DOT/FAAMM-91/13 Civilian Training in

High-Altitude Flight
Office of Aviation Medicine
Washington, D.C.. 20591 Physiology

John W. Turner
EG&G Dynatrcnd

M. Stephen Huntley, Jr.

U.S. Department ofTransportation
Research and Special Programs Administration
John A Volpe
National Transporation Systems Center
Cambridge, MA 02142

August 1991

Final Report

This document is available to the public through

the National Technical Information Service,
Springfield, Virginia 22161.

OU.S. Department
of Transportation
Federal Aviation
Administration
 NOTICE

•This document is disseminated under the sponsorship of

the U.S. Departments ofTransportation and Defense in the interest
ofinformation exchange. The United States Government
assumes noliability for thecontents or use thereof.

•The United States Government does not endorse products or

manufacturers. Trade or manufacturers' names appear herein
solely because they are considered essential
tothe object ofthis report.

:
 Technical Report Documentation Page
1. Report No. 2. Government Accession No. 3. Recipient's Catalog No.

DOT/FAA/AM-91/13
4. Titlo and Subtitle 5. Report Date

CIVILIAN TRAINING IN HIGH-ALTITUDE

August 1991
6. Performing Organization Code
FLIGHT PHYSIOLOGY
DTS-45
B. Performing Organization Report No.
7. Author's)
John W. Turner, M. Stephen Huntley, Jr.
9. Performing Organisation Name and Address 10. Work Unit No. (TRAIS)
U.S. Department of Transportation FA1F9/A1256
Research and Special Programs Administration 11. Contract or Grant No.
John A. Volpe Transportation Systems Center
Cambridge, MA 02142 13. Type of Report ond Period Covered
12. Sponsoring Agency Name and Address FINAL REPORT
U.S. Department of Transportation January 1, 1991-March 31,
Federal Aviation Administration 1991
800 Independence Avenue 14. Sponsoring Agency Code
Washington, DC 20591 AAM-240
15. Supplementary Notes

16. Abstract

A survey was conducted to determine if training in high-altitude physiology should

be required for civilian pilots; what the current status of such training was; and,
if required, what should be included in an ideal curriculum. The survey included
a review of ASRS and NTSB accidents/incidents where high altitude was a contributing
factor, current FARs, the Airman's Information Manual, and military training
courses. In addition, representatives of pilot and flight attendant unions,
airlines, airframe manufacturers, the armed services, NBAA, AOPA, flight schools,
and universities were interviewed. And, an expert in the field was identified
and asked to write a discussion paper for inclusion in the report.

The survey determined that there is a need for such training. It was also found
that current training practices are not uniform and sometimes do not even address
those subjects required by Federal Aviation Regulations.

The report contains recommendations for subjects to be included in a core curriculum

and additional subjects that may be included for a more complete knowledge of high-
altitude physiology issues relevant to civilian flight.

17. Keywords 18. Distribution Stotement

Physiology, high-altitude Document is available to the public

training, civilian, oxygen, hypoxia through the National Technical
decompression Information Service, Springfield,
Virginia 22161
19. Security Classif. (of this report) 20. Security Classif. (of this pogo) 21. No. of Pages 22. Price

Unclassified Unclassified 49

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

PREFACE

This report describes a survey that was conducted to

determine if training inhigh-altitude physiology wasneeded for
civilian flight crews; whethercurrenttraining wasadequate; and
what subjects would be recommended for inclusion in a core
curriculum, if additional training should be required. This
report describes themethods used toacquire theinformation for
the survey and the results of the survey. Also included are
recommendations for subjects for a core curriculum and addi
tional subjects for an expandedcurriculum.

This paper was prepared for the Biomedical and Behav

ioral Sciences Branch of the Office of Aviation Medicine of the
FAA.

The report wasprepared by the OperatorPerformance and

SafetyAnalysis Division of theOfficeof Research andAnalysis
at the VolpeNational Transportation SystemsCenter, and was
completed underthedirection of VNTSC ProgramManagerM.
Stephen Huntley, Jr. Research for thereportandits preparation
were the responsibility of John W. Turner of EG&G Dynatrend.

in
CONTENTS

Section Pa8e

1. INTRODUCTION 1

2. AVIATION SAFETY REPORTING SYSTEM REPORTS 2

3. NATIONAL TRANSPORTATION SAFETY BOARD REPORTS 4

4. PHYSIOLOGICAL PROBLEMS AND FLIGHT CREW UNIONS 5

5. AVIATION TRAINING CENTERS 7

6. AIRLINE FLIGHT PHYSIOLOGY TRAINING 9

7. TRAINING BY OTHER GROUPS 12

8. EXPERT OPINION PAPER REVIEW 16

9. ADDITIONAL PHYSIOLOGICAL CONCERNS 17

10. SUMMARY 18

REFERENCES 19

11. APPENDIX A - EXPERT OPINION PAPER A-1

12. APPENDIX B-ASRS SUMMARIES B-1

13. APPENDIX C-NTSB SUMMARIES C-1

LIST OF TABLES

Table Page

1. SCHOOL PHYSIOLOGY CURRICULA 8

 METRIC/ENGLISH CONVERSION FACTORS
ENGLISH TO METRIC METRIC TO ENGLISH

LENGTH (APPROXIMATE) LENGTH (approximate)

1 inch (in) s 2.5 centimeters (cm) 1 millimeter (mm) a 0.04 inch (in)
1 foot (ft) s 30 centimeters (cm) 1 centimeter (cm) a 0.4 inch (in)
1 yard (yd) a 0.9 meter (m) 1 meter (m) > 3.3 feet (ft)
1 mile (mi) a 1.6 kilometers (km) 1 meter (m) a 1.1 yards (yd)
1 kilometer (km) • 0.6 mile (mi)
AREA (APPROXIMATE) AREA (APPROXIMATE)
1square inch (sq in. in') s 6.5 square centimeters (cm*) 1squarecentimeter(cm') a 0.16squareinch (sq in,in')
1square foot (sq ft. ft') a 0.09 square meter (m') 1 square meter (m2) a 1.2 square yards (sq yd, yd')
1square yard (sq yd.yd') = 0.8 square meter (m') 1 square kilometer (km:) a 0.4square mile (sq mi,mi?)
1square mile (sq mi, mi') a 2.6 square kilometers (km') 1 hectare (he) a 10,000 square meters (m') =2.5 acres
1acre a 0.4 hectares (he) a 4.000 square meters (m')
MASS-WEIGHT (approximate) MASS - WEIGHT (approximate,
1ounce (oz) a 28 grams(gr) 1 gram (gr) a 0.036 ounce (cz)
1 pound(lb) a .45kilogram (kg) 1 kilogram (kg) a 2J pounds (lb)
1 short ton = 2,000 pounds (lb) o 0.9 tonne (t) 1 tonne (t) a 1.000 kilograms(kg) a 1.1short tons
VOLUME (APPROXIMATE) VOLUME (APPROXIMATE)
1 teaspoon (tsp) a 5 milliliters (ml) 1 milliliter(ml) a 0.03 fluid ounce (fl oz)
1 tablespoon (tbsp) = 15 milliliters (ml) 1 liter (I) s 2.1 pints (pt)
1 fluid ounce (fl oz) s 30 milliliters (ml) 1 liter (I) a 1.06 quarts (qt)
1 cup (c) a 0.24 liter (I) 1 liter (I) a 0.26 gallon (gal)
1pim(pt) = 0.47 liter (I) 1 cubic meter (m3) a 36 cubic feet (cu ft, ft')
1 quart (qt) a 0.96 liter (I) 1 cubicmeter (mJ) a 1.3 cubicyards(cuyd, yd')
1 gallon (gal) a 3.8 liters (I)
1 cubic foot (cu ft, ft') a 0.03 cubic meter (m})
1 cubicyard(cuyd, yd1) a 0.76 cubic meter (m>)

TEMPERATURE guoi TEMPERATURE.kxactj

I(x-32)(5/9)),Fa y«c ((9/5)y + 32)'C a x'F

QUICK INCH-CENTIMETER LENGTH CONVERSION

INCHES
°1234S6789 10
I ' ' ' 1 i I i I i |
CENTIMETERS 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 I
25.40

QUICK FAHRENHEIT-CELCIUS TEMPERATURE CONVERSION

*F -CO* -22* -4« 14' 32* 50' 68* 86* 104* 122* 140* 158* 176* 1S4* 212*
~> « • I 1 1 1 1 1 1 1 ! 1 1 h-
*C -40* -30* -20* -10* 0* 10* 20* 30* 40* 50* 60' 70* 80* 5C* 100*

For more exact and'or ether conversion factors, see NBS Miscellaneous Publication 286, Units ofWeights and
Measures. Price S2.50. SDCatalog No. C13 10 266.

VI
EXECUTIVE SUMMARY

Some NationalTransportation Safety Board staff Pilots Association,flightschools, and institu

members have expressed a concern that high-alti tions of higher learning.
tude flight physiology training for civilian flight
personnel should receive greater emphasis than it • To ascertainsubjects to include in a curricu
currently does. Others in the aviationindustry agree. lum, we reviewed pertinent publications and
Among their reasons are the following: curricula.

• New-generation aircraftare capableof reach • To provide additional information inthisfield,

ing higher flight altitudes than before (e.g., we commissioned an expert opinion paper
PiperCheyenne turboprops thatreach FL410 (see Appendix A).
and late-model Learjets reaching FL500).
Moreover, new airline aircraft have the capa Based on the information gathered, we feel that
bility to cruise longer at high altitudes than there is a need for further training in high-altitude
older aircraft,lengthening flightcrews' expo physiology for all civilian flight personnel, includ
sure to the problems of high altitude. ing recreational pilots intendingto fly above 10,000
feet (day) or 5,000 feet (night). (This is because of
• Agingaircraftandgreaterdecompressionpos the hypoxiceffect on night vision above5,000 feet)
sibilities are growing concerns. Although we realize that training all those liable to
fly above 5,000 feet would create very large initial
• There is an apparent disparity between the training demands, we encourage it. Many civilian
high-altitude physiology training for cockpit flight personnelhave not had the benefit of military
crews and cabin crews. While areas ofrespon flight physiology training and arc unaware of the
sibilitydiffer,the need toknow is similar.This physiological phenomena that can affect the safety
becomes more obvious with the knowledge of flight, especially their own bodies' responses to
that during periods of high activity, flight hypoxia. (Each person's response differs in some
attendantstend to become hypoxic fasterthan respect.)
sedentary cockpit crewmembers.
Our study also leads us to believe that at present
The authors were asked to: not even the six subjects required by FAR are being
taught adequately.Forcrewsoperatingabove25.000
• Verify the need for more training in high- feet, those required subjects are:
altitude physiology.
• Respiration.
• Review currenttrainingpracticesinthe indus
try and in academia. • Hypoxia.

• Recommend a curriculum for use in high- • Duration of consciousness without supple

altitude training. mental oxygen at altitude.

The followingmethodswereusedto gatherinfor • Gas expansion.

mation:
• Gas bubble formation.
• To deteimine the need for training, we re
viewed Aviation Safety Reporting System • Physical phenomena and incidentsofdecom
(ASRS) and National Transportation Safety pression.
Board (NTSB) reports and interviewed repre
sentativesofpilot and flight attendantunions. We feel that those required subjects should be
addressed fully, and that the use of oxygen equip
• To identifycurrenttrainingpractices, we sur ment, both fixed and walk-around, should also be
veyed airlines, airframe manufacturers, the taught. In addition, we recommend teaching the
armed services, the National Business Air following subjects, not all of which are altitude
craft Association, the Aircraft Owners and related:

Vll
Flying after diving. This latter group of subjects is addressed in the
AIM and/or in military courses of instruction in
Stress, external and self-imposed, and the flight physiology. We also feel thatadding an alti
mannerin which it affects individual perfor tudechamberflightto training canbejustifiedonthe
mance. basis of individuals' abilities to recognize hypoxic
symptoms and deal with them and by the added
Illusions in flight, especially those leading to safety that would result.
spatial disorientation. (The AIM says that
"Illusions rank among the most common fac FARs 121 and 135 mandate training in flight
torscited ascontributing to fatal aircraft acci physiology only forcrewsoperating above25,000
dents.") feet. Sinceitisknown thathypoxiacanhaveserious
effects as lowas 10,000 feet, we feel that theceiling
Visual problems and nightvision. for required training should be lowered to 10,000
feet.
Acceleration and force fields.
Another finding deals withoxygen useby pilots
Carbon monoxidepoisoning in flight as mandated by FARs 91, 121, and 135. These
regulations specify different altitudes atwhich oxy
Other physiological issues, including self- gen must be used by pilotsoperating underthe three
medication,smoking, use of drugs and alco parts. Sincepilotsundereachofthethree parts have
hol, fatigue, nutrition, physical fitness, and similarneeds for oxygen, and theeffectsof hypoxia
dehydration. can be as disastrous for any, we feel these regula
tions should reflect the same requirements for all
Hearing, noise, and vibration. pilots.

vin
 Civilian Training in High-Altitude Flight Physiology

1. INTRODUCTION

It is a concern of some NTSB staff, as well as • Identify current methods, facilities, and cur
others in the aviation industry, that more emphasis ricula available for use in such training.
shouldbe placedon trainingin high-altitude physi
ology. The following would seem to support that • Identify information that shouldbe included
position: in training for high-altitude physiology and
identifytheflightoperations wheresuchtrain
• New-generation aircraft are being routinely ing would be particularly beneficial.
flown at higher altitudes, including general
aviation aircraft. Thefollowingmethodswereusedtogatherinfor-
mation:
• Ctonwrnsaboutaging aircraftandthepossibil
ity ofdecompression arc growing. \ • To determine the need for training, we re
viewed ASRS and NTSB reports regarding
• Aircraft cabins and remote galley spaces lack accidents/incidents where altitude was a con
devices to alert the cabin crew to slow depres- tributing factor. We also interviewed repre
surization or decompression.This has caused sentatives of pilot and flight attendant unions
faintingincidentsin somecabinerewmembers regarding problems associated withhypoxia,
who were not alerted to the problem by seeing decompression,andotheraltitude-relatedprob
passenger masks deploy. lems.

• There is a lack ofin-depthcabin crew training • To identify current training practices, we sur
in proper use of all supplementary oxygen veyed airlines, airframe manufacturers, the
devices they might encounter in normal du armedservices,NBAA,AOPA,flightschools,
ties.(ArecentDC-lOincident, investigatedby and institutions ofhigher learning.
the NTSB, found flight attendants insuffi
cientlytrainedto recognizeoxygenflowto the • To ascertain subjects to include in a curricu
masks, and resulted in their moving passen lum, we reviewed the Airman's Information
gers around to find "usable masks.") Manual (AIM), current FARs, and military
courses of training.
• An apparent disparity exists in training be
tweencockpitandcabincrewsin high-altitude • To ensure that our information covered as
physiology. While the responsibilities are dif broad a perspective as possible and included
ferent, the need to know is similar. The differ the views of researchers as well as those of
ence in activity level between busy flight practitioners, we commissionedProf. Vogel
attendantsandaseatedcockpitcrewcanresult of OhioState Universityto preparea position
in hypoxic flightattendants withno recogni paper (attached as Appendix A) concerning
tion ofthe problemby the pilots. And, with a currentissuesinflight physiology. Prof.Vogel
two-person cockpit crew becoming more is a retired Air Force fighter instructor pilot
prevalentin theindustry,therewill seldombe and is currently an AdjunctAssistant Profes
a pilot available to help the cabincrew in an sor of flight physiology at theuniversity.
emergency.
The following products were requested and are
To determinewhethermore emphasisshould be provided herein:
placed on high-altitude flight physiology training
we needed to: • Anassessmentofmeneed fortrainings high-
altitude physiology for airline and general
• Identify specific conditions and procedures aviation flight crews.
thatmaycontribute to problems at highalti
tudeandevaluate theneedand requirements • Areview ofcurrent training practices inhigh-
forhigh-altitude physiology trainingforflight altitude physiology.
crews.
 • Recommendations for a core curriculum for ing andcommon sense should have made him aware
high-altitude physiology training wheresuch thatwasalife-threatening move.The flight hadjust
trainingis required. begun to pressurize, so the decompression was
minor, or much worse could have happened.
Other information was received and recommen
dations madeon subjectspertaining to flight physi 47398—The aircraft depressurizedat FL280.
ology which do not directly relate to highaltitude. The reporter felt a pressure change in his ears. The
Captain checked the Second Officer's (S/O) panel
2. AVIATION SAFETY REPORTING SYSTEM (the S/O was in the cabin), donned his 02 mask,
REPORTS actuated thespeed brakes and began anemergency
descent without communicating with the reporter.
A searchofASRS full-form records(versusthose From the Captain's actions, the reporter assumed
withno text) for the period between January, 1983 there was a serious problem, donned his 02 mask,
andMay, 1989, yielded 101 reports concerned with and alerted the en route Air Traffic Control (ATC)
flight physiology. Seventy-three of those pertained centertotheemergencydescent.This incidentshows
specificallytohigh-altitude physiology. Of theother atotal disregard by the Captain of training in emer
33,manyinvolvedpressurization ordecompression gency descent procedures that stress crew commu
problems andsome aspect of flightphysiology, but nication and CRM.
took place at low altitudes, generally 5,000 feet or
below. Many ofthese reports show alack of under 74860 — The aircraft experienced a rapid
standing onthepartofthe flight crew ofthepotential decompression.The crew followed emergency pro
dangers involved. Twelve of the 73 reports were cedures and made arapid descent after transmitting
suggestive of inadequate training and cockpit re in the blind to the center and not receiving a reply.
source management (CRM). Five involved non The crew did not squawk 7700 (emergency tran
compliance with the Federal AviationRegulations spondercode) during descent. The reporter felt, in
(FARs). Fifteen reports involved majorequipment retrospect, thattraining should include thenecessity
problems. However, many of the reports also had to be in contactwith ATC priorto descent, or atthe
positive aspects. Forty-five reports indicated that least, to squawk 7700 so as to alert ATC to the need
the crews followed company-operating procedures to clear other traffic in the area of the descent.
in dealing with the emergencies, and an additional
five reports indicated good crew interaction, good 35579 — The aircraft sustained an explosive
training, or both. Since some of the reports were decompression dueto thelossofthe First Officer's
typical ofmore than one category, the total is more (F/O) side window at FL230. The F/O received
than 73. minor injury, and 1/2 of his 02 mask was ripped
away and unusable. The Captain made an emer
What follows provides illustrations of the five gency descentwith the F/Odoing thechecklists, but
categories of reports mentioned above. As men theCaptain didnotusehis02maskatall. Thisshows
tioned, forty-five reports illustrate good reactive a lack of training in, and understanding of, the
training of front-end crews in the handling of de effects ofunpressurized flight withoutoxygen, since
compressions, whetherexplosive or insidious. How the usual reaction to such a pressurization loss is to
ever, many of these reports show a lack of under don the 02mask.
standingofthe causesandsymptomsofhypoxia and
the other phenomena involved in flight physiology, Noncompliance with FAR Requirements
especially high-altitude physiology.
36950 — The flight continued to its destina
Inadequate Training or Cockpit Resource Man tion after an emergency descent, during which
agement passenger 02 masks were deployed. At one point
during the balance of the trip, flight was conducted
38570—Shortly after takeoff,a rear boarding at FL270. The Minimum Equipment List (MEL) for
door came open and the integral stairs deployed. the airplane specified no flight above FL250 with
The flight crew experienced no control problems out the availability of automatic presentation of
and returnedto land. One of the flight attendantsin passenger 02 masks. The masks could not be pre
the rearunfastened his seat belt and went to the open sented automatically because they had been de
door to check it out, althoughhis emergency train ployed in the previous emergency descent. This
involves noncompliance withFAR91.30,regarding The crew made an emergency descent and ran the
Minimum Equipment Lists, and a lack of knowl "EXPLOSIVE DECOMPRESSION" checklist.
edge of MEL requirements.
48316—A crew at FL350on an oceanic route
30855 — The aircraft suffered a loss of pres experienced an uncontrollable cabin depressur-
surization at FL270. The crew had experienced ization.Theydescendedto 10,000 feetand returned
problems withthe pressurization controlleron three to their point of departure. Seventy-nine of the
previous legs. The FAA jumpseat rider wrote crew passenger 02masks did not deploy automatically,
violations for improper use of oxygenmasks. FAR nor could the crew deploy them with the cockpit
121.329(b)(1)specifies"atcabin pressure altitudes control switch. The passenger 02 masks that did
above 10,000 feet, up to and including 12,000 feet, deploy were of thechemical generator type and left
oxygen must be provided for and used by each aburning odor in the aircraft which the crew could
memberof the flight crewon flight deck duty, and not identify. Because of this, the crew wore 02
must be provided for other crewmembers, for that masks for the remainder of the flight The crew had
partoftheflight atthose altitudesthat isofmore than never been exposed to the smell of a deployed
30 minutes duration." The flight deck crew donned chemical generator 02mask and did notknow what
their 02masks when the cabin altitude (as opposed caused the burning smell. They should have recog
to aircraft altitude)went above12,000feet,andafter nized the smell from exposure to it in initial or
30 minutes. This is anotherexample ofnoncompli recurrent training, as required by FAR 121.417 (c)
ance with the FARs. (2)(i)(Q.

