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Individual Reactions to acute Hypoxia-Symptoms of Jet Fighter Pilots and High Altitude Parachutists. Colonel ret. Dr. med. Dipl.-Ing. H. Welsch former Head (1993 – 2007) of German Institute of Aviation Medicine, - Division Aviation Physiology – Königsbrück.

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slide1

Individual Reactions to acute Hypoxia-Symptoms of Jet Fighter Pilots and High Altitude Parachutists

Colonel ret.

Dr. med. Dipl.-Ing. H. Welsch

former Head (1993 – 2007) of

German

Institute of Aviation Medicine,

- Division Aviation Physiology –

Königsbrück

High Altitude: Physiology and Praxis, Slovenia Sep 2009

slide2

Source:

Wissenschaftliche Prüfungsarbeit zum Ersten Staatsexamen für das Lehramt an Gymnasien

Gegenüberstellende Betrachtung der subjektiven Wahrnehmung von Sauerstoffmangel-Symptomen bei Freifallspringern und Jet-Piloten

“Comparison of acute Oxygen-Deficiency-Symptoms between

High Altitude Parachutists and Jet Fighter Pilots”

Nina Alexandra Gleber

im SoSe 2008

Referenten:

1. Prof. Dr. med. H.-V. Ulmer

2. Prof. Dr. M. Macsenaere

hypothesis and aim of the study
Hypothesis and Aim of the Study
  • High altitude training in a low pressure chamber is a mandatory task in NATO for each military person who takes part in high altitude air traffic.
  • It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
  • The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
hypothesis and aim of the study4
Hypothesis and Aim of the Study
  • High altitude training in a low pressure chamber is a mandatory task in NATO for each military person who takes part in high altitude air traffic.
  • It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
  • The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
hypothesis and aim of the study5
Hypothesis and Aim of the Study
  • High altitude training in a low pressure chamber is a mandatory task in NATO for each military person who takes part in high altitude air traffic.
  • It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
  • The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
hypothesis and aim of the study6
Hypothesis and Aim of the Study
  • High altitude training in a low pressure chamber is a mandatory task in NATO for each military person who takes part in high altitude air traffic.
  • It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
  • The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
slide7

Simulation Centre with Human Centrifuge and Altitude Chamber

German Air Force Institute of Aviation Medicine - Division Aviation Physiology, D-01936 Königsbrück, Germany

slide8

German Air Force Institute of Aviation Medicine

Division Aviation Physiology

  • Actual Training Devices and Areas:
    • Human Centrifuge, Altitude Chamber, Anti-G-Trainer, Spatial Disorientation Device, Night Vision Training Device, Special Physical Training Equipment, Aviation Psychology (CRM)
  • Actual Tasks:
    • Evaluation, Training, Diagnostics, Research, Development, Test facility for industry
slide9

Training Devices

  • Altitude Physiology
  • Acceleration Physiology
  • Sports Physiology
  • (Back/Neck Training!)
  • Nutrition Physiology
  • Aviation Psychology
  • Night Vision Training
slide10
Altitude Physiology
  • Acceleration Physiology
  • Sports Physiology
  • (Back/Neck Training!)
  • Nutrition Physiology
  • Aviation Psychology
  • Night Vision Training

Altitude and Hypoxia Training

slide11

Altitude Simulation Chamber

Hypo baric + Hypoxia Training

slide12

Altitude Simulation Chamber Königsbrück

  • Max. Pressure Alt. 82.000 ft = 25.000m
  • Main Chamber:
    • Climb-/Descend-Rate:
      • +/- 20.000 ft/min
    • Temperature:
      • +15 - +50 0C
  • Decompression-chamber
    • Climb-/ Descend-Rate: +/- 50.000 ft/min
    • Temperature:
      • -50 - +10 0C
    • RD: minimal 300 ms
slide14

oxygen regulator with remote control

Switch „100% Oxygen“

slide15

Pulsoxymeter

ECG-Monitor

Multi-channel- Monitor

slide16

Pulsoxymeter

Multi-channel- Monitor

slide17

Oxygen Saturation Curve

physiological zone

incomplete compensation zone

deadly zone

slide18

Altitude Atmospheric pO²

(ft) (km) pressure (hPa) (hPa)

