Can I drive after fainting?

Are you allowed to drive if you have had blackouts?

A blackout is where you suffer a temporary loss of consciousness. Obviously, when driving a vehicle, this is very dangerous. Blackouts can be caused by a number of physiological factors and chemical factors.

Fainting – more than 50% of blackouts are due to this and it’s often caused by hot weather, prolonged standing, having blood taken or experiencing intense emotions
Syncope (temporary loss of blood flow to the brain) due to cardiovascular disease or arrhythmias
Epileptic seizures (these account for less than 10% of blackouts)
Drug intoxication
Sleep disorders (e.g. microsleeps)
Hypoglycaemia

Drivers will almost certainly need to see a specialist to determine how to manage the blackouts. For fainting (vasovagal syncope) it’s not usually necessary to restrict driving, but a cardiovascular exam may need to be conducted to eliminate any potential heart problems. Specialists will look at the likelihood of it recurring while you drive.

Drivers who develop epilepsy must stop driving until they have been free of seizures for at least 12 months. Drivers should not drive after taking drugs. Drivers suffering from diabetes which caused the hypoglycaemia must follow the procedures here.

Sleep disorders are more insidious. If it was found to be a microsleep then a sleep study might be conducted. Strategies to help drowsy driving include using a CPAP machine, ensuring at least 7-8 hours of sleep a night, changing the mattress, keeping the room temperature comfortable, and not doing shift work. Some factors may be temporary such as a new baby.

When must a driver consider a conditional licence?

The driver licensing authority will take into account the type of driving the driver does. For example, a person that only occasionally is required to drive a medium combination vehicle will be treated differently to a driver driving a multiple combination vehicle across the country, all other things being equal.

If the blackout can’t be diagnosed then the person may not be fit to hold an unconditional licence. If a person doesn’t meet the standard for an unconditional licence because they have had a blackout where the cause can’t be determined, but a specialist is of the opinion that they are safe to drive then they may be eligible for a conditional licence with an annual review.

Private drivers

Where the cause of the blackout is known, if there has been a single blackout or more than one blackout within a 24-hour period, a conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor. There must have been no further blackouts for at least six months.

If there have been two or more blackouts separated by at least 24 hours, a conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor. There must have been no further blackouts for at least 12 months.

Commercial drivers

The rules are the same as above but the time periods without blackouts are 5 years and 10 years respectively.

Darren is an expert on driving and transport, and is a member of the Institute of Advanced Motorists

Can your drivers license be suspended for fainting?

California DMV has the power to suspend or revoke a driver’s license if the driver has a:

lapse of consciousness disorder, or
episodes of marked confusion. 1

In determining whether a driver has one of these medical conditions or a seizure disorder, the DMV will consider numerous factors. These include:

the effect of the disorder on the person’s ability to exercise reasonable control of a motor vehicle,
testimony from the driver and from others about the person’s driving ability,
whether the disorder is under control with or without medication,
whether the driver is likely to comply with a prescribed medication,
other medical conditions that can impact the disorder,
the driver’s past driving record, and
the results of a medical evaluation. 2

Based on these factors, the California DMV can either:

revoke the driver’s license,
suspend it,
put the driver on a medical probation, or
take no action. 3

The DMV has to notify the driver, in writing, of any action that it takes. The driver can appeal the decision by demanding a DMV re-examination or lapse of consciousness hearing. This appeal has to happen within 14 days to trigger the administrative hearing.

What happens at the lapse of consciousness hearing?

A lapse of consciousness hearing is where California drivers can fight a license suspension or revocation for a fainting episode by showing that they can still drive safely.

These hearings happen at the DMV. A DMV hearing officer will interview the driver and examine the evidence. The driver is entitled to have a lawyer represent them at the hearing.

At the hearing, the driver has to show that:

the cause for the fainting spell has been treated,
he or she has no ongoing medical concerns that can cause them to faint, again, and
he or she is a safe driver.

Drivers can do this with testimony, including from friends and family members, and medical reports.

After hearing the evidence, the DMV hearing officer can:

suspend the driver’s license,
revoke it,
reinstate the driver’s license and driving privileges in their entirety,
issue a restricted permit for driving, or
order a medical evaluation to get more information about the fainting spell.

What is medical probation?

In California, drivers can request to be put on medical probation after their license has been suspended for a fainting spell. To be put on medical probation, the driver’s lapse of consciousness must be under control for at least 3 months.

