OCENJEVANJE VOZNIŠKE ZMOZNOSTI
Marjan Bilban1
Uvodnik
Pravico do sodelovanja v prometu v vlogi voznika naj ima vsak,
ki zmore in ho~e skrbeti za svojo, tujo in skupno varnost, in nih~e, ki tega ne zmore ali pa se no~e tako obna{ati (1).
Razvoj motorizacije
Avtomobil, kot simbol svobode in mobilnosti, postaja počasi tudi simbol omejevanja in izredno natančnih zapisanih pravil ravnanja in obnašanja, ki nas spremljajo vsak trenutek od rane mladosti do pozne starosti. V našem življenju namreč ni drugih področij, na katerih bi bila pravila tako natančno opredeljena in tako strogo nadzorovana (2).
V zadnjih desetletjih, je z razvojem motorizacije postala eden ključnih problemov razvoja prometa epidemija travmatizma v cestnem prometu. Današnje civilizacije si brez prometa ne moremo zamisliti. Avtomobil je postal brez dvoma eden simbolov naše civilizacije (3,4). Vključevanje posameznika kot voznika v cestni promet predstavlja moderno potrebo človeka. Ta potreba je tudi del njegovih integralnih pravic (5). Šofiranje je bilo še pred nekaj desetletji dano le izbrancem. Danes je vožnja motornih vozil vsakdanjost. Ob množici voznikov in vozil je žal tudi vse preveč nesporazumov med človekom in avtomobilom (6). Promet in njegova varnost so ne samo splošnega družbenega pomena, ampak s stališča posameznika, udeleženca v prometu, postajajo vse bolj problem, kako v prostoru doseči neko oddaljeno točko in ostati živ. Desettisoči mrtvih na cestah predstavljajo statistiko, smrt samo enega človeka pa dramo, ki neredko preraste v tragedijo (7).
Cestni promet je tisto področje človekove dejavnosti, ki bi moralo biti najbližje interesu ljudi vseh starosti in poklicev, saj je njihov neizogibni in vsakodnevni sestavni del življenja.
Človek opravlja to dejavnosti od rane mladosti do pozne starosti, vselej kot pešec ali potnik, vse bolj pa kot voznik vseh vrst motornih vozil, pri čemer postaja to področje človekovega udejstvovanja tudi področje vse številnejših negativnih pojavov (8). Promet je gibanje, v katerem sodeluje veliko število ljudi, praktično celotna populacija. Ti upravljajo različna motorna ali druga vozila različnih lastnosti ali potujejo z njimi po poteh različne kakovosti z boljšo ali slabšo
prometno signalizacijo, pod različnimi vremenskimi pogoji, ob vplivu različnih družbeno-ekonomskih, socialno-patoloških in drugih dejavnikov (9). Raziskave nezgod kažejo, da jih praviloma povzroči več dejavnikov skupaj. To je razumljivo, saj so v vsaki prometni situaciji vedno navzoči vsaj trije dejavniki: voznik, vozilo in cesta, praviloma pa še drugi, npr. druga vozila oz. vozniki, pešci, sopotniki, vreme itd. -z eno besedo širše (fizično in družbeno) okolje. Pri vsem tem vsi ti dejavniki ne delujejo neodvisno drug od drugega, pač pa kot sestav: voznik - vozilo - okolje, katerega sestavine stalno vplivajo druga na drugo. Vzroki nezgod so povezani bodisi z vozilom (npr. slabe zavore, izrabljene gume, neustrezne lastnosti svetlobnih teles vozila), na okolje (npr. slaba vidljivost, mokra ali poledenela cesta), na človeka (npr. napačna ocena položaja, zapozneli ali neustrezni odzivi, neustrezno opazovanje), oziroma na kakršno koli povezavo omenjenih dejavnikov. Vse dosedanje raziskave ugotavljajo prevladujočo vlogo človeškega dejavnika v povzročanju nezgod. Po nekaterih ugotovitvah je slednji kriv za več kot 90% nezgod, navajajo pa tudi višje ocene.