67544 — This report involves a new type of 70672 — An aircraft suffered a decompres
quick-donning crew 02 mask which does not sion at the beginning of descent Oneof the flight
perform as requiredby the FARs.Theharness is attendants, workingin an aft galley,recognized her
designed to inflate away from the mask when the hypoxicsymptoms, discovered thepassengermasks
maskis removed from its container, and then deflate haddeployed, assisted a small child in goingto its
forasnugfit afterbeingplaced onthe wearer'shead. mother, then passed out from lack of oxygen. She
Instead, most masks tested by the reporter had the was given supplemental oxygen by another flight
harness inflate inside the mask and jam, so as to attendant and was all right. However, flight atten
require a two-handed operation for donning. FAR dants are usually trained to don their own masks
91.32 (b) (1) (ii) requires that a mask can be taken before assisting others so they will be capable of
from its hanger/container, and within five seconds providing such help. This flight attendant reporter
andwith one hand, placedon the face, andbe ready alsobrought out important considerationsconcern
for use. FAR 121.333 (c) (2) has the same require ing chemicaloxygen generators. Considerable heat
ments and adds "the certificate holder shall also and smoke are caused in the generation process.
show thatthe mask canbe puton without disturbing Reportedly, the heat has caused burns to, and the
eyeglasses and without delaying the flight smoke has been inhaled by, crew and passenger
crewmember from proceeding with his assigned alike. In addition, on assuming bracing positions for
emergency duties." (It should be noted that on an emergency landing, a problem arises with the
several occasions we have seen this type of mask stowage of the paraphernalia from the seat-back
demonstrated in acockpitwithoutthe reported prob style ofchemical generators (such as in the DC-10).
lem.) These canisters are also reported as being so hot as
to prevent some passengers from sitting back in their
Other Equipment Problems seatsandextending theiroxygen tubes far enoughto
initiate the sequence for their canister to provide
87585—An aircraft climbing through FL305 oxygen flow. This last problem contravenes FAR
experienced rapid decompression, and cabin 25.1450 (b) (1) that says "Surface temperature de
pressure was lost in about 10 seconds.The aircraft veloped by the generator during operation may not
had been written up for previous pressurization createa hazard to the airplane or its occupants."
problems but maintenance hadbeenunableto dupli
cate the problem. Subsequent to this occurrence, a Crew Followed Company Operating Procedures
large crackwas found in the cabinin the rightwheel
well area. This problemhadbeenthe subjectoftwo 85640—An aircraft in cruise at FL310 expe
previousFAA Airworthiness Directive(AD) notes. rienced an engine explosion and rapid decom-
pression. The exploding engine left a hole in the tion at the lower altitude. Thefollowing quote from
fuselage large enough for a man to crawl through. the reporter indicates a high level of preparedness
Thecrewfollowed emergency training procedures, and professionalism: "As far as I'm concerned, this
madeanemergencydescent,foughtthe fire,anddid wasjustanotherdayinaviation. Nobigdeal,butfelt
all checklists according to their company proce it would be wise to inform you of tiie situation that
dures. The first reporter said it took about 10 sec did occur."
onds todon his02mask and hefelt confusion during
the initial stages of the emergency. Since time of Many of the crews involved in these ASRS re
useful consciousness is measured in seconds, at that ports performed therequired emergencyprocedures
altitude, he might have approached that length of in the manner that they were supposed to, and
time and felt the effects of hypoxia. Both reporters removed theiraircraftandpassengersfromimmedi
felt they had good training to handle single emer ate danger. Buta thread of ignorance of important
gencysituations. However, theyfeltthatthelackof factors dealing with high-altitude physiology and
compounded, multiple-emergency simulator train the dangers involved, and the regulations regarding
ing left them less prepared to copewiththiscombi them runs through the reports.
nationof happenings than they would haveliked.
Awell-trained crew, conversant with emergency
36048 — While the aircraft was climbing procedures, knowledgeable of the regulations, and
throughFL210,thecabinaltitudeexceeded 10,000 familiar with the physiological dangers inherent in
feetand the cabinaltitudewarninghorn sounded. high-altitude pressurized flight, can handle almost
The crew donned their 02 masks and attempted all any emergency without further harm to aircraft,
recommended procedures to control the cabin alti crew, or passengers. However, the preceding ex
tude (e.g., selected standby; selected manual con amples cite unfamiliarity with emergency proce
trol;closedtheoutflowvalve). Theywereunable to dures, ignorance oftheregulations, and a disregard
regain control, made an emergency descent, and for thedangers whichcan accompany high-altitude
returned to the point of departure. They made all problems. For the survival of crews, which in turn
prescribed contact with ATC and followed com provides them the abilityto care for their aircraftand
pany operating procedures for theemergency. its passengers, training should be provided in all
aspects of high-altitude flying rather than just the
33192— On climbout from Newark through rote learning of a proper emergency descent.
FL240, the crew experienced rapid loss of cabin
pressure. They tried all the recommended proce Although these reports do not represent the full
dures to control cabin pressure manually, then re spectrum of aviation, they do show that incidents
quested and made emergency descent, and followed occurwhich require thatthe crewhaveknowledge
emergency procedures. of high-altitude physiology and the dangers in
volved, the regulations governing those aspects of
Good Crew Interaction, Good Training, or Both flight, and the proper procedures for dealing with
emergencies. The reports also show that in many
29778— The aircraft sustained a loss of pres cases, the crews appear to be lacking some part of
surization. The cabin altitude climbed to 20,000 the knowledge required for safe operation in the
feet. The crew followed all emergency procedures. high-altitude environment
The flight attendants were cited by the reporter for
doing a good job. This report had many indications 3. NATIONAL TRANSPORTATION SAFETY
ofgood crew coordination and flight attendant train BOARD REPORTS
ing in these procedures.
The National Transportation Safety Board
96377—The cabin altitude began to climb, for (NTSB) answered our request for information re
no apparent reason, on an aircraft in cruise at garding accidents/incidents involving flight physi
FL350. The crew attempted manual control but ology with eight reports from the time period 1973-
were unsuccessful. They began an emergency de 1985. Of the eight reports, six dealt with specific
scent and were able to control the cabin altitude accidents/incidents and two concerned special stud
when the aircraft reached FL220. The descent was ies done by the NTSB. Summaries of all the reports
done smoothly enough so that passengers were can beseenin AppendixB.The specialstudiescame
unawareof it and the flight continuedto its destina about as a result of other accidents/incidents which
generated common concerns about specific areas • Anin-flight fire on board a Singapore-bound
suchas chemically generated 02 systems. Wewere L-1011 in 1985 led to the discovery of mal
not given specific information about those acci functioning passenger 02system sequencing
dents/incidents, andthey couldhavebeenincluded valves. Some of the 02 masks were neither
in some of the other reports which we did receive. automatically presented nor were presented
when the system was activated from the
While some of the reportsdealt with fires,some engineer's panel. An immediate Airworthi
with decom-pressions, and some with other safety ness Directive (AD) was issued to correct
concerns,all dealt withsome foim ofoxygensystem malfunctionmgoxygeninitiatorsequencetimer
in some manner. The following arc illustrative: switches.

• Anm-flightB-707fireinl973resultedinl24 While hypoxia, gas expansion, and other physi

fatalities and total destruction of the aircraft ological problems were notspecifically addressed
afterasuccessfulemergency landing. Thefire by the reports, these occurrences were still a prob
wasfed bymaterial from theaircraft interior. ability, and some of them may have, in fact been
There was a shortageof protective breathing experienced bycrew and passengers alike.
equipment(PBE)with full facemasks toallow
the crew to fight the fire. The lack of such 4. PHYSIOLOGICAL PROBLEMS AND
equipmentwas addressed. FLIGHT CREW UNIONS

• ADC-9mCmcinnati,Ohio,inl983,hadafirc To ascertain flight crewunionparticipationinthe

in the left rear lav, made an emergency land investigation of physiological problems affecting
ing, and evacuated theaircraftThematerial in their members, seven unions were contacted by
the interior of the aircraft continued to burn telephone. Two of these unions represented pilots
during the descent and evacuation, and 23 andfive represented flight attendants. To date,five
passengersdied.TheNTSBcitedashortageof have responded. We were unable to contact repre
protective breathing equipment withfull face sentatives for health and safety for APFA, repre
masksinthepassengercabinandaccessibleto sentingAmerican Airline flightattendants, and the
thecrew. Anensuingamendmentto theFARs APA, representing American Airline pilots.
required protective breathing equipment for
all crewmembers. In addition, there is an on ALPA,the largestof the unions,representspilots
goingstudyof respiratory protection for pas on 50 different airlines. ALPA is well known for its
sengers from toxic environments during air active participationin safety-relatedmatters, but it
craft fires as a result of this accident doesnot specificallykeep fileson flightphysiology
problems. Although flight physiology might enter
As can be seen from the two previous report into an investigation as a contributing factor to an
summaries, addressing a problem is not synony incident or accident ALPA does not treat flight
mous with solving it Ten years after the B-707 fire, physiologyas a single factor and keep recordson it.
there were still insufficient protective breathing
masks for the entire crew. This lack reduced the The Association of Flight Attendants (AFA), is
effectiveness offire fighting efforts by the crew and the largest of the flight attendant unions. Informa
might have led to greater loss of life. tion received from them, indicates that they deal
with physiological problems affecting their mem
While the lackofequipment was a concern ofthe bers on a case-by-case basis, by gathering informa
above reports, otherreports indicted lack oftraining tion from member incident reports. If a significant
and defective equipment. The following report ex number are received, or an apparent trend develops,
cerpts are illustrative of those: they try to get the management of the company
involved to take corrective action. For example,
• Severalrapiddecompressions involving DC- theyhavehad 27 reportedincidentsof physiological
10s and L-lOlls have uncovered problems problems in the recent past on one airline. The first
with chemically-generated O, systems. Most 18 appeared to be aircraft specific since they all
ofthe problemshave been attributedtolack of happenedon MD-80 series aircraft However,since
understanding of thesystems by bothpassen that time there have been reports of similarsymp
gers and flight attendants. toms on another aircraft type. The problems in-
 eluded nausea, severe headaches, disorientation, The airlinedidanumberoftests, includingchecking
loss of motor skills, numbness, and other hypoxic the ozone filters on the aircraft, withno conclusive
symptoms, and appeared tobealtitude related (most results. The problems continue to be reported. Al
problems occurredwith aircraft at a cruise altitude though they have not been able to supply us with
in the high 30,000 foot range, such as 35,000 or copies of their files for documentation, they have
37,000 feet). If the flight attendants brought the submitted copies ofrecent media coverage ofthis
symptoms to the attention of the front-end crew series of problems. According to the articles, the
when they first occurred, andif the front-end crew airline has found nothing wrong and feels the union
was able tomake adescent of a few thousand feet, is fabricating problems. The media reports men
mostsymptomswerereported tohavedisappeared. tioned, however, that some passengers onthe refer
However, in some cases, the symptoms lasted for enced flights had complaints of physical ailments
days. A pointofinterest isthatthisairline flies much similar to those of the flight attendants.
of its schedule in the higher latitudes where ozone
problems are more prevalent(in the higherlatitudes, IFFA, the union representing TWA and former
the troposphere islowerand the ozone layer altitude Ozark flight attendants, reported keeping files on
varies with the troposphere). Some ofthe symptoms many physiological problems. They participated
ofexcess ozone exposure are similar.Toquote from withother flight attendant groups in whatisreported
an FAA report on theeffects of ozone (FAA-AM- to be awell-documented report regardingthe physi
79-20),someoftheeffects included"markedchanges ological problems to be considered induty rig regu
in pulmonary function, malaise, muscle ache,cough, lations, such as fatigue and concerns related to high-
wheezing, sputum production, substernal pain, altitude pressurized flight for extended periods.
dyspnea (difficulty inbreathing), fatigue, headache, (Duty rigs govern such things as daily, monthly, and
laryngitis, and nasal discharge." Also, from the annual flight time, scheduled flight time versus
samereport, wereaccounts ofsubjects whosesymp actual flight time, scheduled time onduty, minimum
toms lasted from less than four hours tothree days. scheduled rest time between trips, etc.) This report
In the incidents cited by AFA, cockpit crews ap was submitted totheFAA for study (date unknown)
peared not to be affected by the symptoms. This but no definitive answer has been forthcoming.
might be explained with another quote from the OtiierinformationcurrentlybeinggatheredbylFFA
aforementioned FAA report; "Fewer complaints includes reports oncabin air quality and the long-
from flight deck personnel than from cabin person term effectsassociated withjet flight. Thelatter are
nel may be related to the fact that most pilots and just beginningto surface and IFFA is interested in
flight engineers are males with relatively sedentary tracking them. IFFA also participates, as do other
duties, whereas most flight attendants are females flight attendant unions, inquarterly meetings ofthe
and are active in flight." (Thereport also concluded Coalition of Flight Attendants. This group was
that females were more subject to the symptoms formed approximately five years ago to study new
than males.) According to Richard O. Reinhart, research and investigate reports of safety and health
M.D., in the January, 1989 issue of Business & problems encountered by their members, many of
Commercial Aviation: "Increased activity also will which involve areas of flight physiology. Included
increase the need for oxygen by the body. Flight in the group are counterparts from airlines in other
attendants on abusytripcanbecomehypoxicbefore parts ofthe world.The representative of IFFA with
the cockpit crew who are physically inactive." Al whom we talkedreported thatthe Coalitionreceived
though Dr. Reinhart is specifically talking about quite abitof information from research being done
hypoxia, thiswould seemto parallel theFAA report in other countries. However, an apparent shortage
quote regarding increased activity and ozone ef exists of research information from sources in this
fects. Another consideration is the passengers. To country. This was an opinionreportedly shared by
againquote the FAA report, "...it is more likely that the flight attendant unions but we have been unable
theseconditions will occurin the passenger group, to get further specific information. IFFA is also
whose ageandmedicalstatusarebeyond thecontrol involved in other physiology projectsnot related to
or even knowledge of the airlines or the FAA." altitude, such as galley cart design and the carpal
tunnel syndrome involved in use of presentdesign
The information regarding the recurrent flight carts. The IFFA representative spoke of IFFA's
attendantsymptoms was brought to the attention of willingness to shareinformation and participate in
the airlinemanagement by AFA, with a requestthat any forum which would seek to better the safety and
it be investigated further and remedial action taken. health of their members.
 The IBT, Local2707, represents flightattendants older-generation aircraft, thus exposing crews to
from Northwest and World Airlines, and the former higher cabin altitudes for a longer period of time.
Flying Tigerpeople whowere absorbed by Federal This wouldbeaccentuatedby coincidingwithheavier
Express. Although they also participate inthe Coa cabin crew workload during meal service.
litionofFlight AttendantUnions, unlikeIFFA, they
do not keep extensive files on the information ex The aboveunionsrepresentmostunionized flight
changed according to their representative. Theonly crewmembers in this country. Of the five respond
files which they keep pertain to individual cases ing unions, although three unions keep files on
involvinglitigation against anairline by oneof their physiological problems, many of the files do not
members. None currentlyon hand were relevantto pertain to altitude-related physiology. IUFA sent
our interest copies of anumber of their files on air quality. The
reports detailed problems from inadequate aircircu
IUFA, the union representing Pan Am flight lation in cruise which led to hypoxic symptoms, to
attendants, haskept files concerning memberphysi concerns about ozone on extended high altitude,
ological problems for some time. They shared with high latitude flights. The ozone reports gave ex
uscopies of files dating back as far as the late 1970s. amples of physical symptoms reported by flight
Most related to poor airquality and/orcirculation in crewmembers. IFFA has files on many issues re
aircraft cabins and mentioned a number of aircraft garding flight physiology, ranging from air quality
types from 747to A310.The symptoms mentioned to galley cartdesign. Their airquality files report
in the files range from typicalhypoxic symptoms to edly show the same concerns as those of IUFA,
pneumonia. Some were concerned withtheeffects along with many of the same symptoms, and they
of ozone on long, high-altitude flights, especially have indicated a willingness to share any files we
those in the higherlatitudes. Others are concerned mightrequest. AFA, doeshavesome files butare not
with low airflow in the cabin at cruise altitudes when aware of any pertaining to this study otherthanthe
passenger service is at its peak. Examples of this aforementioned ones dealingwith reported hypoxic
problem surface on the 747, which often cruises and othersymptomsatcruise altitudes occurring on
with only two packsout of three available packs in one airline.One common usage of all these files is
operation; with the L-1011, which has had com to document problem areas for presentation to the
plaints of poor aircirculation in the aft cabin; and airlines to seek to rectify the perceived problems.
with the A-310, which has an Econo Fuel Valve
which is supposedto reducebleed air flow from the None ofthe unions with which we spoke engaged
enginesthroughthe airconditioning packsin favor in physiological education of their members, re
of better fuel economy. The latter supposedly af garding that as a company function. However, all
fects both the volume ofair and the rate at which the expressed concern about the physiological effects
air in the cabin is circulated. This has produced on their members ofhigh-altitude flight in the short-
many complaints of hypoxic symptoms from flight term and the long-term. One apprehension con
attendants during periods ofhigh activity, such as a cerned the ability of crewmembers suffering from
meal service with a full load of passengers. Also, short-term adverse physiological effects to ad
when a number of passengers are smoking, the equately aid their passengers in the event ofdecom
reduced air circulation is reported as being inad pression.
equate to keep the cabin relatively clear of smoke.
Recurring physiological complaints of a similar 5. AVIATION TRAINING CENTERS
nature have been forwarded to company manage
ment. The company has set policies which allow for Discussions were held with training personnel
maximum air flow to be used if requested by the from nine aviation training schools to determine
purser, however this is reportedly not often fol how many included flight physiology training in
lowed, and the cabin crews report continuing to their curricula. The schools were selected from the
work in conditionsofinadequate airflow. We found list in the World Aviation Directory (WAD) and
out from another source that when the aircraft is were chosen as examples of universities, colleges,
carrying over 165passengers, it is company policy and professional training organizations engaged in
that the Econo Fuel Valve not be utilized. Another flight training. Four schools engaged in various
comment from this source indicates that because of phases of training from abinitio to corporate recur
aircraft capabilities, the aircraft is able to reach rentThree were examples ofuniversity flight train
higher cruising altitudes earlier in the flight than ing departments which offered undergraduate and
 Ohio Simu- Embry- Flighl t Univ.Flight Univ. Northwest
Parks
State Intl. of Safety of Aerospace
Univ. flite Rlddle Inc. North College Intl. S. Training.
Dakota Calif. Corp.
ALTITUDE RELATED
Hypoxia X X X X X X X
Trapped gases X X X X X
Decompression & evolved gases X X X X X X
Oxygen equipment X X X X simulator
Altitude chamber use available included
Time of useful consciousness at X1 X no no no X
different altitudes mention mention mention
Ozone & radiation X X ozone

OTHERS
Stress X X X X X
Visual problems X X X X X X
Spatial disorientation X X X X
Attention anomalies X X X X
Hyperventilation X X X X X X
Self medication X X X X X
Effects of alcohol X X X X X X
Diet & nutrition X X X X X
Fatigue X •X X
Heat X X X
Acceleration X X X

