[Organization of forensic medical studies in aviation accidents].
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Accidents, Aviation↗
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Role of radiology in aviation accident investigation.
Radiographic screening of fatality victims for skeletal detail, dental and surgical artifacts, personal effects, and foreign bodies is of established value. Radiography as the primary means of positive victim identification, through comparison with antemortem films and records, is an important new role. Data on sources of injury and relationships between victims and the crash environment may be derived from radiographic injury patterns and may be correlated with mechanisms of injury production. The result of such analysis is improved safety design. Such radiography poses unique technical and logistical problems, often involving temporary or remote facilities, which must be solved with consideration for privacy and safety. Advance planning is essential for maximum benefit from radiographic investigation.
Accidents, Aviation↗
Epidemiologic investigation of occupation, age, and exposure in general aviation accidents.
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Accidents, Aviation↗
Toxicological findings in fatal civil aviation accidents, fiscal years 1968-1974.
Toxicological findings in 1,345 fatal general aviation accidents from fiscal year 1968 through 1974 are summarized. Methods used in examination of specimens for alcohol, drugs, carbon monoxide, cyanide, and cholinesterase activity are described. Blood ethanol levels in excess of 0.050% were found in 117 of the 1,345 pilots (8.7%). Drugs were found in 16 cases (1.2%). These and other toxicological findings indicate that in more than 40% of the cases, information worthy of consideration in developing the human-factors history of an accident or the cause of death from survivable crashes was obtained.
Accidents, Aviation↗
Human error analysis of commercial aviation accidents: application of the Human Factors Analysis and Classification system (HFACS).
BACKGROUND: The Human Factors Analysis and Classification System (HFACS) is a general human error framework originally developed and tested within the U.S. military as a tool for investigating and analyzing the human causes of aviation accidents. Based on Reason's (1990) model of latent and active failures, HFACS addresses human error at all levels of the system, including the condition of aircrew and organizational factors. The purpose of the present study was to assess the utility of the HFACS framework as an error analysis and classification tool outside the military. METHODS: The HFACS framework was used to analyze human error data associated with aircrew-related commercial aviation accidents that occurred between January 1990 and December 1996 using database records maintained by the NTSB and the FAA. RESULTS: Investigators were able to reliably accommodate all the human causal factors associated with the commercial aviation accidents examined in this study using the HFACS system. In addition, the classification of data using HFACS highlighted several critical safety issues in need of intervention research. CONCLUSION: These results demonstrate that the HFACS framework can be a viable tool for use within the civil aviation arena. However, additional research is needed to examine its applicability to areas outside the flight deck, such as aircraft maintenance and air traffic control domains.
Accidents, Aviation↗
Aviation suicide: a review of general aviation accidents in the UK, 1970-96.
A review was undertaken of 415 general aviation accidents. Three were definite cases of suicide and in another seven it seemed possible that the deceased had taken their own lives. Therefore, in the United Kingdom, suicide definitely accounts for 0.72% of general aviation accidents and possibly for more than 2.4%. The latter accords more closely with the findings from Germany than from the United States. Previous psychiatric or domestic problems and alcohol misuse are features of these cases. Aerobatics before the final impact is another frequent finding. The investigation of fatal accidents involving "pilot error" is incomplete without an examination of the victim's social and psychological history. An assessment of a pilot's mental well-being is an essential part of aviation medical examinations.
Adult↗
Postmortem coronary atherosclerosis findings in general aviation accident pilot fatalities: 1975-77.
The autopsies of 764 pilots involved in fatal general aviation accidents during the years 1975-77 were reviewed to appraise the age specific prevalence of coronary atherosclerosis among the autopsied group. Of the pilots killed in aircraft accidents and autopsied during 1975-77, 51% were found to have some degree of coronary atherosclerosis ranging from minimal to severe. However, only about 5% of the autopsied group were categorized as having severe coronary atherosclerosis. The rate per 1,000 of severe coronary atherosclerosis increased with age from 14.5 for ages less than 30, to 89.9 for ages 50 years and above; the rate nearly tripled from ages 30-39 to 40-49 (22.1 to 63.6). The prevalence of coronary atherosclerosis among this group of autopsied airmen is less than would have been expected based on the results of other recent studies.
Accidents, Aviation↗
Selective serotonin reuptake inhibitors in pilot fatalities of civil aviation accidents, 1990-2001.
INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression. With a few exceptions, these psychotropic medications are not approved by aeromedical regulatory authorities for use by aviators. Since SSRIs have the potential for impairing performance and causing drug-drug interactions, the prevalence of SSRIs in pilot fatalities of civil aviation accidents was evaluated. METHODS: Postmortem samples from pilots involved in fatal civil aircraft accidents are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological evaluation. Findings from such evaluations are maintained in the CAMI Toxicology Database. This database was examined for the presence of SSRIs in pilot fatalities of the accidents that occurred during 1990-2001. RESULTS: Out of 4,184 fatal civil aviation accidents from which CAMI received samples, there were 61 accidents in which pilot fatalities had SSRIs. Of these accidents, 56 were of the general aviation category, 2 were of the air taxi and commuter category, 2 were of the agricultural category, and 1 was of the ultralight category. Blood concentrations of SSRIs in the fatalities were 11-1121 ng x ml(-1) for fluoxetine; 47-13102 ng x ml(-1) for sertraline; 68-1441 ng x ml(-1) for paroxetine; and 314-462 ng x ml(-1) for citalopram. In 39 of the 61 pilots, other drugs--for example, analgesics, antihistaminics, benzodiazepines, narcotic analgesics, and/or sympathomimetics--and/or ethanol were also present. As determined by the National Transportation Safety Board, the use of an SSRI [with or without other drug(s) and/or ethanol] has been a contributory factor in at least 9 of the 61 accidents. CONCLUSIONS: Numbers of SSRI-involved accidents were low, and blood SSRI concentrations in the associated pilot fatalities ranged from subtherapeutic to toxic levels. However, the interactive effects of other drug(s), ethanol, and/or even altitude hypoxia in producing adverse effects in the pilots cannot be ruled out. Findings from this study should be useful in investigating SSRI and other substance-involved accidents and in making decisions concerning the use of SSRIs in aviation.
Accidents, Aviation↗
Natural sunlight and its association to civil aviation accidents.
BACKGROUND: Glare is a temporary visual sensation produced by luminance within the visual field that is significantly greater than that to which the eyes are adapted. Glare from natural and artificial light sources can result in temporary visual impairment, increasing the risk of an accident. This study investigates the relationship between visual impairment from natural sunlight and aviation accidents. METHODS: The National Transportation Safety Board Aviation Accident/Incident Database was queried for the period January 1, 1988 to December 31, 1998 for terms, which included "sun," "glare," "vision," "blind ed," and "reflections." Reports annotated with one or more of these terms were reviewed to determine whether glare was considered a direct or contributing factor in the event. RESULTS: There were 130 accidents in which glare was found to be a contributing factor. The majority of these events occurred during clear weather and atmospheric conditions (85%), and were associated with approach/landing and takeoff/departure phases of flight (55%). CONCLUSIONS: Exposure to glare from natural sunlight has contributed to aviation accidents, primarily under otherwise optimal visual conditions at low altitude in congested airspace. Preventative techniques are presented that may protect a pilot's visual performance against the debilitating effects of glare from the sun.
Accidents, Aviation↗
Ultralight aviation accident factors and latent failures: a 66-case study.
INTRODUCTION: Little research has been done on ultralight aviation accidents. A better understanding of accident factors allows for better development of preventive measures. This study analyzes ultralight accidents with respect to significant factors related to active and latent failures, as referred to in Reason's Swiss cheese model of human error. METHODS: There were 66 National Transportation Safety Board (NTSB) ultralight accident reports that were examined from 1985-2004. Contextual information about active and latent failures was identified, compiled, and cross-referenced with pilot, aircraft, and accident information for evidence of significant relationships. RESULTS: Pilots with less than 40 make/model-specific flying hours were significantly more likely to crash fatally (chi2 = 9.07; p < 0.005; df=1) than other pilots and/or because of losing control (chi2 = 7.24; p < 0.05; df=1) than other accident causes. In contrast, pilots with 40 or more make/model-specific flying hours were significantly more likely to crash as a result of engine failure (chi2 = 9.33; p < 0.005; df = 1). Loss of control as an active failure was usually associated with such latent failures as strong winds and insufficient mission planning, while the engine failure accidents involved inadequate maintenance. CONCLUSION: In order to reduce accident prevalence, ultralight self-regulation organizations should focus on training in mission planning, aircraft familiarity, and proper maintenance procedures. Further research should concentrate on explaining the prevalence of the active and latent failures shown here and determining the effects of the FAA's new light sport aircraft category.
Accidents, Aviation↗
Aviation accidents and incidents associated with the use of ophthalmic devices by civilian airmen.
