Aviation Medicine

FIS BOOK 4
INDEX
AVIATION MEDICINE
1. Physics of Atmosphere 415

2. Elementary Physiology of Respiration 419
3. Hypoxia 423
4. Hyperventilation 435
5. Altitude Dysbarism 437
6. Pressurisation and Rapid Decompression 453
7. Acceleration 459
8. Vision and Hearing 471
9. Spatial Disorientation 483
10. Thermal Stress in Flying 495
11. Effect of Drugs, Smoking and Alcohol in Flying 499
12. Wounds and Haemorrhages 505
13. Escape from Aircraft 515
14. Survival 529
15. Flying Fatigue and Prevention 543
16. Noise and Vibration in Aviation 553
17. Aircrew Diet and Physical Fitness 559
415
CHAPTER 1
PHYSICS OF ATMOSPHERE
Introduction
1. Atmosphere is the gaseous envelope which surrounds the Earth. An aviator is exposed to this
environment during flight. The physical characteristics of the atmosphere viz. pressure, density,
temperature and their variations with altitude expose the aviator to a hostile environment during the
flight. Hence awareness of the physical characteristics of the atmosphere, the ozone layer and the
radiations from outer space is essential for an aviator. Therefore this chapter is aimed at
understanding the significance of the atmosphere for an aviator, including various natural laws and its
likely effect on the human body.
Composition of Atmosphere
2. The approximate percentage of gases at sea level without the humidity consists of 78%
nitrogen, 21% oxygen and remaining 1% is composed of argon, carbon dioxide, and other inert gases.
This composition remains constant almost up to an altitude of 80 Km above the sea level. Oxygen
(O2) is the most important of the gases in the atmosphere for existence of life on Earth. It helps
produce energy in the living, including humans, hence is vital to sustain life.
Properties of Atmosphere
3. Pressure. The atmospheric (barometric) pressure is due to the weight of all air molecules
above the point of measurement. At sea level the atmospheric pressure is about 760 mm Hg (101.32
K Pa) The atmospheric pressure decreases with altitude but the fall in pressure is not linear with
altitude. The pressure at 5.5 Km (18,000 ft) is about half (380 mmHg) of that at sea level, and at 10.5
Km (34,000 ft) it is about one quarter (190 mm Hg) of that at sea level. The reduction in the ambient
pressure with altitude helps determine requirement of on-board oxygen in flight. It is also important to
understand that there is greater change of pressure near the ground level, and this is responsible for
various types of Barotrauma, especially Otitic Barotrauma.
4. Density. Due to compressibility of gases, the atmosphere has the maximum density near
the surface of the Earth. At sea level, the density of the atmosphere is 1.225 kg/m3. As in the case of
pressure, the density also has a larger variation at lower altitudes. At an altitude of 40,000 ft, the
density falls to about one-fourth of its value at sea level.
5. Temperature. We experience day to day and seasonal variations in atmospheric

temperature. The surface of the Earth is heated up by the thermal radiations of the Sun. The Earth’s
FIS Book 4: Aviation Medicine 416
surface in turn re-radiates part of this heat energy to the lower layers of the atmosphere which are at a
relatively lower temperature. This process repeats itself and gives rise to a steady fall in temperature
with increase in altitude throughout the troposphere. This ‘lapse rate’ of temperature has an average
value of 1.98° C per 300 m (1,000 ft) in the troposphere. The fall in temperature reaches a minimum
of -56.5° C at 11 Km (36,090 ft) and thereafter it remains constant up to 20 Km (65,000 ft) after that it
starts rising again. If the sea level temperature is 30° C on a particular day, at an altitude of 20,000 ft
the temperature would be about -10° C. This makes it imperative on part of the aviator to know that a
case of accidental loss of cabin pressurisation, due to canopy disintegration in a fighter aircraft or
blowing off of the door or cockpit perspex in a transport aircraft, shall expose him/her to temperatures
lower than that s-/he would be comfortable with.
6. The value of atmospheric pressure and temperature at various altitudes taken from an
International Standard Atmospheric chart are shown in Table 1-1.
Altitude Pressure Temperature

Km ft mm Hg mb psi °C
0 0 760 1013 14.70 +15.0
1.5 5,000 632 850 12.23 +5.1
3.0 10,000 523 701 10.11 -4.8
4.5 15,000 429 580 8.29 -14.7
5.5 18,000 380 500 7.34 -20.7
6.0 20,000 349 449 6.75 -24.6
7.6 25,000 282 400 5.45 -34.5
9.1 30,000 228 300 4.36 -44.4
10.0 33,000 197 260 3.80 -50.6
12.2 40,000 141 200 2.72 -56.5
15.2 50,000 87 115 1.68 -56.5
18.3 60,000 54 75 1.04 -56.5
19.2 63,000 47 60 0.90 -56.5
30.5 1,00,000 8.2 12 0.16 -46.0
Table 1-1: Pressure and Temperature of Atmosphere
Classification of Atmosphere
7. The atmosphere is divided into several layers depending on their thermal features viz.,
Troposphere, Stratosphere, Mesosphere and Thermosphere (Ionosphere) (Fig 1-1). Most of the
aviation activities are carried out in the lower most layer of the Earth’s atmosphere i.e. troposphere.
417 Physics of Atmosphere
8. Troposphere. This is the region that

immediately surrounds the Earth’s surface and is
characterized by the presence of water vapour,
weather phenomenon and a steady lapse rate of
temperature. It has an average thickness of 12 Km
and is thicker at the equator (17 Km) and thinner at
the poles (8 Km). The outer boundary of the
troposphere is known as tropopause, which is at an
altitude of 11 Km at temperate latitude of 40° N. The
troposphere can be subdivided into two main layers
as follows:
(a) Ground Layer. This layer extends

up to an altitude of 2 Km (6100 ft) and is
greatly influenced by the nature of terrain,
which may be, mountainous, plain, desert,
jungle or sea. The temperature, wind and
humidity conditions in this layer are often
unstable. The aircraft has the maximum lift Fig 1-1: Layers of Atmosphere and
Ozonosphere
capability hence practice of low level flying
and aerial combat takes place at these altitudes. Due to the effects of weather, bird activity
and limitations of human sensory organs especially vision, this layer accounts for maximum
number of aviation accidents.
(b) Advection layer. This layer extends from 2 Km to tropopause. This is the breeding
place of clouds. The lapse rate of temperature is steady in this layer.
Ozone
9. A layer of ozone exists in the atmosphere between 12 to 43 Km and has a maximum

concentration at an altitude of about 30 Km (Fig 1-1). Ozone is formed by dissociation of oxygen
molecules by ultraviolet rays of lower wavelength up to 210 µm. It is, however, reconverted to oxygen
by ultraviolet rays of higher wavelength (210-300 nm) with the liberation of heat energy. Most of the
ultraviolet rays are used up in the process of formation and destruction of ozone, thereby the living
organisms on Earth are protected from their harmful effects. Ozone by itself is toxic. Since the aircraft
flying at such high altitudes are pressurised, the atmospheric ozone is readily destroyed by the heat
generated during pressurisation. Aircraft which routinely fly through the ozone layer are normally
provided with an ozone monitor, which warned the pilot of any increase in the ozone concentration
beyond the permissible limits.
Ionising Radiation
10. Ionising radiation in the atmosphere comes from the cosmic radiation. The intensity of this
radiation varies with altitude and geographical location. When the primary cosmic rays enter the
Earth’s atmosphere, they collide with air molecules and break down into secondary radiation. The
maximum intensity of cosmic rays occur between 18 Km (60,000 ft) and 36 Km (120,000 ft). The
intensity then diminishes rapidly with decreasing altitude, as it is absorbed by the atmospheric gases.
At sea level, the intensity of radiation reduces to one seventieth of that at 21.3 Km (70,000 ft).
However, the amount of radiation an aircrew is exposed to while operating in aircraft at high altitude is
recorded to be extremely small and is not harmful. This is evident by the fact that even while flying
1,000 hours per year at 16.8 Km (55,000 ft) the radiation dose will be less than half of that considered
safe for an industrial worker.
419
CHAPTER 2
ELEMENTARY PHYSIOLOGY OF RESPIRATION
Introduction
1. The energy essential for living processes is obtained by the oxidation of complex food stuffs.
Thus oxygen is one of the most important materials required for the maintenance of normal function
by living cells. The cells of the brain are particularly sensitive to oxygen lack. The body is only able to
store very small quantities of oxygen. Thus cessation of the oxygen supply to the brain results in
unconsciousness in 6-8 seconds and irreversible damage ensues if the oxygen supply is cut off
completely for longer than about 4 minutes. The maintenance of normal function requires that oxygen
be delivered to the cells of all tissues of the body and that the supply is matched to the rate of
consumption of oxygen so that the partial pressure of oxygen (PO2) is maintained above a certain
critical value. Oxidation of complex food stuffs produces, amongst other substances, carbon dioxide.
The carbon dioxide so formed must be removed from the tissues and voided to the atmosphere since
accumulation of this gas in the tissues interferes with normal function. The processes whereby the
oxygen in the atmosphere is transported to the tissues and the carbon dioxide in the tissues is
transported to the atmosphere is termed respiration.
2. Several steps are involved in these transport systems. These are:
(a) Exchange between the atmosphere and the gas within the lungs - by ventilation of the
lungs (breathing).
(b) Carriage of oxygen and carbon dioxide between the lung gas and the tissues by the
circulating blood.
(c) Exchange between the circulating blood and the tissues where oxygen is consumed
and carbon dioxide is produced.
Anatomy
3. Gas exchange between the external

atmosphere and the blood which transports
oxygen and carbon dioxide around the body
takes place within the lungs. The structure of
the latter is well suited to promoting the rapid
transfer of oxygen and carbon dioxide between
the lung gas and the blood. Within the lung the
air passages divide repeatedly ending eventually
in very small air sacs (alveoli) (Fig 2-1) of which Fig 2-1: Alveoli in the Lungs
the adult lung contains some 300 million giving an effective area for gas exchange of 50 - 100 square
metres. The walls of the alveoli are very thin and the blood flowing through the lungs is thus brought
into very close proximity to the gas in the air sacs (alveolar gas). In a young adult the volume of the
alveolar gas at the end of a normal expiration is approximately 3 litres, whereas the maximum amount
of gas which can be held in the lungs is of the order of 6.5 litres. The passage of a gas across the
walls of the alveoli is controlled essentially by the differences of the partial pressures of the gas in the
blood and alveolar gas. Thus oxygen is taken up by the blood flowing through the lungs as long as
the partial pressure of oxygen (PO2) in the alveolar gas is greater than the PO2 in the blood flowing
into the lungs. As oxygen enters the blood, increasing the concentration of oxygen in it, the PO2 of
the blood also rises. The area of the alveolar wall is so great, and the wall separating the alveolar gas
and the blood is so thin that the PO2 of the blood leaving the lungs virtually always equal the PO2 in
the alveolar gas. Similarly the exchange of carbon dioxide is driven by the difference between the
partial pressure of carbon dioxide (PCO2) in the blood flowing into the lungs and the lower PCO2 in the
alveolar gas. Also the PCO2 of the blood leaving the lungs equals PCO2 in the alveolar gas. Thus the
PO2 and PCO2 in the alveolar gas reflect closely the partial pressures of these gases in the blood
flowing from the lungs to the tissues of the body. The oxygen removed from the alveolar gas by the
blood is replenished by the ventilation of the lungs with air. This process, external respiration, also
removes the carbon dioxide added to the alveolar gas by the blood flowing through the lungs.
4. Air enters the nose and mouth during inspiration and is carried down through the larynx (voice
box) and the trachea (windpipe) to the lungs. During its passage, the air is warmed to body
temperature (37°C), humidified so that it becomes saturated with water vapour at body temperature
(partial pressure of water at 37°C is 47 mm Hg) and filtered. Within the lungs the inspired air mixes
with the alveolar gas thereby adding oxygen to it. The portion of the alveolar gas expelled from the
lungs during expiration carries carbon dioxide to the atmosphere. The ventilation of the lungs with air
is normally regulated so that the PCO2 of the alveolar gas is held constant over a wide range of rates of
production of carbon dioxide by the tissues of the body. Thus, at rest, the average volume of each
breath is approximately 0.5 litre and the average rate of breathing is approximately 16 breaths per
minute so that the lung ventilation is 0.5 x 16 = 8 litres per minute. When the rate of production of
carbon dioxide is increased as in physical exercise both the depth and rate of breathing are
increased. The volume of a single breath typically increases during heavy exercise to 2.5 litres and
the rate of breathing to 40 - 50 breaths per minute giving a total ventilation of 100 - 125 litres per
minute. Trained athletes can achieve lung ventilations of the order of 150 - 200 litres per minute.
5. The composition of the alveolar gas depends upon the composition of the inspired gas and
the balance between ventilation of the lungs on one hand and the rates of consumption of oxygen and
production of carbon dioxide on the other. It has already been stated in the previous paragraph that
the ventilation of the lungs is normally regulated in relation to the CO2 so that the PCO2 of the alveolar
gas is held constant. The ‘normal’ average value of the alveolar PCO2 is 40 mm Hg (range 38 - 42
421 Physiology of Respiration
mm Hg). The composition of the alveolar gas when breathing air at sea level is given in Table 2-1.
The table also shows the concentration of each gas by volume of the dry gas.
Partial Pressure Conc of Dry Gas

Gas Name
(mm Hg) (K Pa) (by Volume %)
Oxygen 100 13.34 14.00
Carbon Dioxide 40 5.33 5.60
Nitrogen 573 76.44 80.90
Water Vapour 47 6.27
Total 760 101.38 100.00
Table 2-1: Composition of Alveolar Gas, Breathing Air at Ground Level
6. With ascent to altitude, breathing air, the fall of the PO2 in the atmosphere produces a fall in
the PO2 in the alveolar gas. Reduction of the alveolar oxygen tension to below 55 - 60 mm Hg
produces a reflex increase in the ventilation of the lungs, so that the ventilation increases relative to
the rate of production of carbon dioxide by the body and the alveolar PCO2 is reduced below normal.
The lower the alveolar PO2 is below 55 - 60 mm Hg, the greater is the increase in ventilation and the
larger is the reduction of alveolar PCO2. The partial pressure exerted by the water vapour in the
alveolar gas is unaffected by ascent to altitude as it depends solely on the temperature of the gas in
the lungs which remains constant at 37°C. Typical values of the partial pressures of the constituents
of the alveolar gas when breathing air at various altitudes are depicted in Table 2-2.
Partial Pressure in Alveolar Gas of

Altitude
Water vapour Oxygen Carbon Dioxide Nitrogen
(Ft)
mmHg K Pa mmHg K Pa mmHg K Pa mmHg K Pa
0 47 6.27 100 13.34 40 5.33 573 76.44
8,000 47 6.27 65 8.67 40 5.33 423 56.43
18,000 47 6.27 40 5.33 28 3.74 265 35.35
25,000 47 6.27 30 4.00 22 2.93 183 24.41
35,000* 47 6.27 18 2.40 12 1.60 103 13.74
* Immediately after rapid decompression to 35,000 ft
Table 2-2: Typical Partial Pressures of Alveolar Gases when Breathing Air at Various Altitudes
Carriage of Oxygen in the Body
7. Oxygen is transported from the lungs to the tissues and the carbon dioxide produced by the
tissues is transported to the lungs by the circulating blood. Although both oxygen and carbon dioxide
are soluble in water the amount that is carried in this manner in the blood is much too small to meet
the demands of the tissues. The blood red cells contain a red pigment, haemoglobin, with which
oxygen forms a loose compound, oxyhaemoglobin. The amount of oxygen held in the blood as
oxyhaemoglobin is a function of the partial pressure of oxygen in the blood (PO2). Oxygen is taken up
where the PO2 is higher, as in the lungs, and released where the PO2 is lower, as in the tissues. A
special mechanism also exists in the blood whereby its capacity for carbon dioxide is greatly
augmented over that of water. Carbon dioxide is taken up where the PCO2 is higher, as in the
tissues, and is released where the PCO2 is lower, as in the lungs. As has been described earlier
(para 3), the PO2 and PCO2 of the blood leaving the lungs equal the partial pressures of these gases
in the alveolar gas. The blood pumped to the tissues by the heart through the systemic arteries also
has the same PO2 and PCO2 as the alveolar gas. As the blood flows through the extensive network
of thin walled, small vessels (capillaries) which permeate all the tissues of the body, oxygen is
released and carbon dioxide is taken up. The blood flow to an organ is normally regulated so that it
matches the demands for oxygen delivery and carbon dioxide removal of its tissues. When these
increase, as in muscle tissue during physical exercise, the muscle blood flow and indeed the amount
of blood pumped by the heart are greatly increased. Thus heavy physical exercise, such as running,
increases the output of the heart by about five fold over the resting value. The matching of blood flow
to tissue demands for oxygen is normally such that between 25% and 75% of the oxygen contained in
the arterial blood is given up by the blood as it flows through the tissues. The blood flowing from the
tissues to the lungs has therefore a lower PO2, and a higher PCO2 than the arterial blood and the
alveolar gas. These differences of partial pressure result in oxygen being taken up and carbon
dioxide unloaded as the blood flows through the lungs and comes into intimate contact with the
alveolar gas.
8. The fall of the PO2 in the alveolar gas which

occurs with ascent to altitude whilst breathing air (para
8) reduces the PO2 of, and the amount of, oxygen
contained in the blood leaving the lungs and arriving at
the tissue capillaries (Fig 2-2). This reduction, if
moderate, will not decrease the rate at which oxygen is
delivered to the tissues, but will reduce the partial
pressure of oxygen in the tissue. Several mechanisms,
including an increase in blood flow, come into operation
to minimize the fall of PO2 in the tissues. A more severe
reduction of the PO2 and oxygen content of the blood
flowing to the tissues results in PO2 of parts of the
tissues falling to zero in spite of the compensatory
mechanisms coming into play. The critical level of
Fig 2-2: Breathing Air at Altitude
alveolar PO2 at which this situation arises in the brain,
causing unconsciousness, is of the order of 30 - 35 mm Hg.
423
CHAPTER 3
HYPOXIA
Introduction
1. Oxygen is one of the most important materials required for the maintenance of normal
function by living material. The absence of a supply of oxygen adequate in quantity of partial
pressure, a condition termed hypoxia, almost always results in a rapid deterioration of most functions
and may cause death. Man is extremely sensitive and vulnerable to the effects of deprivation of
oxygen. Thus the 25% reduction of the partial pressure of oxygen (PO2) in the atmosphere
associated with ascent to an altitude of 8,000 feet produces a detectable impairment of mental
performance, whilst sudden decompression to 50,000 feet, which reduces the alveolar PO2 to 10 mm
Hg, causes unconsciousness in 10 seconds and death in 4 - 6 minutes.
Significance of Hypoxia in Aviation
2. It is generally recognized that the most serious single hazard to man during flight is the
reduction of the PO2 produced by ascent to altitude. Failure of oxygen-equipment and/or of cabin-
pressurization so that the individual has to breathe air at high altitude quickly leads to incapacitation
and perhaps death. The risks are greater in aviation in that a degree of hypoxia which, from the
physiological view-point might not be fatal in itself, but may have fatal results because of deterioration
of performance in an individual leading to loss of control of an aircraft. In the past, oxygen-lack has
taken a regular toll of both lives and aircraft. In World War II many aircrew were killed by hypoxia in
flight while the ability of many more aircrew to perform their tasks was impaired by the condition.
Although improvements in the performance and reliability of cabin pressurization and oxygen delivery
systems have greatly reduced incidents and accidents due to hypoxia, constant vigilance remains
essential.
Classification of Hypoxia
3. Hypoxia can be classified into four different types.
(a) Hypoxic Hypoxia. This can occur when any of the following occurs:
(i) Reduction of a partial pressure of oxygen in the inspired air e.g. on exposure
to altitude, breathing in closed space, breathing oxygen poor gas etc.
(ii) Reduction in alveolar ventilation or hypoventilation e.g. airway obstruction,
paralysis of respiratory muscles, increased airway resistance etc.
(iii) Alveolar capillary diffusion block e.g., pneumonia, blast injuries etc.
(b) Anaemic Hypoxia. This results when there is a reduction in oxygen carrying
capacity of the blood due to decreased haemoglobin content. This is commonly due to poor
nutritional state. Carbon monoxide, nitrates, sulfa drugs etc. could also cause some of this
hypoxia by forming stable compounds with haemoglobin and reducing the amount of
haemoglobin available to transport oxygen to the tissues.
(c) Stagnant or Hypokinetic Hypoxia. This form of hypoxia is due to malfunction of

the circulatory system where the oxygen carrying capacity of the blood is adequate but there
is inadequate circulation of the blood. Conditions such as heart failure, arterial spasm and in
aviation, pooling of blood in lower limbs during aerial combat manoeuvres (+Gz acceleration)
would predispose to stagnant hypoxia.
(d) Histotoxic Hypoxia. This occurs when the utilisation of oxygen by the body tissues
is interfered with. Alcohol, narcotics and certain poisons such as cyanide interfere with the
ability of the cells to make use of the oxygen available to them even though the supply is
normal in all respects.
4. All the above mentioned types of hypoxia may be encountered in flight, but the most frequent
and important type of hypoxia encountered in aviation is hypoxic hypoxia, caused by breathing air at
altitude. The partial pressure of oxygen in the inspired air progressively reduces as compared to
breathing air at sea level. The principal causes of hypoxia in flight are:
(a) Ascent to altitude without supplemental oxygen.

(b) Failure of personal breathing equipment to supply oxygen at an adequate
concentration and/or pressure.
(c) Decompression of pressure cabin at high altitude.
5. The time course of the changes produced by breathing air at altitude is a function of the
manner in which the condition is induced. Typically the changes are produced slowly by ascent at the
usual rate for an aircraft of 2,000 - 3,000 feet per minute, more rapidly by the reversion to breathing
air after failure of oxygen delivery equipment, and fastest by a rapid decompression. Although
breathing air during a steady ascent at 2,000 - 3,000 feet per minute is an uncommon cause of
hypoxia in these days, it is convenient to describe the changes induced by hypoxia in this manner
since the relatively slow rate of climb allows a semi-steady state to be maintained during the ascent.
Symptoms and Signs of Hypoxia
6. The symptoms and signs of hypoxia are extremely variable. The speed and order of
appearance of signs and of the severity of symptoms produced by breathing air at altitude depend
upon the altitude, the duration of the exposure and rate of either ascent or failure of the oxygen supply
425 Hypoxia
at altitude. The other major factor affecting the intensity of hypoxia at altitude is the degree of
physical exercise, as the exercise markedly intensifies the effects of a given degree of hypoxia.
Fatigue, exposure to cold, ingestion of alcohol or certain stimulant drugs such as benzedrine also
increase the severity of the disturbances induced by a given intensity of hypoxia. Finally there is
considerable individual variability in the symptoms and effects of hypoxia. Generally the higher the
altitude, the more marked the symptoms. Rapid rates of ascent, however, allow higher altitudes to be
reached before severe symptoms occur. In these circumstances, unconsciousness may supervene
before any or many of the symptoms of hypoxia appear.
7. The effects of slow ascent (less than 4,000 feet per min) to altitude whilst breathing air are as
follows:
(a) Indifferent Stage (up to 10,000 Ft). The seated individual (unless he is carrying
out heavy exercise) has no symptoms. His ability to perform most complex tasks is
unimpaired. The speed with which he can react to novel conditions is however significantly
impaired at altitudes above 6,000 - 8,000 feet. It is possible to show in the laboratory that the
ability to detect targets at low levels of illumination is impaired at altitudes above 5,000 - 6,000
feet. This degree of impairment however has no practical implications - night vision is only
impaired significantly when the altitude exceeds 12,000 - 14,000 feet.
(b) Compensatory Stage (10,000 to 15,000 Ft). The resting individual has little or
nothing in the way of symptoms but his ability to perform skilled tasks such as aircraft control
and navigation is impaired, the impairment increasing with altitude above 10,000 feet. The
individual is frequently unaware of the hypoxia or of the impairment of performance which it
produces. Indeed he may well believe that he is performing better than usual! Physical
exercise, particularly at altitudes above 12,000 feet, frequently produces mild symptoms,
especially breathlessness. Exposure to these altitudes for longer than 10 - 20 minutes often
induces a severe headache.
(c) Disturbance Stage (15,000 to 20,000 Ft). Above about 15,000 feet, symptoms of
hypoxia occur even in individuals at rest. There is marked impairment of performance, even
of simple tasks, together with a loss of critical judgement and will power. Thinking is slowed,
there is muscular inco-ordination with trembling and clumsiness and marked changes in the
emotional state. Thus the individual may become hilarious, pugnacious or morose. He may
become physically violent. Again he usually has no insight into his condition, an effect which
makes hypoxia such a potentially dangerous hazard in aviation. The individual frequently
feels light-headed and tingling in the lips and limbs. Darkening of vision is a common
symptom although generally the subject is unaware of the change until oxygen is breathed,
when there is a marked apparent brightening of level of illumination. Hearing is not usually
markedly impaired until the hypoxia becomes severe. Physical exertion greatly increases the
severity of all the effects. It often causes unconsciousness.
(d) Critical Stage (above 20,000 Ft). Breathing air at altitudes above 20,000 feet
results in severe symptoms even in individuals at rest. Mental performance and
comprehension decline rapidly and unconsciousness supervenes with little warning. Jerking
of the upper limbs occurs quite often before consciousness is lost and convulsions may occur
after unconsciousness has occurred. Exertion at altitudes above about 20,000 feet rapidly
leads to unconsciousness.
8. In moderate and severe hypoxia, the depth and rate of breathing are increased and this effect
can usually be seen on exposure to breathing air at altitudes above 15,000 - 18,000 feet. Above
18,000 feet the high concentration of haemoglobin which has given up its oxygen in the capillaries of
the skin gives rise to blueness of the lips, tongue and face as well as the skin of the limbs (most
noticeable in the finger nails).
9. Interruption of the supply of supplemental oxygen at altitudes above 10,000 feet with
reversion to breathing air is a more frequent cause of hypoxia in flight than ascent without added
oxygen. As the altitude is increased the times between the reversion to breathing air and the
consequent impairment of performance, followed at the higher altitudes by loss of consciousness,
rapidly decrease. The time which elapses between sudden reversion to breathing air and loss of
useful consciousness, i.e. the point at which an individual is no longer able to carry out his task, is
very variable, especially at altitudes below 28,000 - 30,000 feet. The ranges of times of useful
consciousness found at various altitudes are presented in Table 3-1.
Altitude (feet) Time of Useful Consciousness (Range in Seconds)

25,000 150 -360
27,000 130 – 250
30,000 100 – 180
34,000 60 – 100
36,000 55 – 85
Table 3-1: Times of Useful Consciousness Following Sudden Reversion to Breathing Air
10. The hypoxia induced by either slow ascent whilst breathing air or cessation of supplemental
oxygen at a given altitude is described in the previous paragraphs. The severity and rate of onset of
hypoxia when it is induced by a sudden failure of the pressure cabin of an aircraft (i.e. time for
decompression to above an altitude of 20,000 feet less than 1½ minutes) are considerably greater
than when the hypoxia is induced by cessation of supplemental oxygen at the same altitude. Thus
serious impairment of performance will occur within 1½ minutes on rapid decompression whilst
breathing air to 25,000 feet. It may be seen that the higher the final altitude the shorter the time
between the decompression and the consequent impairment of performance. Oxygen breathing must
be commenced within a few seconds of the beginning of a rapid decompression to altitude between
15,000 and 30,000 feet if no impairment of performance due to hypoxia is to occur. Rapid
427 Hypoxia
decompression to altitudes above 30,000 feet

will result in transient impairment of
performance even if 100% oxygen is breathed
as the decompression commences. These
facts emphasize the importance of the correct
use of oxygen equipment in the event of the
decompression of an aircraft which is
pressurized to provide a cabin altitude below
8,000 feet when the occupants will probably
be breathing air whilst the aircraft is at high
altitude. This lesson is even more important in
aircraft with small, highly pressurized cabins
when loss of a windscreen or entrance door
will result in an explosive decompression of
the cabin and hence the very rapid Fig 3-1: Times of Useful Consciousness at
Given Altitudes
development of hypoxia.
Factors Influencing the Onset and Severity of Hypoxia Effects
11. (a) Altitude. Higher the altitude, lower the partial pressure of alveolar oxygen and
hence greater is the severity of the effects.
(b) Rate of Ascent. When Oxygen is used from ground level at high rate of ascent, it is
possible to attain higher altitudes before the effects of hypoxia are experienced.
(c) Duration of Altitude. The effects are more severe when the duration of stay at
altitude is more.
(d) Ambient Temperature. Both high and low temp favour the development of
symptoms.
(e) Physical Activity. If degree of activity is high the symptoms are more severe as it
demands more oxygen at higher altitudes.
(f) Individual Tolerance. Individuals differ considerably in their ability to withstand

hypoxia.
(g) Physical Fitness. A high state of physical fitness is conducive to a better tolerance.
Physial exercise improves the individual tolerance.
(h) Smoking. Heavy smoking makes an individual more prone to suffer from hypoxia
due to binding of Haemoglobin by the carbon monoxide in the smoke. As is evident below, a
smoker who smokes prior to sortie has already compromised him-/herself to hypoxia:
Actual Altitude (ft) Non- Smoker Apparent Altitude(ft) Smoker

Sea level 7,000ft
10,000ft 14,000ft
20,000ft 22,000ft
(j) Organic Diseases. Effects of hypoxia are more severe with diseases of the lungs
and heart, which interferes with the normal oxygenation and circulation or prevent adequate
physiological compensation.
(k) Emotional State. Apprehension and anxiety make an individual more susceptible
to the effects of hypoxia.
(l) Acclimatisation. Residing at high altitude raises the individual’s ability to withstand
hypoxia.
Prevention of Hypoxia
12. Ensuring that an aircrew has sufficient oxygen to maintain a range of alveolar PO2 between
60 and 100 mm Hg prevents hypoxia. This oxygen level is achieved in aircraft by an oxygen system,
cabin pressurisation, or a combination of the two.
13. Cabin Pressurisation. The most efficient method of preventing the physiological effects of
hypoxia is by providing pressurisation system in the aircraft. This ensures that the occupants of the
aircraft are never exposed to the pressures outside the physiologic zone. In practice there exist two
types of pressurisation schedules:
(a) Isobaric System. The

system maintains a constant cabin
pressure as the ambient pressure
decreases. The cabin altitudes
maintained are between 610 to 2500
meters (2000 to 8000 ft) (Fig 3-2).
This type of pressurization schedule
increases the comfort and mobility of
the occupants. This is commonly used
in commercial aircraft.
Fig 3-2: Isobaric System
429 Hypoxia
(b) Isobaric Differential System. Tactical military aircraft are not equipped with
isobaric pressurisation system because the added weight penalty would severely affect the
range of the aircraft. In such a system
the pressurisation commences at a
given altitude and cabin altitude is
maintained at this value till a preset
pressure differential is reached. With
continued ascent the pressure
differential is maintained (Fig 3-3). In
aircraft provided with isobaric
differential system Oxygen
supplement is mandatory.
Fig 3-3: Isobaric Differential System
14. Provision of supplemental oxygen in the aircraft ensures that the occupant receives
increasing quantity of oxygen in the inspired air. The aircraft oxygen system (regulator assembly)
ensures that the correct percentage of oxygen is added from the on-board Oxygen reserve to the
inspired air in order to maintain lung PO2 at 103 mm Hg. Table 3-2 shows the percentage of oxygen
supplement in inspired air to ensure maintenance of lung PO2 levels at an equivalent of mean sea
level.
Altitude Barometric Pressure Lung Oxygen

(m) (ft) (mm Hg) (%)
Sea 760 21 %
1515 5000 632 25 %
3030 10,000 532 31 %
4545 15,000 429 40 %
6060 20,000 329 49 %
7575 25,000 282 62 %
9090 30,000 225 81 %
10,300 34,000 187 100%
Table 3-2: Supplemental Oxygen Requirements at Altitude to

Maintain Mean Sea Level Air Equivalence
15. Ascent to altitudes above 34,000 feet, even whilst breathing 100% oxygen, results in the
alveolar PO2 falling below that produced by breathing air at ground level, i.e. PO2 of 100 mm Hg,
breathing 100% oxygen at an altitude of 40,000 feet produces an alveolar PO2 of about 60 mm Hg
(Table 3-3) i.e. an intensity of hypoxia equivalent to that produced by breathing air at an altitude of
8,000 - 10,000 feet. Ascent to altitudes higher than 40,000 feet breathing 100% oxygen gives rise to
significant hypoxia. As indicated by the corresponding alveolar PO2 the intensity of the hypoxia
produced by breathing 100% oxygen at 45,000 feet (Table 3-3) is slightly more severe than the
hypoxia produced by breathing air at 18,000 feet. The maximum altitude at which it is acceptable to
fly an unpressurised aircraft, considering hypoxia alone, when oxygen is breathed at ambient
pressure, is 40,000 feet. In the event of decompression of a pressurized aircraft when rapid descent
is initiated immediately the pressure cabin falls, breathing 100% oxygen at ambient pressure will
provide adequate protection against severe hypoxia at cabin altitudes up to 43,000 feet. Severe
hypoxia can only be avoided on exposure to altitudes above 40,000 feet by increasing the total
pressure of the gases in the lungs above the pressure of the environment, a technique termed
positive pressure breathing - usually abbreviated to ‘pressure breathing’.
Altitude (feet)
Partial Pressure of: 34,000 40,000 45,000
mm Hg K Pa mm Hg K Pa mm Hg K Pa
Oxygen 100 13.34 60 8.00 36 4.80
Carbon Dioxide 40 5.33 34 4.54 28 3.74
Water Vapour 47 6.27 47 6.27 7 6.27
Total 187 24.94 141 18.81 71 14.81
Table 3-3: Partial Pressure of Alveolar Gases, Breathing 100% Oxygen at Altitude
Pressure Breathing
16. Prevention of hypoxia on exposure to altitudes above 40,000 feet involves the administration
of 100% oxygen and maintaining the total pressure of the alveolar gas equal to that which exists at
40,000 feet ie 141 mm Hg. This is achieved by delivering 100% oxygen to the respiratory tract at a
pressure greater than that of the environment, known as positive pressure breathing. When the
altitude to which protection is required is greater than 60,000 feet or if protection above 40,000 feet is
required for longer than a few minutes the pressure at which oxygen is delivered to the respiratory
tract is chosen so that it maintains the total pressure within the oxygen mask, and hence in the alveoli,
equal to 141 mm Hg. The positive pressures required at various altitudes to maintain this standard
are presented in Table 3-4. Other standards which are discussed in later paragraphs are also shown
in Table 3-4.
Atmospheric Positive Pressure Required : To maintain 141 mm Hg/18.81 K Pa

