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
N1 - Funding Information:
Funding information The work was funded by Academy of Finland (ISJ, projects 25013080481 and 25013142041), Finnish Medical Foundation (ISJ), Tampere Tuberculosis Foundation (ISJ), and Sigrid Juselius Foundation (ISJ).
Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
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
SN - 0937-9827
VL - 132
SP - 1713
EP - 1718
JO - International Journal of Legal Medicine
JF - International Journal of Legal Medicine
IS - 6
ER -