Sabra R. Botch

Robert D. Johnson

Civil Aerospace Medical Institute

Federal Aviation Administration

Oklahoma City, OK 73125

August 2009

Final Report

Toxicological Findings of Pilots

Involved in Aviation Accidents

Operated Under Title 14 CFR Part 135

DOT/FAA/AM-09/15

Office of Aerospace Medicine

Washington, DC 20591

OK-09-0434-JAH

Federal Aviation

Administration
NOTICE

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of the U.S. Department of Transportation in the interest 

of information exchange. The United States Government 

assumes no liability for the contents thereof.

___________

This publication and all Office of Aerospace Medicine 

technical reports are available in full-text from the Civil 

Aerospace Medical Institute’s publications Web site: 

www.faa.gov/library/reports/medical/oamtechreports
i

Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. 

DOT/FAA/AM-09/15 

4. Title and Subtitle 5. Report Date 

August 2009 6. Performing Organization Code Toxicological Findings of Pilots Involved in Aviation Accidents Operated 

Under 14 CFR Part 135 

 7. Author(s) 8. Performing Organization Report No. 

Botch SR, Johnson RD 

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) 

FAA Civil Aerospace Medical Institute 

P.O. Box 25082 11. Contract or Grant No. 

Oklahoma City, Oklahoma 73125 12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered 

 

 

 

Office of Aerospace Medicine 

Federal Aviation Administration 

800 Independence Ave., S.W. 

Washington, DC 20591 14. Sponsoring Agency Code 15. Supplemental Notes 

This work was accomplished under the approved task AM-B-0-TOX-204. 

16. Abstract 

Introduction: Under the United States Code of Federal Regulations (CFR), aircraft flown under Title 14 

(Aeronautics and Space) Part 135 are operated as either commuter or on-demand flights. The rules governing 

the operation of and the crewmembers on board such aircraft are detailed within these regulations. Aircraft 

operated under 14 CFR Part 135 include medical flights, on-demand cargo flights, on-demand air-taxis, and 

scheduled/non-scheduled domestic passenger flights with or without air cargo. Pilots operating under these 

regulations carry with them the added responsibility of passenger safety or, for those involved in emergency 

medical flights, the importance of their role for the survivability of patients in critical condition. The purpose 

of this study was to examine the toxicological findings of pilots involved in aircraft accidents operated under 

14 CFR Part 135. Methods: Toxicological and aeromedical findings from Part 135 pilots that were involved 

in fatal accidents between the years 1997 and 2007 were collected. Toxicological information was obtained 

from the Civil Aerospace Medical Institute’s (CAMI’s) Bioaeronautical Sciences Research Laboratory. 

Accident information and the probable cause and/or factor(s) of these accidents were obtained from the 

National Transportation Safety Board (NTSB). Results: Between the years 1997 and 2007, CAMI received 

biological samples of 142 pilots operating under Part 135 who had been involved in aviation accidents. Of 

these 142 pilots, 139 had sustained fatal injuries. Of the 139 fatalities, 33 (23%) were found to have taken at 

least one drug and/or had consumed alcohol prior to the accident. The compounds detected in these pilots 

ranged from the benign (such as acetaminophen) to illicit compounds (such as cocaine and marijuana). The 

NTSB attributed either the cause and/or a factor in the accident to drugs and/or alcohol use in 6 of these 33 

accidents. Conclusion: Over the examined time period, aviation accidents operated under these regulations 

accounted for ~4% of all fatal aviation accidents received at CAMI for toxicological analysis. Generally, these 

aircraft were operated without harm to crewmembers, passengers, or bystanders. When accidents did occur, 

the majority were not the result of drug or alcohol impairment but, instead, were due to mechanical 

malfunctions, pilot error, and/or operation of aircraft in adverse weather conditions. 