Altitude
Pressure Mask alone Mask, press Jerkin G trousers
(feet)
mm Hg K Pa mm Hg K Pa mm Hg K Pa mm Hg K Pa
40,000 141 18.81 0 0.00 0 0.00 0 0.00
45,000 111 14.81 30 4.00 17 2.27 28 3.74
50,000 87 11.61 54 7.00 30 4.00 50 6.67
56,000 66 8.80 75 10.00 - - 70 9.34
70,000 33 4.40 108 14.41 - - - -
100,000 8 1.07 133 17.74 - - - -
Table 3-4: Schedules of Positive Pressure Breathing above 40,000 ft

431 Hypoxia
17. Positive pressure breathing, which creates pressure differentials between the respiratory tract
and other parts of the body, produces a number of disturbances, some of which limit the magnitude of
the pressure which can be applied. These disturbances also determine the counter-measures which
must be taken in order to allow the use of higher pressures.
(a) Effect of Pressure Breathing on Head and Neck
(i) The most striking feature of breathing at high pressure using an oxygen mask
is the distension of the mouth and throat that occurs when the pressure exceeds
about 10-15 mm Hg. At higher pressures the floor of the mouth and the whole of the
throat are widely distended, and above about 60 - 70 mm Hg, this distension can give
rise to severe discomfort.
(ii) In certain individuals, oxygen under pressure may force its way up the tear
ducts which connect the inner corners of the eyes to the nose and blow onto the
surface of the eyes causing spasm of the eyelids.
(iii) In order to sustain breathing pressures in excess of 70 mm Hg, a pressurized

helmet which applies the same pressure to the eyes and neck as is being transmitted
to the lungs is used. This support to the neck and throat avoids the effects described
above and also permits speech at high breathing pressures.
(b) Effect of Pressure Breathing on Respiration
(i) Pressure breathing inflates the lungs, causing the lungs and chest to expand.
In the relaxed subject, a breathing pressure of only 20 mm Hg distends the lungs
completely. During the normal breathing cycle, inspiration is achieved by active
muscular contraction, whereas breathing out simply requires the relaxation of the
muscles. In pressure breathing this process is reversed. Breathing-in consists of a
controlled relaxation of the muscles as the gas under pressure inflates the lungs.
Breathing out consists of controlled contraction of the same muscles. Thus the
pattern of muscular contraction required during pressure breathing differs markedly
from that of normal breathing. The unusual pattern is associated with a tendency to
over-breathe. Pressure breathing is a technique which has to be learnt.
(ii) The maximum pressure which can be breathed without counter-pressure to

the chest and abdomen is 30 mm Hg. Breathing pressures much above 50 - 60 mm
Hg without trunk counter-pressure cause marked inflation of the lungs which may
result in serious lung damage.
(iii) The respiratory disturbances produced by pressure breathing can be

minimized by applying counter-pressure to the external surface of the trunk. At high
levels of pressure breathing it is not sufficient to apply counter-pressure to the chest
alone, as the diaphragm and the abdominal muscles play an important part in
breathing. The standard pressure jerkin applies counter-pressure to the chest and
abdomen by means of a bladder which is inflated to the same pressure as that which
is delivered to the mask or pressure helmet. The counter-pressure applied by the
pressure jerkin allows pressures as high as 140mm Hg to be breathed with
comparative ease.
(c) Effects of Pressure Breathing on the Circulation. The rise of pressure within the
chest produced by pressure breathing has very significant effects upon the heart and
circulation. The rise of pressure in the lungs is transmitted to the blood in the heart and great
vessels within the chest and abdomen. The increase of pressure in these areas results in
blood being displaced from within the trunk into the limbs and to the loss of the fluid part of
blood out of the vessels into the tissues of the limbs. The amount of blood displaced out of
the chest and abdomen increases as the breathing pressure increases. The higher the
breathing pressure and longer the time for which it is operative, the greater is the amount of
fluid lost into the tissues of the limb. Both the displacement of blood into the periphery and
the loss of fluid into the tissues reduce the amount of blood available for the maintenance of
the circulation. When this reduction exceeds a critical value the blood pressure falls and a
faint occurs. There are limits therefore to the magnitude and duration of pressure breathing
which can be tolerated with safety. This tolerance can be increased by applying counter-
pressure to the limbs so reducing the displacement of blood and the loss of circulating fluid
into the tissues.
18. In practice, pressure breathing with or without counter-pressure to parts of the body (by
means of a partial pressure suit) is used to provide short duration protection against hypoxia during
emergency exposures to altitudes above 40,000 feet produced by either failure of cabin pressurization
or ejection at high altitude. The other effects produced by decompression to high altitude, e.g.
decompression sickness, in addition to the disturbances produced by pressure breathing limit the
duration of the exposure. Descent is initiated immediately the decompression occurs and provided
that there is no serious structural damage to the aircraft it is carried out at the maximum possible rate.
Compromises related to the maximum absolute pressure in the lungs and the maximum breathing
pressure have been accepted and proved experimentally, thereby providing a number of high altitude
protective assemblies.
(a) Pressure Breathing Mask Alone. The maximum pressure which can be breathed
using a mask alone is 30 mm Hg. The compromise set in this assembly is to provide this
breathing pressure at an altitude of 50,000 feet (Table 3-4). As indicated by the total pressure
in the mask and alveolar gas employed in this assembly at 50,000 feet, i.e. 30 + 87 = 117 mm
433 Hypoxia
Hg, it allows considerable hypoxia at the maximum altitude at which it is used. A pressure
sealing mask used with an oxygen regulator which provides a pressure of 30 mm Hg at
50,000 feet will provide protection to an altitude of 50,000 feet provided that descent is
initiated within one minute of the start of the decompression at a rate exceeding 10,000 feet
per min.
(b) Pressure Breathing Mask with Pressure Jerkin. With counter-pressure applied to
the chest and abdomen by means of the pressure jerkin, pressures of up to 70 mm Hg can be
breathed using a mask. The displacement of blood and fluid into the limbs, however, limits
the altitude to which the combination of a mask and pressure jerkin can be used safely to
52,000 feet.
(c) Pressure Breathing Mask, with Pressure Jerkin and G-Trousers. The
displacement of blood and fluid into the lower limbs produced by pressure breathing may be
greatly reduced by inflating the standard G-trousers to the same pressure as is supplied to
the mask and pressure jerkin. With this degree of counter-pressure it is acceptable to breathe
at a pressure of 70 mm Hg at an altitude of 56,000 feet. The relationship between altitude
and breathing pressure employed in this assembly is given in the last two columns of Table
3-4. It provides protection to an altitude of 56,000 feet provided that descent is initiated with
½ minute of the start of the decompression at a rate exceeding 10,000 feet per min.
(d) Pressure Helmet and Pressure Jerkin and G-Trousers. Much higher breathing
pressures can be tolerated when wearing a pressure helmet. When counter-pressure is
applied to the trunk by the pressure jerkin and to the lower limbs by the G-trousers a pressure
of the order of 110 mm Hg can be breathed for several minutes without serious disturbances.
This assembly, when used with an oxygen regulator which maintains a pressure of 141 mm
Hg absolute in the mask and counter pressure garments (Table 3-4, column 4 & 5), will
provide protection to an altitude of 70,000 feet provided that descent is initiated within one
minute of the start of the decompression at a rate exceeding 10,000 feet per min.
Recovery from Hypoxic Hypoxia: Oxygen Paradox
19. Recovery from Hypoxia usually occurs within seconds after re-establishing a normal alveolar
partial pressure. Nevertheless, mild symptoms such as headache or fatigue may persist after the
hypoxic episode. The persistence of symptoms seems to have a higher degree of correlation with the
duration of the exposure than with its severity.
20. In some instances following the sudden administration of oxygen to overcome hypoxia, the
individual develops a temporary increase in the severity of symptoms. This is known as Oxygen
Paradox. The individual may lose consciousness or develop fits for a period lasting up to a minute.
Accompanying symptoms are mental confusion, deterioration of vision, dizziness, and nausea. This is
caused by reduction in carbon dioxide due to increased respiratory activity to compensate for hypoxia,
which along with reduced blood pressure on re-oxygenation, act together to reduce blood flow to the
brain. This reduced blood flow to the brain apparently intensifies the CNS hypoxic symptoms for a
short period until the circulation improves and the carbon dioxide tension returns to a normal range.
21. Prevention of Hypoxia in Aircrew. In a study of hypoxia related incidences among

aviators during a period of eight years, following were the identifiable causes of in-flight hypoxia:
(a) Failure of the regulator to deliver correct concentration of oxygen.

(b) Inadequate seal of mask to face.
(c) Decompression of the pressure cabin.
(d) Inadvertent break of connection of the hose between mask and regulator.
(e) Failure to turn on the oxygen supply.
22. Conscientious pre-flight checks go a long way in decreasing the incidence of Hypoxia. During
flight, if an aircrew experiences symptoms of hypoxia s-/he must select 100% oxygen setting on the
oxygen regulator. If the symptoms persist despite of selecting 100% oxygen, the aircrew must suspect
contamination of the source and use emergency oxygen while immediately commencing an
emergency descent.
23. Preventing hypoxia among aviators is primarily a matter of understanding and indoctrination.
Thus each ab-initio pilot trainee undergoes mandatory hypoxia indoctrination at 2 AMTC. This
indoctrination is aimed at ensuring that the aviators are aware of hypoxia and instructing them in the
proper use and care of oxygen equipment. In the Squadrons, the Squadron Medical Officer plays an
important role in providing guidance on day to day problems of aircrew related to hypoxia, oxygen
systems and personal protective clothing.
435
CHAPTER 4
HYPERVENTILATION
Introduction
1. The ventilation of the lungs is controlled by the respiratory centre in the brain, which in turn is
controlled by the partial pressure of carbon dioxide (PCO2) in the blood. A rise of PCO2 in the blood
stimulates the respiratory centre and increases ventilation of the lungs. A decrease in blood PCO2
has the opposite effect. The respiratory centre is extremely sensitive to small changes in PCO2 and
continuously adjusts the ventilation of the lungs to maintain the partial pressure of this gas at the
normal level. During exercise the rate and depth of respiration increase to keep pace with the
increased rate of production of carbon dioxide by the tissues. Thus, over a wide range of physical
activity, the PCO2 of the alveolar gas remains constant at the resting value of about 40 mm Hg in spite
of the rate of production of carbon dioxide varying 8 - 10 fold.
Causes of Hyperventilation in Aviation
2. The ventilation of the lungs may be increased out of proportion to the rate of production of
carbon dioxide, and then the PCO2 in the alveolar gas and in the blood and tissues will be reduced
below their normal values. This condition is termed hyperventilation. Hyperventilation may be
produced voluntarily. It can also be produced by anxiety, apprehension or fear. The condition occurs
not uncommonly in student aircrew during flying training. Aircraft passengers who are afraid or
anxious frequently hyperventilate. Hyperventilation is one of the normal responses to hypoxia. It is
also produced by a rise of body temperature. Whole body vibration at frequencies of the order of 4 - 8
Hz induces over-breathing. Another procedure which produces hyperventilation is pressure
breathing. Whatever the cause of the hyperventilation, the individual who is over-breathing is unlikely
to be aware that he is doing so until such time as it produces ill-effects.
Signs and Symptoms of Hyperventilation
3. The excessive removal of carbon dioxide from the blood and tissues which results from
hyperventilation gives rise to the following symptoms:
(a) Tingling in the hands, feet and lips.

(b) Spasm of the muscles of hands and feet.
(c) Vague feeling of unreality.
(d). Light-headedness and dizziness.
(e) Faintness.
(f) If prolonged, unconsciousness.
(g) Cold clammy skin, pale cyamosis and weak pulse

(h) Unconsciousness and even death may result
The lowering of the PCO2 in the tissues of the brain also causes an impairment of performance.
4. Hyperventilation is a condition to be avoided. In order to reduce the likelihood of

hyperventilation occurring in flight the following points should be observed:
(a) Learn to breathe in a normal manner particularly when carrying out tasks which are
known to predispose hyperventilation.
(b) Beware of the tendency to over-breathe during periods of intense concentration or
tension.
(c) Do not attempt to overcome suspected hypoxia by voluntary over-breathing.
5. It is possible for individuals to confuse the symptoms of hypoxia and hyperventilation. When
symptoms are experienced at cabin altitudes at which hypoxia could occur it should always be
assumed that the cause is hypoxia. A thorough check and recheck of oxygen equipment should be
made immediately whilst every effort is made to breathe in a normal and controlled manner. Also,
some cases of reported airsickness turned out to be hyperventilation cases.
437
CHAPTER 5
ALTITUDE DYSBARISM
Introduction
1. Altitude dysbarism is the name given to the effects on the human body of reduced barometric
pressure at altitude. Although hypoxia also results from reduced barometric pressure, it is not included
under the term altitude dysbarism. Reduced barometric pressure at altitude produces its effects in two
main ways:
(a) Effects due to the evolution of gases dissolved in the body fluids.
(b) Effects due to expansion of certain gases contained in the body such as in the
stomach and intestines, middle ear cavity, sinuses - frontal and maxillary and improperly filled
teeth.
2. The first series of effects are grouped under the heading of Decompression Sickness and are
due to the evolution of nitrogen from the blood and other body tissues. The second series of effects
are classified as gas pains.
PHYSIOLOGICAL EFFECTS OF ALTITUDE
3. Flight at high altitude exposes flying personnel to environmental conditions in which the
unprotected human body may not be able to function. It is important, therefore, that the physical
limitations of the body and method of extending these limitations are thoroughly understood by all
aircrew and particularly by captains of aircraft who may be responsible for the safety and well-being of
untrained passengers.
4. In order to understand the effects of altitude on man, it is essential to know about the
characteristics of the atmosphere and also have a basic understanding of man’s respiratory
requirements which have been described in the earlier chapters.
DECOMPRESSION SICKNESS
5. A 47-year-old transport aircrew was on a routine supply-dropping mission. The aircraft was
flying at 13,000 ft and oxygen supply was started in the unpressurised cabin. He was going the job of
a loadmaster moving up and down in the cargo compartment and also checking the proper functioning
of the oxygen supply system. After about 45 minutes of flight, bad weather closed in and the mission
was abandoned. The aircraft turned back and climbed up to 28,000 ft to over-fly the bad weather
patch. About 10 minutes later at this altitude, this aircrew felt pain in his left knee joint, which became
worse on movement. A few minutes later he had scratching sensation on his back, which later on
extended in front of his chest. He also felt vague pain in the left half of the body followed by weakness
of the limb. He was now unable to move about and sat down exhausted but remained fully conscious.
His colleagues noticed that he was pale with cold sweat on palm and forehead. He was made to lie
down and emergency oxygen was switched on. Meanwhile the pilot descended to 14,000 ft. He was
slightly relieved and felt better on landing. He made a complete recovery within next three days in the
hospital and was later sent back to flying.
6. This is a typical case of decompression sickness which can occur on exposure to altitude,
especially above 25,000 ft and when the subject is undertaking physical activity.
Causes & Physical Basis of Decompression Sickness
7. The human body contains small quantities of nitrogen, carbon-dioxide and oxygen gases
dissolved in the body fluids. Of these three gases, nitrogen is dissolved many times more than oxygen
and carbon-dioxide. The body contains about 1000 c.c. of nitrogen at ground level. This nitrogen is in
solution in the blood and body tissues. The amount of gas that goes into solution in a liquid depends,
in addition to some other factors, upon the partial pressure of the gas with which the liquid comes into
contact. The 1000c.c. of nitrogen contained in the blood and other body fluids is the amount that is
held in solution at ground level.
8. If we could, somehow, increase the barometric pressure surrounding us, we could push in
more nitrogen into our body. If, on the other hand, we reduce the barometric pressure and hence the
partial pressure of nitrogen in the lungs, nitrogen would tend to leave the body.
9. Decompression sickness is caused by the liberation of nitrogen bubbles in the body due to
exposure to a lowered atmospheric pressure. The body is normally saturated with nitrogen so that
there is sufficient nitrogen in solution in each tissue and fluid of the body to produce a partial pressure
of gas equal to the PN2 in the alveolar gas. When the pressure of the environment is lowered by
ascent to altitude the nitrogen in solution in the tissues, saturated at sea level pressure, will now be in
a state of super-saturation and under certain conditions will come out of solution. Bubble formation is
influenced by many factors, such as movement of the tissues (hence the need to restrict movement of
the affected part), alterations in the circulation of body fluids and rapid change in gas pressure. The
bubbles tend to be released in tissues with the least blood supply and greatest amount of dissolved
nitrogen. This combination of circumstances occurs principally in fatty tissues. The bubbles which
are released cause pain by pressing on nerve endings. They also pass into the circulation and can
cause disturbances in the lungs and the brain.
10. This process is easily seen in the case of a soda water bottle. The sealed soda water bottle
contains carbon-dioxide at a pressure higher than atmosphere. Under this high pressure, the water in
439 Altitude Dysbarism
the bottle holds a certain amount of carbon-dioxide. When the bottle is opened, the water in the bottle
is suddenly exposed to the atmospheric pressure. Under this pressure, the water in the bottle cannot
hold the amount of gas previously held under high pressure. The gas therefore forms bubbles which
gradually escape from the surface of the water. Similar phenomenon is responsible for
decompression sickness. The gas responsible is nitrogen which forms the major part of dissolved
gases and which is not utilized by the body.
11. When we ascend to high altitudes, the blood and the body tissues cannot hold the amount of
nitrogen which is held in solution at ground level. Hence the nitrogen tends to be evolved in the form
of bubbles. This happens particularly in the fat deposits of the body, since fat contains a large amount
of dissolved nitrogen. The bubbles gradually escape from blood as it passes through the lungs. The
surplus nitrogen in the tissues passes to the blood and finally escapes through the lungs. If the
nitrogen bubbles are formed in large amounts and these cannot be eliminated from the lungs fast
enough, the nitrogen bubbles collect in certain parts of the body and gives rise to symptoms.
Effects of Decompression Sickness
12. Decompression sickness can occur in apparently normal individuals who have no
predisposing disease. There is a wide individual variation in susceptibility to decompression sickness
and its classical symptoms are:
(a) Bends. The nitrogen bubbles commonly collect around the joints and gives rise to
pain in the joints. This condition is commonly referred to as “Bends”. Knees, wrist, elbow,
ankle and hip are normally affected. The joints of the upper limbs are affected first and more
frequently than those of the lower limbs. The pain may come on suddenly or it may start as a
dull ache and gradually become more intense as the duration of the flight increases. It is
difficult for the individual to describe the exact location of the pain. When the pain is very
severe, the movements of the limbs are restricted. The pain disappears on descent to lower
altitudes, but on re-ascent it appears in the same joint. Bends are produced by the formation
of nitrogen bubbles in the tissues surrounding the joints. The bubbles distort the nerve
endings in these tissues and so pain is felt.
(b) Chokes. Chokes are caused by the formation of bubbles in the lungs. Burning
sensation or sharp stabbing pain may be felt in the chest. This burning may be accompanied
with dry cough, which is increased by deep breathing. During descent, the ‘chokes’ subside
but may last after landing.
(c) Other Pains. Pain of moderate intensity may be felt in the hands and feet. It is
sharp, transitory and recurrent. This pain is due to the formation of bubbles in the covering of
the muscle tendons. Pain may also be felt along the nerves due to the formation of bubbles
under the sheaths covering the nerves.
(d) Effects on the Skin. Itching is a common symptom of decompression sickness. It

is over the trunk and thighs. Sometimes, tiny blobs are formed on the skin which is associated
with pricking or burning sensation. Skin rashes may also appear in the form of pale patches,
which later become red and hot. These patches gradually grow in size. They disappear a few
minutes after descent. But pain over the involved areas on deep pressure persists for 2 to 3
days. The effects on the skin are due to the formation of bubbles in the skin and fatty tissues
underneath the skin.
(e) Abnormal Sensations. Hot or cold sensations may be felt in various parts of the
body. One may also experience tingling sensation or sensation of falling asleep of a limb.
Sometimes one may feel as if ants are creeping in some parts of the body.
(f) Neurological Symptoms-Eyes. Blurring of vision may be experienced. Sometimes

one may get the sensation of white glistening lights which appear with eyes open or closed.
These sensations may persist for several hours after landing. The visual effects are due to the
formation of bubbles in the brain.
(g) Dizziness. Dizziness may be experienced due to the formation of bubbles in the
organ of equilibrium which lies in the inner ear.
(h) Fatigue and Headache. Fatigue and headache may persist for several hours after
the flight.
(j) Circulatory Disturbances. The symptoms of decompression sickness mentioned

above may be associated with a circulator disturbance (primary shock) which is characterized
by profuse sweating, nausea, vomiting, pallor and faintness. These reactions are usually
received after landing and if prompt treatment is not instated, circulatory disturbance of a
more severe nature (secondary shock) may develop.
(k) Delayed Reaction. Sometimes the individual may be quite free of the symptoms
after return to ground level, but after a few hours, he may develop signs of circulatory and
nervous disturbances.
(l) Creeps. This is produced by involvement of skin and causes tingling, itching,
mottling, cold and hot sensation of the skin. It is often described as "ants crawling across the
skin".
(m) Collapse. A person suffering from decompression sickness may collapse without
forewarning. He may have fainting attack with pallor, sweating, nausea, giddiness and cold
extremities followed by unconsciousness. This can occur with or without other symptoms
being present. The collapse is a typical faint and is characterized by pallor, sweating,
nausea, giddiness and then unconsciousness. Post decompression collapse may occur after
return to ground level and up to five hours, or even longer, after landing. This type of collapse
is usually preceded by some form of decompression sickness at altitude, but not always.
Decompression collapse is not common but, should it occur, it must be treated as a medical
emergency.
FACTORS INFLUENCING THE EFFECTS OF DECOMPRESSION SICKNESS
General Factors
13. (a) Altitude. Decompression sickness does not occur normally below 25,000 ft. Below
an altitude of 30,000 ft Symptoms of decompression sickness may occur, but are very rare.
There are greater chances of symptoms developing at attitudes above 30,000 feet.
(b) Time at Altitude. Decompression sickness does not develop immediately on

exposure to high altitude. It takes some time for the symptoms to appear. The greater the
time spent at high altitude, the greater is the possibility of developing decompression
sickness.
(c) Rate of Ascent. The range of rates of ascent which occurs in aircraft does not
affect the incidence.
(d) Physical Activity. Physical activity at altitude increases the susceptibility to

decompression sickness. ‘Bends’ are likely to be produced in the joint which has been active.
(e) Re-exposure. Re-exposure to altitude within about 48 hours increases an

individual’s susceptibility.
(f) Hyperbaric Exposure. Exposure to breathing air at pressures above one

atmosphere such as occurs in sea diving, by increasing the amount of nitrogen dissolved in
the tissues, greatly increases susceptibility to the condition. Thus after a recent dive,
breathing air, decompression sickness may occur on ascent to as low an altitude as 6,000
feet.
Personal Factors
14. (a) Age. Those over the age of 35 years are more susceptible to decompression
sickness than those below it.
(b) Over Weight. Fatty tissues dissolve nitrogen about five times more than non-fatty
tissues. These individuals are more prone to suffer from decompression sickness.
(c) Physical Fitness. Fatigue and exhaustion favour the occurrence of decompression
sickness.
(d) Individual Susceptibility. There is a wide range of individual variations. Few

individuals are more prone to decompression sickness without any obvious reason.
(e) Recent Injury. There is some evidence to suggest that joint lesions and recent limb
injuries increase susceptibility.
Prevention of Decompression Sickness
15. (a) Use of Pressure Cabins. Decompression sickness normally does not occur at
altitudes below 25,000 ft. Aircraft flying above this altitude, are pressurised to below 25,000 ft.
As such chances of decompression sickness are rare unless there is failure of cabin
pressurisation or due to mechanical or structural failure of enemy action, Most of the modern
aircraft are for this reason so pressurized as to ensure that the cabin altitude does not
exceed. 25,000 to 30,000 feet.
(b) Time Spent at Altitude. When exposure to a cabin altitude above 30,000 feet
cannot avoided, the risk of decompression can be considerably reduced by limiting as far as
practicable, the time spent at altitude above 30,000 feet.
(c) Avoidance of Obesity. These persons are more prone to suffer from
decompression sickness. Appropriate measures, e.g. diet restriction under medical
supervision, should be taken by those who have a tendency to put on extra weight.
(d) Breathing of 100% Oxygen (De-nitrification). Breathing of 100% oxygen at

ground level prior to a flight helps the body to get rid of nitrogen and thus reduces the risk of
decompression sickness. The breathing of 100% oxygen for 30 minutes to 1 hour, for
producing what is known as de-nitrifications, is necessary for aircrew who are engaged on
special high altitude fights.
(e) Descent. Descent to lower altitudes immediately helps to alleviate the symptoms
and reduces the risk of decompression sickness.
(f) Selection of Aircrew. Decompression Chamber Tests help to eliminate highly

susceptible individuals. For long duration high altitude sorties, selection of aircrew of younger
age groups and smaller body is a better risk.
(g) The second line of defence is the pressure clothing which pressurises the man and
creates a microenvironment around him of low equivalent altitude.
(h) Keep exposure in un-pressurised part of transport aircraft flying above 20,000 ft to the
minimum if it can be avoided. Avoid unnecessary activity.
(j) Descend below 25,000 ft if cabin pressure falls.
(k) If any crew member gets symptoms of decompression sickness in-flight, put him at
rest, give 100 percent oxygen and descend to below 20,000 ft as early as possible. The
symptoms would most likely disappear before landing. But even so do not forget to present
him to the SMC immediately for medical evaluation and surveillance.
16. To summarize, the treatment of decompression sickness is immediate recompression, as fast

as is tolerable, to as low an altitude as possible. Except where operational considerations make
maintenance of altitude essential, descent should be made a height at which the cabin altitude is less
than 10,000 feet. In severe cases, or if symptoms persist, a landing should be made as soon as
possible. If practical, the affected individual, if he is suffering from severe bends, chokes, neurological
disturbances or collapse, should be laid flat and given 100% oxygen to breathe. Medical advice
should be sought immediately by R/T. Whenever decompression sickness occurs in flight the
affected individual should receive medical attention as soon as possible after landing.
17. The incidence of decompression sickness can be markedly reduced by pre-oxygenation, i.e.
by washing out the nitrogen in the body with oxygen. This is done by breathing 100% oxygen at
ground level for some time before take-off. This procedure is time-consuming since it has to be
carried out for at least an hour and possibly several hours, depending upon the height and duration of
exposure which is expected. For example, breathing oxygen at ground level for three hours will
protect a high percentage of subjects when exposed to 40,000 ft for three hours. Individuals who pre-
oxygenate on the ground must proceed to their aircraft and transfer to 100% oxygen on the aircraft
system without taking a breath of atmospheric air.
18. Decompression sickness is a condition which is best avoided. The most satisfactory method
of prevention is limiting the maximum altitude to which aircrew are exposed to below 25,000 feet, by
means of pressurization of the cabin or, in unpressurized aircraft, limiting the maximum cabin altitude
to 25,000 feet. Since a small but significant proportion of individuals may develop decompression
sickness at altitudes below 25,000 feet the tendency over the last 20 years has been to reduce the
maximum cabin altitudes of combat aircraft towards or below 20,000 feet. The marked increase in
susceptibility to decompression sickness which follows exposure to breathing air at environmental
pressures greater than 1 atmosphere requires that, following such an exposure, individuals must not
ascend to altitude either in an aircraft or a decompression chamber until sufficient time has elapsed
for the excess nitrogen to be eliminated from the body. The period spent at ground level before flight
is to exceed 12 hours after swimming using compressed-air breathing apparatus and to be greater
than 24 hours if a depth of 30 feet has been exceeded.
Treatment of Decompression Sickness:
19. In the aviation environment, rapid descent achieves this to a great extent. After landing the
aviator is to be kept under medical surveillance to observe for delayed presentation of decompression
sickness for 12-24 hours. This period is essential, as most cases of post-decompression collapse
manifest within this period. With persistence of symptoms of decompression sickness on ground or in
case of post-decompression collapse, the treatment modality is called as recompression or hyperbaric
therapy. During recompression an
individual is compressed to
pressures greater than 1
atmospheric pressure to promote
dissolution of the Nitrogen
bubbles. This therapy is
undertaken in a rapid
recompression chamber (Fig 5-1),
where an affected individual
should be evacuated at the
earliest. Evacuation should be by
Helicopter or transport aircraft
while ensuring that the cabin Fig 5-1: Rapid Recompression Chamber at 2 AMTC for
Treating Decompression Sickness
altitude is not allowed to exceed
300 m (1000 ft) of the base altitude during the entire sortie.
Ebulism
20. A further effect of exposure to a reduced pressure is the vaporization of tissue fluids, resulting
in a quite rapid, painless swelling of the affected part. Above 63,000 ft the total atmospheric pressure
is less than the vapour pressure of the body fluids at deep body temperature. In regions of the body
where the hydrostatic pressure of the body fluids is low, collections of water vapour could be formed.
In practice, this condition is not likely to occur until the pressure is considerably lower than the
equivalent of 63,000 ft. This condition has been observed in the hands of subjects wearing partial
pressure suits at very high altitudes (above 65,000 ft). It disappears again on descent below that
height. There is no residual disturbance of function due to this phenomenon and it can be prevented
by applying pressure to the area concerned. In the case of the hands, for example, it can be avoided
by wearing close-fitting leather gloves.
GAS PAINS
21. The head contains a number of gas-filled cavities which communicate with the nose; these
are the middle ear cavities and the nasal sinuses. The gas contained in these spaces expands and
contracts on ascent and descent and so long as communication with the nose remains open to permit
gas to flow out of and into these cavities no disturbances will occur. However, if free exchanges of
gas in and out of these cavities do not occur with change of altitude, a very high pressure difference
can soon arise, with painful and serious consequences. The change of pressure for a 1,000 feet
change of height is much greater at low than at high altitude, and thus the disturbances caused in the
ears and sinuses by change of altitude occur predominantly at the lower altitudes. Gas pains also
arise due to expansion of certain gases contained in the body such as in the stomach and intestines,
and improperly filled teeth.
Barotrauma
22. "I was detailed in a cross country sortie as a flight engineer. Two days prior to the sortie did
not fly as I had a mild cold. On the day of the sortie I felt better and did not feel the necessity of getting
a medical check done. During take off I had to clear my ears frequently, At the destination, during
descent, I had pain in the right ear and in spite of attempts I could not clear the ear. The pain
gradually got worse and by the time the aircraft landed, I was in agony. I was immediately taken to the
SMC. The medical officer examined me and told me that I had a bad throat infection and that my right
ear drum was badly damaged due to pressure changes during flight. I was grounded for six months".
23. The above incidence was narrated by a Sergeant, a Flight Engineer in a transport Squadron.
It is a typical case of otitic barotrauma caused due to pressure changes if one flies with cold.
24 Barotrauma is a condition which is usually come across during flying and is caused by the
expansion or contraction of trapped gases in the body cavities due to the changes in pressure. It can
lead to problems in the ear (Otitic Barotrauma), sinuses (Baro sinusitis) and in the intestine. These are
collectively called “Barotrauma”.
Otitic Barotrauma
25. This is also known as Aero-otitis Media. It can occur during ascent or descent in flying, or
during runs in a Decompression Chamber, the basic cause being the rapid changes in pressure. It
can be defined as an injury produced in the middle ear due to the difference between the cabin
pressure and the pressure within the middle ear cavity.
26. The Middle Ear. The middle ear is a cavity covered on one side by the ear drum (Fig 5-1)
and is ventilated through a tube to the throat. The tube is called "Eustachian Tube" which is partly
rigid and partly collapsible. It normally
remains closed and is similar to a flutter
valve. It automatically pens during
swallowing, yawning or yelling. It can also
be opened voluntarily by building up
pressure inside the mouth and throat as in
Valsalva Manoeuvre, in which one takes a
breath in, pinches his nose with finger,
closes his mouth and tries to blow out
through the nose with a force. This opens up
the tube with an audible click as the ear Fig 5-1: Diagram of Eardrum
drum moves outward.
Expansion of Gas in the Middle Ear Cavity
27. Normally on ascent as the air in the middle ear cavity expands it escapes through the
eustachian tubes and no pain is felt. If the Eustachian tube is blocked as a result of cold, or any other
infection, expanded air in the middle ear cavity cannot escape resulting in severe ear acne, and
sometimes rupture of the ear drum. Aircrew suffering from colds should not fly. While descending,
because of the high atmospheric pressure air tends to enter the middle ear though eustachian tubes.
28. The cavity of the middle ear is

separated from the exterior by a thin
diaphragm, the ear drum, and communicates
with the nose via the Eustachian tube whose
walls are soft and normally collapsed together
(Fig 5-2).
29. During ascent, as the ambient

pressure decreases, the expanding gas in the
middle ear cavity readily escapes along the
Eustachian tube, so that pressure is equalized
on either side of the ear drum. Since the
anatomical structure of the tube is such that
Fig 5-2: The Human Ear
this gas can escape easily (Fig 5-2),
disturbances are very rare during ascent. This passive ventilation of the middle ear may be heard as
a popping sensation in the ear.
30. During descent, the

collapsed wall of the Eustachian
tube tends to act as a valve,
preventing gas from flowing back
into the middle ear cavity. The
increase in pressure on the
outside of the ear drum
progressively distorts the drum
inwards as the descent continues
(Fig 5-3). Gas must flow into the
middle ear cavity via the
Eustachian tube during descent if
the drum head is to be restored to
its normal resting position.
Several actions may be employed Fig 5-3: Middle Ear and Ear Drum with Eustachian Tube
to open the Eustachian tube and Open and Blocked
allow gas to flow into the middle ear, such as yawning, swallowing or pushing the jaw forward. If such
actions fail, pinching the nose and blowing into it (as in blowing the nose) is very effective. This
method must be used with some care lest the ears become over-inflated, resulting in discomfort,
which can be confused with a failure to clear the ears. Another widely used method is to pinch the
nose, close the glottis (the gap between the vocal cords) and raise the floor of the mouth. Each
individual soon finds, by trial and error, the method which suits him best.
31. During a descent, the ears must be cleared constantly as difficulty is likely to occur when the
pressure difference across the ear-drum is allowed to build up. This pressure build-up pushes in the
ear drum causing pain and deafness which can become very severe as the pressure differential
increases. The condition is known as otitic barotrauma, that is to say, damage to the ear by pressure.
As the differential across the drum reaches about 50 mm Hg the pain is very severe and, when it
reaches approximately 90 mm Hg, it is not possible to equalize this pressure or “clear the ears” by
voluntary effort. Further descent at this stage would cause rupture of the drum. In cases where
voluntary actions such as those described fail to relieve the condition, it is best (if fuel permits) to
climb again until the ears are clear and let down again at a reduced rate, being careful to keep the
middle ears inflated.
32. A head cold is likely to cause congestion and swelling of the Eustachian tubes, just as the
lining of the nose is affected. Thus it may become difficult or impossible to clear the ears. Aircrew
with head colds should not fly unless they can clear their ears satisfactorily on the ground.
Symptoms
33. One or both ears may be affected. Common complaints are mild to severe pain in the ear,
deafness, vertigo and ringing noise. The pain and deafness usually last from a few hours to a few
days. In very severe cases, there may be bleeding from the ear or even rupture of the drum.
34. During an attack of common cold or allergic nose conditions, the tube remains temporarily
blocked and usually produces serious otitlc barotraumas, if flying is resorted to. Even under normal
conditions, inability to ventilate due to pre-occupation or Ignorance can also lead to similar situation
35. Otitic Barotrauma is basically a preventable disorder because voluntary equalisation of

pressure is possible and in conditions where it is likely to occur flying can be avoided temporarily. Two
factors are important. These are
(a) Proper selection of aircrew where individuals with ear defects are not selected. This is
done at entry.
(b) Indoctrination and practice where it becomes second nature to open the tube during
descent. Indoctrination to avoid flying during an attack of common cold and sore throat can
cut down the Incidence in majority of cases.
Treatment
36. While in the Air. Early recognition and action taken during flying can reduce the severity of
pain as well as the duration to recovery. On getting pain, one should try valsalva method and level off.
If not relieved, one may climb and do valsalva which usually relieves the conditions; subsequent
descent should be gradual with frequent valsalva manoeuvres to open the tube.
37. On Landing. Early start of treatment is essential to prevent complications. MO should be

consulted without delay who can judge the degree of damage and advise accordingly. Flying during
the recovery period should be avoided to prevent another attack and further complications.
38. Delayed Otitic Barotrauma. As the name indicates, it occurs after a delay of 4-6 hours
after completion of flying. Usually It occurs In fighter /bomber aircrew who inhale 100% oxygen during
flying. While breathing 100% oxygen, the air in the middle ear Is replaced with oxygen. If a person
goes to sleep soon after flying, without actively ventilating his ears a few times, no air subsequently
enters the middle ear as swallowing stops during sleep. The oxygen gets absorbed slowly creating a
negative pressure. A typical condition of delayed otitic barotrauma develops where an aircrew wakes
up from sleep with acute pain in one or both ears.
39. Prevention. After a sortie with 100 per cent oxygen one should do valsalva manoeuvres a
number of times.
Baro-sinusitis
40. The sinuses are small air filled spaces in

the bones of the skull (Fig 5-4). Baro sinusitis is a
condition associated with pain in and around
sinuses due to injury produced by pressure
changes during flying. This is less common than
Otitic Barotrauma but more difficult to relieve as
the individual has no active control on the
ventilation of sinuses.
41. The sinuses drain into the nasal cavity by

means of openings which allow the passage of air
without difficulty during ascent and descent. Any
obstruction to these openings will adversely affect Fig 5-4: Sinuses
the ventilation of sinuses and result in Sinus Barotrauma. Thus air present in the sinuses which
normally communicates to the nose, if blocked as a result of any disease, can produce severe pain.
Obstruction to the openings can be due to the following:
(a) Inflammation or infection in the nose as in cold.

(b) Any deformity of the walls of the nose or any growth, e.g. polyp, etc.
42. Symptoms. The main symptoms of baro sinusitis are pain over the affected sinus and
headache. These may be severe and incapacitating. If a frontal sinus is involved, the pain extends
over the forehead above the bridge of the nose. If sinuses in the cheek bones are involved, the pain is
localised over the cheek. This pain .is sometimes referred to the teeth of upper jaw giving a false
impression that the cause is in the teeth.
43. Prevention. Baro sinusitis can be prevented by the following procedures:
(a) Elimination of susceptible candidates with sinus defects at entry.

(b) Adequate and timely treatment of nose infections and avoidance of flying till recovery.
44. Treatment in the Air. The immediate treatment of baro sinusitis is to return to the altitude
where the pain first became perceptible. The flight should then be terminated and aircraft brought
down at as slow a rate as possible.
Abdominal Distension
45. Symptoms. According to Boyle’s Law, the volume of a gas is inversely proportional to its
pressure. On ascent to altitude the barometric pressure falls and so the gases enclosed in the
stomach and intestine expand. As these expand they tend to produce flatus and eructation which help
the gases to leave the body. Sometimes, however, the gases remain trapped in certain parts of the
intestines and thus cause distension of these parts. The discomfort caused by the distension may be
mild or severe, defending upon the altitude, the amount of gas initially present, the sensitivity of the
intestines and the state of general health of the stomach and intestines. Sometimes the pain may be
severe at altitudes below 30,000 feet, when the stomach and intestine are affected by such disorders
as constipation, diarrhoea or infection. The chief danger of gas pains lie in that the pain if severe, can
produce circulatory disturbances.
46. Gas pains can be prevented by avoiding those articles of diet which do not agree with the
individual and specially those food which are gas producing, such a cabbage, beans, onions, aerated
water etc. In addition, one should avoid high altitude flights in case of constipation, diarrhoea or
dyspepsia.
47. The stomach and the intestines normally contain variable amount of gas. In healthy
individuals, the stomach and intestines contain a variable quantity of gas (0-300 millilitres). On
ascent, this abdominal gas expands and normally will escape either upwards or downwards through
the mouth or anus as the case may be. The quantity of gas depends upon the type of food taken,
fermentation and digestion. During constipation or diarrhoea, the quantity of gas in the intestines may
be more than what is normally present.
48. During ascent, as the pressure outside falls, the gas expands. An initial volume of 1.0 litre of
gas would expand to 2.0 litres at 18,000 feet. If the gas is present in the stomach or in the large gut,
one may expel it without much difficulty. But if the quantity is more, it may be difficult to relieve and
one suffers from abdominal distension and painful cramps. Symptoms may be tolerable at low
altitude, but can become serious enough above 25,000 feet to precipitate a collapse. Descent should
be initiated if gas pain cannot be relieved. The symptoms caused by an inability to expel this gas
during ascent vary from mild discomfort to severe pain in the abdomen and vomiting. The incidence
of symptoms from the expansion of abdominal gas is, however, insignificant amongst experienced
aircrew, except at cabin altitudes in excess of 30,000 ft. This problem can be aggravated by intestinal
infection or the consumption of too many gas-forming foods.
49. Gas pains are promptly relieved by descent to lower altitudes.

Prevention
50. The following may reduce the incidence of abdominal symptoms:
(a) Cultivate regular eating habits.

(b) Avoid eating in a hurry.
(c) Avoid certain type of foods which produce more gas e.g. cabbage, cucumber, radish
and any other food that ‘disagrees’ with you.
(d) Avoid chewing gum as one tends to swallow more air.
(e) Avoid aerated drinks before flying.
Aero-Dontalgia
51. If there is a cavity in the teeth, the trapped gas inside the cavity may expand and cause
severe toothache. Regular dental check up should be done to avoid such a situation in flying.
Effects of Changes of Pressure on the Lungs
52. The lungs, being air-containing cavities, are also affected by rapid change of environmental
pressure. Only extremely high rates of decrease in the environmental pressure could, however,
cause damage to the lungs by over-expanding them to the point of rupture, because of the relatively
wide bore air passages along which the gas can escape from the lungs. In practice, very rapid
decompressions over a wide range of pressure, which could possibly give rise to lung damage, will
occur in the event of a serious structural failure of an aircraft. It is possible, however, for lung damage
to occur if the breath is held during a wide range decompression. It is clearly important, therefore, to
ensure that intentional breath holding is avoided during practice decompression. Such an action,
particularly with inflated lungs, would carry a grave risk of lung rupture.
53. Lung damage due to rapid or explosive decompression is extremely rare even when the
decompression occurs over a wide pressure differential.
453
CHAPTER 6
PRESSURISATION AND RAPID DECOMPRESSION
Introduction
1. Aircrew operating aircraft at moderate and high altitudes are normally protected against the
effects of exposure to the environment in which the aircraft is flying by pressurisation of the crew
compartment. Conditioned air is fed into the cabin and allowed to escape through discharge valves.
The opening of the discharge valves is controlled so that the desired pressure difference is created
between the interior of the cabin and the external environment of the aircraft.
Cabin Pressurisation
2. Man is accustomed to sea level conditions so it would be ideal to maintain sea level pressure
in the aircraft cabin at all times. For military aircraft, however, this is impracticable and not always
desirable from the point of view of weight, complexity and the hazards arising from loss of pressure
due to enemy action. In practice, the pressure differential and thus the cabin altitude, is chosen for a
particular aircraft as a compromise between the physiological ideal and the proposed performance
and role of the aircraft.
3. Two major types of cabin pressure schedules are employed in military aircraft, namely high
differential and low differential. In aircraft with high differential pressure cabins the maximum cabin
altitude is generally 8,000 feet. A differential pressure of 475 mm Hg is required at an aircraft altitude
of 50,000 feet to produce a cabin altitude of 8,000 feet. High differential pressure cabins are typically
used in large aircraft such as maritime reconnaissance and transports. The crew and passengers
flying in this type of pressure cabin normally breathe cabin air throughout flight. Oxygen equipment is
fitted in order to provide protection against hypoxia in the event of a decompression. In combat
situations, when the risk of decompression is increased, some or all of the crew may use their oxygen
equipment at a cabin altitude of 6,000 - 8,000 feet in order to ensure full protection against hypoxia
should cabin pressurisation be lost. The degree of pressurisation employed in the low differential
pressure schedule is such that at the altitude ceiling of the aircraft the cabin altitude is in the range
20,000 to 25,000 feet, the exact value varying from one aircraft type to another. A maximum
differential pressure of 250 mm Hg is typically employed in this type of pressurisation schedule. The
low pressure differential schedule is used in fighter type aircraft, where the risk of failure of the
pressure cabin due to battle damage or loss of a canopy is higher and the large weight penalty of a
high differential pressure cabin is unacceptable. Crew operating low differential pressure cabin
aircraft use their oxygen equipment throughout flight. Most military aircraft with high differential
pressure cabins are also fitted with a cabin pressure control system whereby a low differential
pressure schedule can be selected, as desired, in flight.
Types of Pressurisation
4. In general, pressure cabins fall into two broad categories:
(a) Isobaric Pressurisation. In this a high differential pressure is maintained

between the cockpit and the ambient pressure. This is used in commercial airliners
having large volume of pressurised cabin. In this system the cabin is maintained at a
constant pressure altitude of 5,000 ft to 8,000 ft during all flight levels where the
pressure difference between the cabin and the ambient keeps on increasing till the
maximum is reached depending on the design limitations. In most advanced aircrafts,
these pressure differential ranges between 8 to 10 psi.
(b) Hypobaric Pressurisation. In this the pressure difference is kept at a lower

value of 2.75 to 3.5 psi and is a low differential pressure type of system. The cabin
altitude increases with flight altitude in such a way that a differential pressure is
maintained at a low value between 2.75 to 3,5 psi. The ceiling of the cabin pressure is
generally maintained below 25,000 ft so as to avoid occurrence of decompression
sickness. Besides these two types a third type called the Hyperbaric Pressurisation has
been discussed in the airframe book.
Relative Advantages
5. (a) High Differential Pressurisation. In this the occupants of the cabin do not
have to use oxygen and mask and thus they are more free to move around and can
travel at more comfort. Feeding and toilet arrangements become simplified and it
becomes easy to deal with more number of passengers.
(b) Low Differential Pressurisation. Physical risks in the event of sudden failure
of pressurisation are significantly reduced. This is very important in combat flying and
also in small aircraft. As the occupants are already connected with oxygen, they are also
prepared to cope with the emergency of pressure failure.
Accidental Loss of Cabin Pressure
6. Cabin may lose pressure slowly due to some minor mechanical fault or a failure of the
canopy seal. However, a rupture of the cabin wall or loss of canopy or window can lead to,
what is commonly known as, Rapid or Explosive Decompression. The compressed air within the
cabin rushes out of the fault at a velocity near the speed of sound (causing the sound) until the cabin
pressure reaches that of the surrounding air. The rushing air would cause loose objects to fly
around and could be severe enough to push a man out of the aircraft, if not properly restrained
with seat belt or shoulder harness. As this air leaves the cabin, the remaining gas expands, causing
455 Pressurisation and Rapid Decompression
the temperature of the air within the cabin to drop to its dew-point and water condenses as a mist
which can be so dense that it interferes with the occupant’s vision. The fogging may be mistaken for
smoke. In case of a slow leak, such dramatic effects do not occur.
7. The Effects of Rapid Decompression on the Body. This effect mostly depends upon
the rate of decompression, higher the rate more serious are the effects. The rate of
decompression is dependent on the following factors:
(a) Larger the volume of the cabin, slower is rate of decompression.

(b) Larger the opening, faster is the rate of decompression.
(c) Larger the pressure differential, faster and more severe will be the
decompression.
8. Effects upon the Cabin Occupants. Failure of a pressure cabin has two distinct
groups of effects upon the cabin occupants. The first group effects are caused by the change in
pressure itself and include lung damage and abdominal distension. The effects in the second group
are due to the exposure of the occupants to increased altitude.
(a) Effects due to Pressure Change. The severity of the first group of effects is
related to the magnitude of the pressure change and the rate at which it occurs. Even when
the loss of cabin pressure is very rapid the incidence of lung damage will be infinitesimally
low. Following rapid decompression a small proportion of aircrew may suffer from abdominal
distension.
(b) Effects due to Exposure to Increased Altitude. The incidence and severity of
the effects which arise due to the exposure to increased altitude are closely related to the final
cabin altitude. The most important effect is hypoxia, and its magnitude is influenced by
whether the crew are breathing air or oxygen. Decompression sickness is rare if the duration
of the exposure to high altitude is short (a few minutes only). If, however, oxygen lack is
prevented and the occupants of the cabin are exposed to altitudes in excess of 25,000 feet for
any length of time, some of them will develop decompression sickness. A reduction in cabin
temperature may be associated with loss of cabin pressure. If the duration of exposure to low
temperature is short, little reduction in efficiency will occur. If the exposure is extended
beyond a few minutes, serious impairment of performance and injury will occur.
Aerodynamic Effects
71. During rapid decompression as a result of a defect in the cabin wall, aerodynamic
factors may cause either a ram effect or a venturi effect. If the defect faces directly into the air
stream, air is forced into the cabin which keeps the cabin pressure higher than the ambient (ram
effect). But if the defect is in any other place, the airflow tends to suck the residual air out of the
cabin (venturi effect) and the final altitude may exceed the actual altitude at which the aircraft is
flying. The magnitude of this effect will depend upon the speed of the aircraft, flight altitude and
position of the defect. In the worst case, the cabin altitude may exceed many thousands of feet
of actual flying altitude.
Expansion of Gases Inside the Body
72. Rapid decompression causes instantaneous expansion of gases within the body
cavities. Middle ear and sinuses can easily vent off the excess gas. The gases from the
intestine also get out without causing much discomfort. The lungs are most vulnerable because
of the delicate structure and the large volume of air contained. However, during normal
breathing, the expanded gas is freely vented off unless its passage is obstructed. Airway may
be obstructed due to active breath holding in panic or while talking and these actions, during the
vital few seconds during rapid decompression, may lead to some damage to the lungs. The
maxim in an event of rapid decompression is:
(a) Relax.
(b) Breathe normally.
(c) Do not hold the breath.
(d) Check oxygen system for its normal function.
73. Rapid decompression exposes the occupants to hypoxia, decompression sickness and
cold. Hypoxia is not a problem in combat aircraft as the aircrew are connected to the oxygen
system and oxygen is delivered at appropriate pressure by the regulator automatically. If
decompression takes place in transport aircraft, all occupants must connect themselves to
aircraft oxygen supply and, conditions permitting, the aircraft must be brought down to lower
altitude. This will not only reduce chances of hypoxia but also those of decompression sickness
and exposure to cold.
74. Thus, in summary, the principle physiological hazard associated with failure of the pressure
cabin of an aircraft at high altitude is hypoxia. If a descent to low altitude is delayed for operational or
structural reasons, then decompression sickness or the effects of low temperature or both together
will be added to the risk of hypoxia. The immediate action to be taken in the event of a failure of cabin
pressurisation at altitude is to ensure that oxygen is being delivered to the oxygen mask and that the
latter is adequately sealed to the face. Whenever structural and operational considerations allow,
immediate descent to as low an altitude as possible should be carried out at the maximum practical
rate. Rapid descent is essential when a decompression results in a cabin altitude greater than 40,000
feet since most of the pressure breathing systems carried in the aircraft do not provide long duration
protection against hypoxia or decompression sickness.
75. Whenever a decompression results in a cabin altitude greater than 25,000 feet descent to a
457 Pressurisation and Rapid Decompression
cabin altitude below this level should be carried out as soon and as quickly as operational
considerations allow. When passengers are being carried in transport aircraft immediate emergency
descent so that the cabin altitude is reduced to less than 15,000 feet (ideally 8,000 feet) is essential,
even if passenger oxygen equipment is available, since it is unlikely that more than half the
passengers will use the latter correctly during and immediately after the decompression. Should fuel
and operational considerations make maintenance of a higher cabin altitude essential then the re-
ascent should only be performed after the appropriate checks that the passengers are receiving
oxygen have been made.
459
CHAPTER 7
ACCELERATION
Introduction
1. An aircraft has the ability to be manoeuvred in the medium of air in an amazing fashion by the
aerodynamic forces generated by the powerful engine and control surfaces. Such movements of the
aircraft affect its occupants, particularly in a fighter aircraft due to the magnitude and rapidity of
changes in the position and attitude of the aircraft. It is important to remember the basic laws of
motion involved in such changes and their physiological effects on the human being which affect him
to function effectively in the unnatural environment of flying. Invariably, the effects of acceleration on
human being are the resultant of the inertial forces acting on him/her and the gravitational force.
Knowledge of human tolerance limits to different types of acceleration is of paramount importance to
ensure training of the pilots for optimal functioning and mission accomplishment under such
accelerative forces. Therefore in this chapter the physiological effects of accelerative forces in
aviation acting on an aviator, especially in fighter flying, are elaborated. The preventive strategies
against G forces for maximum operational preparedness are also discussed.
Types of Acceleration
2. Acceleration is the rate of change of velocity. Thus any change in either the magnitude of
speed or the direction of motion is acceleration. There are three types of acceleration.
(a) Linear Acceleration. Change in magnitude of speed only. e.g. Take-off, landing,
Ejection, Parachute opening shock. Linear acceleration = v / t
(b) Radial Acceleration. Change in direction but no change in magnitude of speed,

e.g. loop, pulling out of a dive. Radial acceleration = v2 / R
(c) Angular Acceleration. Change in both the direction and magnitude of velocity. e.g.
spin, spiral etc.
Duration of Acceleration
3. As per the duration of acceleration, there are three types of acceleration. These are:
(a) Short Duration. 1 second or less, e.g. Ejection.
(b) Intermediate Duration. 0.5 - 2 sec, e.g. Deck landing.
(c) Long Duration. More than 2 sec which may last up to several minutes; e.g. aerial
combat manoeuvres, space launch and re-entry.
Human tolerance to short duration acceleration is determined by the structural strength of the body,
where as the physiological changes set the limit for the long duration acceleration.
Axes of Acceleration (Fig 7-1)
4. (a) Gx : Acceleration acting in antero-posterior axis.

+ Gx = When inertial force acts from front to back.
- Gx = When inertial force acts from back to front.
(b) Gy : Acceleration acting in side to side axis.

+ Gy = When inertial force acts from left to right.
- Gy = When inertial force acts from right to left.
(c) Gz : Acceleration acting in head to feet axis.

+ Gz = When inertial force acts from head to feet.
- Gz = When inertial force acts from feet to head.
Concept of ‘G’ Forces
5. G is the ratio between a given acceleration and

the acceleration due to gravity. It has no units. The term
G force is used sometimes to describe a force, which
produced acceleration, which is a multiple of the
acceleration due to gravity (9.81 m/sec2). Thus, an
acceleration of 98.1 m/sec2 would be 10 G.
Effects of Acceleration
6. Effects of acceleration depend on the following Fig 7-1: Schematic Representation

factors: of Axes of Acceleration
(a) Magnitude. Higher the magnitude, more the effects.
(b) Duration. Shorter the duration, lesser the effects.
(c) Rate of onset / offset.
Gradual onset - Circulatory reflexes are effective.

Rapid onset - Circulatory reflexes bypassed.
Slow offset - Longer to recover.
Faster offset - Shorter time to recover.
461 Acceleration
(d) Site of Application. If force is dissipated over larger area, there is less distortion of
tissue.
(e) Direction. Human tolerance is least in Gz axis and maximum in Gx axes.
Effects of +Gz Acceleration
7. +Gz is the commonest type of acceleration encountered in aviation and the human tolerance
to +Gz is low. The effects of +Gz are:-
(a) Apparent increase in body weight.
(b) Heaviness of limbs.
(c) Helmet-head limitation.
(d) Difficulty in getting up from the seat.
(e) Viscera is pushed towards the feet.
(f) Disturbance in the mechanics of breathing.
(g) Drop in hydrostatic pressure above the level of heart.
(h) Increase in hydrostatic pressure below the level of heart.
(j) Pooling of blood in lower limbs, reduced venous return.
(k) Reduced cardiac output.
(l) Visual changes (Greyout, Blackout).
(m) G-LOC (G-induced loss of consciousness).
The effects of +Gz on the circulatory system are the most important and determine the tolerance to
+Gz exposure.
Hydrostatic Pressure
8. The hydrostatic pressure of a column of fluid depends upon the height of column (h), density
of fluid (ρ) and acceleration to which it is exposed (G), i.e.,
Hydrostatic pressure = h x ρ x G
9. This pressure under acceleration is directly proportional to the values of ‘G’ provided ‘h’ and
‘ρ’ are constant. The positive acceleration increases the weight of the blood column above and below
the heart resulting in reduced vascular pressure above the heart and increased vascular pressure
below the level of heart. For a column of blood having a height of 30 cm at 1 ‘G’ the pressure exerted
is 22 mm of Hg. Thus, if Mean Arterial pressure (MAP) at heart level is 100 mm Hg, it will be reduced
to 78 mm of Hg at the level of brain at 1 ‘G’ and at 4.5 ‘G’, the reduction will be by 99 mm of Hg,
resulting in only 1 mm Hg MAP in the brain. The pressure levels below the heart are increased
concomitantly, leading to pooling of fluid. The net result is reduction in the circulating volume of blood
in the head and neck area leading to features of ‘Grey out’, ‘Black out’ and G induced loss of
consciousness (G-LOC).
Visual Symptoms of +Gz
10. Visual symptoms of

Grey-out also referred to as
‘Tunneling of vision, veiling of
vision’ and Black-out are due
to disturbances in retinal
circulation (Fig 7-2). As the
Mean Arterial pressure in
head and neck area reduces
below a certain level, retinal
arteries start collapsing at the
periphery and later even
central retinal artery collapses
although cerebral circulation
Fig 7-2: Circulatory Changes in Eyes and Brain Showing
is still maintained. G-Time Relationship
11. An acceleration of +3 to +4 Gz acting for 4 - 6 seconds is sufficient to cause some reduction

in peripheral vision. Plus 4 to +5 Gz acting for 6 to 10 seconds may produce black-out or even loss of
consciousness. These levels can vary widely from individual to individual, or even in the same person
depending upon extraneous factors such as hunger, alcohol, concurrent illness, fatigue or hypoxia. In
general, the grey-out threshold is about 1 G below the black-out threshold, and this in turn about 1 G
below the threshold for unconsciousness. The range is wide, however, and unconsciousness has
been encountered as low as + 3 Gz.
Secondary Circulatory Changes
12. Within 6-12 seconds of the onset of acceleration, reflex changes occur in the circulatory
system. These result in vasoconstriction, increased force of contraction of heart and increased heart
rate.
463 Acceleration
G-Induced Loss of Consciousness
13. G-LOC is G-induced loss of consciousness. It is a “State of altered perception wherein one’s
awareness of reality is absent as a result of sudden, critical reduction of blood circulation in the brain
caused by increased G force”. It is characterized by sudden loss of consciousness (Fig 7-3). The
overall or total incapacitation associated with a G-LOC can be divided into two periods, first the
absolute incapacitation or the period during which the pilot is unconscious lasting for an average
duration of 15 sec. This is followed by the
second period of relative incapacitation or
the period during which the pilot is confused
/ disoriented for an average duration of
another 15 sec. This may be associated with
retrograde amnesia, dream like state and
jerky movements during the recovery stage.
Thus, the pilot may not be in control of
aircraft for up to 30 sec which could lead to
disastrous consequences. G-LOC involves
loss of vision, consciousness, postural
muscular control, memory and dream lets.
These together constitute a symptom
Fig 7-3: G-Time Tolerance Curve
complex that has been defined as the G-
LOC syndrome.
Operational Significance of G-LOC
14. During human centrifuge training of pilots, first symptom is a total loss of muscle tone and the
head and neck slumps. On gaining consciousness, the pilots may report dreams. There is a dawning
awareness of the situation and stimuli, and an inability to gain motor control and press the proper
switch to disengage the sound/ light warnings during the relative incapacitation period. G-LOC has the
potential to exert a temporary, psychologically crippling effect on aircrew aggressiveness in aerial
combat. The embarrassment, fear, confusion, anxiety, euphoria and above all give up attitude may
significantly impair combat readiness during the most critical period of combat. Thus a pilot recovering
from G-LOC might be technically conscious, but the observed psychological factors combined with
physical slowness, would certainly put him at a disadvantage against a fully functional enemy pilot for
up to several seconds.
15.. G-LOC is more likely to occur in a trainee pilot or co-pilot who is not prepared for the sudden
onset of G and a pilot whose tolerance has been lowered due to any of the factors discussed later.
However, no one is immune to G-LOC, irrespective of his flying experience. On any given day if the
pilot pulls more G than his tolerance, he is likely to undergo G -LOC. With a rapid onset of G as in
Mirage-2000 and Mig-29 aircraft, there may not be any warning signs of Grey out or Black out before
the pilot lapses into G-LOC. Symptoms following G-LOC have been identified and are grouped as
physiological and psychological symptoms and are discussed below.
Physiological Symptoms Post G-LOC
16. (a) Convulsive (flail) movements.
(b) Tingling: extremities, face.
(c) Impaired motor coordination.
(d) Unaware of G-LOC episode (amnesia).
(e) Dream state/sense of falling asleep.
Psychological Symptoms Post G-LOC
17. (a) Confusion and disorientation.
(b) Suppression of G-LOC recognition (protection of self-esteem or self-image)-denial.
(c) Altered judgment (lack of self-trust).
(d) Embarrassment (ashamed of losing self-control).
(e) Dissociation.
(f) Euphoria (false sense of well-being).
(g) Anxiety.
(h) Fear (basal survival instinct).
(j) Antagonism (towards centrifuge personnel and / or situation).
(k) Give-up attitude.
18. The most important of these symptoms are amnesia, impaired motor coordination, confusion,
disorientation and denial. Amnesia and denial would reduce the number of reported G-LOC
incidences, thereby artificially reducing the perception of the hazard. Impaired motor coordination and
mental confusion extend the length of recovery and therefore increase the hazard of G-LOC.
19. The pilot may suffer from convulsions during last 4 secs of absolute incapacitation. These
convulsions involve the extremities, face, neck, and trunk. Usually violent jerks terminate the seizures
in 2 to 5 sec.
465 Acceleration
20. The incidence of in-flight G-LOC in IAF is between 10.53 to 10.8%; while the incidence in
USAF is 12% and in RAF 19% respectively. Several Air Forces have implicated G-LOC in various
fighter aircraft mishaps.
Tolerance to +Gz
21. The average relaxed ‘G’ tolerance of IAF fighter pilot population is 4.7 + 0.7 G. It increases
with experience. The G tolerance of non-fighter aircrew or ground crew is little less. However, it must
be realized there are large individual variations in G tolerance and even in the same individual
tolerance may vary at different times.
Factors Affecting Tolerance
22. (a) Hypoglycemia. Reduces tolerance to Gz.
(b) Heat Stress. Heat stress reduces tolerance to +Gz due to reduced effective
circulatory volume caused by sweating.
(c) Alcohol. Ingestion of Alcohol reduces the tolerance to positive acceleration.
(d) Hyperventilation. Hyperventilation markedly reduces tolerance to +Gz. This is due

to reduced blood flow to the brain due to wash off of Carbon dioxide.
(e) Gastric Filling. Filling of Stomach minimises the descent of diaphragm and also
heart. Experimentally, it is observed that ingestion of 1.5 L of water could increase Gz
tolerance by 0.6G.
(f) Hypoxia. Hypoxia reduces tolerance to +Gz.
(g) Fatigue. Fatigue due to any cause e.g. excessive flying, sleep deprivation etc. will
reduce tolerance to +Gz.
(h) Psychological Factors. Motivation, fear etc. change an individual’s tolerance to

+Gz.
(j) Minor Disablements. Mild rise in body temperature and infections etc. reduces
tolerance to +Gz.
(k) Break in Flying. Even a one-week period off flying can reduce Gz tolerance.
Protection Against +Gz
23. Protection against +Gz and increase in +Gz tolerance is gained principally by:
(a) Avoidance of factors that reduce ‘G’ tolerance.

