1 Colonel ret. Dr. med. Dipl.-Ing. H. Welsch former Head (1993 – 2007) of German Institute of...
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Transcript of 1 Colonel ret. Dr. med. Dipl.-Ing. H. Welsch former Head (1993 – 2007) of German Institute of...
1
Colonel ret. Dr. med. Dipl.-Ing. H. Welsch
former Head (1993 – 2007) ofGerman
Institute of Aviation Medicine, - Division Aviation Physiology –
Königsbrück
High Altitude: Physiology and Praxis, Slovenia Sep 2009
Individual Reactions to acute Hypoxia-Symptoms of Jet Fighter
Pilots and High Altitude Parachutists
2
Gegenüberstellende Betrachtung der subjektiven Wahrnehmung von
Sauerstoffmangel-Symptomen bei Freifallspringern und Jet-Piloten
Wissenschaftliche Prüfungsarbeit zum Ersten Staatsexamen für das
Lehramt an Gymnasien
Source:
“Comparison of acute Oxygen-Deficiency-Symptoms between High Altitude Parachutists and Jet Fighter Pilots”
Nina Alexandra Gleber
im SoSe 2008
Referenten:
1. Prof. Dr. med. H.-V. Ulmer
2. Prof. Dr. M. Macsenaere
3
Hypothesis and Aim of the Study• High altitude training in a low pressure chamber is a
mandatory task in NATO for each military person who takes part in high altitude air traffic.
• It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
• The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
4
Hypothesis and Aim of the Study• High altitude training in a low pressure chamber is a
mandatory task in NATO for each military person who takes part in high altitude air traffic.
• It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
• The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
5
Hypothesis and Aim of the Study• High altitude training in a low pressure chamber is a
mandatory task in NATO for each military person who takes part in high altitude air traffic.
• It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
• The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
6
Hypothesis and Aim of the Study• High altitude training in a low pressure chamber is a
mandatory task in NATO for each military person who takes part in high altitude air traffic.
• It was presumed that fast jet fighter pilots, all of them full ranked officers, might react more sensitively on hypoxia symptoms than high altitude parachutists, most of them enlisted soldiers with quite a different education in military behaviour.
• The aim of the study was to compare reaction times from both groups to verify or deny the hypothesis.
7
Simulation Centre with Human
Centrifuge and Altitude Chamber
German Air Force Institute of Aviation Medicine - Division Aviation Physiology, D-01936 Königsbrück, Germany
8
– Actual Training Devices and Areas:
– Human Centrifuge, Altitude Chamber, Anti-G-Trainer, Spatial Disorientation Device, Night Vision Training Device, Special Physical Training Equipment, Aviation Psychology (CRM)
– Actual Tasks:
– Evaluation, Training, Diagnostics, Research, Development, Test facility for industry
German Air Force Institute of Aviation Medicine
Division Aviation Physiology
9
• Altitude Physiology
•
• • Acceleration
Physiology
• Sports Physiology• (Back/Neck Training!)
• Nutrition Physiology• Aviation Psychology• Night Vision Training
Training Devices
10
• Altitude Physiology
•
• • Acceleration
Physiology
• Sports Physiology• (Back/Neck Training!)
• Nutrition Physiology• Aviation Psychology• Night Vision Training
Altitude and Hypoxia TrainingAltitude and Hypoxia Training
11
Altitude Simulation Chamber
Hypo baric + Hypoxia Training
12
Altitude Simulation Chamber Königsbrück• Max. Pressure Alt.
