DOT/FAA/AM-21/11

Office of Aerospace Medicine

Washington, DC 20591

Passenger Oxygen Mask Design Study

Susan M. Jay, Ph.D.

Robert K. Hettman
DK Deaderick
Joseph G. Mandella
Shannon Lennon

Civil Aerospace Medical Institute

Federal Aviation Administration
Oklahoma City, OK 73125

March 2021
 NOTICE

This document is disseminated under the sponsorship of the U.S. Department of

Transportation in the interest of information exchange. The United States
Government assumes no liability for the contents thereof.
_________________

This publication and all Office of Aerospace Medicine technical reports are
available in full-text from the Civil Aerospace Medical Institute’s publications
Web site: (www.faa.gov/go/oamtechreports)
 Technical Report Documentation Page
1. Report No. 2. Government Accession No. 3. Recipient's Catalog No.
DOT/FAA/AM-21/11
4. Title and Subtitle 5. Report Date
March 2021
Passenger Oxygen Mask Design Study
6. Performing Organization Code

7. Author(s) 8. Performing Organization Report

No.
Jay, S. M., Hettman, R. K., Deaderick, DK, Mandella, J. G., Lennon, S.

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS)
Civil Aerospace Medical Institute
Federal Aviation Administration 11. Contract or Grant No.
Oklahoma City, OK 73125

12. Sponsoring Agency name and Address 13. Type of Report and Period
Covered
Office of Aerospace Medicine
Federal Aviation Administration Final Report
800 Independence Ave., S.W.
Washington, DC 20591 14. Sponsoring Agency Code

15. Supplemental Notes

16. Abstract
In response to Section 536 of Public Law 115-254, the Federal Aviation Administration (FAA)
Reauthorization Act of 2018, the FAA conducted a review of the design, use, and effectiveness of
commercial aircraft passenger oxygen masks. The intent was to determine whether the current design of
passenger oxygen masks is adequate and whether changes to the design could increase correct passenger
use of the masks. The yellow “Dixie-Cup” mask has changed little since the late 1950s, but its deceptively
simple appearance belies a well-thought-out design. The round shape allows for quick and easy donning
regardless of mask orientation. The mask also conforms to a wide range of face sizes and shapes, and one
mask shape performs well for infants, children, and adults. Oxygen masks located throughout the
passenger cabin typically meet minimum design, construction, and performance requirements using the
FAA Technical Standard Order approval process and associated industry consensus standards.
Following the completion of our review, we determined that the current passenger oxygen mask design is
adequate and significant changes to the size and shape of the mask facepiece are not necessary. Although
we determined that the general design and effectiveness of the mask facepiece is adequate, we made
recommendations that may increase the correct use of the passenger mask. We made recommendations
related to mask measurement, as well as increased comprehension of preflight briefing materials by
passengers. We also made a recommendation to explore a cost- effective means to add text or symbology
that would specify that the mask should be worn over the nose and mouth.

17. Key Words 18. Distribution Statement

Passenger Oxygen Mask, Dixie-Cup, Emergency Procedures, Document is available to the public through the
Passenger Briefings Internet:
http://www.faa.gov/go/oamtechreports/
19. Security Classif. (of this 20. Security Classif. (of this page) 21. No. of Pages 22. Price
report)
Unclassified Unclassified 49

i
 Table of Contents
List of Tables............................................................................................................................................... iv
List of Figures ............................................................................................................................................. iv
Executive Summary.................................................................................................................................... v

Introduction ................................................................................................................................................. 1
Legislative Mandate .................................................................................................................. 1
Background ............................................................................................................................... 1
Passenger Cabin Occupant Oxygen Mask Design and Function ....................................... 1
Mask Components .............................................................................................................. 2
Mask Deployment and Oxygen Flow Activation ............................................................... 4
Mask Function .................................................................................................................... 6
Mask Not for Use as Protective Breathing Equipment....................................................... 7
Mask Design, Materials, and Performance Testing Standards ........................................................... 8
Mask Design/Presentation ........................................................................................................ 8
Mask Materials ......................................................................................................................... 8
Mask Face Piece ....................................................................................................................... 9
Mask Performance Testing Standards....................................................................................... 9
Passenger Education and Situational Awareness ................................................................................ 10
Passenger Behavior ................................................................................................................. 10
Oxygen Mask Deployments................................................................................................... .11
Passenger Apathy .................................................................................................................... 11
Passenger Briefings ................................................................................................................. 12
Conclusions ................................................................................................................................................ 14
Appendix A: Sample Briefing Cards and Safety Briefing Script........................................... 15
Appendix B: Aviation Oxygen Masks - Historical Overview ................................................ 17
World War I: The Pipe Stem ............................................................................................ 17
1930s-1940s: The BLB Mask and the K-S Disposable Oxygen Mask ............................ 17
1950s–1960s: New Oxygen Mask Designs for Jet Airplanes .......................................... 22
1970s to the Present: Mask Presentation and Passenger Preflight Briefing ..................... 26
Appendix C: Oxygen Systems and Oxygen Mask Assemblies .............................................. 29
Oxygen Systems ............................................................................................................... 29
Chemical Oxygen Generators .................................................................................... 29
Gaseous Oxygen Systems .......................................................................................... 29
Oxygen Mask Assemblies ................................................................................................ 30
Crew Oxygen Mask Assembles ................................................................................. 30
Passenger Cabin Occupant Mask Assemblies ........................................................... 30
Mask Assemblies with Portable Oxygen Cylinders................................................... 30
Appendix D: Flight Physiology .............................................................................................. 32
Definitions ........................................................................................................................ 32
The Atmosphere ............................................................................................................... 32

ii
 Partial Pressure of Oxygen ............................................................................................... 32
Pulmonary Gas Exchange................................................................................................. 33
Atmospheric Areas and Normal Body Function .............................................................. 33
Hypoxia ............................................................................................................................ 33
Hypoxic (altitude) hypoxia ........................................................................................ 35
Physiological Requirements and Mask Performance Standards ...................................... 35
Time of Useful Consciousness or Effective Performance Time ...................................... 36
Hyperventilation ............................................................................................................... 37
Emergency Procedures ..................................................................................................... 37
References .................................................................................................................................................. 39

iii
List of Tables

Table 1. Hypoxia Types................................................................................................................. 34

Table 2. Altitude, Atmospheric and Lung Gas Pressures, and Blood Oxygen Saturation Levels. 35

List of Figures

Figure 1. Passenger cabin occupant mask ....................................................................................... 3

Figure 2. Mask face piece with valves............................................................................................. 4
Figure 3. Deployed but not yet activated oxygen masks ................................................................. 5
Figure 4. Oxygen tubing and in-line flow indicator ...................................................................... ..6
Figure 5. Southwest Flight 1380 .................................................................................................... 10
Figure 6. Jet Airways Flight 9W697.............................................................................................. 11
Figure 7. Excerpts from Industry Representative Examples of Passenger Briefing Cards –
Passenger Oxygen Mask Use .................................................................................................. 15
Figure 8. Industry Representative Example of a Safety Briefing Script ........................................ 16
Figure 9. Patent diagrams of the BLB mask ................................................................................. 18
Figure 10. Passengers wearing the BLB mask during the first operational test flight, on board a
Northwest Airlines Lockheed 14H twin motor airplane, March 10, 1939. ............................. 19
Figure 11. The K-S disposable oxygen mask ................................................................................ 21
Figure 12. The adhesive oxygen mask assembled. ........................................................................ 25
Figure 13. Experimental study participants wearing the adhesive oxygen mask.......................... 25
Figure 14. Average times of useful consciousness at altitude in the event of a slow or rapid
decompression. ....................................................................................................................... 37

iv
 Executive Summary

In response to Section 536 of Public Law 115-254, the Federal Aviation Administration (FAA)
Reauthorization Act of 2018, the FAA conducted a review of the design, use, and effectiveness of
commercial aircraft passenger oxygen masks. The intent was to determine whether the current design
of passenger oxygen masks is adequate and whether changes to the design could increase correct
passenger use of the masks. The yellow “Dixie-Cup” mask has changed little since the late 1950s, but
its deceptively simple appearance belies a well-thought-out design. The round shape allows for quick
and easy donning regardless of mask orientation. The mask also conforms to a wide range of face
sizes and shapes, and one mask shape performs well for infants, children, and adults. Oxygen masks
located throughout the passenger cabin typically meet minimum design, construction, and
performance requirements using the FAA Technical Standard Order approval process and associated
industry consensus standards.

In the event of a sudden loss of cabin pressure at high altitudes, passenger cabin occupants must
be able to don the oxygen mask quickly and breathe high concentrations of oxygen to prevent the
onset of hypoxia (i.e., an insufficient supply of oxygen to the tissues). Once a high concentration
of oxygen is administered, recovery usually begins in a matter of seconds. Once the oxygen mask
is donned, it is important to breathe as normally as possible to prevent hyperventilation, which
may exacerbate an already present hypoxic condition.

