one percent rule

2/7/2013 gasabeh.com

gasabeh47@gmail.com 1

(1% rule)

Aviation medicine (Safety---------------------factor-------------------------Risk)

Flight

safety

Flight

safety

1%rule is a example for risk management process (Retrospective)

-Bad consequence in medicine :Mortality-Morbidity

-Bad consequence in Aviation :Accident-Incident

-Bad consequence in Aviation medicine :

Pilot sudden medical incapacitation

History

This "1 percent rule" began in the late 1980s and early 1990s in a series of British and then European aviation cardiology workshops. The application of this "1 percent rule" has subsequently spread beyond the domain of aviation cardiology to all potential causes of medical incapacitation.

Risk management

process

1-Identify hazard& 2-Assess hazard: Epidemiological study -On average 1person mortality in 100000 population in one year or 10000 hours= 1/1000000000 (Risk Threshold)

Risk management

process

3-Control of hazard

A-If100 year flight B-10000 hour in one year Risk rate:1/1000000 1000

Risk management

process

3-Control of hazard

C-Incapacitation becomes critical only during landing or take-off, approximately 10% of an average one hour flight.(1/10)

Risk management

process

3-Control of hazard& 4- Implement control

D-A simulator study indicated that

subsequent to pilot incapacitation at a critical part of the flight (takeoff and initial climb, approach and Landing the second pilot would take over successfully on 399 occasions out of 400 such events (Chapman 1984). Taking this into account, it was assumed that a trained pilot should be able to take over safely on 99 occasions

out of 100 (Bennett 1988). 1/100 or

(1%rule) Acceptable risk in two-pilot operations

DxCxBXA=Risk Threshold

D=1/100(sudden incapacitation risk) C=1/10(Critical period) B=1/10000(one hour per one year) A=1/100(one year per one century) 1/100x1/10x1/10000x1/100=Risk Threshold

1/1000000000

The acceptable maximum incapacitation rate of one per cent per annum outlined above has become known as the “1% rule”.

This is widely regarded as an acceptable risk level and was adopted by the European Joint Aviation Authorities as the basis of aeromedical risk assessment.

Applying the one per cent rule

5-Suprevie& Evaluate

Risk management

process 1-Evidence-Based Medicine 2-Aeromedical Decision-Making 3- Medical Incapacitation Risk of Airline Pilots(Renal colic/Seizure/Pneumothorax) 4-Flight Safety(Medical-Environmental-Aircraft)in ICAO annexes-FAR(FAA)-JAR(JAA)-IATA 5-Flight Time(long haul:multizones/multisegments) 6-Aircraft automated/simulated 7-Number of pilots 8-Waivers 9-Controversy

RISK LIMITS:1%, 2%, or 5%

Systematic Review

Definition A document often written by a panel that provides a comprehensive review of all relevant studies on a particular clinical or health-related topic/question. The systematic review is created after reviewing and combining all the information from both published and unpublished studies (focusing on clinical trials of similar treatments) and then summarizing the findings.

Advantages Exhaustive review of the current literature and other sources (unpublished studies, ongoing research) Less costly to review prior studies than to create a new study Less time required than conducting a new study Results can be generalized and extrapolated into the general population more broadly than individual studies More reliable and accurate than individual studies Considered an evidence-based resource

Disadvantages Very time-consuming May not be easy to combine studies

Ref: 1-Ernsting's Aviation Medicine-2006 2-Manual of Civil Aviation Medicine-2012 3-Joint Aviation Authorities -2009 4-Internet sources 5-Stuart J. Mitchell and Anthony D. Evans.Flight Safety and Medical Incapacitation Risk of Airline Pilots. Aviation, Space, and Environmental Medicine • Vol. 75, No. 3 • March 2004 6-Dougal B. Watson. Aeromedical Decision-Making: An Evidence-Based Risk Management Paradigm. Aviation, Space, and Environmental Medicine • Vol. 76, No. 1 • January 2005

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