Assessing Fitness to Drive
Quarterly Newsletter

April 2024

Welcome to the April edition of the Assessing Fitness to Drive newsletter. Each quarter we will deliver to your inbox a host of useful updates and resources relating to Assessing Fitness to Drive. In this issue we are pleased to have expert contributions on a range of topics including seizures and older driver education. There are also new resources for managing mental health and driving and support for commercial vehicle drivers.

We are keen to hear from you. If you have ideas or useful resources to share, please get in touch.

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Education

No changes to fitness to drive requirements for people diagnosed with autism

Recent publicity relating to the management of driver licensing for people with autism spectrum disorder (ASD) has raised concerns among drivers, potential drivers, their families and health professionals.

This statement from Austroads clarifies how neurodevelopmental conditions such as ASD are intended to be managed according to the national Assessing Fitness to Drive standards.

What are the reporting requirements for people with autism spectrum disorder?

For all health conditions and disabilities, if the symptoms of a condition are likely to impact a person’s ability to drive safely, they are obliged to report this to the licencing agency in their state or territory. This is a requirement of state and territory road safety laws throughout Australia.

The range and severity of ASD symptoms vary considerably. Some people diagnosed with ASD will not have symptoms that impact their ability to drive safely. A diagnosis of ASD or another neurodevelopmental disorder does not compel a person to report.

• Adults who are diagnosed with autism and who hold a licence, are not required to report the diagnosis if their symptoms are not likely to affect their capacity to drive safely.
• Novice drivers and those learning to drive who are diagnosed with autism are not required to report the diagnosis if their symptoms are not likely to affect their capacity to drive safely.

How do you know if your condition impacts on driving?

For all health conditions and disabilities, it is the role of the treating health professional to advise about the potential impacts on driving and road safety. For neurodevelopmental conditions, they will consider the impact on a range of attributes required for safe driving, such as visuospatial perception, insight, judgement, behaviour, attention, comprehension, reaction time, memory, sensation, muscle power, coordination and vision.

To gain an understanding of the impact of a person’s condition on driving, the health professional may refer them for a practical driver assessment or for an appropriate allied health assessment. Practical driver assessments are used to supplement the clinical assessment and are used for many health conditions to inform fitness to drive decisions.

Anyone concerned or uncertain about the impacts of their condition on driving should consult their treating health professional.

Periodic reviews of the Standards consider current evidence, including evidence of crash risk associated with medical conditions and evidence relating to the assessment and management of medical conditions that are likely to affect safe driving. Reviews also consider inputs from the public and health professionals. The next review is scheduled for 2025.

Supporting understanding among health professionals, drivers and families

One of the first initiatives we are planning is a fact sheet for aspiring drivers and their families. Through our ongoing engagement with relevant stakeholders, the fact sheet will draw on advice from experts in the field as well as the lived experience of those with ASD and their families. It will support understanding of how ASD can impact on safe driving, and the key considerations and steps involved for young people with autism and their families when they are thinking about the possibility of driving.

It is timely that our work in this area coincides with the release and consultation for the draft National Autism Strategy, an Australian Government initiative aimed at improving life outcomes for autistic people through a coordinated national approach to services and supports.

The draft Strategy outlines a vision, guiding principles, outcome areas and commitments to guide the Australian Government efforts. Implementation of the Strategy will be supported through action plans, an evaluation framework and a plan for facilitating the continued involvement of Autistic people and the autism community.

The draft National Autism Strategy is now available for public comment and feedback until 3.00pm 31 May 2024. 

Austroads and the NTC see this as an opportunity to highlight the importance of driving as an issue for people with autism and to propose strategies relevant to Assessing Fitness to Drive. We plan to make a joint submission to the consultation on the Strategy and to engage with the National Autism Strategy Oversight Council. 

Seizures and epilepsy - exceptional cases

We have received a number of enquiries from driver licensing authorities, health professionals and drivers about the application of the “exceptional cases” criteria for seizures and epilepsy contained in Assessing Fitness to Drive. We sought advice from Professor Ernest Somerville, who is a longstanding contributor of expertise in the development and implementation of the Standards and sits on the Austroads Implementation Advisory Group.

