The problem of flight safety and aviation injury were considered, data on aviation accidents in Civil aviation were shown, the main causes of aviation accidents were presented: technical failure, difficult meteorological conditions, deficiencies in flight organization and «human factor». The conditional classification of aviation injury was presented. Detection of primary injuries is especially important for aeromedicine (head impact on dashboard, bone fracture at the ankle, «loss of vital space», laceration between 1st and 2nd fingers from the control wheel), that determine the pattern of pilots’ actions in an emergency situation. A three-link flight medical support system was remained to prevent flying under the influence of alcohol, drugs and psychoactive substances. The Department of Aerospace Medicine developed the algorithm of pilots’ examination suspected of using toxic substances. The materials of pilot’s psychological examination after an aviation accident in the state of posttraumatic stress disorder are presented.