(b) Prevention of blood pooling in lower parts of body and enhancement of venous
return.
(c) Reduction of height of hydrostatic column above heart i.e. reduced heart to brain
distance.
Various Means Used to Achieve Protection Against +Gz Are:
24. Physiological Measures
(a) Anti-G Straining Manoeuvre. (AGSM) is the single most cost effective means of
increasing G-tolerance. AGSM has two components: muscle tensing and breathing out
against a closed glottis (L-1) or with a semi closed glottis (M-1). Timing of the breathing
components is very important. The inspiration should be sharp, as a gasp, lasting 0.5 to < 1
sec followed by expiration over next 3 seconds. A well-performed AGSM can increase a
pilot’s tolerance by 4 G. It is advisable that AGSM be practiced in the safety of human
centrifuge. High G centrifuge training has been introduced in the IAF w.e.f. 1991 to make
fighter pilots proficient in performing AGSM.
(b) Crouching. Crouching forward can reduce heart-brain vertical distance and thus
increase G tolerance, however, this tends to reduce the pilot’s vision outside the cockpit.
(c) Exercise Training. A judicious mix of moderate aerobic and weight training
exercises increase the G tolerance. Aerobic exercises done in moderation improve the cardio-
respiratory fitness. Weight training of the torso, limb and neck muscles results in an improved
ability of the pilot to perform an effective AGSM under high-G conditions.
25. Anti-G System. This consists of anti-G valve and anti-G suit (AGS).
(a) Anti-G Valve. The conventional Anti-G valve is a mechanical device which consists
of spring loaded weights adjusted in such a way that at 2 G the weights are pushed down to
an extent where an inlet to the anti-G suit is made to open and allow flow of air/O2 into the
AGS, causing it to inflate. The pressure in AGS is built up at a rate of 1 psi/G at low setting
and at 1.5 psi/G at high setting. As acceleration is washed off, the springs pull the weight up
closing the inlet and allowing the suit to deflate.
(b) HFRP. High flow ready pressure valve is an improvement over the conventional
anti-G valve. This type of valve provides a ready pressure of 0.15 to 0.2 psi on being
connected to AGS even at 1 G. This pressure fills up 60% of the suit volume and along with
higher flow rates of the valve helps in rapid inflation of the suit to maximal pressure under
further acceleration. HFRP valve matches the capability of modern aircraft which can build up
467 Acceleration
G at rates of 6-7 G/Sec. HFRP valve along with AGS can give a protection of 1.5 - 2.0 G.
Mirage-2000 has an HFRP valve.
(c) Anti-G Suit (AGS). Design varying from a

simple elastic belt to pneumatic as well as water
filled belts has been used as AGS. Later garments
covered legs also. Present day AGSs are
pneumatically inflated and cover abdomen and lower
limbs causing compression to prevent pooling of
blood. Most commonly used AGS in IAF is
indigenously manufactured cut-away type (Fig 7-4).
A typical AGS covers abdomen and lower
extremities like a trouser, cut -away at crotch and
knees to permit greater mobility and to reduce heat
load. An outer non-stretch layer contains 5 bladders
inside; one covers the abdomen and one each for
both thighs and calves. The suits are available in 5
Indian and 6 Russian sizes and fitment is done with
the help of lacing-cords and suit is tightened around
abdomen and legs with the help of slide fasteners. Fig 7-4: Cut-away Type Anti-G
The bladder system is inflated through a flexible Suit
hose present on the left side, which is connected to the Personal equipment connector (PEC)
mounted in aircraft. An AGS should ideally be worn directly over the skin, but for
convenience, most aircrew wear it over the flying overall. A well fitting AGS gives a protection
of 1.0 to 1.5 G. In all aircraft in the IAF, except Jaguar and Mirage-2000, AGS is inflated by
air derived from the compressor of the aircraft engine, whereas in the Jaguar and Mirage-
2000, O2 derived from the stored liquid Oxygen is used for inflation of AGS.
26. Reclining seat with heel elevation. This leads to a decrease in heart-brain distance and
also reduces venous pooling in the lower limbs. Such a seat with 30-degree tilt-back has been
introduced in F-16 aircraft and is reported to give an additional protection of 1G.
27. Positive Pressure breathing for protection against G (PBG). This increases G tolerance
by increasing the intrathoracic pressure, which is transmitted to great vessels in the chest thus, aiding
the cardiac pump pressure.
Negative Gz (-Gz)
28. It is a form a radial acceleration where the inertial force acts from feet to head. This is
experienced during ‘bunt’ manoeuvre, inverted flying or during an inverted spin. However, negative G
manoeuvres are often deliberately not performed because human tolerance to -Gz is very low and
aircraft structure is not designed to tolerate high -Gz forces.
Physiological Effects
29. These are mainly due to the pooling of blood in the head and neck region and give rise to
symptoms like heaviness to feeling of bursting in the head, throbbing and intense headache. Halos
may be seen around brightly lit objects with general dimming of vision. ‘Red Out’ may occur at about
3.0 G. The feeling is like viewing through a red -filter. It occurs because the lower lid gravitates over
the eye. Telltale signs of a pilot having undergone -Gz could be pinpoint to large bleeding spots in the
soft tissue of head and neck. Slowing of the heart rate may occur due to increased blood pressure in
the area above the level of heart.
Transverse Acceleration (+ Gx)
30. In present day conventional flying, transverse acceleration of long durations are rarely
encountered. However, the seats of future combat aircraft may be inclined back to convert positive
acceleration to transverse acceleration. Aircraft like SU-30 MKI have a significant Gx capability (upto
3Gx) as a result of fully integrated canards and two-dimensional thrust vectoring. A Gx of much higher
magnitude is however, encountered during space flights. Flight conditions where +Gx is encountered
are catapult launch, rocket and jet assisted take off, and carrier landings and flat spin (-2 Gx).
Effects of +Gx
31. As ‘Gx’ increases, difficulty in breathing is noted, especially over lower third of the chest. By
about 9-12 +Gx, respiration becomes shallow and difficult. At about 15 +Gx, respiration is extremely
difficult. Limbs cannot be lifted at 8 +Gx and head at 9 +Gx with the back raised 250 from horizontal,
black out occurs around 10 +Gx and unconsciousness at about 14 - 16 +Gx. Respiratory discomfort
and difficulty reduces with raising of head end and also flexion of limbs.
Tolerance to +Gx
32. Tolerance to +Gx is set primarily by increased difficulty in breathing due to increased weight
of anterior chest wall and the abdominal contents pressing on diaphragm. The maximum voluntary
tolerance for periods of 5-150 secs is of the order of 14-15 +Gx with 100º inclination of seatback.
Backward Acceleration (-Gx)
33. Tolerance to - Gx is influenced by the support afforded to the front of the body. For a seated
man support comes from the harness system and in a prone position it is provided by a specially
contoured pouch.
469 Acceleration
Effects on a Seated Person
34. (a) Difficult to operate ejection handle
(b) Blood displacement to head and limbs.
(c) -5Gx can be tolerated for 10 secs.
(d) -3Gx can be tolerated for 5 mins.
Effects on a Prone Person
35. (a) Difficulty in breathing.
(b) Nasal drip
(c) Salivation
(d) Sagging of lower eyelid.
(e) Pinpoint bleed.
(f) Respiratory system - affected (but less than +Gx)
(g) Tolerance
(i) -5 Gx for 5 mins.

(ii) -10Gx for 2 mins.
Lateral Acceleration : + Gy
36. There is no lateral acceleration in conventional aircraft, except the SU-30 MKI which has 1.5
+Gy capability. Although it is not well studied, it is known that the human tolerance varies between 3
to 4 + Gy.
471
CHAPTER 8
VISION AND HEARING
Introduction
1. The ability to see well is a most necessary requirement in flying. The aviator relies on his
eyes completely at every stage in order to see the ground, the instruments and other objects. Vision
is more than just an act of seeing as it depends on the proper utilization of the eyes and then the
correct interpretation of the visual picture by the brain.
The Eye
2. The eye receives rays of light directly from luminous sources or reflected from objects and
focuses them on to the retina at the back of the eyeball by means of the cornea at the front and the
lens within the eye. Photoreceptors in the retina convert light into nerve impulses which are then
transmitted by the optic nerve to the brain where they are interpreted as a picture.
3. Each eyeball is roughly spherical, approximately 2.5 cm in diameter and lies within the bony
orbit suspended in fat. It is protected against damage from all directions except at the front where
protection is limited to that provided by the eyelids.
4. The eyeball is fluid filled and depends on its own

internal pressure to maintain its shape and integrity. It is
composed of three skins which are modified at the front to
admit light (Fig 8-1). The outermost skin, the sclera, is tough,
supportive and relatively free from blood vessels. It has a
transparent region at the front called the cornea. The middle
skin or uvea contains many blood vessels and its prime
function is nutritive. At the front this middle skin becomes the
ciliary body and iris, while at the rear it forms the choroid. The
innermost skin is the retina which is light sensitive and in its
extent corresponds to the choroid. The globe of the eyeball is
divided into two main compartments by the lens iris
diaphragm, a large rear compartment filled with a clear jelly
called the vitreous and a smaller front chamber filled with a
Fig 8-1: The Human Eye
clear liquid called the aqueous.
5. It is conventional to compare the human eye with a camera, but this analogy is too simple.
The eye is self-focusing, it can adjust over an enormous range of brightnesses, it is capable of fine
hue discrimination, and it can distinguish detail which subtends visual angles of less than 30 seconds
of arc.
6. The optical system of the eye is, however, relatively crude and the sophisticated visual
performance is principally due to the co-ordination between eye and brain. The brain and the neural
retina process visual information, adding, subtracting and comparing as necessary, to improve the
image falling upon the retina.
Visual Function
7. It is convenient to separate visual function into its three component senses, light, form and
colour.
8. The eye is capable of functioning over a wide range of luminances. The luminance of an
object is a measure of its brightness, it is the product of the illumination falling on an object and the
object’s reflectance. The eye is capable of detecting light as dim as faint starlight, and the maximum
limit, where discomfort is evident is as high as bright sunlight on snow. Two visual mechanisms
function over this range. Scotopic or rod vision operates over the lowest quarter of luminance and
over this range the ability to see form is poor and colour is not perceived. Over the remainder of the
range, photopic or cone vision takes over progressively giving, with increasing luminance, the
advantages of good form sharpness and the ability to discriminate colours. The transitional stage,
when both rods and cones are functioning, is
known as mesopic vision and corresponds
roughly to full moonlight.
9. The eye requires time to adjust to

varying luminances because the control is a
photochemical reaction. When it adapts from
dark to light the adjustment is rapid, but in
adapting from light to dark the adjustment is
Fig 8-2: Dark Adaptation Curve
slow. The dark adaptation curve (Fig 8-2)
describes the threshold luminance required to
see a light source as a function of total
darkness, and shows that there is not a steady
increase in sensitivity. The curve is in two
portions, the initial rapid adaptation being that of
the cones and the slower adaptation that of the
rods. A further feature of rod and cone vision is
their different colour sensitivity. Rods are most
sensitive to blue/green light and cones to Fig 8-3: Rod and Cone Colour Sensitivity
473 Vision and Hearing
yellow/green light (Fig 8-3). This differing colour sensitivity is evident at dusk when red objects
appear relatively darker and blue objects retain their subjective brightness.
10. The field of view of each eye, defined as that portion of the external world visible to the
stationary eye, extends from about 60° nasally to 75° temporally. These limits are imposed by
anatomical features such as the bridge of the nose and the depth of recession of the eyes. On the
nasal side of each visual field there is a blind spot covering about 5° of which the observer is largely
unaware. This is where the optic nerve leaves the eye (Fig 8-1), and there are no photoreceptors.
The fields of the two eyes have a central overlapping area of approximately 60° where the same
object is seen with both eyes and vision is therefore binocular. Helmets, visors, and aircrew
spectacles are specially designed to have a minimal impairment on the field of view.
11. When one looks at an object it is imaged on the fovea and the surrounding macula. The
fovea is a specialized region of the retina composed entirely of cones. Covering approximately 1°, it
is where vision is sharpest and colours are most readily seen. Peripheral to the fovea the retina is
composed of both rods and cones, the ratio of rods to cones increasing and visual resolution
decreasing with distance from the fovea.
12. A result of this double mechanism for light appreciation is that to detect dim lights one must
look off centre. It also used to be customary to wear red goggles in lighted crew rooms and to use red
cockpit lighting since rods, unlike cones, are insensitive to the longer red wavelengths. The
advantages of preserving rod adaptation are limited as few flight tasks can be performed with rod
vision. In most cases the sharpness of vision given by the cones is imperative and the disadvantages
involved with red cockpit lighting systems in colour discrimination, the increased focusing effort
required and the distortion in the relative luminance of coloured objects outweigh any theoretical
advantage.
13. A valuable feature of rod vision is its ability to detect movement as an image traverses the
retina. It is useful, therefore, in search procedures at night, not to allow the rod image to stabilize
within the range of involuntary eye movements but to scan the area of search in small arcs, inducing a
moving image of a stationary object on the retina.
14. Under good conditions the eye can resolve detail which subtends a visual angle of 30
seconds of arc. However, under some special circumstances much finer resolution is possible. A
single line may be differentiated against a plain background when it subtends a visual angle as small
as 0.5 seconds of arc. This is more a measure of contrast than of resolution, but it is important in
aviation, as aircraft or wires may first be sensed by their contrast against the sky.
15. There are many factors which may influence the resolution of the eye. These include
atmospheric conditions, the optical quality and cleanliness of interposed transparencies, the
requirement for spectacles, and eye disease. The large pupillary diameters which occur in near
darkness reduce the depth of field of the eye, rendering the decrement caused by the need for
corrective spectacles more evident.
16. Recognition of targets is profoundly influenced by the inductive state of the retina. One part
of the retina modifies the function of another part. This is known as spatial induction. In aviation,
spatial induction will enhance the recognition of aircraft against the sky. The bright sky diminishes
retinal sensitivity and a grey aircraft therefore appears darker, with a consequent increase of the
contrast between the target and the sky. However, a stimulus on a portion of retina will also affect the
function of that portion to a subsequent stimulus. This is known as temporal induction and may
reduce target recognition. If a bright object such as the sun forms an image on a portion of the retina,
the sensitivity of that portion will be depressed for a considerable period of time. This may cause low
contrast targets to remain unseen.
17. Visual resolution is greatly influenced by contrast between target and background and by the
prevailing brightness of the target. Sharpness improves with increasing luminance up to a moderate
level beyond which no further increase occurs, and, at very high luminances, may be impaired. The
best resolution is achieved when the luminance of the target and the ambient lighting are similar. If an
aviator is placed in a dark cockpit with only a small window on the world, the resolution of bright
external targets will suffer. When cockpit illumination is increased resolution improves. Conversely,
resolution will be impaired with a bright cockpit and a dim target.
18. Colour sense is a function of cones and therefore of photopic (day) vision. According to the
generally accepted theory of colour vision, there are three classes of cones present at the macula, in
the ratio of 1:10:10. These cones have absorption peaks at blue, green and red in the colour
spectrum. A combination of these three primary colours in the correct proportions is seen as white
light, and by varying the proportions and saturation (subtraction of white light) any other colour can be
matched. The fovea, is rod free and does not possess blue cones. As a result, if signal lights may
only be seen as point sources, it is important to exclude blue as this colour may be seen as white.
VISUAL FUNCTION IN FLIGHT
19. There are a number of visual problems which are specific to aviation. These are:
(a) Empty field and Night Myopia.

(b) Night Vision and Dark adaptation.
(b) Reaction Time
(c) Dynamic visual acuity
(d) Depth perception
Empty Field and Night Myopia
20. During flight, particularly at night or in cloud, the external scene is often featureless. Without
visual cues to attract attention, the eye frequently comes to focus at a point in space perhaps 1-2
metres away, making the aviator functionally short-sighted. Should another aircraft enter his visual
field it may not be seen, as objects at infinity will be blurred. For this reason it is important that
aircrew look periodically at objects at virtual infinity, such as wing tips or head up display symbols, in
order to relax their focus.
Night Vision and Dark Adaptation
21. Vision at night is achieved through the light sensitive rods on the retina and is called scotopic
vision. Vision in bright daylight is viewed by cones and is called photopic vision. Vision at dusk /dawn
is called mesopic vision and is achieved by the combined efforts of the rods and cones.
22. The rods have a pigment rhodopsin which is extremely sensitive to light and on exposure to
the minimal light it breaks into rhode and opsin, in the process producing an electrical impulse which
is conducted to the brain and interpreted by the brain as a speck of light in that direction. Importantly,
the vision in dark has no colour sense and a very poor sense of acuity.
23. The amount one sees in the dark can hence be related to the amount of rhodopsin present in
the rods at a given time. Throughout the day the rods are constantly being bombarded by light and
hence rhodopsin levels are negligible. This explains one’s blindness on entry into the dark environs of
a movie hall from bright sunlight. The rhode and opsin start regenerating almost immediately in the
dark and an optimum level of regenerated rhodopsin is achieved almost 30 to 40 minutes after being
in the dark. This again explains the fact that one can move out of the movie hall rather comfortably
midway through a movie compared to the blindness experienced while first entering the movie hall
24. During Night flying a pilot must be educated for ease of aviation activities at night as follows:
(a) Hypoxia which causes significant loss of night vision can be overcome by breathing
100% Oxygen from ground level at startup itself.
(b) The rods and hence the rhodopsin is absent at the fovea but is in abundance 4 to 5
mm (10 to 15 degrees) away from it. It is hence best advised to look off-the-centre i.e. 10 to
15 degrees above or below the likely site of target.
(c) It is said that smoking 3 cigarettes before takeoff causes 20% loss of night vision.
This is because Carbon monoxide from smoking has a greater affinity for the oxygen binding
sites of the haemoglobin than oxygen itself. Thus smoking reduces the oxygen carrying
capacity of blood.
Reaction Time
25. Aircraft fly at very high speeds particularly fighters and interceptors. As speed increases,
distances covered in a short span of time increases. This may lead to accidents as when an aircraft
coming out of a cloud finds another aircraft on a collision course or a natural obstacle as in a valley
flying. It takes the image 0.1 sec to be transmitted to the brain from the retina. It takes a pilot another
0.4 seconds to shift the image from the peripheral retina on to the fovea (central retina with most
accurate vision). The brain studies this image 0.1 sec later and takes about 0.45 sec of constant
viewing to recognize it as an obstacle. This 1.05-sec is called the ‘Minimum Recognition Time.’
26. It takes another 2.5 sec, after recognising the object, for the brain to interpret that the obstacle
is on a collision course and to decide and execute the necessary evasive action (to climb, descend or
bank).
27. Once the evasive action is executed, the aircraft with its momentum takes another 1.5 to 2
sec to respond to the control. Thus, a total of 5 to 5.5 sec elapses since the first spotting of the
obstacle by the peripheral vision. This crucial span time is called the reaction time. Table I gives
corresponding distances covered by the aircraft in nautical miles at different speeds in 5-5.5 sec of
reaction time.
Stage in Avoidance of an Object Distance Travelled in Nautical Miles

by an Aircraft Flying at Speeds
500 kt 1000 kt 1500 kt
Time taken from image first falling on peripheral retina to 0.14 0.28 0.42
focused central fixation and recognition 1.0 second
Time taken for decision and subsequent action 2.5 0.35 0.70 1.04
seconds.
Time taken for aircraft to change heading 1.5 seconds 0.21 0.42 0.62
Total time elapsed = 5.0 seconds 0.70 1.40 2.08
Table 8-1: Distance Travelled by an Aircraft whilst the Pilot is Perceiving and Reacting to
an Object Approaching in his Visual Field
Note: The above distances must be doubled when two aircraft, travelling at the same speed, are on
a head-on collision course.
28. Two aircraft on a collision course shall cover

the sum of their distances depending on the speed
in the same span of time (Fig 8-4).
Dynamic Visual Acuity
29. In the previous paragraphs, where visual

resolution was discussed, it was assumed that the
object of interest was stationary. Where a target
Fig 8-4: Visual Image of an Aircraft on
moves across the visual field the eye must track it in Collision Course
order to maintain its image on the part of the retina which will give the sharpest picture (the fovea).
The ocular pursuit mechanism is capable of maintaining steady fixation on a moving target where the
angular velocity does not exceed a value of about 30° per second. At an angular velocity of about 40°
per second, visual acuity may drop to half its static value, the decrement increasing further as angular
velocity increases.
Depth Perception
30. Both binocular and monocular cues are used to assess depth. The binocular cues of
accommodation and convergence have a limited value at the visual ranges important in aviation. This
limitation is largely due to the small distance between the two eyes of about 6 cm making the base of
the ‘rangefinder’ too short. These binocular cues will only provide depth information at short ranges of
up to one kilometre. Stereoscopic vision which is produced by the slightly different images of the
object falling on the fovea of the two eyes, due to the separation of the eyes, also gives some depth
perception out to a distance of one kilometre. Monocular cues to depth perception are as follows:
(a) Parallax. Head movements cause targets which are at different distances from the
observer to move in opposite directions relative to each other. The nearer target moves in the
reverse direction to the head movement.
(b) Perspective. Converging parallels such as runways and railway lines show the
recedence of these terrain features.
(c) Relative Size. Objects, the size of which are known, are able, by virtue of the angle
they subtend, to provide information as to their distance from the observer.
(d) Relative Motion. If two objects are moving at the same speed parallel to the
horizon (i.e. at right angles to the viewer’s line of sight) then the angular velocity of the near
one will be greater than the angular velocity of the far one. Since angular velocity is
determined by the objects velocity and range, knowledge of either one can enable an
estimate of the other to be made.
(e) Overlapping Contours. Objects which overlap others must be closer.
(f) Aerial Perspective. Objects at great distances appear bluer due to the scattering
of light. White lights may appear more red when seen at a distance because the red
component is less subject to scatter than the blue component. This is a further reason to
exclude blue signal lights in aviation.
Factors Affecting Vision in Flight
31. Heat stress. The pilot is subjected to two forms of heat, the ambient temperatures of the
tropics as well as the kinetic heating on the skin of the aircraft as during a low level sortie. The net
result is that the high heat factor causes sweating which in the close confines of the cockpit, further
aggravated by the mask and helmet raises the humidity and causes fogging of the visor. Sweat
trickling down the brows can also cause discomfort. This affects the vision.
32. Vibrations. The body is subjected to vibrations of an aircraft in flight. This is attenuated to a
certain extent by the soft tissues of the body. However the vibrations reaching the head and eyes
have been studied and found to affect it in various ways. Vibrations of the range of 2 to 8 Hz reduce
vision due to movements of the eyes, those from 25 to 40 Hz are found to cause severe fatigue to the
eye and neck muscles, there after the vibrations in the range of 50 to 55 and 65 to 90 Hz are recorded
to cause a lesser but significant amount of fatigue.
Visual Illusions
33. The most important illusions in flight are those associated with the vestibular apparatus and
these are dealt with later in this chapter. Only those illusions which are purely visual are included
here.
34. Autokinesis. A light, such as a star or aircraft tail-light, seen against a black background,
will, after a short time lapse, appear to wander in different directions. These apparent movements
occur because the background does not provide sufficient information about the involuntary eye
movements which are occurring. These eye movements are then interpreted as movements of the
light. In modern aircraft, some degree of general lighting is usually provided which gives a visual
reference.
35. Flicker. The flicker produced by helicopter rotors has been found to cause epileptiform
episodes. The problem arises when the frequency is between 5 and 20 Hz, being worst at 12 Hz.
Anti-collision strobe lighting systems, which are favoured for their conspicuity, have a flash frequency
of around 60 flashes per minute and are harmless.
Vision Protection Devices in Military Aviation
36. In military aviation, vision has to be protected from several possible hazards. These are given
below.
37. Solar Glare. Glare from direct, reflected or scattered sunlight causes discomfort and
reduction in visual sharpness. In transport aircraft spectacles suffice to overcome the problem but in
high performance aircraft, where crews wear protective helmets, an adjustable tinted visor, integral
with the helmet, provides protection against external glare and gives an undiminished view of the flight
instruments. In the fully lowered position the visor is capable of filtering all of the incoming light. The
amount of tint in the spectacles or visor is chosen to be a reasonable compromise in attenuating high
luminances without producing a significant visual decrement. The tint is neutral in order to avoid
affecting colour discrimination, particularly the recognition of red warning signals. As discomfort from
glare is eliminated, it is also necessary to attenuate blue light and infra-red and ultra-violet radiation in
order to avoid the possibility of retinal damage. The field of view is as wide as possible and the
optical and physical properties conform to carefully calculated specifications. Unapproved sunglasses
are unlikely to satisfy these requirements.
38. Protection of the Face Against Bird strike. The hazard of bird strike is always present
during flight (both day and night) at low level. The incidence of bird strikes in low-level, high-speed
flight is such that a strike in the cockpit area is not an uncommon emergency. Ideally cockpit
transparencies should be strong enough to withstand bird impact, but the cost in weight may be
prohibitive. In the absence of other forms of protection, a helmet-mounted visor made of a strong
transparent material, such as polycarbonate, is essential. The visor protects all the uncovered area of
the face as well as the eyes. Tinted and clear visors are incorporated in the new dual visor helmets to
provide day and night protection against glare and bird strike.
39. Blast Protection. During a high-speed ejection, the head is exposed to very high
aerodynamic forces. These may damage the face and eyes. With the visor lowered the helmet, visor
and mask are so integrated that they remain in place throughout the ejection and provide the
necessary protection.
40. Canopy Fragmentation Devices. Where there is no reasonable certainty that the canopy
can be clear of the aircraft before the ejection seat moves, explosive devices are fitted to shatter the
transparencies and permit the seat and occupant to pass safely through. There have been a number
of occasions in which lead spatter from the explosive charges has caused superficial damage to the
face and the eyes. It is most unlikely that any damage will result if the visor is lowered and/or the
eyes closed at the time of ejection.
41. Lasers. Lasers are devices which produce beams of monochromatic light, usually of small
diameter, intense and highly collimated. The energy density within the beam only decreases slowly
with increasing distance from the laser. The eye has the ability to focus the collimated beam of some
lasers and to concentrate the energy into small image sizes on the retina. Thus, lasers can damage
eyes at a considerable distance from the source. The applications of lasers in military aviation include
ranging and target illumination. Protection is best provided by distance. Hazard distance will increase
with the use of magnifying optical instruments, e.g. binoculars or telescopes, as a result of the greater
amount of radiation collected by the object glass. The necessity for protection of a pilot from his own
laser is debatable. The likelihood of a specular reflector in the range area orientated normal to the
beam must be small, the probability being less than one in a million. Should a reflector be present, its
reflectivity at the laser wavelength is not likely to be high. Where it is considered necessary,
protection may be provided by goggles or visors with the requisite level of protection at the laser
wavelength.
42. Nuclear Flash. The fireball resulting from a nuclear explosion is capable of producing direct
and indirect flash blindness and indeed may cause eye damage. By day, the small pupillary diameter
and the optical blink reflex should prevent retinal burns from direct flash at distances at which survival
is possible. Similarly, indirect flash blindness from scattered light within the atmosphere and the globe
itself does not pose a problem. Temporary blindness from the image of the fireball is difficult to avoid,
but again, at survival distances, the irradiated area is likely to be small. Even in the worst case, where
the fireball is imaged on the macula, para-macula vision should allow all vital flight procedures to
continue. At night, when the pupil is dilated, the situation is much worse and indirect flash blindness
may deprive the aviator of all useful vision for an unacceptably long time. In short, protection against
nuclear flash is only desirable by day but is vital at night. Protection devices are being developed for
this purpose.
HEARING
General
43. A good standard of hearing is important to the aviator because the recognition of auditory
signals is an integral part of his tasks. Audition is more than the act of passive listening and involves
the interpretation by the brain of signals often embedded in background noise. The ear receives
pressure variations or sound waves normally through the air and converts these into neural impulses.
For the normal adult the range of vibrations within the audible spectrum is 20 Hz to 10,000 Hz
although the frequency limits of the ear can vary between 2 Hz and 20,000 Hz. Within the audible
range the ear is most sensitive to sounds between 750 Hz and 3,000 Hz.
44. The function of the hearing apparatus

is to collect sound waves and convert them
into nerve impulses. It consists of three main
parts, the outer ear, the middle ear and the
inner ear, and is shown in Fig 8-5. The ear
drum is in the outer wall of the middle ear
cavity, separating it from the outer ear. Sound
waves are collected by the external ear and
directed onto the ear drum which vibrates.
Attached to the inner surface of the ear drum
is a system of three small bones, lying in the Fig 8-5: The Human Ear
air-filled cavity of the middle ear, which condition the vibrations and transfers them to the fluid-filled
inner ear. The air-filled cavity of the middle ear is vented via the Eustachian tube and temporary
hearing loss can occur when there is pressure difference between the middle and outer ear, as may
be caused by descent from altitude. A common cold or respiratory infection can cause the Eustachian
tube to become blocked. A climb or descent in this condition can result in rupture of the ear drum.
This is one reason for not flying with a cold. It is the part of the inner ear known as the cochlea which
transduces vibrations into nerve impulses, essentially performing a frequency analysis of the sounds.
45. One percent or more of the total power output of a jet engine is in the form of noise, ranging
from the lower limits of audibility to ultrasonic oscillations. Sound intensity is measured in decibels
(dB) (a logarithmic measure of the ratio of the measured
sound intensity to a reference sound intensity). A
logarithmic formula is used to avoid an excessively large
scale since the range of responsiveness of the human is
very large. The noise levels in decibels of certain familiar
sounds are given in Fig 8-6. An increase of 3 dB
represents a doubling of sound intensity.
46. Intense sounds or noise can induce temporary

hearing loss and produce ringing in the ears when the
noise ceases although recovery from this is fairly rapid.
The extent of temporary loss is related to the frequency of
the sounds, their intensity and duration. In temporary
hearing loss the reduction of sensitivity is at frequencies
higher than those of the stimulating noise. A noise at one
intensity will produce the same temporary loss of hearing
as another noise at double the intensity if the duration of
the former sound is double that of the latter. Noise-
Fig 8-6: Noise Levels of Familiar
induced loss is not normally induced by sounds below 90 Sounds
dB. If noise levels that induce temporary loss are experienced regularly over a period of years, then
permanent loss of hearing is likely. Permanent loss is observed at the higher frequencies with a
pronounced loss at 4,000 Hz. Permanent loss of hearing can be allayed by keeping the noise dose
within specific limits. Very intense sounds can invoke special responses even in a short time. At 120
dB localized discomfort in the ear is experienced, 140 dB produces pain in the ear and the ear drum
may be ruptured at levels of 160 dB.
47. Sounds and voices are normally perceived within a background of unwanted noise. Sounds
of similar frequencies interfere and make hearing difficult. To offset the effects of this masking it is
necessary to have the signal at a greater intensity than the background noise. A difference of 15 dB
will ensure accurate recognition and as the difference increases so will recognition accuracy. The
rate of decrease of recognition with the difference between signal and background noise can be
minimized by the use of familiar, meaningful or predictable signals.
48. The noise inside a jet aircraft is generated by four sources: the jet efflux, boundary layer
noise, subsidiary systems like cabin conditioning and communications, and special sources such as
armament discharge. These four sources combine to produce different noise pictures for different
aircraft types. The fast jet will show a flat noise spectrum with a high proportion of boundary-layer
noise whereas a rotary-wing will show high noise at the low frequencies because of the rotor and
blade mechanisms. The wearing of properly fitting headgear is very important because helmets can
attenuate the impinging noise considerably. Minimizing noise levels not only safeguards hearing but it
also reduces the stress caused by high noise levels. Work in high noise levels produces fatigue,
irritation and an accompanying risk of accident, though there are wide individual differences in the
stress reaction to noise. People not directly involved in aviation are most likely to be disrupted by
aircraft noise and so it is important that as much as possible of the ground running of aircraft is done
away from buildings housing such personnel. Additionally it is valuable to protect buildings in aircraft
movement areas by such means as double glazing of windows. Individuals who, by nature of their
work, are required to be in high noise fields must be suitably protected by means of personal noise-
excluding ear protectors.
483
CHAPTER 9
SPATIAL DISORIENTATION
Introduction
1. Spatial Disorientation (SD) is one of the commonest stresses in aviation. The most important
consequence of SD is the orientation error accident, which claims lives of aircrew and is responsible
for loss of costly aircraft and lives of passengers as well.
Definition
2. Spatial disorientation is a state characterized by an erroneous sense of position, attitude,

altitude and motion of oneself or one’s aircraft in relation to a fixed, three dimensional co-ordinate
system defined by the surface of the earth and the gravitational vertical. In addition, this also includes
errors of perception by the aviator of his position, attitude or motion with respect to his aircraft or of his
own aircraft relative to other aircraft.
3. Human orientation has evolved and been adapted for a stable terrestrial environment. This
enables him / her to move around easily on the Earth. However, man’s desire to soar into the sky led
to departure from his natural habitat. This resulted in a mismatch between the orientation demands of
the new environment and his innate ability to orient. In aviation man is exposed to motion stimuli,
which differ in magnitude, direction, frequency and in the degrees of freedom from that experienced
on the ground. The human orientation sensory system is unable to cope with this dynamic ever-
changing scenario resulting in a mismatch between human sensory limitation and dynamic motion in
flight. This mismatch is referred to as Spatial Disorientation, and the physiological limitations of the
sensory system result in aviators experiencing illusory sensations of position, attitude or motion in
flight.
Mechanisms of Orientation in Flight
4. Man’s ability to sense or perceive

orientation in three-dimensional space depends on
his learned interpretation of the continuous input of
signals from many sensory receptors. Some of
these receptors are grouped together to form
specialized sense organs like the eye and the
vestibular apparatus (organ of balance) of the
inner ear. Others are more generally distributed in
the body and are found in the skin, the capsules of Fig 9-1: Orientation Triad
joints and supporting tissues. Together they form an ‘orientation triad’ (Fig 9-1). In this ‘orientation
triad’ vision is responsible for 90% of all orientation cues, vestibular system gives 5% and rest 5%
come from the muscle joint senses (proprioceptive or kinaesthetic system, seat of the pants
sensation).
Vision in Orientation
5. Vision is the most important of all the senses of orientation on ground and in air, and as
stated is responsible for 90% of all orientation cues. There are, in fact, two distinct visual systems.
First is the ‘Focal’ (central) vision. This is concerned with recognition and identification of an object
and in general answers the question of “what”. This comprises of the central 30° of the visual cone.
Focal vision is responsible for discerning the fine details of the object. Information processed by focal
vision is ordinarily well represented in consciousness. Second is the ‘Ambient’ (peripheral) vision
which sub-serves spatial localisation and orientation and is generally concerned with the question
“where”. Ambient vision provides a relatively coarse detail.
6. An important aspect of these two modes of visual processing is that they can be dissociated.
Such dissociation can easily be demonstrated by considering the fact that one can walk while reading.
Although attention is concentrated in the central visual field to read with focal vision, maintenance of
body posture, locomotion and avoidance of most obstacles is readily accomplished with little or no
conscious awareness by ambient vision. Various functions of vision can be divided into these two
modes. During driving for example, the steering of the vehicle is a function, which is sub-served by
stimuli impinging on the peripheral visual field. On the other hand recognition of obstacle such as
pedestrians, animals, potholes etc. is a focal function involving the central visual field. During daylight
both modes of processing function normally and at their maximum capacities. However with reduced
illumination e.g. at night, the efficiency of the focal mode is sharply reduced. The net result is that
unexpected hazards are recognised late. Under the same conditions the ambient mode is operating
under daytime efficiency levels, for there is no reduction in the ability to steer the vehicle.
Form and Function of the Vestibular Apparatus
7. The vestibular apparatus is about the size

