NRCME Removal From Registry

The NRCME registration process requires the completion of a training course and the passing of the NRCME test by April 2014 to be eligible to perform Department of Transportation (DOT) medical exams.  Though many questions are being asked about the certification and registration process, many are wondering how the registry works, how they will be contacted, and how they can be removed from the registry if necessary.

Removal from the registry can come in three forms: Voluntary removal, Involuntary removal, and Emergency removal.  To voluntarily remove oneself from the registry, the medical examiner can submit a request to the director, office of carrier, driver and vehicle safety standards.  This submission will result in removal immediately upon acceptance, unless the involuntary removal process is in motion.

Involuntary removal comes in the form of a “Notice of proposed removal” send to the medical examiner.  The examiner may submit a response no later than 30 days after the notice of proposed removal, and may follow the process for review and correction and reinstatement.  There is also an emergency removal of an examiner if there is an inability to comply with standards.

The FMCSA states that it may remove a medical examiner from the National Registry of Certified Medical Examiners if the ME fails to meet or maintain the qualifications as outlined in the regulation.  Reasons for removal may include:

  • Failure to comply with the requirements for continued listing on the National Registry of Certified Medical Examiners as outlined in the regulation
  • Errors, omissions, or other indications of improper certification of an operator in either the complete Medical Examination Reports or the medical examiner’s certificates.
  • Issuance of a medical examiner’s certificate to an operator of a commercial motor vehicle who failed to meet the applicable standards at the time of the examination
  • The medical examiner fails to comply with the examination requirements specified in the FMCSA regulations
  • the medical examiner falsely claims to have completed training in physical and medical examination standards

NRCME Certification: Your Questions Answered

The NRCME Certification was just finalized April 2012, so many DOT Examiners are still figuring out the details of the certification, registration, and how this will affect examination procedures.


Each medical examiner is required to pass a training course to qualify for NRCME certification.  This training will be executed by accredited private companies and institutions.  The FMCSA indicated that they thought that training could be completed in one day, though several reviewers indicated that the training process could take up to five or six days, depending on the provider and the intensity of the review.  The FMCSA did not indicate how long the training must be, rather just the material covered.  As a result, training could come in a self-paced, online format, a traditional classroom model, or a mix of the two.

The training programs are all accredited by a nationally recognized medical profession accrediting organization to provide continuing education units.  The training programs are not required to grant CME for the CMDE training.

As a part of the training program, each medical examiner will be required to pass a test provided by the FMCSA.  After completing the training, the medical examiner will be required to take the NRCME certification test.  The exam may be taken once every 30 days, and cannot be taken more than three years after completing the training.  We highly encourage utilizing a NRCME Practice Test to test your knowledge and understand the format of the questions that you will face on the real exam.

Communicating with the FMCSA

After providing DOT exams, naturally the medical examiner will now be required to communicate the results to the FMCSA to ensure registration of the driver.  The name of the CMV driver and a numerical identifier for any completed Medical Examination Report must be electronically transmitted to the FMCSA Chief Medical Examiner on a monthly basis.  The MEs must also retain the Medical Examination Report for each examination performed and the medical examiner’s certificate for at least three years, consistent with any state or local requirement for medical record retention.

NRCME Certification for Chiropractors

Fact: Chiropractors in all states (except Michigan and Washington) can perform DOT medical exams

Fact: Very few of the millions of truck drivers, school bus drivers, and pilots that require annual physicals receive a DOT examination at a doctor of chiropractic office

A new program developed by the Federal Motor Carrier Safety Administration (FMCSA) called the National Registry of Certified Medical Examiners (NRCME) requires all medical examiners performing exams for commercial motor vehicle drivers to complete a training program and pass the NRCME Test.  Though over 200,000 medical examiners currently perform DOT medical exams, it is estimated that only 40,00 – 50,000 examiners will remain in 2014 once NRCME training is mandatory.  The number of drivers will remain the same (if not increase), thus providing opportunity for clever medical examiners to take part in the NRCME training and test and increase their business through these potentially lucrative physicals.

DOT exams are good for business for three reasons:

1.) They are required for all drivers of commercial motor vehicle drivers

2.) The exams typically have reimbursements higher than the average chiropractic procedure

3.) They are relatively easy to perform

Since these exams are required, they tend to be recession resistant.  They can be as short as a few minutes for a healthy individual, netting you a quick $50-$120 and a happy patient who is free to go about his/her driving career.  These appointments can be made same-day to fill lag in the schedule throughout the day.  With the number of physicians dropping considerably, these benefits may become even more dependable and lucrative for those who pursue the NRCME certification.

