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

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Junttila , I S , Vuorio , A , Budowle , B , Laukkala , T & Sajantila , A 2018 , ' Challenges in investigation of diabetes-related aviation fatalitiesan analysis of 1491 subsequent aviation fatalities in USA during 2011-2016 ' , International Journal of Legal Medicine , vol. 132 , no. 6 , pp. 1713-1718 . https://doi.org/10.1007/s00414-018-1879-4

Title: Challenges in investigation of diabetes-related aviation fatalitiesan analysis of 1491 subsequent aviation fatalities in USA during 2011-2016
Author: Junttila, Ilkka S.; Vuorio, Alpo; Budowle, Bruce; Laukkala, Tanja; Sajantila, Antti
Contributor: University of Helsinki, Medicum
Date: 2018-11
Language: eng
Number of pages: 6
Belongs to series: International Journal of Legal Medicine
ISSN: 0937-9827
URI: http://hdl.handle.net/10138/260565
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 (similar to 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.
Subject: Pilot incapacitation
Fatal flight accident
Accident investigation
Diabetes
Glucose measurement
Diabetic ketoacidose
Hypoglycemia
Hyperglycemia
CORONARY-HEART-DISEASE
POSTMORTEM DIAGNOSIS
VITREOUS-HUMOR
POISONING DEATHS
LC-MS/MS
INSULIN
MELLITUS
GLUCOSE
HYPOGLYCEMIA
PILOTS
319 Forensic science and other medical sciences
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