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Assessing aeromedical risk: a three-dimensional risk matrix approach
  1. Gary Gray1,
  2. Dennis Bron2,
  3. Eddie D Davenport3,
  4. Joanna d’Arcy4,
  5. Norbert Guettler5,
  6. Olivier Manen6,
  7. Thomas Syburra7,
  8. Rienk Rienks8,
  9. Edward D Nicol4
  1. 1 Canadian Forces Environmental Medical Establishment, Toronto, Ontario, Canada
  2. 2 Aeromedical Centre, Dubendorf, Zürich, Switzerland
  3. 3 Aeromedical Consult Service, United States Air Force School of Aerospace Medicine, Wright-Patterson AFB, Dayton, Ohio, USA
  4. 4 Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
  5. 5 German Air Force Center for Aerospace Medicine, Fuerstenfeldbruck, Germany
  6. 6 Aviation Medicine Department, AeMC, Percy Military Hospital, Clamart, Île-de-France, France
  7. 7 Cardiac Surgery Department, Luzerner Kantonsspital, Luzern, Lucerne, Switzerland
  8. 8 Department of Cardiology, University Medical Center Utrecht and Central Military Hospital, Utrecht, The Netherlands
  1. Correspondence to Dr Edward D Nicol, Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire SG16 6DN, UK; e.nicol{at}, cyprusdoc{at}


Early aeromedical riski was based on aeromedical standards designed to eliminate individualsii from air operations with any identifiable medical risk, and led to frequent medical disqualification. The concept of considering aeromedical risk as part of the spectrum of risks that could lead to aircraft accidents (including mechanical risks and human factors) was first proposed in the 1980s and led to the development of the 1% rule which defines the maximum acceptable risk for an incapacitating medical event as 1% per year (or 1 in 100 person-years) to align with acceptable overall risk in aviation operations. Risk management has subsequently evolved as a formal discipline, incorporating risk assessment as an integral part of the process. Risk assessment is often visualised as a risk matrix, with the level of risk, urgency or action required defined for each cell, and colour-coded as red, amber or green depending on the overall combination of risk and consequence. This manuscript describes an approach to aeromedical risk management which incorporates risk matrices and how they can be used in aeromedical decision-making, while highlighting some of their shortcomings.

  • research approaches
  • healthcare delivery
  • quality and outcomes of care

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  • Contributors All authors were involved in the NATO Aviation Cardiology WG panel and contributed to the writing of this article.

  • Funding Produced with support from NATO CSO and HFM-251 Partner Nations.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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