DRUG AND ALCOHOL FORENSIC TOXICOLOGY ANNUAL REPORT 2017
DOT/FAA/AM-20/14Office of Aerospace MedicineWashington, DC 20591DRUG AND ALCOHOL – FORENSICTOXICOLOGY ANNUAL REPORT 2017Kacey CliburnKristi CraftHeather HunnKristi ThompsonRoxane RitterSunday SaenzMike AngierDoug CaldwellAshley GriffinJeff HickersonChristy HilemanRussell LewisJohn SoperKelly WilliamsonPhilip KempCivil Aerospace Medical InstituteFederal Aviation AdministrationOklahoma City, OK 73125Final Report
NOTICEThis document is disseminated under the sponsorshipof the U.S. Department of Transportation in the interestof information exchange. The United States Governmentassumes no liability for the contents thereof.This publication and all Office of Aerospace Medicine technical reports areavailable in full-text from the Civil Aerospace Medical Institute’s publicationsWeb ports/index.cfm
Technical Report Documentation Page1. Report No.2. Government Accession No.3. Recipient's Catalog No.DOT/FAA/AM-20/144. Title and Subtitle5. Report DateDRUG AND ALCOHOL – FORENSIC TOXICOLOGY ANNUALREPORT 2017December 20206. Performing Organization Code7. Author(s)8. Performing Organization Report No.Cliburn K, Craft K, Hunn H, Thompson K, Ritter R, Saenz S, AngierM, Caldwell D, Griffin A, Hickerson J, Hileman C, Lewis R, Soper J,Williamson K, Kemp P.9. Performing Organization Name and Address10. Work Unit No. (TRAIS)Civil Aerospace Medical InstituteP.O. Box 25082Oklahoma City, OK 7312511. Contract or Grant No.12. Sponsoring Agency Name and Address13. Type of Report and Period CoveredOffice of Aerospace MedicineFederal Aviation Administration800 Independence Ave., S.W.Washington, DC 2059114. Sponsoring Agency Code15. Supplemental NotesThis effort was performed in fulfillment of 2018-AAM-611-CHE-10164.16. AbstractThe Bioaeronautical Sciences Research Branch (BSRB) is a branch of the Aerospace MedicalResearch Division that includes three teams focused on improving aviation safety through accidentinvestigation. The Autopsy Program Team is an operational team that collects, manages, and maintainsall autopsy records from the investigation of fatal aircraft accidents in the United States and supports theaeromedical review of these accidents. The Biochemistry and Forensic Toxicology Research Teamsconduct research on accident fatalities and serve as the primary national site for toxicology testing ofaccidents overseen by federal agencies, including the FAA and the National Transportation Safety Board(NTSB).In 2017, the BSRB received 297 cases from accidents in various modes of transportation includingaviation, highway, marine, and rail. The laboratory received biological specimens from 15 incidents inwhich the pilot, driver, or primary operator was nonfatal. Toxicological analyses, includingcarboxyhemoglobin, glucose, volatiles, and drug analyses were performed on cases during theinvestigation process. Of the 272 cases that had a comprehensive drug screen performed, 142 cases werenegative while 130 cases were positive for at least one drug.This report contains widely requested data on the toxicological findings of the cases handled by theBSRB. This report includes comparisons of data over a five-year period. The aerospace community,including FAA leadership, NTSB personnel, aerospace researchers, forensic toxicologists, and the publicwill use the findings and trends of this report to assess transportation safety.18. Distribution StatementForensic Toxicology, Postmortem Toxicology, Civil AviationAccidents, Surface Accidents, Drugs, Ethanol19. Security Classif. (of this report)UnclassifiedForm DOT F 1700.7(8-72)20. Security Classif. (of this page)UnclassifiedReproduction of completed page authorizediDocument is available to the public through theNational Technical Information ServiceSpringfield, Virginia 2216121. No. of Pages5522. Price
ContentsINTRODUCTION . 1Autopsy Program Team . 4Biochemistry Research Team . 5Forensic Toxicology Research Team. 7Objectives . 8METHODS . 8RESULTS . 9Aviation. 10Location . 11Month . 12Occupant Role – Age and Gender . 14Medical Certification . 15BasicMed . 16Accidents Requiring Valid Medical Certificate . 17Accidents Not Requiring Valid Medical Certificate . 18Other Modes of Transportation . 19Month . 20Day of Week . 21Fatality Status. 22Age . 22Toxicology . 23Toxicology Testing Flow Chart . 24Carboxyhemoglobin . 25Cyanide . 25Glucose and Hemoglobin A1c . 26Ethanol . 27Drugs . 28Medical Certificate – Reporting of Drugs by the Airman . 34Diphenhydramine . 35ii