17. Key Words 18. Distribution Statement 

 

 

Emergency Medical Services, 14 CFR § 135, Toxicology, 

Aircraft Accident Investigation, Safety 

Document is available to the public through the 

Defense Technical Information Center, Ft. Belvoir, 

VA 22060; and the National Technical Information 

Service, Springfield, VA 22161 

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price 

Unclassified Unclassified 11 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized 

iii

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Pilots Involved in Fatal Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Pilots Involved in Non-fatal Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1

Toxicological Findings of Pilots Involved in Aviation Accidents

Operated Under Title 14 CFR Part 135

Introduction

Under the United States Code of Federal Regulations 

(CFR), aircraft flown under Title 14 (Aeronautics and 

Space), Part 135 are operated as such as either commuter 

or on-demand flights. The rules governing the operation of 

and the crewmembers on board such aircraft are detailed 

within these regulations. Aircraft operated under Part 

135 include emergency medical service (EMS) flights, 

on-demand cargo flights, on-demand air taxis, and 

scheduled/unscheduled domestic passenger flights. Safe 

operation under these regulations is extremely important, 

as Part 135 pilots bear the added responsibility of passenger safety. Additionally, for those pilots involved in 

EMS flights, there is the added factor of the patients well 

being. Aviators operating under these regulations endure 

added stress due to these critical responsibilities.

Unfortunately, aviation accidents involving aircraft 

operated under Part 135 do occur. From an aviation 

safety perspective, it is important to determine why these 

accidents take place. The purpose of this study was to 

examine the toxicological findings obtained from pilots 

involved in aircraft accidents operated under these regulations. Toxicological results give the accident investigator 

information as to whether a substance consumed by the 

pilot prior to the flight could have diminished his or her 

capacity to operate the aircraft safely and if the substance 

may have been a factor in the accident. Toxicological 

results from the examined accidents have been summarized and combined with the National Transportation 

Safety Board’s (NTSB’s) finding(s) for these accidents.

These data have shown that, although rare, pilots operating under Part 135 have taken medications or illicit 

substances that are currently not allowed and that some 

of these substances have been either the cause or a factor 

in fatal aviation accidents.

Methods

The Civil Aerospace Medical Institute’s (CAMI’s) 

Bioaeronautical Sciences Research Laboratory analyzes 

specimens collected from pilots involved in civil aviation accidents.

1,2 Toxicological and aeromedical findings 

from incidents involving pilots certified under Part 135 

were collected for accidents that occurred between the 

years 1997 and 2007. Toxicological information was 

obtained from CAMI’s ToxFloTM toxicology database 

(DiscoverSoft Development, LLC, Oklahoma City, OK).

Accident-specific information and the probable cause(s) 

and/or factor(s) of these accidents were obtained from 

the NTSB database.

 15

Results

From 1997 to 2007, 142 pilots operating under Part 

135 certification were involved in aviation accidents (both 

fatal and non-fatal), and biological specimens from these 

pilots were received at CAMI for toxicological analysis.

Over the examined time period, there were a total of 181 

fatal aviation accidents operated as Part 135. Thirty-nine 

pilot fatalities were not received by CAMI due to various 

factors, including a limited amount or the lack of biological specimens available to conduct toxicological analysis.

There were only 3 cases in which specimens were received 

and the pilots survived the accident. Of the remaining 

139 pilot fatalities, specimens from 33 (23%) were found 

positive for ethanol, a pharmaceutical compound, and/or 

an illicit drug. The compounds found in these pilots 

ranged from benign substances such as acetaminophen 

to abused compounds such as cocaine and marijuana.

Pilot fatalities from this certification category accounted 

for ~4% of the 3,354 fatal aviation accidents received by 

CAMI during this time period.

Pilots Involved in Fatal Accidents

Further analysis of these 33 drug-positive airmen demonstrated that more than half (19 of 33) had consumed 

either ethanol or an unapproved substance with potentially 

severe side effects prior to flight. A summary follows of the 

compounds that are not allowed prior to flight but were 

found in these 19 pilots. Of the 33 pilot fatalities that 

were positive for drugs, illicit compounds were detected 

in 5 cases. These illicit substances included tetrahydrocannabinol (THC), which is one of the pharmacologically 

active constituents of marijuana. THC was detected in 2 

pilots. Also, cocaine and/or metabolites were found in 3 

pilots. Ethanol was present in 5 of these 33 airmen. The 

FAA’s legal limit for ethanol is 40 mg/dL (14CFR91.17); 

however, it must be stated that no pilot is allowed to fly 

until 8 hours has passed since the consumption of the 

last alcoholic drink.

