Skip to main content

Pathophysiology of Flight

  • Chapter
  • First Online:
In-Flight Medical Emergencies

Abstract

The in-flight environment is a potentially hostile one that exposes patients and medical transport teams to a number of significant physiological changes and environmental stressors. It is important to understand the implications of these on the human body so as to develop strategies to minimise their potential for related adverse clinical consequences during flight. This chapter reviews the physics of the atmosphere with a particular emphasis on the behaviour of gases. The effects of altitude on the human body are considered demonstrating the clinical significance of Boyle’s, Dalton’s and Henry’s law. The impact of changes in humidity, ambient temperature and exposure to G forces is discussed. The potential effects of exposure to noise and vibration are reviewed with special consideration to how these can impair human performance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gratton G. The atmosphere. In: Gratton G, editor. Initial airworthiness: determining the acceptability of new airborne systems. Switzerland: Springer; 2015. p. 15–32.

    Google Scholar 

  2. Reinhart RO. Basic flight physiology. 3rd ed. New York: McGraw-Hill; 2008.

    Google Scholar 

  3. Martin T. Aeromedical Transportation: a clinical guide. 2nd ed. Aldershot: Ashgate; 2006.

    Google Scholar 

  4. Grissom T. Critical care air transport: patient flight physiology and organizational considerations. In: Hurd WW, Jernigan JG, editors. Aeromedical evacuation: management of acute and stabilized patients. New York: Springer; 2003. p. 111–35.

    Chapter  Google Scholar 

  5. Wirth D, Rumberger E. Fundamentals of aviation physiology. In: Christiansen CC, Draeger J, Kriebel J, editors. Principles and practice of aviation medicine. New Jersey: World Scientific; 2009. p. 71–150.

    Chapter  Google Scholar 

  6. West JB, Schoene RB, Luks AM, Milledge JS. The atmosphere. In: High altitude medicine and physiology. 5th ed. Boca Raton: CRC Press; 2013. p. 16–27.

    Google Scholar 

  7. West JB. Respiratory physiology: the essentials. 9th ed. Baltimore: Lippincott Williams & Wilkins; 2012.

    Google Scholar 

  8. Aerospace Medical Association, Aviation Safety Committee, Civil Aviation Subcommittee. Cabin cruising altitudes for regular transport aircraft. Aviat Space Environ Med. 2008;79(4):433–9.

    Article  Google Scholar 

  9. Muhm JM, Rock PB, McMullin DL, Jones SP, Lu IL, Eilers KD, et al. Effect of aircraft-cabin altitude on passenger discomfort. N Engl J Med. 2007;357:18–27.

    Article  CAS  PubMed  Google Scholar 

  10. Fitz-Clark J, Quinlan D, Valani R. Flying with a pneumothorax: a model of altitude limitations due to gas expansion. Aviat Space Environ Med. 2013;84(8):834–9.

    Article  Google Scholar 

  11. Majercik S, White TW, Van Boerum DH, Granger S, Bledsoe J, Conner K, et al. Cleared for takeoff: the effects of hypobaric conditions on traumatic pneumothoraces. J Trauma Acute Care Surg. 2014;77(5):729–33.

    Article  PubMed  Google Scholar 

  12. International Air Transport Association. Medical manual. 8th ed. 2016 [cited 2016 Nov 23]. http://www.iata.org/publications/Pages/medical-manual.aspx.

  13. Samuels MP. The effects of flight and altitude. Arch Dis Child. 2004;89:448–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kanick SC, Doyle WJ. Barotrauma during air travel: predictions of a mathematical model. J Appl Physiol. 2005;98(5):1592–602.

    Article  PubMed  Google Scholar 

  15. Mittermayr M, Fries D, Gruber H, Peer S, Klingler A, Fischbach U, et al. Leg edema formation and venous blood flow velocity during a simulated long-haul flight. Thromb Res. 2007;120(4):497–504.

