19 - Syncope - CCMTA Medical Standards
Syncope and medical fitness to drive.
- 19.6.1 Single episode of typical vasovagal syncope – Non-commercial drivers
- 19.6.2 Single episode of unexplained syncope or atypical vasovagal syncope – Non- commercial drivers
- 19.6.3 Syncope with a reversible cause
- 19.6.4 Syncope with a diagnosed and treated cause – Non-commercial drivers
- 19.6.5 Recurrent typical vasovagal syncope – Non-commercial drivers
- 19.6.6 Recurrent situational syncope with an avoidable trigger
- 19.6.7 Recurrent atypical vasovagal or recurrent unexplained syncope – Non- commercial drivers
- 19.6.8 Single episode of typical vasovagal syncope – Commercial drivers
- 19.6.9 Syncope with a diagnosed and treated cause – Commercial drivers
- 19.6.10 Single or recurrent unexplained, single or recurrent atypical vasovagal, or recurrent typical vasovagal syncope – Commercial drivers
19.1 About syncope
Syncope refers to a partial or complete loss of consciousness, usually resulting from a temporary reduction in blood flow to the brain. The onset of syncope is relatively rapid and recovery is generally prompt, spontaneous and complete. The non-medical term for syncope is fainting.
Syncope has many different causes, including cardiovascular disease and neurological disorders. In some cases, no underlying cause can be found.
The following are the major types of syncope:
- Vasovagal syncope
- Postural syncope, and
- Cardiac syncope
The most common types of syncope are vasovagal (neurocardiogenic) and cardiac syncope.
Vasovagal syncope
Vasovagal or neurocardiogenic syncope refers to syncope that is triggered by an exaggerated and inappropriate nervous system response to a particular stimulus. The response is characterized by alterations in heart rate and blood flow, with a subsequent reduction in blood pressure. The stimulus can be any of a wide range of events such as:
- Dehydration
- Intense emotional stress
- Anxiety
- Fear
- Pain
- Hunger, or
- The use of alcohol or drugs
Stimuli can also include forceful coughing, turning of the neck or wearing a tight collar (carotid sinus hypersensitivity), or urinating (micturition syncope).
Postural syncope
Postural syncope is syncope that results from a sudden drop in blood pressure immediately after standing or sitting up. It can be a side-effect of some medications or may be caused by dehydration or medical conditions such as Parkinson’s disease.
Cardiac syncope
Cardiac syncope refers to syncope caused by cardiac conditions such as:
- Valvular heart disease
- Chronic heart failure, or
- Arrhythmias (bradycardias or tachycardias)
Cardiac arrhythmias are the most common cause of cardiac syncope.
19.2 Prevalence
The prevalence of syncope is difficult to determine. One study reported that 3% of males and 3.5% of females had at least one episode of syncope over a 26 year period. The Canadian Cardiovascular Society estimates that syncope may affect as many as 50% of Canadians at some point during their lives. Higher rates of syncope are reported in older individuals.
19.3 Syncope and adverse driving outcomes
Few studies have considered the relationship between syncope and driving. Of those that have, most indicate a relationship between syncope and impaired driving performance for at least some groups that experience syncope.
19.4 Effect on functional ability to drive
Condition | Type of driving impairment and assessment approach | Primary functional ability affected | Assessment tools |
Syncope | Episodic impairment: Medical assessment – likelihood of impairment | All – sudden incapacitation | Medical assessments |
Syncope causes an episodic impairment of all the functions necessary for driving.
19.5 Compensation
As syncope causes an episodic impairment of the functions necessary for driving, compensation does not apply.
19.6 Guideline for Assessment
The following table lists the standards applicable to various types of syncope.
