Toxicological findings in fatally injured pilots of 979 amateur-built aircraft accidents.

BACKGROUND Specimens from aviation accident pilot fatalities are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological analyses. Trends of fatal amateur-built aircraft accidents and toxicological findings in the associated pilot fatalities have not been examined. METHODS Fatal amateur-built aircraft accidents that occurred during 1990-2009 were evaluated by retrieving information from the CAMI toxicology database. Probable cause/factor in the amateur-built aircraft mishaps were obtained from the National Transportation Safety Board's (NTSB's) aviation accident database. RESULTS Of 6309 fatal aviation accidents from which CAMI received postmortem samples, 979 (16%) were related to amateur-built aircraft. There was a decreasing trend in non-amateur-built aircraft accidents, but an increasing trend in amateur-built aircraft accidents. In the 979 accidents, 392 pilots (40%) were positive for ethanol and/or drugs. In these 392 accidents also, the review showed a decreasing trend with non-amateur-built aircraft and an increasing trend with amateur-built aircraft. Percentages of pilots with prescription drugs were 26% for amateur-built aircraft, 16% for non-amateur-built aircraft, and 18% for all aircraft. Ethanol/drug use and medical condition were determined to be a cause/factor in 42 (11%) of the 385 ethanol/ drug-positive amateur-built aircraft accidents investigated by the NTSB. DISCUSSION Drugs found in the pilots were consistent with commonly used medications in the general population. The contributory role of mechanical malfunction of home-built aircraft cannot be ruled out in the observed increasing trends in their accidents, with or without ethanol and/or drugs. Regardless, the increasing trends of such accidents are of significant concern.