http://www.simhq.com/_air/PDF/IL-2_guide_v410.pdf
Improved Pilot Damage Difficulty Option
With this difficulty option turned on, damage to the pilot is more severe. Being hit is something
that has very serious consequences now. That apply to AI pilots and gunners too, it is much
easier to kill them. You will have to adjust your tactics to accommodate this change, avoid
being hit at all costs and when on attack, aim at the cockpit, especially if you are in plane
armed with light machine guns only. Against bombers, aim at gunners first to disable them,
you are better protected and you have more guns than them.
As you can imagine, if you can get killed easier, than you can get wounded easier too. In
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addition, there are more variations in wounds, you can get hit in the arm or leg with a
corresponding loss of control over the plane. To make things even more complicated, some
wounds will cause bleeding and you can bleed to death unless you reach home in time.
Gunners ability to shoot is also reduced when they get wounded.
watch your six, i'm behind you