turbo-prop wrote:Night or day you still have to be able to see the runway through the whole circling procedure to final to make a safe landing.
That'd be nice..welcome to the black hole...
Take it easy there guys, this is just a forum, and we're chatting here.
It could be sky clear, the only light, is now behind me. What you see, is nothing, and you'd better be on the instruments; departing or arriving transition to "VFR" is something a few comments here show, that they have no experience in this flight regime. Which concerns me.
In these northern areas, "IFR" is a piece of paper with an alternate on it, and not much more.
"VFR" is any maneuvering below 500'.
In the south, at night; the world is lit up like a christmas tree around the airport and runway (S).
In the north, at night; It's an aircraft carrier; and there are no other lights.
pelmet wrote:Seem to remember that dark started at about 3 in the afternoon farer up north. Now we shouldn't fly past this time? Hmmm. Kind of limiting.
A perfect example of a complete lack of common sense.
In fact we used to go into a place called Grise Fiord. Winter Memo to Grise Fiordians....Due to common sense being applied and 24 hour darkness, no medevacs will available for the next two months. Please don't become ill.
willow burner wrote:Your job as a medivac pilot is to determine if you can safely depart, shoot the approach, come home, and if necessary procede to your alternate, taking into account weather, darkness, equipment, and your own fitness to fly. Once you have made a decision to launch, the rest should be pretty cut and dried on an IFR flight. ( Night VFR is sketchy and best, I'm not talking bout that,)So I submit that as a medevac pilot your focus should be on the flight. If it can't be done safely, don't start the engines.
+1.
Any time you are at the controls of an airplane, the number 1 priority is safety. Not just air ambulance. Like the above poster alluded to, all of those factors need to be considered: weather, equipment, day or night, ifr/vfr, crew, fatigue. Having fown medevac in both AB and BC for years, the biggest issue I encountered which was counter-productive to flight ops was fatigue. Middle of the night, dead of winter, night shifts for nights on end...let's face it, you get tired. Unfortunately in that realm of flying, it's just part of the job. Switching from day to night. And back again. I've had more than one guy start to doze off while he was in control. That's why there's 2 up front. Think about the medics; a shift for 48 hours straight with no sleep. No thanks. I'd rather be tired and know that I duty out at 12 hrs.
I realize that there has been plenty of discussion on fatigue on this board. It's an industry-wide problem. It was in the 703 medevac world, it was in the 704 world, and it still happens now in the 705 world.
Bottom line; if you're unfit to fly - regardless of why, don't get in the airplane.
pelmet wrote:Seem to remember that dark started at about 3 in the afternoon farer up north. Now we shouldn't fly past this time? Hmmm. Kind of limiting.
A perfect example of a complete lack of common sense.
In fact we used to go into a place called Grise Fiord. Winter Memo to Grise Fiordians....Due to common sense being applied and 24 hour darkness, no medevacs will available for the next two months. Please don't become ill.
Still no common sense? Obviously if it's dark all the time, you go when it's dark. NOWHERE have I ever indicated we should never fly at night....but then you'd have to be able to read to gleam that simple fact from my original post. Sound out the word pelmet, it's not all that tough.
I am with Doc 100% on this one. A pilots job is to minimize risk. I am sure a lot of people (nurses especially) will argue that since we are pilots, the patients condition is none of our business and our only job is to get them where it's been deemed necessary that they go. While this is partially true, we are responsible entirely for the health and safety of the crew and passengers in transit from airport to airport, and since our job is to MINIMIZE RISK to all souls on board (including the patients) I think captains should be taking more responsibility to ask the nurses on the phone what is wrong with the patient and playing a part in the decision of go or no go. Especially when the call comes in in the middle of the night and a crew is not well rested. Actually, I think this should be a law written in stone in the CARs, but since it is not..
It's a team effort, while everyone performs different roles and functions differently (pilots worry more about flight conditions, and nurses/paramedics about patient conditions), everyone has to be watching out for each other and working together or it won't get done efficiently, effectively, and safely. So in light of that, I argue that yes, a pilot should be involved in the decision to send a medevac flight, particularly when the weather or ambient conditions are not favorable for flight (increased risk).
I do remember doing three missed approaches in one night, after medcom kept sending us to different destinations on a particularly nasty night. I later learned (they were a lot freer with their communications ten years ago) that all three patients caught the morning skeds to YXL. I was a little miffed.
