Tom

Hypothetical concern based on non-contextual application of information is not evidenced-based medicine. The supplemental oxygen situation for someone having a heart attack is not the same as someone in respiratory failure or another person undergoing anesthesia. And none of this has anything to do with pilots in GA aircraft. It is controversial to offer hypothetical concern about an intervention when that concern has already been studied and found to not be clinically relevant when doing so may dissuade the population to benefit from the intervention. NASA and the aeromedical community has studied this stuff forever, even if Uptodate doesn't have a section on it. It may be of interest for some to know that astronauts on spacewalks are still using 100% oxygen... No one advocated against using a pulse-oximeter, but no one should feel afraid of "overdoing it" with oxygen on a GA aircraft flight. At minimum, the pulse-ox is needed to make sure enough oxygen is being used. We should be encouraging more supplemental oxygen use. It's pointless to caution over-doing it.

--Off-topic warning-- The only thing that can increase total C02 concentration in the blood is either increased metabolic activity (i.e. increased production of C02) or decreased ventilation (i.e. decreased disposal of C02). Renal processing notwithstanding/relevant here. The point about "not shallow breathing" speaks specifically to the need to increase tidal volume to avoid the consequence of shunting, or, put simply, needing to breath deeply/normally so as to aerate the lower lung to blow off the C02. I don't see how the graph has anything to do with aviation. Most pilots don't have severe COPD and fly intubated with an Fi02 of 80%. There is really no good to come from providing hazards of 02 use nor good about warnings of "hyperoxia." Presumably the hyperoxia concern would be related to oxidative concerns, which I'd respond with concerns about normobaric hypoxia. We've seen brain white-matter changes resulting from normobaric hypoxia as a result of simple chamber flights. Flying with a little too much 02, if breathing normally, is not a concern whereas flying hypoxic is always going to degrade performance and endurance to some degree..

I should not have intimated that the increase 02 would somehow increase C02, all else equal. I should have said "shallow breathing can increase C02" which can itself cause deleterious effects to similar low oxygen. The concern to highlight is that someone who is shallow breathing on supplemental oxygen with good oxygen saturations may think that they're doing good, but in reality they're resolving one problem (low oxygen) while possibly (if shallow breathing for hours at a time) creating another...(elevated C02 with associated issues). I don't mean to over-blow (mild pun intended) the C02 concern. Just don't be a slouch in the cockpit. Deep breath every now in then. Work on the posture. Agreed. On a related point, not good to hyperventilate to keep saturation up as this causes other wonky things to happen. Bottom line, if you find your sats dropping and you're breathing normally...as you would be sitting breathing in an office chair...time for supplemental 02.

The "oxygen can cause you to stop breathing" idea is, practically speaking, a myth and has nothing to do with aviation. Shallow breathing coupled with supplemental oxygen is not a good idea as, all else equal, this is a recipe to increase CO2 in the blood. Some C02 is normal. Increased C02 causes fatigue, headache, concentration impairment, sleepiness... It never hurts to practice good sitting upright posture while flying to try to establish more normal chest excursion while breathing--especially if you're well-endowed in the midsection. As Don said, it's recommended to use oxygen at night if you can, especially over 5-6k, if only for improved vision functions. I bought a used Inogen G2 concentrator with 3 extra batteries off Craigslist for $800. I've only had it to 15k but it kept my sats over 92%. I use it routinely, even when I don't need to at lower altitudes if I'll be up longer than a couple hours. Basically zero hassle to use (no refills, etc). Edit: to more precisely answer the OP question, no medical problems using supplemental 02 at lower altitude while flying.

Consider looking into the rolling log bucket type trap. Drowns the mice (maybe not acceptable to some) but can be used for catch and release or traps could be added in the bottom of the bucket. CB options exist. https://www.youtube.com/watch?v=6SIlYiiCGLI

-I did not mean to imply that I wrote the books! Sorry for the confusion. Not even a chapter in a book. I was referring to the notion that there are books containing subject matter that is customary knowledge to one medical specialty that another medical specialty may not be familiar with. That when a physician is practicing outside of his specialty, which is legal, he is sticking his head out from a liability standpoint. Whether or not he knows how much is a different matter. Whether or not a non-physician understands this is even a different matter. -To be clear, I don't think that any physicians should have a government mandated role in the ~third class medical process. What has occurred is that previously no physician had any real liability for 3rd Class medicals....now there is clearly liability. People here may not understand this, but if history is a teacher then the "success" of the PBOR2 will be short-lived. This is the biggest concern. Some say "let's see." Others encourage continuing the fight for more freedom now. -Regarding SI timeframes, for routine-type SIs, if the AME and applicant have done the indicated work, it can be a same/next day issue. For oddball issues, maximum typical couple few weeks. As with all other bureaucratic issues...the long wait horror stories are usually related to people (i.e. the AME) not understanding the bureaucratic process. Not submitting the right stuff. Getting kicked back 2 weeks later. Resubmission stuff deficient, kicked back 2 weeks later, and so on.

