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need to investigate the victim’s psychological status. Psychomotor, perceptual or judgemental performance
decrements may result from drug ingestion or accidental exposure to a variety of environmental toxins.
Samples should be obtained from all accident victims, if possible. Specimens from passengers may
function as controls for samples obtained from flight crew and provide valuable evidence as to, for example,
the presence of fermentation producing ethanol.
ICAO Preliminary Unedited Version — October 2008 IV-1-12
Fire patterns may be discerned through the detection of distribution patterns in the levels of hydrogen
cyanide or carbon monoxide in cabin crew and passengers. Carbon monoxide in flight crew may suggest a
causal contamination problem due possibly to faulty heat exchangers.
Victims of crop-spraying accidents should be screened for the presence of pesticides or herbicides and
the inhibition of cholinesterase. Accident investigators should be warned of the dangers of contamination in
investigating agricultural accidents and be given adequate protective suits and equipment. They too should
be tested if they experience symptoms.
Post-mortem biochemistry
Apart from those post-mortem biochemistry tasks normally part of forensic toxicology, other tests are
generally not useful in air accident investigations owing to the length of time elapsing from time of death to
discovery and autopsy.
THE INTERPRETATION AND VALUE OF THE
PATHOLOGICAL EVIDENCE
The determination of the cause of death of each person
Many bodies from an air crash will be extensively damaged by mechanical forces and by burns. It is
tempting for those not aware of the value of the pathological contribution to an aircraft accident
investigation to ascribe death to burning or to multiple injuries based on a superficial external post-mortem
examination. A fire produces so many additional factors that such an analysis represents little more than
guess work; moreover, a superficial examination fails to distinguish between ante-mortem and post-mortem
injury. The investigator must keep in mind the differences between ante-mortem and post-mortem injuries
particularly in the flight crew; it is important to establish whether death occurred in flight and led to the
accident or whether death was the result of the accident.
It is important to determine, if it is at all possible, the precise cause of death in each case in relation both
to the technical aspects of the accident investigation and to later medico-legal problems.
The careful external post-mortem examination and internal autopsy and the laboratory investigations
referred to earlier will frequently allow a precise diagnosis of the cause of death to be made as in the
following examples:
a) following the death from heart disease of a pilot at the controls of an aircraft, the resultant crash
could cause multiple injuries to his body which external examination alone might suggest were the
cause of his death. Internal examination supplemented by histology may reveal severe coronary
artery disease, coronary artery thrombosis, recent silent myocardial infarction, or
myocarditis - whichever heart disease had caused his death at the controls;
b) if a passenger had sustained head injury of lethal severity, important conclusions could be drawn as
to the survivability of the accident. Internal and subsequent laboratory examination, however,
showing swallowed carbon in the oesophagus and stomach, inhaled carbon in the trachea and
bronchi, congested oedematous lungs and a raised carboxyhaemoglobin level in the blood, would
show the true cause of death as burning. The head injury might then be ascribable to heat and its
interpretation would be quite different;
ICAO Preliminary Unedited Version — October 2008 IV-1-13
c) a husband and wife might both appear to have sustained multiple injuries and incineration. Detailed
autopsy and laboratory examinations might show the one to have died as the passenger referred to
in b) above while the other having a ruptured aorta and no evidence of survival during the
post-crash fire had died from injury. It could then be held that the former had survived the latter
with far-reaching medico-legal implications regarding the disposal of estates.
The nature and cause of injuries and their timing
This refers in particular to a single major lethal injury sustained by a victim or to potentially incapacitating
injuries that would have prevented a conscious and otherwise capable person from effecting his own escape.
An assessment of the nature and cause of injuries is required so that consideration can be given to appraising
safety features within the aircraft and to improving them. Examples include penetrating head injuries or
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Manual of Civil Aviation Medicine 2(132)
