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PubMed2006

Simultaneous analyses of cocaine, cocaethylene, and their possible metabolic and pyrolytic products.

A method was developed for simultaneously analyzing cocaine (COC), benzoylecgonine (BZE), norbenzoylecgonine (BNE), norcocaine (NCOC), ecgonine (ECG), ecgonine methyl ester (EME), m-hydroxybenzoylecgonine (HBZE), anhydroecgonine methyl ester (AEME), cocaethylene (CE), norcocaethylene (NCE), and ecgonine ethyl ester (EEE) in blood, urine, and muscle. Available deuterated analogs of these analytes were used as internal standards. Proteins from blood and muscle homogenate were precipitated with cold acetonitrile. After the removal of acetonitrile by evaporation, the supernatants and urine were subjected to solid-phase extraction. The eluted analytes were converted to their hydrochloride salts and derivatized with pentafluoropropionic anhydride and 2,2,3,3,3-pentafluoro-1-propanol. The derivatized products were analyzed by a gas chromatograph (GC)/mass spectrometer by selected ion monitoring. The limit of detection (LOD) for COC, BZE, NCOC, EME, CE, NCE, and EEE was 2ng/ml, while the LODs for BNE, ECG, HBZE, and AEME were 25, 640, 50, and 13 ng/ml, respectively. This method was successfully applied in analyzing 13 case samples from aviation accident pilot fatalities and motor vehicle operators. AEME concentrations found in the 13 samples were consistent with those produced solely by the GC inlet pyrolysis of COC controls in blood. Anhydroecgonine cannot be used as a marker for the abuse of COC by smoking because it is also pyrolytically produced from COC metabolites on the GC inlet. The developed method can be effectively adopted for analyzing COC and related compounds in urine, blood, and muscle by a single extraction with increased sensitivity through formation of hydrochloride salts and using a one-step derivatization.

Animals↗
PubMed2004

Accurate assignment of ethanol origin in postmortem urine: liquid chromatographic-mass spectrometric determination of serotonin metabolites.

Toxicological examination of fatal aviation accident victims routinely includes analysis of ethanol levels. However, distinguishing between antemortem ingestion and postmortem microbial formation complicates all positive ethanol results. Development of a single analytical approach to determine concentrations of 5-hydroxytryptophol (5-HTOL) and 5-hydroxyindole-3-acetic acid (5-HIAA), two well-known metabolites of serotonin, has provided a convenient, rapid and reliable solution to this problem. Antemortem ethanol leads to an elevation in the 5-HTOL/5-HIAA ratio for 11-19 h after acute ingestion. The liquid-liquid extracts of postmortem urine samples were subjected to liquid chromatography-mass spectrometry (LC-MS) for the simultaneous quantitation of these two analytes, yielding detection limits of 0.1 ng/ml for each. Examination of the 5-HTOL/5-HIAA ratio was undertaken for 44 urine samples known to be antemortem ethanol-positive or antemortem ethanol-negative. Recent ethanol ingestion was conveniently and accurately separated using a 5-HTOL/5-HIAA ratio of 15 pmol/nmol, a value previously suggested using human volunteers. All 21 ethanol-negative postmortem samples were below this cutoff, while all 23 ethanol-positive postmortem samples were above this cutoff. Thus, we recommend the employment of this cutoff value, established using this straightforward LC-MS procedure, to confirm or deny recent antemortem ethanol ingestion in postmortem urine samples.

Chromatography, High Pressure Liquid↗
PubMed1997

Aircrew fatigue in long-haul operations.

