View the feedback we have received on the Improving health screening for heavy vehicle drivers paper.

• q11

  - benefits outweigh costs. means risks are picked up early and interventions provided early before end organ disease develops, and before conditions progress. EOD and complications of disease prevent extra hospital beds taken up in hospital, reduces risk of morbidity and mortality.

• q2

  1/ substance use - more strict guidelines needed for PRN use (benzo, opioid- tramadol, endone )- should be deemed unacceptable. Some crashes relating to heavy vehicle drivers eg the Hunter valley bus driver crash - driver was found to be taking PRN tramadol, which is NOT detected in traditional random drug screens. 2/ Those with complex conditions on MULTIPLE medications capable of causing sedation. Specific types of medications should be flagged as HIGH risk eg PRN use and Tramadol use, with AFTD legislation stating that this type of medication and its type of use are not compatible with safety risk work (aside from use of benzo for night time sleep/ post shift work eg temazepam)

• q3

  - not cohesive. pieces of paperwork to be signed off by various specialists , instead of ALL medical conditions, meaning one truck driver can be signed off by one specialist be considered "conditional licence"

• q4

  - existing guidelines are too "reactive" rather than proactive - meaning some high risk workers continue to work without their risks being managed. It defeats the purpose of promoting safer drivers on the road in a very narrow minded process. Current guidelines (AFTD guidelines) are not consistent with other safety critical roles eg rail which has increased their risk factor monitoring process. AFTD should be updated to align with this process ie adopting recommendations C - diabetes guidelines - EXISTING guidelines - overly unnecessarily strict eg enforcing annual endocrinologist reviews for those who are on medications other than metformin -> overly unnecessarily strict guidelines for those with existing conditions form more of a barrier (cost and time barrier) than the actual screening process itself. yearly reviews on existing other conditions acceptable - RE - stop bang score of 4 - currently rail standard of stop bang 3 have dramatically increased the number of sleep studies. risk benefit would be - high benefit, and risk of time/cost delays (especially if transport operators DO NOT pay for their workers to undergo the sleep studies). currently SOME to MOST rail transport operators pay for their EXISTING workers to undergo investigative testing legislated under the rail standard, but not their NEW workers. currently, the transport operators we work with DO NOT pay for their workers to undergo testing. worst case scenario is - existing workers quit their jobs because they refuse to pay for a sleep study. there is a currently huge lack of education and insight into risk of health conditions and impact on safety critical roles in drivers. with Rail workers - when the new legislation was enforced, a large proportion who were referred were quite disgruntled, and to a certain extent, their discontent was somewhat alleviated when they were told their test was paid for by the RTOs. A potential way to overcome this would be to MANDATE referral for HSS when their STOP bang is 4, instead of 3 *as per current rail standard. As well as when BMI is >40. Easing certain aspects of regulation - eg to allow for review of 90 day cpap usage as a method of compliance rather than yearly sleep specialist reviews which can be financially costly. - CVD risk - agree that CVD risk should be reviewed in drivers and appropriately raised as a concern to GPs as a first instance.