TC 3-04.93 (FM 3-04.

301)

Aeromedical Training for Flight Personnel

August 2009

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

Headquarters, Department of the Army

 This publication is available at
Army Knowledge Online (www.us.army.mil) and
General Dennis J. Reimer Training and Doctrine
Digital Library at (www.train.army.mil).
 *TC 3-04.93 (FM 3-04.301)

Training Circular Headquarters

No. 3-04.93 (FM 3-04.301) Department of the Army
Washington, DC, 31 August 2009

Aeromedical Training for Flight Personnel

Contents
Page
PREFACE ........................................................................................................... viii
Chapter 1 TRAINING PROGRAM ...................................................................................... 1-1
Training Overview............................................................................................... 1-1
Responsibilities................................................................................................... 1-3
Revalidation and Waiver .................................................................................... 1-3
Training Record Documentation......................................................................... 1-3
Chapter 2 ALTITUDE PHYSIOLOGY ................................................................................. 2-1
Section I – The Atmosphere ............................................................................ 2-1
Physical Characteristics ..................................................................................... 2-1
Structure ............................................................................................................. 2-1
Composition........................................................................................................ 2-4
Atmospheric (Barometric) Pressure ................................................................... 2-4
Physiological Zones of the Atmosphere ............................................................. 2-6
Section II – Circulatory System ....................................................................... 2-7
Structure and Function of the Circulatory System.............................................. 2-7
Components and Functions of Blood ................................................................. 2-8
Section III – Respiratory System ..................................................................... 2-9
Breathing and Respiration .................................................................................. 2-9
Functions of Respiration ................................................................................... 2-10
Phases of External Respiration ........................................................................ 2-11
Components of the Respiratory System .......................................................... 2-11
Section IV – Hypoxia ...................................................................................... 2-14
Characteristics of Hypoxia ................................................................................ 2-14
Types of Hypoxia .............................................................................................. 2-15
Signs, Symptoms, and Susceptibility to Hypoxia ............................................. 2-17
Stages of Hypoxic Hypoxia .............................................................................. 2-19
Prevention of Hypoxic Hypoxia ........................................................................ 2-20
Treatment of Hypoxia ....................................................................................... 2-21
Section V – Hyperventilation ......................................................................... 2-21
Characteristics .................................................................................................. 2-21
Causes ............................................................................................................. 2-21

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

*This publication supersedes FM 3-04.301, 29 September 2000.

i
Contents

Signs and Symptoms of Hyperventilation ......................................................... 2-22

Treatment .......................................................................................................... 2-22
Section VI – Pressure-Change Effects.......................................................... 2-22
Dysbarism ......................................................................................................... 2-22
Trapped-Gas Disorders .................................................................................... 2-23
Evolved-Gas Disorders ..................................................................................... 2-28
Chapter 3 STRESS AND FATIGUE IN FLYING OPERATIONS ........................................ 3-1
Stress Defined..................................................................................................... 3-1
Identifying Stressors ........................................................................................... 3-1
Stress Responses ............................................................................................... 3-8
Stress and Performance ..................................................................................... 3-9
Stress Management .......................................................................................... 3-10
Fatigue .............................................................................................................. 3-11
Effects of Fatigue on Performance ................................................................... 3-12
Diurnal (Circadian) Rhythms and Fatigue......................................................... 3-13
The Sleep Cycle ................................................................................................ 3-13
Sleep Requirements ......................................................................................... 3-13
Prevention of Fatigue ........................................................................................ 3-14
Treatment of Fatigue ......................................................................................... 3-15
Chapter 4 GRAVITATIONAL FORCES .............................................................................. 4-1
Terms of Acceleration ......................................................................................... 4-1
Types of Acceleration ......................................................................................... 4-1
Gravitational Forces ............................................................................................ 4-3
Factors Affecting Accelerative Forces ................................................................ 4-4
Physiological Effects of Low-Magnitude Acceleration ........................................ 4-5
Physiological Effects of +Gz Acceleration ........................................................... 4-5
Physiological Effects of –Gz Acceleration ........................................................... 4-7
Physiological Effects of +/–Gx Acceleration ........................................................ 4-8
Physiological Effects of +/–Gy Acceleration ........................................................ 4-8
Physiological Effects of High-Magnitude Acceleration and Deceleration ........... 4-8
Preventive Measures ........................................................................................ 4-12
Chapter 5 TOXIC HAZARDS IN AVIATION ....................................................................... 5-1
Section I – Aviation Toxicology Principles..................................................... 5-1
Acute Toxicity ...................................................................................................... 5-1
Chronic Toxicity................................................................................................... 5-1
Time and Dose Relationship ............................................................................... 5-1
Physiochemical Factors ...................................................................................... 5-2
Entry Points ......................................................................................................... 5-2
Preexisting Conditions ........................................................................................ 5-2
Individual Variability ............................................................................................ 5-2
Allowable Degree of Bodily Impairment .............................................................. 5-2
Body Detoxification ............................................................................................. 5-3
Section II – Aircraft Atmosphere Contamination ........................................... 5-3
Contamination Overview ..................................................................................... 5-3
Exhaust Gases .................................................................................................... 5-3
Carbon Monoxide ................................................................................................ 5-4

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 Contents

Aviation Gasoline................................................................................................ 5-5

Tetraethyl Lead in Aviation Gasoline.................................................................. 5-6
Jet Propulsion Fuels ........................................................................................... 5-6
Hydraulic Fluid .................................................................................................... 5-6
Coolant Fluid ...................................................................................................... 5-6
Engine Lubricants ............................................................................................... 5-7
Solvents and Degreasers ................................................................................... 5-7
Composite Materials ........................................................................................... 5-7
Fire Extinguishing Agents ................................................................................... 5-7
Fluorocarbon Plastics and Polyurethane ........................................................... 5-8
Oxygen Contamination ....................................................................................... 5-9
Chapter 6 EFFECTS OF TEMPERATURE EXTREMES ON THE HUMAN BODY ........... 6-1
Section I – Heat in the Aviation Environment ................................................ 6-1
Heat Transfer...................................................................................................... 6-2
Heat Injury .......................................................................................................... 6-3
Performance Impairment .................................................................................... 6-3
Heat Stress Prevention ...................................................................................... 6-4
Inflight Heat Stress Reduction ............................................................................ 6-4
Section II – Cold in the Aviation Environment............................................... 6-5
Cold Injury .......................................................................................................... 6-5
Cold Injury Prevention ........................................................................................ 6-6
Chapter 7 NOISE AND VIBRATION IN ARMY AVIATION ................................................ 7-1
Characteristics and Effects................................................................................. 7-1
Sound and Vibrational Measurement ................................................................. 7-1
Noise and Hearing Levels .................................................................................. 7-3
Vibrational Effects............................................................................................... 7-4
Hearing Loss ...................................................................................................... 7-4
Hearing Protection .............................................................................................. 7-5
Vibration Preventive Measures .......................................................................... 7-8
Chapter 8 VISION................................................................................................................ 8-1
Section I – General ........................................................................................... 8-1
Anatomy and Physiology of the Eye................................................................... 8-1
Section II – Types of Vision ............................................................................. 8-3
Photopic Vision ................................................................................................... 8-4
Mesopic Vision ................................................................................................... 8-4
Scotopic Vision ................................................................................................... 8-5
Section III – Visual Deficiencies ...................................................................... 8-6
Myopia ................................................................................................................ 8-6
Night Myopia ....................................................................................................... 8-7
Hyperopia ........................................................................................................... 8-7
Astigmatism ........................................................................................................ 8-7
Presbyopia .......................................................................................................... 8-8
Retinal Rivalry .................................................................................................... 8-8
Surgical Procedures ........................................................................................... 8-8
Section IV – Factors Affecting Object Visibility ............................................ 8-9

31 August 2009 TC 3-04.93 iii

Contents

Section V – Night Vision ................................................................................... 8-9

Dark Adaptation .................................................................................................. 8-9
Protective Equipment ........................................................................................ 8-10
Protective Measures ......................................................................................... 8-11
Night Vision Techniques ................................................................................... 8-11
Distance Estimation and Depth Perception ...................................................... 8-14
Visual Illusions .................................................................................................. 8-18
Meteorological Conditions and Night Vision ..................................................... 8-18
Section VI – Self-Imposed Stress and Vision............................................... 8-19
Drugs ................................................................................................................. 8-19
Exhaustion ........................................................................................................ 8-19
Alcohol .............................................................................................................. 8-20
Tobacco ............................................................................................................ 8-20
Hypoglycemia and Nutritional Deficiency ......................................................... 8-21
Section VII – Other Vision Considerations ................................................... 8-21
Nerve Agents and Night Vision ......................................................................... 8-21
Flight Hazards ................................................................................................... 8-21
Protective Measures ......................................................................................... 8-23
Chapter 9 SPATIAL DISORIENTATION ............................................................................. 9-1
Common Terms of Spatial Disorientation ........................................................... 9-1
Types of Spatial Disorientation ........................................................................... 9-1
Equilibrium Maintenance..................................................................................... 9-2
Semicircular Canals ............................................................................................ 9-5
Proprioceptive System ........................................................................................ 9-7
Visual Illusions .................................................................................................... 9-7
Vestibular Illusions ............................................................................................ 9-12
Proprioceptive Illusions ..................................................................................... 9-16
Prevention of Spatial Disorientation .................................................................. 9-16
Treatment of Spatial Disorientation .................................................................. 9-17
Chapter 10 OXYGEN EQUIPMENT AND CABIN PRESSURIZATION .............................. 10-1
Oxygen Systems ............................................................................................... 10-1
Storage Systems ............................................................................................... 10-1
Oxygen Regulators ........................................................................................... 10-2
Oxygen Masks .................................................................................................. 10-3
Passenger Oxygen Mask .................................................................................. 10-3
Oxygen Equipment Checklist ............................................................................ 10-5
Cabin Pressurization ......................................................................................... 10-5
Appendix A HYPOBARIC CHAMBER FLIGHT PROFILES ................................................. A-1
Medical Clearance ............................................................................................. A-1
Purpose of Hypobaric Chamber Training .......................................................... A-1
Chamber Profiles and Applicability of Training .................................................. A-1
GLOSSARY .......................................................................................... Glossary-1
REFERENCES.................................................................................. References-1
INDEX ......................................................................................................... Index-1

iv TC 3-04.93 31 August 2009

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Figures
Figure 2-1. Earth’s atmospheric structure ....................................................................... 2-2
Figure 2-2. Standard atmospheric pressure measurements........................................... 2-5
Figure 2-3. Dalton’s Law and the Earth’s atmosphere .................................................... 2-6
Figure 2-4. The circulatory system .................................................................................. 2-7
Figure 2-5. Functions of blood components .................................................................... 2-8
Figure 2-6. Respiratory cycle ........................................................................................ 2-11
Figure 2-7. Components of the respiratory system ....................................................... 2-12
Figure 2-8. Exchange of carbon dioxide and oxygen between an alveolus and a
capillary ...................................................................................................... 2-13
Figure 2-9. Oxygen and carbon dioxide exchange between tissue and a capillary ...... 2-14
Figure 2-10. Hypoxic hypoxia ........................................................................................ 2-15
Figure 2-11. Hypemic hypoxia ....................................................................................... 2-15
Figure 2-12. Stagnant hypoxia ...................................................................................... 2-16
Figure 2-13. Histotoxic hypoxia ..................................................................................... 2-16
Figure 2-14. Physiological altitude limitations of a smoker ........................................... 2-18
Figure 2-15. Boyle’s Law ............................................................................................... 2-23
Figure 2-16. Expansion of trapped gas ......................................................................... 2-23
Figure 2-17. Expanding air in the middle ear ................................................................ 2-25
Figure 2-18. Middle ear and eardrum pressure during descent .................................... 2-25
Figure 2-19. Sinus cavities ............................................................................................ 2-27
Figure 2-20. Henry’s Law .............................................................................................. 2-28
Figure 2-21. Denitrogenation ......................................................................................... 2-31
Figure 4-1. Linear acceleration........................................................................................ 4-2
Figure 4-2. Centripetal (radial) acceleration .................................................................... 4-2
Figure 4-3. Angular acceleration ..................................................................................... 4-3
Figure 4-4. Effects of G-force on the body ...................................................................... 4-4
Figure 4-5. Impact direction ............................................................................................. 4-5
Figure 4-6. Physiological effects of +Gz acceleration ...................................................... 4-6
Figure 4-7. Physiological effects of –Gz acceleration ...................................................... 4-8
Figure 4-8. Crash force decelerations ........................................................................... 4-10
Figure 4-9. Crash forces in Gx, Gy, and Gz axes ........................................................... 4-10
Figure 4-10. UH-60 Black Hawk crashworthy design ................................................... 4-11
Figure 6-1. Wind chill chart .............................................................................................. 6-6
Figure 7-1. HGU-56P aviator helmet ............................................................................... 7-6
Figure 7-2. Communications earplug .............................................................................. 7-7
Figure 7-3. Earmuffs ........................................................................................................ 7-8
Figure 8-1. Anatomy of the human eye ........................................................................... 8-2
Figure 8-2. Day blind spot ............................................................................................... 8-3
Figure 8-3. Photopic vision .............................................................................................. 8-4

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Contents

Figure 8-4. Mesopic vision ............................................................................................... 8-4

Figure 8-5. Scotopic vision............................................................................................... 8-5
Figure 8-6. Night blind spot .............................................................................................. 8-5
Figure 8-7. Visual blind spot ............................................................................................ 8-6
Figure 8-8. Myopia (nearsightedness) ............................................................................. 8-6
Figure 8-9. Hyperopia (farsightedness) ........................................................................... 8-7
Figure 8-10. Astigmatism ................................................................................................. 8-7
Figure 8-11. Rod and cone cell sensitivities .................................................................. 8-10
Figure 8-12. Off-center vision technique........................................................................ 8-12
Figure 8-13. Right-to-left or left-to-right scanning pattern .............................................. 8-13
Figure 8-14. Stop-turn-stop-turn scanning pattern ........................................................ 8-13
Figure 8-15. Geometric perspective .............................................................................. 8-14
Figure 8-16. Known size of objects ................................................................................ 8-15
Figure 8-17. Terrestrial association ............................................................................... 8-16
Figure 8-18. Overlapping contour .................................................................................. 8-16
Figure 8-19. Fading of colors or shades ........................................................................ 8-17
Figure 8-20. Position of light source and direction of shadow ....................................... 8-18
Figure 8-21. Self-imposed stress factors ....................................................................... 8-19
Figure 9-1. The three equilibrium systems ...................................................................... 9-2
Figure 9-2. Vestibular system .......................................................................................... 9-3
Figure 9-3. Otolith organs ................................................................................................ 9-3
Figure 9-4. Position of hair cells when head is upright .................................................... 9-4
Figure 9-5. Position of hair cells when head is tilted forward and backward ................... 9-4
Figure 9-6. False sensation of backward tilt .................................................................... 9-5
Figure 9-7. Reactions of semicircular canals to changes in angular acceleration .......... 9-5
Figure 9-8. Cutaway view of the semicircular canal ........................................................ 9-6
Figure 9-9. Position of hair cells during no acceleration .................................................. 9-6
Figure 9-10. Sensation during a clockwise turn ............................................................... 9-6
Figure 9-11. Sensation during a prolonged clockwise turn ............................................. 9-7
Figure 9-12. Sensation during slowing or stopping of a clockwise turn........................... 9-7
Figure 9-13. Confusion of ground lights and stars at night .............................................. 9-8
Figure 9-14. False horizon illusion ................................................................................... 9-9
Figure 9-15. Structural illusion ....................................................................................... 9-10
Figure 9-16. Size-distance illusion ................................................................................. 9-10
Figure 9-17. Altered planes of reference ....................................................................... 9-11
Figure 9-18. Flicker vertigo ............................................................................................ 9-12
Figure 9-19. Leans ......................................................................................................... 9-13
Figure 9-20. Graveyard spin .......................................................................................... 9-14
Figure 9-21. Fluid movement in the semicircular canals during a turn .......................... 9-15
Figure 9-22. Proprioceptive illusion ............................................................................... 9-16
Figure 10-1. Helicopter oxygen system ......................................................................... 10-2

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Figure 10-2. Quick-donning mask-regulator assembly unit .......................................... 10-3

Figure 10-3. Passenger oxygen mask .......................................................................... 10-4
Figure 10-4. MBU-12/P oxygen mask ........................................................................... 10-4
Figure 10-5. MBU-20/P oxygen mask ........................................................................... 10-5
Figure 10-6. C-12D cabin pressurization changes with altitude changes ..................... 10-6
Figure A-1. Type I 35,000-foot U.S. Air Force original training profile ............................ A-2
Figure A-2. Type II 25,000-foot U.S. Air Force refresher training profile ........................ A-2
Figure A-3. Type IV 25,000-foot U.S. Army profile .......................................................... A-3
Figure A-4. Type V 35,000-foot U.S. Army/U.S. Air Force profile ................................... A-4
Figure A-5. Military rapid decompression profile ............................................................. A-4

Tables
Table 2-1. Standard pressure and temperature values at 40 degrees latitude for
specific altitudes ........................................................................................... 2-3
Table 2-2. Percentages of atmospheric gases................................................................ 2-4
Table 2-3. Partial pressures of oxygen at various altitudes ............................................ 2-6
Table 2-4. Correlation of altitude and blood oxygen saturation .................................... 2-14
Table 2-5. Possible signs and symptoms of hypoxia .................................................... 2-17
Table 2-6. Relationship between time of useful consciousness and altitude................ 2-19
Table 2-7. Stages of hypoxic hypoxia ........................................................................... 2-19
Table 2-8. Decompression sickness symptoms ............................................................ 2-29
Table 3-1. Possible side effects of commonly used drugs .............................................. 3-4
Table 3-2. Caffeine content of common beverages, foods, and over-the-counter
drugs ............................................................................................................ 3-5
Table 5-1. Physiological responses to various carbon monoxide concentrations .......... 5-4
Table 7-1. Effects of various sound intensities................................................................ 7-2
Table 7-2. Resonant frequencies and the human body .................................................. 7-3
Table 7-3. Recommended allowable noise exposure levels ........................................... 7-3
Table 7-4. Rotary- and fixed-wing aircraft noise levels ................................................... 7-4
Table 7-5. Estimated attenuation levels by helmet ......................................................... 7-6
Table 7-6. Attenuation levels for the HGU-56P with earplugs ........................................ 7-7
Table 8-1. Night vision reduction rates for smokers and nonsmokers .......................... 8-20

31 August 2009 TC 3-04.93 vii

 Preface
This manual is intended for use by all Army crewmembers in meeting requirements set forth in Army
Regulation 95-1, Training Circular 1-210, and other appropriate aircrew training manuals.
Lessons learned from previous military conflicts and recent contingency operations have caused changes in
Army aviation doctrine. With the development of more sophisticated aircraft and weapons systems, Army
crewmembers must be capable of operating these systems around the clock, in austere environments, and under
adverse conditions. The hazards of stress and fatigue in combat operations and concept of operations will
eventually take a toll in aircrew performance and could jeopardize mission accomplishment unless
crewmembers are trained to recognize and understand these hazards. Proper training prepares crewmembers
and prevents stress and fatigue from reducing mission effectiveness, thereby increasing their chances of
survival.
Training Circular 3-04.93 provides crewmembers with an understanding of the physiological responses that can
occur in the aviation environment. It also describes the effects of the flight environment on individual mission
accomplishment. In addition, this publication outlines essential aeromedical training requirements (in Chapter
1) that assist commanders and flight surgeons in conducting aeromedical education for Army crewmembers.
Subject areas addressed are by no means all inclusive but are presented to assist crewmembers in increasing
performance and efficiency.
This publication applies to the Active Army, the Army National Guard/Army National Guard of the United
States, and the United States Army Reserve unless otherwise stated.
The proponent of this publication is Headquarters, U.S. Army Training and Doctrine Command. Send
comments and recommendations on Department of the Army Form 2028 (Recommended Changes to
Publications and Blank Forms) to Dean, U.S. Army School of Aviation Medicine, ATTN: MCCS-HA, Fort
Rucker, AL 36362-5377.
The provisions of this publication are the subject of the following international agreement: Standardization
Agreement 3114.
The use of trade names in this manual is for clarity only and does not constitute endorsement by the Department
of Defense.
This publication has been reviewed for operations security considerations.

viii TC 3-04.93 31 August 2009

 Chapter 1
The Training Program

This chapter outlines essential aeromedical training requirements needed for

crewmembers. Aircrews must be trained and ready in peacetime to perform their
missions in combat or other contingency operations. Therefore, leaders at all levels
must understand, sustain, and enforce high standards of combat readiness. Tough,
realistic training should be designed to challenge and develop Soldiers, leaders, and
units. This chapter outlines the essential aeromedical training requirements needed
for all crewmembers.

TRAINING OVERVIEW
1-1. The U.S. Army provides aeromedical training
during initial flight training and during designated Contents
courses to all flight students at the U.S. Army
Aviation Center of Excellence (USAACE), Fort Training Overview ..................................... 1-1
Rucker, AL. In addition, unit commanders are Responsibilities ......................................... 1-3
responsible for aeromedical training at the unit Revalidation and Waiver ........................... 1-3
level. Training Record Documentation .............. 1-3

AEROMEDICAL TRAINING IN SPECIFIC

COURSES
1-2. Initial aeromedical training is conducted for all U.S. Army students in the Initial Entry Rotary Wing
Course. Initial physiological training is performed according to the provisions of Standardization
Agreement 3114 and U.S. Army Training and Doctrine Command programs of instruction (POIs) at
USAACE. Aeromedical training is conducted for aviators receiving transition or advanced training at
USAACE.
HYPOBARIC REFRESHER TRAINING
1-3. Fixed- or rotary-wing crewmembers who fly in pressurized aircraft or in aircraft that routinely
exceed 10,000 feet mean sea level (MSL) must complete aeromedical refresher training every 5 years.
Crewmembers are required to participate in a hypobaric (low pressure/high altitude) chamber exercise or a
reduced oxygen breathing device (ROBD) exercise using the appropriate profile for the aircraft and
mission requirements (see appendix A). Crewmembers who fly in pressurized aircraft also must complete a
rapid decompression. Training will be conducted by an approved physiological training unit for
crewmembers meeting these criteria, with the exception of personnel specified in paragraph 1-4.
1-4. Crewmembers with 240 months total operational flying duty credit (TOFDC) and four successful
altitude chamber iterations must complete classroom training requirements but are exempt from the altitude
chamber and rapid decompression practical exercise requirements. Department of the Army civilians
(DACs) and contractors with documentation of prior Department of Defense-approved training may, upon
approval from the Government flight representative, request exceptions through the unit standardization
section. (DACs and contractors are required to complete annual altitude physiology training requirements.)
All crewmembers who meet these requirements and provide the unit standardization section with
documented proof of training may receive altitude physiology review classroom training at the unit level.
See paragraph 1-20 for Department of the Army (DA) Form 759 (Individual Flight Record and Flight
Certificate-Army) requirements.

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Chapter 1

1-5. Refresher training consists of classroom instruction to review the essential materials presented in
initial training. The minimum refresher training needed to meet the requirements of paragraph 1-3 are—
z Altitude physiology review.
z Altitude chamber orientation.
z Altitude chamber practical exercise.
z Rapid decompression practical exercise.

APPROVED PHYSIOLOGICAL TRAINING UNITS

1-6. U.S. Air Force or U.S. Navy physiological training units may be used if aviators cannot attend
aeromedical training, including hypobaric (low pressure/high altitude) chamber qualification, at the U.S.
Army School of Aviation Medicine (USASAM), Fort Rucker, AL. Initial and refresher training conducted
by other services meets U.S. Army requirements for renewal of aeromedical training currency for a 5-year
period.

UNIT TRAINING
1-7. The unit commander must develop an aeromedical training program that meets the unit’s specific
needs as part of the Aircrew Training Program governed by Training Circular (TC) 1-210. This training is
crucial because most Army crewmembers are not required to attend the established refresher training
courses described previously.
1-8. The unit’s mission and its wide range of operations are important factors for the commander to
consider in developing an aeromedical training program. The program should include the various
aeromedical factors that affect crewmember performance in different environments, during flight
maneuvers, and while wearing protective gear. The unit aeromedical training program will contain, at a
minimum, the continuation training described in paragraph 1-10.
1-9. Because of the medical and technical nature of the aeromedical training program, the commander
must involve the unit’s supporting flight surgeons in developing the program. The flight surgeon will
provide input for all aspects of unit aviation plans, operations, and training. Commanders can obtain further
assistance in developing a unit aeromedical training program from the Dean, USASAM, ATTN: MCCS-
HA, Fort Rucker, AL 36362-5377, http://usasam.amedd.army.mil.

CONTINUATION TRAINING
1-10. The requirement for continuation training applies to all Army crewmembers in operational flying
positions. The POI must be conducted once a year. The following subjects provide the minimum training
necessary for the unit to reach adequate safety and efficiency in the aviation environment:
z Altitude physiology.
z Spatial disorientation (SD).
z Aviation protective equipment.
z Stress, fatigue, and exogenous factors.

MISSION CONSIDERATIONS
1-11. The unit commander must evaluate the unit’s missions to incorporate mission considerations into the
aeromedical training POI. This analysis should include—
z Combat missions.
z Installation support missions.
z Contingency missions.
z Geographic and climatic considerations.
z Programmed training activities.

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 The Training Program

1-12. The supporting flight surgeon will help identify the aeromedical factors present during various flight
conditions and their effects on aircrew performance. The flight surgeon and the unit commander will then
develop a POI that meets the unit’s specific needs. For example, a unit stationed in the Northwest may
have a war-trace mission in Southeast Asia. The unit commander and flight surgeon would evaluate the
environmental concerns of that region and incorporate those factors into the aeromedical training program.
1-13. The commander must include all crewmembers in the unit aeromedical training program. Individual
crewmembers will be evaluated on their aeromedical knowledge during the Annual Proficiency and
Readiness Test (APART) period in accordance with the appropriate aircrew training manual (ATM).
Lesson materials can be obtained at http://usasam.amedd.army.mil.

RESPONSIBILITIES
U.S. ARMY SCHOOL OF AVIATION MEDICINE
1-14. USASAM is responsible for planning, supervising, and conducting all formal aeromedical Army
aviation training programs. USASAM also advises and assists unit commanders and flight surgeons in
developing local unit aeromedical training programs.

UNIT COMMANDER
1-15. The unit commander, assisted by the flight surgeon, will develop a local unit aeromedical training
program. The program should be designed to meet the unit’s mission requirements.

FLIGHT SURGEON
1-16. The flight surgeon provides medical support. He or she also assists the unit commander in
developing, presenting, and monitoring a unit aeromedical training program.

REVALIDATION AND WAIVER

REVALIDATION
1-17. Crewmembers are required to stay current in aeromedical training and hypobaric (low pressure/high
altitude) chamber training per Army Regulation (AR) 95-1, TC 1-210, and the appropriate ATM. If a
crewmember’s aeromedical training currency lapses, that individual must meet the requirements of
paragraph 1-3 or 1-10 as appropriate.

WAIVERS AND EXTENSIONS

1-18. AR 95-1 contains waiver procedures. An extension to hypobaric training may be granted prior to the
expiration period on a case-by-case basis for those individuals who will exceed the 5-year currency
requirement. The waiver request will be forwarded with the local flight surgeon’s recommendation to the
commander with aircrew training plan (ATP) authority. The commander has approval authority for DA
Form 4186 (Medical Recommendation for Flying Duty) to grant the extension. The extension period will
not exceed 30 days. Individuals who do not have a current altitude chamber exposure or valid extension
will be administratively restricted from flying duties and processed according to AR 600-105 and AR 600-
106.

TRAINING RECORD DOCUMENTATION

1-19. Upon completion of prescribed qualifications, training will be documented in the crewmember’s
health record and Individual Flight Records Folder (IFRF) and retained by the individual.

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Chapter 1

INITIAL AEROMEDICAL TRAINING

1-20. After the crewmember has completed training, the following entry will be made in the REMARKS
section of DA Form 759: “Individual has completed initial physiological training prescribed in TC 3-04.93,
including hypobaric (low pressure/high altitude) chamber qualification and/or rapid decompression, on
(date).”

CONTINUATION AEROMEDICAL TRAINING

1-21. After the crewmember has completed training, the remarks section of DA Form 759 should contain
the following entry: “Individual has completed refresher physiological training prescribed in TC 3-04.93,
including hypobaric (low pressure/high altitude) chamber or ROBD and/or rapid decompression
qualification, on (date).” The following entry is required for individuals who meet paragraph 1-4
requirements: “Individual has 240 TOFDC as of (date) and four successful chamber runs (dates) and has
completed refresher flight physiology academic training on (date).” The unit is responsible for verifying
official documentation and requirements for paragraph 1-4. Assistance is available through the Chief,
Warrior Track, USASAM.

SPECIAL TRAINING BY OTHER SERVICES

1-22. When aeromedical training is conducted by the U.S. Air Force or U.S. Navy and the forms listed in
paragraph 1-18 are not available, the forms listed below may be used to document the training
qualification. Appropriate entries will be made in the REMARKS section of the applicable form when the
crewmember completes training. The forms other services may use are—
z AF1274 (Physiological Training).
z AF702 (Individual Physiological Training Record).
z NAVMED 6150/2 (Special Duty Medical Abstract).
z NAVMED 6410/7 (Completion of Physiological Training).
1-23. Appropriate entries will be made on Standard Form 600 (Health Record-Chronological Record of
Medical Care), which is filed with DA Form 3444 (Inpatient Treatment Records and Dental Records
[Orange]). This information will document any medical difficulties the individual might have encountered
during altitude chamber qualification.

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 Chapter 2
Altitude Physiology

Humans are not physiologically equipped for high altitudes. To cope, humans rely on
preventive measures and, in some cases, life-support equipment. Although Army
aviators primarily fly rotary-wing aircraft at relatively low altitudes, aircrews may
still encounter altitude-associated problems that cause hypoxia, hyperventilation, and
trapped- and evolved-gas disorders. By understanding the characteristics of the
atmosphere, aircrews are better prepared for the physiological changes that occur
with increasing altitudes.

SECTION I – THE ATMOSPHERE

PHYSICAL CHARACTERISTICS
2-1. The Earth’s atmosphere is a mixture of water
and gases. The atmosphere extends from the surface Contents
of the Earth to approximately 1,200 miles (1,931
Section I – The Atmosphere ..................... 2-1
kilometers) in space. Gravity holds the atmosphere
in place. The atmosphere exhibits few physical Section II – Circulatory System ................ 2-7
characteristics; however, it shields the Earth from Section III – Respiratory System .............. 2-9
ultraviolet radiation and other hazards in space. Section IV – Hypoxia ............................... 2-14
Without the atmosphere, the Earth would be as Section V – Hyperventilation .................. 2-21
barren as the moon. Section VI – Pressure-Change Effects ... 2-22

STRUCTURE
2-2. The atmosphere consists of several concentric layers, also known as spheres, each displaying its own
unique characteristics. Thermal variances within the atmosphere help define these spheres, offering
aviation personnel an insight into atmospheric conditions within each area. Between each sphere is an
imaginary boundary known as a pause. Figure 2-1 (page 2-2) provides an illustration of the Earth’s
atmospheric structure.

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Chapter 2

Figure 2-1. Earth’s atmospheric structure

TROPOSPHERE
2-3. The troposphere extends from sea level to about 26,405 feet (8 kilometers) over the poles to nearly
52,810 feet (16 kilometers) above the equator. It is distinguished by a relatively uniform decrease in
temperature and the presence of water vapor, along with extensive weather phenomena.

Mean Temperature Lapse Rate

-1.98 degrees Celsius per 1,000 feet

2-4. Temperature changes in the troposphere can be accurately predicted using a mean temperature lapse
rate of –1.98 degrees Celsius per 1,000 feet. Temperatures continue to decrease until the rising air mass
achieves an altitude where temperature is in equilibrium with the surrounding atmosphere. Table 2-1 (page
2-3) illustrates the mean lapse rate and the pressure decrease associated with ascending altitude.

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 Altitude Physiology

Table 2-1. Standard pressure and temperature values at 40 degrees latitude for specific
altitudes

Altitude Pressure Pressure Pressure Temperature Temperature

(ft) (in/Hg) (mm/Hg) (psi) (°C) (°F)
Sea level 29.92 760.0 14.69 15.0 59.0
10,000 20.58 522.6 10.11 –4.8 23.3
18,000 14.95 379.4 7.34 –20.7 –5.3
20,000 13.76 349.1 6.75 –24.6 –12.3
25,000 10.51 281.8 5.45 –34.5 –30.1
30,000 8.90 225.6 4.36 –44.4 –48.0
34,000 7.40 187.4 3.62 –52.4 –62.3
35,332 6.80 175.9 3.41 –55.0 –67.0
40,000 5.56 140.7 2.72 –55.0 –67.0
43,000 4.43 119.0 2.30 –55.0 –67.0
50,000 3.44 87.3 1.69 –55.0 –67.0

STRATOSPHERE
2-5. The stratosphere extends from the tropopause to about 158,430 feet (30 miles or 48 kilometers). The
stratosphere is subdivided into two regions based on thermal characteristics. Although these regions differ
thermally, the water-vapor content of both regions is virtually nonexistent.
2-6. The first region of the stratosphere is the isothermal layer. In this layer, temperature is constant at –55
degrees Celsius (–67 degrees Fahrenheit). Turbulence is a common occurrence in the stratosphere and can
be attributed to the presence of fast-moving jet streams.
2-7. The stratosphere’s second region is the ozonosphere. It is characterized by rising temperatures. The
ozonosphere serves as a double-sided barrier that absorbs harmful solar ultraviolet radiation while allowing
solar heat to pass through to the Earth’s surface unaffected. In addition, the ozonosphere reflects heat from
rising air masses back toward the Earth’s surface, keeping the lower regions of the atmosphere warm even
at night, when there is an absence of significant solar activity.

MESOSPHERE
2-8. The mesosphere extends from the stratopause to an altitude of 264,050 feet (50 miles or 80
kilometers). Temperatures decline from a high of –3 degrees Celsius at the stratopause to nearly –113
degrees Celsius at the mesopause. Noctilucent clouds are a characteristic of this atmospheric layer. Made
of water ice vapor, these cloud formations are visible only at night when illuminated by sunlight from
below the horizon while the ground and lower layers of the atmosphere are in the Earth’s shadow.

THERMOSPHERE
2-9. The uppermost atmospheric region, the thermosphere extends from the mesopause to approximately
435 miles (700 kilometers) above the Earth. Thermosphere temperatures increase with altitude and are in
direct relation to solar activity. Temperatures in the thermosphere range from –113 degrees Celsius at the
mesopause to 2,000 degrees Celsius during periods of extreme solar activity.
2-10. The presence of ionic particles is a characteristic of the thermosphere. These particles are the result
of high-speed subatomic particles emanating from the sun that collide with gas atoms and are split apart.

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Chapter 2

COMPOSITION
2-11. The Earth’s atmosphere contains many gases; however, few are essential to human survival. Those
gases required for human life are nitrogen, oxygen, and carbon dioxide. Table 2-2 indicates the percentage
concentrations of gases commonly found in the atmosphere.

Table 2-2. Percentages of atmospheric gases

Gas Symbol Volume (%)

Nitrogen N2 78.0840
Oxygen O2 20.9480
Argon Ar 0.9340
Carbon dioxide CO2 0.0314
Neon Ne 0.0018
Helium He 0.0005
Hydrogen H2 <0.0001

NITROGEN
2-12. The Earth’s atmosphere consists mainly of nitrogen. Although a vital ingredient in the chain of life,
nitrogen is not readily used by the human body. However, nitrogen saturates body fluids and tissues as a
result of respiration. Aircrews must be aware of possible evolved-gas disorders due to the decreased
solubility of nitrogen at higher altitudes.

OXYGEN
2-13. Oxygen is the second most plentiful gas in the atmosphere. Oxygen and sugars are combined
through the process of respiration to meet the human body’s energy requirements. A lack of oxygen in the
body at altitude can cause drastic physiological changes resulting in death.

CARBON DIOXIDE
2-14. Carbon dioxide is the product of cellular respiration in most life forms. Although not present in large
amounts, carbon dioxide in the atmosphere plays a vital role in maintaining Earth’s oxygen supply.
Through photosynthesis, plants use carbon dioxide to create energy and release oxygen as a byproduct.
Due to animal metabolism and photosynthesis, carbon dioxide and oxygen supplies in the atmosphere
remain constant.

OTHER GASES
2-15. Other gases such as argon, xenon, and helium are present in trace amounts in the atmosphere. They
are not as critical to human survival as nitrogen, oxygen, and carbon dioxide.

ATMOSPHERIC (BAROMETRIC) PRESSURE

2-16. Standard atmospheric (barometric) pressure is the force (or weight) exerted by the atmosphere at any
given point. Atmospheric pressure is an observable characteristic and can be expressed in different forms
such as psi, millimeter/mercury (mm/Hg), inches of Hg, or in feet as indicated by an altimeter.
Atmospheric pressure decreases with increasing altitude, which causes difficulties with the body’s ability
to circulate oxygen. This decrease in pressure is the cause of most physiological problems in flight. Figure
2-2 (page 2-5) illustrates standard atmospheric pressure measurements at 59 degrees Fahrenheit (15
degrees Celsius) at sea level.

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 Altitude Physiology

Figure 2-2. Standard atmospheric pressure measurements

DALTON’S LAW OF PARTIAL PRESSURES

2-17. A close relationship exists between atmospheric pressure and the amount of various gases present in
the atmosphere. This relationship is referred to as Dalton’s Law of Partial Pressures. Dalton’s Law states
that the pressure exerted by a mixture of ideal (nonreacting) gases is equal to the sum of the partial
pressures of each gas in the mixture. The independent pressure of each gas is termed the partial pressure of
that gas. Figure 2-3 (page 2-6) represents the concept of Dalton’s Law as related to the Earth’s atmosphere.
Mathematically, Dalton’s Law can be expressed as follows:

Dalton’s Law
PT = PN2 + PO2 + PCO2 + ... (at constant V and T)
PT = total pressure of the mixture
PN2 = partial pressure of nitrogen
PO2 = partial pressure of oxygen
PCO2 = partial pressure of carbon dioxide
PN2 + PO2 + PCO2 = partial pressures of each individual gas
V = volume
T = temperature

2-18. To determine the partial pressure of gases in the atmosphere (or any gaseous mixture whose
concentrations are known), the following mathematical formula can be used:

Partial Pressure of Gases in the Atmosphere

Percentage of atmospheric concentration of the individual gas x
Total atmospheric pressure at a given altitude =
100

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Chapter 2

Figure 2-3. Dalton’s Law and the Earth’s atmosphere

2-19. Dalton’s law illustrates that as altitude increases, there is a proportional decrease in partial pressures
of gases in the atmosphere. Although the percentage concentration of gases remains stable with increasing
altitude, each partial pressure decreases in direct proportion to the total barometric pressure. Table 2-3
shows the relationship between barometric pressure and partial pressure.

Table 2-3. Partial pressures of oxygen at various altitudes

Altitude Atmospheric PAO2 PVO2 Pressure Blood

(ft) Pressure (mm/Hg) (mm/Hg) Differential Saturation
(mm/Hg) (mm/Hg) (%)
Sea level 760 100 40 60 98
10,000 523 60 31 29 87
18,000 380 38 26 12 72
22,000 321 30 22 8 60
25,000 282 7 4 3 9
35,000 179 0 0 0 0

2-20. Any change in the partial pressure of oxygen dramatically affects respiratory function. A decrease in
the partial pressure of oxygen quickly results in physiological impairment. Although this impairment might
not initially be noticed at lower altitudes, the effects are cumulative and grow progressively worse as
altitude increases.
2-21. A decrease in the partial pressure of nitrogen, especially at high altitude, can lead to a decrease in the
solubility of nitrogen in the body and possibly result in decompression sickness (DCS).

PHYSIOLOGICAL ZONES OF THE ATMOSPHERE

2-22. Humans are unable to adapt physiologically to all the physical changes that occur in the different
regions of the atmosphere. Humans are especially susceptible to the dramatic temperature and pressure
changes that take place during ascent and sustained aerial flight. For these reasons, the atmosphere is
further divided (by altitude) into three distinct physiological zones. These zones are based on pressure
changes and the resultant effects on human physiology.

THE EFFICIENT ZONE

2-23. Extending upward from sea level to 10,000 feet, the efficient zone provides aircrews with a near-
ideal physiological environment. Although barometric pressure drops from 760 mm/Hg at sea level to 523
mm/Hg at 10,000 feet, partial pressure of oxygen (PO2) levels within this range permit humans to operate

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 Altitude Physiology

without protective equipment. However, sustained flight in the upper portions of this area might require
acclimatization. Some minor problems associated with the efficient zone are ear and sinus blockages and
gas expansion in the digestive tract. Without use of supplemental oxygen, a decrease in night vision
capabilities occurs above 4,000 feet.

THE DEFICIENT ZONE

2-24. The deficient zone ranges from 10,000 feet at its base to 50,000 feet at its highest point. Because
atmospheric pressure at 10,000 feet is only 523 mm/Hg, missions in the deficient zone carry a high degree
of risk unless supplemental oxygen/cabin pressurization systems are used. As flights approach the upper
limit of the deficient zone, decreasing barometric pressure (down to 87 mm/Hg) increases the frequency of
trapped-gas disorders.

THE SPACE EQUIVALENT ZONE

2-25. Extending from 50,000 feet and continuing to the atmosphere’s outer fringes, the space equivalent
zone is deadly to humans. Therefore, flight in the space equivalent zone requires an artificial atmospheric
environment. Unprotected exposure to the extremely low temperatures and pressures found at these high
altitudes can quickly result in death. For example, at 63,000 feet (Armstrong’s line), the barometric
pressure is only 47 mm/Hg, equal to the partial pressure of water in the body at 37 degrees Celsius. At this
pressure, water begins to boil within the body as it changes into a gaseous vapor.

SECTION II – CIRCULATORY SYSTEM

STRUCTURE AND FUNCTION OF THE CIRCULATORY SYSTEM

2-26. The circulatory system (figure 2-4) constitutes the physiologic framework required to transport blood
throughout the body. A fundamental function of the circulatory system (along with the lymphatic system)
is fluid transport. Other important functions of this system include meeting body cell nutrition and
excretion demands, along with body heat and electrochemical equilibrium requirements. Circulatory
components include arteries, capillaries, and veins.

Figure 2-4. The circulatory system

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Chapter 2

ARTERIES
2-27. Arteries are strong, elastic vessels that transport blood away from the ventricles of the heart. Arterial
vessels generally carry oxygen-rich blood to the capillaries for use by the tissues. Arteries can withstand
relatively high pressures.

CAPILLARIES
2-28. Capillaries are the body’s smallest blood vessels and form the junction between the smallest arteries
(arterioles) and the smallest veins (venules). Capillaries are actually semipermeable extensions of the inner
linings of the arterioles and venules and provide body tissues with access to the bloodstream. Capillaries
are found virtually everywhere in the body, providing needed gas and nutrient exchange capabilities to
nearly every cell.

