Australia National Standard for Health Assessment of Rail Safety Workers 2024 4.1: Blackouts: unpredictable loss of consciousness is incompatible with Category 1 work; assess both Category 1 and 2 workers who have had a blackout as Temporarily Unfit for Duty until the cause is established through investigation and specialist referral, distinguishing vasovagal syncope, cardiovascular causes, epileptic seizure and metabolic, psychiatric or drug causes, and apply the fitness criteria in Table 5 with the cause-specific chapters; consider the Category 3 standard for Category 2 workers on track

What does 4.1 require?

A spontaneous, unpredictable loss of consciousness cannot be reconciled with Category 1 Safety Critical Work, and because a blackout or near-faint may signal a condition such as seizures, diabetes, cardiovascular disease or a sleep disorder it also matters for Category 2. Blackouts arise from vasovagal syncope (more than half of cases, usually benign but sometimes recurrent), other cardiovascular causes such as structural heart disease, arrhythmia or vascular disease, epileptic seizure (under a tenth of cases) and other causes including hypoglycaemia, psychiatric states, drug intoxication or unknown causes. Both Category 1 and Category 2 workers who have had a blackout are assessed Temporarily Unfit for Duty until the cause is established, which may require extensive investigation and specialist referral and may remain unknown. Fitness is then determined under the blackout criteria in Table 5 together with the chapter for the underlying cause, and the Category 3 standard is considered for Category 2 workers who work on track.