If I'd known the condition of the patients I might have parked after the first missed? By the same token, knowing the patient has a "real" emergency might cause pilots to "try harder". This has an undesirable affect. It kills.
A New Zealand helicopter pilot (nobody you know...this was in NZ) was flying support for an adventure race through the back woods of the South Island. He asked the attending doctor how hard he should "push" if somebody needed a medevac. The doctor told him "Push no harder than you would to pick up a loaf of bread...." THIS is (perhaps?) how it should be.
Switchfoot wrote:
Bottom line; if you're unfit to fly - regardless of why, don't get in the airplane.
Switchfoot.
I realize I am being the devil's advocate here but.........
Suppose I fly into a remote airstrip to camp with friends. I have a beer with lunch. An idiot slashes his leg with a chainsaw. A nurse stops the bleeding, applies an tourniquet. The nurse then states that if he gets to a hospital today he will keep the leg, otherwise, he will lose it.
The only way to get him to the hospital today is if you fly him. What do you do?
We are genetically hardwired to put ourselves at risk to save others. How many times have you read stories where people die saving others, or people die attempting to "bring a body back" ?
Oh right, aviation is different!
Please remember I am not a commercial pilot so my opinions are irrelevant
YMMV
LF
(and I have never understood jeopardizing oneself to "bring a body back")
Switchfoot wrote:
Bottom line; if you're unfit to fly - regardless of why, don't get in the airplane.
Switchfoot.
I realize I am being the devil's advocate here but.........
Suppose I fly into a remote airstrip to camp with friends. I have a beer with lunch. An idiot slashes his leg with a chainsaw. A nurse stops the bleeding, applies an tourniquet. The nurse then states that if he gets to a hospital today he will keep the leg, otherwise, he will lose it.
The only way to get him to the hospital today is if you fly him. What do you do?
We are genetically hardwired to put ourselves at risk to save others. How many times have you read stories where people die saving others, or people die attempting to "bring a body back" ?
Oh right, aviation is different!
Please remember I am not a commercial pilot so my opinions are irrelevant
YMMV
LF
(and I have never understood jeopardizing oneself to "bring a body back")
Circumstances alter cases.
If it were me, and I'd had a beer with lunch, he gets tossed into the airplane and off we go. I'm hoping this wasn't a serious question? ONE stinking beer. Some CARS need to be broken under some circumstances. This is one of those. Unless you're an 80 pound girl, one beer puts nobody at risk. Got to know when to hold 'em....know when to fold 'em....
A man's got to know his limitations.....
Safe is not always legal. Legal is not always safe. Learn this.
As one who has knowledge about how both sides operate(being a medevac dispatcher myself as well as a commercial pilot) I can see things from both sides of the story.
On one side, I can see how fatigue can weigh very heavily on flight crews. We as dispatchers understand the fact. We will most definitely explore all of our available resources accordingly. I will admit that we have dispatched crews knowing they've already done 3 trips for us one night, only to have them go again at 0300. But that's either due to patient condition, or there are simply no other options.
It's important to note that most times, the go-no go decision is not always up to the dispatcher. If a critically ill patient needs to get out, and after the conference with sending, receiving, as well as transport physicians(STARS), the doc says "If the plane can fly, send them" our hands are tied. We are not doctors. We do not have the authority to decide if a patient "really" needs to go or not. Simply put, if we are asked to dispatch, we dispatch. And it all starts with phoning up the PIC, and asking to do a weather check for the trip at hand. At the dispatch center I work at, if a pilot says no for any reason at all(it might as well be because the PIC hasn't had his cup of coffee yet) that they can't go, we don't push the fact. We just simply do not dispatch, and look at other options. The way I see it, there are 3 in the medevac world. Fixed wing, Rotor, and ground. If fixed wing is out of the picture, we phone up the STARS doc, and ask if this is truly a STARS event. If the doc see's fit, he sends the Rotor. If not, we ground them. Not saying that a pilot would ever turn down a flight because he hasn't had his coffee yet, but if the pilot turns down a flight, it's because he legitimately has concerns with what he has been asked to do. If his reasoning has some merit, I would suspect when the decision is questioned a few days later by the higher ups, his decision should be backed up by his employer. So if he has concerns about fatigue or night flying, don't get in the plane. I've seen both cases. One example would be Duncan, BC. If we attempt to send a plane in, a pilot needs to take a quick look at the CFS and read that its 1500', and it stresses only pilots familiar with the area should attempt to use the airstrip at night. If the PIC turns down the flight because of that reasoning, I will bet dollars to donuts the pilot probably wont even hear about the trip again.