If you’re worried about demand, check out these figures: the number of drivers is estimated to increase almost 10 percent per year for the next decade. A significant fraction of all drivers are required to have an exam each year due to medical conditions, and all drivers must be certified at least every two years, irregardless of their health.  Plus, many companies require drivers to get a fresh certification when changing jobs.

NRCME certification opens in the Fall of 2012, with all medical examiners performing DOT exams to be NRCME certified by May 2012.  To become certified, a physician must attend an accredited training course and pass the NRCME certification exam.  Since the training course and exam can be somewhat costly, we suggest utilizing NRCME Practice Tests to ensure you pass the test the first time.

NRCME Certification: History and Current State

History of the NRCME Certification
The National Registry of Certified Medical Examiners (NRCME) has been discussed for a long time, since the late 1970s. In 1992, the definition of medical examiner was expanded to include all licensed health care professions that are licensed in their state to perform the DOT examinations. Finally, in 1997 the Medical Certification and Commercial Drivers License (CDL) process merged.


Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements:

  • Individuals performing medical examinations for drivers are qualified to do so and are educated about occupational issues for drivers
  • A tracking mechanism is established that ensures that every prior application by an individual for medical certification is recorded and reviewed
  • Medical certification regulations are updated periodically to permit trained examiners to clearly determine whether drivers with common medical conditions should be issued a medical certificate
  • Individuals performing examinations have specific guidance and a readily identifiable source of information for questions on such examinations
  • The review process prevents or identifies and corrects the inappropriate issuance of medical certification
The Final Ruling
The final ruling for the NRCME came on April 20, 2012.  Examiners are defined as any licensed healthcare provider licensed by the state to perform physical examinations.  Aviation medical examiners, board certified MD and DO, certified by specialty society (AAOHN), and participants in the development of DOT requirements and guidance are not exempt.  All drivers must be certified by taking an accredited class and passing the NRCME test.  The ruling states that all medical examiners must be NRCME certified and registered within 24 months of the final ruling (April 20, 2014).  It is anticipated that 40,000 medical examiners will become NRCME certified by this date.

All of these goals culminated in the NRCME program certification, which can be followed at  This site includes the option to join an NRCME mailing list, which will allow you to receive periodic updates regarding the certification process as it progresses.

Attention NASM Trainers: Don’t Forget About Nutrition!

A basic knowledge of nutrition is helpful to ensure the safety and success of a client. Though, it is very important to note that a basic level understanding of nutrition does not qualify a fitness professional to counsel high-risk clients or treat medical or health related illnesses or disease. However, good nutrition can work synergistically with an exercise program to improve health, better body composition, increase energy, and even help reduce the risk of certain illnesses and diseases. Proper nutrition is vital, especially in light of troubling statistics. For instance, it is estimated that by 2015, 75% of all US adults will be considered either overweight or obese. A person’s total energy expenditure (TEE) can roughly be broken down into three categories. Resting metabolic rate (RMR) is the amount of energy expended while at rest, consisting roughly 70% of TEE. Energy expended during physical activity accounts for roughly 20% of TEE. The thermic effect of food (TEF) is the energy that it takes to digest and transport food, constituting roughly 10% of TEE. A person’s daily caloric needs depend on many things such as goals, sex, age, and genetics.

When talking about nutrition for exercise there are three main groups of nutrients: proteins, carbohydrates, and lipids. Protein is important as its primary function is to build and repair body tissues and structures, a key in exercise recovery. There are about 20 different types of amino acids that bind using peptide bonds to form proteins. There are two types of proteins, essential and nonessential, all providing 4 calories of energy per gram. Essential proteins such as lysine cannot be manufactured within the body and must be ingested, whereas, the human body can produce nonessential proteins such as alanine. Protein requirements depend on many different factors such as exercise, body composition goals, and age. Carbohydrates are compounds containing carbon, hydrogen, and oxygen and classified as sugars, starches, or fiber. Carbohydrates yield 4 calories per gram and are the chief source of energy for all body functions and exertion. Higher carbohydrate meals are often consumed preceding a workout to provide the body with the necessary energy to perform at optimal levels. Fiber is an incredibly important carbohydrate that helps provide bulk in a diet, regulates bowel movements, may help reduce heart and artery disease, and helps regulate the absorption of glucose.

Finally, lipids are a group of compounds that include triglycerides (fats and oils), phospholipids, and sterols. Lipids are the most concentrated source of energy; a single gram yields 9 calories. Fat is vital in providing energy, acting as a carrier for vitamins, functioning as the building blocks of some hormones, and protecting some organs. In addition, fat consumption stimulates the release of a hormone, CCK, which signals satiety. Fat consumption sometimes becomes a problem when people over consume fatty foods to achieve a feeling of satisfaction. Creating a well-balanced and rounded diet that provides a person with all the various nutrients, vitamins, and minerals needed for healthful living can take many forms. The key to a good diet is a long-term view and sustainable eating habits, rather than fad eating habits, crash dieting, and diet pills all of which are neither effective nor sustainable.

