title: In-flight hypoxia incidents in military aircraft: causes and implications for training.
abstract: BACKGROUND
  Hypoxia has long been recognized as a significant physiological threat at altitude. Aircrew have traditionally been trained to recognize the symptoms of hypoxia using hypobaric chamber training at simulated altitudes of 25,000 ft or more. The aim of this study was to analyze incidents of hypoxia reported to the Directorate of Flying Safety of the Australian Defence Force (DFS-ADF) for the period 1990-2001, as no previous analysis of these incidents has been undertaken. The data will be useful in planning future training strategies for aircrew in aviation physiology.
  
  
  METHODS
  A search was requested of the DFS-ADF database, for all Aircraft Safety Occurrence Reports (ASOR) listing hypoxia as a factor. These cases were reviewed and the following data analyzed: aircraft type, number of persons on board (POB), number of hypoxic POB, any fatalities, whether the victims were trained or untrained as aircrew, if the symptoms were recognized as hypoxia, symptoms experienced, the altitude at which the incident occurred, and the likely cause.
  
  
  RESULTS
  During the period studied. 27 reports of hypoxia were filed, involving 29 aircrew. In only two cases was consciousness lost, and one of these resulted in a fatality. Most incidents (85.1%) occurred in fighter or training aircraft with aircrew who use oxygen equipment routinely. The majority of symptoms occurred between 10,000 and 19,000 ft. The most common cause of hypoxia (63%) in these aircraft was the failure of the mask or regulator, or a mask leak. Rapid accidental decompression did not feature as a cause of hypoxia. Symptoms were subtle and often involved cognitive impairment or light-headedness. The vast majority (75.8%) of these episodes were recognized by the aircrew themselves, reinforcing the importance and benefit of hypoxia training.
  
  
  CONCLUSIONS
  This study confirms the importance and effectiveness of hypoxia training for aircrew. Hypoxia incidents occur most commonly at altitudes less than 19,000 ft. This should be emphasized to aircrew, whose expectation may be that it is only a problem of high altitude. Proper fitting of masks, leak checks, and equipment checks should be taught to all aircrew and reinforced regularly. Current hypobaric chamber training methods should be reviewed for relevance to the most at-risk aircrew population. Methods that can simulate subtle incapacitation while wearing oxygen equipment should be explored. Hypoxia in flight still remains a serious threat to aviators, and can result in fatalities.
authors.affiliation: Royal Australian Air Force Institute of Aviation Medicine, RAAF Base Edinburgh, South Australia, Australia. Gordon.Cable@defence.gov.au
authors.forename: Gordon G
authors.initials: GG
authors.lastname: Cable
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D000401:Aircraft; D000532:Altitude Sickness / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D001315:Australia; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology; D003625:Data Collection; D006801:Humans; D015994:Incidence; D016272:Occupational Health; D012449:Safety; D014474:Unconsciousness / Q000209:etiology* / Q000503:physiopathology