Now the idea of having pilots know the condition of the patient and making a go-no go decision scares me......a lot. Again, we as pilots are not medical professionals. We spent half our lives learning how to fly planes, and safely. The doctors spend half of their lives learning about the body, and how to preserve life. 2 totally different topics, and to mix the 2 is reason for disaster....And by that logic, it doesn't matter if the patient has a hang nail or a heart attack. If the medical professionals are asking us to fly, if its possible to do (and in a safe manner) we do it. No questions asked. What if the patient has an underlying condition that warrants transport by air a better decision than by ground? Pilots, dispatchers, and some times even the nurses requesting the transport are not any of the wiser. It all boils down to the doctor requesting transport, and the reasoning behind the decision(either good or bad) is not for any of us to know. Also, if a pilot knows the guy is having a huge jammer, I would be inclined to believe that there is a very real tendency to push the limits a bit further than someone who may have a hang nail. That, in itself, is asking for an accident.
Really at the end of the day, the pilot has 1 goal....To get from point A to B....safely. It's none of our concern to know of any other information. All we need to know is weights of all px's, and a dispatch number. Go and check weather, evaluate your crews condition, and if any factor in the grande scheme of things puts the lives on board at risk, say no. It goes right back to all of our ground school training, very plain and simple. And if you say no for a legitimate reason, no one should ever have the right to tell you that you are to do other wise.....
Now finally on the flip side, we all are truly sorry the call didn't come in just after your lunch that you ate after your full 8 hrs of sleep, but quite frankly... I can summarize it in 2 words...Tough Sh**. Anything in life rarely comes at the most opportune moments, and you as a pilot understood what you may be required to do when you accepted the job offer. Granted there will be points in time where the following doesn't apply, but splash some water on your face, grab a coffee and a quick smoke or something, and wake up....We've all been there. If you truly are concerned with the state of your crews, you wouldn't be doing trips like these, and quite frankly, I don't think we would even be having this discussion......Just my 2 cents though
teh1pilot. I must ask you one question. One question only.
Haven't you, as a dispatcher every wondered why you have to call out the same crew three times late at night, and never during the day?
I remember well the simple FACT that as soon as the last skeds were headed south, the phones would start ringing.
I just hope you are not the poor dispatcher who called me at midnight one night several years ago to tell me to fly from Kenora to Sudbury, pick up a patient transfer (ambulatory) and fly him to North Bay. I think I said something like..."Don't you people own a MAP?" I talked him out of it.
BTW, for what it's worth, I don't think pilots should be privy to a patients condition either. I would like to see a little common sense when it comes to flying folks around at 02:30 because they missed the sked and have an appointment with their dermatologist the next day at 16:00!
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
Doc wrote:
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
+1
And it shouldn't be any harder than this, keep it simple! Crappy midnight IFR? Simple. Shot the approach down to minimums;if you see something land. If not, up and out...
No need to know the patients condition. Sounds brutal, but it isn't going to change the minimums of an approach. There is no situation where you can justify risking an aircraft, crew and medics trying to get to into many of these places.
And as for the nurses and medics deciding to go or not, pants... Definitely advise them of the conditions, but the final say IS down to the crew, simple.
Doc wrote:
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
Unfortunately, you know as well as I do that too many pilots will push weather and fly around overweight with not enough gas for a load of pop and chips.
Doc wrote:
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
Unfortunately, you know as well as I do that too many pilots will push weather and fly around overweight with not enough gas for a load of pop and chips.
True but has no bearing on this discussion. Medevac machines are very rarely not fully fueled, and operate well under gross due to the nature of the work. (Discussion not necessarily the correct work, more like a witch hunt with a few people being burnt on the stake by the end of it...)
teh1pilot wrote:Really at the end of the day, the pilot has 1 goal....To get from point A to B....safely. It's none of our concern to know of any other information. All we need to know is weights of all px's, and a dispatch number. Go and check weather, evaluate your crews condition, and if any factor in the grande scheme of things puts the lives on board at risk, say no. It goes right back to all of our ground school training, very plain and simple.
