Traffic Medicine Research Articles

How to Assess Fitness to Drive in Patients with Cardiac Rhythm Disturbances Through an Applicable Decision Support System

Disturbances in cardiac rhythm affect a significant fraction of the population; they can have an ample range of repercussions on one person's quality of life, from negligible to lethal. As an implication, arrhythmias concern many private, commercial and public-passenger-vehicle driving licence holders.In their practice, medical professionals can be asked to assess an arrhythmia patient's fitness to drive effectively.Due to the subject's complexity (requiring an extent of multidisciplinary competencies), the current guidances' heterogeneity and the possible ethical conflicts, the decision-making process becomes challenging and of particular concern to the doctor.To offer an applicable decision support system to doctors of various backgrounds to implement in their practice when asked to assess for fitness to drive in a patient with a suspected disease, a formulated diagnosis or subjected to therapy for cardiac rhythm disturbances, we started gathering the issues concerning the fitness assessment of drivers (or candidates) who present with any condition, symptom or treatment possibly or knowingly caused by cardiac rhythm disturbances.Subsequently, we reviewed the English-based literature, including various countries' published medical standards.Then, the overview was revised by local medical experts in clinical arrhythmology, electrophysiology and traffic medicine to reach a consensus statement at a local level.The result is an easily consultable operational protocol that lists conditions, symptoms or treatments caused or possibly caused by cardiac rhythm disturbances; the certifications required for the assessment of the driver (or candidate); the orientation about the fitness or unfitness to drive under the enlisted medical conditions (distinguishing between private and professional drivers); and the recommended time limits to revise the case.A particular focus is applied to patients subject to the remote monitoring system of an implantable cardiac device, as this innovative approach constitutes a solid and efficient instrument for an accurate evaluation of the patient's cardiovascular situation.Despite some limitations, mainly concerning the lack of information at the moment of the evaluation or the infrequency of the medical condition, this proposal offers a ready-to-use solution for doctors who are asked to give their professional (clinical or medico-legal) opinion about the fitness to drive of patients with an arrhythmia problem. As an advantage, the constant cooperation among professionals from different backgrounds, like electrophysiologists and traffic medicine experts, allows a more individual, less predetermined evaluation of the specific case.

Comprehensive evaluation of cocaine and its hydroxy metabolites in seized cocaine and a large cohort of hair samples.

As cocaine (COC) is not only incorporated into hair via blood following ingestion but also by external contamination, hair samples are commonly tested for COC metabolites to prove ingestion. However, COC metabolites can also be present as degradation products in typical street COC samples. The present study investigates minor hydroxycocaine (OH-COC) metabolites p- and m-OH-COC together with p- and m-hydroxybenzoylecgonine (OH-BE) in seized COC (n = 200) and hair samples from routine case work (n = 2389). Analytical results of hair samples were interpreted using an established decision model for the differentiation between actual use and external contamination using metabolic ratios (metabolite to COC). They were further examined concerning background of request, hair color, body site of sample collection, sex, and metabolic ratios of the main metabolites [benzoylecgonine (BE), norcocaine (NC), and cocaethylene (CE)]. All seized COC samples were positive for p- and m-OH-COC with a maximum percentage of 0.025% and 0.052%, respectively; p- and m-OH-BE were detected in 55% and 56% of samples with a maximum percentage of 0.044% and 0.024%, respectively. Analytical results of 424 hair samples (17.7%) were interpreted as being predominantly from contamination; the majority of these samples were from traffic medicine cases (83.7%). Metabolic ratios of minor OH-COC metabolites were significantly higher in hair samples interpreted as originating from use than in samples interpreted as caused by contamination. Metabolic ratios for OH-COCs were significantly higher in forensic cases compared to abstinence controls and also in black hair compared to blond/gray hair. However, this was not the case for OH-BE metabolic ratios. No statistical difference was observed with regard to the donor's sex. OH-COC metabolic ratios increased significantly with increasing ratios of NC and CE to COC, respectively. The study demonstrates that OH-COC metabolites (including thresholds for their metabolic ratios) must be used for a reliable interpretation of positive COC results in hair samples.

