【Introduction】Driving cessation was reported to be associated with a significant decrease in quality of life （QOL） and greater risks of declines in cognitive function. Therefore, it is desirable for re-training driving skills of elderly drivers to extend their driving years. Nevertheless, it is physically impossible to conduct a detailed ability evaluation which is affected by diverse abilities and social backgrounds for all drivers.【Purpose】To propose a method that enables multifaceted screening for driving ability of elderly drivers （identification of subjects for detailed examination）.【Subjects】 Elderly drivers aged 65 years or older who voluntarily participated in the Senior Driver Support Project of Fujikawaguchiko Town.【Methods】Multiple simple tests （surveys） including visual search and processing ability tests using the Trail Making Test （TMT）, surveys of personal attributes （age, years of schooling, etc.） using a questionnaire, and risk avoidance tests using a simple driving simulator （DS） were conducted, then the relationships between the results of these tests （surveys） were analyzed. 【Results】①age, ②years of schooling, ③time required to complete TMT-A and ④TMT-B were found to be slightly correlated with risk avoidance ability. The boundary values at which the greatest significant difference in risk avoidance ability （DS scores） occurred were set as the evaluation criterion. Therefore, a driving ability screening method based on four evaluation criteria （age: 81 or older, years of schooling: less than 12 years, time required to complete TMT-A: longer than 60 seconds, time required to complete TMT-B: longer than 150 seconds） was proposed.【Conclusion】If two or more of the above criteria are met, additional tests, such as a driving skill test in a real car and medical diagnosis, are recommended.

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We investigated the recent judicial precedents on reinstatement, resignation and dismissal after injury or disease among professional drivers.
We examined cases involving fifteen male professional drivers. The causes of absence from work （with some overlap） included five injuries, five cases of nervous or musculoskeletal system disorder, two chronic disease cases, two psychiatric disorder cases, one cancer case, one cerebrovascular disease case, and one case of adverse drug reaction. Of these, three cases were sentenced as wrongful dismissal, and eight were sentenced to effective dismissal.
Frequency, discerning whether dismissals between drivers and the company are court-approved is challenging. For example, though a medical leave order can be issued at the companyʼs discretion, drivers on medical leave may be dismissed or force out of work if they do not recover fully. Therefore, the medical leave order and the temporary retirement period must be communicated clearly. In addition, professional drivers are limited to jobs that require them to drive business vehicles. They cannot be reinstated unless a safe driving environment can be assured. Lately, however, there have been judicial precedents in which are the company has had to provide some sort of attention for drivers on medical leave.
Many companies in the transportation field do not have industrial doctors. Thus, a medical doctor unfamiliar with the transportation business environment may issue a fit-to-work certificate for the drivers. Simultaneously, the employer might determine whether drivers can be reinstated independently. Given such arbitrary measures, the entire transport industry must consider and set criteria for drivers returning to driving work from injury or disease. Furthermore, it must adopt a system allowing drivers to continue their required treatment free from anxiety while working.

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Highways are traveled at high speeds, and motor vehicle collisions on highways are thus often serious accidents. Additionally, collisions in tunnels require ingenious responses by emergency services in carrying out rescue operations, life-saving treatment, and transportation. A joint drill was thus conducted assuming that multiple motor vehicle collisions had occurred in a tunnel of a highway before the opening of the newly constructed Expressway Kisei Line. The medical staffs traveling in the medical car were two medical doctors and one nurse. After reporting their arrival at the field command headquarters, one medical doctor participated in the field command headquarters, and the other medical doctor and nurse began to provide medical care at the first-aid station. The first triage performed by the emergency clue who arrived earlier than the medical car determined that two people were seriously injured, three people were moderate injured, and three people were mildly injured. The nurse then performed a second triage and the medical doctor stabilized the patients according to their severity of injury. As there was only one nurse, the paramedic assigned to the first-aid station also provided medical care. The destination of each patient was determined considering the road conditions for travel by ambulance. The drill highlighted that, for accidents in expressway tunnels providing a harsh environment for rescue and emergency activities, it is necessary to modify life-saving measures in accordance with the situation of the collision, respond to secondary disasters, and select a transport destination flexibly according to the situation. It is expected that training under such assumptions will help medical staff smoothly perform pre-hospital relief activities.

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A man age of sixties has referred to a physician with a diagnosis of decompensated liver cirrhosis, hyperammonemia and esophageal varices and received medications. He lived alone and was a taxi driver. Although he had been advised to quit driving a vehicle by the physician, he drove a vehicle daily. One day, he drove a vehicle for the opposite direction to his intended destination. Then, he deviated to the oncoming lane and collided to an oncoming vehicle. He suffered from multiple lacerations of the lower extremities, comminuted fractures of the left tibia and fibula and transferred to a hospital, however, died next day due to the hemorrhagic shock. At the forensic autopsy performed two days after his death, progressed liver cirrhosis, splenomegaly, and ascites were found in addition to the injuries. As the hyperammonemia was observed by blood examination, he was considered as suffering from hepatic encephalopathy and this condition is suspected as the cause of the vehicle collision. Although the health condition of the driver becomes a cause of motor vehicle collisions, it is not widely recognized that the progressed liver cirrhosis can affect the ability to safely drive a vehicle. With this case, we emphasize the importance of confirming driving ability of the patients with progressed liver diseases and guiding about driving a vehicle adequately. Also, keeping good adherence of the patients and advising to quit driving with patients’ family if necessary are required for the prevention of health-related motor vehicle collisions.

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