[Federal Register Volume 80, Number 18 (Wednesday, January 28, 2015)]
[Notices]
[Pages 4582-4585]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-01623]
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DEPARTMENT OF HOMELAND SECURITY
Coast Guard
[Docket No. USCG-2014-0720]
Request for Public Comment on Waiver Revisions for Certain
Medications and Suggestions for Risk Evaluation
AGENCY: Coast Guard, DHS.
ACTION: Notice of proposed policy clarification and request for
comments.
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SUMMARY: The Coast Guard is seeking public comment on the policy
clarification proposed in this Notice regarding the criteria for
granting medical waivers to mariners who require the use of potentially
impairing prescription medications. The Coast Guard is also seeking
input regarding effective methods of risk evaluation of such mariners.
Current Coast Guard guidance states that the ``use of certain
medications is considered disqualifying for the issuance of
credentials,'' and that ``the underlying cause or need for use of these
medications and potential side effects may result in denial of a
credential application or require a waiver.'' Current guidance
specifically identifies that use of benzodiazepine medications, opioid
and opiate medications, non-benzodiazepine sedative hypnotic
medications, and barbiturate medications require a waiver, but does not
specify the factors that the Coast Guard will consider in making its
determination on whether the risks associated with use of these
medications are low enough to warrant consideration for a waiver.
The Coast Guard is proposing additions to the current medication
policy that will clarify the circumstances that the Coast Guard will
consider when determining whether to grant a medical waiver for use of
these medications. Additionally, the Coast Guard is proposing to
include a safety warning to mariners advising them to refrain from use
of impairing medications while operating under the authority of their
credential. The Coast Guard is seeking comments from the public on
whether the proposed policy adequately addresses safety concerns
regarding merchant mariners whose medical conditions require the use of
medications that have the potential to impair cognitive ability,
judgment or reaction time.
DATES: Comments and related material must either be submitted to our
online docket via http://www.regulations.gov on or before March 30,
2015 or reach the Docket Management Facility by that date.
ADDRESSES: You may submit comments identified by docket number USCG-
2014-0720 using any one of the following methods:
(1) Federal eRulemaking Portal: http://www.regulations.gov.
(2) Fax: 202-493-2251.
(3) Mail: Docket Management Facility (M-30), U.S. Department of
Transportation, West Building Ground Floor, Room W12-140, 1200 New
Jersey Avenue SE., Washington, DC 20590-0001.
(4) Hand delivery: Same as mail address above, between 9 a.m. and 5
p.m., Monday through Friday, except Federal holidays. The telephone
number is 202-366-9329.
To avoid duplication, please use only one of these four methods.
See the ``Public Participation and Request for Comments'' portion of
the SUPPLEMENTARY INFORMATION section below for instructions on
submitting comments.
FOR FURTHER INFORMATION CONTACT: If you have questions about this
notice, call or email Lieutenant Ashley Holm, Mariner Credentialing
Program Policy Division (CG-CVC-4), U.S. Coast Guard, telephone 202-
372-2357, email [email protected]. If you have questions on viewing
material in the docket, call Docket Operations at 202-366-9826.
SUPPLEMENTARY INFORMATION:
Public Participation
You may submit comments and related material regarding whether the
policy clarifications proposed in this Notice should be incorporated
into a final policy on issuing medical waivers to mariners whose
medical conditions require use of benzodiazepine medications, opioid
and opiate medications, non-benzodiazepine sedative hypnotic
medications, or barbiturate medications. All comments received will be
posted, without change, to http://www.regulations.gov and will include
any personal information you have provided.
Submitting Comments
If you submit a comment, please include the docket number for this
notice (USCG-2014-0720) and provide a reason for each suggestion or
recommendation. You may submit your comments and material online or by
fax, mail or hand delivery, but please use only one of these means. We
recommend that you include your name and a mailing address, an email
address, or a telephone number in the body of your document so that we
can contact you if we have questions regarding your submission.
To submit your comment online, go to http://www.regulations.gov,
type the docket number (USCG-2014-0720) in the ``SEARCH'' box and click
``SEARCH.'' Click on ``Submit a Comment'' on the line associated with
this notice.
If you submit your comments by mail or hand delivery, submit them
in an unbound format, no larger than 8\1/2\ by 11 inches, suitable for
copying and electronic filing. If you submit them by mail and would
like to know that they reached the Facility, please enclose a stamped,
self-addressed postcard or envelope. We will consider all comments and
material received during the comment period.
