MEDICAL GUIDELINES

FOR DRIVERS
TABLE OF
CONTENTS
PRELIMINARY NOTICES AND TERMS 4 NEUROLOGY 17
Introduction 4 Dementia or cognitive impairment 17
Disclaimer 4 Epilepsy 17
Limitation & indemnity 4 Head injury 17
Governing law & jurisdiction 5 Multiple Sclerosis 18
Parkinson’s disease 18
GUIDANCE MATERIAL 6 Stroke/TIA 18
CARDIOLOGY 9 OBSTETRICS & GYNAECOLOGY 19
Cardiovascular assessment 9
Gynaecological surgery 19
Blood pressure 9
Pregnancy 19
Valvular abnormalities 9
Cardiomyopathy 9 ONCOLOGY 19
Coronary artery disease 9
Myocardial ischaemia or infarction 9 Chemotherapy 19
Rhythm and conduction disturbances 9 Radiotherapy 19
Surgery 19
DERMATOLOGY 10 Metastatic disease 19
Acne 10 OTORHINOLARYNGOLOGY (ENT) 21
Eczema and psoriasis 10
Skin cancer 10 Hearing 21
Syncope 10 Vestibular disturbance 21
Pacemakers and implanted defibrillators 10
Thromboembolic disorders 10 RESPIRATORY 21
Asthma 21
GASTROINTESTINAL 11 Pneumothorax 21
Diverticular disease 11 Sarcoidosis 21
Peptic ulceration 11 Sleep apnoea 21
Inflammatory bowel disease 11
VISUAL 22
GENITOURINARY 11 Colour vision 22
Haematuria 11 Correcting lenses and visual acuity 22
Chronic renal disease 11 Eye surgery 22
Erectile dysfunction 11 Sub-standard vision and visual fields 22
Renal Calculi 11
Renal transplant 11

HAEMATOLOGY 13
Abnormal haemoglobin 13
Anaemia 13
Coagulation or haemorrhagic disorders 13
Leukaemia and lymphomas 13

INFECTIOUS DISEASES 13
Hepatitis A/B/C 13
HIV 13

METABOLIC & ENDOCRINOLOGY 14

Diabetes and abnormal glucose metabolism 14
Obesity 14
Thyroid disease 14

MENTAL HEALTH 14
ADHD and ASD 14
Depression and anxiety 14
Psychosis 14

MUSCULOSKELETAL 17
Acute injury and recovery 17
Physical disability mechanical or neurological 17

MEDICAL GUIDELINES FOR DRIVERS 3

PRELIMINARY
5. The Guidelines do not contain any advice or guidance in
relation to Applicable Laws, and the FIA makes no representation
or warranty that the general informational guidance within the

NOTICES AND Guidelines complies with the Applicable Laws applying to a

particular Motor Sport Event. Accordingly, it is the full responsibility

TERMS
of Third Parties to i) take appropriate advice and make their own
enquiries as to Applicable Laws and any particular local safety
requirements or other relevant considerations applying to a Motor
Sport Event and ii) to adapt and implement the Guidelines in a
©2024 Fédération Internationale de l’Automobile (FIA) – All rights suitable and safe manner depending on the circumstances of the
reserved. particular Motor Sport Event. The FIA assumes no responsibility in
this regard.
The publication, reproduction or distribution of this “Medical
Standards for Drivers” (“Guidelines”), in whole or in part, without the 6. For the avoidance of any doubt, compliance with the
written permission of the FIA, is prohibited. Guidelines in isolation does not guarantee the safety of a particular
Motor Sport Event or of the participants to a particular Motor Sport
INTRODUCTION Event.

1. The Guidelines set out general informational guidance 7. If there is any conflict, or any doubt as to a conflict,
as to how medical conditions may affect the ability to achieve between the contents of the Guidelines and Applicable Laws,
medical fitness to compete and drive in competitions within a Applicable Laws always take precedence. If it is possible to
motorsport context. This document has no binding regulatory effect comply both with Applicable Laws and the Guidelines (driver to all
and is provided, at the FIA’s discretion, to assist National Sporting appropriate adaptations as per paragraph 5), Third Parties should
Authorities (“ASN(s)”) and other organisations or individuals (the endeavor to do so.
ASNs and other organisations or individuals together the “Third
Party(ies)”) involved in granting competition licences for motorsport 8. The FIA does not make any representation or warranty,
events (“Motor Sport Event(s)”). express or implied, and does not assume any responsibility as to the
quality, suitability or fitness for purpose:
2. Use of the Guidelines by any Third Party is strictly driver to
the Third Party’s acceptance of and agreement to comply with these A. of any equipment, structures, installations, products or facilities
Preliminary Notices and Terms. that may be referred to within the Guidelines; nor
B. as to the applicability or suitability of the Guidelines in relation
DISCLAIMER to a particular Motor Sport Event.