Knowledge is an important factor in the effective use of passenger oxygen masks. Studies show
that an alert, knowledgeable individual has a much better chance of surviving a dangerous or life-
threatening situation that could occur during passenger-carrying flight operations. Therefore,
FAA operating regulations require air carriers and commercial operators to develop oral briefings
and passenger safety information briefing cards.

Following the completion of our review, we determined that the current passenger oxygen mask
design is adequate and significant changes to the size and shape of the mask facepiece are not
necessary. Although we determined that the general design and effectiveness of the mask
facepiece is adequate, we made recommendations that may increase the correct use of the
passenger mask. We made recommendations related to mask measurement, as well as increased
comprehension of preflight briefing materials by passengers. We also made a recommendation to
explore a cost- effective means to add text or symbology that would specify that the mask should
be worn over the nose and mouth.

v
Introduction

This report is provided in response to the legislative requirements established in the Federal
Aviation Administration (FAA) Reauthorization Act of 2018 (Public Law 115-254), Section
536, Oxygen Mask Design Study.

Multiple data sources and references were used, including but not limited to FAA regulations
and advisory circulars, aerospace industry consensus standards, recommended practices and
information reports, proprietary design information from oxygen mask manufacturers, aerospace
medicine technical reports, peer-reviewed academic research, and National Transportation Safety
Board (NTSB) accident/incident reports.

This literature review presents a description of the current passenger cabin occupant oxygen
mask design and function, followed by information on mask design, materials and performance
testing standards, and passenger education. Appendices contain a historical overview of aviation
oxygen masks, information on oxygen systems and mask assemblies, and flight physiology. We
present evidence that the current mask design is adequate, and we provide recommendations that
may increase passenger understanding and correct use of the mask.

Legislative Mandate

The FAA Reauthorization Act of 2018 (Public Law 115-254), Section 536; Oxygen Mask Design
Study, specified:
Not later than 180 days after the date of enactment of this Act, the Administrator shall conduct a
study to review and evaluate the design and effectiveness of commercial aircraft oxygen masks.
In conducting the study, the Administrator shall determine whether the current design of oxygen
masks is adequate, and whether changes to the design could increase correct passenger usage of
the masks.

Background

Passenger Cabin Occupant Oxygen Mask Design and Function

This section describes the general design and function of the continuous flow, phase-dilution
oxygen mask (i.e., yellow “Dixie Cup”) currently used throughout the passenger cabin
onboard commercial transport aircraft. Specific design details are not provided in this report
because oxygen mask suppliers and oxygen system installers consider such detailed
information proprietary. Therefore, we provide only general or publicly available information.

Transport category airplane oxygen systems meet minimum performance requirements described
1
in Title 14 Code of Federal Regulations (14 CFR), Part 25. For oxygen masks located throughout
the passenger cabin, the most common compliance method is to meet the minimum performance
requirements stipulated in FAA Technical Standard Order (TSO)-C64, Passenger Oxygen Mask
Assembly, Continuous Flow. The most current version at the time of this writing is TSO-C64b
(FAA, 2008). TSO-C64b refers to the SAE International Aerospace Standard AS8025A,
Passenger Oxygen Mask, an industry consensus standard that establishes the minimum
requirements for the design, construction, and performance of the continuous flow, phase-
dilution oxygen mask for passenger cabin occupants in civil commercial aircraft (SAE
International, 2016a)

Mask Components
The continuous flow, phase-dilution oxygen mask consists of oxygen tubing with an in-line
oxygen flow indicator, a reservoir bag to accumulate/hold highly concentrated oxygen, and a
face piece with three valves (Figure 1).

2
 Lanyard
Elastic

Mask Face Piece

Knotted

Strap

Note: oxygen tubing

and in-line flow
indicator not shown

Reservoir Bag

Figure 1: Passenger Cabin Occupant Mask

The three valves include an inhalation valve located between the bag and face piece that allows
for the inhalation of highly concentrated oxygen from the bag, an ambient inhalation valve that
allows for the intake of ambient air, and an exhalation valve that releases exhaled gases to the
ambient air (Figure 2). An elastic band goes over and behind the head to secure the mask to the
face over the nose and mouth, with knotted adjustment straps to tighten the mask.

3
 Ambient Inhalation
Valve Exhalation
Valve

Reservoir Bag
Inhalation Valve

Figure 2: Mask Face Piece with Valves

Mask Deployment and Oxygen Flow Activation

Airplane oxygen masks do not contain their own oxygen supply source. Phase-dilution oxygen
masks require a constant flow of oxygen from either a small, single-use oxygen source located in
the overhead passenger service unit (PSU) with the masks or from a remote location with a
plumbing system to transfer oxygen to the PSU. For airplanes certified for operation above
30,000 ft (9,144 m), 14 CFR § 25.1447(c) requires that oxygen masks providing the required
oxygen flow must automatically deploy before the cabin pressure altitude reaches 15,000 ft
(4,572 m). Individual oxygen masks are suspended from the PSU by a lanyard to prevent the
masks from being donned without activating the flow of oxygen. Several oxygen masks are
deployed from each PSU (e.g., four masks for a row of three seats; Figure 3). Extra masks

4
may be used by lap children or the flight attendants and are required per 14 CFR § 25.1447(c),
which stipulates that the total number of oxygen masks must exceed the number of seats by at
least 10% and be as uniformly distributed throughout the cabin as practicable.

Figure 3: Deployed But Not Yet Activated Oxygen Masks

To activate the flow of oxygen, the user pulls the mask down and to the face. It is important to
pull the mask (i.e., the yellow Dixie cup facepiece), not the oxygen tubing; pulling on the tubing
may pull it free from the oxygen dispensing unit. Pulling on the mask places tension on the
lanyard, and the pull force releases a mechanism to start the flow of oxygen. Once activated,
oxygen flows to the mask. For some system designs, every mask in a seat row will drop when one
mask is pulled, and oxygen flows to all the masks suspended from the PSU. An indication of
oxygen flow is required for oxygen mask approval to the FAA TSO, and many systems use an in-
5
 line flow indicator in the oxygen tubing that turns GREEN to indicate oxygen flow to the
reservoir bag (Figure 4).

GREEN
In-line flow indicator

Figure 4: Oxygen Tubing and In-Line Flow Indicator

Mask Function
Oxygen from the supply source flows into the reservoir bag, interposed between the delivery
tubing and the mask facepiece. The continuous flow of oxygen fills the reservoir bag throughout
the breathing cycle—inhalation, exhalation, and the pauses in between. The reservoir bag is
separated from the mask facepiece by a sensitive, one-way check valve. During inhalation, highly
concentrated oxygen drawn from the bag flows deep into the lungs. If the reservoir bag empties
before inhalation is complete, the second inhalation valve opens to permit the flow of ambient air,
allowing a full breath intake without feeling suffocated.

6
Highly concentrated oxygen is provided at the most advantageous point in the breathing cycle—
at the beginning of inspiration—and flows deep into the lungs where it is most needed. Any
ambient air (with <100% oxygen) inhaled at the end of breath intake flows no farther than the
upper respiratory tract (i.e., mouth cavity, trachea, and bronchi—the anatomical “dead space”
where no pulmonary gas exchange occurs).

During exhalation, oxygen diluted with ambient air is swept from the mask (last in, first out),
along with expired air from the lungs. The expired air vents “overboard,” out of the mask via the
exhalation valve; expired air is not returned to the reservoir bag. The next inhalation starts with
highly concentrated oxygen drawn from the reservoir bag.

Mask Not for Use as Protective Breathing Equipment

There is a general lack of understanding among the flying public of how passenger oxygen masks
work and when they should be deployed. The passenger cabin occupant mask is for use only in
the event of a loss of cabin pressurization to provide hypoxia protection from the increase in cabin
pressure altitude. The mask is not intended to provide fire/smoke/fume protection due to the
inhalation valve that permits the flow of ambient air, including potential smoke and fumes. In the
event of a cabin fire with spreading flames, if oxygen masks are deployed, oxygen flowing from
the supply source may increase the intensity of a fire.

There are several recent incidents in which the passenger oxygen masks were incorrectly
deployed, or the passengers demanded that the masks be deployed during a fire/smoke/fume
event. JetBlue Airways Flight 1416 (September 18, 2014; Long Beach, CA) experienced several
right engine fire indications shortly after takeoff. The flight crew deployed the engine fire
extinguishers and initiated an air turnback for Long Beach. During descent, the cabin filled with
smoke. The oxygen masks did not deploy (the airplane leveled off at approximately 9,400 ft
[2,865 m]), but the flight attendants manually deployed the masks. The airplane made a
successful, uneventful single-engine landing at Long Beach, and the passengers evacuated via
slides (NTSB, 2016).

British Airways Flight 2276 (September 8, 2015; Las Vegas, NV) and American Airlines Flight
383 (October 28, 2016; Chicago O’Hare) both experienced uncontained engine failures during
takeoff and aborted flight on the runway. In both incidents, while the flight crew and flight
attendants assessed the situation (e.g., engine shut down, fire location to avoid evacuation slide
deployment into the fire) billowing smoke filled the cabin. Passengers became aggressive and
combative when flight attendants did not deploy the oxygen masks, causing confusion and
slowing the emergency evacuation once initiated (NTSB, 2017a; NTSB, 2017b). Emirates Flight
521 (Dubai International Airport, August 3, 2016) experienced significant wind shear during the

7
approach, made a hard landing, and skidded down the runway. As the plane came to rest, several
fires broke out under the fuselage. The oxygen masks deployed due to the hard landing, and
confused passengers attempted to don the masks instead of heeding the flight attendants’ urgent
orders to evacuate (General Civil Aviation Authority, 2016).

Per FAA regulations, oxygen systems for flight crew on flight deck duty include minimum
performance requirements for supplemental oxygen and are meant to serve as protective
breathing equipment (PBE; e.g., full-face visor, mask plus smoke goggles) against fire, smoke, or
fumes in the flight deck. FAA regulations do not require passenger PBE for fire, smoke, or fumes
in the cabin.

The FAA’s Civil Aeromedical Institute conducted a series of studies from 1965 to 1989 to
evaluate the feasibility of providing smoke/fume passenger PBE by modifying the passenger
oxygen mask for dual-use (i.e., hypoxia protection and fire/smoke/fume protection) or
developing completely separate passenger PBE (e.g., smoke hoods). The researchers also
investigated what effect PBE had on passengers’ ability to initiate and complete an emergency
evacuation (McFadden et al., 1967; DeSteiguer et al., 1978; DeSteiguer & Saldivar, 1983;
Higgins et al., 1985; McLean et al., 1989).

Ultimately, the FAA determined not to require PBE for passenger cabin occupants. Even if the
passenger oxygen mask could be adapted for dual-use as PBE, that would be undesirable due to
concern that the PBE might cause a delay in evacuation (Higgins, 1987).

Mask Design, Materials, and Performance Testing Standards

Oxygen masks located throughout the passenger cabin typically meet FAA TSO-64b, which
refers to SAE AS8025A and contains details of minimum design, construction, and performance
requirements. The most pertinent standards related to the Congressional tasking are summarized
below.

Mask Design/Presentation
The mask assembly application (i.e., how to don the mask) shall be obvious. The mask “shall be
capable of quick and easy donning regardless of any special orientation requirements” (SAE
International, 2016a). This general presentation requirement has been in effect for 60 years. First
introduced in the original industry consensus standard (National Aerospace Safety [NAS] 1179)
in 1959, it has been included in all SAE AS8025 revisions since 1988.

Mask Materials
All mask materials must be of a type, grade, and quality (demonstrated by test, experience, or
both) to be suitable for the intended purpose. Materials that contaminate oxygen or are affected
8
adversely by continuous service with oxygen must not be used. The facepiece must be free of
objectionable odors. Materials in contact with the skin must be nonallergenic and nonirritating.
The mask must be made of materials that permit cleaning and sterilization without adverse effects
and without disassembly. Per TSO requirements, oxygen mask suppliers provide a component
maintenance manual that provides detailed inspection, cleaning, and replacement criteria to
equipment installers.

Mask Face Piece

The facepiece shall be of sufficient resilience, size, and shape to conform readily to extreme
facial contours using no more pressure than that supplied by the mask suspension device. The
facepiece shall cover the airways of the nose and mouth. The main body of the mask shall be stiff
enough to minimize deformation due to incorrect handling, which may result in reduced
operating performance. The chamber formed between the face and the mask shall be of a
minimum volume at all times to prevent the build-up of carbon dioxide during exhalation. SAE
AS8025A also prescribes the color of the facepiece - No. 13538 yellow of Federal Standard No.
595.

Mask Performance Testing Standards

FAA regulation 14 CFR § 25.1443 prescribes minimum tracheal oxygen partial pressures. To
demonstrate compliance with the FAA regulation, passenger oxygen masks are tested using
procedures described in SAE AS8025A to determine the minimum oxygen flow required to the
mask as a function of cabin pressure altitude. Once the minimum oxygen flow to the mask is
determined, oxygen mask installers use the data to ensure that the oxygen system supply source
provides sufficient flow rates to the oxygen mask for each airplane installation.

Determining the minimum oxygen flow required to an oxygen mask design is a three-
step testing process:

(1) Determine the typical fit leakage value (i.e., how much oxygen/air leakage occurs
between the mask and the user’s face) by fitting the mask to human test participants of
various ages and facial contours.
(2) Test the oxygen mask on a breathing machine to determine the minimum oxygen flow
needed to the mask at various cabin pressure altitudes. The breathing machine simulates
breathing rate, tidal volumes (i.e., the volume of air inspired and expired with each normal
breath), and the tracheal oxygen partial pressures described in FAA regulation
§ 25.1443.
(3) Validate the breathing machine results using human participants in an altitude
chamber.

9
Passenger Education and Situational Awareness

Passenger Behavior
Regardless of oxygen mask design, minimum performance requirements, and applicable
regulations, passengers must still understand how to don and use the equipment correctly.
Assuming that the social media pictures from Southwest Flight 1380 (April 17, 2018; diverted to
Philadelphia, PA) were taken during the emergency descent (Figure 5 [p. 14]; Shapiro, 2018), not
all passengers on that particular flight understood how to use the oxygen masks. Conversely, in
the course of our historical review of similar oxygen mask deployments, no data suggest that the
social media pictures from the Southwest Flight 1380 event and Jet Airways Flight 9W697
(September 20, 2018, Mumbai), where the flight crew failed to activate the cabin pressurization
system (Figure 6 [p. 15]; The Hindu, 2018) are indicative of how the flying public typically uses
passenger oxygen masks.

Figure 5: Southwest Flight 1380

10
 Figure 6: Jet Airways Flight 9W697

Oxygen Mask Deployments

In a notice of proposed rulemaking (NPRM) issued January 9, 2013 (FAA, 2014), the FAA
provides statistics related to the probability of in-service decompression events and related
oxygen mask deployments. As discussed in the NPRM, the FAA identified 2,800 instances over
40 years when supplemental oxygen was needed, and there was no reported loss of life due to
lack of oxygen.

It is easy for passengers to become complacent because the instances are so rare; however,
knowing how to use the oxygen equipment correctly, when needed, reduces the probability of
injury should a high-altitude decompression occur. Information in the history and flight
physiology appendices (Appendices B and D, respectively) describes how, as technological
advances led to high-altitude flight, it became imperative that passengers don their oxygen
equipment quickly and correctly to prevent rapid-onset hypoxia (insufficient supply of oxygen to
the tissues).

Passenger Apathy
In 1996, the European Transport Safety Council (ETSC) estimated that 90% of commercial
aircraft accidents were survivable (ETSC, 1996). In 2001, the NTSB performed a comprehensive
11
review of national aviation accidents (Part 121 carrier operations) from 1983 through 2000 and
found that 95.7% of passengers survived accidents. The NTSB also examined the proportion of
occupants who survived each accident from 1983 to 2000 and found that, in 528 of the 568
accidents (93%), more than 80% of the passengers survived (NTSB, 2001). Although these
statistics are dated, commercial air travel has, if anything, become safer due to improvements in
impact protection (e.g., 16 G-force passenger seats, updated brace position instructions), fire
survivability (e.g., fire retardant materials), and evacuation procedures.

However, despite the survival statistics, passengers continue to display a dangerous level of
apathy towards the preflight safety briefing. The average airline passenger does not think that an
emergency such as a loss of cabin pressure will happen to them. Very few people, except perhaps
airline crews or military personnel, have been exposed to or trained for the details of an inflight
emergency. Appropriate training for an inflight emergency brings required, time-sensitive action
steps to mind immediately during a crisis event. Studies show that an alert, knowledgeable
individual has a much better chance of surviving any life-threatening or dangerous situation that
could occur during passenger-carrying flight operations (FAA, 2019a). Therefore, FAA operating
regulations (14 CFR § 121.571, § 125.327, and § 135.117) require air carriers and commercial
operators to develop oral briefings and passenger safety information briefing cards.
Passenger Briefings
Regardless of the delivery method of the oral (including video) safety briefing, passengers often
do not pay attention and do not review the safety information cards. As with other forms of
transportation, the level of passenger distraction has increased dramatically with the expanded
use of portable electronic devices (FAA, 2019b).

