It is hard to believe that it’s been over 20 years since the first edition
of this guide was published. Our hope for the first edition was that it
would serve not only as a resource to occupational health professionals
but also as a convenient reference for others involved in the commercial
driver medical certification process. The extent to which this manual
has been utilized has been beyond our imagination.
Although much of the original guidance information had been
available for years, it was not easily accessible, nor were many examin-
ers aware of its existence or location. While the first edition attempted
to collate the information primarily from the Federal Highway Admin-
istration (FHWA) conference reports, the next few editions focused on
the “official” guidance from FHWA and later the Federal Motor Carrier
Safety Administration (FMCSA) but included relevant information
from the medical literature. The fifth edition took things even further
from our original goal, presenting not only the “official” guidance, but
inclusion of the “less official” information from the FMCSA’s Medical
Review Board (MRB) and Medical Expert Panels (MEP).
The long gap prior to this sixth edition saw major changes in the
commercial driver medical certification process—we kept waiting for
the dust to settle. The FMCSA Medical Examiner Handbook was taken
down for update and, several years later, we are still waiting for its
return. Since 2007, FMCSA has heard recommendations from numer-
ous MEPs and the MRB, but none of those have been incorporated into
“official” guidance. The greatest change was the implementation of the
National Registry of Certified Medical Examiners (NRCME) along
with a new form (several changes even to that) and a lot of bumps in
the road. The NRCME limited the performance of the commercial
driver medical examinations (CDME) to those who meet specific
criteria, including training and certification. This is a far cry from when
many of us started performing these examinations, having little to no
guidance and no available training.
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