3. The contents of the Guidelines (including general 9. All Third Parties are made aware that technology utilised
informational guidance in relation to health and safety, sporting or in motor sport vehicles, equipment, structures, installations and
technical matters) taken in isolation may not be suitable or appropriate products is driver to ongoing change and development, as well
for each and every Motor Sport Event (which incorporates all of as good and best practice evolving over time. As a result, the
the following activities i) motor sports competitions, practices, tests, Guidelines are driver to ongoing review and amendment over time.
reconnaissance’s / “recce’s”and demonstrations, ii) any associated
entertainment, marketing or commercial activities and iii) any 10. All Third Parties are made aware of the risks that are
engineering, scrutineering, maintenance or other technical activities, inherent in the attendance of any person at or within the vicinity of
and begins from the time the relevant locations where these activities a Motor Sport Event. Depending on the circumstances of the Motor
are taking place are made accessible to any persons, and ends Sport Event, these risks may include (non-exhaustive): the possibility
when the relevant locations are closed to access or the activities of incidents (resulting from motor sports or otherwise) resulting in
end, whichever occurs later). This is because the Guidelines are physical and/or mental injury or death; exposure to noise; exposure
derived from good practice in competitions appearing on the FIA to / interaction with high voltage or other technical / mechanical
International Sporting Calendar which operate within a regulatory
equipment; or contracting/spreading communicable diseases.
and safety environment that does not apply to Motor Sport Events
that do not appear on the FIA International Sporting Calendar.
LIMITATION & INDEMNITY
4. It is the full responsibility of Third Parties to ensure that 11. The FIA disclaims, excludes and limits (to the fullest extent
they understand and comply with any relevant obligations or permitted under Applicable Laws) any and all claims, liability,
duties relating to health and safety, product design, construction/ costs, expenses, damages, losses (including but not limited to any
manufacturing or consumer law which are placed on them under direct, indirect, incidental, special, consequential or exemplary
i) any applicable National Sporting Authority requirements, damages or losses, property damage, breach of intellectual
regulations and safety standards (“ASN Regulations”), ii) FIA property rights, breach of contract, loss of profit, loss of reputation
requirements, regulations and safety standards (“FIA Regulations”) or goodwill, use, data or other intangible loss, loss of agreements
and/or iii) any relevant transnational, national and/or local laws, or contracts, loss of sales of business and all interest, penalties and
regulations, directives and decrees passed by the government, legal costs) and any personal or mental injury (including nervous
a quasi-governmental entity or by any entity which has the same shock, disease, disablement and death and any financial losses
authority as the government in any applicable country or other resulting), sustained by any organisation or person (including Third
territory, including all applicable local, state and federal laws, and Parties and their subsidiaries, affiliates, licensors, licensees, agents,
any industry practices, codes of practice and/or codes of conduct co-branders, partners, employees, directors, members, officers,
incorporated into any of the foregoing, and all binding court orders, advisors, consultants, representatives, successors and assigns
decrees, and any decisions and/or rulings of any competent (collectively the “Representatives”)), howsoever arising from any use
authority that are relevant (“Applicable Laws”). The FIA assumes no or implementation of, or reliance placed on the contents of, the
responsibility in relation to such understanding or compliance. Guidelines in relation to a particular Motor Sport Event by Third
Parties or their Representatives, including in relation to:

4 MEDICAL GUIDLINES FOR DRIVERS

A. statements (including false statements), acts or omissions
by the FIA or its Representatives or Third Parties and their
Representatives; or
B. any other negligence, lack of reasonable care, breach of any
statutory or other duty or Applicable Laws, careless or wrongful
act or wilful default by the FIA or its Representatives or Third
Parties and their Representatives.

12. Any use or implementation of, or reliance placed on the

contents of, the Guidelines in relation to a particular Motor Sport
Event by any Third Party or its Representatives is (to the fullest extent
permitted under Applicable Laws) strictly driver to acceptance by
the Third Party and its Representatives of the following:

A. the Third Party and its Representatives agree to waive any rights
and/or claims, agree to release, hold harmless and not to sue
the FIA or its Representatives in relation to any claims, liabilities,
costs, expenses, damages and losses (including those referred
to in paragraph 11); and
B. the Third Party and its Representatives agree to indemnify the
FIA and its Representatives in relation to any and all claims,
liabilities, costs, expenses, damages and losses (including
those referred to in paragraph 11), and this indemnity shall
apply whether or not the FIA has been negligent or is at fault;

in each case arising from the use or implementation of, or reliance

placed on the contents of, the Guidelines in relation to a particular
Motor Sport Event.