13 Three of these 5 pilots were found 

to have ethanol concentrations above 40 mg/dL in the 

blood. The NTSB deemed the consumption of ethanol 

to be a factor in 1 of these accidents. One or more opiates 
2

were detected in 5 of the 33 pilots. Opioid compounds, 

including morphine, hydrocodone, codeine, dihydrocodeine, oxycodone, and oxymorphone, are commonly 

prescribed in the U.S. for pain management and other 

uses such as cough suppression.

3

 Due to the severe sideeffects of opioid medications, including nausea, drowsiness, dizziness, and delirium, pilots are not allowed to 

use these medications prior to flight.

3, 14

Antidepressants are commonly prescribed in the U.S., 

with 10 to 15% of prescriptions written intended to affect mental processes and/or modify mood, thinking, or 

behavior.

3

 These compounds can have various undesirable 

side effects, including memory loss, confusion, drowsiness, 

and unsteadiness. Although controversial and primarily 

exhibited in young adults and children, clinical studies 

have shown that antidepressant use has been associated 

with an increase in suicidal thoughts.

4

 When considering 

all of these factors, the use of antidepressants by airmen 

was prohibited and remains prohibited per current FAA 

regulations.

12 Antidepressant medications, including 

paroxetine (Paxil®), sertraline (Zoloft®), fluoxetine 

(Prozac®), and citalopram (Celexa®) were present in 4 

airmen examined in this study.

Over-the-counter medications are readily available 

to the general public without prescription. Unfortunately for pilots, however, some of these medications 

are performance-impairing and can be dangerous when 

taken prior to operating an aircraft. These side effects 

can be exasperated by concomitant use of more than 

one of these readily available compounds.

5

 Seven of the 

33 certified pilots evaluated were found positive for an 

antihistamine medication. Each had taken an antihistamine medication belonging to the class of H1

-antagonists, 

including diphenhydramine (3 pilots), chlorpheniramine 

(3 pilots), and promethazine (1 pilot). Side effects of 

these compounds can be severe and include drowsiness 

and dizziness. Due to these adverse effects, the use of 

H1

-antihistimines by pilots is not allowed prior to flight.

6

Allergy, respiratory, and over-the-counter cold medications were the most often detected drugs in this group 

of airmen. The frequency with which they were detected 

may be due to the accessibility of these compounds and 

the inability to control what airmen consume outside 

of consulting their aviation medical examiner (AME).

Additional examples of drugs encountered from the 

over-the-counter class were pseudoephedrine (3 pilots), 

phenylpropanolamine (3 pilots), dextromethorphan (2 

pilots), doxylamine (1 pilot), naphazoline (1 pilot), and 

theophylline (1 pilot).

Other medications found in these 33 airmen include 

amlodipine, a calcium channel blocker used alone or in 

combination with other medications to treat high blood 

pressure and chest pain (angina); metoprolol, a beta 

blocker also used to treat high blood pressure; quinine, an 

anti-malarial drug; and phentermine, an anorectic drug 

which can be used to assist in weight loss. Azacyclonol, 

an active metabolite of terfenadine7,8 (Seldane®), was 

detected in 2 airmen. Terfenadine was found in rare 

cases to induce fatal arrhythmia when the metabolism 

of the compound was impaired by either liver disease or 

drugs that inhibit the Cytochrome P450 CYP3A family 

of enzymes. This severe side effect resulted in the drug’s 

withdrawal from the U.S. market in 1998.

3

Elevated glucose levels were detected in 5 airmen.

Elevated glucose levels may indicate a diabetic condition 

or could be the result of stress. A diabetic condition, if 

undiagnosed and unknown to the pilot, would not have 

been properly controlled at the time of the accident, 

resulting in hyperglycemia, which can have significant 

side effects such as fatigue and blurred vision.

9

 One of the 

pilots had a reported history of diabetes that was, according to the pilot, controlled by diet. However, following 

analysis, this individual’s urine glucose concentration 

was found to be an extraordinarily high at 1750 mg/dL.