Noise & vibration X X X X

Smoke & fumes X X X

CRM (recognition of symptoms) X X

TABLE 1 - SCHOOL PHYSIOLOGY CURRICULA

advanced degree courses and preparationfor FAA Ohio State and Embry-Riddle have flight physi
flight ratings; one of these has also done ab initio ology courses as part of their academic curricula.
training for at least two airlines.The remainingtwo The UniversityofSouthern California teaches flight
training centers were colleges that specialized in physiology as a part of their "AviationSafetyPro
flight training and education - one with courses to gram Management" course. Individual aspects of
provide preparation for FAA ratings of varying flight physiology are taught in a number of their
kinds; and one with degree-conferring courses of other courses, as well. The University of North
study which also provided preparation for FAA Dakota has an ab initio course designed to take zero-
flight ratings. time students and train them to entry-level standards
forregional aircarriers. Theyreport having trained
The otherschools contacted varied in theirteach- such pilots for Evergreen and Gulf Air, among
ingof flight physiology, as canbe seen in Table 1. others. Their curriculum includes a course in flight
Flight International, Inc., which does training from physiology, which is also made available to any of
abinitioto corporate refresher andlists22locations their other students, such as corporate and commer
for training; statesthat they do no training in flight cial recurrent students. North Dakota reports having
physiology. Ohio State, Embry-Riddle, University the only altitude chamber not connected with the
of Southern California, and University of North military or the FAA in this country. Flight Safety
Dakotaarc examplesof schools whichoffer exten International teaches little flight physiology, only
sive courses of a semester or more in length. the effects of alcohol and hypoxia. The latter is
taught only in their CRM course as it pertains to
Ofthe nine aviation schools, seven include some recognition ofincapacitation. However, anyoftheir
subjects in altitude-related physiology and teach instructorswho will be teaching in jets are required
hypoxia, its effects, and how to deal with it The to take analtitudechambersession, and theystrongly
causesandeffectsoftrappedgasesaretaughtby five recommend to their students who arc transitioning
schools. Six include information on decompression into jets that they take a chamber ride also. Their
and evolved gases.The use of oxygen equipmentis instructors take the altitude chamber familiarization
a classroom subject for four schools and is ad and ride given at the FAA's CAMI in Oklahoma
dressedduring simulatorsessionsby a fifth.The use City. Simuflitetrains corporatepilots and has con
of an altitude chamber to illustrate hypoxic effects tractswithsome governmentagenciesto do training
and teach self-recognitionis included in the course in small aircraft for them. Their jet indoctrination
of study at one school and is made available to includes three days of high-altitude pilotage which
students at a second. The time of useful conscious incorporates two hours of flight physiology. The
ness atvarious altitudes is mentioned atthree schools, contents of all the mentioned courses can be seen in
according to their curricula. The effects of ozone Tablet
and radiation at varying altitudes and latitudes is
included in course matter at two of the facilities; From the information received, it is apparent that
another does not teach radiation effects but does there are organizations that do provide instruction in
cover the effects of ozone. flight physiology. Some of them presently have
longer courses than might be applicable for general
Flight physiology curricula included subjects civilian flight personnel education. However, more
other than those related to altitude. Four schools had abbreviated courses could be developed. Other
very extensive courses, as can be seen from Table 1. schools provide short courses. From the information
Six addressed visual problems, hyperventilation, on current flight physiology training that we re
and the effects of alcohol. Five dealt with stress, ceived through our small sampling, and given the
self-medication, and diet and nutrition. Fourschools large number ofschools available countrywide, it is
covered spatial disorientation, attention anomalies, clear that useful curricula currently exist for provid
and, noise and vibration. Three spoke to the effects ing flight physiology training to airline and corpo
offatigue, heat, acceleration, and smoke and fumes. rate flight crews and general aviation pilots.
Two of the facilities had course material dealing
with cockpit resource management 6. AIRLINE FLIGHT PHYSIOLOGY TRAIN
ING
(CRM) as it pertained to the recognitionof inca
pacitation in fellow crewmembers andthenecessity FAR 121.417, "CrewmemberEmergencyTrain
to take action because of it. ing," specifies in section (e) that "crewmembers
who serve in operations above 25,000 feet must cover all subjects on an annual basis but does go
receive instructions in the following: throughthe list of subjects in recurrent reviews on
about a four-year cycle. Another airline does not
(1) Respiratioa have recurrent training in flight physiology. Other
airlines review subjects when they are relevant to
(2) Hypoxia. incidents that have occurred in the industry in the
recent past but provide no planned recurrenttrain
(3) Durationofconsciousnesswithoutsupple- ing in that subject
mental oxygen at altitude.
Reviewofannual, recurrent-training, home-study
(4) Gas expansion. materials from two of the five airlines was con
ducted by a pilot from each airline. The material
(5) Gas bubble foimatioa from oneairline consisted ofquarterly handouts. A
review of six handouts revealed three mentions of
(6) Physical phenomenaand incidentsofde- subjects related to flight physiology: (1) in areview
compressioa" of pressurization, the time of useful consciousness
(TUC) for FL350 was given as an example; (2)
FAR 135.331(d) specifies exactly the same re another section presented a review of oxygensys
quirements. tems; and (3) one quarterly recurrent presented a
table of TUCs at various altitudes. The annual,
To determine whattraining isbeingconducted in home-study, open-book exam for the other airline
the airline segment of the industry, we gathered was reviewed for references to flight physiology by
information on six airlines. Representatives of the the pilot taking the recurrent exam. There was one
training departments of four airlines responded with question regarding explosive decompression and
informationon whattraining theycarried out Train time of useful consciousness.
ing at a fifth airline was recalled from personal
involvement of one of the writers. Information on The actual use ofoxygenequipment is practiced
recurrent training fortwo airlines was presented by in simulator recurrent training for emergency de
pilotsfrom thoseairlines, andfrom a flight attendant scent in the event of rapid decompression. This
representative of one airline we received informa trainingis mandated by FAR and is carried out on a
tion on flight attendant training. semiannual basis for Captains and on an annual
basis forother flightofficers forthe airlines studied,
All five airlines profess to meet the minimum and presumably for all airlines.
requirements of FAR 121.417, but the depth and
method oftrainingvarieswidely. Two ofthe airlines Most ofthe airlinerepresentativeswith whom we
use old GI films put invideo tape format. One airline spokehadinformation regarding pilottraining only
uses a combination of films, videos, slides, lectures, and could give us no information regarding flight
and handouts. Another airline gives all new-hire attendant training. One airline stated that initial
pilots abook on high-altitude jet flight.This encom trainingwas the same forpilots and flight attendants
passes many subjects, including flight physiology. with recurrent training directed to equipment more
This is presented to the pilots asmandatoryreading, likely to be used by that group, i.e., quick-donning
and is the only exposure to the subject that they oxygen masks reviewed by pilots. One union repre
receive in indoctrination. The training representa sentative sent copies of flight attendant manual
tives with whom we talked were only ableto provide excerpts regarding the training she had received.
information on pilot training, except for one airline She stated that this material was representative of
where indoctrination training in flight physiology the indoctrination training received and was their
was identical forpilotsand flight attendants,accord sole reference for altitude-related flight physiology
ing to its training representative. review. Three related subjects were covered: (l)the
indications of cabin pressure loss and actions to be
Recurrent training in the subject of flight physi taken; (2) the symptoms ofhypoxia; and (3) a chart
ology is required by FAR on an "as required" and oftimes ofuseful consciousness at various altitudes.
"as appropriate" basis. This allows the airlines a The chartofTUCs showed times which were longer,
greatdeal of discretion in the selection of subjects and considerably longer in some cases, than those
and the frequency ofcoverage. One airlinedoes not shown in another airline's chart or some of those in

10
the Bioastronautics Data Book. What source the 10,000 feet regardless of the particular altitude
airline used for its information was not stated and the flown above that "In exposure to altitudes be
chart appeared to give information which would low 10,000 feet the effects of hypoxia on the
givecrewmembers a falseimpression of theamount pilotare mild and acceptable. Above this alti
oftime that they could function without supplemen tude, human performance degrades very rap
taloxygen.Wefeelthisis informationwhichshould idly."(AC91-8B) Another quoteis evenmore
come from a common source for any airline and specific: "Visualthresholds havebeenshownto
should be subject to POI review to assure that the increase at altitudes above 4,000 feet probably
correct information is presented. becauseoftheveryhighoxygenrequirementsof
thelight-sensing cells in theeye.Impairment of
Some concernsare raisedby this reviewof flight ability to learn new complex tasks has been
physiology tnuningby airlines. Theyareasfollows: demonstratedat8,000 feet impairmentofrecent
memory, judgmentand abilityto perform com
The requirement for flightphysiology train- plex calculations are seen at altitudes in the
ingasstatedinFAR 121.417 is forthosecrews neighborhood of 10,000 feet (Bioastronautics
flying above25,000 feet- TheAirman's Infor- DataBookNASASP-3006±"\nconsidcTa\ionof
mationManual(AIM) states that "Foroptimum the aforementioned, perhaps the altitude men
protection, pilotsareencouraged to use supple tioned in FARs 121.417 (e) and 135.331 (d)
mentaloxygenabove10,000feetduringtheday, should be lowered to 10,000 feet.
and above 5,000 feet at night" Other experts in
theindustryagreewiththosefigures. Wehavea There is a lack of altitude chamber training
greatdealof concern overthe apparent discrep for airline flight personnel - Anypilottrained
ancy betweenthe AIM recommendations and in themilitary is required to takealtitude cham
the requirement for training only those ber runs for indoctrination and for recurrent
crewmembers servingabove25,000feet Recurrenttrainingison athree-yearbasisforthe
Armyandthe AirForce.The Navyison a four-
Whflepressurizedairciaftofrerprotectionagainst year recurrent cycle. If the individual pilot is
many of the effects of altitude, the insidious scheduled for a new tour ofduty in less than the
onset ofhypoxiadue to a pressurizationleakcan scheduled recurrentcycle, they must take recur
be verydifficult to detect To quoteFAAAdvi rentpriorto thenewtourof duty.Civilianpilots
sory Circular 91-8B, "A common misconcep normally are not exposed to this training. The
tion exists amongpilots whohave notcompleted AIM says: "Since the symptomsof hypoxiado
physiologicaltrainingthat it is possible to know notvary in an individual,the abilityto recognize
the symptoms of hypoxia and then to take cor hypoxia can be greatlyimproved by experienc
rective measures once the symptoms are noted. ing and witnessingthe effects of hypoxia during
This concept is appealingbecause it allows all an altitudechamber 'flight'" Since the military
action, both preventive and corrective, to be servicesrequirealtitudechamberflights fortheir
postponed until the actual occurrence. Unfortu flying personnel and for passengers in some of
nately,thistheoryis both falseanddangerousfor their aircraft types, and the AIM recommends
the untrained crewmember, since one of the this trainmgforrecognitionofhypoxia, wethink
earliesteffectsofhypoxiais impairmentofjudg it only logical that it be required by FAR that
ment Although a deterioration in night vision civilian pilots have at least an initial altitude
occurs at a cabin pressure altitudeas low as5,000 chamber flight The current altitude chamber
feet othersignificanteffectsof altitudehypoxia runs used by the U.S. Navy for their multi-
usually do not occur in normal healthy pilots engine flight crews are low altitude (8,000 to
below 12,000 feet From 12,000 to 15,000 feet 25,000 feet), and they are considering doing a
altitude, in addition to impairment ofjudgment feasibility studyon theuse of mixed,inertgases
memory, alertness, and coordination being af to producehypoxiceffectsat sea level pressures.
fected, headache, drowsiness, and either a sense According to the spokesman we contacted, if
ofwell-beingor ofirritability may occur.These thisprovesfeasible, theirintentistoreplacemost
effectsincrease withshorterperiods ofexposure oftheirrecurrenttrainingaltitudechamberflights
to higheraltitude." The following quotewould withthisuse ofgases.We aretold,however,that
seem to indicate the need for training in flight this is not an official Navy position. We think
physiology for all crewmembers flying above this could be a sensible alternative to the altitude

11
 chamber for civilian pilot training in therecog following:
nition of hypoxicsymptoms, both from safety
and economic perspectives. • Times of useful consciousness tables should
emanate from a single, authoritative source
The amount of training given flight atten andshould be commonthroughout theindus
dants versus pilots seems to vary - From the try.
reports of flight attendantunion representatives,
we were given theimpression that although the • Training mandated by theFARs shouldbe for
letter of the FARs might have been met in any flight crews flying above 10,000 feet as
indoctrination, thedepth of knowledge resulting opposed to the present 25,000 foot require
was less than that of the pilot group. Although ment
the job functions are not similar, it has been
suggested thatflight attendants are moresubject • Training forrecognition ofhypoxia should be
than pilots to the effects of hypoxia because of required for civilian pilots. Ideally, thiscould
their higher activity level during flight They taketheform of altitude chamber flights orthe
must also deal with passengers who might be useof mixed gases asisbeing investigated by
subjecttohypoxia. Forthesereasons we feelthat the Navy.
flight attendants should receiveasthoroughtrain
inginaltitude-related flight physiology aspilots. • Training given flight attendants shouldbe as
thorough and informative as that given pilots.
The' subject matter required by FAR for While the training could be oriented more
flightphysiologytraining doesnotcoversome specificallytoeachtask, thebasicinformation
subjects relevant for safe operation - The on flight physiology should be the same.
subject list covered in military flight training is
more extensive and includes a number of sub • Recurrent training in altitude-related flight
jects covered alsoin the section on "Fitness For physiology should be mandated at specific
Flight" intheAIM.We feel that subjects such as intervals by FAR and shouldreview all sub
acceleration and force fields, stress, fatigue, and jects required for initialindoctrinatioa
spatial orientation should be included in flight
physiology training for pilots. Since most of 7. TRAINING BY OTHER GROUPS
theseare notpertinent tothe flight attendantjob,
training for that group in these subjects should In order to determine what physiology training
not be necessary. was done in aviationother than by the airlines, we
contacted Beech Aircraft Corp., Cessna Aircraft
The FARs leave a great deal of room for Co.,Gulfstream Aerospace Corp., MooneyAircraft
interpretation regarding the necessity and Corp.,PiperAircraftCorp.,the AircraftOwnersand
frequencyofrecurrenttrainingin flight physi Pilots Association (AOPA), the National Business
ology - Flight physiology training is mandated Aircraft Association (NBAA), the U.S. Air Force,
"as required"and"as appropriate." We feelthat the U.S. Army, and the U.S. Navy.
the FARs should specify a time period within
which allrequired subjectsmust be reviewedby Fourofthe airframe manufacturers providecon
all flight crewmembers. tract training for new customers at delivery of the
aircraft Beech, Cessna, and Mooney provide cus
The subject matter presentedin indoctrinationby tomers that are taking delivery of an aircraft with a
the airlines contacted appearedto cover the require check-out at the nearby Flight Safety International
ments set out by the FARs for flight crcwmember facility. (As can be seen from the section on schools
training. The degree to which the subjects were and reference to Table 1,Flight Safety International
covered varied widely, andthe effectiveness ofeach provides no altitude-related flight physiology train
programwas impossible forus to judge. The amount ing with the exception ofthe properuse ofanoxygen
and frequency ofrecurrenttrainingin those subjects mask.They discussthe recognitionofhypoxic symp
also varied. Although our sampling of airlines was toms in other crewmembers as a part of CRM
quite limited, we feel that it provides a good ex courses for multiple-crew aircraft The effects of
ample of what goes on in the industry. We also feel alcohol at altitude are also mentioned.)
that serious consideration should be given to the

12
 Gulfstream varies the training as a function of AOPA was contacted to determine if flight physi
what the customer requests and what the contract ology training was something which they offered
amount calls for. The basic contract calls for pilots their members. The spokesman with whom we
to have two weeks trainingatthe localFlightSafety talked said that they had no involvement in that
International facility with additional trainingin the
aircraft with Gulfstream training personnel. Once The NBAA spokesmansaidthat at present, they
again, a minimum of flight physiology training is do no training in flight physiology. They do have
involved. However, Gulfstream recommends annual four-day seminars fordifferent groups within
strongly to each customer that they get additional their membership (e.g., pilots, maintenance, man
training in flight physiology. Since the training is agement), and said theywouldliketohaveinforma
not required by FAR and is an expense to the tion on flight physiology to present at those semi
customer, Gulfstream philosophy is to recommend nars involving aircraft flight crews.
andleave it to the customer to follow through. Since
most of the pilots for their customers are former The people contacted who provided the most
military, theyhavehadpriortraining inmostaspects informationon flightphysiologytraining werethose
of flight physiology and would need recurrent train in the military. Military pilots receive the most
ing only. thorough training inphysiology and theinformation
that the services sent to us was quite complete.
Piper provides aircraft check-out for their cus
tomers with their own personnel. For customers The U.S. Air Force structures their physiology
buying pressurized aircraft, training is given in the training somewhat differently for members of the
use ofthe pressurization system.There is also brief three basic groupsof pilot and other flying person
mention made of hypoxia and time of useful con nel. The groups are(TARF) trainer, attack, recon
sciousness (TUC) at altitude without oxygen, ac naissance, fighter, (TTB) tanker,transport, bomber,
cording to a Piper spokesman. Piper has in their and(L&S) low and slow. Since the only two which
inventory a pressurized turbo-prop, the Cheyenne would have parallels in civilian flying are the TTB
400, which is capable of altitudes up to 41,000 feet and L&S groups, only those are represented here.
The nominal TUC at that altitude is 10-16 seconds. Pilots receive a46-hour curriculum in Undergradu
If the aircraft sustains a rapid decompression, the atePilotTraining(UPT) with fouraltitudechamber
pilotneeds to recognizethe event immediately and flights. Navigators receive a 50-hour curriculum
take action to sustain life very quickly. For this with three chamber flights. Other members of the
reason, Piper recommends that its pressurized air primary crew receive the 24-hour original course
craft customers take an altitude chamber ride. While with three chamber flights. Operational support
FAR 91.32 mandates when oxygen must be used, it flying personnel receive a 12-hourcourse with two
does not requiretrainingin depressurizationorother chamber flights.
altitude-related physiology.
There are minor variations in the academics for
A point ofinterest is that Beech and Cessna send the two groups. The TTB group receives additional
their own pilots to the Civil Aeromedical Institute trainingin crew coordination(CRM) andsituational
(CAMI) in Oklahoma City for training in high- awareness. The L&S group receives additional
altitude physiology, including a ride in the altitude emphasis on noise, vibration, and low-altitude hy
chamber. Beech requiresthis before a pilot becomes poxia. Altitude chamber training in initial training
aircraftcommander in any pressurized aircraft No consists of the specified number of rides, including
schedule is set forthis. When they have a groupthat a high-altitude rapid decompression flight, and in
needs the training, they transport them to and from cludes altitudes to 43,000 feet When pilots enter
the one-day course. At Cessna this is not mandatory, advancedtrainingin the T-38, additionaltrainingis
but is also done on an irregular schedule. Cessna received. At the time of assignment to a squadron,
pays allexpenses incurred and providestransporta furtherspecialized training is received in the aircraft
tion. Most of their pilots are former military and to be flown. The general subjects covered in initial
have had this training before, but Cessna feels the training consist of the following:
recurrent is important Piperalso recommends this
totheirpilotswhenandiftheycandoit,and suggests Physiological effects of altitude. This covers
taking refresherat nearby MacDill Air Force Base. the characteristics of the atmosphere; anatomy
and physiology of circulation and respiration;

13
 circulatoryand respiratory responsestoenviron ate flight trainees arc given aride inthe spatial
mental stresses; hypoxia and hyperventilation, disorientation demonstrator.
their causes, prevention, recognition, and treat
ment; andthephysiologyoftrapped andevolved Noiseandvibration.Teachesthebasicanatomy
gas problems, including cause, prevention, rec ofhearing. Discussion includes the harmfulef
ognition, and treatment
fectsofexposure to hazardous noise andvibra
tion, and means toavoid overexposure.
Human factors. Covered are self-imposed
stresses, oxygen discipline (the use of masks at Speed. Deals with aeromedical aspects ofhigh
the proper times), alcohol, carbon monoxide, speed flight aircraftejection, flight instruments,
blooddonationbythepilotandtheeffectsthereof, cockpit temperatures, closure rate, visual prob
shock, extremes oftemperature, diet dehydra lems, etc.
tion, drugs, fatigue, circadian rhythms, physical
fitness, and psychophysiological factors (exces Acceleration. Teaches the physical and physi-
sive motivation to succeed, over-confidence, ologicaleffectsofaccelerativeforces(G-forces),
personal problems, supervisor and peer pres human tolerance, and means used to raise G
sure, task saturation, and anomalies of atten tolerance and endurance.
tion.)
Prechamber flight indoctrination. Teaches
Oxygen equipment Deals with the various thepurpose ofthe altitudechamberflightandthe
types of oxygen masks and regulators; aircraft chamber flight profiles.
oxygen systems; gas, liquid, on-board oxygen
generation systems and chemical oxygen; ser This listing does not include training not perti
vicing procedures; and the emergency use and nent tocivilian aircraft such as useof ejection seats
inspection of this equipment and escape procedures. However, it does include
training which is notdirectly altitude related which
Cabin pressurization and decompression. illustrates the thoroughness oftraining which exists
Teaches the principles of cabin pressurization, inthe AirForce and the emphasis that they place on
rapid and slowdecompression and theirhazards, all aspects of flight physiology.
and the precautions totake. Includes procedures
to be followed after any cabin depressurization Recurrent training for Air Force flight crews is
and their physical and physiological conse normally scheduled every three years. However, if
quences.
a flight crcwmember is to be assigned overseas for
aperiod of 36months orless and currency in flight
Pressure breathing. Deals with the need for physiology training and altitude chamber will ex
pressure breathing, its limitations, pressure pire whenthey are overseas, theymustrenew their
breathing techniques, and the precautions to currency prior to deployment. Recurrent training
take. includes a six to eight hour academic refresher
tailored tothe specific major weapons system and a
Principlesand problemsofvision.Teachesthe ride inthealtitude chamber. The L&S group covers
basic anatomy and physiology ofday and night self-medication, alcohol, diet and nutrition, heat
vision, factors affecting vision, dark adaptation, fatigue, includingthatgeneratedby noiseand vibra
scanning methods, and flashblindness. Includes tion, trapped gas, decompression sickness, hypoxia,
a demonstration in the night vision trainer and hyperventilation, smoke and fumes, anomalies of
practice in methods of improving night vision. attention, aircrew coordination training, and spatial
disorientation. The TTB group academic recurrent
Spatial disorientation andothersensory phe includes air crew coordination training, alcohol,
nomena. Teaches how thebodyorients itselfon anomalies ofattention, effects ofdehydration (heat),
the ground andcompares thiswiththeeffects of hyperventilation, evolved gas decompression sick
flight Includes anexplanationofthecentral and ness, smoke and fumes, and spatial disorientation.
peripheral visual modes and their effects on The recurrent altitude chamber flight also differs
orientatioa Also, covers problems associated betweenthe two groups.The recurrent chamberride
withthedistortion ofplexiglas, sizeanddistance fortheL&S group doesnotinvolvealtitudes ashigh
illusions and motionsickness. All undergradu as that for the TTB group.

14
 The U.S. Army School of Aviation Medicine at all used for recurrent training, but the amount of
FortRucker, Alabama does flight physiology train coverage is left to the instructor to determine ac
ing for Army fixed and rotary wing pilots, foreign cording to the amount of time he has available.
militarystudents,U.S. Air Force rotary wing pilots,
and EURO/NATO rotary wing pilots. They process Altitude chamber rides are required for all Navy
about 8,000 pilots per yearandhave the anecdotal crewmembers in initialtraining,but not for helicop
reputation ofgiving thebesttraining available. The ter pilots thereafter. Recurrent training takes place
academic subject matter covered is basically the every four years or with eachnew operational tour
same as that covered by the Air Force, and the ofduty, whicheveris less.The Navy altitude cham
interval for recurrent is the same, three years. The ber ride involves altitudes lower than the otiier two
Army providesthe same threechamberridesasthe services.The Navy currentlyis usingwhatthey term
U.S. Air Force to Initial Entry Rotary Wing Air "SneakyPete"runs. The chamberstarts at8,000 feet
Force pilots which include a high-altitude rapid and pressure is bled off slowly to not more than
decompression and altitudes to 43,000 feet One 25,000 feet to demonstrate the effects of a slow
difference in the instruction is the altitude chamber aircraft pressure leak.This provides a good demon
training. The Army training uses 25,000 feet to stration of the effects of hypoxia but doesn't stress
demonstrate hypoxia and 18,000 feet to illustrate the body asmuch asthe high-altitude chamberruns.
night vision problems. The Navy is considering a feasibility study to assess
the use of mixed gases in lieu of altitude chamber
The U.S. Navy changed their physiology pro flights in response to a 1989 Naval AviationPhysi
gram about eight years ago. From the information ologyProgram Review.AccordingtoaNavyspokes
given us during telephone conversations with the man, the mixed gases could be used in simulators
Navy, and from the lesson plans submittedto us, it and would allow recurrent training throughout the
appears thattheirprogram usesmoreofa"shotgun" fleet without the use of altitude chambers. The
approach (according to their spokesman) than the thought is to give indoctrination, and perhaps the
Air Force and the Army. They cover more subjects first recurrent, in the altitude chamber, and any
in broader detail. Lessons on the following topics further trainingwould use inertgasesto providethe
are given in indoctrination: hypoxic effects. We have been told thatthis is only
aconsideration and not anofficial position. Accord
Hypoxia. ing to the Navy spokesman with whom we talked,
the U.S. Air Force and the Canadian services inves
Hyperventilation, trappedgases, and decom tigatedthe use of gasesanddecidednot to pursueit.
pression sickness. According to an Air Force spokesman "the Air
Force evaluated a proposal to use mixed gases to
Stress. produce hypoxia at ground level and rejected the
proposal on the basisofrisk to the student difficulty
Self-imposed stress. in ensuring quality control of the gas mix, lack of
realistic training, and negative training outcome."
Spatial orientation.
One other change in Navy training includes the
Visual problems. introduction of cockpit resource management. Its
inclusionis being urgedby a formerNavy flier, now
Night vision, including spatial orientation a civilian and experimental psychologist.
demo.
In investigating the other sources oftraining and
Acceleration and force fields. depth oftraining provided in other areasof aviation
besidesthe airlines, it seems obviousthatthe great
Oxygen equipment est amountoftraining is being done in the military.
While a good deal of the academic training they
Altitude chamber brief. provide is not directly related to altitude, they feel
the other subjects have sufficient importance to
Other subjects included in indoctrination deal warrant inclusion in initial indoctrination and recur
withsurvival, ejection seats, egress training, etc.but rent training. The subjects they include in their
haveno pertinence forthisstudy.These subjects are curricula and the emphasis placed on them and

15
exposure to an altitude chamber might serve as a training at least once every five years.
model for a core curriculum for flight physiology
training in the civilian sector. We found evidence to support the addition of
altitude chamber flights to mandated training (see
8. EXPERT OPINION PAPER REVIEW SUMMARY). The interval between recurrent train
ing periods is not a subjecton which many agree.
The ExpertOpinionPaperpresented in Appendix Mr. Vogel indicated that the Air Force School of
A represents the views of a retired USAF fighter Aviation Medicine may be recommending a five-
instructor pilotwell versedin USAF flight physiol year interval between recurrent training sessions.
ogytraining. Joseph L.Vogel iscurrently employed However, the Chief, Aerospace Physiology of the
as an Adjunct Assistant Professor teaching flight Surgeon General's Office of the Air Force states:
physiology in the aviation department of a major "At thistime,theUSAF School ofAerospace Medi
university. The recommendations he made in this cine wouldhavenobasis for recommending achange
paper are listed below with our comments. in trainingfrequency, eithergreaterthanorless than
every three years." The Army recurrent training
It is my recommendation that the basic core interval is the same as the Air Force and the Navy
curriculum be the same for all pilots regardless has an interval of four years. On the subject of
of theirratings orthetypeof equipment theyarc recurrent training in flight physiology, we tend to
flying. agree with themajority and feel thatthreeyears is a
good interval.
We basicallyagreewiththis position.Ourrecom
mendationwould require this forany pilotlikely to All pilotsshouldreceive training andbe ableto
operate above 10,000 feet recognizethatadequatenutritionandgood physi
calconditioningalsoplayasignificant partinthe
All pilots should receive a thorough academic pilot's capability to fly safely.
indoctrination concerning physiological prob
lems that relate to reductions in performance These are also good subjects for inclusion in the
with the onset of a hypoxic conditioa expanded curriculum.

The effects of hypoxia and how they affect each Recommend thatitems beyond the corecurricu
individual should be a required part of the core lum for instrument-rated pilots flying aircraft
curriculum. capable of blind flight would cover spatial dis
orientation, visual illusions, and false sensa
All pilots should receive training about factors tions. Pilotsshould experience disorientation in
that produce performance decrements such as the BaranyChair,the Vertigon or the Vertifuge
stress, sleep deprivation, fatigue, alcohol and wherever possible.
drug use. Smoking, diet, and aging should be a
part of the course. Recognition of those symp Oneexceptiontotheequipmenthypothesiswould
toms, and the corrective actions that must be be the proposed requirement that all flight
taken, should be a centerpoint in the course. instructors be required to take the full academic
and chamber flight curriculum.
These recommended additions to the core cur
riculum arc very similar to our recommendations We agree that the academic subjects mentioned
made in the report summary. Although we recog should be included in the expanded curriculum.
nize that not all of these are altitude-related physi However, we do not feel that exposure to these
ologicalconcerns,they areofsufficient importance subjects should be limited to only instrument pilots
to warrant inclusion in the expanded curriculum. or instructors. A ride in the Barany Chair, the
Vertigon, or the Vertifuge could provide additional
Any person who is to fly any aircraft capable experience; however, the additional expense in
of operating in the Physiological Deficient volved could prove prohibitive for the general pilot
Zone (12,000 to 50,000 feet) or above should population.
be requiredto take a full physiological train
ing course including the altitude chamber Recommend thatcommercialpilotsand airline
"flight" and to continue to receive recurrent transport pilotsberequired totakethe fullcourse

16
 includingthealtitudechamber.theBaranychair, broughtthe matter to public attention in articles in
and rapid decompression. the New York Times in February, 1990. One article
quotedthemaximumallowableannualexposurefor
We recommend that all pilots be required to take nuclearworkers as 500milliremperyear. They went
expanded flight physiology training. We feel that on to quotea draftmemofromthe FAAstatingthat
the addition of altitude chamber training, including flight crews working an Athens-New York route,
arapid decompression, tothatacademic training can with en route times in excess of nine hours and
be supported. As mentioned above, although the altitudes up to 41,000 feet, would accumulate 910
Barany Chaircouldprovide valuable experience, it millirem peryear.While thisisnot representative of
might not be cost effective for many pilots. all flight crews, it is indicative of a problem that
needs further study. To put this somewhat in per
9. ADDITIONAL PHYSIOLOGICAL CON spective, thesamearticlequotedtheNational Coun
CERNS cil on Radiation Protection and Measurements as
recommending to the government that the maxi
There are three subjects not yet addressedin this mum allowable exposure for the general public be
report which fall within the purview of altitude- lowered to 100 millirem per year. Much has still to
related flight physiology. One deals with the FAR be learned about this problem and the long-term
requirements for oxygen use by pilots operating effects involved, and we recommend further study
under Parts 91,121, and 135. Another deals with to accomplish this and to eventually set standards
radiation exposure at high altitudes and high lati for flight crew exposure to radiation. It has been
tudes.The thirddeals with flyingafterscubadiving. suggested thatthe expertise available in the Armed
Forces Radiobiological Research Institute (AFRRI)
FAR91 allows a pilot ofanunpressurized aircraft and the Aerospace Medical Association (ASMA)
to fly between 12,500 and 14,000 feet, for a period could be utilized as research resources.
not to exceed 30 minutes, without using oxygen. For
any flight above 14,000 feet, the pilot must use Scuba diving has become a very popular sport in
oxygen. FARs 121 and 135 differ from this as recent years and is often enjoyed by flight crews on
follows: the 30 minutes allowed without oxygen is layovers in warm climates. Since tiie gases inhaled
between 10,000 and 12,000 feet, and above 12,000 in scuba diving remain in the system for a significant
feet oxygen must be used. For the purposes of period of time, flying soon after scuba diving can
emergency descent ofa pressurized aircraft, Part 91 lead to decompression sickness. We quote from the
states that above 35,000 feet, one pilot must wear Airman's Information Manual:
and use an oxygen mask unless both pilots are at the
controls and have available quick-donning masks. 1. "A pilot or passenger who intends to fly after
Parts 121 and Part 135 require the use of a mask by scuba diving should allow the body sufficient
one pilot above 25,000 feet unless both pilots are at time to rid itself of excess nitrogen absorbed
the controls and have quick-donning masks avail during diving. If not decompression sickness
able. However, Part 135 requires one pilot to wear a due to evolved gas can occur during exposure
mask at all times above 35,000 feet, whereas Parts to low altitude and create a serious in-flight
91 and 121 require one pilot to wear a mask above emergency.
41,000 feet The inequities in the requirements for
pilotsoperatingunderdifferentFARsis puzzling.A 2. The recommended waitingtimebeforeflight-
corporatepilotoperatinga B-727underPart 91 is no to-cabinpressurealtitudesof8,000fect or less
less susceptible to hypoxia than an airline pilot is atleastfourhoursafterdivingwhichhas not
flyingthe same equipment. And, a total incapacita requiredcontrolled ascent(nondecompression
tion leading to an aircraft accident might be no less diving), and at least 24 hours after diving
catastrophic in either case. We recommend that the whichhas requiredcontrolledascent(decom
FARs be revised to reflect a single standard for pressiondivmg).Thewaitmgtimebeforeflight-
oxygen use regardless of whether an aircraft is to-cabin pressure altitudes above 8,000 feet
operated under Part 91,121, or 135. should be at least 24 hours after any scuba
diving."
The subjectof radiation exposure at higheralti
tudes and higher latitudes is a matter of concern to
flight crews. Recent media exposure onthesubject

17
10. SUMMARY amended to reduce the maximum altitude at
which pilots can breathe air towards, and
The first task ofthis report is to determinethe need eventually below, 10,000 ft."
fortraining in altitude-related physiology for aircar
rier and general aviation flight crews. These should These quotes show the concern surrounding the
includerecreational andbusinessPart 91 pilots, Part physicalincapacitation, partial or complete, which
121 and 135 pilots, and flight attendants. To help could occur due to hypoxia at altitudes 4,000 feet
establish thisneed for training wequote thefollowing: and above. This concern is escalated by the follow
ing quote from an article entitled "HYPOXIA: the
Bioastronautics Data Book NASA SP-3006 - unlikely event?" in Flight International, 8 April,
"Visual thresholds have been shown to in 1989:
crease at altitudes above4,000 feet, probably
becauseofthe very highoxygen requirements Dr. AlistairMacMillan, Head ofthe Altitude
of the light-sensing cells in the eye. Impair Division of the Royal Air Force Institute of
ment ofabilityto leam new complex taskshas Aviation Medicine says,"In anactualdecom
been demonstrated at8,000 feet (PB 565mm pression at25,000 ft. (sic)the partial pressure
Hg) (Ledwith and Denison, 1964); impair (of oxygen) drops immediately. The residual
ment ofrecentmemory,judgmentandability oxygen in the bloodstream and lungs is thus
to perform complex calculations are seen at 'dumpedoverboard' immediately, sothebody
altitudes in the neighborhood of 10,000 feet is in a worse position than was previously
(PB 520 mm Hg) (McFarland, 1953)." thought Instead of simply not taking in oxy
gen, the body is actually dumping it. The
According to J. Ernsting, Ph.D.,of the Royal onset ofthe symptoms ofhypoxia is therefore
Air Force Institute of Aviation Medicine, much faster than was previouslythought"
"The most importantsinglehazard of flight at
high altitude is hypoxia." To continue, "The It has been indicated earlier in this report that
results of the studies of the effects of mild there are physiological conditions other than hy
hypoxia upon the performance ofnovel tasks poxia which could lead to incapacitation, e.g., ex
conducted in the last two decades lead to the pansion of gases and gas bubble formation (decom
conclusion that the maximum altitude at which pressionsickness). The inability in pilots andother
pilots should breathe air is 8,000 ft. This flight crewmembers to recognize symptoms ofhy
conclusion is reflected in the United King poxia and other physiological problems could lead
dom by the current Royal Air Force Regula to total incapacitation and potentially fatal aircraft
tions covering the use of oxygen in accidents. This is borneoutby accidentreports from
unpressurised (sic) aircraft. Thus aircraft not a number of sources, including the National Trans
fitted with oxygen equipment are not to be portationSafety Board(NTSB) andAviation Safety
flown above 10,000 feet; where practicable, Reporting System (ASRS). Fortius reason, we feel
they arcnot to be flown above 8,000 ft. These very strongly that training of civilian flight
regulations may be compared with the regula crewmembers, including flight attendants, and gen
tions of the United Kingdom Civil Aviation eral aviation pilots in the subject of flight physiol
Authority which allow pilots of private air ogy is necessary and should be mandated by FAR.
craft to fly for up to 30 min. without oxygen
at altitudes between 3048 and 3962 m (10,000 The addition of altitude chamber flights to that
and 13,000 ft.). The corresponding regula mandated training would seem to be supported by
tions of the United States Federal Aviation the following quote from an article in Aviation,
Agency (sic)(FAA) for the crew of Space and Environmental Medicine by Dr. C.J.
unpressurised private aircraft allow even Brooks ofMaritime Command Headquarters, FMO
greater hypoxia. Thus the minimum standard Halifax, Nova Scotia, Canada.
required by the FAA is that oxygen shall be
used at and above 3657 m (12,000 ft.) but "Loss ofpressurization is an extremely low, but
pilots may fly for 30 min. without oxygen at definite risk to the pilot and passengers, thus
altitudes between 3810 and 4267 m (12,500 aeromedical training with practical demonstra
and 14,000 ft). It is believed that these civil tions in the hypobaric (altitude) chamber for
regulations aretoo lax andthatthey shouldbe aircrew and flight attendants shouldcontinue."

18
 The second task of the reportis to review current • Flying after diving.
trainingpracticesin the industry andacademia. Avia
tion trainingschools have courses ranging from one- • Stress - external and self-imposed.
day recurrent training classes to four-year degree-
conferringcolleges.Mostofthese include flightphysi • Illusions in flight especially those leading to
ology in their subject matter, however briefly. To spatial disorientatioa The ATM says "Illu
provideadditional information in this field, we com sions rank among the most common factors
missionedanexpertopinionpaper(Appendix A). The cited as contributing to fatal aircraft acci
writer is currently teaching flight physiology at a dents."
majoruniversity. He is alsoaretired Air Force fighter
pilot instructor well-versed in USAF flight physiol • Visual problems and night visioa
ogy.
• Acceleration and force fields.
The scheduled airlinesarerequiredby FAR 121 or
135to teach the six subjects listed in the FARs to their • Carbon monoxide poisoning in flight
crews flying above 25,000 feet Reports from airline
trainingpersonnelandcrewmembers indicatethatthe • Human factors, including self-medication,
trainingranges from nonexistent to minimal. smoking, use of drugs and alcohol, fatigue,
nutrition, physical fitness, anddehydration.
Other sourcesof flight physiology training such as
the Civil Aeromedical Institute (CAM!) are used by • Hearing, noise, and vibration.
some coiporate aviation departments for refresher
trainingand are available to others on request As presently written, the FARs reflect dissimilar
requirementsfor pilotsoperatingunderdiffercntParts
The third task ofthis reportis to develop a curricu ofthe FARs. We recommend that the FARs be revised
lum that can be used to provide the training that to reflect asingle standardforoxygen use regardless of
appears tobenecessary. Atpresent theFARs mandate whether an aircraft is operatedunder Part91,121, or
that flight crews operating above 25,000 feet receive 135.Perhaps a common ground could be reachedby
instructionin the following subjects: using the standards currently specified in Part 121 as
a basis for all operations.
• Respiration.
REFERENCES
• Hypoxia
1. Reinhart Richard O., M.D., Thin Air Flight,
• Duration of consciousness without supple Business and Commercial Aviation, January,
mental oxygen at altitude. 1989.

• Gasexpansioa 2. Vogel, Joseph L., AnExpertOpinion Paper On

High-Altitude Physiology Training for Civilian
• Gas bubble formatioa Pilots, Ohio State University, Department of
Aviation, 1990.
• Physicalphenomenaandincidentsofdecom-
pressioa 3. Ernsting, J.PhD., MildHypoxia andthe Useof
Oxygen inFlight, Aviation, Space and Environ
We feel that the use of oxygen equipment both mental Medicine, U.K., May, 1984.
fixed and walk-around, should be added to that list of
altitude-related subjects, and that the mandated alti 4. MacMillan, Alistair, M.D., Hypoxia: The Un-
tude should be lowered to 10,000 feet likety Event?,Fligrt International, April 8,1989.
We also feel that the following subjects addressed 5. Brooks, C.J., M.B. ChB, D.Av. Med., Loss of
bytraining inthemilitaryand bysomecivilian schools Cabin Pressure in Canadian Forces Transport
should beadded tothecurriculum, despite thefact that Aircraft, 1963-1984, Aviation, Space and Envi
they may not be altitude related. Some of these sub ronmental Medicine, Canada, March 1987.
jects arealso addressedin the ATM.

