Medical Literature Review

107 6. Medical Literature Review This section reviews the medical literature that addresses the relationship between operator medical conditions, incapacitation and accidents. For many medical conditions, there is either inconclusive or inconsistent data on the direct relationship between accidents and that condition. Any condition that causes sudden incapacitation may result in an accident. The literature appears to support a direct causal relationship between sleep disorders, certain medications, and hypoglycemia and the increased risk of incapacitation that could result in an

accident. There is also a relationship between the risk of impairment or sudden incapacitation and poorly controlled or end stage medical conditions. Articles focusing on the natural progression of diseases that may lead to impairment are beyond the scope of this review. The first six subsections are organized by organ system. The literature search did not identify any relevant articles for hearing loss. The literature on syncope, sleep disorders and attention deficit disorders are each reviewed separately. The final three subsections cover medications, health care provider knowledge and risks posed by the presence of multiple medical conditions. Appendix C contains the abstracts for the articles supporting the information in each subsection along with a glossary of relevant medical terminology. The references cited in this section are summarized in Appendix C. While the search for relevant literature focused on all modes of transportation, the majority of available research focuses on automobile drivers and commercial motor vehicle operators. Some literature is available from the aviation community, but there is no literature for railroad environments. 6.1 Blood Pressure High blood pressure (hypertension) is very common and correlates with an increased risk of developing additional cardiovascular diseases. The Joint National Committee on Prevention, Detection...

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