Kaj je sploh vožnja
Vožnja je neprekinjena kompleksna zaznavno-motorična veščina. Vožnja je veščina oziroma spretnost, saj gre za nalogo z nekim namenom oziroma nalogo, usmerjeno k specifičnemu cilju, ki se je je treba učiti. Je odprta veščina, ker je okolje med njenim izvajanjem spremenljivo in v nekem obsegu nepredvidljivo. Vožnja je z enega vidika neprekinjena (kontinuirana) veščina, kjer operacije voznika potekajo dlje časa in nimajo posebnega začetka in konca, z drugega vidika pa serialna veščina, saj voznik niza spretne in hitre medsebojno povezane gibe v serijo ali zaporedje gibov. Ker zahteva hotene premike telesa in/ali udov, je motorična veščina. Pri tem je pomembna kakovost giba(nja), kar pride najbolj do izraza v okoliščinah, ki
1 Zavod za varstvo pri delu d.d., Chengdujska cesta 25, 1000 Ljubljana
zahtevajo kar najbolj hitro odzivanje, denimo hipen stisk zavore. Obenem je vožnja tudi kognitivna ve{~ina, saj so za uspe{no krmiljenje vozila kriti~nega pomena tudi odlo~itve o izbiri ustreznega giba(nja) oziroma dejanja, ki temeljijo na zaznavi (10).
U~inkovitosti izvedbe motori~nih ve{~in botrujejo tri kategorije ~lovekovih sposobnosti in sicer: splo{na inteligentnost (sposobnosti, orientirane h kogniciji), sposobnost zaznave hitrosti (sposobnosti, orientirane k hitrosti procesiranja informacij pri re{evanju problemov) ter kon~no psihomotori~ne sposobnosti (kategorija ~lovekovih sposobnosti, ki se nana{ajo na hitrost in natan~nost gibov, pri katerih je prisotnih malo ali ni~ kognitivnih zahtev).
U~inkovitost upravljanja vozila krojijo senzori~ne in psiholo{ke (kognitivne) sposobnosti in lastnosti v tesni akcijski povezavi z motori~nimi (telesnimi) sposobnostmi. V vozni{ki motoriki je osnovna primarna gibalna sposobnost, ki jo potrebuje voznik, koordinacija. Zanjo je klju~no natan~no, pravo~asno, ritmi~no in usklajeno premikanje udov tako, kot zahteva motori~na naloga (11).
Optimatizacije gibov v prostoru in ~asu ter z dolo~eno silo ne moremo dose~i brez zadostne ravni gibljivosti, hitrosti in mo~i, pa tudi ne brez ravnotežja in preciznosti. Samo ustrezno mo~an (silovit), hiter, »gibljiv« (spro{~en, nerigiden), precizen in uravnotežen gib je tudi koordiniran gib. Čim dolo~en segment npr. ni gibljiv v zahtevanem obsegu giba, ~im agonisti niso dovolj mo~ni in se vklju~ijo pomožne mi{ice, je koordinacija giba poru{ena. Koordinacija se torej lahko uresni~i le, kolikor imamo (ob integriteti centralnega živ~nega sistema) zadosti »kondicije« (oziroma smo telesno pripravljeni). Koordinacija pri vožnji ima svojo specifiko. Pri njej je najbrž kognitivni vidik {e bolj poudarjen in dolo~eni gibalni vidiki, denimo vzdržljivost in ravnotežje, malce manj.
Ena od motori~nih sposobnosti, ki je gotovo pomembna za vozni{ko zmožnost, je tudi gibljivost. Ohranjanje normalne gibljivosti sklepov s pravilno ekscitacijo sodelujo~ega mi{i~ja omogo~a natan~ne in nezmanj{ane obsege gibov.
