Basic Aeromedical

Transport

Presented at: ACEM Workshop

By: Sutuspun Kay Kajornboon,
M.D., Dip. Av. Med. (UK)
Director, Civil Aeromedical Center, BMC

Date: 2011

TROPOSPHERE
From sea level to FL 300-600 Depending
on temperature
Temperature Lapse Rate 1.98 oC / 1,000 ft.
Water Vapor : Seasons & Weather,
Turbulance
Most Flying occurs

Dr. Sutuspun Kajornboon

Physiological Division
PHYSIOLOGICAL ZONE:
MSL to 10,000 ft.
PHYSIOLOGICAL DEFICIENT ZONE
10,000 ft. to 50,000 ft.
SPACE - EQUIVALENT ZONE

> 50,000 ft.

Dr. Sutuspun Kajornboon

Physiological impact of decreased atmospheric

pressure
Decrease of Atmospheric Pressure
Decrease of Partial
Pressure

Hypoxia

Decrease of Total Pressure

Trapped Gas Problem

*Ear Barotrauma
*Sinus Barotrauma
*Gastrointestinal gas
expansion
*Barodentalgia
*Etc.: pneumothorax,
peumomediastinum

Evolved Gas Problem

*Decompression
sickness

Dr. Sutuspun Kajornboon

Change of Pressure with Altitude

80k
70k
60k

50k
Feet

40k
30k

1/10

1/4
1/2

20k
10k
0

mm Hg

200

400

600

760

Partial Pressure
Air at Sea Level
O2 = 21%

pO2 = 160 mm Hg

N2 = 78%

pN2 = 593 mm Hg

Other =

1%

Total = 100%

7 mm Hg

= 760 mm Hg

Partial Pressure
Air at 10,000 ft.
O2 = 21%

pO2 = 110 mm Hg

N2 = 78%

pN2 = 408 mm Hg
5 mm Hg

Other=1%

Total=100%

=523 mm Hg

Partial pressures in mm Hg at sea level

Atmospheric air
760

Alveolar air

Oxygen

160

Oxygen

103

Nitrogen

593

Nitrogen

570

Carbon dioxide
Water vapour

40
47

Other 7

Alveolar Gases
10,000 ft

Sea level
O2

N2

103

O2

55

N2

381

CO2
H2O

40
47

570

523 mm Hg
CO2
H2O

760 mm Hg

40
47

Relationship between alveolar p02, altitude and Hb

saturation
Altitude (ft)

20k 15k 10k

5k

sea level

100

90
80

70
60

% Hb
50
saturation
40
30
20
10
0

10 20 30 40 50 60 70 80 90 100 110
Alveolar pO2 (mm Hg)

Alveolar Gases
10,000 ft

Sea level
O2

103

O2

N2

N2

523 mm Hg

760 mm Hg

55

40
47

O2

39

N2

264

CO2
H2O

30
47

381

570
CO2
H2O

CO2
H2O

18,000 ft

40
47

380 mm Hg
Air

Symptoms and Signs

Performance Effects
personality

change
loss of judgement
loss of self-criticism
euphoria
loss of short term memory
mental incoordination

Symptoms and Signs

Physical Effects
muscular

incoordination
sensory loss - vision
- touch
hot flushes
cyanosis
hyperventilation

Symptoms and Signs

Late Effects

semi-consciousness
unconsciousness

death

Times of Useful Consciousness

Altitude
FL 180
FL 220
FL 250
FL 300
FL 350
FL 400
FL 430

TUC
20 - 30 min
10 min
3 - 5 min
1 - 2 min
30 - 60 sec
15 - 30 sec
9 - 12 sec

Factors Affecting Tolerance to

Hypoxia - I

altitude
time
rate of ascent
exercise
cold
illness

Factors Affecting Tolerance to

Hypoxia - II

fatigue
drugs and alcohol
smoking
stress and workload
physical fitness
hangover

TRAPPED GAS
DISORDERS

Gas Expansion at Altitude

80k
10 x

53k
4x

34k

18k
1x

The Middle Ear

Outer ear

Inner ear

Eardrum

Eustachian tube

Gas Expansion in
the Ear - Climb
Pressure in the
middle ear is
greater than the
outsides pressure.

