Postmortem Alcohol Production in Fatal Aircraft Accidents

Abstract

During 1989 and 1990, the Civil Aeromedical Institute received specimens from 975 victims of fatal aircraft accidents. The maximum concentration of ethanol allowed under FAA regulations (0.04%, 40 mg/dL) was exceeded in 79 of these cases (8%). It was determined based on the distribution of ethanol in urine, vitreous humor, blood, and tissue that 21 of the positive cases (27%) were from postmortem alcohol production. Twenty-two of the positive cases (28%) were found to be from the ingestion of ethanol. In 36 cases (45%), no determination could be made regarding the origin of the ethanol. In two cases, postmortem alcohol production exceeded 0.15% (150 mg/dL). The opinion held by some toxicologists that postmortem alcohol production can be inferred from the presence of acetaldehyde, acetone, butanol, and other volatiles was found to be incorrect. Several cases with postmortem ethanol had no other volatiles. Volatile compounds were found in several cases where no ethanol was present. In addition a case was found in which the relative ethanol concentrations in blood, bile, and vitreous humor were solely consistent with the ingestion of ethanol, but acetaldehyde, acetone, and 2-butanol were also found in blood. This clearly indicates that the presence or absence of other volatiles does not establish postmortem ethanol production.

Prevalence of Drugs and Alcohol in Fatal Civil Aviation Accidents Between 1994 and 1998

“…No change was observed in the positive rate for alcohol between 1994 and 1998, compared with the positive cases found between 1989 and 1993. The reported positive alcohol increase does not differentiate between ingested and postmortem alcohol (5). In 1995 the number of positive alcohols dropped from the normal 8% positive alcohols to 4%.…”

“…The Civil Aeromedical Institute (CAMI), Office of Aviation Medicine (OAM), Federal Aviation Administration (FAA), is required under Public Law 100-591 [H.R.4686] (2) to help assess the role of potential medical or drug related pilot impairment in aviation accidents. The Department of Transportation (DOT) Order 8020.11 (3) requires CAMI to "conduct toxicological analyses on specimens from, and special pathologic studies on, aircraft accident fatalities" (5). This includes the identification of abused drugs such as cocaine, amphetamines, and benzodiazepines; or prescription drugs such as cardiovascular and neurological medications.…”

A study of ethyl glucuronide in post-mortem blood as a marker of ante-mortem ingestion of alcohol

“…Occasionally, levels of ethanol can reach significant concentrations (>1.5 g/L) (89)(90)(91)(92). There are a large number of examples, especially from traumatic accidents, where high ethanol concentrations are considered to be false positives.…”

“…From American aircraft accidents, very likely or possible false positive ethanol findings were concluded in 27% and 46% of the ethanol positive cases, respectively (82,89,90). The findings of 1.75 g/L ethanol in the blood of Princess Diana's driver in the fatal car accident has been questioned (88) as well as the Austrian politician, Jørg Haider's, BAC of 1.8 g/L (93).…”

EtG and EtS in Autopsy Blood Samples With and Without Putrefaction Using UPLC–MS-MS

“…Production of ethanol may also occur in vitro in a sample obtained at autopsy if not handled properly. In the interpretation of a postmortem ethanol finding, criteria like specific case information and comparisons of ethanol levels in blood, urine and vitreous humor are often used, but are not always reliable (2,3). A supplementary method to distinguish antemortem ethanol consumption from postmortem ethanol formation is the analysis of the ethanol metabolites ethyl glucuronide (EtG) and ethyl sulfate (EtS) (4)(5)(6)(7).…”