19
APPENDIX A

AN EXPERT OPINION PAPER ON

HIGH-ALTITUDE PHYSIOLOGY TRAINING
FOR CIVILIAN PILOTS
by

Joseph L. Vogel
Adjunct Assistant Professor
The Ohio State University
Departmentof Aviation

TABLE OF CONTENTS

SECTION PACE

INTRODUCTION A-2

CURRENTREGULATORYREQUIREMENTS A-3

CURRENT TRAINING A-3

TEACHING MATERIALS A-4

AIRLINE TRAINING A-5

UNITED STATES AIR FORCE TRAINING A-5

THE NEED FOR TRAINING A-6

RECURRING TRAINING RECOMMENDATIONS A-8

THE CORE CURRICULUM A-8

SUBJECTS TO BE TAUGHT IN ADDITION

TO THOSE DIRECTLY RELATED TO ALTITUDE A-9

EXPANSION OF THE CORE CURRICULUM A-9

RECOMMENDATIONS A-10

COMMENT A-ll

CONCLUSION A-12

BIBLIOGRAPHY A-12

A-l
INTRODUCTION To further exacerbate the shortages, the military
services arc not producing as many pilots as in
The requirement for training in high-altitude previous times and those that do enterthe service are
physiology for civilian pilots has not been a part of faced with lengthened commitments. For instance,
their training curriculum for a number of reasons. in April 1990, the United States Air Forcelength
Basically, throughout aviation history, most civil ened a pilot's service commitment from 8 years to
flying has occurred atthe lower, or relatively physi 10 years after pilot training. The net effect is to slow
ologically-safe altitudes. With the advent of turbo- the movement of military-trained pilots from the
charged equipped aircraft engines mounted on air services to the airlines.
frames that are unpressurized, the need for physi
ological training increased. Even though most civil It is estimated by the Future Airline Pilots Asso
flying still occurs at the lower altitudes, there are ciation (FAPA) that as many as 6000 new airline
specific actionsthatpilotstake before flightthatcan hireswill be neededeach year forthe next 10 years
raisethe effective altitudeoftheirbodiesandsubject to meet the demand. The obvious answer to that
them to the same dangers that occur atmuch higher shortage is that pilots will have to come from civil
altitudes. ian-trained sources. Those sourcesrange from indi
vidual flight instructors operating withone airplane
The lack ofphysiological trainingbecomes more "out of the trunk of a car" to fixed base operators
acute when pilots fly in pressurized aircraft above with Part 141 schools, to the Flight Departments
25,000 feet The insidiouseffects oflack ofoxygen, maintainedas academicinstitutions in leading uni
when pressurization is slowly reduced, such as versities.
would occur with a minor leak in the system or a
less-than-catastrophic failure can cause problems. Even though a pilot may fly aircraft that are
Minor illnesses, impairedjudgement, memory and incapable of climbing above the physiologically-
alertness,andthe effects ofmedications on the body safe altitudes, their need for information and train
andbrainmakes high- altitude flying too dangerous ing concerningphysiologicalphenomenon still ex
for untrained pilots and their passengers. ists. The need fornigh-altitude physiologytraining
for civilian pilots becomes more important as they
When pilots combine their private flying skills begin to take their places flying high-performance
with their business transportation needs and use aircraft With the adventofmore sophisticated gen
their aircraft to meet those needs, it is inevitable that eralaviation aircraftbecoming availableon the used
in order to meet a schedule, arrive at a destination, aircraft market at reasonable prices, the need for
or get home after a meeting, the urge to complete a training becomes even more acute. When the cur-
mission will lead the pilot into a physiologically- rentcropofsingle-engine.pressurized,turbo-charged
unsafe altitude or into conditions for which there has aircraft such as the Piper Malibu become more
been insufficient training or experience. widely used, and the trend toward single-engine
turbo-prop planes such as the TBM 700 come into
Recently, anew trend has taken place in commer wide use, the personal high-altitude-capable gen
cial and airline aviation. Formerly, the airlines and eralaviation aircraftwill be a reality.TBM plansto
many ofthe commercial or corporate operators have sell four ofthese aircraft permonth with the United
relied upon military-trained pilots to fly their air States being the target market
craft These military-trained individuals have had
the benefit of an extensive physiological training The problem ofwhether to requirephysiological
program and have carried that expertise into their training for private pilots should be beyond argu
civilian jobs. Now, with the forced retirement of ment. What can be argued is the type of training to
airline pilots at age 60, and formermilitary pilotsof be requiredand to whom should it be applied. This
the Korean War era reaching that age, a large num paper will primarily address flight physiology as
berof pilots areretiring each year,creatinga strong affected by altitude;however, other aspectsof flight
need fornew pilotsto enterthe field. Airline deregu physiology will be included as suggestions where
lation has resulted in many new airliners being additional training may be required. The goal is to
purchased, new routes being flown by established produce a safe,efficient andcompetentpilot
airlines, and feeder or commuter airlines increasing
their market shareandconsequently, their need for
pilots.

A-2
CURRENT REGULATORY REQUIREMENTS "An applicantfor a privatepilotcertificatemust
have logged ground instruction from an autho
The requirements for physiological training for rized instructor, or must presentevidence show
individuals who aspire to the private pilots license ing that he has satisfactorilycompleted a course
is, at best, minimal. The Federal Aviation Adminis of instruction or home study in at least the
tration (FAA) Private Pilot Practical Test Stan- following areas of aeronautical knowledge ap
<&zr<frbookletfor Airplane single-engine land (FAA- propriateto the categoryof aircraftfor which a
S-8081-1A) is admittedly task oriented. Moreover, rating is sought"
they treat"AEROMEDICAL FACTORS" as 'Task
F." (The last in the lineup) in the preflight prepara The FAR proceeds to outline the aeronautical
tion Area of Operation.The objective of this area is knowledge appropriate to each category of aircraft
that the applicant for a pilot's license: for whichthe rating is sought No mention ofknowl
edge of physiological problems or procedures is
"Exhibits a knowledge ofthe elements related to presented in the outlines.
aeromcdical factors, including the symptoms, ef
fects, and corrective action of - The key words"home study" indicate the lack of
formal education needed to become the pilot of a
(a) hypoxia. high-performance aircraft Persons who are trained
(b) hyperventilatioa under Part 61 of the Federal Aviation Regulations
(c) middle ear and sinus problems. therefore are not considered by the Federal Aviation
(d) spatial disorientatioa Administration to have any need for formal physi
(e) motion sickness. ological training.lt is also important to note that
(f) carbon monoxide poisoning." flight instructors are not required to undergo a
formal school for their profession. There is, in fact,
The objective section goes on to suggest that the no provision in FAR part 61.181 through 61.187
pilot applicant have knowledge of the effects of indicating that an applicant for a flight instructor
alcohol and drugs and their relationship to flight rating must know about physiological subjects.
safety, and the effects during flight of nitrogen
excesses derived from scuba diving. Pilots are responsible for the basic flight informa
tion and ATC procedures for use in the National
CURRENT TRAINING Airspace System (NAS) of the United States. The
Airman's Information Manual (AIM) provides that
(How is Flight Physiology Being Taught in the information, however, it also contains items "...of
Civilian Sector?) interest to pilots concerning health and medical
facts..." but does not make these items mandatory
In orderto accurately portray what flight physiol reading.
ogy subjects are being taught in the civilian sector
and how they are being taught one must first under Chapter 7 of the ATM is entitled, "Medical Facts
stand the types oftraining that can be obtained in the For Pilots" and does address fitness for flight, ef
civilian sector. First all aspirants to pilot and flight fects of altitude, hyperventilation in flight, carbon
instructor certificates and ratings must comply with monoxide poisoning in flight, illusions in flight,
therequirements set forthinFederalAviationRegu vision in flight aerobatic flight and judgement
lation (FAR) Part 61. FAR Part 141 schools must aspects of collision avoidance. All of this takes
comply with somewhat more rigid requirements but place within six pages in a very large manual de
the basic rules are contained in FAR Part 61. It is voted to the "mechanics" of flying.
important to note here that anyone who passes the
appropriate written and flight examinations, and is The Flight Training Handbook, AC 61-21A,
otherwisequalified,mayobtaina pilot's certificate. published by the Department of Transportation,
Furthermore,thatpersonneednothaveattended any Federal Aviation Administration,Flight Standards
formal school, informal classes, or other academi Servicecontainsless than four full pagesof "Aero-
cally-oriented study group to obtain the licenses and medicalFactors." The section on Hypoxiacontains
ratings. According the FAR Part 61.105: two paragraphs. In fact, at four paragraphs, more
space is devoted to hyperventilation than to hy
poxia. Pilotsareremindedhowever, thatthey should

A-3
know more about this subject. To quote from AC 61- actually teach aviation physiology as a separate
21A, "It is the responsibility ofthe pilot to consider course. Only three universities indicated that they
the status of his or her personal health and to be use a textbook. One of them used the USAF pam
informed on aeromedical facts. Advisory Circular phlet on Physiological Training, and two used local
67-2, Medical Handbookfor Pilots, provides much texts. "Local texts" is a euphemism for a locally-
of this information." prepared handout

Advisory Circular 67-2 is a very comprehensive Only one institution in the entire United States,
andeasy to readtreatiseon the physiological factors the University of North Dakota, has an altitude
ofconcern to people who fly. It deals with subjects chamber for human aviation training. The courses
ranging from the physical examination to the flying offered include one for commercial aviators, senior
passenger. In all, the subjects are adequately cov training personnel, and flight attendants who have
ered, however, one criticism is that it does not offer not ever participated in an aerospace physiology
the subject an understanding of how the body is course or an altitude chamber flight. It consists of 18
constructed and therefore whv we behave the way hours of classroom instruction over a three-day
we do when deprived ofoxygen. Knowing these two period and includes two chamber"flights." Another
things, the how and the why adds credence to the course involves regional and corporate pilots and
argument for supplemental oxygen at the higher flight attendants who have never participated in an
altitudes, and provides a convincing argument for aerospace physiology course or altitude chamber
further investigation and training. flight It consists of 13 hours of classroom instruc
tion with two chamber flights and is a two-day
Merely stating that lack of oxygen will cause a program. The third programinvolves general avia
certain set of symptoms and have a probable effect tion pilots and helicopter aviation initial training.
is no substitute for actually experiencing the symp The classroom instruction is covered in six hours
toms and observing the effects of lowered atmo and is completed in one day. A similar program for
spheric pressure.AC 67-2 should be taken for what coiporate and commercial recurrency is available
it is, i.e., an Advisory Circular and not a regulation for pilots who have completed FAA or military
that must be read and obeyed. aerospace physiology training within the past five
years. They receive five hours of instruction in the
AC 67-2 states in Chapter 4, Hypoxia, "Lack of classroom and a hypoxia demonstration flight in the
oxygen is the greatest single dangerto man at high altitude chamber. Since no suitable textbook can be
altitudes, despite the importance of pressure and found for these classes, the instructor relies upon
temperatures." Pilots areexpected to instantly rec handouts that he has authored.
ognize and quickly react to urgent or emergency
situations, so it is necessary that the pilots be aware The Ohio State University Aviation Department
of the threats that face them at various stages of offers a three quarter-hour credit course entitled
flight Incivil aviation, no flight surgeon checks out AVN 414, FlightPhysiology.The objectives ofthe
each pilot before each flight. There is generally no courseareto develop aknowledge andawarenessof
one who acts as a supervisorto check-out the pilot the mechanics of the human body as related to the
before the planned flight In fact there is often very atmosphere on earth and in flight to understand the
little planning taking place before most flights in effects of altitude, lowered atmospheric pressure,
privately owned or rented, civil aviation aircraft. stress, drugs and alcohol, "G" forces, and other
Consequently, itbecomesincreasingly moreimpor phenomenon the body will encounterin flight, and
tant that civil aviators know the physiological con to understand the types anduse of protective equip
sequences ofthe actions that theymaytake, and act ment, survival equipment and techniques, and to
accordingly. relate them to practical situations.The text used is
Physiological AspectsofFlight written by Dr. Rob
TEACHING MATERIALS ert J.Del Vecchio, Ph.D. and handouts developed by
the professor. The book is only partially oriented to
The University Aviation Association recently the pilot and deals in technical detail which is
took a survey of its members to determine which generally unimportant to the average general avia
textbooks are being used for the courses thattheir tion pilot Since the University lacks proper facili
membercolleges and universities teach. No infor ties, no altitude chamber flight is offered; however,
mationwasavailable concerning how many schools participation in an altitude chamber flight spon-

A-4
sored by the FAA at nearby Wright Patterson Air were not due to enemy action. Consequently, the
Force Base is greatly encouraged. first Chief Surgeon of the Aviation Section of the
Signal Corps, U. S. Army, one Lt Col Theodore
Middle Tennessee State University was another Charles Lyster, recommended that a researchboard
school that responded to the University Aviation be established to investigate all of the conditions
Association survey. They use a locally-formulated that affected the physical efficiency of pilots, to
text carry out tests and experiments and to "provide
suitable apparatus for the supply of oxygen." A
AIRLINE TRAINING research laboratory was established and it gradually
became a training academy for flight surgeons. By
Typically, the airlines, when training their pilots 1922, it had become the School of Aviation Medi
either as new hires or for recurrent training do not cine.
address physiological problems. For most airlines,
pilots who come to their "schoolhouse" are ex The School of Aviation Medicine was originally
pected to be fully qualified for flight The basic intended to be a placewhere pure researchprograms
assumption is that they have received all of the on the effects of flying at altitude were to be carried
training necessary to make them safe, efficient pi out. In fact, in the beginning, Dr. Lyster and his
lots who only need to be trained in the type of associates were charged only with examining pilot
equipment to which they are to be assigned. The recruits. Lyster had more in mind than examining
training they receive depends upon the type of centers. He wanted to establish a semi-independent
equipment they will be flying and is basically com medical service, modeled after the British "Care of
posed of aircraft systems such as hydraulic, electri the Flyer" service with specially-trained doctors
cal, pneumatic, pressurization, heating and cooling, attached to flying units in the field. They were to go
and other mechanical systems. beyond the basic conditions of the pilot's health to
discover the conditions that had influence over the
AtUS Air, anofficial noted that for initialtraining capabilities of the persons who were flying.
(new hires) approximately 65% of the class time
was devoted to systems and the remaining 35% was A Medical Research Board was established on
devoted to FAA-mandated training which includes October 18,1917. They were to report to Colonel
security, defense against hijacking and other related Lyster who had been appointed as Chief Surgeon of
subjects. A query to an American Airlines pilot the Aviation Section, Army Signal Corps a little
brought the response, "Nothing. I don't remember over a month earlier. Their charter included the
being taught anything about physiological subjects power:
during my training at American." Later queries to
American revealed that civilian-trained pilots are 1.To investigate allconditions which affect the
shown a video tape on physiological training. The efficiency of pilots.
pilot went on to indicate that the emergency masks
were ill-fitting andoften dirty. The one-size-fits-all 2.To instituteandcarryout at flying schoolsor
concept was not optimum in that pilot's mind and it elsewhere, such experiments and tests as will
was further stated that each pilot should have their determine the ability of pilots to fly in high
own insert for the quick-don mask to encourage altitudes.
inspectionbefore flight andtotake awaythe stigma
of inhaling someone else's germs. 3. To carry out experiments and tests, at flying
schoolsorelsewhere, toprovidesuitable appara
UNITED STATES AIR FORCE TRAINING tus for the supply of oxygen to pilots in high
altitudes.
The United States Air Force operates the School
ofAviation Medicine at B rooks Air Force Base near 4. To act as a standingMedical Board for the
San Antonio, Texas. That this school came into considerationofall matters relating tothephysi
existence at all significantlybears on the problem cal fitness of pilots.
this paperaddresses. The development of aviation
medicine took place in part because oftheappalling Inshort, the Board wastoestablish thepractice of
death rate among flying cadets during the First Aviation Medicine (Although that description was
WorldWar.In fact duringWW-I, most airfatalities to come much later) and to do all such things as

A-5
might affect the pilot's health and safety. alternatives, make appropriate decisions and get us
safely on the ground at Wright-Patterson AFB,
In the book, 50 Years ofAerospaceMedicine,by where a recompression chamber would have been
Green Peyton, (page 10) the board had already come available had we needed it.
to some significant conclusions about the forces and
effects that flying had on the human body. Speed, It is significant to note that although a great deal
"G" forces, height optical illusions, spatial disori of progress has been made in aviation technology,
entation, turbulence, and the effects ofatmospheric that is, the ability of general aviation aircraft to fly
pressure on the body all played a part, but to them, higher and faster, and a great deal of advancement
the problem of insufficient oxygen at high altitudes has been made in the equipment that helps people to
was the single most important problem to solve. survive and work at higher and higher altitudes, no
change has been made either in the physiological
Ifone looks at the current United States AirForce makeup of the individual, or in the environment in
curriculum for physiological training, it is easy to which an individual pilot or crew member must
tell that these conclusions are the basis for that operate.
curriculum and that with some minor exceptions,
very little has changed over the years. Oxygen The conclusionthen is that if the problem of
deficiency, with its attendant confusion or loss of oxygen deprivation was discovered in the
consciousness, was believed to be responsible for early 1900s by the military, when their air
many otherwise unexplained accidents in flying. craft were generally only capable of flying
The obvious remedy then, as it is now, is to deter where civil airplanes now fly, it is equally
mine the progressive effects of oxygen starvation important now that civil aviation officials
and to train and equip the pilots to overcome them. take the same course of action as was done
The problem was that equipment for overcoming back then and take steps to protect and edu
the problems had not yet been developed. cate the pilots oftoday.

