Traumatic brain injuries (TBI) can have lasting effects on a driver’s memory, reasoning, sensation, communication and understanding, and cause emotional issues including depression, anxiety and personality changes.
I have examined a driver who has history of auto accident and suffered a fractured skull, small subdural hematoma, no history of seizures, no surgery. He was cleared to drive by Neurologist. Is it ok for him to drive commercial motor vehicle under these circumstances?
Certified Medical Examiner
There are 3 classes of TBI:
- Severe head injury penetrates the dura and causes a loss of consciousness lasting longer than 24 hours. There is a high risk for unprovoked seizures, and the risk does not diminish over time.
- Moderate head injury does not penetrate the dura but causes a loss of consciousness lasting longer than 30 minutes, but less than 24 hours. Skull fractures and sub-dural hematoma are considered moderate head injuries even where loss of consciousness is less than 30 minutes.
Medical Expert Panel report, Traumatic Brain Injury, Oct, 2009:
In addition, the presence of a skull fracture, even with the shorter (<30 minutes of loss or alteration of consciousness or post-traumatic amnesia) would place the TBI in the moderate category.
- Mild head injury has no dural penetration or loss of consciousness and lasts for fewer than 30 minutes. Be sure to distinguish between mild TBI with or without early seizures.
The length of time an individual is seizure free and off anticonvulsant medication is considered the best predictor of future risk for seizures. Therefore, for the entire waiting period before being considered for certification, the driver must be both:
- Seizure free.
- Off anticonvulsant medication prescribed for control of seizure.
NOTE: Surgical procedures involving dural penetration have a risk for subsequent epilepsy similar to that of severe head trauma. Individuals who have undergone such procedures, including those who have had surgery for epilepsy, should not be considered eligible for certification.
- Severe TBI: Cannot be certified due to the high life long risk of seizures and other neurological effects
- Moderate TBI: Without seizure: Minimum 2 year waiting period seizure free and off anti-seizure medication, With Seizure: minimum 5 year waiting period
- Mild TBI with seizure: Minimum 2 year waiting period.
The driver with a mild or moderate TBI may be certified who has:
- Completed the minimum waiting period seizure free and off anticonvulsant medication.
- Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological test.
- Clearance from a neurologist who understands the functions and demands of commercial driving.
In the case of the driver posed above, he would be considered to have a moderate TBI and must undergo a waiting period of 2 years before consideration for medical clearance.
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