The Documentation of Injuries Caused by Traffic Accidents.

Persons injured in traffic accidents may have injuries of characteristic types that are of significance for the complex reconstruction of the accident and whose medicolegally sound clinical documentation is highly important. This is of particular relevance for the approximately 55 000 persons who are severely injured in traffic accidents in Germany each year. Gaps in documentation are often disadvantageous for the injured persons. This review is based on pertinent publications retrieved by a selective literature review, with additional consideration of relevant textbooks in traffic medicine and legal medicine, as well as the guidelines of the AWMF (Association of the Scientific Medical Societies in Germany). Injuries in traffic accidents typically differ depending on the mode of participation of the injured person in traffic. They must be examined with a view toward the sequence of events of the accident and documented in medicolegally sound fashion. In particular, because of the different mechanical forces involved, it is important to document the seat that the injured person occupied in the automobile, the nature of the collision (pedestrian vs. automobile; bicycle, e-bike, e-scooter, and motorcycle accidents), and the protective devices that were in use. The precise documentation of injuries and examination findings, with critical consideration of their plausibility in relation to the sequence of events of the accident as far as it is known, is an important duty of the physician. This documentation serves as the basis for further judicial steps leading to compensation when legally appropriate.

From Deutsche Zeitschrift to International Journal of Legal Medicine—100 years of legal medicine through the lens of journal articles

The interruption of the publication of the Deutsche Zeitschrift für die gesamte gerichtliche Medizin due to the war ended with volume 39 for the years 1948/1949. Until volume 66/1969, the journal appeared unchanged under the historical title. The 912 publications contained in the 28 volumes of these two decades cover topics from the main fields of forensic medicine, but also from related and unrelated disciplines. The topic-specific analysis of the publications shows a shift of the research focus in the German institutes since the post-war period. This is most evident in the decline in the number of publications from the fields of scientific and technical criminalistics as well as forensic psychiatry and psychology. An opposite trend with a significant increase in scientific papers was observed in alcohology, forensic genetics and traffic medicine. While the evaluated publications on most topics contain new findings that are still valid today, the use of blood group characteristics for forensic purposes came to an end as a result of the introduction of DNA analysis.

A Bio-Inorganic Hybrid Hemostatic Gauze for Effective Control of Fatal Emergency Hemorrhage in "Platinum Ten Minutes".

Death from massive hemorrhage represents a global problem. It is a challenging task to design hemostatic materials with significant efficacy, good biocompatibility, reliable safety, and high stability. In this study, we demonstrate an effective bio-inorganic hybrid hemostat fabricated by stepwise procedures of on-site growth of zeolite gauze and immobilization of trypsin on the zeolite gauze. The as-synthesized hybrid hemostat catalyzes the transition of prothrombin-to-thrombin and exhibits excellent procoagulant performance in the both normal plasma and FX-deficient plasma. The hemostatic treatment of junctional femoral artery rupture in the porcine model confirms that this hybrid hemostat manifests itself with superior hemostatic performance over commercial hemostatic dressings, in terms of a reduced time to hemostasis and blood loss. The stability of the hybrid hemostat is validated through high temperature and violent shaking evaluation. This bio-inorganic hybrid hemostat displays high procoagulant activity, low cytotoxicity, and extended shelf life which may achieve the "Platinum Ten Minutes" rescue in battlefield and traffic accident medicine.

