I don't get it. This thread is lactating? Is there something to the Eastern PA reference? What am I missing?

 

Drivers generally crash on track because of either driver error or a mechanical problem. It is very difficult to conclusively determine the factors that contributed to a driver error. If a driver was affected by a health condition, they may not realize it and just think that they were tired, or pushing too hard, or had a brain fart, or their attention was misdirected. So the big question with this medical screening is: is there any evidence that health conditions which could be identified through medical screening are generally a significant contributor to track incidents? I think the answer is probably no, which is why I'm not in favor of all this medical screening for either racing or DE.

However, if a club like PCA has set a policy where they're doing medical screening, I think they have to be pretty diligent in doing the screening (like asking for CPAP data) in order to manage their liability. But again, I think this really opens up a can of worms, and it's better to not do the screening, and instead have drivers attest that they're healthy enough to go on track (thus transferring the liability to them).

 

G-d dammit!!!

PCA or The PCA?

Now you’re just fukin with me.

Et tu Brute?

 

Just remember that you need PCA to spell CPAP.

 

I’m across from Smokin Dave’s lookers left of garage. White 981S #694. Red F-150
Find me in the morning

 

Nicely played, Glyn

 

But you can’t spell The PCA with CPAP

 

Is that Lactation pod PCA approved? And I hope you're happy, now you're going to need to provide 6 months of your lactation pod usage to go PCA racing.

 

No. It's approved by The PCA. 😎

 

I'll be at the track tomorrow afternoon. Not doing the lapping day as I sold the Vette. Just coming to instruct for the weekend.

 

Trying to understand your statement, above. Actually, what DO you mean by the above ?

There is an FMCSA (the federal regulators) standard that must be met here. While there are some exemptions that don't require a CDL Medical Certificate to drive CMV (commercial motor vehicles), if you wish to hold an unrestricted license for intrastate and interstate driving of a CMV, you are required to have a current DOT medical examiner's certificate. You will be asked about OSA during that medical exam by a CDL medical examiner, and if your answer is "Yes, I've been diagnosed with OSA", there are a whole bunch of other things that triggers.

So...yes, in occupational medicine related to a "DOT Medical", you will be asked about OSA, and indicating you have OSA triggers an avalanche of other stuff.

Just trying to keep everybody on-point and accurate with their statements.

PHT
...who holds a current CDL, and a current DOT medical examiner's certificate)(and yes...I have to have a DOT medical exam EVERY FREAKIN YEAR, since I'm old and cranky...
...I don't actually need a CDL for anything currently, but it's such a massive PITA to get a CDL now I just keep mine "valid" in case something weird thing comes up...
...like arguing on the internet...

 

What I mean is this:

I think If you disclose OSA, the Pulmonary Standard allows the medical examiner "discretion."

I suspect that there can be borderline cases, where CPAP therapy is prescribed, but the supporting info (exempli gratia, medical history info) provided by the candidate suggests to the examiner that the collection of CPAP data is not necessary.

Medical providers have different parameters for prescribing CPAP for OSA, and medical insurance providers have various parameters for reimbursement.

It is not a "one size fits all" deal.

My wife an I are going through this right now.

Can be very complicated.

I think one needs to consider that there can be "corner cases," in medicine, including the examination of candidates for CDLs and/or racing licenses, sometimes allowing physician discretion is best.

I don't agree that PCA should or must simply rely on a candidate's doctor's assurances. What they should or must do is based, at least in part on their risk management criteria, goals and processes.

I was responsible for rules for the Porsche Racing Club. We raced under NASA sanction from 2002 until about ~2017. I remember when there was a lot of concern about fuels cells and dating, and NASA created a rule about fuel cells. I think it is still in place.

We negotiated a separate rule for the PRC for a number of reasons.

So under NASA sanction and insurance, we had a different rule for cells than everybody else.

There are plenty of other examples.

Risk management.

Remember when seat dating and seat back braces became "an issue?"

Like I stated earlier, I think IF PCA can proactively inform candidates about rx compliance/effectiveness (like A1C) data they will be obligated to submit, they should do so so folks can provide it up front. Perhaps the instructions/form can be made much more clear.

 

Makes me thing of the quote "We are dealing with subtleties here."

Some perspective:

https://www.concentra.com/-/media/pr...B0734E4DA6DC73


https://www.fmcsa.dot.gov/driver-saf...ve-sleep-apnea

"Can You Still Drive if You Have Sleep Apnea?