VEINS
2-29. Veins transport blood from the capillaries back to the atria of the heart. A low-pressure pathway,
veins possess flap-like valves to ensure blood flows only in the direction of the heart. In addition, veins can
constrict or dilate based on body requirements. This unique ability allows blood flow and pressure to be
modified based on factors such as body heat or trauma.

COMPONENTS AND FUNCTIONS OF BLOOD

2-30. Although blood volume varies with body size, the average adult has a blood volume approaching 5
liters. Blood accounts for approximately 5 percent of total body weight and is a form of connective tissue
whose cells are suspended in a liquid, intercellular material. The cellular portions of blood compose
roughly 45 percent of blood volume and consist mainly of red blood cells (RBCs), white blood cells
(WBCs), and blood platelets. Plasma makes up the remaining 55 percent of blood. Each component
performs unique functions (figure 2-5).

Figure 2-5. Functions of blood components

RED BLOOD CELLS

2-31. RBCs, or erythrocytes, are produced in red bone marrow. They transport most of the body’s supply
of oxygen and transfer carbon dioxide from the tissues to the lungs. The red blood count is a count of the
number of RBCs per cubic millimeter of blood. The number of RBCs in circulating blood is relatively
stable; however, environmental factors play a large role in determining actual red blood count. Smoking,
an inadequate diet, and the altitude where one lives all contribute to fluctuations in red blood count. In fact,

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 Altitude Physiology

people residing above 10,000 feet sea level could have up to 30 percent more erythrocytes than those living
at sea level.
2-32. Because oxygenation of RBCs depends on the PO2 in the atmosphere, aircrews could suffer from
hypoxia (oxygen deficiency; see section IV) even at low altitudes. RBC structure, appearance, and
production are among the factors affected when a crewmember experiences hypoxia.
2-33. Hemoglobin makes up about one-third of every RBC. Composed of several polypeptide chains and
iron-containing heme groups, hemoglobin attracts oxygen molecules through an electrochemical magnetic
process. Just as opposing poles on a magnet attract, so does the iron content within hemoglobin (Fe2+)
attract oxygen (O22–).
2-34. When the blood supply is fully saturated with oxygen (in the case of arterial blood), blood takes on a
bright red color as oxyhemoglobin forms. As blood passes through the capillaries, it releases oxygen to the
surrounding tissues. As a result, deoxyhemoglobin forms and gives venous blood a dark red color.

WHITE BLOOD CELLS

2-35. The principal role of WBCs, or leukocytes, is to fight and control various disease conditions,
especially those caused by invading microorganisms. Although WBCs are typically larger than RBCs, they
can squeeze between the cells of blood vessels to reach diseased tissues. WBCs also help form natural
immunities against numerous disease processes.

PLATELETS
2-36. Although not complete cells, platelets, or thrombocytes, arise from small, fragmented portions of
much larger cells produced in red bone marrow. About half the size of RBCs, platelets react to any breach
in the circulatory system by initializing blood coagulation and blood vessel contraction.

PLASMA
2-37. The liquid portion of blood is a translucent, straw-colored fluid known as plasma. All cellular
structures in the bloodstream are suspended in this liquid. Composed mainly of water, plasma also contains
proteins and inorganic salts. One important function of plasma is the transport of nutrients (such as
glucose) and waste products (such as carbon dioxide).

SECTION III – RESPIRATORY SYSTEM

BREATHING AND RESPIRATION

2-38. All living organisms exchange gases with their environment. This gas exchange is known as
respiration. The processes of respiration are breathing, external respiration, and internal respiration.

BREATHING
2-39. Breathing can be described as a spontaneous and rhythmic mechanical process. Contraction and
relaxation of the respiratory muscles cause gases to move in and out of the lungs, thereby providing the
body a gaseous media for exchange purposes.

EXTERNAL RESPIRATION
2-40. External respiration takes place in the alveoli of the lungs. Air moves to the alveoli by the
mechanical process of breathing. Once in the alveolar sacs, oxygen diffuses from incoming air into the
bloodstream. At the same time, carbon dioxide diffuses from venous blood into the alveolar sacs.

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Chapter 2

INTERNAL RESPIRATION
2-41. Internal respiration includes the use of blood oxygen and carbon dioxide production by tissue cells
and gas exchange between cells and the surrounding fluid medium. Together these mechanisms, known as
the metabolic process, produce the energy needed for life.

FUNCTIONS OF RESPIRATION
2-42. Respiration has several functions. It brings oxygen into the body, removes carbon dioxide from the
body, and helps maintain body temperature and acid-base balance.

OXYGEN INTAKE
2-43. The primary function of respiration is the intake of oxygen. Oxygen enters the body through the
respiratory system and is transported within the body through the circulatory system. All body cells require
oxygen to metabolize food material.

CARBON DIOXIDE REMOVAL

2-44. Carbon dioxide is one byproduct of the metabolic process and dissolves in blood plasma. The plasma
transports it from the tissues to the lungs for release.

BODY HEAT BALANCE

2-45. Body temperature is usually maintained within a narrow range (from 97 to 100 degrees Fahrenheit).
Evaporation of perspiration produces heat loss and helps maintain body heat balance. During exhalation,
the release of warm, moist air also aids in this process.

BODY CHEMICAL BALANCE

2-46. A delicate balance exists between the amounts of oxygen and carbon dioxide in the body. The uptake
of oxygen and carbon dioxide takes place through extensive chemical changes in hemoglobin and plasma.
Disrupting these pathways changes the body’s chemical balance.
2-47. The measure of a solution’s hydrogen ion concentration is its pH level. The higher the pH level, the
more alkaline and oxygen rich blood is; the lower the pH level, the more acidic and oxygen deprived blood
is. Level pH 7 is considered neutral because it is the accepted pH of water at 25 degrees Celsius. Under
normal conditions, the body’s relative acidity or alkalinity (pH level) measures in a very narrow pH range
(between 7.35 to 7.45).
2-48. During respiration, the partial pressure of carbon dioxide (PCO2) elevates, the acidity level increases,
and the pH value lowers to less than 7.3. Conversely, too little carbon dioxide causes blood to become
more alkaline and the pH value to rise. Figure 2-6 (page 2-11) shows how the amount of carbon dioxide in
the body affects the pH level of blood.

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 Altitude Physiology

Figure 2-6. Respiratory cycle

2-49. Because the human body maintains equilibrium within narrow limits, the brain’s respiratory centers
sense any shift in blood pH and PCO2 levels. When unusual levels occur, chemical receptors trigger the
respiratory process to help return PCO2 and pH levels to normal limits. Without proper pH balance, the
body does not function correctly. Normal pH levels of 7.2 to 7.6 are critical for the necessary uptake of
oxygen by blood and release of oxygen to tissues.

PHASES OF EXTERNAL RESPIRATION

2-50. The respiratory cycle is an involuntary process that continues unless a conscious effort is made to
control it. External respiration occurs in two phases—active (inhalation) and passive (exhalation). Figure
2-6 (page 2-10) illustrates these phases.

ACTIVE PHASE (INHALATION)

2-51. Inhalation (the movement of air into the lungs) is the active phase of external respiration. It is caused
by the expansion of the chest wall and downward motion of the diaphragm. Inhalation creates an area of
low pressure due to increased volume in the lungs. Because of the greater outside pressure, air will rush
into the lungs to inflate them.

PASSIVE PHASE (EXHALATION)

2-52. During exhalation (the passive phase of external respiration), the diaphragm relaxes and the chest
wall contracts downward to create increased pressure in the lungs. Once the epiglottis (the lid-like flap of
cartilage attached to the root of the tongue) opens, this pressure causes air to rush out, which releases
carbon dioxide into the atmosphere.

COMPONENTS OF THE RESPIRATORY SYSTEM

2-53. The respiratory system consists of passages and organs that bring atmospheric air into the body. The
components of the respiratory system, shown in figure 2-7 (page 2-12), include the oral-nasal passage,
pharynx, larynx, trachea, bronchi, bronchioles, alveolar ducts, and alveoli.

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Chapter 2

Figure 2-7. Components of the respiratory system

ORAL-NASAL PASSAGE
2-54. The oral-nasal passage includes the mouth and nasal cavity. The nasal passages are lined with a
mucous membrane that contains many fine, ciliated hair cells. The membrane’s primary purpose is to filter
air as it enters the nasal cavity. The hairs continually clean the membrane by sweeping filtered material to
the back of the throat, where it is either swallowed or expelled through the mouth. Therefore, air that enters
through the nasal cavity is better filtered than air that enters through the mouth.

PHARYNX
2-55. The pharynx is a fibromuscular, cone-shaped tube found in the back of the throat. It is connected to
the nasal and oral cavities. It primarily humidifies and warms air entering the respiratory system.

TRACHEA
2-56. The trachea (windpipe) is a tube through which air moves down into the bronchi. From there, air
continues to move down increasingly smaller passages, or ducts, until it reaches the small alveoli within the
lung tissue.

ALVEOLI
2-57. Each tiny alveolus is surrounded by a network of capillaries that joins veins and arteries. The
microscopic capillaries, each having a wall only one cell in thickness, are so narrow that RBCs move
through them in single file. The actual gaseous exchange between carbon dioxide and oxygen occurs in the
alveoli.
2-58. Carbon dioxide and oxygen move in and out of the alveoli due to pressure differentials between gas
levels in surrounding capillaries. This movement is based on the law of gaseous diffusion: gas always
moves from an area of high pressure to an area of lower pressure. Figure 2-8 (page 2-13) illustrates the
exchange of carbon dioxide and oxygen between an alveolus and a capillary.

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 Altitude Physiology

Figure 2-8. Exchange of carbon dioxide and oxygen between an alveolus and a capillary

2-59. When oxygen reaches the alveoli, it crosses a thin cellular barrier and moves into the capillary bed to
reach the oxygen-carrying RBCs. As oxygen enters the alveoli, it has a PO2 of approximately 100 mm/Hg.
Within blood, the PO2 of venous return blood is approximately 40 mm/Hg. As blood traverses the capillary
networks of the alveoli, oxygen flows from the area of high pressure within the alveoli to the area of low
pressure within the blood. Thus, oxygen saturation takes place.
2-60. Carbon dioxide diffuses from blood to the alveoli in the same manner. The PCO2 in the venous
return blood of the capillaries is roughly 46 mm/Hg, as compared to 40 mm/Hg in the alveoli. As blood
moves through the capillaries, carbon dioxide moves from the high PCO2 in the capillaries to an area of
lower PCO2 in the alveoli. Carbon dioxide is then released during exhalation, the next passive phase of
respiration.
2-61. The exchange of oxygen and carbon dioxide between tissue and capillaries occurs in the same
manner as between alveoli and capillaries. Figure 2-9 (page 2-14) shows this exchange between tissue and
a capillary.

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Chapter 2

Figure 2-9. Oxygen and carbon dioxide exchange between tissue and a capillary

2-62. The amount of oxygen and carbon dioxide transferred across the alveolar-capillary membrane into
the blood depends primarily on the difference between the alveolar pressure of oxygen (PAO2) in relation
to the venous pressure of oxygen (PVO2). This pressure differential is critical; blood oxygen saturation
decreases as altitude increases, which can cause hypoxia. Table 2-4 shows the relationship between altitude
and oxygen saturation.

Table 2-4. Correlation of altitude and blood oxygen saturation

Altitude Atmospheric PAO2 PVO2 Pressure Blood

(ft) Pressure (mm/Hg) (mm/Hg) Differential Saturation
(mm/Hg) (mm/Hg) (%)
Sea level 760 100 40 60 98
10,000 523 60 31 29 87
18,000 380 38 26 12 72
22,000 321 30 22 8 60
25,000 282 7 4 3 9
35,000 179 0 0 0 0

SECTION IV – HYPOXIA

CHARACTERISTICS OF HYPOXIA
2-63. Hypoxia results when the body lacks oxygen. It generally is associated with flights at high altitude.
However, other factors such as alcohol abuse, heavy smoking, and various medications can interfere with
blood’s ability to carry and absorb oxygen, thereby reducing the body’s tolerance to hypoxia.

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TYPES OF HYPOXIA
2-64. There are four major types of hypoxia: hypoxic, hypemic, stagnant, and histotoxic. Each type is
classified according to cause.

HYPOXIC HYPOXIA
2-65. Hypoxic hypoxia occurs when there is not enough oxygen in the air or when decreasing atmospheric
pressure prevents diffusion of oxygen from the lungs to the bloodstream. Aviation personnel are most
likely to encounter this type of hypoxia at high altitudes due to the reduction of PO2 in the atmosphere
(figure 2-10).

Figure 2-10. Hypoxic hypoxia

HYPEMIC HYPOXIA
2-66. Hypemic, or anemic, hypoxia is caused by a reduction in blood’s oxygen-carrying capacity (figure 2-
11). Anemia and blood loss are the most common causes of this type of hypoxia. Other possible causes
include exposure to carbon monoxide, nitrites, and sulfa drugs, which form compounds with and reduce
the amount of hemoglobin available to combine with oxygen.

Figure 2-11. Hypemic hypoxia

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Chapter 2

STAGNANT HYPOXIA
2-67. With stagnant hypoxia, blood’s oxygen-carrying capacity is adequate but circulation is inadequate
(figure 2-12). Conditions such as heart failure, arterial spasm, and blood vessel occlusion predispose
affected individuals to stagnant hypoxia. This type of hypoxia often occurs when a crewmember
experiences extreme gravitational forces and blood flow is disrupted, causing blood to stagnate.

Figure 2-12. Stagnant hypoxia

HISTOTOXIC HYPOXIA
2-68. Histotoxic hypoxia results from an interference with the use of oxygen by body tissues (figure 2-13).
Alcohol, narcotics, and certain poisons such as cyanide interfere with a cell’s ability to use an adequate
supply of oxygen.

Figure 2-13. Histotoxic hypoxia

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SIGNS, SYMPTOMS, AND SUSCEPTIBILITY TO HYPOXIA

SIGNS AND SYMPTOMS OF HYPOXIA
2-69. Signs of hypoxia can be observed by other crewmembers and are therefore considered objective.
However, individual crewmembers can observe or feel their own symptoms. Since symptoms can vary
from person to person, they are considered subjective.
2-70. Aviation personnel commonly experience mild hypoxia at altitudes at or above 10,000 feet (3
kilometers). Personnel must be able to recognize possible signs and symptoms of hypoxia, as its onset is
subtle and produces a false sense of wellbeing. Crewmembers engrossed in flight activities often do not
readily notice such symptoms. However, most individuals experience two or three unmistakable symptoms
or signs that cannot be overlooked. Table 2-5 lists possible signs and symptoms of hypoxia.

Table 2-5. Possible signs and symptoms of hypoxia

Symptoms (Subjective) Signs (Objective)

Increased breathing rate Euphoria Hyperventilation
Apprehension Belligerence Cyanosis
Fatigue Blurred vision Mental confusion
Headache Tunnel vision Poor judgment
Dizziness Numbness Lack of muscle coordination
Hot and cold flashes Tingling
= UNCONSCIOUSNESS

SUSCEPTIBILITY TO HYPOXIA
2-71. An individual’s susceptibility to hypoxia varies widely. Several factors determine individual
susceptibility. These factors include—
z Onset Time and Severity. The onset time and severity of hypoxia varies with the amount of
oxygen deficiency. The primary concern is to recognize and immediately determine the cause of
hypoxia.
z Physiological Altitude. An individual’s physiological altitude, or the body’s perceived altitude,
is as important as true altitude. Self-imposed stressors such as tobacco and alcohol increase
physiological altitude.
„ Tobacco. The hemoglobin molecules of RBCs have a 200- to 300-times greater affinity for
carbon monoxide than for oxygen. Cigarette smoking significantly increases the amount of
carbon monoxide bound with hemoglobin, a combination known as carboxyhemoglobin
(CoHb). Thus, carbon monoxide reduces the capacity of blood to combine with oxygen.
Smoking 3 cigarettes in rapid succession or 20 to 30 cigarettes within 24 hours before a
flight can saturate 8 to 10 percent of blood’s hemoglobin. Physiological effects of this
condition include loss of about 20 percent of a smoker’s night vision at sea level and a
physiological altitude of 5,000 feet at sea level (figure 2-14, page 2-18).

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Chapter 2

Figure 2-14. Physiological altitude limitations of a smoker

„ Alcohol. Alcohol creates conditions in the body for histotoxic hypoxia. For example, an
individual who has consumed 1 ounce of alcohol can have a physiological altitude of 2,000
feet sea level.
z Individual Factors. Metabolic rate, diet and nutrition, and emotions greatly influence an
individual’s susceptibility to hypoxia. Some areas to consider include—
„ Physical Activity. When physical activity increases, the body demands a greater amount of
oxygen. This increased oxygen demand causes a more rapid onset of hypoxia.
„ Physical Fitness. An individual who is physically conditioned normally has a higher
tolerance to altitude problems than one who is not. Physical fitness raises an individual’s
tolerance ceiling.
„ Diet and Nutrition. Some preprocessed foods can increase the occurrence of an oxygen-
depleting agent similar to carbon monoxide, which lowers blood’s ability to absorb and
deliver oxygen and thereby decreases altitude tolerance. Many crewmembers have noticed a
positive difference when they eat a balanced diet.
z Ascent Rate. Rapid ascent rates affect an individual’s susceptibility to hypoxia. High altitudes
can occur before a crewmember notices serious symptoms.
z Exposure Duration. The effects of exposure to altitude relate directly to an individual’s length
of exposure. The longer the exposure, the more detrimental the effects; however, the higher the
altitude, the shorter the exposure time required before symptoms of hypoxia occur.
z Ambient Temperature. Extremes in temperature generally increase the body’s metabolic rate.
A rise in temperature increases an individual’s oxygen requirements while decreasing the body’s
tolerance to hypoxia. These conditions can cause hypoxia to develop at lower altitudes than
usual.

EFFECTS OF HYPOXIA
2-72. The most important effects of hypoxia are those directly or indirectly related to the nervous system.
Nerve tissue has a heavy requirement for oxygen. Brain tissue is one of the first areas affected by oxygen
deficiency, and a prolonged or severe lack of oxygen destroys brain cells. Hypoxia demonstrations
conducted in an altitude chamber do not produce any known brain damage since the severity and duration
of hypoxia are minimized.
2-73. The time of useful consciousness (TUC) is the period of time between interruption of the oxygen
supply and when an individual loses the ability to take corrective action. Table 2-6 (page 2-19) shows the
TUC varies with the altitude at which an individual is flying. In a pressurized aircraft that loses cabin
pressurization—as in rapid decompression—an individual has only one-half the TUC shown in table 2-6.

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 Altitude Physiology

Table 2-6. Relationship between time of useful

consciousness and altitude

Altitude (ft) TUC

>50,000 9–12 seconds
43,000 9–12 seconds
35,000 30–60 seconds
25,000 4–6 minutes
22,000 8–10 minutes
18,000 20–30 minutes

STAGES OF HYPOXIC HYPOXIA

2-74. There are four stages of hypoxic hypoxia: indifferent, compensatory, disturbance, and critical. Table
2-7 shows the variance of stages according to altitude and severity of symptoms.

Table 2-7. Stages of hypoxic hypoxia

Stages Altitude (thousands Symptoms

of ft)
Indifferent 0–10 Decreased night vision
(98%–90% oxygen
saturation)
Compensatory 10–15 Drowsiness; poor judgment; impaired coordination
(89%–80% oxygen and efficiency
saturation)
Disturbance 15–20 Impaired flight control, handwriting, speech,
(79%–70% oxygen vision, intellectual function, and judgment;
saturation) decreased coordination, memory, and sensation
to pain
Critical 20–25 Circulatory and central nervous system failure;
(69%–60% oxygen convulsions; cardiovascular collapse; death
saturation)

INDIFFERENT STAGE
2-75. Mild hypoxia in the indifferent stage causes night vision to deteriorate at about 4,000 feet (1,219
meters). Crewmembers who fly above 4,000 feet at night should be aware that visual acuity decreases
significantly in this stage due to dark conditions and the development of mild hypoxia.

COMPENSATORY STAGE
2-76. The circulatory system and, to a lesser degree, the respiratory system provide some defense against
hypoxia at the compensatory stage. Pulse rate, systolic blood pressure, circulation rate, and cardiac output
increase. Respiration increases in depth and sometimes in rate. At 12,000 feet (3,658 meters) to 15,000 feet
(4,572 meters), the effects of hypoxia on the nervous system become increasingly apparent. After 10 to 15
minutes, impaired efficiency is obvious. Crewmembers might become drowsy and make frequent errors in
judgment. They might also find it difficult to perform even simple tasks requiring alertness or moderate
muscular coordination. Crewmembers preoccupied with duties can easily overlook hypoxia at this stage.

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Chapter 2

DISTURBANCE STAGE
2-77. In the disturbance stage, physiological responses can no longer compensate for oxygen deficiency.
Occasionally, crewmembers can become unconscious from hypoxia without undergoing the subjective
symptoms described in table 2-7. Fatigue, sleepiness, dizziness, headache, breathlessness, and euphoria are
the symptoms most often reported at this stage. Other symptoms include—
z Loss of Senses. Peripheral vision and central vision are impaired, and visual acuity is
diminished. Weakness and loss of muscular coordination are experienced. The sensations of
touch and pain are diminished or lost. Hearing is one of the last senses to be lost.
z Reduced Mental Processes. Intellectual impairment is an early sign that often prevents an
individual from recognizing disabilities. Thinking is slowed, and calculations are unreliable.
Short-term memory is poor, and judgment—as well as reaction time—is affected.
z Unusual Personality Traits. There might be a display of basic personality traits and emotions
much the same as with alcoholic intoxication. Euphoria, aggressiveness, overconfidence, or
depression can occur.
z Reduced Psychomotor Functions. Muscular coordination is decreased, and delicate or fine
muscular movements might be impossible to complete. Stammering and illegible handwriting
are typical of hypoxic impairment.
z Cyanosis. When cyanosis occurs, the skin becomes bluish in color. This effect is caused by
oxygen molecules failing to attach to hemoglobin molecules.

CRITICAL STAGE
2-78. Within 3 to 5 minutes without oxygen, judgment and coordination usually deteriorate. Mental
confusion, dizziness, incapacitation, and unconsciousness subsequently occur.

PREVENTION OF HYPOXIC HYPOXIA

2-79. Understanding the causes and types of hypoxia assists in its prevention. Hypoxic hypoxia is the type
most often encountered in aviation. It can be prevented by ensuring sufficient oxygen is available to
maintain PAO2 between 60 and 100 mm/Hg. Prevention methods include limiting time at altitude, using
supplemental oxygen, and pressurizing the cabin.

LIMITING TIME AT ALTITUDE

2-80. The amount or percentage of oxygen required to maintain normal saturation levels varies with
altitude. At sea level, a 21-percent concentration of ambient air oxygen is necessary to maintain the normal
blood oxygen saturation of 96 to 98 percent. At 20,000 feet (6,096 meters), however, a 49-percent
concentration of oxygen is required to maintain the same saturation.
2-81. The upper limit of continuous-flow oxygen is reached at about 34,000 feet. Above 34,000 feet,
positive pressure is necessary to maintain an adequate oxygen saturation level. Positive pressure, however,
cannot exceed 30 mm/Hg because—
z Most oxygen masks cannot hold positive pressures of more than 25 mm/Hg without leaking.
z Excess pressure might enter the middle ear through the Eustachian tubes, causing a painful
condition where the eardrum bulges outward.
z Crewmembers can encounter difficulty when exhaling against the pressure, resulting in
hyperventilation.

USING SUPPLEMENTAL OXYGEN

2-82. During night flights above 4,000 feet (1,219 meters), crewmembers should use supplemental oxygen
when available. Supplemental oxygen is necessary because of the risks of mild hypoxia and loss of visual
acuity.

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PRESSURIZING THE CABIN

2-83. Pressurization such as that found in C-12 aircraft can prevent hypoxia. Supplemental oxygen should
be available in the aircraft in case of pressurization loss.

TREATMENT OF HYPOXIA
2-84. Individuals who exhibit signs and symptoms of hypoxia must be treated immediately. Treatment
consists of giving the individual 100-percent oxygen. If oxygen is not available, descent to an altitude
below 10,000 feet is mandatory. When hypoxia symptoms persist, the type and cause must be determined
and treatment administered accordingly.

SECTION V – HYPERVENTILATION

CHARACTERISTICS
2-85. Hyperventilation is an excessive rate and depth of respiration that leads to an abnormal loss of
carbon dioxide from blood. This condition occurs more often among aviators than is generally recognized.
Hyperventilation seldom incapacitates an individual completely, but it causes disturbing symptoms that can
alarm an uninformed aviator. In such cases, an increased breathing rate and heightened anxiety further
aggravate the problem.

CAUSES
2-86. The human body reacts automatically under conditions of stress and anxiety regardless of whether a
problem is real or imaginary. A marked increase in breathing rate often occurs, which then leads to a
significant decrease in the body’s carbon dioxide content and a change in the acid-base balance. Among
the factors that can initiate this cycle are emotions, pressure breathing, and hypoxia.

EMOTIONS
2-87. An individual might attempt to consciously control breathing when fear, anxiety, or stress alters his
or her normal breathing pattern. The respiration rate is then likely to increase without an elevation in
carbon dioxide production, causing hyperventilation.

POSITIVE-PRESSURE BREATHING
2-88. Positive-pressure breathing is used to prevent hypoxia at altitude. It reverses the normal respiratory
cycle of inhalation and exhalation.

Inhalation
2-89. Under positive-pressure conditions, an aviator is not actively involved in inhalation as in the normal
respiratory cycle. Oxygen is not inhaled into the lungs; instead, it is forced into the lungs under positive
pressure.

Exhalation
2-90. Under positive-pressure conditions, an aviator is forced to breathe out against the pressure. The force
the individual must exert when exhaling results in an increased rate and depth of breathing. At this point,
too much carbon dioxide is lost and alkalosis, or increased pH, occurs. Pauses between exhaling and
inhaling can reverse this condition and maintain a near-normal level of carbon dioxide during pressure
breathing.

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Chapter 2

HYPOXIA
2-91. With the onset of hypoxia and the resultant decreased blood oxygen saturation level, the respiratory
center triggers an increase in breathing rate to gain more oxygen. Although rapid breathing is beneficial for
oxygen uptake, it can cause an excessive loss of carbon dioxide if continued too long.

SIGNS AND SYMPTOMS OF HYPERVENTILATION

2-92. The signs and symptoms of hyperventilation are caused by chemical imbalance and an excessive loss
of carbon dioxide. Signs and symptoms include—
z Dizziness.
z Muscle spasms.
z Unconsciousness.
z Visual impairment.
z Tingling sensations.
z Hot and cold sensations.
2-93. The signs and symptoms of hyperventilation and hypoxia are similar, making them difficult to
differentiate. The following indications help distinguish the two conditions.

HYPERVENTILATION
2-94. Hyperventilation results in nerve and muscle irritability and muscle spasms. Symptoms appear
gradually.

FAINTING
2-95. Fainting produces loose muscles but no muscle spasms. Symptoms appear rapidly.

TREATMENT
2-96. The most effective treatment for hyperventilation is voluntary reduction in the affected individual’s
rate of respiration. However, an extremely apprehensive person might not respond to directions to breathe
more slowly.
2-97. Although it is difficult, the affected individual should try to control their respiration rate (the normal
rate is 12 to 16 breaths per minute). If conscious control of respiration is not possible and symptoms
continue, the individual should talk or read a checklist aloud. It is physiologically impossible to talk and
hyperventilate at the same time. Talking or singing elevates the body’s carbon dioxide level and helps
regulate breathing.
2-98. When hypoxia and hyperventilation occur concurrently, a decrease in the respiratory rate and intake
of 100-percent oxygen will correct the condition. If hypoxia is severe, the affected individual must return
to ground level before becoming incapacitated.

SECTION VI – PRESSURE-CHANGE EFFECTS

2-99. The human body can withstand enormous changes in barometric pressure as long as air pressure in
the body cavities equals ambient air pressure. Difficulties occur when expanding gas cannot escape the
body, allowing ambient and body pressures to equalize. The discussion in this section applies to
nonpressurized flight and direct exposure of aircrews to potentially harmful altitudes.

DYSBARISM
2-100. Dysbarism refers to the various manifestations of gas expansion induced by decreased barometric
pressure. These manifestations can be just as dangerous, if not more so, than hypoxia or hyperventilation.

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 Altitude Physiology

The direct effects of decreased barometric pressure can be divided into two groups: trapped-gas disorders
and evolved-gas disorders.

TRAPPED-GAS DISORDERS
2-101. During ascent, the free gas normally present in various body cavities expands. If escape of this
expanded volume is impeded, pressure builds within the cavity and causes pain. The expansion of trapped
gas accounts for abdominal pain, ear pain, sinus pain, and toothache.

BOYLE’S LAW
2-102. Trapped-gas problems are explained by the physical laws governing the behavior of gases under
conditions of changing pressure. Boyle’s Law (figure 2-15) states that, at constant temperature, the volume
of a gas is inversely proportional to the pressure exerted upon it. Differences in gas expansion are found
under dry- and wet-gas conditions.
z Dry-Gas Conditions. Under dry-gas conditions, the atmosphere is not saturated with moisture.
With constant temperature and increased altitude, gas volume expands as pressure decreases.
z Wet-Gas Conditions. Gases within the body are saturated with water vapor. Under constant
temperature and at the same altitude and barometric pressure, the volume of wet gas is greater
than dry gas.

Figure 2-15. Boyle’s Law

TRAPPED-GAS DISORDERS OF THE GASTROINTESTINAL TRACT

2-103. With a rapid decrease in atmospheric pressure, aircrews frequently experience discomfort from gas
expansion within the digestive tract. At low or intermediate altitudes, symptoms are not serious in most
individuals. Above 25,000 feet (7,620 meters), however, enough distension might occur to produce severe
pain. Figure 2-16 shows the dramatic expansion of trapped gas as altitude increases.

Figure 2-16. Expansion of trapped gas

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Chapter 2

Cause
2-104. The stomach and small and large intestines normally contain a variable amount of gas at a pressure
roughly equal to the surrounding atmospheric pressure. The stomach and large intestine contain
considerably more gas than the small intestine. The primary sources of this gas are swallowed air and, to a
lesser degree, gas formed by digestive processes, fermentation, bacterial decomposition, and
decomposition of food undergoing digestion. The gases normally present in the gastrointestinal tract are
oxygen, carbon dioxide, nitrogen, hydrogen, methane, and hydrogen sulfide. The proportions vary, but the
highest percentage of the gas mixture is always nitrogen.

Effects
2-105. The absolute volume or location of gas can cause gastrointestinal pain at high altitude. Sensitivity
or irritability of the intestine, however, is a more important cause of gastrointestinal pain. Therefore, an
individual’s response to high altitude varies depending on factors such as fatigue, apprehension, emotion,
and general physical condition. Gas pains of even moderate severity can produce a marked lowering of
blood pressure and loss of consciousness if distension is not relieved. For this reason, any individual
experiencing gas pains at altitude should be watched for pallor or other signs of fainting. If these signs are
noted, an immediate descent should be made.

Prevention
2-106. Aircrews should maintain good eating habits to prevent gas pains at high altitudes. Some foods
that commonly produce gas are onions, cabbages, raw apples, radishes, dried beans, cucumbers, and
melons. Crewmembers who participate regularly in high-altitude flights should avoid foods that disagree
with them. Chewing food well is also important. When people drink liquids or chew gum, they
unavoidably swallow air. Therefore, crewmembers should avoid drinking large quantities of liquids,
particularly carbonated beverages, before high-altitude missions and chewing gum during ascent. Eating
irregularly, hastily, or while working makes individuals more susceptible to gas pains. Crewmembers who
fly frequent, long, and difficult high-altitude missions should be given special consideration in diet and in
the environment in which they eat. They should watch their diet, chew food well, and keep regular bowel
habits.

Relief
2-107. If trapped-gas problems exist in the gastrointestinal tract at high altitude, belching or passing flatus
ordinarily will relieve gas pains. If pain persists, descent to a lower altitude is necessary.

TRAPPED-GAS DISORDERS OF THE EARS

2-108. The ear is not only an organ of hearing but also one of regulating equilibrium. When ascending to
altitude, crewmembers often experience physiological discomfort as atmospheric pressure changes. As
barometric pressure decreases during ascent, expanding air in the middle ear (figure 2-17, page 2-25) is
intermittently released through the Eustachian tube (a slender tube between the middle ear and pharynx)
into the nasal passages. As inside pressure increases, the eardrum bulges until an excess pressure of
approximately 12 to 15 mm/Hg is reached. At this time, air trapped in the middle ear is forced out into the
Eustachian tube, producing a sensation of fullness in the ear and often a click or pop as the eardrum
resumes its normal position.

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 Altitude Physiology

Figure 2-17. Expanding air in the middle ear

Cause

During Flight
2-109. During descent, pressure changes within the ear might not occur automatically. Equalizing
pressure in the middle ear with that of outside air can be difficult. The Eustachian tube allows air to pass
easily outward but resists passage in the opposite direction. With the increase in barometric pressure during
descent, the pressure of external air is higher than that in the middle ear. As a result, the eardrum is pushed
inward (figure 2-18). If the pressure differential increases appreciably, it might be impossible for the
Eustachian tube to open. This painful condition could cause the eardrum to rupture because the Eustachian
tube cannot equalize the pressure. Marked pain will ensue if the ears cannot be cleared. When pain
increases with further descent, the only option for relief is ascending to a level at which pressure can be
equalized. A slow descent is then recommended.

Figure 2-18. Middle ear and eardrum pressure during descent

2-110. Descending rapidly from 30,000 feet (9,144 meters) to 20,000 feet (6,096 meters) often causes no
discomfort for crewmembers. A rapid descent from 15,000 feet (4,572 meters) to 5,000 feet (1,524 meters),
however, causes great distress. The change in barometric pressure is much greater in the latter situation.
For this reason, special care is necessary during rapid descents at low altitudes.

After Flight
2-111. Crewmembers who have breathed pure oxygen during an entire flight sometimes develop delayed
ear blocks several hours after landing, even though they adequately cleared their ears during descent.

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Chapter 2

Delayed ear blocks are caused by oxygen saturation of the middle ear. After crewmembers return to
breathing ambient air, their tissue gradually reabsorbs oxygen present in the middle ear. When a sufficient
amount of oxygen is absorbed, pressure in the ear becomes less than that outside the eardrum. Ear pain
might awaken crewmembers after they have gone to sleep, or they might notice it when they awake the
following morning. This condition usually is mild and can be relieved by performing the Valsalva
maneuver explained in paragraph 2-114 below.

Complications from Preexisting Physical Conditions

Respiratory Infections
2-112. Crewmembers often complain of discomfort in the ears caused by an inability to ventilate the
middle ear adequately. Such inability occurs most frequently when the Eustachian tube or its opening is
swollen shut as the result of inflammation or infection coinciding with a head cold, sore throat, middle ear
infection, sinusitis, or tonsillitis. In such cases, forceful opening of the tube might cause disease-carrying
infection to enter the middle ear along with the air. Therefore, crewmembers who have colds and sore
throats should not fly. If flight is essential, slow descents will equalize pressure more easily.

Temporal Bone and Jaw Problems

2-113. Upper respiratory infections are the primary culprits in narrowing of the Eustachian tubes, but
there can be other causes. Crewmembers with abnormal positioning of the temporomandibular joint
(temporal bone and jaw) can experience ear pain and difficulty in both hearing and ventilating the middle
ear. In these cases, jaw movement (or yawning) relaxes the surrounding soft tissues and clears the
Eustachian tube opening.

Prevention and Treatment

During Flight
2-114. Crewmembers can equalize pressure during descent by swallowing, yawning, or tensing the throat
muscles. If these methods do not work, personnel can perform the Valsalva maneuver. To do this, close the
mouth, pinch the nose shut, and blow sharply. This maneuver forces air through the previously closed
Eustachian tube into the middle ear cavity and equalizes pressure. With repeated practice in rapidly
clearing the ears, crewmembers can more easily tolerate increased rates of descent.

Note. To avoid over-pressurization of the middle ear, crewmembers should never attempt a
Valsalva maneuver during ascent.

After Flight
2-115. If middle ear and ambient pressures do not equalize after landing and the condition persists,
aviation personnel should consult a flight surgeon to prevent barotitis media. This disorder is an acute or
chronic traumatic inflammation of the middle ear caused by a difference in pressure on opposite sides of
the eardrum. It is characterized by congestion, inflammation, discomfort, and pain in the middle ear and
might be followed by temporarily or permanently impaired hearing (usually the former).

TRAPPED-GAS DISORDERS OF THE SINUSES

2-116. Like the middle ear, sinuses can trap gas during flight. The sinuses (figure 2-19, page 2-27) are
air-filled, relatively rigid, bony cavities lined with mucous membranes. They connect to the nose by means
of one or more small openings. The two frontal sinuses are located within the bones of the forehead; the
two maxillary sinuses are found within the cheekbones; and the two ethmoid sinuses are located within the
bones of the nose.

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 Altitude Physiology

Figure 2-19. Sinus cavities

Cause
2-117. If the sinus openings work properly, air passes into and out of these cavities without difficulty and
pressure equalizes during ascent or descent. However, swelling of the mucous membrane lining, caused by
an infection or allergic condition, can obstruct the sinus openings. Viscous secretions that coat tissues also
might cover the openings. These conditions can make it impossible to equalize pressure. A change in
altitude produces a pressure differential between the inside and outside of the cavity, sometimes causing
severe pain. Unlike the ears, ascent and descent affect the sinuses almost equally. If the frontal sinuses are
involved, pain extends over the forehead and above the bridge of the nose. If the maxillary sinuses and/or
ethmoid sinuses are affected, pain is felt on either side of the nose in the cheekbone regions. Maxillary
sinusitis or inflammation of the sinuses and nasal passages can cause pain in the teeth of the upper jaw,
which could be mistaken for toothache.

Prevention
2-118. Like middle ear problems, sinus problems during flight are usually preventable. Crewmembers
should avoid flying when they have a cold or congestion. During descent, they can perform the Valsalva
maneuver often. The openings to the sinus cavities are quite small as compared to the Eustachian tubes and
unless pressure is equalized, extreme pain will result. If crewmembers notice sinus pain on ascent, they
should avoid any further increase in altitude.

Treatment
2-119. If a crewmember experiences sinus blockage during descent, the aircrew should avoid further
descent. The crewmember should attempt a forceful Valsalva maneuver; if this does not clear the blockage,
the aircrew should ascend to a higher altitude to ventilate the sinuses. The crewmember also can perform
the normal Valsalva maneuver during slow descent to the ground. If the aircraft is equipped with pressure-
breathing equipment, the crewmember can use oxygen under positive pressure to ventilate the sinuses. The
crewmember should consult the local flight surgeon if pressure does not equalize after landing.

TRAPPED-GAS DISORDERS OF THE TEETH

2-120. Changes in barometric pressure can cause toothache, or barodontalgia. This indisposition is
significant but correctable. Toothache usually results from an existing dental problem. The onset of
toothache generally occurs from 5,000 feet (1,524 meters) to 15,000 feet (4,572 meters). In a given
individual, the altitude at which pain occurs shows remarkable constancy. The pain might or might not

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Chapter 2

become more severe as altitude increases. Descent almost invariably brings relief, and the toothache often
disappears at the same altitude at which it first occurred.

EVOLVED-GAS DISORDERS
2-121. Evolved-gas disorders occur in flight when atmospheric pressure is reduced because of an increase
in altitude. Gases dissolved in body fluids at sea-level pressure are released and enter the gaseous state as
bubbles as ambient pressure decreases. These disorders cause various skin and muscle symptoms, which
are sometimes followed by neurological symptoms. Evolved-gas disorders are also known as DCS.

HENRY’S LAW
2-122. Henry’s Law states the amount of gas dissolved in a solution is directly proportional to the
pressure of the gas over the solution. Henry’s Law is similar to the example of gases being held under
pressure in a soda bottle (figure 2-20). When the cap is removed, the liquid inside the bottle is subject to
pressure less than that required to hold the gases in the solution; therefore, the gases escape in the form of
bubbles. Nitrogen in blood is affected by pressure changes in this same manner.

Figure 2-20. Henry’s Law

2-123. Inert gases in body tissues (principally nitrogen) are in equilibrium with the partial pressures of the
same gases in the atmosphere. When barometric pressure decreases, the partial pressures of atmospheric
gases decrease proportionally. This decrease in pressure leaves the tissues temporarily supersaturated. The
body responds by attempting to establish a new equilibrium by transporting the excess gas volume in
venous blood to the lungs.

CAUSE
2-124. DCS can be attributed to nitrogen saturation of the body. This condition is related in turn to
inefficient removal and transport of expanded nitrogen gas volume from the tissues to the lungs. Nitrogen
diffusion to the outside atmosphere normally would take place at this point.
2-125. Body tissues and fluid contain 1 to 1.5 liters of dissolved nitrogen, depending on the pressure of
nitrogen in the surrounding air. As altitude increases, the partial pressure of atmospheric nitrogen
decreases, and nitrogen leaves the body to reestablish equilibrium. If change is rapid, recovery of
equilibrium lags, leaving the body supersaturated. Excess nitrogen diffuses into the capillaries and is
carried by venous blood for elimination. With rapid ascent to altitudes of 30,000 feet (9,144 meters) or
above, nitrogen tends to form bubbles in the tissues and blood. In addition to nitrogen, these bubbles

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 Altitude Physiology

contain small quantities of carbon dioxide, oxygen, and water vapor. Additionally, fat dissolves five or six
times more nitrogen than blood. Thus, tissues having the highest fat content are more likely to form
bubbles.

INFLUENTIAL FACTORS
2-126. Evolved-gas disorders do not affect everyone who flies. The following factors tend to increase the
likelihood of evolved-gas problems.

Rate of Ascent, Level of Altitude, and Duration of Exposure

2-127. In general, the more rapid the ascent, the greater the chance evolved-gas disorders will occur. The
body does not have time to adapt to rapid pressure changes. At altitudes below 25,000 feet (7,620 meters),
symptoms are less likely to occur; above 25,000 feet, they are more likely to occur. The longer the
exposure—especially above 20,000 feet (6,096 meters)—the more likely evolved-gas disorders will occur.

Age and Body Fat

2-128. The incidence of DCS increases with age, with a three-fold rise in incidence between the 19- to
25-year-old and 40- to 45-year-old age groups. The reason for this increase is not understood but could
result from changes in circulation caused by aging. No scientific validation exists to support any link
between obesity and the incidence of DCS.

Physical Activity
2-129. Physical exertion during flight significantly lowers the altitude at which evolved-gas disorders
occur. Exercise also shortens the amount of time that normally passes before symptoms occur.

Frequency of Exposure

Types of Evolved-Gas Disorders

2-130. Frequency of exposure tends to increase the risk of evolved-gas disorders. The more often
individuals are exposed to altitudes above 18,000 feet (5,486 meters) without pressurization, the more they
are predisposed to evolved-gas disorders. There are two major types of DCS: Type I and Type II. Type I
DCS is considered less serious than Type II DCS. However, it is important to remember both types are
medical emergencies. Table 2-8 provides a listing of symptoms for Type I and Type II DCS.