GOVERNING LAW &

JURISDICTION
13. The Guidelines and any dispute or claim (including non-
contractual disputes or claims) arising out of or in connection with the
Guidelines or their driver matter or formation, shall be governed by
and construed in accordance with the laws of France.

14. The courts of France shall have exclusive jurisdiction to

settle any dispute or claim (including non-contractual disputes or
claims) arising out of or in connection with the Guidelines or their
driver matter or formation.

15. Any matters relating to investigation and enforcement of

FIA Regulations are driver to the jurisdiction of the internal judicial
and disciplinary bodies of the FIA.

MEDICAL GUIDELINES FOR DRIVERS 5

GUIDANCE MATERIAL
This material is a guide as to how medical conditions affect the ability to achieve medical fitness to compete and drive
in competitions. Guidance is given for common conditions.

The doctor performing the competition licence medical examination, and where necessary the medical panel at the
ASN in the country granting the competition licence should be consulted in the first instance for any decisions regarding
fitness to race.

Drivers are reminded to review Appendix L of the FIA International Sporting Code for the regulations regarding medical
examination.

A 2% risk of subtle or sudden incapacity per annum should be considered the upper limit of acceptability for competition.

Where a medical condition exists that may be incompatible with fitness to compete, always follow the advice of the
treating doctor. Drivers should not undergo treatment purely in order to seek motorsport medical fitness certification.

Note, drivers must also be aware of WADA anti-doping rules (see Appendix A of the FIA ISC) and request a therapeutic
use exemption if required. This is the driver’s personal responsibility.

6 MEDICAL GUIDLINES FOR DRIVERS

MEDICAL GUIDELINES FOR DRIVERS 7
CARDIOLOGY
DERMATOLOGY
GASTROINTESTINAL
GENITOURINARY

8 MEDICAL GUIDELINES FOR DRIVERS

CARDIOLOGY LVEF >40%. Septal thickness should be <2.5 cm.

CORONARY ARTERY DISEASE

CARDIOVASCULAR ASSESSMENT Where coronary artery disease is suspected or
diagnosed, a cardiology report should normally be
For drivers aged 59 or under at the start of the year
provided to include the results of an exercise ECG,
of their licence application, an electrocardiogram
24 hour ECG and echocardiogram. In some cases a
(ECG) should have taken place within the previous 36
cardiac MRI or perfusion scan will be recommended.
months. The result should be evaluated by the doctor
performing the medical examination and action taken if
An angiogram result will normally be required. There
any condition is suspected.
should be no more than 50% stenosis in any major
vessel. A stenosis of more than 30% in the left main
For drivers aged 60 or over at the start of the year
or proximal left anterior descending artery should not
of their licence application and ECG and an exercise
normally be acceptable.
tolerance test (ETT) should have taken place within the
previous 12 months. The result should be evaluated by MYOCARDIAL ISCHAEMIA OR
the doctor performing the medical examination and
action taken if any condition is suspected. INFARCTION
Ischaemia causing angina, whether stable or unstable
Subsequently an ECG should take place every year and may not be compatible with competing. Post infarction,
an ETT and cardiology consultation every two years. The sufficient time should be given to fully recover, 3-6 months
result should be evaluated by the doctor performing the is recommended, before a full cardiology assessment
medical examination and action taken if any condition should be undertaken to establish the cardiac function
is suspected. and ongoing risk. This would normally include an
exercise ECG, 24hr ECG and echocardiogram as a
BLOOD PRESSURE minimum.
Where high blood pressure (BP) is suspected, care
should be taken to confirm the diagnosis with 3 blood RHYTHM AND CONDUCTION
pressure readings on different days or a 24 hour BP DISTURBANCES
measurement. A discussion with the treating doctor
should address risk factors such as smoking or increased Any rhythm or conduction disturbance with a risk of
BMI. A consultation with a cardiologist is strongly subtle or sudden incapacity may not be compatible with
recommended. competing in the first instance. This includes but is not
limited to:
If commencing medication, care should be taken to • Second or third degree heart block
ensure the choice is compatible with competition. Note, • Atrial fibrillation or flutter
drivers must also be aware of WADA rules and request • Broad or narrow complex tachycardia
a therapeutic use exemption if required. • Long QT syndrome
• Brugada pattern
VALVULAR ABNORMALITIES
Where such a condition exists, the driver should follow
Where a heart valve is stenosed or ruptured an the advice of their treating doctor and attend for the
echocardiogram is recommended in order to evaluate motorsport medical examination once the condition is
the heart and establish the left ventricular ejection investigated, resolved or managed with reports and
fraction. Normal left ventricular size and function and results for the motorsport medical examining doctor. A
a LVEF >40% can be considered acceptable. A full report from a cardiologist, together with the results of
report from a cardiologist is recommended. A 3-6 any investigations such as 24hr ECG, exercise ECG,
month period away from competition post heart valve echocardiogram, conduction studies or cardiac MRI
surgery is recommended with recertification depending should be provided if undertaken. Where ablation is
on cardiology report. undergone, a post-procedure report should be provided
with the results of a 24 hr ECG.
CARDIOMYOPATHY
Hypertrophic cardiomyopathy should be evaluated by a Extrasystole (ectopy), whether supraventricular or
cardiologist. There should be no unexplained dizziness ventricular, is normally accepted provided the burden
or syncope and no significant rhythm or conduction does not compromise normal cardiovascular function. A
disturbance. Exercise ECG and 24 hour ECG are 24 hr ECG may need to be provided where the rate of
recommended. An echocardiogram should confirm a extrasystole is high in order to establish the burden.