In my mind what this all comes down to (on the pilots end), is pilot decision making. Which can't be learned from reading a book. Yes, we are trained on the airplane/systems, weather, etc., but learning one's own capabilities is something completely different. It only comes from years of actual hands on experience in all of these various circumstances.
The issue isn't whether a patient needs to go or not; that's not the responsibility of the flight crew to determine. As has been said, we are there to get the airplane from A to B safely, and manage all of these other factors at the same time. It's learning to manage the airplane and crew and to do that in a timely and safe manner.
Doc wrote:teh1pilot. I must ask you one question. One question only.
Haven't you, as a dispatcher every wondered why you have to call out the same crew three times late at night, and never during the day?
I remember well the simple FACT that as soon as the last skeds were headed south, the phones would start ringing.
I just hope you are not the poor dispatcher who called me at midnight one night several years ago to tell me to fly from Kenora to Sudbury, pick up a patient transfer (ambulatory) and fly him to North Bay. I think I said something like..."Don't you people own a MAP?" I talked him out of it.
BTW, for what it's worth, I don't think pilots should be privy to a patients condition either. I would like to see a little common sense when it comes to flying folks around at 02:30 because they missed the sked and have an appointment with their dermatologist the next day at 16:00!
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
And my answer to the question is very simple...Yes, I have wondered whether or not the trip would be justified transporting now, or at a later time to let the pilots/medics sleep. But the problem of the matter is simply TIME. When a dispatcher processes a call, at least where I work, we do do some minor triaging. If the patient is going to a lower level of care(home for example), the book tells us we have 24 hours to get that patient out and back home. So, being resourceful, we would dispatch a crew to send them home only if it makes sense. For example, your plane lands to drop off a patient, and the one going home just so happens to be in the same town/city, we would more than likely dispatch you to take the 2nd patient home. This is also assuming they're going home to a place at or near your base.
On the flip side, situations have also come up where back to back to back yellow, or even red patients come to our attention, more often than not, very suddenly. We have what we call a "chart of call" that quotes us times from point A to point B. When evaluating who we need to send, since time is of the essence, we dispatch the closest available resource. Lets say you are first up after just getting home from another mission, as long as you have enough duty time, enough food in your belly, and plane/weather is OK, we send you. Again because the trip is time sensitive, I don't think it's too far of a stretch to say it's understandable to send the fastest resource. I'm sure you would want the same for your families.
In light of all of that, again, the ultimate decision rests in the PIC's hands. If you are hallucinating because of a lack of sleep and a cup of joe can't shake you out of your stupor, than I think its more than reasonable to decline the flight. Quite frankly, there are a lot of factors and people that all come together to ultimately get a patient out, and because of that, I would go out on a limb and say im not going to even get involved with what goes where and when. If I'm asked to do a trip, if its possible, and my crews are reasonably fit to fly as to not pose a threat to anyone/thing, I would just go ahead and do it.
Doc wrote:teh1pilot. I must ask you one question. One question only.
Haven't you, as a dispatcher every wondered why you have to call out the same crew three times late at night, and never during the day?
I remember well the simple FACT that as soon as the last skeds were headed south, the phones would start ringing.
I just hope you are not the poor dispatcher who called me at midnight one night several years ago to tell me to fly from Kenora to Sudbury, pick up a patient transfer (ambulatory) and fly him to North Bay. I think I said something like..."Don't you people own a MAP?" I talked him out of it.
BTW, for what it's worth, I don't think pilots should be privy to a patients condition either. I would like to see a little common sense when it comes to flying folks around at 02:30 because they missed the sked and have an appointment with their dermatologist the next day at 16:00!
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
Your comment is fair, but why shouldn't a pic be privy to a patients condition? Is a pax aboard his flight, after all, and why should the pic not be allowed to know everything about this pax?
Doc wrote:teh1pilot. I must ask you one question. One question only.
Haven't you, as a dispatcher every wondered why you have to call out the same crew three times late at night, and never during the day?
I remember well the simple FACT that as soon as the last skeds were headed south, the phones would start ringing.
I just hope you are not the poor dispatcher who called me at midnight one night several years ago to tell me to fly from Kenora to Sudbury, pick up a patient transfer (ambulatory) and fly him to North Bay. I think I said something like..."Don't you people own a MAP?" I talked him out of it.
BTW, for what it's worth, I don't think pilots should be privy to a patients condition either. I would like to see a little common sense when it comes to flying folks around at 02:30 because they missed the sked and have an appointment with their dermatologist the next day at 16:00!