Table 2-8. Decompression sickness symptoms

Type I DCS:
(a) Bends. At the onset of bends, pain in the joints and related tissues might be mild but can become
deep, gnawing, penetrating, and eventually intolerable. Pain tends to be progressive and becomes
worse if ascent is continued. Severe pain can cause loss of muscular power in the involved extremity
and, if sustained, could result in bodily collapse. Pain sensations might diffuse from the joint over the
entire area of the arm or leg. In some instances, pain will arise initially in muscle or bone rather than a
joint. Larger joints such as the knees and shoulders are most frequently affected. The hands, wrists,
and ankles also are commonly involved. In successive exposures, pain tends to recur in the same
location. It also might occur in several joints at the same time and worsen with movement and weight
bearing. Coarse tremors of the fingers often are noted when bends occur in joints of the arm.
(b) Skin manifestations. Tingling, itching, and cold and warm sensations known as paresthesias are
believed to be caused by bubbles formed either locally or in the central nervous system, where they
involve nerve tracts leading to affected areas in the skin. Cold and warm sensations of the eyes and
eyelids, as well as occasional itching and gritty sensations, are sometimes noted. A mottled red rash
might appear on the skin. More rarely a welt might appear and be accompanied by a burning
sensation. Bubbles might develop just under the skin and cause localized swelling. In affected regions
with excess fat beneath the skin, soreness and abnormal fluid accumulation might be present for 1 or
2 days.

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Chapter 2

Table 2-8. Decompression sickness symptoms

Type II DCS:
(a) Chokes. Symptoms occurring in the thorax probably are caused in part by innumerable small
bubbles that block smaller pulmonary vessels. At first, a burning sensation is noted under the sternum.
As the condition progresses, a stabbing pain is felt and inhalation becomes markedly deeper. The
sensation in the chest is similar to one an individual experiences after completing a 100-yard dash.
Short breaths are necessary to avoid distress. There is an almost uncontrollable desire to cough, but
the cough is ineffective and nonproductive. Finally, there is a sensation of suffocation; breathing
becomes shallower and the skin turns bluish. When symptoms of chokes occur, immediate descent is
imperative. If allowed to progress, the condition leads to collapse and unconsciousness. Fatigue,
weakness, and soreness in the chest might persist several hours after the aircraft lands.
(b) Central nervous system disorders. In rare cases when aircrews are exposed to high altitude,
symptoms might indicate the brain or spinal cord is affected by nitrogen bubble formation. The most
common symptom is visual disturbance (for example, the perception lights are flashing or flickering
when they are actually steady). Other symptoms include a dull to severe headache, partial paralysis,
inability to hear or speak, and loss of orientation. Paresthesia or one-sided numbness and tingling also
might occur. Hypoxia and hyperventilation can cause similar numbness and tingling; however, these
symptoms are bilateral—they occur in arms, legs, or sides on both sides of the body. Central nervous
system disorders are a medical emergency; if they occur at high altitude, immediate descent and
hospitalization are required.

PREVENTION
2-131. During high-altitude flight and hypobaric chamber operations, aircrews can be protected against
DCS. Protective measures include—
z Denitrogenation.
z Cabin pressurization.
z Limitation of time at high altitude.
z Aircrew restrictions.

Denitrogenation
2-132. Aircrews are required to breathe 100-percent oxygen for 30 minutes before takeoff for flights
above 18,000 feet (5,486 meters). Denitrogenation rids the body of excess nitrogen. This dumping of
nitrogen takes place because the oxygen mask provides only 100-percent oxygen. The amount of nitrogen
lost depends strictly on time. Within the first 30 minutes of denitrogenation (figure 2-21), the body loses
about 30 percent of its nitrogen.

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 Altitude Physiology

Figure 2-21. Denitrogenation

Cabin Pressurization
2-133. Aircraft cabin pressurization usually is maintained at a pressure equivalent to an altitude of 10,000
feet (3,048 meters) or below. This pressure decreases the possibility of nitrogen bubble formation.

Limitation of Time at High Altitude

2-134. The longer an individual stays at high altitude, the more nitrogen bubbles will form. Extended,
unpressurized flight above 20,000 feet (6,096 meters) should be minimized.

Aircrew Restrictions
2-135. AR 40-8 restricts crewmembers from flying for 24 hours after self-contained underwater breathing
apparatus (scuba) diving. During scuba diving, an individual experiences excessive nitrogen uptake while
using compressed air. Flying at 8,000 feet (2,438 meters) within 24 hours after scuba diving at 30 feet (9
meters) subjects an individual to the same factors a nondiver faces when flying unpressurized at 40,000
feet (12,192 meters) and causes nitrogen bubbles to form.

TREATMENT
2-136. When signs or symptoms of evolved-gas disorders appear, crewmembers should take the
following corrective actions:
z Descend to ground level immediately.
z Place the affected individual on 100-percent oxygen to eliminate any additional nitrogen uptake
and remove excess nitrogen from the system.
z Immobilize the affected area to prevent further movement of nitrogen bubbles in the circulatory
system.
z Report to a flight surgeon or the best medical assistance available.
z Undergo compression therapy in a hyperbaric chamber if symptoms persist and when prescribed
by a flight surgeon.

DELAYED ONSET OF DECOMPRESSION SICKNESS

2-137. The onset of DCS can occur as long as 48 hours after exposure to altitudes above 18,000 feet
(5,486 meters). Delayed onset can occur even if no signs or symptoms were evident during flight.

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 Chapter 3
Stress and Fatigue in Flying Operations

Stress and fatigue in flying operations adversely affect mission execution and
aviation safety. Consequently, crewmembers must be familiar with the effects of
stress and fatigue on the body and how their behavior and lifestyle might reduce or,
alternatively, increase the amount of stress and fatigue they experience. This chapter
reviews aviation stressors and their effects on crewmember performance, presents
several strategies for coping with stress, and concludes with a discussion of fatigue
and its prevention and treatment.

STRESS DEFINED
3-1. In 1926, Hans Selye, an Austrian
endocrinologist, identified what he believed was a Contents
consistent pattern of mind-body reactions he called
“the nonspecific response of the body to any Stress Defined ........................................... 3-1
demand.” He later referred to this pattern as the Identifying Stressors ................................. 3-1
“rate of wear and tear on the body.” In search of a Stress Responses ..................................... 3-8
term that best described these concepts, he turned to Stress and Performance ........................... 3-9
the physical sciences and borrowed the term Stress Management ................................. 3-10
“stress.” Fatigue ...................................................... 3-11
3-2. Selye’s definition is necessarily broad Effects of Fatigue on Performance ........ 3-12
because the notion of stress involves a wide range of Diurnal (Circadian) Rhythms and
human experiences. However, it incorporates two Fatigue ...................................................... 3-13
very important basic points: stress is a physiological The Sleep Cycle ....................................... 3-13
phenomenon involving actual changes in the body’s Sleep Requirements ................................ 3-13
chemistry and function, and it involves some Prevention of Fatigue .............................. 3-14
perceived or actual demand for action. This Treatment of Fatigue ............................... 3-15
definition does not qualify these demands as either
positive or negative; both types of demands can be
stressful. For example, coming into the zone for promotion to a higher rank generally is considered a
positive, potentially rewarding event; however, the ambiguity and uncertainty of the process are stressful.

IDENTIFYING STRESSORS
3-3. A stressor is any stimulus or event that requires an individual to adjust or adapt in some way—
emotionally, physiologically, or behaviorally. Stressors can be psychosocial, environmental, physiological
(self-imposed), and cognitive (mental). The first step an individual must take in devising an effective
stress-management plan is identifying the significant stressors in his or her life. This section reviews
stressors aviation crewmembers typically encounter.

PSYCHOSOCIAL STRESSORS
3-4. Psychosocial stressors are life events. These stressors can trigger adaptation or change in one’s
lifestyle, career, and/or interaction with others.

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Chapter 3

Job Stress
3-5. Work responsibilities can be a significant source of stress for crewmembers. Regardless of job
assignment, carrying out assigned duties often produces stress. Conflict in the workplace, low morale and
unit cohesion, boredom, fatigue, overtasking, and poorly defined responsibilities all are potential
debilitating job stressors.
3-6. Crewmembers who lack confidence in their abilities or have problems communicating and
cooperating with others experience considerable stress.
3-7. Poor coworker performance also can impose stress on an aviator. For example, flight crews might
not trust those who service their aircraft to perform proper maintenance. As a result, crewmembers could
experience anxiety during flight that adversely affects the unit’s cohesion and morale.

Illness
3-8. Although the aviation population undergoes frequent and thorough medical examination, organic
disease can occur and should be considered a source of stress. In addition, fatigue is a common symptom of
many diseases.

Family Issues
3-9. Although family can be a source of emotional strength for crewmembers, it also can cause stress.
Family commitments might adversely affect performance, particularly when duty assignments separate
crewmembers from their families. Concern for family might become a distraction during flight operations
or increase fatigue or irritability. The potential dangers of flight operations also act as a stressor on families
and could cause tension in spousal relationships.

ENVIRONMENTAL STRESSORS

Altitude
3-10. Stress caused by altitude is most evident at altitudes below 5,000 feet (1,524 meters). This is where
the greatest atmospheric changes occur and crewmembers are subject to problems resulting from trapped
gas. Even a common cold can cause ear and sinus problems during descent. Because flights seldom exceed
an altitude of 18,000 feet (5,486 meters), hypoxia and evolved-gas problems such as the bends are not
significant sources of stress for most Army aviators. Chapter 2 covers the effects of evolved gas, trapped
gas, and hypoxia in more detail.

Speed
3-11. Flight usually is associated with speeds greater than those experienced in an everyday, earthbound
environment. These speeds are stressful because they require a high degree of alertness and concentration
over prolonged periods.

Hot or Cold Environments

3-12. Extreme heat or cold causes stress in the aviation environment. Heat problems might be due to hot,
tropic-like climates or direct sunlight entering through large canopies. Cold problems might be due to
altitude or arctic climates. To reduce temperature stress, crewmembers should gradually adapt to extremes
and use proper clothing and equipment.

Aircraft Design
3-13. Human factors engineering items such as cockpit illumination, instrument location, accessibility of
switches and controls, and seat comfort significantly affect aviator performance. Other influential human
factors include visibility, noise level, and the adequacy of heating and ventilating systems. When such

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 Stress and Fatigue in Flying Operations

items are inadequate or uncomfortable, crewmembers will experience increased stress, which might divert
their attention from performing operational duties.

Airframe Characteristics
3-14. Airframe handling and flight characteristics are potential stress factors. For example, fixed-wing
aircraft have innate stability so that, when trimmed, they can be flown relatively well with minimal pilot
attention. Rotary-wing aircraft, however, require constant pilot attention to maintain stability.

Instrument Flight Conditions

3-15. Poor weather resulting in instrument flight conditions imposes significant stress on aircrews and
increases fatigue. Awareness of a greater potential for physical danger and the need for increased vigilance
and accuracy in reading, following, and monitoring flight instruments are very stressful. A high correlation
exists between adverse weather and accident rates.
3-16. The stress of night flying is similar to the stress of flying in poor weather. Aviators lose their usual
visual references and must rely on flight instruments.

PHYSIOLOGICAL (SELF-IMPOSED) STRESSORS

3-17. Although crewmembers often have limited control over many aspects of aviation-related stress, they
can exert significant control over self-imposed stress. Many crewmembers engage in maladaptive
behaviors that are potentially debilitating and threaten aviation safety. This category can be remembered
using the acronym DEATH, which stands for drugs, exhaustion, alcohol, tobacco, and hypoglycemia
(discussed further in chapter 8).

Drugs

Self Medication
3-18. Commercial advertising continually encourages the purchase of nonprescription, over-the-counter
medications for a range of minor ailments. The primary purposes of such medications are to cure or control
symptoms of a medical problem. According to AR 40-8, crewmembers must keep their flight surgeon
informed of any significant changes in their physical health. Furthermore, most drugs, whether prescribed
or over-the-counter, have unwanted side effects that can vary from person to person. In general, no
crewmember taking medication is fit to fly unless cleared to do so by a flight surgeon.

Predictable Side Effects

3-19. Side effects accompany the use of a drug and are incidental to its desired effect. Table 3-1 (page 3-4)
includes examples of common over-the-counter drugs and their known side effects. These side effects
highlight the need for crewmembers to be aware of known potential problems with drugs. Although
crewmembers might not experience all the listed side effects, they should know these might occur.

Overdose Problems
3-20. Drugs are to be taken in a given amount over a specified time. Taking more than the recommended
dosage of a medication does not reduce recovery time and can be dangerous.

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Chapter 3

Table 3-1. Possible side effects of commonly used drugs

Substance Possible Side Effects

(Generic or Brand Name)
Alcohol • Impaired judgment, perception, coordination, motor control, and
(beer, liquor, wine) sensory perception
• Reduced reaction time, intellectual functions, and tolerance to G-
forces
• Inner-ear disturbance and spatial disorientation (up to 48 hours)
• Central nervous system depression
Nicotine • Sinus and respiratory system infection and irritation
(cigars, cigarettes, pipe and • Impaired night vision
chewing tobacco, snuff) • Hypertension
• Carbon monoxide poisoning (from smoking)
Amphetamines Used to treat obesity and tiredness
(Ritalin®, Obetrol®, Eskatrol®) • Prolonged wakefulness or sleep disturbance
• Nervousness, shakiness, and rapid heart rate
• Impaired vision
• Suppressed appetite
• Excessive sweating
• Seriously impaired judgment
Caffeine • Impaired judgment
(coffee, tea, chocolate, No- • Reduced reaction time
Doz®, energy drinks) • Sleep disturbance
• Increased motor activity, tremors, and rapid heart rate
• Hypertension
• Irregular heart rate
• Body dehydration (through increased urine output)
• Headaches
Antacid Used to treat stomach acid
(Alka-2®, Di-Gel®, Maalox®) • Liberation of carbon dioxide at altitude (distension can cause
acute abdominal pain and mask other medical problems)

Antihistamines Used to treat allergies and colds

(Coricidin®, Contac®, Dristan®, • Drowsiness and dizziness (sometimes recurring)
Dimetapp®, Chlor-Trimeton®) • Visual disturbances (when medications also contain
antispasmodic drugs)
Aspirin Used to treat headaches, fever, aches, and pains
(Bayer®, Bufferin®, Alka- • Irregular body temperature
Seltzer®) • Variation in rate and depth of respiration
• Hypoxia and hyperventilation
Aspirin can contribute to nausea, ringing in the ears, deafness, diarrhea, and hallucinations when
taken in excessive dosages; corrosion of the stomach lining; gastrointestinal problems; and
decreased clotting ability of blood (clotting ability could be the difference between life and death in a
survival situation).

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 Stress and Fatigue in Flying Operations

Allergic Reactions
3-21. Some individuals might experience an exaggerated or pathological reaction to a given medication.
An example is an allergic reaction to penicillin.

Synergistic Effects
3-22. This term refers to undesired effects resulting from the combination of two or more drugs or from a
stressful situation experienced while taking a prescribed drug.

Caffeine
3-23. Many people commonly ingest caffeine. However, it is a drug with potentially negative effects on
flight operations if not used properly and in moderation. Many beverages and foods such as tea, chocolate,
and most cola-type drinks contain caffeine. Table 3-2 shows the varying amounts of caffeine in these
products.

Table 3-2. Caffeine content of common beverages, foods, and over-the-counter drugs

Product Amount Caffeine Content (mg)

Coffee
Brewed 8 oz 107.5
Instant 8 oz 57
Decaffeinated (brewed) 8 oz 6
Espresso 1.5 oz 77
Tea
Leaf or bag 8 oz 50
Snapple®, all varieties 16 oz 42
Cola-Type and Energy Drinks
Coca-Cola Classic® 12 oz 34
Diet Coke® 12 oz 45
Red Bull® 8 oz 80
Mountain Dew® 12 oz 55
Dr. Pepper® 12 oz 41
Chocolate
Hershey’s® Chocolate Bar 1 bar 9
Hershey’s® Special Dark 1 bar 31
Over-the-Counter Drugs
No Doz®/Vivarin® (maximum strength) 1 tablet 200
Dexatrim® 1 tablet 200
Excedrin® 1 tablet 65
Midol® (maximum strength) 1 tablet 60
Anacin® 1 tablet 32
Dristan® 1 tablet 16

3-24. Caffeine is a central nervous system stimulant that counteracts and delays drowsiness and fatigue.
Although it increases alertness, the side effects of caffeine might degrade crewmember performance.
Caffeine can elevate blood pressure, impair hand-eye coordination and timing, and cause nervousness or
irritability. Some people can experience adverse effects when ingesting only 150 to 200 milligrams of
caffeine (the equivalent of one or two cups of coffee or several cups of tea). Caffeine also is addictive, and

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Chapter 3

continued use builds tolerance. Over time, people must ingest increasing amounts of caffeine to obtain the
same physiological and behavioral effects.

Exhaustion

Lack of Rest and Sleep

3-25. Crewmembers require adequate rest to ensure optimal flight performance. Sleep problems are
common during deployments, when the sleep environment might be hot, cold, or noisy. Changes in time
zones also can affect sleeping patterns. Crewmembers should discuss sleeping difficulties with their flight
surgeon, as inadequate sleep is a potential flight-safety hazard. Changing the work routine or improving the
environment can promote sleep and increase operational efficiency.

Physical Conditioning
3-26. Exercise stimulates the various body systems and has well-documented positive effects on mental
health. Lack of exercise impairs circulatory efficiency, reduces endurance, and increases the likelihood of
illness. General toning of the muscles, heart, and lungs is essential in preparing aircrews for field exercises
and survival situations. Sports that require agility, balance, and endurance are an excellent means of
keeping the body and mind in top form.

Alcohol
3-27. Ethyl alcohol acts as a depressant and adversely affects normal body functions. Even a small amount
has detrimental effects on judgment, perception, reaction time, impulse control, and coordination. Alcohol
reduces the ability of brain cells to use oxygen. Each ounce of alcohol consumed increases physiological
altitude by 2,000 feet.
3-28. The effects of alcohol on the body and brain depend on the following three factors:
z The amount of alcohol consumed.
z The rate of absorption from the stomach and small intestine.
z The body’s rate of metabolism, which is relatively constant at about 1 ounce every 3 hours.
3-29. After drinking alcohol, an aviator should wait at least 12 hours before beginning flying duties.
Alcohol’s side effects are dangerous. If side effects (hangover symptoms) are present, the nonflying period
should be extended beyond 12 hours. Taking cold showers, drinking coffee, or breathing 100-percent
oxygen does not increase the body’s metabolism of alcohol. Only time dissipates alcohol’s effects.
3-30. Crewmembers should recognize alcohol as a potential safety hazard and assess their own risk for
developing an alcohol-abuse problem. This assessment involves examining the frequency and amount of
one’s consumption as well as the reasons for consumption. Alcohol should not be a stress-coping strategy.
3-31. Some individuals are more prone to develop an alcohol-abuse problem. For example, people with a
family history of alcoholism are at greater risk for developing an alcohol problem than those without such a
history. The following four questions will help crewmembers determine if they are misusing or have
misused alcohol:
z Have you ever tried to cut back on your alcohol consumption?
z Are you annoyed by comments people make about your drinking?
z Have you ever felt guilty about your drinking?
z Have you ever had a drink first thing in the morning to get you started?
3-32. Answering “yes” to two or more of these questions might indicate inappropriate alcohol use.
Crewmembers should more closely examine how frequently, how much, and why they drink alcohol.

Tobacco
3-33. The detrimental effects of tobacco on the body are well known. Apart from the long-term association
with lung cancer and coronary heart disease, there are other important, but less dramatic, effects. For

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 Stress and Fatigue in Flying Operations

example, chronic irritation of the lining of the nose and lungs caused by tobacco increases the likelihood of
infection in those areas. This is a significant problem for aviators because it affects their ability to cope
with the effects of pressure changes in the ears and sinuses. In addition, even a mildly irritating cough
causes distress when oxygen equipment is used.
3-34. Although smoking has many long-term effects including emphysema and lung cancer, aviators
should be just as concerned about the acute effects of carbon monoxide produced by smoking tobacco.
Carbon monoxide combines with hemoglobin to form carboxyhemoglobin (CoHb). Carbon monoxide
attaches to hemoglobin molecules 200 to 300 times more readily than oxygen. The net effect is a degree of
hypoxia. Average cigarette smokers have about 8 to 10 percent CoHb in their blood, which adds about
5,000 feet of physiological altitude. Cigarette smoking also decreases night vision. A pilot who does not
smoke begins to experience decreased night vision at 4,000 to 5,000 feet because of hypoxia, but a pilot
who does smoke begins flight at sea level with a physiological night-vision deficit of 5,000 feet.

Hypoglycemia
3-35. Aviation medicine experts recognize the importance of a nutritious, well-balanced diet. The body
requires periodic refueling to function. Normal, regular eating habits are important, but nutrition depends
largely on individual behavior. Crewmembers should consume meals at regular intervals whenever
possible. Because mission requirements can disrupt regular eating habits, crewmembers often skip meals.
Missing meals or substituting a quick snack and coffee for a balanced meal can induce fatigue and
inefficiency.
3-36. The liver stores energy in the form of glycogen, a blood sugar. The liver readily converts glycogen to
glucose, which maintains the body’s blood-sugar level. Unless food is consumed at regular intervals, stored
glycogen depletes and results in a low blood-sugar condition called hypoglycemia. When the blood-sugar
level falls, weakness or fainting occurs and the body’s efficiency decreases.
3-37. Insulin lowers the blood-sugar level, but at the same time, blood sugar also decreases through its
normal function of fueling the body. These two factors can result in hypoglycemia. It is important to
maintain a balanced diet of proper foods that include proteins, fats, and carbohydrates.
3-38. Aviators must guard against obesity because of its detrimental effects on general health and
performance. Inactivity and boredom during standby duty and long flights easily can lead to overeating.
Therefore, it is wise to weigh oneself regularly and adjust diet to maintain desired weight. This habit is
easier and safer than repeated dieting. In addition, crewmembers should consult a flight surgeon before
beginning a weight-loss regimen. Herbal or dietary supplements need to be discussed with and approved by
a flight surgeon prior to use.

COGNITIVE (MENTAL) STRESSORS

3-39. How one perceives a given situation or problem is a potentially significant and frequently
overlooked source of stress. Pessimism, obsession, failure to focus on the present, and/or low self-
confidence can create a self-fulfilling prophecy that will ensure a negative outcome. Below are some
typical thought problems crewmembers might encounter that can increase overall stress.

“Musts” and “Shoulds”

3-40. Albert Ellis, a renowned clinical psychologist, observed that stress results when individuals believe
things must go their way or should conform to their own needs and desires or they cannot function. This
lack of flexibility in thinking causes problems when reality does not accommodate one’s wishes. Failure to
accept the possibility things might happen contrary to one’s wishes leaves one unprepared, frustrated, and
dysfunctional.

Responsbility of Choice
3-41. Life is full of choices; depending on the situation, some choices are adaptive and others maladaptive.
However, not all adaptive choices are favorable, and while certain consequences might make some choices

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Chapter 3

unpalatable, they are choices nonetheless. Some individuals actively make choices, increasing their sense
of personal control and decreasing stress in their life. Others tend to believe in “fate” or “destiny” and see
the world as the cause of their problems, which can lead to unhappiness and increased stress.

Failure to Focus on the Here and Now

3-42. Living in the past or future and overemphasizing what should have been or could be can increase
one’s overall stress. Although there is utility in both learning from the past and planning for the future,
over engaging in either of these activities can cause people to fail at tasks and miss opportunities in the
present.

STRESS RESPONSES
3-43. Stress affects individuals in a variety of ways. These effects can include emotional, behavioral,
cognitive (thought), and physical responses.

EMOTIONAL RESPONSES
3-44. Emotional responses to stress range from increased anxiety, irritability, or hostility to depressed
mood, loss of self-esteem, hopelessness, and an inability to enjoy life. Crewmembers should consult a
flight surgeon if emotional responses are severe and interfere significantly with social or occupational
functioning. Aviation personnel often are reluctant to seek help for emotional problems, but it is important
to recognize stress can become overwhelming at times and present a serious threat to aviation safety.

BEHAVIORAL RESPONSES
3-45. High stress can adversely affect one’s work performance, decrease motivation, and increase the
likelihood of conflict, insubordination, and violence in the workplace. Some individuals might become
socially isolated. Others might abuse drugs or alcohol as an ineffective stress-coping strategy.

Suicide Risk
3-46. Suicidal thoughts and intent can occur in individuals under high stress. The following are danger
signs of suicide risk:
z Talking or hinting about suicide.
z Having a specific plan to commit suicide and the means to accomplish it.
z Obsession with death.
z Giving away possessions or making a will.
z A history of prior suicide attempts.
z Multiple, recent life stressors.
z Alcohol consumption, which increases the risk of following through on suicidal thoughts.
3-47. Crewmembers should always take these danger signs seriously. Individuals exhibiting some or all of
these signs should be approached supportively and referred to a mental health provider for evaluation. The
local flight surgeon should be contacted to make an appropriate referral to a mental health provider.

COGNITIVE RESPONSES
3-48. Stress can significantly affect one’s thought processes. It can decrease attention and concentration,
interfere with judgment and problem solving, and impair memory. Stress can cause aviators to commit
errors in thought and take mental shortcuts that could be potentially fatal.

The Simplification Heuristic

3-49. Under high-stress conditions, people tend to oversimplify problem solving, ignore important relevant
information, and take the easy way out. For example, an aviator experiencing high stress before going into

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 Stress and Fatigue in Flying Operations

combat might think “I just have to get in and start up,” an oversimplification of the steps involved in
preparing the aircraft that results in failure to follow all preflight inspection steps.

Stress-Related Regression
3-50. Many individuals under high-stress conditions forget learned procedures and skills and revert to
previously learned and often bad habits. For example, a student aviator preparing for takeoff might forget
to turn on the fuel switch and then, realizing the problem and feeling stressed and embarrassed, turn the
switch on and risk overheating the engine. This action is clearly contrary to training and represents a kind
of regression or failure to use prior learning.

Perceptual Tunneling
3-51. Perceptual tunneling is a phenomenon in which an individual or entire crew under high stress
becomes focused on one stimulus such as a flashing warning signal and neglects to attend to other
important tasks or information involved in flying the aircraft. A similar situation might occur when an
aviator realizes during flight that he or she overlooked some aspect of flight such as missing a radio
communication. The stressed aviator might then over attend to rectifying this problem, become emotionally
and mentally fixated on the error, and fall “behind the aircraft,” missing new information and further
compromising the mission.

PHYSICAL RESPONSES
3-52. The immediate physical response to a stressful situation involves overall heightened arousal of the
body, including increased heart rate and blood pressure, rapid breathing, muscle tension, and the release of
sugars and fats into circulation to provide fuel for “fight or flight.”
3-53. Prolonged stress and its continuous effects on the body can produce longer-term physical symptoms
such as muscle tension and pain, headaches, high blood pressure, gastrointestinal problems, and decreased
immunity to infectious diseases.

STRESS UNDERLOAD
3-54. Having too little stress in one’s life can be as dysfunctional as having too much stress. A lack of
challenges can lead to complacency, boredom, and impulsive risk taking. Individuals should strive to
balance stress so they are optimally challenged without overwhelming their coping resources. The effects
of stress underload are of particular concern in peacekeeping operations. In such operations, Soldiers often
have a considerable amount of unstructured time, and work tasks can become routine and monotonous.
Thus, leaders need to minimize unstructured time as much as possible, using it instead as an opportunity
for skills training, cross-training, physical training, and other activities that challenge and develop
subordinates.

STRESS AND PERFORMANCE

3-55. The relationship between stress and performance depends on a variety of factors.

MENTAL SKILLS REQUIRED BY THE TASK OR SITUATION

3-56. The degree to which a given task or situation requires specific cognitive skills (including attention,
concentration, memory, problem solving, or visual-spatial orientation) influences the extent to which stress
degrades performance. Performance in situations involving simple mental tasks tends to be less affected by
stress than performance in situations that require more complex cognitive skills. For example, writing a
letter under high stress would probably result in fewer errors than taking a written exam under high stress.

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Chapter 3

STRESS CHARACTERISTICS OF THE SITUATION

3-57. The degree to which stress affects performance also depends on the environment and conditions
under which a given task is performed. For example, taking a stressful, timed problem-solving test in a
quiet, comfortable room is much easier and results in fewer errors than taking the same test in a hot, noisy
room.

PHYSICAL CHARACTERISTICS OF THE INDIVIDUAL

3-58. Individual differences in strength, endurance, and physical health greatly influence the extent to
which stress affects performance. This is especially true in aviation operations, where crewmembers must
be in top physical condition to perform in the physically challenging environments of continuous
operations and combat.

PSYCHOLOGICAL MAKEUP OF THE INDIVIDUAL

3-59. Mental health, much like physical health, serves to moderate the effects of stress on performance.
Individuals with good coping, problem solving, and social skills perform much better under stress than
those who are weaker in these areas.

STRESS MANAGEMENT
3-60. Stress-coping mechanisms are psychological and behavioral strategies for managing the external and
internal demands imposed by stressors. Coping mechanisms can be characterized according to the
following categories.

AVOIDING STRESSORS
3-61. This is the most powerful coping mechanism. Crewmembers can avoid stressors with good planning,
foresight, realistic training, good time management, and effective problem solving. Staying physically fit
and eating right also are effective strategies for avoiding fatigue, illness, and related stressors. Good crew
coordination and communication (including asking questions, using three-way confirm responses, and
briefing lost communication) also help mitigate flight stress.

CHANGING THINKING
3-62. As indicated in the earlier discussion on cognitive stressors, how individuals perceive their
environment and choose to think about themselves and others greatly affects their stress level and
performance. Crewmembers can greatly enhance stress management and personal effectiveness by—
z Practicing positive self-talk.
z Taking responsibility for their actions.
z Recognizing the choices they make.
z Avoiding perfectionism and inflexibility in thinking.
z Focusing on the here and now rather than the past or future.

LEARNING TO RELAX
3-63. Relaxation is incompatible with stress. It is impossible to be relaxed and anxious at the same time.
Learning and regularly practicing relaxation techniques, breathing exercises, or meditation or regularly
engaging in a quiet hobby greatly reduce stress. Although this recommendation might sound simple, few
people actually practice relaxation regularly. Making time to relax during a busy schedule is perhaps the
biggest obstacle to this coping strategy.

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VENTILATING STRESS
3-64. This strategy involves “blowing off steam” in some manner, either through talking or vigorous
exercise. Talking out problems can be accomplished informally with friends or family, or professionally
with a mental-health practitioner or chaplain. Exercise should be a regular part of everyone’s lifestyle; it is
effective in both preventing and coping with stress. Volumes of research have documented the positive
benefits of exercise for both physical and mental health.

FATIGUE
3-65. Fatigue is the state of feeling tired, weary, or sleepy that results from prolonged mental or physical
work, extended periods of anxiety, exposure to harsh environments, or loss of sleep. Boring or monotonous
tasks can increase fatigue.
3-66. As with many other physiological problems, crewmembers might not be aware of fatigue until they
make serious errors. Sleep deprivation, disrupted diurnal (circadian) cycles, or life-event stress can produce
fatigue and concurrent performance reduction. The three types of fatigue are acute, chronic, and
motivational exhaustion (burnout).

ACUTE FATIGUE
3-67. Acute fatigue is associated with physical or mental activity between two regular sleep periods. Loss
of coordination and lack of error awareness are the first signs of fatigue to develop. Crewmembers might
experience these symptoms, for example, at night after being awake 12 to 15 hours. With adequate rest or
sleep, typically after one regular sleep period, crewmembers will overcome this fatigue. These and other
mental deficits (listed below) are apparent to others before the individual notices any physical signs of
fatigue. Acute fatigue is characterized by—
z Inattention.
z Distractibility.
z Errors in timing.
z Neglect of secondary tasks.
z Loss of accuracy and control.
z Lack of awareness of error accumulation.
z Irritability.

CHRONIC FATIGUE
3-68. This type of fatigue is much more serious than acute fatigue, occurs over a longer period, and is
typically the result of inadequate recovery from successive periods of acute fatigue. Mental tiredness
develops in addition to physical tiredness. It might take several weeks of rest to eliminate chronic fatigue.
There also might be underlying social causes such as family or financial difficulties that must be addressed
before any amount of rest will help the individual recover. The crewmember or unit commander must
identify chronic fatigue early and initiate a referral to the flight surgeon for evaluation and treatment.
Chronic fatigue is characterized by some or all of the following characteristics:
z Insomnia.
z Depressed mood.
z Irritability.
z Weight loss.
z Poor judgment.
z Loss of appetite.
z Slowed reaction time.
z Poor motivation and performance on the job.

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Chapter 3

MOTIVATIONAL EXHAUSTION (BURNOUT)

3-69. If chronic fatigue remains untreated for too long, the individual will eventually “shut down” and
cease functioning occupationally and socially. Motivational exhaustion is also known as burnout.

EFFECTS OF FATIGUE ON PERFORMANCE

REACTION-TIME CHANGES
3-70. Fatigue can result in either increases or decreases in reaction time. Decreased reaction times occur
because of the general decrease in motivation and sluggishness that often accompany fatigue. Increased
reaction times occur when individuals become impulsive and react quickly and poorly. When fatigued,
both increased and decreased reaction times can lead to inaccurate results.

REDUCED ATTENTION
3-71. Crewmembers might exhibit the following signs and symptoms of reduced attention:
z Tendency to overlook or misplace sequential task elements (for example, forgetting items on
preflight checklists).
z Preoccupation with single tasks or elements (for example, paying too much attention to a bird
and forgetting to fly the aircraft, the cause of many accidents).
z Reduction of audiovisual scan both inside and outside the cockpit.
z Lack of awareness of poor performance.

DIMINISHED MEMORY
3-72. Crewmembers might be experiencing diminished memory when they display the following
characteristics:
z Short-term memory and processing capacity decrease, although long-term memory tends to be
well preserved despite fatigue.
z Integrating new information and making decisions becomes more challenging, as does
adaptability to change in general.
z Inaccurate recall of operational events (for example, forgetting the objective rally point
location).
z Neglect of peripheral tasks (for example, forgetting to check if the landing gear is down).
z Tendency to revert to bad habits.
z Decreased ability to integrate new information and analyze and solve problems.

CHANGES IN MOOD AND SOCIAL INTERACTION

3-73. Fatigued individuals can become irritable and combative. They also might experience mild
depression and withdraw socially.

IMPAIRED COMMUNICATION
3-74. Fatigue impairs a person’s abilities to communicate and receive information. Crewmembers might
leave out important details in the messages they send to others. They might neglect or misinterpret
information they receive. Fatigue also can affect a crewmember’s pronunciation, rate of speech, tone, or
volume.

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 Stress and Fatigue in Flying Operations

DIURNAL (CIRCADIAN) RHYTHMS AND FATIGUE

3-75. Humans have an intrinsic biological clock with a cycle of roughly 24 to 25 hours. Many important
body functions such as core body temperature, alertness, heart rate, and sleep cycle occur along these
diurnal rhythms. In the typical circadian cycle, performance, alertness, and body temperature—
z Peak between 0800 and 1200.
z Drop off slightly between 1300 and 1500.
z Begin to increase again from 1500 to 2100.
z Drop off again and fall to a minimum circadian trough between 0300 and 0600.
3-76. While the body clock can monitor the passage of time, it differs from most clocks in that it is flexible
and must be set, or synchronized, before it can accurately predict the timing of events. External
synchronizers or “zeitgebers” (a German word that means “time givers”) are—
z Sunrise and sunset.
z Ambient temperature.
z Meals and other social cues.

CIRCADIAN DESYNCHRONIZATION (JET LAG)

3-77. Rapid travel between time zones causes the body to resynchronize its diurnal or daytime rhythms to
the local geophysical and social time cues. Until intrinsic rhythms are reset, sleep disorders and fatigue will
prevail. Traveling eastward shortens the day; westward travel lengthens the day. Consequently,
resynchronization occurs much more rapidly when traveling west. Shift work can have effects similar to
crossing time zones because of the changes in light exposure and activity times.

THE SLEEP CYCLE

3-78. Sleep is not simply being unconscious—it is an active process essential to life. The sleeping brain
cycles between rapid eye movement (REM) and non-REM sleep through five stages. This cycling occurs
every 90 minutes. In 8 hours of sleep, an individual normally attains five to six REM stages.
3-79. The duration and quality of sleep depend on body temperature. People sleep longer and report a
better night’s sleep when they retire near the temperature trough (the lowest average temperature in a given
climate).
3-80. As indicated in the section above on diurnal rhythms, it is the timing of sleep, not necessarily the
amount of sleep, that is most significant. A sleep schedule inconsistent with one’s circadian rhythm and
environmental light and social cues ultimately will result in fatigue, as will frequent changes in one’s sleep
schedule.
3-81. Sleep efficiency deteriorates with age. Older individuals spend less time in deep non-REM sleep.
Nighttime awakenings and daytime sleepiness result.

SLEEP REQUIREMENTS
3-82. Individuals cannot accurately determine their own impairment from sleep loss. During operations in
which sleep loss is expected, crewmembers should closely monitor each other’s behavior for indicators of
fatigue such as those identified in paragraphs 3-73 through 3-77.
3-83. The average person sleeps 7 to 9 hours per day. Sleep length can be reduced 1 to 2 hours without
performance reduction over an extended period. Once the period ends, however, the individual must return
to his or her normal sleep length.
3-84. As a rule, 5 hours of sleep per night is the minimum for continuous operations. However, some
individuals can tolerate as little as 4 hours of sleep per night for short periods.

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Chapter 3

3-85. AR 385-10 provides guidance on crew endurance planning. The following factors regarding fatigue
and sleep restriction decisions should be considered during crew endurance planning:
z Complexity of the job tasks to be performed under conditions of fatigue.
z Potential for loss from errors committed because of fatigue.
z The individual’s tolerance for sleep loss.

PREVENTION OF FATIGUE
3-86. Total prevention of fatigue is impossible, but its effects can be moderated significantly. The
following recommendations should be considered in any individual or crew endurance plan.

CONTROL THE SLEEP ENVIRONMENT

3-87. The sleep environment should be cool, dark, and quiet. It is best to avoid working or reading in bed,
which could contribute to problems with falling asleep. The bed should be associated only with sleeping
and sexual activity. If an individual wants to read before going to bed, they should do so in a chair,
preferably in a room other than the bedroom, and then go to bed.

ADJUST TO SHIFT WORK

3-88. Crewmembers should adhere to the following measures to better adjust to shift work and prevent
circadian desynchronization:
z Maintain a consistent sleep-wake schedule, even on days off.
z When on the night shift, avoid exposure to daylight from dawn to 1000. Wear sunglasses if
necessary before the sun rises (as long as doing so does not pose a safety hazard). Consider
wearing a sleep mask to avoid exposure to light.
z Do not go to sleep too full or too hungry, although a light snack may be eaten before bedtime.
z Avoid caffeine consumption for 6 hours before going to sleep.

MAINTAIN GOOD HEALTH AND PHYSICAL FITNESS

3-89. Crewmembers can maintain good physical fitness with regular strenuous exercise, which also
promotes healthy sleep. However, strenuous exercise should be avoided within a few hours of bedtime
because it can increase core body temperature and delay sleep. Elimination of tobacco use also promotes
good health and sleep.

PRACTICE GOOD EATING HABITS

3-90. It is important to maintain a balanced diet that includes proteins, fats, and carbohydrates. Failing to
give the body the quality fuel it needs contributes to crewmember fatigue and poor work performance.

PRACTICE MODERATE, CONTROLLED USE OF ALCOHOL AND CAFFEINE

3-91. Use of alcohol as a sleep aid can interfere with REM sleep and disrupt sleep patterns. Frequent use
of caffeine often contributes to insomnia.

PLAN AND PRACTICE GOOD TIME MANAGEMENT

3-92. Planning and practicing good time management help avoid last-minute crises. A reasonable, realistic
work schedule also assists greatly in preventing fatigue.

PRACTICE REALISTIC PLANNING

3-93. Practice realistic planning for total duty and flying hours as outlined in AR 95-1. Studies have shown
the relative fatigue factor of a flight hour varies with the flight environment. For example, chemical
mission-oriented protective posture (MOPP) flight is more fatiguing than day nap-of-the-earth (NOE)
flight.

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 Stress and Fatigue in Flying Operations

MAINTAIN OPTIMAL WORKING CONDITIONS

3-94. Particular attention should be devoted to addressing problems associated with the following factors:
z Glare.
z Vibration.
z Noise levels.
z Poor ventilation.
z Temperature extremes.
z Uncomfortable seating.
z Inadequate oxygen supply.
z Instrument and control location.
z Anthropometry (body measurements).

TAKE NAPS
3-95. Naps are a viable alternative when sleep is not possible or is shortened by operational concerns. In
general, longer naps (greater than 1 hour) are more beneficial than shorter naps, but even naps as short as
10 minutes can increase one’s energy level. Longer naps can result in sluggishness (sleep inertia) for 5 to
20 minutes after awakening. Therefore, when deciding how long to nap, the crewmember should consider
what work requirements will be following the nap. The best time to nap is when body temperature is low
(around 0300 and 1300).

Note. Anyone having problems sleeping during their normal sleep period should not take naps
during the rest of the day. Napping can delay sleep onset during the regular sleep period.

TREATMENT OF FATIGUE
3-96. The most important actions for treating fatigue are resting and getting natural (not drug-induced)
sleep. Alcohol is the number-one sleep aid in the United States, but it suppresses REM sleep. Correcting
bad sleep habits is one treatment for fatigue.
3-97. After lying awake in bed for more than 30 minutes, the individual should get up and read a boring
book or listen to relaxing music until he or she is ready to fall asleep. Lying awake in bed could produce a
mental association between being in bed and anxiety and wakefulness, which might promote insomnia. If
the individual returns to bed and remains awake for more than 30 minutes, he or she should get up again
and continue to do so as often as needed. Fatigue eventually will take over and the individual will fall
asleep.
3-98. When attempting to recover from 24 to 48 hours of sleep deprivation, the individual should not sleep
longer than 10 hours. Sleeping too long could further disrupt the sleep-wake schedule and cause
sluggishness during the day.
3-99. Other measures that can be taken to prevent or treat fatigue are—
z Modifying the workplace to promote rest and prevent further fatigue.
z Rotating or changing duties to avoid boredom.
z Pacing and avoiding heavily task-loaded activities, those requiring short-term memory, or those
demanding prolonged or intense mental activity.
z Limiting work periods and delegating responsibility.
z If possible, suspending activity during periods when fatigue is higher and efficiency is lower
(for example, between 1300 and 1500 hours).
z Using brief periods of physical exercise immediately before task performance, particularly
administrative work. However, individuals should not exercise within 1 hour before bedtime, as
exercising might delay sleep onset.
z Removing a crewmember from flying duties when fatigue affects flight safety.

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 Chapter 4
Gravitational Forces

Army aviation crewmembers must understand gravitational forces and the body’s
physiological responses to them in the aviation environment. This chapter discusses
the physics of motion and acceleration and covers the types and directions of
accelerative forces and their influences and effects. It also discusses deceleration and,
more importantly, crash sequence and how aircraft design offers protection from
crash forces. Crewmembers must have a fundamental but thorough understanding of
the accelerative forces encountered during flight and their relationship to the human
body.

