Assessing Fitness to Drive

Table of Contents

1.3 Medical standards for licensing

Where a firm diagnosis has been made, the standard appropriate to the condition should be referred to in this publication (refer to Figure 6). For blackouts due to medical causes not covered in the standard, refer to first principles (refer to Part A section 2 Principles of assessing fitness to drive). For blackouts of unknown mechanism, refer to the criteria in the table 'Medical standards for licensing – Blackouts of uncertain nature'.

Figure 6: Management of blackouts and driving

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

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)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition)

Blackouts (episode/s of impaired consciousness) of uncertain nature

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 six 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 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 five 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.
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.

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, 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 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 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 different 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.

The presence of other medical conditions

While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive, for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7 Multiple medical conditions and age-related change).

Reporting responsibilities

Patients should be made aware of the effects 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 affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3.1 and step 6 of the assessment and reporting process).

Further reading

Sorajja D, Nesbitt GC, Hodge DO, Low PA, Hammill SC, Gersh BJ, Shen WK. Syncope while driving: clinical characteristics, causes and prognosis. Circulation. 2009 Sep 15; 120(11): 928–934.