0 0 1013 213

3.000 0,914 908 191

7.000 2,134 782 164

10.000 3,048 697 146

12.000 3,658 645 135

15.000 4,572 572 120

18.000 5,486 506 106

20.000 6,096 466 98

22.000 6,706 428 90

25.0007,620377 79

30.000 9,144 302 63

36.000 10,973 228 48

40.000 12,192 188 40

objective of training 1
Objective of Training (1)
  • Barometric Changes
    • ear drum, sinuses, trapped gases
  • Pressure Breathing (>28.000 ft)
    • hyperventilation, breathing workload
  • Acute Hypoxia (25.000 ft)
    • individual symptoms (at least 2!)
  • Hypoxia in max.operational cabin altitude (18.000 ft): only jet fighter pilots
objective of training 2
Objective of Training (2)
  • Altitude Hypoxia Exposure
    • primarily no diagnostic/evaluation tool!
    • situational awareness training:
      • flying in high altitude
      • instrumental cross check including oxygen equipment; “PRICE”-check
  • Oxygen Equipment Safety Training
  • Confidence Training
signs and symptoms of hypoxia
Signs and Symptoms of Hypoxia
  • Because there is always a risk of equipment failure at high altitude, early recognition of hypoxic symptoms is mandatory.
  • The constellation of hypoxic symptoms and their sequence of appearance tend to be idiosyncratic to the individual.
  • As a rule, the individual‘s symptoms do not change dramatically over time, but refresher training in a chamber does reacquaint the individual with the symptoms, as well as identify any change in symptoms.
signs and symptoms of hypoxia24
Signs and Symptoms of Hypoxia
  • Because there is always a risk of equipment failure at high altitude, early recognition of hypoxic symptoms is mandatory.
  • The constellation of hypoxic symptoms and their sequence of appearance tend to be idiosyncratic to the individual.
  • As a rule, the individual‘s symptoms do not change dramatically over time, but refresher training in a chamber does reacquaint the individual with the symptoms, as well as identify any change in symptoms.
signs and symptoms of hypoxia25
Signs and Symptoms of Hypoxia
  • Because there is always a risk of equipment failure at high altitude, early recognition of hypoxic symptoms is mandatory.
  • The constellation of hypoxic symptoms and their sequence of appearance tend to be idiosyncratic to the individual.
  • As a rule, the individual‘s symptoms do not change dramatically over time, but refresher training in a chamber does reacquaint the individual with the symptoms, as well as identify any change in symptoms.
pilots and parachutists
Pilots and Parachutists
  • Aircrew (Pilots and WSO):
    • above 8.000 ft pressure altitude in the cockpit: additional oxygen in the breathing gas is required. Jet fighter aircraft aircrew is always equipped with oxygen breathing mask.
  • High altitude parachutists:
    • HAHO: High Altitude, High Opening:
      • Pre-breathing in the A/C, oxygen breathing in the air
    • HALO: High Altitude, Low Opening
      • Pre-breathing in the A/C, normal breathing in the air
slide27

Altitude-Time-Profile

Jet Fighter Pilots

Altitude (ft)

III

Hypoxia training:

pressure altitude 25.000 ft

35 000

30 000

10 000 ft/min

IV

25 000

4 000 ft/min

V

4 000 ft/min

20 000

18 000

15 000

2 000 ft/min

II

10 000

8 000

4 000 ft/min

5 000

VI

3 000

I

Time

(min.)

20

30

40

50

60

70

80

90

10

pilots and parachutists28
Pilots and Parachutists
  • Aircrew (Pilots and WSO):
    • above 8.000 ft pressure altitude in the cockpit: additional oxygen in the breathing gas required. Jet fighter aircraft aircrew is always equipped with oxygen breathing mask.
  • High altitude parachutists:
    • HAHO: High Altitude, High Opening:
      • Pre-breathing in the A/C, oxygen breathing in the air
    • HALO: High Altitude, Low Opening
      • Pre-breathing in the A/C, normal breathing in the air
slide29

Altitude-Time-Profile for High Altitude Parachutists

Hypoxia training:

pressure altitude 25.000 ft

III

35000

10000 ft/min

30000

IV

25000

Höhe (ft)

10000 ft/min

20000

4000 ft/min

V

15000

II

2000 ft/min

10000

2000 ft/min

5000

VI

4000 ft/min

I

30

40

50

60

70

80

10

20

Zeit (min)

monitoring
Monitoring

Oxygen saturation %

100%

90%

75%

60%

Heart rate

Breathing 21% oxygen

25.000 ft

18.000 ft

early covert features signs and symptoms of acute hypoxia
Early (covert) features (signs and symptoms) of acute hypoxia*
  • Visual function:
    • Light intensity perceived as reduced
    • Visual acuity diminished in poor illumination
    • Light threshold increased
    • Peripheral vision narrowed
  • Psychomotor function:
    • Choice reaction time impaired
    • Eye-hand co-ordination impaired
  • Cognitive function:
    • Memory impaired
overt features signs and symptoms of acute hypoxia
Overt features (signs and symptoms) of acute hypoxia*
  • Personality Change:
    • Lack of insight
    • Loss of judgement
    • Loss of self-criticism
    • Euphoria
    • Loss of memory
    • Mental incoordination
    • Muscular incoordination
    • Sensory loss
    • Cyanosis
  • Hyperventilation:
    • Dizziness
    • Light-headedness
    • Feeling of unreality
    • Feeling of apprehension
    • Neuromuscular irritability
    • Paraesthesia of skin
  • Unconsciousness
  • Death
results pressure altitude 25 000 ft questions and answers

