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crushing fractures of the lower legs. Both of these may suggest an unsatisfactory design of the back of the
seats in relation to those situated immediately behind them.
The causes of unusual types of injury need to be fully examined. On more than one occasion conclusions
have been reached as to which pilot was actually at the controls of an aircraft when it crashed, based upon
the nature of the injuries to the hands and wrists or feet and ankles as determined both by naked eye
examination at autopsy and by radiographs.
Sabotage and the possible injuries due to blast or shrapnel from explosive devices must not be missed.
Tissues from around any such suspect wounds should be preserved by the pathologist for laboratory
analysis for the appropriate trace evidence. Injuries so caused will be reflected in damage to the clothing;
the dangers of premature removal of clothing purely for the purpose of identification are, thereby,
emphasized.
The detection of disease or impaired efficiency
in the flight crew
The autopsy and subsequent examinations may reveal disease as the unequivocal cause of death of one of
the pilots and, therefore, as already suggested, provide a strong clue to the likely circumstances or cause of
the accident. It cannot be too strongly emphasized, however, that evidence that a medical abnormality was
present in a pilot is usually a long way from proof that the abnormality was either the cause of his death or
connected with the accident. A list of diseases known to cause sudden complete incapacitation and death in
apparently normal healthy persons can readily be prepared. It would include coronary artery disease with
or without thrombosis, myocarditis and ruptured cerebral arterial aneurysm, for example. However, severe
coronary artery disease and myocarditis can be present and consistent with normal function and both are
known to have an appreciable incidence in the normal population. The presence of either could be
coincidental in a pilot whose aircraft had crashed because of some technical failure. Similarly, in the
presence of extensive cranial injury it would be only a careful examination that would reveal a cerebral
arterial aneurysm. Even if found, it might be difficult to be sure whether it had ruptured in life or had been
traumatically ruptured as part of the cranial injury.
Pilot function may be adversely affected, especially in managing some in-flight emergency, by almost
any form of illness, however minor, even though clinically unsuspected. The detailed autopsy and
subsequent laboratory investigations advocated imply that every effort will be made to discover whether the
flight crew were suffering from any disease or illness or whether they were suffering from any form of
intoxication or any possible effect of having taken drugs. When all investigations have been completed and
no evidence of any disease or cause for impaired function has been found, it is possible to state that this has
been excluded, for practical purposes, as an event or cause of the accident. When some evidence has been
ICAO Preliminary Unedited Version — October 2008 IV-1-14
found of disease or potential cause of impaired function, very careful consideration must be given to the
nature of the condition, its potential for affecting function, and any discovery of an alternative hypothetical
cause for the accident derived from the engineering and general investigation of the accident. When
correlation of all this evidence has been effected by the Investigator-in-Charge, through the reports of the
Human Factors Group and other groups, it will be possible to put forward any theory formed concerning
human factors on the flight deck in relation to the circumstances and the cause of the accident with a
balanced judgement as to its probability.
Evidence to be derived from the examination
of passengers and cabin crew
The volume of work involved in an accident with many fatalities dictates that the autopsy examinations and
organ and tissue sampling of bodies known to be those of the passengers should be less extensive than for
the operating crew on the flight deck or in the cockpit. Nevertheless, there are certain points that should not
be overlooked in the examination of any body.
Sufficiently detailed examination and sampling of these bodies are required to provide the precise cause
of death:
a) an estimate of deceleration forces, derived from the state of the heart, aorta, diaphragm,
liver and spleen together with the presence of fractures in sternum, spine and pelvis;
b) an assessment of any evidence of seat belt injury and associated cranio-facial damage;
c) evidence of survival in fire as shown by the presence of raised carboxyhaemoglobin levels
in blood or tissues;
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Manual of Civil Aviation Medicine 2(133)