MEDICAL GUIDELINES FOR DRIVERS 9

SYNCOPE
A first clear-cut vasovagal syncope, not occurring in
DERMATOLOGY
a motorsport environment and unlikely to recur during
competition is acceptable for medical fitness to compete. ACNE
Topical treatments and oral antibiotics are acceptable.
Subsequent events should be investigated by a Care should be taken with isotretinoin because of the risk
cardiologist, and if required a neurologist. If there is of mood changes and depression and the association
no clear pointer to cardiac disease and no features with photophobia and night blindness.
suggestive of epilepsy or neurological disease, vaso-
vagal syncope is the likeliest cause. Recurrent syncope ECZEMA AND PSORIASIS
requires a period as temporarily unfit to compete in order
Topical treatments are acceptable. Care should be
to assess future risk, typically 6 months.
taken with oral steroid use because of the risk of mood
changes and the condition being severe enough to be
PACEMAKERS AND IMPLANTED distracting causing subtle incapacity. Note, drivers must
DEFIBRILLATORS also be aware of WADA rules and request a therapeutic
Where an individual is entirely dependent on a use exemption if required.
pacemaker such that if it was to fail, incapacity will
occur, this is incompatible with medical certification. An
SKIN CANCER
implantable defibrillator is never acceptable because of Squamous cell carcinoma in early stage, basal cell
the risk of incapacity when it discharges. carcinoma and actinic keratosis are not disqualifying but
should be treated as soon as possible after diagnosis.
THROMBOEMBOLIC DISORDERS
Medical certification following a deep vein thrombosis or Malignant melanoma with a thickness of <4 mm after
pulmonary embolism is possible provided recovery from primary excision and with no lymph node involvement
the underlying condition has taken place, the condition is compatible with medical fitness to compete. Where
has stabilised and the incapacitation risk is acceptable. the condition has spread to lymph nodes or a distant
site, that is not normally compatible with medical fitness
Drivers on anticoagulant medication should normally be to compete due to the risk of incapacity caused by a
on a DOAC or a stable dose of warfarin with the INR distant lesion.
in range for 3 months. The driver should declare the
medication to the Chief Medical Officer of the event.

10 MEDICAL GUIDLINES FOR DRIVERS

GASTROINTESTINAL GENITOURINARY
DIVERTICULAR DISEASE HAEMATURIA
Diverticular disease is compatible with medical fitness Significant visible haematuria may not be compatible
to compete if stable and controlled, without evidence of with fitness and should be investigated. Persistent
bleeding and once any treatment is completed. microscopic haematuria should be investigated to rule
out renal calculi capable of causing sudden incapacity.
PEPTIC ULCERATION
Drivers with an active ulcer may not be considered fit
CHRONIC RENAL DISEASE
until treatment has taken place, such as the eradication Applicants for motorsport medical fitness certification
of Helicobacter pylori. Proton pump inhibitors and H2 with chronic renal disease should submit medical reports
blockers are acceptable. during the examination. A very low creatinine clearance
rate and a low albumin level is not normally acceptable
INFLAMMATORY BOWEL DISEASE
Drivers with inflammatory bowel disease may not be
ERECTILE DYSFUNCTION
fit to compete until the condition is in remission and Medication used for erectile dysfunction can cause a
stable on minimal medication. In some cases steroid change in blood pressure regulation. Notably Sildenafil
medication is used. Note, drivers must also be aware can cause a transient change in colour vision on the
of WADA rules and request a therapeutic use exemption blue-yellow spectrum in some individuals. This typically
if required. returns to normal in around 4 hours.