Marijuana . 37Methamphetamine/Amphetamine . 40Five-Year Comparisons . 41REFERENCES . 48Figure 1. AAM-610 Organizational Chart, as of December 2017. . 3Figure 2. Number of Cases Received by Mode of Transportation. . 9Figure 3. Aviation Accidents Investigated by the NTSB/FAA Classified by Location(N 204). . 11Figure 4. All Aviation Accidents Classified by Month (N 212). . 12Figure 5. All Aviation Accidents Classified by Day of the Week (N 212). . 13Figure 6. Age (at the time of accident) of Pilots, Co-pilots, Flight Instructors. . 14Figure 7. Age (at time of accident) of all Non-pilots. . 14Figure 8. Medical Certificate Status for Accidents Requiring a Valid Certificate. . 17Figure 9. Medical Certificate Status for Accidents Not Requiring a Valid Certificate. . 18Figure 10. Non-Aviation Accidents Classified by Location (N 16). . 19Figure 11. Non-Aviation Accidents Classified by Month. . 20Figure 12. Non-Aviation Accidents Classified by Day of Week. . 21Figure 13. Fatality status of non-aviation cases. . 22Figure 14. Number of Cases and Positives for each Toxicology Analysis Performed. . 24Figure 15. Ethanol Results for Blood, Urine, Liver, and Muscle. . 27Figure 16. Most Common Drugs Detected. . 33Figure 17. Ten-Year Period for Methamphetamine and Amphetamine Positive Cases. . 40Figure 18. Five-Year Comparison: Number of Cases Received and Aviation Accidents. 42Figure 19. Five-Year Comparison: Prevalence of Common Controlled Substances. . 46Figure 20. Five-Year Comparison: Prevalence of Common Rx Medications. . 47iii
Table 1. Nonfatal Cases Received by Mode of Transportation. . 9Table 2. Type of Aviation Accidents. . 10Table 3. Occupant Role and Gender for each Case Received. . 14Table 4. Demographics and Toxicology for BasicMed Pilots (N 8). . 16Table 5. Descriptive Statistics of Age for Non-Aviation Cases. . 22Table 6. Carboxyhemoglobin Levels and Symptoms (4). . 25Table 7. Carboxyhemoglobin and Cyanide Results for 2017. . 25Table 8. Glucose and Hemoglobin A1c Results. . 26Table 9. OTC Drugs Identified by the Laboratory in 2017. . 29Table 10. RX Medications Identified by the Laboratory. . 30Table 11. CS Identified by the Laboratory in 2017. 32Table 12. Cases Positive for Diphenhydramine. . 36Table 13. Demographics for Marijuana-Positive Aviation Cases. . 38Table 14. Quantitative Results (ng/mL) of Marijuana-Positive Cases. . 39Table 15. Five-Year Comparison: Types of Cases Received. 43Table 16. Five-Year Comparison: Number of Nonfatal Cases Received. . 43Table 17. Five-year Comparison: Descriptive Statistics for Age of all Cases Received. . 43i
INTRODUCTIONThis is the second annual report, reviewing the findings of the Federal AviationAdministration (FAA) while processing postmortem samples from aviators involved in fatalaerospace accidents. This report covers the findings from fatal aerospace accidents thatoccurred during 2017. This report will cover the characteristics of the accidents thatoccurred during the timeframe under investigation, including the type of flight, the aircraft,the geographic location of the accident, the medical certification status of the aviators,including any positive findings of drugs or alcohol in the postmortem remains of theaviators. These findings are provided to the National Transportation Safety Board (NTSB)on a continuing basis where they are used by NTSB investigators as a part of theirdetermination of probable cause for fatal transportation accidents. These findings are theresult of the efforts of several teams of scientists working at the Civil Aerospace MedicalInstitute (CAMI). CAMI is the medical certification, education, research, and occupationalmedicine wing of the Office of Aerospace Medicine (AAM) under the guidance of the FAAOffice of Aviation Safety (AVS). CAMI is located at the Mike Monroney AeronauticalCenter (MMAC), in Oklahoma City, OK.The Bioaeronautical Sciences Research Branch (BSRB, AAM-610) is part of the AerospaceMedical Research Division (AAM-600). The mission of AAM-600 is “to develop new andinnovative ways to support FAA regulatory and advisory missions to improve the safety ofhumans in civilian aerospace operations.” As such, its goal is to “Continuously maintainthe Absorptive Capacity for applying Science, Medicine, Bioengineering, and Technologyto unrelentingly enhance human safety.”The BSRB is divided into two sections, Forensic Sciences (AAM-611) and BiomedicalSciences (AAM-612). Forensic Sciences Section is composed of the Forensic ToxicologyResearch Team and the Biochemistry Research Team. The Functional Genomics andKnowledge Management Research Teams, along with the Autopsy Program Team, makeup the Biomedical Sciences Section. The Autopsy Program Team is an operational teamthat collects, manages, and maintains all autopsy records from the investigation of fatalaircraft accidents in the United States and supports the aeromedical review of theseaccidents by AAM-600’s Research Medical Officer. The Biochemistry and ForensicToxicology Research Teams conduct research on accident fatalities and serve as the primarynational site for toxicology testing of accidents overseen by federal agencies, including theFAA and the NTSB. The AAM-610 organizational chart is presented in Figure 1.The BSRB is certified in accordance with the International Organization for Standardization(ISO) standard 9001:2008 (July 2015). Additionally, the Forensic Sciences Laboratory isalso accredited by the American Board of Forensic Toxicology (ABFT). The mission ofthe ABFT is to establish standards for the practices of laboratories involved in postmortemtoxicology and/or human performance testing. The accreditation process includes an on1