    Article  CAS  PubMed  Google Scholar 

  16. Stephenson J. Pathophysiology, treatment and aeromedical retrieval of SCUBA-related DCI. J Mil Veterans Health. 2009;17(3):10–9.

    Google Scholar 

  17. MacDonald RD, O’Donnell C, Allen B, Breeck K, Chow Y, DeMajo W, et al. Interfacility transport of patients with decompression illness: literature review and consensus statement. Prehosp Emerg Care. 2006;10:482–7.

    Article  PubMed  Google Scholar 

  18. Bassi M, Zuercher M, Erne JJ, Ummenhofer W. Endotracheal tube intracuff pressure duriung helicopter transport. Ann Emerg Med. 2010;56(2):89–93.

    Article  PubMed  Google Scholar 

  19. Flynn JG, Singh B. The performance of Drager Oxylog ventilators at simulated altitude. Anaesth Intensive Care. 2008;36:549–52.

    CAS  PubMed  Google Scholar 

  20. Dechow M, Nurcombe CAH. Aircraft environmental control systems. In: Hocking MB, editor. Air quality in airplane cabins and similar enclosed spaces. New York: Springer; 2005. p. 4–24.

    Google Scholar 

  21. Pilcher JJ, Nadler E, Busch C. Effects of hot and cold temperature exposure on performance: a meta-analytic review. Ergonomics. 2002;45(10):682–98.

    Article  PubMed  Google Scholar 

  22. Nagda NL, Hodgson M. Low relative humidity and aircraft cabin air quality. Indoor Air. 2001;11(3):200–14.

    Article  CAS  PubMed  Google Scholar 

  23. Newman DG. High G flight: physiological effects and countermeasures. Farnham: Ashgate; 2015.

    Google Scholar 

  24. Metidieri MM, Rodrigues HFS, Barros de Oliveira Filho FJM, Ferraz DP, Fausto de Almeida Neto A, Torres S. Noise induced hearing loss (NIHL): literature review with a focus on occupational medicine. Int Arch Otorhinolaryngol. 2013;17(2):208–12.

    PubMed  PubMed Central  Google Scholar 

  25. Nassiri P, Monazam M, Fouladi Dehaghi B, et al. The effect of noise on human performance: A clinical trial. Int J Occup Environ Med. 2013;4:87–95.

    CAS  PubMed  Google Scholar 

  26. Randall JM, Matthews RT, Stiles MA. Resonant frequencies of standing humans. Ergonomics. 1997;40(9):879–86.

    Article  CAS  PubMed  Google Scholar 

  27. Griffin MJ. Handbook of human vibration. London: Academic Press; 1990.

    Google Scholar 

  28. Golding JF, Mueller AG, Gresty MA. A motion sickness maximum around the 0.2 Hz frequency range of horizontal translational oscillation. Aviat Space Enviro Med. 2001;72(3):188–92.

    CAS  Google Scholar 

  29. Carchietti E, Cecchi A, Valent F, Rammer R. Flight vibrations and bleeding in helicoptered patients with pelvic fractures. Air Med J. 2013;32(2):80–3.

    Article  PubMed  Google Scholar 

  30. Vann RD, Clark HG. Bubble growth and mechanical properties of tissue in decompression. Undersea Biomed Res. 1975;2(3):185–94.

    CAS  PubMed  Google Scholar 

  31. Lockley SW, Bargar LK, Ayas NT, Rothschild JM, Czeisler CA, Landrigan CP. Effects of health care provider work hours and sleep deprivation on safety and performance. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl 1):S7–18.

    Article  Google Scholar 

  32. Brainard A, Gresham C. Motion sickness clinical presentation [Internet]. New York: Medscape; 2016. [cited 2016 Dec1]. http://emedicine.medscape.com/article/2060606-clinical

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geoffrey A. Ramin M.B.B.S., F.A.C.E.M. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ramin, G.A. (2018). Pathophysiology of Flight. In: Nable, J., Brady, W. (eds) In-Flight Medical Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-74234-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74234-2_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74233-5

  • Online ISBN: 978-3-319-74234-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics