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8 August, 2003

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Human beings have the remarkable ability to adapt to their environment. The human body continuously makes adjustments for changes in external temperature, acclimates to barometric pressure variations from one habitat to another, compensates for motion in space and postural changes in relation to
gravity, and performs all of these adjustments while meeting changing energy requirements for varying
amounts of physical and mental activity. The human body can adjust to acute and chronic reductions in
its oxygen supply by increasing respiratory rate, chemical changes in the blood, and by increasing the
production of red blood cells. As efficient as it is, however, a complete absence of oxygen will cause
death in approximately five to eight minutes.
In aviation, the demands upon the compensatory mechanisms of the body are numerous and of
considerable magnitude. The environmental changes of greatest physiological significance involved in
flight are: marked changes in barometric pressure, considerable variation in temperature, and movement
at high speed in three dimensions.
Advances in aviation engineering over the past 100 years have resulted in the development of
highly versatile aircraft. Since humans are essentially creatures of the ground, we must learn how to
adjust to the low pressures and temperatures encountered during flight, and the effects of acceleration
on the body. Low visibility, with its associated problems of disorientation, and problems related to the
general physical and mental stress associated with every flight, must also be considered. Humans
cannot operate these machines at full capacity without physical aids, such as a supplemental supply of
oxygen or pressurized cabins for use at altitudes starting as low as 10,000 feet.
We must learn to overcome the handicaps imposed by nature upon an organism adapted for
terrestrial life. In particular, the limiting factors in adjustment of the human body to flight must be appreciated. The extent to which these limiting factors are alleviated by available equipment must be clearly
understood. Indifference, ignorance, and carelessness can nullify the foresight, ingenuity, and effort
involved in supplying the pilot with efficient equipment.
The following booklet will outline some of the important factors regarding the physiological effects
of flight upon the human body, and also describe the devices and procedures that will contribute to the
safety and efficiency of all who fly.

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One of the primary problems of flight related to physiology has to do with the fact that the pressure of
gases in the atmosphere change as we ascend and descend. It is essential that we have an understanding of the gases found in the atmosphere and their effects upon the body. Other factors, such as temperature change, also need to be understood so we can protect ourselves from these potential hazards.
The atmosphere is a gaseous envelope that covers the earth. The boundary of the atmosphere has been
debated for years. While some scientists and physicists set the boundary at 35,000 miles, and a few
biologists at 50,000 feet, most scientist, physicists, and meteorologists agree that a more practical
boundary is around 1,000 nautical miles. Without the atmosphere there would be no life on earth. The
atmosphere provides protection from harmful ultraviolet (UV) rays, cosmic rays, and meteorites. The
atmosphere also protects the earth from extreme temperature variations. It supports animal and plant
life through its gaseous content and provides rain to grow crops.
The atmosphere is a mixture of gases. It is composed primarily of nitrogen (N2) and oxygen (O2).
Because atmospheric gases other than oxygen and nitrogen are so low in percentage they will not
be considered in this discussion. Therefore from this point on, we will consider the atmosphere
to be composed of only oxygen and nitrogen.


Nitrogen (N2)

78.09 %

Major portion of total atmospheric pressure
or weight. Gas is chemically inert in the body
and is simply stored in tissues and cells.

Oxygen (O2)

20.95 %

Essential for animal life. Supports body

metabolism (the catabolic breakdown of
glucose for the production of heat energy).

Argon (A)
Carbon Dioxide (CO2)
Neon (Ne)
Helium (He)
Krypton (Kr)
Hydrogen (H2)
Xenon (Xe)

00.93 %
00.03 %
1.82 X 10-3
5.24 X 10-4
1.14 X 10-4
5.00 X 10-5
8.70 X 10-6

Noble Gas (no bodily function)

End product of metabolism - i.e. waste
Noble Gas (no bodily function)
Noble Gas (no bodily function)
Noble Gas (no bodily function)
(no bodily function)
Noble Gas (no bodily function)

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The gaseous atmosphere surrounding the earth is affected by the gravitational pull of the
Earth. Atmospheric pressure is the combined weight, or force, of all the atmospheric gases exerted at
any given point. In 1924 the U.S. Weather Bureau in conjunction with the Bureau of Standards set
forth the values used in measuring a standard day at sea level. This standard atmospheric pressure can be
expressed in many different forms, depending on the method of measurement.
The various forms of measurement are:



Pounds per
Square Inch (PSI)


Inches of Mercury


Millimeters of Mercury






This is the weight of the atmosphere in

pounds exerted on one square inch

This is the height in inches that a column

of mercury will rise in a vacuum tube when
subjected to the weight of the atmosphere
This is the height in millimeters that a column
of mercury will rise in a vacuum tube when
subjected to the weight of the atmosphere
Often used in scuba diving. At a depth of 33
of sea water the pressure is 2 atmospheres.
Used in Europe and elsewhere to set altimeters

As previously described, the combined weight, or force, of all gases in the atmosphere at any
given point gives us our atmospheric pressure. As you ascend from sea level, the atmospheric
pressure will correspondingly drop. As atmospheric pressure drops, the air becomes less dense.
The primary reason for this phenomenon lies in the kinetic nature of atoms and molecules.
Molecules, especially those of a gas, are highly kinetic, or, in a constant state of motion. As
pressure around the molecules is reduced, the molecules will travel further apart. This explains
why air becomes less dense as altitude increases, thus explaining the phenomenon of gas expansion.

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The envelope of air that surrounds the earth varies in pressure and temperature throughout its
entire height. This is due to differential heating of the air by heat radiated from the earth. The
rays from the sun strike the earth at a very low angle at the poles and almost vertically at the
equator. Thus, more heat is radiated into the air at the equator than at the poles causing the air to
rise higher which can vary the heights of the Troposphere division listed below. All the divisions
of the atmosphere have their own special characteristics that separate them from the others.