This elevated glucose concentration is evidence that the 

pilot’s diabetic condition was not under control prior to 

the fatal flight.

Pilots Involved in Non-fatal Accidents

Of the 3 pilots who survived their accidents and whose 

specimens were received at CAMI, only 1 did not test 

positive for any pharmaceutical or illicit compounds.

The NTSB’s findings in this case attributed the cause 

of the accident to pilot error, improper training, and 

adverse weather conditions. The compound midazolam, 

a benzodiazepine derivative, was detected in 1 of the 

non-fatal airmen. Medical records documented that the 

pilot had been administered midazolam in the hospital 

post-accident, suggesting that the drug was not taken 

prior to the flight. The NTSB attributed the cause of 

this accident to a combination of pilot error and poor 

weather conditions. The compounds acetaminophen, 

lidocaine, morphine, and promethazine were detected 

in the third non-fatal accident victim. Promethazine has 

strong anticholinergic and sedative effects. Acetaminophen, lidocaine, and morphine are commonly given to 

patients who are hospitalized, and that may account for 

their presence in the airman. This pilot had a previously 

documented drug offense on his record; however, the 

NTSB report has not been finalized for this accident, so 

a determination has not been made deciding whether 

the compounds present were a cause or factor in the accident. These aircraft were operated as either scheduled 

or nonscheduled passenger and/or cargo flights.
3

Discussion

After reviewing all aspects of an aviation accident the 

NTSB is responsible for the determination of cause and 

any factors that led to the event. CAMI provides the NTSB 

with toxicological information obtained after examination 

of biological specimens received from the pilots involved 

in both fatal and non-fatal accidents. After reviewing the 

toxicological findings obtained from CAMI, the NTSB 

attributed drug and/or alcohol use a cause, a factor, or a 

finding in 6 (18%) of the 33 fatal accidents in which the 

pilot had tested positive for some pharmaceutical compound or ethanol (Table 1). Of the non-fatal accidents 

in which a determination of the cause/factor had been 

made, the NTSB did not attribute the use of drug(s) 

and/or alcohol to any of the accidents in which the pilot 

survived and specimens were received at CAMI. Pilot 

error, weather, and/or mechanical issues were attributed 

to be a cause and/or factor in 21 of the fatal accidents 

and 2 of the non-fatal accidents. Physical impairment 

of the pilot was deemed a cause in 1 fatal accident, due 

to hemopericardium (blood in the pericardial sac) and 

blunt force trauma. The cause or factor in the remainder 

of these accidents (5 fatal and 1 non-fatal) had not been 

determined at the time of the publication of this report.

Of the Part 135 accidents received by CAMI, 3 were 

operated as EMS flights. Pilot error and weather were 

cited as either a cause or a factor in 2 of these accidents, 

while pressure to complete the EMS mission was cited 

as an additional factor in 1. The cause/factor of the third 

accident is pending determination.

Federal law Title 49, United States Code sections 

109(9), 40113(a), 44701-44703, and 44709 (1994), 

authorizes the FAA administrator to entrust AMEs to 

inspect, test, and examine so that they may issue, deny, 

or defer to the FAA a pilot’s certificate.

14 The Federal Air 

Surgeon may grant an Authorization for Special Issuance 

(SI) of a medical certificate to an airman whose specific 

medical conditions do not meet established medical standards. After the initial authorization for SI, the AME can 

re-issue an airman medical certificate under the provisions 

of an Authorization to an applicant who has a medical 

condition that is disqualifying under Part 67.

14

Of the 35 drug-positive cases (fatal and non-fatal) 

evaluated by CAMI that were operating under Part 135, 

only one had been issued an SI. This pilot had a history 

of drug abuse and, following toxicological analysis, was 

found to have taken opiates (hydrocodone and dihydrocodeine) concomitantly with diphenhydramine. The pilot 

in question held an airline transport 2nd-class certificate 

and had self-disclosed the habitual use of dihydrocodeine 

6 years prior to the accident. Subsequent drug screens 

(pre-employment and randomly by his employer) had not 

revealed the use of opiates. However, the drug screen used 

was not comprehensive and could only reveal the use of 

codeine and/or morphine; therefore, the results would not 

have reflected the pilot’s continued use of hydrocodone.