Drivers who have not lost consciousness for 3 months are put on Type II medical probation. It is up to the driver to request Type II probation. They can do so by having their physician complete the Driver Medical Evaluation (DS 326). 4 The DMV will decide whether to grant a Type II medical probation based on the driver’s:

seizure type,
seizure manifestation,
medical, lifestyle, and seizure history, and
time period since the last seizure. 5

Type III medical probation is for drivers who have been seizure free for a six-month period, but who still carry the risk of having one, again. Drivers have to request to be put on Type III probation, as well. This requires drivers to self-report their condition to the DMV on a regular basis. In making this decision, the DMV considers:

the medical history and the driver’s history of seizures,
the seizure type, manifestation, and the period of time since the last episode,
the driver’s prior non-compliance,
any incidents where the driver withheld information from the DMV or his or her doctor, and
any inconsistent statements made by the driver during the probationary process. 6

What medical conditions cause fainting?

Fainting can be caused by numerous medical conditions, including:

irregular heartbeats or arrhythmia,
seizures,
drug or alcohol impairment,
anemia,
hypoglycemia, or low blood sugar,
diabetes,
epilepsy,
sleep disorders,
Alzheimer’s disease and certain other mental disorders, and
narcolepsy.

However, not all fainting spells are connected to a medical condition. Sometimes, people faint or blackout from a vasovagal attack, also known as syncope. This happens when blood pressure drops drastically, cutting blood circulation to the brain.

Vasovagal attacks can get triggered by non-medical conditions, like:

anxiety,
fear,
shock,
pain, or
dehydration.

These types of fainting spells are unlikely to repeat in the future. Drivers who have seen their license suspended because of a vasovagal attack should strongly consider appealing the suspension.

How does the DMV hear of fainting episodes?

State DMVs can hear about a driver’s fainting episode through a variety of channels, including:

police reports by law enforcement of a car accident that was caused by a driver’s loss of consciousness,
tips from other drivers or members of the public, and
reports from doctors.

California is one state that requires doctors to immediately report a patient’s lapse of consciousness or fainting spell to the DMV. 7 In doing so, healthcare professionals are immune from civil or criminal liability.

Legal References:

California Code of Regulations Title 13 Section 110.01.
Same.
California Code of Regulations Title 13 Section 110.02.
DMV website – Driver Safety Information Lapses of Consciousness Disorders.
Same.
Same.
California Health and Safety Code 103900 HSC.