Troposphere Sea Level to:

25-30,000 (at poles)
55-65,000 (at equator)

Variable temperature, water vapor, turbulence,

storms, weather, temperature lapse rate


Region of temperature stability that forms the

boundary between the troposphere & stratosphere

Separates Troposphere
and Stratosphere

Stratosphere Tropopause - 160,000

(or about 30 miles)

Relatively constant temperature of -55 degrees

Celsius, little water vapor, jet streams, little


About 160,000

Where steadily increasing temperatures of the

upper Stratosphere begin to drop again



Ionosphere 290,000 - 435 miles


Provides protection from UV rays, gets name from

the ionized gas within this layer (UV rays strip
electrons from gaseous molecules and creates ions)


435 miles - 1000 miles

Gradually becomes the vacuum of space, so little

pressure and density that gaseous molecules rarely


Over 1000 miles


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Divisions of the Atmosphere

1000 Miles

Based on Temperature

435 Miles

290,000 Feet

160,000 Feet



25-30,000 Feet




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Another way to classify divisions of the atmosphere is from the point of view of the
physiological effects on the human body.

Sea Level to

760-523mm/Hg Generally, the body has adapted to
operate in the lower regions of this
zone. Minor trapped gas problems
(ears, sinus, and GI tract.) occur in
the lower region of this zone while
shortness of breath, dizziness,
headaches and fatigue in the upper
region if exposure too long


12,000 - 50,000



50,000- 1000 miles

87-0mm /Hg


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The majority of flying is conducted

in this zone. The lack of atmospheric
pressure causes major physiological
problems: hypoxia and
decompression sickness
This environment is very hostile to
humans. Armstrongs Line is at
63,000 and any unprotected
exposure above this level causes
body fluids to boil. There is a need
for a sealed cabin and thrusters on
the air/space craft.

Divisions of the Atmosphere

Based on Physiology


Armstrongs Line
At 63,000 Feet
Blood boils at 98.6F

63,000 Feet
50,000 Feet

10-12,000 Feet


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A human clothed in everyday street apparel, rapidly exposed to an altitude of 45,000 feet,
would become unconsciousness in 9 - 12 seconds with death following shortly thereafter. The
dangerous element here is the reduced partial pressure of oxygen found at this altitude. Since air
is a mixture of gases, it will behave as such and, therefore, is subject to the laws that govern all
gases. The following laws explain the effects of reduced barometric pressure and its interplay on
the human body.



Daltons Law
PT = P1+ P2+...Pn

The total pressure of a

mixture of gas is equal to
the sum of the partial
pressure of each gas in the

Explains how ascent to altitude
reduces the total atmospheric
pressure as well as each of the
partial pressures associated with
the total atmospheric pressure.

Boyles Law
P1 = V2
P2 V1

A volume of a gas is
inversely proportional to
the pressure to which it is
subjected, temperature
remaining constant

Explains how pressure change allows the
gas to expand and contract in body
cavities (ears, sinuses, and GI tract) with
increasing and decreasing altitude.

Henrys Law
P1 = Al
P2 A2

The amount of gas

dissolved in solution
varies directly with the
pressure of that gas over
the solution.

Explains why nitrogen in the body comes
out of solution forming bubbles that cause
altitude decompression sickness. As altitude
increases, pressure decreases and nitrogen
will attempt to leave the body and equalize
with the surrounding environment. If the
pressure change is too rapid, the excess
nitrogen may form a bubble(s).

Grahams Law
A gas will diffuse from an
Law of gaseous diffusion area of high concentration
to an area of low
Charles Law
P1T2 = P2Tl

The pressure of a gas is

directly proportional to its

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Explains the transfer of gases between the
atmosphere and the lungs, the lungs and
blood, and the blood & the cells of the body
This gas law has no physiological bearing
since body temperature is a constant
98.6 degrees Fahrenheit.

The atmosphere, through its life giving gases coupled with its ability to screen its occupants
from the harmful properties of space (cosmic rays, x-rays, meteors, etc..), helps to ensure life on
earth. Without an atmosphere, there would be no life as we know it. Additionally, the atmosphere, through aviation, provides career opportunity and a source for potential income. With all
its benefits, the atmosphere can be your best friend, but, it can also be a formidable enemy.
Humans are ground dwelling creatures that function best at low altitudes. Anytime humans find
themselves at extreme altitude they are at a disadvantage. Precautions must be taken to curb the
threats of hypoxia, decompression sickness, hypothermia, and spatial disorientation. Appreciate
the atmosphere for what it does for you, but, respect it for what it can do to you.

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The ICAO (1964) International Standard Atmosphere


mm Hg lb/in2
760 14.70
733 14.17
706 13.67
681 13.17
656 12.69
632 12.23
609 11.78
586 11.34
565 10.92
543 10.50
523 10.11
503 9.72
483 9.35
465 8.98
447 8.63
429 8.29
412 7.97
395 7.64
380 7.34
364 7.04
349 6.75
335 6.48
321 6.21
307 5.95
294 5.70
282 5.45
270 5.22
258 4.99
247 4.78
236 4.57
226 4.36
215 4.17
206 3.98
196 3.80
187 3.63
179 3.46
170 3.30
162 3.14
155 3.00
147 2.95

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Degrees C


mm Hg lb/in2
141 2.72
134 2.59
128 2.47
122 2.36
116 2.24
111 2.14
106 2.04
101 1.95
96.0 1.85
91.5 1.77
87.3 1.68
83.2 1.61
79.3 1.53
75.6 1.46
72.1 1.39
68.8 1.32
65.5 1.27
62.4 1.21
59.5 1.15
56.8 1.10
54.1 1.04
42.3 0.828
33.3 0.644
26.2 0.507
20.7 0.401
16.4 0.317
13.0 0.251
10.3 0.199
8.2 0.158
TABLE 6 (continued)

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Degrees C


When the human organism is exposed to the various stressors of aerial flight, (physical and
psychological) all body functions are affected. However, the areas of the body that are affected
most directly are the respiratory and circulatory systems. Therefore, it is important for the individual to be familiar with the actions and limitations of the human respiratory and circulatory

The Concept of Respiration
Respiration is defined as the exchange of gases between the organism and its environment.
The more obvious features of this process are the absorption of oxygen from the atmosphere and
the elimination of carbon dioxide from the body in the lungs. However, respiration in the larger
sense takes place throughout the body as gasses are exchanged between the atmosphere and the
blood in the lungs and then, via the circulatory system, between the blood and the tissues of the
body. We refer to EXTERNAL RESPIRATION when discussing breathing and the gas exchange
within the lungs. When referring to the gas exchange between blood and the tissues of the body
the term INTERNAL RESPIRATION is used.
The respiratory system is made up of the lungs, a series of conducting tubes called the bronchi, the trachea, the mouth, and the nose. Air first enters the nasal passages, or the mouth, where
it is warmed, moisturized, and filtered. It passes down the throat to the trachea and then into the
bronchial tubes and the lungs. Once inside the lungs, the large bronchial tubes will branch 16
times, while getting progressively smaller with each branch. Located at the very end of the 16th
branch are the alveoli (air sacs). These air sacs are very small but are large in quantity. There are
an estimated 300,000 air sacs total. Though each individual air sac is small, if every air sac was
removed from your lungs, and placed on a flat surface in a rectangular fashion, it would occupy a
space equal to half a tennis court. Each air sac is surrounded by a dense network of tiny capillaries. The capillaries are so dense that they actually resemble a sheet of blood around each air sac.
Each air sac is constructed of a very thin membrane that is just one cell (1/50,000th of an inch)
thick. This allows oxygen, as well as other gases, to diffuse across the membrane and into and
out of the capillaries and blood.
Cells in the body require oxygen for the burning of food material to produce energy. This
process, called metabolism, converts glucose (blood sugar) and oxygen into carbon dioxide and
water. The carbon dioxide produced from this reaction must be removed from the body. The
lungs receive oxygen from the atmosphere which then diffuses into the blood. The blood, at the
same time, releases carbon dioxide into the lungs to be exhaled. The oxygen is then transported
by the blood to all cells that are low in oxygen. Once the oxygen is in the cell, and metabolism
has taken place, carbon dioxide then leaves the cell for the blood. Once in the blood, the carbon
dioxide is transported back to the lungs for exhalation.

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Breathing In



Active Phase - Inhalation

Diaphram - Contracted
Chest Cavity - Expands
Air enters to fill void

Vena Cava




Breathing Out

Left Atrium

Left Ventricle
Vena Cava



Passive Phase - Exhalation

Diaphram - Relaxed
Chest Cavity - Contracts
Air in lungs escapes via trachea

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External Respiration
External respiration is the exchange of gasses between the lungs and the surrounding atmosphere. The gas - air - is brought into the lungs through the process of inspiration or breathing
in. Inspiration is accomplished by the constriction several muscle groups: the diaphram and the
chest muscles. The contraction of these muscles causes the chest cavity to expand or increase its
volume. The expansion causes the air pressure in the lungs to be lower than the ambient air
pressure outside the body. therefore, air rushes into the lunghs to equalize the pressure. Inspiration is the active phase of respiration.
Soon after inspiring a fresh lungful of air the diaphram and chest muscles relax and the chest
cavity contracts. This process is called expiration or breathing out. This contraction of the chest
cavity causes the pressure in the lungs to be higher than the ambient air pressure outside the body
and therefore, the air in the lungs escapes. Expiration is the passive phase of breathing.
It is estimated that with every normal breath, you will inhale approximately 13 billion trillion
oxygen molecules. This number is so large that it is difficult to grasp the sheer magnitude of the
amount of molecules that are brought into the lungs. For that reason, the principle of partial
pressure will be used. But, as mentioned before, partial pressure relies solely on the number of
molecules available for gas exchange per unit of volume (density).
The partial pressure of oxygen forces oxygen through the air sacs and into the blood (keep in
mind that gaseous pressure in physiology depends entirely on concentration of molecules). The
partial pressure of oxygen is approximately 20% of the total atmospheric pressure. If at sea level,
this would be about 152mm/Hg of pressure
Sea Level Pressure
Oxygen concentration

= 760 mm/Hg
= 0.20 (20%)
152 mm/Hg = Partial Pressure of Oxygen at Sea Level
102 mm/Hg = Partial Pressure of Oxygen in the Lungs

When a breath is drawn into the lungs, one would expect the partial pressure of oxygen to remain
at 152mm/Hg However, since the gas exchange is going on continuously in the lungs, they
contain other gases that exert a relatively constant pressure which dilutes the expected 152mm/
Hg of oxygen. Water vapor is the largest and represents 47mm/Hg and carbon dioxide represents
40mm/Hg. These gases tend to displace a part of the oxygen as it reaches lung level. Therefore,
these gases reduce the partial pressure of the oxygen at the air sac level down to 102mm/Hg.
Due to the function of Grahams Law which states: An area of high gaseous pressure will
exert force towards an area of low gaseous pressure, this will cause gases to move back and
forth across a gas permeable membrane (such as the air sacs in the alveoli). The high partial
pressure of oxygen (102mm/Hg) now diffuses through the air sac wall and into the blood. This

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Superior Vena Cava

Pulmonary Artery

Pulmonary Valve

Mitral Valve
Intermuscular Septum

Aortic Valve
Right Atrium

Papillary Muscle

Inferior Vena Cava

Left Ventricle

Tricuspid Valve
Right Ventricle

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External Respiration
Gas exchange between the ambient air and the blood in the lungs

Internal Respiration
Gas exchange between the blood and the cells of the body

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in turn, raises the partial pressure oxygen in venous blood (blood that has left the cells and
therefore is low in oxygen) from 40mm/Hg to 102mm/Hg. At the same time this is happening,
the high pressure of carbon dioxide (approximately 47mm/Hg) in the blood will cause some of
the carbon dioxide to diffuse into the air sacs where carbon dioxide pressure is a constant 40mm/Hg.
Internal Respiration
The same principle that applies to external respiration also applies to internal respiration
(the exchange of gases from the blood to the cells). The high partial pressure of oxygen in
arterial blood, causes the oxygen to move from the blood into the cells. Due to metabolism
carbon dioxide is produced in the cells, this high partial pressure of carbon dioxide in the cell
will causes it to diffuse into the blood for transport to the lungs.