Prof Somerville notes that the standards for seizures and epilepsy were developed with strict criteria to provide treating clinicians with a clear and objective foundation for decision-making about driving. This supports consistent management but also protects the client and doctor relationship.

There are however some circumstances where a patient may be unfairly affected by the strict application of the criteria. These are the types of cases that can be considered under the “Exceptional cases” criteria. 

The test for the application of these criteria is whether the patient’s risk is substantially less than the rest of the group where the standards apply. Doctors/drivers seeking assessment under the exceptional cases criteria will need to provide evidence accordingly.

Driver licensing authorities will generally need to seek their own independent expert advice to establish whether the evidence provided does reflect a reduced risk. Independent medical panels or specialist advisors are means by which driver licensing authorities can seek independent expert advice for complex cases and cases such as those seeking consideration under the Exceptional cases criteria.
 

Research

Landmark trial examines best driver education methods for enhancing safety and skills in older drivers

Through the world-first Better Drive Study, Researchers at the University of New South Wales Ageing Futures Institute and Neuroscience Research Australia are seeking to understand which methods of driver education can best improve the driving skills and safety of older drivers.

Driving is critical for enabling mobility and community participation, reduces loneliness and isolation, and helps us maintain independence as we age; over 90% of those aged in their 70s are licensed drivers. However, older drivers are overrepresented in fatal crashes per distance travelled and have the highest health care costs when involved in a crash. With an ageing population, there is an urgent need for evidence-based methods to enhance and maintain older drivers’ skills - methods that are ready for translation into cost-effective and practical interventions.

“Our research program has identified factors that increase older driver risk, and developed interventions that target skills and knowledge, with the potential to significantly improve drivers’ safety and crash risk.” says Professor Kaarin Anstey from the UNSW Ageing Futures Institute and Neuroscience Research Australia. 

This research, along with pilot work conducted in Australia and internationally, has identified intervention elements that are key to improving safety. However, Professor Anstey notes that “we lack data on whether intervention gains are maintained over time, adherence and cost-effectiveness”. The Better Drive Study is a world-first trial investigating which methods of driver education can best improve the driving skills and safety of older drivers.

The three-arm randomised controlled trial assesses the effectiveness of different driver education types on safety outcomes for older adults. The study will examine the relative effectiveness of tailored lessons, road-rules workshops, and tailored feedback on on-road driver performance. Over 500 individuals expressed interest in participating in the trial, with 210 eligible and enrolled in the past year. This level of interest reflects a wider demand from seniors for evidence-based driver safety programs. One study participant reported: “Many of my friends and acquaintances around the same age are envious I am in this program. I get lots of comments, most people would love the opportunity to check and improve their driving.” Participants are now completing a 12-month follow-up off-road test and an on-road driving test. The project outcomes will lead to the development of translatable programs for older drivers that seek to maintain safety, mobility, and community participation.

For more information
Website: UNSW Ageing Futures Institute and Better Drive Study 
Email: ageingfutures@unsw.edu.au or betterdrive@​neura.​edu.​au

References

1. Thompson, J. P., Baldock, M. R. J., & Dutschke, J. K. (2018). Trends in the crash involvement of older drivers in Australia. Accident; analysis and prevention, 117, 262–269. https://doi.org/10.1016/j.aap.2018.04.027

2. Anstey, K. J., Eramudugolla, R., Huque, M. H., Horswill, M., Kiely, K., Black, A., & Wood, J. (2020). Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia. JAMA network open, 3(6), e208263. https://doi.org/10.1001/jamanetworkopen.2020.8263

Contribution of driver fatigue to casualty and fatal crashes in SA

Researchers at the Centre for Automotive Safety Research in South Australia have recently completed a study exploring the contribution of driver fatigue to motor vehicle crashes that have resulted in death or serious injury. The findings point to the value of vehicle safety technology in preventing fatigue-related crashes.

This study explored the contribution of driver fatigue to casualty and fatal crashes
in South Australia, as well as the role that fatigue played in the crashes, the risk factors that led to the fatigue and the countermeasures that could have prevented the crashes from occurring.