Viewing the comments: To view comments, go to http://www.regulations.gov, type the docket number (USCG-2014-0720) in the
``SEARCH'' box and click ``SEARCH.'' Click on ``Open Docket Folder'' on
the line associated with this rulemaking. You may also visit the Docket
Management Facility in Room W12-140 on the ground floor of the
Department of Transportation West Building, 1200 New Jersey Avenue SE.,
Washington, DC 20590, between 9 a.m. and 5 p.m., Monday through Friday,
except Federal holidays. We have an agreement with the Department of
Transportation to use their Docket Management Facility.
Privacy Act: Anyone can search the electronic form of comments
received into any of our dockets by the name of the individual
submitting the comment (or signing the comment, if submitted on behalf
of an association, business, labor union, etc.). You may review a
Privacy Act system of records notice regarding our public dockets in
the January 17, 2008, issue of the Federal Register (73 FR 3316).
Background and Purpose
Coast Guard regulations in 46 CFR 10.302 contain the medical
standards that merchant mariners must meet prior to being issued a
merchant mariner credential (MMC). In cases where the mariner does not
meet the medical standards in 46 CFR 10.302, waivers may be granted
when extenuating circumstances exist that warrant special
consideration. 46 CFR 10.303. Additionally, 46 CFR 10.304 specifies
[[Page 4583]]
the scope of the general medical exam required for receiving an MMC and
directs that ``this exam must also document any condition requiring
medication that impairs cognitive ability, judgment, or reaction
time.''
On September 8, 2008, the Coast Guard issued Navigation and Vessel
Inspection Circular (NVIC) 04-08, ``Medical and Physical Evaluation
Guidelines for Merchant Mariner Credentials'' (NVIC 04-08). In
Enclosure (4) of NVIC 04-08, the Coast Guard identifies medications
that may be disqualifying or may require a medical waiver. (NVIC 04-08
is available on the Internet at: http://www.uscg.mil/hq/cg5/nvic/pdf/2008/NVIC%2004-08%20CH%201%20with%20Enclosures%2020130607.pdf.)
The medications identified have a documented potential to impair
cognitive ability, judgment and/or reaction time. In many instances,
the medication labels also warn against driving or operating heavy
machinery while under the influence of these medications. Because of
the documented potential for impairment associated with these
medications, the Coast Guard considers the use of these medications to
be generally disqualifying. In some cases, waivers are granted to allow
for limited use of the medication; while in other cases, the mariner is
denied medical certification. When waivers are granted for use of these
potentially impairing medications, the conditions of the waiver usually
stipulate that the mariner must refrain from use of the medication for
a specified time period, in order to decrease the likelihood that the
mariner will be under the influence of the medication while working.
However, such waiver stipulations cannot be applied to mariners who are
medically required to take their potentially impairing medications
prior to, and while working. As a result, mariners in this situation
often have to change their medical treatment plan or risk denial of
medical certification.
Enclosure (4) to NVIC 04-08 lists benzodiazepine medications,
opioid and opiate medications, non-benzodiazepine sedative hypnotic
medications, and barbiturate medications as requiring a waiver. Since
the issuance of NVIC 04-08, there have been several instances where
mariners sought waivers for use of these specific medications. However,
NVIC 04-08 does not provide any guidance on the circumstances that will
warrant consideration for a medical waiver. Published guidance on the
circumstances that will be considered in determining whether the use of
these medications warrant consideration for a medical waiver will
support Coast Guard efforts to consistently evaluate merchant mariners
whose medical condition requires the use of these medications and to
assess whether an applicant's use of one of these medications warrants
a medical waiver under 46 CFR 10.303.
The proposed policy changes seek to clarify the extenuating
circumstances related to use of potentially impairing medications that
the Coast Guard weighs in evaluating risk to public and maritime safety
and in determining suitability for a medical waiver. Additionally, the
policy would allow for consideration of the treating physician's formal
assessment of impairment in determining whether the risk associated
with the mariner's medication use is acceptable for a safety sensitive
position.