The circulatory system is concerned with the transportation of blood throughout the body.
Blood carries food, oxygen, and water to the tissues and waste materials from the tissues. Blood
has the additional function of maintaining body heat.
The segments of the body that comprise the circulatory system are the heart, arteries, veins,
and capillaries.
The heart is a pumping organ capable of forcing blood through the blood vessels as tissue
requirements dictate. The interior of the heart is divided into the right and left halves and each
half has two chambers: an atrium and an ventricle.
The arteries are the vessels that carry oxygenated blood away from the heart. The elastic
walls of the arteries are muscular and strong, permitting the arteries to vary its carrying capacity.
Small arteries connect larger arteries to capillaries.
The capillaries convey blood from the arteries to the veins. They are very small, thin walled,
and usually form a network in the tissues in which the exchange of gases take place. The capillaries are typically only one cell thick and this is where all of the gas exchanges in the body take
The veins are the vessels that carry deoxygenated blood back to the heart. They have thinner
walls and are less elastic than the corresponding sized arteries. When blood enters the veins
from the capillaries it is under low pressure. Therefore, some method is necessary to get blood
back to the heart, especially from the lower regions of the body. The muscles around the veins
produce a milking action of the veins forcing blood back toward the heart. Back flow of blood
is prevented primarily by one-way valves located in veins.

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Composition of the Blood

Blood is made up of two parts, plasma and solids. Approximately 90% of plasma is water,
in which many substances are dissolved or suspended. The solid part of the blood is made up of
the white blood cells and red blood cells.
White blood cells are composed largely of a substance that act as antibodies to assist in the
fighting of disease and infections.
Red blood cells are formed in the bone marrow and there are approximately 35 trillion total
in the body. Each red blood cell is largely made up of a substance called hemoglobin. Each red
blood cell contains approximately 250 million hemoglobin molecules. Each hemoglobin molecule within the red blood cell can carry 4 molecules of oxygen, so each red blood cell can carry
approximately 1 billion oxygen molecules. The secret of hemoglobin is that it contains one atom
of iron (Fe) for every hemoglobin molecule. This gives the blood a chemical attraction for
oxygen as well as its characteristic red color. The red blood cells carry 95% of the oxygen in the
blood while the remainder is dissolved in the plasma.
It can be readily seen that a person who is anemic, for example, does not have enough functioning red blood cells and will begin to suffer the effect of lack of oxygen at a relatively low
altitude. The blood of the average person contains about 15 grams of hemoglobin per 100 ml
(milliliter) of blood. Each gram of hemoglobin is capable of combining with 1.34 ml of oxygen
so the blood could contain 20 ml of oxygen per 100 ml of blood or 20 volumes percent if it were
completely saturated.
Normal arterial saturation is about 95-97% and the oxygen content is 19 volumes percent.
The ability of hemoglobin to take up or release oxygen is not a linear function of the partial
pressure. However, the relationship is well defined and is usually shown in the form of the
oxygen dissociation curve. Venous or return blood has a normal oxygen tension of 40mm/Hg
and contains 14 volume percent of oxygen, and is 65-75 % saturated.

The respiratory and circulatory systems of the human body work very simplistically, yet, very
efficiently. It gives the human body the capability to adjust and function in a variety of environments. However, the body has distinct limitations. If an environmental change is too abrupt, then
the respiratory system may not be capable of adjusting quickly enough and the body will suffer
some deleterious affects. It is important to remember that the magnitude of the environmental
change needed to adversely affect any given person may differ markedly from that needed to
affect some other person. In fact, the magnitude of the change needed to affect any given individual may change from day to day. Know your bodys limitation at altitude and take appropriate
measures to compensate for those limitations.

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This chapter deals with one of our most important physiological problems. One factor that
tends to make hypoxia so dangerous is its insidious onset. Any aviator who flies above 12,000
feet in an unpressurized aircraft without supplemental oxygen is a potential hypoxia case.
Hypoxia is defined as a state of oxygen deficiency in the blood, tissues, and cells sufficient to
cause an impairment of body functions. Anything that impedes the arrival or utilization of oxygen to the cell, places the body in a hypoxic state. There are many conditions that can interrupt
the normal flow of oxygen to the cells. The following table describes the various levels at which
hypoxia can occur:

Hypoxic Hypoxia

Reduced partial pressure of oxygen causes a reduced
amount of oxygen in the blood. A reduced percentage
of oxygen or absence of oxygen in the air can also
cause hypoxic hypoxia

Hypemic Hypoxia

Any condition that interferes with the ability of the

blood to carry oxygen. Causes can be anemia (too
few red blood cells to carry the oxygen), carbon
monoxide poisoning (CO attraction to hemoglobin
is 250 times greater than for oxygen!)


Histotoxic Hypoxia

Any condition which interferes with the normal

utilization of oxygen in the cell. Causes can be
alcohol, cyanide, various drugs.


Stagnant Hypoxia

Any condition which interferes with the normal

circulation of the blood. Causes can be heart
failure, shock, positive G-forces, tourniquet.



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From the table, it is plain to see that any condition that interferes with oxygens normal path
to the cells will bring on hypoxia. While all cells require oxygen to function, some cells require
more oxygen than others. Most cells have the ability to store an emergency supply of O2. The
central nervous system (made up of the brain and spinal cord) do not have this ability and also
demand a great deal of oxygen (approximately 20% of all oxygen that you inhale feeds the
brain). So, if the oxygen supply to the body is reduced, the brain will be one of the first organs
to be affected. Another problem is that when the brain starts to feel the effects of hypoxia, the
higher reasoning portion of the brain is the first affected. This means that judgment and cognitive skills diminish from the very start.

Oxygen Consumption
% of Total
Splanchic Region
Skeletal Muscles
Other Organs
Oxygen Consumption in a normal person at rest


Signs of hypoxia can usually be detected in an individual by an outside observer. Unfortunately, Since the higher brain functions are the first affected by hypoxia, these signs are not a
very effective tool for the victim to use to recognize hypoxia in themselves. Therefore, these
signs should not be included with the personal symptoms one gets while experiencing hypoxia.
Symptoms (as opposed to signs) are the sensations a person can detect while in a hypoxic
state. Personal symptoms of hypoxia are as individual as the person experiencing them. A group
of people who are hypoxic will, a majority of the time, get the same or similar symptoms. However, the symptoms may appear in a different order and in varying intensities. The greatest
benefit of hypoxia symptoms is that the order and the intensity of the symptoms will usually
remain constant over the years. This is a great gift, because a pilot will always know what to look
for to keep hypoxia in check. This is also why it is so important to experience hypoxia under
controlled conditions (in an altitude chamber) so that each individual can experience these
symptoms for themselves. Some of the more common signs and symptoms of hypoxia are:

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Rapid Breathing
Air Hunger
Cyanosis (Bluing effect of the skin)
Poor Coordination
Executing Poor Judgment
Hot & Cold flashes
Visual Impairment
Of the listed symptoms, visual impairment is probably the least reliable. Your visual field will
be affected, but, at such a slow rate that it could easily go unnoticed. Generally, symptoms will
appear before unconsciousness occurs. Except for headache and nausea, there are no other
uncomfortable symptoms. Of all the symptoms, euphoria (a false sense of well being) is probably
the most dangerous. It puts the pilot in such a state of mind that individual well being, as well as
that of the passengers, is a low priority. Another consideration is that, in most cases, hypoxia is
very insidious. Any preoccupation with flying duties could be enough of a distraction to allow
the hypoxia to progress beyond the point of self help.
Effective Performance Time and the Time of Useful Consciousness are two broad and
interchangeable terms used to describe the time/hypoxia limit. Time of Useful Consciousness
(TUC) is described as the period of time from interruption of the oxygen supply or exposure to
an oxygen-poor environment to the time when an individual is no longer capable of taking proper
corrective and protective action. Effective Performance Time (EPT) is described as the amount
of time an individual is able to perform flying duties efficiently in an environment with inadequate oxygen supply. The following table will show the TUC/EPT for various altitudes:

20 - 30 Minutes
10 Minutes
3 - 5 Minutes
2.5 - 3 Minutes
1 - 2 Minutes
0.5 - 1 Minutes
15 - 20 Seconds
9 - 12 Seconds
9 - 12 Seconds

Note: The above times are to be used as averages only and are based on a young healthy individual at rest. Physical activity at altitude, fatigue, self-imposed stress, and individual variation
will make the times vary.

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Some of the more common factors that will cause your EPT/TUC to vary are:
Rate of Ascent

The faster you ascend to altitude, the shorter your EPT/TUC becomes.

Physical Activity

Any physical activity at altitude will reduce your EPT/TUC. For

example, if you did 10 deep knee bends at 25,000 feet with your
oxygen mask off, your EPT/TUC would be reduced by 50%.


If you enter the cockpit in a fatigued state, you are less resistant to
hypoxia. This can include both physical fatigue (tired from a workout)
as well as mental fatigue (stress at home or work).

Poor Nutrition

The brain feeds exclusively from glucose (blood sugar), so, if your
glucose is low (hypoglycemia) you are more prone to hypoxia.


Alcohol brings about its own form of hypoxia (histotoxic hypoxia).

When altitude is coupled alcohol, you are a strong candidate for a
hypoxic episode.

Over the Counter


Some drugs will cause cells not to utilize oxygen properly and therefore
will make you less altitude resistant (histotoxic hypoxia).

One fact to keep in mind is that, with a rapid decompression to and above 30,000 feet, the
average EPT/TUC will be reduced from 1/3 to 1/2 of its original value. This is due to a phenomenon known as reverse diffusion or fulminating hypoxia. This phenomenon is where oxygen,
due to the rapid expansion of gas during a decompression, is forced from the lungs and creates a
very acute hypoxia that is immediate.
There are certain countermeasures pilots can use to PREVENT hypoxia from occurring.
1. Fly at an altitude where oxygen is not required (Below 10,000 - 12,000 MSL)
2. Fly in a pressurized cabin
3. Fly in accordance with FARs (in reference to the use of supplemental oxygen)
12,500 - 14,000 feet for not more than 30 minutes.

The FAAs Civil Aeromedical Institute (CAMI) recommends
that ANY unpressurized flight to or above 10,000 feet should
use supplemental oxygen.
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Hypoxia, under most situations, will be insidious in its onset; this insidious onset represents
hypoxias most dangerous nature. Fortunately, once the hypoxia is detected and 100% oxygen is
administered, recovery is usually only a matter of seconds. Because of the rapid breathing associated with hypoxia, you must slow your breathing rate to prevent hyperventilation.
Remember - breathing 100% oxygen when you are not hypoxic will not harm you. However,
NOT going on 100% oxygen when you are hypoxic can ruin your entire day. If you are in doubt go on 100% oxygen and alert other crewmembers that you think you might be hypoxic. If your
personal symptoms disappear you were hypoxic and did the correct thing. If your personal
symptoms do not go away then something else is wrong and you still took the correct action.
Finally, you simply misread your personal symptoms, thought you were hypoxic, went on 100%
oxygen and nothing happened, you still took the correct action. The most dangerous thing you
can do when dealing with hypoxia is NOTHING.
Hypoxia is a constant danger. Many people suffer from ground level hypoxia before they
even step inside the aircraft. The insidious nature of hypoxia is its true danger. You must always
be on the lookout for hypoxia symptoms. Once hypoxia is recognized, recovery is only seconds
away. Know your symptoms. Know your oxygen system and be ready to battle this potential
threat to safe flight.

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Vision & Visual Illusions

Of all the senses used to fly an aircraft vision is the most important.
Vision provides approximately 90% of all the cues used for orientation.
Most of these orientation cues are obtained from your peripheral vision.
After a loss of outside visual references...
a non-instrument rated pilot will loose control of their aircraft in about 178 seconds!


Attention all aviation enthusiasts - you may have only 178 seconds to live if you are ever
tempted to take off and fly in marginal weather with a pilot friend who has no instrument rating
or current training. Read this article first - before you go. If you decide to go anyway and lose
visual contact, start counting down from 178 seconds.
How long can a pilot who has had no instrument training expect to live after he flies into bad
weather and loses visual contact?
For years, the Federal Aviation Administration, through its Accident Prevention Program,
has tried to educate the aviation and nonaviation public by putting on pilot educational seminars
throughout the country covering all phases of aviation. One part in particular allowed pilots and
passengers to experience spacial disorientation (pilot vertigo) without killing themselves. This
was done by spinning the people in a specially designed chair at 3 degrees per second. It only
takes 2.5 degrees per second to disturb the fluid contained in the inner ears semicircular canals.
The rest is history. All of the participants experienced going into spirals, rolls, or roller coaster
effects. The outcome differed in only one respectthe time required until control was lost. The
interval ranged from 480 seconds to 20 seconds. The average time was 178 seconds2 seconds
short of 3 minutes.
Heres the fatal scenario: The sky is overcast and the visibility poor. That reported 5-mile
visibility looks more like 2, and you cant judge the height of the overcast. Your altimeter says
youre at 1500, but your map tells you theres local terrain as high as 1200. There might even be
a tower nearby because youre not sure just how far off course you are. But youve flown into
worse weather than this, so you press on.