TERMS OF ACCELERATION
4-1. Acceleration is the rate of change in velocity
and is measured in units of acceleration, or Gs. Contents
Several terms are used in discussing acceleration;
these include speed, velocity, inertial force, Terms of Acceleration ............................... 4-1
centrifugal force, and centripetal force. Types of Acceleration ............................... 4-1
Gravitational Forces .................................. 4-3
4-2. Speed is an object’s magnitude of motion and
Factors Affecting Accelerative Forces..... 4-4
rate of change. It is expressed as distance covered in
Physiological Effects of Low-
a unit of time such as miles per hour.
Magnitude Acceleration ............................ 4-5
4-3. Velocity is an object’s speed in a given Physiological Effects of +Gz
direction. It describes magnitude and direction of Acceleration ............................................... 4-5
motion. Velocity is measured in distance per unit of Physiological Effects of –Gz
time such as feet per second. Acceleration ............................................... 4-7
Physiological Effects of +/–Gx
4-4. Inertial force is an object’s resistance to Acceleration ............................................... 4-8
change in a state of rest or motion. A body at rest
Physiological Effects of +/–Gy
tends to remain at rest, while a body in motion tends Acceleration ............................................... 4-8
to remain in motion.
Physiological Effects of High-
4-5. Centrifugal force is the force exerted on an Magnitude Acceleration and
object moving in a circular pattern. It causes the Deceleration ............................................... 4-8
object to break away and move outward in a straight Preventive Measures ............................... 4-12
line.
4-6. Centripetal (radial) force is the force acting on
an object moving in a circular pattern that holds the object on its circular path.

TYPES OF ACCELERATION
4-7. Flight imposes its greatest effects on the body through the accelerative forces applied during aerial
maneuvering. In constant speed and straight-and-level flight, crewmembers encounter no human
limitations. With changes in velocity, however, they can experience severe physiological effects.
Crewmembers must understand where and how accelerative forces—linear, centripetal (radial), and
angular—develop in flight.

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Chapter 4

LINEAR ACCELERATION
4-8. Linear acceleration occurs when there is a change in an object’s speed without a change in direction.
It occurs during takeoffs and changes in forward airspeed. Linear acceleration also is encountered when
speed is decreased. Figure 4-1 illustrates the concept of linear acceleration.

Figure 4-1. Linear acceleration

CENTRIPETAL (RADIAL) ACCELERATION

4-9. Centripetal (radial) acceleration can occur during any change of direction without a change in speed.
Crewmembers might encounter this type of acceleration during banks, turns, loops, or rolls (figure 4-2).

Figure 4-2. Centripetal (radial) acceleration

ANGULAR ACCELERATION
4-10. Angular acceleration is complex and involves a simultaneous change in both speed and direction. A
good example of this is an aircraft put into a tight spin. For practical purposes, angular acceleration does
not pose a problem in understanding the physiological effects of accelerative forces. Its principal effects
are important, however, because they produce many of the disorientation problems encountered in flight
(figure 4-3, page 4-3).

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 Gravitational Forces

Figure 4-3. Angular acceleration

GRAVITATIONAL FORCES
4-11. Newton’s three laws of motion describe the forces of acceleration. The first law states a body
remains at rest or in motion unless acted upon by a force, which describes inertia. Newton’s second law
states that to overcome inertia, a force (F) is required, the result of which is proportionate to the
acceleration (a) applied and its mass (m), so F = ma. Newton’s third law states that for every action, there
is an equal and opposite reaction. For example, when an aircraft is in a bank (a change in direction without
a change in speed), the centripetal force is directed toward the center of the aircraft’s circular path.
Crewmembers, however, experience the opposite force acting on their bodies. This force, called inertial
centrifugal force, is directed away from the center of the aircraft’s circular path.
4-12. Gravitational force (G-force) and the direction in which the body receives that force are important
physiological factors that affect the body during acceleration. G-force can affect the body in three axes: Gx,
Gy, and Gz. Gx pushes the body forward or backward. Gy pushes the body left or right. Gz pushes the body
up or down.
4-13. The physiological effects of prolonged acceleration depend on the direction of accelerative
(centripetal) force and, consequently, how inertial (centrifugal) force acts upon the body. Inertial force is
always equal to but opposite of the accelerative force; however, in terms of the physiological effects of
sustained acceleration, inertial force is of greater significance. The various G-forces are explained below
and illustrated in figure 4-4 (page 4-4):
z Positive G, or +Gz, acceleration occurs when the body is accelerated headward. Inertial force
acts in the opposite direction toward the feet, and the body is forced down into the cockpit seat.
z Negative G, or –Gz, acceleration occurs when the body is accelerated footward. Inertial force is
directed toward the head, and the body is lifted out of the cockpit seat.
z Forward transverse G, or +Gx, acceleration occurs when accelerative force acts across the body
in a chest-to-back direction. This acceleration is experienced during acceleration.
z Backward transverse G, or –Gx, acceleration occurs when accelerative force acts across the body
in a back-to-chest direction. This acceleration is experienced during deceleration.
z Right- or left-lateral G, or +/–Gy, acceleration occurs when accelerative force acts across the
body in a shoulder-to-shoulder direction. This acceleration is experienced primarily during
sideward flight in rotary-wing aircraft.

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Chapter 4

Figure 4-4. Effects of G-force on the body

FACTORS AFFECTING ACCELERATIVE FORCES

4-14. Crewmembers must consider several factors to determine the effects of accelerative forces on the
human body. These factors include intensity, duration, rate of onset, body area and site, and impact
direction.

INTENSITY
4-15. In general, the greater the intensity, the more severe the effects of accelerative force. Intensity,
however, is not the only factor that determines the effects.

DURATION
4-16. The longer force is applied, the more severe the effects. The body can absorb high G-forces applied
for extremely short durations without harm, while low G-forces can be tolerated for longer periods. A force
of 5 Gs applied for 2 to 3 seconds is usually harmless, but the same force applied for 5 to 6 seconds can
cause blackout or unconsciousness. In ejection seats, pilots can tolerate a headward acceleration of 15 Gs
for approximately 0.2 second without harm but will become unconscious when the same force is applied
for 2 seconds. A force of 40 Gs received intermittently for fractions of a second during a crash landing is
tolerable, but the same force is fatal if applied steadily for 2 to 3 seconds.

RATE OF ONSET
4-17. The rate of onset of accelerative or decelerative forces is another factor that determines effects.
When an aircraft decelerates gradually, such as in a wheels-up landing, decelerative forces are exerted at a
rather slow rate. Generally, when the rate of application is higher, such as when an aircraft decelerates
suddenly during an accident, the effects are more severe. When an aircraft impacts vertically, the stopping
distance is considerably shorter, and the rate of accelerative force application is many times greater. The
application rate is often slowed in helicopter crashes by spreading of the skids and crumpling of the

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 Gravitational Forces

fuselage, giving the body 3 or 4 extra feet in which to decelerate. Therefore, both distance and time are
important factors in acceleration or deceleration. The shorter the stopping distance, the greater the G-force.

BODY AREA AND SITE

4-18. The size of the body area over which a given force is applied is important; the greater the body area,
the less harmful the effects. The body site to which a force is applied is also important. The accelerative
effect of a given force, such as a blow to the head, is much more serious than the same force applied to
another body part such as the leg.

IMPACT DIRECTION
4-19. The direction from which a prolonged accelerative force acts on the body also determines the
physiological effects that occur. The body tolerates a force applied to the Gx axis better than to the Gz, or
long, axis (figure 4-5).

Figure 4-5. Impact direction

PHYSIOLOGICAL EFFECTS OF LOW-MAGNITUDE

ACCELERATION
4-20. The physiological effects of low-magnitude acceleration are the result of inertial centrifugal force
and increased weight of the body and its components. Low-magnitude acceleration is described as Gs in
the range of 1 to 10 with prolonged time of application lasting for at least several seconds. During aircraft
maneuvers, the main body part affected by excessive force is the cardiovascular system. The skeleton and
soft tissues can withstand such stress without harm. The circulatory system, however, consists of elastic
blood vessels and needs well-defined blood pressure and volume to perform properly. Excessive
gravitational forces such as those experienced in prolonged acceleration can disrupt normal circulatory
function.

PHYSIOLOGICAL EFFECTS OF +GZ ACCELERATION

4-21. Positive Gz is acceleration in a headward direction, such as the centripetal force experienced in a
turn. However, individuals are more aware of centrifugal (inertial) force, which acts in the opposite
direction toward the feet. Crewmembers experience +Gz during pullout from a dive or execution of a high,
banking turn.

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Chapter 4

4-22. During a maneuver that produces +Gz, body weight increases in direct proportion to the magnitude
of the force. For example, a 200-pound person weighs 800 pounds during a 4-G maneuver. Normal
activities are greatly curtailed, and the person is pushed downward into the seat. The arms and legs feel
heavy, the cheeks sag, and the body becomes incapable of free movement. In fact, a pilot cannot escape
unassisted from a spinning aircraft if the magnitude of the force exceeds 2 to 3 +Gz. This is the primary
reason for the implementation of ejection seats in tactical jet aircraft.
4-23. Internal organs are pulled downward during +Gz maneuvers. The increased weight of the internal
organs pulls the diaphragm downward, increases relaxed thoracic volume, and disturbs the mechanics of
respiration.
4-24. Comparing the body to a long cylinder helps explain the effects of a +Gz maneuver on arterial blood
pressure. In a seated individual, the heart lies approximately at the junction of the upper and middle thirds
of the cylinder. The head and brain (the structures most sensitive to decreased blood pressure) are at the
upper end of this vertical cylinder, about 30 centimeters from the heart. When a force of 5 +Gz is exerted
on the body, a standing blood column of 30 centimeters exerts a pressure of 120 mm/Hg upon its base.
Because this pressure is equal to the normal arterial systolic blood pressure, it exactly balances out the
arterial pressure and causes the brain’s blood perfusion to cease. Unconsciousness can result when a force
of 5 +Gz is applied to the body. Figure 4-6 shows the effects of 1 +Gz to 5 +Gz conditions.

Figure 4-6. Physiological effects of +Gz acceleration

4-25. At about 4 +Gz—the point at which vision is completely lost before a loss of consciousness—
blackout occurs. Static intraocular pressure is about 20 mm/Hg. When a positive G-force is sufficient to
reduce systolic arterial blood pressure in the head to 20 mm/Hg, intraocular pressure causes the collapse of
retinal arteries. The retinas cease to function as the blood supply fails, and vision narrows from the
periphery. At about 4 to 4.5 Gz, vision disappears and blackout occurs. When the force reaches about 5
+Gz, cerebral blood flow stops and unconsciousness ensues. Therefore, the sequence of events following
exposure to +Gz is the dimming of vision, blackout, and then unconsciousness.
4-26. The effects described above are usually progressive, as shown in figure 4-6. In relaxed subjects in
the human centrifuge, for example, the first symptoms from increased +Gz forces occur at 2.5 to 4 +Gz and
involve a graying or dimming of visual fields. At slightly higher accelerations (4 to 4.5 +Gz), blackout
occurs and individuals can no longer see although they remain conscious. The retinal arteries have
collapsed, but some blood still flows through the brain’s blood vessels. At 4.5 to 5 +Gz, unconsciousness
occurs.

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 Gravitational Forces

4-27. Blood pools in the lower extremities, and there is a relative loss of blood volume and blood pressure
to the brain. Stagnant hypoxia and hypoxic hypoxia, caused by unoxygenated blood from impaired
respiration, also occur. Blood oxygen saturation can fall from the normal 98 percent to 85 percent during
an exposure of 7 +Gz for 45 seconds.
4-28. With the loss of blood pressure and induced hypoxic state combined, it can take up to 1 minute
following the end of acceleration for an individual to recover. After regaining consciousness, the
crewmember might still experience a period of disorientation and memory loss for some time.

INDIVIDUAL TOLERANCE FACTORS

4-29. Although G-force tolerance limits are relatively constant from one person to another, certain factors
decrease or increase an individual’s tolerance to +Gz. These factors are classified as decremental and
incremental.

Decremental Factors
4-30. Any factor that reduces the body’s overall efficiency, especially that of the circulatory system,
causes a marked reduction in an individual’s tolerance to +Gz. Loss of blood volume, varicose veins, and
decreased blood pressure (chronic hypotension) can affect the circulatory system. Self-imposed stress such
as that caused by alcohol abuse also affects an individual’s tolerance to +Gz.

Incremental Factors
4-31. The L-1 maneuver is an anti-G straining maneuver (AGSM) that increases a crewmember’s G
tolerance and offers protection that does not overstress the larynx. In this maneuver, crewmembers
maintain a normal upright sitting position, tense the skeletal muscles, and simultaneously attempt to exhale
against a closed glottis at 2- to 3-second intervals. Although the L-1 maneuver was developed by the U.S.
Air Force for its fighter pilots, rotary-wing crewmembers experiencing grayout conditions also will benefit
from this maneuver.

PHYSIOLOGICAL EFFECTS OF –GZ ACCELERATION

4-32. When accelerative force acts on the body in a direction toward the feet (as would be experienced in a
rapid descent), –Gz occurs. In this case, the accelerative, or centripetal, force acts toward the axis of the
turn. Actually, –Gz does not present a great problem in military flying. Because it is an uncomfortable
experience, pilots tend to avoid it.
4-33. Negative acceleration, or the inertial force applied from foot to head, causes a sharp rise in arterial
and venous pressures at the head level. Increased pressure within the veins outside the cranial cavity could
be sufficient to rupture the thin-walled venues, or small veins. Intracranial venous pressure also rises, but it
is counterbalanced by an accompanying rise in intracranial cerebral spinal fluid pressure. Therefore, there
is little actual danger of intracranial hemorrhage or cerebral vascular damage as long as the skull remains
intact. Hemorrhages within the eye present the primary source of damage from –Gz. Distension of the
jugular and sinus veins and conjunctiva is caused by –Gz.
4-34. Sudden acceleration producing a force of 3 –Gz reaches the limit of human tolerance. When such a
force is applied, venous pressure of 100 mm/Hg develops and causes small conjunctival bleeding and
marked discomfort in the head region.
4-35. Redout might be experienced during a –Gz maneuver (figure 4-7, page 4-8). This phenomenon
occurs when gravitational pull acts on a lower eyelid, causing it to cover the cornea. The constant pull of
gravity tends to weaken the lower eyelid muscles.

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Chapter 4

Figure 4-7. Physiological effects of –Gz acceleration

4-36. If sufficiently prolonged, gravitational pull in the foot-to-head direction leads to eventual circulatory
distress. Blood pools in the head and neck regions, which results in the passage of fluid from the blood to
the head and neck tissues. In addition, the return of blood to the heart becomes inadequate due to the loss
of effective blood volume. Therefore, blood stagnates in the head and neck. The cerebral-arterial and
venous pressure differential is inadequate to sustain consciousness.

PHYSIOLOGICAL EFFECTS OF +/–GX ACCELERATION

4-37. Transverse G occurs when accelerative force impacts across the body at right angles to the long axis.
Inertial (centrifugal) force crosses the body in the opposite direction. Crewmembers undergo mild
transverse acceleration during takeoffs and landings. The physiological effects of transverse acceleration
are important in manned space missions because they are experienced during initial lift-off and reentry.
4-38. Individuals are more tolerant of forces received in the positive or +/–Gx axis than those received in
the other axes because transverse G interferes very little with blood flow. Extreme values of transverse G
(12 to 15 +/–G) acting for 5 seconds or more can displace organs or shift the heart’s position and interfere
with respiration.
4-39. At levels above 7 +Gx, breathing becomes more difficult because of the effect on chest movement.
Some individuals, however, have withstood levels of 20 +G for several seconds with no severe difficulty.

PHYSIOLOGICAL EFFECTS OF +/–GY ACCELERATION

4-40. The human body has minimal tolerance to Gy (right- or left-lateral) acceleration. In general, most
aircraft do not apply significant lateral accelerative forces; therefore, this type of G-force is of little
significance during low-magnitude acceleration.

PHYSIOLOGICAL EFFECTS OF HIGH-MAGNITUDE

ACCELERATION AND DECELERATION
4-41. High-magnitude acceleration and deceleration affect aircraft accident survivability. High-magnitude
acceleration occurs when acceleration exceeds 10 Gs and lasts for less than 1 second. The effects of high-
magnitude acceleration usually are the result of linear acceleration. The terms acceleration and deceleration

4-8 TC 3-04.93 31 August 2009

 Gravitational Forces

(negative acceleration) are synonymous when used to describe the forces encountered in aircraft crashes,
ejection-seat operations, and parachute-opening shock.

HIGH-MAGNITUDE ACCELERATION
4-42. Adverse effects and injury result from the abruptness and magnitude of forces. Other factors include
the body area to which the force is applied and the extent of distortion in shearing, compressing, or
stretching body structures. The severity of effects progresses from discomfort, incapacitation, minor injury,
and irreversible injury to lethal injury. A thorough examination of the causes of injury and effects on the
body is essential to determining survival limits and devising protective and preventive measures.

HIGH-MAGNITUDE DECELERATION
4-43. Several factors cause the adverse effects of high-magnitude decelerative forces. These factors
include—
z Degree of acceleration intensity, known as the “peak G.”
z Peak G duration and total deceleration time.
z Rate of acceleration application or onset, known as the “jolt.” The jolt, expressed in feet per
second or Gs per second, is the rate of change of acceleration or the rate of onset of accelerative
forces.
z Direction or axis of force application, which determines whether acceleration or deceleration
occurs.

CRASH SEQUENCE
4-44. Occupant survival during the crash sequence depends on three criteria. These criteria are crash forces
transmitted to the occupants, occupiable living space, and aircraft design features.

Crash Forces
4-45. The intensity of the decelerative force to which the body is subjected is not a single decelerative G.
Instead, crash forces produce a series of decelerations at various G loads until all motion is stopped (figure
4-8, page 4-10). These crash forces occur in all three axes (Gx, Gy, and Gz) at the same time (figure 4-9,
page 4-10). Tolerance limits to high-magnitude deceleration vary with force duration and direction. The
human body is far more vulnerable to injury when exposed to a series of high-G shocks in all three axes
and can withstand these forces for only an extremely short time (less than 0.1 second). If this time is
exceeded, injury or death occurs.

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Chapter 4

Figure 4-8. Crash force decelerations

Figure 4-9. Crash forces in Gx, Gy, and Gz axes

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 Gravitational Forces

Occupiable Living Space

4-46. Occupiable living space influences survivability and must not be compromised by either airframe
failure or possible penetration of the cabin area by outside objects. If human tolerance limits to decelerative
forces are exceeded or living space is lost, accident survivability decreases significantly. Certain design
features can be built into aircraft to absorb crash forces and provide maximum protection to crewmembers
during an accident. The UH-60 Black Hawk provides a good example of crashworthy design (figure 4-10).

Figure 4-10. UH-60 Black Hawk crashworthy design

Aircraft Design Features

4-47. Design features that promote crash survival are commonly referred to as CREEP factors. These
factors include—
z C—Container. An aircraft must be designed with an effective protective shell around the
occupants. Its maximum structural and component weight should be below the occupants to
reduce cabin crushing by inertial loading. The airframe should contain crushable material to
attenuate crash forces before they are transmitted to crewmembers. Fuel cells (tanks) should be
of crashworthy design and protected by the airframe to prevent outside objects from penetrating
them.
z R—Restraint Systems. Restraint systems should attenuate crash forces and protect the
occupants in all flight conditions. These systems should be comfortable to wear and not interfere
with cockpit duties. The head is the most likely point of injury in a crash sequence; therefore,
occupants should use shoulder harnesses to minimize upper-body motion. A failure in any part
of the restraint system—seat, seat belt, or anchor points—results in a higher degree of exposure
to injury.
z E—Environment. The cockpit and cabin area must be made less lethal to the occupants, to
include adequate equipment restraints for withstanding crash forces.
z E—Energy Absorption. With their energy-absorbing features, aircraft are designed to
withstand disruptive forces. Some of these features include the aircraft undercarriage, landing

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Chapter 4

gear, and seats that deform during a crash sequence. These features modify high peak G loads of
short duration into more survivable G loads of longer duration.
z P—Postcrash Protection. Two major postcrash factors must be considered in aircraft design:
fire and evacuation. The crashworthy fuel system has drastically reduced the fire hazard in
Army aircraft accidents. However, timely evacuation is still desirable. Timeliness in evacuating
aircraft occupants who survive an impact is often governed by the adequacy of emergency exits.
Other factors that enhance timely evacuation are convenience of location, ease of operation (the
UH-1 cargo door window is a prime example), and adequacy of markings.

PREVENTIVE MEASURES
INCREASE THE AREA TO WHICH FORCE IS APPLIED
4-48. This measure is accomplished through a variety of methods. The HGU-56/P protective helmet
distributes pinpoint pressure over a larger area and reduces the chance of head injury. Seat belts with
shoulder harnesses distribute decelerative forces over a larger area of the body and help prevent hazardous
contact with the cabin environment. Backward seating arrangements also distribute decelerative forces
normally found in a crash sequence.

INCREASE THE DISTANCE OVER WHICH DECELERATION OCCURS

4-49. The aircraft’s built-in design features can absorb and dissipate much kinetic energy during a crash.
These features increase the distance over which deceleration occurs.

ALIGN THE BODY TO TAKE ADVANTAGE OF THE MUSCULOSKELETAL SYSTEM’S

STRUCTURAL STRENGTH
4-50. Correct alignment of the body is a preventive measure that can be taken during a crash.
Crewmembers can align their bodies to take advantage of the musculoskeletal system’s structural strength
by properly using seat belts, shoulder harnesses, and the crash position (with the body bent forward)
ensures the strongest body parts absorb crash forces.

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 Chapter 5
Toxic Hazards in Aviation

The effects of toxic chemicals in the aviation environment could lead to human error,
which is the leading cause of aviation accidents. The exposure of crewmembers to
toxins during flight can range from a sudden, incapacitating event after acute (short-
term) exposure to long-term health effects secondary to chronic (long-term)
exposure. Aviation personnel must understand the dangers and recognize the often
near-imperceptible effects of toxic hazards. The flight surgeon or aeromedical
physician assistant educates aircrews in the prevention of toxic exposure and
treatment of flight personnel exposed to known toxic substances.

SECTION I – AVIATION TOXICOLOGY PRINCIPLES

5-1. In aviation, the unique toxicological
environment is limited primarily to an enclosed Contents
environment. Thus, this chapter’s focus is on
Section I – Aviation Toxicology
aircraft cockpit exposures. Included, however, are Principles ................................................... 5-1
some important issues facing Class III (petroleum,
Section II – Aircraft Atmosphere
oil, and lubricant) supply personnel. Contamination ........................................... 5-3

ACUTE TOXICITY
5-2. The greatest toxicological risk during flight is an acute, high-dose exposure to a toxic agent. Cabin
air quality can change rapidly or insidiously. Air quality changes might be due to the generation of toxic
substances from fluid leaks, fire, and/or variations in altitude and ventilation rates.
5-3. Exposure to chemical fumes from burning wire insulation or engine exhaust can degrade a pilot’s
ability to function. Two types of acute inflight exposure are—
z Sudden, incapacitating exposure.
z Subtle, performance decrement exposure.
5-4. Exposure to toxic chemicals has contributed to some accidents that were erroneously attributed to
pilot error. During the most demanding flight modes, the balance between critical flight tasks and human
abilities is sometimes delicate and fragile even for well-trained crews. Therefore, any performance
decrement caused by toxic substances is a cause for concern.

CHRONIC TOXICITY
5-5. Chronic (long-term) exposure to potentially toxic agents can occur during ground support and
aviation operations. Chronic exposure over time can lead to adverse health outcomes many years later. This
type of exposure does not cause immediate health effects. The handling of munitions and propellants and
storage of fuels and fluids pose special problems.

TIME AND DOSE RELATIONSHIP

5-6. With most substances, the medical effects of exposure depend on chemical concentration and the
duration and method of exposure. As concentration increases, the interval between initial exposure and
onset of symptoms decreases. The adverse physical effects of many chemicals change as concentration

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Chapter 5

increases. At high concentrations, gases such as nitrogen dioxide, numerous petrochemicals, and other
mechanical fluids are highly irritating to the upper respiratory tract, nasal passages, and mucous
membranes. At lower concentrations, these chemicals might have little to no effect.

PHYSIOCHEMICAL FACTORS
5-7. The kidneys and liver are the principal organs that detoxify chemicals within the body. The body
attempts to break down toxic and foreign substances into less toxic material it can use, but in some cases a
more toxic substance is produced with adverse effects. For example, when ethylene glycol is ingested, the
body produces oxalic acid crystals it cannot excrete, causing kidney damage and/or death. Specific organs
or tissues selectively absorb chemical substances as they enter the bloodstream. For example, fat-soluble
compounds such as carbon tetrachloride and most aviation fuels tend to accumulate in nervous system
tissues. Heavy metals from lead-acid batteries tend to produce kidney damage, as these organs are the point
of exit from the bloodstream.

ENTRY POINTS
5-8. Toxic agents enter the body through inhalation into the lungs, ingestion into the stomach, or
absorption through the skin. The most common route of entry in the aviation environment is inhalation.
Crewmembers often are in close contact with volatile fuels and other potentially hazardous petroleum
products, oils, lubricants, and hydraulic fluids. For example, a well-intentioned crew chief might choose to
eat while working on the engine deck without realizing the potential danger of ingesting toxins through
contaminated food or water. A crewmember, hurried after aircraft refueling, might not wash his or her
hands and then smoke a cigarette and inhale hazardous petroleum vapors. Acute toxic exposures are
characteristically related to inhalation or ingestion, whereas toxin exposure through skin absorption usually
produces symptoms only after chronic, repeated exposures. Contact dermatitis is the most common health
effect from skin contact.

PREEXISTING CONDITIONS
5-9. People with organ impairment (such as liver or lung damage), sickle cell disease, or an active disease
process are generally more susceptible to toxic agents.

INDIVIDUAL VARIABILITY
5-10. Due to individual variability, not everyone responds the same way to toxic exposure. Metabolic rate,
fat content, and physical fitness level varies greatly among individuals. In addition, some people have
genetic conditions that predispose them to adverse health effects at lower concentrations of toxic substance
exposure. Therefore, physical responses to exposure vary considerably. For example, in an environment in
which several people are in daily contact with a specific chemical at a low concentration, only one person
might exhibit signs or symptoms because of his or her unique genetic characteristics (metabolic rate,
retention and excretion rates, and physical fitness level).

ALLOWABLE DEGREE OF BODILY IMPAIRMENT

5-11. Even a slight degree of inflight impairment is hazardous to crewmember performance of required
tasks. The flight surgeon, working with the industrial hygienist, should be aware of chemicals within the
flight line area and ensure personnel exposure remains within safe limits.

THRESHOLD LIMIT VALUES

5-12. Threshold limit values (TLVs) are chemical concentration limits. These values are time-weighted,
average concentrations that should produce no apparent adverse effects for the average worker who is
routinely exposed 8 hours a day and 40 hours a week for a working lifetime of 40 years. TLVs usually are
measured in parts per million for gases and vapors and milligrams per cubic meter for fumes and dusts.

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 Toxic Hazards in Aviation

SHORT-TERM EXPOSURE LIMITS

5-13. Short-term exposure limits (STELs) are maximum time-weighted average concentrations of specific
chemicals that are allowed for only 15 minutes during the workday. These limits were developed to protect
against acute toxicity. STELs should not be reported more than four times daily per person.

CEILING CONCENTRATION
5-14. Ceiling concentration is the maximum allowable concentration of a specific chemical that must never
be exceeded during any part of the workday. Even an instantaneous value in excess of the TLV ceiling is
prohibited.

BODY DETOXIFICATION
5-15. The human body has varied and intricate chemical defense mechanisms. Upon entry of a toxic
substance, the body immediately begins to reduce the substance’s concentration through multiple
processes. These processes include metabolism (the chemical breakdown of a substance), detoxification,
and excretion. The flight surgeon must be familiar with the metabolic pathways of well-known poisons and
understand the physical and psychological symptoms of subtle chemical intoxication. For example, the
amount of carbon monoxide eliminated by the body during a single exposure decreases by 50 percent every
4 hours.

SECTION II – AIRCRAFT ATMOSPHERE CONTAMINATION

CONTAMINATION OVERVIEW
5-16. Depending on the mission and other circumstances, an aircraft’s interior might contain various
contaminants that could pose risks to crewmembers. Aircrews and ground crews transporting hazardous
cargo should refer to AR 50-5, AR 50-6, AR 95-1, AR 95-27, and TM 38-250. Information concerning
chemical, biological, radiological, and nuclear (CBRN) environments is beyond the scope of this field
manual but can be found in FM 3-11.5 and TM 3-4240-280-10 (Air Force Joint Manual 44-151 contains
more detailed medical information on CBRN environments). Aircraft atmosphere contamination can
include—
z Exhaust gases.
z Tetraethyl lead.
z Carbon monoxide.
z Jet propulsion fuels.
z Hydraulic fluid vapors.
z Coolant fluid vapors.
z Engine lubricants.
z Solvents and degreasers.
z Composite materials.
z Fire extinguishing agents (including halogenated hydrocarbons).
z Fluorocarbon plastics and polyurethane.
z Oxygen contamination.

EXHAUST GASES
5-17. The physical relationship of engine positioning to the cockpit is important. Depending on aircraft age
and the power plant used (jet or reciprocating), there are a wide range of potential cockpit air contaminants
caused by exhaust gases. Single-engine, piston-type aircraft with the engine located directly in front of the
fuselage are subject to greater contamination than multiengine aircraft with lateral engines. Reciprocating
engines uniformly produce much more carbon monoxide than modern jet engines. Liquid-cooled, single-

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Chapter 5

engine airplanes are less likely to be contaminated by exhaust gases than air-cooled, radial-engine
airplanes.

CARBON MONOXIDE
5-18. The effects of carbon monoxide are subtle but deadly. Carbon monoxide, a product of incomplete
fuel combustion, is the most common gaseous poison found in the aviation environment. An engine that
yields complete combustion produces only carbon dioxide. As the fuel-to-air ratio decreases and complete
combustion increases, the percentage of carbon dioxide in exhaust gas rises while the percentage of carbon
monoxide declines. Conversely, as the mixture becomes richer (increasing the fuel-to-air ratio), the
percentage of carbon monoxide in exhaust gas increases. Carbon monoxide is a colorless, odorless gas
slightly lighter than air and should be suspected whenever exhaust odors are detected.
5-19. Carbon monoxide is the most common cause of both intentional and unintentional poisoning in the
United States. More deaths have been attributed to carbon monoxide than any other toxic gas. Carbon
monoxide acts as a tissue asphyxiant that produces hypoxia at both sea level and altitude. It preferentially
combines with hemoglobin to the partial exclusion of oxygen and thus interferes with blood’s oxygen
uptake. Carbon monoxide greatly reduces hemoglobin’s oxygen-carrying capacity; it combines with
hemoglobin to produce CoHb, creating a bind 256 times stronger than that of oxygen. The carbon
monoxide concentration in blood is based on a variety of factors, including gas concentration, respiratory
rate, hemoglobin-carbon monoxide saturation, and exposure duration. Table 5-1 shows the body’s
physiological responses to various concentrations of carbon monoxide.

Table 5-1. Physiological responses to various carbon monoxide concentrations

Carbon monoxide CoHb saturation in Exposure Symptoms

concentration in air blood (%) time
(ppm*)
0-50 No appreciable effect
0-100 0-17 No significant effects except
possible headache and flushing
of skin
200-300 23-30 5-6 hours Weakness, headache, dizziness,
loss of visual acuity, nausea, and
vomiting
400-600 36-44 4-5 hours Same as above, with lack of
muscular coordination
700-1,000 47-53 3-4 hours Same as above, with increased
pulse and respiration
1,100-1,500 55-60 1.5-3 Coma
hours
1,600-2,000 61-64 0.5-1 hour Depressed heart rate and
respiration
5,000-10,000 73-76 2-15 Death
minutes
*ppm = parts per million

5-20. A relatively low concentration of carbon monoxide in the air can, in time, produce high blood
concentrations of carbon monoxide. For example, a resting person who inhales air with a 0.5-percent
carbon monoxide concentration for 30 minutes will have a 45-percent blood saturation. As noted in Table
5-1, this saturation is sufficient to produce a near-coma condition.
5-21. Reduced oxygen concentration in the air and increased temperature or humidity can increase the
concentration of carbon monoxide-bound hemoglobin. Any of these changes or an increase in physical
activity can accelerate carbon monoxide’s toxic effects.

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 Toxic Hazards in Aviation

5-22. The effects of carbon monoxide on the human body vary. Symptoms of carbon monoxide
intoxication include—
z Tremors.
z Headache.
z Weakness.
z Joint pain.
z Hoarseness.
z Nervousness.
z Muscular cramps.
z Muscular twitching.
z Loss of visual acuity.
z Speech and hearing impairment.
z Mental confusion and disorientation.
5-23. The symptoms of carbon monoxide poisoning are the same as those of hypemic hypoxia. Of
particular importance to aviators is the loss of visual acuity. Peripheral vision and, more importantly, night
vision is significantly decreased, even with blood carbon monoxide saturation as low as 10 percent.
5-24. The dangers of carbon monoxide rise sharply with increasing altitude. When experienced separately,
a mild degree of hypoxic hypoxia (caused by increased altitude and decreased partial pressures of oxygen)
or exposure to small amounts of carbon monoxide can be harmless. When experienced simultaneously,
however, their effects become additive. These cumulative effects can cause serious pilot impairment and
result in loss of aircraft control.
5-25. For practical purposes, the elimination rate of carbon monoxide depends on respiratory volume and
the percentage of oxygen in inspired (inhaled) air. Smoking one to three cigarettes in rapid succession or
one and one-half packs per day can raise an individual’s carbon monoxide hemoglobin saturation to 10
percent. At sea level, it can take a full day to eliminate that small percentage of carbon monoxide because
carbon monoxide gas is reduced by a factor of only 50 percent about every 4 hours.
5-26. When flight personnel suspect the presence of carbon monoxide in their aircraft, they should turn off
all exhaust heaters, inhale 100-percent oxygen if available, and land as soon as practical. After landing,
they can investigate the source and evaluate their own possible symptoms of carbon monoxide intoxication.

AVIATION GASOLINE
5-27. Aviation gasoline, a mixture of hydrocarbons and additives such as tetraethyl lead and xylene, is
used only as an emergency fuel. A gallon of evaporated aviation gasoline will form about 30 cubic feet of
vapors at sea level. Personnel exposed to these vapors might suffer adverse physical or psychological
reactions.
5-28. Aviation gasoline vapors, which are heavier than air, are readily absorbed in the respiratory system
and can produce symptoms in exposed personnel after only a few minutes. Unconsciousness can occur if
vapors equal to one-tenth of the concentration that could cause combustion or explosion are inhaled for
more than a short time. The maximum safe concentration for exposure to ordinary fuel vapors is about 500
ppm, or 0.05 percent. However, aviation gasoline vapors are at least twice as toxic as ordinary fuel vapors.
Symptoms of exposure to aviation gasoline vapors include—
z Burning and tearing of the eyes.
z Restlessness.
z Excitement.
z Disorientation.
z Speech, vision, or hearing disorders.
z Convulsions.
z Coma.
z Death.

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Chapter 5

TETRAETHYL LEAD IN AVIATION GASOLINE

5-29. Tetraethyl lead, an antiknock substance, is highly toxic. Poisoning can occur through both skin
absorption and vapor inhalation. Tetraethyl lead poisoning primarily affects the central nervous system.
Symptoms include insomnia, mental irritability, and instability. In less dramatic cases, sleep interruption
with restlessness and terrifying dreams can occur. Other symptoms include nausea, vomiting, muscle pain
and weakness, tremors, and visual difficulty. The amount of tetraethyl lead in aviation gasoline is so small
(only about 4.6 cubic centimeters per gallon, or about one teaspoon) that encountering a lead hazard
through normal handling is remote. However, poisoning has resulted from personnel entering fuel storage
tanks containing concentrated amounts of tetraethyl lead within accumulated sludge. Maintenance
personnel who work (welding, buffing, or grinding) on engines that have burned leaded gasoline are at risk
of significant exposure to lead compounds.

JET PROPULSION FUELS

5-30. Jet propulsion fuel, type 4 (JP-4); jet propulsion fuel, type 5 (JP-5); and jet propulsion fuel, type 8
(JP-8) are mixtures of hydrocarbons that produce different grades of kerosene. Each JP fuel has a specific
vapor pressure and flashpoint. JP fuels do not contain tetraethyl lead. The recommended threshold limit for
JP fuel vapors is 500 parts per million. However, toxic symptoms can occur below explosive levels, so JP
fuel intoxication is possible even in the absence of a fire hazard. Excessive inhalation of JP fuels degrades
central nervous system function and poses an irritant hazard to skin and mucous membranes. JP fuels can
produce narcotic effects in high enough concentrations.

HYDRAULIC FLUID
5-31. Hydraulic fluid can be based in petroleum, castor oil, silicon, or phosphate ester. A leak from a
hydraulic hose or gauge under pressure up to 1,200 pounds per square inch can produce a finely divided
aerosol that diffuses quickly throughout the cockpit. Large leaks can cause liquid to accumulate on the
floor. In either case, a high level of aerosolized hydraulic fluid can develop quickly in cockpit air. Like
other hydrocarbons, hydraulic fluid can be toxic when inhaled. For example, phosphate ester-based
hydraulic fluid has effects identical to military nerve agents known as organ ophosphoesterase inhibitors.
Increasing temperature or altitude can aggravate the toxic effects of inhaled aerosolized hydraulic fluid.
These effects include—
z Irritation of the eyes and respiratory tract.
z Headache.
z Vertigo.
z Nerve dysfunction in the limbs.
z Impairment of judgment and vision.

COOLANT FLUID
5-32. The coolant fluid used in liquid-cooled engines consists of ethylene glycol diluted with water.
Ethylene glycol is toxic when ingested. Although volatile, its vapors rarely exert any significant acute toxic
effects when inhaled. Respiratory passages can become moderately irritated, however, with continued
exposure to ethylene glycol vapors.
5-33. Ruptured coolant lines frequently produce smoke in the cockpit resulting from either engine
overheating or leaking fluid. Cockpit smoke is always a concern for pilots—some have abandoned their
aircraft because of coolant line leaks. Pure ethylene glycol has a flash point of 177 degrees Fahrenheit;
however, the fire hazard from leaking coolant is not especially great because its ethylene glycol content has
been diluted with water.

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 Toxic Hazards in Aviation

ENGINE LUBRICANTS
5-34. Oil hose connections in aircraft consist of various types of adjustable clamps rather than the
pressure-type connections used in the hydraulic system. Hose clamps occasionally break or loosen. When
oil escapes onto hot engine parts, smoke often forms and enters the cockpit. Inhaling hot oil fumes causes
symptoms similar to those of carbon monoxide poisoning:
z Headache.
z Nausea.
z Vomiting.
z Irritation of the eyes and upper respiratory passages.

SOLVENTS AND DEGREASERS

5-35. Solvents and degreasers are organic bases used to dissolve other petroleum products. Organic
solvents irritate the skin (causing contact dermatitis), and they all produce nervous system effects similar to
those of general surgery anesthesia. Common solvents and degreasers present in the aviation environment
include toluene isocyanates (found in paints, foams, and adhesives) and methyl ethyl ketone, which is
specified for use in aviation maintenance manuals.

COMPOSITE MATERIALS
5-36. Composite materials are used in many Army airframes due to their strength, thermal resistance, and
light weight. These composite materials are composed of fibers and resins.
5-37. Fibers include carbon graphite, boron, Kevlar, and fiberglass, which generally are safe as long as
they remain intact. Disruption of the fiber matrix occurs with grinding, scraping, sanding, reworking, or
burning and during a crash. These disruptions create an inhalation hazard. Particles smaller than 3.5
microns long are more likely to become lodged in the lungs and produce lung disease similar to that caused
by asbestos.
5-38. Resins are bonding agents that provide insulation and the physically resistant properties of
composites. Epoxy is an example of a resin. The primary hazard posed by resin vapors is inhalation during
the curing process. Resins can cause asthma, skin irritation, and nervous system effects.

FIRE EXTINGUISHING AGENTS

5-39. Fire extinguishing agents pose a toxic threat to aircrews fighting fires, especially within enclosed
cabins or cockpits. Crewmembers can be exposed to these agents while using portable extinguishers or to
gaseous agents in the ventilation system following the discharge of automatic or semiautomatic fire
extinguishing systems aboard the aircraft. Ground support personnel are at risk as well, but to a lesser
extent because of their nonenclosed environmental conditions. The three chemical classes of fire
extinguishing agents in current use are—
z Halogenated hydrocarbons.
z Carbon dioxide.
z Aqueous film forming foam.

HALOGENATED HYDROCARBONS
5-40. The halogenated hydrocarbon group is composed of carbon tetrachloride, chlorobromomethane,
dibromodifluoromethane, and bromotrifluoromethane. Because of their toxicity, these halogenated
hydrocarbons are no longer used to fight fires. Currently, Halon is the halogenated hydrocarbon most
commonly used as a fire extinguishing agent.
5-41. Frequently found on the flight line, Halon is also used in automatic fire suppression systems
designed for large electrical and computer areas. It offers excellent fire suppression properties without
chemical residuals and is relatively nontoxic to personnel, except when discharged extensively in an

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Chapter 5

enclosed space. Within a confined area, Halon acts as a simple asphyxiant, displacing oxygen from the
room upon release. In addition, the discharge of Halon from a compressed state can generate impulse noise
levels greater than 160 decibels. Because of its strong tendency to deplete the atmospheric ozone layer,
Halon is being removed from all areas except those deemed mission essential. Under extremely high
temperatures, Halon can decompose into other, more toxic gases such as hydrogen fluorine, hydrogen
chloride, hydrogen bromide, and phosgene analogues.
5-42. Phosgene (a thermal byproduct of Halon) and carbon tetrachloride significantly irritate the lower
respiratory tract. Exposure to sublethal concentrations of phosgene can permanently damage the respiratory
system.

CARBON DIOXIDE
5-43. Large quantities of carbon dioxide are required to extinguish a fire; therefore, it can be hazardous
when used as a fire extinguishing agent. At low concentrations, carbon dioxide acts as a respiratory
stimulant. Inhaling a 2- to 3-percent concentration results in discomfort and shortness of breath and is
tolerable for approximately 20 to 25 minutes. A person can tolerate a concentration of up to 5 percent for
10 minutes. A concentration above 20 percent can cause unconsciousness within several minutes.
5-44. Initial acute exposure of less than 2 percent carbon dioxide can result in excitement or increases in
heart rate, blood pressure, and breathing rate and depth. These effects are followed by—
z Drowsiness.
z Headache.
z Increasing difficulty in respiration.
z Vertigo.
z Indigestion.
z Muscle weakness.
z Lack of coordination.
z Poor judgment.
5-45. At concentrations of 10 percent or above, crewmembers can experience mental degradation,
collapse, and death. If the concentration increases slowly, symptoms appear more slowly and have less
effect because the body’s defenses have time to act. Although the individual is aware of the changes
occurring, he or she might be unable to assess the situation and take corrective action.
5-46. Carbon dioxide is heavier than air and accumulates in lower areas of enclosed spaces, causing
normal air to become diluted and allowing the carbon dioxide to act as a simple asphyxiant. Because of this
risk, crewmembers must be familiar with the hazards and symptoms of carbon dioxide poisoning. The
cabin area must be ventilated quickly when initial symptoms are detected, and the crew should use 100-
percent oxygen if available.

