Appendix C

Canadian Cardiovascular Society’s risk of harm formula*

The risk of harm (RH) to other road users posed by the driver with heart disease is assumed to be directly proportional to the following:

  • time spent behind the wheel or distance driven in a given time (TD)
  • type of vehicle driven (V)
  • risk of sudden cardiac incapacitation (SCI)

the probability that such an event will result in a fatal or injury-producing accident (Ac).

Expressing this statement as formula 1:

(1)        RH = TD · V · SCI · Ac

Fewer than 2% of reported incidents of driver sudden death or loss of consciousness have resulted in injury or
death to other road users or bystanders (Hossack, 1974; Parsons, 1986; Ostrom and Eriksson, 1987; Antecol and Roberts, 1990). In formula 1, therefore, Ac = 0.02 for all drivers. There is evidence that loss of control of a heavy truck or passenger-carrying vehicle results in a more devastating accident than loss of control of a private automobile (Ontario Ministry of Transport, 1987). Truckers are involved in only approximately 2% of all road accidents but in approximately 7.2% of all fatal accidents (Parsons, 1986). In formula 1, if V = 1 for a commercial driver, then V = 0.28 for a private driver.

There is no published standard or definition of what level of risk is considered to be acceptable in Canada even though this information is crucial in the formulation of guidelines based on the probability of some event occurring in a defined period. It was necessary, therefore, to develop such a standard.

For several years, the guidelines of the Canadian Cardiovascular Society, the Canadian Medical Association, and
the Canadian Council of Motor Transport Administrators have permitted the driver of a heavy truck to return to that occupation after an acute myocardial infarction provided that he or she is New York Heart Association Class I with a negative exercise stress test at 7 metabolic equivalents, has no disqualifying ventricular arrhythmias, and is at least
3 months post infarct. On the basis of available data, however, such a person cannot be assigned a risk lower than 1% of cardiac death in the next year. The risk of sudden death would be lower than this but would be at least partially offset by the risk of other suddenly disabling events such as syncope or stroke. For such a person, risk of SCI is estimated to be equal to 0.01 in formula 1.

*Excerpt from: Ross D, Simpson C, et al. Canadian Cardiovascular Society Consensus Conference 2003 Assessment of the Cardiac Patient for Fitness to Drive and Fly: final report. Ottawa: Canadian Cardiovascular Society; 2003. Available: https:// (accessed 2023 Feb. 14).

It may be assumed that the average commercial driver spends 25% of his or her time behind the wheel (Parsons, 1986). Thus, in formula 1, TD = 0.25. As indicated above, V may be assigned a value of 1 for commercial drivers and Ac = 0.02 for all drivers. Substituting into formula 1:

    RH = TD · V · SCI · Ac
        = 0.25 · 1 · 0.01 · 0.02
        = 0.00005

Allowing such a driver on the road is associated with an annual risk of death or injury to others of approximately 1 in 20,000 (0.00005). This level of risk appears to be generally acceptable in Canada.

A similar standard may be applied to the driver of a private automobile. The average private driver spends approximately 4% of his or her time behind the wheel (TD = 0.04) (Statistics Canada, 1987). As indicated above, for such a driver, V = 0.28 and Ac = 0.02. The acceptable yearly risk of sudden death or cardiac incapacitation for such a person would be calculated as follows:

    RH = TD · V · SCI · Ac
    0.00005 = 0.04 · 0.28 · SCI · 0.02
    SCI = 0.223

Thus, the private automobile driver with a 22% risk of sustaining an SCI in the next year poses no greater threat to public safety than the heavy truck driver with a 1% risk.

Finally, for the commercial driver who drives a light vehicle, such as a taxicab or delivery truck, V = 0.28 and TD = 0.25, placing that driver at a risk between that of the private driver and that of the tractor-trailer driver.


Antecol DH, Roberts WC. Sudden death behind the wheel from natural disease in drivers of four wheeled motor vehicles. Am J Cardiol. 1990;66(19):1329-35.

Hossack DW. Death at the wheel. A consideration of cardiovascular disease as a contributory factor to road accidents. Med J Aust. 1974;1(6):164-6. 

Ontario Ministry of Transportation. 1987 Ontario road safety annual report. Toronto (ON): The Ministry; 1987.

Ostrom M, Eriksson A. Natural death while driving. J Forensic Sci. 1987;32(4):988-98.

Parsons M. Fits and other causes of loss of consciousness while driving. Q J Med. 1986;58(227):295-303.

Statistics Canada. Fuel consumption survey annual report: October 1981 to September 1982 and October 1982 to September 1983. Ottawa (ON): Statistics Canada; 1987. (Cat. no. 53-226.)