Strong evidence for age as the single most dominant predictor of medically supervised driving test\u2014mini mental status test outcomes provide only weak but significant moderate additional predictive value

BackgroundWith age, medical conditions impairing safe driving accumulate. Consequently, the risk of accidents increases. To mitigate this risk, Swiss law requires biannual assessments of the fitness to drive of elderly drivers. Drivers may prove their cognitive and physical capacity for safe driving in a medically supervised driving test (MSDT) when borderline cases, as indicated by low performance in a set of four cognitive tests, including e.g. the mini mental status test (MMST). Any prognostic, rather than indicative, relations for MSDT outcomes have neither been confirmed nor falsified so far. In order to avoid use of unsubstantiated rules of thumb, we here evaluate the predictive value for MSDT outcomes of the outcomes of the standard set of four cognitive tests, used in Swiss traffic medicine examinations.MethodsWe present descriptive information on age, gender and cognitive pretesting results of all MSDTs recorded in our case database from 2017 to 2019. Based on these retrospective cohort data, we used logistic regression to predict the binary outcome MSDT. An exploratory analysis used all available data (model 1). Based on the Akaike Information Criterion (AIC), we then established a model including variables age and MMST (model 2). To evaluate the predictive value of the four cognitive assessments, model 3 included cognitive test outcomes only. Receiver operating characteristics (ROC) and area under the curve (AUC) allowed evaluating discriminative performance of the three different models using independent validation data.ResultsUsing N = 188 complete data sets of a total of 225 included cases, AIC identified age (p < 0.0008) and MMST (p = 0.024) as dominating predictors for MSDT outcomes with a median AUC of 0.71 (95%-CI 0.57–0.85) across different training and validation splits, while using the four cognitive test results exclusively yielded a median AUC of 0.55 (95%-CI 0.40–0.71).ConclusionsOur analysis provided strong evidence for age as the single most dominant predictor of MSDT outcomes. Adding MMST provides only weak additional predictive value for MSDT outcomes. Combining the results of four cognitive test used as standard screen in Swiss traffic medicine alone, proved to be of poor predictive value. This highlights the importance of MSDTs for balancing between the mitigation of risks by and the right to drive for the elderly.

Recommendations to improve young and novice driver safety in the State of Qatar

Introduction: Young driver behavior and safety are key concerns in Qatar, where they are disproportionately represented amongst road victims and fatalities. This paper summarizes the proceedings of a workshop, entitled “Enhancing the Safety of Young and Novice Drivers in Qatar”, held as a pre-conference workshop of the 24th World Congress of the International Traffic Medicine Association (ITMA) in Doha, Qatar. Methods: A guided discussion was conducted amongst a selected multi-sectoral group of 50 stakeholders, representing Law Enforcement, Health, Society and Education, Transport, and Road Safety. Each group discussed the best evidence and local realities of young driver safety in the State of Qatar. Using a modified Delphi approach, key areas were identified and prioritized; consensus recommendations were obtained and summarized. Results: Based on the stakeholders’ discussions a list of twelve key recommendations has been developed and its elements have been classified in order of priority. These recommendations are supported by relevant published evidence as well as expert opinion and have been shared with the relevant authorities to inform future policies. Conclusions: This article summarizes the workshop presentations and the twelve key recommendations that arose from the discussions and put them forward to the concerned authorities. It should be emphasized that the concerned authorities concerned need to take action on at least the top three recommendations (GDL, improved police enforcement, and improved licensing and training), but also to prioritize all other recommendations that can be easily addressed such as improved roads and auditing and risk-based insurance.

Usability of Norm Values on Results from a Simulator Device and Cognitive Tests in Traffic Medicine

IntroductionDriving is an essential everyday task for most adults, and fitness to continue car-driving after a brain injury/disease is a common issue in rehabilitation settings. There is no consensus on how this assessment should be performed and thus further research and development are of great value. The aim was to study the usability of cut-off values, based on recently developed norm values for a driving simulator device (CyberSiM), as well as cognitive tests, for patients already considered fit-to-drive after a standardized traffic medical investigation.MethodsThe study had a retrospective case-control design. Norm results (n = 129) were compared with patient results (n = 126) divided into two age groups (≤59 years and ≥60 years). Results from Useful Field of View, Trail Making Test, Nordic Stroke Driver Screening Assessment as well as a simulator device (CyberSiM) were compared.ResultsThe group of patients considered fit-to-drive after a traffic medicine assessment had worse results on all cognitive tests compared with norms. Results on CyberSiM subtests II and III did not differ from norms. The proportion of patients within suggested cut-off limits (mean±2SD norm) and considered fit to drive (mean±2SD norm) were highest (75–95%) for all three subtests of CyberSiM and for Useful Field of View in both age groups.ConclusionAvailability of norm values in decision on continued driving is of value when interpreting the results of cognitive assessments sensitive to age, but it must be handled with care because many factors are important for individuals’ ability to drive.