This pilot had been issued a SI, and his history of drug 

abuse was noted in his airmen medical file. Toxicological 

analysis performed by CAMI revealed hydrocodone and 

dihydrocodeine in each specimen examined, confirming 

the pilot’s continued use of opioid medications.

In addition, there were 5 other airman that had reported previous drug and/or alcohol related offenses or 

substance-abuse problems. Of these 5, only 1 was found 

to be negative for all drugs. All were found to be negative for alcohol. Diphenhydramine, pseudoephedrine, 

cocaine, chlorpheniramine, amlodipine, acetaminophen, 

morphine, promethazine, and lidocaine were the various 

compounds detected in the other 4 pilots.

Of the 35 airmen involved in accidents where pharmaceutical compounds were found upon toxicological 

analysis, only 7 pilots had reported to their AME that 

they were taking medication(s). Of these 7, 3 had been 

issued a 2nd-class commercial certificate and had reported 

taking metoprolol (Lopressor® or Toprol XL®), pravastatin (Pravachol®), atorvastatin (Lipitor®), rosuvastatin 

(Crestor®), amlodipine (Norvasc®), benazepril (Lotensin®), lisinopril (Prinivil® or Tensopril®), metformin 

(Glucophage®), atenolol (Tenormin®), salicylic acid 

(aspirin), and hydrochlorothiazide (diuretic).

These medications are conditionally allowed for use by 

pilots prior to flight; indicated uses are as follows:

•	 Pravastatin, atorvastatin, and rosuvastatin are hydroxymethylglutaryl-coenzyme A (HMG-CoA) 

reductase inhibitors used in the treatment of high 

blood cholesterol.

•	 Benazepril, a prodrug, is transformed following 

consumption into benazeprilat by hepatic esterases 

and acts as a potent angiotensin-converting enzyme 

(ACE) inhibitor.

•	 Lisinopril is also an ACE inhibitor; however, this 

compound has properties that prevent its accumulation 

in the body’s tissues, as it is cleared from the body via 

the kidneys as the intact compound.

•	 Metformin, an antihyperglycemic, improves glycemic 

control and lipid concentrations.

•	 Atenolol is a β1-receptor specific antagonist which 

cannot pass through the blood brain barrier and 

therefore does not cause as many central nervous 

system side effects.

•	 Aspirin is the most common analgesic and is readily available; its misuse and serious toxicity is often 

underappreciated.

3
4

Table 1. Case Histories of Accidents Where Drugs or Alcohol Were Either a Cause or a Factor. 

Case

Drugs Attributed to the Cause of 

an Accident (Concentration in 

blood if available) 

Other 

Substances 

Detected 

Drugs

Reported to 

AME

Conditions Noted 

by AME 

NTSB Findings 

(Cause/Factor/Finding)

Medical Certificate 

Category 

Flying 

Certificate 

Category 

1

Doxylamine (0.084 μg/mL), Dextromethorphan (0.045 μg/mL), Dextrorphan, Pseudoephedrine, Ephedrine, Phenylpropanolamine 

— None None 

Factor related to the accident was the use of over-the-counter medications.

First Class Airline Transport

2 Cocaine (0.062 μg/mL) — None None 

One of the causes of the accidents was the captain's impairment from drugs. A factor was the first officer's impairment from drugs. 

First Class Airline Transport

3 Codeine (0.049 μg/mL), Paroxetine — None None A finding was the pilot's use of FAA prohibited drug paroxetine. First Class Commercial 4 Ethanol (115 mg/dL) — None 

Genitourinaryrelated 

condition(s)

Factor was the pilot's alcohol impaired condition. Second Class Commercial 

5

Sertraline (0.027 μg/mL), Chlorpheniramine (0.007 μg/mL), Phenylpropanolamine, Pseudoephedrine 

Acetaminophen 

(13.31 μg/mL, 

urine)

Antihistamine 

Medications

Allergic Rhinitis, 

Hernia

Cause of the accident was the pilot's failure to maintain aircraft control with the use of over-thecounter cold medications and the disqualifying compound sertraline noted.