82.000 ft = 25.000m
• Main Chamber:– Climb-/Descend-Rate:
• +/- 20.000 ft/min
– Temperature:• +15 - +50 0C
• Decompression-chamber– Climb-/ Descend-Rate:
+/- 50.000 ft/min
– Temperature:• -50 - +10 0C
– RD: minimal 300 ms
13
14Switch „100% Oxygen“
oxygen regulator with remote control
15
ECG-MonitorPulsoxymeter
Multi-channel- Monitor
16
Pulsoxymeter
Multi-channel- Monitor
17
physiological zone
deadly zone
incomplete compensation zone
Oxygen Saturation Curve
18
Altitude Atmospheric pO²
(ft) (km) pressure (hPa) (hPa)
0 0 1013 213
3.000 0,914 908 191
7.000 2,134 782 164
10.000 3,048 697 146
12.000 3,658 645 135
15.000 4,572 572 120
18.000 5,486 506 106
20.000 6,096 466 98
22.000 6,706 428 90
25.00025.000 7,6207,620 377 377 7979
30.000 9,144 302 63
36.000 10,973 228 48
40.000 12,192 188 40
19
Time of useful consciousness at various pressure altitudesof 50 seated young med following a change from breathing oxygen to breathing air*
Time of useful consciousness (s)Altitude (ft) Altitude (m) Mean standard deviation
25.000 7.620 270 9627.000 8.230 201 4930.000 9.144 145 4534.000 10.363 84 1736.000 10.973 71 16
*Ernsting, King: Aviation Medicine Butterworths 1988
TUC: Time of Useful Consciousness
20
Altitude (ft) Altitude (m) Effective Performance Time
18.000 5.500 20 to 30 min22.000 6.700 10 min25.000 7.600 3 to 5 min28.000 8.500 2,5 to 3 min30.000 9.100 1 to 2 min35.000 10.700 0,5 to 1 min40.000 12.200 15 to 20 s43.000 13.100 9 to 12 s
*DeHart, Fundamentals of Aerospace Medicine, Lippincott Williams & Wilkins, 2002
Effective Performance Time at Altitude*
21
Objective of Training (1)
• Barometric Changes– ear drum, sinuses, trapped gases
• Pressure Breathing (>28.000 ft)– hyperventilation, breathing workload
• Acute Hypoxia (25.000 ft)– individual symptoms (at least 2!)
• Hypoxia in max. operational cabin altitude (18.000 ft): only jet fighter pilots
22
Objective of Training (2)
• Altitude Hypoxia Exposure– primarily no diagnostic/evaluation tool!– situational awareness training:
• flying in high altitude
• instrumental cross check including oxygen equipment; “PRICE”-check
• Oxygen Equipment Safety Training
• Confidence Training
23
Signs and Symptoms of Hypoxia
• Because there is always a risk of equipment failure at high altitude, early recognition of hypoxic symptoms is mandatory.
• The constellation of hypoxic symptoms and their sequence of appearance tend to be idiosyncratic to the individual.
• As a rule, the individual‘s symptoms do not change dramatically over time, but refresher training in a chamber does reacquaint the individual with the symptoms, as well as identify any change in symptoms.
24
Signs and Symptoms of Hypoxia
• Because there is always a risk of equipment failure at high altitude, early recognition of hypoxic symptoms is mandatory.
• The constellation of hypoxic symptoms and their sequence of appearance tend to be idiosyncratic to the individual.
• As a rule, the individual‘s symptoms do not change dramatically over time, but refresher training in a chamber does reacquaint the individual with the symptoms, as well as identify any change in symptoms.
25
Signs and Symptoms of Hypoxia
• Because there is always a risk of equipment failure at high altitude, early recognition of hypoxic symptoms is mandatory.
• The constellation of hypoxic symptoms and their sequence of appearance tend to be idiosyncratic to the individual.
• As a rule, the individual‘s symptoms do not change dramatically over time, but refresher training in a chamber does reacquaint the individual with the symptoms, as well as identify any change in symptoms.
26
Pilots and Parachutists
• Aircrew (Pilots and WSO): – above 8.000 ft pressure altitude in the cockpit:
additional oxygen in the breathing gas is required. Jet fighter aircraft aircrew is always equipped with oxygen breathing mask.
• High altitude parachutists: – HAHO: High Altitude, High Opening:
• Pre-breathing in the A/C, oxygen breathing in the air
– HALO: High Altitude, Low Opening• Pre-breathing in the A/C, normal breathing in the air
27
5 000
10 000
15 000
20 000
25 000
30 000
35 000
Altitude (ft)
Time(min.)
