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In-flight incapacitation of a fully trained crewmember due to a serious underlying medical condition is a rather infrequent event. In order to delineate the extent and nature of the incapacitation problem we reviewed the data base at the Air Force Safety and Inspection Center for all incidents coded for incapacitation, preexisting disease, or other acute illnesses occurring during the 10 years between 1978 and 1987. During this period there were 23 in-flight incidents of incapacitation due to significant underlying medical conditions. In 11 of the incidents the incapacitation resulted in a loss of consciousness. Neurologic conditions were the most frequent cause followed by cardiovascular conditions. We calculated a rate of incapacitation as 0.19 per million aircrew flying hours.