The flight crew must use supplemental oxygen for the entire duration of flight operations above a cabin pressure altitude of 14,000 feet MSL (14 CFR § 91.211).
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When the altitude of an airplane is less than 12,500 feet, there is no supplemental oxygen required for anyone in a private plane. From 12,500 feet to 14,000 feet, supplemental oxygen must be used by the required flight crew for any portion of the flight that is more than 30 minutes.
The minimum safe altitude of a route is 19,000 feet MSL and the altimeter setting is reported between 29.92 and 29.43 “Hg, the lowest usable flight level will be 195, which is the flight level equivalent of 19,500 feet MSL (minimum altitude (TBL ENR 1.7-1) plus 500 feet).
Lower levels of oxygen in your blood may make you feel unwell or could even be harmful to you during or after your flight. This means that, even if you do not usually need oxygen, you may need it while flying. Additional oxygen keeps the oxygen levels in your blood at a comfortable level and keeps you safe.
Values >95% on room air suggest that inflight hypoxemia is unlikely and that further evaluation is likely not necessary. Patients with saturations <92% on room air at rest should receive supplemental oxygen inflight, because they are at high risk of hypoxemia at altitude.
For most passengers, even those with respiratory disease, air travel is safe and comfortable. Some patients with COPD may be at risk but, with screening, these patients can be identified and most can travel safely with supplemental oxygen.
For best protection, you are encouraged to use supplemental oxygen above 10,000 feet MSL. At night, because vision is particularly sensitive to diminished oxygen, a prudent rule is to use supplemental oxygen when flying above 6,000 feet MSL. So, when you fly at high altitudes, supplemental oxygen is the only solution.
Low air pressure during air travel also decreases the amount of oxygen in the air. This effect is modest and generally not noticeable for healthy travelers. For patients with significant lung disease, a small decrease in available oxygen can cause significant symptoms, especially with exercise.
The only oxygen equipment allowed on an airplane is the portable oxygen concentrator (POC). If you need oxygen in flight, you must take a portable oxygen concentrator with you, and , you must let your airline know ahead of time. They may require a doctor's letter to verify the need for the POC on the plane.
A Flight Level (FL) is the vertical distance of an aircraft above the ISOBARIC SURFACE of 1013.25hPa (hecto Pascal) or 29.92 in Hg (inches of Mercury).