10 20 30 40 50 60 70 80 90
8 000
3 000
18 000
I
II
III
IV
V
VI4 000 ft/min
4 000 ft/min
10 000 ft/min
4 000 ft/min
2 000 ft/min
Hypoxia training:
pressure altitude 25.000 ft
28
Pilots and Parachutists
• Aircrew (Pilots and WSO): – above 8.000 ft pressure altitude in the cockpit:
additional oxygen in the breathing gas required. Jet fighter aircraft aircrew is always equipped with oxygen breathing mask.
• High altitude parachutists: – HAHO: High Altitude, High Opening:
• Pre-breathing in the A/C, oxygen breathing in the air
– HALO: High Altitude, Low Opening• Pre-breathing in the A/C, normal breathing in the air
29Zeit (min)
Höh
e (f
t)
5000
10000
15000
20000
25000
30000
35000
10 20 30 40 50 60 70 80
I
II
III
IV
V
VI4000 ft/min
2000 ft/min
4000 ft/min
2000 ft/min
10000 ft/min
10000 ft/min
Hypoxia training:
pressure altitude 25.000 ft
30
Monitoring100%
90%
75%
60%
Oxygen saturation %
Heart rate
25.000 ft18.000 ft
Breathing 21% oxygenBreathing 21% oxygen
31
objective subjective
tachypnoe hyperpnoe/dyspnoetachycardia dizziness
hyperventilation anxietycyanosis excitement
loss of interpretation feeling hot/warm/coldloss of critical faculties headache
loss of discernment drowsinessloss of consciousness euphoria/ apathia
tunnel vision
Signs and Symptoms of Hypoxia
32
Early (covert) features (signs and
symptoms) of acute hypoxia*
• Visual function:– Light intensity perceived as reduced– Visual acuity diminished in poor illumination– Light threshold increased– Peripheral vision narrowed
• Psychomotor function:– Choice reaction time impaired– Eye-hand co-ordination impaired
• Cognitive function:– Memory impaired
33
Overt features (signs and symptoms) of acute hypoxia*
• Personality Change:– Lack of insight– Loss of judgement– Loss of self-criticism– Euphoria– Loss of memory– Mental incoordination– Muscular incoordination– Sensory loss– Cyanosis
• Hyperventilation:– Dizziness– Light-headedness– Feeling of unreality– Feeling of apprehension– Neuromuscular
irritability– Paraesthesia of skin• Unconsciousness
• Death
34
Results: Pressure Altitude 25.000 ftQuestions and Answers
1. Statistic Data of Trainees
2. First Hypoxia Symptoms (Time and SaO2)
3. Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)
4. Time between first Hypoxia Symptom and Re-connection to 100% Oxygen
35
Results Pressure Altitude 25.000 ft
1. Statistic Data of Trainees
2. First Hypoxia Symptoms (Time and SaO2)
3. Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)
4. Time between first Hypoxia Symptom and Re-connection to 100% Oxygen
36
Biographic Data of TraineesJan 2005 – Nov 2006
Pilots Parachutists Σ
Trainees 265 250 515
age 21 - 57 19 - 52 19 - 57
medium age 35,1 30,3 32,8
smoker 58 (22%) 79 (32%) 137 (27%)
non-smoker 207 (78%) 171 (68%) 378 (73%)
37
Results Pressure Altitude 25.000 ft
1. Statistic Data of Trainees
2. First Hypoxia Symptoms (Time and SaO2)
3. Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)
4. Time between first Hypoxia Symptom and Re-connection to 100% Oxygen
38
First Hypoxia Symptoms
unknown 12 (5%) 9 (4%) 21 (4%)
32 - 60 s 4 (1%) 13 (5%) 17 (3%)
61 – 75 s 16 (6%) 28 (11%) 44 (9%)
76 – 90 s 52 (20%) 47 (19%) 99 (19%)
91 – 105 s 46 (17%) 40 (16%) 86 (17%)
106 – 120 s 47 (18%) 42 (17%) 89 (17%)
121 – 135 s 43 (16%) 28 (11%) 71 (14%)
136 - 240 s 45 (17%) 43 (18%) 88 (17%)
Time Pilots Parachutists Σ
39
First Hypoxia Symptoms SaO2
unknown 12 (5%) 9 (4%) 21 (4%)
99% 20 (8%) 37 (15%) 57 (11%)
90 – 99% 84 (32%) 76 (30%) 160 (31%)
80 – 89% 40 (15%) 27 (11%) 67 (13%)
75 – 79% 25 (9%) 30 (12%) 55 (11%)
70– 74% 38 (14%) 25 (10%) 63 (12%)
65 – 69% 33 (12%) 34 (14%) 67 (13%)
60 – 64% 13 (5%) 12 (5%) 25 (5%)
SaO2 Pilots Parachutists Σ
40
Results Pressure Altitude 25.000 ft
1. Statistic Data of Trainees
2. First Hypoxia Symptoms (Time and SaO2)
3. Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)
4. Time between first Hypoxia Symptom and Re-connection to 100% Oxygen
41
Time: Re-Connection to 100% Oxygen Breathing Gas
unknown 0 (0%) 0 (0%) 0 (0%)
72 - 100 s 19 (7%) 14 (6%) 33 (6%)
101 – 120 s 45 (17%) 21 (8%) 66 (13%)
121 – 150 s 110 (42%) 79 (32%) 189 (37%)
151 – 180 s 62 (23%) 86 (34%) 148 (29%)
181 – 210 s 22 (8%) 37 (15%) 59 (11%)
211 – 240 s 6 (2%) 8 (3%) 14 (3%)
241 - 322 s 1 (0%) 5 (2%) 6 (1%)
Time Pilots Parachutists Σ
42
Oxygen Saturation when re-connected to 100% Oxygen breathing gas
0
20
40
60
80
100
120
Oxygen Saturation (%)
Nu
mb
er o
f T
rain
ees
Pilots
Parachutists
99% 95% 90% 85% 80% 75% 70% 65% 60%
43
SaO2: Re-Connection to 100% Oxygen Breathing Gas
unknown 0 (0%) 6 (2%) 6 (1%)
99% 2 (1%) 1 (0%) 3 (1%)
90 – 99% 15 (6%) 14 (6%) 29 (6%)
80 – 89% 27 (10%) 18 (7%) 45 (9%)
75 – 79% 64 (24%) 20 (8%) 84 (16%)
70– 74% 99 (37%) 93 (37%) 192 (37%)
65 – 69% 56 (21%) 95 (38%) 151 (29%)
60 – 64% 2 (1%) 3 (1%) 5 (1%)
SaO2 Pilots Parachutists Σ
Most of these trainees are forced by the instructor to re-connect themselves to 100% oxygen breathing gas, when reached the 70% SaO2-level. The „after-drop“ explains the values between 60 – 70% SaO2.
44
Oxygen Saturation whenre-connected to 100% Oxygen
• 207 (78%) of 265 pilots are re-connected before their oxygen-saturation dropped beneath 70%.
• Only 146 (60%) of 244 parachutists are re-connected before their oxygen-saturation dropped beneath 70%.
45
Results Pressure Altitude 25.000 ft
1. Statistic Data of Trainees
2. First Hypoxia Symptoms (Time and SaO2)
3. Duration of Breathing 21% Oxygen until Re-connection to 100% Oxygen Breathing Gas (Time and SaO2)
4. Time between first Hypoxia Symptom and Re-connection to 100% Oxygen
46
Time between First Symptom and Re-Connection to 100% Oxygen Breathing Gas
0s 10 (4%) 6 (2%) 16 (3%)
1 - 15 s 47(18%) 21 (8%) 68 (13%)
16 – 30 s 76 (29%) 51 (20%) 127 (25%)
31 – 45 s 65 (25%) 48 (19%) 113 (22%)
46 – 60 s 31(12%) 42 (17%) 73 (14%)
61 – 120 s 22 (8%) 64 (26%) 86 (17%)
121 – 248 s 2 (1%) 9 (4%) 11 (2%)
unknown 12 (4%) 9 (4%) 21 (4%)
Time Jet-Pilots Parachutists Σ
72%
62%
47
Hypoxia Duration between first Symptom and Re-Connection to 100% Oxygen
0
5
10
15
20
25
30
0
15
30
45
60
75
90
10
5
12
0
13
5
15
0
16
5
18
0
18
1-2
40
un
kno
wn
Duration Time (s)
Nu
mb
er
of
Tra
ine
es Pilots
Parachutists265 Pilots
250 Parachutists
48
Duration of Hypoxia between first Symptom and
Re-Connection to 100% Oxygen
• 229 (91%) of 253 pilots are re-connected within the first minute (60 seconds) after recognition of their first hypoxia-symptom.