As a former jet fighter pilot this writer has been THE NEED FOR TRAINING
involved in the use of life support equipment for a
considerable length of time. The inspection, check In this writer's opinion, every pilot needs some
ing, and proper wear of that equipment became physiological training. The extent of that training
second nature as a result of continuous training should be dependent upon the type of equipment
afforded by the Air Force. Because of that in that the individual will be flying, that is, whetherthe
grained respect for the use ofthe equipment and that machine is capable of taking the pilot and passen
second-nature habit of wearing and using it prop gers to altitudes into the upper reaches or above the
erly, I suffered no physiological effects from a physiological zone. In order to understand this con
surprisingly violent incident. I was instructing from cept it is important to know what can happen to the
the back seat of a 2-seat F-100F jet fighter when at body at certain levels.
28,000 feet, the entire canopy completely and ex
plosively separated from the aircraft The gasses The FAA has divided the atmosphere into physi
inside our bodies expanded approximately fivetimes ological divisions. The lower division is known as
theiroriginal volume in less than a second. We were the Physiological Zone and generally goes from sea
fortunate to be below 50,000 feet altitude where this level to about 12,000 feet. The next zone is from
event would have been non-survivable. We were 12,000 feet to about 50,000 feet and is known as the
subjected to the extreme cold temperaturesof high Physiological Deficient Zone. Above that is the
altitude, and were also subjected to violent buffet Partial Space Equivalent Zone and the Total Space
ing, turbulence, and gyrations ofthe aircraft. Equivalent Zone. The latter two are not relevant to
this discussion.
Because I had my equipment on tightly and
securely, had taken the precaution to pre-breath In the physiologicalzone, the body is more or less
100%oxygenfor 30 minutes prior to the incident, adapted. Humans can experience middle ear or
and had not removed my mask thereafter, I suffered trapped gas difficulties, shortness of breath, dizzi
no ill-effectsof nitrogen-induced bends, chokes or ness, or headaches with prolonged exposure or
any symptoms of hypoxia. I was therefore able to exertion. The zone can become dangerous if a pilot
remain in control the aircraft, rationally think ofour choosesto fly whenill, fatigued,underthe influence

A-6
of alcohol or drugs, smoking heavily, or under Many pilots do not know the effects that poor
stress. Significant degradation in performance is nutrition or physical conditioning can have on the
possible after long exposureto the upper reachesof body. I would in particular recommend that each
this zone and when under the influence of one or personwhowishesto become a commercial pilotor
more of the above factors.
an airline transport pilot be exposed to a formal
course of study on flight physiology and take a
It is in the physiological deficient zone that most "flight" in the altitude chamber if they will fly
ofthetroublesdue to oxygendeprivationoccur.The aircraft capable of sustained flightabovethe physi
effectsof illness, drugandalcohol abuse, hangover, ological zone. Private pilots, in my opinion, need
smoking, fatigue and stress are much more pro only to be exposed to the altitude chamber when
nounced. The effects may be insidious and the onset theyplanto upgrade to an aircraft thatis capable of
ofeffectshardlyknownto onewhoisnot trainedand flying above the physiological zone.
hasnotexperienced themincontrolledsituations. It
is this last situation that inclines me to believe Persons wishing to become flight instructors
that some form of physiological training must be should also be exposed to the altitude chamber. The
required for all pilots during their initial train reason why I believe that flight instructors must be
ing.AsI teach physiological training tomycollege exposedto significanttrainingand analtitudecham
students, discuss the subject in informal sessions, ber "flight"is that they are often the first exposure
andspeakto groupsofaviationenthusiasts,I find an to aviation that a non-flyer encounters. They are
amazing lackof understanding on thesubject. Most often thelastinstructorthatthenewly-licensed pilot
comments arc of the "Gee, I never knew that could willencounterbetween the practical flighttest and
happen to me." type. Some even relate one or more the next bi-annual review. Since the bi-annual re
incidents thathad puzzled them during a flight that viewis so nonstructured, it is likelythattheinstruc
wereexplained whentheylearned moreaboutflight tor giving the check will not take the time to include
physiology.
physiological factors inthe review, especially if the
instructors are ignorant of the effects themselves.
Asa resultof myflightphysiology classes, many Consequently, the private pilot has no recurring
young aspiring pilots have applied for the altitude exposure tothephysiological problems anddangers
chamber sessions at nearby Wright-Patterson Air posed when theyleavethe ground. If the emphasis
Force BaseorattheFAAfacility atOklahoma City. were placed on physiological training in order to
Comments from students returning from the train qualify for the commercial or instructor ratings,
ingarealways positive and express how much they those instructors would bemore likely toemphasize
were ableto relate totheacademics thatwere taught that subject during their reviews. The solution is to
in our classes. In fact, most comment that the half-
require certain items to becovered during thebasic
day of academics offered before the chamber ride
course of instruction and at every bi-annualreview
should beused as a refresher because thesubject is and to make physiological factors, relative to the
too broad for a beginner to learn in a session that performance ofthe aircraft to be flown, one ofthose
short.
required items.
The need for exposureto the altitudechamberfor General aviation pilots who will operateaircraft
pilots who have a very small chance to exceed the capable of flying above the physiological zone,
physiological zone is problematical. In lieu of that (12,000 feet) should be required to undergo physi
exposure,
ological training which includes a chamber flight
for their initial certification. My recommendation
I would recommend a very thorough academic for recurringtrainingwouldincludea refreshersuch
indoctrination concerning physiological prob asisgiven atOklahoma City oratany cooperating
lemsthatrelate toperformance decrementwhen AirForce or Navy Base or NASA facility. In the
altitude iscombined with stress, age, sleep dep event thechambertraining is not possible or avail
rivation, fatigue, alcohol, drag use, (either pre able, instruction from a prescribed syllabus (which
scribed ornon-prescription) and smoking. Em will bedetailed laterinthis paper) could begiven by
phasis should also be placed on proper diet aqualified instructorandacheck flight inanaircraft
nutrition and physical conditioning.
capableofflyingabove 25,000 feet could be substi
tuted. This check ride should include a hypoxia
demonstration which would, in an unpressurized

A-7
aircraft include removing the mask and observing 1. The Physics of the Atmosphere:
the symptoms.
Introduce the Physiological Zones:
In apressurized aircraft, the pressurization should
be gradually released so that the insidious nature of PhysiologicalZone, PhysiologicalDeficient
hypoxia is demonstrated. The flight instructor or Zone, Partial Space Equivalent Zone, Total
examiner would remain on oxygen at all times. Space Equivalent Zone.
Flight instructors/examiners would have to be espe
cially certified to perform this hypoxia demonstra The Gas Laws:
tion and would have to be in complete control ofthe
aircraft An additional observerwould have to be on Graham's Law which explains the transfer
board to place the mask on the individual in case ofoxygen into and carbon dioxide and other
they were unable to do so for themselves. gasses out ofthe body, Boyle's Law, which
explains the expansionsof trapped gasses,
RECURRING TRAINING RECOMMENDA middleear andtoothpainswhileclimbingor
TIONS descending; Henry's Law which explains
"evolved gasses" which in turn are the cause
This recurring training should take place every of the bends; Charles' law, explaining the
five years as long as thepilot is flyinghigh-altitude- effects of pressure changes with tempera
capable aircraft There are several reasons for this ture, and Dalton's Law, which explains
recommendation. First ofall, an individual's symp altitude sickness (hypoxic hypoxia).
toms of hypoxia generally remain the same for
lengthy periods of time; however, some symptoms 2. Knowledge of Bodily Functions:
are dominant and others occurwith longerexposure.
The dominance of symptoms changes over time. In order to understand the affects of these
Where one individual may begin to have "tunnel laws on the body, some knowledge of the
vision" as the first symptom early in life, the first working of the body itself must be knowa
symptom may become tingling, and hot and cold Respiration, bothinternalandexternalshould
flashes later in life. The need for constant monitor be examined.The rolethat circulationplays
ing of one's symptoms is apparent. in the onset of hypoxia is important This
would lead to a study of the types of hy
The Director of Aerospace Physiology at the poxia,themethodsofcombattingeachtype,
UniversityofNorth Dakota,Mr. David B. Blumkin and therequirementsforsupplemental oxy
is a Board Certified aviation physiologist and has gen.Sincesymptoms canbe similar, hyper
spent 20 years in the UnitedStates Air Force as an ventilationrecognitionandtreatmentshould
Aviation Physiologist. He recommends recurring alsobeemphasized inthisphaseoftraining.
training every five years.
3. DecompressionSickness:
The current Air Force regulation calls for recur
ring training to be required at three-year intervals. Theeffectsoftrapped andevolvedgasseson
As more experienceis being compiled,and budgets the organsof the body and their effect on
are being squeezed, the School of Aviation Medi pilot performance should be taught The
cine will be recommending a five-year interval sinuses,teeth,joints,bloodstream,andsense
between recurring training sessions. organs areaffected bydecompression sick
ness and those altered states should be thor
THE CORE CURRICULUM oughly examined and explained. The ef
fectsof hypoxiaon vision,especially night
As has been previously stated, the core curricu visionareimportantto the pilot and should
lum for pilots who will not fly aircraft capable of be understood.
rising above 12,000feetwould belessstringent than
those who will fly higher performanceaircraft The 4. Oxygen Equipment:
following topicsshouldbeconsidered theminimum
necessary to be awareof thedangers of flight in the Pilots should know about the types ofoxy-
physiological zone. genequipmentthatarerequiredfordifferent

A-8
 situations in flight A familiarization with 3. Aging:
regulators and masks, equipment checks,
and other general rules is very important The problems of aging on eyesight night
They shouldalsohaveanunderstanding and vision adaptability, loss of hearing,vision,
appreciation for the dangersof storageand muscular coordination, and other factors
useofoxygea Some studyonthedangers of should be taught Older pilots can be ca
toxic gasses andvapors,theirsymptoms and pable of many years of flyingif they often
the emergency actionsthatneed to be taken and faithfully check themselves out forde
when those symptoms are detected is also terioration of skills, learn new material and
important techniques, andcarefully monitortheirper
formance. They shouldalsobe checkedby
5. Drugs, Alcohol and Medication: and consult an Aviation Medical Examiner
(AME) when in doubtabouttheircapabili
The effects of drugs, both prescription and ties. The time to quit flying voluntarily
non-prescription, arenot well known in the should be one topic ofdiscussioa
general aviationcommunity especiallywhen
relatedto flying evenin the lower reaches of EXPANSION OF THE CORE CURRICULUM
the physiological zone. Some study should
be related to the kindsofdrugs andmedica Forthose crewmemberswho will be flying in the
tions that cjn. be safely used by the pilot physiological deficient zone, additional problems
Often, pilots self-medicate or do not see a can be encountered andtraining should be enhanced
flight-qualified physician forfearofground to be ableto cope with those problems. Although it
ing.Some medicationshavebeen provedto is not astated requirement, aninstrumentrating is a
be safe for flightandthose shouldbe known practical necessity when flying high performance
to the flier. The dangers of combining two aircraft at or above 18,000 feet The stresses of
different prescriptions should also be em flying under instrument conditions can cause the
phasized. body to use oxygen at a higher rate.

SUBJECTS TO BE TAUGHTIN ADDITION TO 1. Time of Useful Consciousness (TUC):

THOSEDERECTLYRELATEDTO ALTITUDE
Stressthe rapidity ofonsetofhypoxiawhen
1. The Effects of Stress: rapid or explosive decompression takes
place. Teach the causes and problems of
All pilots should have an appreciation for shortened TUC andtheways pilots may be
the effects of stress whether it is self-im preparedto deal with them.
posedby theuse ofillicitdrugsoralcohol or
externally-imposed by associates, family It is in this regime thatphysiological prob
members, financial difficulties, and other lems take placerapidly. In fact at around
causes. Stress can significantly lowerjob 20,000 feet the Time ofUseful Conscious
performance, memory, concentration, and ness (TUC) is approximately 30 minutes.
situationalawareness.Pilotsshouldbeaware The TUC shortens as altitude is increased;
ofandmakeallowances forlowered perfor for instance, at 25,000 feet the TUC is
mance.. reduced to three to five minutes. Time of
Useful Consciousness is defined as that
2. Spatial Disorientation: length oftime within which an individual is
able to effectively or adequately perform
The problemsofspatial disorientation reach flight duties with aninsufficient supply of
far beyond those encountered during instru oxygea
ment flight In fact many fatal accidents
have been attributed to "pilot's loss ofcon Factors affecting those times include the
trol" when visual references have been lost rate ofascent withthemorerapid theascent
Being aware of the problem and taking the shorter the TUC becomes. The most
corrective action such asa 180-degree turn dangerous form of ascent occurs when a
foranon-instrumentedpQot shouldbetaught rapid decompression takes place. Inapres-

A-9
 surized aircraft, the loss of a window, or flown.
door, or some similar large portion of the
pressure vessel causes the occupants to be It is my recommendation that the basic core
raised from a nominal pressure altitude in curriculum be the same forall pilots regardless
side the cabin of6,000 to 8,000 feet to actual of their ratings or the type ofequipment they
flight altitude in a few seconds. Typically, if are flying.
the aircraft is flying above 25,000 feet this
can cut down the TUC to somewhere be The effects of lack of oxygen are insidious
tween 30 and 60 seconds. Physicalactivity whether it is caused by unprotected high-
and day-to-day factors such as diet rest, altitude flying, or by carbonmonoxide from a
drugs, smoking, and illness also tend to leaking exhaust system. Either condition can
shortenTUC. Pilots flying aircraft capable lead to the same result When an untrained
of reaching critical altitudes must be made pilotencountersthese symptoms, which often
aware of these factors. appearto be similar, they may not be recog
nized, therefore,no correctiveactionmaytake
2. Survival and Post-Crash Actions: place.Pilotsmust know the limitationsoftheir
bodies and know how to cope with oxygen
Aids to survival including care and testing deprivation situations.
ofemergencylocatorbeacons, firstaidkits,
basic survival equipment and terrain-spe All pilots should receiveathoroughacademic
cific equipment should become familiar to indoctrinationconcemingphysiological prob
the pilot Pilotsshould know basic firstaid, lems that relateto reductions in performance
evacuationtechniques.signalling.radiotech- with the onset of a hypoxic condition.
niques, and self-help ideas.
All pilotsshouldreceivetraining aboutfactors
Some studyofthe actionsthatmustbe taken that produceperformancedecrements such as
in orderto survive in a post-crashsituation stress,sleep deprivation, fatigue, alcohol and
would be highly recommended although druguse. Smoking, diet and agingshouldbe
not mandatory. The subject matter should a part of the course. Recognition of those
be slantedtowardthe type ofequipment that symptoms,andtheconnective actionsthatmust
the pilotswould be flying. In caseof a pilot be taken should be acenterpointin the course.
flying a personal aircraft with few passen
gers, small-scale escape and evacuation, Performance degradation, and the attendant
post-crash trauma, first aid, andall-terrain, problems related to it while flyingeven alow-
all-weather survival techniques should be performance aircraft can lead to a fatality.
subjects ofthe course. NTSB reports show where pilots have lost
control of the aircraft during all phases of
With larger aircraft such asairliners, emer flight for no apparent reasoa Toxicological
gencyevacuation, fire and smokedisorien reports range from drugs andalcoholtocarbon
tation, passenger safety and survival, and monoxide poisoning. With education, pilots
other factors relatingto the carriage oflarge would be more incluied to take their physical
numbers of people should be taught. condition into consideration during the pre-
Overwater techniques, ditching, and sur flight phase of the missioa
vival atseaareadditionalsubjects forrecur
ring training. Any person who is to fly any aircraft ca
pableof operatingin the Physiological De
RECOMMENDATIONS ficient Zone or above should be required to
take a full physiological training course
Basic recommendations have already been made includingthealtitudechamber"flight"and
andjustifiedin various sections of this paper. How to continue to receive recurrent training at
ever, whathasnot beendirectly addressedis whether least once every five years.
flight physiology training should differ for general
aviation, corporate, or airline pilots or should it be Aircraft incommoncorporate usetodayoften
addressed only on the basis of the type of aircraft exceed 40,000 feet and many, including the

A-10
latest Learjets, are certified for flight above • Recommend that items beyond the core cur
50,000 feet In order to maintain an adequate riculum for instrument-rated pilots flying air
cabin pressure altitude, the pressuredifferen craft capable ofblind flight would cover spa
tial,that is the difference betweenthe pressure tial disorientation, visual illusions, and false
of the air compressed within the pressure sensations. Pilotsshouldexperiencedisorien
vessel of an aircraft and the outside air, is tationin the Barany Chair, theVertigonorthe
approaching 10 poundspersquare inch(psi). Vertifuge whereverpossible.
Non-survivabledecompression is defined as
one in which the pressure differential loss of One exception to the equipment hypothesis
10 psi occurswithin one second. At that rate, would be the proposed requirement that all
the alveoli (small sacs within the lungs that flight instructors be required to take the full
transferoxygen to the blood andcarbon diox academicandchamber flightcurriculum.The
ide from the blood) will rupture. Survival is purposeofthisaction istomakeflightinstruc-
impossible once this occurs. tors intimately familiar with the hazards of
flight intophysiologically-dangerous regimes
The supersonic Concorde usesa 10psidiffer andto havethem be knowledgeable in passing
entialbut it hasadoor ofthe inverted plugtype along this infonnationto theirstudents. Since
which is impossible to open under pressure studentsandprivate pilotsarecapableofblun-
and more importantly, it has very small win deringintodangerous physiologicalsituations,
dows and a largesupply of pressurization air. the trained instructor can alert them to the
Smallcorporateaircrafthavebiggerwindows, hazards and warn them, with some authority,
asmallercabinspaceandlowerpressure flows. not to venture into that realm.
Private aircraft such as the CessnaP-210 have
even larger windows, an even smaller cabin • Recommend that commercial pilots and air-
area and a low flow pressurization system. linetransport pilotsbe required to takethe full
Although they generally fly at farlower pres course including the altitude chamber, the
sure differentials, the rapidity of decompres Baranychair, and rapid decompressioa
sion could easily be less than one second.
The recommendation that commercial pilots
All pilots should receive trainingandbe able andairline transport pilotsbe required to take
to recognize that adequate nutritionandgood the fullcourse including the altitudechamber
physical conditioningalso play a significant is that they will most likely be called upon to
partin the pilot's capabilityto fly safely. fly higher performance aircraft capable of
reaching dangerous altitudes. If they arenot
In my experience as a professor of aviation assigned to fly aircraft capable of reaching
physiology teaching students who hold rat critical altitudes, altitude chamber training
ingsup to andincludingthe AirlineTransport should be made optional. Commercial pilots
Pilotrating, an alarming lack of appreciation andairline transport pilotswill alsobe respon
for the effects ofhypoglycemia, or low blood sible forthe lives ofother personswho pay for
sugar is exhibited. Symptoms can be very theirflightsandwho dependuponthem to care
similar to hypoxia but cannot be cured by for their well-being in flight
supplemental oxygea Symptoms are aggra
vated by flying at higher altitudes and under COMMENT
stress situations. Prevention is therefore the
best cure. Only through participationincourse It is awell-publicized factin the aviation commu
work that stresses these points can accidents nity that eight out often accidents involving fatali
caused by this condition be remedied. ties arecaused by pilot factors or operator error. At
this writing, accurate statistics are not available
Beyond that however, additional items and detailing how many of those operator error acci
whether or not an altitude chamber flight dents can be attributed to physiological causes.
would be required would depend upon what However, in discussing the subject with individuals
the capabilities areofthe aircraft thatthe pilot in the National Transportation Safety Board, the
would be flying. Department ofTransportation, andthe United States
Air Force, it becomes apparent that significant

A-ll
amounts of accidents occurred with physiological BIBLIOGRAPHY
or psychological factors as either the primary or a
contributing cause. HIGH-ALTITUDE PHYSIOLOGY TRAINING
FOR CIVILIAN PILOTS
It is also a well-known fact in the aviation com
munity that timely, accurate, and recurrent training Books and Pamphlets
is the best method available to prevent mishaps.
Another well-known fact is that usually, training is Payton, Green, "Fifty Years of Aviation Medi
not mandated until some significant accident has cine," Brooks Air Force Base, Texas, AFSC
occurred to shock regulatory agencies into action. Historical Publications Series No. 67-180,
This is one significant area where a precedent has
1968.
already been set by aviation authorities in the mili
tary services. Over the past two decades, military
Physiological Training, Tulsa, Oklahoma,Pam
accidents as a function offlying hours (withone year
as a notable exception) has continued to decline. phlet U. S. Department of Transportation,
Training of pilots has intensified during those years Civil Aeromedical Institute, Aiiman Educa
in all phases of flight as money to do so has been tion Section, 1988.
made available in significant amounts.
Alcohol andFlying, Washington, D. C.Pamphlet
According to officials of the School of Aviation U. S. Government Printing Office, Aviation
Medicine, only one accident in the history ofthe Air Medical Education Series #5,1967.
Force has ever been attributed to the use ofdrugs. Of
course, service pilots are admittedly the cream ofthe Oxygen and the Potent Pint Washington, D. C,
crop, with a great deal of elimination taking place Pamphlet Federal Aviation Administration,
throughout the training environment However, as Office of Aviation Medicine, 1971.
one doctor noted in an interview, "We still represent
the population of the United States and we still will IFR VFR Either Way Disorientation Can Be
have some pilot who will use drugs." Training and Fatal, Washington, D.C., Pamphlet Federal
the threat of enforcement has kept that usage to a Aviation Administration, Office of Aviation
manageable minimum. Medicine, 1953.

The private sector cannot hope to duplicate that Del Vecchio, Robert J, PhD., "Physiological
record but by addressing the problems of physi Aspects of Flight" Commack, NY, Rodel
ological training before serious accidents begin to Press, 1985.
occur, by implementing adequate training programs,
and by anticipating those training needs, physi Ehret,Dr.CharlesF„ and Scanlon,Lynne Waller,
ologically-related accidents can be eliminated be "Overcoming Jet Lag," New York, NY,
fore they happen.
Berkley Books, 1985.
CONCLUSION
Wiseman,John,"SurviveSafelyAnywhere,"New
York, NY, Crown Publishers, Inc., 1986.
In this expert opinion paper, I have provided a
few suggestions for curriculumand training needs.
I have also attempted to provide justification for HypoxiaandPerformanceDecrementOklahoma
each of those ideas. The task does not end here. It is City, Civil Aeromedical Institute Pamphlet,
now the job of the regulators and policymakers to ReportNo. 66-15,1966.
take these suggestionsand mold them into effective
additions to the Federal Aviation Regulations so Age,Altitude, andWorkload Effectson Complex
that people in the field can implementthem. It will Performance, Oklahoma Gty, Civil Aero
take the cooperationof all of the segmentsof avia medicalInstitutePamphlet Report No. FAA-
tionacting inconcerttoprovidetheindustry withthe AM-83-15,1983.
numbers of safe, intelligent, trained, and experi
enced pilots that will be needed in the next decade.
I hope that my part is significantin this endeavor.