Air carriers continually evaluate passenger briefings. Guidance to air carriers to encourage
effective passenger briefings is found primarily in the sources below which provide
minimum safety content and presentation guidelines:
(1) Federal Aviation Administration (FAA) Advisory Circular (AC) 121-24D,
Passenger Safety Information Briefing and Briefing Cards (FAA, 2019a)
(2) SAE Aerospace Recommended Practice ARP1384, Passenger Safety Information
Cards (SAE International, 2006)

Flight attendants prepare passengers for critical flight phases, irregular activities, and potential
inflight emergencies by using scripted oral announcements, video briefings (where available), and
by pointing to safety information card pictorials. Per 14 CFR § 121.333(f), a passenger briefing is
required for flights conducted above flight level 250 during which “…a crewmember shall
instruct the passengers on the necessity of using oxygen in the event of cabin depressurization
and shall point out to them the location and demonstrate the use of the oxygen-dispensing
equipment.” Advisory Circular (AC) 121-24D guidance cautions air carriers about passenger

12
distractions during the safety briefing, where it states,

Consideration should be given to the content and assessment of the passenger safety
information system delivery methods, taking into account passenger behavior and
strategies to mitigate distractions during safety briefings. Every passenger should be
motivated to focus on the safety information in the required passenger safety briefing;
however, motivating people, even when their own personal safety is involved, is not
easy. One way to increase passenger motivation is to make the safety information
briefings and safety information cards as interesting, entertaining, and attractive as
possible.

The NTSB conducted a Safety Study of passenger safety briefing methods titled, Airline
Passenger Safety Education: A Review of Methods Used to Present Safety Information (NTSB,
1985). The rationale for the study was “a long-standing concern that some passengers onboard
air carrier airplanes contributed to their own injuries or deaths because they were not prepared to
respond appropriately to emergencies.” The NTSB concluded that many safety card depictions
were confusing and ambiguous, and provided three recommendations to improve safety briefing
cards:

(1) Develop tests and minimum comprehension standards to assure proper passenger
actions based on the safety information presented.
(2) Revise air carrier Operations Handbooks and Bulletins and FAA inspector
training programs to provide better guidance based on results of passenger
comprehension testing.
(3) Revise FAA AC 121-24 to include updated information on emergency procedures.

Further, the NTSB called for greater standardization of safety briefing materials based on
qualitative and quantitative research into the best content and manner to convey safety
information to passengers. The FAA published multiple revisions to the guidance in AC 121-24,
and in the current revision (AC 121-24D, dated March 05, 2019), Appendix 6 provides guidance
to improve safety briefings and specifically encourages the collection, evaluation, and continuous
improvement of safety briefings using survey data (FAA, 2019a). Appendix A of this report
provides industry representative examples of a briefing card and script related to passenger
education on oxygen mask use (Figure 7 [p. 19] and Figure 8 [p. 20]).

13
Conclusions

Historically, the current design of the passenger cabin occupant oxygen mask has effectively
provided protection from hypoxia during typical decompression events. As such, we determined
that the current oxygen mask design is adequate, and significant changes to the size and shape of
the mask facepiece are not necessary.

All the early phase-dilution masks retained the most important design feature—a round,
symmetrical facepiece, which eliminates confusion in having to orient the mask into a single
position or putting the mask on upside down. The general presentation requirement of “the mask
shall be capable of quick and easy donning regardless of any special orientation requirements”
has been in effect for 60 years. First introduced in the original industry consensus standard in
1959, the presentation requirement has been included in all revisions of the mask design
standards (SAE AS8025) since 1988. The round, symmetrical facepiece is essential not just for
quick mask donning regardless of orientation—a round shape conforms to the broadest range of
face shapes and sizes, and one mask shape fits infants, children, and adults.

Based on the review conducted, we determined that the general design and effectiveness of the
oxygen mask facepiece is adequate.

To address the concern of correct passenger use of the mask, efforts should be directed to
passenger education versus a mask redesign. Passengers should have a better understanding of
how the passenger oxygen mask works, the situations in which the mask is deployed, and why it
is important to don the mask over both the nose and mouth.

14
Appendices

Appendix A: Sample Briefing Cards and Safety Briefing Script

Figure 7: Excerpts from Industry Representative Examples of Passenger Briefing Cards –

Passenger Oxygen Mask Use

15
Figure 8: Industry Representative Example of a Safety Briefing Script

16
Appendix B: Aviation Oxygen Masks - Historical Overview

World War I: The Pipe Stem

The pipe stem was the first aviation oxygen delivery system. Developed by the Germans for
dirigible aircrew, the pipe stem delivered compressed oxygen from heavy iron flasks through a
mouthpiece clenched between the teeth. By the war’s end, both German and Allied pilots carried
small, “personal” oxygen supplies using an early liquid oxygen-generating system (Kalei, 2008).
Inefficient and difficult to use—most of the constant flow oxygen vented into ambient air, cold
temperatures and altitude made it difficult to hold the pipe stem for long periods, and water
vapor froze in the line blocking oxygen flow—the pipe stem did however provide a measure of
protection against hypoxia (Boothby & Lovelace, 1938; Kalei, 2008).

The 1930s–1940s: The BLB Mask and the K-S Disposable Oxygen Mask
By the 1930s, unpressurized commercial transport airplanes routinely flew between 10,000 ft
(3,048 m) and 14,000 ft (4,267 m), avoiding most terrain and flying above the weather for a
smoother, less turbulent flight (Boothby & Lovelace, 1938). However, airline executives were
increasingly concerned with the rising number of airplane crashes, and the medical community
suspected that pilot impairment from hypoxia was a significant underlying factor in many
accidents initially attributed to “pilot error” (Barach, 1937).

Most individuals begin to exhibit mild symptoms of hypoxia (e.g., headache, fatigue) around
10,000 ft (3,048 m), although more subtle impairments may go unrecognized at lower altitudes
(e.g., night vision degradation at 5,000 ft [1,524 m]) (Pickard & Gradwell, 2008). In the absence
of any standardized aviation oxygen rules, some airlines instituted their own. United Airlines
required oxygen use above 10,000 ft (3,048 m) regardless if pilots felt it necessary (Boothby &
Lovelace, 1938).

In the late 1930s, the pipe stem was still the most common method to deliver aviation oxygen,
and although the anticipated introduction of a pressurized airplane1 was expected to render
oxygen use unnecessary, the flight crew still needed a reliable oxygen mask system in the event
of a depressurization (Miller, 1995; Nelson, 1995).

1 The first flight of a fully pressurized airplane, an Army Lockheed XC-35, occurred May 7,
1937. The Boeing 307 Stratoliner, the first commercial transport airplane with a pressurized
cabin, launched December 3, 1938. Commercially unsuccessful, the Stratoliner was surpassed
by the Lockheed Constellation. Developed in 1937, the “Connie” was the first pressurized cabin
civilian airliner in widespread use (Grant, 2002; FAA, 2017a).
17
The BLB mask was the first successful, widely used aviation oxygen mask. Developed by the
Mayo Clinic and named for its designers, Dr. Walter M. Boothby (surgeon/anesthesiologist),
Dr. W. Randolph Lovelace II (surgeon/flight surgeon), and Dr. Arthur H. Bulbulian
(dentist/orthodontist, an expert in facial prosthetics), the mask was introduced for aviation use
in 1939. The Mayo Clinic physicians originally developed the BLB oronasal mask to deliver
patient oxygen more efficiently than using an oxygen tent (Miller, 1995). A rebreather-dilution
mask design, the BLB mask consisted of a molded, soft rubber nasal mask and connecting
tubes, an oxygen inlet and regulator, and a rebreather bag (Figure 9) (Cooper & Street, 2017).
Gaseous oxygen passed through a reducing valve and flowmeter calibrated for altitude, then
flowed into the rebreather bag via the oxygen inlet. On inhalation, oxygen was drawn up
through the connecting tubes to the nasal cavity. Expired air flowed down the connecting tubes,
a portion of which passed into the rebreather bag to be mixed with ambient air and incoming
oxygen, the remaining vented via an exhalation port (Boothby & Lovelace, 1938).

Figure 9: Patent Diagrams of the BLB Mask (Lovelace et al., 1941)

The mask was tested extensively in the laboratory, in altitude chambers, and in-flight—the first
of which occurred March 10, 1939, on board a Northwest Airlines Lockheed 14H twin motor
airplane. The 1,150-mile (1,851-km) flight from Minneapolis to Boston was completed in 4.5

18
hours, flying 270 mph at an average altitude of 23,000 ft (7,010 m). The pilot, copilot, and nine
passengers (the mask designers and Northwest Airlines executives) all wore BLB masks
throughout the flight with no discomfort or ill effects from hypoxia (Figure 10) (Whitemule,
2019).

Figure 10: Passengers Wearing the BLB Mask During the First Operational Test Flight, On
Board a Northwest Airlines Lockheed 14H Twin Motor Airplane, March 10, 1939

Additional test flights demonstrated that the BLB mask could successfully maintain lung partial
pressures and arterial blood saturation levels to meet the physiological demands of high-altitude
flight and protect flight crew and passengers from hypoxia (Boothby & Lovelace, 1938; Cooper
& Street, 2017).

The BLB mask had numerous advantages over the clenched-in-the-mouth pipe stem, the most
important being efficiency. Mixing supply source oxygen with exhaled air (16% oxygen) and
ambient air (21% oxygen) substantially decreased the number of large, gaseous oxygen bottles
required onboard the flight, thus saving airplane weight and space. The mask was comfortable
and could be worn for long periods, the mouth was free and unobstructed for talking over the
radio or to other crew members, and the mask was mechanically simple and easy to use (Cooper
& Street, 2017; Boothby & Lovelace, 1938). Widely used in commercial transport airplanes for
19
flight crew and passengers alike, the BLB mask was also used by American and Allied pilots
during World War II and became the prototype for today’s military tactical jet oxygen masks
(Cooper & Street; 2017).