The Coast Guard recognizes that there are instances when a mariner
may take a medication or start a prescription for a medication outside
of the timeframe of the MMC application process, and thus the
medication use has not been included in the Coast Guard's review of the
mariner's MMC application. Because a number of prescription medications
and over-the-counter medications have effects that may impair cognitive
ability, judgment and reaction time, it is critical that each mariner
consider the effects of his or her medication before deciding to
operate under the authority of his or her credential. Between 1987 and
2000, the National Transportation Safety Board investigated a
significant number of accidents across all modes of passenger
transportation that involved the use of potentially impairing
prescription and over-the-counter medications, and their analysis
determined that ``prescription and over-the-counter medications
continue to be factors in transportation accidents and incidents.'' \1\
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\1\ National Transportation Safety Board Safety Recommendation
I-00-5, January 13, 2000. http://www.ntsb.gov/doclib/recletters/2000/I00_5.pdf.
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The current Coast Guard guidance advises mariners that certain
medications may be considered disqualifying for the issuance of
credentials, but the policy does not provide guidance on whether it is
appropriate to operate under the authority of the credential while
under the effects of a potentially impairing medication. As such, one
of the proposed changes to the medication policy includes a safety
warning to mariners advising them to refrain from operating under the
authority of the credential when they are under the influence of any
medication that can cause drowsiness, or impair cognitive abilility,
judgment or reaction time. The Coast Guard is proposing to include
these policy changes in a replacement to Enclosure (4) to NVIC 04-08.
In addition to seeking comments from the public about whether the
proposed policy adequately addresses safety concerns regarding merchant
mariners whose medical conditions require use of potentially impairing
medication, the Coast Guard is also seeking public input on five
specific questions relating to the medical waivers for the use of such
medications.
Questions for the Public
1. What factors, if any, should the Coast Guard consider in
determining whether to grant a waiver for mariners whose conditions
require them to use (or be under the effects of) a potentially
impairing medication while operating under the authority of the
merchant mariner credential?
2. What methods of objective evaluation are available to reliably
assure that a mariner is free of any impairing medication effects,
specifically effects that would interfere with the safe operation of
the vessel?
3. Should the treating physician's opinion that the mariner has no
medication impairment be considered sufficient to mitigate risk to
public and maritime safety?
4. Should formal neuropsychological/neurocognitive evaluation be
required of all mariners who require chronic use of potentially
impairing medications, or use of potentially impairing medications
while operating under the authority of the credential? If so, what
functions should be measured/evaluated, and what would be the
appropriate standard for a test's outcome?
5. Under what circumstances, if any, should the Coast Guard
consider granting waivers for mariners whose conditions require use of
opioid maintenance therapy (for example, methadone or buprenorphine)?
The Proposed Policy
The proposed replacement to Enclosure (4) to NVIC 04-08, provided
below, outlines more specific guidance for each class of medication
discussed above. Additionally, the guidance advises mariners to
carefully consider manufacturers' warnings for any medication(s) they
may be taking, whether prescription or over-the-counter, before acting
under the authority of the credential. The proposed replacement for
Enclosure (4) to NVIC 04-08 follows:
[[Page 4584]]
Medications
Definitions
A. Acting under the authority of the credential. The definition
of ``acting under the authority of a credential'' is found in 46 CFR
5.57. It states that
(a) A person employed in the service of a vessel is considered
to be acting under the authority of a credential or endorsement when
the holding of such credential or endorsement is:
(1) Required by law or regulation; or
(2) Required by an employer as a condition for employment.
(b) A person is considered to be acting under the authority of
the credential or endorsement while engaged in official matters
regarding the credential or endorsement. This includes, but is not
limited to, such acts as applying for renewal, taking examinations
for raises of grade, requesting duplicate or replacement
credentials, or when appearing at a hearing under this part.
(c) A person does not cease to act under the authority of a
credential or endorsement while on authorized or unauthorized shore
leave from the vessel.
B. Alcohol means any form or derivative of ethyl alcohol
(ethanol). See 33 CFR 95.010.
C. Controlled substance has the same meaning assigned by 21
U.S.C. 802 and includes all substances listed on Schedules I through
V as they may be revised from time to time (21 CFR part 1308). See
33 CFR 95.010.
D. Dangerous drug means a narcotic drug, a controlled substance,
or a controlled-substance analog (as defined in section 102 of the
Comprehensive Drug Abuse and Control Act of 1970 (21 U.S.C. 802)).
See 46 CFR 16.105.
E. Drug means any substance (other than alcohol) that has known
mind or function-altering effects on a person, specifically
including any psychoactive substance, and including, but not limited
to, controlled substances. See 33 CFR 95.010.
F. Intoxicant means any form of alcohol, drug or combination
thereof. See 33 CFR 95.010.
