Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

Ilkka S. Junttila, Alpo Vuorio, Bruce Budowle, Tanja Laukkala, Antti Sajantila

Research output: Contribution to journalArticle

Abstract

Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau’s database between years 2011–2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.

Original languageEnglish
Pages (from-to)1713-1718
Number of pages6
JournalInternational journal of legal medicine
Volume132
Issue number6
DOIs
StatePublished - 1 Nov 2018

Fingerprint

Aviation
Diabetes Mellitus
Glucose
Diabetes Complications
Hypoglycemia
Accidents
Ketone Bodies
Diabetic Ketoacidosis
Cerebral Arteries
Glycosylated Hemoglobin A
Carotid Arteries
Hypoglycemic Agents
Documentation
Toxicology
Coronary Artery Disease
Autopsy
Coronary Vessels
Arteries
Databases

Keywords

  • Accident investigation
  • Diabetes
  • Diabetic ketoacidose
  • Fatal flight accident
  • Glucose measurement
  • Hyperglycemia
  • Hypoglycemia
  • Pilot incapacitation

Cite this

@article{6412dc2a71d54c5bad36a68aaa576c08,
title = "Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016",
abstract = "Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau’s database between years 2011–2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3{\%}) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac{\%}, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.",
keywords = "Accident investigation, Diabetes, Diabetic ketoacidose, Fatal flight accident, Glucose measurement, Hyperglycemia, Hypoglycemia, Pilot incapacitation",
author = "Junttila, {Ilkka S.} and Alpo Vuorio and Bruce Budowle and Tanja Laukkala and Antti Sajantila",
year = "2018",
month = "11",
day = "1",
doi = "10.1007/s00414-018-1879-4",
language = "English",
volume = "132",
pages = "1713--1718",
journal = "International Journal of Legal Medicine",
issn = "0937-9827",
publisher = "Springer Verlag",
number = "6",

}

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016. / Junttila, Ilkka S.; Vuorio, Alpo; Budowle, Bruce; Laukkala, Tanja; Sajantila, Antti.

In: International journal of legal medicine, Vol. 132, No. 6, 01.11.2018, p. 1713-1718.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

AU - Junttila, Ilkka S.

AU - Vuorio, Alpo

AU - Budowle, Bruce

AU - Laukkala, Tanja

AU - Sajantila, Antti

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau’s database between years 2011–2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.

AB - Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau’s database between years 2011–2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.

KW - Accident investigation

KW - Diabetes

KW - Diabetic ketoacidose

KW - Fatal flight accident

KW - Glucose measurement

KW - Hyperglycemia

KW - Hypoglycemia

KW - Pilot incapacitation

UR - http://www.scopus.com/inward/record.url?scp=85049562316&partnerID=8YFLogxK

U2 - 10.1007/s00414-018-1879-4

DO - 10.1007/s00414-018-1879-4

M3 - Article

C2 - 29974235

AN - SCOPUS:85049562316

VL - 132

SP - 1713

EP - 1718

JO - International Journal of Legal Medicine

JF - International Journal of Legal Medicine

SN - 0937-9827

IS - 6

ER -