Za upravljanje krmilnega mehanizma (vrtenje volana, prestavljanje, stiskanje zavore^) je potrebna bazi~na funkcionalna mo~ spodnjih in zgornjih udov, {e posebej rok. Toda voznik v sodobnih avtomobilih s servomehanizmi ne potrebuje zelo veliko mo~i. Tudi vzdržljivost v mo~i (repetitivne mo~i) je z vidika vožnje najbrž manj pomembna. Bolj kot maksimalno ali vzdržljivostno mo~ pa voznik ob~asno potrebuje hitro (eksplozivno) mo~ - takrat, ko mora hitro potegniti ro~no zavoro ali stisniti nožno zavoro, hitro prestaviti v drugo
prestavo ipd. Za vožnjo je torej potrebna tudi dolo~ena hitrost, natan~neje hitrost posami~nega giba. Kljub predvideno manj{emu vplivu na vozni{ko zmožnost velja omeniti {e ravnotežje. Mehanizmi, ki uravnavajo ravnotežje, so podobni mehanizmom, ki uravnavajo medmi{i~no koordinacijo. Če je med vožnjo treba npr. hitro prestaviti prestavno ro~ico, mora biti izveden gib ne le hiter, ampak tudi natan~en in podprt s ~asovno ustrezno stabilizacijo trupa. Pomembno vlogo pri vožnji naj bi imela tudi vzdržljivost oziroma aerobne sposobnosti zaradi potencialnega vpliva na kognitivne sposobnosti (12). Vozni{ka uspe{nost pa je tudi rezultat vozni{ke spretnosti (ve{~osti), ki se razvije na osnovi obsežne vadbe in izku{enj ter vozni{ke zmožnosti in ne nazadnje tudi sre~e - zunanjega dejavnika, katerega nadzor nikoli ne bo v ~love{ki mo~i. Vozni{ka zmožnost pa je pravzaprav posledica vozni{kih sposobnosti -sposobnosti posameznih organov in organskih sistemov, ki so potrebne za varno upravljanje vozila. Vozni{ka zmožnost se lahko opi{e kot sposobnost varnega upravljanja avtomobila in vklju~evanja v promet kljub morebitni (senzori~ni, kognitivni ali gibalni) oviranosti ali prizadetosti.
Upad vozni{ke zmožnosti npr. zaradi telesne oviranosti ne pomeni nujno tudi prizadetosti vozni{ke uspe{nosti, ker je slednja odvisna tudi od vozni{ke spretnosti (4). Vožnja prav zaradi svojih zna~ilnosti, da je nau~ena ve{~ina s hierarhi~no organizacijo, nudi možnost kompenzacije v vedenju voznika. Uspe{en voznik zagotovo ne povzro~a prometnega nasilja, ki v skrajnem primeru povzro~i prometno nezgodo. Uspe{en voznik je tudi tisti, ki s svojimi ustreznimi manevri uspe prepre~iti morebitne usodne(j{e) posledice neustreznega ravnanja drugih udeležencev v prometu.
Ugotavljanje vozniške zmožnosti
Relativno veliko {tevilo voznikov cestnih motornih vozil v starosti od 16 let naprej predstavlja zelo pester sestav po svoji socialni, biolo{ki, izobrazbeni, kulturni in spolni strukturi kot tudi po vozni{kih izku{njah, kar ni brez pomena za posledice, ki se dogajajo na na{ih cestah (13). Zahteve, ki se danes postavljajo pred voznika motornega vozila v cestnem prometu, predstavljajo neredko kar krepko preizku{njo njegovih psihofizi~nih sposobnosti. S sodelovanjem v cestnem prometu mora biti voznik v stanju, da se prilagodi specifi~nim pogojem prometa. V intelektualnem in psihi~nem pogledu to pomeni, da mora biti sposoben, da se koncentrira na
vožnjo, znati mora predvidevati zveze med pojavi, oceniti nastalo situacijo, predvideti zaporedje dogodkov, biti mora emocionalno stabilen itd. Za u~inkovito preventivo in represivno dejavnost v odnosu do prometne delinkvence si je nujno zastaviti vpra{anje o tem, katere lastnosti naj ima voznik, da bo lahko varen zase in za druge udeležence v prometu. Peterson (14) meni, da bi morali pri oceni sposobnosti za pridobitev vozni{kega dovoljenja upo{tevati naslednje tri elemente:
1.	voznik mora imeti dolo~ene psihofizi~ne odlike, ki mu omogo~ajo, da je telesno in du{evno kos obremenitvam v sodobnem prometu;
2.	voznik si mora z u~enjem in vajo pridobiti dolo~eno zadovoljivo stopnjo spretnosti in izku{enj;
3.	vozniku je za nemoteno sodelovanje v prometu in za obzirno obna{anje do drugih soudeležencev potrebna dolo~ena stopnja samoobvladovanja in odgovornosti, skratka, voznik mora imeti dolo~eno stopnjo zna~ajske zanesljivosti.
