Table 1.

Specific hazards pertinent to various ‘high risk’ professions, highlighting why these cases need a differential approach from standard clinical assessment

Occupation	Environmental/occupational risks	Additional clinical cardiovascular considerations
Commercial transportation: Pilot Aircrew—hypoxia, hypobaria, sustained acceleration Non-pilot aircrewa Heavy Goods Vehicles Train drivers Professional taxi services	Barometric and environmental effects Effects of sustained acceleration (i.e. +Gz) Loss of control of vehicle; risk to passengers, others	Statutory regulations on risk tolerance for cardiovascular disease Maximum risk of incapacitation: 1% pilots, 2% Heavy Goods Vehicle etc. Effect on environment on occult cardiovascular disease
Emergency services Fire crew Police	Thermal load Emotional stress	Effect on environment on occult cardiovascular disease
Divers	Barometric pressure, Remoteness	Effect on environment on occult cardiovascular disease
Military	Physically demanding occupational roles Remoteness and timely access to healthcare	Serious event may become life-threatening without timely access to appropriate specialist care
Isolated/Remote workers Mountaineering, polar workers Space Offshore (e.g. Oil-rig) workers	Barometric and environmental effects Effects of zero G environment Timely access to healthcare	Serious event may become life-threatening without timely access to appropriate specialist care Effect on environment on occult cardiovascular disease

^aSuch as navigators and weapons systems operators of high-performance aircraft, or others who have a mission critical role.