Links to further reading:

personal trainer assessment

Client Fitness Assessments

personal trainer assessmentFitness assessments are a crucial piece of creating an effective and safe training program for a client. Fitness assessments are comprehensive measurements, both objective and subjective, that help determine the current health and fitness levels of clients. A fitness professional can only accurately create an appropriate training program if they know his or her client’s baseline health and fitness levels. It must be noted that a fitness professional is not a doctor and should not be diagnosing medical conditions, prescribing treatment and diets, or providing rehabilitation services, unless specifically trained and certified in those areas. The Physical Activity Readiness Questionnaire (PAR-Q) helps identify clients who made need further medical screenings before undergoing physical activity. General health history also helps provide insight into a client’s health. Some occupations that require long hours of sitting or repetitive movements may predispose some clients to muscular imbalances or other structural issues, making some exercises unsafe for them. General lifestyle choices including hobbies, smoking, drinking, and sleep habits can also help provide information about a client’s health and the appropriate training program design. Medical history such as past injuries, past surgeries, chronic conditions, and medications are also necessary information to ensure a selection of appropriate exercises that are both beneficial and safe for the client.

Blood pressure and body fat measurements can provide insight into the general body composition of clients and a benchmark for progress, while the YMCA 3-minute step test and Rockport walk test can determine cardio-respiratory capacity. Finally, the observation of static postures and dynamic movements can provide information about the client’s flexibility, strength, coordination, and muscular imbalances, allowing the fitness professional can create a training program that effectively addresses the client’s needs effectively and safely. Fitness assessments are a key piece in creating an effective training program for client’s and should never be overlooked when creating a fitness program.

Links for further reading:

Obesity in America: A Nation in Need of NASM Certified Trainers

Obesity is one of the fastest growing health problems in the United States. Estimations of the number of obese adults in the past 15 years have nearly doubled from around 19% to approximately 34%. In addition to the many personal problems that obesity and obesity-related health issues bring, the direct medical cost of obesity and indirect economic loss due to obesity combined to cost the US over 200 billion dollars in 2000. Further, diabetes, which is often correlated with obesity, has become the 7th leading cause of death in the US. Obesity, a problem primarily affecting adults, has frighteningly begun spreading to the young at a rapid pace. In Mississippi, the “fattest” state in the US, obesity in adults has risen to a shocking 67.4%, while childhood obesity has risen to nearly 18%. Bad eating habits, sedentary lifestyles, and an abundance of over-processed and unhealthy foods have contributed to this massively growing problem.

While the many factors that contribute to obesity including genetics, age, environmental factors, and lifestyle choices make it impossible to pinpoint a single cause of obesity, it is hard to disagree that the primary problem is energy balance (too many calories consumed and too few expended). However, many people are starting to recognize the dangerous nature of this often-referred to “epidemic” and are taking steps to fight the problem through promotion of daily exercise and healthful eating. People such as the First Lady Michelle Obama have started health programs like “Let’s Move”, and national organizations such as the YMCA have joined the fight against childhood obesity and diabetes. States like California and Connecticut have even passed bans against the sale of high-fat snack foods and sugary soft drinks on school campuses. This fight against obesity places fitness professionals in a strong position to help through providing effective and safe training programs and promoting healthy eating habits.

Links for further reading:

blood specimen phlebotomy

Preparing Blood Specimens: Phlebotomy at its Best

blood specimen phlebotomyBlood is a specialized fluid that is conducted throughout the body via certain vessels (arteries, capillaries, and veins). The function of blood is to deliver vital substances such as oxygen and nutrients to all the cells of the body. At the same time blood functions to transport metabolic waste products such as nitrogen and urea away from those same cells. Whole blood is composed of formed elements (red blood cells, white blood cells, and platelets) suspended in a liquid known as blood plasma. On average 45% of blood fluid is comprised of formed elements, while the other 55% is plasma.

Red blood cells comprise the vast majority of blood’s formed elements. These cells lack a nucleus and are rich in hemoglobin, an iron-containing protein which facilitates the transportation of oxygen in the blood. Carbon dioxide, a major waste product of cellular respiration, is transported almost entirely as bicarbonate ion dissolved in the plasma. Blood plasma is essentially an aqueous solution that is 92% water by volume. The other 8% of the fluid is composed of blood plasma proteins and trace amounts of other dissolved nutrients, such as glucose, amino acids, and fatty acids (these substances can be dissolved in the blood or bound to plasma proteins). Albumin is the most prominent plasma protein and its function is to regulate the colloidal osmotic pressure of blood. Blood serum is plasma minus fibrinogen, a blood clotting protein. Serum samples are prepared by allowing the blood to clot before centrifuging the specimen.