I'll push just as hard as I would for pop and chips. Which is what every pilot should do.....
Your comment is fair, but why shouldn't a pic be privy to a patients condition? Is a pax aboard his flight, after all, and why should the pic not be allowed to know everything about this pax?
If the patient has an infectious disease, for example, and we're not fully aware of it, my first call would be to a lawyer. I would turn these trips down as I had young children. After my years at med school I knew when we were swinging at windmills, which was at least 75% of the time. I just didn't care. I'd go to sector (lots of places had no approaches, and I never went below sector unless visual) and missed lots of approaches. Flew enough tooth and tummy aches to gag a maggot. Had no respect for the whole business. Users don't impress me much.
The problem, as Doc has pointed out, is nothing will ever be done by TC. I wonder if this has something to do with it? http://www.winnipegfreepress.com/local/ ... 51731.html
teh1pilot wrote: the book tells us we have 24 hours to get that patient out and back home.
I think this is the crux of the matter right here. Pilots are Pilots and Doctors are Doctors and never the twain shall meet. Doctors don't understand black holes just as pilots don't understand myocardial infarctions. There is no reason EVER to be sending people blasting down to minimums on snowy, black holed nights, because the book says you have to get someone home by xx:xx time.
Why can't we have a matrix of sorts of risk vs patient condition. Night, black hole, Snowy, non precision minimums, tired crew 10/10 risk. Patient missed sked for appointment tomorrow 0/10. Risk is too high for patient condition therefore nobodys going flying tonight.
Ambulances have this sort of thing. If you just need a ride to the hospital because you're drunk, it's a nice slow ride. If you're one foot in the grave, we're running red lights. We just need to apply the same philosophy. Not all medivac calls are created equal and we need to stop treating them as such.
Seems like a good idea. But....how far past minimum should I go for a heart attack? How high above them should I stay for a drunk with a broken arm? And if the nurse says his tummy hurts, how do we know whether to stay in bed or not?
Medevacs will never be a slick, glamerous kind of flying. Its probably more like being a freight dog. Id much rather treat it as such, and not even know whats going on back there.
willow burner wrote:Seems like a good idea. But....how far past minimum should I go for a heart attack? How high above them should I stay for a drunk with a broken arm? And if the nurse says his tummy hurts, how do we know whether to stay in bed or not?
Medevacs will never be a slick, glamerous kind of flying. Its probably more like being a freight dog. Id much rather treat it as such, and not even know whats going on back there.
Pretty simple answer to the first question. NEVER go below minimums for ANY reason. DOH
If its a drunk with a broken arm....call us in the morning.
This "We have 24 hours to move a patient...." scares the living shit out of me! Hospital induced "get homeitis"? Like this syndrome hasn't killed enough pilots and passengers over the years?
Tired of the ground.....we don't need a matrix. We need some common sense. And a new dispatch mandate, before more people die.
willow burner wrote:Seems like a good idea. But....how far past minimum should I go for a heart attack? How high above them should I stay for a drunk with a broken arm? And if the nurse says his tummy hurts, how do we know whether to stay in bed or not?
Medevacs will never be a slick, glamerous kind of flying. Its probably more like being a freight dog. Id much rather treat it as such, and not even know whats going on back there.
Pretty simple answer to the first question. NEVER go below minimums for ANY reason. DOH
If its a drunk with a broken arm....call us in the morning.
This "We have 24 hours to move a patient...." scares the living shit out of me! Hospital induced "get homeitis"? Like this syndrome hasn't killed enough pilots and passengers over the years?
Tired of the ground.....we don't need a matrix. We need some common sense. And a new dispatch mandate, before more people die.
I'd way rather be a freight dog!
And my apologies, I should have worded the statement a little bit better. By "we have 24 hours"......it's not a SOLID! rule. Its simply a guideline. These trips are, as I said, only repatriations. We have a window of about 24 hours to really look at the trip, and have a plan for it. And to be resourceful, in that window of 24 hours, we look at all outgoing and incoming trips. If weather, fuel, duty day, crews, and any other detail all allow it, we would look at doing the trip then. However, if its coming up to the 23.5 hour mark, we may have a pilot check weather. If weather is bad, we phone the sending site and inform them weather isnt good and we haven't been able to do the trip in the mean time.....the patient will simply wait until then all the stars align