AQUEOUS FILM FORMING FOAM

5-47. Aqueous film forming foam is a protein-based material used to physically separate a flammable
liquid (for example, fuel) from its oxygen source. Even if ingested it is essentially nontoxic, but the foam
produces irritation in the eyes and skin similar to that caused by household soaps.

FLUOROCARBON PLASTICS AND POLYURETHANE

5-48. Fluorocarbon plastics are used in all aircraft as corrosion-resistant coatings and insulation for radio
wires and other electronic equipment. Polyurethane is used in cockpit and cabin interiors. These materials
are chemically inert at ordinary temperatures but decompose at high temperatures and pose a problem in
aircraft only when a fire occurs. At about 662 degrees Fahrenheit, these materials release fluorine gas,
which then reacts with moisture to form hydrogen fluoride, a highly corrosive acid. Above 700 degrees
Fahrenheit, a small quantity of highly toxic perfluoroisobutylene is released. Phosgene and cyanide also are
produced through thermal decomposition. Rapid, uncontrolled burning of fluorocarbon plastics yields more

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 Toxic Hazards in Aviation

toxic products than controlled thermal decomposition. If an aircraft fire occurs, crewmembers must wear
oxygen masks (if available) to protect themselves against fumes from fluorocarbon plastics. These agents
are very irritating to the eyes, nose, and respiratory tract.

OXYGEN CONTAMINATION
5-49. Perceived oxygen contamination can affect the performance of aircrews that routinely fly high-
altitude profiles. Aviators often report objectionable odors in breathing systems using compressed gaseous
oxygen. These odors, while not present in toxic concentrations, can produce nausea and vomiting.
However, some odors are neither offensive nor disagreeable, as indicated by such descriptive terms as
stale, sweet, cool, and fresh. In situations other than accidental or gross contamination, oxygen analysis has
indicated the presence of small amounts of a number of contaminants. These contaminants include water
vapor, methane, carbon dioxide, acetylene, ethylene, nitrous oxide, traces of hydrocarbons, and other
unidentified substances. Odors also have been attributed to trichlorethylene, a solvent that previously was
used to clean oxygen tank cylinders. Either singly or in combination, these contaminants seem to never
reach concentrations toxic to humans, although distinctive symptoms such as headache, nausea, vomiting,
and disorientation have been reported. However, the problem with perceived oxygen contamination is most
often psychological rather than physiological. Aviators might become more concerned and apprehensive
during flight about their oxygen source. This preoccupation can lead to stress-induced hyperventilation or
loss of situational awareness. If pilots are concerned about this issue, they should land as soon as practical
and evaluate their oxygen equipment.

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 Chapter 6
Effects of Temperature Extremes on the Human Body

Body temperature must be maintained within narrow limits, usually between 94 and
100 degrees Fahrenheit. However, heat injuries and hypothermia can occur within
much narrower limits. Extreme temperatures can have a devastating effect on the
body’s ability to control its temperature. Exposure to temperature extremes in the
aviation environment impairs aircrew efficiency and intensifies other stresses such as
hypoxia and fatigue. Extreme climates can cause uncomfortable or unbearable
cockpit conditions, as can atmospheric temperature or altitude changes. Interior
aircraft ventilation and heating and protective equipment also can create temperature
extremes. This chapter briefly covers aviation operations in extreme climates.

SECTION I – HEAT IN THE AVIATION ENVIRONMENT

6-1. Army aviation operations generally take
place at low altitudes associated with extremely high Contents
temperatures and humidity. Heat can seriously
hamper mission requirements and hinder Section I – Heat in the Aviation
Environment............................................... 6-1
accomplishment of complex tasks. Army aircraft
construction and unit locations increase the potential Section II – Cold in the Aviation
Environment............................................... 6-5
for heat stress problems.

RADIANT HEAT
6-2. Solar radiant heat is the primary heat stress problem in aircraft. Large expanses of glass or
Plexiglas™ produce a greenhouse effect caused by conflicting transmission characteristics for radiation of
differing wavelengths, trapping thermal energy within the cockpit. The cockpit temperature of aircraft
parked on airfield ramps can be 50 to 60 degrees Fahrenheit higher than those parked in hangars due to the
radiation of solar heat through transparent surfaces. This radiation heats objects within the cockpit, which
then reradiate the waves at frequencies that cannot penetrate the glass or Plexiglas™. Therefore, heat
accumulates within the cockpit and becomes a significant stress factor at altitudes below 10,000 feet.

KINETIC HEAT
6-3. During flight, the aircraft structure is heated by friction between its surface and the air and by the
rise in temperature caused by air compression at the aircraft’s front. Cockpit insulation and cabin air
ductwork can reduce effects of kinetic heating.

ELECTRICAL HEAT LOADS AND COOLING SYSTEMS

6-4. The electrical heat load in cockpits is increasing as new high-performance aircraft are developed and
fitted with additional improved avionics equipment. The possibility of degraded performance increases
with escalations in cockpit temperature.
6-5. Comfortable limits in the cockpit are between 68 to 72 degrees Fahrenheit and 25 to 50 percent
relative humidity. To maintain this temperature and humidity range, aircraft must have extra heating and
cooling equipment installed, which is expensive in both cost and performance. In general, 1 pound of extra
load on an aircraft requires 9 pounds of structure and fuel to fly it.

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Chapter 6

HEAT TRANSFER
TEMPERATURE REGULATION
6-6. The body maintains its heat balance with several mechanisms. These mechanisms are radiation,
conduction, convection, and evaporation.

Radiation
6-7. Radiation involves the transfer of heat from an object of intense temperature to an object of lower
temperature through space by radiant energy. The rate of heat transfer depends primarily on the difference
between the objects’ temperatures. If body temperature is higher than the temperature of surrounding
objects, more heat radiates away from the body than is radiated to it.

Conduction
6-8. Conduction is the transfer of heat between objects, in contact at different temperatures, from heated
molecules of the body to cooler molecules of adjacent objects. The objects’ proximity determines the
overall rate of conduction.

Convection
6-9. Convection is the transfer of heat from the body in liquids or gases where molecules are free to
move. During body heat loss, air molecules move as the body heats surrounding air; the heated air expands
and rises as it is displaced by denser, cooler air. Respiration, which contributes to body temperature
regulation, is a type of convection.

Evaporation
6-10. Evaporative heat loss involves the transformation of a substance from a liquid state (such as sweat)
to a gaseous state. Heat is lost when water on the body surface evaporates. Evaporation is the most
common and generally the most easily explained form of heat loss.

Limitations
6-11. Radiation, convection, and conduction all suffer one major disadvantage in cooling the body: they
become less effective as temperature increases. When the temperature of air and nearby objects exceeds
skin temperature, the body gains heat. This gain can be dangerous for aviators.
6-12. When ambient temperature increases to about 82 to 84 degrees Fahrenheit, sweat production
increases abruptly to offset the loss of body cooling through radiation, convection, and conduction. At 95
degrees Fahrenheit, sweat evaporation accounts for nearly all heat loss.
6-13. Many factors affect the evaporation process. These factors include—
z Protective clothing.
z Availability of drinking water.
z Relative humidity above 50 percent.
z Environmental temperature above 82 degrees Fahrenheit.
6-14. Relative humidity is the factor that most limits evaporation. At relative humidity of 100 percent, no
heat is lost through evaporation. Although the body continues to sweat, it loses only a tiny amount of heat.
For example, a person can function all day at a temperature of 115 degrees Fahrenheit with relative
humidity of 10 percent if given enough water and salt. If relative humidity rises to 80 percent at the same
temperature, that person might be incapacitated within 30 minutes.

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 Effects of Temperature Extremes on the Human Body

HEAT INJURY
6-15. The body undergoes certain physiological changes to counteract heat stress. Cutaneous circulation,
or blood flow to the skin, increases tremendously to draw heat from the body’s inner core to the surface,
where it can be lost to ambient air. Blood flow to other organs such as the kidneys and liver is reduced, and
heart rate is increased so the body can maintain adequate blood pressure. As temperature increases,
receptors in the skin, brain, and neuromuscular system are stimulated to increase sweat production. Heavy
sweating produces 1 pint to 1 quart of sweat per hour; however, heat stress can result in 3 to 4 quarts being
produced. If a person does not replace this sweat by drinking liquids, the body rapidly dehydrates, sweat
production drops, and body temperature increases, causing further heat injury.
6-16. Individuals vary in their responses to heat stress. Factors that influence physiological responses
include the amount of work performed, physical condition, and ability to adapt to the environment. Other
factors that might predispose a Soldier to heat injury include—
z Exposure to 2 or 3 days of—
„ Sleep loss.
„ Increased exertion levels.
„ Increased heat exposure.
z Poor fitness.
z Overweight.
z Minor illness (such as cold symptoms).
z Taking prescribed or over-the-counter medications, supplements, or dietary aids.
z Use of alcohol within the last 24 hours.
z Prior history of heat illness (any heat stroke or more than two episodes of heat exhaustion).
z Skin disorders (such as rash or sunburn).
z Age (greater than 40 years).
6-17. Heat injuries, which range from marginal to critical-catastrophic, include—
z Sunburn: red, hot skin that might blister; victim might experience moderate to severe pain
and/or fever.
z Heat rash (prickly heat): red, itchy skin that might be bumpy due to blocked pores.
z Heat cramps: painful skeletal muscle cramps or spasms that primarily affect the legs and arms.
z Heat exhaustion: dizziness, headache, nausea, unsteady walk, weakness, fatigue, rapid pulse,
and shortness of breath; heat exhaustion is the most common exertional heat illness.
z Heat stroke: same symptoms as heat exhaustion but more severe; elevated temperature, usually
above 104 degrees Fahrenheit; altered mental status with confusion, agitation, delirium, and
disorientation; nausea and vomiting; can progress to loss of consciousness, coma, and seizures;
heat stroke is a medical emergency that can cause death.
6-18. Additional medical considerations in a hot weather environment are—
z Dehydration.
z Over hydration (hyponatremia).
6-19. Additional information on treating and preventing hot weather injuries can be found in Technical
Bulletin (Medical) (TB MED) 507.

PERFORMANCE IMPAIRMENT
6-20. Heat stress causes general physiological changes but also results in performance impairment. Even a
slight increase in body temperature impairs an individual’s ability to perform complex tasks such as those
required to fly an aircraft safely. A body temperature of 101 degrees Fahrenheit roughly doubles an
aviator’s error rate. Increases in body temperature generally have the following effects on an aviator:
z Error rates increase.
z Short-term memory becomes less reliable.

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Chapter 6

z Perceptual and motor skills slow.

z The capacity to perform aviation tasks decreases.
z Reaction and decision times slow.
z The conduct of routine tasks slows.
z Errors of omission are more common.
z Vigilant task performance degrades slightly after 30 minutes and markedly after 2 to 3 hours.

HEAT STRESS PREVENTION

6-21. Personnel can take preventive measures to avoid heat stress. They can reduce workload, replace
water and salt loss, acclimate properly, and wear protective clothing.

REPLACE WATER AND SALT LOSS

6-22. The human body cannot adjust to decreased water intake. Daily water requirements depend on the
environment, heat stress, activity level, and duration of exposure. Soldiers must replace water lost through
sweating to avoid heat injury. The body normally absorbs water at a rate of 1.2 to 1.5 quarts per hour. Fluid
intake should not exceed 1.5 quarts per hour or 12 quarts per day. Conducting activities in the cool early
morning or evening hours can minimize water loss.
6-23. Salt loss is high in personnel who either have not acclimated or have acclimated but are subject to
strenuous activity under heat stress. Replenishing lost salt is important. Eating all meals (including field
rations and meals, ready to eat with salt packet) usually provides the body’s salt requirement. Soldiers
should not use salt tablets; if larger amounts of salt are required, they should consult their flight surgeon.

ACCLIMATE
6-24. Heat acclimation greatly enhances a Soldier’s resistance to heat injury and improves physical work
capabilities. A minimum of 2 weeks should be allowed for healthy individuals to acclimate, with
progressive increases in heat exposure and physical exertion. Individuals who are less physically fit might
require more time to fully acclimate. Significant heat acclimation can be attained in 3 to 5 days. Full heat
acclimation takes up to 14 days with 2 to 3 hours per day of carefully supervised exercise in the heat.

WEAR PROTECTIVE CLOTHING

6-25. In direct sunlight, an individual should wear loose clothing to allow adequate ventilation and
evaporative cooling. In a hot environment, clothing protects an individual from solar radiation but reduces
the loss of body heat from convection and conduction. Dark clothing absorbs radiant heat while light
clothing reflects it. Individuals should wear headgear to reduce heat load to the head.

INFLIGHT HEAT STRESS REDUCTION

6-26. Army aviation crewmembers are required to work in hot cockpits. Their ability to handle a particular
situation depends on the specific aircraft and problem. If crewmembers will be exposed to heat for an
extended period, the only alternative might be to terminate the mission to prevent incapacitation (mission
termination should be treated as a last resort, however). Crewmembers can minimize inflight heat stress by
increasing ventilation and continually replacing fluids.

INCREASE VENTILATION
6-27. More than any other crewmember, the pilot must guard against heat stress. When speed and altitude
permit, the pilot should open a window or canopy and direct cool air onto the head and neck to reduce heat
buildup.

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 Effects of Temperature Extremes on the Human Body

CONTINUALLY REPLACE FLUIDS

6-28. Fluid intake during flight helps prevent dehydration and makes up for profuse sweating.
Crewmembers should be encouraged to drink fluids as conditions permit, especially in anticipation of
physical exertion.

SECTION II – COLD IN THE AVIATION ENVIRONMENT

6-29. Although heat stress causes the most significant problems for crewmembers, cold weather also
adversely affects the body. Aircrews must understand how the body reacts to cold temperature extremes.

COLD INJURY
6-30. Many factors influence the incidence of cold injury. If troops are in a static defensive position, the
incidence of injury drops as they have time to take care of their bodies. Factors that can increase an
individual’s susceptibility to cold injury include—
z Previous cold injury or other significant injuries.
z Use of tobacco, nicotine, or alcohol.
z Skipping meals or poor nutrition.
z Low activity.
z Fatigue and sleep deprivation.
z Little experience or training in cold weather.
z Previous cold casualty.
z Over-motivation.
6-31. Cold weather injuries include—
z Chilblain: acutely red, swollen, hot, tender skin, usually accompanied by itching.
z Immersion foot (trench foot): cold, numb feet that might progress to hot with shooting pains;
victim might also experience swelling, redness, and bleeding; Soldiers with suspected
immersion foot should seek medical attention immediately.
z Frostbite, which can be superficial or deep:
„ Superficial: involves only the skin, which usually appears pale, yellowish, and waxy-
looking (grayish in dark-skinned Soldiers); the skin’s surface feels very stiff or hard, but
underlying tissue is soft.
„ Deep: extends beyond the first layer of skin and can include the bone; discoloration is the
same as superficial frostbite but underlying tissue is hard; large areas might appear purple;
deep frostbite is a medical emergency that requires immediate evacuation to a medical
facility.
z Hypothermia: shivering might or might not be present; victim might exhibit drowsiness, mental
slowness, or lack of coordination, which can progress to unconsciousness, irregular heartbeat,
and death; hypothermia is the most serious cold injury and victims must be evacuated
immediately.
z Snow blindness: a temporary condition that results in pain, redness, or a watery or gritty feeling
in the eyes.
6-32. First aid for cold injuries depends on the injury. In frostbite, a superficial cold injury can be
adequately treated by warming the affected part with body heat. This warming can be done by covering
cheeks with hands, placing hands under armpits, or placing feet under a buddy’s clothing next to the
abdomen. The injured part should not be massaged, exposed to a fire or stove, rubbed with snow, slapped,
chafed, or soaked in cold water. Individuals should avoid walking when they have cold-injured feet. Deep
frostbite is very serious and requires more aggressive first aid to avoid or minimize the loss of parts of
fingers, toes, hands, or feet. The sequence for treating cold injuries depends on whether the condition is life
threatening; the priority is to remove injured Soldiers from the cold. More information on treating and
preventing cold weather injuries can be found in TB MED 508.

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Chapter 6

COLD INJURY PREVENTION

6-33. Some general measures can be taken to prevent all types of cold injury. Individuals can—
z Keep their body dry.
z Limit exposure to the cold.
z Avoid wearing wet clothing.
z Monitor the wind chill factor.
z Keep activity below the perspiration level.
z Avoid direct contact of bare skin and cold metal.
z Use the buddy system to check for early signs of cold injury.
z Wear several layers of loose-fitting clothing to increase insulation and cold weather headgear to
prevent loss of body heat.
z Avoid alcohol intake. Alcohol dilates surface blood vessels, a process that initially causes the
body to feel warmer but actually chills it through heat loss.
6-34. Wind chill charts provide time limits for cold exposure before an individual suffers injury. These
charts correlate wind velocities and ambient air temperature to provide an equivalent temperature based on
the wind chill factor. The same data apply when wet boots or wet clothing is worn or flesh is exposed.
These charts also indicate the level below which frostbite becomes a real hazard. Immersion (trench) foot
can occur at any temperature shown on these charts, given the right combination of wind velocity and
ambient air temperature. Figure 6-1 provides an example of a wind chill chart.

Figure 6-1. Wind chill chart

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 Chapter 7
Noise and Vibration in Army Aviation

Noise levels in both rotary- and fixed-wing aircraft exceed safe noise exposure limits.
In addition, crewmembers are subjected to aircraft vibrations that can produce
fatigue, degrade comfort, interfere with performance effectiveness, and under severe
conditions, influence operational safety and occupational health. Both noise and
vibration effects can occur simultaneously with initial exposure or manifest only after
the passage of time and repeated exposure. This chapter addresses the physiology of
noise and vibration and offers strategies to minimize short- and long-term exposure.

CHARACTERISTICS AND EFFECTS

7-1. Noise is loud, unpleasant, or unwanted sound. Vibration is the motion of objects relative to a
reference position, usually an object at rest. In
aviation, noise and vibration can cause annoyance, Contents
speech interference, fatigue, and hearing loss.
Characteristics and Effects ...................... 7-1
Sound and Vibrational Measurement ...... 7-1
ANNOYANCE
Noise and Hearing Levels ......................... 7-3
7-2. Noise is undesirable when it warrants Vibrational Effects ..................................... 7-4
unnecessary attention or interferes with routine Hearing Loss .............................................. 7-4
activities. High-frequency noise and vibration are Hearing Protection .................................... 7-5
especially irritating and can cause a subjective sense Vibration Preventive Measures................. 7-8
of fatigue.

SPEECH INTERFERENCE
7-3. When noise and vibration reach a certain loudness or amplitude, they mask normal communication
and words become difficult to understand.

HEARING LOSS
7-4. Permanent hearing damage is the most common and significant undesirable effect of noise. The
effects of excessive vibration include internal organ malfunctions and skeletal disabilities. Damage can be
rapid when noise is extremely intense or prolonged, but it is often subtle in onset and results from continual
exposure at lesser intensities. All aviation personnel must understand this damage can become permanent.

SOUND AND VIBRATIONAL MEASUREMENT

7-5. Sound and vibration energy have measurable characteristics. These characteristics are frequency,
intensity/amplitude, and duration.

FREQUENCY
7-6. Frequency is the physical characteristic that gives sound pitch. Frequency of periodic motion is the
number of times per second air pressure oscillates. The number of oscillations, or cycles per second, is
measured in hertz (Hz).

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Chapter 7

Human Hearing and Speech Range

7-7. The human ear is very sensitive and can detect frequencies from 20 to 20,000 Hz. Speech involves
frequencies from 200 to 6,800 Hz, the range in which the ear is most sensitive.

Speech Intelligibility
7-8. People must be able to hear in the range of 300 to 3,000 Hz to understand speech communication.
Speech outside these ranges can result in incoherence or misinterpretation.

Vibration
7-9. Vibration most affects the body in low frequencies, usually confined to frequency ranges below 100
Hz to displace body parts. These effects vary greatly with direction, body support, and restraint.

INTENSITY/AMPLITUDE
7-10. Intensity is a measure that correlates sound pressure to loudness. Amplitude (for vibration) is the
maximum displacement about a position of rest.
7-11. Aviation personnel must understand the relationship of decibels to sound pressure (vibration). For
every 20-decibel increase in loudness, sound pressure increases by a factor of 10. At 80 decibels, sound
pressure is 10 thousand times greater than at 0 decibels; at 100 decibels, sound pressure is 1 million times
greater than at 0 decibels. The sound pressure that moves through air to stimulate hearing also can cause
hearing loss under certain conditions. Table 7-1 shows the effects of various sound intensities on listeners.

Table 7-1. Effects of various sound intensities

Frequency (decibels) Effect

0 Hearing threshold
65 Average human conversation
85 Damage-risk limit
120 Discomfort threshold
140 Pain threshold
160 Eardrum rupture

DURATION
7-12. Duration is the length of time an individual is exposed to noise or vibration. It is a variable factor
that can be measured in seconds, minutes, hours, days, or any other selected unit of time.

NATURAL BODY RESONANCE

7-13. Natural body resonance is the mechanical amplification of vibration by the body at specific
frequencies. Table 7-2 (page 7-3) shows resonant frequencies for various parts of the human body.

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 Noise and Vibration in Army Aviation

Table 7-2. Resonant frequencies and the human body

Body Part Resonant Frequency (Hz)

Whole body 4–8
Shoulder girdle 4–8
Head 25
Eyes 30–90

DAMPING
7-14. Damping is the loss of mechanical energy in a vibrating system. This loss causes vibration to slow.

NOISE AND HEARING LEVELS

7-15. Army aviation personnel are exposed to two types of sound levels that can impair hearing: steady-
state noise and impulse noise.

STEADY-STATE NOISE
7-16. Aviation personnel encounter steady-state noise around operating aircraft. This noise is usually at a
high intensity over a wide range of frequencies. The U.S. Surgeon General has established 85 decibels at
all frequencies as the maximum permissible sound level for continuous exposure to steady-state noise
(damage-risk criteria). There is a direct link between exposure duration and intensity; the louder the sound,
the shorter the time required to cause hearing loss. Table 7-3 shows recommended allowable noise
exposure levels for various exposure durations. Exposure to noise above recommended duration levels
could result in noise-induced hearing loss, which is the primary risk to Army aviation personnel.

Table 7-3. Recommended allowable noise exposure levels

Exposure Duration Per Day Maximum Exposure Level

(hour) (decibel)
8 85
4 90
2 95
1 100
1/2 105
Note: For every 5-decibel noise intensity increase, the exposure time limit is cut
in half.

IMPULSE NOISE
7-17. Weapons fire produces impulse noise, which is an explosive sound that builds quickly to a high
intensity but then falls rapidly. Although the entire cycle usually lasts only milliseconds, impulse noise is
detrimental to hearing when intensity exceeds 140 decibels.
7-18. In both rotary- and fixed-wing aircraft, overall noise levels generally equal 100 or more decibels and
therefore exceed the 85-decibel damage-risk criteria. Table 7-4 (page 7-4) shows estimated noise levels for
rotary- and fixed-wing Army aircraft.

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Chapter 7

Table 7-4. Rotary- and fixed-wing aircraft noise levels

Aircraft Noise Level (decibels)

OH-58C 103
OH-58D 100
CH-47D 112
UH-60A 108
AH-64 104
TH-67* 102
C-12/RC-12 106**
UC-35 96***
*Based on a Bell 206 helicopter
** Exterior noise level
*** Cabin noise level

7-19. The frequency that generates the most intense noise level is 300 Hz. Low-frequency noise produces
high-frequency hearing loss. Providing adequate hearing protection for lower frequencies is very difficult.
Exposure to these levels without hearing protection ultimately will result in permanent hearing loss.

VIBRATIONAL EFFECTS
7-20. The human body reacts in various ways to vibration:
z Vibration can cause short-term acute effects due to the body’s biomechanical properties.
z The human body acts like a series of objects connected by springs.
z The connective tissue that binds the major organs together reacts to vibration the same way
springs do.
z When the body is subjected to certain frequencies, tissue and organs begin to resonate (increase
in amplitude).
z Objects create momentum when they reach their resonant frequency, which then increases in
intensity with each oscillation.
z Without shock absorption, vibration will damage the mass or organ.
7-21. Helicopters subject crewmembers to vibrations over a frequency range that coincides with the body’s
resonant frequencies. Prolonged exposure to vibration causes both short- and long-term effects on the
body. Vibration can affect the respiratory system, as well as cause—
z Motion sickness.
z Disorientation.
z Pain.
z Microcirculatory effects.
z Visual problems.

HEARING LOSS
7-22. Factors such as age, health, and the noise environment contribute to hearing loss. There are three
types of hearing loss: conductive, presbycusis, and sensorineural.

CONDUCTIVE
7-23. Conductive hearing loss occurs when some defect or impediment blocks sound transmission from
the external ear to the inner ear. Wax buildup, middle-ear fluid, or ossicle calcification can impede the

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 Noise and Vibration in Army Aviation

mechanical transmission of sound. Conductive hearing loss primarily affects low frequencies and, in most
cases, can be treated medically. A hearing aid is often beneficial because the inner ear can still detect
sounds if they are loud enough. An aviator can fly with a hearing aid if he or she is given a waiver to
continue on flight status.

PRESBYCUSIS
7-24. Presbycusis hearing loss usually results from old age. The hair cells of the cochlea become less
resilient as people age.

SENSORINEURAL
7-25. Sensorineural hearing loss occurs when the cochlea’s hair cells are damaged within the inner ear.
This type of hearing loss is caused primarily by noise exposure, but disease or aging can contribute as well.
Sensorineural hearing loss caused by noise exposure generally occurs first in the higher frequencies. A
hearing aid might be of benefit in some cases, but no known medical cure exists for this type of hearing
loss.

MIXED
7-26. A crewmember might have an ear infection that could cause conductive hearing loss but be
diagnosed with sensorineural hearing loss. The ear infection is treatable; sensorineural hearing loss is not.

HEARING PROTECTION
INDIVIDUAL RESPONSIBILITY
7-27. Pilots, crewmembers, ground support troops, and passengers should wear hearing protection at all
times. Hearing loss is one hazard in the aviation environment that adequate protective measures can
minimize. Every individual has a responsibility to use hearing protection.
7-28. The amount of sound protection offered by a protective device is determined first by its fit and
condition, but most importantly by the willingness and ability of the individual to use it properly. Using
individual devices in combination provides the best hearing protection.
7-29. While individual devices are not foolproof, virtually all noise-induced hearing loss is preventable if
the devices fit properly and are worn on all flights. Even if hearing is already affected somewhat,
protective devices will help prevent further damage.

PROTECTIVE DEVICES
7-30. Aircraft noise levels interfere with speech communication between crewmembers and pose the risk
of hearing loss. Protective measures that can reduce the undesirable effects of noise include—
z Use of personal protective measures.
z Isolation or distance from the noise source.

Helmets
7-31. The HGU-56P aviator helmet (figure 7-1, page 7-6) provides excellent protection in terms of noise
and crash attenuation. Designed primarily for noise protection, this helmet also provides exceptional noise
attenuation from 3,000 to 8,800 Hz.

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Chapter 7

Figure 7-1. HGU-56P aviator helmet

7-32. The HGU-56P helmet reduces noise exposure to safe limits for every aircraft in the Army inventory
except the UH-60 Black Hawk and CH-47 Chinook. Table 7-5 shows estimated attenuation levels for
various helmet types.

Note: Operations in UH-60 and CH-47 aircraft require both helmet and earplug use to attenuate
noise and prevent hearing loss.

Table 7-5. Estimated attenuation levels by helmet

Aircraft Hearing Protector Effective Exposure Level

(decibels)
OH-58D HGU-56P 81.6
OH-58C HGU-56P 76.9
UH-60A HGU-56P 90.6
CH-47D HGU-56P 86.8
AH-64 IHADSS (Reg and XL) 80.2
C-12 H-157 headset 70.5

7-33. Ancillary devices worn with the aviator’s helmet can significantly compromise hearing protection.
For example, eyeglass frames break the ear seal and create a leak that produces a sound path from outside
to inside the ear cup.

Earplugs

Communications Earplug
7-34. The communications earplug (CEP) (figure 7-2, page 7-7) improves hearing protection and speech
communication reception. The CEP includes a miniature transducer that reproduces speech signals from
the aircraft’s internal communications system (ICS). The foam tip acts as a hearing protector similar to the
yellow foam earplugs worn by pilots for double hearing protection. A miniature wire from the CEP
connects to the ICS through a mating connector mounted on the rear of the helmet. The CEP was recently
issued an airworthiness release (AWR) for all Army aircraft using the HGU-56P helmet and M24 mask.

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 Noise and Vibration in Army Aviation

Figure 7-2. Communications earplug

Insert-Type Earplugs
7-35. Insert-type earplugs are a common form of hearing protection. All earplugs tend to loosen with
talking or vibration and must be reseated periodically to prevent inadvertent noise exposure. Users’ voices
sound lower and muffled with properly fitted earplugs, and initial use can diminish the user’s ability to
hear cockpit communications. Noise protection with earplugs is 18 to 45 decibels across all frequency
bands. Three types of earplugs are—
z The E-A-R® foam earplug, which provides excellent noise attenuation, comfort, and ease in
maintaining a seal. To ensure maximum attenuation, these plugs should be inserted properly and
kept clean.
z The V-51R single-flange earplug, which is available in five different sizes and provides a
suitable fit for more than 95 percent of all Army aviation personnel (10 percent of crewmembers
need a different size for each ear). These plugs can be cleaned with soap and water.
z The triple-flange earplug, which provides nearly the same attenuation as the V-51R and is
available in three sizes (small, medium, and large). These plugs are comfortable for most
individuals and can be cleaned with soap and water.

Combined Hearing Protection

7-36. In combination with the HGU-56P and IHADSS helmets, earplugs provide additional protection
from noise generated by all aircraft in the U.S. Army inventory. Table 7-6 shows attenuation levels at the
pilot’s station for crewmembers wearing the HGU-56P helmet with the three earplug types described
above.

Table 7-6. Attenuation levels for the HGU-56P with earplugs

Earplug UH-60A (120 knots) CH-47D (100 knots) OH-58 (100 knots)
Triple-flange plug 70.6 75.5 63.7
Single-flange plug 73.3 76.4 65.4
E-A-R® foam plug 68.4 75.3 61.5

Earmuffs
7-37. Several types of earmuffs (figure 7-3, page 7-8) provide adequate sound protection for aviation
ground support personnel. When adjusted properly and in good condition, most earmuffs attenuate sound
as well as properly fitted earplugs. However, earmuffs tend to provide slightly more high-frequency
protection and slightly less low-frequency protection than earplugs.

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Chapter 7

Figure 7-3. Earmuffs

VIBRATION PREVENTIVE MEASURES

7-38. Vibration cannot be eliminated, but its effects on human performance and physiological function can
be reduced. Preventive measures include—
z Maintaining good posture during flight.
z Restraint systems provide protection against high-magnitude vibration experienced in extreme
turbulence.

CAUTION
Body supports such as lumbar inserts and added seat cushions can
reduce discomfort and dampen vibration. However, they might
increase the likelihood of injury during a crash sequence due to their
compression characteristics. Do not modify aircraft seats for the sake
of comfort.

z Maintaining equipment. Proper aircraft maintenance such as blade tracking can reduce
unnecessary vibration exposure.
z Isolating crewmembers and passengers. Patients placed on the floor of medical evacuation
(MEDEVAC) aircraft experience more vibration than those situated in upper racks.
z Limiting exposure time. Short flights with frequent breaks are preferred over one long flight,
mission permitting.
z Letting the aircraft do the work. Crewmembers should not grip controls tightly. Vibration can be
transmitted through control linkages during turbulence.
z Maintaining good physical condition. Fat multiplies vibration, but muscle dampens it by
reducing the magnitude of oscillations encountered in flight. Good physical condition also
lessens the effects of fatigue and allows Soldiers to function during extended combat operations
with minimum rest.
z Maintaining sufficient hydration. Crewmembers should drink a minimum of two quarts of water
in addition to fluids taken with meals. Coupled with vibration, dehydration can cause fatigue
twice as fast and requires double the time needed for recovery.

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Vision

Crewmembers rely more on their vision than any other sense to orient themselves in
flight. While vision is the most accurate and reliable sense, visual cues can be
misleading and contribute to incidents within the flight environment. Aviation
personnel must be aware of and know how to effectively compensate for physical
deficiencies and self-imposed stressors as well as visual cue deficiencies and
limitations. This chapter discusses visual limitations and compensation techniques.

SECTION I – GENERAL
8-1. Crewmembers must completely understand
eye function and techniques they can employ to Contents
overcome visual limitations. It is usually not a lack
of visual acuity that causes problems for Section I – General .................................... 8-1
crewmembers; rather, it is not understanding “how” Section II – Types of Vision ...................... 8-3
to see properly. Section III – Visual Deficiencies ............... 8-6
Section IV – Factors Affecting Object
Visibility ...................................................... 8-9
ANATOMY AND PHYSIOLOGY OF Section V – Night Vision ........................... 8-9
THE EYE Section VI – Self-Imposed Stress and
Vision ........................................................ 8-19
8-2. Understanding basic anatomy and physiology
Section VII – Other Vision
of the eye enables crewmembers to use their eyes
Considerations ........................................ 8-21
more effectively during flight. Light enters the eye
and passes through the cornea, a circular,
transparent protective tissue that projects forward
and protects the eye. From there it enters the pupil, which is the opening (black portion) in the center of the
iris. The pupil allows light to enter the eye and stimulate the retina. The iris is the round, pigmented
(colored) membrane surrounding the pupil and adjusts pupil size by using ciliary muscles attached to the
pupil. The iris adjusts the size of the pupil’s exposed portion to regulate the amount of light entering the
eye. When the pupil dilates (enlarges) under low light levels, it allows more light to enter the eye to further
stimulate the retina. When the pupil constricts (becomes smaller) under high light levels, it decreases the
amount of light entering the eye to avoid oversaturation (stimulation) of the retina. Light entering the eye is
regulated so the retina is neither undersaturated nor oversaturated with light images, both of which have
negative effects on visual acuity.
8-3. After light travels through the pupil it strikes the lens, a transparent, biconvex membrane located
behind the pupil. The lens then directs (refracts) the light to the retina, the posterior or rear portion of the
eye. The retina is a complex, structured membrane consisting of 10 layers called the Jacob’s membrane.
The retina contains many tiny photoreceptor cells known as rods and cones. When light stimulates the
retina, it produces a chemical change within the photoreceptor cells that stimulates and transmits nerve
impulses to the brain via the optic nerve. The brain deciphers these impulses and creates a mental image
that interprets what the individual is viewing. Figure 8-1 (page 8-2) illustrates the basic anatomy of the
human eye.

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Figure 8-1. Anatomy of the human eye

VISUAL ACUITY
8-4. Visual acuity measures the eye’s ability to resolve spatial detail. The Snellen test is commonly used
to measure an individual’s visual acuity. Normal visual acuity is 20/20, a value that indicates an individual
reads at 20 feet the letters an individual with normal acuity (20/20) reads at 80 feet.
8-5. The human eye functions like a camera. It has a simultaneous field of view (FOV), which is oval and
typically measures 130 degrees vertically by 160 degrees horizontally. When two eyes are used for
viewing, overall FOV measures about 120 degrees vertically by 200 degrees horizontally.

RETINAL PHOTORECEPTOR CELLS

Rods and Cones

8-6. Retinal rod and cone cells are named for their shape. Cone cells are used primarily for day or high-
intensity light vision (viewing periods or conditions). The rods are used for night or low-intensity light
vision (viewing periods or conditions). Some characteristics of day and night vision are due to the
distribution pattern of rods and cones on the retina. The center of the retina, the fovea, contains a very high
concentration of cone cells but no rod cells. The concentration of rod cells begins to increase toward the
retina’s periphery.

Cone Neurology
8-7. The retina contains seven million cone cells. Each cone cell in the fovea is connected to a single
nerve fiber that leads directly to the brain. Each cell generates a nerve impulse under sufficient light levels
during daylight or high-intensity light exposure. Cone cells provide sharp visual acuity and color
perception. Under low light or dark conditions, cone cells depict shades of black, gray, and white;
crewmembers will perceive other colors if light intensity is heightened by artificial sources such as:
z Aircraft position lights.
z Anticollision lights.
z Runway lights.
z Beacon lights.
z Artificial light in metropolitan areas.

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Rod Neurology
8-8. There are 120 million rod cells in the retina. There is a 10-to-1 to 10,000-to-1 ratio of rod cells to
neuron cells within the retina. Due to the large number of rod cells connected to each nerve fiber outside
the fovea, dim light can trigger a nerve impulse to the brain. The periphery of the retina, where the rods are
concentrated, is much more sensitive to light than the fovea. This concentration is responsible for night
vision, which provides silhouette recognition of objects. It is also why crewmembers’ eyes are highly
sensitive to light during low ambient light or dark conditions.

Iodopsin and Rhodopsin

8-9. Vision is possible due to chemical reactions within the eye. The chemical iodopsin is always present
within cone cells. Iodopsin allows cone cells to immediately respond to visual stimulation regardless the
ambient light level. Rod cells, however, contain an extremely light-sensitive chemical called rhodopsin,
more commonly referred to as visual purple. Rhodopsin is not always present in the rods because light
bleaches it out and renders the rods inactive to stimulation. Rhodopsin is so sensitive that bright light
exposure can bleach out all visual purple within seconds.

Night Vision
8-10. Night vision requires a buildup of rhodopsin be present in the rods. The average time required to
gain the greatest sensitivity or adaptation to a dark environment is 30 to 45 minutes. When fully adapted,
the rod cells become up to 10,000 times more sensitive than at the start of the dark adaptation period. Total
light sensitivity can increase 100,000 times through a dilated pupil.

Day Blind Spot

8-11. Since humans have two eyes, they view all images with binocular vision. Each eye compensates for
the day blind spot in the optic disk of the opposite eye. The day blind spot covers an area of 5.5 to 7.5
degrees and is located about 15 degrees from the fovea, originating where the optic nerve attaches to the
retina. The size of the day blind spot is due to the optic nerve’s oval shape combined with its offset
position where it attaches to the retina. No cones or rods are present at the attachment point. The day blind
spot causes difficulty when individuals do not move their head or eyes but continue to look straight
forward while an object is brought into the visual field. Figure 8-2 demonstrates the day blind spot.

Figure 8-2. Day blind spot

SECTION II – TYPES OF VISION

8-12. The three types of vision and viewing periods associated with Army aviation are photopic, mesopic,
and scotopic. Each type requires different sensory stimuli or ambient light conditions.

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PHOTOPIC VISION
8-13. Photopic vision (figure 8-3) is experienced during daylight or under high levels of artificial
illumination. Cones concentrated in the fovea centralis are primarily responsible for vision in bright light.
Due to the high-level light condition, rod cells are bleached out and become less effective. Sharp image
interpretation and color vision are characteristics of photopic vision. The fovea centralis is automatically
directed toward an object by a visual fixation reflex. Therefore, under photopic conditions, the eye uses
central vision for interpretation, especially in determining details.

Figure 8-3. Photopic vision

MESOPIC VISION
8-14. Mesopic vision (figure 8-4) is experienced at dawn, dusk, and under full moonlight. Vision is
achieved by a combination of rods and cones. Visual acuity steadily decreases with declining light. Color
vision is reduced or degraded as light levels decrease and the cones become less effective. Mesopic vision
is the most dangerous vision type for crewmembers. How degraded the ambient light condition is
determines what type of scanning or viewing technique crewmembers should use to detect objects and
maintain safe and incident-free flight. For example, the gradual loss of cone sensitivity might necessitate
off-center viewing to detect objects in and around the flight path. Incidents might occur if crewmembers
fail to recognize the need to change scanning techniques from central or focal viewing to off-center
viewing.

Figure 8-4. Mesopic vision

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SCOTOPIC VISION
8-15. Scotopic vision (figure 8-5, page 8-5) is experienced in low light environments such as partial
moonlight and starlight conditions. Cones become ineffective in these conditions, causing poor resolution
in detail. Visual acuity decreases to 20/200 or less, and color perception is lost. A central or night blind
spot occurs when cone cell sensitivity is lost. Scotopic vision degrades primary color perception to shades
of black, gray, and white unless the light source is of adequate intensity to stimulate the cones. Peripheral
vision is used primarily while viewing with scotopic vision.

Figure 8-5. Scotopic vision

NIGHT BLIND SPOT

8-16. The night blind spot (figure 8-6) should not be confused with the day blind spot. The night blind spot
occurs when the fovea becomes inactive in low light conditions and involves an area from 5 to 10 degrees
wide in the center of the visual field. An object viewed directly at night might not be seen due to the night
blind spot; if the object is detected, it will fade away when stared at longer than 2 seconds. The size of the
night blind spot increases as the distance between the eyes and object increases. Therefore, the night blind
spot can hide larger objects as the distance between the observer and object increases. Figure 8-7 (page 8-
6) illustrates this effect.

Figure 8-6. Night blind spot

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Figure 8-7. Visual blind spot

PERIPHERAL VISION
8-17. Stimulation of only rod cells (peripheral vision) is primary for viewing during scotopic vision.
Crewmembers must use peripheral vision to overcome the effects of scotopic vision. Peripheral vision
allows crewmembers to see dimly lit objects and maintain visual reference to moving objects. The natural
reflex of looking directly at an object must be reoriented through night vision training. To compensate for
scotopic vision, crewmembers must use searching eye movements to locate an object and small eye
movements to retain sight of the object. Crewmembers also must use off-center viewing; if the eyes are
held stationary when focusing on an object for more than 2 to 3 seconds using scotopic vision, images can
fade away or bleach out completely.

SECTION III – VISUAL DEFICIENCIES

8-18. Aviation personnel must be able to recognize and understand common visual deficiencies. Important
eye problems related to degraded visual acuity and depth perception include myopia, hyperopia,
astigmatism, presbyopia, and retinal rivalry. Surgical procedures to sculpt or reshape the cornea also might
result in visual deficiencies.

MYOPIA
8-19. Myopia, often referred to as nearsightedness, is caused by an error in refraction where the lens of the
eye does not focus an image directly on the retina. When a person with myopia views an image at a
distance, the eye’s actual focal point is in front of the retinal plane or wall, causing blurred vision. Thus,
distant objects are not seen clearly and only nearby objects are in focus. Figure 8-8 depicts this condition.

Figure 8-8. Myopia (nearsightedness)

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NIGHT MYOPIA
8-20. Blue wavelengths of light prevail in the visible portion of the spectrum at night. Therefore, slightly
nearsighted or myopic individuals viewing blue-green light at night might experience blurred vision. Even
crewmembers with perfect vision will find image sharpness decreases as pupil diameter increases. For
individuals with mild refractive errors, these factors combine to make vision unacceptably blurred unless
they wear corrective glasses.
8-21. Another issue crewmembers must consider is “dark focus.” When light levels decrease, the eye’s
focusing mechanism might move toward a resting position, making the eye more myopic. These factors
become important when crewmembers rely on terrain features during unaided night flights. Special
corrective lenses can be prescribed to correct night myopia.