INTRODUCTION: Approximately 54% of civilian pilots rely on ophthalmic lenses to correct defective vision in order to maintain a valid airman medical certificate. This report reviews aviation accidents and incidents where the use or misuse of ophthalmic devices was considered to have been a contributing factor in the mishap. METHODS: The NTSB's Aviation Accident/Incident Database and the FAA's Incident Data System were queried for terms related to ophthalmic devices. All reports were reviewed to determine whether an ophthalmic device was a factor in the mishap and then stratified based on the type of ophthalmic correction involved. Additionally, the Aviation Safety Reporting System (ASRS), which allows aviation personnel to report actual or perceived safety-related problems was similarly queried and reviewed. RESULTS: The NTSB and FAA databases included 19 mishaps with contributing factors such as lost and/or broken eyeglasses, problems with sunglasses, incompatibility with personal protective breathing equipment adaptation difficulties, or inappropriate ophthalmic prescriptions and contact lenses. Aviation personnel voluntarily submitted 26 ASRS reports describing operational problems involving ophthalmic devices that adversely affected aviation safety. CONCLUSIONS: Ophthalmic devices used by pilots have contributed to aviation accidents and incidents. The review and reporting of these events provides important information that can be used to educate flight crewmembers, Aviation Medical Examiners, and eyecare practitioners about the potential hazards of using inappropriate ophthalmic devices. Recommendations in this report may assist pilots in avoiding similar hazardous situations and enhance aviation safety.
Accidents, Aviation↗
Applications of gas chromatographic head space analysis to aviation accident toxicology.
The use of head space sampling in conjunction with gas chromatography has proved a useful technique for analyzing aviation accident post mortem material for ethanol, carbon monoxide, and volatile contaminants. An account of the experience of the technique to date at the Royal Air Force Institute of Pathology and Tropical Medicine is given, and the problems and advantages associated with the method are discussed.
Accidents, Aviation↗
[Spinal cord injuries caused by aviation accidents].
During the past 15 years fewer than 1% of those treated in the National Spinal Cord Injury Center were injured as a result of aviation accidents. In addition to 9 such patients treated at the center since 1973, another 6 were found among the many hundreds receiving ambulatory care in our clinics. 3 patients had survived a helicopter crash, 2 were injured while ejecting from combat aircraft, 3 were injured in crashes of light aircraft, 1 fell from a hand glider and 6 were injured in parachute drops. Of the 15 reviewed, 6 use wheelchairs, 3 walk assisted by orthopedic devices, while 6 ambulate freely. Although initial hospitalization was not substantially longer than in other patients with spinal cord injuries, extended ambulatory psychological intervention was necessary.
Accidents, Aviation↗
Prevalence of chlorpheniramine in aviation accident pilot fatalities, 1991-1996.
BACKGROUND: Chlorpheniramine is known to cause drowsiness, and this side effect has a potential to impair performance and could be a factor in accidents. METHODS: Therefore, to establish the prevalence of this drug in pilot fatalities of aviation accidents, a postmortem toxicology database--maintained at the Civil Aeromedical Institute--was examined for the presence of chlorpheniramine in the fatalities, occurred during 1991-1996. RESULTS: There were 47 (2.2%) accidents involving chlorpheniramine. Of these, 16 had only chlorpheniramine at 109 ng.ml-1 (n = 4) in blood and 1412 ng.g-1 (n = 12) in liver. Other drugs were also present in the remaining 31 cases, wherein chlorpheniramine concentrations were 93 ng.ml-1 (n = 18) in blood and 747 ng.g-1 (n = 12) in liver. Ninety-five percent of all quantitated blood values were at or above the therapeutic level (10 ng.ml-1), giving a 100 ng.ml-1 (n = 21) mean blood value. The drug's mean liver concentration from all cases was 1080 ng.g-1 (n = 24). The average blood value was approximately 10 times higher than the therapeutic value. CONCLUSIONS: The presence of other drugs did not appear to significantly alter the blood chlorpheniramine level, but no such correlation could be established with the hepatic value. The approximate 10-fold increase in the liver concentration was consistent with the general trend of drug distribution in the hepatic compartment. However, the contribution of postmortem redistribution of the drug to alter its concentration cannot be entirely ruled out. This study suggests that chlorpheniramine was present in some aviation fatalities at levels higher than therapeutic levels.
Accidents, Aviation↗
U.S. fatal general aviation accidents due to cardiovascular incapacitation: 1974-75.