4.	Potrebna je torej dolo~ena kakovost osebnosti, ki nastane iz razli~nih individualnih psihofizi~nih lastnosti, delno z vajo in izku{njo in delno z oblikovanjem zna~aja.
Med vožnjo je voznik ves ~as izpostavljen nepretrganemu toku obvestil, ki prihajajo iz okolja. Vsa ta obvestila mora »predelati« in na osnovi tega ustrezno ukrepati. Čim ve~ja je hitrost vozila, bolj ko je gost promet in bolj ko je zapletena pot gibanja, ve~ja je koli~ina sprejetih obvestil. Kako se bo voznik odzival, je odvisno od njegovih sposobnosti, znanja in izku{enj. Zahteve, ki se danes postavljajo pred voznikom motornega vozila v cestnem prometu, so neredko kar krepka preizku{nja njegovih psihofizi~nih sposobnosti. Ko voznik sodeluje v cestnem prometu, se mora prilagoditi specifi~nim pogojem odvijanja prometa. Pri oceni vozni{ke sposobnosti upo{tevamo vse telesne lastnosti in zmogljivosti posameznih organov in organskih sistemov ter vse du{evne lastnosti in sposobnosti. Upo{tevamo ne le sedanjo obliko in strukturo (statiko), ampak tudi funkcijo (dinamiko), predvsem pa integriteto ~loveka kot osebnosti. Pri oblikovanju zahtev »Pravilnika o zdravstvenih pogojih, ki jih morajo izpolnjevati vozniki motornih vozil«, so upo{tevane tako potrebe posameznika za udeležbo v motoriziranem CP, kot tudi interes skupnosti glede varnosti v prometu. Seveda v mejnih primerih nikoli ni mogo~e izklju~iti možnosti, da se kljub skrbnemu tehtanju vseh okoli{~in okvara oziroma po{kodba lahko pojavi. Razmejitev med zmožnimi in nezmožnimi je zelo težka. Potegnemo pa lahko lo~nico izklju~no ob upo{tevanju vseh sposobnosti
posameznika, kajti vemo, da so zaradi specifi~nih osebnih predispozicij, izku{enj ter individualnih stali{~ oziroma vedenjskih lastnosti možne kompenzacije. Pojem telesne in du{evne sposobnosti za vožnjo motornega vozila ni enak du{evnemu in telesnemu zdravju, kajti sposobnost dovoljuje pri voznikih obstoj dolo~enih blažjih sprememb, katerih oblika in intenzivnost pa ne vplivata na sposobnost za vožnjo oz. na zmožnost vožnje dolo~enih kategorij. Zato pravilnik o zdravstvenih pogojih ne predpisuje, da je pogoj za vožnjo telesno in du{evno zdravje, ampak kot pogoj navaja odsotnost dolo~enih oblik telesnih in du{evnih bolezni ali stanj, odsotnost po{kodb ali hib. Žal je pomembna vrzel v zdravstveni selekciji negativna motivacija, tj. nesprejemanje sodelovanja z zdravnikom. Vsak voznik ali tisti, ki to želi postati, ima svoje stali{~e o svojih sposobnostih, pa tudi svoje stali{~e o spretnosti in znanju upravljanja MV ter svoje stali{~e o oceni lastnega zdravja in zaznavnih sposobnostih svojih ~util. Zato vsakdo tudi pri~akuje potrditev svojih hipotez oz. stali{~, ki jih ne želi spremeniti. Vsakdo, ki posku{a ovre~i taka stali{~a o vidu, sluhu, zdravju v celoti ali samo prodreti v du{evnost takega voznika ali kandidata, naleti na mo~an odpor. To je svet ~lovekove zasebnosti, katerega vpogled je dovoljen izklju~no le v primeru težav oziroma bolezni (klicu na pomo~). Vsako pomanjkljivost skrbno ~uvamo (skrivamo) in je ne želimo izdati, ~eprav se moramo desetkrat podpisati pod pretnjo kazni, ~e nismo povedali resnice. Hiba seveda za na{ega preiskovanca lahko sploh ne predstavlja hibe. Pomembno je, kako okolica gleda na to, kaj okolica, v kateri posameznik živi, sploh ima za hibo, telesno ali du{evno^
Seveda v prvi vrsti voznik sam odgovarja za svojo varnost v cestnem prometu in se mora vsakokrat, glede na svoje trenutno zdravstveno stanje, tudi sam odgovorno odlo~iti, ali bo sedel za volan. Vendar je tu prav tako velika in pomembna odgovornost slehernega zdravnika, ki prihaja z njim v stik. Vsak zdravnik ima dolžnost opozoriti svojega pacienta (pa tudi njegovega izbranega zdravnika), ~e pri pregledu ali zdravljenju ugotovi take spremembe v zdravju, ki lahko vplivajo na njegovo varno udeležbo v cestnem prometu. Še posebej veliko odgovornost ima izbrani zdravnik, ki svojega pacienta najbolje pozna in zato tudi z njim najlaže vzpostavi ustrezen dogovor in specialistu medicine dela, prometa in {porta, ki kot izvedenec ocenjuje in odlo~a o vozni{ki zmožnosti ter o tem tudi obve{~a upravni organ.
Pri tem se sre~ujemo s {tevilnimi deontolo{kimi dilemami ter z vpra{anji, ki se vsak dan postavljajo {tevilnim zdravnikom, ki so povezani s poklicno
skrivnostjo, čeprav pri svojem pacientu - vozniku motornega vozila ugotovijo tak{ne zdravstvene spremembe, ki so lahko usodne zanj in posredno tudi za njegovo družino in ostale udeležence v cestnem prometu. S pravnega vidika bomo nedvomno morali odtehtati poklicno skrivnost in odvezo od nje na eni strani, na drugi strani pa {tevilne žrtve, do katerih pride v prometu zaradi tak{nih ali drugačnih hib, bolezni ali omejitev, za katere smo vedeli, pa smo jih kot zdravniki zamolčali zaradi poklicne molčečnosti. Kodeks medicinske etike jasno določa, da je zdravnik razre{en poklicne molčečnosti, če na to pristane bolnik ali, je to nujno potrebno za dobrobit bolnika, njegove družine ali družbo. Zato se bomo tudi zdravniki morali odločiti, ali se v prvi vrsti borimo za življenje, ki nam je sveto in, v prometu vse prepogosto uga{a, ali pa se držimo togih pravil, ki nam pod grožnjo kazni ali kr{enja moralno -etičnih norm preprečujejo, da pravočasno preprečujemo »napade« na življenje (15).
Literatura
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2.	Žlender B. Prometne nesreče v Sloveniji; Strokovni posvet o medicini prometa, SZD - SMD, Rogaška Slatina, 1985: 33-51.
3.	Jelčic I. Ljudski faktor u prometu; Covjek i promet 1980: 3-4, 92-105.
4.	Kučan M. Uvodnik, Šefman P.: Vozi in preživi, ZVD RS, Ljubljana 1991.
5.	Matas D. O problemima i zauzimanju kriterija prilikom neuropsihiatrijske ocjene vozača; Covjek i promet, 1975: 1, 47-52.
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7.	Šeparovic Z. Stradanje u prometu (sigurnost i odgovornost); Djela 2, Zagreb 1987.
8.	Topolšek A. Krajevna skupnost in njena vloga pri uveljavljanju družbene samozaščite v cestnem prometu, RSPCP RS; Preventiva v cestnem prometu v občini, Ljubljana 1984: 27-32.
9.	Stanic M. Alkohol i druga opojna sredstva kao faktori u etiologiji prometne delikvencije; Covjek i promet, 1985: 4, 17-23.
10.	Schmidt R.A. Motor learning at performance, Champaign: Human Kinetics, 1991.
11.	Uršaj A. Kratek pregled osnov športnega treniranja. Univerza v Ljubljani, Fakulteta za šport, Ljubljana 1996.
12.	Ažman D. Razlike v telesni pripravljenosti in kognitivni učinkovitosti med starejšimi vozniki z vidika povzročanja prometnih nesreč. Doktorska disertacija, Univerza v Ljubljani, Fakulteta za šport, Ljubljana 2000.
13.	Mlačic M. Specifična psihofiziološka obelježja cestovnih prometnih delikvenata; Covjek in promet, 1978: 1, 3-18.
14.	Jelčic I. Medicina prometa, Istraživački centar za medicinu i psihologiju prometa, ZZZ grada Zagreba, 1985.
15.	Balažic J. Deontološki problemi ocenjevanja zdravstvene sposobnosti voznikov motornih vozil. ZZD - SMD Strokovni posvet o medicini prometa, Rogaška Slatina, 1995: 127-130.
DRIVING COMPETENCE ASSESSMENT
Marjan Bilban1
Editorial
Entitlement to participate in traffic as a driver should be hold by all those
who are able and willing to ensure their own and other people's safety, and should not be given to those who are unable or unwilling to adopt safe driving habits (1).
The development of motor vehicles traffic
A car, a symbol of freedom and mobility, is gradually becoming also a symbol of restriction: driving is governed by very precise and strict rules of behaviour that we have to follow from our youth to old days. There is no other sphere of life that would be subject to stricter legislation and stronger law enforcement (2). Over the past decades, epidemics of road trauma has emerged as one of the leading problems of traffic development. It is hard to imagine our modern civilization without motor traffic. A car has undoubtedly become one of the symbols of our civilization (3, 4). Today people perceive a need for participating in motor traffic as drivers, and this activity is one of their integral rights (5). Several decades ago, car driving was reserved for a select few, but today it has become a generally mastered skill. Yet, the ever-growing number of drivers and motor vehicles has been unfortunately paralleled by an increasing rate of conflicts between these two traffic protagonists (6). Transport and road traffic safety are of primary importance to the society as a whole. Individual road users, however, are increasingly faced with the problem of how to get from point A to point B without being involved in a road accident. Tens of thousands victims of road accidents tend to be considered just bleak statistics, yet a loss of each individual is always a painful event, and infrequently has tragic consequences (7). Since road traffic is an inevitable and integral part of everyday life, traffic safety should be in the interest of people of all ages and professions. People are road users, either pedestrians or passengers, from the earliest days to old age. Recently, the number of drivers of various motor vehicles has been increasing very rapidly and so has been the number of negative phenomena accompanying this sphere of man's activity (8).
Traffic equals mobility for large numbers of people, practically for the whole population. People use motor and
non-motor vehicles of different types, and they drive roads of different quality, equipped with different traffic signs and road markings. They use roads in different weather conditions and are influenced by various socioeconomic, socio-pathologic and other factors (9). Research in road traffic accidents showed that road crashes are usually caused by multiple interacting factors. In addition to the basic three elements, i.e. the driver, vehicle and road, many other factors tend to be involved in every traffic accident. These factors, including other vehicles or drivers, pedestrians, passengers and weather, constitute our broader (physical and social) environment. They do not act independently from each other but rather interact within a driver-vehicle-environment group. Road crashes can be attributed to vehicle factors (faulty brakes, worn tyres, faulty or insufficient lights), road environment factors (poor visibility, wet or frozen roadway)or human factors (poor judgement, late response, poor perception), or to interaction between all these factors. Research into traffic safety has shown that human factor is responsible for 90 % of all road accidents, but it is estimated that this proportion is even higher.
What is driving
Driving is defined as a task that requires continuous and complex perceptive- motor skills. The aim of this activity is to accomplish a predetermined objective and must be learned. Driving is an open skill activity carried out in a changeable and, to a certain extent, unpredictable environment. Driving a vehicle requires continuous skills because the driver's activities are uninterrupted and have no distinctive beginning or end. Since driving is also characterized by a series or sequence of dexterous and quick movements, the driver should also have serial skills. Operating a vehicle is an activity that involves voluntary movements of the body and/ or extremities, and therefore also requires motor skills. Quality of driver's movements is of great importance,
1 Institute of Occupational Safety, Chengdujska cesta 25, 1000 Ljubljana
especially in conditions that require quick reaction, such as prompt braking. Driving also requires cognitive abilities, and the perception- based choices of proper movement(s) and activity(ies) are critical to effective steering of a vehicle (10).
Skilled motor performance is based on three categories of man's abilities, including general intelligence (cognitive abilities), ability to perceive speed (information-processing speed required in problem solving) and psychomotor skills (defined as abilities related to speed and precision of movements, which involve few or no cognitive skills).
Effective driving requires sensory and psychological (cognitive) skills and characteristics in close connection with motor (physical) abilities. Coordination ability is a prime motor skill required for driving, and is reflected in timely, precise, rhythmical and coordinated motion of the driver's extremities, necessary for the performance of a given motor task (11). Spatial and temporal optimization of movements carried out with adequate force is not possible without adequate range of motion, speed, strength, balance and precision. Only a sufficiently powerful, quick, and "flexible" (relaxed) movement is a coordinated movement of high quality. Deranged movement coordination is a result of limited range of motion and impaired function due to weak agonistic muscles, usually with auxiliary muscles taking over. Coordination abilities depend on integrity of the central nervous system and adequate body fitness. Specifically, coordination during driving has to do mostly with the cognitive aspect and to somewhat lesser extent with other motor skills, such as endurance and balance.
Unrestricted range of motion is one of the motor skills essential to quality driving. Normal range of joint motion is maintained through proper excitation of the corresponding muscles, and enables the driver to perform precise and unrestricted movements. For effective operation of steering mechanisms (turning steering wheel, changing gear, braking), the driver needs basic functional strength of the lower and upper extremities, especially of the arms. Modern motor vehicles are equipped with servo mechanisms therefore driving does not require a great amount of strength. Similarly, endurance strength is a component that is less important to driving.
For certain activities involved in the operation of a vehicle, such as manual braking, pushing the breaking pedal or quick gear changing, the driver occasionally needs explosive strength much more than maximal and endurance strength. Driving requires individual movements to be performed with a certain speed.
Balance control is another skill needed, although it is of somewhat lesser importance to driving ability. Mechanisms of balance control are similar to those involved in intermuscular coordination. When quick gear changing is required during driving, the movement must be performed quickly and accurately and should be supported by properly timed trunk stabilization. Endurance and aerobic capacities are also considered to play an important role in driving because of their potential effect on cognitive skills (12).
Driving performance depends on a subject's driving skills acquired by extensive practical training and experience and on his/her driving ability, but also on luck - an extrinsic factor uncontrollable by man. Driving ability is a result of the function of individual organs and organ systems important to safe driving. A subject's driving ability is his/her ability to operate a vehicle and to merge into traffic safely despite possible impairments of sensory, cognitive or motor functions. Decreased driving ability due to physical impairment does not necessarily involve a decline in driving performance, because the latter also depends on the driving skills learned (4).
Since driving is an acquired skill with hierarchical organization, it allows for compensation in driving behaviour. A good driver avoids violent behaviour in the driving environment which may result in a road accident, and knows how to use appropriate manoeuvres to evade emergency situations and prevent possible serious consequences of reckless behaviour of other road users.
Driving ability assessment
A large proportion of people aged 16 years and older are motor vehicle drivers. They constitute a group with a vast spectrum of social, biological, educational and cultural characteristics, and various degrees of driving experience. All these elements contribute to the current traffic situation (13). Today's traffic often puts great demands on psychophysical functions of motor vehicle drivers. Road users must always be able to adjust to specific traffic conditions, which in intellectual and psychical terms means that they must focus on driving, foresee relationships between events, judge the situation, anticipate the sequence of events and be emotionally stable.
For accident prevention and enforcement of safety regulations to be effective it is necessary to determine which driver characteristics are necessary for the safe operation of vehicles, i.e. for ensuring own safety and safety of other road users.
According to Peterson (14) assessment of driving ability which is necessary for driving licence should consider the following three components of safe driving:
1.	psychophysical qualities that a driver must have to cope physically and psychically with stressful traffic situations;
2.	a satisfactory level of skill and experience acquired through learning and practical training;
3.	tactful behaviour towards other road users, and quality driving performance, based on self-control and psychical stability.
4.	To drive, a person needs certain qualities derived from different psychophysical characteristics, which are acquired through experience and character formation.
During driving a person is exposed to constant flow of information from the environment. The driver has to "process" all these data and act accordingly. The higher the driving speed, the denser the traffic and the more complicated the driving path, the greater is the amount of data received. The way in which drivers will react depends on their skills, knowledge and experience. Driving should always be adjusted to specific traffic situations.
Driving ability assessment includes evaluation of all physical characteristics and abilities, evaluation of organ and organ system functions, as well as evaluation of all psychical characteristics and abilities. This evaluation includes not only assessment of the present form and structure (statics) of the subject but also of his/her function (dynamics) and personal integrity. "Regulations on health requirements for driver entitlement" consider both the needs of individual road users, as well as the interest of the community in traffic safety. In borderline cases, however, an impairment or injury may occur in spite of close consideration given to all circumstances. Delineating between ability and inability is not easy. It is important to take into consideration all skills of an individual, bearing in mind that it is frequently possible to compensate for an impairment with personal predispositions, experience, attitudes and behavioural traits.
Physical and mental driving ability does not equal good physical and mental health. Impairments of mild severity and intensity need not affect the quality of driving performance, and a subject with these impairments may be entitled to drive certain categories of motor vehicles. Therefore, instead of physical and mental health, absence of certain physical and mental diseases and conditions, injuries and impairments is stated as a health requirement for driver entitlement in "Regulations on health requirements for driver entitlement".
Negative motivation, i.e. unwillingness to cooperate with the doctor, constitutes an important gap in health assessment. Drivers or applicants for driver entitlement have their own opinion not only about their skills and driving competence, but also about their health status and sensory abilities. They expect others to share their view and are mostly unwilling to accept any other interpretation. Generally, people allow others to invade their privacy only when they urgently need help because of a disease or other problems. People refuse to disclose their impairments and tend to keep them secret even at a risk of facing charge for signing untrue statements. A subject may not perceive an impairment as an actual drawback, what really matters is what people surrounding him/her regard as a physical or mental impairment. It goes without saying that drivers carry the greatest responsibility for their safety; and that before every drive they must decide whether they are able or not to operate the vehicle. The doctor contacting the driver, however, has an equally important role in ensuring his/her safety. Every physician has a duty to inform his patients (or their family doctors) of health problems that may interfere with their safe driving. Great responsibility is carried by family doctors who know their patients and are therefore better positioned to negotiate an agreement with them. Equally important is the role of occupational medicine specialists who assess the applicant's driving ability and issue an official certificate attesting to this capacity.
In their everyday practice, doctors have to deal with numerous deontological issues that challenge their professional confidentiality.
Doctors are subject to professional secrecy rules and are therefore daily faced with a dilemma whether to preserve or not absolute secrecy on their patients' health problems and impairments that may be potentially detrimental both to the patient - driver, his family and other road users. Law will have to weigh the principle of professional confidence and secrecy against numerous road accidents that involve individuals with impairments, limitations or diseases that had been kept secret by doctors bound by their ethical obligations. Medical ethics code states clearly that doctors are allowed to disclose information held in confidence if authorized by the patient, or when this disclosure is necessary for the benefit of the patient, family or community. Doctors will have to solve the following dilemma: is their primary goal to save human lives that are all too frequently lost in road accidents, or should they - under threat of professional secrecy infringement - adhere to strict ethical rules that do not allow them to prevent in time "attacks" on human lives (15).
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