Prohibitions
A. Illegal Substances: Use of illegal or illegally obtained
substances, including all illegal or illegally obtained dangerous
drugs (as defined in 46 CFR 16.105), is incompatible with maritime
service and is not waiverable under any circumstances.
B. Intoxicants: Operation of vessels while under the influence
of drugs or alcohol is regulated under 33 CFR part 95. Issuance of a
credential does not authorize a mariner to operate a vessel in
contravention of 33 CFR part 95. See also 46 U.S.C. 2302.
Important Safety Warning
Certain medications, whether prescription or over-the-counter,
have known impairing effects and their labels warn about risk of
drowsiness and caution against use while driving or operating
hazardous machinery.
The nature of shipboard life and shipboard operations is such
that mariners may be subject to unexpected or emergency response
duties associated with vessel or crew safety, prevention of
pollution, and maritime security at any time while aboard a vessel.
In the interest of safety of life and property at sea, the Coast
Guard views shipboard life and the attendant shipboard duties that
can arise without warning, as safety sensitive duties that are
analogous to operating hazardous machinery. As such:
A. Mariners are advised to discuss all medication use with their
treating providers and to inform them of the safety sensitive nature
of their credential; and
B. Mariners are cautioned against acting under the authority of
their merchant mariner credential while under the influence of
medications that:
(a) Can cause drowsiness, or
(b) can impair cognitive ability, judgment or reaction time, or
(c) carry warnings that caution against driving or operating
heavy machinery.
C. Mariners are advised that they are considered to be acting
under the authority of the credential anytime they are aboard a
vessel in a situation to which 46 CFR 5.57(a) applies, even when
off-watch or while asleep.
Prescription and Over-the-Counter Medications
Credential applicants who are required to complete a general
medical exam should disclose on the Merchant Mariner Credential
Medical Evaluation Report, CG-719K, all prescription and over the
counter medications, filled or refilled and/or taken within 30 days
prior to the date that the applicant submits the CG-719K to the
Coast Guard. 46 CFR 10.302(a) and 10.304(a).
In addition, credential applicants who are required to complete
a general medical exam should disclose on the CG-719K all
prescription medications and over-the-counter medications, including
dietary supplements and vitamins, that were used for a period of 30
days or more within the 90 days prior to the date the applicant
submits the CG-719K to the Coast Guard. 46 CFR 10.302(a) and
10.304(a).
Medications which may impair cognitive ability, judgment or
reaction time are considered disqualifying for issuance of
credentials. Additionally, the underlying condition requiring use of
the potentially impairing medication and/or the possible side-
effects of these medications may result in denial of a credential
application. Mariners who require the use of disqualifying
medications may seek consideration for a waiver in accordance with
46 CFR 10.303.
The following is a non-exhaustive list of medications that may
be deemed disqualifying due to risk of impaired cognitive ability,
judgment or reaction time. Mariners on these medications are subject
to further medical review, in accordance with enclosure (6) of NVIC
04-08, to determine whether the applicant's use of the medication is
disqualifying. If the applicant's medication use is deemed
disqualifying by the Coast Guard, then the Coast Guard will
determine whether the mariner qualifies for a waiver under 46 CFR
10.303. Please refer to the section on Medication Waivers that
follows.
A. Anti-Depressants:
(1) Conditions which require Selective serotonin reuptake
inhibitors (SSRI), serotonin and norepinephrine reuptake inhibitors
(SNRIs), or Wellbutrin (bupropion) do not require a waiver unless
the underlying condition is deemed disqualifying.
(2) Conditions which require the use of other anti-depressants
will be evaluated for stability of the underlying condition and the
absence of impairing medication side-effects.
(3) A waiver is not required when used as a smoking cessation
aid and with Premenstrual Dysphoric Disorder (PMDD).
B. Anti-Motion Sickness Agents: Use is approved and a waiver is
not required when used in accordance with manufacturers' warnings
and directions.
C. Anti-Psychotics: The medication and the underlying condition
will be reviewed to determine whether the mariner qualifies for a
waiver under 46 CFR 10.303.
D. Anti-Convulsives: The medication and the underlying condition
will be reviewed to determine whether the mariner qualifies for a
waiver under 46 CFR 10.303. See enclosure (8) for guidance on
evaluating waivers of underlying conditions that may require anti-
convulsives.
