Aviation Physiology: Ensuring Safety at High Altitudes

Dr. Chris Salvino, 27 July 2024

Dr. Chris Salvino during his time as a USAF Flight SurgeonAs a medical professional with extensive experience in aviation, trauma surgery, and aerospace medicine, I believe it is imperative to share knowledge that can enhance aviation safety. Aerospace physiology is a critical area of study for anyone working in aviation, in order to understand the physical and mental effects of flight on aircrew and passengers. Knowledge of physiology concepts is essential for any aviation professional, so let’s go over some of the key aspects of aviation physiology:

The Basics of Aviation Physiology

Human bodies are designed to adapt to various environmental conditions, but the unique challenges posed by high-altitude flight require a specialized understanding. As altitude increases, atmospheric pressure decreases, leading to significant physiological changes. These changes must be managed effectively to optimize crew performance and ensure the safety of everyone on board.

Hypoxia: A Primary Concern

One of the most critical issues in aviation physiology is hypoxia, a condition characterized by insufficient oxygen reaching the body's tissues. At high altitudes, the reduced partial pressure of oxygen can lead to hypoxia, which impairs cognitive and physical functions. Symptoms include dizziness, shortness of breath, and impaired judgment. Recognizing and responding to hypoxia is crucial for pilots and passengers alike, and knowledge of the factors that contribute to hypoxia is critical education for pilots.

US Air Force altitude chamber trainingI highly recommend that professional pilots go through a full altitude chamber training profile, which allows you to experience the onset of hypoxia symptoms in a controlled profile. You’ll get to discover your primary symptoms from hypoxia, which typically include feeling lightheaded, some color vision changes, and cognitive confusion -- but these symptoms can also vary significantly between individuals.

The Role of Oxygen Systems

Modern aircraft are equipped with advanced oxygen systems to mitigate the effects of hypoxia. These systems provide supplemental oxygen at higher altitudes, ensuring that both crew and passengers receive adequate oxygen levels. It is vital for crew members to be proficient in the use of these systems and understand their operational principles.

Pressurized cabins play a crucial role in maintaining a stable and safe environment at high altitudes. By effectively lowering the cabin altitude, pressurization allows passengers to breathe comfortably and reduces the risk of hypoxia. Pilots must be vigilant to monitor cabin pressure and prepared to initiate emergency procedures if cabin pressure is lost.

Trapped Gas and Decompression Sickness

Because of the varying atmospheric pressures during flight, an important topic in aviation physiology is the expansion of trapped gases within the body as atmospheric pressure decreases with altitude. This can lead to discomfort in the ears, sinuses, and gastrointestinal tract. For example, during a rapid ascent, a passenger might experience severe ear pain due to the inability to equalize pressure.

Decompression sickness, though rare, is a potential hazard with serious consequences. It occurs when nitrogen dissolved in the blood forms bubbles as pressure decreases, causing joint pain, dizziness, and, in severe cases, neurological impairment. Pilots need to be trained to recognize the symptoms and manage the condition effectively to ensure safety.

Spatial Disorientation and Visual Impairments

Acceleration forces on the body’s vestibular system can lead to spatial disorientation and visual impairments in flight. Spatial disorientation happens when the body's sensory inputs conflict, making it challenging to determine the aircraft’s orientation relative to the earth. Instrument training teaches pilots to rely on their instrument displays under these conditions, but it’s quite beneficial for pilots to learn what conditions are likely to contribute to spatial disorientation and the various types of spatial disorientation that are commonly experienced.

Physical Fitness and Health

Maintaining physical fitness is crucial for aircrew performance during flight, and especially if the flight conditions are strenuous or require focus for extended duration. Aerobic and anaerobic exercise enhances cardiovascular health, muscle strength, and overall endurance, enabling pilots to handle the physical demands of flight more effectively. Additionally, pilots must be aware of the performance detriments from self-imposed stressors, such as fatigue, poor nutrition, and dehydration. Aircrew that incorporate a regular exercise routine and proper nutrition into their lifestyle are better equipped to handle long flights, and the associated stresses from the flight environment, with optimal performance.

Conclusion

The study of aviation physiology is vital to ensure the safety and optimal performance of flight operations. By understanding the physiological effects of high altitude, pilots can better prepare for the challenges of flying, including managing hypoxia, avoiding decompression sickness, and combatting spatial disorientation. I’m passionate about teaching aviation physiology to equip individuals with knowledge and airmanship. By sharing my knowledge, I hope to enhance aviation safety and ensure a secure and efficient flying experience for all.

About the Author

Instructor Flight Test Engineer and Flight Surgeon Chris Salvino

Dr. Chris Salvino is a graduate of the National Test Pilot School and brings a wealth of experience in aviation, medicine, and engineering. As a former US Air Force Flight Surgeon and currently a practicing trauma/critical care surgeon, his aerospace and medical experience includes serving as State Air Surgeon for Indiana and an F-16 flight surgeon for the Air National Guard. His military service includes deployments to Antarctica and participation in the Air Force Top Knife Program. Dr. Salvino's aerospace experience extends far beyond the military; he founded an FAA Part 135 EMS air ambulance program (rotor and fixed wing) and has extensive experience as an Aviation Medical Examiner. He's a seasoned lecturer on aerospace medicine and altitude physiology. He has completed aerobatic, instrument, multi-engine and commercial pilot certificates including Learjet Part 135 initial and L-39 ground and refresher schools. He served as a Part 135 Learjet pilot flying both medical as well as business clients and has logged time at the flight controls of over 16 different aircraft. Academically, Dr. Salvino holds impressive credentials: a Doctor of Medicine degree, two undergraduate degrees in biology and mechanical engineering, and six master's degrees spanning space studies, flight test technology, aerospace medicine, planetary geology, engineering mining, and aerospace engineering. He's currently pursuing a Ph.D. in engineering mining, focusing on lunar Helium-3 extraction to fuel future Earth based fusion reactors.