RENAL CALCULI
Where an individual has had an episode of ureteric
colic, imaging is recommended to establish if stone free.
Where there are residual stones or an incidental finding
of stones, if the stones are in the parenchyma of the
kidney only this is acceptable. Where the stones are in
the pelvis of the kidney and there is a risk of incapacity
this may not be considered acceptable.

RENAL TRANSPLANT
Drivers who have undergone renal transplant are
considered fit once fully recovered, anti-rejection drugs
are in the therapeutic range, renal function and blood
pressure stable with an acceptable cardiovascular risk.
If taking steroid medication the driver should be aware
of WADA rules and request a therapeutic use exemption
(TUE) if required.

MEDICAL GUIDELINES FOR DRIVERS 11

HAEMATOLOGY
INFECTIOUS DISEASES
METABOLIC
& ENDOCRINOLOGY
MENTAL HEALTH

12 MEDICAL GUIDELINES FOR DRIVERS

HAEMATOLOGY INFECTIOUS
ABNORMAL HAEMOGLOBIN DISEASES
Applicants for medical fitness to compete with
thalassaemia trait or sickle cell trait are considered fit. HEPATITIS A/B/C
Hepatitis A infection may not render the driver unfit.
ANAEMIA Medical fitness to compete can be considered on full
A haemoglobin of less than 12.0 g/dl in a biological recovery.
male and less than 11.0 g/dl in a biological female
should be investigated. Fitness can be considered when Acute hepatitis B may render the driver unfit. Medical
the haemoglobin has returned to an acceptable range. fitness to compete can be considered on full recovery
(viral clearance). Chronic hepatitis B – fitness to compete
COAGULATION OR can be considered for those in an inactive carrier state.
HAEMORRHAGIC DISORDERS Acute hepatitis C may render the driver unfit. Medical
In thrombocytopaenia, medical certification is considered fitness to compete can be considered on full recovery
subject to to an acceptable haematology report. Platelet (viral clearance). Chronic hepatitis C – fitness to compete
counts below 75 x 10-9/l should lead to assessment as can be considered following successful treatment that
unfit. renders the driver disease free.

In haemophilia. Medical certification is generally HIV

withheld but can be considered in mild forms driver to a Applicants living with HIV can be assessed as fit. They
haematologist report. A history of spontaneous bleeding should be asked to provide a medical report which
is not acceptable for medical fitness to compete. should include as far as possible:
LEUKAEMIA AND LYMPHOMAS • A clinical history to include any current symptoms
Leukaemias and disorders of the lymphatic system are and physical signs
not normally compatible with fitness to compete until • Any history of AIDS defining illness
in full remission with acceptable laboratory results and • CD4+ and T-cell counts, HIV viral levels and routine
specialist reports. laboratory test results.
• Antiretroviral therapy
• Any relevant co-infection
• Any neurocognitive features or impairment

Fitness can usually be considered in those where the

viral load is undetectable and the CD4+ count is >500
cells per cubic millimetre.

MEDICAL GUIDELINES FOR DRIVERS 13

METABOLIC & MENTAL HEALTH
ENDOCRINOLOGY ADHD AND ASD
Where there is a diagnosis of attention deficit disorder,
DIABETES AND ABNORMAL attention deficit hyperactivity disorder or autistic spectrum
GLUCOSE METABOLISM disorder, medical certification depends on the level of
functioning, ability to follow rules and obey commands
Drivers are recommended to review Appendix L of
and impulse control. The candidate for medical
the FIA Sporting Code. Type 2 diabetes, where the
certification may need to present a neuropsychological
driver is under diet control or taking non-hypoglycaemic
assessment report to the examining doctor. Medication
medication should not be a problem for medical
for ADHD is prohibited unless a therapeutic use
certification. Type 1 diabetes, on insulin or sulphonylurea
exemption has been obtained.
medication, where there is a risk of hypoglycaemia may
be acceptable with evidence of good diabetes control. DEPRESSION AND ANXIETY
Drivers should provide a medical report confirming good
management of the condition with a recent HBA1c and Acute or severe untreated depression and anxiety may
3 months of glucose measurement data. Evidence of not be compatible with holding medical certification to
cardiovascular fitness may also be required. compete. Once recovered, or fully treated, fitness can
be considered with a medical report from the treating
OBESITY doctor. At all times, the driver should be without
significant memory or concentration problems, agitation,
Obesity is defined as a BMI of 30 or more. Drivers
behavioural disturbance or suicidal thoughts.
with a BMI over 35 may require further investigation to
ensure absence of any underlying medical condition. Drivers should be aware of the WADA rules on anti-
doping if taking medication and should not compete
THYROID DISEASE if taking medication that would affect alertness or
Drivers should have acceptable and stable thyroid concentration.
function test results when treated for hypothyroidism
after treatment for hyperthyroidism. Equally, post
PSYCHOSIS
thyroidectomy there should be evidence of adequate Psychosis or a history of a psychotic event is not
thyroid hormone replacement. compatible with medical certification to compete.

14 MEDICAL GUIDLINES FOR DRIVERS

MEDICAL GUIDELINES FOR DRIVERS 15
MUSCLOSKELETAL
NEUROLOGY
OBSTETRICS & GYNAECOLOGY
ONCOLOGY

16 MEDICAL GUIDELINES FOR DRIVERS

MUSCULOSKELETAL NEUROLOGY
ACUTE INJURY AND RECOVERY DEMENTIA OR COGNITIVE
Drivers should demonstrate satisfactory range and IMPAIRMENT
strength of neck and limb movement, stability of joints
Dementia (cognitive and behavioural problems severe
likely to be subjected to prolonged or sudden stress and
enough to impair normal function) is incompatible with
the absence of pain likely to lead to subtle incapacity.
any form of motorsport medical certification. Mild
Attention is drawn to Appendix L of the FIA Sporting
cognitive impairment may not interfere with normal daily
Code where the procedure following an accident or
activities but may represent a significant safety risk. It is
physical problem is detailed.
increasingly common with advancing age and may not
be recognised by the driver. A neurology report may be
PHYSICAL DISABILITY indicated where there is doubt over fitness to compete.
MECHANICAL OR
NEUROLOGICAL EPILEPSY
Epileptiform seizures occurring within 24 hours of a head
Impairment of the musculoskeletal system may cause
injury may be acceptable within the context of the injury
difficulty in exit from a vehicle and safe operation of
timeline once the driver with a head injury has been
controls. Restricted mobility may lead to difficulty with
fully evaluated for fitness to compete from that aspect
power, strength and range of movement such that an
on recovery.
assessment might be required. Candidates for medical
fitness to compete are directed to the FIA ISC Appendix
Neonatal and febrile convulsions under the age of five
L section 18. Licences for participants with disabilities
years are not disqualifying.

A single unprovoked seizure does not constitute epilepsy.

Two or more unprovoked seizures more than 24 hours
apart fulfil the criteria for epilepsy.

A diagnosis of epilepsy is not compatible with medical

fitness to compete. Consideration can be given to
fitness once a period of 10 years has passed with no
recurrence of seizures on no preventative medication.

HEAD INJURY
Assessment should include the date of the event,
post-traumatic amnesia, duration of unconsciousness,
presence or absence of skull fracture, results of any
imaging performed, report on any surgical procedure
performed.

Fitness depends on the category of head injury and the

following can be used as a guide. Where a driver
does not fit into a clear category, the higher category is
generally selected.

Minimal head injury is defined as any concussive

symptoms lasting less than 48 hours, initial Glasgow
Coma Score (GCS) of 15, no loss of consciousness
(LOC), no post-traumatic amnesia (PTA), focal neurological
deficit or seizure. Minimal head injury is compatible
with medical fitness to compete once recovery has taken
place.

Mild head injury is defined as any concussion lasting

>48 hrs, initial GCS 12-15, LOC <30 mins, PTA <30

MEDICAL GUIDELINES FOR DRIVERS 17

mins. A period of up to 6 weeks off competing may basis with the ASN medical dept and will require a
be required. Drivers may not be considered fit until fully neurologist report and a cardiologist report which would
assessed on recovery without symptoms with appropriate normally include the results of investigations such as
reports. exercise ECG, 24 hr ECG, carotid artery imaging, a
thrombophilia screen and visual field mapping.
Moderate head injury is defined as initial GCS 9-12,
LOC 30 mins-24 hrs, PTA 30 mins-24 hrs, linear skull
fracture. A period of up to 3 months off competing
may be required. Drivers may not be considered fit
until fully assessed on recovery without symptoms with
appropriate reports.

Severe head injury is defined as initial GCS <9. LOC

>24 hrs, PTA >24 hrs. Brain contusion or intracranial
haemorrhage on CT or MRI. Complex skull fracture.
Any operative intervention. A period of up to 6 months
off competing may be required. Drivers may not be
considered fit until fully assessed on recovery without
symptoms with appropriate reports.

Very severe head injury may not be compatible with

medical certification. It is defined as penetrating brain
injury, significant parenchymal damage on CT or MRI,
enduring focal neurological deficit. Assessment is on
a case-by-case basis with the ASN medical dept. A
period of up to 1 year off competing may be required.
Drivers may not be considered fit until fully assessed on
recovery without symptoms or with stable symptoms with
appropriate reports.

MULTIPLE SCLEROSIS
Drivers with acute symptoms of primary multiple sclerosis
(MS) may be unfit until full remission. Drivers should
be aware of the WADA anti-doping rules if prescribed
treatment.

Drivers with secondary progressive MS may not be fit to

compete. Assessment is on a case-by-case basis with
the ASN medical dept.

PARKINSON’S DISEASE
A diagnosis of Parkinson’s disease may not be compatible
with medical fitness to compete. Even in the early stages,
there may be anxiety and depression, bradykinesia and
intention tremor. The disease is progressive. Assessment
is on a case-by-case basis with the ASN medical dept
and will require a neurologist report.

STROKE/TIA
As a general rule, a driver who has had a stroke, transient
ischaemic attack or reversible ischaemic neurological
deficit may not be considered fit. Medical fitness to
compete may be possible where any residual deficit
has been assessed and risk factors considered. Risk
of a further event will always exceed 1% per annum
and may exceed 2%. Assessment is on a case-by-case

18 MEDICAL GUIDLINES FOR DRIVERS

OBSTETRICS & ONCOLOGY
GYNAECOLOGY Drivers may not be considered fit to compete on
diagnosis of malignancy. Fitness may be considered
once treatment is completed and full recovery has taken
GYNAECOLOGICAL SURGERY place. There should be no symptom or complication
Any period of unfitness will vary according to the type of that may affect the ability to compete safely. Detailed
surgery undertaken. Fitness may be considered after full oncology reports should be provided to the doctor
recovery. Where there is doubt, the driver should provide examining the driver for fitness to compete.
medical reports. In most cases, a self-declaration of full
recovery is acceptable. CHEMOTHERAPY
The side effects of chemotherapy may cause subtle
PREGNANCY incapacity and fitness may be considered after a
Physiological changes due to pregnancy which normally minimum of 4 weeks after the last dose of chemotherapy
cause only inconvenience may have significant safety if other aspects of the disease do not preclude fitness.
implications for competing. These include, but are not
limited to, faintness or dizziness, nausea or vomiting, RADIOTHERAPY
anaemia, vaginal bleeding (spotting), high or low blood Complications of radiotherapy such as pulmonary
pressure, change to mental wellbeing. These may fibrosis may require specialist evaluation. Fitness can
render the pregnant driver not fit. be considered after a minimum of 4 weeks after the last
dose of radiotherapy.
Medical certification to compete could be possible if
agreed by the ASN where obstetric evaluation indicates SURGERY
a normal pregnancy without the above symptoms
and the uterus is not palpable outside of the pelvis – Fitness can be considered after full recovery from any
generally taken to be up to 12 weeks duration – beyond surgical procedure related to a diagnosis of malignancy
which significant risk may occur and the driver may be if other aspects of the disease do not preclude fitness.
considered unfit to compete.
The ASN may choose to render the pregnant driver unfit
METASTATIC DISEASE
per se once confirmed. Because of the risk of incapacity due to metastatic spread
(for example in the brain, lungs or bones) metastatic
At all times, the driver should be made aware of the risk, disease is not compatible with fitness to compete.
and choose to compete at their own risk. The CMO of
the event should be informed where the driver consents
to do so.

MEDICAL GUIDELINES FOR DRIVERS 19

OTORHINOLARYNGOLOGY
RESPIRATORY
VISUAL

20 MEDICAL GUIDELINES FOR DRIVERS

OTORHINOLARYN- RESPIRATORY
GOLOGY (ENT) ASTHMA
Drivers with a new or established diagnosis of asthma
HEARING should provide evidence of stability to the doctor
Drivers with some degree of hearing loss may be examining for motorsport medical fitness. Drivers using
able to operate normally and should be considered inhaled steroid or beta-agonist medication should
fit if their condition does not affect normal operations. be aware of WADA anti-doping rules and request a
Where there is profound or total deadness, this is not therapeutic use exemption if required. Where the
disqualifying but may have implications for safety, condition is severe and oral steroid medication is
in particular where radio communication is required. required, the driver should not be considered fit due to
Hearing aid devices, in particular external devices used the severity of the condition and possible side effects of
with cochlear implants may present difficulty with helmet the medication.
fitting and function. Assessment is on a case-by-case
basis and is a matter for ASN medical departments. A PNEUMOTHORAX
deaf driver should inform the CMO for the event so that Where a spontaneous pneumothorax has been
consideration can be made in the event of a medical diagnosed, the driver may not be fit until full recovery
rescue situation where verbal commands may be used has taken place. Where surgical intervention is
and difficulty communicating anticipated. undergone such as partial pleurectomy or video assisted
thoracic surgery, the driver can be considered fit after full
VESTIBULAR DISTURBANCE recovery – typically at 4 weeks post procedure.
Benign positional vertigo or labyrinthitis carries a
significant risk of recurrence and the symptoms can cause SARCOIDOSIS
sudden incapacitation. Drivers should be symptom free Drivers with this condition require assessment on a
and off medication for a period of 4 weeks before case-by-case basis by the ASN medical department.
resuming competition. Particular attention should be made to the potential for
cardiac, eye, central nervous system and respiratory
system involvement. Full medical reports should be
provided to give evidence of stability, ideally inactivity
of the condition. These reports should be accompanied
by the results of any investigations required such as 24 hr
ECG, CT or MRI at the discretion of the treating doctor.

Regular updated reports may be required in order to

fully assess fitness over time.

SLEEP APNOEA
A driver with sleep apnoea should provide evidence
of self-assessment in the form of an Epworth Sleepiness
Scale result. Less than or equal to 10 is acceptable.

MEDICAL GUIDELINES FOR DRIVERS 21

VISUAL SUB-STANDARD VISION AND
VISUAL FIELDS
Drivers are directed to the regulations on the medical Where a driver has a visual field defect, individual
examination of drivers in Appendix L of the FIA Sporting and binocular visual field results should be provided
Code and Appendices. to the medical examiner along with a report from an
ophthalmologist or specialist optometrist. A bilateral
COLOUR VISION field of vision of at least 120 degrees is required,
Colour deficiency affects up to 8% of biological males with the central 20 degrees being unaffected by any
and about 0.5% of biological females. defect. Monocularity is not considered compatible with
competition.
Drivers should be able to distinguish colours correctly in
order to compete safely. The standard test is the Ishihara
test where the first 15 plates are presented out of 24,
allowing 3 seconds per plate for a response. Where
the driver fails to identify one or more plates there may
a deficiency in colour vision.

Where further testing is required, the gold standard is

the Colour Assessment and Diagnosis test (CAD test),
where the normal candidate scores around 1. The test
assesses the red-green axis and the yellow-blue axis with
red-green being the most commonly affected axis by far.

A deutan deficiency is a green receptor deficiency and

candidates can score up to 6 and be considered safe.

A protan deficiency is a red receptor deficiency and

candidates can score up to 12 and be considered safe.

In some countries, other tests are used to further define

if a candidate can distinguish colours safely in order to
compete. Fitness is at the discretion of the ASN medical
panel.

CORRECTING LENSES AND

VISUAL ACUITY
A driver should be able to demonstrate visual acuity,
with or without correction, of at least 6/9 (20/30) in
each eye individually and 6/6 (20/20) with both eyes
together in order to compete in international competition.
For further information see Appendix L of the FIA
International Sporting Code.

EYE SURGERY
Drivers who have undergone LASEK, LASIK or other
refractive surgery should attend the medical examination
for motorsport with evidence of post-operative visual
acuity and confirmation there is no glare, haze or
sensitivity.

Where cataract surgery has taken place, a full post-

operative report should be provided confirming visual
standards are met.

22 MEDICAL GUIDLINES FOR DRIVERS

MEDICAL GUIDELINES FOR DRIVERS 23
©2024 Fédération Internationale de l’Automobile (FIA)
All rights reserved.

The publication, reproduction or distribution of this

“Medical Standards for Drivers” (“Guidelines”), in whole
or in part, without the written permission of the FIA, is
prohibited.