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

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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.

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Abbreviations

FAA:

Federal aviation administration

AME:

Aviation medical examiner

ICAO:

International civil aviation organization

CAA:

Civil aviation authority

NTSB:

National transportation safety board

DKA:

Diabetic ketoacidosis

HbA1c:

Glycated hemoglobin

AMI:

Acute myocardial infarction

CNS:

Central nervous system

PM:

Postmortem

CO:

Carbon monoxide

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Funding

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).

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Author notes

  1. Ilkka S. Junttila and Alpo Vuorio contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland

    Ilkka S. Junttila

  2. Fimlab Laboratories, Tampere, Finland

    Ilkka S. Junttila

  3. Mehiläinen Airport Health Centre, Vantaa, Finland

    Alpo Vuorio

  4. Department of Forensic Medicine, University of Helsinki, Helsinki, Finland

    Alpo Vuorio & Antti Sajantila

  5. Center for Human Identification, University of North Texas Health Science Center, 3500 Camp, Bowie Blvd., Fort Worth, TX, 76107, USA

    Bruce Budowle

  6. Mehiläinen Kielotie Health Centre, Vantaa, Finland

    Tanja Laukkala

Authors
  1. Ilkka S. Junttila
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  2. Alpo Vuorio
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  3. Bruce Budowle
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  4. Tanja Laukkala
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  5. Antti Sajantila
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Corresponding author

Correspondence to Antti Sajantila.

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Junttila, I.S., Vuorio, A., Budowle, B. et al. Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016. Int J Legal Med 132, 1713–1718 (2018). https://doi.org/10.1007/s00414-018-1879-4

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  • DOI: https://doi.org/10.1007/s00414-018-1879-4

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