of a pea, in the inner ear. Within this small volume
are sensory receptors, which are stimulated by
angular accelerations as low as 0.05°/s2 (0.9
mrad/s2) and linear acceleration of less than 0.01
G (0.1 m/s2). In form and function the vestibular
apparatus may be divided into two distinct parts -
the semicircular canals (SCC) and the otolith
organ. The semicircular canals are responsible for
Fig 9-2: The Vestibular Apparatus
485 Spatial Disorientation
detecting angular acceleration and the otolith organ detects the linear acceleration (Fig 9-2). The
basic sensory unit of the vestibular system is the hair cell. Both the SCC and the otolith organ use the
hair cells to detect acceleration. The cells are sensitive to direction. Movement of the hair cell can be
sensed to detect magnitude and direction of acceleration.
(a) Semicircular Canals. These are

transducers of angular motion. In each
semicircular canal there is a swelling where
the sensory cells are located. Sensory hairs
from these cells pass into the substance of a
gelatinous flap (the cupula) which lies across
the bulge (or ampula) of the canal (Fig 9-3).
An angular acceleration in the plane of the
canal causes a deflection of the flap, because
its motion is resisted by the inertia of the ring
of fluid. Deflection of the flap bends the
sensory hairs and produces a corresponding
alteration of the neural signal which is
Fig 9-3: Section of Semicircular Canal
transmitted to the brain. Although the
receptors of each semicircular canal are stimulated by an angular acceleration, in the normal
course of events the signal transmitted is more closely related to head angular velocity (ie
rate of turn) than angular acceleration, because the dynamics of the organ are such that it
acts like a leaky integrator of angular acceleration. The flap has the same density as the fluid
in the canal and so it is not deflected by linear accelerations.
(b) Otolith Organs. These are transducers of linear motion. The otolith organs (Utricle
and Saccule) each house a plate-like congregation of sensory hair cells covered by a
gelatinous layer that carries in its free surface a ‘frosting’ of calcium carbonate crystals (Fig 9-
4). The density of this mineral is more than twice that of the fluid which fills the system so it
behaves as an inertial mass restrained and supported by the hairs of the sensory cells.
Accordingly, a
linear acceleration
acting in the plane
of the otolithic plate
deflects the hairs
and alters the
neural signal from
the sensory cells.
The otolithic plate,
unlike the cupula of Fig 9-4: Section of an Otolith Organ
the semicircular canal, is not heavily damped so it conveys information to the brain about the
magnitude and direction of linear accelerations and rate of change acceleration (jerk),
experienced by the head. Like any man-made linear accelerometer, the otolith organs are
influenced both by their orientation to the Earth’s gravitational acceleration (the gravitational
vertical) and by applied linear accelerations, and like the ball in the turn and slip indicator,
they indicate the direction of the resultant force vector. The configuration of the four otolith
organs allows man to sense the direction and magnitude of a resultant linear acceleration in
any axis.
8. Vestibular-Visual Reflex Responses. The function of the vestibular reflex is to stabilize

the position of the eye, relative to an object fixed in space, when the head moves. Thus when the
head is suddenly turned, the eye reflexly moves in the opposite direction to that of the head in order to
stabilise the image of the outside world on the retina. This is due to the projection from vestibular
nuclei in brain stem to the nuclei of nerves supplying the extraocular muscles, responsible for the
coordinated movement of both the eyes.
Kinesthetic/Proprioceptive Receptors
9. A variety of sensory endings in the

skin, the capsules of joints, muscles,
ligaments and deeper supporting structures
are stimulated mechanically and hence are
influenced by the forces acting on the body.
This system in a combined manner provides
orientation information regarding the various
forces acting on the body and the positions
Fig 9-5: Various Seat-of-the-Pants
of the various parts. This is also called as
(Proprioceptive or Kinaesthetic)
the seat of the pants sensation (Fig 9-5). inputs for Orientation in Aviation
Illusions
10. Various illusions as per the limitations of the sensory organs viz. visual or vestibular are
briefly discussed below.
Visual Illusions
11. (a) Shape Constancy. The pilot uses the shape of various objects, e.g., the runway to
get a perspective of his position in space above the runway. If the runway slopes upwards or
downwards, this perspective gets warped. For example, when landing on an up-sloping
runway, feeling that he is high on

approach, the pilot tends to come in
low approach. The down-sloping
runway leads to a higher than normal
approach (Fig 9-6).
(b) Size Constancy. Size

constancy is extremely important in
judging distances. During landing, the
size of the runway determines the
landing approach slope angle flown by Fig 9-6: Shape Constancy
the pilot. In case of variation in the
width or the length of the runway, a
pilot may err in making his approach
(Fig 9-7). This can be visualised in
AFA, with the availability of short and
long runway, a trainee pilot with
practice of landing on short runway
may err in making approach if landing
on long runway especially during an
emergency. So also, during combat, in
a rapidly changing scenario, distances Fig 9-7: Size Constancy
between aircraft are gauged by the
size of the retinal image of other aircraft. Consider a pilot used to flying a large aircraft like a
SU-30. He is used to seeing an aircraft of a particular size at a distance of 3 Km. This pilot,
during dissimilar combat with a MiG-21, is likely to come in extremely close, expecting the
MiG to look the same size as a Su-30.
(c) Visual Autokinesis. The apparent wandering of an object or a light when viewed
against a visually unstructured background or dark background is called auto kinesis (Figure
10). This is a result of the pursuit tracking movement of the eyes especially if there is little to
focus upon. A bright star may be seen as moving in a circle or moving linearly. During night
formation flying, when only one wandering light of the lead aircraft is seen, other pilots may
have trouble distinguishing the real movements of the aircraft. The pilot should avoid staring
at solitary lights for more than a few seconds and establish a reliable reference to some
structure in the aircraft, such as the canopy bow.
(d) Linear and Angular Vection. If a large structure nearby moves forward, there is an
illusion that one is slipping backwards. The most familiar situation occurs when one is in a
train and an adjacent train moves forward. A false impression is created that your train has
started moving in the opposite direction. A person may also perceive a rotational sensation
when an image rotates in the surrounding background e.g. in a static simulator or while
watching a film especially on big screen like an IMAX.
(e) Black-Hole Approach. The black hole illusion is produced during night landings,
when there are no references except for
the runway lights. This situation may be
worsened when the lights of city on an up-
sloping terrain at the end of the runway
make the approach look high and the
horizon is not distinct (Fig 9-8). A
correction to the perceived steep
approach may cause a crash short of the Fig 9-8: Black-Hole Approach
runway.
(g) False Horizon or Sloping

Cloud Deck. A sloping cloud deck
may cause the pilot to adjust the
aircraft attitude to what is perceived as
the real horizon. There is a strong
tendency to accept the level
appearance of the clouds as the true
horizon, especially if the horizon is
indistinct (Fig 9-9). An unperceived
angle or bank will lead to loss of
altitude, if it is not corrected. This is Fig 9-9: Sloping Cloud Deck [Pilot perceives
incorrectly as a horizontal surface]
particularly hazardous when flying
near mountainous terrain.
(h) Lean on the Sun Illusion. Terrestrial creatures are accustomed to seeing the
brighter part of the horizon above and the darker ground below. This may be reversed,
especially when flying in weather or at high altitudes above clouds. In such circumstances,
basing ones decisions on such an assumption may result in an accident.
Vestibular Illusions Due To Otolith Organs
12. (a) Somatogravic Illusions. Due to head movement i.e. up, backwards or forward, the
otolith organ also remains up or tilts backwards or forward. From past experience we come to
know whether we are facing forward, upward or backward due to different stimulus going from
the otolith organ inspite of our eyes closed. In the event of otolith organ being pulled
backwards or forwards due to inertial

forces acting on it during acceleration
or deceleration of the aircraft, one
gets the sensation of facing upwards
or downwards even though he has not
moved his head. Thus, one interprets
these feelings as if the nose of the
aircraft is going up or down even
though it is actually not taking place.
These illusions are called
somatogravic illusions (Fig 9-10).
During flying, sudden acceleration of
the aircraft may give climbing Fig 9-10: Somatogravic Illusion on Takeoff
sensation and during deceleration, one may get nose down sensation. Correction of this
misperception can rapidly cause an accident. Pilots operating on aircraft carrier need to be
particularly aware of this illusion as they typically receive impulses of +3 to +5 Gx during a
catapult take-off. Usually this sensation is ignored with experience or wherever adequate
visual cues are available. However, when both these are lacking, it may lead to problem in
maintaining orientation.
(b) The Oculogravic illusion It

is the visual analogue of the
somatogravic illusion. This illusion
results from the same stimulus
conditions as the somatogravic
illusion. This illusion results in the
perception, that instrument panel has
moved upward or downward during
acceleration or deceleration
respectively (Fig 9-11).
Fig 9-11: The Oculogravic Illusion
Vestibular illusions due to SSC
13. (a) Somatogyral Illusion. The basis of this illusion is false sensation of self-rotation
caused by inability of the semicircular canals to accurately register sustained motion. During
angular acceleration (bank to right or left side), the cupula of the SSC deflect to the side
opposite to the rotation due to inertia and thus the sensations from the canal inform the brain
the speed and direction of the rotation. However, once uniform velocity is reached, the cupula
returns to the resting position, hence no information goes to the brain about the rotation. One
may feel one is ‘not rotating’ when actually he continues to rotate at a constant velocity.
During deceleration (correction of bank), due to movement of the fluid in the canal, the cupula
is now deflected in the opposite direction for sometime till the fluid movement stops. The
movement of the cupula again informs the brain regarding rotation in the opposite direction
even though he has stopped rotating. Thus one gets disoriented during a roll or a spin i.e. one
during uniform velocity period and secondly during deceleration period. All these illusions can
take place in the absence of visual information available from the ground or horizon. In
addition to this, the individual will be affected by nystagmus due to stimulation of vestibular
system, which will adversely affect the visual cues thus leading to a serious situation. Various
illusions like graveyard spin (Fig 9-12), graveyard spiral (Fig 9-13), turning in opposite
direction, reversal of roll are of this nature.
Fig 9-12: The Graveyard Fig 9-13: The Graveyard Spiral
(b) The Oculogyral Illusion. It is the visual element of somatogyral illusion. In this,
there is a false sensation of the motion of an object viewed by a subject undergoing angular
motion. The subject perceives that an object, which is actually stable in front, is rotating in the
opposite direction and this confirms the perception of the subject’s own rotation.
(c) The Coriollis Illusion. It is

an abnormal sensation appreciated by
the pilots when more than one set of
semicircular canals are stimulated
simultaneously (Fig 9-14). It results in
a bizarre sensation or sensation of
tumbling in the space. For example, if
a pilot in a right-sided roll moves his
head forward he gets a sensation of
yaw to the left, though actually he is in
a roll. Accidents may occur due to this
Fig 9-14: Mechanism of the Coriolis illusion
sensation.
(d) The Leans. It is the most common vestibular illusion. This phenomenon is basically
an illusion of bank when one is straight and level (Fig 9-15). The roll rate is below that
perceptible by the pilot (sub-threshold bank) as predicted by the Mulders constant. If the pilot
then notices the bank on the
instruments, and abruptly returns to
straight and level flight, there will be
the misperception that the aircraft is
banked in the opposite direction.
The pilot resolves this situation by
leaning in the opposite direction,
and flying the aircraft like that. It can
thus be understood that leans are a
result of resolved conflict and
usually do not result in a mishap. Fig 9-15: The Leans
(e) Pressure Vertigo. The semicircular canals may also be stimulated by changes of
pressure in the middle ear. Characteristically, on the first rapid ascent of a sortie, there is a
sudden onset of a false sensation of turning (ie vertigo) which is associated with the venting
of air from the middle ear. This disorientating sensation usually dies away within 15-20 sec,
although initially it can be quite intense, and be accompanied by blurring of vision and
apparent movement of the visual scene. The same symptoms may also be produced if an
over-pressure in a middle ear is achieved when the ears are ‘cleared’ by a too forceful
‘Valsalva’ manoeuvre. Usually the disability is associated with impaired middle ear ventilation
due to a common cold or other respiratory tract infection, and it is another reason for not flying
when affected by these common ailments.
Operational Spatial Disorientation
14. An operational definition of spatial disorientation is, ‘it is an erroneous sense of the magnitude
or direction of any of the control or performance flight instruments’.
Types of spatial disorientation
15. There are three types of spatial disorientation described. This includes:
(a) Type-I. This is unrecognized SD. Here pilot gets disoriented, but does not
recognize it as such leading to wrong decisions and accident.
(b) Type-II. Recognized SD. Here pilot knows that he is disoriented and takes
corrective action.
(c) Type-III. Is called Recognized but pilot is incapacitated to take any corrective
action. Incapacitation may be psychological, physiological or physical in nature.
Conditions Conducive to SD
16. Various conditions conducive to give rise to SD are:
(a) Lack of visual cues, cloud flying etc.

(b) Night flying.
(c) Inattention.
(d) Inexperience.
(e) Hypoxia, cold, alcohol and drugs.
(f) Violent manoeuvres.
(g) Unnecessary head movements.
(h) Fatigue.
(j) Anxiety, preoccupation and emotional stresses.
(k) Glare and Dazzle.
(l) Inadequate cues from vestibular and other mechanoreceptors.
(m) Errors of expectancy.
(n) High-+Gz forces.
(p) Diseases affecting vestibular system.
Prevention of SD
17. Prevention of SD is a multi-pronged approach.
(a) Aircrew factors.
(i) Selection. Selection of candidates with normal vestibular function.
(ii) Health and medication. aircrew should be physically and mentally healthy.
While aircrew is under any kind of medication, flying should be avoided.
(iii) Indoctrination and proper training. Aircrew should be indoctrinated to the

different types of illusions by didactic lectures and demonstration and training in the
laboratory.
(iv) In-Flight Procedures. All pilots should be proficient in instrument flying, so

that they can fly in bad weathers effectively.
(b) Aircraft Factors. Various modifications in the aircraft design and display should be
brought in, to decrease the incidence of SD in flight. These include:
(i) Good cockpit layout.

(ii) Head up display.
(iii) Inside-out vs outside-in display.
(iv) Autopilot.
(c) Operational Factors:
(i) Instrument proficiency. All pilots should be proficient in instrument flying.

(ii) Break in flying. After coming back from leave, they should fly the first
sortie under supervision and care.
Practical advice for pilots
18. When Spatial Disorientation Strikes
(a) Make a positive effort to redirect attention to instruments. Believe in your instruments.
(b) Do not try to analyse the situation. This may lead to waste of valuable time. Try to
make your instruments read right.
(c) Maintain instrument scan pattern.
(d) Do not attempt to mix instrument flying (IMF) and flying by visual reference (VMF).
Once on instruments, maintain the IMF unless outside visual cues are unambiguous.
(e) Seek help. Hand over controls to co-pilot if available.
(f) Talk. Tell the ATC, Radar or any other aircraft in vicinity that you are disoriented.
They may be able to help.
(g) Engage autopilot.
(h) If nothing else works – abandon aircraft.
495
CHAPTER-10
THERMAL STRESS IN FLYING
Introduction
1. The temperature conditions in our country differ markedly and range from extreme cold to
extreme hot.
2. Our pilots, who have to fly at odd hours of the day, all throughout the year and practically over
all types of terrains like snow bound, jungle, sea, etc, are exposed to the ill effects of both hot and
cold climate. Extremes of weather can adversely affect efficiency of aircrew. Hence the aircrew need
to know about hazards of hot and cold climates and prevention of any ill effects so that they can
maintain themselves fit all the time.
Basal Temperature
3. The human being is warm blooded and his body’s vital organs like brain, heart, kidney, liver
etc need an optimum body temperature of 37º ± 0.5º C for their ideal functioning. This is maintained
by a thermo-regulating centre situated in the brain. Whenever body temperature increases beyond
normal, either due to high ambient temperature or due to failure of the thermo-regulating centre, ill
effects of heat appear. Similarly when body is exposed to subnormal temperature and if not protected,
individual suffers from cold injuries. The heat required is generated within the body as a by-product of
energy production for body’s physical activities. This is called ‘metabolic heat’.
Heat Transfer from Body
4. Our body follows the simple physical means of going or loosing heat, so as to maintain ideal
body temperature. The means are radiation, convection and conduction. The physiological means of
loosing heat is sweating (evaporative heat loss) and gaining of heat is by shivering (more heat
generation).
5. When ambient temperature increases beyond 29º C body starts sweating and looses heat
which becomes obvious when surrounding temperature is 37º C and above. When ambient
temperature drops below 25º C body starts shivering and conserves heat. This is how body heat
balance is maintained.
Sources of Heat Stress in Flying
6. Various sources that contribute to heat are:

(a) Metabolic Heat. Body’s internal heat generation is directly dependent on amount of
physical activity. More activity under warm conditions will result in greater heat load which has
to be expelled for maintaining normal body temperature.
(b) Heating by Sunlight. Aircraft exposed to Sun on ground and in air get heated up.
When an aircraft is parked in open with closed canopy solar radiations enter aircraft
canopy/Perspex/transparencies and accumulate heat inside the cockpit. They can not come
out due to altered wave lengths and result in excessive heating (Green-house effect).
(c) Equipment Heat. Electrical lighting and heating systems as well as electronic
equipment generate heat and increase heat load on the pilot.
(d) Ram Heating Effect. High aircraft speed at lower altitude generates heat by friction
with air and poses extra heat load on the pilot.
(e) Environmental Factors. High ambient temperature at low altitude associated with
high humidity, reduces heat loss by sweating. This heat load is further increased, if the air is
still, by reducing sweating.
(d) Flying Clothing. Flying clothing, which interferes with heat dissipation by
evaporation, adds to heat load.
Ill Effects of Heat
7. Once the ambient temperature increases, heat stress on body rises which produces various ill
effects starting from feeling of warmth, uneasiness, sweating, prickly heat, sun burn, feeling of
tiredness and the following:-
(a) Heat Cramps. This is the least severe of them and is primarily due to salt loss
following excess of sweating. Feeling of exhaustion and painful cramps in calf, abdominal &
limb muscles are usual. This can be easily corrected by taking cool salted water.
(b) Heat Exhaustion. This is mainly due to depletion of salt & water. The individual
may have headache, mental confusion, vertigo, loss of appetite and some times nausea &
vomiting. The skin is cold and wet, pulse rapid, he will be hyperventilating. This is easily
corrected by taking him to cool room and giving cold salted water.
(c) Heat Stroke. Last but the most serious of the ill effects of heat is heat stroke. When
the ambient temperature is too high, our thermoregulatory mechanism is unable to increase
sweating any more and dissipate heat. Heat accumulates inside the body. This manifests as
497 Thermal Stress in Flying
increase in body temperature, skin is hot and dry, individual may be confused or
semiconscious. The individual should be taken to cool room, swabbed with cold water, given
cold water to drink and treated by doctor to avoid serious consequences.
Ill Effects of Heat on Flying
8. When an individual is exposed to high ambient temperature, body thermoregulatory

mechanism increases blood flow to skin for sweating, thereby reducing, the amount of blood reaching
the heart. In turn blood supply to eyes and brain is also reduced. Heat stress can affect flying by
reducing Gz tolerance, predisposing to hypoxia, aggravate hyperventilation, setting flying fatigue early
and reduced overall performance.
Prevention of III Effects of Heat on Aircrew
9. (a) Fluid Consumption. It is necessary to provide and supervise the consumption of

water and other fluids to prevent dehydration by excessive seating. Sweating regulates the
body temperature through evaporation and hence cools the body.
(b) Acclimatization. The body level of adapting itself to the new surroundings is known
as acclimatization. So the aircrew must be made to exercise only for short durations, at first.
Later the time frame can be increased gradually.
(c) Cooling Off. Rest is of great importance for a human being. Minimum of 8 hours of
comfortable sleep is essential for the body to recover from the days’ fatigue.
(d) Hygiene. Proper clothing, nutritious food with sufficient salt, bathing and washing
facility, clean living quarters and other accessories like sun glasses, sun screen lotion, etc.
helps in conquering the heat.
COLD STRESS IN FLYING
Source and Situations
10. North and North eastern parts of our country are covered with snow for almost half the year.
Western part of our country is very cold during winter months. The hazards of exposure to cold
weather are commonly experienced by armed forces personnel including pilots.
Effects of Cold and Snow
11. (a) Hypothermia. Hypothermia results when body temperature falls below normal. It
may be recognised by fatigue from excessive shivering and low vitality. This is treated by
warm padded clothing, application of warmth, hot drinks and removing individual from cold
environment. One should avoid alcohol which opens blood vessels near surface of skin and
allows loss of heat.
(b) Frost Bite. Frostbite is freezing of exposed body parts like toes, fingertips, nose
tip, earlobes or face. This often occurs without the individual being aware of it. There may be
a prickly sensation and some stiffness with a whitish or cream colouring of the affected part
and wrinkling of skin. The treatment is by gradual warming of the part or thaw in hot water or
hold near fire. Severe pain is usually an indication that warmth is being applied too quickly.
Frozen parts of the face should be thawed with warm hands, frozen hands under the armpit
and by properly covering with clothes.
(c) Snow Blindness. Initially the eyes become sensitive to glare, when blinking and
squinting occurs. The eyes begin to water, the landscape becomes increasingly red and
finally vision is obscured completely, as if by a flaming red curtain. There is intense pain
which can be reduced by cold compresses.
Prevention of Ill Effects of Cold and Snow
12. The ill effects of cold can be prevented by keeping body specially face, hands, and feet
properly covered by woolen padded clothes, by keeping parts dry and by exercising muscles. Use
cream, Vaseline etc on exposed body parts to prevent cold air touching skin directly. Avoid touching
cold aircraft body or any metal with bare hands. If touched, it should be thawed. Avoid consumption of
alcohol which increases heat loss when the body is not properly covered.
13. Snow blindness can be prevented by wearing goggles or improvised sun shields. As an
additional precaution, cheeks and nose should be blackened with soot, charcoal or engine oil to
reduce number of sun rays, reflecting towards the eyes.
499
CHAPTER 11
EFFECTS OF DRUGS, SMOKING AND ALCOHOL ON FLYING
Introduction
1. One of the primary responsibilities of a Squadron Medical Officer towards the aviators is their
personal safety in flight and on ground. By their decisions, aviators are directly responsible for saving
both lives and costly aircraft. This is not only preventive medicine, but also cost-effective industrial
safety being practiced at a very personal, physician-patient or more appropriately, Squadron Doctor-
Pilot relationship level. An ideal situation is that aviators remain healthy and thus have no need for
medication. However, when drugs do become necessary, they should be selected so as to produce, if
possible, an early and fast, permanent cure, do no harm, and have minimal side effects, if any. The
benefits of this approach for an aviator patient are to keep him/her comfortable during the healing
process, to restore him/her to health, and to preserve and prolong his/her active flying career.
2. However, it is important to remember that aviators may seek consultation from physicians
who may not be aware of the hazards associated with taking medications while flying. Thus, they may
fail to warn the aviator of the associated dangers, or fail to advise him/her not to fly till recovered and
even fail to label the prescriptions with appropriate warnings. A second and related hazard is that all
the medication may not be used up with the initial illness, but may be saved and used later for another
illness. By then the aviator may have forgotten the need to restrict his flying.
3. In most of the situations the proper course is to advise the aviator not to fly until their illness
and their need for medication have passed.
Effects of Drugs
4. Perhaps the most important factor to be considered when deciding whether to ground an
aviator for taking medication is not the medication itself, but rather the disease or the physical state for
which the medication was prescribed. Normally, any illness significant enough to bring an aviator to
the doctor and prompt the doctor to prescribe drugs is sufficient by itself to warrant advise not to fly till
recovered. This takes care of whether the disease or the drug has effects or side effects, which would
impair the physical, mental, or emotional functioning of the aviator, thus making temporary unfitness
for flying essential.
5. In deciding whether to temporarily make an aviator unfit to fly while on medication, it is

important to analyse the effects of the drug, and then relate these effects to the mission and to the
individual's role in the mission. For instance, loose motions and/or vomiting (Gastroenteritis) in a radar
operator could be handled in a much different way from the same illness in a fighter pilot. In the latter
instance the illness itself should decide unfitness of the pilot to fly. When the effects of the drug
compromise an individual's ability to perform effectively and safely, and when they decrease his/her
ability to withstand the stresses of flight or of a survival situation, temporary unfitness for flying duty is
a mandatory advise. On the other hand, when prior testing has shown the drug to accomplish its
purpose and to produce no adverse side effects, the Squadron Medical Officer may decide to
prescribe the drug for use in flight when it is necessary for accomplishment of a mission, example
might be the prescribing of anti-motion sickness drugs for student pilots, accompanied by an
instructor, for their first few flights or for their first aerobatic flights.
6. It is important that all the likely effects of a prescribed drug be considered while analysing
whether to allow an aviator to use drugs and fly. Many drugs have more than one effect - some are
desirable and intended, and others are unwanted side effects. The latter are further subdivided into
predictable physiological responses, unpredictable physiological responses, and idiosyncratic
reactions. Examples of drugs, which might demonstrate these side effects, are atropine and similar
anti-cholinergics. The intended physiological response might be suppression of acid production or
gastrointestinal motility. A predictable, unwanted side effect might be pupillary dilation and decreased
accommodation. An unpredictable, unwanted, physiological side effect might be the degree to which
an individual's heart rate response to the G-forces during flight is compromised. An idiosyncratic
reaction might be a rash or precipitation of glaucoma. Other drugs should be analysed similarly.
7. Basic to the analysis of a drugs’ applicability for the aviator is the requirement that the
Squadron Medical Officer must know all the effects and side effects of the drug. He must then analyse
those actions as they relate to aviation safety. The following discussion highlights some of the factors
considered by the Squadron Medical Officer while prescribing medicine for aviators.
Conclusion
8. Medication can kill. For this reason, it is of paramount importance for the Squadron Medical
Officer to be aware of any drugs an aviator under his care may be taking. This may be difficult to do
because of the ready availability of medications, cold preparations, sleeping pills, and a variety of
other "over-the-counter" medicines at most drugstores and some grocery shops. With the increasing
medical sophistication of the general public through radio and television advertising and articles in
magazines and on the internet, there is a definite possibility of self-diagnosis and self-prescription.
9. When considering whether an aviator should or should not fly while on medication, the
medical condition of the patient should always be the first and overriding concern of the Squadron
Doctor. Then the effects and side effects of the drug should be considered as they interrelate with the
requirements and stresses of flying.
501 Effects of Drugs, Smoking
and Alcohol on Flying
CIGARETTE SMOKING
Nicotine Addiction
10. Tobacco contains a very potent acid known as nicotinic acid. Nicotinic acid if taken in pure
form is lethal. Beside this, there are a number of products of combustion of cigarette paper and
tobacco, including carbon monoxide (CO). CO combines with haemoglobin of blood, thereby reducing
its capacity to carry Oxygen since CO does not part with haemoglobin very easily. Smokers are liable
to suffer effects of hypoxia even before the flight because of lowered tolerance equivalent to 6,000 ft
at ground level itself. The other products when inhaled cause irritation of surface layers of the throat
and lungs. Smokers suffer from repeated attacks of sore throat, dry cough etc. which are due to
irritation. If smoking is continued over a long period, it may lead to lung disease or lung cancer.
Besides, smoking is also known to increase chances of heart attack, as the blood supply to heart is
reduced. Smoking is also known to cause disease of arteries leading to blocking of blood supply.
11. Cigarette smoking men have 70% higher overall death rates then non-smokers. Main
contributors to smoking related excess mortality are Coronary Heart disease, leading to heart attack
and Lung Cancer. The factors which contribute to morbidity due to smoking are age when smoking
was taken up, number of cigarettes smoked daily and total number of years of smoking.
Diseases Related to Smoking
12. (a) 20% of deaths due to heart disease may be due to smoking.
(b) 18% of stroke deaths can be related to smoking.
(c) Diseases of the blood vessels of the limbs are caused due to smoking.
(d) Hypertensive who smoke, are at a greater risk to develop malignant hypertension and
to die from hypertension.
(e) Smoking is the most important cause of cancer deaths, accounting for 30% of cancer
deaths. 85% of lung cancer deaths are found to be due to smoking. Other cancers caused by
smoking are laryngeal, oral, oesophageal and urinary bladder.
(f) Smoking may delay conception and smoking during pregnancy may affect the foetus
adversely.
(g) Gastric and duodenal ulcer disease and Depression cam be associated to smoking
(h) Even passive smoking can cause respiratory diseases and lung cancer.
13. Types of Smoking and Associated Risk. Risk of lung and laryngeal cancer is lower in
people who smoke cigarettes with low content of tar and nicotine. The smoke exposure and over all
mortality rates are lower for pipe and cigar smokers. Chewing tobacco and snuff may lead to nicotine
dependence or addiction, besides increasing the risk for oral cancer.
ALCOHOL
14. Alcohol has become an accepted social drink. So long as one drinks occasionally or regularly
but restricts it to couple of small pegs, it is a matter of individual choice and social acceptance. Higher
the levels of education, the higher are the chances of the person having used alcohol. The main
danger is that alcohol is habit forming and once the habit is formed the acceptable limits are easily
exceeded.
15. Alcohol affects almost all the system of the body but the central nervous system is affected
most, even in low concentrations. Alcohol is primarily a cerebral depressant. The lack of inhibition
evident after alcohol consumption is due to the removal of the higher cerebral control over the lower
centres of the brain. Finer grades of discrimination, immediate memory concentration and judgment,
and finer skills are dulled. Reaction time increases. The individual becomes uncritical, casual and self
satisfied. There is a tendency to disregard rules and conventions and s-/he may become
argumentative. All these effects are dependent on the level of alcohol in the blood.
16. A single drink contains about 12 gm of alcohol, which is usually equivalent to 12 oz. Beer (7.2
proof, 3.6%); 4 oz. Non-fortified Wine; or 1-1.5 oz. Whisky, Gin, or Rum (80 proof, 40%)
Metabolism
17. Alcohol is absorbed from the stomach in 2 to 6 hours depending on whether it is taken on
empty stomach or with food, which delays absorption particularly if it is greasy e.g. fried snacks. Only
10% of alcohol is absorbed from the stomach and the rest from the small intestine. Peak
concentrations are reached between 30 to 90 minutes later, depending on the contents of the
stomach. The stomach protects excessive inundation by alcohol by closing the pyloric valve and
reverse peristalsis, leading to vomiting. Alcohol is distributed in all the body tissues, and tissues with
greater water content have a higher level of alcohol.
18. 90% of consumed alcohol is oxidised in the liver, and 10% is excreted unchanged by the
kidneys and lungs. About 2-3 Oz. of drinks, like whisky or rum are eliminated in an hour. Thus, if one
takes three small pegs (3 Oz.) of whisky/rum alcohol will disappear from blood in 4 ½ hour plus the
time required for absorption depending on the total period over which the person had consumed and
whether he had taken it on empty stomach or with snacks. Thus the total period for metabolism may
be about 8 to 12 hours.
Effects on Flying
19. Apart from the general effects mentioned above and their affecting the flying performance,
alcohol reduces ‘G’ tolerance, makes one prone to hypoxia, and diminishes psychomotor and visual
503 Effects of Drugs, Smoking
and Alcohol on Flying
functions. Episodes of spatial disorientation are more likely after consumption of alcohol. Hence
aviators become prone to accidents.
Alcohol and Flight Safety
20. As per current IAF rules and ICAO regulations, a delay of 12 hours between ‘bottle to throttle’
or after the last drink and first take-off is mandatory. The same is practiced in IAF. The limit of alcohol
in blood far safe flying is Zero Level. Therefore, the time interval between completion of drinking and
flying should be such that blood level of alcohol should fall to zero and the effects of congeners should
disappear. A 12 hour interval may not be adequate if one consumes large quantity of alcohol.
Alternatively, one small peg of whisky may take only 4 hours to completely disappear from blood.
The Hangover
21. These effects result from intake of alcohol in large quantities. Common symptoms are acidity,
discomfort, lack of desire to eat, nausea, headache and inability to concentrate. The effects may last
even when alcohol has been completely eliminated from the blood. This is due to congener content of
the drink which may take 15 to 18 hours or some times more to be eliminated.
505
CHAPTER 12
WOUNDS AND HAEMORRHAGES
Wounds
1. A wound may be defined as a break in the continuity of the tissues of the body which thus
permits the escape of blood and entrance of disease producing germs or other injurious agents.
Wounds may be classified as follows:-
(a) Incised wounds. These are caused by sharp instruments such as a razor and
bleed freely because the blood vessels are clean cut.
(b) Lacerated wounds. These have torn and irregular edges. They are caused by
such things as machinery, a piece of shell or the claws of an animal. As the blood vessels are
through , lacerated wounds bleed less freely than incised wounds.
(c) Punctured wounds. These have comparatively small openings but may be very
deep and are caused by a stab from any sharp pointed instrument, such as a needle, knife or
a bayonet. Gun shot wounds come under one or more of the above headings.
2. Wounds are associated with two complications, bleeding and infection. Let us consider them
one by one.
Bleeding
3. Severe bleeding must be controlled quickly. The loss of much blood without the facilities for
replacement can quickly induce shock and may well be fatal. The exact amount of loss, which is
critical, will vary from person to person, but losses of more than 1 to 2 liters must be treated as
serious in an adult.
4. There are four major indications of bleeding. They are:
(a) Signs of shock.