Post-World War II airplanes capable of flying at higher altitudes prompted revisions to the Civil
Air Regulations oxygen use rules for both flight crew and passengers. The 1947 regulation
recommended that oxygen and an oronasal mask be provided for each passenger for flight above
12,000 ft (3,658 m) (Tuttle et al., 1951). Before this, masks were not required for all passengers
and were hung in the cabin as a convenience for passengers suffering from airsickness or used to
“refresh” themselves during flight.

The 1947 regulation prompted United Airlines to design and introduce the K-S Disposable
Oxygen Mask.2 Designed for passenger use only, the K-S disposable mask was a constant flow,
rebreather-dilution mask consisting of a double bag (i.e., a bag within a bag) of lightweight
plastic. The inner bag fitted over the nose and mouth with air exchange occurring via two holes
with the outer (rebreather) bag into which oxygen flowed. Two additional, smaller holes in the
inner bag permitted ambient air exchange. An adjustable elastic band secured the mask around
the head, and a pliable metal strip in the upper rim of the facepiece could be molded to fit over the
nose and cheeks (Figure 11).

Designed to meet oxygen requirements in pressurized airplanes from sea level to 14,000 feet
(4,267 m), and up to 25,000 feet (7,620 m) in the event of depressurization, passengers easily
donned the mask without the need for complicated instructions, and one mask shape/design
could be used for children and adults (Tuttle et al., 1951). The K-S disposable mask was quickly
adopted for use onboard commercial airplanes—its lightweight and compact size made it an
attractive alternative to the bulky BLB mask.

Despite performing well in experimental altitude chamber flights from 10,000 ft (3,048 m) to
25,000 ft (7,620 m), meeting or exceeding all material and physiological performance test
criteria and comparing favorably to BLB mask performance, a rapid loss of cabin pressure (i.e.,
rapid decompression) to 25,000 ft (7,620 m) pushed the K-S mask to its performance limits.

2 Named for mask designers Mr. Koza and Mr. Stockam

20
 Figure 11: The K-S Disposable Oxygen Mask

Researchers evaluated the K-S disposable mask in a series of experimental altitude chamber
flights, exposing test participants to simulated rapid decompressions from 6,000 ft (1,823 m) to
20,000 ft (6,096 m), 25,000 ft (7,620 m), and up to 27,000 ft (8,230 m). Test participants
successfully donned the K-S disposable mask within 38 seconds on average (range, 15 to 70
seconds), well within the time of useful consciousness (TUC)3 at these altitudes which is 10
minutes at 20,000 ft (6,096 m) to approximately 1.5 minutes at 27,000 ft (8,230 m) (FAA, 2015;
Pickard & Gradwell, 2008). However, the participants’ arterial blood oxygen saturation took
longer than 1 minute to reach a minimum of 90% with the K-S disposable mask, in contrast to

3 Time from interruption of the oxygen supply, or exposure to an oxygen-poor environment, to the
time when an individual is no longer capable of reacting and taking effective corrective actions
(i.e., donning oxygen mask); TUC it is not the time to total unconsciousness; a rapid
decompression reduces the TUC by 50% (FAA, 2015).

21
10 to 15 seconds using a flight crew “on-demand” oxygen mask. The delay was due to increased
dilution of mask air with ambient air at higher altitudes, and although not serious enough to
endanger healthy individuals, it demonstrated the performance limits of the K-S disposable
mask. The researchers recommended that for altitudes above 25,000 ft (7,620 m), passenger
masks should provide 100% oxygen using a non-diluting oronasal mask (Luft, 1951; Tuttle et
al., 1951).

The 1950s–1960s: New Oxygen Mask Designs for Jet Airplanes

Flight in pressurized commercial airplanes of the 1940s and early 1950s was generally limited to
20,000 ft (6,096 m); the Lockheed Constellation had a service ceiling of 24,000 ft (7,315 m) and
the Boeing’s Stratoliner was limited to 23,000 ft (7,010 m). The first commercial jet airliner, the
British de Havilland Comet, entered service in 1952. The Comet’s ability to fly up to 40,000 ft
(12,192 m), and similar jet aircraft designs by American manufacturers Boeing, Douglas
Aircraft, and Convair, prompted the need to develop oxygen systems that could provide hypoxia
protection at much higher altitudes. The need was even more apparent when the Comet
experienced a series of fatal explosive decompressions that grounded the airplane in 1954.
Realizing that cabin pressure decompressions could be a recurring hazard, an industry standard
was needed for an extremely lightweight, “get me down” passenger oxygen mask for use from
40,000 ft (12,192 m) until the airplane reached a lower safe flying altitude.

In the early 1950s, the Society of Automotive Engineers (SAE) started to scrutinize aircraft
oxygen systems within an environmental control systems working group. By 1957, the
SAE formally established a separate, independent A-10 Aircraft Oxygen Equipment
Committee.

The SAE A-10 committee also developed equipment and performance specifications for a new
type of passenger oxygen mask to provide short-term hypoxia protection up to 40,000 ft (12,192
m). These specifications were the basis for National Aerospace Standard (NAS) 1179 (published
in 1959) that established minimum standards for materials, testing, and performance of the
“phase-dilution” mask. In 1961, NAS 1179 standards were incorporated into and became the
basis for the FAA TSO-C64 - Passenger Oxygen Mask Assembly, Continuous Flow4 (SAE
International, 2016b; Garner, 1996).

4 In 1988, NAS 1179 was superseded by a revised SAE A-10 standard, AS8025. The current
FAA TSO-C64b (effective 2008) refers manufacturers to SAE Aerospace Standard AS8025A -
Passenger Oxygen Mask (reaffirmed, 2016) for minimum design, construction, and performance
requirements of continuous flow passenger oxygen masks.
22
In the 1940s and early 1950s, unpressurized and pressurized airplanes typically cruised below
20,000 ft (6,096 m), and Civil Air Regulations limited cabin pressure altitude to no more than
8,000 ft (2,438 m). Below 10,000 ft (3,049 m), most healthy individuals exhibit no overt signs of
hypoxia. Between 10,000 ft (3,049 m) to 15,000 ft (4,572 m), the cardiopulmonary system
compensates for the lack of oxygen by increasing heart rate and the rate and depth of breathing.

At 25,000 ft (7,620 m), most individuals become severely hypoxic and lose consciousness
within 3 to 5 minutes, and supplemental oxygen must be administered within 3 to 4 minutes
before irreversible brain cell damage and death begins (Guyton & Hall, 2006). Above 40,000 ft
(12,192 m), 100% oxygen must be administered under positive pressure (Pickard & Gradwell,
2008).

The BLB oronasal and K-S disposable masks provided adequate hypoxia protection from sea
level to 14,000 ft (4,267 m), and up to 25,000 ft (7,620 m) in the event of a rapid decompression
if the airplane descended quickly to a lower altitude. However, the rebreather-dilution design
limited the physiological effectiveness of these masks at higher altitudes. Expired air forced back
into the rebreather bag mixes with ambient air and supply source oxygen, and although this saves
airplane weight and space (less oxygen needs to be carried), the oxygen within the bag is diluted
and never reaches the 100% concentration needed for hypoxia protection at cabin pressure
altitudes above 25,000 ft (7,620 m).

In addition to physiological performance limitations, the shape of the BLB and K-S masks raised
concerns about a passenger’s ability to don the mask quickly following a rapid decompression.
Most aircraft depressurizations are slow and gradual, and at the 20,000 ft (6,096 m) cruising
altitude of the 1940s and early 1950s, a passenger had approximately 15 minutes of TUC to don
the mask. However, the TUC for a slow decompression at 30,000 ft (9,144 m) is 1 to 2 minutes,
and only 15 to 20 seconds at 40,000 (12,192 m) (Pickard & Gradwell, 2008; FAA, 2015). A rapid
decompression at any altitude reduces the TUC by 50% (FAA, 2015). Thus, a rapid
decompression at 40,000 ft (12,192 m) provides occupants approximately ≤10 seconds in which
to don the mask and obtain a good seal.

In the mid-1950s, researchers at the FAA’s Civil Aeromedical Research Institute (CARI)
conducted a series of studies focused specifically on mask shape, ease of donning, and the design
of a new shape/type of passenger oxygen mask. Over 150 naïve participants of different ages and
facial configurations practiced donning the BLB and K-S oxygen masks following rapid
decompressions to simulated altitudes of 35,000 to 40,000 ft (10,668 to 12,192 m). Donning the
K-S disposable mask was more difficult; over half of the participants (58%) donned the K-S
mask correctly within the approximately 20-second TUC compared to 85% who donned the BLB
mask correctly (McFadden, 1955). A follow-up study included the evaluation of a new cup-like,
adhesive oxygen mask. In this study, all participants (100%) successfully donned and sealed the
23
adhesive mask within 10 seconds, compared to 29% who correctly donned the BLB mask and
only 6% who correctly donned the K-S mask within the same 10-second period (McFadden,
1955; Swearingen, 1957).