The results revealed that fatigue contributed to:

• 11 (4.3%) of 254 casualty crashes and
• 18 (11.5%) of 156 fatal crashes in South Australia.  

The most common risk factors for fatigue were: 

• long-distance driving (41.4%)
• no/reduced/broken sleep (27.6%)
• illicit drug use (17.2%), and 
• abnormal work/sleep routines (17.2%). 

The researchers identified that vehicle technologies would have prevented many of these crashes:

• lane keep assist (could have prevented 79.3% of crashes)
• lane departure warnings (65.6%)
• drowsiness detection/warnings (55.2%)
• audio tactile centre lines (41.4%), and 
• autonomous emergency braking (34.5%).

The findings will assist in the targeting of future public education messaging to prevent driving while fatigued and have identified that vehicle technologies are likely to be the most effective countermeasures for preventing fatigue crashes.

Read the report

Managing health and safety for aging heavy vehicle drivers

Researchers at the Monash University Accident Research Centre (MUARC) and the Queensland University of Technology (QUT) have recently explored how middle managers in the transport industry understand and manage health and safety issues for older heavy vehicle drivers. 

At 48 years, the average age of heavy vehicle drivers is well above the average for Australian workers (41 years), and there is ongoing interest in ensuring the transport industry is equipped to support the health and safety of aging drivers. 

Through a series of interviews with middle managers in the transport industry, the researchers sought to understand the barriers and facilitators associated with the health, safety and well-being management of aging heavy vehicle drivers. This level of management plays an important role in interpreting and translating policies and procedures created by senior management and conveying safety messages to drivers.

The researchers found that, despite an abundance of health, safety and well-being resources, there was limited specific guidance or direction from regulators, government bodies, and upper levels of organisational management on how to manage aging issues. This is compounded by a lack of disclosure by aging workers about their health and medical conditions. 

The study suggests training road freight transportation managers about aging issues, including typical age-related changes; hazardous work tasks for aging workers; modifications available to suit aging workers; and healthy lifestyle guidance for aging, would empower them to deal consistently with the aging issues they are already managing on an individualised basis and thus benefit heavy vehicle drivers across the industry.

Read the report

Resources

Mental health and driving – updated guidelines launched by Northern Health 

Driving is an important consideration for people living with mental health conditions, due not only to the potential safety impacts of their condition and treatments, but also to the potential challenges associated with not driving such as isolation and lack of independence, which may limit their recovery and re-engagement with their community. 

Mental health clinicians play an important role in identifying and managing road safety risks, supporting consumers to understand their responsibilities and make decisions about driving, and helping them to access necessary support.

Recognising the need for comprehensive guidance for clinicians working in this complex area, the Northern Health Drive Safe Program first developed guidelines in 2009. For the latest version consumer and carer lived experience staff were integral to the review team. The team endeavoured to underpin the guidelines with the mental health recovery framework and encourage clinicians to collaborate and partner with consumers, supporting them to drive safely and avoid driving when not fit or safe to drive.

With the aim of assisting mental health clinicians to support consumers to reach their driving goals, the guidelines address key aspects such as:

• Having conversations with consumers, family and carers about driving and road safety responsibilities.
• Supporting consumers in gaining and/or maintaining their driver’s licence and facilitating alternative community mobility and maintenance of routines if consumers need to cease driving temporarily or longer term.

The guidelines include information relevant to the various phases of a mental illness, including on entry to the service, and during the acute, sub-acute, rehabilitation and transition/discharge phases. They also provide advice on where to obtain advice and support regarding complex clinical scenarios.

Download the Guidelines here

For further information please contact Carolyn Dun, Lead Drive Safe Program, Professional Leader Occupational Therapy, Northern Area Mental Health Service, Northern Health, Preston Victoria.

About the Drive Safe Program

The Drive Safe Program created by Northern Health mental health occupational therapists, aims to support consumers to be aware of their responsibilities as drivers with a mental health condition, whether they choose to maintain, resume, begin or cease driving during their recovery.

 Free counselling and 24/7 phone support for transport and logistics workers and their families

Developed by the OzHelp Foundation, in collaboration with truck drivers and the transport community, Health in Gear has been created to support the health and wellbeing of transport and logistics workers on the job and at home.