site inspection every two years and a thorough review of documentation and procedures inthe year between the on-site inspections. Accreditation is also contingent upon thesuccessful performance of proficiency tests provided by the College of American Pathology.ABFT has established a certification program for scientists that are engaged in the practiceof forensic toxicology and successfully pass an examination. In 2017, three BSRBemployees held certifications as a Fellow of ABFT (F-ABFT) and one employee as aDiplomat of ABFT (D-ABFT).2
Bioaeronautical Sciences Research Branch (AAM-610)Branch Manager: Philip M. Kemp, PhD, F-ABFTForensic Sciences Section (AAM-611)Biomedical Sciences Section (AAM-612)Supervisor: Russell Lewis, PhD, F-ABFTSupervisor: Hilary A. Uyhelji, PhDForensic Toxicology Research TeamFunctional Genomics Research TeamTeam Coordinator: VacantTeam Coordinator: Scott Nicholson, PhDMike Angier, BSSusan Munster, MSDoug Caldwell, BSVicky White, BSDavid Hutchings, MS (Venesco)Roxane Ritter, MS, D-ABFTSunday Saenz, MSKelly Williamson, PhDKnowledge Management Research TeamJenny Barrett, BS (Venesco)Team Coordinator: Christopher StitesMarc DavidsonMohammad Siddiki, MSBiochemistry Research TeamTeam Coordinator: Kacey D. Cliburn, MSAutopsy Program TeamKristi Craft, ABT, AASTeam Coordinator: Christy Hileman, MBAJeff Hickerson, BSAshley Griffin, MSJohn Soper, PhD, F-ABFTHeather Hunn, BSKristi Thompson, MSFigure 1. AAM-610 Organizational Chart, as of December 2017.3
Autopsy Program TeamThe FAA has statutory authority and a congressional mandate to conduct accidentprevention and crash injury research by collecting relevant data in the interest of protectingpublic safety. The Autopsy Program Team at the FAA exists to assist accident investigationwith the medical portion of the investigation process. The Autopsy Program Team isinvolved in all U.S. registered civilian aviation accidents where a fatality occurs. The teamworks with FAA and NTSB investigators as well as local medicolegal jurisdictions to obtainautopsy and toxicological specimens for each fatal pilot, co-pilot, pilot rated passenger,and/or other passenger that may have had control of the aircraft at the time of the accident.Autopsy and toxicology are an important part of the accident investigation in that they aidinvestigators in determining what was going on with the airman or occupants at the time ofthe accident. Results from the autopsy report and toxicology report help to rule out ordiscover any impairments or incapacitations. The reports also assist in identifying anyexisting medical conditions that may or may not have been previously disclosed to theFAA’s Aviation Medical Examiner (AME).In 2017, the Autopsy Program Team consisted of three full time autopsy recordsadministrators whose background is in health information management. The AutopsyProgram Team has a database, the Medical Analysis and Tracking (MANTRA) Registry, tostore all of the information obtained during their role in accident investigation. Others withinthe FAA use the data contained in this database to conduct research on fatal accidents. Theresearch is intended to improve aviation safety, health, security, and survivability in theaviation community. The research conducted at CAMI brings understanding to aeromedicalfactors in aviation accidents and studies performance decrements resulting from diseaseprocesses to determine their effects on aviation safety. One of the focuses of the researchperformed at CAMI is to evaluate factors that influence human performance in aviation andcommunicate that to the aviation community.4
Biochemistry Research TeamThe Biochemistry Research Team started 2017 with five members: one ResearchToxicologists, two Research Chemists, and two Laboratory Technicians. Their functionsinclude, but are not limited to: 1) receiving cases and creation of the initial case folders, 2)accessioning, 3) analytical batch review, 4) completion of the case reports, and 5) research.After an aviation accident, or other transportation related accident, an autopsy is performedby the local Medical Examiner or Coroner. The FAA provides a leak-proof kit to the localMedical Examiner or Coroner for them to use to collect and then ship the postmortemremains of aerospace accident victims to CAMI. This kit contains multiple vials andcontainers along with instructions on what biological samples need to be collected for ourtoxicology analysis, and instructions on how to ship the box back for processing. This kitis euphemistically called a TOX-BOX. Upon request by the NTSB, biological specimensfrom an accident victim are shipped in a TOX-BOX to the Forensic Sciences Laboratory.Toxicological testing is provided to several agencies, in addition to the FAA and NTSB,including the Federal Railroad Administration, U.S. Coast Guard, and various other U.S.and foreign agencies, including the Royal Canadian Air Force.Once a TOX-
The BSRB is divided into two sections, Forensic Sciences (AAM-611) and Biomedical Sciences (AAM-612). Forensic Sciences Section is composed of the Forensic Toxicology Research Team and the Biochemistry Research Team. The Functional Genomics and Knowledge Management Research Teams, along with the Autopsy Program Team, make
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