The studies were conducted on the transmeridian routes Düsseldorf (DUS)-Atlanta (ATL) and Hamburg (HAM)-Los Angeles (LAX), and on the north-south route Frankfurt (FRA)-Mahe (SEZ). Scheduled flight duration was between 8:50 hours (ATL-DUS) and 11:50 hours (HAM-LAX). In total, 25 rotations (50 flights) have been investigated by pre-, in- and post-flight data collection of sleep, taskload, fatigue and stress by electroencephalogram and electrocardiogram measurements and subjective ratings. Inflight ratings of taskload showed low perceived exertion during the Atlantic flights, and were moderate during the north-south transitions. Fatigue ratings increased with progressing flight duration. Towards the end of long U.S.-westcoast flights performed at day-time, and in all night flights, fatigue was elevated compared to the 'baseline' ratings collected during the day-time DUS-ATL flights. Fatigue was rated as being 'critical' by several pilots, particularly during the return flight SEZ-FRA when fatigue was severely pronounced. From the findings it is concluded that duty schedules, as performed on the route HAM-LAX (because of long duty hours), and particularly on the route FRA-SEZ (because of consecutive night work), may place excessive demands on mental and physiological capacity. With respect to legal aspects, the results are significant and should promote further deliberations for advanced schemes of flight duty time limitations and rest requirements.

Accidents, Aviation↗
PubMed1984

Alcohol and trauma.

Available evidence implicates alcohol consumption as a major risk factor for almost all types of injury. An exceptionally strong relationship is noted between alcohol and motor vehicle accidents--particularly single-vehicle crashes. Recognition of the association between alcohol and trauma is important not only for proper care and for treatment of the underlying alcoholism, but to stimulate enactment of preventive measures aimed at reducing the risk of alcohol-associated injuries.

Accidents, Aviation↗
PubMed1990

The shared experience of catastrophe: an expanded classification of the disaster community.

Based on observational and interview data following a major air crash, a classification of individuals affected by catastrophe is proposed in which degree of involvement is used to characterize the dynamic nature of the disaster community. The model encompasses individual and group activities, roles and relationships, and the shared meaning of the traumatic event. Implications for the identification of neglected participants and for preventive community intervention are offered.

Accidents, Aviation↗
PubMedDate not supplied

Pediatric critical care transport--the safety of the journey: a five-year review of vehicular collisions involving pediatric and neonatal transport teams.

OBJECTIVE: To determine the frequency and consequences of vehicular crashes among dedicated pediatric and neonatal transport teams. METHODS: A three-page questionnaire was sent to the transport teams of National Association of Children's Hospitals and Related Institutions (NACHRI) member hospitals. The survey instrument consisted of three sections. The first section requested demographic information about the team and asked the team to report any vehicular collisions or incidents in the previous five years. The second section was directed at teams that did not report collisions or incidents and asked the team to identify potential reasons for their safety record. The third section was directed to those teams reporting collisions or incidents and asked about the causes and consequences of these events. RESULTS: Ninety of 153 (59%) surveys were returned. Thirty-eight of the 90 teams (42%) reported at least one collision in the previous five years. A total of 66 collisions were reported (nine aircraft crashes and 57 ambulance collisions). The number of collisions was not related to the total number of transports performed by the team. Most teams attributed the collisions to errors on the part of a team member or to the actions of a third party. Collisions resulted in eight deaths, ten cases of moderate to severe injury, and 28 minor injuries to patients, health care workers, and/or the ambulance crew. All deaths resulted from aircraft crashes. Additionally, there were operational impacts upon the teams. These included missed workdays and disability on the part of team members and changes in team practices. Collision-free teams attributed their safety record to specific policies of the team and/or the vehicle owner or vendor and to luck. CONCLUSIONS: Collisions/crashes among pediatric transport teams are unusual. However, they have resulted in deaths, injuries, and disability. Collisions/crashes appear to be caused by the actions of a team member and/or those of third parties. Specific safety policies on the part of the team and/or vehicle owner or provider may prevent or decrease collisions/crashes.

Accidents, Aviation↗
PubMed2001

Factors associated with pilot fatality in work-related aircraft crashes, Alaska, 1990-1999.