The “needs antibiotic prophylaxis or not” and "pre light anesthesia" consults each are algorithms that could basically fit on the front and back of a single piece of paper. I have three aerospace medicine texts. The smallest is over 300 pages and the other two are over 700 pages. So you are saying that you consult a physician for questions about antibiotic prophylaxis, but a primary care physician without aviation medicine familiarity is not exposed to extra liability for signing off a physical on a patient with compensated heart failure...a condition that causes them no problems while driving? https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/media/basicmed_faq.pdf Q36: I don’t have a doctor who is a M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy). I do use a chiropractor physician and a naturopathic physician. Can I use them? A: The FAA relies on the determination of each state (as well as each territory and possession of the United States) as to which persons it will license as physicians. If the person holds a license as a Physician issued by any state, territory, or possession, then he or she meets the requirement as a state-licensed Physician. However, the FAA recommends that you check with the medical licensing board or authority in your state for clarification as to whether other classes of “state-licensed physicians” are felt to have the privileges, training and experience to conduct all portions of the comprehensive Medical Examination Checklist (CMEC).

I hope that this can be the case forever. I really do. Do you mean that if you were a physician that you'd start signing off on a bunch of 75 year-old wealthy males who fly 300k airplanes who have had cardiac stents in the past??? I would ask you to think of it this way: Pilots have an intrinsic right to fly. The government has an intrinsic responsibility to keep people safe. The government made some medical rules that they think meets the government's obligation to keep people safe. The FAA doesn't have physician resources to see every pilot, so they designate physicians as AMEs. The AME acts as a surrogate on behalf of the government to make sure that the pilot-applicant doesn't have a reason for the government to ground the pilot. When the AME signs off on the pilot-applicant, s/he is only saying that the government doesn't have evidence to ground the pilot. Belaboring the point, an FAA medical is not an endorsement of safe or healthy to fly...only verification that the FAA has met it's perceived obligation to keep people safe. BasicMed is different: it's an endorsement that the pilot is safe. Moreover it includes an all-inclusive blanket statement by a physician who probably has little knowledge of what is otherwise a specific specialty in the practice of medicine. Agree with the reality or not, aviation is considered a substantial enough different environment that an entire specialty of medicine exists to serve the "specific" medical needs of people operating in the aviation environment (i.e. stress, oxygen, ~guaranteed death if incapacitated, etc). Let me ask you to think of it this way: Do you think I'll provide you a medical clearance for major surgery (e.g. hip replacement) because the FAA gave you a 3rd Class 23 months ago and you haven't had any problems since? That nothing in your medical history from 10 years ago matters? That the two previous times you had surgery you had a bad reaction to anesthesia and almost died doesn't matter? I mean to present the SI as "pick me, pick me" grounds for a lawsuit. An approved SI issuance means that a team of govt doctors agreed, at the time it was issued, that the information presented to them did not meet govt criteria to ground the pilot. The government's criteria for grounding is not the same as a plaintiff's criteria for finding physician culpability for signing off as "no condition that could interfere with the ability to operate an aircraft." An SI highlights that the condition does present a specific and significant risk. Just that they government can't keep the pilot on the ground because of it. An SI given 41 months ago is not a clean bill of health today. I would ask you to think about how difficult it would be to find 5 physicians, cardiologists, or aeromed physicians who would act as a plaintiff's expert witness to testify that they "would not have signed off on that BasicMed form without repeating the same testing required by the FAA and/or the tests that aeromedical physicians would routinely obtain for such a patient." Ignorance is not a defense in malpractice cases. Imagine this exchange in court: Plaintiff's attorney: "Dr. Kidsdoc, you gave the patient medicine X and they had a prolonged seizure that resulted in brain damage, is that correct?" Dr. Kidsdoc: "yes" Plaintiff's attorney: "but Dr. Kidsdoc, it is well known that medicine X can cause seizures in adults" Dr. Kidsdoc: "well, I wasn't aware of that" Or the following exchange: Plaintiff's attorney: "Dr. Sawhimonce, you okayed the patient for major surgery but he had a heart attack and died during surgery" Dr. Sawhimonce: "yes, I cleared him" Plaintiff's attorney: "But everyone in the patient's family that ever went to surgery all died on the table" Dr. Sawhimonce: "I didn't know that...I just saw him once...and besides, the form didn't ask about that" Plantiff's 5 expert witnesses testimony "I only clear a patient for surgery after obtaining lots of records...if the patient has no records, we do lots of tests, and obviously that information matters" Seriously: please explain why dentists send dental patients to their doctor with a form to "clear the patient" before performing a simple dental procedure! The next time you receive such a form back, is it okay for the GP to write: "Well Dr. Sherman, I don't know if the patient will have a massive coronary and die or not....God knows when it will end...good luck with the extraction." Agreed. The 3rd class medical system is silly (and the 1st/2nd Class needs reform). It literally harms pilots (who neglect treatment), family/passengers (who suffer when the pilot's neglected condition causes loss of life, livelihood, or causes an accident), and on occasion people on the ground (societal loss and/or personal injury).

AMEs are not affiliated with the FAA any more than a pilot is affiliated with the FAA. Both are given certification by the FAA. The AME has basically no liability because the AME is NOT making a medical decision and is NOT making a determination of health and safety. The AME is only saying that the information on the airman's MedXPress application does not conflict with FAA rules. That's basically it. Glorified cross-reference technician with tax write-off privileges. The BasicMed physician certification is completely different. The physician signing off a BasicMed applicant is saying that applicant's medical history does not contain any information that is in conflict with the entire body of aeromedical scientific literature (i.e. that which will be called upon in a lawsuit), or at least customary practice in the field of aviation medicine. Moreover, if/when the physician signing off the BasicMed application has a relationship with said patient-pilot, an entirely different customary due diligence expectation exists for medical decision-making. The AME has, relatively speaking, no due diligence responsibility except as required by FAA. ---- Points to ponder for people who think that BasicMed is a reasonable step forward: Do you really think that an AME is going to sign off a condition under BasicMed that would require a SI for a 3rd Class? Do you really think that s/he will sign a form that says "I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft" when s/he knows, based on more broad aeromedical training and experience, that there is scientific literature demonstrating a safety issue (that the FAA allows but that nonetheless is known to interfere with an individual’s ability to operate an aircraft)? Do you think that your AME is going to accept going from no liability with giving 3rd classes to signing a form that admits ignoring the science and customary aviation medical practices? Do you realize how easy it will be to hang a family doc out to dry after a certified BasicMed pilot has an accident? ---- Chiropractors, naturopathic physicians, optometrists, dentists, and MD/DOs all can sign off on BasicMed. We'll see how long this lasts...I say chiropractors will last the longest. This is a far cry from "just need a valid driver's license" and I'm afraid it's only to get further away as time goes on.

I stand corrected. See below. I meant to refer to the concept that the president still can and does fly fixed wing without the 74. I think typically in a G5. https://en.wikipedia.org/wiki/Executive_One I agree it that it would be cheaper for a president fly in his own plane, or a smaller government plane. There is no law preventing.a president from flying in his own plane if the president wanted to.

Nonsense, unless you believe that the leader of the secret service has more power than the president. And AF1 isn't always the 74.

Don's point is entirely valid, that a state of affairs may erupt that causes people to walk away from the table resulting in a permanent loss to the hive mind. When this happens, the opportunity to learn things diminishes. From a resource standpoint it's not realistic to expect post-by-post monitoring here, thus locking a discussion is thus reasonable (specifically because it is convenient). If you've not lived in the US I might point you towards reading a little Tocqueville. If you go to the website, control+F "independence of mind" for a primer.

Hardly self-promoting (his work speaks for itself) Hawking in fact wrote an aptly-named compendium entitled "On the Shoulders of Giants."

She built a Zenith 601XL (or was it 650) back in the day. The design had a problem where a few planes folded wings...she was developing (or developed) a structural fix of her own for her own plane. Inspires not only the youth but some of us older lard assess to push down a little harder on the accelerator.

Assuming 10 passengers per 100k are bumped against their will, we can make some guesses on how much extra ticket prices would be for everyone else. If airlines kept upping the ante in forced bump situations: $1000 cash x10 bumped passengers = $10,000/100,000 =$10 extra per ticket to to the 100k. You can expand this for higher average ante prices, but I don't agree that the extra cost would make the ticket cost prohibitive. Why don't airlines do this now? I'd assume race to the bottom economics and that it's simply easier from an administrative standpoint to default to the mandatory minimum airline payout.

This article states that United bumped 11/100,000 in 2014, not sure what more recent data is, but your point is valid. In the balance is the issue that the airline is a basic service provider operating in a realm that is heavily subsidized by the general society (i.e. the airlines don't build and maintain runways, terminals, etc). No one could legitimately question the airline's ability to make a profit. The issues is if/when they operate a business model (routine systematic overbooking) that maximizes their profit....when this business model literally leaves a passenger stranded...who should be responsible for bearing the brunt of the cost? . The article linked above shows that you are right (in saying that the majority of passengers appreciate being bumped), because of how the airlines handle routine cases. It is 11/100,000 case where they failed here. From the article: ""In 2014, about 96 of every 100,000 Delta fliers had to take a later flight because the plane was overbooked. This compared to 95 at United and 50 at American. But only three of every 100,000 Delta passengers were bumped involuntarily. United had to bump 11 and American, five. Multiplied out, Delta was able to get thousands more of its passengers to agree to stay behind and bumped thousands fewer passengers involuntarily. ""

I was raised to respect authority as well. In the Marines I was taught to question orders that didn't seem legitimate or correct and to stand up for people who couldn't protect themselves. Oh for goodness sake....Binky time already. Wow. That was quick. You mean insult like calling an old man prepubescent and an idiot?

-You entirely miss the point. You can "categorically" deny what you want. -The point is about how the average man on the street responds to witnessing such events (i.e.2/3 sides with authority, 1/3 does not). How 2/3 of any group of people naturally allow bad things to happen where 1/3 will not.

It doesn't matter. Just victim blaming. You mean like experienced by dentists? -Dentists suffer psycho-neurotic disorders at a rate of 2 1/2 times greater than physicians. -Emotional illness ranks third in order of frequency of health problems amongst dentists, while in the general population it ranks tenth. -The suicide rate of dentists is more than twice the rate of the general population and almost three times higher than that of other white collar workers. -One study summarized in the Journal of the American Dental Association examined more than 3,500 dentists. Thirty-eight percent reported feeling worried or anxious constantly or frequently. In the same study, 34% of respondents said they always or frequently felt physically or emotionally exhausted,

I don't agree. Quite the opposite. Let's turn to Stanley Milgram. Milgram's research was motivated by trying to understand how Germans committed or at least supported atrocities against the Jews. Milgram taught us that 2/3 of people will, for whatever combination of reasons, side with authority, even if doing so will cause their fellow man suffer. Just like the Germans. In this case we have a man who, by all accounts, legally bought a plane ticket, boarded the plane, wasn't doing anything wrong, then was singled out against his will to get off the plane so that another passenger could take his spot. No humanitarian crisis, no extra-ordinary accommodation attempted by the airline. Yet he was manhandled. If watching the video doesn't raise you're hackles then I'd say that you don't understand the Holocaust.

I suspect that this will play out, like so many things in history, where a single person said "no" for the right reason (if if technically inappropriate) and millions will benefit from it. Meanwhile so many others, including people who will directly benefit from his actions, will be critical of him...

Not everyone is a sheep who so mindlessly submits to authoritarianism. Simple as that.

-You have American frequent fliers who, by nature of elite airline status, have no clue what it is like for people flying cattle class. To this elite crowd, the cattle are noisy, unkempt,and sometimes need to be reminded of their station in life, even if it includes being dragged off of a plane. The cattle class should feel lucky to even be allowed on the plane. -I spent 6 years working abroad as an expat plus a few in the military. I continue to work with a several Aussies. Comparatively, Aussies are more egalitarian and much, mush less tolerant of bullshit. I think you were wrong in your quote of an absolute ban, and this was used against you to completely discount your otherwise correct position that Australian airlines don't screw with people like US airlines screw with Americans . -This thread shows many anecdotes representing the reality that in Australia Qantas doesn't play the systematic games that American airlines play, as is described in this article. -From Forbes yesterday:

VERY easy solution: increase the mandatory payouts that the airline has to pay you if/when they bump you in an overbook situation. Instead of the current 400% of the ticket cost max $1300 cost....raise it to $6,000 or somesuch. There currently is no incentive for the airline to offer you more at the gate than they've have to pay per the regs to bump you. Zero. Buying a ticket is not the entrance fee to an auction that starts at the gate. It's a freaking airplane ticket.

Of course you/I literally are in a different class than the majority of the flying public. I flew a little north of 85,000 last year. I'd reckon that a minimum of 75% of the incivility I see at the counters results from the overbooking practice....the overbooking practice having little to do with the accessibility or affordability of flying in the modern era. As GA guys we really need to be defenders of the flying public. In many areas hub landing fees are used to support smaller surrounding fields and I'm pretty sure most people here aren't ready/willing/able to personally pay for that which the flying public currently subsidizes.