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Blood .................................................................................................... IV-1-10
Urine..................................................................................................... IV-1-10
Liver fluid extracts................................................................................ IV-1-11
Post-mortem biochemistry ..........................................................................IV-1-12
The interpretation and value of the
pathological evidence ..................................................................................... IV-1-12
The determination of the cause of
death of each person................................................................................. IV-1-12
The nature and cause of injuries
and their timing........................................................................................ IV-1-13
The detection of disease or impaired
efficiency in the flight crew ..................................................................... IV-1-13
Evidence to be derived from the examination of passengers
and cabin crew ......................................................................................... IV-1-14
Release of human remains and personal property ............................................. IV-1-14
Correlation with the aircraft wreckage examination ......................................... IV-1-15
The cockpit .................................................................................................IV-1-15
The passenger compartment........................................................................IV-1-15
Other medical aspects of the Human Factors Investigation .............................. IV-1-16
Flight crew medical and personal records - basic mental and
physical health ......................................................................................... IV-1-16
The problems of a particular flight ............................................................. IV-1-16
The medical contribution in the survived accident ..................................... IV-1-17
Summary .......................................................................................................IV-1-18
Further Reading.................................................................................................IV-1-19
Attachment A. Air accident laboratory support ............................................... IV-1A-1
ICAO Preliminary Unedited Version — October 2008 IV-1-1
INTRODUCTION
This chapter of the Medical Manual is intended as a general guide to a medical examiner appointed as a
member of the accident investigation team. It outlines how specialists in aviation medicine, pathology and
human engineering may contribute to an accident investigation and the nature of the work involved in their
contribution. It supplements guidance material for the conduct of an investigation given in the Manual of
Aircraft Accident and Incident Investigation (“AIG Manual”, Doc 9756).
The Standards and Recommended Practices for Aircraft Accident Investigation contained in Annex 13 to
the Convention on International Civil Aviation have been adopted by the ICAO Council as the procedure to
be followed by Contracting States for inquiries into accidents involving death or serious injury and
instituted in accordance with the provisions of Article 26 of the Convention. Annex 13 to the Convention,
Chapter, 5 deals with the investigation and refers also to the AIG Manual.
The fundamental purpose of inquiry into an aircraft accident is to determine the events, conditions and
circumstances pertaining to the accident so that appropriate steps may be taken to prevent a recurrence of
the accident and the factors that led to it. An equally important purpose is to determine the facts, conditions
and circumstances pertaining to the survival or non-survival of the occupants and to the crashworthiness of
the aircraft.
The prime object of the human factors investigation is to obtain evidence (related to the sequence, cause
and effect of the accident) through an examination of the flight crew, the cabin crew and the passengers.
Coincidentally with the investigation, evidence as to identification will automatically emerge - particularly
if each examination is assisted by the co-ordinated efforts of a Human Factors Group that includes aviation
medicine specialists, pathologists and human engineering experts.
Aircraft accident investigation is a highly specialized task which should only be undertaken by personnel
trained in investigation techniques and with a sound working knowledge of aviation and professional skill
in their specialities. To achieve its purpose an investigation should be properly organized, carried out,
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Manual of Civil Aviation Medicine 2(123)
