Aeromedical decision making: from principles to practice

While there is literature which describes aeromedical decision making (ADM), there is not much which describes a process identifying the steps to be taken in arriving at such decisions. A five-step algorithm is proposed to clarify the ADM process. The five steps are: 1) determine the likelihood of a clinically significant event from the health condition; 2) determine the likelihood of an undesirable aviation event from the health condition; 3) determine the acceptability of the combined risks (#1 and #2); 4) determine the risk level after clinical intervention for the health condition; and 5) determine the risk level after operational restrictions for the health condition. There are several factors which can affect the various steps in the algorithm, such as uncertainty, difficulty in generalization, power and "fit" of the studies, etc. Notwithstanding these issues, the algorithm serves a useful purpose in providing a pathway for ADM.