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No Pressure: Altitude Decompression Sickness

Gemini Sparkle

Key Takeaways:

  • Pilots flying unpressurized at high altitudes (especially above FL220) risk Altitude Decompression Sickness (ADCS), where nitrogen bubbles impair brain function and decision-making, often without the pilot's awareness.
  • Surveys reveal that a high percentage (84%) of general aviation pilots flying unpressurized above FL180 experience ADCS symptoms, highlighting it as a significant yet commonly unrecognized safety hazard.
  • Preventing ADCS primarily involves avoiding cockpit altitudes above FL210 or continuously breathing 100% oxygen; immediate treatment requires descent, supplemental oxygen, and potentially hyperbaric oxygen therapy for severe symptoms.
  • Scuba diving significantly increases the risk of decompression sickness during subsequent flights, even at lower altitudes, requiring specific flight delay recommendations.
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Altitude means different things to different pilots. In crop dusting or banner towing, it’s not something we need. When striving for efficiency and economy over a distance, it can be, since the air is thinner and cooler the higher we climb. True airspeed increases and so do tailwinds, if you’re headed in the right direction. Higher altitudes also bring with them some physiological changes we should already know about, like hypoxia—the lack of oxygen—which demands we use supplemental oxygen in unpressurized aircraft. The altitudes and hypoxic effects vary with the individual and duration, but it’s a good idea to start thinking about supplemental oxygen at and above 10,000 feet msl.

In fact, the proportion of oxygen in the atmosphere at, say, 25,000 feet is the same as it is on the surface—there’s just less of it because the air is thinner. The lower atmospheric pressure at altitude, which is one way we measure altitude, can affect the human body in ways we may not realize. For example, very few people know that flying can cause something called decompression sickness. It’s important for pilots to know when it’s likely, how it feels (so you can recognize it), what to do about it and—most important—what risks it entails.

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