Sublimation is a process in which a substance transitions from a solid to a gaseous state without passing through an intermediate liquid state. Dry ice sublimates into large quantities of CO2 gas, which can rapidly displace oxygen-containing air and potentially cause hypoxia via carbon dioxide intoxication. Case studies have shown that both illness and death can be caused by occupational and/or unintentional exposure when transporting dry ice in small, confined spaces such as a flightdeck or airplane. Exposure to high concentration of CO2 gas may lead to increased respiration, tachycardia, cardiac arrhythmia, and unconsciousness. Exposure to concentration of CO2 gas in excess of 10 percent may cause convulsions, coma, and/or death.

The tendency of dry ice to rapidly sublimate also means that without proper ventilation, it can rapidly pressurize. For this reason, dry ice should never be placed inside a sealed transport container (i.e., leak-proof secondary container) and must be placed within an outer shipping container or storage container that allows adequate ventilation to release the CO2 gas and avoid pressurization. Sealing dry ice within a leak-proof container may result in explosion of the container potentially leading to serious physical injury or death.

Hypemic hypoxia occurs when the blood is not able to take up and transport a sufficient amount of oxygen to the cells in the body. Hypemic means “not enough blood.” This type of hypoxia is a result of oxygen deficiency in the blood, rather than a lack of inhaled oxygen, and can be caused by a variety of factors. It may be due to reduced blood volume (from severe bleeding), or it may result from certain blood diseases, such as anemia. More often, hypemic hypoxia occurs because hemoglobin, the actual blood molecule that transports oxygen, is chemically unable to bind oxygen molecules. The most common form of hypemic hypoxia is CO poisoning. This is explained in greater detail later in this chapter. Hypemic hypoxia can also be caused by the loss of blood due to blood donation. Blood volume can require several weeks to return to normal following a donation. Although the effects of the blood loss are slight at ground level, there are risks when flying during this time.

Stagnant means “not flowing,” and stagnant hypoxia or ischemia results when the oxygen-rich blood in the lungs is not moving, for one reason or another, to the tissues that need it. An arm or leg “going to sleep” because the blood flow has accidentally been shut off is one form of stagnant hypoxia. This kind of hypoxia can also result from shock, the heart failing to pump blood effectively, or a constricted artery. During flight, stagnant hypoxia can occur with excessive acceleration of gravity (Gs). Cold temperatures can also reduce circulation and decrease the blood supplied to extremities.

The inability of the cells to effectively use oxygen is defined as histotoxic hypoxia. “Histo” refers to tissues or cells, and “toxic” means poisonous. In this case, enough oxygen is being transported to the cells that need it, but they are unable to make use of it. This impairment of cellular respiration can be caused by alcohol and other drugs, such as narcotics and poisons. Research has shown that drinking one ounce of alcohol can equate to an additional 2,000 feet of physiological altitude.

High-altitude flying can place a pilot in danger of becoming hypoxic. Oxygen starvation causes the brain and other vital organs to become impaired. The first symptoms of hypoxia can include euphoria and a carefree feeling. With increased oxygen starvation, the extremities become less responsive and flying becomes less coordinated. The symptoms of hypoxia vary with the individual, but common symptoms include:

As hypoxia worsens, the field of vision begins to narrow and instrument interpretation can become difficult. Even with all these symptoms, the effects of hypoxia can cause a pilot to have a false sense of security and be deceived into believing everything is normal.

Treatment for hypoxia includes flying at lower altitudes and/ or using supplemental oxygen. All pilots are susceptible to the effects of oxygen starvation, regardless of physical endurance or acclimatization. When flying at high altitudes, it is paramount that oxygen be used to avoid the effects of hypoxia. The term “time of useful consciousness” describes the maximum time the pilot has to make rational, life-saving decisions and carry them out at a given altitude without supplemental oxygen. As altitude increases above 10,000 feet, the symptoms of hypoxia increase in severity, and the time of useful consciousness rapidly decreases. [Figure 17-1] Since symptoms of hypoxia can be different for each individual, the ability to recognize hypoxia can be greatly improved by experiencing and witnessing the effects of it during an altitude chamber “flight.” The Federal Aviation Administration (FAA) provides this opportunity through aviation physiology training, which is conducted at the FAA CAMI in Oklahoma City, Oklahoma, and at many military facilities across the United States. For information about the FAA’s one-day physiological training course with altitude chamber and vertigo demonstrations, visit the FAA website at www.faa.gov.

Hyperventilation is the excessive rate and depth of respiration leading to abnormal loss of carbon dioxide from the blood. This condition occurs more often among pilots than is generally recognized. It seldom incapacitates completely, but it causes disturbing symptoms that can alarm the uninformed pilot. In such cases, increased breathing rate and anxiety further aggravate the problem. Hyperventilation can lead to unconsciousness due to the respiratory system’s overriding mechanism to regain control of breathing.

Pilots encountering an unexpected stressful situation may subconsciously increase their breathing rate. If flying at higher altitudes, either with or without oxygen, a pilot may have a tendency to breathe more rapidly than normal, which often leads to hyperventilation.

Since many of the symptoms of hyperventilation are similar to those of hypoxia, it is important to correctly diagnose and treat the proper condition. If using supplemental oxygen, check the equipment and flow rate to ensure the symptoms are

not hypoxia related. Common symptoms of hyperventilation include: