FMCSA's medical review board: five years of progress in commercial driver medical examinations.

OBJECTIVE: To revise and update guidance recommendations to the Federal Motor Carrier Safety Administration for evaluating commercial drivers.

METHODS: The Federal Motor Carrier Safety Administration's medical review board has addressed guidance for commercial drivers for the past 5 years. The processes for most topics involve comprehensive literature searches, evidence reports, medical expert panel reports, critique of the literature, testimony, and decision making.

RESULTS: No quality literature evaluating risk of crash among commercial motor vehicle drivers was found for most medical conditions. Little literature was available for crash risk among all drivers. For select conditions, such as seizure disorders, obstructive sleep apnea, and narcolepsy, there is evidence of increased crash risk among the general driving population and evidence-based guidance is now available.

CONCLUSIONS: Detailed guidance from the Medical Review Board is available for assessing commercial drivers with various disorders. Many challenges remain.