HYPEROPIA
8-22. Hyperopia, often referred to as farsightedness, also is caused by a refraction error; the eye’s lens
does not focus images directly on the retina. When a crewmember views a near image in a hyperopic state,
the eye’s actual focal point is behind the retinal plane or wall, causing blurred vision. Nearby objects are
not seen clearly; only more distant objects are in focus. Figure 8-9 depicts this condition.

Figure 8-9. Hyperopia (farsightedness)

ASTIGMATISM
8-23. Astigmatism is the inability to focus different meridians simultaneously. It results from an unequal
curvature of the cornea or eye lens that causes a ray of light to spread over a diffused area on the retina. In
normal vision, a ray of light is sharply focused on the retina. If, for example, an astigmatic individual
focuses on power poles (vertical), the wires (horizontal) will be out of focus, as shown in figure 8-10.

Figure 8-10. Astigmatism

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PRESBYOPIA
8-24. Presbyopia, a condition that causes the lenses to harden, is part of the normal aging process.
Beginning in the early teens, the human eye gradually loses the ability to accommodate for and focus on
nearby objects. When people are about 40 years old, their eyes are unable to focus at normal reading
distances without reading glasses. Reduced illumination interferes with focus depth and accommodation
ability.
8-25. Lens hardening can result in clouding of the lenses, a condition known as cataracts. Aviators with
early cataracts might see a standard eye chart clearly in normal daylight but have difficulty under bright
light conditions due to the light scattering as it enters the eye. This glare sensitivity is disabling under
certain circumstances. Glare disability, related to contrast sensitivity, is the inability to detect objects
against varying shades of backgrounds. Other visual functions that decline with age and affect
crewmember performance include:
z Dynamic acuity.
z Glare recovery.
z Function under low illumination.
z Information processing.

RETINAL RIVALRY
8-26. Retinal rivalry might be experienced when the eyes attempt to simultaneously perceive two
dissimilar objects independently. This phenomenon can occur when pilots view objects through the heads-
up display in the AH-64. Conflict in total perception arises when one eye views one image and the other
eye views another image. Quite often, the dominant eye overrides the nondominant eye, possibly causing
information delivered to the nondominant eye to be missed. Additionally, this rivalry can lead to ciliary
spasms and eye pain. Mental conditioning and practice appear to alleviate this condition; therefore, retinal
rivalry becomes less of a problem as crewmembers gain experience.

SURGICAL PROCEDURES
8-27. Various surgical procedures are available to correct visual deficiencies. The most common
procedures are described below, but this list is not inclusive of all available options. AR 40-501 states all
corrective eye surgeries involving laser-assisted in-situ keratomileusis (LASIK), photorefractive
keratectomy (PRK), or other forms of corrective eye surgery disqualify Army crewmembers from flight
duty. Crewmembers must consult their flight surgeon before undergoing these procedures.

PHOTOREFRACTIVE KERATECTOMY
8-28. PRK is a procedure that corrects corneal refractive errors through a series of fine laser ablations that
resculpt the cornea. This procedure flattens the cornea, which then bends or refracts light properly on the
retina and corrects myopic deficiency. Some studies suggest there is increased risk of haze at the treated
interface with increased ultraviolet exposure due to the destruction of the corneal membrane, even years
after surgery.

LASER EPITHELIAL KERATOMILEUSIS

8-29. Laser epithelial keratomileusis (LASEK) is similar to PRK in its depth of corneal involvement but
utilizes a flap technique similar to LASIK. An epithelial flap is made and removed mechanically, followed
by laser sculpting of the corneal stroma. One benefit to this procedure is that postsurgical flap
displacement, while more likely to occur due to the thinness of the flap, is less likely to cause permanent
vision change as compared to the thicker and deeper LASIK flap.

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LASER-ASSISTED IN-SITU KERATOMILEUSIS

8-30. LASIK is the procedure surgeons use to carve and reshape the cornea. A laser is used to shave the
anterior half of the cornea, creating a flap that is then retracted. The inner side of the cornea is then
reshaped with the laser, causing the cornea to flatten. The flap is replaced in its original position when
reshaping is complete. After surgery, the flatter cornea properly bends and refracts light on the retina.
Unlike PRK, this technique can correct for severe myopia and hyperopia. LASIK’s primary adverse effect
is astigmatism caused by irregularities in the corneal surface. In addition, permanent damage to the cornea
and severely degraded visual acuity will result if the flap becomes suddenly detached in an accident.

SECTION IV – FACTORS AFFECTING OBJECT VISIBILITY

8-31. The ease with which an object can be seen depends on various factors. Each factor can either
increase or decrease the object’s visibility. Object visibility increases as—
z Object angular size increases and distance between the object and viewer decreases.
z Ambient light illumination (overall brightness) increases.
z Degree of retinal adaptation increases.
z Color and contrast between the object and background increase.
z Object position within the visual field (visibility threshold) increases.
z Eye focus and viewing time increase.
z Atmospheric clarity increases; ND-15 sunglasses can aid visibility in excessive light or bright
conditions.
8-32. Interference in the perception of instantaneous visual pictures occurs as aircraft speed increases. In
some cases, it might take 1 to 2 seconds or longer to recognize and consciously assess a complex situation.
By the time an object is eventually perceived, it might already have been overtaken. The time it takes to
perceive an object is significant for crewmembers. Perception time includes the time it takes—
z The message indicating an image has been identified within the visual field to travel from the
eye to the brain, including the time it takes the brain to receive, comprehend, and identify the
information.
z The eye to turn toward and focus on an unknown object.
z An individual to recognize the object and determine its importance.
z To transmit a decision to move muscles and cause the aircraft to respond to control inputs.

SECTION V – NIGHT VISION

8-33. Crewmembers should achieve maximum dark adaptation in the least time possible. Crewmembers
also must protect themselves against the loss of night vision. There are several methods for accomplishing
these requirements.

DARK ADAPTATION
8-34. Dark adaptation is the process by which the eyes become more sensitive to low levels of
illumination. Rhodopsin (visual purple) is the substance in the rods responsible for light sensitivity. The
degree of dark adaptation increases as the amount of visual purple in the rods increases through
biochemical reaction. Each person adapts to darkness in varying degrees and at different rates. For
example, a person in a darkened movie theater adapts more quickly to the prevailing illumination level.
However, compared to a moonless night, the light level within a movie theater is high. Additionally, a
person in a darkened theater requires less time to adapt to complete darkness than an individual in a lighted
hangar. The lower the starting illumination level, the less time required for adaptation.
8-35. Dark adaptation for optimal night vision acuity approaches its maximum level in about 30 to 45
minutes under minimal lighting conditions. If the eyes are exposed to bright light after dark adaptation,
their sensitivity is temporarily impaired. The degree of impairment depends on the intensity and duration of

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the exposure. Brief flashes from high-intensity, white xenon strobe lights commonly used as aircraft
anticollision lights have little effect on night vision because the energy pulses are of such short duration,
lasting only milliseconds. Exposure of 1 second or longer to a flare or searchlight, however, can seriously
impair night vision. Depending on brightness (intensity) and exposure duration or after repeated exposures,
complete dark adaptation recovery time can range from several minutes to 45 minutes or longer.
8-36. Exposure to bright sunlight also has a cumulative and adverse effect on dark adaptation. Reflective
surfaces such as sand, snow, water, and manmade structures intensify this condition. Exposure to intense
sunlight for 2 to 5 hours decreases visual sensitivity for up to 5 hours and also decreases the rate of dark
adaptation and degree of night visual acuity. These cumulative effects can persist for several days.
8-37. Retinal rods are least affected by the wavelength of a dim red light. Figure 8-11 compares rod and
cone cell sensitivities. Since rods are stimulated by low ambient light levels, red lights do not significantly
impair night vision if proper techniques are used. To minimize the adverse effects of red lights on night
vision, crewmembers should adjust light intensity to the lowest usable level and view instruments only
briefly.

Figure 8-11. Rod and cone cell sensitivities

8-38. Illness adversely affects dark adaptation. Individuals with high body temperatures consume oxygen
at a higher-than-normal rate, causing oxygen depletion that can induce hypoxia and degrade night vision.
In addition, the unpleasant feelings associated with sickness are distracting and can restrict a
crewmember’s ability to concentrate on flight duties and responsibilities.

PROTECTIVE EQUIPMENT
SUNGLASSES
8-39. When exposed to bright sunlight for prolonged periods, crewmembers anticipating night flight
should wear military-issued, neutral-density sunglasses (ND-15) or equivalent filter lenses. This precaution
minimizes the negative effects of sunlight and solar glare on rhodopsin production, which maximizes the
rate of dark adaptation and improves night vision sensitivity and acuity.

RED-LENS GOGGLES
8-40. If possible, crewmembers should wear approved red-lens goggles or be exposed to red lighting to
achieve complete dark adaptation before executing night-flying operations. These procedures allow
crewmembers to begin dark adaptation in an artificially illuminated room before flight. Red-lens goggles
and red lighting reduce dark adaptation time and can preserve up to 90 percent of dark adaptation in both
eyes. Red lighting and red-lens goggles do not significantly interfere with rhodopsin production and
decrease the possibility of undesirable effects from accidental exposure to bright lights, especially as
crewmembers transition from the briefing room to the flight line. Exposure to bright lights does, however,
lengthen the time crewmembers wearing red-lens goggles need to achieve dark adaptation. Crewmembers

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 Vision

wearing red-lens goggles will not achieve complete dark adaptation if the light source is intense enough
and exposure is prolonged.
8-41. Crewmembers must not use red lighting or red-lens goggles when viewing inside or outside the
aircraft during flight. Red lighting is a longer nanometer, which is very fatiguing to the eyes. In addition,
the reds and browns found on nontactical maps not constructed for red light use bleach out when viewed
under red lighting.

SUPPLEMENTAL OXYGEN EQUIPMENT

8-42. When flying at or above 4,000 feet pressure altitude, crewmembers should use pressure-altitude
supplemental oxygen if available. Adverse effects on night vision begin at 4,000 feet pressure altitude.
Effective night vision depends on the optimal function and sensitivity of the retinal rods. A lack of oxygen
(hypoxia) significantly reduces rod sensitivity, increases dark adaptation time, and decreases night vision.
AR 95-1 describes the requirements for supplemental oxygen use related to pressure altitudes.

PROTECTIVE MEASURES
COCKPIT LIGHT ADJUSTMENT
8-43. Instrument, cockpit, and rear cargo area overhead lights should be adjusted to the lowest readable
level that allows instruments, charts, and maps to be interpreted without prolonged staring or exposure.
Although blue-green lighting at low intensities can be used in cockpits without significantly disrupting
unaided night vision and dark adaptation, items printed in blue-green might wash out. However, the use of
blue-green lighting has several benefits. Blue-green light falls naturally on the retinal wall and allows the
eye to focus easily on maps, approach plates, and instruments, thereby decreasing eye fatigue. In addition,
the intensity necessary for blue-green lighting is less than that for red lighting, resulting in decreased
infrared signature and less glare. When blue-green lighting is used properly, the decrease in light intensity
and ease of focusing make it more effective for night vision.

EXTERIOR LIGHT ADJUSTMENT

8-44. If possible, exterior lights should be dimmed or turned off, mission permitting. Aviators should
consult command policy for local procedures.

LIGHT FLASH COMPENSATION

8-45. The pilot should turn the aircraft away from a light source if a high-intensity flash is expected from a
specific direction. When flares illuminate a viewing area or are inadvertently ignited nearby, the pilot
should maneuver the aircraft away from the flares to a position along the illuminated area’s periphery. To
minimize exposure, the pilot should turn the aircraft so vision is directed away from the light source. When
lightning or other unexpected conditions occur, crewmembers can preserve dark adaptation by covering or
closing one eye while using the other eye to observe. The covered eye provides the night vision capabilities
required for flight after the light source has passed. Time spent expending ordnance should be limited to
decrease the effects of flash from aerial weapons systems and keep light levels low. Similarly,
crewmembers firing automatic weapons should use short bursts of fire. If direct view of a light source
cannot be avoided, crewmembers should cover or close one eye because dark adaptation occurs
independently in each eye. Depth perception is severely degraded or lost, however, if both eyes are
exposed to a light source since neither remains completely dark adapted.

NIGHT VISION TECHNIQUES

8-46. The human eye functions less efficiently at reduced ambient light levels. This reduction limits a
crewmember’s visual acuity. Normal color vision decreases and finally disappears as the cones become
inactive and the rods begin to function. Tower beacons, runway lights, and other colored lights still can be
identified if the light is of sufficient intensity to activate the cones. Normal central daylight vision also

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decreases due to the night blind spot that develops in low illumination or dark viewing conditions.
Therefore, proper techniques for night vision viewing must be used to overcome reduced visual acuity at
lower light levels.

OFF-CENTER VISION
8-47. There are no limitations to viewing an object with central vision during daylight. If this same
technique is used at night, however, the viewer might not see the object due to the night blind spot that
exists under low light illumination. To compensate for this limitation, crewmembers must use the off-
center vision technique (figure 8-12). This technique requires crewmembers to view an object by looking
10 degrees above, below, or to either side rather than directly at the object. The eyes maintain visual
contact with the object via peripheral vision.

Figure 8-12. Off-center vision technique

8-48. Rapid head or eye movement and fixation decrease the integrating capability of dark-adapted eyes. A
steady fixation lasting .5 second to 1 second achieves maximum sensitivity.
8-49. Objects viewed longer than 2 to 3 seconds tend to bleach out and become one solid, invisible tone,
resulting in a potentially unsafe operating condition. Crewmembers must be aware of this phenomenon and
avoid viewing objects longer than 2 to 3 seconds. By shifting their eyes from one off-center point to
another, crewmembers can continue to see objects in their peripheral field of vision.

SCANNING
8-50. During daylight, objects can be perceived at great distances with good detail. At night, however,
range is limited and detail is poor. Objects along the flight path can be more readily identified at night
when crewmembers use proper techniques to scan the terrain. Effective scanning requires crewmembers to
look from right to left or left to right. They should begin scanning at the greatest distance at which an
object can be perceived (top) and move inward toward the aircraft’s position (bottom). Figure 8-13 (page
8-13) illustrates this scanning pattern.

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 Vision

Figure 8-13. Right-to-left or left-to-right scanning pattern

8-51. The retina’s light-sensitive elements are unable to perceive images in motion, so crewmembers
should use a stop-turn-stop-turn scanning pattern to compensate. For each stop, crewmembers should scan
an area about 30 degrees wide, to include an area about 250 meters wide at a distance of 500 meters. Each
stop’s duration is based on the degree of detail required, but no stop should last more than 2 to 3 seconds.
When moving from one viewing point to the next, crewmembers should overlap the previous field of view
by 10 degrees. This scanning technique allows greater clarity in observing the periphery. Other scanning
techniques, as illustrated in figure 8-14, may be developed to fit the situation.

Figure 8-14. Stop-turn-stop-turn scanning pattern

SHAPES OR SILHOUETTES
8-52. Since visual acuity is reduced at night, objects must be identified by their shapes or silhouettes.
Therefore, crewmembers must be familiar with the architectural design of structures in the area covered by
the mission. A building silhouette with a high roof and steeple is easily recognized as a church in the
United States. However, religious buildings in other parts of the world might have low-pitched roofs with
no distinguishing features, including cylinder-shaped structures. For example, minarets attached to
mosques or religious temples are similar in shape to barn silos in the United States. Features depicted on
maps assist crewmembers in recognizing silhouettes.

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DISTANCE ESTIMATION AND DEPTH PERCEPTION

8-53. Distance estimation and depth perception cues are easy to recognize when crewmembers use central
vision under good illumination. As light levels decrease, however, the ability to accurately judge distance
degrades and the eyes become vulnerable to illusions. Crewmembers can better judge distance at night if
they understand the mechanisms of distance estimation and depth perception cues. Distance can be
estimated using individual cues or a variety of cues. Crewmembers usually use subconscious factors to
determine distance. They can more accurately estimate distance if they understand these factors and learn
to look for or be aware of other distance cues. Distance estimation and depth perception cues can be
binocular or monocular.

BINOCULAR CUES
8-54. Binocular cues depend on the slightly different view each eye has of an object. Thus, binocular
perception is of value only when the object is close enough to make a perceptible difference in the viewing
angle of both eyes. However, since most distances outside the cockpit are so great, binocular cues are of
little to no value to crewmembers. Binocular cues also operate on a more subconscious level than
monocular cues and are not greatly improved through study and training. Therefore, these cues are not
covered further in this publication.

MONOCULAR CUES
8-55. Several monocular cues assist crewmembers with distance estimation and depth perception. These
cues are geometric perspective, retinal image size, aerial perspective, and motion parallax and can be
remembered by the mnemonic acronym GRAM.

Geometric Perspective
8-56. An object appears to have a different shape when it is viewed at varying distances and from different
angles. As illustrated in figure 8-15, the types of geometric perspective include linear perspective (A),
apparent foreshortening (B), and vertical position in the field (C) and can be remembered by the mnemonic
acronym LAV.

Figure 8-15. Geometric perspective

Linear Perspective
8-57. Parallel lines such as railroad tracks tend to converge as distance from the observer increases, as
illustrated in part A of figure 8-15.

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 Vision

Apparent Foreshortening
8-58. The shape of an object or terrain feature appears elliptical (oval and narrow) when viewed from a
distance at both higher and lower altitudes. As the distance to the object or terrain feature decreases, the
apparent perspective changes to its true shape or form. When flying at lower altitudes and at greater
distances, crewmembers might not see objects clearly. If the mission permits, pilots should gain altitude
and decrease distance from the viewing area to compensate for this perspective. Once altitude increases
and distance between the aircraft and viewing area decreases, the viewing field widens and enlarges so
objects become apparent. Part B of figure 8-15 illustrates how the shape of a body of water changes when
viewed at different distances while the aircraft maintains the same altitude.

Vertical Position in the Field

8-59. Objects or terrain features at greater distances from the observer appear higher on the horizon than
those closer to the observer. In part C of figure 8-15, the higher vehicle appears closer to the top and at a
greater distance from the observer. Before flight, crewmembers should already be familiar with the actual
sizes, heights, and altitudes of known objects or terrain features within and around the planned flight route.
If the situation and time permit, crewmembers can reference published information to verify actual sizes
and heights of objects and terrain features within their flight path. In addition, crewmembers should cross-
reference the aircraft altitude indicator to confirm actual aircraft altitude is adequate to safely negotiate the
object or terrain feature without prematurely changing aircraft heading, altitude, attitude, or a combination
thereof.

Retinal Image Size

8-60. Retinal image size is used in distance estimation. An image focused on the retina is perceived by the
brain to be of a given size. The factors that aid in determining distance using the retinal image are known
size of objects, increasing and decreasing size of objects, terrestrial association, and overlapping contours
or interposition of objects. These factors can be remembered by the mnemonic acronym KITO.

Known Size of Objects

8-61. The nearer an object is to the observer, the larger its retinal image. By experience, the brain learns to
estimate the distance of familiar objects by the size of their retinal image. Figure 8-16 shows how this
method works. A structure projects a specific angle on the retina based on its distance from the observer. If
the angle is small, the observer judges the structure to be a great distance away, while a larger angle
indicates the structure is close. To use this cue, the observer must know the object’s actual size and have
prior visual experience with it. If no experience exists, the observer determines the distance to an object
primarily by motion parallax (discussed in paragraph 8-69 below).

Figure 8-16. Known size of objects

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Chapter 8

Increasing or Decreasing Size of Objects

8-62. If the retinal image of an object increases in size, the object is moving closer to the observer. If the
retinal image decreases, the object is moving further away. If the retinal image is constant, the object is at a
fixed distance.

Terrestrial Association
8-63. Comparison of one object such as an airfield with another object of known size such as a helicopter
helps in determining the relative size and apparent distance of the object from the observer. Figure 8-17
shows that objects ordinarily associated together are judged to be at about the same distance. For example,
a helicopter observed near an airport is judged to be in the traffic pattern and, therefore, at about the same
distance as the airfield.

Figure 8-17. Terrestrial association

Overlapping Contours or Interposition of Objects

8-64. When objects overlap, the overlapped object is further away. For example, an object partially
concealed by another object is behind the object concealing it. Crewmembers must be especially conscious
of this cue when making an approach for landing at night. Lights disappearing or flickering in the landing
area should be treated as barriers and the flight path adjusted accordingly. Figure 8-18 illustrates
overlapping contour.

Figure 8-18. Overlapping contour

Aerial Perspective
8-65. An object’s clarity and its shadow are perceived by the brain and cues for estimating distance.
Crewmembers must use the factors discussed below to determine distance with aerial perspective.

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 Vision

Fading of Colors or Shades

8-66. An object viewed through haze, fog, or smoke appears less distinct and at a greater distance than it
actually is. Conversely, if atmospheric transmission of light is unrestricted, the object appears more distinct
and closer than it actually is. For example, the cargo helicopter in figure 8-19 is larger than the observation
helicopter but, due to the difference in viewing distance and size, they both project the same angle on the
observer’s retina. Assuming the observer has no previous experience with either aircraft’s appearance, this
cue causes both helicopters to appear the same size. However, if the observer knows the cargo helicopter is
the larger aircraft but sees it less distinctly because of visibility restrictions, he or she will judge it to be
further away and larger than the observation helicopter. Another example: crewmembers might not be able
to distinguish green and red anticollision lights nor the actual interval between aircraft when an additional
aircraft is operating at a distance. Both lights can appear white and even blend in with the surrounding
foreground.

Figure 8-19. Fading of colors or shades

Loss of Detail or Texture

8-67. The further an observer is from an object, the less apparent discrete details become. For example, at
a distance a cornfield appears to be a solid color, tree leaves and branches appear to be a solid mass, and
objects appear to be at a great distance. When an aircraft is operating on the ground, crewmembers can see
the grass or gravel immediately below, in front of, and alongside the aircraft. If they maintain that view as
the aircraft slowly ascends, the crewmembers will notice the clarity and detail of the surface fades and
eventually blends in with the terrain as a whole, making identification of individual blades or stones
impossible. Environmental factors increase the effects of degraded texture and detail throughout the visual
field, an issue that severely decreases depth perception. This issue is a contributing factor to crewmember
misjudgments of what they do or do not see and the occurrence of incidents related to those misjudgments.

Position of Light Source and Direction of Shadow

8-68. Every object casts a shadow in the presence of a light source. The direction in which the shadow is
cast depends on the position of the light source. If an object’s shadow is cast toward an observer, the object
is closer to the observer than the light source. Figure 8-20 (page 8-18) illustrates how light and shadow
help determine distance.

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Chapter 8

Figure 8-20. Position of light source and direction of shadow

Motion Parallax
8-69. Motion parallax is often considered the most important depth perception cue. Motion parallax refers
to the apparent relative motion of stationary objects as viewed by an observer moving across the landscape.
Near objects appear to move past or opposite the path of motion; far objects appear to move in the
direction of motion or remain fixed. The rate of apparent movement depends on the distance the observer is
from the object. Objects near an aircraft appear to move rapidly, while distant objects appear to be almost
stationary. Thus, objects that appear to be moving rapidly are judged to be nearby while those moving
slowly are judged to be at a greater distance. Motion parallax can be apparent during flight. One example is
an aircraft flying at 5,000 feet above ground level. At this altitude distant terrain appears stationary, while
the terrain immediately below and to either side of the aircraft appears to be moving slowly (depending on
forward airspeed). The opposite is true when an aircraft descends to 80 feet above highest obstacle with a
forward airspeed of 120 knots. Terrain and objects in the horizon appear to move at a faster rate, while the
terrain and objects underneath and to either side of the aircraft appear to pass at a high rate of speed.

VISUAL ILLUSIONS
8-70. The probability of SD increases as visual information decreases. Reduced visual references create
several illusions that can cause SD. Chapter 9 discusses these illusions in more detail.

METEOROLOGICAL CONDITIONS AND NIGHT VISION

8-71. Although a mission might begin with clear skies and unrestricted visibility, meteorological
conditions can deteriorate rapidly during flight. Clouds can appear gradually and, due to reduced visibility
at night, easily go undetected by crewmembers. Aircraft can enter clouds inadvertently and without
warning. Fog and haze can be encountered at low altitudes. Visibility can deteriorate gradually or
suddenly. It is difficult to detect adverse weather at night, and crewmembers must constantly be aware of
changing weather conditions. The following paragraphs discuss adverse weather indicators crews might
encounter at night.
8-72. Ambient light levels gradually decrease as cloud coverage increases, causing a loss of visual acuity
and terrain contrast even to the point of complete obscurity. Should this condition occur, pilots must
initiate inadvertent instrument meteorological conditions (IMC) procedures. Crewmembers also must
follow local standing operating procedures and command directives. Inadvertent IMC at night is one of the
leading causes of Class A aviation mishaps.

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 Vision

8-73. Clouds are present if the moon and stars are not visible. The less visible the moon and stars, the
heavier the cloud coverage.
8-74. Clouds obscuring moon illumination create shadows. Crewmembers can detect these shadows by
observing the varying levels of ambient light along the flight route.
8-75. The halo effect observed around ground lights indicates the presence of moisture and possible
ground fog. As fog and moisture increase, the intensity of these lights decrease. This same effect is
apparent during flight. As moisture increases, light emitted from the aircraft is reflected back on the
aircraft. This reflection makes it possible for crewmembers to misjudge critical factors such as the layout
and height of terrain features and manmade structures, as well as actual position, heading, and altitude of
other aircraft.
8-76. The presence of fog over water indicates the temperature and dew point are equal and that fog might
soon form over ground areas.

SECTION VI – SELF-IMPOSED STRESS AND VISION

8-77. Crewmembers experience stressors such as altitude during flight. These stressors might not be
controllable and can affect mission performance. Crewmembers also must cope with self-imposed stress
but, unlike aviation stress, this type can be controlled. Factors leading to self-imposed stress include drugs,
exhaustion, alcohol, tobacco, and hypoglycemia/nutritional deficiency. These factors (figure 8-21) can be
remembered by the mnemonic acronym DEATH (more information can be found in AR 40-8).

Figure 8-21. Self-imposed stress factors

DRUGS
8-78. Adverse side effects associated with drug use are illness and decreases in motor skill function,
awareness level, and reaction time. Crewmembers who become ill should consult their flight surgeon and
avoid self-medicating, which is unauthorized for flight personnel. AR 40-8 contains restrictions on drug
use while on flight status.

EXHAUSTION
8-79. A combination of multiple factors causes exhaustion; it rarely stems from one factor alone.
Contributing factors include poor diet habits and dehydration; poor sleep patterns and lack of rest; poor
physical condition and inadequate exercise; various environmental factors; and combat stress. Common
side effects of exhaustion include altered levels of concentration, awareness, and attentiveness; increased
drowsiness (nodding off or falling asleep); and ineffective night-vision viewing techniques (staring rather
than scanning).
8-80. Exhaustion reduces mental alertness and causes crewmembers to respond more slowly to situations
that require immediate reaction. Exhausted crewmembers tend to concentrate on one aspect of a situation
rather than consider the total environment. They also are prone to staring instead of practicing proper
scanning techniques, a mistake that can cause incidents.

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8-81. Good physical conditioning should decrease fatigue and improve night scanning efficiency.
However, excessive exercise in a given day can lead to increased fatigue. Night flight is more stressful than
day flight, and crewmembers must follow prescribed crew rest policies.

ALCOHOL
8-82. Alcohol impairs a person’s judgment and causes him or her to become uncoordinated. It also hinders
a crewmember’s ability to view properly. Crewmembers under the influence of alcohol are more likely to
stare at objects and neglect proper scanning techniques, particularly at night. The effects of alcohol are
long lasting, as evidenced by the body’s physiological response to a hangover.
8-83. Alcohol causes histotoxic hypoxia, a poisoning of the bloodstream that interferes with oxygen use by
body tissues. At sea level, every ounce of alcohol in the bloodstream increases the body’s physiological
altitude. For example, 1 ounce of alcohol in an individual’s bloodstream at sea level has an equivalent
physiological altitude of 2,000 feet. An individual who consumes 3 ounces of alcohol at sea level and is
then placed at 4,000 feet has an equivalent physiological altitude of 10,000 feet. Hypoxic hypoxia
combines with histotoxic hypoxia at these higher altitudes, and the individual’s time of useful
consciousness is severely diminished. If a flight lasts longer than 60 minutes, the individual can become
unconscious or even die from a lack of oxygen (see paragraph 8-7, AR 95-1).
8-84. Guidance for performing or resuming crewmember duties after alcohol consumption is 12 hours
after the last drink with no residual physiological effects present. Crewmember duties consist of preflight
and postflight actions including maintenance and are not limited to actual aircraft operation or flight.
Detrimental effects associated with alcohol consumption include poor judgment, decision making,
perception, reaction time, coordination, and scanning techniques (staring).

TOBACCO
8-85. Of all self-imposed stressors, cigarette smoking most impairs visual sensitivity at night. Hemoglobin
in the red blood cells has a 200 to 300 times greater affinity for carbon monoxide than oxygen, meaning it
accepts carbon monoxide far more rapidly than oxygen. When an individual exhales, the process of
pulmonary perfusion (gas exchange within the lungs) releases carbon dioxide from the bloodstream. When
an individual inhales, oxygen is usually absorbed into blood through hemoglobin in the red blood cells.
These processes maintain normal levels of oxygen and other gases within the bloodstream.
8-86. Smoking increases carbon monoxide, which in turn reduces blood’s capacity to carry oxygen.
Hypemic hypoxia, a condition that negatively affects an individual’s peripheral vision and dark adaptation,
results from this increase in carbon monoxide. For example, if an individual smokes three cigarettes in
rapid succession or 20 to 40 cigarettes within a 24-hour period, blood carbon monoxide content increases
by 8 to 10 percent. The resulting physiological effects at sea level are the same as flying at 5,000 feet but,
more importantly, the individual loses about 20 percent of his or her night vision capability. Table 8-1
compares night vision reduction rates at varying altitudes for smokers and nonsmokers.

Table 8-1. Night vision reduction rates for

smokers and nonsmokers

Altitude (feet) Nonsmoker (%) Smoker (%)

4,000 Sea level 20
6,000 5 25
10,000 20 40
14,000 35 55
16,000 40 50

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 Vision

HYPOGLYCEMIA AND NUTRITIONAL DEFICIENCY

8-87. Aviation personnel must not skip or postpone meals and should avoid supplementing primary meals
with fast sugars such as sodas and candy bars. These foods and beverages can cause hypoglycemia, a
condition that results in hunger pangs, distraction, habit pattern breakdown, shortened attention span, and
other physiological changes. Supplementing meals with fast sugars sustains an individual for 30 to 45
minutes on average, followed by an increase in the intensity of negative effects. Hypoglycemia is not the
only adverse effect of an improper diet; a diet deficient in vitamin A can impair night vision. Vitamin A is
an essential element in the buildup of rhodopsin (visual purple), which stimulates rod cells. Nigh vision is
severely degraded without this buildup. A balanced diet that includes foods such as eggs, butter, cheese,
liver, carrots, and most green vegetables provides adequate vitamin A intake and helps maintain visual
acuity. Crewmembers must consult a flight surgeon before consuming vitamin A supplements not organic
to these foods.

SECTION VII – OTHER VISION CONSIDERATIONS

NERVE AGENTS AND NIGHT VISION

8-88. Night vision is adversely affected by minute amounts of nerve agents. When direct contact occurs,
the pupils constrict and do not dilate in low ambient light, resulting in a condition known as miosis.
Currently available automatic chemical alarms are not sensitive enough to detect low agent concentrations.
8-89. The exposure time required to cause miosis depends on agent concentration. Miosis can occur
gradually as the eyes are exposed to low concentrations over a long period. However, exposure to high
concentrations can cause miosis in the few seconds it takes to put on a protective mask. Repeated exposure
over a period of days is cumulative.
8-90. Symptoms of miosis range from minimal to severe, depending on dosage to the eye. Severe miosis,
which is characterized by a reduced ability to see in low ambient light, persists about 48 hours after onset.
The pupil gradually returns to normal over several days, but full recovery can take up to 20 days. Repeated
exposure within the affected time is cumulative.
8-91. The onset of miosis is insidious since it is not always immediately painful. Miotic Soldiers might not
recognize their condition even as they carry out tasks requiring vision in low ambient light. After a nerve
agent attack (especially with the more persistent types), commanders should assume some night vision loss
has occurred among personnel otherwise fit for duty and consider grounding crewmembers until they fully
recover. All exposed crewmembers and maintenance personnel must consult their flight surgeon and local
medical personnel immediately after exposure.

FLIGHT HAZARDS
8-92. Solar glare, bird strikes, nuclear flash, and lasers are possible hazards crewmembers might encounter
during low-level flight.

SOLAR GLARE
8-93. Glare from direct, reflected, and scattered sunlight causes discomfort and reduces visual acuity. To
reduce or eliminate discomfort, all crewmembers should use their helmets’ tinted visor or wear ND-15
sunglasses with the clear visor. Day blindness can occur in areas with extreme solar glare such as snowy
terrain, bodies of water, or desert environments.

BIRD STRIKES
8-94. Bird strikes can occur anytime, day or night, during low-level flight. Cockpit windshields are
designed to withstand impacts but the potential for shattering exists. According to the Federal Aviation
Administration, if an aircraft traveling at an airspeed equivalent to a 120-mile per hour ground speed
strikes a 2-pound seagull, the force exerted would be equal to 4,800 pounds (some antiaircraft rounds exert

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Chapter 8

less force). Therefore, if the viewing environment permits, crewmembers should wear or lower the clear
visor for night flights and tinted visor for day flights. These visors also protect the eyes from glass
fragments should the windshield shatter.

NUCLEAR FLASH
8-95. A fireball from a nuclear explosion can cause flash blindness and retinal burns. By day, the optical
blink reflex should prevent retinal burns from distances where survival is possible. When the pupil is
dilated at night, however, retinal burns are possible and indirect flash blindness can deprive crewmembers
of all useful vision for periods exceeding 1 minute. No practical protection against nuclear flash has been
developed.

LASERS
8-96. Mobile military lasers currently work by converting electrical and chemical energy into light. This
light can be either continuously emitted or collected over time and suddenly released. A laser is light
amplified by a stimulated emission of radiation through one prism or a series of multiple prisms, which
increases light frequency and intensity. The beam of light produced is usually less than 1 inch in diameter
and might or might not be visible to the naked eye (ultraviolet, infrared, and thermal lasers).
8-97. Laser range finders and target designators (except thermal infrared lasers) operate by accumulating
and suddenly releasing light energy in the form of a crystal rod about the size of a cigarette. The laser pulse
is controlled by an electrical signal that turns the laser on and off. Laser pulses travel at the speed of
light—300,000 kilometers per second. When a laser emits light during a pulse, the power output averages
about 3 megawatts (3 million watts) along a narrow beam. About 90 percent of emitted energy is contained
in this beam. This characteristic makes lasers useful as range finders and target designators but renders
them dangerous to human eyes.
8-98. Lasers can damage eyes from a considerable distance, although a beam’s energy level decreases as
its diameter widens with increasing distance. Therefore, distance is the best protection against lasers. If
distance is not possible, protective ballistic and laser protective eyewear goggles or visors might offer
limited protection. Ballistic limit protections (BLPs) are specific to laser frequency. Crewmembers must
identify the type of laser frequency threats they might encounter to ensure they receive the correct BLP
eyewear from the unit aviation life support equipment technician.
8-99. Smoke, fog, and dust weaken laser light, but even in these conditions lasers present a real danger to
crewmembers. A useful rule is if a target can be seen through smoke, laser energy can hit the target and
also strike the eyes. In daylight, even visual-light lasers are virtually invisible unless there is smoke, mist,
or fog in the air.
8-100. The four major classes of directed-energy laser systems are high-energy lasers, low-energy lasers,
radio-frequency lasers, and particle-beam lasers.

Class 1 (Low Energy)

8-101. Class 1 laser devices do not emit hazardous laser radiation in any operating or viewing condition.
Class 1 lasers include fully enclosed lasers such as the PAQ-4A/B/C infrared aiming light and many laser
marksmanship trainers.

Class 2 (Low-to-Medium Energy)

8-102. Class 2 laser devices usually include continuous-wave visible laser devices. Crewmembers must
take precautions to prevent staring into the direct beams of these devices. Momentary exposure (greater
than 0.25 second) is not considered hazardous; for example, current laser pointers, construction lasers, and
alignment lasers.

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Class 3a (Medium Energy)

8-103. Class 3a lasers generally are not hazardous unless crewmembers view them with magnifying
optics from within the beam. Class 3a lasers include visible and invisible frequency lasers such as the
miniature eye-safe laser infrared observation set (MELIOS).

Class 3b (Medium-to-High Energy)

8-104. Class 3b lasers are potentially hazardous if a direct or specularly reflected beam is viewed by
unprotected eyes. Care must be taken to prevent intrabeam (within the beam) viewing and control specular
reflections from surfaces such as mirrors and still water. Class 3b lasers include many rangefinders and the
AIM-1, GCP-1, and AN/PEQ-2A laser pointers.

Class 4 (High Energy)

8-105. Class 4 lasers are pulsed, visible, near-infrared lasers that produce diffuse reflections, fire, and
skin and eye hazards, with the eyes being especially vulnerable. These lasers have an average output of 500
milliwatts or greater. Safety precautions generally consist of using door interlocks to protect personnel
entering a laser facility from exposure, baffles to terminate primary and secondary beams, and use of
protective eyewear and clothing. Crewmembers inadvertently or suddenly exposed to these lasers will
receive serious retinal burns within tenths of a second if their eyes are unprotected. During peacetime
military operations, these lasers typically are operated only on cleared, approved laser ranges or while
personnel are using appropriate eye and skin protection. Actual enemy forces, however, might intentionally
expose crewmembers to deplete their fighting capability. Class 4 lasers include industrial welders and
target designator lasers.

PROTECTIVE MEASURES
BUILT-IN PROTECTIVE MEASURES
8-106. Filters constructed of glass or plastic can stop laser light. These filters absorb or reflect light of a
given color or wavelength. Sunglasses are specially created to filter visual light, but an infrared or
ultraviolet laser will penetrate the lenses and damage the eyes. The Army currently provides protective
eyewear such as ballistic-laser protective spectacles (B-LPS) that help prevent eye injuries from certain
types of lasers.
8-107. Crewmembers can take active and passive protective measures to protect themselves from laser
injury. Passive protective measures include—
z Taking cover.
z Getting out of the laser’s path.
z Using available protective gear.
z Keeping all exposed skin covered to prevent burns.
8-108. Active protective measures include—
z Using countermeasures as taught or directed by the unit commander.
z Applying evasive action.
z Scanning the battlefield with one eye or monocular optics.
z Minimizing the use of binoculars in areas where lasers could be in use.
8-109. If actively engaged by lasers, crewmembers should deploy smoke and use hardened optical
systems and built-in or clip-on filters such as the B-LPS. FM 8-50 contains information regarding laser
injury prevention and medical management.

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 Chapter 9
Spatial Disorientation

SD is a contributing factor in more aircraft accidents than any other physiological

problem in flight. Regardless of their flight experience, all crewmembers are subject
to disorientation. The human body is structured to perceive changes in movement on
land in relation to the Earth’s surface. In aircraft, the visual, vestibular, and
proprioceptive sensory systems can provide the brain erroneous orientation
information. This misinformation can cause sensory illusions that lead to SD.

COMMON TERMS OF SPATIAL DISORIENTATION

SPATIAL DISORIENTATION
Contents
9-1. SD is an individual’s inability to determine
his or her position, attitude, and motion relative to Common Terms of Spatial
the Earth’s surface. When SD occurs, pilots are Disorientation ............................................ 9-1
unable to see, believe, interpret, or prove Types of Spatial Disorientation ................ 9-1
information derived from their flight instruments. Equilibrium Maintenance .......................... 9-2
They instead rely on false information provided by Semicircular Canals .................................. 9-5
their senses. Proprioceptive System .............................. 9-7
Visual Illusions .......................................... 9-7
SENSORY ILLUSION Vestibular Illusions.................................. 9-12
Proprioceptive Illusions .......................... 9-16
9-2. A sensory illusion is a false perception of
reality caused by the conflict of orientation Prevention of Spatial Disorientation ...... 9-16
information derived from one or more equilibrium Treatment of Spatial Disorientation ....... 9-17
mechanisms. Sensory illusions are a major cause of
SD.

TYPES OF SPATIAL DISORIENTATION

TYPE I (UNRECOGNIZED)
9-3. In type I SD, an aviator does not perceive any indication of SD or think anything is wrong. What the
aviator sees—or thinks he or she sees—is corroborated by other senses. The pilot might see the instruments
functioning properly and have no suspicion of instrument malfunction. Likewise, the aircraft might be
performing normally with no indication of aircraft control malfunction. Unaware of a problem, the pilot
fails to recognize or correct the SD, a mistake that usually results in a fatal aircraft mishap. Type I SD is
the most dangerous type of disorientation. An example is the height/depth perception illusion, where a pilot
descends into the ground or some obstacle above the ground due to a lack of situational awareness.

TYPE II (RECOGNIZED)
9-4. In type II SD, the pilot perceives a problem resulting from SD but might not recognize it as SD. The
pilot might feel a control is malfunctioning or perceive an instrument failure as in the graveyard spiral, a
classic example of type II SD. The pilot will not correct aircraft roll as indicated by the attitude indicator
because his or her vestibular indications of straight-and-level flight are so strong.

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Chapter 9

TYPE III (INCAPACITATING)

9-5. In type III SD, the pilot experiences such an overwhelming sensation of movement that he or she
cannot orient using visual cues or the aircraft instruments. Type III SD is not fatal if the copilot can gain
control of the aircraft.

EQUILIBRIUM MAINTENANCE
9-6. The visual, vestibular, and proprioceptive sensory systems (figure 9-1) are especially important in
maintaining equilibrium and balance. The combined functioning of these senses usually maintains
equilibrium and prevents SD. The visual system is the most reliable of the three systems during flight. The
vestibular and proprioceptive systems are unreliable in flight without the visual system.

Figure 9-1. The three equilibrium systems

VISUAL SYSTEM
9-7. Of the three sensory systems, the visual system is the most important in maintaining equilibrium and
orientation. To some extent, the eyes can help determine the speed and direction of flight by comparing
aircraft position relative to some fixed reference point. The visual system provides 80 percent of
orientation in humans (chapter 8 contains more information about the eyes).
9-8. Under IMC, crewmembers lose fixed reference points outside the aircraft and the pilot must rely on
visual sensory input from the instruments for spatial orientation. Relying on the visual sense and believing
the instruments rather than the input of the other senses requires disciplined training.
9-9. The eyes allow the pilot to scan sensitive flight instruments that provide accurate spatial orientation
information. These instruments indicate unusual aircraft attitudes resulting from turbulence, distraction,
inattention, mechanical failure, or SD.