Results and observations from these studies illustrated the need for a radically new oxygen mask
design and mask presentation system to provide passengers short-term hypoxia protection up to
40,000 ft (12,192 m). Recommendations from the study included the following:
(1) Mask presentation must be automatic, turning on the oxygen and deploying the mask

instantaneously into passenger view at a predetermined cabin pressure altitude.5

(2) The mask should be extremely simple and possess radial symmetry to eliminate
passenger confusion orienting the mask into a single position or putting the
mask on upside down.
(3) The mask should be quickly attached to the passenger’s face without the need for
elastic bands or tangled straps.
(4) The mask should fit infants, children, and adults.
(5) The mask should be lightweight and comfortable to wear over long periods
(Swearingen, 1957).

The CARI researchers (Swearingen and McFadden) ultimately designed and developed an
adhesive-type oxygen mask assembly composed of a light plastic, cup-shaped mask with an
oxygen hose attachment and an exhalation valve, surrounded by a disposable adhesive cone
(Figure 12 [p. 28]) (Swearingen, 1957). The mask presentation system consisted of spring-loaded
doors in the overhead luggage compartment that opened when the cabin pressure altitude
increased to a predetermined altitude (ideally 12,000 to 14,000 ft [3,658 to 4,267 m]). The
passenger needed only to reach up and pull the mask loose from its package, place the mask over
the nose and mouth, and press the adhesive to the face (Figure 13 [p.28]) (Swearingen, 1957;
Mohler & Collins, 2005).

5 A drop in cabin pressure results in an increase in cabin pressure altitude.

24
Figure 12: The Adhesive Oxygen Mask Assembled

Figure 13: Experimental Study Participants Wearing the Adhesive Oxygen Mask

25
In 1957, Swearingen and McFadden patented their “adhesive-type oxygen mask” and automatic
drop-down mechanism. The adhesive mask provided a superior seal compared to other masks, but
concern about the shelf life of the then-available adhesive material precluded introduction and
widespread use. Future passenger oxygen mask designs adopted the cup-like design and radial
mask shape, and a drop-down mask presentation system was widely used onboard the first
generation of American passenger jets such as the Boeing 707, Douglas DC-8, and Convair 880
(Mohler & Collins, 2005).

Throughout the 1950s and into the 1960s, numerous aircraft companies (Boeing, Douglas
Aircraft, Lockheed), commercial airlines (United Airlines, British European Airways,
Scandinavian Airlines Systems), and engineering companies (Aero Equipment Company, Bendix
Corporation, Scott Aviation, Sierra Engineering, Puritan Equipment, Puritan Bennet Company)
developed and manufactured passenger oxygen masks of varying shapes and configurations. All
retained a round shape because it allowed for quick donning regardless of any particular
orientation and because a round mask conforms to the broadest range of face shapes and sizes.
Numerous anthropometric studies provided valuable information on adult facial features and
anthropometric landmarks (Emanuel et al., 1959; Seeler, 1961), and special attention was paid to
anthropometric measurements of infants and young children (Young, 1966).

The basic design of the new continuous flow, phase-dilution mask came from the NAS 1179
standards. A reservoir bag replaced the rebreather bag, and two valves on the mask face piece
work sequentially to support inhalation and exhalation. Mask design has changed little since the
mid-1950s, although small modifications and gradual refinement have led to the phase-dilution
mask in use today. More robust, lightweight plastic valves replaced flap seals. The large
cylindrical face piece evolved into a smaller, tapered, conical shape to reduce the build-up of
carbon dioxide. A sharp edge seal produced a better fit/face seal than the original rounded inner
lip design.

The 1970s to the Present: Mask Presentation and Passenger Preflight Briefing

The continuous flow, phase-dilution mask design of the 1950s meets the minimum FAA
requirements for an emergency, “get me down” passenger oxygen mask to provide hypoxia
protection for altitudes up to 40,000 ft (12,192 m). Since the 1970s, few changes have been
made to the mask itself; however, significant changes were made to how the mask is presented
and to the passenger preflight briefing

In the mid-1970s, several rapid decompression incidents and accidents involving Douglas DC-10
and Lockheed L-1011 aircraft, in which passengers failed to use the supplemental oxygen system
correctly, prompted the National Transportation Safety Board (NTSB) to issue a special study and
26
several safety recommendations (NTSB, 1976a; NTSB, 1976b).

Problems arose from mask presentation systems that were confusing or required excessive
passenger involvement. The L-1011 incorporated the automatic drop-down design; however,
some passengers failed to pull the mask down to their face (required to activate oxygen flow);
instead, they leaned forward and attempted to breathe from the mask. The DC-10 supplemental
oxygen system was contained in the seatback in front of the passenger. The compartment door
opened automatically, but the mask remained stowed, and oxygen flow did not activate unless
the passenger removed the mask and pulled it toward him/her. Passenger life vests were
installed in an adjacent compartment, leading to additional confusion, and passengers were
hesitant to disturb a neatly packed system. The entire presentation of the DC-10 system—the
exposed oxygen generator, linkages, piping, and connections—tended to frighten passengers
who ignored the oxygen system rather than use it (NTSB, 1976a).

The NTSB also noted that the passenger preflight briefing contained little information on system
activation and lacked a demonstration on how to don and adjust the mask properly. In several
incidents, passengers and flight attendants believed the equipment malfunctioned because the
reservoir bag did not fully inflate, and there was no oxygen flow indicator. Many were unaware
that 10 to 15 seconds must elapse after generator activation for sufficient oxygen flow to fill the
bag. Passengers did not use the elastic headband or could not find the adjustment straps used to
tighten the mask (NTSB, 1976a).

The NTSB’s findings prompted revisions to FAA regulations, as well as changes to mask
presentation standards (which are in effect today) and led to a more informative/detailed
passenger preflight briefing.

For flights operating above 30,000 ft (9,144 m), oxygen masks providing the required oxygen
flow must automatically deploy before the cabin pressure altitude exceeds 15,000 ft (4,572 m).
The mask must be within reach of a seated, belted passenger with a reach arc in front, to the
sides, and above based on a seated passenger ranging in size from a 5th percentile female to a 95th
percentile male. The mask must not reach the face of a seated, belted passenger without
activating the flow of oxygen. Mask stowage under or around the seat is discouraged due to
confusion and possible delays in accessing the mask (SAE International, 2016c; SAE
International, 2017a). Although not required by regulation, most airlines use a drop-down system
from an overhead PSU. An in-line flow indicator, which turns green when oxygen flows towards
the reservoir bag, was added to the oxygen tubing. Located at approximately eye-level for a
standing flight attendant, the oxygen flow indicator is easy to see and provides an additional
indication of oxygen flow compared to bag inflation alone (SAE International, 2019).

27
The FAA revised Advisory Circulars to provide guidelines for improved passenger briefings and
printed instruction cards on the use of supplemental oxygen systems and ordered a review of the
passenger preflight briefing to ensure the use of factual, unambiguous information. Airlines
provided enhanced training to flight attendants on chemical oxygen generating systems, which
became common oxygen supply sources, and included a mask-donning demonstration to the
passenger preflight briefing.

The passenger oxygen mask has evolved from the pipe stem, through the early rebreather mask
designs of the BLB and K-S oxygen masks, to the current continuous flow, phase-dilution mask
that provides short-term hypoxia protection up to 40,000 ft (12,192 m). The mask has changed
little since the late 1950s, but its deceptively simple appearance belies a well-thought-out
design—the round shape allows for quick and easy donning regardless of mask orientation (i.e.,
there is no upside-down), it conforms to a wide range of face sizes and shapes, and one mask
shape is easily used for infants, children, and adults.

28
Appendix C: Oxygen Systems and Oxygen Mask Assemblies

This section provides a brief overview of the most common oxygen systems used onboard
commercial transport airplanes, as well as a general discussion of oxygen mask assemblies.
Specific design details are not provided in this report because oxygen systems and oxygen mask
assemblies contain proprietary information. Therefore, we provide only general information or
publicly available information.

Oxygen Systems
The purpose of an airplane oxygen system is to provide a short-term, sustainable breathing
environment in extreme conditions—to provide hypoxia protection in the event of exposure to
high cabin pressure altitudes, or to protect against smoke/fumes/toxic gases from fire. Oxygen
systems for the flight crew in the flight deck offer protection for both scenarios per applicable
FAA regulations. Oxygen systems in the passenger cabin provide a highly concentrated oxygen
supply only for hypoxia protection when exposed to high cabin pressure altitudes, also per
applicable FAA regulations.

Current airplane oxygen systems may use either a gaseous, chemical, liquid, or onboard-
generated oxygen supply. The various system types relate to oxygen storage and distribution
methods because gaseous oxygen is always delivered to the user. Airplane oxygen systems are
discussed in detail in SAE Aerospace Information Report AIR825/3, Gaseous Oxygen and
Oxygen Equipment, Introductory (SAE International, 2015). We describe the two most common
oxygen systems used onboard civil commercial airplanes: chemical oxygen generators and
gaseous oxygen systems.

Chemical Oxygen Generators

Chemical oxygen generators produce gaseous oxygen using a chemical reaction. The
decomposition of certain chemicals produces a continuous flow of nearly 100% oxygen for
approximately 12 to 20 minutes, depending on the type and size of the generator installed (SAE
International, 2016d; SAE International, 2014).

Gaseous Oxygen Systems

Gaseous oxygen systems store oxygen in its gaseous state in high pressure (1850 to 3000 Psig
[12.75 to 20.7 Mpa]) or low pressure (400 to 500 Psig [2.76 to 3.45 Mpa]) cylinders. A
regulator/shutoff device installed on the cylinder starts and stops the flow of oxygen.
Additionally, the regulator lowers the oxygen pressure from the cylinder to 100 Psi (0.68 Mpa) or
less to minimize the use of high-pressure oxygen lines. Some airplanes use centralized gaseous
oxygen cylinders for the passenger oxygen system with one or more large, refillable cylinders
29
located within a cargo compartment. The large, centralized cylinders are connected with
plumbing and other hardware to direct oxygen to the point of use. Other airplanes use a
distributed gaseous oxygen system of small, single-use pressurized cylinders located near the
point of use, such as above an individual seat row or within a lavatory (SAE International, 2015).

Oxygen Mask Assemblies

Oxygen is delivered from the supply source to the user through a mask assembly. The type of
mask used depends on the applicable FAA regulations and the environment in which the mask
assembly provides protection.

Crew Oxygen Mask Assemblies

Crew oxygen mask assemblies are typically “demand flow” (i.e., dispense oxygen only during
breath intake) equipment. The mask assembly provides hypoxia protection at high cabin pressure
altitudes and acts as PBE from fire smoke, fumes, and toxic gases. Demand flow equipment can
be straight demand (i.e., delivers pure oxygen) or diluter-demand (i.e., mixes ambient air with
oxygen), which conserves the gaseous oxygen supply. Additional information on crew demand
oxygen systems may be found in SAE Aerospace Information Report AIR825/9, Demand Oxygen
Systems (SAE International, 2017b).

Passenger Cabin Occupant Mask Assemblies

Passenger cabin occupant mask assemblies are discussed in detail on page 6 of this report
(Passenger Cabin Occupant Oxygen Mask Design and Function).

Mask Assemblies with Portable Oxygen Cylinders

Portable oxygen cylinders are located throughout the passenger cabin for use by flight attendants
as a supplemental oxygen supply for mobility or to be used by passengers for first aid. Oxygen
mask assemblies installed for use with portable oxygen cylinders come in a variety of mask types
and shapes. When portable oxygen equipment is used to administer first aid, FAA regulation 14
CFR § 25.1443(d) requires a minimum flow rate for transport airplanes of 4 liters per minute
(lpm), standard temperature and pressure dry (STPD; air or gas at 60oF [15.6oC] and 14.67 psia
[1 atm, 101.3 kPa]), with a means to decrease the flow rate to not less than 2 lpm-STPD.
However, the FAA regulation does not specify the type of oxygen mask that may be used with a
portable first aid oxygen cylinder. Typically, the type of oxygen mask installed with a portable
oxygen cylinder for first aid varies based on the intended use and customer preference.

When portable oxygen equipment is used as a supplemental oxygen supply, such as what flight
attendants may use following a decompression event, additional FAA regulations and minimum

30
performance standards apply. Additional information for portable oxygen equipment used for
flight attendant mobility on transport airplanes is provided in FAA Policy PS-ANM-25.1447-01;
Portable Oxygen Equipment Requirements for Cabin Attendants (FAA, 2017b).

31
Appendix D: Flight Physiology

An in-depth discussion of flight physiology is beyond the scope of this document. Only the
most relevant physiological information as it pertains to human performance at altitude and
oxygen mask design is presented here.

Definitions

Respiration Rate = 12 to 20 breaths/minute, average 16 breaths/minute under resting conditions

for a healthy adult; the rate can increase to 30 breaths/minute with moderate exercise
and/or mild anxiety

Respiratory Minute Volume = Volume of air inspired per minute, normally 6 to 8 L/min
at rest (0.5 L of oxygen X 12 breaths per minute = 6 L/min), increases to 10
L/min with light to moderate work/exercise or mild anxiety

Tidal Volume = Volume of air inspired and expired with each normal
breath; approximately 500 ml (0.5 L) per breath for a healthy adult

The Atmosphere
The atmosphere is a mixture of gases of approximately 78% nitrogen and 21% oxygen, with the
remaining 1% composed of carbon dioxide, water vapor, and trace gases. The combined weight,
or force, of all atmospheric gases at any given point is the atmospheric (barometric) pressure
(PB). Atmospheric pressure (PB) decreases with altitude. Gas molecules are in a state of constant
motion, and as the pressure around the gas molecules decreases, the molecules spread out and
travel farther apart. The air becomes less dense with altitude as PB decreases, and gas volume
expands (Boyle’s Law: pressure is inversely proportional to volume). The total pressure of a gas
mixture is equal to the sum of the partial pressure of each gas in the mixture (Dalton’s Law). As
total PB decreases with altitude, the partial pressure of oxygen (PO2) decreases as well; however,
the percentage of oxygen remains constant (21%) (FAA, 2015; Pickard & Gradwell, 2008).

Partial Pressure of Oxygen

The partial pressure of oxygen (PO2) is approximately 21% of the total atmospheric pressure. At
sea level, total PB is 760 millimeters of mercury (mmHg); thus, PO2 is approximately 160 mmHg
(i.e., PB x 21% oxygen). As air is drawn into the lungs, the oxygen is diluted by other gases that
exert a constant pressure (water vapor at 47 mmHg and carbon dioxide at 40 mmHg). Water
vapor and carbon dioxide displace part of the oxygen, reducing the PO2 within the lung air sacs
(alveoli) to approximately 100 mmHg. This alveolar partial pressure of oxygen (PAO2) is the
“driving” pressure that oxygenates blood as it passes through the lungs (FAA, 2015; Green et al.,
2019).
32
 Pulmonary Gas Exchange
Oxygen and carbon dioxide are involved in pulmonary gas exchange within the alveoli; carbon
dioxide is removed from the blood, and the oxygen supply is replenished.6 Pulmonary gas
exchange occurs by diffusion and depends on a pressure gradient (i.e., movement of gas from an
area of high pressure to an area of low pressure). At sea level, the high PAO2 within the lungs
(100 mmHg) drives oxygen from the lungs into the bloodstream, where the PO2 of venous blood
is a constant 40 mmHg. Maintaining this pressure gradient within the lungs is critical to ensure
adequate blood oxygen saturation (SaO2).7 As PB decreases with altitude, so too does the PAO2
within the lungs, and the pressure gradient begins to diminish, decreasing SaO2 (McArdle et al.,
2015; Pickard & Gradwell, 2008).

Atmospheric Areas and Normal Body Function

The human body functions normally in the atmospheric area from sea level to approximately
10,000 ft (3,048 m). In this range, SaO2 levels provide sufficient oxygen for normal body
functions, especially for the brain and mental/cognitive performance. Optimal function occurs at a
brain oxygen saturation level >96%. At 10,000 ft (3,048 m), brain oxygen saturation is
approximately 88% to 90%, which begins to approach a level that affects cognitive performance
(FAA, 2015). Between 10,000 ft (3,049 m) and 15,000 ft (4,572 m), the cardiopulmonary system
compensates for the lack of oxygen by increasing heart rate and the rate and depth of breathing;
above 15,000 ft (4,572 m), brain oxygen saturation levels steadily decline (Guyton & Hall, 2006;
McArdle et al., 2015).

Hypoxia
Hypoxia is an insufficient supply of oxygen to the tissues leading to impairment of body
functions (FAA, 2015; Pickard & Gradwell, 2008). Any condition that impedes the delivery or
use of oxygen at the cellular level places the body in a hypoxic state. All cells require oxygen,
and brain cells demand a great deal of oxygen for optimal function. If the blood supply to the
body is reduced, the brain is one of the first organs affected.

6 Nitrogen is physiologically inert in that it is neither used nor produced in metabolic reactions;
nitrogen levels remain essentially unchanged during pulmonary gas exchange.

7 Simultaneous with oxygen diffusion, carbon dioxide diffuses from the bloodstream (partial
pressure of 47 mmHg) into the lungs (constant partial pressure of 40 mmHg) and is exhaled.

33
Brain cells are unable to store oxygen and rapidly deplete their oxygen reserve. Fully 100%
oxygen must be administered in 3 to 4 minutes before irreversible brain cell damage and death
begins (Guyton & Hall, 2006; Pickard & Gradwell, 2008). Many conditions can interrupt the
normal flow of oxygen to body tissues and cells, leading to hypoxia. The remainder of this
discussion focuses on hypoxic (altitude) hypoxia. Table 1 lists the types of hypoxia, the location
or organ impaired, and a description of the impairment (FAA, 2015).