Results: Pressure Altitude 25.000 ftQuestions and Answers

Statistic Data of Trainees

First Hypoxia Symptoms (Time and SaO2)

Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)

Time between first Hypoxia Symptom and Re-connection to 100% Oxygen

results pressure altitude 25 000 ft

Results Pressure Altitude 25.000 ft

Statistic Data of Trainees

First Hypoxia Symptoms (Time and SaO2)

Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)

Time between first Hypoxia Symptom and Re-connection to 100% Oxygen

results pressure altitude 25 000 ft37

Results Pressure Altitude 25.000 ft

Statistic Data of Trainees

First Hypoxia Symptoms (Time and SaO2)

Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)

Time between first Hypoxia Symptom and Re-connection to 100% Oxygen

results pressure altitude 25 000 ft40

Results Pressure Altitude 25.000 ft

Statistic Data of Trainees

First Hypoxia Symptoms (Time and SaO2)

Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)

Time between first Hypoxia Symptom and Re-connection to 100% Oxygen

slide42

Oxygen Saturation when re-connected to 100%

Oxygen breathing gas

120

100

80

60

Number of Trainees

Pilots

Parachutists

40

20

0

99% 95% 90% 85% 80% 75% 70% 65% 60%

Oxygen Saturation (%)

sao 2 re connection to 100 oxygen breathing gas
SaO2: Re-Connection to 100% Oxygen Breathing Gas

Most of these trainees are forced by the instructor to re-connect themselves to 100% oxygen breathing gas, when reached the 70% SaO2-level. The „after-drop“ explains the values between 60 – 70% SaO2.

oxygen saturation when re connected to 100 oxygen
Oxygen Saturation whenre-connected to 100% Oxygen
  • 207 (78%) of 265pilots are re-connected before their oxygen-saturation dropped beneath 70%.
  • Only 146 (60%) of 244parachutists are re-connected before their oxygen-saturation dropped beneath 70%.
results pressure altitude 25 000 ft45

Results Pressure Altitude 25.000 ft

Statistic Data of Trainees

First Hypoxia Symptoms (Time and SaO2)

Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)

Time between first Hypoxia Symptom and Re-connection to 100% Oxygen

slide47

265 Pilots

250 Parachutists

duration of hypoxia between first symptom and re connection to 100 oxygen
Duration of Hypoxia between first Symptom and Re-Connection to 100% Oxygen
  • 229 (91%) of 253pilots are re-connected within the first minute (60 seconds) after recognition of their first hypoxia-symptom.
  • Only 168 (70%) of 241parachutists are re-connected within the first minute (60 seconds) after recognition of their first hypoxia-symptom.
results smoker non smoker50
Results – Smoker/Non-Smoker

MORE OR LESS: NO DIFFERENCE!

summary pilots parachutists
Summary Pilots - Parachutists
  • No Differences in Type of Hypoxia Symptoms
  • No Differences in Recognition of first Hypoxia Symptoms in Time and SaO2
  • Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
  • Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
  • There is no Difference between Smokers and Non-Smokers.
summary pilots parachutists52
Summary Pilots - Parachutists
  • No Differences in Type of Hypoxia Symptoms
  • No Differences in Recognition of first Hypoxia Symptoms in Time and SaO2
  • Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
  • Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
  • There is no Difference between Smokers and Non-Smokers.
summary pilots parachutists53
Summary Pilots - Parachutists
  • No Differences in Type of Hypoxia Symptoms
  • No Differences in Recognition of first Hypoxia Symptoms in Time and SaO2
  • Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
  • Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
  • There is no Difference between Smokers and Non-Smokers.
summary pilots parachutists54
Summary Pilots - Parachutists
  • No Differences in Type of Hypoxia Symptoms
  • No Differences in Recognition of first Hypoxia Symptoms in Time and SaO2
  • Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
  • Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
  • There is no Difference between Smokers and Non-Smokers.
summary pilots parachutists55
Summary Pilots - Parachutists
  • No Differences in Type of Hypoxia Symptoms
  • No Differences in Recognition of first Hypoxia Symptoms in Time and SaO2
  • Pilots Re-connect earlier than Parachutists (Time and SaO2) to 100% Oxygen Breathing Gas
  • Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Oxygen Breathing Gas
  • There is no Difference between Smokers and Non-Smokers.
slide57

Incidence of Decompression Sickness (DCS) and Venous Gas Emboli (VGE) staying in high altitude; without pre-breathing(Andrew A. Pilmanis, Ph.D.)

100

90

80

70

60

50

% Vorkommen

40

VGE

30

20

DCS

10

0

11

13

15

17

19

21

23

25

Höhe, ft X 1000