Tricyclic Antidepressants Found in Pilots Fatally Injured in Civil Aviation Accidents.

Prevalence of tricyclic antidepressants (TCAs) has not been explored in pilots. The National Transportation Safety Board (NTSB) aviation accident and the Federal Aviation Administration's Civil Aerospace Medical Institute (CAMI) toxicology and medical certification databases were searched for pilots fatally injured in aviation accidents. During 1990-2012, CAMI received bio-samples of pilots from 7037 aviation accidents. Of these, 2644 cases were positive for drugs. TCAs were present in 31. TCA blood concentrations ranged from therapeutic to toxic levels. The NTSB determined that the use of drugs and ethanol as the probable cause or contributing factor in 35% (11 of 31) of the accidents. None of the 31 pilots reported the use of TCAs during their aviation medical examination. The prevalence of TCAs in aviators was less than 0.5% (31 of 7037 cases). There is a need for aviators to fully disclose the use of medications at the time of their medical examination.

Ethanol and Drugs Found in Civil Aviation Accident Pilot Fatalities, 1989-2013.

BACKGROUND: Biological specimens from pilots fatally injured in civil aviation accidents are analyzed for ethanol and drugs at the Civil Aerospace Medical Institute (CAMI). Prevalence of these substances in the pilots has been evaluated at 5-yr intervals since 1989. In continuation, a fifth 5-yr study (2009-2013) was conducted. METHODS: The CAMI toxicology/medical certification and National Transportation Safety Board (NTSB) aviation accident databases were searched. RESULTS: During 2009-2013, samples from 1169 pilots were analyzed. Aircraft involved in the accidents were primarily operating under general aviation. Most airmen were private pilots and held third-class medical certificates. In relation to the first 5-yr (1989-1993) period, the pilot fatality cases decreased by 37% and the presence of ethanol and/or drugs in the pilots increased by 239% in the fifth 5-yr period. The ethanol usage was unchanged, but increases were 267% and 583% with illicit and prescription drugs, respectively. The use of ethanol and/or drugs by aviators, along with underlying medical conditions, was determined by the NTSB to be cause/factors in 5% of the accidents. CONCLUSION: The observed decrease in the fatality cases does not necessarily suggest the decrease in aviation accidents, as active airmen numbers also declined. The increase in the drug positive cases is primarily attributed to the continuous rise in the use of prescription drugs. Although prevalence of ethanol and drugs has been evaluated in fatally injured aviators, such evaluation has not been performed in active pilots not involved in accidents. This type of comparative study would be crucial in assessing aviation safety.

Toxicological findings in fatally injured pilots of 979 amateur-built aircraft accidents.

BACKGROUND: Specimens from aviation accident pilot fatalities are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological analyses. Trends of fatal amateur-built aircraft accidents and toxicological findings in the associated pilot fatalities have not been examined. METHODS: Fatal amateur-built aircraft accidents that occurred during 1990-2009 were evaluated by retrieving information from the CAMI toxicology database. Probable cause/factor in the amateur-built aircraft mishaps were obtained from the National Transportation Safety Board's (NTSB's) aviation accident database. RESULTS: Of 6309 fatal aviation accidents from which CAMI received postmortem samples, 979 (16%) were related to amateur-built aircraft. There was a decreasing trend in non-amateur-built aircraft accidents, but an increasing trend in amateur-built aircraft accidents. In the 979 accidents, 392 pilots (40%) were positive for ethanol and/or drugs. In these 392 accidents also, the review showed a decreasing trend with non-amateur-built aircraft and an increasing trend with amateur-built aircraft. Percentages of pilots with prescription drugs were 26% for amateur-built aircraft, 16% for non-amateur-built aircraft, and 18% for all aircraft. Ethanol/drug use and medical condition were determined to be a cause/factor in 42 (11%) of the 385 ethanol/ drug-positive amateur-built aircraft accidents investigated by the NTSB. DISCUSSION: Drugs found in the pilots were consistent with commonly used medications in the general population. The contributory role of mechanical malfunction of home-built aircraft cannot be ruled out in the observed increasing trends in their accidents, with or without ethanol and/or drugs. Regardless, the increasing trends of such accidents are of significant concern.