(b) Visible blood.
(c) Swelling.
(d) Bruising.
5. Signs of Shock. The presence of shock is a very good indication of a major loss of blood,
whether from internal or external bleeding. The body, in an attempt to maintain a blood supply to the
vital organs, restricts the flow to non-vital areas such as the skin so that the casualty becomes pale
and clammy. The pulse becomes faster as the heart pumps more rapidly to try to maintain an
adequate oxygen supply with the limited amount of blood available. In more extreme shock
consciousness may become clouded, blood pressure will fall and the pulse will become even faster
and weak, and difficult to detect.
6. Visible Blood. In some ways visible blood is the best indication of serious bleeding, but it
can also be the most misleading. A small amount of blood seems to go a very long way and may lead
the rescuer to the conclusion that more blood has been lost than is actually the case. Visible blood
can be an indication of both external and internal bleeding:
(a) External Bleeding. Serious external bleeding is a sure indication of a potentially

dangerous injury but a simple scalp wound can provide a lot of blood and may appear worse
than it is. On the other hand a casualty lying on his back concealing a stab wound may die
from loss of blood because his clothing absorbs the blood and none is apparent on casual
examination.
(b) Internal Bleeding. Visible external signs of internal bleeding are valuable
indications of injury. They can include bleeding from:
(i) The Ears and Nose. Bleeding from the ears or nose may indicate a head
injury.
(ii) The Mouth. Blood in the mouth may have come from a local injury to the
tongue, lips or teeth but may have originated in the lungs or the bowels. Dark brown
granular material in vomit ("coffee-ground vomit") is blood that has been altered in the
stomach after a bleed some time ago.
(iii) Urine and/or Motions. Blood in the urine or motions indicates a potentially
serious internal injury.
7. Swelling. Swelling round the site of a fracture indicates bleeding into the surrounding
tissues. The blood loss due to a serious fracture can be extensive and is potentially dangerous,
particularly as, once the fracture is splinted and bandaged, the swelling caused by further bleeding
may no longer be visible.
8. Bruising. Bruising is a visible sign of bleeding into the tissue. A common example is the
black eye, which will usually be accompanied by swelling.
507 Wounds and Hemorrhages
9. Treatment of External Bleeding. The most effective way of stopping external bleeding is
by the direct application of pressure to the source of the bleeding. A sterile dressing or clean piece of
material should be used if it is directly to hand. If not, the thumb or hand can be employed. It is better
to have a live person with an infected wound than a bloodless corpse. Elevation of the wound will
reduce the blood flow to the wound and will aid the reduction of blood loss. If the bleeding continues,
either insufficient pressure is being maintained or the pressure is being applied to the wrong area or to
too small an area. Once the bleeding has been controlled, the wound should be immobilized so as
not to disturb the blood clot which forms. Dressing must be bandaged firmly into place and, if
bleeding starts again, the existing dressing should not be removed but further ones applied on top of
them and bandaged firmly into place.
10. Treatment of Internal Bleeding. There is little that can be done in the case of internal
bleeding other than treating any shock and keeping the casualty quiet.
11. Tourniquets and Pressure Points. Tourniquets and pressure points should not be used in
an attempt to control haemorrhage. Their use is unnecessary and potentially dangerous.
12. Summary. Severe bleeding should be treated by:
(a) Direct pressure on the bleeding point.

(b) Elevation of the part which is bleeding.
(c) Treating for shock.
(d) Resting the injured part/patient.
Infection
13. The signs of infection are:
(a) Pain and throbbing.

(b) Redness.
(c) Heat.
(d) Swelling.
(e) Loss of function.
(f) Unpleasant smell.
(g) Appearance of pus.
14. Local infections are treated by removal of the dressing, re-cleaning the wound and covering
with new, dry dressings. The symptoms of a wound infection can be alleviated by hot poultices or
soaks, and an abscess should be treated in this way until it eventually bursts. General infection,
indicated by fever, sweating, thirst, a fast pulse and "the shakes", is far more serious. Treatment is by
rest in cool surrounds, anti-infection tablets and fluids. Recovery will usually take some days and
should be followed by an equal period of convalescence.
15. Methods of Preventing Infection.
(a) Medical Assistance. If medical assistance is available within a fairly short time
(say 4 hours), do not attempt to clean the wound or remove foreign material and do not apply
ointment or cream of any kind. Simply apply a sterile, or at least clean and dry dressing,
firmly enough to stop bleeding. If medical help is not readily available proceed as sub-paras
b-d.
(b) Clean the Wound. Remove loose splinters, pieces of glass or other foreign matter.
Use sterile tweezers if available. If a large piece of foreign matter is stuck in a wound, great
care should be exercised in its removal, so as not to cause further damage or bleeding. Dirty
or contaminated wounds should be cleaned with soap and clean water if available. If no
sterile dressings are to hand, use the cleanest cloth available.
(c) Cover the Wound. Use antiseptic cream and clean, dry sterile dressings if
possible. The drier the dressing the better, the wound will stay sterile longer. Do not change
the dressings unless they become wet or signs of infection become apparent. If this happens,
remove the old dressing re-clean the wound and cover with new dressings. As long as
bleeding is under control do not bandage too tightly as this can restrict circulation and can
eventually lead to gangrene. Never talk, breathe or cough over an open wound.
(d) Close Gaping Wounds. Press the edges together and hold in position with
transverse strips of plaster across the wound before applying the dressing. Alternatively sew
together the skin edges with needle and thread sterilized in boiling water.
Special Wounds
16. Chest Injuries. If the chest has been punctured, air can be sucked into the chest cavity
causing collapse of a lung. Indications are wheezing or bubbling through the injury and difficulty in
breathing. The treatment is to close the gap so as to exclude air from the wound. The adjacent ribs
and a chest/arm splint will provide some degree of immobilization, and any air already admitted will
gradually be absorbed to allow natural re-inflation of the lung. If it is necessary to place the casualty
in the unconscious position, he should lie injured side down.
17. Abdominal Injuries. There are two types of abdominal injury, perforating and crushing. A
perforating abdominal wound allows intestinal contents (partially digested food) to escape into the
abdominal cavity where they set up an intense irritation. It follows from this that the casualty should
be given nothing by mouth as it will increase the chances of further irritation and possibly cause
collapse and death. If the patient is very thirsty he may be allowed just enough water to moisten his
mouth. The position can be explained to him. As with a perforating abdominal injury give nothing by
mouth in crush injuries in case there is perforation of the bowel.
Burns
18. All burns are painful and cause fluid loss. Major burns are potential killers. Prevention is
better than cure and the correct protective clothing should be worn at all times whilst flying. As much
as possible of the body should be kept covered so that in the event of a fire, damage to the skin is
minimized. Even a thin layer of clothing of the correct type offers a large measure of protection
against flash fires and direct contact with hot surfaces.
19. Burns are of three main types; thermal, chemical and electrical. The survivor will be
concerned primarily with thermal burns and to a lesser extent with chemical burns. Electrical burns
are not likely to be encountered.
20. The dangers from burns are:
(a) Shock. Any burn will cause fluid loss. More extensive the burn, the greater the loss
of fluid and the greater the danger from shock.
(b) Pain. All burns are painful. The pain can be intense and this will tend to increase
the effects of shock.
(c) Infection. Destruction of the skin not only causes fluid loss, but also can allow the
ingress of dirt and germs. Infection is therefore a danger.
(d) Long-Term Damage. In third degree burns (where the deep tissues are damaged)
considerable tissue loss and interference with function can be expected. Second degree
burns (full thickness of the skin destroyed) can result in severe scarring and may require
treatment by skin grafting. Only minor loss of function can be expected. First degree burns
(only the superficial layers of skin destroyed) are not likely to lead to long-term effects.
21. Treatment of Thermal Burns. The treatment of a thermal burn is largely commonsense:
(a) Further damage should be prevented by removing the victim from the source of heat.
Extinguish clothing that is on fire. Do this by smothering the flames with a blanket or soil or
rolling the victim on the ground. Remove smouldering items. Do not allow the victim to run
as this will fan the flames and increase the damage. Take precautions against getting burnt
during the rescue process.
(b) Cool the burnt part in cold, clean running water, if available, for ten minutes.
(c) Cover the burn with a dry sterile dressing remembering the following points:
(i) Do not burst blisters.

(ii) If clothing is sticking to the burn, cut round it. Do not attempt to pull it off.
(iii) Unless help is more than 12 hours away, do not apply lotions, grease or
antiseptics. If help is more than 12 hours away, apply antiseptic ointment from the
first aid kit.
(iv) Do not talk, cough or breathe over the burned area.
(v) Avoid touching or handling the affected area as much as possible.
(vi) Do not take off dressings once they have been applied.
(vii) Avoid the use of fluffy materials such as lint or cotton wool. If no dry, sterile
fluff-free materials are available, leave the burn uncovered.
(d) Give the victim water to replace the inevitable fluid loss; about half a cup to sip every
ten minutes or so. This helps to counteract shock.
(e) Alleviate pain.
(f) Treat for shock.
22. Treatment of Chemical Burns. Chemical burns are not very likely in a peacetime survival
situation. The most probable cause is fuel contamination. Fuel soaked clothing, as well as being a
severe thermal fire hazard, can also cause chemical burns. The symptoms are redness, heat, pain
and possible blistering. If left untreated, and if large areas are affected, the patient can quickly
become incapacitated. The treatment is to remove the contaminated clothing and gently clean the
affected area. From then on treat as a thermal burn.
23. Summary. The treatment for burns is to:
(a) Extinguish the flames.

(b) Cool the burn.
(c) Cover the burn.
(d) Give fluids.
(e) Alleviate pain.
(f) Treat for shock
Fractures, Dislocations and Sprains
24. Bone damage (fractures and dislocations) and sprains will all be considered under this
heading. Strictly speaking a fracture is any break in a bone, and can range from a small surface crack
to a complete break with the ends of the bone protruding through a wound. A dislocation is the
displacement of a joint from its normal position and a sprain is damage to a joint area not involving an
actual fracture or dislocation. In all three cases the final treatment is the same and can be summed
up in one word - immobilization. There are, however, differences in diagnosis and initial treatment.
25. Diagnosis.
(a) Fractures. There are several positive indications of a fracture, some or all of which
may be present. As a guide, if in doubt, treat as a fracture. The positive indications, which
are as usual common sense are:
(i) The casualty heard or felt something break.

(ii) Deformity other than at a joint.
(iii) Pain in the affected part.
(iv) Tenderness of the bone around the fracture.
(v) Broken bone visible in a wound.
(vi) Swelling (see para 12).
(vii) Loss of function.
(viii) Unnatural movement or position.
(b) Dislocation. A dislocation is recognized by the shape of a joint appearing unusual.

The limb may be in an unusual position and there will be loss of movement at the joint.
(c) Sprain. The general shape of the affected joint will be normal but there will be pain
and swelling at the site of the sprain. It may be difficult to distinguish between a fracture close
to the site of a joint and a sprain, so if in doubt, treat as a fracture.
26. Treatment - General. The treatment of a simple fracture or sprain, when within easy reach
of medical aid, is simple; stop any bleeding, immobilize the affected part of the body and await
medical help. In a survival situation, medical aid may be unavailable in the foreseeable future, and
some definitive treatment may have to be attempted for the well-being of the rest of the party even
though there are some dangers in dealing with such injuries. For example the party may have to
travel and it may be impossible to move the casualty without treatment. Only one person on the spot
can make the decision whether to treat or not. Little time should be lost if an attempt is to be made to
set a fracture of a major bone or reduce a dislocation. Action must be taken as soon as possible after
the accident, before muscle spasm sets in and makes treatment impossible. Shock will always be
present to a greater or lesser degree in all cases of sprains, fractures or dislocations and its alleviation
will be an important part of treatment.
27. Treatment of Fractures. Some or all of the following steps may be required, depending on
the severity of the fracture and the degree of treatment to be attempted.
(a) Administer pain killers.
(b) Check for and correct deformities. Most humans are approximately symmetrical from
side-to-side and a simple comparison will indicate deformities. Be as careful as possible not
to cause further injuries. Be gentle yet firm in aligning the ends of broken bones. Gentle
traction along the line of a limb may be all that is required.
(c). If the skin is broken, clean the wound and remove any foreign material that comes
away easily. Dress with dry sterile dressings as for a normal wound.
(d) Splint the Fracture. Splints can be improvised from straight pieces of wood or pieces
of metal from the aircraft. At a pinch the body itself, or the opposite limb in the case of a leg,
can be used as an emergency splint. Ideally two splints should be used opposite each other
and they should be long enough to immobilize not only the fracture but also the joints each
side of it. For example, if the shin is broken the splints should extend from below the ankle to
above the knee. When splinting, apply plenty of padding between the limb and splint and
then strap into place. Tie at intervals (at least twice each side of the fracture) and then further
immobilize by strapping the injured limb to a convenient part of the body.
(e) A crush fracture of one or more of the vertebral bodies of the spine is not uncommon
after ejection: it should be suspected if pain in the back is persistent and localized in the mid-
line. Rest in the recumbent position is the only treatment but this injury may limit any attempt
of the aircrew member to walk.
(f) Treat for shock.
28. Treatment of Dislocations. As with a fracture, some or all of the following steps may be
required depending upon the treatment decided upon:
(a) Administer pain killers.
(b) Reduce the Dislocation. The most likely dislocation to be encountered is that of the
shoulder. Lay the victim on his back. Apply traction by placing the unbooted foot in his armpit
and pulling on the forearm in an outwards and downwards direction. If reduction does not
occur by the time full traction is being applied give the arm a twist either way whilst
maintaining the pull. If it still does not reduce, leave it.
(c) Immobilize the affected part. In the case of the shoulder, if reduction has been
successful, support the arm in a sling with padding in the armpit and the upper arm strapped
to the chest for a few days only. Encourage gentle use of the arm after this.
(d) Treat for shock.

29. Treatment - Sprains. As indicated earlier, it may be difficult to distinguish between a

severe sprain and a fracture. If in doubt, treat as a fracture. If it is certain that it is not a fracture,
proceed as follows:
(a) Sprain of a Joint. Apply a cold compress and then bandage very firmly. After two
or three days rest, encourage gentle use of the affected part.
(b) Sprain of the Spine. Sprains of the spine are not uncommon after any incident
involving a sudden jolt. Ejections and crash landings are therefore likely to cause this type of
injury. The treatment is rest and the application of cold compresses. After a few days
introduce massage and gentle movement.
(c) Shock. Treat for shock.
(d) Pain. Give pain killers

515
CHAPTER 13
ESCAPE FROM AIRCRAFT
Introduction
1. Flying Officer Handa was concentrating on two green ejection lights on the instrument panel.
As the aircraft gathered speed down the 3000 m (10000 ft) runway, he braced his body against the
seat and hands found the seat-firing handle. The green lights blinked, he pulled the handle and heard
a bang. Except for sudden compression of his body he did not remember any details till he was
swinging 50 feet above the ground. He controlled the parachute descent and landed safely.
2. The above description is not of an emergency escape but that of a test ejection from a seat
capable of ejection at zero altitude. Most of the modern ejection seats are fitted only with seat pan
type of ejection firing handles except some aircraft like the Kiran aircraft which has overhead seat
firing handles also. Emergency ejection in flight has its own problems. The emergency is to be
recognized and decision made before the ejection is initiated. If it is an act emergency, one must take
actions accordingly, to save precious time to either abandon the take off or eject. If it is a react
emergency, one must take corrective actions as warranted by the evolving emergency situation, and
yet if aircraft is going out of control, one must make the decision to abandon the aircraft before it is too
late.
3. This chapter is aimed at knowing the means of escape in flight, the correct technique of
leaving a crippled aircraft, and mechanism of ejection. It is also to understand reasons of delay in
ejection leading to fatality.
Types of Escape
4. (a) Unassisted escape. Implies egress from an aircraft, affected without the use of
any mechanical or ballistic aids other than muscular power of the escaping aviator and force
of gravity. The maximum speed of the aircraft for unassisted safe escape is approximately
200 Knots. This may be necessitated in Gliders, trainer aircraft like Pushpak or HPT-32,
helicopters and transport aircraft.
(b) Assisted Escape. At aircraft speeds more than 200 Knots it becomes necessary
for the man to be propelled out of the aircraft, as in a fighter aircraft. In such case, an ejection
seat is the method of choice.
Unassisted Escape
5. This is defined as escape without any mechanical or ballistic assistance to push an aviator
out of a crippled aircraft. In the days when the aircraft flew 'low and slow' it was customary in an
emergency to put the aircraft down in any place, provided that there was a reasonably flat surface
available. With increasing speed this method gave way to unassisted escape commonly known as
bailing out of the aircraft. This is the method of escape from the basic flying trainer HPT-32.
6. Various techniques are used for bailing out such as rolling the aircraft on its back and falling
out or jumping out, depending upon the type of aircraft. For each aircraft, a set procedure is to be
followed. Proper knowledge of procedures and limitations for bail out is essential for safe escape.
Assisted Escape
7. With increase in aircraft speed, it becomes impossible for man to manually separate from the
aircraft in an emergency because of high-pressure forces of windblast or immobilization by ‘G’ forces
during uncontrolled aircraft manoeuvres. It is therefore necessary to have an assisted means of
escape. The ejection seat provides the assistance to leave a disabled aircraft in case of an
emergency. Most of the fighter aircraft have an open types of assisted escape system, except MiG 21
type 77 which has semi-capsular system. F-111 aircraft has closed capsular ejection system. Ejection
seat and sequence of ejection are discussed in the following paragraphs.
Ejection Seat
8. An ejection seat is a rigidly

constructed metallic seat, which is
forcibly ejected from the aircraft cockpit
by means of an explosive charge.
Different types of ejection seat in fighter
aircraft are enumerated in Table 13-1.
The basic design features of seats
include an ejection gun, guide rail, seat
frame structure, adjustable seat pan,
parachute container, drogue, seat pan
and/or overhead seat-firing handle (Fig
13-1). Some seats are provided with
armrest firing handles. A barostatic
control is incorporated to initiate
separation of seat and man, when high
altitude ejections are made. The seat is
Fig 13-1: Schematic Diagram on an Ejection Seat
517 Escape from Aircraft
stabilized by a drogue parachute. A time-release mechanism is designed to disconnect the drogue

from the seat and unlock the safety harness automatically at a tolerable preset altitude. The present
day ejection seats have a 'G’ switch; sensitive to loads imposed by deceleration which delays the
deployment of main parachute till the forward speed is reduced. An automatic leg restraint mechanism
is also fitted, which on egress automatically withdraws and secures the occupant to the seat pan.
Similarly arm restraints or arm guards are provided to prevent flailing of the arms.
Aircraft Ejection Seat Characteristic

Kiran MB H4H A 0-90 Kt (manual canopy jettison)
MiG-21 (T-77) CK-4 0-130 Kmph
MiG-21 (T-69, 75, 96, 24) KM-1M Series I 0-130 Kmph
MiG-23, -27 KM-1M Series II 0-130 Kmph
Jaguar MB Mk 9A and 9B 0-0
Mirage, Harrier, LCA MB Mk 10 0-0
MiG-29 K-36 DM Series II 0-0
SU-30 K K-36 DM Series II 0-0
Table 13-1: Ejection Seats in Different Aircraft
Minimum Safe Ejection Altitude (MSEA)
9. The minimum safe ejection altitude quoted for an ejection seat is only applicable to the aircraft
in straight and level flight. For an aircraft in descent, the stated MSEA is no longer applicable and has
to be proportionately increased. A rule of thumb is to divide the rate of descent by 12 and add the
result to the basic limitation of the seat, e.g. in aircraft fitted with zero altitude seat diving at 6,000
ft/min, the MSEA would be:
MSEA = 0 + (6000/12) =500 feet
Remember, it is NOT ZERO feet, but MSEA in this case is 500 ft.
Sequence of Operation of an Ejection Seat
10. On pulling the firing handle, the canopy gun fires immediately and jettisons the canopy. After
a short delay (typically about one second) after the canopy jettisons, the ejection gun fires and the
harness locking mechanism gets actuated, which locks and tightens the pilot into the seat harness. As
the seat rises, the leg restraint cords pull the feet close to the seat pan and hold them in place. The
Oxygen, anti-G suit, and R/T connections are automatically severed at the Personal Equipment
Connector (PEC).
11. Half a second later, the drogue gun fires and extracts the controller drogue, which pulls out
the main drogue parachute. The drogue parachute stabilises the seat man combination. After a
certain delay determined by the barostatic time delay unit (BTRU) (altitude and time capsule) and ‘G’
switch, the drogues are released, seat harness opens and the parachute released from the seat.
When the drogues are released they pull on the lifting line, which in turns deploys the parachute.
Manual Release
12. In the event of the damage to the seat mechanism, resulting in failure of the seat to eject or
failure of the automatic gear to operate, provision is made for occupant to bail out. However, the latest
trend in seat design is to annul this facility, both due to weight penalty, as well as the very high
reliability of modern systems. After ejection, in case of failure of the seat-man separation, manual
override handle (MOH) is available to separate and to deploy the parachute. MOH is located on the
left hand side of the seat pan in Kiran trainer, whereas in the aircraft like the Mirage and Jaguar, it is
located on the right hand side.
13. The sequence of events in assisted escape is variable and differs from seat to seat. It is
important to be familiar with the sequence of events during ejection for the particular aircraft one flies
in order to take prompt action in emergency, which is vital for survival. To this end one must read and
understand the pilot notes thoroughly. The sequence of events in general can be enumerated as in
Fig 13-2.
Fig 13-2: Sequence of Ejection and Parachute Deployment

(a) Pulling of firing handle.

(b) Occupant pulled into seat with inertia reel system.
(c) Canopy jettisoning/ MDC initiated fragmentation/separation of canopy.
(d) Ejection gun fires.
(e) Rockets activated.
(f) Seats start moving up.
(i) Leg restrainers (Garters) and Arm guards activated.
(ii) PEC aircraft seat portion separate.
(iii) Emergency oxygen starts. (From seat mounted/ PSP contained Oxygen
bottle.
(iv) BTRU activated.
(v) Drogue gun activated.
(vi) IFF (Indication Friend/Foe) disabled.
(g) Deployment of drogue shoot.
(h) BTRU operates.
(i) Unlocks seat harness.
(ii) Leg restrainers released.
(iii) Scissors shackle opens.
(iv) PEC seat man separation.
(j) Parachute deployment.
(k) Parachute descent.
(l) Landing.
Biodynamics of Ejection
14. The force moving the seat must be sufficient to enable it to clear the tail of the aircraft. To
achieve this, the seat must be accelerated from zero velocity to about 12.2 to 24.4 m/sec (40 to 80
ft/sec). This gives a rapid rate of rise of acceleration or jolt factor, which must remain within the
physiological tolerance of the human spine. The maximum acceptable limit for jolt factor is 300 g/sec
with a peak acceleration of not more than 25 G for a period not exceeding 0.1 sec. The peak jolt factor
and thrust in current ejection seats do not exceed 240 g/sec and a peak of 20 G. This allows sufficient
margin of safety for the variables like pilot’s weight and ambient temperature.
Parachute Opening
15. The time to open the parachute depends primarily on the altitude of escape. At altitudes
below 152 m (500 ft) there should be a minimum delay, just sufficient enough to clear the aircraft. A
delay of about one second is usually adequate. The minimum altitude for safe parachute opening in
bail-out would depend on various factors such as rate of descent of disabled aircraft, parachute
diameter. It must be remembered that at 30 m (100 ft) and below, bailing out would invariably end up
in a fatality. At medium altitudes of 610 - 4572 m (2000 – 15000 ft), a pilot should wait for 3-5 seconds
before pulling the ripcord. Estimation of time can be roughly done by counting “one thousand one”,
“one thousand two”…, where each of these count represent approximately one second. This delay is
also essential when the aircraft is traveling at speeds beyond 250 Knots, so that the aircrew’s velocity
reduces sufficiently before safe opening of his parachute.
Parachute Descent
16. Although the sequence of events in assisted escape is automatic and rapid, in case of bail out
it is necessary and possible to adapt correct body posture prior to the opening of the parachute. The
ideal position is head out, torsos slightly bent at the waist and feet held together. This position will
prevent the head being stuck by parachute lift web and the entanglement of rigging lines between the
legs. Following parachute deployment sometimes there are minor complications. Lift webs and rigging
lines may get twisted. These can be untwisted by manually spreading them apart. A rigging line may
be thrown over the canopy making two bulges. This can be corrected by pulling the rigging lines of the
smaller of the two bulges. Oscillation and pendulum like movement of the body can occur prior to
landing. These can be dangerous during landing and can be controlled by pulling down on two
adjacent lift webs and slowly releasing them to their normal position once the oscillations are
dampened. During descent, it is necessary to release the survival pack from its attachment to the
body.
Parachute Landing
17. A high percentage of non-fatal injuries resulting from emergency escape occur on landing. It
is, therefore, important to know the basic rules of parachute landing. Pre-landing position should be
assumed approximately 305 m (1,000 ft) above the ground. Both arms should be stretched over the
head, firmly grasping the lift webs. The knees should be bent and feet held together. The line of vision
should be directed at an angle of 45° to the ground and not straight down. The landing should be on
the balls of the feet and the body rolled in the direction of moving parachute. This distributes the
impact over a large area of the body. After landing, injuries can still be caused by dragging of the
parachute, which must therefore be collapsed immediately. The best method is to operate the quick
release box and release the harness. Another one is to pull on the lower rigging lines, which will
cause the canopy to collapse. At night the landing position should be assumed from the moment the
parachute canopy has been deployed. If landing on trees cannot be avoided, the arms should be
folded in front of the face and feet kept together. Before landing over water, pre-landing preparation is
important. During such landing, the oxygen mask should be removed, the flotation stole (Mae West)
inflated on touching the water, and the parachute canopy release operated immediately. As soon as
parachute has been released, one must swim upwind from it to avoid entanglement in the rigging
lines.
18. Tolerance of a man (trained paratrooper) for parachute touch down on ground (parachute
landing) is a descent rate of approximately 7.9 m/sec (26 ft/sec). Normal touch down with a 28 feet
diameter parachute canopy and for a 70 Kg man is approximately 6.19 m/sec (20 ft/sec), which is
considered safe.
Personal Survival Packs (PSP)
19. Most PSPs are carried in the seat pan of the ejection seat. PSPs must be packed correctly or
else it may alter the ejection characteristics of the ejection seat. PSP is also responsible for sitting
height limitations in MiG-21 Type 77 aircraft or in MiG 21 Type 96 operating in coastal regions. Ideally,
a PSP should be as hard as is compatible with sitting comfort. Spring like physical characteristics of
the pack increases the injury potential to the spine of the pilot by giving rise to acceleration overshoot.
Personal survival packs are evaluated for safe ejection characteristics before introduction in service
and their contents should not be altered thereafter. If any alteration is considered necessary, further
test of the modified packs should be made. The PSP can be separated from the man, during descent
either automatically or by pulling on a special ‘D’ ring.
Potential for Injuries during ejection
20. Different phases of ejection are as follows:
(a) Canopy separation/ fragmentation.

(b) Egress.
(c) Ram Air/ Wind blast.
(d) Wind drag deceleration.
(e) Free fall.
(f) Parachute deployment.
(g) Landing.
Spinal Injury
21. As per the phase of ejection, various injuries are

discussed. The commonest among them is the spinal
injury. The normal human spine consists of 33 vertebrae
arranged one above the other and giving two posterior
curvatures to the spine in the erect posture (Fig 13-3).
These curvatures help in weight bearing by the spine. The
width/ diameter of the vertebrae varies, being maximum in
the cervico-thoracic junction and lumbo-sacral region and
Fig 13-3: Spinal Column and
least in the thoraco-lumbar region. The weight bearing of
Various Vertebrae
the spinal vertebrae increases from neck downwards and at the lower most thoracic (T-12) level, 60 %
of body weight is borne by this vertebra. Any factor, which deforms the normal curvatures of the spine,
reduces its tolerance to ejection forces. The most common cause for this is the forward bending of the
spine thus reducing the vertebral surface area in opposition due to any reason and hence increasing
the force per unit area (Figure 4). Therefore, it is important that pilot should assume erect seated
posture, the ejection posture, before initiating ejection sequence.
22. Some pilots may sustain spinal injuries during ejection, mainly during the phase of egress.
Spinal injuries commonly occur during the egress phase of ejection. This occurs because the ejection
forces are directly transmitted to seated pilot’s spine via the ejection seat (Fig 13-5). Besides the
ejection forces, the
posture of the seated pilot
during ejection is an
important factor which can
aggravate the spinal
injuries. These may result
in stable or unstable
fractures of the spine,
most commonly in the
lower part (thoraco-
lumbar) of the vertebrae Fig 13-4: Different Mechanism of Vertebral Injuries during
Ejection
(Fig 13-4).
23. Another important consideration for a

proper body alignment is the mounting of the seat
in the cockpit. To avoid fouling of the pilot’s body
parts, proper body alignment is necessary along
with proper mounting of the seat in the cockpit. To
avoid fouling of the pilot’s knees against the main
instrument panel, or the wind shield and HUD, the
ejection seat is so mounted on the guide rails that
it follows a path upward and rearward. There is an
included angle between the thrust line of the seat
and the pilot’s spine (Fig 13-5). Such an included
angle leads to an increased forward thrust on the
upper part of the torso during ejection. With a
large included angle, the forward flexion
components become greater consequently the
harness becomes less effective in preventing Fig 13-5: Schematic Diagram depicting the
Included Angle during Egress Phase of
forward flexion of the spine, thus producing spinal Ejection from Aircraft
injuries more frequently.
Wind Drag
24. As the seat enters the air stream as a blunt body travelling forward with the speed of aircraft,
it is rapidly decelerated. The magnitude of the deceleration depends on the airspeed, mass of system
and cross sectional area exposed to the drag. For moderate speeds the forces of wind drag in the Gx
axis are within human tolerance limits viz. peak 50 G @ 500 G/s for maximum duration of 0.2
seconds.
Wind Blast
25. During ejection at high speed, windblast can give raise to serious injuries. 350 Knots is about
safe limit for exposure. Above this speed, windblast forcibly separates the knees resulting in severe
damage to the hip joints. Leg restraint prevents this from happening. Arms and shoulders are equally
vulnerable to wind blast. Other parts of the body such as the abdomen and chest do not appear to
suffer any ill effects from short duration windblast up to the level of sonic speeds. Above 350 Knots,
gloves, shoes, helmets and masks are frequently lost and flying clothing is torn.
Rotational Stresses
26. Although almost any type of rotation can occur after separation from the aircraft, essentially
two types are of concern. The first is head over heels tumbling about a transverse body axis. The
second is a flat spin in which the body is stretched in an essentially horizontal altitude, and spins
about an axis passing from back to front. Drogue stabilization obviates these hazards. Tumbling and
spinning in a free fall commonly cause disorientation, nausea and vomiting.
Escape from submerged aircraft
27. Escape from submerged aircraft by use of ejection seat is especially applicable to naval
operations or during transcontinental flights. It is recommended that manual escape with the help of
the floatation stole be used if the canopy is open or has separated off during submersion. However, if
the canopy has not separated, it is preferable to eject through the canopy. Recommended procedure
for escape includes breathing 100% Oxygen until ready for ejection, inhaling normally and blowing out
slowly. After activating the ejection seat, the parachute harness is released and the floatation stole
inflated, pushing free from the seat and as the floatation stole carries the aircrew to the surface, he
should blow out excess lung gases to avoid air embolism. If the aircrew becomes entangled and
cannot separate from the seat, inflation of the dinghy will carry both him and the seat rapidly to the
surface. Such escape should be carried out before the aircraft sinks too deep. Assisted escape is
effective up to 100 ft under water.
Recent Advances in Ejection Seats
28. With advancement in technology in every field, significant improvements have been made in
the ejection seat and life support system.
(a) Harness System. This has seen several changes from the conventional
5-point harness system to the newer concept of integrated harness assembly. Integrated
harness assembly consists of lower and upper torso restraint system along with Passive Arm
Restraint System (PARS), which is activated on ejection. This provides in-flight retention of
aircrew with full mobility, vision and ability to control the aircraft. The lower torso restraint
system provides protection at all times where as upper torso restraint is needed when
exposed to a maximum of 30 G in the forward and downward axis. The distribution of the
ejection forces, crash loads and parachute opening shock are distributed evenly over a larger
area of contact provided by this integrated harness assembly.
(b) PIRD (Powered Inertia Restraint Device). The gas initiation mechanism initiated
on ejection helps in restraining the pilot into the seat prior to ejection. This concept has been
introduced in the newer ejection seats.
(c) DART (Directional Automatic Realignment of Trajectory). DART action during

the rocket burn stage provides stabilising force based on center of gravity and aerodynamic
movements. It is composed of 2 lanyards, a disc brake and a DART bridle. As the seat moves
up, the lanyard play out under minimal line tension and once fully stretched help rotate the
bridle downward for realignment of trajectory.
(d) STAPAC. The gyro stabilised thrust vector control helps in stabilising the pitch
through rockets.
(e) WORD (Wind Oriented Rocket Development). WORD is fired by a lanyard

operated firing mechanism. During development of the drogue chute the direction of the
WORD trajectory is aligned with the relative air streams thus facilitating early deployment of
the chute.
(f) MDC (Miniature Detonating Cords). MDC connected through thin layer explosive
(RDX) lines facilitate fragmenting the canopy for early exit. There are two types – In-flight
Egress System (IES) wherein the MDC is placed over inside or about the midline of the
canopy and Ground Egress System (GES) wherein the MDC is located at periphery.
(g) AIM (Automatic Inflation Modulation). This concept of parachute deployment is

being made available in the ACES, SIIS and MB XIV seats. The size of the parachute is from
28-29 ft with maximum rate of descent at 7 m/sec (22.96 ft/sec). Automatic inflation of
parachute reduces the parachute opening shock. Aero conical parachutes are now being
used on MB XIV and later versions of MB seats.
29. With the advent of computerisation in every field, the modern seats e.g. MB Mk XVI have a
microprocessor-based control. This is continuously updated with the various parameters of flight
(attitude, altitude, airspeed etc.) and has increased the overall capabilities and safety of ejection
seats. Thus an inverted aircraft will withhold firing of rocket, motors and pass on to the next stage of
operation.
Human Factors in Delayed Ejection
30. Once the decision to abandon the aircraft is taken, the only action required is to fire the seat
by pulling the seat-firing handle. This does not take more than a second or two, yet the IAF has lost a
number of experienced pilots because they waited too long to eject. The factors involved in such
delays are the following: -
(a) Delayed Decision. Decision to eject involves recognition of emergency and coming
to a conclusion that no other procedure is compatible with safety and survival. Both require
information processing and decision making. This is avoided by thorough and repetitive
training on ground and correct pre-flight briefing procedure.
(b) Delayed Action.
(i) Fear of the Unknown. The cockpit environment is known to the pilot and
he feels safe in it. To leave such an environment and ‘jump’ into thin air is a new
experience and one may feel quite unsafe or disinclined to do it till it is too late.
(ii) Fear of Victimisation or Ridicule. It is an accepted fact that no pilot

chooses to eject if he can help it. Pilots who have ejected once and were harangued
for the accident have often been known to delay ejection the next time.
(iii) Past Success With or Without Recognition. Success in bringing back a

disabled aircraft with very marginal control is an event that induces a sense of pride.
This self-appreciation is transmitted into a high level of confidence if the performance
also gets recognition in the form of appreciation or commendation. Whenever, the
next occasion arises, such a pilot may again be likely to do ‘his best’ and can delay
ejection till it is too late.
(iv) Saving the Civilian Population. An experienced pilot was leading a

formation of two aircraft. The element was over a city at 303 m (approx.) AGL. Where
No. 2 came too close and collided with the leader. An eyewitness saw the disabled,
rudderless aircraft fly straight and turn for a clear area below. The pilot ejected but
unfortunately the aircraft had entered into a spin by then. The pilot sacrificed his life to
save the civilians below.
(v) Professional Pride. This is a necessary quality for all pilots but it is a
double-headed monster. A few years ago an experienced pilot had runaway tail trim
in an aircraft type on which he was converting. The aircraft bunted viciously and the
pilot made a few quick checks to find the cause and remedy the situation. Since he
was not yet ‘hot’ on the aircraft, he was unable to solve the problem and decided to
eject. He had a safe ejection. In a similar situation, an experienced test pilot went
nose diving into the ground.
(vi) Communication and Protocol in Multi-Seat Aircraft. This is a problem

with trainer aircraft. Escape from trainer aircraft requires specified procedure to be
followed. R/T defects or lack of understanding or communication by one of the pilots,
delays the ejection. Good R/T and proper briefing between the two pilots is vital for
successful ejection, particularly when time is at a premium. In tandem seat aircraft
with two pilots, the average time to eject is 6 to 11 seconds.
(vii) Pre-Ejection Drill. This is not a problem in most of the advanced aircraft,
except for some old generation aircraft with seats requiring many actions by the pilot
before ejection. Pilots of such aircraft must be thorough with the drill and practice it at
frequent intervals to get familiar with the sequence of pre-ejection serial actions. As a
standing practice, pilots are required to undergo mock ejection drill once every month.
(c) Physical / Physiological / Psychological Factors. These factors cause temporary

incapacity to operate the ejection seat firing handle.
(i) Excessive Positive or Negative ‘G’. Positive G impairs the raising of arms
to the face blind handle (FBH). Negative G is worse in its effects as it renders the pilot
unstable in the cockpit and the hands can cover the handle. The flailing and unsteady
arms cause further difficulties. Under such unsteady conditions the seat pan handle
(SPH) is the best choice between firing handles to use in seats provided with two
types of handles.
(ii) Ejection Emergency Coupled with Canopy Blow Out. Here again the
SPH is the best handle to use as the air blast not only separates the hands rising to
grip the FBH but also deflects the handle backward.
(iii) Physical Injuries. Mid-air collision, bird strike etc. may injure the eyes,
face or head. This may render the pilot incapacitated or unable to act quickly.
(iv) Physiological. Hypoxia, decompression sickness, acute decompression,

toxic fumes may delay ejection because of physical/ mental incapacitation.
(v) Psycho / Physiological Factors. As per the type of personality and the
type of the emergency, sometimes some pilot may panic and ‘freeze’ on controls, not
able to take decisive actions.
(vi) Disorientation. Certain aircraft emergencies such as lateral control failure,

tail trim runaway or badly performed aerobatic manoeuvres such as roll of the top or
barrel roll, may cause disorientation. In such a confused state the pilot may delay
ejection.
Points to Remember
17. (a) Know your ejection seat well.