E. Anti-Histamines:
(1) Non-sedating medications, such as loratadine (Claritin),
fexofenadine (Allegra) and desloratadine (Clarinex), are acceptable
when used in accordance with manufacturers' warnings and directions.
(2) Sedating medications--The medication and the underlying
condition will be reviewed to determine whether the mariner
qualifies for a waiver under 46 CFR 10.303.
F. Barbiturate Medications: Due to the risk of impaired
cognitive ability, judgment, and reaction time, use of barbiturate
medications is disqualifying. The medication and the underlying
condition will be reviewed to determine whether the mariner
qualifies for a waiver under 46 CFR 10.303. Waivers for use within
48 hours prior to, or while acting under the authority of the
credential will only be approved on a case-by-case basis if the
Coast Guard determines that there are exceptional circumstances that
mitigate risk to public safety. See medication waiver discussion
below.
G. Benzodiazepines: Due to the risk of impaired cognitive
ability, judgment, and reaction time, use of benzodiazepine
medications is disqualifying. The medication and the underlying
condition will be reviewed to determine whether the mariner
qualifies for a waiver under 46 CFR 10.303. Waivers for use within
48 hours prior to, or while acting under the authority of the
credential will only be approved on a case-by-case basis if the
Coast Guard determines that there are exceptional circumstances that
mitigate risk to public safety. See Medication Waivers discussion
below.
H. Cough Preparations with Dextromethorphan, Codeine, or other
Codeine-Related Analogs:
(1) Use of over-the-counter medications is approved when used in
accordance with manufacturers' warnings and directions.
(2) For prescription medications containing opioid or opiate
ingredients, see section K, Legally Prescribed Controlled
Substances.
I. Diet Aids (e.g. Dexatrim, Metabolife, etc.) and Stimulants
(e.g. modafinil, amphetamines, etc.):
[[Page 4585]]
(1) Use of over-the-counter medications is approved when used in
accordance with manufacturers' warnings and directions.
(2) Prescription medications--The medication and the underlying
condition will be reviewed to determine whether the mariner
qualifies for a waiver under 46 CFR 10.303.
J. Non-benzodiazepine Sedative Hypnotic Medications: Due to the
risk of impaired cognitive ability, judgment, and reaction time, use
of non-benzodiazepine sedative hypnotic medications is
disqualifying. The medication and the underlying condition will be
reviewed to determine whether the mariner qualifies for a waiver
under 46 CFR 10.303. Waivers for use within 12 hours prior to, or
while acting under the authority of the credential will only be
approved on a case-by-case basis if the Coast Guard determines that
there are exceptional circumstances that mitigate risk to public
safety. See medication waiver discussion below.
K. Legally Prescribed Controlled Substances (including legally
prescribed narcotics, opiates, opioids and legally prescribed
medications which contain narcotics or opioids such as Tylenol with
codeine): Due to the risk of impaired cognitive ability, judgment,
and reaction time, use of legally prescribed controlled substances
is disqualifying. The medication and the underlying condition will
be reviewed to determine whether the mariner qualifies for a waiver
under 46 CFR 10.303. Waivers for use within 12 hours prior to, or
while acting under the authority of the credential will only be
approved on a case-by-case basis if the Coast Guard determines that
there are exceptional circumstances that mitigate risk to public
safety. See medication waiver discussion below.
L. Medical Use of Hallucinogens (e.g. medical marijuana, peyote
or ecstasy): Even if legalized by a state, is disqualifying and not
waiverable under any circumstances.
M. Muscle Relaxants: Centrally acting (e.g. carisoprodol,
meprobamate, cyclobenzaprine, methocarbamol, orphenadrine citrate,
anti-muscarinics and phenyltoloxamine, etc.): The medication and the
underlying condition will be reviewed to determine whether the
mariner qualifies for a waiver under 46 CFR 10.303. Waivers for use
within 12 hours prior to, or while acting under the authority of the
credential will only be approved on a case-by-case basis if the
Coast Guard determines that there are exceptional circumstances that
mitigate risk to public safety. See medication waiver discussion
below.
Medication Waivers
A. As stated previously, medications which may impair cognitive
ability, judgment or reaction time are considered disqualifying for
issuance of credentials. The underlying condition, as well as the
effects of the medications, may lead to denial of a credential
application or may result in issuance of a waiver.
