title: Air, rail and road: Medical Guidelines for Employees with a History of Cerebrovascular Disease.
abstract: Background An acute medical condition following a previous stroke among those who operate trains, airplanes, and commercial vehicles can result in serious accidents. There are guidelines in place to assist physicians and employers in assessing the risks of returning to work after stroke but the extent and comprehensiveness across nations and among safety-critical occupations are not widely known. Methods Medical guidelines currently in place to regulate safety critical occupations including railway engineers, pilots and commercial vehicle drivers were systematically reviewed. Electronic and hand literature searches as well as review of grey literature for Canada, the USA, the UK, and Australia were conducted. Results There is no consistent set of guidelines that address the risk of a second catastrophic event after an initial cerebrovascular event in those employed in safety critical occupations in the four countries assessed. Some broad principles existed between the different countries and occupations but there was major variation in the approach to cerebrovascular disease and its impact on those working in safety-critical occupations. Conclusions A synthesis of current knowledge would assist in establishing risks of a catastrophic event in those who have already suffered from cerebrovascular illness. This will allow the creation of medical guidelines which could be applied to any safety critical occupation in any nation.
authors.affiliation: 1 Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.|2 Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Klein
authors.affiliation: 1 Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.|2 Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.affiliation: 2 Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.|3 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|4 Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Doreen
authors.initials: D
authors.lastname: Rabi
authors.affiliation: 2 Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.|5 Department of Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|6 Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Canada.|7 Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Stell
authors.affiliation: 1 Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.|2 Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.|3 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.|8 Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D000401:Aircraft; D001334:Automobile Driving; D002561:Cerebrovascular Disorders; D006801:Humans; D018986:Motor Vehicles; D009790:Occupations; D000070356:Pilots; D017410:Practice Guidelines as Topic; D011890:Railroads; D062707:Return to Work; D012449:Safety
keywords: Cerebrovascular disease; commercial vehicle; driving; medical guidelines; pilot; rail; stroke