syncope and driving

Transient loss of consciousness (TLoC) or ‘blackout’ is very common — it affects up to half the population in the UK at some point in their lives.
- estimated 3% of A&E presentations and 1% of hospital admissions are due to TLoC.
- road traffic collisions resulting from blackouts are two or three times more common than those resulting from seizures. Recurrent TLoC (more than one isolated event), not including syncope, is uncommon — but always requires detailed medical assessment
- prodrome — are there warning symptoms sufficient in both nature and duration?
- posture — do the episodes of TLoC occur while sitting?
  - a prodrome must allow time for a driver to find a safe place to stop before losing consciousness. A prodrome is reliable if the signs are clear, consistent across all events and provide sufficient duration to find a safe stop, or unreliable if these are absent.
  Licence holders or applicants should be informed that they must notify the DVLA when TLoC occurs while sitting
  For syncope occurring while standing or sitting, the following factors indicate high risk:
  - abnormal ECG
  - clinical evidence of structural heart disease.
  Further investigations such as 48-hour ambulatory ECG, echocardiography and exercise testing may be indicated after specialist opinion has been sought.
  Transient loss of consciousness — solitary episode
  Typical vasovagal syncope
  - Group 1
    - While standing
      - May drive and need not notify the DVLA
      - May drive and need not notify the DVLA if there is an avoidable trigger which will not occur whilst driving.
      - Otherwise must not drive until annual risk of recurrence is assessed as below 20%
      Syncope with avoidable trigger or otherwise reversible cause
      - Group 1
        While standing
        May drive and need not notify the DVLA
        Must not drive for 4 weeks. Driving may resume after 4 weeks only if the cause has been identified and treated. Must notify the DVLA if the cause has not been identified and treated.
        Unexplained syncope, including syncope without reliable prodrome
        This diagnosis may apply only after appropriate neurological and/or cardiological opinion and investigations have detected no abnormality.
        Group 1
        While standing or sitting
        Must not drive and must notify the DVLA. If no cause has been identified, the licence will be refused or revoked for 6 months
        Cardiovascular, excluding typical syncope
        Group 1
        While standing or sitting
        Must not drive and must notify the DVLA.
        Driving may be allowed to resume after 4 weeks if the cause has been identified and treated.
        If no cause has been identified, the licence will be refused or revoked for 6 months
        Blackout with seizure markers
        This category is for those where on the balance of probability there is clinical suspicion of a seizure but no definite evidence. Individuals will require assessment by an appropriate specialist and investigation, for example EEG and brain scan, where indicated. The following factors indicate a likely seizure:
        loss of consciousness for more than 5 minutes
        amnesia longer than 5 minutes
        injury
        tongue biting
        incontinence
        post ictal confusion
        eadachhe post attack
        While standing or sitting
        Must stop driving and notify the DVLA.
        6 months off driving from the date of the episode.
        If there are factors that would lead to an increased risk of recurrence, 1 year off driving would be required
        Transient loss of consciousness- recurring episodes
        Recurrent episodes of TLoC are less common than isolated episodes but the relevance to increased risk in driving cannot be overemphasised (1)
        recurrent TLoC is most commonly due to recurrent syncope, occurring in around 20% to 30% of patients.
        recurrence of syncope is usually within three years of the first episode, and in over 80% of these cases there has been at least one additional episode within two years of the first episode
        prodrome — are there warning signs sufficient in both nature and duration?
        posture — do the episodes of TLoC occur while sitting?
        a prodrome must allow time for a driver to find a safe place to stop before losing consciousness. A prodrome is reliable if the signs are clear, consistent across all events and provide sufficient duration to find a safe stop, or unreliable if these are absent.
        Recurrent pre-syncopal events should be treated (from a licensing point of view) in the same way as recurrent syncope, and should therefore be categorised according to the standards for recurrent syncope.
        Licence holders or applicants should be informed that they must notify the DVLA when transient loss of consciousness occurs while sitting
        Recurrent typical vasovagal syncope with identifiable consistent prodrome
        Group 1
        While standing
        May drive and need not notify the DVLA
        Must not drive and must notify the DVLA. Must not drive until annual risk of recurrence is assessed as below 20%.
        May drive and need not notify the DVLA if there is an avoidable trigger which will not occur whilst driving.
        Otherwise must not drive until annual risk of recurrence is assessed as below 20%
        Recurrent syncope with avoidable trigger or otherwise reversible cause
        Group 1
        While standing
        May drive and need not notify the DVLA
        Must not drive for 4 weeks.
        Driving may resume after 4 weeks only if the cause has been identified and treated.
        Must notify the DVLA if the cause has not been identified and treated
        For syncope occurring while standing or sitting, the following factors indicate high risk:
        abnormal ECG
        clinical evidence of structural heart disease.
        Further investigations such as 48-hour ambulatory ECG, echocardiography and exercise testing may be indicated after specialist opinion has been sought.
        Recurrent unexplained syncope, including syncope without reliable prodrome
        This diagnosis may apply only after appropriate neurological and/or cardiological opinion and investigations have detected no abnormality.
        Group 1
        While standing or sitting
        Must not drive and must notify the DVLA. If no cause has been identified, the licence will be refused or revoked for 12 months
        Recurrent cardiovascular but excluding typical vasovagal syncope
        Group 1
        While standing or sitting
        Must not drive and must notify the DVLA. If there are factors that would lead to an increased risk of recurrence, then 1 year off driving would be required
        Recurrent blackout with seizure markers
        This category is for those where on the balance of probability there is clinical suspicion of a seizure but no definite evidence. Individuals will require assessment by an appropriate specialist and investigation, for example EEG and brain scan, where indicated
        Group 1
        While standing or sitting
        Must stop driving and notify the DVLA.
        Depending on previous medical history, the standards for isolated seizure or epilepsy will apply
        Cough syncope
        Group 1
        Must not drive and must notify the DVLA.
        Must not drive for 6 months following a single episode and for 12 months following multiple episodes over 5 years.
        If more than one episode of cough syncope occurs within a 24 hour period, this will be counted as a single event. However if the episodes of cough syncope are more than 24 hours apart, these are considered as multiple episodes.
        (1) DVLA (March 2019). At a glance guide to the current medical standards of fitness to drive