The first update published was the one distributed in August of 2002 that shortens the duration of not driving after a seizure in uncomplicated cases. This is incorporated into the body of guidelines.

Further updates were published in March 2006 for five conditions and these are available on the Home page for viewing and printing as .pdf files. As a new BC Guide is currently under development for expected publication in 2007, the latest guidelines are not incorporated into the body of the 1997 Guidelines.

"Parking Lot" first posting in spring 2005, as follows:

The "Parking Lot" is a new feature for 2005.

If practitioners have any concern about these proposed updates to the "Guide to Drive," please advise Dr. John McCracken or Dr. Ian Gillespie, as soon as possible. Implementation of updates may be delayed if we are presented with reasons to give more consideration to these proposals.

Vision, Cardiovascular, Hearing, Seizure, and AAA Revisions appear below:

May 4, 2005 - Vision

In 2000, the Working Group on Driving Standards, of the Canadian Ophthalmological Society (COS), developed a set of recommendations for new vision standards for driving in Canada and a new standardized approach to the application of these standards. These recommendations were presented to the Canadian Medical Association for inclusion in the ongoing revision of the Physician’s Guide to Driver Examination. The recommendations represent the consensus opinion of the working group and are based on a literature review, the experience and expert opinion of the members of the working group and comments from other individuals and organizations. The recommendations contain substantial changes from the current BC Guide, with more liberal standards and an emphasis on binocular testing. It was the working group’s opinion that these changes reflected a more sensitive, evidence-based approach to the minimum vision requirements for licensing.

In 2004 further changes were recommended by the COS Driving Standards Committee and were approved by the Canadian Ophthalmological Society the same year. These changes were also reviewed by the BC Society of Eye Physicians and Surgeons and have been widely accepted. The changes were recommended primarily out of a need to rationalize and standardize the methodology used in visual field testing, and to simplify the classification of drivers for the purpose of applying vision standards. Significant changes include the requirement for 50 degrees of field along the horizontal meridian on either side of fixation, and a further relaxation of acuity standards.

The 2004 amendments to the vision guidelines were presented to the Canadian Council of Motor Transport Administrators (CCMTA), an interprovincial association of licensing regulators, to consider for inclusion in the national guidelines governing driver fitness (the National Safety Code for drivers). The CCMTA will ask the provinces to vote on these changes in the near future. The editors of the BC Guide also wish to be ready to update Section 2 of our Guide in a timely way. Exact wording of the proposed new section is available in this Vision Section Proposed Change .pdf file.

We appreciate any feedback that you may have pertaining to these guidelines, as it will assist the Office of the Superintendent of Motor Vehicles in its voting decision and in making the necessary alterations to our “BC Guide.”

February 24, 2005 - Cardiovascular

The following guidelines for cardiac fitness to drive were approved by the Canadian Cardiovascular Society in 2004 and submitted to the Canadian Council of Motor Transport Administrators (CCMTA), an inter-provincial association of licensing regulators, to consider for inclusion in the national guidelines governing driver fitness (the National Safety Code for drivers). The CCMTA will ask the provinces to vote on these changes in the near future. The editors of the BC Guide also wish to be ready to update Section 4 of our Guide in a timely way. We appreciate any feedback that you may have pertaining to these guidelines, as it will assist the Office of the Superintendent of Motor Vehicles in its voting decision and in making the necessary alterations to our “BC Guide”.
The most significant changes that will affect physicians’reporting requirements are:
· Use of the NYHA functional class in place of the CCS functional class.
· Reduced reliance on treadmill testing to determine functional class and driving fitness.
· Reduced frequency of reassessment of drivers with stable cardiac conditions.
Exact wording of the proposed new section follows is in this Cardiovascular Diseases .pdf file.

January 24, 2005 - Hearing

The literature pertaining to driving risk associated with hearing loss is scant and results are inconsistent and not strongly supportive of a need to restrict these drivers. The editors thus wish to minimize the restriction on professional drivers in the BC Guide and bring this into alignment with current National Safety Code and CMA recommendations. Details, including comparisons of content, are available in a pdf file for your review.

After deleting the last sentence of paragraph 2 in sec 3.0 and deleting sec 3.3 in its entirety, the preamble in the “BC Guide”will remain unchanged. The editors propose to revise the BC guide by substituting the NSC standard. We request your input regarding this proposed change.

January 24, 2005 - Seizure

The following change (italic section) to the Neurology chapter has been approved by a survey of the Neurology Section of the BCMA. The rationale is that a person would be less likely to experience a seizure on medication than off, so why wait ten years on, while only 5 years off?

7.3.3 - It is unsafe for a person who must take antiepileptic medication to prevent seizures to operate passenger carrying or commercial transport vehicle (classes 1,2,3 or 4) because of the greater degree of certainty required that they will not have a seizure while driving. Professional drivers are often unable to avoid driving for long periods of time under extremely adverse conditions or avoid highly stressful or fatiguing situations that could act to precipitate another seizure. Unfortunately, seizures do sometimes recur, even after many years of successful treatment, however, individuals may drive any class of vehicle if they have been seizure free for 5 continuous years on medication or five continuous years off medication.

7.3.7 - Since some patients with fully controlled seizures whose antiepileptic medication is being withdrawn by their physician, do have a recurrence of their seizures, persons whose medication is being discontinued, should always be cautioned that they could have further seizures. Private drivers must not drive for a period of three months from the time that their medication has been discontinued. If the seizures recur after discontinuing their antiepileptic medication on their physician's instructions, they can again drive safely when they have resumed the medication, provided they had previously been seizure free for six months and their physician is satisfied that the medication is adequate.

Professional drivers whose medication is being discontinued by their doctor must be seizure free for five years before resuming professional driving. If the seizures recur, they must be seizure free and back on medication for a period of six months before resuming professional driving.

Patients with epilepsy whose antiseizure medication has been discontinued and wish to obtain a professional licence can do so once seizure free and off medication for five years.

January 24, 2005 - AAA (Abdominal Aortic Aneurysm)

The current B.C. guidelines state that no class of driving licence should be issued to a person with an untreated AAA of 5 cm or greater diameter. The Canadian Cardiovascular Society developed a the Risk of Harm Formula in which the amount of time spent driving and the size of the vehicle driven are taken into account in calculating the risk of harm to others posed by a driver who suddenly lost control of a vehicle from a cardiac event. The formula is somewhat crude and not widely accepted, but it does reflect the fact that an accident resulting from sudden incapacitation would be more likely to occur while driving if you drive more, and that the bigger your vehicle is, the more harm you could cause. The calculation asserts that a private driver with a 22% per year risk of sudden incapacitation poses no greater threat to public safety than a heavy truck driver with a 1% risk.

The National Safety Code has been revised to reflect the foregoing to at least some extent. The NSC recommendation is that a professional driver may not be licenced with an AAA of 5.5 cm diameter or greater, and for a private driver, 6.5 cm or greater. We propose to incorporate this standard in the BC Guide.

The derivation of the Risk of Harm Formula can be found in the pdf file provided for your reference.

There is no published standard or definition of what level of risk is considered acceptable in Canada, even though this is crucial in the formulation of guidelines based on the probability of some event occurring in a defined time period. It was necessary, therefore, to develop such a standard.

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