Sleep and the Fitness to Drive: A Swiss Perspective

Medical conditions and behavioral patterns affecting sleep are a largely underestimated threat to traffic safety. Unsupervised or even illegal self-treatment of sleep issues by, for example, anti-histamines, cannabis products, or stimulants, questions safe driving and the fitness to drive as well as low compliance/adherence to treatments (CPAP, medication, etc.) of medical conditions, such as OSAS, or narcolepsy. In such cases, Swiss law calls for a medical assessment of the fitness to drive by experts in traffic medicine. With increasing complexity, this medical assessment is escalated in a four-tiered system of qualified experts, ranging from a qualified practitioner to experts in traffic medicine, at, for example, an Institute for Legal Medicine. The following overview provides insight in the Swiss framework of traffic medicine assessments that – with all caveats and potential drawbacks – helps mitigating the risk of sleep-related accidents. For this, we first introduce Swiss traffic medicine and then argue for consistent terms and measurements to assess sleepy driving. A concise summary of those sleep related conditions most relevant in traffic medicine is followed by an overview over potential issues of sleep-medication.

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 the fitness-to-drive assessment of older drivers. We also aimed to assess the frequency with which physicians used the information sources provided by the Swiss traffic medicine website.DesignQuestionnaire-based cross-sectional study.SettingThe study was conducted in four cantons of Western Switzerland (Geneva, Vaud, Neuchâtel and Jura).ParticipantsAll physicians certified to carry out fitness-to-drive assessments in the canton of Geneva (medical assessors; n=69) and a random sample of 500 general practitioners practising in the cantons of Vaud, Neuchâtel and Jura were invited to participate. They were asked to report their estimated average number of fitness-to-drive assessments per week and to rate on a 5-point Likert scale the perceived usefulness of the preconsultation patient questionnaire and reference guide, and the frequency of use of the information sources provided by the traffic medicine website. We computed the proportion of physicians who found the assessment tools very/somewhat useful and the proportion of physicians who always/often used the traffic medicine website. We compared the responses according to medical specialty (medical assessors vs general practitioners) using design-based F tests and weighted logistic regressions.Results268 physicians (47%) agreed to participate in the study. Their median number of assessments was 2 per week (IQR 2). Overall, the majority of physicians found the questionnaire (75%) and reference guide (89%) very/somewhat useful. Only 17% of the sample always/often used the traffic medicine website. There were no statistically significant associations in multivarible analysis between the medical specialty and the perceived usefulness of the questionnaire and reference guide and the frequency of use of the traffic medicine website.ConclusionMany physicians find the preconsultation patient questionnaire and reference guide useful to guide them for assessing the driving ability of older drivers, but only a minority regularly use the information sources provided by the traffic medicine website. Future studies should explore the reasons why many physicians do not use these available sources of information.

Cannabis and alcohol in road traffic: an overview

Traffic medicine is an important part within the scope of concerns of forensic medicine. We are dealing with consequences of traffic accidents – fatal or survived – but this problem overlaps the borders of our specialization. Sustained injuries are the focus of various fields of medicine and in combination with alcohol and illicit drugs abuse this issue is growing. The following review has an ambition to bring more light into the problem concerning the effect of alcohol and cannabis (which is the most common illicit drug used worldwide) on driving abilities.