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You find yourself unconsciously easing back just a bit on the controls to clear those none-tooimaginary towers. With no warning youre in the soup. You peer so hard into the milky white mist
that your eyes hurt. You fight the feeling in your stomach. You swallow, only to find your mouth
dry. Now you realize you should have waited for better weather. The appointment was important,
but not that important. Somewhere a voice is saying, Youve had it - its all over!
You now have 178 seconds to live. Your aircraft feels on an even keel but your compass turns
slowly. You push a little rudder and add a little pressure on the controls to stop the turn, but this
feels unnatural and you return the controls to their original position. This feels better, but your
compass is now turning a little faster and your airspeed is increasing slightly. You scan your
instrument panel for help but what you see looks somewhat unfamiliar. Youre sure this is just a
bad spot. Youll break out in a few minutes. (But you dont have a few minutes.... ).
You now have 100 seconds to live. You glance at your altimeter and are shocked to see it
unwinding. Youre already down to 1200 feet. Instinctively, you pull back on the controls but the
altimeter still unwinds. The engine RPM is into the redand the airspeed nearly so. You have 45
seconds to live. Now youre sweating and shaking. There must be something wrong with the
controls. Pulling back only moves that airspeed indicator further into the red. You can hear the
wind tearing at the aircraft.
You have 10 seconds to live. Suddenly, you see the ground. The trees rush up to you - You can
see the horizon if you turn your head far enough, but its at an unusual angle - youre almost
inverted. You open your mouth to scream but..... you have no seconds left.
Here a typical cross section from our files of those who decided to go anyway and started,
but never finished, the countdown.
1. At the briefing, the forecaster emphasized that the weather was not suitable for VFR flight due
to low ceilings, snow, and generally poor conditions. The pilot was advised that the weather
would improve later that day, and a delay in the flight until then was suggested. Ignoring the
forecast, the pilot decided to go with his wife and two children. Witnesses near the accident scene
reported hearing the aircraft going overhead at low attitude. They heard a change in the engine
noise and then the sound of a crash. They found the site shortly after. It was snowing, and the
temperature was just above freezing. The aircraft had hit the ground in a near vertical nose
down attitude at high speed, indicating loss of control. Four fatals.
2. The pilot had landed successfully, dropping off his business associate at an en route airport.
Instead of waiting out the oncoming weather, he decided to press on another 25 miles to his
farm. He had planned a special evening with his wife and daughter - it was Christmas Eve. The
weather had moved in faster than he thought. Within 5 miles after takeoff, he was engulfed in a
pea soup like condition. The crash site was located the next morning. Damage to the aircraft
indicated it had impacted the ground in a spin. One fatal.
3. The pilot took off in special VFR conditions from an uncontrolled airport, contacted radar
shortly after being airborne and asked for assistance. Shortly after getting vectors, he reported

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the aircraft was in a spiral. The radar controller said that he went off of the radar scope 2
minutes after initial contact. Two fatals.
4. There is no evidence that the pilot checked the weather or filed a flight plan or flight notification. He departed just at dusk with his wife and two children. He was not licensed for night
flying. Eventually in darkness, he lost visual reference with the ground and crashed into a Mountain side at the 1400-foot level. Four fatals.
5. The pilot departed on a short night VFR flight with his girlfriend. Ceilings en route were
reported at 1200 feet. When he failed to arrive at his destination, a search was initiated. The
wreckage was discovered the following morning. The aircraft had struck a small mountain ridge
at an elevation of 1000 feet.
6. The pilot had received a night endorsement 12 years earlier. In the interim, he had logged 20
hours of night flying - the last entry being 3 and 1/2 years prior to the occurrence. During the
flight, the pilot encountered showers and attempted to continue to destination. The aircraft struck
the ground inverted at high speed, suggesting a loss of control after disorientation. Two fatals.
Since 1981, private flying has produced about half of the aircraft accidents in the United States,
and this trend is on the increase. Passengers who find comfort in the fact that pilots are licensed
by the government authorities, might be shocked if they knew how much safe flying practices
depend on the pilots own attitude and judgment, rather than how smoothly the wheels kiss the
ground on touchdown. Here are a few thoughts you may want to think about to assess the skills
of the pilot with whom you or your friends may fly.
Beware of the pilot who doesnt check the airplane thoroughly before takeoff, including taking fuel
samples. Ask about the weather. If the skies arent clear, be suspicious. Ask the pilot if he is instrument
rated, current, and if he will be flying on an IFR flight plan. If the skies are cloudy and the answer is
no, you may be in great peril - especially at night. If every seat in the airplane is full, ask if it is too
heavy for takeoff - especially on a warm day, if the runway is short and at a high elevation, or any
combination thereof. Many aircraft are simply quite dangerous with all the seats full. If its a tricyclegear aircraft that seems tail-low, ask the pilot about the balance as well.
Once in the aircraft, watch the pilot prepare for departure. If he uses a checklist and sets everything in a methodical manner - good. If its done in a cavalier manner, as thought theres nothing
to it, hes probably right. There may well be nothing left in a short time.
Once aloft, watch the weather. If the pilot is flying IFR and conversing with the Air Traffic
Controller about thunderstorms, and the aircraft does not have weather-avoidance gear (a radar
or stormscope), emphasize that you are in no hurry to reach the destination. When there is ice
forming on the airplane, or when the pilot says, I think I can make it through, is a good time
to suggest an emergency visit to the restroom at an airport behind, where conditions are better.

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What is Normal Vision?

Normal vision is said to be 20/20. What does this mean? 20/20 means that an individual can
see at 20 feet what a normal person can see at 20 feet. 20/40 means that the individual in question needs to be at 20 feet to see what a normal person can see at 40 feet. They need to be closer
to see the same thing clearly. 20/15 means that an individual can see at 20 feet what a normal
person needs to be at 15 feet to see. They can be farther away and still see with the same clarity.
Vision is very subjective and humans are good at masking and adapting to poor or failing
eyesight. Objective testing is the only reliable method to measure visual acuity. It should also be
noted that daytime visual acquity is not the only measure of human eyesight. Day visual acuity
may be very different than acuity at night. There can also be abnormalities in color vision.
What does the eye actually see? The human eye is sensitive to a small slice of the spectrum
of Electro-Magnetic Radiation. Electro-magnetic radiation is the same thing as radio, and Xrays, and heat radiation. The human eye is sensitive to a very small segment of that radiation. We
call this visible light.

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The colors of the rainbow are functions of the frequency or wavelength of the electromagnetic
radiation. The wavelength also determines the characteristics of the radiation. The colors of the rainbow
Below the red of human vision is Infra Red (IR) or below red. Above the violet is Ultra
Violet (UV) or beyond violet. IR we feel as heat. UV is what causes our skin to tan and burn
in the sun. Farther below IR are microwaves and radio. Above UV Rays are are X- rays and
cosmic rays. All just differens forms of the same thing - Electro-Magnetic Radiation.

Anatomy of the Eye


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Cornea - Clear outer portion of the eye. Cornea also refracts the incoming light so the lens does
not have to do all of the work.
Sclera - The white part of the eye. A tough flexible membrane which contains all the goey
stuff inside
Lens - Second refractive portion of the eye. The lens can change its focus to accomodate near
or distant objects and bring them into focus.
Iris - Adjusts the size of the Pupil to allow more or less lighht into the eye for different
levels of illumination. The pupil is just the hole where the Iris isnt. In bright daylight the iris
expands to make the Pupil smaller which allows less light into the eye. The smaller diameter
opening also means that the eye has more depth of field. Depth is the term used to describe the
distance between the closest object in focus and the farthest object in focus. The smaller the
Pupil the greater the depth of field. This explains why some people with imp\erfect vision may
have better vision in bright sunlight than in a dark room.
Retina - The filmof the eye. The retina consists of light sensitive cells called Rods and
Cones. Rods only see Black & White (actually they detect shades of grey). Rods are more
sensitive to light than Cones. Cones can detect Color but require much more light to do so.
The retina consists of several different areas. In each of these areas the number of rods and
cones differ. The area of most accute vision or Focal Vision is the Fovea Centralis. The Fovea
Centralis is made up almost exclusively of color sensitive cone cells. These cone cells are connected one to one with nerves leading to the visual centers of the brain. This allows for small
details to be seen.
The area around the Fovea Centralis is the Peripheral Retina. This area consists almost
exclusively of Rod cells. Many rod cells may be connected to one nerve leading to the brain.
While this arrangement does not allow for small details to be seen it does allow for dimly light
objects to be seen. It is also very sensitive to motion.
The area where the Fovea Centralis and the Peripheral Retina meet is the Para Foveal Area
where there are both rods and cones.
Blind Spot - The blood vessels and the nerves that support the Rods and Cones are actually
above the Rod and Cone cells. (Yes, the light has to go through or around the blood vessels and
nerves to get the the retina!) All of these blood vessels and nerves congregate at one spot to leave
the eye and connect the eye to the rest of the body. This one spot contains no Rods or Cones and
therefore is a Blind Spot. Each of your eyes has one blind spot.

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Refractive Error
People who do not have normal vision are said to be Near Sighted (Myopic) or Far Sighted
(Hyperopic). Corrective lenses (glasses or contact lenses) may be used to correct Myopia or

Night Vision
The Human eye actually operates in one of three modes depending on the amount of available light. During times of bright illumination (daytime or under bright artificial light at home or
a stadium) we use Photopic Vision. At night when there is not very much illumination (star or
moon light or a candle) we use Scotopic Vision. At dusk, when the light is fading from bright to
dark there is a transitional mode called Mesopic Vision.
Photopic - Day vision - Bright light
Mesopic - Transition - Fading light
Scotopic - Night vision - Dim light (stars or the moon)

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Transition to Night Vision

The shift from day (Scotopic) vision to night (Scotopic) vision takes up to 45 minutes to
complete. While the Iris allows more light into the eye when in low light situations the real
change occurs in the retina itself. Actual chemical changes in the rod cells makes them more
sensitive to light.
During the day Cone cells in the Fovea use a chemical called Iodopsin to allow them to
convert the strong bright light into electrical nerve impulses. As the light intensity fades, however, the Cones do not receive enough illumination to stimulate them to fire.
In the Peripheral Retina Cone cells are always producing a substance called Rhodopsin (or
visual purple). This chemical allows even small amounts of light to stimulate the Rods to trigger
a nerve impulse. During times of bright light the light breaks down this chemical and the rod
cells become less sensitive. In the absence of bright illumination the Rhodopsin remains and,
after a period of time, alllows the Rods to become more and more sensitive to dim light.
This dark adaptation takes time and is variable among individuals. Typically, it takes longer
for older people to adapt than younger folks (see graph on previous page).
Note: While in the daytime each eye has one blind spot, at night each eye has TWO blind
spots! Since the Fovea Centralis is made up almost exclusively of Cone cells it is virtually blind
to dimly lit objects. Therefore, in order to scan for other aircraft at night you must use off
center viewing. Off center viewing means looking just to the side of an object in order to place
the image of the object onto the Para Foveal Area orn Peripheral Retina where more sensitive
Rod cells can detect the dim light from the object.

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Visual Illusions
What we see is a product of our eyes, but to a much greater extent, what we see is a product
of our brains. Humans evolved on a planet where the sun is above us and casts shodows down.
Objects recede in the distance to a vanishing point. Similarly sized objects close to us appear
larger than the same object farther away. Objects closer to us seem to move faster when we run
by them than objects in the distance. We use all of these observations to judge the size, distance
and orientation of the things we see. But our brains can easily be fooled!
The following examples represent just a few of the ways we can fool our visual system.

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Runway Visual illusions

It is important to understand visual illusions because they can easily cause problems in aviation.
Runway visual illusions are only one such example.