Fitness to drive after acquired brain injury: Results from patient cognitive screening and on-road assessment compared to age-adjusted norm values.

Fitness to drive after acquired brain injury or disease is a common question in rehabilitation settings. The aim of the study was to compare age-matched norms with patient cognitive test results used to predict fitness to drive. A second aim was to analyze the contribution from an on-road assessment to a final decision on resumption of driving after an acquired brain injury. Retrospective cognitive test results from four traffic medicine units (n = 333) were compared with results from a healthy norm population (n = 410) in Sweden. Patients were dichotomized according to the final decision as fit or unfit to drive made by the traffic medicine team. The norm group had significantly better results in all age groups for all cognitive tests compared with the patients considered unfit to drive and fit to drive. A binary regression analysis for the patient group showed an explained value for fit to drive/unfit to drive of 88%, including results for the Nordic Stroke Driver Screening Assessment total score, Useful Field of View total score and the final outcome from an on-road assessment. Results from the present study illustrate the importance of using several tests, methods and contexts for the final decision regarding fitness to drive.

Simultaneous Determination of 5- and 6-APB in Blood, Other Body Fluids, Hair and Various Tissues by HPLC--MS-MS.

5-(2-Aminopropyl)benzofuran (5-APB) and 6-(2-aminopropyl)benzofuran (6-APB) are benzofuran analogues of amphetamine and belong to the category of new psychoactive substances. Despite already published fatal 5- and 6-APB intoxication after consumption of both substances in most cases, no sensitive method for the simultaneous detection and quantification of these new psychoactive compounds in human blood samples has yet been developed. Therefore, an easy and fast sample preparation and specific high-performance liquid chromatography and tandem mass spectrometry methods for the determination of both substances in blood were established and validated. In a fatal intoxication in 2017 at the Institute of Forensic and Traffic Medicine in Heidelberg, Germany, concentrations of 850 (5-APB) and 300 ng/mL (6-APB) were determined in peripheral blood. Besides, other body fluids (central blood, urine and bile), hair and various tissues were examined to verify the presence of both compounds and to gain first insights into their distribution. In this publication, we show a method for the simultaneous determination of 5- and 6-APB in human samples by a chromatographic method and to investigate their distribution in the human body.

The Influence of Different Auditory Stimuli on Attentiveness and Responsiveness in Road Traffic in Simulated Traffic Situations.

The use of portable media has become an integral part of our increasingly mobile society. The use of digital audio books is also growing steadily in Germany. The connection between the psychological effect of music of different volumes and rhythms and the change in reaction in road traffic with a corresponding increase in risk behavior, especially when driving, has already been proven in previous studies. Only a few studies are available on the effects of listening to radio plays on reaction behavior and concentration in road traffic as well as on risk behavior among pedestrians and cyclists. In the present study, we have investigated the influences of pop music and a radio play on reaction behavior and thus driving ability during the execution of a traffic psychological test series from the “Wiener Test System”. The central topic deals with the performance of the test subjects in the individual tests. Conclusions are drawn on the reaction behavior and concentration during participation in road traffic and thus the risk of distraction and possible increased risk of accidents. Studies on the influence of auditory stimuli and their effects on concentration and reaction during participation in traffic are of great interest from the point of view of traffic psychology and occupational medicine, since a reduction in the risk of accidents can increase general traffic safety and lead to a decrease in sick leave and therefore fewer absences from work.

Inclusion of medical fitness to drive in medical postgraduate training curricula.

