Aerosp Med Hum Perform. 2023 Jul 1;94(7):514-522. doi: 10.3357/AMHP.6154.2023.
The 1% rule has long been a standard threshold for aerospace medical risk acceptance, but medical literature has noted multiple shortcomings with this threshold. Previous studies have suggested a risk matrix approach in aeromedical decision-making. General use of risk matrices for risk assessment is already codified in the U.S. Air Force (USAF). Based on this, the USAF School of Aerospace Medicine (USAFSAM) Aeromedical Consultation Service (ACS) generated and evaluated the ACS Medical Risk Assessment and Airworthiness Matrix (AMRAAM). The ACS adapted existing USAF standards to build the AMRAAM, gathered expert feedback, and sampled 100 previously adjudicated cases to compare legacy case dispositions to AMRAAM dispositions using polychoric correlation. The AMRAAM disposition showed strong agreement with legacy dispositions (ρ* = 0.9424). One case was discarded as it did not meet inclusion criteria. Of the 99 remaining cases, 88 had perfect agreement between legacy and AMRAAM dispositions. With the AMRAAM, eight cases were less restrictive and three were more restrictive (two due to an erroneous omission in the legacy disposition). The AMRAAM produces disposition recommendations that are highly consistent with the legacy approach informed by the 1% rule, with discordant AMRAAM dispositions tending to be more permissive. The USAFSAM AMRAAM allows a more dimensional risk evaluation than the 1% rule, communicates aeromedical risk consistent with nonmedical USAF organizations, and harmonizes aeromedical risk with the level of risk the USAF has defined for all flying systems. The ACS will use the AMRAAM as standard practice in future aeromedical risk assessments.
1% 法则长期以来一直是航空航天医学风险接受的标准阈值，但医学文献已经注意到该阈值存在多个缺陷。先前的研究表明，在航空医学决策中采用风险矩阵方法。美国空军（USAF）已经将风险矩阵用于风险评估的一般用途编入法规。基于此，美国空军航天医学院（USAFSAM）航空医疗咨询服务（ACS）生成并评估了 ACS 医疗风险评估和适航性矩阵（AMRAAM）。ACS 采用现有的美国空军标准来构建 AMRAAM，收集专家反馈，并对 100 个先前裁决的案例进行抽样，使用多项相关系数比较传统案例的处置与 AMRAAM 处置。AMRAAM 的处置与传统处置具有很强的一致性（ρ* = 0.9424）。有一个案例因不符合纳入标准而被丢弃。在 99 个剩余案例中，88 个案例的传统处置与 AMRAAM 处置完全一致。使用 AMRAAM，有 8 个案例的限制较少，3 个案例的限制较多（两个案例是由于传统处置中的一个错误遗漏）。AMRAAM 提出的处置建议与 1% 法则所依据的传统方法高度一致，不一致的 AMRAAM 处置往往更宽松。USAFSAM AMRAAM 允许比 1% 法则更具维度的风险评估，与非医疗 USAF 组织一致地传达航空医学风险，并使航空医学风险与 USAF 为所有飞行系统定义的风险水平保持一致。ACS 将在未来的航空医学风险评估中使用 AMRAAM 作为标准做法。