A-12
The Effects of Age, Sleep Deprivation, and Alti Flight Training Handbook, Washington, D. C,
tude on Complex Performance, Oklahoma Federal Aviation Administration, AC61 -21 A,
City, Civil Aeromedical Institute Pamphlet Revised 1980.
FAA-AM-85-, 1985,
FAR-AIM, Federal Aviation Regulations, Se
Some Effects of Smoking Withdrawal on Com attle,WA, Reprintedby Aviation Supplies &
plex Performance and Physiological Re Academics, Inc., 1990.
sponses. Oklahoma City, Civil Aeromedical
Institute, FAA-AM-83-4,1983. Kerschner, William K., "The Flight Instructor's
Manual," Ames, Iowa, Iowa State University
Age, Alcohol, and Simulated Altitude: Effects on Press, Second Edition, 1981.
Performanceand BreathalyzerScores, Okla
homaCity, Civil Aeromedical Institute, DOT/ Harding, Richard M., and Mills, John F., "Avia
FAA/AM-88/2,1988. tion Medicine," London, British Medical As
sociation, 1988.
Biological Rhythms and Rotating Shift Work,
Washington, D. C. Office of Aviation Medi The Human Body, World Book Encyclopedia,
cine Pamphlet DOT/FAA/AM-86-2,1986. Chicago, Field Enterprises Educational Cor
Effects of Decompression on Operator Perfor poration, Volume 9,1968.
mance, Oklahoma City, Civil Aeromedical
Research Institute, Report No. 66-10.1966. Hehs, Eric A., 'Fast Dreams, Loss ofConscious
ness Researchatthe Naval Air Development
Spatial Disorientation in GeneralAviation Acci Center," General Dynamics CodeOne,April
dents, Washington, D. C, Office of Aviation 1990.
Medicine Pamphlet FAA-AM-78-13,1978.

Physiology of Flight Washington, D. C, Air

Force Pamphlet 160-10-4,United States Air
Force, 1961.

Physiological Training, Washington, D. C, Air

R)rcePampMetl6X)-5,UratedStotesAirForce,
1976.

Medical Handbook forPilots, Washington, D. C.

Federal Aviation Administration Pamphlet
AC 67-2,1974.

InflightAircrewIncapacitation, AReportbyTimo-
thy J. McCormick, Major, USAF, MC, FS.,
School of Aviation Medicine, Brooks AFB,
Texas, 1989.

Spatial Disorientation in Flight Brooks AFB,

Texas, USAF SchoolofAerospace Medicine
Pamphlet USAFSAM-TR-85-31,1986.

Private Pilot Practical Test Standards, Washing

ton, D. C, Federal Aviation Administration,
FAA-S-8081-1A, 1987.

A-13
 APPENDKB

SUMMARY OF ASRS REPORTS

29778—The aircraft sustained a lossof pres crew for improper use of their oxygen masks. FAR
surization. The cabin altitude climbed to 20,000 121.329 (b) (1) specifies: "at cabin pressure alti
feet. The crewfollowed allemergency procedures. tudesabove10,000 feet, up to and including 12,000
The flight attendants werecitedby the reporter for feet oxygen mustbe provided forandused byeach
doinga goodjob. This reporthad manyindications memberof the flight crew on flight deck duty, and
ofgoodcrewcoordinationand flightattendanttrain must be provided for other crewmembers, for that
ing in these procedures. partofthe flight at those altitudes that is ofmore than
30 minutes duration." The flight deck crew donned
30052 — The aircraft experienced a cabin their 02 maskswhenthe cabinaltitude (as opposed
pressure rise to about 13,500 feet, while in cruise to aircraft altitude) went above 12,000feet and after
at FL350. Thepassenger02masks deployed and an 30minutes. Thisisanother example ofnon-compli
emergency descent was made. Control of cabin ance with the FARs.
pressurizationwas regained and, after a fuel check,
the flight climbed back to FL310 and continued to 31372 — The aircraft overshot assigned alti
their destination. Since the masks had already de tude during climb. The F/O was attempting to
ployedtheywerenolongeravailablewithautomatic adjust the pressurization while the Captain was
presentation. TheMinimum Equipment List(MEL) adjusting the fuel flows. The reporter (Captain)
usually states that passenger 02 masks must be stated that he wasn't sure who was flying the air
available for automatic presentation above a speci craft.
fied altitude, suchasFL250. Thisisprobably acase
of noncompliance with FAR 91.30. 31716—While in cruise at FL370, the aircraft
sustained a rapid lossof pressurization which the
30118—The aircraft had to be depressurized crew was unable to control manually. The crew
manually. During this process the crew was dis made an emergency descent During the incident,
tracted and lined up for approach to a runway at a some passengers and a flight attendant received
nearby military base. The mistake was noticed and injuries. The crew elected to land short of their
a side-step approach was made to the correct desti destination for medical attention.
nation.
31745—Thisaircraftwasin descent through
30524—One of the involved aircraft had lost FL350,over mountainous terrain, and sustained
pressurizationand was holding.A second aircraft eithera static discharge or a lightning strike..As
departed a nearby, busyairportand,dueto a trainee a result, their glass cockpit instruments went hay
controller, was cleared through the altitude of the wire, with all alarm signals sounding, and thesys
holding aircraft The trainee was being monitored tem went to standby power. From what instruments
bya recently-certified controller. Theshift supervi they could occasionally read (the instrumentation
sorcaught the error and corrected it with vectors and was intermittent), they lost both engines and the
altitude changes before any conflictcouldarise. cabin pressure. They declared an emergency and
attempted restarts. Both initial restarts overtemped
30535 — The aircraft had a touchy pressur the engines and the crew shut them down. On
izationsystemwhich the FirstOfficer(F/O) was subsequent restarts they eventuallygotbothengines
trying to handle. During the descent the crew got running again atabout 12,000feet and made ahigh,
behind the checklist and the Captain descended fast approach to the airport (During all this a pas
below theircleared altitude with opposite direction, sengerthreatened aflight attendant and the crew had
conflicting traffic. (The aircraft does not have an security meet the aircraft at the gate.)
altitude reminder.)
31958—This aircraft sustained a loss of pres
30855 — The aircraft suffered a loss of pres surization while in cruise at FL350. The crew
surization at FL270. The crew had experienced made an emergency descent and landed short of
problemswith thepressurizationcontrolleron three their destination.
previous legs.TheFAAjumpseat riderviolated the

B-l
 32363—During cruise, at FL370, this aircraft the aircraft. This was because of a short turnaround
lost its right air conditioning pack. The Captain time on the ground for their next flight.
descended to FL250, the single pack altitude for the
aircraft. The crew contacted maintenance and, while 33192 — On climbout from Newark through
performing the recommended procedure, lost the FL240, the crew experienced rapid loss of cabin
left pack. The aircraftdepressurized, the passenger pressure. They tried all the recommended proce
02 masks deployed, and the crew made an emer dures to control cabin pressure manually, then re
gency descentto 13,000feet. While atthataltitude, questedandmadeemergencydescent,and followed
the Flight Engineer (F/E) was able to get the packs emergency procedures.
to operate again andthey continued to theirdestina
tion. 33550 — During climbout the crew experi
enced pressurization problems, got distracted,
32473 — In cruise, at FL370, the pressure and overshot the assigned altitude. They cor
control "Auto Fail" light came on and the system rected the problems andcontinued the flight.
shifted to standby. Cabin pressure continued to
climb and the passenger 02 masks deployed. The 33816 — Shortly after takeoff, the crew no
crew attemptedto reachATC to declare theiremer ticed that the aircraft was not pressurizing and
gencydescent wereunableto,and squawked'7700" the cabin altitude was rising with the aircraft
(the emergencytransponder code)while making an They were experiencing surging of the number 3
emergency descent. At 16,000 feet they regained engine andhadanopen door annunciator light The
control of the pressurization, reestablished contact crew shut down the engine, dumped fuel, and re
with ATC, and continued to their destination. turned to correct the problem.

32476 — During climb, at FL330, aircraft 33970 — While the aircraft was cruising at
pressurization became unmanageable and the FL330, the crew noticed a slow rise in cabin
crew made an emergency descent The F/Ehad set altitude. They were unable to control it manually,
the pressurization systemimproperly, andat power requested a descent and received a descent clear
reduction for the emergency descent, the cabin anceto FL290. They had intermittent communica
altitude ran away and descended at 2,000 feet per tions with ATC, declared an emergency, and con
minute (fpm) from a cabin altitudeof 12,000 feet+ ducted an emergency descent. At 16,500 feet they
to sealevel. A number of passengers complainedof regained control ofcabin altitude and radio contact
ear pain. The reporter felt the F/E (a recycled pilot with ATC. The flightlandedshortofits destination.
over60 years of age) was incompetent and should
not be flying. 34227 — The aircraft cabin altitude was not
descending at the proper rate and the crew was
32827 — The Captain of this flight was flying distracted by the pressurization problem. As a
while suffering from fatigueand recovering from result of the distraction, the crew missed radio
viralpneumonia and,asa result,madeanumber transmissions from ATC and didn't descend at the
of errors. Navigation errors were made as well as propertime.
impropercheckingofthemaintenancelogfomeeded
repairs that were notperformed. Theoverlooking of 34916 — The aircraft had a loud air leak
undone maintenance items created more problems around the Captain's side window and the crew
for the crew on their return flight. The Captainwas was unable to control cabin altitude. They initi
flying when heshould nothave been because of fear ated anemergency descent and landed short of their
of repercussions from the company. destination. The aircraft was ferried unpressurized
to amaintenancebase where it was found to havethe
33149 — This crew did not make their as pressure-sensinghosesbehind theF/E panel hooked
signedcrossing restriction on the arrival route. upbackwards, causing a pressurization leak atone
Theproblems leadinguptothis included fluctuating of the outflow valves.
cabin pressure, emergency lights blinking on and
off, the stall warning sounding for protracted inter 35030—On descent into Houston, at FL360,
vals, and a cross-tie lockout. The crew was dis both air conditioning packs shut down and an
tracted andthe F/O was writingup the maintenance emergency descent was begun. At FL240 both
log at atime when heshould have been monitoring packs came back onthe lineand a normal descent

B-2
wascontinued intoHouston. Theproblem wasdiag 36950 — The flight continued to its destina
nosed as overheatedpacksshuttingdown automati tion after an emergency descent, during which
cally. After they had cooled off, they came back on passenger02 masks were deployed. At one point
the line automatically. during the balance of the trip, flight was conducted
atFL270. The MinimumEquipment List (MEL) for
35417 — On climbout, this crew had no con the airplane specified no flight above FL250 with
trol over pressurization and requested a return out the availability of automatic presentation of
to the airport During theapproach, with theCap passenger 02 masks. The masks could not be pre
tain and the F/E troubleshooting the problem, the sented automatically because they had been de
flying pilot allowed his mind to wander and under ployed in the previous emergency descent This
shot his assignedaltitude.Fortunately therewas no involvesnoncompliance withFAR91.30, regarding
traffic conflict and they were cleared to continue Minimum Equipment Lists, and a lack of knowl
approach and land. edge of MEL requirements.

35579 — The aircraft sustained an explosive 36895— This military transport had a swell
decompression due to thelossofthe First Officer's ing ofa high pressure hydraulic line in the cabin
(F/O) side window at FL230. The F/O received with subsequent leaking. Rather than burst the
minor injury, and 1/2 of his 02 mask was ripped hose and have the fluid spray throughout the cabin,
away and unusable. The Captain made an emer with potential toxic effects on passengers,the crew
gency descent with the F/O doing the checklists, but isolated the system. While dealing with the prob
the Captaindid notuse his 02mask atall. This shows lem, the crew was distracted and overshot their
a lack of training in, and understanding of, the assigned altitude by more than 1,000 feet Since the
effectsofunpressurized flight withoutoxygen, since flight was near its destination, the crew continued at
the usual reaction to such a pressurizationloss is to low altitude without further problems.
don the 02mask.
37284 — Because of distraction discussing a
35883 — At FL200 this aircraft sustained a prior pressurization problem, the crew of this
rapid loss of pressurization, the crew made an aircraft was inattentive and missed an assigned
emergency descent, and landed short of their crossingaltitude. No comment wasmadeby ATC
destination. and no further problems ensued.

35901— This aircraft was unable to pressur 37289 — The crew experienced a pressure
ize the cabin with the engine driven blower. The controller malfunction and were unable to con
crew had been pressurizing with power from the trol the cabin pressure. They asked for and re
auxiliary power unit (APU) to get maximum cool ceived a descentclearance.At FL180 they regained
ing power for the cabin. At this time other equip control of the cabin pressure and continued to their
ment problems occurred with hydraulics and fuel destination at that altitude.
crossfeeding.The crew requestedpriorityhandling,
descended, and discontinued cabin pressurization 37351 — This aircraft overshot its assigned
with the APU. They were able to handle their other altitude in climb because the crew was distracted
problems and continued to their nearby destination by manually controlling the pressurization. The
with priority handling. aircraft is a commuter in service in a high ambient
temperature area, with many legs per day. Since the
36048 — While the aircraft was climbing pressurization does not provide adequate cooling
through FL210,thecabinaltitudeexceededlO,000 automatically, the crews attempt to do it manually.
feetand the cabin altitudewarning horn sounded. The body stresses incurred in eight pressurization
The crewdonned their02 masks andattempted all cycles in a very hot environment are reported as very
recommended procedures to control the cabin alti wearing. The crew, in attempting to alleviate pas
tude (e.g., selected standby; selected manual con senger complaints and increase the comfort level,
trol; closed the outflow valve). They were unable to was distracted and overshot the altitude.
regain control, made an emergency descent, and
returned to the point of departure. They made all 38010 — Crew fatigue and aircraft mechani
prescribed contact with ATC and followed com cal problems led to the crew flying the wrong
pany-operating procedures for the emergency. departure headings. The crew had flown an aver-

B-3
age of 110 hours in each of the prior five months. by the fact that the autopilot was set for altitude
Shortly after takeoff, the pressurization and the captureand level-off anddid not capture.The crew
Captain's intercom failed. In addition, the location wasbusyworkingwiththe pressurizationand didn't
of the aircraft was a known area of radio reception monitor the aircraft progress closely enough.
difficulties with the tower. All of the above and a
misunderstanding on the part of the flying pilot led 40406 — The pressurization was erratic in
to the navigational error. FAR 121.471 (a) (2) al descent, occupying the F/E; the Capt and F/O
lows Part 121 crews to fly 100 hours maximum per were busy interpreting radar echoes and avoid
month; FAR 135.265(a) (2) allows Part 135 crews ing heavy cells; and, the aircraft overshot the
to fly 120 hours maximum per month. From the assigned altitude. The altitude clearance was not
author's experience as an airline pilot 120 hours of the same as usual for that approach profile, the pilots
actual flying in one month, combined with the were "programmed" to continue descent, and they
additionalduty time required to produce those 120 flew through the assigned altitude despite the alti
hours, leads to crews fatigued to the point where tude alert warning.
they start making mistakes. This, combined with
airlines which schedule minimum legal layovers for 40423 — The crew was unable to pressurize
rest, and consecutivemultipleleg days (sometimes the aircraft and elected to proceed from Dallasto
4 to 6 in a row) leads one to believe that FAR Chicago at 10,000feet unpressurized. Becauseof
135.265 hours should be revised downward in the unforecast winds, the flight arrived with 6,000 lbs.
interest of safety. of fuel instead of the planned 9,000 lbs. and had to
requestpriorityhandling from ATC.
38565—Crew missed the crossing altitude for
the STAR they were assigned. The F/O (pilot 40570—On departure the crew experienced
flying) had beentryingto controlthe pressurization problems maintaining cabin pressurization. At
while the Captain was working the radio to get the tention of the crew was diverted from flying the
ATIS and gate assignment Nobody was minding aircraft and they overshot the assigned altitude.
the store. Pressurization was controllable and the flight was
continued.
38570—Shortly after takeoffa rear boarding
door came open and the integral stairs deployed. 40611 —The F/O's windshield began to disin
The flight crew experienced no control problems tegrate while the aircraft was at 16,000 feet on a
and returned to land. One ofthe flight attendants in ferry flight. The Captain directed the crew to put on
the rear unfastened his seat belt and wentto the open 02 masks and goggles, depressurized the aircraft
door to check it out, although his emergency train and slowed. As the windshield continued to delami-
ing and common senseshould have made him aware nate, the Captain sent the F/O back to take a seat in
that was a life-threatening move. The flight hadjust the cabin, declared an emergency, and continued the
begun to pressurize, so the decompression was approach to their destination at reduced speed,
minor, or much worse could have happened. unpressurized.

39749 — The aircraft descended through the 40690 — A pressurization abnormality di

assigned altitude as a result of crew distraction verted the crews attention and the aircraft de
due to pressurization problems. The entire flight scended below the assigned altitude. The pilots
had been made partially pressurized, at 10,000 feet, were warned by the altitude alert and corrected.
due to a tear in the fuselage. The F/E was busy trying
to coordinate the pressurization and power applica 41184 — While cruising at FL350 the cabin
tion with the F/O, who was flying. One item on the altitude warning system activated and the air
"DESCENT" checklist required a dual response craft depressurized. The crew was unable to con
from both pilots and their attention to a bug setting. trol the pressurization and made an emergency de
At this point the pilots' concentration was shifted scent, continuing to their destination at low altitude.
and the overshoot occurred. Upon examination it was found that an anti-ice duct
had broken loose, creating a six-inch hole for the
40389 — An altitude overshoot occurred as escape of cabin pressurized air.
the crew was trying to reset an inoperative cabin
pressure controller.Theproblemwascompounded

B-4
 41846 — The crew leveled the aircraft at the failure of maintenance to reinstalla transponder
FL240 when they were unable to control cabin antenna,whichallowedthepressurization to escape
pressurization.They tried all the alternate meansof through that hole.
control unsuccessfullyand requested an immediate
descent The ATC controllerreplied "standby," at 45195 — While in cruise at FL230 the crew
which time the Captaindeclaredan emergencyand experienced an uncontrollable loss ofcabin pres
made anemergency descent.The aircraft returnedto sure and requested an emergency descent On
the point of departure. passing through FL190 the F/E regained control of
the cabin pressure and the flight continued to its
41936 — The crew was unable to control destination. The crew lauded ATC fortheir immedi
pressurization in descent without power on en ate response and good handling.
gines 1 and 3. As a result,theywereunableto make
the previously issuedcrossingrestrictioa Theydid 45648— While in cruise the master warning
inform the controller and did not receive a very light illuminated, followed by the cabin pressure
satisfactory answer. The reporter was writing to light; the crew performed the emergency check
inform ASRS ofthe problem with the controller as lists and made an emergency descent. During
it related to their mechanical problem. climb, the pressurization had been erratic but con
trollable. A slow duct leak caused the pressureloss
42208—In cruise, at FL310, the cabin altitude and the flight landed short of its destination.
horn sounded and the cabin pressure went to
10,000 feet and stayed there. The crew was unable 45746 — While in climb the crew was unable
tocontrolitfurther,requested anemergency descent to control pressurization. When the cabin altitude
and return to point of departure. At no time did the exceeded 10,000 feet the crew declared an emer
"Auto Fail" light illuminate or the system switch gency and made an emergency descent landing
automaticallyto standby. short of their destinatioa All alternate means of
controlling cabin pressure were tried.
42890—Shortly after arriving at cruise alti
tude, the "Auto Fail" light illuminated. The crew 46814 — During a communication outage,
ran the emergency checklist and made an emer while dodging thunderstorms, the crew lost pres
gency descent. On the descent through FL200 the surization and made an emergency descent An
passenger 02 masksdeployed. The crewcontinued other flight got a new frequency for all, but while
the descent and continued to their destination. trying to make contact this flight experienced the
pressurization loss and declared an emergency.
43540—Passing FL220 in climb the altitude Before contact was regained with ATC, the crew
warning horn sounded, emergency procedures broadcast in the blind for all other aircraft to turn on
were followed, and an emergency descent was their landing lights. Fmdingone aircraft particularly
made. The flight continued at 10,000 feet At the close, they arrested their descent to miss that air
nextstop.maintenancesignedtheitemoffas"fixed." craft. The mechanical problem was subsequently
Despitethis, on the returntrip the aircraftwouldnot found to be an outflow valve so badly contaminated
hold pressure although the cabin did not exceed with sludge that it would not close and allow pres
10,000 feet ofcabin pressure. surization.

