Benbassat J, Ribak J, Gross M, Shochat I, Froom P
Aeromedical Center of the Israel Air Force, Tel Hashomer.
J Occup Med. 1989 Jun;31(6):513-7. doi: 10.1097/00043764-198906000-00006.
Decisions regarding professional fitness after an incidental detection of a clinical disorder are often problematic. The added risk of an occupational error related to the detected disorder may be smaller than the risk of an error due to lack of experience if a veteran is replaced by a novice. In this paper, we examine the choice between grounding or granting a waiver to an experienced fighter pilot with an incidental finding of premature ventricular contractions. The decision considers the probability of sudden incapacitation during flight and of pilot error-related air accidents in novices and veterans. Although deliberately biased in favor of grounding the veteran, the analysis indicates that the risk of sudden death or incapacitation in an experienced fighter pilot with an incidentally detected illness should be increased ten-fold to 46-fold to justify his or her replacement by a novice. In the specific case considered, the analysis suggests that the risk of an air accident due to sudden death or incapacitation of a veteran with incidentally detected premature ventricular contractions is similar to the estimated added risk of an error-related air accident if she or he is grounded and replaced by a novice. When reliable data on the frequency of human error by age and experience become available, the proposed model may be applied to other situations in which trained professionals develop a potentially disabling disease.
偶然发现临床疾病后有关职业健康状况的决策往往存在问题。如果用新手取代经验丰富的人员，与所发现疾病相关的职业失误额外风险可能小于因缺乏经验导致失误的风险。在本文中，我们探讨了对于一名偶然发现室性早搏的经验丰富的战斗机飞行员，是停飞还是给予豁免的选择。该决策考虑了飞行过程中突然失能的概率以及新手和经验丰富飞行员中与人为失误相关的航空事故概率。尽管分析有意偏向于停飞经验丰富的飞行员，但结果表明，对于一名偶然发现疾病的经验丰富的战斗机飞行员，其突然死亡或失能的风险应增加10倍至46倍，才能证明用新手取代他或她是合理的。在所考虑的具体案例中，分析表明，一名偶然发现室性早搏的经验丰富的飞行员因突然死亡或失能导致航空事故的风险，与如果让其停飞并用新手取代他或她所估计的与失误相关的航空事故额外风险相似。当有关于不同年龄和经验人群人为失误频率的可靠数据可用时，所提出的模型可应用于其他情况，即训练有素的专业人员患上可能导致失能的疾病。