Transport mobility and access to driving are important factors in social inclusion and wellbeing. Doctors have an important role to play in supporting safe mobility through applying the knowledge developed in the field of traffic medicine and incorporating state of the art national and international medical fitness to drive (MFTD) guidelines. Little is known about the profile of MFTD in postgraduate curricula for core and higher specialist training. We profiled the inclusion of MFTD in the curricula of postgraduate core, higher and streamlined medical and surgical specialties in the Republic of Ireland (ROI) and the UK. All publicly available syllabi of basic and higher/ streamlined specialist training in postgraduate medical and surgical colleges in both jurisdictions were analysed (n = 122). In Ireland 25% of basic training schemes included MFTD in the curriculum. Two-thirds of curricula of higher specialty and streamlined training schemes also included MFTD. For the UK 44% of core and 36% of higher training scheme curricula included MFTD. Just under one-quarter of all curricula reviewed included MFTD for more than one medical condition or treatment. Common topics in both Irish and UK curricula included seizures/epilepsy, syncope and visual disturbances. There are notable deficits in MFTD training for specialists in Ireland and the UK. Common conditions which can significantly impair MFTD such as stroke, diabetes and alcohol use disorders are severely underrepresented and curricula should be revisited to include relevant training and guidance on MFTD for trainees.

Physicians’ views on the usefulness of practical tools for assessing the driving ability of older drivers: a cross-sectional study

ObjectiveWe aimed to explore Swiss physicians’ views on the usefulness of a self-administered questionnaire completed by older drivers before the consultation and a reference guide summarising current Swiss guidelines on...

Medicina de tráfego e primeiros socorros: interlocuções com a formação do instrutor de trânsito

O objetivo deste estudo é compartilhar um relato de experiência sobre a realização do módulo de medicina de tráfego e primeiros socorros de um curso de formação em instrutor de trânsito. Trata-se de um relato de experiência, com abordagem qualitativa, descritiva e exploratória, tendo como participantes, 13 estudantes do módulo de medicina de tráfego e primeiros socorros de um curso de formação em instrutor de trânsito. A coleta de dados ocorreu por meio de questionário, sendo posteriormente analisado com aproximações da Análise de Conteúdo de Bardin (2016). Durante toda a pesquisa, foram seguidos e respeitados os preceitos éticos para pesquisas com seres humanos. Os resultados seguiram a transversalidade do módulo, intuindo sobre a interação dos participantes com as aulas, discutindo a metodologia empregada e a presença de aspectos da relação entre teoria e prática. Observou-se também a inter-relação do conteúdo apresentado e a importância para a vida pessoal. E também, identificou-se a importância do módulo para a formação profissional, sob a premissa da qualidade em ensinar os futuros condutores de veículos. Sendo assim, compreende-se a importância do módulo de medicina de tráfego e primeiros socorros para a formação do instrutor de trânsito, sendo uma profissão fundamental para a formação de condutores de veículos.

Saúde e segurança: reflexões sobre a formação do instrutor de trânsito

O presente estudo objetiva refletir sobre a importância do módulo de noções de primeiros socorros e medicina de tráfego para a formação do instrutor de trânsito. Para tanto, realizou-se uma pesquisa descritiva e exploratória com abordagem qualitativa. Os participantes foram 12 estudantes de um curso de formação em instrutor de trânsito, sendo que a coleta de dados ocorreu por meio da aplicação de um questionário durante o primeiro semestre de 2019. Os resultados foram analisados com aproximações da Análise de Conteúdo de Bardin. Os resultados demonstraram que os participantes compreendem a importância do conteúdo em seu contexto acadêmico e profissional, refletindo sobre os conceitos trabalhados em aula e os ideais profissionais do futuro. Observou-se também que os participantes possuem uma preocupação com a própria formação profissional e o seu impacto na atuação com os futuros condutores de veículos e a comunidade onde residem e atuam. Deste modo, verificou-se que o módulo de primeiros socorros e medicina de tráfego possui importância para a formação do instrutor de trânsito, principalmente ao capacita-lo para ensinar aos futuros condutores de veículos. Desta forma, os participantes demonstraram compreender a importância do módulo para a sua atuação profissional e capacitação dos futuros alunos.