A blood test refers to a laboratory analysis performed on a blood sample in order to determine the physiological and biochemical state of a patient’s blood. The majority of blood tests involve obtaining a blood sample from the patient’s vein. There are also a number of specialized blood tests, such as arterial blood gas, that require blood to be extracted from an artery rather than a vein. The component of blood used in a diagnostic test depends on the specific test being performed. A platelet count (Plt. Ct) test, for example, requires the use of whole blood. Other tests, such as the glucose tolerance (GTT) test, require the use of plasma rather than whole blood. In order to obtain plasma from a whole blood sample, whole blood is centrifuged to remove the cellular components. Anti-coagulated blood yields plasma, which contains fibrinogen and clotting factors. Clotted or coagulated blood yields serum. Certain tests such as the high and low-density lipoprotein tests require the use of serum. It is also the specimen of choice for most chemistry department tests.

NRCME Certification Process

With the new NRCME certification and registry ramping up this fall, many are wondering exactly what the entire process entails.  The process includes two main parts, the training portion and the test portion.  The training is available through privately accredited companies, which medical examiner candidates and begin and complete now.  The certification exam and registration process, however, will not be available until August 20th, 2012.  Each training company has their own training method, and will communicate with the NRCME and the candidates in their own way (all will provide some sort of a certificate of completion).  However, the testing part of the exam will be standardized across all 50 states.  Here’s our list and order of everything you’ll need to do to get NRCME certified and start performing DOT examinations:

  1. Candidate medical examiner visits the National Registry website to select a testing location
  2. Candidate will link to website which will permit scheduling of a test at a local or nearby testing center
  3. The candidate arrives at the testing center prior to the scheduled exam time
  4. The candidate presents the clerk at the testing center with the ID, medical credentials, training certificate and National Registry Number (NRN)
  5. The test center clerk will log onto the National Registry website to look up the candidate by NRN
  6. The testing center clerk verifies the credentials and the ID
  7. Assuming verification, the testing center clerk enters the ID and verification into the NR website
  8. The NR website displays the test id to be provided to the candidate
  9. The candidate medical examiner takes the multiple-choice exam
  10. The testing center scores the test and provides the results to the candidate
  11. The testing center calls the NR web service to upload the test results.
  12. A short period of time later, the medical examiner is eligible to perform DOT medical exams.

The exam will be administered on a computer.  To become comfortable with the format of the exam and the content it covers, we recommend studying with Med Preps to take unlimited NRCME practice tests.

phlebotomy collection tube

Evacuated Collection Tubes For the Phlebotomist

phlebotomy collection tubeEvacuated collection tubes are specially designed tubes that have a vacuum (negative pressure) and fill with a predetermined volume of blood. The rubber tops/stoppers are color coded according to the additive (or lack thereof) contained within the tube. Blood collection with evacuated tubes occurs as one end of the needle enters the patient’s vein, and the other end penetrates through the rubber top/stopper as the tube is pushed into the open end of the holder. The vacuum within the tube enables it to fill with the appropriate volume of blood. If multiple specimens are required, additional tubes may be inserted into the holders after the previous draw is complete. It is important to note that blood should never be poured from one tube to another in order to avoid cross contamination from tubes containing different additives.

Production of these tubes is a multi-step process. Once the glass portion of the evacuated tube is formed, any additive that is required is inserted. “Dry” additives are applied topically and dispersed along the inside wall of the tube. The tubes are spray coated with the desired additive(s) using a series of nozzles and then dried. Alternatively, “Wet” additives are dispensed into the tube as a fluid and remain as a liquid. Additives may exist as either “dry” or “wet” in the evacuated tubes depending on whether the tube is plastic or glass, and depending on the stability of the solution. The CLSI and ISO are the agencies that establish the concentration of additive to be dispensed into each tube per milliliter of blood. A gel barrier can also be dispensed into the evacuated tube for gel separator tubes. The gel functions to provide a physical and chemical barrier between the serum or plasma and the cells. After the insertion of any additive or gel, the tubes are evacuated and capped.

The color of the tube-top/stopper acts as a code, indicating what additive the evacuated tube contains. For example lavender-top tubes contain the additive EDTA, whereas light blue-top tubes contain sodium citrate as their additive. In addition to indicating the tube’s additive, the top/stopper color is used to identify a specific order in which multiple tubes are to be drawn, a concept known as the “Order of Draw”. The reason for having an order to the draw is to prevent an additive from contaminating and affecting the results from another test. According to the “Order of Draw” you would want to collect a draw for a sodium test prior to collecting a test that contained sodium as an additive.