PANEL OVERVIEW: Routine cabin altitude in aeromedical evacuation exposes ill/injured patients to flight stressors that can add physiologic insult to the initial illness/injury, the so-called second hit. Cabin altitude restriction (CAR) is a countering intervention that the validating flight surgeon can prescribe for an aeromedical evacuation patient. It sets the cabin altitude for a mission below the standard 8,000-10,000 ft. Conventional wisdom states the CAR is costly—longer flights, greater fuel use, more costly flights, lower cruising altitudes, and added physical stress to the aircraft; however, this thinking may not be entirely accurate. Traditional indications for a CAR have focused on countering both the hypoxia of altitude (e.g., severe pulmonary disease) and the consequences of Boyle's law (e.g., trapped gas and decompression illness); however, these may not be the only indications. This panel will address the physiologic foundation for prescribing a CAR, the evidence for prescribing a CAR (ecological population study, matched case-control study, and dual case-control study), the cost of prescribing a CAR (early Line assessment, matched case-control study, operational study), and a methodology for prescribing a CAR.
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