(b) Practice ejection drills, especially if you have not flown for some time or have
changed type of aircraft.
(c) Aircraft is expensive but your life is invaluable.
(d) Ensure that seat safety pin is removed before you start up your aircraft.
(e) Each pilot must undergo routine training on Ejection Procedure Simulator, if available.
529
CHAPTER 14
SURVIVAL
Introduction:
1. The instinct to survive is a law of nature and when forced with a hostile environment, survival
mainly depends on two factors:-
(a) The ingenuity of the individual.

(b) Resources available.
2. With proper knowledge, good training and reasonable equipment, it will be possible to
achieve this objective. The time to study survival techniques is not after abandoning the aircraft but
before.
3. The important aids to survival are:
(a) Will to survive.

(b) Prior knowledge of terrain.
(c) Preparedness in use of available aids and improvisation.
(d) Available equipment, food, water and confidence in available aids.
Pattern of Survival:
4. The pattern of survival depends upon:

(a) Pre Flight plan.
(b) Protection from animals, enemies, environment.
(c) Location of aids.
(d) Water, food and health hazards.
Factors Promoting Chances of Survival:
5. (a) Common sense.

(b) Determination and will to survive.
(c) Courage.
(d) Training
(e) Equipment.
(f) Luck.
Factors Reducing Chances of Survival :
6. (a) Psychological. Panic, fear, loneliness, boredom fear of unknown, darkness and
jungle animals.
(b) Physiological. Heat / Cold, injuries, illness, shortage of food and water
Stages in Survival
7. (a) Pre-Flight. Proper knowledge and training about terrain and equipment, good
physical fitness and reasonability of equipments provided, are all extremely important preparations for
survival. Practical survival training earned during survival exercises, which are conducted periodically
is very helpful.
(b) In Flight. Communicate to the base about emergency, location and decision to
abandon aircraft. During descent with the aircraft or by parachute observe all ground features,
as far as possible.
(c) Post Flight. Immediately clear off the aircraft to safer distance to avoid hazard of
fire and explosion. Attend to injuries if any. Rest, cool down and assess the situation. Contact
base, if possible, by aircraft radio set or use distress signal radio set, if available. Plan and
decide the course of action depending on available shelter, food and water. Decide whether
to stay near or leave the aircraft. Always choose to remain with the aircraft unless:
(i) Shelter and assistance are within easy range and can be reached with the
equipment and rations available.
(ii) In enemy territory.
(iii) If after several days it is apparent that rescue has failed or is not forth
coming. Even in this case all possible precautions should be taken for traveling.
(d) Subsequent Action. Signaling so as to indicate your own location and help rescue
team in locating the survivors. This is done by using mini flare or radio sets provided with the
survival pack. Signaling can also be done by smoke, fire , pyro-technique or heliograph. Do
everything and anything to disturb the natural look of surroundings to catch the attention of
rescue team
Classification
8. Survival may be classified into two main groups:

531 Survival
(a) Survival on land. This may be:
(i) Jungle survival.

(ii) Desert survival.
(iii) Snow survival.
(b) Survival at sea.
9. Most operational squadrons are deployed over areas where, in the course of a single sortie
the aircraft may fly over jungle and snow covered terrains or jungle and desert or over desert and sea.
LAND SURVIVAL
Jungle Survival
10. “Jungle” is a term applied to natural forest of a particular land or region. It may be wet tropical
rain forest or dry open scrub country. Whatever the type of country, the chances of survival after a
successful landing depend on a number of factors, viz:
(a) Previous knowledge.

(b) Previous attention to personal clothing and kit.
(c) Strict observance of a few simple rules.
(d) Initiative.
(e) Discipline.
(f) Frequent Practices.
(g) Ability to learn by mistakes.
11. Entering Jungle. Prior to entering the jungle, whether by bailing out or by crash landing, a
mental note of the topography should be made. This should include features like rivers, lakes, paddy
fields, high ground, villages etc. The heading and bearing of the aircraft ad the position of the aircrew
members, who may have bailed out, will help orientation on the ground and location of crew
members.
12. On Landing. A set drill should be adhered to. This should include:
(a) First Aid is important and especially in tropical countries where wounds become
septic very quickly. There fore, learn how to use the few simple remedies provided in first aid
kits.
(b) Orientate yourself as regards position and time.
(c) Prepare emergency signaling gear remembering that depending on the terrain, the
ground may have to be cleared to enable ground signals o be see from the air. These signals
may include the use of cloth strips (parachute canopy is use full), fire, smoke, and the use of
pyrotechnics provided in the survival pack.
(d) Check the equipment and rations that may be available and calculate the estimated
requirements, remembering that this can be supplemented by the jungle.
Plan of Action
13. Decide on a plan of action whether to remain with the aircraft or to trek factors which would
help in coming to a decision are as follows:
(a) Is base aware of the exact position and predicament?

(b) What are the chances of air / surface search?
(c) Will the weather be favorable for air search?
(d) Is the area in the vicinity of a recognized air route?
(e) Distance from human habitation.
(f) Time of the year.
(g) Type of country.
(h) Hazards of trek.
(j) Condition of personnel and equipment.
14. Whatever decisions is made, act without delay but not in haste. If remaining with the aircraft
attract attention. In addition to the emergency signaling gear, the fullest use should be made of
parachutes, dinghies, engine cowlings and broken glass as reflecting surfaces. Ground signals to be
effective should be 8` in length. If trekking, select only those items of equipment which are absolutely
essential to survival- do not carry too much use full items are parachute packs from which shoes can
be improvised, shroud lines of parachutes which will be useful as fishing tackle, first aid kit, personal
pack and a hatchet / knife. A compass, maps, matches/ lighter, mirror for signaling, pencil and note
book will also be useful should you decide to take extra clothing, socks should be given a priority.
15. The Trek. The technique for trekking is to conserve energy and therefore to proceed
slowly and deliberately follow streams “down stream” as they will lead to habitation don’t try any short
cuts. Use game trails, dry water courses, ridges and other high ground if available. While trekking
always lay a trail by marking trees, felling branches with yours jungle knife etc. Avoid swampy ground.
16. Camping. When camping chooses a site close to sources of water, food and solid ground,
taking whatever natural protection is available from the weather. Avoid areas where there is dead and
decaying vegetation. Prepare the site and light a fire as soon as possible, both to drive away insects
and also for cooking. When the fire has produced a certain amount of ash, spread it in an unbroken
line round the camp site to prevent the intrusion of crawling insects. Lighting a fire is not as simple as
533 Survival
it would appear, and this becomes even more difficult when improvised methods are used. It would
pay aircrew to practice the several methods of lighting a fire, e.g. by user of sun glass drill method,
flint and steel etc.
17. Water. All water should be purified, using the water sterilizing tables provided or boiling for
at least three minutes. There are some sources of water which do not require purification:
(a) Rain
(b) Jungle vines- the lower loop of any vine will provide water.
18. Food. This is seldom a problem in the jungle. It is important to know types of edible fruits
available in the particular area in which you operate. The food eaten by monkey can be considered as
generally fit for human consumption. The chief sources of food are normally plant, fish and birds.
Animal are potential source of food but are not always easy o catch and kill.
19. Jungle Hazards. Most stories about animals, snakes and other terrors of the jungle are not
based on fact you are safe from sudden death in a jungle than you are in a city. The real dangers are:
(a) Panic. This is by far the greatest hazards. Remember that the obstacles you have
to overcome are not so much natural ones as mental ones. Other people have lived in such
areas intentionally and by adjustments to the demands of terrain, climate and environment.
You too can survive.
(b) Sun and Heat. This may take the form of heat exhaustion or heat stroke. The
former is characterized by vomiting, and cramps and a feeling of faints, and later by high
temperature, dry skin and may be unconsciousness. Keep yourself under shade and
consume enough cold water.
(c) Dysentery. This is an inflammation of the bowel characterized by pain in the

abdomen and the passage of frequent loose stools with possibly blood. Prevention is by
cooking your food and purifying. If dysentery is suspected solid food could be avoided. Large
quantities of water should be taken to replace lost body fluids.
(d) Animals Leaches. Leaches attach themselves to human body and should be
removed either by touching with salt or tobacco or burning with the lighted end of a cigarette.
They should not pull off as they leave their jaws in the bite which will cause a festering sore.
(e) Ticks. These infect clothing and can be flicked off the skin. Be careful in this case
also as the head may stay in the skin and start infection. Use an antiseptic on the bitten area.
(f) Snakes. These seldom attack man unless provoked. In case of snake bite do not
run about. Tie a tourniquet above the wound. Loosen the tourniquet every 10 – 15 minutes for
2- 3 minutes. Squeeze out the blood from the wound and wash with water.
(g) Wild Animals. Wild animals seldom interfere with man. While traveling through
animal infested country, make as much noise as possible. This will scare away big game. At
night keep a fire burning and a member of the party on watch. Bamboo thrown on a fire will
burn with a loud noise resemble gun shots sufficient to drive away animals.
20. Personal Hygeine. This most important and the following points must be borne in mind:
(a) Care Of Feet. Wash socks each day, wash your feet thoroughly, keep your foot
wear dry by keeping hear the fire at night.
(b) Sanitary Arrangements. Keep all sanitary arrangements clear of the shelter or
camp. Keep all waste matter covered with a layer of earth to prevent fly breeding.
(c) Blisters. These should be treated immediately. The edge may be pricked by a
sterilized needle and the fluid pressed out. It should then be kept clean and dry.
Desert Survival
Introduction
21. Deserts are large tracts of barren land consisting entirely of sand, or areas of broken stones
and pebbles. Rain is infrequent, sand storms may occur and the alternating hot days and cool nights
are a characteristic feature.
22. Shelter. The shade of the main plane, using the parachute canopy as an awning can be
used. Two layers of cloth should be arranged so that there is an intervening air space of several
inches to provide insulation.
23. Clothing. In hot weather your clothing will protect you against sunburn, heat sand and
insects, so do not discard any of it. Keep your head and body covered during the day you will last
longer on less water improvise a head dress the Arabs do not use their head dress to keep up with
fashion but to protect them from heat. If you have lost your shoes, improvise. Use parachute cloth cut
into strips 2 feet long and 4 inches wide, wrapped around the foot. They feel and look ordinary socks
and enable you to walk in comfort even with blistered heels.
535 Survival
24. Water, In desert your life depends on your water supply. When you sweat, the body looses
water and you must replace your loss by drinking water, other wise you will be dehydrated and
exhausted. In the hot deserts you need a minimum of 3-5 liters of water a day. The only way to
conserve your water is to avoid excessive sweating. You may feel cooler without any clothes, but you
will sweat more and therefore your demand for water will be greater. So keep your clothes on. You will
last longer on less water if you move less. All walking should be done in the cool hours of day or at
night. Therefore take it easy remember the Arab. He is not surviving in the desert, but lives there and
likes it. His life is live in “slow motion”. Live with the desert, do not fight it. There are some sources of
water in the desert and it is as well o know of them. They may help to augment the supply.
(a) Dew. You may find this on the metal wings of your aircraft wipe it off with a
handkerchief and wring it out into a container. Dig a small pit, place stones in a piece of
canvas in this. Moisture will condense on this and serve as additional sources of water
remember that with the rising sun, the dew evaporates, therefore collect you water early.
(b) Wells. Hand dug wells have provided the only available water for irrigation in
deserts for many centuries and can be found in low places in the desert. They are generally
located along trails. Wells are gathering places for the local people as well as stopping places
for caravans. Camp fire ashes, animal dropping will indicate that a well must be some where
in the vicinity.
(c) Other Sources. When away from trails or wells you may still find water. Damp
surface sand any where indicates a good place where water may be found. Among sand
dunes, dig at the lowest point between the dunes where you may find water. The lowest point
on the outside of a bend in a dry river bed in another useful site to dig for water.
25. Food. Food spoils very quickly in the desert and therefore should be eaten as soon as
possible after the containers are opened. Animals are not scarce. Their presence depends on water
and cover. Rabbits, snakes and birds have learned to live in desert and may provide you food. You
will have to bait them, trap them or shoot them.
26. Travel. This should be done at night only. The barest minimum of equipment should be
taken. Take as much water as possible at the expense of food. The following items should be
included. Sun glasses, salt tablets, maps matches, first aid kit, mini flares and compass. A knapsack
can be made from the parachute pack and harness. A portion of the parachute canopy would be
useful for a tent. When traveling the easiest route should be followed. If a sand storm starts, cover
your mouth, ears and nose with a piece of cloth. If wind and dust impede your progress or shut out
visibility stop traveling. Mark the direction in which you are traveling, with a deep scratched arrow on
the ground `or a row of stones or other markers.
27. Health Hazards. The chief hazards in the desert are heat stroke and heat exhaustion.
These are best prevented by avoiding unnecessary exposure to sun and unnecessary exertion. Also
take as much water as possible with a little salt.
SNOW SURVIVAL
Introduction
28. Snow occurs throughout the northern borders of India. Landing with the aircraft or being near
the aircraft is always helpful as it has the advantage of providing shelter, food, fuel and equipment,
apart from the aircraft acting as a land mark. A uniform overcast sky with clouds at fairly high level,
reflects the surrounding terrain “the sky map” and will form a useful guide to force landing areas, e.g.
open water, timber and snow free terrain are evidenced by black areas in he cloud reflection. When
there is uniform snow covering, it will appear uniformly white on the sky map. A slightly mottled area is
the reflection from snow drifts. These drifts are hazardous to landings and safe landing can be
affected parallel to the drifts.
Immediate Action after Landing
29. Unless it is absolutely certain that food and shelter are available within easy reach, remain
with the aircraft. The following action should be carried out immediately:-
(a) Draining Of Oil. Oil from the engine sump and oil tank must be drained out to
prevent congealing. It provides an immediate source of fuel for heating and cooking.
(b) First Aid. Attend to injuries. Try to keep warm.
(c) Position And Time. Orientate your self in relation to both.
30. Signal. The aircraft it self is a good land mark. Therefore keep its surface free from snow
and frost. Three signal fires should be kept burning at prominent point by day and night. By day
burning oily rags, rubber etc produce dense black smoke. Tramp SOS into the snow and line with
dark branches. The letters should be at least 100 feet in length. Signaling by mirror should be
practiced regularly. Pyrotechnics should be kept dry and available for instant use. Use these
sparingly.
31. Clothing. It is important to wear clothing properly to keep warm at dry. Insulation, combined
with body heat is the secret of warmth. The former is achieved by having multiple layers of garments
around the body. The outer clothing should be wind proof. Sweating should be minimized as leads to
freezing. When working; open clothing at the neck and wrists and loosen at the waist or remove a
537 Survival
layer or two of outer clothing. When work is finished put on your clothes again immediately to prevent
chilling. Do not wear tight clothing as it cuts off the circulation. Boots should not be worn tight by
wearing too many socks. Improvise foot wear by wrapping parachute cloth lined with dry grass, keep
clothing as dry as possible. Brush snow of your clothes before you enter a shelter or go near a fire.
Dry socks thoroughly. Do not get boots too near the fire. Wear one o two pairs of woolen mittens
inside a windproof shell and try to do everything with your mittens on. Goggles should be worn to
prevent snow blindness At night arrange dryly spare clothing loosely around your shoulders and hips.
It will help to keep you warm. If you fall in water, roll in dry snow to blot up moisture. Then brush off
the snow. Repeat several times, the face can be protected against cold winds by a cloth fastened to
hand loosely from just below the level of the eyes and covering the collar as a face shield.
32. Shelter. In the summer you can use the aircraft for shelter cover openings with netting or
parachute cloth to keep insects out. Alternatively, a surface shelter can be improvised using
parachute cloth and locally available timber. Whatever type of shelter is used do not sleep on bare
ground. Provide some sort of insulation under yourself. In the winter do not live in the aircraft. If
possible camp near timber. If you can not then choose a spot protected from wind and snow. Avoid
bases of slopes where snow may come down in avalanches keep the front opening of all shelters
crosswind and make a wind break of snow or ice block s close to the shelter. Remember to work
slowly to avoid excessive sweating. In timberless country, make a snow cave. Should a fire be lit
inside, remember to ventilate it to prevent carbon monoxide poisoning. Do not sleep directly oo snow.
Provide some insulation underneath your sleeping bag. Keep your sleeping bag clean, dry and fluffed
up to give maximum warmth. Regardless of how cold it may be outside, the temperature inside a
small well-constructed snow cave will probably not be lower than 10 degree F ( even when it is -50
degree F outside ). Body heat alone will raise the temperature 45 degree F above the outside air.
Burning a candle will raise the temperature 4 degree f. A burning stove will raise it to 20 degree F.
Keep entrances and exits from the shelter to the barest minimum. It is a standard practice to relive
yourself indoors whenever possible. If it is possible to dig a connecting snow cave one may be
emptied in a remote corner opposite from the side from which snow is taken for cooking. Try to have
your bowel movements just prior to leaving the shelter in the morning and remove faecal matter with
rubbish.
33. Fire and Emergency Stores. The availability of lighting material and equipment may mean
success or failure in a fight for survival. Fires, matches, fire-making tablets, a candle and a magnifying
glass are supplied in a personal survival pack. Maches should be conserved as much as possible and
a candle or fire-making tablet used to start fire. In emergencies, a burning lens may be obtained from
binoculars, gunsights, bombsights, or cameras. Where wood is not available, aircraft fules such a
rubber, wax, fuel and oil may be used.
34. Food. Emergency food packs and uneaten flying rations provide an immediate and valuable
food supply. Additional sources of food are: Fish, animal, bird and plants. Fat is most important to
health in cold climates and is a good heat producing food. Large quantities should be consumed only
when at least two pints of water are available daily.
(a) Land Animals. Look out for signs of animal life such as excrement, tracks, hair and
in extremely cold weather, by animal smoke streaming from their bodies, Snares and simple
traps will enable animals to be caught. Certain animal may be attracted by making a
sequeaking noise to imitate the presence of a wounded animal or bird.
(b) Birds. In summer large number of birds migrate north to breed, forming colonies
which may be found on islands, marshes, lakes etc. At this time eggs may be collected for
food. During the late summer, water birds such as ducks, geese etc. lose their wing feathers
for a period of one or two weeks and are unable to fly. Their capture at this time presents no
difficulties.
(c) Plant Food. Although not abundant, it is not absent. There are varieties of gerries,
breens, roots, fungi and lichens.
35. Water. This is not fundamental problem in snow survival. In summer it may be obtained
from streams, lakes or ponds. In the winter, melt ice rather than snow as it gives more water for
volume and take less time to heat. Avoid eating snow as it lowers body temperature.
36. Cooking. Since fuel is scarce, it is advisable to cook by means of boiling and if possible to
drink cooking water. By boiling for two or three minutes only vitamins and heat will be conserved.
When a cooking pot is not available the food may be roasted or fried over a slow non- smoking fire, or
wrapped in a clay of mud wet leaves and baked in hot embers. If no fire is available the food becomes
more palpable if fried or frozen.
37. Travel. Travel on snow is difficult. Plans must be carefully made if the decision to travel is
made. Plenty of food and rest is essential and at least one hot meal a day is essential. Snow shoes,
sledges and shelters should be improvised from various parts of the aircrafts like inspection penels, or
fuselage doors. The general direction of travel should be “down stream”. Camp should be struck in the
afternoon so that adequate time is available for drying clothes and building a fire and shelter.
38. Health Hazard. The chief danger to health are hypothermia, frost bite, snow blindness and
carbon monoxide poisoning.
(a) Hypothermia. It occurs when the body temperature is below normal. It may be
recognized by excessive shivering and low vitality and should be treated by shelter, hot drinks
and the application of heat. The person may be warmed by placing heated rocks, wrapped in
539 Survival
cloth near the stomach, back, armpits, neck, wrists and between the thighs. Avoid alcohol. It
only opens blood vessels near the surface of the skin and allows heat to be lost more rapidly.
(b) Frost Bite. This is local freezing and although it cannot be entirely eliminated, the
risk can be minimized. Parts most likely to be affected are the face, nose, band and feet. It
often occurs without the victim being aware of it. There may be a “prickly” sensation and
some stiffness but a whitish or cream discoloration of the part of body affected and can be
recognized by observers. Treatment is to warm the part gradually. Do not rub snow on the
part or thaw in hot water or before a fire. Severe pain is usually an indication that warmth is
being applied too quickly. Frozen part of the face should be thawed with warm hands, frozen
feet under the warm clothing of another person. Prevention of frost bite is by keeping face,
ears, nose, wrists, hands and feet warm and dry. The face may be protected by exercising the
face muscles frequently. Cold metal is touched with bare hands. If by accident metal is
touched, it should be thawed from the skin and not pulled from it directly.
(c) Snow Blindness. Initially the eyes become sensitive to glare when blinking and
squinting occurs. They begin to water. The landscape becomes increasingly red, and finally
vision is obscured completely as if by a flaming red curtain. There is by wearing goggles or
improvised sun shields. As an additional precaution or engine oil to reduce the number of sun
rays, entering the eyes.
(d) Carbon Monoxide Poisoning. It can occur in a completely closed shelter filled with
smoke fire. It is difficult to recognize the onset of poisoning as it is a colourless, odourless gas
and victims often becomes unconscious without previous warning. Treatment is by fresh air,
oxygen if available, and artificial respiration.
(e) Insects. The use of nets and insect repellents are essential.
(f) General Health. Energy must be conserved, fatigue avoided and sleep obtained. If
sleep proves difficult it is beneficial to merely lie down and to relax mind and body.
SEA SERVIVAL
39. Stay clear of airplane but in vicinity until it sinks. Search for missing men. Salvage floating
equipment and stow all items securely. Plug leaks in raft and bail it out. Check condition of crew; give
first aid if necessary. The sickness pills, if available. Get emergency radio into operation. Directions
are on equipment. Prepare other signaling devices for instant use. Keep compass, watches, matches
and lighters dry. Place in water proof containers. If there is more than one raft, connect them with at
least 25 feet of line. Check raft for inflation and leaks and point of possible chafing. Be careful not to
snag raft with shoes or sharp objects.
40. In Cold Water. If near shore, get ashore at once or try to minimize exposure to cold water.
Huddle together and exercise regularly.
41. In Warn Ocean. Rig sun shade. Keep skin covered. Use sunburn cream. Keep sleeves
rolled down and socks pinned up or pulled up over trousers. Wear hat and sun glasses. Make use of
parachute to cover the raft to avoid exposure to the sun heat.
42. Make a clam estimate of your situation and plan course of action carefully.
43. Keep a log. Record navigator’s last fix, time of ditching, names and condition of personnel,
ration schedule, winds, weather, direction of swells and other navigation data. Inventory all
equipment. Keep calm. Conserve water and food by conserving energy. Don’t move around
unnecessarily-life rafts capsize easily.
44. Health Hazards
(a) Sea Sickness. Use airsickness or seasickness tablets as early as possible and
repeat at every 6-8 hrs. Do not eat or drink while sea sick.
(b) Salt Water Sores. Apply antiseptic cream, do not squeeze them.
(c) Immersion Foot. Individual complaints of burning, itching, mottling or redness

tingling, numbness and blister may develop. This is due to exposure of feet to cold. Keep the
feet dry, maintain circulation by exercising toes and keeping feet warm.
(d) Sore Eyes. Glare from sky and sea water causes itching watering and irritation of
eyes. Can be easily prevented by using goggles, visors or antiglare sheets provided.
Types Of Survival Kits
45. The survival packs are basically two types- Fighter Type and Transport / Helicopter type. The
contents of most of the survival packs are, a first aid kit, water, food, signaling & location aids, some
safety equipment, extra clothing like socks, antiglare goggles and a booklet on survival.
46. The specific items in different types of survival packs are as follows:
(a) Desert Type - Extra water bottles.

541 Survival
(b) Snow Type - A sleeping bag.
(c) Sea Type - One man dinghy in Fighter type & multi-men dinghy in Transport /
Helicopter along with its accessories. These accessories are:
(i) Fluorescent dye for identification and as shark repellent.

(ii) Chemical Desalination Kit for making sea water drinkable.
Points to Remember
(a) You have every chance to come out safely. Keep cool, don’t get panicky. Save your
energy. Don’t rush off wildly, Stop think out & size up your situation. Plan a sensible course of
action and keep up your morale.
(b) Remember Help is on the way.
(c) Avoid hardship and stay well. Find food and water. Obtain help and out safely.
(d) Every survival pack has a booklet for guidance. Read it as soon as possible.
543
CHAPTER 15
FLYING FATIGUE AND PREVENTION
Fatigue
1. Fatigue is deep tiredness and similar to stress, it is cumulative. It can be caused by:
(a) Lack of restful sleep.

(b) Lack of physical or mental fitness.
(c) Excessive physical or mental stress and anxiety.
(d) De-synchronisation of the body cycles (Jet Lag).
2. Whereas tiredness is instantly recognisable by the sufferer and is an acceptable social

admission, fatigue is more insidious. A pilot suffering from fatigue can be unaware of his/her condition
for a long period of time until a crisis forces realisation. Even if aware that fatigue is a problem, a pilot
will be hesitant to admit the fact openly. It appears to be akin to an admission that s-/he is not up to
the job. It is critical to be able to recognise the symptoms of fatigue both in oneself and as importantly
in other colleagues in one’s squadron or crew.
3. Fatigue can be sub-divided into short and long-term (chronic) fatigue.
(a) Short-term Fatigue. This type of fatigue is akin to tiredness. It is usually due to a
lack of sleep, hard physical or mental exertion, duty scheduling, operational commitment, and
prolonged duty period, lack of food or Jet Lag. Short-term fatigue is easily recognised and
remedied by not flying and sufficient rest.
(b) Long-term (Chronic) Fatigue. This type of is difficult to recognise and admit. It can
come from a number of different causes which may include a lack of physical or mental
fitness, a stressful marriage coupled with problems at work, financial worries and a high
workload. It also can be subjective, one aviator being able to tolerate more than the next
before chronic fatigue sets in. Anyone who suspects that she / he is suffering from chronic
fatigue must take him-/herself off flying
(c) Symptoms of Fatigue. The symptoms of fatigue can be:
(i) Lack of awareness.

(ii) Diminished motor skills.
(iii) Obvious tiredness.
(iv) Diminished vision.
(v) Increased reaction time.
(vi) Short-term memory problems.

(vii) Channelled concentration.
(viii) Easily distracted.
(ix) Poor instrument flying.
(x) Increased mistakes.
(xi) Irritability and / or abnormal mood swings.
(xii) Reduced scan.
(xiii) Reversion to 'old' habits.
(xiv) Decrease in communication.
Active Methods to Cope with or Delay the Onset of Fatigue
4. Some of the active methods that aircrew may consider and employ to cope or delay the onset
of fatigue are:
(a) Accept that fatigue is a potential problem.

(b) Plan sleep strategies pro-actively (plan sleep ahead of the next day's activities.
(c) Use exercise as part of the relaxation period and ensure you are fit.
(d) Avoid alcohol.
(e) Eat a regular and balanced diet.
(f) Have your emotional and psychological life under control.
(g) Ensure cockpit comfort and adjust the seat for adequate performance.
(h) Ensure that during long flights adequate food and drink are available.
Vigilance and Hypovigilance
5. State of Vigilance. The State of Vigilance is the degree of activation of the central nervous
system. This can vary from deep sleep to extreme alertness and is controlled by the circadian cycle. A
vigilant man is an alert man and so, in normal circumstances, as workload increases so does
vigilance. Vigilance is not synonymous with attention.
6. Hypovigilance. This is the phase of sub-conscious sleepiness when an individual is active

and not aware. However in operational situations, it compromises an aviators alertness and
performance in flight. It is akin to a microsleep which is discussed later. Hypovigilance can occur
during periods of:
(a) Monotony
(b) Reduction of workload
(c) During simple or repetitive tasks
(d) Constant and monotonous noise
(e) Low lighting
545 Flying Fatigue and Prevention
(f) High temperature

(g) Isolation
(h) Sleep debit
(j) Fatigue.
(k) It can also occur shortly after a meal.
Forestalling Hypovigilance in Flight
7. It may not be possible to totally eliminate hypovigilance during flight. Active measures that an
aircrew can take to forestall hypovigilance include:
(a) Ensure that you have sufficient sleep credit.
(b) Be aware of the physical danger signs which may include:
(i) Drowsiness, head dropping forward and a vague but persistent sensation of
discomfort causing one to constantly shift his/her sitting position.
(ii) Slower sensory perception (having to look at in instrument for a longer time
than normal before registering the information sought).
(iii) Preoccupation with a problem completely unrelated to the current situation.
(iv) Moodiness and a reluctance to talk.
(c) Maintain social contact with the rest of the crew.
(d) Vigilance decreases with lack of stimuli so keep mentally and physically active.
(e) In a multi-crew environment members of the crew should take their meals at different
times. This is to ensure that if hypovigilance is to be a problem amongst the crew, its
occurrence will probably be staggered
Prevention of Flying Fatigue
8. Timely food and pre-flight meal good, regular exercise, adequate sleep, rest and relaxation
does prevent or delay onset of fatigue. Meditation and yoga are beneficial for maintaining positive
health and to cope with various life stresses including fatigue. In addition one should not be
overweight; and consumption of alcohol and smoking should be in moderation.
SLEEP
9. Peaceful sleep, adequate rest and relaxation enhance physical and mental efficiency. Sleep
is essential to human well-being. During the period of sleep the body not only recuperates from the
physical activity of the day but also carries out essential organisation of the mental processes. This is
vital for individual health and work performance. Sleep provides mental and muscular relaxation and
renders the individual ready for taking burden of day’s routine and various stresses. Late nights and
disturbed routine deprive one of adequate sleep and reduce efficiency. Prolonged work without
adequate rest and relaxation in-between causes fatigue, reduces one’s capacity for work and his/her
alertness. Eight hours of undisturbed sleep and short periods of rest and relaxation between periods
of activity are conducive to optimum efficiency.
10. The amount of sleep required varies according to age, amount of physical and mental energy
used prior to sleep and individual differences. Sleep exhibits particular cycles during each sleep
period, varying from light snooze or dozing to deep sleep, with intervals of a unique type of sleep in
which vivid dreams occur. The duration of sleep and its quality depends to a large extent on our
internal body rhythms. Hence biological rhythm is also discussed to understand sleep better.
Aircrew's Attitude to Sleep
11. Aircrew must not regard sleep as merely a mechanism for recuperation from the previous
day's activity. It is of fundamental importance that aircrew’s attitude towards sleep is pro-active and
that sleep is actively planned in order that flying activity is performed at maximum physical and mental
efficiency.
Time of Day and Performance
12. Performance of different tasks is affected by the time of day. Simple tasks, requiring little
short-term memory input, follow the pattern of body temperature. Performance improves as
temperature increases and declines as the temperature decreases. Performance using short-term
memory tasks declines throughout the day. Verbal reasoning and mental arithmetic skills peak around
midday.
Performance Decrement due to Sleep Loss
13. Sleep loss hastens the onset of, and increases the frequency of cognitive performance
decrements, especially on attention demanding vigilance tasks during sustained work.
14. Performance on cognitive tasks involving memory, learning, logical reasoning, arithmetic
calculations, pattern recognition, complex verbal processing and decision making is impaired by sleep
loss to a measurable extent beyond that anticipated by the effect of sustained efforts alone.
Biological Rhythms and Body Clocks
15. Many physiological processes in the body undergo rhythmic fluctuations throughout the sleep
or wakefulness period. These rhythms are controlled internally by brain and are not a reaction to the
environment. The most common rhythms exhibited by humans and most other animals have
periodicities of about 24 hours and are known as ‘Circadian rhythms’. These rhythms are seen as
measurable and regular daily fluctuations in various parameters like body temperature, heart rate,
blood pressure, sensory acuity, brain neuro-transmission levels and adrenal gland secretions. In
normal conditions our circadian rhythms are locked to 24 hours by external time cues. These cues are
provided by clock times and other external events, such as the rising Sun, light and darkness, the
increase in traffic noise at certain times, regular meal times and work schedules. All these cues assist
in the regulation of our internal biological clock. These cues are known as Zeitgebers (German;
means 'time givers'). Interestingly, if an individual is isolated from these zeitgebers, say without
clocks, set meal timings or not exposed to change in light during day or night, the circadian rhythms
will 'free run' to a periodicity of about 25 hours. This means that an average individual, if isolated from
these cues, instead of average 16 hours awake and 8 hours sleep, shall extend the day to 17 hours
awake and 8 hours sleep.
Timing Planned Sleep
16. Time spent awake is important in determining readiness for sleep but there is also a circadian
rhythm of sleep. This means that at certain times of the day even the sleep-deprived individual may
have difficulty in falling asleep. It is the timing of sleep not the amount of time awake that is the critical
factor in determining sleep duration. Duration of sleep is linked to the body temperature cycle. Body
temperature variations follow a regular cycle. The body temperature is highest at around 1700 hours
and the lowest at about 0500 hours, this occurs at a time when one is least efficient and the desire to
sleep is at its peak. Therefore, sleep taken at times near the temperature peak or when the
temperature is falling will be longer and more refreshing than sleep taken when body temperature is
rising. On the contrary, if an individual attempts to sleep when the body temperature is on the rise will
have considerably more difficulty getting to sleep, and if successful, will usually awaken within a
relatively short period of time.
Sleep and Wakefulness as a Credit and Debit Analogy
17. The sleep / wake cycle can be thought of as a credit and debit system. In this system the
individual is given two points for every hour spent asleep and has one point deducted for every hour
spent awake. This is only a rough measure, as individuals vary considerably in the amount of sleep
they require.
Sleep Credit Limit
18. The maximum credit available is 16 points. You cannot store credit points above 16 in
anticipation of a long period of wakefulness. A sleep of 10 to 12 hours after a long period of strenuous
activity will only give the 16 credits and the individual will feel sleepy again after 16 hours, not after 20
to 24 hours.
19. However, if a period of wakefulness is significantly foreshortened (the individual is still in a

state of sleep credit) then a good sleep is unlikely.
20. Sleep Debit. The fewer points you have the readier you are to sleep. Normally the person
will sleep when s-/he has little or no credit and will sleep for about eight hours, followed by a wakeful
period of about sixteen hours when the sleep credit will be exhausted. A gradual reduction in level of
credit may build up over a period of time as a ‘cumulative sleep debt’. It is important to realise
performance reduction, resulting from sleep deprivation, increases with altitude.
Phases of Sleep
21. Stages of Sleep. The stages of sleep are classified into 4 stages.
(a) Stage 1. The sleeper is in a very light sleep. It is a transitional phase between
waking and sleeping; if woken at this stage the individual may claim that s-/he has not even
been asleep. In early sleep one passes through about 10 min of Stage 1 before moving to the
deeper Stage 2.
(b) Stage 2. In early sleep one spends about 20 minutes in stage 2 before moving on
to the deeper Stage 3 and 4. About 50% of a normal sleep is spent in Stage 2.
(c) Stages 3 and 4. During Stage 3 and 4 sleep, the brain is semi-active referred to as
‘Slow Wave’ or orthodox sleep. The eyes remain still behind the eyelids. The muscles are
relaxed. Dreams are of choking or crushing nature. This is meant to refresh the body and is
essential for tissue restoration. After strenuous physical activity the body will require slower
wave sleep.
22. Superimposed on the above 4 stages of sleep is Rapid Eye Movement (REM) Sleep or
paradoxical sleep. This is quite different from orthodox sleep, in that during the paradoxical sleep the
brain is active, as if the individual is fully awake except that the person is asleep. Rapid eye
movement behind the eyelids is found. Muscles twitch. Complex, bizarre, and emotionally-coloured
dreams take place. REM sleep refreshes the brain. It strengthens and organises the memory. After a
period of learning new tasks or procedures REM sleep will increase. In addition, REM sleep
contributes significantly to emotional equilibrium and good humour. Thus, irritability normally follows a
period of disrupted sleep.
23. Some characteristics of Orthodox and Paradoxical sleep are compared in Table 15-I.
Characteristic Orthodox Sleep Paradoxical Sleep
EEG (brain waves) Large slow waves High frequency

EOG (eyes) Still Rapid eye movements
EMG (throat) Tensed muscles Relaxed muscles

ECG (heart) Regular Irregular
Dreaming Normally no recall Recall
Sleep walking Yes No

Body movements Less frequent More frequent
Stomach acids Steady Increase
Table 15-1: Characteristics of Orthodox and Paradoxical Sleep
24. Various stages of sleep will vary depending on the activities prior to sleep. If a great deal of
strenuous activity has taken place then the sleep stages 3 and 4 will be extended. Alternatively, if a lot
of mental work has been undertaken, such as learning new information or procedures, then REM
sleep will be increased.
Sleep Cycles
25. During any normal night’s sleep the pattern operates on an approximately 90 min cycle.
Towards the end of the first 90 minutes of falling asleep the first REM stage occurs but this lasts only
10 to 20 min before the person passes back into slow wave sleep. At the end of the second cycle of
90 min the duration of REM sleep periods increases.
Rebound Effect
26. If an individual is deprived of either slow wave or REM sleep there will be a 'rebound' effect in
the next sleep period. That is the individual will make up the deficit in either case. For example if one
is woken after 3 hours of a normal sleep period then the body will have had all its required slow wave
sleep, but be deficient in REM sleep. In the next sleep period it is found that REM sleep will occur
earlier and last longer than normal.
Naps and Microsleeps
Naps
27. A nap is a short period of sleep taken at any hour. The time of day, the duration of nap and
the sleep credit/deficit of the individual will determine through which sleep stages the individual will
pass. The restorative properties of naps vary from one individual to another. Those who habitually
take naps appear to gain more benefit than non-habitual nappers, who sometimes perform at a
reduced level for some time after awakening from the nap. The minimum duration for a nap to be
restorative appears to be not less than 20 minutes.
28. Aircrew, especially pilots should remember that after napping it may take some minutes to
collect one's thoughts and they will have slow responses and reactions for up to 5 min after being
roused. This is especially important for fighter pilots on ORP (operational readiness platform) duty.
Microsleeps
29. Microsleeps are very short periods of sleep lasting from a fraction of a second to two to three
seconds. Although their existence can be confirmed by electroencephalography (EEG)] readings, the
individual may be unaware of their occurrence which makes them particularly dangerous. They occur
most often in conditions of fatigue but are of no assistance in reducing sleepiness. Episodes of
microsleeps have been a major likely cause of road traffic accidents especially at night where the
driver lapsing into microsleeps lost control of his vehicle
Sleep Hygiene
30. If one really needs sleep she / he will sleep under almost any condition. If one is attempting to
sleep whilst still in sleep credit or at a time of low circadian sleepiness then:
(a) Avoid drinks containing caffeine near bed time (coffee, tea, cola and "fizzy" soft
drinks). Caffeine affects both Stage 4 and REM sleep. When caffeine is removed from a drink,
the sleep-disturbing effect is also removed.
(b) Avoid napping during the day.
(c) Make sure the room and bed are comfortable, with any daylight excluded, well
ventilated or efficient air conditioning, and ensure insects are kept out of the room or use a
mosquito net.
(d) Avoid excessive mental stimulation, emotional stress.
(e) A warm milky drink, light reading, or simple progressive relaxation techniques help to
promote sleep.
(f) Avoid alcohol and heavy meals.
Sleep and Alcohol
31. Alcohol is widely used by aircrew as an aid to sleep, especially when away from base or on
deployment. It is however a non-selective central nervous depressant. It may induce sleep but the
sleep pattern will not be normal as REM sleep will be reduced considerably and early waking is likely.
Drugs and Sleep Management
32. Sometimes an aircrew may require the assistance to obtain sleep or to stay awake. The
commonest drug used to delay sleepiness is caffeine, contained in tea or coffee. Knowingly or
unknowingly, aircrew consume a quite a few cups of tea or coffee. This assists the user to stay
awake, but may hamper falling off asleep or in the long term cause acidity or gastric ulcers. For
inducing sleep, although drugs like Barbiturates and Benzodiazepines are available. Barbiturates are
not only addictive but fatal if taken in overdose. Benzodiazepines can be addictive and all have an
adverse effect on performance especially if taken with alcohol. There is no place in aviation for such
drugs except under the strict supervision of an Aviation Medical Specialist.
553
CHAPTER 16
NOISE AND VIBRATION IN AVIATION
Introduction
1. Both noise and vibration independently and in combination, can affect the health, safety and
well-being of people associated with aircraft operations. Excessive exposure to noise may interfere
with routine living activities, induce annoyance, degrade voice communication, reduce the
effectiveness of performance, and/or cause noise-induced hearing loss. Similarly, mechanical
vibrations that reach the human operator may cause fatigue, degrade comfort, interfere with task
performance, and under severe conditions influence operational safety and occupational health. The
influence of these physical stressors can be minimised by focusing on the source, in the transmission
path and at the receiver. To protect the aircrew and ground crew from the deleterious effects of noise
and vibration, it is imperative that they adhere to the preventive measures.
NOISE
2. The waves of compression and rarefaction set up in a medium by a vibrating body that reach
the human ear is defined as sound while any unwanted sound is termed noise. Noise is unwanted as
it interferes with communication by speech or other auditory signals. Moreover, it is harmful to the ear
and to the person in general or to structures and materials. The harmful effects of noise take place
even when it is consciously desired by the recipient.
Sources of Noise
3. The primary source of noise in aviation is the propulsion system of the vehicle itself. The
secondary sources include auxiliary ground equipment that are required for the maintenance and
support of the aircraft as well as onboard life support and cabin conditioning systems. All these
equipment and aerodynamic causes generate sound energy of different levels. Besides aircraft, other
sources of noise include vehicles, workshop machinery, PA systems, and background noise on RT
etc. The sound energy generated during the ground running of aircraft affects all the individuals who
are working in close proximity while mainly the aircrew and the people onboard gets affected when
flying an unpressurised aircraft or helicopter.
Decibel Scale for Measurement of Sound
4. Human ear is sensitive to a wide range of sound pressure variations - from the threshold of
hearing to threshold of ear pain. Moreover, the auditory sensation is approximately related
logarithmically to the intensity of acoustical excitation of the eardrum. For these reasons, sound
pressure and other subjective attributes of sound like loudness are conveniently evaluated using
logarithmic scales.
5. Some of the typical instantaneous values of Sound Pressure Levels, thresholds of hearing
and pain are given in table 16-1.
Source of Sound SPL (dB)

Artillery gun fire 150-160
Immediate hearing damage 150
Pain threshold 140
MiG-21 ac ground running with afterburner 130
MiG-21 ac ground running 120
Kiran ac at full RPM 110
Kiran ac at moderate RPM 100
Motor cycle 90
Average street noise 70-80
Conversation at 2 meter 65-75
Threshold of hearing 0
Table 16-1: Root Mean Square (RMS) Values of various sources of Sound
Effects of Noise on Hearing
6. Whenever the human ear is exposed to loud noise, the hearing mechanism is over stimulated
and soon becomes fatigued. Once exposure to loud noise is stopped, the ear gradually recovers from
fatigue. Hearing is impaired during the fatigued state but becomes normal when the fatigue
disappears.
7. Prolonged exposure to various levels of noise can cause different degrees of hearing loss (or
threshold shift) over time. These are caused by slow and progressive degeneration of the sound
sensitive cells in the inner ear. The threshold shift brought about by noise may be temporary or
permanent in nature. Temporary threshold shift refers to a loss of sensitivity, of one or both ears,
which returns to normal or pre-exposure hearing levels within a reasonable time on cessation of the
noise exposure while permanent threshold shift is a loss of hearing that persists, with no recovery of
sensitivity, regardless of the time away from the noise exposure.
8. The extent of threshold shift depends upon the intensity and duration of exposure and the
time taken for recovery is directly proportional to both these parameters. High frequency noise is more
damaging as the sensitivity of the ear is higher at high frequencies. From a single or intermittent noise
source, severe or permanent damage may result if the intensity is sufficiently high.
555 Noise and Vibration in Aviation
9. Aircrew as well as ground crew may suffer such temporary loss of hearing on exposure to
loud noise. If the exposures to loud noise occur as a routine for months and years, the ability of the
ear to recover quickly from fatigue is gradually lost. After many years of regular exposure to aircraft
noise or any other loud noise, the hearing loss or deafness may become permanent. Noise induced
permanent hearing loss is similar to deafness of old age and no medicines can be of help. Hearing
loss develops very gradually and hence remains unnoticed until it becomes severe and other
symptoms like ringing or whistling in ear appears. More often than not it is detected during routine
medical examination. The hearing loss initially affects the high frequencies and later on low
frequencies are also affected, which interferes with hearing of spoken words.
10. Effects of noise may also be manifested in the form of fatigue, loss of appetite, irritability,
sleep interference, startle, annoyance, distraction, interference with speech communication, etc.
Permissible Noise Exposure Limits
11. Noise induced permanent threshold shift appears to be less dependent on the type of noise to
which the individual is exposed than temporary threshold shift. Analysis of survey findings have
revealed that exposure to noise below 80 dB(A) over an 8 hour working day has little effect on
hearing loss. Here, dB(A) scale is used to express the subjective sensation of sound or in other words
the loudness of the sound pressure in question. Exposure to 85 dB(A) can produce a loss of the
order of 15 dB at high frequencies but many people remain unaffected. Noise at a level of 90 dB(A)
over the working day will produce a hearing loss well in excess of 20 dB in many people. At sound
levels higher than 90 dB(A), the degree and scope of loss increase markedly: severe loss at high
frequencies together with modest loss at low frequencies.
12. A trading relationship between Exposure

duration
exposure duration and sound level based on Sound level in dB(A)
(Hours per day)
‘the equal energy rule’ is followed in many 8 90
countries to arrive at an acceptable noise 4 95
exposure limit. If 90 dB(A) for 8 h is considered 2 100
as the acceptable limit, then for every halving 1 105

of exposure time, the overall level is increased 0.5 110
by a certain fixed value. Permissible noise 0.25 115
exposure levels allowed by United States’
Table 16-2: Permissible Noise Exposure
OSHA Standard for 8 hours a day, 5-day week Levels
(OSHA Standards, USA)
work schedule, is given in Table 16-2.
13. As a preventive measure no person should be permitted to enter, for any period of time, into
an area where the sound level is equal to or exceeds 115 dB(A) unless s-/he is wearing appropriate
hearing protective devices and nobody should ever penetrate into an area where the sound level
exceeds 140 dB(A).
Prevention of noise effects
14. Since the damage caused by noise cannot be corrected by any treatment, adherence to the
preventive measures in order to avoid exposure to loud noise is the best means available. There are
several ways to reduce noise, and together these measures help prevent damaging effects of noise.
(a) Noise Control at Source. Ideally, there should be aircraft available which do not
make much noise, but in spite of best efforts only small reduction of noise has been possible
so far.
(b) Keep the Noise Away. Noise that reach the ground crew / personnel can be
reduced significantly by adhering to the following procedures:
(i) Ground running or engine testing should be carried out at a place away from
populated areas with the aircraft tail pointed away.
(ii) Positioning Aircraft in front of noise deflectors during ground running so that
most of the sound energy is deflected upwards.
(iii) Provisioning of sound barriers and sound proofing of rooms.
(c) Keep People Away. All personnel other than those who need to be near the
aircraft or on airfield during flying or ground running of aircraft should keep themselves away
so that unnecessary exposure to noise is avoided.
(d) Ear Protective Devices. Those who have to be near the aircraft i.e., aircrew and
ground crew, should wear ear protective devices which attenuate the noise reaching the ears.
There are plug type defenders which are inserted into ears and the muff type which are worn
like head sets. They are personal issue to all ground crew. Aircrew may also use them
whenever necessary. Helmet in fighter aircraft and helicopter also serves the valuable
purpose of conserving the hearing of aircrew. The degree of attenuation offered by ear
protectors varies from one type to another. However, when the ear protective devices are
used in combination, they give an additional protection of up to 15 dB approximately.
(e) Monitoring of Hearing. The hearing of those exposed regularly to aircraft noise is
periodically checked to identify the ones who are showing greater tendency for hearing loss.
Such individuals can then be shifted to less noisy areas.
VIBRATION
15. Vibration is defined as sustained structure borne to and fro motion which is perceived by
senses other than hearing. The sources of vibration in aviation are:-
(a) Engines and auxiliary machinery.

(b) Interaction between the aircraft and the air through which it flies or the ground over
which it runs for take off and landing.
Routes of Transmission of Vibration to Man
16. Vibration reaches the crew/passengers through the principal supporting surfaces (e.g. seats
or floors) or through secondary points of contact with the structure of the vehicle (e.g. arm rests, head-
rest, hand or foot controls, man mounted equipment and connectors or restraint systems). In the
conventional sitting position, the seat is the principal route of entry of vibration into the person.
Effects of Whole-Body Vibration
17. The effects of vibration fall broadly into two categories – frequency dependent and intensity
dependent. In the former, responses are attributable directly to the differential vibratory movement or
deformation of the organs or tissues of the body – these are related to the body resonance
phenomena. In the latter, frequency dependence is less predominant and the effect appears to be
related more to the intensity of vibration and the cumulative duration of exposure.
18. The significance of relatively high intensity and continuous low frequency vibration is that it
may degrade performance of flying tasks. This is mainly due to the deterioration in visual acuity due
to blurring of vision as the eye is not able to follow the image. Legibility of pointers may also be
affected while viewing instrument dials. Tasks like tracking of radar may become difficult. Speech and
communication on R/T may be disturbed. Prolonged exposure to vibration may cause fatigue which in
turn may affect vigilance, concentration and reaction time.
19. Helicopters expose aircrew to vibrations over a range of frequencies that coincides with the
resonant frequencies of the body. It may cause short-term or long-term effects on the body. Low
amplitudes of vibration encountered in the aircraft and the ability of the body to provide some damping
are the reasons why humans do not receive injuries every time they fly. It should be noted that
vibration is rarely the sole cause of discomfort or fatigue in helicopter flying but is commonly a part of
a compositely stressful environment.
Preventive Measures Against Vibration
20. The effects of vibration on the body can be reduced by adopting the classical engineering
approach viz:
(a) Reduction of vibration at source.

(b) Reduction of vibration transmission from source to man.
(c) Restricting the exposure duration.
(d) Although vibration cannot be eliminated completely, adherence to the following
measures can lessen the effects of vibration on human performance and physiological
functions:
(e) Proper maintenance of aircraft.
(f) Use of restraining harness during extreme turbulence.
(g) Short flights with frequent breaks, rather than one long flight, if possible.
(h) Good posture during flight, sitting straight in the seat, will enhance blood flow
throughout the body.
21. Good physical condition can reduce the effect of vibration encountered in flight, as muscles
dampen the vibration while fat amplifies it. An overweight aircrew is more susceptible to performance
decrements and physiological effects under vibration.
559
CHAPTER 17
AIRCREW DIET AND PHYSICAL FITNESS
Introduction
1. An aviator must have positive health. This state is something more than mere freedom from
disease. Positive physical and mental health can be acquired by anybody who indulges in balanced
nutrition, graduated regular exercises, avoidance of smoking and drinking, adequate rest before a
day’s work (minimum six to seven hours of peaceful sleep is required for mental and physical
relaxation), protection from adverse weather factors and development of a healthy attitude of mind
towards work, leisure and environment.
Nutrition
2. As food is a prime necessity of life, a balanced diet is required for a normal healthy life. It is a
combination of different essential foodstuff in proper proportion, which supplies the nutrients in the
required quantities for the body, for its upkeep and well being. The broad principles of various
components of food are:
(a) Carbohydrates. The requirement is about 200-600 gm per day. These are
available in wheat, rice, legumes, potato, sugar etc. Half of our total energy requirement must
be met from complex carbohydrates like wheat and rice. Refined carbohydrates (e.g. sugar)
must be kept to a minimum.
(b) Fats. The requirement is abut 1 gm per kg body weight per day, upto a maximum of
70 gm per day. The unsaturated fatty acids contained in plant oils (Sunflower oil, palm oil,
mustard oil, rapeseed oil etc.) are rich in these essential factors. Animal fats contain more
saturated fatty acids. Consumption of large quantity of the animal fat is not good for health as
it results in increased cholesterol in blood. This will result in the hardening and premature
narrowing of the blood vessels (atherosclerosis). This is the major cause for high blood
pressure, heart attacks and strokes. Some other foods which are rich in saturated fatty acids
are hydrogenated oils, ghee, butter, processed cheese etc.
(c) Proteins. Its requirement is about 1 gm per kg body weight per day. It supplies
essential amino acids which are required for the growth and maintenance of the body tissues.
There are proteins of plant origin and animal origin. The animal proteins (e.g. meat, liver, egg,
milk etc.) are better digested and absorbed. They contain amino acids in the same proportion
as present in human tissues. The biological value of vegetable proteins (e.g. cereals, pulses,
vegetables etc) can be improved, if, it is taken along with animal proteins in a ratio of 1:3.
(d) Vitamins and Minerals. These are very essential for the growth and maintenance
of health. However, they are required in very small quantities only. In case one consumes
nutritious diet regularly, s-/he does not require any vitamin or mineral supplements.
(i) Vitamin A. This is essential for the health of skin and for good night vision.
Carrot, tomato, papaya, fish, milk, egg yolk etc are good source of it.
(ii) Vitamin B-complex. This is required for the proper body metabolism.
Whole grain, cereals, beans, nuts, meat, fish, liver, eggs are the source.
(iii) Vitamin C. It increases body’s resistance against infection and stress and
helps in tissue repair. Citrus fruits, guava, sprouted grams, green vegetables,
gooseberry are the natural sources.
(iv) Vitamin D. This promotes the health of bone and teeth. Sunshine helps to
produce this vitamin by our body. Fish, egg, milk etc. are the sources.
(v) Calcium. This is available in milk and eggs.
(vi) Iron, Iodine and Copper. These are is present in meat, fish, liver, eggs
etc.
(vii) Sodium, Potassium and Magnesium. These are present in citrus fruits,
green vegetables and banana etc. In a properly constituted diet these are normally
available in adequate quantities and there is no need for any separate intake.
3. Table 17-1 can be used to calculate the approximate energy requirement for a healthy adult
of about 70 Kg weight:
Type of work kCal/kg/h Activity Duration Energy consumption

Very light 1.5 Sleep 6 (1.5 X 6) X 70
Light 2.0 Light workout including Flying 15 (2 X 15) X 70
Moderate 4.0 Moderate work 2 (4 X 2) X 70
Heavy 8.0 Heavy workout 1 (8 X 1) X 70
Total 3850
4. This requirement must be divided among the three major food factors. As per the principles,
the fat (each gram gives 9 Kcal approx) will be 70 gm, the protein (each gm provides 4 KCal) 70 gm.
They provide a total of (70 x 9 + 70 x 4) 910 KCal. The remaining should come from carbohydrates
(1 gm provides 4 KCal), in other words (3850 - 910) 2940 KCal must come from it. This is equal to
(2940 / 4) 735gm. Note that this is only an example.
Pre-Flight, In-Flight and Post-Flight Meals
5. It is a healthy practice to have a Pre-flight meal. The pre-flight meal is recommended to be

rich in protein and fruits (green leafy vegetables, citrus fruits, salads, tomatoes, milk, milk products,
meat, fish, poultry, eggs, bread, potato, peas, nuts etc.). Prior to a sortie, the aircrew must avoid
highly concentrated carbohydrates, fatty food, highly seasoned foods (chilli and garlic sauces,
pickles etc), gas forming foods (raw apple, melons, cauliflower, lentils, cucumber, radish, turnip,
onion, garlic etc), high roughage foods (bran), alcoholic and carbonated beverages and any food
which is unduly laxative or may cause an allergy. In a long duration flight (more than 2hr) an in-flight
meal consisting of eggs, vegetables, meat, sandwiches, chocolates, biscuits and fluids in the form of
hot coffee, tea, milk or cold fruit juices or water should be taken. After landing immediate
refreshment and nourishment should be provided. It is desirable to have milk, fruit juices, coffee and
non alcoholic beverages. This is the post flight meal.
Physical Exercise
6. Physical exercise plays an important role in the promotion of positive health. It strengthens
the muscles, improves its tone and reaction time and thereby improves the stamina. It also smoothens
the functioning of the body in general and that of the circulation, respiration and neuro-muscular
activity in particular. This also helps reduce the mental tension inherent in an aviator’s profession and
life.
7. Physical exercise can be obtained by games, running, walking, cycling, swimming, etc. The
important considerations are the regularity and the will, availability of time and existing facilities.
Walking
8. Walking as an exercise is highly beneficial and suitable for all ages. "An hour’s walk a day will
keep the Doctor away". Walking promotes circulation, respiration, tones the muscles up and helps to
form extra blood vessels in the heart and muscles. The increased blood supply to heart prevents heart
attacks and in case of heart attacks, helps to limit the damage to the heart muscles. It also helps
control diseases like diabetes and high blood pressure, besides controlling obesity.
9. Depending upon the age, the speed of walking can be 1 Km in 8 to 15 min (4 to 6 kmph).
Individuals who are not fit, unaccustomed to exercise or old should start walking short distances at a
slower pace till they achieved the target of 4 kmph. Once the target of 4 kmph has been achieved the
pace should be gradually increased to the maximum of 6 kmph. Walking also helps reduce the mental
stress, depression and anxiety. During walking or any other forms of exercise, if one feels unduly
fatigued or has developed some discomfort, especially in the chest, then it is advisable that the
Squadron Medical Officer be consulted immediately.
A Word of Advice
10. Have a balanced diet, drink six pints of clean water, walk five to six km and sleep for about six
to seven hours daily and shun smoking. That is the ‘mantra’ for a healthy, satisfying and long flying
career.
11. Aging affects ones visual and hearing acuity, memory, physical strength, etc. However the
changes are gradual and it is difficult for the one to believe that he/she is getting old. Our mental
frame may remain at an evergreen youth. This is a tricky situation. An individual with positive health
will understand and adjust to this situation. It is important to remember that five common major
diseases that can be prevented or its onset postponed to a desirable age are obesity, diabetes
mellitus (DM), essential hypertension (HTN), ischaemic heart disease (IHD) and the one that can be
prevented for ever is alcoholism.
12. Obesity results when food intake exceeds the caloric requirement of the body. The excess
food will be stored in the body as fat. Whenever the body weight exceeds more than 20% of the ideal
weight, obesity is suspected. Obesity is the forerunner of major diseases like DM, HTN and IHD.
13. By the same methods applicable for prevention of obesity, the other three major diseases
which can be prevented are DM, HTN and IHD. The medical standard required for aviation duties are
the highest. Therefore, aircrew is medically examined periodically to ensure that s-/he is fit. The
doctor cannot deliver the goods unless the aircrew consult and confide in him and discuss all the
assailing problems, be it physical, psychological or sometimes even financial or marital. You, as a
professional aviator must feel free to consult your Squadron Doctor, if you feel that there is a need.
Squadron Doctor is your close confidante and true friend: so trust him and seek his help.

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FIS BOOK 4

1. Physics of Atmosphere 415

5. Temperature. We experience day to day and seasonal variations in atmospheric

Altitude Pressure Temperature

Table 1-1: Pressure and Temperature of Atmosphere

8. Troposphere. This is the region that

(a) Ground Layer. This layer extends

9. A layer of ozone exists in the atmosphere between 12 to 43 Km and has a maximum

ELEMENTARY PHYSIOLOGY OF RESPIRATION

2. Several steps are involved in these transport systems. These are:

3. Gas exchange between the external

Partial Pressure Conc of Dry Gas

Table 2-1: Composition of Alveolar Gas, Breathing Air at Ground Level

Partial Pressure in Alveolar Gas of

Carriage of Oxygen in the Body

8. The fall of the PO2 in the alveolar gas which

Significance of Hypoxia in Aviation

3. Hypoxia can be classified into four different types.

(c) Stagnant or Hypokinetic Hypoxia. This form of hypoxia is due to malfunction of

(a) Ascent to altitude without supplemental oxygen.

Symptoms and Signs of Hypoxia

Altitude (feet) Time of Useful Consciousness (Range in Seconds)

decompression to altitudes above 30,000 feet

Factors Influencing the Onset and Severity of Hypoxia Effects

(f) Individual Tolerance. Individuals differ considerably in their ability to withstand

Actual Altitude (ft) Non- Smoker Apparent Altitude(ft) Smoker

(a) Isobaric System. The

Altitude Barometric Pressure Lung Oxygen

Table 3-2: Supplemental Oxygen Requirements at Altitude to

Atmospheric Positive Pressure Required : To maintain 141 mm Hg/18.81 K Pa

Table 3-4: Schedules of Positive Pressure Breathing above 40,000 ft

(a) Effect of Pressure Breathing on Head and Neck

(iii) In order to sustain breathing pressures in excess of 70 mm Hg, a pressurized

(b) Effect of Pressure Breathing on Respiration

(ii) The maximum pressure which can be breathed without counter-pressure to

(iii) The respiratory disturbances produced by pressure breathing can be

Recovery from Hypoxic Hypoxia: Oxygen Paradox

21. Prevention of Hypoxia in Aircrew. In a study of hypoxia related incidences among

(a) Failure of the regulator to deliver correct concentration of oxygen.

Causes of Hyperventilation in Aviation

Signs and Symptoms of Hyperventilation

(a) Tingling in the hands, feet and lips.

(g) Cold clammy skin, pale cyamosis and weak pulse

4. Hyperventilation is a condition to be avoided. In order to reduce the likelihood of

PHYSIOLOGICAL EFFECTS OF ALTITUDE

Causes & Physical Basis of Decompression Sickness

Effects of Decompression Sickness

(d) Effects on the Skin. Itching is a common symptom of decompression sickness. It

(f) Neurological Symptoms-Eyes. Blurring of vision may be experienced. Sometimes

(j) Circulatory Disturbances. The symptoms of decompression sickness mentioned

FACTORS INFLUENCING THE EFFECTS OF DECOMPRESSION SICKNESS

(b) Time at Altitude. Decompression sickness does not develop immediately on

(d) Physical Activity. Physical activity at altitude increases the susceptibility to

(e) Re-exposure. Re-exposure to altitude within about 48 hours increases an

(f) Hyperbaric Exposure. Exposure to breathing air at pressures above one

(d) Individual Susceptibility. There is a wide range of individual variations. Few

Prevention of Decompression Sickness

(d) Breathing of 100% Oxygen (De-nitrification). Breathing of 100% oxygen at

(f) Selection of Aircrew. Decompression Chamber Tests help to eliminate highly

(j) Descend below 25,000 ft if cabin pressure falls.

16. To summarize, the treatment of decompression sickness is immediate recompression, as fast

Treatment of Decompression Sickness:

drum moves outward.

Expansion of Gas in the Middle Ear Cavity