Work-related aircraft crashes are the leading cause of occupational fatality in Alaska, with civilian pilots having the highest fatality rate (410/100,000/year). To identify factors affecting survivability, the authors examined work-related aircraft crashes that occurred in Alaska in the 1990s (1990-1999), comparing crashes with pilot fatalities to crashes in which the pilot survived. Using data from National Transportation Safety Board reports, the authors carried out logistic regression analysis with the following variables: age, flight experience, use of a shoulder restraint, weather conditions (visual flight vs. instrument flight), light conditions (daylight vs. darkness), type of aircraft (airplane vs. helicopter), postcrash fire, crash location (airport vs. elsewhere), and state of residence. In the main-effects model, significant associations were found between fatality and postcrash fire (adjusted odds ratio (AOR) = 6.43, 95% confidence interval (CI): 2.38, 17.37), poor weather (AOR = 4.11, 95% CI: 2.15, 7.87), and non-Alaska resident status (AOR = 2.10, 95% CI: 1.05, 4.20). Protective effects were seen for shoulder restraint use (AOR = 0.40, 95% CI: 0.21, 0.77) and daylight versus darkness (AOR = 0.50, 95% CI: 0.25, 0.99). The finding that state of residence was associated with survivability offers new information on pilot survivability in work-related aircraft crashes in Alaska. These results may be useful in targeting safety interventions for pilots who fly occupationally in Alaska or in similar environments.

Accidents, Aviation↗
PubMedDate not supplied

An accurate method for the determination of carboxyhemoglobin in postmortem blood using GC-TCD.

During the investigation of aviation accidents, postmortem samples from accident victims are submitted to the FAA's Civil Aerospace Medical Institute for toxicological analysis. In order to determine if an accident victim was exposed to an in-flight/postcrash fire or faulty heating/exhaust system, the analysis of carbon monoxide (CO) is conducted. Although our laboratory predominantly uses a spectrophotometric method for the determination of carboxyhemoglobin (COHb), we consider it essential to confirm with a second technique based on a different analytical principle. Our laboratory encountered difficulties with many of our postmortem samples while employing a commonly used GC method. We believed these problems were due to elevated methemoglobin (MetHb) concentration in our specimens. MetHb does not bind CO; therefore, elevated MetHb levels will result in a loss of CO-binding capacity. Because most commonly employed GC methods determine %COHb from a ratio of unsaturated blood to CO-saturated blood, a loss of CO-binding capacity will result in an erroneously high %COHb value. Our laboratory has developed a new GC method for the determination of %COHb that incorporates sodium dithionite, which will reduce any MetHb present to Hb. Using blood controls ranging from 1% to 67% COHb, we found no statistically significant differences between %COHb results from our new GC method and our spectrophotometric method. To validate the new GC method, postmortem samples were analyzed with our existing spectrophotometric method, a GC method commonly used without reducing agent, and our new GC method with the addition of sodium dithionite. As expected, we saw errors up to and exceeding 50% when comparing the unreduced GC results with our spectrophotometric method. With our new GC procedure, the error was virtually eliminated.

Autopsy↗
PubMed1982

Occurrence of pulmonary fat and bone marrow embolism.

The lungs of 136 persons dying as a result of road traffic accidents were studied retrospectively for the presence of fat and bone marrow emboli. Comparable investigations were made in 54 cases of acute myocardial failure reported to the medicolegal authorities and in 50 cases of fatal drug overdose. A further 50 cases of myocardial failure dying in hospital were studied for the presence of bone marrow embolism only. It was considered that despite occurrence of an occasional anomalous case, both fat and bone marrow emboli are related to injury but that the incidence and severity of bone marrow embolism in particular depends greatly upon the conditions of the accidental death. The occurrence of pulmonary embolic phenomena in cases of natural death was attributed to resuscitative measures rather than the underlying condition. The results indicated that the medicolegal significance attached to the findings should, by themselves, be limited to the positive identification of injuries sustained before or at the time of death in the individual case.

Accidents, Aviation↗