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less severe than when an accident is fatal and their precise cause and mode of production will be more
obvious. The human factors investigation of a non-fatal accident essentially calls for a specialist in aviation
medicine and such specialists are available in many Contracting States.
The totally fatal accident is a rather different proposition. This is a problem in deductive reasoning from
the outset and the approach and expertise of a forensic pathologist are generally required. Few forensic
pathologists have had much experience in investigating aircraft accidents, and these accidents pose
problems that are quite distinct from those encountered in routine medico-legal pathology practice. It is
largely by personal experience that expertise in this field is acquired. The appointment in each Contracting
State of a relatively small number of pathologists, one of whom could be called to participate in the
investigation of every fatal accident in that State, would be a positive step towards establishing a source of
such expertise for the future. Many articles have been published in appropriate journals and there are also
a few books available dealing specifically with this subject, which will be of help to a pathologist
inexperienced in this work (See further reading list at the end of this Chapter). Some States offer courses of
varying lengths for medical officers wishing to specialize in aircraft accident investigation.
ICAO Preliminary Unedited Version — October 2008 IV-1-3
It is the purpose of this chapter to summarize the potential value of medical investigation of aircraft
accidents, and to detail some of the important steps in the approach to the various aspects of the task. Some
material is a repetition of the material in the AIG Manual where the subject is presented for the non-medical
accident investigator; the rest consists of material more properly the concern of the medical investigator.
DISASTER PLANNING
Human factors evidence will vary mainly in emphasis, rather than substance, depending upon whether the
accident involves large or small aircraft. In either case its full value will not be achieved unless there has
been pre-planning by aviation authorities and accident investigation units. It is to be expected that one or
more of the aviation medicine specialists or pathologists designated to assist in aircraft accident
investigation will be called upon to help in such pre-planning. This pre-planning should be based on the
supposition of the largest likely disaster; a small accident merely means using fewer of the resources
provided. The matters to be considered are detailed either in the AIG Manual or in subsequent sections of
this chapter, but may be summarized as follows:
a) the large aircraft, non-fatal accident: the plans are concerned with the provision of rescue
equipment, the availability of hospital facilities and the interview and examination of the crew to
determine possible medical and psychological factors, and of both crew and passengers regarding
injuries and their causes, and escape and survival aspects;
b) the major fatal accident: the disaster plan will include training in the mapping and recovery of
bodies, the provision of mortuary and refrigeration facilities, and the establishment of a medical
team of investigators together with an identification secretariat or commission.
RECONSTRUCTION
The circumstances and cause of the accident
Some medical evidence relating to the reconstruction of the circumstances of the accident may come from
surviving crew members or passengers. In the main, however, medical evidence related to the
reconstruction of the accident circumstances is associated with the autopsy of the victims of the accident.
In fatal light aircraft accidents the examination of the pilot is likely to contribute most. Here the medical
investigations should be directed towards determining or excluding disease and its possible association with
the accident and towards such aspects as alcohol, drugs and toxic substances as possible accident causes.
However, in light aircraft with dual controls, one cannot be certain that a “passenger” was not actually
flying the aircraft. Additionally, toxicological examination of passengers’ tissues may validate findings in
the pilot’s body such as raised carbon monoxide levels.
The presence of two or more pilots on the flight deck of larger aircraft makes pilot incapacitation from
disease or drugs as a cause of a major accident unlikely. This is, however, not entirely true when the
accident has occurred at a critical phase of flight, such as take-off or landing. Nevertheless, the pathologist
may often find it appropriate in a large accident to concentrate on the search for evidence of conditions
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Manual of Civil Aviation Medicine 2(125)