VESTIBULAR SYSTEM
9-10. The vestibular system is located within the inner ear, which contains the sense organs that detect
motion and gravity. This system is located in the temporal bone on each side of the head. Each vestibular
apparatus consists of two distinct structures, the semicircular canals and vestibule proper, which contains
the otolith organs. Both the semicircular canals and otolith organs sense changes in aircraft attitude. The

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 Spatial Disorientation

semicircular canals also sense changes in angular acceleration and deceleration. Figure 9-2 depicts the
vestibular system.

Figure 9-2. Vestibular system

Otolith Organs
9-11. The otolith organs are small sacs located in the vestibule. Sensory hairs project from each macula
into the otolithic membrane, an overlying, gelatinous membrane that contains chalklike crystals called
otoliths. The otolith organs (figure 9-3) respond to gravity and linear acceleration and deceleration.
Changes in head position relative to gravitational force cause the otolithic membrane to shift position on
the macula. The sensory hairs then bend, signaling a change in head position.

Figure 9-3. Otolith organs

9-12. When the head is upright, the hair cells generate a “resting” frequency of nerve impulses (figure 9-4,
page 9-4).

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Chapter 9

Figure 9-4. Position of hair cells when head is upright

9-13. The resting frequency is altered when the head is tilted, and the brain is informed of the new
position. The position of the hair cells when the head is tilted forward and backward is illustrated in figure
9-5.

Figure 9-5. Position of hair cells when head is tilted forward and backward

9-14. Linear acceleration and deceleration stimulates the otolith organs. The body cannot physically
distinguish between the inertial forces resulting from linear acceleration and the force of gravity. Forward
acceleration results in backward displacement of the otolithic membrane. When an adequate visual
reference is not available, crewmembers might experience a false sensation of backward tilt (figure 9-6,
page 9-5).

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 Spatial Disorientation

Figure 9-6. False sensation of backward tilt

SEMICIRCULAR CANALS
9-15. The semicircular canals sense changes in angular acceleration and react to any changes in roll, pitch,
or yaw attitude. Figure 9-7 shows where these changes are registered in the semicircular canals.

Figure 9-7. Reactions of semicircular canals to changes in angular acceleration

9-16. The semicircular canals are situated in three planes perpendicular to each other and filled with a fluid
called endolymph. The inertial torque resulting from angular acceleration in the canal plane puts this fluid
into motion. This motion bends the cupula, a gelatinous structure located in the ampulla of the canal. This
bending then moves the hair cells situated beneath the cupula, stimulating the vestibular nerve. These nerve
impulses are then transmitted to the brain, where they are interpreted as rotation of the head. Figure 9-8
(page 9-6) shows a cutaway section of the semicircular canal.

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Chapter 9

Figure 9-8. Cutaway view of the semicircular canal

9-17. When no acceleration takes place, the hair cells are upright. The body senses that no turn has
occurred. The position of the hair cells and the actual sensation correspond, as shown in figure 9-9.

Figure 9-9. Position of hair cells during no acceleration

9-18. When the semicircular canal is stimulated during clockwise acceleration, fluid within it lags behind
the accelerated canal walls. The lag creates a relative counterclockwise movement of this fluid. The canal
wall and cupula move in the direction opposite the fluid motion. The brain interprets movement of the hairs
to be a turn in the same direction as the canal wall, and the body correctly senses a clockwise turn is being
made. Figure 9-10 shows the position of the hair cells and resulting true sensation during a clockwise turn.

Figure 9-10. Sensation during a clockwise turn

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9-19. If a clockwise turn continues at a constant rate for several seconds or longer, the motion of the fluid
within the canals catches up with the canal walls. At this point the hairs are no longer bent, and the brain
receives the false impression that turning has stopped. A prolonged constant turn in either direction results
in a false sensation of no turn. The position of the hair cells and resulting false sensation during a
prolonged clockwise turn is shown in figure 9-11.

Figure 9-11. Sensation during a prolonged clockwise turn

9-20. When the aircraft’s clockwise rotation slows or stops, fluid within the canal moves briefly in a
clockwise direction. This movement sends a signal to the brain that is falsely interpreted as body
movement in the opposite direction. In an attempt to correct the falsely perceived counterclockwise turn,
the pilot might turn the aircraft in the original clockwise direction. Figure 9-12 shows the position of the
hair cells and resulting false sensation when a clockwise turn slows or stops.

Figure 9-12. Sensation during slowing or stopping of a clockwise turn

PROPRIOCEPTIVE SYSTEM
9-21. The proprioceptive system reacts to sensations resulting from pressure on sensors in the joints,
muscles, and skin and from slight changes in the position of internal organs. The proprioceptive system is
closely associated with the vestibular system and, to a lesser degree, the visual system.
9-22. Forces act upon seated pilots in flight. With training and experience, pilots can easily distinguish the
most discrete aircraft movements by gauging the pressure of the seat against their bodies. Recognition of
these movements led to the term “seat of the pants” flying.

VISUAL ILLUSIONS
9-23. Visual illusions give false impressions or misconceptions of actual conditions. Therefore,
crewmembers must understand the types of illusions that can occur and disorientation resulting from each.

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9-24. Although the visual system is the most reliable of the senses, some illusions can result from
misinterpreting what is seen; what is perceived is not always accurate. Even with references outside the
cockpit and instrument displays inside, crewmembers must be vigilant to interpret information correctly.

RELATIVE MOTION ILLUSION

9-25. Relative motion is falsely perceived self-motion in relation to another object’s motion. The most
common example is when an individual in a car is stopped at a traffic light and another car pulls alongside.
The individual stopped at the light perceives the second car’s forward motion as his or her own rearward
motion, resulting in the individual applying more pressure to the brakes than necessary. This illusion can
be encountered during flight in situations such as formation flight, hover taxi, or hovering over water or tall
grass.

CONFUSION WITH GROUND LIGHTS

9-26. Confusion with ground lights occurs when a pilot mistakes ground lights for celestial lights. The
illusion prompts the pilot to place the aircraft in an unusual attitude to keep the misperceived ground lights
above the aircraft. Isolated ground lights can appear as celestial lights, which could lead to the illusion the
aircraft is in a nose-high or one-wing-low attitude (part A, figure 9-13). When no celestial lights are visible
because of overcast conditions, unlighted terrain can blend with the dark overcast to create the illusion the
unlighted terrain is part of the sky (part B, figure 9-13). This illusion can be avoided by referencing the
flight instruments and establishing true horizon and attitude.

Figure 9-13. Confusion of ground lights and stars at night

FALSE HORIZON ILLUSION

9-27. False horizon illusions (figure 9-14, page 9-9) occur when a pilot confuses cloud formations with the
horizon or ground. A sloping cloud deck can be difficult to perceive as anything but horizontal if it extends
any great distance in the pilot’s peripheral vision. The pilot might perceive the cloudbank to be horizontal
even if it is not horizontal to the ground, causing he or she to fly the aircraft in a banked attitude. This
condition is often insidious and goes undetected until the pilot recognizes it, transitions to instruments, and
makes necessary corrections. This illusion also might occur if the pilot looks outside after having given
prolonged attention to a task inside the cockpit. Confusion can result in the pilot placing the aircraft
parallel to the cloudbank.

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Figure 9-14. False horizon illusion

HEIGHT-DEPTH PERCEPTION ILLUSION

9-28. Height-depth perception illusions are due to a lack of sufficient visual cues and causes crewmembers
to lose their depth perception. Flying over areas devoid of visual references such as desert, snow, or water
deprives crewmembers their perception of height. Misjudging the aircraft’s true altitude, the pilot might fly
the aircraft dangerously low to the ground or other obstacles above the ground. Flight in an area where
visibility is restricted by fog, smoke, whiteout, brownout, or haze can produce the same illusion.

CRATER ILLUSION
9-29. Crater illusions occur when crewmembers land at night under night vision device (NVD) conditions
and the infrared searchlight is directed too far under the aircraft’s nose. This combination creates the
illusion of landing with upsloping terrain in all directions or landing in a crater. This illusionary depression
lulls the pilot into continually lowering the collective and could result in the aircraft prematurely impacting
the ground, causing damage to both aircraft and crew. If observing another aircraft during hover taxi, the
pilot might perceive the crater is moving with the aircraft being observed.

STRUCTURAL ILLUSION
9-30. Structural illusions are caused by the effects of rain, snow, sleet, heat waves, or other visual
obscurants. A straight line can appear curved when viewed through heat waves in the desert. A single
wingtip light might appear as a double light or in a different location when viewed through rain. Curvature
of the aircraft windscreen also can cause structural illusions due to the refraction of light rays as they pass
through the windscreen (figure 9-15, page 9-10). Pilots must remain aware of the potential for false
perceptions when operating in environments containing these obscurants.

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Figure 9-15. Structural illusion

SIZE-DISTANCE ILLUSION
9-31. Size-distance illusions (figure 9-16) are false perceptions of distance from an object or the ground,
created when a crewmember misinterprets an unfamiliar object’s size to be the same as an object they are
accustomed to viewing. These illusions can occur if visual cues such as a runway or trees are of a different
size than expected. A pilot making an approach to a larger, wider runway might perceive the aircraft is too
low, while a pilot making an approach to a smaller, narrower runway might perceive the aircraft is too
high. A pilot making an approach 25 feet above the trees in Washington State, where the average tree is
100 feet tall, might fly the aircraft dangerously low if trying to make the same approach at Fort Rucker,
AL, where the average tree height is 30 feet. This illusion also can occur when a crewmember views
another aircraft’s position lights at night. The observed aircraft will appear further away than before if it
suddenly flies into smoke or haze.

Figure 9-16. Size-distance illusion

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FASCINATION (FIXATION) IN FLYING

9-32. Fascination or fixation in flying can be separated into two categories: task saturation and target
fixation. Task saturation occurs when crewmembers become so engrossed with a problem or task within
the cockpit they fail to properly scan outside the aircraft. Target fixation, commonly referred to as target
hypnosis, occurs when crewmembers ignore orientation cues and focus their attention on an object or goal.
For example, an attack pilot on a gunnery range might become so intent on hitting a target that he or she
forgets to fly the aircraft, causing it to strike the ground, target, or shrapnel.

REVERSIBLE PERSPECTIVE ILLUSION

9-33. Reversible perspective illusions occur at night when a crewmember perceives another aircraft to be
moving away as it is actually approaching. If each aircraft’s pilot has the same assumption and the rate of
closure is significant, by the time both pilots recognize their misperception it might be too late to avoid a
mishap. This illusion is often experienced when a crewmember observes another aircraft flying a parallel
course. Aircrew coordination is paramount in these situations, and crewmembers must observe the other
aircraft’s position lights to determine the direction of flight. “Red on right returning” is an easy way to
remember this principle; if the other aircraft’s red position light is on the right and its green position light
on the left, it is traveling in the opposite direction of the observing aircraft’s flight path.

ALTERED PLANES OF REFERENCE

9-34. Altered planes of reference (figure 9-17) create an inaccurate sense of altitude, attitude, or flight path
position in relation to an object so great in size it replaces the horizon as the plane of reference. For
example, a pilot approaching a line of mountains might feel the need to climb even though the aircraft’s
altitude is adequate. The pilot comes to this mistaken conclusion because he or she subconsciously moves
the horizon, which helps maintain orientation, to the top of the ridgeline. Without an adequate horizon, the
brain attempts to fix a new horizon. Conversely, an aircraft entering a valley that contains a slowly
increasing upslope condition might become trapped because the slope can quickly increase and exceed the
aircraft’s ability to climb above the hill, causing it to crash into the surrounding hills.

Figure 9-17. Altered planes of reference

AUTOKINESIS
9-35. Autokinesis occurs primarily at night when ambient visual cues are minimal and a small, dim light is
seen against a dark background. After about 6 to 12 seconds of visually fixating on the light, an individual
perceives movement at up to 20 degrees in any particular direction or in several directions in succession,
although there is no actual object displacement. This illusion can cause a pilot to mistake the fixated object
for another aircraft. In addition, a pilot flying at night might perceive a relatively stable lead aircraft to be
moving erratically when, in fact, it is not. The unnecessary and undesirable control inputs the pilot makes

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Chapter 9

to compensate for the illusory movement result in increased workload and wasted motion at best and an
operational hazard at worst.

FLICKER VERTIGO
9-36. Flicker vertigo (figure 9-18) is not technically an illusion. However, as most people are aware from
personal experience, viewing a flickering light can be both distracting and annoying. Flicker vertigo is
created by helicopter rotor blades or airplane propellers interrupting direct sunlight at a rate of 4 to 20
cycles per second. Flashing anticollision strobe lights can produce this effect, especially when an aircraft is
in the clouds. Though rare, crewmembers should be aware that photic stimuli (flickering light) at certain
frequencies can cause seizures in individuals susceptible to flicker-induced epilepsy.

Figure 9-18. Flicker vertigo

VESTIBULAR ILLUSIONS
9-37. The vestibular system provides accurate information as long as an individual is on the ground. Once
the individual is airborne, however, the vestibular system might malfunction and cause illusions that pose
the greatest problem with SD. Aviators must understand vestibular illusions and the conditions in which
they occur and be able to distinguish between accurate vestibular system inputs and those that cause SD.

SOMATOGYRAL ILLUSIONS
9-38. Somatogyral illusions occur when angular acceleration and deceleration stimulates the semicircular
canals. Some types of somatogyral illusions that might be encountered in flight are the leans, graveyard
spin, and Coriolis illusion.

Leans
9-39. Leans is the most common form of SD. This illusion occurs when a pilot fails to perceive angular
motion. During continuous straight-and-level flight, the pilot correctly perceives that he or she is straight
and level (part A, figure 9-19, page 9-13). However, if the pilot were to roll into or out of a bank, he or she
might experience perceptions that contradict the reading on the attitude indicator. In a slow roll, for
instance, the pilot might fail to perceive the aircraft is no longer vertical or feel the aircraft is still flying
straight and level although the attitude indicator shows it is in a bank (part B, figure 9-19). Once the pilot
detects the slow roll, he or she will make a quick recovery and resume straight-and-level flight. However,
the pilot might perceive the aircraft is banking in the opposite direction even though the attitude indicator
shows it is flying straight and level (part C, figure 9-19). The pilot might then feel it is necessary to turn the
aircraft so it aligns with the falsely perceived vertical position. Instead, the pilot should maintain straight-
and-level flight as shown by the attitude indicator. To counter the falsely perceived vertical position, the
pilot must lean his or her body in the original direction of the subthreshold roll until the false sensation
subsides (part D, figure 9-19).

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Figure 9-19. Leans

Graveyard Spin
9-40. The graveyard spin, shown in figure 9-20 (page 9-14), usually occurs in fixed-wing aircraft. For
example, if a pilot enters a spin and remains in it for several seconds, the semicircular canals will reach
equilibrium and no motion will be perceived. Upon recovering from the spin, the pilot will undergo
deceleration, which is sensed by the semicircular canals. He or she will have a strong sensation of being in
a spin in the opposite direction even if the flight instruments contradict that perception. If deprived of
external visual references, the pilot might disregard the instruments and make control corrections against
the falsely perceived spin, causing the aircraft to reenter a spin in the original direction.

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Chapter 9

Figure 9-20. Graveyard spin

9-41. A pilot, noting a loss of altitude as the spin develops, might apply back pressure on the controls and
add power in an attempt to gain altitude. This maneuver will tighten the spin and possibly cause the pilot to
lose control of the aircraft.

Coriolis Illusion
9-42. Regardless of aircraft type, Coriolis illusions are the most dangerous of all vestibular illusions and
cause overwhelming disorientation.
9-43. These illusions occur during prolonged turns when a pilot makes a head motion in a different
geometrical plane. When the pilot enters and remains in a turn, the semicircular canal corresponding to the
yaw axis equalizes and the endolymph fluid no longer deviates or bends the cupula. Figure 9-21 (page 9-
15) illustrates fluid movement in the semicircular canals during a turn.
9-44. If the pilot moves his or her head in a geometrical plane different from the turn, the yaw axis
semicircular canal moves from a plane of rotation to a new plane of nonrotation. Fluid in that canal then
slows, resulting in a sensation of turning in the direction opposite the original turn. The other two canals
are simultaneously brought within a plane of rotation, and fluid stimulates the other two cupulas. The
combined effects of coupler deflection (fluid movement) in all three canals creates a new perception of

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motion in three different planes of rotation—yaw, pitch, and roll—and causes the pilot to experience an
overwhelming head-over-heels tumbling sensation.

Figure 9-21. Fluid movement in the semicircular canals during a turn

SOMATOGRAVIC ILLUSION
9-45. Somatogravic illusions are caused when changes in gravity or linear acceleration and deceleration
stimulate the otolith organ. The three types of somatogravic illusions encountered in flight are oculogravic,
elevator, and oculoagravic.

Oculogravic Illusion
9-46. Oculogravic illusions occur when inertia from an aircraft’s linear acceleration and deceleration
causes the otolith organ to sense a nose-high or nose-low attitude. During linear acceleration, the
gelatinous layer that contains the otolith organ is shifted aft, resulting in a false perception that the aircraft
is in a nose-high attitude. Intuitive reactions to this false perception can have catastrophic results. For
example, a pilot correcting for this illusion without a through instrument cross-check will most likely dive
the aircraft.
9-47. These illusions do not occur if adequate outside references are available. A pilot making an
instrument approach in inclement weather or darkness is considerably more susceptible to oculogravic
illusions.

Elevator Illusion
9-48. Elevator illusions occur during upward acceleration. Inertia causes the eyes to track downward as the
body tries, through inputs supplied by the inner ear, to maintain visual fixation on the environment or
instrument panel. With his or her eyes tracked downward, the pilot senses the aircraft’s nose is rising. This
illusion is common among aviators flying aircraft that encounter updrafts.

Oculoagravic Illusion
9-49. Oculoagravic illusions result from downward movement of an aircraft. Inertia causes the pilot’s eyes
to track upward, resulting in a false sensation that the aircraft is in a nose-low attitude. This illusion is
commonly encountered as a helicopter enters autorotation. The usual intuitive response is to add aft cyclic,
which decreases airspeed below desired levels.

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PROPRIOCEPTIVE ILLUSIONS
9-50. Proprioceptive illusions rarely occur alone. They are closely associated with the vestibular system
and, to a lesser degree, the visual system. Proprioceptive information input to the brain can lead to false
perceptions of true vertical. During turns, banks, climbs, and descending maneuvers, proprioceptive
information is fed into the central nervous system. A properly executed turn vectors gravity and centrifugal
force through the aircraft’s vertical axis. Without visual references, the body senses only being pressed
firmly into the seat. Because this sensation is usually associated with climbs, a pilot might falsely interpret
it as such. Conversely, recovering from turns lightens pressure on the seat and creates an illusion of
descending. This false perception might cause the pilot to pull back on the stick and reduce airspeed.
Figure 9-22 illustrates a proprioceptive illusion.

Figure 9-22. Proprioceptive illusion

PREVENTION OF SPATIAL DISORIENTATION

9-51. SD cannot be eliminated, but crewmembers must remember the misleading sensations from sensory
systems are predictable. Due to normal functioning and limitations of the senses, all pilots, regardless of
experience level, can suffer the effects of SD. As such, crewmembers must be aware of SD’s potential
hazards, understand their significance, and learn to overcome them. Training, instrument proficiency, good
health, maintaining situational awareness, and aircraft design all help to minimize SD. Additional measures
pilots should take to prevent SD include—
z Never fly without visual reference points (either the actual horizon or artificial horizon provided
by the instruments).

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 Spatial Disorientation

z Trust the instruments. Pilots must never try to fly visual meteorological conditions and IMC at
the same time.
z Avoid fatigue, smoking, hypoglycemia, hypoxia, and anxiety, all of which intensify illusions.

TREATMENT OF SPATIAL DISORIENTATION

9-52. SD can easily occur in the aviation environment. If SD occurs, pilots should—
z Refer to the instruments and develop a good cross-check.
z Delay intuitive actions long enough to check both visual references and the instruments.
z Transfer control to the other pilot (if two pilots are in the aircraft); rarely will both pilots
experience SD at the same time.

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 Chapter 10
Oxygen Equipment and Cabin Pressurization

With the technological advances of today’s Army aircraft and the increase in
operational requirements at altitudes exceeding 10,000 feet mean sea level (MSL),
oxygen equipment and cabin pressurization are crucial. Without supplemental oxygen
and cabin pressurization, crewmembers are at increased risk of hypoxia, evolved-gas
disorders, and DCS. This chapter explains cabin pressurization and oxygen
equipment and their use in Army aviation.

OXYGEN SYSTEMS
10-1. Aircraft oxygen systems consist of containers that store oxygen in a gaseous, liquid, or solid state;
tubing to direct the flow; devices that control
oxygen pressure and percentage; and a mask to Contents
deliver oxygen to the user. Oxygen systems exist in
many forms throughout the military, but the Oxygen Systems ...................................... 10-1
following equipment is used in Army aircraft. Storage Systems ..................................... 10-1
Oxygen Regulators .................................. 10-2
GASEOUS OXYGEN Oxygen Masks ......................................... 10-3
Passenger Oxygen Mask ........................ 10-3
10-2. Aviator’s gaseous oxygen is the most
Oxygen Equipment Checklist ................. 10-5
common breathing oxygen found in Army aircraft.
Cabin Pressurization ............................... 10-5
It is classified as Type I, Grade A, and meets MIL-
O-27210E military specifications. Gaseous oxygen
is 99.5 percent pure by volume and contains no more than 0.005 milligrams of water vapor per liter at
760mm/Hg pressure and 15 degrees Celsius. Gaseous oxygen is odorless and contaminant free.
10-3. Oxygen used for medical purposes is classified as Type I, Grade B, and is not acceptable for use by
aviators because of its high moisture content. Temperatures at high altitudes can cause freezing in the
oxygen-delivery system and restrict oxygen flow.

ONBOARD OXYGEN-GENERATING SYSTEM

10-4. The onboard oxygen-generating system (OBOGS) is the primary method of oxygen delivery for
patients aboard the UH-60Q Black Hawk. Use of this system reduces many of the potential hazards
associated with gaseous high-pressure systems and offers the added benefits of simpler service and
maintenance. Various OBOGS have been tested and some show great potential for future military use. The
applicable aircraft technical manual contains specific OBOGS capabilities.

STORAGE SYSTEMS
GASEOUS LOW-PRESSURE SYSTEM
10-5. Low-pressure oxygen is commonly used during emergencies. This system’s breathing oxygen is
stored in yellow, lightweight, shatterproof cylinders with a maximum charge pressure of 400 to 450 pounds
per square inch. The low-pressure system is not very effective because the volume of oxygen that can be
stored is limited. In addition, if system pressure falls below 50 pounds per square inch, the system must be

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Chapter 10

recharged within 2 hours to prevent moisture condensation within the cylinders. If not recharged within
this timeframe, the system must be purged before refilling.

GASEOUS HIGH-PRESSURE SYSTEM

10-6. The gaseous high-pressure system is in use aboard most Army aircraft with internal storage systems.
Breathing oxygen is stored in green heavyweight cylinders that contain a maximum charge pressure of
1,800 to 2,200 pounds per square inch. This system allows the safe storage of large amounts of oxygen to
meet mission requirements of Army fixed-wing aircraft.
10-7. The H-2 bailout bottle is an example of a gaseous high-pressure system. The H-2 provides
crewmembers with an emergency oxygen source should their aircraft oxygen system fail and also supplies
oxygen to high-altitude parachutists during jumps. This system is automatically activated during an
ejection sequence or manually activated by pulling the ball handle (“green apple”). The H-2 provides about
10 minutes of breathing oxygen and cannot be stopped once activated.
10-8. The helicopter oxygen system (HOS), pictured in figure 10-1, is a self-contained portable oxygen
system that supplies oxygen to crewmembers on missions requiring oxygen at altitude. The HOS is tailored
for use in the UH-60, CH-47 (forward or aft), and the UH-1 but can be used in other aircraft, although
additional supply hoses might be required. Each HOS can provide 100-percent oxygen to six personnel for
1 hour at altitudes up to 25,000 feet MSL. Oxygen is stored in two tandem-connected storage cylinders that
must be recharged by an oxygen servicing unit.

Figure 10-1. Helicopter oxygen system

OXYGEN REGULATORS
10-9. The flow of oxygen into a mask must be controlled whenever oxygen systems are used onboard
aircraft. Two types of oxygen regulators, diluter demand and continuous flow, are currently used in Army
aircraft.

DILUTER-DEMAND REGULATOR
10-10. A diluter-demand oxygen regulator fits better, wastes less oxygen, and provides a higher
percentage of oxygen than a continuous-flow regulator. A mask-regulator makes up the self-contained,
quick-donning unit available to pilots who encounter cabin pressurization problems (figure 10-2, page 10-
3).

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 Oxygen Equipment and Cabin Pressurization

Figure 10-2. Quick-donning mask-regulator assembly unit

10-11. During each inhalation, negative pressure closes the one-way exhaust valve in the mask and opens
the demand valve in the regulator, thereby providing oxygen flow only on demand. The regulator can mix
suitable amounts of ambient air and oxygen to prolong the oxygen source. When the diluter level is placed
in the NORMAL position, the breathing mixture at ground level is primarily ambient air with very little
added oxygen. During ascent, an air inlet is partially closed by an aneroid pressure valve to provide a
higher concentration of oxygen. This inlet valve closes completely at 34,000 feet MSL, and the regulator
then delivers 100-percent oxygen. On descent, this process reverses.
10-12. The regulator can also provide 100-percent oxygen at any altitude when the diluter lever is placed
in the 100% OXYGEN position. The diluter level should be set on NORMAL for routine operations and
placed on 100% OXYGEN when hypoxia is suspected or prebreathing is required.

CONTINUOUS-FLOW REGULATOR
10-13. Continuous-flow regulators provide protection at altitudes up to 25,000 feet MSL and supply a
continuous flow of 100-percent oxygen to the user. The three major types of regulators are manual,
automatic, and automatic with manual override.

OXYGEN MASKS
10-14. The three oxygen masks primarily used in the Army aviation community are the passenger, MBU-
12/P or MBU-20/P, and diluter-demand quick-don masks. The passenger mask is a continuous-flow
device, while the MBU-12/P and diluter-demand quick-don masks are pressure-demand devices. The
continuous-flow mask supplies the user with continuous oxygen; the pressure-demand masks provide
oxygen when the user inhales. Oxygen in the mask is then maintained at a positive pressure until the
regulator pressure is overcome during exhalation.

PASSENGER OXYGEN MASK

10-15. The passenger oxygen mask found onboard Army fixed-wing aircraft supplies a continuous flow
of oxygen to the user regardless of inhalation. The mask, pictured in figure 10-3 (page 10-4), plugs into
receptacles within the passenger compartment.

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Chapter 10

Figure 10-3. Passenger oxygen mask

MBU-12/P OXYGEN MASK

10-16. The MBU-12/P oxygen mask (figure 10-4) is available in four sizes: short, regular, long, and extra
long. To ensure a proper fit, crewmembers should wear a mask in the size that most closely matches their
facial measurements.
10-17. The MBU-12/P oxygen mask consists of a silicone-rubber inner facial piece bonded to a hard shell
to form a one-piece assembly. The MBU-12/P mask offers several improvements over previous masks,
including greater comfort, better fit, and increased downward vision.

Figure 10-4. MBU-12/P oxygen mask

MBU-20/P OXYGEN MASK

10-18. Used for flights up to 50,000 feet MSL, the MBU-20/P oxygen mask (figure 10-5, page 10-5) is
available in four sizes: small narrow, medium narrow, medium wide, and large wide. The mask assembly
allows for communication and integrates with HGU-series flight helmet assemblies.
10-19. The MBU-20/P oxygen mask consists of a hard shell, upper and lower strap assemblies, breathing
hose, inhalation valve elbow, and inhalation and exhalation valves.

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 Oxygen Equipment and Cabin Pressurization

Figure 10-5. MBU-20/P oxygen mask

OXYGEN EQUIPMENT CHECKLIST

10-20. Since oxygen equipment can malfunction easily, it must be checked continually. Crewmembers
must check their oxygen equipment using the appropriate checklist or technical manual.

CABIN PRESSURIZATION
10-21. The Army’s fixed-wing aircraft can fly at higher altitudes than crewmembers can physiologically
tolerate. Therefore, cabin pressurization was developed to ensure the safety and comfort of crewmembers
and passengers.

CABIN PRESSURIZATION SYSTEM

10-22. The most efficient method for protecting crewmembers flying at altitude is to increase barometric
pressure inside the cabin so it is greater than ambient pressure outside. In high-altitude flight without
pressurization, crewmembers require continuous use of oxygen equipment, which increases crew fatigue.
Pressurization has some disadvantages, however. Crewmembers encountering problems with cabin
pressurization can suffer serious physiological impairment.
10-23. Because greater pressure must exist inside the cabin than outside, aircraft walls must be
structurally reinforced to contain this pressure. This reinforcement increases design and maintenance costs
and also reduces aircraft performance due to added weight and increased power requirements.
10-24. Cabin pressurization is achieved by extracting outside ambient air, forcing it through compressors,
cooling it, and maintaining it at a given cabin altitude. Pressurization is maintained by controlling the
amount of air allowed to escape in relation to compressed air. In a typical cabin pressurization system,
controls sense changes in cabin and outside ambient air pressure and make adjustments necessary to
maintain cabin pressure at a fixed pressure differential, determined by the difference between cabin and
outside ambient air pressure. A cabin altimeter, usually part of the pressurization system, allows the pilot to
observe cabin altitude and make required pressure changes.
10-25. On most aircraft, cabin altitude usually increases with aircraft altitude up to 5,000 to 8,000 feet
MSL. Barometric control maintains the cabin at that set altitude until the maximum pressure differential is
reached.
10-26. From sea level to 20,000 feet MSL, a barometric controller modulates the outflow of air from the
cabin to maintain a selected cabin rate of climb. Cabin altitude increases until the maximum cabin pressure
differential of 6.0 pounds per square inch is reached. Thus, below an altitude of 20,000 feet MSL, cabin
pressure altitude is maintained at 3,870 feet MSL.

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Chapter 10

10-27. The maximum pressure differential is maintained from 20,000 to 31,000 feet MSL (the service
ceiling of the C-12D); however, cabin altitude increases with aircraft altitude (figure 10-6). At 31,000 feet
MSL and a pressure differential of 6.0 pounds per square inch, cabin altitude reaches 9,840 feet MSL.

Figure 10-6. C-12D cabin pressurization changes with altitude changes

10-28. The cabin pressurization selected for a particular aircraft is usually a compromise among
physiological requirements, engineering capabilities, overall aircraft performance, and cost.

ADVANTAGES OF CABIN PRESSURIZATION

10-29. Cabin pressurization offers several advantages for aircraft capable of flight above 20,000 feet
MSL. In general, pressurization—
z Eliminates the need for supplemental oxygen equipment.
z Significantly reduces the occurrence of hypoxia and DCS.
z Minimizes trapped gas expansion.
z Reduces crew fatigue since cabin temperature and ventilation can be controlled within desired
ranges.

LOSS OF CABIN PRESSURIZATION

10-30. Pressurization system failure and resulting decompression can produce significant physiological
problems in crewmembers. Slow cabin decompression, while dangerous because of the slow and insidious
onset of hypoxia, is not as physiologically dangerous as rapid decompression. Rapid decompression occurs
when the fuselage or pressure vessel is compromised and cabin pressure equalizes almost instantaneously
with outside ambient pressure.
10-31. The following factors control the rate and time of decompression:
z Volume of the pressurized cabin. The larger the cabin area, the slower the decompression time.
z Size of the opening. The larger the opening, the faster the decompression time.

10-6 TC 3-04.93 31 August 2009

 Oxygen Equipment and Cabin Pressurization

z Pressure differential. The larger the pressure differential between outside absolute pressure and
interior cabin pressure, the more severe the decompression.
z Pressure ratio. The greater the difference between inside and outside cabin pressure, the longer
the time for air to escape and the longer the decompression time.
10-32. The physiological effects of rapid decompression range from trapped gas expansion within the
ears, sinuses, lungs, and abdomen to hypoxia. Gas expansion disorders can be painful and might become
severe, but they are temporary. Crewmembers might also experience DCS and adverse effects from cold
and wind chill. Hypoxia, however, poses the most serious hazard to crewmembers; its onset can be rapid,
depending on cabin altitude after decompression. An average individual’s EPT is decreased by half
following rapid decompression.

INDICATIONS OF RAPID DECOMPRESSION

10-33. The rapidity of decompression determines the magnitude of observable decompression
characteristics. The earlier crewmembers detect a loss of pressure, the quicker they can take appropriate
emergency measures to increase survival. The following observable characteristics indicate pressure loss.

Noise
10-34. A loud popping noise is produced whenever two different air masses make contact. This explosive
sound is often called “explosive decompression.”

Flying Debris
10-35. Crewmembers must be aware of the possibility of flying debris during rapid decompression. The
rush of air from inside to outside an aircraft is so forceful that unsecured items might be ejected from the
aircraft.

Fogging
10-36. A sudden loss of pressure causes condensation and a resulting fog effect. Fogging is one of the
primary characteristics of decompression because air at a given temperature and pressure holds only so
much water vapor.

Temperature
10-37. A loss of pressurization causes cabin temperature to equalize with outside ambient temperature,
significantly decreasing temperature inside the cabin. The amount of temperature decrease depends on
altitude.

IMMEDIATE ACTIONS FOLLOWING DECOMPRESSION

10-38. All crewmembers and passengers must breathe supplemental oxygen after cabin decompression
occurs. The crew must also initiate immediate descent to an altitude that minimizes the physiological
effects of pressure loss.

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 Appendix A
Hypobaric Chamber Flight Profiles

MEDICAL CLEARANCE
A-1. All personnel must have a current flight physical and DA Form 4186 indicating full flying duty
before participating in any hypobaric chamber exercise.

PURPOSE OF HYPOBARIC CHAMBER TRAINING

A-2. The purpose of hypobaric chamber training is to safely demonstrate—
z Crewmember limitations associated with hypoxia at altitude.
z Effects of trapped gas on the body.
z Effects of hypoxia on night vision.
z Capabilities of oxygen equipment.

CHAMBER PROFILES AND APPLICABILITY OF TRAINING

A-3. Figures A-1 through A-5 show the standard hypobaric chamber profiles. For information regarding
nonstandard profiles, contact the U.S. Army School of Aviation Medicine, ATTN: MCCS-HA, Fort
Rucker, AL 36362-5377.
A-4. Procedures for the U.S. Air Force (USAF) Type I profile in figure A-1 (page A-2) are as follows:
z Begin 30-minute denitrogenation.
z Perform 5,000-feet ear and sinus check by 2,500 feet per minute.
z Ascend main accumulator and lock to 8,000 feet by 2,500 feet per minute.
z Ascend main accumulator and lock to 18,000 feet by 5,000 feet per minute.
z Perform running break of main accumulator and lock; maintain lock at 18,000 feet.
z Continue main accumulator ascent to 35,000 feet by 5,000 feet per minute.
z Descend main accumulator to 30,000 feet for 90-second hypoxia demonstration.
z Descend main accumulator and lock to 25,000 feet by 5,000 feet per minute.
z Begin 5-minute hypoxia demonstration.
z Descend lock to ground level by 5,000 feet per minute.
z Descend main accumulator to 18,000 feet by 5,000 feet per minute for night vision
demonstration.
z Descend main accumulator from 18,000 feet to ground level by 2,500 feet per minute.
z Terminate chamber flight.

31 August 2009 TC 3-04.93 A-1

Appendix A

Figure A-1. Type I 35,000-foot U.S. Air Force original training profile

A-5. Procedures for the USAF Type II profile in figure A-2 are as follows:
z Begin 30-minute denitrogenation.
z Perform 5,000-feet ear and sinus check by 2,500 feet per minute.
z Ascend main accumulator from ground level to 8,000 feet by 2,500 feet per minute.
z Ascend main accumulator from 8,000 feet to 25,000 feet by 5,000 feet per minute.
z Begin 5-minute hypoxia demonstration.
z Descend main accumulator from 25,000 feet to 18,000 feet by 5,000 feet per minute for night
vision demonstration.
z Descend main accumulator from 18,000 feet to ground level by 2,500 feet per minute.
z Terminate chamber flight.

Figure A-2. Type II 25,000-foot U.S. Air Force refresher training profile

A-2 TC 3-04.93 31 August 2009

 Hypobaric Chamber Flight Profiles

A-6. Procedures for the U.S. Army Type IV profile in figure A-3 are as follows:
z Begin 30-minute denitrogenation.
z Perform 5,000-feet ear and sinus check by 5,000 feet per minute.
z Ascend main accumulator from 8,000 feet to 25,000 feet by 5,000 feet per minute.
z Begin 5-minute hypoxia demonstration.
z Descend main accumulator from 25,000 feet to 18,000 feet by 5,000 feet per minute for night
vision demonstration.
z Descend main accumulator from 18,000 feet to ground level by 2,500 feet per minute.
z Terminate chamber flight.

Figure A-3. Type IV 25,000-foot U.S. Army profile

A-7. Procedures for the U.S. Army/USAF Type V profile in figure A-4 (page A-4) are as follows:
z Begin 30-minute denitrogenation.
z Perform 5,000-feet ear and sinus check by 5,000 feet per minute.
z Ascend main accumulator and lock to 18,000 feet by 5,000 feet per minute.
z Perform running break of main accumulator and lock; maintain lock at 18,000 feet.
z Continue main accumulator ascent to 35,000 feet by 5,000 feet per minute.
z Ascend main accumulator to 30,000 feet for 90-second hypoxia demonstration.
z Descend main accumulator to 15,000 feet by 10,000 to 12,000 feet per minute with lock joining
descent at 18,000 feet.
z Descend main accumulator and lock to 8,000 feet by 5,000 feet per minute.
z Ascend main accumulator to 25,000 feet by maximum rate of ascent.
z Begin 5-minute hypoxia demonstration.
z Descend lock to ground level by 5,000 feet per minute.
z Descend main accumulator to 18,000 feet by 5,000 feet per minute for night vision
demonstration.
z Descend main accumulator from 18,000 feet to ground level by 5,000 feet per minute.
z Terminate chamber flight.

31 August 2009 TC 3-04.93 A-3

Appendix A

Figure A-4. Type V 35,000-foot U.S. Army/U.S. Air Force profile

A-8. Procedures for the military rapid decompression profile in figure A-5 are as follows:
z Ascend main accumulator to 12,500 feet by maximum rate.
z Ascend lock to 1,500 feet by 2,500 feet per minute.
z Perform rapid decompression.
z Equalize main accumulator and lock at 8,500 feet.
z Descend main accumulator and lock from 8,000 feet to ground level by 2,500 feet per minute.

Figure A-5. Military rapid decompression profile

A-4 TC 3-04.93 31 August 2009

 Glossary

SECTION I – ACRONYMS AND ABBREVIATIONS

AFI Air Force Instruction
AGSM anti-G straining maneuver
AR Army Regulation
Ar argon
ATM aircrew training manual
ATP aircrew training plan
AWR airworthiness release
BLP ballistic limit protection
C Celsius
CBRN chemical, biological, radiological, and nuclear
CEP communications earplug
CoHb carboxyhemoglobin (found in blood as a result of carbon monoxide inhalation)
CO2 carbon dioxide
CREEP container, restraint system, environment, energy absorption, postcrash
protection (aircraft design features that aid crash survival)
DAC Department of the Army civilian
DCS decompression sickness
DEATH drugs, exhaustion, alcohol, tobacco, hypoglycemia
EPT expected performance time
F Fahrenheit
Fe2 iron content within hemoglobin
FFD full flying duty
FOV field of view
G unit of acceleration
GRAM Geometric perspective, retinal image size, aerial perspective, motion parallax
He helium
Hg mercury
H2 hydrogen
HOS helicopter oxygen system
ICS internal communication system
IMC instrument meteorological conditions
in/Hg inches of mercury
JP Joint Publication
JP-4 jet propulsion fuel, type 4
JP-5 jet propulsion fuel, type 5
JP-8 jet propulsion fuel, type 8

31 August 2009 TC 3-04.93 Glossary-1

Glossary

KITO Known size of objects, increased and decreased size of objects, terrestrial
association, and overlapping contours or interposition of objects
LASEK laser epithelial keratomileusis
LASIK laser-assisted in-situ keratomileusis
LAV linear perspective, apparent foreshortening, and vertical position
MEDEVAC medical evacuation
mm millimeter
mm/Hg millimeters of mercury
MOPP mission-oriented protective posture
MSL mean sea level
N2 nitrogen
ND neutral density
Ne neon
NOE nap-of-the-earth
NVD night vision device
O2 oxygen
OBOGS onboard oxygen-generating system
PAO2 alveolar partial pressure of oxygen
pH relative acidity of blood: chemical balance (the symbol for the logarithm of the
reciprocal of hydrogen ion concentration in gram atoms per liter, used to
express the acidity or alkalinity of a solution on a scale of 0 to 14, where less
than 7 represents acidity, 7 neutrality, and more than 7 alkalinity)
PCO2 partial pressure of carbon dioxide
PO2 partial pressure of oxygen
POI program of instruction
ppm parts per million
PRK photorefractive keratectomy
psi pounds per square inch
PVO2 venous pressure of oxygen
RBC red blood cell
REM rapid eye movement
ROBD reduced oxygen breathing device
scuba self-contained underwater breathing apparatus
SD spatial disorientation
SF standard form
STANAG standardization agreement
STEL short-term exposure limit
TB MED Technical Bulletin Medical
TLV threshold limit values
TRADOC United States Army Training and Doctrine Command
TUC time of useful consciousness

Glossary-2 TC 3-04.93 31 August 2009

 Glossary

USAACE United States Army Aviation Center of Excellence

USASAM United States Army School of Aviation Medicine
WBC white blood cell

SECTION II – TERMS
absorption
A process in which an object collects other materials within itself. Two examples of absorption are a
sponge absorbing water and the tissues of the middle ear absorbing oxygen from the middle ear cavity.
acceleration
A change of velocity in magnitude or direction expressed in feet per second squared, or fps2. The most
common accelerative force is gravity. The acceleration produced by gravity is a constant and has a
value of 32.2 fps2.
acclimatization
The physiological adjustment of an organism to a new and physically different environment. An
example would be the adaptation of valley dwellers to life in a mountainous region where ambient
pressures are relatively low. In this example, acclimatization would occur through a temporary
adjustment in cardiac and respiratory rates and an increase in the number of red blood cells.
acute
An incident or disease characterized by sharpness or severity that has a sudden onset, sharp rise, and
short course. In physiological training, this term usually describes a severe chamber reaction in which
the onset is rapid and immediate aid is required.
alkalosis
The term used by physiological training personnel to refer to a respiratory condition in which there is
an increase in blood’s basicity produced by abnormally rapid respiration and elimination of excessive
amounts of carbon dioxide.
altimeter
An instrument used to measure the altitude of an aircraft or chamber. By making appropriate
adjustments and pressure settings, the altimeter can be set to indicate the pressure altitudes used in
chamber operations or the true altitudes used during most Army aircraft flights.
altitude sickness
In acute cases, the symptoms of hypoxia seen especially in flying personnel and individuals new to
mountainous regions of high altitude; in chronic cases, the symptoms of hypoxia usually seen in
individuals who have been at high altitudes in mountainous regions for long periods. Apparently, these
individuals’ physiological compensatory processes for hypoxia become inadequate. Descent to lower
altitudes usually brings relief.
alveoli
The saclike, extremely thin-walled tissues of the lungs in which the flow of inspired gases terminates
and across the walls of which gas diffusion takes place between the lungs and blood.
ambient
The existing and adjacent environment. Ambient air pressure is the pressure of the immediate
environment.
angular acceleration
Acceleration that results in a simultaneous change in both speed and direction.
anoxia
A total absence of oxygen in blood presented to the tissues or the inability of the tissues to use oxygen
delivered to them. Anoxia is an extremely severe and morbid condition. The lack of oxygen with
which physiological training personnel are concerned is, strictly speaking, hypoxia, not anoxia.