Table 1. Hypoxia Types

Hypoxia Type Location/Organ Impaired Impairment

Lungs
Hypoxic Any condition that interrupts the flow of oxygen
(Altitude) into the lungs. Encountered at altitude due to the
Hypoxia decrease in the partial pressure of oxygen

Blood Any condition that interferes with the ability of

the blood to carry oxygen, such as:
Hypemic • Anemia
Hypoxia • Bleeding
• Carbon monoxide poisoning
• Smoking
• Certain prescription drugs

Blood Transport Any condition that interferes with normal blood

circulation. Heart failure, shock, and positive
Stagnant Hypoxia G- forces (acceleration) can result in blood
pooling in the lower extremities

Cell Any condition that interferes with the normal

Histotoxic use of oxygen in the cell. Alcohol, narcotics,
Hypoxia and cyanide can all interfere with the cell’s
ability to use oxygen in support of
metabolism

34
 Hypoxic (altitude) Hypoxia

Hypoxic (altitude) hypoxia is caused by an insufficient partial pressure of oxygen (PO2) due to a
decrease in atmospheric pressure (PB) at altitude. Hypoxic hypoxia poses the greatest potential
physiological hazard to the flight crew and cabin occupants when at altitude, as decreasing blood
(and brain) oxygen saturation levels (SaO2) lead to reduced mental/cognitive and physical ability
(FAA, 2015). As PB decreases with altitude, there is a corresponding decrease of PO2 in the
inspired air and ultimately in the lungs. The decreased “driving pressure” in the lungs (PAO2)
leads to reduced blood (and brain) SaO2 levels (Table 2).

Table 2. Altitude, Atmospheric and Lung Gas Pressures, and Blood Oxygen Saturation Levels

Altitude PB PAO2 SaO2

(ft) (mm Hg) (mm Hg) (%)
(meters)
Sea Level 760 100 96-98

10,000 523 61 88-90

(3,048)
15,000 429 46 75
(4,572)
25,000 282 30 50
(7,620)

Ten thousand feet (3,048 m) is considered a physiological “breakpoint” where most healthy
individuals begin to exhibit mild hypoxic symptoms (e.g., headache, fatigue). At 15,000 ft (4,572
m), the maximum cabin pressure altitude at which passenger oxygen masks automatically
deploy, hypoxic symptoms are more pronounced with noticeable cognitive and physical
impairment. At 25,000 ft (7,620 m), the pressure gradient within the lungs is nearly non-existent,
SaO2 drops to 50%, and most individuals become profoundly hypoxic and lose consciousness
within 3 to 5 minutes if not given highly concentrated oxygen (Green et al., 2019; Pickard &
Gradwell, 2008; FAA, 2015).

Physiological Requirements and Mask Performance Standards

14 CFR § 25.1443(c) prescribes minimum tracheal partial pressures of oxygen. To meet
compliance, oxygen masks are tested using AS8025A standards to determine the minimum
oxygen flow required to the mask as a function of cabin pressure altitude (see “Mask
Performance Testing Standards,” p. 13). Typical oxygen flow rates to the mask range from 0.00
to 4.50 lpm-normal temperature and pressure dry (NTPD; air or gas at 68oF [20oC] and 14.7
psia [1 atm, 101.3 kPa])). During certification/validation testing, human participants engage in
light to moderate exercise (approximately 3.5-mph walking on a level treadmill) to increase their
35
respiratory minute volume (and thus the flow rate to the mask) to approximately 10 lpm.

Peak inspiratory flow rate is an important consideration in oxygen mask design. The mask needs
to provide a sufficient quantity of oxygen to meet the instantaneous demand of a large, deep
breath, as well as the rapid breathing rate during hyperventilation (Sheffield & Heimbach, 1996;
McFadden et al., 1962). Peak inspiratory flow is determined by multiplying respiratory minute
volume by three; thus, a respiratory minute volume of 10 lpm in a working individual produces a
peak inspiratory flow of 30 lpm.

Per 14 CFR § 25.1443(c), at cabin pressure altitudes above 10, 000 ft (3,048 m) up to and
including 18,500 ft (5,639 m), the oxygen flow rate to the mask must maintain a mean tracheal
partial pressure of oxygen of 100 mmHg when breathing 15 lpm-body temperature and pressure
saturated (BTPS), and a tidal volume of 700 cc with a constant time interval between respirations.
At cabin pressure altitudes above 18,500 ft (5,639 m), up to and including 40,000 ft (12,192 m),
oxygen flow rate to the mask must maintain a mean tracheal partial pressure of oxygen of 83.8
mmHg when breathing 30 lpm-BTPS, and a tidal volume of 1,100 cc with a constant time interval
between respirations.

Time of Useful Consciousness or Effective Performance Time

A loss of cabin pressurization results in an increase in cabin pressure altitude and the onset of
hypoxia if highly concentrated oxygen is not used. Most depressurizations result from
malfunctions in the cabin pressurization system, leading to a slow, gradual increase in cabin
pressure altitude; however, in the event of a rapid decompression, cabin occupants must react
quickly.

The TUC is the time from interruption of the oxygen supply, or exposure to an oxygen-poor
environment, to the time when an individual is no longer capable of taking proper corrective
actions (i.e., donning oxygen mask); the TUC does not span the time to the onset of
unconsciousness (FAA, 2015). Time of useful consciousness decreases with altitude.
Additionally, the faster the rate of ascent (e.g., rapid decompression), the worse the impairment
and the more rapid the onset (FAA, 2015; Green et al., 2019). The TUC is reduced by 50%
following a rapid decompression to cabin pressure altitudes between 25,000 ft (7,620 m) to
40,000 ft (12,192 m) (FAA, 2015). At 40,000 ft (12,192 m), the TUC is < 10 seconds—
essentially the time it takes the blood to circulate from the lungs to the brain (FAA, 2015; Guyton
& Hall, 2006). Figure 14 (p. 40) depicts TUC at altitude in the event of a slow/gradual
decompression and a rapid decompression (Fan, 2018; FAA, 2015).

36
Figure 14: Average Times of Useful Consciousness at Altitude in the Event of a Slow or Rapid
Decompression

Hyperventilation
Hyperventilation is rapid, shallow breathing typically induced by anxiety or stress, but it can also
be triggered by hypoxic conditions. Hyperventilation “blows off” excessive amounts of carbon
dioxide, which slows the rate and depth of breathing and exacerbates hypoxia (Pickard &
Gradwell, 2008). Once the passenger oxygen mask is donned, it is important for passengers to
breathe as normally as possible (even if the reservoir bag appears not to inflate) so they do not
hyperventilate. A build-up of carbon dioxide can also induce hyperventilation. The original 1950s
cylindrical facepiece was modified to the current smaller, more conical shape to prevent a build-
up of carbon dioxide in the mask during exhalation.

Emergency Procedures
The treatment for hypoxia, regardless of type, is highly concentrated oxygen. In the event of a
loss of cabin pressurization with oxygen mask deployment, passenger cabin occupants must don

37
the mask quickly and breathe 100% oxygen to prevent the onset of hypoxia. Once 100% oxygen
is administered, recovery usually begins in a matter of seconds (FAA, 2015).

Donning the oxygen mask is only part of an overall emergency procedure in the event of a loss of
cabin pressurization. The first and most important protection against hypoxia is the airplane
emergency descent initiated by the flight crew. For commercial airplanes with pressurized cabins,
FAA regulation 14 CFR § 25.841(a)(2) prescribes airplane design requirements intended to limit
the potential exposure of high cabin pressure altitudes following a sudden loss of cabin pressure.
To meet these regulations, emergency procedures performed by the flight crew include the
initiation of an emergency descent. The emergency descent will be steep and rapid, and flight
attendants may be unable to render immediate assistance until the airplane reaches a safe level off
altitude, which could take several minutes. Airline and FAA policies require flight attendants to
don the closest available oxygen mask and brace against/sit in the nearest available seat until the
airplane levels off, and they can safely move about the cabin. During the emergency descent, it is
imperative that passengers don the oxygen mask quickly and correctly, first for themselves (to
avoid hypoxia-induced impairment) and then assist others.

Once the oxygen mask is donned, passengers must breathe as normally as possible; highly
concentrated oxygen is flowing into the reservoir bag even if the bag does not appear to inflate.
Typically, there is more bag inflation at higher cabin pressure altitudes (high oxygen flow and
low ambient air pressure) and less inflation at lower cabin pressure altitudes (low oxygen flow
and higher ambient air pressure).

Passengers may need to keep the oxygen mask in place at lower altitudes after the emergency
descent. Flight crews typically perform an emergency descent to 10,000 ft (3,048 m). However,
some air routes prevent descent to lower altitudes due to terrain and/or fuel burn limitations.
Passenger cabin occupants should continue to wear the oxygen mask until instructed by flight
attendants to remove them.

38
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