Paying attention is the best safety strategy
Whatever mode of transport you use, road accidents generally have multiple causes – above all, excessive speed, inattention or alcohol. The person at the wheel is the biggest risk factor, which is why our attention must also be focused on people if we want to make our roads even safer. This begins with considering whether a person is even fit or proficient enough to drive at all, but it also involves other aspects such as proneness to distraction or daytime drowsiness, voluntary health checks for elderly road users and driver training.
Anyone in Germany who wants to drive a car on public roads must first prove that they are able to drive and pass the mandatory driving test. Whether a person is fit to drive a car at all, however, is not generally checked before the driver’s license is issued. Section 2, paragraph 4, clause 1 of the Road Traffic Act addresses the question of who is deemed fit to drive a vehicle, where, among other things, it states: “Persons deemed fit to drive motor vehicles are those who fulfill the necessary physical and mental requirements and who have not seriously or repeatedly violated traffic regulations or criminal law.”
The German Federal Ministry of Transport and Digital Infrastructure is authorized to enact rules regarding fitness to drive with the consent of the Bundesrat. Among such rules is the driver’s license ordinance (FeV), which in sections 11–14 and annexes 4, 4a, 5 and 6 stipulates the details of the assessment of physical and mental fitness. Annex 4 of the FeV (fitness and conditional fitness to drive motor vehicles – in addition to sections 11, 13 and 14) contains a list of somatic and mental illnesses/impairments that could potentially affect a person’s fitness to drive. This list contains not only specific illnesses/impairments but also covers areas relating to alcohol, narcotics, other psychoactive substances and medicines.
Fitness to drive versus ability to drive
In the case of documented, conspicuous behavior such as drunk-driving or certain illnesses such as diabetes, cardiovascular disease or mental impairments, the German administrative authorities can order an expert medical (pursuant to section 11 of the FeV) or medical-psychological (pursuant to section 13 of the FeV) assessment. Through this expert assessment, the person in question has an opportunity to put to rest any doubts on the part of the authorities regarding his or her fitness to drive. The contract to draw up an expert assessment is concluded between the person in question and an assessment center for driving fitness, which he or she is free to choose. Only assessment centers that comply with the professional and organizational guidelines issued by the German Federal Highway Research Institute (BASt), which also form the basis for regular monitoring, are officially accepted. The expert medical or medical-psychological assessment is used as a basis for the driver’s license authorities to decide, taking into account all aspects of road safety, whether a person is allowed to either be granted their first driver’s license, have their driver’s license re-issued or retain their existing driver’s license.
The expert assessment on fitness to drive concludes with a prognosis concerning whether, despite the facts known to the authorities (drink- or drug-driving, illnesses, criminal or motoring offenses), the person in question can be expected to drive a motor vehicle safely or whether his or her road use constitutes a hazard. Fitness to drive, therefore, is a general term covering the mental and physical requirements a person must fulfill in order to be a safe road user. The German terminology differentiates between the fitness and the ability to drive. The term “inability to drive” describes a momentary state whose causes could be temporary or permanent. For example, section 2, paragraph 12, clause 1 of the Road Traffic Act indicates that temporary problems such as fatigue are not relevant to driving fitness if the person experiencing fatigue is not driving a vehicle (Patermann, 2015). So if a person feels nauseous due to food poisoning, for example, and decides not to drive a car he/she obviously is not able to drive but still has the overall driving fitness.
Statistics on the effectiveness of MPAs
Evaluation studies with increasingly unequivocal results prove that medical-psychological assessments (MPAs) are a highly effective means of increasing road safety. In the most recent evaluational research, “EVA-MPU” (Hilger et al., 2012), the continued law-abidingness of drunk-drivers three years after their MPA is determined using data obtained from the Federal Office for Motor Vehicles. The recidivism rate is between 6.5% among first-time offenders and 8.3% among repeat offenders. When evaluation studies were first conducted, the figures were much higher. In the first MPA evaluation conducted by Stephan back in 1984, the recidivism rates after three years were 24.9% among first-time offenders and 16.7% among repeat offenders. The recidivism rate among third-time and serial offenders was as high as 26.7%. The positive trend toward sharply declining recidivism rates is testament to the increasing effectiveness of MPAs, which, among other things, can be attributed to the systematic application of a scientifically sound list of criteria for assessing conspicuous drivers (DGVP & DGVM, 2013).
In Germany, any driver whose behavior comes to the attention of the authorities can undergo a driving fitness assessment (MPA or medical opinion) in order to put to rest any doubts on the part of the driver’s license authorities regarding his or her fitness to drive. The driver’s license authorities, however, do not generally have access to data on other modes of transport, which means that the captain of a ship, for example, might have his or her driver’s license withdrawn due to drunk-driving, but is still authorized to navigate a cruise ship. The same applies to air and rail transport. Especially given this fact, it would appear sensible to consider a possible “personal checkup”, that is, a personal check of a person’s fitness to operate any mode of transport.
Statistics from the USA demonstrate the importance of considering the introduction of a body for conducting medical-psychological personal checkups. An analysis of 1,524 pilots killed in accidents between 1999 and 2003 showed that 830 (52%) were under the influence of alcohol or drugs (Chaturvedi et al., 2005). An analysis of 1,353 pilots killed in accidents between 2004 and 2008 showed that 507 had drugs in their system and 92 had a blood alcohol concentration of more than 0.4 (Canfield et al., 2012). It is highly likely that all of them had driven or ridden some of form of transport on the roads, too, in the period prior to their accident. A study conducted by the National Transportation Safety Board revealed a significant increase among pilots in the consumption of narcotics and medication.
According to the German driver’s license ordinance (FeV), the regular consumption of medication can call into question a person’s fitness to drive. The situation is similar with illnesses such as diabetes, high blood pressure and other cardiovascular problems. On the basis of the medicines taken by the subjects under analysis in this study, it can be concluded that in addition to the consumption of narcotics, the US pilots involved in these accidents also suffered from illnesses that, in Germany at least, would have called into question their fitness to drive but that did not appear to result in a flying ban following their medical examination for pilots.
Given, too, the tragic end of the Germanwings flight on March 24, 2015 in the French Alps, it is only sensible that we at least discuss the introduction of checkups for people exhibiting medical, psychological or behavioral abnormalities in whatever field of transport – road, rail, marine, air – in terms of their fitness to operate any mode of transport.