31 August 2009 TC 3-04.93 Glossary-3

Glossary

arterial saturation
The hemoglobin in arterial blood containing as much oxygen as it can hold, giving an arterial oxygen
concentration of about 20 milliliters of oxygen per 100 milliliters of blood.
arteries
The blood vessels that possess relatively thick, muscular walls that transport oxygenated blood from
the left ventricle to the body tissues. Arteries also transport poorly oxygenated blood from the right
ventricle to the lungs.
arterioles
The smaller extensions of the arteries. The muscular walls of these arterial extensions are responsive to
nerve and chemical control by the body and thereby regulate the amount of blood presented to the
capillaries.
astigmatism
A visual problem caused by an unequal curvature of the cornea or lens of the eye.
atmosphere
The gaseous layer surrounding the earth that is composed primarily of oxygen and nitrogen.
attenuation
The amount of noise protection provided by a specific protective device. The attenuation of any given
noise protective device is the number of decibels it reduces the total energy reaching the eardrum.
auricles (atria)
The upper two chambers of the heart, designated the right and left auricles. These chambers receive
blood from the vessels and force it into the ventricles.
autokinesis
An illusion in which a single, stationary point of light seen against a dark background appears to move
erratically. The illusion is probably caused by involuntary movement of the eyeballs because relative
points of reference are missing.
barodontalgia (aerodontalgia)
A toothache that occurs during ascent to altitude or during descent. Causes for this painful condition
include poor or loose restorations; presence of decay, infection, or abscess; or gritting of the teeth in
times of stress.
barometer
An instrument used to measure atmospheric pressure based on the principle that the pressure exerted
by ambient air is sufficient to hold up a column of mercury. The height to which this column is held
varies directly with air pressure. The aneroid barometer operates on the principle that the volume of
gas in a flexible, enclosed space increases when the pressure on it decreases; for example, during
ascent to altitude.
barometric pressure
The pressure of air in a particular environment as measured by the barometer. For example, at 18,000
feet in an altitude chamber, barometric pressure should be 380 mm/Hg.
barotitis media
A condition that develops when equalization of pressure in the middle ear cannot be accomplished
during changes in barometric pressure.
bends
A form of decompression sickness that can be produced by the liberation of gaseous emboli (bubbles),
primarily nitrogen, in body tissues. This condition is characterized by mild to incapacitating pains in
the joints. Pain might be localized to a single area (for example, knee or joint) or generalized in severe
cases.

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 Glossary

blackout
Temporary blindness caused by an extinguished blood supply to the retina. Blackouts are usually seen
during +Gz maneuvers. In such cases, force exerted on the column of blood traveling to the eyes
reduces effective blood pressure in the vessels going to the eyes, thereby reducing bloodflow to the
eyes. If continued, the force will actually stop bloodflow to the retina.
Boyle’s Law
The physical law that states the volume of a gas is inversely proportional to the pressure exerted upon
it.
bronchi
The two main tubes leading to the lungs from the trachea. The bronchi are part of the conducting
portion of the respiratory system.
bronchioles
The smaller tubules extending from each bronchus. Two types of bronchioles can be distinguished: the
conducting bronchioles that provide the air passageway into the portion of the lungs where diffusion
occurs; and the respiratory bronchioles that contain some alveoli in their walls through which the
diffusion of gases occurs.
calorie
The amount of heat needed to raise the temperature of 1 gram of water from 250 degrees Celsius to
260 degrees Celsius.
capillaries
The most minute blood vessels. Capillaries have walls of one-cell thickness. These vessels link the
arteries and veins; through them, gas diffusion takes place between body tissues and blood.
cardiac arrhythmia
Any variation in the heart’s normal rhythm.
cataract formation
A clouding or opacification of the lens resulting from hardening that usually occurs during the aging
process.
centrifugal force
The force exerted on an object moving in a circular pattern that causes the object to break away and
move outward in a straight line.
centripetal force
The force acting on an object moving in a circular pattern that holds the object on its circular path.
chemoreceptors
The receptors adapted for excitation by chemical substances; for example, aortic and carotid bodies
that sense reduced oxygen content in blood and automatically send signals to the cardiovascular and
respiratory systems to make necessary adjustments.
chill factor
The temperature decrease resulting from wind velocity. An increased cooling of exposed skin occurs
when the skin is subjected to wind.
chloride shift
The passage of chloride ions from plasma into red blood cells when carbon dioxide enters the plasma
from the tissues, and the return of these ions to the plasma when carbon dioxide is discharged in the
lungs.

31 August 2009 TC 3-04.93 Glossary-5

Glossary

chokes
A form of decompression sickness that can occur at altitude and is believed to be caused by gases
evolving in the lung tissue. This condition is characterized by a deep substernal pain or burning
sensation, difficulty breathing, and nonproductive cough.
chronic
A continued or prolonged condition; for example, a chronic illness is an illness that continues for
several years.
cilium
A minute, vibratile, hairlike structure attached to the free surface of a cell.
circadian rhythm
The rhythmic biological functions geared to an internal “biological clock.” Circadian rhythm affects
processes such as the sleep-wake cycle, hormone production, and body temperature.
circadian desynchronization (jet lag)
Rapid travel from one time zone to another causes the body to resynchronize its diurnal rhythms to the
local geophysical and social time cues. Until intrinsic rhythms are reset, sleep disorders and fatigue
will prevail. Traveling eastward shortens the day; westward travel lengthens the day. Consequently,
resynchronization occurs much more rapidly when traveling west. Shift work can produce effects
similar to crossing time zones because of changes in light exposure and activity times.
circulation
Blood movement throughout the body.
coma
A state of complete loss of consciousness from which a patient cannot be aroused despite the use of
powerful stimulants.
combustion
An act or instance of burning; a chemical process (as in oxidation) accompanied by the emission of
heat and light.
conduction
Heat transfer between molecules of adjacent bodies or in a single body. Heat flows from a body or
body portion with a lower heat content; for example, heat transfer from the hand to an ice cube.
Physical contact is necessary for heat transfer by conduction.
cones
Nerve cells in the central portion of the retina, with the greatest concentration at the fovea. These cells
are used for day vision and allow a person to see detail and distinguish between various colors.
conjunctiva
The mucous membrane lining the inner surface of the eyelids and covering the front part of the
eyeball.
continuous flow
The earliest supplementary oxygen breathing system designed for use in aircraft, still used today in
certain transport aircraft and for air evacuation. This system provides a constant flow of oxygen to the
mask.
contrast sensitivity
The ability to detect objects on varying shades of backgrounds.
convection
A form of heat transfer effected by the flow of fluid across an object of a different temperature. If the
object is warmer, the heat will transfer from the object to the liquid or gas; if the object is cooler, the
heat will transfer from the liquid or gas to the object.

Glossary-6 TC 3-04.93 31 August 2009

 Glossary

convulsion
A violent, involuntary contraction or series of contractions of voluntary muscles. Convulsions can
occasionally be seen in hypoxic individuals or in people who have hyperventilated.
coriolis illusion
A condition that exists when the head is moved from one plane to another while the body is in
rotation, causing an illusion of moving in a plane or rotation in which no angular motion exists.
cornea
The transparent part of the eyeball coat that covers the iris and pupil and admits light to the interior.
counterpressure
The pressure exerted on the outside of the body to balance the high pressure of gases in the lungs.
cyanosis
Blueness of the skin caused by insufficient oxygenation of blood. Blood that has most of its
hemoglobin combined with oxygen appears bright red, whereas blood with low oxygenated
hemoglobin appears reddish blue or cyanotic.
Dalton’s Law of Partial Pressures
The physical law that states the total pressure of a mixture of gases is equal to the sum of the partial
pressures of each gas in the mixture.
dark adaptation
The process by which the retinal cells (rods) increase their concentration of the chemical substance
(rhodopsin) that allows them to function optimally in twilight or in dimly illuminated surroundings.
The process takes between 30 and 45 minutes in a darkened room.
deceleration (negative acceleration)
Any reduction in the velocity of a moving body.
decibel
An arbitrary unit for measuring the relative intensity of a sound.
decompression
Any reduction in the pressure of one’s surroundings. A chamber is decompressed each time it ascends.
decompression sickness
The effects produced by the evolvement of body gases or expansion of trapped body gases when
ambient pressure is decreased, as in ascent to altitude.
denitrogenation
The reduction of nitrogen concentration in the body. Nitrogen concentration can be reduced by
breathing 100-percent oxygen over a period of time. This process diffuses nitrogen from blood to the
lungs and eliminates much of the nitrogen dissolved in body tissues.
diffusion
The process through which a substance moves from a place of high concentration to a new location of
lower concentration. An example is the diffusion of carbon dioxide from the tissue (with a partial
pressure of 50 mm/Hg) to blood (with a partial pressure of 40 mm/Hg).
diluter-demand oxygen regulator
A supplementary oxygen delivery system in which a dilution of pure oxygen (with ambient air) is
provided automatically to an individual with each inhalation. At 34,000 feet, the system automatically
delivers 100-percent oxygen with each inhalation.
ejection
A method of emergency escape in which a pilot’s or crewmember’s seat is propelled out of the aircraft
by an explosive catapult or rocket charge.

31 August 2009 TC 3-04.93 Glossary-7

Glossary

endolymph
The watery fluid contained in the ear’s membranous labyrinth.
erythrocytes
Red blood cells.
euphoria
A feeling of well-being.
eustachian tube
The passage leading from the middle ear to the pharynx. The eustachian tube provides the only means
by which equalization can be maintained between pressure in the middle ear and ambient pressure
during flight.
evaporation
The process by which a liquid changes to a gaseous state and, in doing so, increases its temperature.
For example, when sweat evaporates (changes from a liquid to a vapor), it takes heat from the body
and increases its own temperature.
expiration
The act of exhaling or breathing outward. Expiration usually involves contraction of certain abdominal
muscles and relaxation of the diaphragm.
explosive decompression
A collision of two air masses that produces an explosive sound. A decompression that occurs in about
1 second or less is termed an “explosive decompression.”
external respiration
The movement of air into and out of the lungs, ventilation of the lung passages and alveoli, and
diffusion of gas across the alveolar-capillary membrane.
flatus
Gas or air in the gastrointestinal tract.
frequency
The measurable characteristic of a noise that gives it a distinctive pitch, measured in cycles per second
or hertz.
G-force (+Gx)
The positive accelerative force that acts to move the body at a right angle to the long axis in a back-to-
chest direction.
G-force (–Gx)
The negative accelerative force that acts to move the body at a right angle to the long axis in a chest-
to-back direction.
G-force (+Gy, –Gy)
The positive or negative accelerative force that acts to move the body at a right angle to the long axis
in a shoulder-to-shoulder direction.
G-force (+Gz)
The positive accelerative force that acts to move the body in a headward direction.
G-force (–Gz)
The negative accelerative force that acts to move the body in a footward direction.
glare
A bright light that enters the eye and causes a rapid loss of sensitivity.
glottis
The vocal apparatus of the larynx.

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 Glossary

gravity
The force of attraction between the Earth and all bodies on Earth by which each body is held to the
Earth’s surface. The normal force that acts on all bodies at all times is 1 G.
headward direction
Movement toward the head.
heat
In the absolute sense, the motion of any substance’s molecules. The greater the motion, the higher the
heat content. The heat content of any object is measured in calories.
heat cramps
A condition marked by sudden development of cramps in skeletal muscles. Heat cramps result from
prolonged work in high temperatures and are accompanied by profuse perspiration with loss of sodium
chloride (salt) from the body.
heat exhaustion
A condition marked by weakness, nausea, dizziness, and profuse sweating. Heat exhaustion results
from physical exertion in a hot environment.
heatstroke
An abnormal physiological condition produced by exposure to intense heat and characterized by hot,
dry skin (caused by cessation of sweating), vomiting, convulsions, and collapse. In severe cases, the
body’s heat control mechanism can be disturbed, causing body temperature to rise to morbid levels.
hemoglobin
An organic chemical compound contained within red blood cells that combines with oxygen to form
oxyhemoglobin. In this combination, oxygen is transported within the body.
Henry’s Law
The physical law that states the amount of gas that can be dissolved in a liquid is directly proportional
to the pressure of that gas over the liquid.
hyperbaric dive
Exposure to increased air pressure by insertion of compressed air into a metal chamber to simulate the
pressure found in underwater diving. This exposure to increased pressure is also used as therapy for
certain illnesses such as evolved-gas disorders and decompression sickness.
hyperventilation
An abnormally rapid rate of respiration that can lead to an excessive loss of carbon dioxide from the
lungs, resulting in alkalosis. Hyperventilation is characterized by dizziness, tingling of the extremities,
and, in acute cases, collapse.
hypoxia
Any condition in which the body’s oxygen concentration is below normal limits or in which oxygen
available to the body cannot be used because of some pathological condition.
hypoxia (histotoxic)
Hypoxia caused by the inability of body tissues to accept oxygen from blood. An example of this type
of hypoxia is cyanide or alcohol poisoning.
hypoxia (hypemic)
Hypoxia caused by a reduced capacity of blood to carry oxygen. Two examples of hypemic hypoxia
are anemia caused by iron deficiency or a reduction in red blood cells, and carbon monoxide poisoning
caused by carbon monoxide combining with hemoglobin, a condition that reduces hemoglobin’s
oxygen-carrying capacity.

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Glossary

hypoxia (hypoxic)
Hypoxia caused by a decrease in the partial pressure of respired oxygen or the inability of oxygen in
the air to reach the alveolar-capillary membrane due to conditions such as strangulation, asthma, and
pneumonia. Hypoxic hypoxia is also known as altitude hypoxia.
hypoxia (stagnant)
A condition that results from blood’s failure to transport oxygen rapidly enough due to conditions such
as shock or heart attack, in which blood moves sluggishly.
illusion
A false impression or misconception with respect to actual conditions or reality.
inertial force
Resistance to change in a state of rest or motion. A body at rest tends to remain at rest, while a body in
motion tends to remain in motion.
inspiration
The act of drawing air into the lungs.
intensity
The loudness or pressure produced by a given noise, measured in decibels.
internal respiration
The transport of oxygen and carbon dioxide by blood and the diffusion of these gases into and out of
body tissues. Internal respiration also includes oxygen use in metabolism and the elimination of carbon
dioxide and water as waste products.
iodopsin
A photosensitive, violet retinal pigment found in retinal cones and important for color vision.
iris
The opaque, contractile diaphragm perforated by the pupil that forms the colored portion of the eye.
isobaric control
The cabin altitude control achieved by maintaining constant pressure as ambient barometric pressure
decreases.
isobaric differential
A system built into certain aircraft to control the pressurized environment at a predetermined level.
jet stream
A relatively narrow band of high-velocity winds located between 35,000 and 55,000 feet at
approximate north and south latitudes of 30 and 60 degrees.
jolt
The rate of change of acceleration or rate of onset of accelerative forces.
lens
The portion of the eye located behind the pupil that focuses light rays on the retina.
leukocytes
White blood cells.
linear acceleration
Any change in an object’s speed without a change in direction; for example, increasing the speed of an
automobile from 40 to 65 miles per hour while driving down a straight-and-level highway.
L-1 maneuver
A physiological maneuver that increases G tolerance.

Glossary-10 TC 3-04.93 31 August 2009

 Glossary

mesopic vision
A combination of cone and rod vision used at dawn or twilight wherein both rod cells and cone cells
are used but not to their maximum point of efficiency.
metabolism
The chemical changes in living cells by which energy is provided for vital processes and activities and
new material is assimilated.
miosis
Contraction of the eye’s pupil.
otolith organs
The small sacs located in the vestibule of the inner ear.
oxidation
The act of oxidizing or state of being oxidized; to combine with oxygen. Chemically, oxidation
consists of an increase in positive charges on an atom or a loss of negative charges.
oxygen flow indicator
An instrument connected directly to an oxygen regulator that indicates oxygen flow through the
regulator during a user’s respiratory cycle. This flow is manifested by the movement of shutters on the
indicator’s face.
pallor
A paleness or absence of skin coloration.
paresthesia
A form of decompression sickness characterized by abnormal skin sensations; for example, itching and
hot and cold sensations. Paresthesia can be caused by the formation of gas bubbles in the layers
beneath the skin.
partial pressure
The pressure exerted by any single constituent of a mixture of gases.
photopic
Vision in the daytime or in bright light in which the retinal cones are primarily used.
pitch
Rotation of an aircraft about its lateral axis.
plasma
The fluid portion of blood containing many dissolved compounds including proteins, carbon dioxide,
bicarbonates, sugar, and sodium.
platelets
Disk-shaped structures found in blood and known primarily for their role in blood coagulation.
presbycusis
Hearing loss attributed to old age and the aging process in general. Presbycusis can be conductive or
sensorineural in nature and is commonly referred to as “senile deafness.”
presbyopia
A visual condition that becomes apparent in middle age in which the eye’s lens loses elasticity,
causing defective accommodation and an inability to focus sharply for near vision.
pressure altitude
Pressure expressed in feet of altitude. Pressure altitude can be obtained by reading the altitude
indicated on the altimeter set at 29.92 in/Hg (the standard datum plane).

31 August 2009 TC 3-04.93 Glossary-11

Glossary

pressure breathing
Breathing in which the gases respired are at a pressure greater than the ambient pressure. The normal
respiratory cycle is reversed during pressure breathing; that is, inhalation is the passive phase of
respiration and exhalation is the active phase.
pressure demand
A type of oxygen-delivery system (mask and regulator) that incorporates both the standard demand
mechanism and a mechanism for delivering oxygen under a positive pressure. This process
necessitates pressure breathing.
pressure differential
The difference in pressure, usually expressed in pounds per square inch, that exists between one or
more objects or parts of the same object. This term also refers to a system of pressurizing aircraft
cabins in which cabin pressure is kept uniformly higher than ambient pressure.
pressure gauge
An instrument used to measure the air or oxygen pressure in any given system. The dial on the gauge
face indicates pressure within the system in pounds per square inch.
pressure suit (full)
A specially designed suit that protects an individual by surrounding the body with a pressurized gas
envelope.
pressurized cabin
Any aircraft interior that is maintained at a pressure greater than ambient pressure.
proprioceptive system
A combination of the vestibular, subcutaneous, and kinesthetic sensors that enables an individual to
determine body position and its movement in space.
radial acceleration
Any change in the direction of a moving body without a change in its speed.
radial keratotomy
A surgical procedure that creates multiple, radial, spokelike incisions on the eye’s cornea to produce
better visual acuity.
radiation (heat)
The transfer of heat in the form of wave energy from a relatively warmer body to a cooler body.
rapid decompression
A sudden loss of pressure from an area of relatively high pressure to one of lower pressure.
Conventionally, a decompression that occurs in 3 seconds or less is termed a “rapid decompression.”
red blood cells
Blood cells that contain, among several other components, the hemoglobin necessary for oxygen
transport.
redout
A phenomenon in which individuals lose their vision (and sometimes consciousness). Individuals
suffering from redout see nothing but red in their field of vision, often when experiencing –Gz. Redout
is believed to be the result of engorgement of the facial blood vessels and movement of the lower
eyelid over the eye.
relative gas expansion
The number of times a given volume of gas will expand when the pressure surrounding it is reduced.
Relative gas expansion is conventionally determined for body gases by dividing initial gas pressure by
estimated final gas pressure. These pressures must be corrected for the constant water vapor pressure
of 47 mm/Hg at normal body temperature.

Glossary-12 TC 3-04.93 31 August 2009

 Glossary

relative humidity
The amount of water vapor in a given air sample at a given temperature. Relative humidity is
expressed as a percentage of the maximum amount of water vapor the same sample could contain at
that temperature.
residual volume
The volume of air always present in the lungs.
respiration
The process of pulmonary ventilation. Respiration involves gas diffusion between the lungs and blood,
gas transport by blood between the lungs and body tissues, the diffusion of gas between blood and
body tissues, the use of oxygen within cells, and the elimination of carbon dioxide and water as the
cells’ chief waste products.
retina
The sensory membrane that lines the eye and receives images formed by the lens. The retina is the
immediate instrument of vision and connects to the brain via the optic nerve.
retinal rivalry
The difficulty of the eyes in simultaneously perceiving two dissimilar objects independent of each
other due to the dominance of one eye.
rhodopsin
A photosensitive, purple-red chromoprotein in the retinal rods that enhances night vision and is
commonly referred to as visual purple.
rods
Nerve endings located in the retina’s periphery that are sensitive to the lowest light intensities. Rods
respond to faint light at night and in poor illumination but cannot discern color or perceive detail.
roll
Rotation of an aircraft about its longitudinal axis.
speed
The magnitude of an object’s motion and rate of change. Speed is expressed as distance covered per
unit of time such as miles per hour.
velocity
Speed in a given direction. Velocity describes the magnitude and direction of motion and is measured
in distance per unit of time such as feet per second.
vestibule
The oval cavity in the middle of the bony labyrinth in the ear.
yaw
Rotation of an aircraft about its vertical axis.

31 August 2009 TC 3-04.93 Glossary-13

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 References
These publications are sources for additional information on the topics in this FM. Most joint publications can
be found at http://www.dtic.mil/doctrine/doctrine.htm. Most Army doctrinal publications are available online at
http://www.army.mil/usapa. Most Air Force and Navy publications and forms are available online at
http://www.e-publishing.af.mil/ and https://navalforms.daps.dla.mil/web/public/forms, respectively.

SOURCES USED
These documents are the sources quoted or paraphrased in this publication.
AFJMAN 44-151/ NAVMED-P-5059. NATO Handbook on the Medical Aspects of NBC Defensive
Operations, A Med P-6(B). 1 February 1996.
AR 40-8. Temporary Flying Restrictions Due to Exogenous Factors Affecting Aircrew Efficiency.
16 May 2007.
AR 40-501. Standards of Medical Fitness. 14 December 2007.
AR 50-5. Nuclear Surety. 1 August 2000.
AR 50-6. Nuclear and Chemical Weapons and Material Chemical Surety. 28 July 2008.
AR 95-1. Flight Regulations. 12 November 2008.
AR 95-27. Operational Procedures for Aircraft Carrying Hazardous Materials. 11 November 1994.
AR 385-10. The Army Safety Program. 27 August 2007.
FM 3-04.301. Aeromedical Training for Flight Personnel. 29 September 2000.
FM 3-11.5. Multiservice Tactics, Techniques, and Procedures for Chemical, Biological, Radiological,
and Nuclear Decontamination. 4 April 2006.
FM 8-50. Prevention and Medical Management of Laser Injuries. 8 August 1990.
MIL-0-27210E. Amendment 1 - Oxygen, Aviator’s Breathing, Liquid and Gas. Note: This military
specification is available from Commanding Officer, Naval Publications and Forms Center,
ATTN: NPFC 105, 5801 Tabor Avenue, Philadelphia, PA 19120.
Selye, Hans. Stress Without Distress. Philadelphia: Lippincott Publishing Company, 1974.
Selye, Hans. The Stress of Life. New York: McGraw-Hill Publishing Company, 2nd Edition, 1978.
STANAG 3114 (Edition 8). Aeromedical Training of Flight Personnel. 22 November 2006.
TB MED 507. Heat Stress Control and Heat Casualty Management. 7 March 2003.
TB MED 508. Prevention and Management of Cold-Weather Injuries. 1 April 2005.
TC 1-210. Aircrew Training Program Commander’s Guide to Individual, Crew, and Collective
Training. 20 June 2006.
TM 3-4240-280-10. Operator’s Manual for Mask, Chemical-Biological: Aircraft, ABC-M24 and
Accessories and Mask, Chemical-Biological, Tank, M25A1 and Accessories. 15 March 1988.
TM 38-250. Preparing Hazardous Materials for Military Air Shipments. 15 April 2007.
DOCUMENTS NEEDED
These documents must be available to the intended users of this publication.
AF Form 702. Individual Physiological Training Record (DD Form 2005, Privacy Act Statement
Serves).
AF Form 1274. Physiological Training.
DA Form 759. Individual Flight Record and Flight Certificate-Army.
DA Form 2028. Recommended Changes to Publications and Blank Forms.
DA Form 3444. Inpatient Treatment Records and Dental Records (Orange).
DA Form 4186. Medical Recommendation for Flying Duty.
NAVMED 6150/2. Special Duty Medical Abstract.

31 August 2009 TC 3-04.93 References-1

References

READINGS RECOMMENDED
These sources contain relevant supplemental information for the intended users of this publication.
AFI 11-403. Aerospace Physiological Training Program. 20 February 2001.
AGARD 154. Aeromedical Handbook for Aircrew.
AR 25-52. Authorized Abbreviations, Brevity Codes, and Acronyms. 4 January 2005.
AR 40-5. Preventive Medicine. 25 May 2007.
Ellis, Albert and Harper, Robert. A New Guide to Rational Living. Hollywood: Wilshire Book
Company, 1979.
FM 1-02. Operational Terms and Graphics. 21 September 2004.
FM 3-04.203. Fundamentals of Flight. 7 May 2007.
FM 3-11. Multiservice Tactics, Techniques, and Procedures for Nuclear, Biological, and Chemical
Defense Operations. 10 March 2003.
FM 4-25.11. First Aid. 23 December 2002.
FM 21-10. Field Hygiene and Sanitation. 21 June 2000.
JP 1-02. Department of Defense Dictionary of Military and Associated Terms. 12 April 2001.
TM 10-8400-202-13. Maintenance Instructions for NOMEX Flight Gear Coveralls, Types CWU-27/P
and CWU-28/P; Gloves, Type GS-FRP-2; Jacket, Flyer's, Summer, Type CWU-36/P and
Winter, Type CWU-45/P; Hood, Winter, Flyer's (CWU-17/P JACKET); Trousers, Flyer's,
Extreme Cold Weather, CWU-18/P. 15 October 1972.
TM 10-8415-206-12&P. Operator's and Organizational Maintenance Manual Including Repair Parts
and Special Tools List for Helmet, Flyer's, Protective, Model SPH-4 Regular (NSN 8415-00-
144-4981) and Extra Large (8415-00-144-4985). 5 May 1986.
TM 55-1680-351-10. Operator’s Manual for SRU-21/P Army Vest, Survival (NSN 8465-00-177-4819)
(LARGE) (8465-01-174-2355) (SMALL). 22 April 1987.
TRADOC Program of Instruction 2C-IERW (Common Core). Initial Entry Rotary-Wing Aviator
Common Core. This POI is available from Commander, U.S. Army Aviation Center of
Excellence, ATTN: ATZQ-OP, Fort Rucker, AL 36362-5000.
USAF Special Report, AL-SR-1992-0002. Night Vision Manual for the Flight Surgeon. August 1992.

References-2 TC 3-04.93 31 August 2009

 Index

A axes, 4-3, 4-8, 4-9, 4-10 cold injury, 6-5, 6-6

Gx, 4-3, 4-5, 4-8, 4-9, 4-10 conductive hearing loss, 7-4
acceleration, 4-1, 4-2, 4-3, 4-4, Gy, 4-3, 4-8, 4-9, 4-10
4-5, 4-6, 4-7, 4-8, 4-9, 9-3, Gz, 4-3, 4-5, 4-6, 4-7, 4-8, cone cells, 8-2, 8-3
9-4, 9-5, 9-6, 9-12, 9-15 4-9, 4-10 continuous-flow oxygen, 2-20
accelerative forces, 4-1, 4-2, 4- Coriolis illusion, 9-12
4, 4-8, 4-9 B
crashworthy design, 4-11
backward transverse G, 4-3 barometric pressure, 2-6, 2-7,
2-22, 2-23, 2-25, 2-26, 2-28, CREEP factors, 4-11
forward transverse G, 4-3 2-29, 10-5 cupula, 9-5, 9-6, 9-14
high-magnitude, 4-8 bends, 2-30, 3-2, 8-8, 8-9, 9-5,
low-magnitude, 4-5, 4-8
D
9-14
negative G, 4-3 Dalton’s Law of Partial
blackout, 4-4, 4-6
Pressures, 2-5
positive G, 4-3 blood
damage-risk criteria, 7-3
right- or left-lateral G, 4-3 pH, 2-10, 2-11, 2-21
pooling, 4-7, 4-8 damping, 7-3
acute fatigue, 3-11
blue-green lighting, 8-7, 8-11 dark adaptation, 8-3, 8-9, 8-10,
acute toxicity, 5-3 8-11, 8-20
body
aerial perspective, 8-14, 8-16 day blind spot, 8-3, 8-5
chemical balance, 2-10, 2-
aeromedical training, 1-1, 1-2, 11, 2-21, 3-6, 3-9, 5-1, 9- DEATH, 3-3, 8-19
1-3, 1-4 2 decelerative forces, 4-4, 4-9, 4-
aircraft atmosphere heat balance, 2-10, 6-2 11, 4-12
contamination, 5-3 Boyle’s Law, 2-23 decompression sickness, 2-6
aircraft design features, 4-9 breathing oxygen, 10-1, 10-2 decremental factors, 4-7
aircrew restrictions, 2-31 burnout, 3-11, 3-12 denitrogenation, 2-31
alcohol, 2-14, 2-17, 2-18, 3-3,
3-6, 3-8, 3-14, 4-7, 6-3, 6-5, C depth perception, 8-6, 8-14, 8-
6-6, 8-19, 8-20 cabin pressurization, 2-7, 2-19, 17, 8-18, 9-1, 9-9
altitude chamber training, 1-1, 2-31, 10-1, 10-2, 10-5, 10-6 detoxification, 5-3
1-3, 1-4, 2-18 caffeine, 3-5, 3-14 diet, 2-8, 2-18, 2-24, 3-7, 3-14,
rapid decompression, 1-1, carbon dioxide, 2-4, 2-8, 2-9, 2- 8-19, 8-21
1-4, 2-19, 10-6, 10-7, A-4 10, 2-11, 2-12, 2-13, 2-14, 2- diffusion, 2-15, 2-29
Type II chamber flight, 2-30, 21, 2-22, 2-24, 2-29, 3-4, 5- diluter-demand oxygen
9-1, A-2 8, 5-9, 8-20 regulator, 10-2
Type IV chamber flight, A-3
carbon monoxide, 2-15, 2-17, diluter-demand quick-don
Type V chamber flight, A-3
2-18, 3-7, 5-3, 5-4, 5-5, 5-7, masks, 10-3
alveolar pressure of oxygen, 2- 8-20
14 dimming of vision, 4-6
intoxication, 2-20, 5-3, 5-4,
alveoli, 2-9, 2-11, 2-12, 2-13 5-5, 5-6 distance estimation, 8-14
binocular cues, 8-14
ampulla, 9-5 cataracts, 8-8
monocular cues, 8-14
aqueous film forming foam, 5- central nervous system, 2-19,
drugs, 2-15, 3-3, 3-4, 3-5, 3-8,
7, 5-8 2-30, 3-5, 5-6, 9-16
8-19
Armstrong’s line, 2-7 disorders, 2-30
duration, 2-18, 3-13, 4-4, 4-9,
astigmatism, 8-6, 8-9 centrifugal force, 4-1, 4-3, 4-5, 4-12, 5-1, 5-4, 6-4, 7-1, 7-3,
atmosphere, 2-1, 2-2, 2-3, 2-4, 9-16 8-9, 8-13
2-5, 2-6, 2-7, 2-9, 2-11, 2-15, centripetal force, 4-1, 4-3, 4-5 dysbarism, 2-22
2-23, 2-29, 5-3 chokes, 2-30
deficient zone, 2-7 E
chronic toxicity, 5-1
space equivalent zone, 2-7 ear, 2-7, 2-20, 2-23, 2-25, 2-26,
circadian cycle, 3-12 2-27, 2-28, 3-2, 3-4, 7-2, 7-4,
atmospheric gases, 2-4, 2-29
circulatory system, 2-7, 2-9, 2- 7-5, 7-6, 7-7, 9-3, 9-15, A-1,
atmospheric pressure, 2-4
10, 2-19, 2-32, 4-5, 4-7 A-2, A-3

31 August 2009 TC 3-04.93 Index-1

Index

E-A-R® foam earplug, 7-7 graying of visual field, 4-6 intensity, 4-4, 4-9, 7-1, 7-3, 7-4,
earmuffs, 7-7 greenhouse effect, 6-1 8-2, 8-5, 8-9, 8-10, 8-11, 8-
19, 8-21, 8-22
earplugs, 7-6, 7-7 H internal respiration, 2-9
efficient zone, 2-6 H-2 bailout bottle, 10-2 iodopsin, 8-3
ejection seat, 4-4, 4-6 hair cells, 2-12, 7-5, 9-4, 9-5, 9-
elevator illusion, 9-15 6, 9-7 J
endolymph, 9-5, 9-14 hearing damage, 7-1 jet stream, 2-3
equilibrium, 2-2, 2-7, 2-11, 2- hearing loss, 7-1, 7-2, 7-3, 7-4, jolt, 4-9
25, 2-29, 9-1, 9-2, 9-13 7-5, 7-6 L
evolved-gas disorders, 10-1 hearing protection, 7-4, 7-5, 7- L-1 maneuver, 4-7
exhalation, 2-10, 2-11, 2-13, 2- 6, 7-7
LASEK, 8-8
21, 10-3, 10-4 heat
heat injury, 6-3, 6-4 lasers, 8-21, 8-22, 8-23
exhaustion, 3-3, 3-11, 3-12, 6-
3, 8-19 heat stress, 6-1, 6-3, 6-4, 6- LASIK, 8-8, 8-9
5 leans, 9-12
expected performance time, 2-
19 heat stroke, 6-3
M
explosive decompression, 10-7 heat transfer, 6-2
maximum allowable
external respiration, 2-9, 2-11 hemoglobin, 2-9, 8-20 concentration, 5-3
eye Henry’s Law, 2-28, 2-29 maximum permissible sound
anatomy and physiology of, histotoxic hypoxia, 2-18, 8-20 level, 7-3
8-1 humidity, 5-4, 6-1, 6-2 mesopic vision, 8-4
F hypemic hypoxia, 5-5 metabolism, 2-4, 3-6, 5-3
fainting, 2-22 hyperopia, 8-6, 8-9 meteorological conditions, 8-
fatigue, 1-2, 2-24, 3-1, 3-2, 3-3, hyperventilation, 2-1, 2-20, 2- 18, 9-17
3-5, 3-7, 3-10, 3-11, 3-12, 3- 21, 2-22, 2-30, 3-4, 5-9 miosis, 8-21
13, 3-14, 3-15, 6-1, 6-3, 7-1, hypoglycemia, 3-3, 3-7, 8-19, motion parallax, 8-14, 8-15
7-8, 8-11, 8-20, 9-17, 10-5, 8-21, 9-17
10-6 myopia, 8-6, 8-7, 8-9
types of fatigue, 3-11 hypothermia, 6-5
hypoxia, 2-1, 2-9, 2-14, 2-15, 2-
N
fight or flight\ syndrome, 3-9 natural body resonance, 7-2
16, 2-17, 2-18, 2-19, 2-20, 2-
fire extinguishing agents, 5-3, 21, 2-22, 3-2, 3-7, 4-7, 5-4, nerve agents, 5-6, 8-21
5-7 5-5, 6-1, 8-10, 8-11, 8-20, 9-
carbon dioxide, 2-4, 2-10, 2- nicotine, 6-5
17, 10-1, 10-3, 10-6, 10-7, A-
12, 2-13, 5-7, 5-8 1, A-2, A-3 night blind spot, 8-5, 8-12
chemical classes of, 5-7 stagnant hypoxia, 2-16 night vision, 2-7, 2-17, 2-19, 3-
halogenated hydrocarbons, hypoxic hypoxia, 2-15, 2-20 4, 3-7, 5-5, 8-2, 8-3, 8-6, 8-9,
5-7 8-10, 8-11, 8-12, 8-20, 8-21,
flicker vertigo, 9-12 I 9-9, A-1, A-2, A-3
frequency, 2-7, 3-6, 7-1, 7-2, 7- illusions, 8-14, 8-18, 9-1, 9-8, nitrogen, 2-4, 2-6, 2-24, 2-29,
4, 7-7, 8-22, 8-23, 9-4 9-9, 9-10, 9-11, 9-12, 9-14, 2-30, 2-31, 2-32, 5-2
9-15, 9-17
frostbite, 6-5 proprioceptive, 9-16 noise, 3-15, 7-1, 7-3, 7-4, 7-7,
somatogyral, 9-12 10-7
G
vestibular, 9-12, 9-14 noise level, 3-2, 7-4
gas expansion, 2-7, 2-22, 2-23, visual, 9-8
10-6, 10-7 noise levels, 7-3, 7-4, 7-5
immersion foot, 6-5, See trench noise-induced hearing loss, 7-3
gaseous diffusion, 2-12 foot
gaseous oxygen, 5-9, 10-1 impulse noise, 5-8, 7-3
O
geometric perspective, 8-14 obesity, 2-30, 3-4, 3-7
incremental factors, 4-7
G-force, 4-3, 4-4, 4-5, 4-6, 4-7, occupiable living space, 4-9
inertial force, 4-1, 4-3, 4-7
4-8 off-center viewing, 8-4, 8-6
inhalation, 2-11, 2-21, 2-30, 5-
graveyard spin, 9-12, 9-13 2, 5-6, 5-7, 10-3, 10-4 off-center vision technique, 8-
gravitational forces, 2-16, 4-1, 12
4-5

Index-2 TC 3-04.93 31 August 2009

 Index

onboard oxygen-generating respiratory system, 2-10, 2-11, 6, 6-1, 6-2, 6-3, 6-5, 6-6, 8-
system, 10-1 2-12, 2-19, 3-4, 5-5, 5-8, 7-4 19, 10-6, 10-7, 8
oral-nasal passage, 2-11, 2-12 retinal image size, 8-14 threshold limit values, 5-2
orientation, 1-2, 2-30, 3-9, 9-1, retinal rivalry, 8-6, 8-8 tobacco, 2-17, 3-3, 3-4, 3-7, 3-
9-2, 9-11 rhodopsin, 8-3, 8-10, 8-21 14, 6-5, 8-19
otolith organs, 9-3, 9-4 rod cells, 8-2, 8-3, 8-4, 8-6, 8- toxic
oxygen masks, 2-20, 5-9, 10-3 21 chemicals, 5-1
MBU-12/P, 10-3, 10-4 exposure, 5-1, 5-2
passenger, 10-3 S hazards, 5-1
scanning, 8-4, 8-12, 8-13, 8-19, substances, 5-1
oxygen systems, 10-1
8-20 toxicology, 5-1
P scotopic vision, 8-5, 8-6 trachea, 2-11, 2-12
paresthesia, 2-30 seat of the pants flying, 9-7 trapped-gas disorders, 2-7, 2-
partial pressure, 2-5, 2-6, 2-7, self-imposed stress, 3-3, 8-19 23
2-10, 2-29 trench foot. See immersion foot
self-imposed stressors, 2-17
peak G, 4-9 triple-flange earplug, 7-7
self medicating, 8-19
perception time, 8-9 tropopause, 2-3
self-talk, 3-10
peripheral vision, 8-3, 8-6, 8- troposphere, 2-2
12, 8-20, 9-8 semicircular canals, 9-3, 9-5, 9-
12, 9-13, 9-14, 9-15 U
pharynx, 2-11, 2-12, 2-25
sensorineural hearing loss, 7-5 unconsciousness, 2-20, 2-30,
photopic vision, 8-4
sensory illusion, 9-1 4-4, 4-6, 5-8, 6-5
photosynthesis, 2-4
short-term exposure limits, 5-3 unit aeromedical training
physiological altitude, 2-17, 2- program, 1-2
18, 3-6, 3-7, 8-20 silhouette identification, 8-3, 8-
13
physiological zones, 2-6 V
smoking, 2-14, 2-17, 3-4, 3-7,
plasma, 2-9, 2-10 V-51R single-flange earplug, 7-
8-20, 9-17
7
platelets, 2-8, 2-9 solar heat, 2-3, 6-1
Valsalva maneuver, 2-26, 2-27,
positive pressure, 2-20, 2-21, somatogravic illusions, 9-15 2-28
2-28, 10-3
spatial disorientation, 3-4 venous pressure of oxygen, 2-
presbycusis, 7-4
speech communication, 7-2, 7- 14
presbyopia, 8-6 5, 7-6 vertigo, 5-6, 5-8, 9-12
pressure breathing, 2-21 stagnant hypoxia, 2-16 vestibular system, 9-3, 9-7, 9-
pressurization, 2-21, 2-27, 2- Standardization Agreement 12, 9-16
30, 2-31, 10-1, 10-5, 10-6, 3114, 1-1 vibration, 3-14, 7-1, 7-2, 7-4, 7-
10-7
steady-state noise, 7-3 8
PRK, 8-8, 8-9
stratosphere, 2-3 visibility, 3-2, 8-9, 8-17, 8-18, 9-
proprioceptive system, 9-7 9
stress, 2-21, 3-1, 3-2, 3-3, 3-6,
protective device, 7-5 3-7, 3-8, 3-9, 3-10, 3-11, 4-5, visual deficiencies, 8-6, 8-8
R 4-7, 5-9, 6-1, 6-3, 8-19 visual fixation reflex, 8-4
rapid decompression, 1-2, 10-6 structural illusions, 9-9 visual purple, 8-3, 8-9, 8-21
red blood cells, 2-8, 8-20 supplemental oxygen, 2-7, 2- visual system, 9-2, 9-7, 9-8, 9-
20, 8-11, 8-20, 10-1, 10-6, 16
red lighting, 8-10, 8-11 10-7
red-lens goggles, 8-10, 8-11 survivability, 4-8, 4-11 W
refresher training, 1-1, 1-2 white blood cells, 2-8
T
respiration, 2-4, 2-9, 2-10, 2- wind chill factor, 6-6
11, 2-13, 2-21, 2-22, 3-4, 4- temperature, 2-2, 2-3, 2-5, 2-6,
6, 4-7, 4-8, 5-4, 5-8 2-10, 2-18, 2-23, 3-2, 3-4, 3-
12, 3-13, 3-14, 3-15, 5-4, 5-

31 August 2009 TC 3-04.93 Index-3

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 TC 3-04.93
31 August 2009

By order of the Secretary of the Army:

GEORGE W. CASEY, JR.

General, United States Army
Chief of Staff

Official:

JOYCE E. MORROW
Administrative Assistant to the
Secretary of the Army
0922203

DISTRIBUTION:
Active Army, Army National Guard, and U.S. Army Reserve: To be distributed in accordance with the
initial distribution number (IDN) 110725, requirements for TC 3-04.93.
PIN: 085753-000