Detox shampoos for EtG and FAEE in hair – Results from in vitro experiments

In this study, we investigated if “detox” shampoos, which are sold online can have an impact on EtG or FAEE concentrations in hair. Recently, we showed, that prolonged washing with water can lead to significant washout of EtG in hair [1] . According to customer reviews, positive drug testing results could be avoided after long-term incubation with shampoo under a swimming cap. To evaluate the potential of four detox shampoos, we incubated distal hair samples from three subjects, obtained during a standard haircut, for 2.5, 5, 7.5 and 10 h. For EtG, three shampoos performed similar to deionized water. The fourth shampoo showed additional heavy washout effects with a decrease of up to 86% after 2.5 h. For the apolar FAEE, no washout was observed. Incubation with two shampoos resulted in increases in FAEE concentrations due to FAEE being present as shampoo ingredients. Further investigation of EtG washout in proximal forensic hair samples ( n = 9) with the most potent shampoo showed a mean decrease in deionized water of 23% ± 25%, and a decrease by the use of detox shampoo of 73% ± 12%, compared to non-incubated hair after 8 h. Detox shampoos proved to have the potential to alter EtG and FAEE concentrations in hair during in vitro experiments. Further in vivo studies need to be performed. Since several possibilities of manipulation (e.g., by heat, chemical treatment, washing-out) are known for hair – and dilution or adulteration are known for urine – but not for blood, further investigations of alcohol markers for abstinence monitoring should include phosphatidyl ethanol (PEth) in blood [2] , [3] . Especially for abstinence monitoring, one should not only rely on one marker in hair – as pointed out in the consensus: “A concentration < 7 pg/mg does not contradict self-reported abstinence of a person during the corresponding time period before sampling.” This statement implies that it is not a proof of abstinence. However, in practice of traffic medicine, the result (EtG < 7 pg/mg) is very often interpreted as a proof of abstinence.

Adherence to guidelines when evaluating fitness-to-drive in the elderly: a practice review of Swiss physicians.

We aimed to explore the extent to which general practitioners (GPs) in Western Switzerland adhere to Swiss recommendations when assessing fitness-to-drive in the elderly. A random sample of 500 GPs practicing in Vaud, Neuchatel and Jura, and all GPs certified to conduct fitness-to-drive assessments in Geneva ("experts", n = 69) were invited to participate. They were asked how often they performed twenty procedures (recommended in Swiss guidelines developed by experts in traffic medicine) when assessing older drivers during the previous year, scored on a five-point Likert scale ranging from "never" to "always performed". The GPs were considered to be adhering to the recommended procedure if they performed it often or always. We computed the proportion of GPs adhering to each procedure, and compared GPs with or without specialised expertise. A total of 268 GPs completed the questionnaire (participation rate 47%). The most frequently reported procedures were asking for current medication (96%), cardiovascular (94%) and neurological diseases (91%), and screening for visual acuity impairment (93%), whereas the least frequently reported procedures were screening for cognitive impairment in drivers aged between 70 and 80 years (44%) and for mood disorder (31%), asking for a history of driving license withdrawal (38%), and interviewing close relatives (10%). Six procedures were statistically significantly more frequently performed by the experts than by the other GPs. In general, GPs reported using validated tools, except when screening for at-risk drinking and mood disorder (tools used by 26 and 28%, respectively). Many Swiss GPs seem not to systematically follow the current Swiss recommendations. Although several important procedures appear to routinely be part of older drivers' assessment, others are infrequently performed. Further research should identify how GPs select the recommended items to which they adhere and those they never apply, and how to facilitate the use of recommended procedures to help them decide if a person is fit, unfit or requiring further evaluation.

Adherence to guidelines when evaluating fitness-to-drive in the elderly: a practice review of Swiss physicians.

