United States Department of Transportation
i
Unreported Medications Used in Incapacitating Medical Conditions Found in Fatal Civil Aviation Accidents
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1994-08-01
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[PDF-367.76 KB]
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Abstract:One of the major concerns in aviation medicine is sudden incapacitation of the pilot resulting in a fatal accident. The Office of Aviation Medicine (OAM) for the Federal Aviation Administration (FAA) is charged with the medical certification of pilots. All pilots are required by OAM to receive a medical examination by a qualified Aviation Medical Examiner before they can receive medical certification. The pilots must complete a Medical Certification Form listing all of their medical conditions and medications. The Civil Aerospace Medical Institute's (CAMI's) Toxicology and Accident Research Laboratory analyzes all fatal aviation accidents that occur in the United States.
This paper reports the cases where drugs used in the treatment of incapacitating illnesses were found along with the frequency with which these drugs and illnesses had been reported on the pilots' medical examinations. Specimens were collected by pathologists near the accident and placed in evidence containers provided by CAMI. These samples were refrigerated and shipped by overnight air. Upon receipt the specimens were inventoried and accessioned for the analysis of drugs, alcohol, carbon monoxide, and cyanide. All data collected by the laboratory were electronically entered into a computer for future analysis. We identified those cardiovascular, neurological, and psychiatric drugs most likely to be associated with the treatment of potentially incapacitating illness. Pilots using drugs for neurological and psychiatric conditions would normally not receive their medical certification.
A full review of the complete accident file was conducted in several of the cases reported in this research. The Toxicology and Accident Research Laboratory received specimens from 2192 pilots for postmortem toxicology analysis between 1987 to 1992. Drugs used in the treatment of potentially incapacitating medical conditions were found in 48 of the cases received during this time. Most of the pilots did not report these drugs and medical conditions to their Aviation Medical Examiner and the FAA. Drugs used in the treatment of cardiovascular diseases were found in 13 cases. Neurological medications were found in 7 of the cases. Medications used in the treatment of psychiatric conditions were found in 28 of the cases.
In most of the cases reported, the drugs or illnesses found would have caused OAM to reject certification of the pilot. These pilots might not have died in the accident if they had notified their Aviation Medical Examiner and the FAA of the drugs and medical conditions found. Some of the pilots who are deceitful in completing their medical certification forms are not identified and do receive medical certification. The information in this report will provide useful information to Aviation Medical Examiners regarding cases in which pilots did not report potentially incapacitating illnesses and the drugs used in the treatment of these illnesses.
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