Examining Hypoxia: a Survey of Pilots' Experiences and Perspectives on Altitude Training

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Examining Hypoxia: a Survey of Pilots' Experiences and Perspectives on Altitude Training DOT/FAA/AM-03/10 Examining Hypoxia: A Survey Offi ce of Aerospace Medicine of Pilots’ Experiences and Washington, DC 20591 Perspectives on Altitude Training Carla A. Hackworth1 Linda M. Peterson1 Dan G. Jack2 Clara A. Williams1 Blake E. Hodges3 1Civil Aerospace Medical Institute Oklahoma City, OK 73125 2OMNI Corporation Oklahoma City, OK 73125 3Oklahoma City University Oklahoma City, OK 73106 May 2003 Final Report This document is available to the public through the National Technical Information Service, Springfi eld, Virginia 22161. NOTICE This document is disseminated under the sponsorship of the U.S. Department of Transportation in the interest of information exchange. The United States Government assumes no liability for the contents thereof. ������������������������������������ ��������������� ����������������������������� ���������������������������� ����������������� ����������������������� ���������������� �������������������������������������������������������������������������������� ��������� ���������� ��������������������������������� �������������� ������������������������������������������������������������������� ��������������������������������������� ��������������������������������������������� �������������������������������������������������������������������������������� ��������������������������� ������������������������������������������ �������������������������������������������������� ��������������������������� ���������������������������������������� ����������������������������� ��������������������������������������� �������������������������������� ���������������������������� ���������������������������� ��������������������� ������������������������ ����������������������������������������������������������� �������������� �������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������ �������������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������������� ������������������������������������������������� �������������������������������������������������������������������������������������������������������������������������� ��������������������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������������������������������ �������������������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������������� ��������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������������������������������ ������������ �������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������� ��������������� ���������������������������� ����������������������������������������������������� ������������������������������������������������� ������������������������������������������������������ ���������������������������������������� ��������� ����������������������������� ���������������������������������������� �������������������������������������� ������������������ ����������� ������������� ������������� �� � ����������������� �������� ������������������������������������������ i EXAMINING HYPOXIA: A SURVEY OF PILOTS’ EXPERIENCES AND PERSPECTIVES ON ALTITUDE TRAINING Altitude (hypoxic) hypoxia is a physiological concern more procedural errors during descent of a fl ight simu- in the high-altitude aviation environment. Flying at in- lation than pilots breathing sea level concentrations of creasingly higher altitudes is possible due to technologi- oxygen. When considering the onset of hypoxia while cal advances; however, higher altitude fl ight presents the fl ying at night, affected altitudes are much lower, with risk of experiencing hypoxia. Specially designed aircraft 5,000 ft reported to degrade night vision (Harding, 1999; and pressurization systems protect the operator and Mohler, 1966). passenger(s) while traveling at altitudes that would Preventing hypoxia within the aviation environment otherwise be impossible. However, a failure in equip- (i.e., hypoxic hypoxia) has included researching possible ment resulting in a loss of cabin pressure is possible, vulnerabilities (e.g., smoking; Nesthus, Garner, Mills, and the operator(s) must be aware of what to do and & Wise, 1997; Yoneda & Watanabe, 1997), timing what to expect should hypoxia occur in that situation of the progressive complications (e.g., time of useful (Pickard, 2002). consciousness, TUC; Yoneda, Tomoda, Tokumaru, The Federal Aviation Administration (FAA) defi nes Sato, & Watanabe, 2000), and investigating regulatory hypoxia as “a state of oxygen defi ciency in the body suf- requirements including training and education (e.g., fi cient to impair function of the brain and other organs” use of oxygen, Turner & Huntley, 1991; physiological (FAA, 2002a). Hypoxia impairs vision, judgment, motor training, Vogel, 1991; cabin altitude pressures, Ernsting, control, and can result in incapacitation or, in severe cases, 2002; and oxygen mask donning, Marotte, Toure, Clere, death. The effects of hypoxia are visible in most healthy & Vieillefond, 1990). individuals after reaching 10,000 ft (Green et al., 1996). The importance of human factors, including awareness Due to individual differences in susceptibility, hypoxia of fl ight physiology, has been described as essential for may appear at lower altitudes for some (Harding, 1999). fl ying safe (Reinhart, 1999). Indeed, the Code of Federal Generally, the signs and symptoms are subtle and may Regulations (CFR) requires ground training in altitude include rapid breathing, headache, drowsiness, nausea, physiology for pilots operating pressurized aircraft that behavioral changes (e.g., euphoria, irritability), slurred have “a service ceiling or maximum operating altitude, speech, and diminished thinking capacity (FAA, 2002b; whichever is lower, above 25,000 ft MSL” (Title 14 of Pickard, 2002). the CFR Part 61, §61.31(g)(1,2), 2003), although certain A pilot experiencing hypoxia has a limited amount exceptions apply, as noted in 14 CFR 61.31(g)(3). The of time to recognize signs and symptoms, don an oxy- subjects that must be covered in the required ground gen mask, and begin additional emergency procedures, training include the effects, symptoms, and causes of including descent to a lower altitude. The time of use- hypoxia and any other high-altitude sickness; duration of ful consciousness (TUC) ranges from minutes at lower consciousness without supplemental oxygen; and physi- altitudes to seconds at higher altitudes (Pickard, 2002), cal phenomena and incidents of decompression, 14 CFR and it is within this time frame that a pilot must execute 61.31(g)(1)(i-ix). the correct decisions. Advisory Circular (AC) 61-107 (Department of Trans- Numerous individuals have examined factors associated portation, FAA, 2003) discusses the training recommenda- with hypoxia (Bonnon, Noel-Jorand, & Therme, 1995; tions mandated in 14 CFR 61.31. Specifi cally, AC 61-107 Ernsting & Sharp, 1978; Nesthus, Rush, & Wreggit, recommends extending the required ground training to 1997; Reinhart, 1999; Sheffi eld & Heimbach, 1996; all pilots who fl y above 10,000 ft/msl (Chap 1, para.1(a)). Stivalet et al. 2000). Within the aviation environment, Additionally, fl ight physiology training requirements for decrements while performing a well-learned task (e.g., pilots and crewmembers are stated in Title 14 of the CFR maintaining a given air speed) have been reported at Parts 121 and 135. Crewmembers conducting fl ights 12,000 ft, with higher altitudes
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