Type of syncope | Standards for non-commercial drivers | Standards for commercial drivers | |
Single (one episode within a 12 month period) | Typical vasovagal - Typical vasovagal syncope is a vasovagal syncope that occurs when standing and is preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness. | 19.6.1 | 19.6.8 |
Unexplained | 19.6.2 | 19.6.10 | |
Atypical vasovagal - Atypical vasovagal syncope is a vasovagal syncope that occurs in the sitting position or is not preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness. | 19.6.2 | 19.6.10 | |
Recurrent (two or more episodes within a 12 month period) | Reversible cause | 19.6.3 | 19.6.3 |
Diagnosed and treated cause (e.g. pacemaker for bradycardia) | 19.6.4 | 19.6.9 | |
Typical vasovagal (see definition above) | 19.6.5 | 19.6.10 | |
Situational with an avoidable trigger (e.g. micturition syncope, defecation syncope) | 19.6.6 | 19.6.6 | |
Unexplained | 19.6.7 | 19.6.10 | |
Atypical vasovagal (see definition above) | 19.6.7 | 19.6.10 |
The following table summarizes the syncope standards and waiting periods
National Standard |
Non Commercial Driver Class 5-8 |
Commercial Driver Class 1-4 |
Single episode of typical vasovagal syncope* | No restriction | |
Diagnosed and treated cause e.g. permanent pacemaker for bradycardia |
1 week | 1 month |
Reversible cause e.g. hemorrhage, dehydration |
Successful treatment of underlying condition | |
Situational syncope with avoidable trigger e.g. micturition syncope, defecation syncope |
1 week | |
|
1 week | 12 months |
Recurrent episode of unexplained syncope (within 12 months) | 3 months | 12 months |
Syncope due to documented tachyarrhythmia, or inducible tachyarrhythmia at EPS | Refer to Cardiac Section on Syncope |
(* No restriction is recommended unless the syncope occurs in the sitting position or if it is determined that there may be an insufficient prodrome to pilot the vehicle to the roadside to a stop before losing consciousness. If vasovagal syncope is atypical, the restrictions for “unexplained” syncope apply. EPS: Electrophysiology study)
Rationale for all syncope standards
These guidelines are based primarily on recommendations contained in the final report of the 2003 Canadian Cardiovascular Society (CCS) Consensus Conference Assessment of the Cardiac Patient for Fitness to Drive and Fly. When applying these standards, the CCS indicates that waiting periods may be modified based on individual factors such as length of any reliable warning symptoms (prodrome), reversible or avoidable precipitating factors, and position from which the individual experiences syncope.
19.6.1 Single episode of typical vasovagal syncope – Non-commercial drivers
Typical vasovagal syncope is a vasovagal syncope that occurs when standing and is preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
National Standard | Non-commercial drivers eligible for a licence |
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence | None |
Reassessment | No re-assessment is required after an episode of typical vasovagal syncope |
Information from health care providers | Description of the type of syncope |
Rationale | CCS recommendation |
19.6.2 Single episode of unexplained syncope or atypical vasovagal syncope – Non- commercial drivers
Atypical vasovagal syncope is a vasovagal syncope that occurs in the sitting position or is not preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
National Standard |
Non-commercial drivers eligible for a licence if:
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence | Report to the authority and your physician if you have another episode of syncope |
Reassessment |
|
Information from health care providers |
|
Rationale | CCS recommendation. When applying these guidelines, the CCS indicates that waiting periods may be modified based on individual factors such as length of any reliable warning symptoms (prodrome), reversible or avoidable precipitating factors, and position from which the individual experiences syncope. |
19.6.3 Syncope with a reversible cause
National Standard |
All drivers eligible for a licence if:
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence |
RoadSafetyBC will impose the following condition on an individual who is found fit to drive:
|
Reassessment | No re-assessment, other than routine age-related re-assessment or routine commercial re-assessment is required, unless re-assessment is required because of the underlying medical condition or treatment |
Information from health care providers |
|
Rationale | CCS recommendation |
19.6.4 Syncope with a diagnosed and treated cause – Non-commercial drivers
Syncope with a diagnosed and treated cause (e.g., pacemaker for bradycardia)
National Standard |
Non-commercial drivers eligible for a licence if:
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence |
RoadSafetyBC will impose the following condition on an individual who is found fit to drive
|
Reassessment | No re-assessment, other than routine age-related re-assessment is required, unless re-assessment is required because of the underlying medical condition or treatment |
Information from health care providers |
|
Rationale | CCS recommendation |
19.6.5 Recurrent typical vasovagal syncope – Non-commercial drivers
This guideline applies to non-commercial drivers who have had two or more episodes of typical vasovagal syncope within a 12 month period.
