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ICAO Preliminary Unedited Version — October 2008 IV-1-10
necessity to sample specific sites or organs must be emphasized.
The main cardiac vessels should be serially sectioned to detect the presence of occlusal disease. Similarly,
the detection of cardiomyopathy requires multiple cardiac sections.
Histological examination of the liver may reveal a variety of conditions ranging from fatty liver to
cirrhosis. Microscopic changes in this organ could provide the only indication of ethanol abuse or drug use.
Pulmonary embolization may provide vital information concerning survivability and the timing of death.
Soot in the airways and the alveoli will indicate survivability in conditions of post-impact fire.
As well as taking specimens from all major organs, any suspected abnormality, including tumour growth,
should automatically be sampled.
Toxicology
The adequate toxicological investigation of tissue and fluid specimens from air accident victims requires a
careful examination for the presence of prescription and over-the-counter medicines and illicit drugs,
substances of social use and abuse, environmental contaminants and toxins as well as the detection and
discrimination of artefactual changes such as the production of ethanol due to post-impact fermentation.
The range of tests will ideally be broad and the sensitivity at the therapeutic and subtherapeutic level. Since
in many instances, physical trauma is severe, toxicological examination may provide the only evidence of
the existence of disease states that could produce insidious or sudden incapacitation such as hypertension,
epilepsy, etc.
If possible, examinations should be carried out by a central reference laboratory which will have
developed methods specific for air accident services as opposed to general forensic testing (see
Attachment A)
A variety of tissues and fluids are required for successful testing. Due to the high impact forces often
involved, fluids may not be available, but adequate quantities of blood from three separate sites, sterile urine
from an unpunctured bladder, bile and vitreous humour are all extremely useful to the toxicologist. The tests
commonly performed on usually available fluids and liver tissues are as follows:
Blood
Qualitative and quantitative analyses for:
a) ethanol
b) other alcohols, solvents, fuels, hydraulic fluids, etc.;
c) carbon monoxide;
d) hydrogen cyanide;
e) delta-9-THC (tetrahydrocannabinol) and metabolites (“marijuana”);
f) gas chromatography-mass spectrometry (GC-MS) screen and quantitation for medicines and drugs
and their metabolites
g) GC-MS screen and quantitation of pesticides and herbicides;
h) High Performance Liquid Chromatography (HPLC) screen and quantitation of medicines and
drugs;
i) Radioimmunoassay (RIA) analyses when indicated;
j) Enzyme-multiplied immunoassay technique (EMIT) analyses of medicines.
ICAO Preliminary Unedited Version — October 2008 IV-1-11
Urine
Qualitative and quantitative analyses for:
a) ethanol;
b) other alcohols and solvents;
c) GC-MS screen for medicines, drugs and their metabolites
d) GC-MS screen for pesticides, herbicides, etc.;
e) HPLC screen for medicines and drugs;
f) RIA screen of digoxin, various antibiotics, THC metabolites, amphetamines, barbiturates,
morphines and cocaine;
g) EMIT screen for illicit drugs.
Liver fluid extracts
See blood tests.
The following table indicates the optimum sample size required for specific types of testing by most
laboratories:
Specimen
1%
Fluoride/Oxalate
Preservative
EDTA
Anticoagulant
Plain
No
Preservative
Frozen
Blood
2mL from 2 clean
sites
5mL
10mL
*******
Urine
2mL
*******
Remainder
*******
Bile
2mL
*******
Remainder
*******
Vitreous Humour
2mL
*******
*******
*******
Stomach Contents
*******
*******
All
*******
Liver
*******
*******
*******
200g
Lung
*******
*******
*******
100g
Kidney
*******
*******
*******
100g
Brain
*******
*******
*******
100g
Specimens should be uncontaminated if possible and preserved as indicated. Prevention of bacterial or
fungal growth is especially important in the examination for the presence of ethanol.
The rationale behind toxicological testing should not require much elaboration. However, some pertinent
points will be emphasized.
The detection of some classes of medicines such as tranquillizers and illicit compounds may indicate the
　
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