We aimed to explore the extent to which general practitioners (GPs) in Western Switzerland adhere to Swiss recommendations when assessing fitness-to-drive in the elderly. A random sample of 500 GPs practicing in Vaud, Neuchatel and Jura, and all GPs certified to conduct fitness-to-drive assessments in Geneva ("experts", n = 69) were invited to participate. They were asked how often they performed twenty procedures (recommended in Swiss guidelines developed by experts in traffic medicine) when assessing older drivers during the previous year, scored on a five-point Likert scale ranging from "never" to "always performed". The GPs were considered to be adhering to the recommended procedure if they performed it often or always. We computed the proportion of GPs adhering to each procedure, and compared GPs with or without specialised expertise. A total of 268 GPs completed the questionnaire (participation rate 47%). The most frequently reported procedures were asking for current medication (96%), cardiovascular (94%) and neurological diseases (91%), and screening for visual acuity impairment (93%), whereas the least frequently reported procedures were screening for cognitive impairment in drivers aged between 70 and 80 years (44%) and for mood disorder (31%), asking for a history of driving license withdrawal (38%), and interviewing close relatives (10%). Six procedures were statistically significantly more frequently performed by the experts than by the other GPs. In general, GPs reported using validated tools, except when screening for at-risk drinking and mood disorder (tools used by 26 and 28%, respectively). Many Swiss GPs seem not to systematically follow the current Swiss recommendations. Although several important procedures appear to routinely be part of older drivers' assessment, others are infrequently performed. Further research should identify how GPs select the recommended items to which they adhere and those they never apply, and how to facilitate the use of recommended procedures to help them decide if a person is fit, unfit or requiring further evaluation.

Fahreignung bei Synkope

Although medical students are rarely instructed in traffic medicine in Germany, they are obliged to inform their patients about their fitness to drive after having become amedical doctor. This article gives an overview on the fitness to drive for patients with syncope by referring to the driving license regulation and the current guidelines released by the department of traffic. The driving license regulation distinguishes between group1 and group2 drivers. Group1 drivers drive vehicles with atotal weight less than 3.5 t, whereas group2 drivers drive vehicles with atotal weight above 3.5 t or provide commercial passenger transport. Since patients with syncope may suffer from different serious illnesses, the first approach is to clarify the cause of syncope. If no treatable cause of syncope (e. g., pacemaker, aortic valve replacement) is found, drivers of group1 are not fit to drive for 6months after asecond unexplained syncope, whereas in this situation, drivers of group2 are not fit to drive permanently. If, however, syncopes occur in conditions which cannot be expected to occur while driving (e. g. venipuncture, defecation, micturition) fitness to drive will persist. Syncope due to ventricular tachycardia in ischemic heart disease and reduced left ventricular ejection fraction are in general treated with an implantable cardioverter-defibrillator (ICD). Group2 drivers with an ICD are normally unfit to drive. Group1 drivers with an ICD are fit to drive when no syncope or adequate shock occurred within the last three months.

Traffic accidents and medicine use in United Arab Emirates

Background: The present study was undertaken to evaluate the knowledge, attitude and practice of drivers of the cautious driving while taken prescription and OTC drugs.Methods: A cross sectional questionnaire was developed, pre-validated and distributed to 150 drivers who showed willingness to participate in the study. The survey included questions on driving habits, number of accidents, and number of accidents due to sleep or medication use.Results: All drivers approached answered the questionnaire producing a 100% response rate with male: female ration being 1.2: 1. Slightly more than half (78, 52 and 80, 53.3%) the responders were within 17-28 years of age and with a university degree respectively. More than 50% of respondents follow driving regulations and more than two thirds (112, 74.4%) use seat built again the majority (133, 88.7%) never had traffic accidents. Use of medications as a cause of accidents was reported by only 4 (2.7%) drivers.Conclusions: Regardless of the low incidence of medication use related accidents, authorities are advised to develop new regulations with respect to driving under the influence of medications or when suffering diseases that affect driving ability.