Driver Screening and Evaluation Program
Volume III: Guidelines for Motor Vehicle Administrators
The screening and evaluation of drivers in the interest of personal and public health and safety has received increasing attention since the publication in 1992 of the Model Driver Screening and Evaluation Program: Guidelines for Motor Vehicle Administrators by the National Highway Traffic Safety Administration and the American Association of Motor Vehicle Administrators. Researchers and policy makers in this area have recommended a comprehensive framework that ties the screening and assessment of high-risk drivers to referral, education and counseling, and remediation activities, with an explicit goal of safe mobility for life for all citizens.
In 1998, AAMVA conducted a survey of licensing officials throughout the United States and Canada to address cost and time constraints, as well as legal, ethical, and policy implications that could influence program implementation. Even more recently, pilot programs have yielded important new information about the types of screening techniques likely to be most valuable to identify drivers with significant mental and physical impairments, and also about the costs and feasibility of administering such programs.
This report has been produced by TransAnalytics, LLC and the Scientex Corporation under NHTSA sponsorship, in cooperation with AAMVA, as a resource for jurisdictions in North America wishing to introduce or update a driver screening program. It is not intended as a mandate, nor does it represent the only approach with the potential to promote safe mobility for individuals while meeting Departments of Motor Vehicles' responsibilities in the public health and safety arena. It serves as a Model that may be useful, in whole or in part, as States move to address the changes brought on by an aging population-a population that experiences much higher levels of functional impairment while continuing to depend, to an extraordinary degree, on private vehicles to meet their transportation needs.
This Document is disseminated under the Sponsorship of the Department of Transportation, National Highway Traffic Safety Administration, in the interest of information exchange. The United States Government assumes no liability for its contents or the use thereof. This report does not constitute a standard, specification, or regulation.
The United States Government does not endorse products or manufacturers. Trade and manufacturers' names appear herein only because they are considered essential to the object of this document.
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Essential contributors to the development and review of these guidelines included Dr. Robert Raleigh, Chief, Maryland Motor Vehicle Administration (MVA) Medical Advisory Board; Michael R. Calvin, Senior Vice President, Programs Division, American Association of Motor Vehicle Administrators (AAMVA); Anita Drews-Oppedahl, Motor Vehicle Division, Montana Department of Justice (current Chair) and Julie Clark, Wisconsin Department of Transportation (past Chair), AAMVA Driver License and Control Committee.
It is undeniable that as we age, each in our own unique fashion, we are at increasingly greater risk of experiencing deficits in the various functional capabilities needed to drive safely. These include the visual abilities needed to detect hazards, and the capacity to devote attention to key driving tasks in the face of mounting distractions. The mental skills needed to accurately judge gaps in traffic, and the cognitive functions necessary to make rapid and appropriate maneuver decisions are also essential. Not least are one's physical abilities, including the head and neck flexibility to scan for safety threats before turning, backing, changing lanes, or merging, as well as the arm and leg strength and stamina needed for effective control of the vehicle under normal and emergency response conditions. For virtually everyone in modern society, safely operating a motor vehicle demands a higher level of functional ability and functional integration than any other activity that is a daily part of life.
During the 1990s, evidence began to mount linking functional loss to increasing risk of crash involvement. Department of Motor Vehicle studies have found that unrestricted drivers with certain medical conditions have significantly higher crash and citation rates than control groups without impairments. Analyses conducted by NHTSA provide a strong argument that, given current practices and demographic trends, we can expect to see a sharp increase in both the number and proportion of traffic fatalities related to the declining abilities and frailties of aging over the first quarter of the 21st century.
Following the publication in 1988 of the Transportation Research Board (TRB) Special Report 218, Transportation in an Aging Society, research efforts in this area increased dramatically. An update to this seminal work, entitled A Decade of Experience, was released by TRB in 2002 to summarize current understanding of the problem, and to recognize evolving program activities and countermeasures in this area that appear most effective and feasible to implement. The Office of the Secretary of the U.S. Department of Transportation released the report Improving Transportation for a Maturing Society in 1997, and in 1998-99 organized forums across the country to obtain community-level input to a National Agenda in this area. A major international conference held on the campus of the National Institutes of Health in Bethesda, MD, was similarly devoted to this subject in 1999. In 1999, NHTSA published the Safe Mobility for Older People Notebook, which contains a more detailed discussion of many of the program elements described in this document, plus examples of their application. This resource can also be accessed at www.nhtsa.dot.gov/people/injury/olddrive/safe/tech-doc.htm. Together, such activities reflect a growing consensus that the identification of individuals who pose unacceptable risks to themselves and others by continuing to drive should be a part of public health policy.
To lend support to those officials charged with ensuring safe access to our public roads and highways, the 1992 NHTSA/AAMVA Model Driver Screening and Evaluation Program: Guidelines for Motor Vehicle Administrators has been updated. To the extent that jurisdictions have already implemented elements in the Model Program, this report reinforces best practices. For other jurisdictions, the Model Program may represent a fundamental shift away from a policy that defers primary responsibility for control of at-risk drivers to the individual, family, or physician and toward more active management of at-risk drivers by motor vehicle agencies.
The consistent goal in these Guidelines is to document a means of fairly, effectively, and affordably screening high-risk drivers - identifying those individuals who pose the greatest risk to themselves and to others without placing an unacceptable burden on motor vehicle agencies. To that end, the program elements described herein offer a template that may be tailored to best meet the needs of a particular jurisdiction.
The key features of the Model Program are:
It may be readily acknowledged that, at first glance, the recommended practices in the Model Program will appear unrealistic to some jurisdictions due to budgetary or administrative hurdles. Yet, pilot program results offer encouraging evidence of a substantial and offsetting increase in the efficiency with which an agency can conclude a medically sound determination of fitness-to-drive. And given the near-certainty that dramatically higher numbers of functionally-impaired drivers will seek (re)licensure in the years ahead, the collateral savings to society from the prevention of motor vehicle injuries makes the case for innovative public health initiatives all the more compelling.
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