Second Class Airline Transport

6 Cocaine (0.985 μg/mL, urine), Chlorpheniramine — None 

Multiple drug and 

alcohol related 

offenses, drug 

abuse not meeting 

the criteria for 

drug addiction, and 

use of contact 

lenses

Factors in the accident were the pilot's impairment from cocaine, alcohol, and over-the-counter cold medication, and the FAA's inadequate medical certification of the pilot and follow-up of his known substance abuse problems. 

First Class Airline Transport
5

•	 Hydrochlorothiazide is a diuretic drug of the thiazide 

class.

In these 35 pilots, 63 various compounds were detected. These compounds included those the FAA has 

deemed safe to consume prior to flight, which are allowed after waiting an appropriate period of time after 

consumption, and those which result in an airman being 

disqualified from duty. For the purpose of this study, 

the categories “allowed, conditionally allowed and disqualifying substances” (respectively) have been used to 

differentiate these compounds. The distribution of each 

type of compound can be seen in Figure 1. Sixteen of 

the 35 drug-positive airmen (~45%) were taking more 

than one compound. Some of the drug combinations 

seen are known to produce potentially severe drug interactions. The potentially dangerous drug combinations 

found included chlorpheniramine in combination with 

ethanol. The use of these compounds has been shown 

to cause muscle tremors, convulsive seizures, and central 

stimulation.

10 Naphazoline and phenylpropanolamine, 

which were detected together in one pilot, are both used 

as decongestants and have been shown to promote strokes 

in individuals with previous morbidities.

11

Additional drugs used in combination included 

dextromethorphan and azacyclonol, which is the active 

metabolite of terfenadine. Morphine, codeine, and the 

antidepressant paroxetine were detected in one pilot. The 

over-the-counter compounds chlorpheniramine, phenylpropanolamine, acetaminophen, pseudoephedrine, as 

well as the antidepressant sertraline, were detected in 

another pilot. The illicit compound, cocaine, and its 

metabolites were detected with chlorpheniramine in one 

airman and with quinine in another. Amlodipine and 

acetaminophen were used together. Another airman had 

consumed multiple cold medications with the compounds 

34

20

9

0

5

10

15

20

25

30

35

Conditionally Allowed Substances*

Disqualifying Substances†

Allowed Substances‡

*Conditionally allowed substances are those that are not immediately disqualifying and, when used appropriately, do not 

interfere with aviation safety. 

†

Disqualifying substances are those which result in denial of medical certification. 

‡

Allowed substances are those which are not likely to compromise aviation safety, unless in toxic levels. 

Figure 1. Drug types detected in Part 135 pilots involved in fatal aviation accidents between 1997 

and 2007.
6

pseudoephedrine, phenylpropanolamine, dextromethorphan, doxylamine, and dextrorphan. Finally, lidocaine, 

acetaminophen, morphine, and promethazine were all 

detected in one airman.

ConclusionS

Accidents involving aircraft operating under Part 135 

are not common events. Of the 3,354 fatal aviation cases 

received at CAMI over the examined time period (1997-

2007), Part 135 accidents accounted for ~4% (139 of 

3,354). Biological specimens were received for analysis 

from 139 fatal accidents, of which 33 pilots (23%) were 

found to have taken at least 1 compound and/or had 

consumed alcohol at some point prior to flight. In addition, 2 (66%) of the 3 non-fatal cases received were found 

positive for pharmaceutical compounds. The compounds 

detected and the concentrations of these compounds were 

not impairing in most cases, with the NTSB attributing 

a cause, factor, and/or finding to the use of drugs and/

or alcohol in only 6 of the accidents received at the time 

of publication of this report. The vast majority of the 

Part 135 flights operated during this time period were 

performed safely and without injury to crewmembers, 

passengers, or in the event of an accident involving an 

EMS flight, to patients. The vast majority of all pilots that 

operated under Part 135 which resulted in an accident 

were found to be free of drugs and/or alcohol.

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