43606 — After takeoff the aircraft would not 46855 — This crew initiated an emergency
pressurize anda returnwasmadeto the pointof descent due to uncontrollable cabin pressureand
departure. It was found that a door seal was not landed short of their destination. The problem
seating. The door wasopenedand closedproperly, was found to be bird nesting material blocking a
with the seal seated, and the flight proceeded to its radiorackcoolingvent,not allowingit to close,and
destination. thus venting pressurized air over the side.
43996 — After takeoff from a high altitude
airport, the crew heard a loud pop followed by 47398—The aircraft depressurized at FL280.
erratic pressurization and elected to return to Thereporter felta pressure change in hisears. The
land,overweight They didnotknow what caused Captain checked the Second Officer's (S/O) panel
the problem and chose to return right away rather (the S/O was in the cabin), donned his 02 mask,
thandump fuels first The problem was caused by actuated the speed brakes and began an emergency

B-5
descent, without communicating with the reporter. 49197 _ While in cruise at FL330 the crew
From the Captain's actions, the reporter assumed experienced electrical problems which created
there was a serious problem, donned his 02 mask, fluctuating pressurization problems. In addition,
and alerted the en route Air Traffic Control (ATC) they lost parts of their glass cockpit displays and
centertotheemergency descent.This incidentshows navigation information. To remain VFR and to
a totaldisregard by the Captain of trainingin emer control the cabin pressure they squawked '7700"
gency descent proceduresthat stress crew commu andmadeanemergencydescent Oncecommunica
nication and CRM. tions was regained they received clearance for a
VFR approach to their destination.
47533 — The crew was unable to control the
cabin pressure by any means, donned their O, 49389 — The crew was fatigued from an 11-
masks and made an emergency descent to 3,000 hour day, including bad weather, was trying to
feet The cabin pressure climbedto 15,000 feetand cope with a pressurization problem, and almost
thepassenger 02masks deployed. At 3,000 feet the flew into the ground on an approach. The F/O
packs restarted, the airplane pressurized and anor lookedupjustin timeto seetheimpending disaster,
mal landing was made. After landing, the F/O and took the aircraft away from the Captain, andmade a
the Captain checked with all passengers and none go-around.The aircraftdidmakemomentary ground
expressed healthor injury concerns. contact Due to deteriorating weather the crew di
verted,and they declared an emergency because of
48316—A crew at FL350 on an oceanic route the momentary touchdown.The flightlanded atthe
experienced an uncontrollable cabin depressur- alternate with no problem.
ization.They descended to 10,000 feetand returned
to their point of departure. Seventy-nine of the 50164 — En route, at FL310, the aircraft lost
passenger 02 masks did not deploy automatically, pressurization and made an emergency descent.
nor could the crew deploy them with the cockpit The 02 masks deployed and the flight diverted to
control switch. The passenger 02 masks that did land short of its destination.
deploy wereof thechemical generator type and left
a burning odorin the aircraft whichthe crewcould 53120 — The aircraft departed with a defec
notidentify.Becauseofthisthecrewwore02masks tive door seal. The crew flew at 17,000 feet to their
for the remainderof the flight The crew had never destination and laterrealized the implications ofthe
been exposed to the smell of a deployed chemical doorseallettinggoin flightatthataltitude.They had
generator02mask and didnotknow whatcausedthe beenwarned by themechanic whocheckedthedoor
burning smell. They should have recognized the thatthey should not fly above 10,000 feet Inexpe
smell from exposure to it in initial or recurrent rience and the desire to go led to a potentially
training, asrequired by FAR 121.417 (c)(2) (i) (Q. dangerous situation.

48441 — The crew made a precautionary 54596 — On departure the aircraft would not
descent to 10,000 feet and a return to the point of pressurize and the crew returned to land. They
departure when they were unable to control the were informed by anotheraircraft that it appeared
pressurization.They did not declare anemergency, they hadtwo doorsopen—they subsequently found
but then wondered why the controllers kept asking that both autopressurization doors had failed.They
their intent On checking, maintenance found adoor should have seen this on the warning lights for their
sealthat wasn't seating and anoutflow valve so dirty EICAS. However, they had been taught that the
it wasn't working. The aircraft then departed and EICAS would automatically recall any warning
proceeded to its destination at FL240. lights on shifting to ship's power.That is not thecase
andthey did not see the warninglights forthe doors
48496 — Aircraft experienced pressurization beforetakeoff.The ground schoolhassincechanged
problems while climbing out on departure. The their teaching on that subject and the crew is now
Captain becamesoinvolvedin solvingtheproblem awareof the fact that warning messages have to be
that he didn't monitor the F/O who was flying the manually recalled after certain tests and after shift
airplane. They werenavigatingon the wrongairway ing to ship's power.
and had neglected to reset their altimeters so were
flying at the wrong altitude. Insufficient attention
was being paid to flying the aircraft

B-6
 54751 — This aircraft was dispatched with a on the PA to the passengers and on the radio to the
restriction to a single pack operating altitude of company. As the Captain looked outside he
FL250. Despite this, the Captain operated the misidentified the runway being approached and
aircraft at FL310. The aircraft hadaninoperative called for a go-around. The aircraft was then vec
aircycle machine intherightairconditioning pack. tored for another visual approach. The Captain
Thiswasnoted in the maintenance log, along with* shouldhavebeen payingmore attentionto whatwas
thealtitude restriction. Enroute, aftermanipulating happening with the airplane.
thepackcontrols, theCaptain feltthatthepackwas
operating and requested FL310. He did thisdespite 62685—While in cruise at FL370 this aircraft
theF/Osprotests andtheMELrestriction inthelog. lost pressurization and made a rapid descent.
This is a clear case of noncompliance with FAR The crew was unable to control the pressurization
91.30. manually, but did not declare an emergency. The
cabin altitude never exceeded 12,000 feet and the
55845 — This cargo aircraftwould not pres passenger 02 masks did not deploy. The crew re
surize after takeoffand the crew flew the remain gainedpartial controlleavingFL200,descended to
derofthe flightunpressurized and wearing oxy 12,000 feet and continued to their destination.
gen masks. Later inspectionon the groundshowed
thatanexternalelectricalcompartmentdoorhadnot 62916—In cruise at FL220 this crew heard a
been properly closed after maintenance work and loud noise followed by a rapid decompression,
had not been properly checked by the F/E on pre- made an emergency descent and landed short of
flight The warning light for the door did not come their destination. Inspection for damage in flight
on until well into the flight. indicated a vibration near the number 2 engine.
Inspection on the ground revealed an 8-16 inch tear
56019 — This aircraft lost pressurization at in the fuselage. The NTSB determined the tear was
FL260and made an emergency descent.Thecrew caused by metal fatigue resulting from a manufac
used 02 masks and the passenger 02 masks de turing error.
ployed.The causewasfoundto be a pieceof aircraft
insulation blocking theoutflow valvefrom closing. 63322— When the crew began descent they
lost control of the cabin pressure and made an
58221 — Precautionary engine shutdown in emergency descent. Upon leveling at 11,000 feet
flight caused lossofcabin pressure and a prema they regained control of the cabin pressure and
ture descent The aircraft then proceeded at low landed without incident at theirdestination. Pressur
altitude to its destination. izationhadnot beena problemthroughoutthe flight
and no reason for the anomaly was found.
58293 — Malfunction of the automatic pres
surization control pressurized this aircraft to 64363 — The aircraft lost cabin pressure and
2,000 feet below sea level and caused the crew to the crew made an emergency descent. The crew
return to their point of departure. The crew had been deviating around thunderstorms with en
misread the cabin altimeter as being at 8,000 feet gine and wing anti-ice on. They got annunciator
and attempted to descend the cabin manually. At lights warning them of the pressurization problem
that point they pressurized the cabin for 10,000 feet and tried to correct it They were unable to do so and
below sea level. They misread the cabin altimeterby requested an immediate descent. ATC complied
10,000 feet and were not aware of the proper read rapidly and made it unnecessary for the crew to
ings to indicate a cabin pressurized below sea level. declare an emergency.

60953 — In cruise, at FL310, the crew lost 64705 — Neither air conditioning pack was
pressurization,decIaredanemergency,andmade operating during climb, cabin pressure contin
an emergency descent to 14,000 feet. The crew ued to climb, and the crew returned to land at the
continued to their destination at that altitude. point of departure. During the climb the Flight
62611 — This aircraft lost pressurization on Attendants (F/As) complained of poor ventilation.
climb through 16,000 feet, could not control it A check of the pack indications showed that the
manually, and returned to their point of depar packs were inoperative. On further inspection after
ture. The F/O was flying the aircraft for a visual landing the Start/Arm switches were found to be in
approachandthe Captainwasoutofthelooptalking the Arm position—this cuts out the packs on this

B-7
model of aircraft, and is not the proper position for cabin pressure started to climb. Fatigue was a
takeoff. The crew had not run the checklist care factor, after a long duty day. The crew had readthe
fully. checklistsandresponded correctlytothe pressuriza
tionswitchitemdespiteswitchpositioaThey turned
66870—The crew was unable to stop a cabin the switches on at a lower altitude and continued to
altitude climb and made an emergency descent. their destination.
Despite attempts tocontrol pressurization, thecabin
continued to climb. The passenger O, masks de 70672 — An aircraft suffered a decompres
ployed and during the descent, pressunzation con sion at the beginning of descent. One of the flight
trol was regained. The flight continued to its desti attendants, working in an aft galley,recognizedher
nation at a lower altitude. hypoxicsymptoms,discovered thepassengermasks
had deployed, assisted a small child in going to its
67644 — This report involves a new type of mother, then passedout from lack of oxygen. She
quick-donning crew 02 mask which does not was given supplemental oxygen by another flight
perform as required by the FARs. The harness is attendant and was all right. However, flight atten
designed to inflate away from the mask when the dants are usually trained to don their own masks
mask is removed from its container, and then deflate before assisting others so they will be capable of
for asnugfitafterbeingplaced onthewearer*s head. providing such help. This flight attendant reporter
Instead, most masks tested by the reporterhad the alsobroughtout importantconsiderations concern
harness inflate inside the mask and jam, so as to ing chemical oxygen generators. Considerable heat
require a two-handed operation for donning. FAR and smoke are caused in the generation process.
91.32 (b) (1) (ii) requires that a mask can be taken Reportedly the heat has caused burns to, and the
from its hanger/container, and within five seconds smoke has been inhaled by, crew and passenger
andwith one hand, placedon the face, andbe ready alike. In addition, on assuming bracing positions for
for use. FAR 121.333 (c) (2) has the same require an emergency landing, a problem arises with the
ments and adds: "the certificate holder shall also stowage of the paraphernalia from the seat-back
show that the mask can be put on without disturbing style ofchemicalgenerators (such asin the DC-10).
eyeglasses and without delaying the flight These canisters are also reported as being so hot as
crcwmember from proceeding with his assigned to prevent somepassengers from sittingbackintheir
emergency duties." (It should be noted that on one. seatsandextending theiroxygen tubes farenoughto
occasion we have seen this type of mask demon initiate the sequence for their canister to provide
strated in a cockpit without the reported problem.) oxygen flow. This last problem contravenes FAR
25.1450 (b) (1) that says: "Surface temperature
68363 — This Captaindepleted his 02 supply developed by the generator during operation may
after testingthe regulator in flight and continued not createahazardto the airplane or its occupants."
the flight to his destination with standby 02
bottles in the cockpit. When the F/Oleft thecockpit 70885 — This aircraft had a pressurization
foramoment, the Captain put on his mask andtested problem after starting descent from FL310 and
the regulator.The regulatorstuck open and bled off made an emergency descent Pressurization con
the system. Without thequick-donningmasks avail trol was regained at a lower altitude and the flight
able for use, the crew did not comply with FAR continued to its destination at that altitude.
121.333 and did put themselves and theirpassengers
in potential danger. 73739—While in cruise at FL220 this aircraft
experienced sudden depressurization and made
68673 — The crew was unable to control an emergency descent. The forwarddoor sealblew
pressurization during climb and requested lower out The crew had difficulty advising ATC because
altitude. An emergency was not declared and the of frequency congestion but finally determined that
crew regained control of cabin pressure at a lower no traffic conflict had existed.
altitude. With the concurrence oftheir company, the
crew continued to their destination at the lower 74860 — The aircraft experienced a rapid
altitude. decompression.Thecrewfollowed emergency pro
ceduresandmade a rapid descent aftertransmitting
70236—The crew did not turn on pressuriza in the blind to the center and not receiving a reply.
tion switches and had to make a descent after the The crew did not squawk 7700 (emergency tran-

B-8
spondercode) during descent. The reporterfelt, in fuselage large enough for a man to crawl through.
retrospect, thattrainingshouldincludethenecessity The crew followedemergency training procedures,
to be in contact with ATC prior to descent, or at the made an emergency descent, fought the fire, and did
least to squawk 7700 so as to alert ATC to the need all checklists according to their company proce
to clear other traffic in the area of the descent dures. The first reporter said it took about 10 sec
onds todon his02mask and hefelt confusionduring
81701 —The crewhad a pressurization prob the initial stages of the emergency. Since time of
lem, declared an emergency, and made an emer useful consciousness is measured in seconds at that
gency descent They also suspected they might altitude, he might have approached that lengthof
have an air conditioning fire and requested direct time andfelt theeffects of hypoxia. Both reporters
routing to their destination. ATC was going to felt they had good training to handle singleemer
vector them around military airspace, but after the gency situations.However,they felt that the lack of
crew redeclared the emergency, ATC gave them compounded,multiple-emergencysimulator train
direct routing. The crew felt it should be unneces ingleft them lessprepared to copewith thiscombi
sarytogointolengthy explanations togetexpedited nation of happenings than they would have liked.
handling after declaring an emergency.
87585—An aircraft climbingthrough FL305
82610— The aircraft sustained a partial loss experienced rapid decompression, and cabin
of pressurization and made a descent to regain pressure was lost in about 10 seconds. The aircraft
control. The crew regained control at a lower alti had been written up for previous pressurization
tude and continued to their destination. problems butmaintenance hadbeen unable todupli
cate the problem. Subsequent to this occurrence, a
82612 — After partial loss of cabin pressure largecrackwasfound inthecabinin therightwheel
and deployment of the passenger 02 masks, the well area.This problemhad beenthe subjectof two
crew made a descent. They regained control of previousFAA AirworthinessDirective(AD) notes.
cabin pressure and climbed back to FL270 to con The crew made an emergency descent and ran the
tinue to their destination. There, maintenance cor "EXPLOSIVE DECOMPRESSION" checklist
rected what they thoughtwas the problem, but the
problem recurred onthereturn flight. Nopassengers 88641 — Aircraft sustained a pressurization
were on board on this second flight. loss which the crew could not control and made
an emergency descent. The crew had trouble noti
82754— The aircraft lost partial cabin pres fying ATC because of frequency congestion. When
sure andmade a descent after thepassenger 02 they made contact they were cleared direct to their
masks deployed. After regaining control of the destination at a lower altitude.
cabin, they climbed back to altitude and continued
on. It was not necessary to declare an emergency 89413 — Both air conditioning packs quit
because of good handling by ATC. F/As reported simultaneously while the aircraft was cruising at
that there was no panic amongst the passengers and FL330 and the crew made an emergency descent.
their reaction was good. At 10,000 feet the packs came back into operation
and the crew elected to continue to their destination
84894 — Aircraft in cruise at FL310 had an at 10,000 feet.
uncontrollable loss of pressurization, made an
emergency descent, and returned to its point of 93641 — While cruising at FL330, the crew
departure. There was confusion about the altitude noticed a climb in cabin pressure, could not
cleared to in the descent, but nothing was said by control it manually, made a descent, and re
ATC about going through an assigned altitude. turned to the point of departure. During this, one
Passenger 02 masks did not automatically deploy elderly passenger with a heart problem required
because cabin altitude never got that high. A burned supplemental oxygen. No other problems were en
out outflow valve control motor caused the loss of countered.
pressurization.
94955 — While trouble-shooting a 'tail com
85640—An aircraft in cruise at FL310 expe partment high temp" light, the crew shut down
rienced an engine explosion and rapid decom one pack. The other pack would not maintain
pression. The exploding engine left a hole in the pressure and they made an emergency descent.

B-9
Anemergency wasdeclared and thecrew manually 98080—Uncontrollablecabin pressure caused
deployed thepassenger 02 masks and toldthepas the crew to make an emergency descent An
sengers to use them. The crew diverted to their emergency was declared. Thedescent was notrapid
alternate. A loose duct connection in the tail was the enough to prevent cabin altitude from exceeding
cause of the original problem and exacerbated the 14300 feet and the passenger 02 masks from de
pressure loss. ploying. Theflight landed at itsdestination unpres
surized.
96377—The cabin altitude began to climb, for
no apparent reason, on an aircraft in cruise at 98876 — The flight crew had an uncontrol
FL350. The crew attempted manual control but lable loss of cabin pressure and made an emer
were unsuccessful. They began an emergency de gency descent. Attempts were made to control
scent and were able to control the cabin altitude pressure by alternate means. All emergency proce
when the aircraft reached FL220. The descent was dures were followed. Because of a passenger in
done smoothly enough so that passengers were distress, the flight diverted to a nearby airport.
unaware of it andthe flight continued to itsdestina Mention was specifically made of calm, deliberate
tion at the lower altitude. The following quote from crew performance.
the reporter indicates a high levelof preparedness
and professionalism: "Asfar asI'mconcerned, this
wasjustanotherday inaviation. No big deal, butfelt
it wouldbe wise to inform you of the situationthat
did occur."

97776 — This crew lost pressurization, de

clared an emergency, and made an emergency
descent The problem was with a cargo door seal
that blew out One passenger with a prior heart
problem required medical attention and the flight
landed short of its destination for that reason.

B-10
APPENDIX C

NTSB REPORT SUMMARIES

0488—An in-flight B-707firein 1973resulted - circuit breakerpanel. The use of fire-resistant hy

in 124 fatalities and total destruction of the air draulic fluid andinspection of all hydraulic and02
craft after a successful emergency landing. The lines for leakage was required to prevent recurrence
fire was fed by material from the aircraft interior. in this model aircraft
Therewasa shortage of protective breathing equip
ment (PBE) with full face masks to allow the crew 1636— In 1983, A DC-9 in Cincinnati, Ohio
to fight the fire. The lack of such equipment was had a fire in the left rear lavatory, made an
addressed. emergency landing, and evacuated the aircraft.
The material in the interior of the aircraft continued
0527 — A DC-10 accident in 1973 revealed to bum during the descent and evacuation, and 23
unsafeconditionsin the passenger 02systemand passengers died. The NTSB cited a shortage of
portable02system.Thechemically-generatedpas protective breathingequipment withfull face masks
senger02system had designflaws which resulted in in tiiepassengercabinandthatwasaccessible tothe
poormountingoftheunitsand theconnecting hoses crew. An ensuing amendmentto the FARs required
andmasks. Theportable02systemswerenotreadily protectivebreathingequipmentforall crewmembers.
available to the crew and did not have supply hoses In addition,there is an ongoing study of respiratory
and full face masks attached. The unsafe conditions protection for passengers from toxicenvironments
have since been corrected. during aircraft fires as a result of this accident.

0713—Several rapid decompressions involv 1829A — An in-flight fire on board a

ing DC-lOs and L-lOlls have uncovered prob Singapore-bound L-1011, in 1985,led to the dis
lemswith chemically-generated02 systems. Most covery of malfunctioning passenger 02 system
of the problems have been attributed to a lack of sequencing valves. Some of the 02 masks were
understanding of the systems by both passengers neither automaticallypresentednor were presented
and flight attendants.This Special Studywas issued whenthe system was activatedfrom the engineer's
in 1976, and Air Carrier Operations Bulletins panel. Animmediate Airworthiness Directive (AD)
(ACOBS) were to be issued to improve training, was issued to correct malfunctioning oxygen initia
passenger briefings, and printed instructions on tor sequence timer switches.
these systems.Otherissuessuch as 0. mask design
were still being debated as late as 1988. 1848 _ This 1985 report dealt with the con
cern of the NTSB regarding passenger compre
0864 — A 1977 accident involving a general hension ofsafety briefings and their performance
aviation aircraft led to discovery of a problem oftasks described in safety briefings. These tasks
withsupplemental 02masksfor general aviation include the use of supplemental oxygen and life
aircraft The dilution valve filter dislodged, caus vests, and the opening of emergency exits. This
ing the problem. Tests were done on the particular concern was addressed at a Public Technical Con
type of 0, mask without conclusively demonstrat ference and is still being studied by three working
ing that the problem was a common one. Eleven groups set up as a result of that conference.
years after the accident, there was a Technical
Service Order (TSO) regarding 02 masks in the
Federal Register for public comment If adopted,
this TSO should address the problem.

1619—A Swearingen Metro taxiing for take

offat Hot Springs, AR, in 1983,caught fire in the
cockpit and was gutted. All crew and passengers
safely evacuated. The aircraft used non-fire-resis
tanthydraulic fluidandhadpossible hydraulic leak
age and 02 leakage in the vicinity of the electrical

6ll.S. GOVERNMENT HUNTING OFFICE! tMI • MMUO/40144

C-l
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