• Only 168 (70%) of 241 parachutists are re-connected within the first minute (60 seconds) after recognition of their first hypoxia-symptom.
49
Results – Smoker/Non-Smoker
Trainees Age 1. Symp. - EndTime (s) SaO2 (%) Time (s) SaO2 (%) (s)
Non-smoker 207 35,5 110,1 85,6 143,2 74,1 32,5Pilots (265) Smoker 58 34,0 110,5 84,3 144,9 74,9 35,1
mean 35,1 110,2 85,3 143,6 74,2 33,1
Non-smoker 171 30,8 109,6 86,2 157,4 72,1 47,7Parachutists (250) Smoker 79 29,5 101,3 87,9 153,1 73,2 51,8
mean 30,3 106,9 86,7 156,0 72,5 49,0
1. Symptom Reconnection
50
Results – Smoker/Non-Smoker
Trainees Age 1. Symp. - EndTime (s) SaO2 (%) Time (s) SaO2 (%) (s)
Non-smoker 207 35,5 110,1 85,6 143,2 74,1 32,5Pilots (265) Smoker 58 34,0 110,5 84,3 144,9 74,9 35,1
mean 35,1 110,2 85,3 143,6 74,2 33,1
Non-smoker 171 30,8 109,6 86,2 157,4 72,1 47,7Parachutists (250) Smoker 79 29,5 101,3 87,9 153,1 73,2 51,8
mean 30,3 106,9 86,7 156,0 72,5 49,0
1. Symptom Reconnection
MORE OR LESS: NO DIFFERENCE!
51
Summary Pilots - Parachutists
• No Differences in Type of Hypoxia Symptoms• No Differences in Recognition of first Hypoxia
Symptoms in Time and SaO2
• Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
• Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
• There is no Difference between Smokers and Non-Smokers.
52
Summary Pilots - Parachutists
• No Differences in Type of Hypoxia Symptoms• No Differences in Recognition of first Hypoxia
Symptoms in Time and SaO2
• Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
• Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
• There is no Difference between Smokers and Non-Smokers.
53
Summary Pilots - Parachutists
• No Differences in Type of Hypoxia Symptoms• No Differences in Recognition of first Hypoxia
Symptoms in Time and SaO2
• Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
• Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
• There is no Difference between Smokers and Non-Smokers.
54
Summary Pilots - Parachutists
• No Differences in Type of Hypoxia Symptoms• No Differences in Recognition of first Hypoxia
Symptoms in Time and SaO2
• Pilots Re-connect themselves earlier than Parachutists (Time and SaO2) to 100% Breathing Gas
• Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Breathing Gas
• There is no Difference between Smokers and Non-Smokers.
55
Summary Pilots - Parachutists
• No Differences in Type of Hypoxia Symptoms• No Differences in Recognition of first Hypoxia
Symptoms in Time and SaO2
• Pilots Re-connect earlier than Parachutists (Time and SaO2) to 100% Oxygen Breathing Gas
• Parachutists wait much longer after first Experience of Hypoxia Symptoms until Re-connection to 100% Oxygen Breathing Gas
• There is no Difference between Smokers and Non-Smokers.
56
Thank You for Patience and Listening!
Questions?
57
Incidence of Decompression Sickness (DCS) and Venous Gas Emboli (VGE) staying in high altitude;
without pre-breathing(Andrew A. Pilmanis, Ph.D.)
0
10
20
30
40
50
60
70
80
90
100
11 13 15 17 19 21 23 25
Höhe, ft X 1000
% V
ork
omm
en
VGE
DCS