those medical records that your family doctor will be sending me and also get back the results of the urine and blood tests. Okay, is there anything that I should be concerned about? The most important thing is that you follow up with your doctor regarding this new blood pressure medicine. It's important to know that this medicine will control your blood pressure plus that it doesn't give you any of the side effects such as drowsiness that the old medicine gave you. It's important that you stay alert because of all the responsibility that you carry while you're out there on the road. Okay, as soon as I get back from back east I'll make an appointment with the doctor and get in and talk to him. I see you're a non-smoker Clint, that's real important as far as your long-term health and your ability to stay behind the wheel. So you'll give me a call when you're ready to sign my card? I sure will and I'll let the company know how things turned out also. Okay, well Doc, I sure appreciate your help and everything today. Glad to have been assistance. Clint is a good patient. He was cooperative and is in reasonably good shape. He has a good attitude and an even temperament. High blood pressure is a fairly common problem amongst drivers and the right types of medication are essential. Drugs that create side effects that might have an impact on the driver's ability to handle his vehicle should be avoided. It's also important to remember that drivers who see you for their physical will do their very best to make everything look great. Ask questions, be curious, and when something doesn't seem quite right, don't hesitate to check the driver's medical history and records. You need to get his permission to do this, but it could reveal a great deal about his current physical status. So, if there's any doubt in your mind at all, get the patient's permission and check the previous records. Also, if you do run across a driver that you see as a possible safety threat, don't be afraid to contact the company he drives for or another physician that has seen him in the past. You need to honor your patient's right to confidentiality, but you can alert others to the fact that you are not signing his card or clearing him for further driving duties. Many drivers will shop around looking for an easy mark. Don't be intimidated into signing the driver's medical card. Pay close attention to the details. Dig a little bit. Don't assume someone else will catch a problem if there is one. The lifestyle and pressures that commercial truck drivers are forced to deal with are incredible. Poor sleep habits, improper diets, pressures of weather, safety, and tight schedules all add up to have a serious impact on the driver's health. It is important that you are aware of these unique factors when you are dealing with commercial drivers and giving them advice about their personal health habits. When you sign the driver's card, it's normally valid for two years, but if you have concerns about specific medical conditions, it is within your power to shorten this time frame. For elevated blood pressure, give the driver a three to six month card and tell him you need to see him toward the end of that period to ascertain control of the high blood pressure. When you sign this card, be sure to date it, and don't forget to write in the expiration date as well. For many drivers, you may be the only physician they are seeing until a serious health problem arises. If you cannot clear him for health reasons, he may be out of work and not qualified for another occupation. The safety of this driver as well as numerous other road users rests upon this card. Studies show that 80% of those killed in highway accidents involving large trucks are persons other than those operating the trucks. Therefore, the traveling public takes on the vast majority of the risk in trucking accidents. The examination that you give the commercial truck driver can help decrease that risk. Keeping drivers fit for the road can be one of the most important roles that you play in keeping the nation's highways safe. Funding for this program has been provided to the state of Idaho through the U.S. Department of Transportation Motor Carrier Safety Assistance Program.