Gas Contraction in
the Ear - Descent
Pressure in the middle

ear is less than the

outsides pressure.

Acute Barotitis Media

Eardrum

Eustachian tube

BAROTITIS MEDIA
An acute/chronic traumatic inflammation
caused by pressure difference between
the air in the middle ear and that of the
surrounding atmosphere.
Symptoms: pain, deafness, tinnitus and
occasionally, vertigo.

Prevention
Equalized pressure by:
Chewing action or moving jaw side to
side
Yawning or swallowing
Valsalva
Do not fly with a cold.

Valsalva Maneuver

Take a deep breath.

Hold the nostrils shut tight.
Tense the cheek & neck muscles.
Force pressure similar to blowing your
nose. ( Strong short burst )

The Sinuses

Ethmoidal sinuses

Sphenoidal sinus

Frontal sinus
Maxillary sinus

Barosinusitis Media
Signs: fullness around the eyes area to
sharp stabbing pain

: trace of blood with nasal discharge

Treatment & Prevention

Seek treatment for URI/Sinusitis
Do a valsalva maneuver for relief
Use antihistamine nasal spray

Intestinal Gas Expansion

Sea Level
10,000 ft.
30.000 ft.
40,000 ft.
50,000 ft.

=
=
=
=
=

1.0
1.5
4.0
7.0
17.0

Liter
Liter
Liter
Liter
Liter

Gas Expansion in
the Stomach

Gas Expansion in
the Large Bowel

Gas Expansion in
the Small Bowel

Prevention
Avoid gas producing food.
Chew your food completely.
Avoid drinking large amount of liquid
before flight.
Start the day with good bowel habits
Avoid chewing gum during ascent

RELIEF OF SYMPTOMS

Belching (upper GI)

Passing wind (lower GI)
Maintain level flight (for cockpit crew)
Descent to lower altitude if pain is severe
(for cockpit crew)

Gas Expansion in the Lungs

- pneumothorax

- air embolism
- pneumomediastinum

Prevention of Trapped Gas

Problems
Fly only when healthy
See a doctor if ill
Equalize pressures frequently on
descent

Avoid gas producing foods, maintain

a healthy diet

Flight Environment
GLARE
Strong bright light from the sun above and
reflected from the clouds below
Health effect from UVa & UVb causing
eyes irritation
pterygium & cataract
(long term)
Effect pilot more than cabin crew

Noise & Vibration

Pa

200,000,000 140

20,000,000
Pneumatic road drill

Jet take-off
120

2,000,000

100

200,000

80

20,000

60

2000

40

Business office

dB

Heavy truck

Library
Quiet woods

200

20

20

Acceptable Noise Levels.

No NIHL with 75
exposures.

- 80 dB(A)

OH&S limit of 85 dB(A) for 8 hour

working day (Daily Noise Dose).
Aircrew exposures regularly exceed this.

Flight Environment
Noise

Vibration

Communication
Stress
Fatigue
Distraction
Deafness (hearing loss)
Vibro-acoustic Syndrome

Pain threshold
Stress
Fatigue
Motion Sickness
Speech problem
Hyperventilation
Soft tissue injury (backpain)

Personal Protective Equipment:

Aircrew helmets.
Aircrew headsets.
Earmuffs.

Insert earplugs.
Active Noise Reduction.

Flight Environment
HUMIDITY
Human are comfortable with humidity
around 60-70%; Cabin humidity could be as
low as less than 30%
Can cause throat & upper airway irritation
prone to viral infection & make jet lag
worse
Dryness exacerbate chronic skin problems
such as allergy, eczema, dandruff

HUMIDITY

Drinks more water or fluids

Avoid alcohol, too much
coffee or tea

Flight Environment
UNUSUAL MOTION
Unexpected movements in all three axis
which is not normally encounter on the
ground
confusion, stress and motion
sickness.
Long term
worsen the effect of jet lag
and fatigue easily
Turbulence are health hazard for aircrew

Med-crew Environment
CONFINED WORKING AREA
Psychologically stressful: constantly
avoiding obstacles; worse in claustrophobia
Physically a safety hazard: can get injured
easily especially during turbulence

Thank you for your attention