A study was undertaken to determine the relative impact of inflight cardiovascular incapacitation among general aviation pilots with respect to general aviation flight safety. During calendar years 1974-75, the National Transportation Safety Board reports reveal that 13 U.S. general aviation pilots died of cardiovascular incapacitation during flight. The analysis of these accidents will bear on any suggested changes in pilot medical screening procedures for cardiovascular disease, as well as on pilot safety education programs. Of the 13 cases noted above, nine pilots were flying alone. Of the remaining multiple occupant cases, the nonpilot wife of one deceased victim managed to land the aircraft. Eighteen deaths resulted from the inflight incapacitations. The ages of the pilots ranged from 33-68 years, with both a mean and a median of 52. Postmortem examinations revealed extensive coronary disease (atherosclerosis) in 12 cases (no pilot autopsy data is available in the case where the passenger landed the aircraft). Of these 12 cases, five demonstrated recent occlusions. In four more, evidence of old infarcts was revealed by the postmortem examination. It is concluded that these 13 inflight cardiovascular incapacitations, occurring among a total of 1,404 fatal general aviation accidents in the 1974-75 period, constitute such a small proportion (0.93%) of the documented fatal general aviation accidents that extensive additional cardiovascular screening procedures are not justified at present on cost/yield basis.
Accidents, Aviation↗
Toxicological findings in Federal Aviation Administration general aviation accidents.
Blood, urine, and tissue specimens were received from 377 Federal Aviation Administration (FAA) aviation fatalities during fiscal year 1989. Carbon monoxide at less than 10% saturation was found in 94% of the cases, and cyanide at less than 0.5 mg/L was found in 96% of the cases. Ethanol at greater than 10 mg/dL was found in 14.8% of the cases, but only 4.5% were determined to be due to ethanol ingestion from toxicological findings. Excluding nicotine and ethanol, 12.6% of the cases were positive for one or more drugs. Acetaminophen and salicylate were the most frequently found drugs. Cannabinoids were found in 1.3% of the cases and benzoylecgonine in 1.6%. There was minimal use of therapeutic drugs that cause central nervous system depression or stimulation. These results show no consistent pattern of drug involvement in civilian aviation fatalities.
Accidents, Aviation↗
Review of aviation safety measures which have application to aviation accident prevention.
Introduction of certain human-factors techniques has been followed by market reduction in military and airline accident rates. In this study, these safety measures are analyzed to determine the value of their application to general aviation activity. Some techniques are already in use. They are: 1. medical evaluation of iarcrews; 2. aeronautical innovations which tailor the machine to the man; 3. imporvement of precision navigational air traffic control and flight procedures; 4. standardization of flight training and flight procedures. A remaining field of interest, and one which appears to be underused, is that of supervision. After ending his association with the flight instructor, the general aviation pilot is essentially unsupervised. Accident data gathered over several years show that with increases in the proportion of pilots who have not maintained an association with a flight instructor, the general aviation fatal accident rate is increased. Current regulations, which require revalidation of airman's certificates, provide a method by which this association can be maintained. The flight instructor, or some similar aviation professional, can maintain an element of supervision with otherwise independent general aviation pilots. Data from previous years supports the hypothesis that such a program would make a substantial improvement in general aviation safety.
Accident Prevention↗
General aviation accidents in degraded visibility: a case control study of 72 accidents.
BACKGROUND: Accidents in degraded visibility continue to account for a disproportionately large number of fatal crashes and fatalities in general aviation (GA). However, the relatively small percentage of these crashes annually suggests that even a small reduction in the number of crashes can result in a large reduction in associated fatalities. OBJECTIVE: This study identified risk factors associated with GA accidents that occur in degraded visibility. METHODS: Data collected during 72 National Transportation Safety Board investigations of GA accidents were compared with data collected from 135 control flights matched on weather conditions, location, time, and rules of flight. Study variables included pilot demographics, experience, testing and accident histories, and the purpose and length of flights. Initial comparisons were conducted using Chi-square analyses, followed by the development of a logistic regression model. RESULTS: Univariate analyses identified significant differences in pilot age at accident, age at initial certification, certificate level, instrument rating, testing performance, and previous accident involvement. There were also significant differences between groups related to aircraft ownership, purpose of flight, and intended flight length. The logistic regression revealed significant increased risk for pilots initially certified after age 25 [odds ratio (OR) 4.5, 95% confidence interval (CI) 1.9-10.81, without instrument ratings (OR 4.8, 95% CI 1.8-12.8), with prior accidents/incidents (OR 3.1, 95% CI 1.1-8.7), and for intended flights longer than 300 nmi (OR 4.6, 95% CI 1.6-13.8). CONCLUSIONS: Certain risk factors (e.g., instrument rating) were consistent with previous research, while others (e.g., age at certification) raise questions for future research.
Accidents, Aviation↗