Nationally, truck drivers represent the second highest occupational group, after construction workers, at risk of suicide. With this in mind, the program has designed support focused on the health and wellbeing of road transport and logistics workers and their families.

This includes health tips for staying well, roadside health checks, free counselling and 24/7 phone support services, and the Share the Load podcast.

The 24/7 phone support line is answered by trained professionals who understand the unique demands and challenges of the industry. Afterhours support is provided by Trauma Centre Australia, where their team of trusted psychologists continue to offer tailored support to those who need it.

The initiative aims to get workers thinking about how small actions can make a big difference, helping them stay mentally and physically healthy while keeping the wheels turning too!

The Health in Gear program is a health promotion initiative funded by the National Heavy Vehicle Regulator’s Heavy Vehicle Safety Initiative supported by the Federal Government with contribution from OzHelp and industry partners.

For more information visit https://healthingear.com.au/

Fatigue & distraction heavy vehicle toolbox talk

In-vehicle distraction has been shown to represent a specific risk for professional drivers, contributing to an estimated 10-30% of collisions.

Fatigue has physical, mental, and emotional attributes. Heavy vehicle drivers are at high risk of developing chronic fatigue due to hectic work schedules and sleep loss associated with long-haul driving. In 2020, 8% of all truck large loss crashes in Australia were caused by fatigue. When we are fatigued, our brains start looking for thoughts or activities to keep us awake — distractions. In-vehicle distraction has been shown to represent a specific risk for professional drivers, contributing to an estimated 10-30% of collisions.

The talk features interviews with drivers from Holcim and Bingo. Each give their own tips and stories about their experiences, but ultimately they share the same message: the importance building resilience as a professional driver.

The package was peer reviewed by industry experts to ensure it is relevant, accurate and delivered in a way that will engage drivers. This information is sourced from a combination of industry bodies and scholarly texts.

Download the pack

Exploring the complexities of assessing older drivers' fitness to drive

The latest edition of the clinical communique looks at the challenging aspects of determining fitness to drive in older drivers.

Advancing age is associated with co-morbidities that cumulatively increase driving risk
and will affect a person’s fitness to drive. Stroke, dementia, sleep disorders, mobility
issues, hearing and vision impairment may warrant cessation of driving.

The two cases in this edition demonstrate two main risk profiles in older drivers – the driving risks when a patient is bodily capable but easily disorientated, and the driving risks when a patient is mentally sharp but physically slow. Professor Dimity Pond’s expert commentary shares insights about fitness to drive in older drivers from the perspective of the patient, the health professional, and the system.

Read the communique

Stakeholder news

New Action Plan to guide road safety in the ACT

The ACT Road Safety Action Plan 2024-2025 continues to apply the goals of the current Road Safety Strategy 2020-2025 and builds on the achievements of the outgoing action plan.

The 5 focus areas of the new Action Plan include:

• distracted and dangerous driving
• impaired driving
• vulnerable road users
• education, awareness, engagement and compliance
• safe roads and infrastructure.

Several actions are relevant to Assessing Fitness to Drive including those relating to the health and heavy vehicle drivers and to senior road users:

• Implementing the new requirements under the Road Transport Legislation Amendment Act 2022 for mandatory reporting by health practitioners of conditions affecting heavy vehicle drivers’ fitness to drive.
• Advocating to achieve health screening requirements for heavy vehicle drivers similar to those for train drivers.
• Promoting safe choices among seniors and supporting their independence by, where appropriate, identifying and supporting the adoption of safe and practical alternatives to driving.

The new Action Plan sets clear expectations and directions for the ACT Government to do everything possible to reduce road trauma as we strive for Vision Zero. The ACT Government is committed to Vision Zero acknowledging that road deaths and serious injuries are preventable and no death or injury on our roads is acceptable.

Read the Road Safety Action Plan 2024-2025

Austroads and the National Transport Commission welcome your feedback

Do you have any feedback about Assessing Fitness to Drive?

Austroads and the National Transport Commission welcome your feedback about the Assessing Fitness to Drive standards so that we can consider these in preparation for the next review, and address implementation issues in a timely way through Austroads' ongoing Implementation Project.

Provide feedback here