National Standard |
Non-commercial drivers eligible for a licence if:
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence | No conditions are required |
Reassessment |
|
Information from health care providers |
|
Rationale | CCS recommendation. When applying these guidelines, the CCS indicates that waiting periods may be modified based on individual factors such as length of any reliable warning symptoms (prodrome), reversible or avoidable precipitating factors, and position from which the individual experiences syncope |
19.6.6 Recurrent situational syncope with an avoidable trigger
This guideline applies to drivers who have had two or more episodes of situational syncope with an avoidable trigger (e.g. micturition syncope, defecation syncope) within a 12 month period.
National Standard |
All drivers eligible for a licence if
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence | None |
Reassessment | No re-assessment, other than routine age-related re-assessment is required for individuals with situational syncope. |
Information from health care providers |
|
Rationale | CCS recommendation |
19.6.7 Recurrent atypical vasovagal or recurrent unexplained syncope – Non- commercial drivers
This guideline applies to non-commercial drivers who have had two or more episodes of atypical vasovagal syncope, or unexplained syncope within a 12 month period.
Atypical vasovagal syncope is a vasovagal syncope that occurs in the sitting position or is not preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
National Standard |
Non-commercial drivers eligible for a licence if:
|
BC Guidelines |
If further information is required, RoadSafetyBC may request
|
Conditions for maintaining licence |
RoadSafetyBC will impose the following condition on an individual who is found fit to drive
|
Reassessment |
|
Information from health care providers |
|
Rationale | CCS recommendation. When applying these guidelines, the CCS indicates that waiting periods may be modified based on individual factors such as length of any reliable warning symptoms (prodrome), reversible or avoidable precipitating factors, and position from which the individual experiences syncope |
19.6.8 Single episode of typical vasovagal syncope – Commercial drivers
This guideline applies to commercial drivers who have had a single episode of typical vasovagal syncope within a 12 month period.
Typical vasovagal syncope is a vasovagal syncope that occurs when standing and is preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
National Standard |
Commercial drivers eligible for a licence if:
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence |
RoadSafetyBC will impose the following condition on an individual who is found fit to drive:
|
Reassessment | No re-assessment, other than routine commercial re-assessment, is required |
Information from health care providers | Description of the type of syncope |
Rationale | CCS recommendation |
19.6.9 Syncope with a diagnosed and treated cause – Commercial drivers
This guideline applies to commercial drivers who have syncope with a diagnosed and treated cause (e.g. pacemaker for bradycardia).
National Standard |
Commercial drivers eligible for a licence if:
|
BC Guidelines | RoadSafetyBC will not generally request further information |
Conditions for maintaining licence |
RoadSafetyBC will impose the following condition on an individual who is found fit to drive:
|
Reassessment | No re-assessment, other than routine commercial re-assessment is required, unless re-assessment is required because of the underlying medical condition or treatment |
Information from health care providers |
|
Rationale | CCS recommendation |
19.6.10 Single or recurrent unexplained, single or recurrent atypical vasovagal, or recurrent typical vasovagal syncope – Commercial drivers
This standard applies to commercial drivers who have had:
- Single or recurrent atypical vasovagal syncope
- Single or recurrent unexplained syncope, or
- Recurrent typical vasovagal syncope within a 12 month period
Typical vasovagal syncope is a vasovagal syncope that occurs when standing and is preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
Atypical vasovagal syncope is a vasovagal syncope that occurs in the sitting position or is not preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
National Standard |
Commercial drivers eligible for a licence if:
|
BC Guidelines |
If further information is required, RoadSafetyBC may request:
|
Conditions for maintaining licence |
RoadSafetyBC will impose the following conditions on an individual who is found fit to drive:
|
Reassessment |
|
Information from health care providers |
|
Rationale | CCS recommendation. When applying these guidelines, the CCS indicates that waiting periods may be modified based on individual factors such as length of any reliable warning symptoms (prodrome), reversible or avoidable precipitating factors, and position from which the individual experiences syncope |