B. Due to the documented risks of impaired cognition, judgment
and reaction time associated with the use of centrally acting
opioid/opiate medications, benzodiazepine medications, non-
benzodiazepine sedative hypnotic medications, and barbiturate
medications, the Coast Guard has determined that use of these
medications while acting under the authority of the credential is
generally not waiverable. However, waivers may be considered, on a
case-by-case basis, if the Coast Guard determines that there are
exceptional circumstances that warrant consideration for a waiver.
C. The Coast Guard retains final authority for the issuance of
waivers.
D. Waivers may include restrictions and/or limitations on the
credential.
E. Applicants seeking consideration for waivers for the use of
medications that may impair cognitive ability, judgment, or reaction
time should submit the additional information detailed below, for
each medication:
(1) A letter from the prescribing and/or treating physician that
includes the following:
a. Whether the physician has familiarized him/herself with the
detailed guidelines on medical conditions and medications contained
in Navigation and Vessel Inspection Circular 04-08.
b. Whether the physician understands the public-safety sensitive
nature of the merchant mariner credential.
c. A detailed discussion of the condition which requires use of
the potentially impairing medication.
d. A description of any known complications experienced by the
mariner from the use of a particular medication, level of current
stability and prognosis of the underlying condition. The physician
should also provide his or her professional opinion on whether the
condition is suitable for safety-sensitive work.
e. A description of the dosage and frequency of use of the
medication (this description should be very specific; ``as needed''
is not sufficient information). The description should also reflect
that the physician has reviewed the mariner's pharmacy records for
documentation of the number of pills dispensed for use each month
and documentation of the length of time that mariner has been on the
medication.
f. A detailed statement about whether the mariner is taking the
medication as directed and if there are any concerns of misuse or
overuse of the medication.
g. A statement about whether the mariner is compliant with
therapy and follow-up appointments.
h. A statement about whether the mariner requires use of this
medication while at work, or while aboard the vessel. If the mariner
requires use of the potentially impairing medication while at work
or while aboard the vessel, the physician should provide a detailed
explanation and rationale for the use.
i. A statement about whether the physician has advised the
mariner of the risks of impairment related to the medication. The
physician should also discuss any risks advised, as well as any
instructions discussed with the mariner for mitigating risk.
j. A statement about whether the mariner's other medications,
medical conditions, and work/sleep conditions might compound the
impairing effects of this medication. This discussion should reflect
that the physician has knowledge of the specifics of the mariner's
medications, medical conditions and work/sleep schedule.
k. A statement about whether the physician has formally
evaluated the mariner for the presence of any impairing medication
effects. This discussion should include a description of the method
of evaluation utilized, as well as the findings.
l. A medical opinion of whether the mariner has any medication
effects that would impede safe operation of a vessel or interfere
with work in a safety sensitive position. This discussion should
include the rationale for the physician's opinion.
m. A statement whether the physician has advised the mariner
that it is safe to operate a vessel, operate hazardous machinery and
perform safety sensitive functions while under the influence of this
medication.
(2) When requested, additional amplifying information, to
include formal neuropsychological/neurocognitive evaluation.
a. In particular, mariners seeking waivers to use or be under
the influence of potentially impairing opioid/opiate,
benzodiazepine, sedative hypnotic, and/or barbiturate medications,
while acting under the authority of the credential, may be asked to
submit the results of a formal neuropsychological/neurocognitive
evaluation.
b. When formal neuropsychologic or neurocognitive evaluation is
requested, the assessment should include objective evaluation of the
following functions, at a minimum: \2\
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\2\ Kay, GG and Logan BK, (2011). Drugged Driving Expert Panel
report: A consensus protocol for assessing the potential of drugs to
impair driving. (DOT HS 811 438). Washington, DC: National Highway
Traffic Safety Administration.
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i. Alertness, arousal and vigilance
ii. Attention (focused, shifting and divided), processing
speed,and working memory
iii. Reaction time (choice and complex), psychomotor function,
upper motor speed and coordination
iv. Sensory perceptual function
v. Executive function: Mental flexibility, adaptive problem
solving, abstract reasoning, impulse control, risk taking/risk
assessment, organizational ability (including visual spatial
organization), and planning
Authority
Ths notice is issued under the authority of 5 U.S.C. 552(a) and 46
U.S.C. 7101 et seq.
Dated: January, 16, 2015.
J.C. Burton,
Captain, U.S. Coast Guard, Director of Inspections & Compliance.
[FR Doc. 2015-01623 Filed 1-27-15; 8:45 am]
BILLING CODE 9110-04-P