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Hearing & Vestibular Illusions

Of all the senses used to fly an aircraft hearing is the most second most important behind
vision. Hearing provides information about the engine and airspeed. Hearing can also be used to
draw attention to some condition (audio alerts, Stall Warning, Bitching Betty) Hearing also
provides the pirmary method of communication in aviation via radio as well as verbally across
Coupled with the sense of hearing is the sense of balance
The same organs used for detecting vibrations in the air (hearing) are also used to detect
our orientation in space.
Diseases or damage which affects our hearing can also affect our ability to sense our orientation. Colds, flu, hearing damage, Meniers disease, etc. which cause problems in the ears can all
cause problems with orientation.
What is Sound?
Sound is vibrations in a medium (usually air - but also water and solid objects). Sound is
similar to electro-magnetic radiation in that it is a wave phenomenon, HOWEVER! sound needs
a medium to carry the vibration (EM radiation does not need a medium - it still works in the
vacuum of space). In space no one can hear you scream but your radio still works.
Sound is measured in Hz (frequency or tone) and decibells (db) for intensity.
Below a certain frequency sound is not heard but felt as a vibration (10-60 Hz). Even deaf
people can feel the beet of a drum or the deep bass notes of some music.
What is Normal Hearing?
A normal young human should be able to hear frequencies in the range of 20 Hz to about
12,000 Hz. Like poor vision, people are good at adapting to poor hearing. The only sure method
to determine if you can hear normally (or have a loss of hearing) is to measure it with an audiogram.
Function of the Ear
The ear detects vibrations in the ambient medium (air or water) and converts the mechanical
energy of the sound into electrical impulses which travel via the nerves to the brain. The brain
processes the signals and interprets them as noise, familiar sounds, music, a human voice, etc...
As with vision, what we hear is more determined by oor brains than by our ears.

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Anatomy & Physiology of the Ear

The ear may be split into thre major parts:
Outer Ear
Middle Ear
Inner Ear
Outter Ear is composed of the:
Auricle - the outer part of the ear which directs sound into the rest of the ear.
External Canal - Carries the sound to the...
Eardrum - the flexible membrane which vibrates sympathetically with the incoming
vibrations or sound.
Anything which interferes with the transmission of sound energy to the eardrum will adversely
affect hearing. Blockages can include ear wax, foreign objects, golf balls, etc.
The eardrum itself can also be adversely affected - Anything adversely affecting the eardrum can
deminish hearing. Some of these can incluse:
Inflamation due to infection or injury
Scarring from a previous injury
Perferation of the eardrum from a puncture (foreign objects) or loud noises or explosions

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Middle Ear is composed of the:

An air filled cavity with pressure equalized to the ambient pressure (normally)
Ossicles (three tiny bones) which transmit the sound from ther eardrum to the Cochlea in
the inner ear. Anything which interferes with the functioning of the Ossicles will adversely affect
hearing. These can include:
Inflamation or Fluid in the middle ear from an infection
Stiffening of the Ossicle joints (Theyre bones and they can get arthritis!)
Calcification of the joints
Dislocation of the joints (from loud noises like gunshots or explosions)
Ear block from trapped gas (usually on descent from altitude)
Inner Ear is made up of:
Cochlea - The Organ of Hearing
| The Organs of Balance or Orientation
Semicircular Canals /
The Cochlea is filled with endolymphatic fluid. Lining the walls of the Cochlea are tiny hairlike receptors of various sizes. These hairs respond to vibrations of a specific frequency. The hairs
move when the fluid moves (like tall grass moving in the wind) and each hair is connected to a nerve
at its base. When a sound of a specific frequency vibrates the ear drum and causes the Ossicles to
move the Cochlea the hairs sensitive to that frequency move and fire their nerve cells. This sends an
electrical nerve impulse to the brain.
All of the hairs are attached to nerves and these nerves all come together to from the Cochlear
Nerve (or Acoustic Nerve or Auditory Nerve) which transmits all of the vqarious signals to the brain.
Hearing Loss
Hearing loss can have two major causes:
Nerve Damage: If the Cochlear or Auditory Nerve is damaged the nerve signals cannot reach
the brain.
Noise induced: Loud noises can damage the hairs in the Cochlea. Loud noises can flatten the
hairs like stepping on wet grass. Given some quiet time the hairs can usually repair themselves unless
the noise was very loud or continues for some time. Then the damage and subsequent hearing loss can
be premanent.
Tinnitus: A ringing in the ears usually associated with nerve damage. Tinnitus is also associated with exposure to noise. The ringing can be continuous or suddenly appear and then disappear.
The only way to retain your hearing is to protect your hearing!
Use ear plugs whenever you are in an noisy environment!

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Spatial Disorientation
Orientation information comes from three sources:
Vision (most important and reliable source - usually from peripheral vision
Represents about 90% of cues)
Vestibular System (inner ear)
Proprioceptive (relative muscles position - Seat of the Pants feeling)
Postural Orientation & Disorientation
The muscles and joints in our body inform the brain of its orientation. Since gravity always
pulls things down on the Earth we assume that any force acting on us is due to gravity and that the
force is acting doward the earth or down. Since Humans are adapted to being stationary on the
Earths surface our reactions when in motion or accelarating are often in error. Down isnt always the
down were used to.
Vestibular Orientation and Disorientation
The Vestibular system (the otolith organs - Utricle and Saccule) also provide reliable information when standing on the Earth. However, once we introduce two dimensional motion (car) or three
dimensional motion (boat or aircraft) in a vehicle all bets are off. Humans are not fully adapted to life
in three dimensional motion. Our senses of motion (vestibular system) are unrelaible. We must learn
to trust our flight instruments.
Normally, our vestibular system informs us about our motion in three axes (roll, pitch, yaw).

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Like the Cochlea, the Semicircular Canals and the Otolith Organs all have tiny hairs connected
to nerve cells. When the fluid in the Semicircular Canals deflects these hairs they signal the brain that
the body is in motion. In the Otolith organs, when the head is tilted the Otolith deflect the hairs and
send a signal to the brain. On the earth these work well. In an aircraft they are easily fooled.

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Some of the illusions which can be caused in flight include:

Coriolis Illusion - Cross coupling semicircular canals. This is when you are rotating in one plane
and then tilt your head. The information sent to the brain makes no sense and your reaction to this can
be completely incapacitating! This illusion can cause total incapacitation and result in total loss of
control of the aircraft.
Leans - Usually from a prolonged turn.
Oculogravic Illusion - Accelleration or decelleration in level flight
These actions simulate climbing and diving to the otolith organs
May cause a pilot to nose over on takeoff or pull up on landing
Rotational Illusions - Endolymphatic fluid catches up with rotation
After slowing or stopping the fluid continues moves in the direction of the turn
The brain interprets the moving fluid as a turn in the OPPOSITE DIRECTION!

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