Under the hood of the new driving guidelines  

The evolving specialty of traffic medicine has taken a step forward with newly updated guidelines on medical fitness to drive. David Lynch reports

New guidelines provide doctors an opportunity to “look under the hood” of what rehabilitation means for drivers, the Director of the National Office for Traffic Medicine (NOTM) has told the Medical Independent (MI).

Prof Desmond O’Neill described the publication of the document as a “major” update to Ireland’s medical fitness to drive guidelines. It has been produced by the Road Safety Authority (RSA) and the NOTM.

Doctors are being urged to familiarise themselves with the updated guidelines, which offer revised advice for drivers with a range of medical conditions, including stroke, epilepsy, diabetes, and sleep disorders.

The guidelines are said to reflect the latest medical research and best practices in road safety.

Guidance

The document, Sláinte agus Tiomáint, provides guidance for healthcare professionals (HCPs) in assessing whether a patient is fit to drive following a medical diagnosis, injury, or treatment.

According to the RSA, for many people, driving is essential for maintaining independence and wellbeing. “The updated rehabilitation framework within the guidelines acknowledges this, emphasising a multidisciplinary approach that includes medical professionals, physiotherapists, occupational therapists, and optometrists to support people in safely returning to the road,” stated the RSA.

Continued driving may be facilitated through licence restrictions, which can include vehicle adaptations, limits to daytime driving, and restrictions on speed and distance.

The Government’s decision to provide a free travel pass for individuals medically unfit to drive for at least 12 months “offers crucial support” to those affected, according to the RSA.

As for the changes to which doctors should pay particular attention, Prof O’Neill said: “The ones that they should watch out for are [recommendations] like the advice around night blindness.”

Prof O’Neill was speaking to MI at the launch of the new guidelines at Trinity College Dublin (TCD) in April. He stressed the guidelines provide the opportunity to examine the meaning of rehabilitation medicine.

“Every practice works with someone who has had a stroke, or brain injury, so they know what happens.”

Prof O’Neill added that the updated guidelines also provide important advice on how clinicians may have to “break the bad news” to patients regarding driving. “I think that’s really helpful.”

He also highlighted the importance of updated clarifications on insulin-treated diabetes, for both group 1 and group 2 drivers, in relation to interstitial glucose monitoring systems.

Prof O’Neill said that doctors should take into account a patient’s profession when providing advice on driving.

While doctors are certifying someone for a licence category rather than a specific job, he noted that the nature of a person’s work – such as a sales representative who drives extensively – should influence the guidance given. This might mean “advising them to return to their job part-time”.

Prof O’Neill said that knowledge of the guidelines is important for all HCPs, not just GPs.

“There has been very good engagement with the courses and the CPD courses that we have [in the NOTM],” he said. “I’m finding that people need to be advising in the context of the work that they are doing.”

For example, he said that HCPs working in secondary care settings, such as stroke or dementia services, also have a “key” role in providing advice.

Specialty

Traffic medicine may still be a “relatively new specialism”, but Prof O’Neill said it has seen major recent developments. During its early years, there was significant attention on “embracing all those disciplines, techniques, and methods aimed at reducing death and injury” caused by traffic crashes.

However, over time, traffic medicine has also developed an enabling/rehabilitative focus “in trying to ensure that transport mobility is not hampered, or rendered unsafe, by remediable illness or functional loss”.

In terms of the future, autonomous vehicles is an area of discussion among traffic medicine specialists, Prof O’Neill told MI.

He said he regularly engages with the Californian Department of Motor Vehicles at a major annual meeting on the subject.

“They have actually said that at the moment, the medical fitness [guidelines] should actually be the same [for autonomous as for human-driven cars]. Because you have got to be able to know what to do in terms of an accident, or an emergency.”

Prof O’Neill said that while he believes autonomous vehicles will potentially play a “useful role” in facilitating driving for people, they may not “supplant” traditional driving. 

“Take Google Maps, it can still send you to the wrong place. I was recently looking for the UCD Humanities Institute and it sent me 15 metres from it – on the other side of a wall in a housing estate.”

So while he argued that autonomous vehicles are “never going to be the full solution” to improving safety, they are “going to help”.

Evolution

During his address at the TCD launch, Prof O’Neill added that updates to the guidelines “reflect the evolving nature” of road safety and medical science.

“We recognise the importance of balancing road safety with individual mobility and independence. By equipping healthcare professionals with clear, up-to-date guidance, we can ensure that decisions around fitness to drive are made with confidence, fairness, and safety in mind.

“If doctors and other health professionals routinely provide advice based on these guidelines to their patients, we can reduce crash rates by up to one-third and also maintain safe mobility for longer.”

Prof O’Neill said that the NOTM has provided a successful programme since its foundation in 2011 and remains relatively unique internationally.

The Office engages both medical professionals and the wider public through a range of outreach efforts, including leaflets, media campaigns, and information stands at major events such as the annual National Ploughing Championship.

Also speaking at the launch, Mr Sam Waide, Chief Executive of the RSA, said Ireland has an ageing population and an increasing number of drivers managing chronic health conditions. These new guidelines are, therefore, “more relevant than ever.”

“By aligning with international best practices and drawing on the latest medical research, we aim to ensure that medical fitness assessments are fair, transparent, and prioritise road safety.”

The launch also heard presentations by Prof Conor Deasy, Clinical Lead of the Major Trauma Audit (MTA), who discussed the MTA and road traffic collisions in Ireland and Dr Paul Carroll, Consultant in Rehabilitation Medicine, National Rehabilitation Hospital, St Vincent’s University Hospital, and the Royal Hospital Donnybrook, Dublin, who spoke on rehabilitation and driving.

The revised Sláinte agus Tiomáint guidelines are available at: www.rsa.ie/docs/default-source/road-safety/slainte-agus-tiomaint-medical-fitness-to-drive-guidelines-2025.pdf?sfvrsn=2855c887_3