Yes! While FMCSA regulations do not specifically address sleep apnea, they do prescribe that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle (CMV) in interstate commerce.

However, once successfully treated, a driver may regain their “medically-qualified-to-drive” status. It is important to note that most cases of sleep apnea can be treated successfully.

Because each State sets its own medical standards for driving a CMV in intrastate commerce, check with your local Department of Motor Vehicles for regulations in your State."

"What Level of Sleep Apnea (mild, moderate, severe) Disqualifies a CMV Driver?

The disqualifying level of sleep apnea is moderate to severe, which interferes with safe driving. The medical examiner must qualify and determine a driver’s medical fitness for duty."


So... what would PCA do with a candidate that discloses OSA and CPAP therapy, and provides history info that the OSA was diagnosed in the "mild" category?

 

I guess my point would be this:

If PCA requires the submission of CPAP data when evaluating a racing license application and does not grant a license based on the lack of sufficient CPAP data or insufficient use, they have taken on responsibility to assure that any racers they have granted licenses to with OSA are using their CPAP machine appropriately before every race. After all, what is more important, the correct and sufficient use of a CPAP machine at the time of license application or the correct and sufficient use of a CPAP machine when actually racing?

A good analogy would be the **** industry. What good would it do to test for STDs only once before the **** movie making season started?

 

I hear you but...

I am not sure PCA requires CPAP usage for those candidates that have a dx of OSA and an rx for CPAP.

They seem to require data, but again the exact circumstances are not clear.

It is not clear what they do with the data they receive.

Do they look at the "quality" of the data?

I think all we know is that they claim a standard of x hours of usage per day for y percentage of days over a z period.

It is not clear that they look at any other parameters like AHI.

It is possible that medical examiners for CDL and PCA CR only care that x, y and z are within spec.

It is also possible that these medical professionals assess candidates in a more holistic sense when it comes to the patient's history.

You can learn more about CPAP data here:

https://www.sleepfiles.com/OSCAR/


"...they have taken on responsibility to assure that any racers they have granted licenses to with OSA are using their CPAP machine appropriately before every race. After all, what is more important, the correct and sufficient use of a CPAP machine at the time of license application or the correct and sufficient use of a CPAP machine when actually racing?"

I don't think that is correct from a liability and/or risk management standpoint. If there is a standard or precedent in the medical/legal space (I suspect there is), then a good faith effort, manifest by in spec x, y and Z, might be all that is required to get to an "acceptable" level of risk.

Just like a form documenting self-inspection of fuel cell bladders past their FIA dating.

Plus of course from a physiology standpoint, a person with even severe OSA might not be plagued with their worst symptoms (and human performance shortcomings) after missing a few days.

This might be considered to relate to the y number of days, which I think is 70%.

OSA rx and dx are a bit more complex than many realize...

I know a person that started having clinically meaningful interruptions in about 2005 or 2006. Did not get around to asking for a test until about 2008 when symptoms became more marked.

ENT did a PE and noted anatomical characteristics like a deviated septum and said yes to test and get ready for rx. He was certain of the result.

Test showed very mild OSA. ENT was shocked.

ENT could not prescribe CPAP rx that would include insurance reimbursement (Sutter Health... at the time a PRC/PCA racer was chairman of the board; that racer is still at it and has a handicap).

Symptoms got worse.

Tried OTC device.

Symptoms got worse.

Another test circa 2010. Same results.

Sleep labs and studies have variances based on a number of factors.

Finally in 2013, in a more desperate condition, this person made an ENT appointment-- this time with a different doc in the same department.

This doc suffered badly with OSA himself through secondary school, college and medical/graduate school (MD., PhD).

He used a different sleep lab which he tightly controlled.

So test 1, under 10 interruptions per hour.

Test two, same.

This different lab result was 29 interruptions per hour. Within about two weeks, CPAP therapy was started.

The DME specialized in CPAP and provided great training and support.

Within just a few days of CPAP rx, major positive impact.

We had at least three racers with OSA in the PRC. At least two of them tried surgical procedures. Insufficient results.

One raced in RR IV, and there was a picture of us fooling around in the Corkscrew in the Autoweek article.

One was militant about his CPAP machine.

One had to quit racing. I have seen that he is more recently doing DE in a potent GT3 variant. I hope he has found an rx that has helped him.

What would happen if a candidate disclosed amphetamine rx for severe ADHD.

What would be a good way for PCA to ensure rx compliance?

Risk management.