Night Medevacs

[teh1pilot]

But fearing we are going too far off topic everyone, my point I wanted to make is very clear. Pilots are pilots.....and the medical professionals are the doctors, nurses, etc etc. We simply do not mix the 2. The fact of the matter is that a patient needs to move, whether the hospital needs the bed for potentially much more critically ill patient, or they have 1 foot already in the grave. Let the medics deal with the medical side of things, and pilots just drive the bus. That's really as hard as it needs to be. As a pilot myself, as PIC I really don't care about every detail about my passengers, and in bigger operations like Jazz, it's impossible to know. I don't care when the guys who are sitting behind me last had their rectum's checked.

And again, the first thing we do when dispatching crews is have pilots check weather. We don't even so much as talk to anyone else until we get the OK from the guys flying the tin. And this weather check serves one purpose, and one purpose only.....to allow the pilots to evaluate the task at hand, and decide if its safe to do so. That's it. So, if you feel you are posing a threat to anyone involved, just say so; Whether its fatigue, weather, duty day, even the weight of the patient. And I've had trips turned down for every one of those reasons. You can do the same, and no one has the right to put your lives or others lives in danger by telling you otherwise. On the same token, though, the bottom line is people need to get from point A to B....It doesn't matter whether it be on a medevac, or a sched. And those people don't care if it's an ungodly hour, the just trust you to make the right decisions, and get them there safely. Keeping that in mind, if you are consistently turning down trips because you hadn't had your 8 hours, I'm sorry but you aren't going to be making many friends in the industry. While I understand it sucks....and by sucks I mean SUCKS!.....the reality is it's a down side to the job, and will continue to be for the rest of our careers. And as long as there are young prospective pilots who would give their left nut to so much as sit in a -200, citation, or even 1900, then there will still be pilots willing to do the trips at the early hours(safely of course), just so they can stack their log book.....Thus, trips still going out at the said ungodly hours.

[willow burner]

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!

Agreed! In case it went over anyones head, I was being sarcastic about busting minimums. The point was I would nt want to try and be judge of who is sick enough to need out. Id rather fly safely to minumums every time....its just another trip.

[flyinthebug]

Interesting topic. I agree completely with teh1pilot. We are pilots and fly planes...doctors fix people. The two are so many miles apart, what good would it do to know the condition of the patient?

Ive told this story before but as an example of why pilots should NOT know the condition of the patient...
Back in the mid 90s I was flying a C414 medevac for a company with government contract to provide medevac services to Northern MB. Its funny how "bad days" stick in your head. My captain and I had been paired for the day and flew 3 missions starting at 0900. As we were putting the plane away after a 14 hour day...our CP calls us and says we are the ONLY machine available and if we dont get up to Thompson and take the patient to YWG, there was a very good chance the patient would die. We felt an incredible amount of pressure to get the flight done despite the fact we had already blown our duty day.

The young Captain and I discussed what we should do, and we decided we were going to do the right thing and try to save this persons life. We blasted off again with 15 hours duty time under our belts, enroute to Thompson from Cross Lk and then down to YWG. The flight to Thompson was fine, but we ran into very hard IMC enroute to YWG and heavy snow and moderate turbulance. When we landed in YWG, we had over 20 hours straight flying...and when I look back at that flight and myself and the left seat trading off every 10 mins because we were too fatigued to keep up a proper scan. That became an extremely dangerous flight and we are very lucky we didnt hurt ourselves or our patient (and flight nurse).

In this particular case, the patient had a blocked bowel and would have died of septic shock within a few hours if we didnt get him to YWG.

Ive seen far too many times when as Doc said, the skeds are done for the day and the phones start to light up. Its rare that its a life or death situation for most medevacs, but I strongly believe the pilots have no business knowing how serious or non-serious the patient is. We are hired to drive airplanes and doctors are hired to diagnose and fix sick people. If its legal to go, then go and if its not, then dont. The days of CP pressure like that are hopefully few and far between in this day and age, but it wasnt always that way. If we hadnt been told the condition of the patient as being serious, it wouldnt have affected our decision making. Knowing someone could potentially die, made both of us feel we had to get the job done. I think its far better to not know, and just do our jobs... within the parameters of the regs.

Let doctors fix people and pilots continue to fly people safely to their destinations. That is the ONLY job a pilot has...and knowing the condition of the patient if frankly none of my business...my business is to get that patient where he/she is going...and do so safely. If it cant be done safely and within the confines of the CARs, then no matter how ill the patient is, it will have NO bearing on the decision making of the pilot(s).

My 2 cents.
Fly safe all.

[spaner]

I agree, we should never know.

In my first medevac placement; this was against company policy, and enforced in company culture.
But, we tended to ask, after the deed was done/canceled. Often, following up on long term condition.
It didn't take long before I stopped asking, for just the reasons that Doc mentions. We tend to remember and resent the situations where all the hard work is put into a benign situation; like pop and chips in a blizzard.

Just a few years later, at another company, where the culture was the reverse; I insisted on not knowing, and of course was not considered a "team player", as to the culture of the business. which of course, was money.

I'd rather just never know.

BTW. I hate being asked "if it's safe to try". An extremely uninformed question. It's risk level. "How risky is it to go". We don't try, we go; and that risk level associated, is accepted by the crew, from the moment we go.

[Jack In The Box]

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.

That's half of my point actually. In addition to knowing a pax condition for health reasons, why shouldn't that play a part in the pics go/no go decision?

[Jack In The Box]

I'm surprised at all you people who think a pilot should not know. If I was called early in the am, I'd want to know why. If it were a drunk with a booboo, which a surprising amount are, unless my crew and I feel very well rested, I'd want him to wait until the morning.

It's a fair point about using a patients condition to stress a crew, but ultimately we are professionals and cannot allow that to stress us past where we are comfortable.

A pilots job is to minimize risk. A flight in the dead of night is a risk. If a pax is going to die, it's an acceptable risk. If its something that can wait until morning, it should. Nurses have proven, to me, they are incapable of making such rational decisions. A lot of them seem to be the "just get him out of here type." I remember once in a certain Northern nursing station, my nurse rushed to the bed of a man experiencing severe heart pains. He stabilized the patient and have him nitrogen, etc. he turned to me after, somewhat white faced, and said "he likely would have died had I not stabilized him."
The nurse sat behind the counter on her iPhone the texting the whole time, and when asked a detail about his treatment responded with "I don't care, I'm off in 10 minutes"

Medical transportation has to be a team effort. Ambulance drivers are part of the team, so should Medevac pilots be.

[flyinthebug]

I'm surprised at all you people who think a pilot should not know. If I was called early in the am, I'd want to know why. If it were a drunk with a booboo, which a surprising amount are, unless my crew and I feel very well rested, I'd want him to wait until the morning.

Medical transportation has to be a team effort. Ambulance drivers are part of the team, so should Medevac pilots be.

Why should this surprise you? What qualifications as a pilot do you hold to decide whether the patient is in serious condition or not? You likely have no medical training (98% of pilots have none) and therefore have about as much business making a decision about any patient`s condition, as a flight nurse does telling us how to shoot the approach.

The key difference between medevac pilots and Ambulance drivers is almost ALL ambulance drivers are also EMT`s or paramedics themselves...again, giving them the right to be part of the "medical" team.

It never ceases to amaze me how some of "you" seem to think that because we are pilots, we can now diagnose a person`s medical condition?...to such an expert degree that we will decide if its worth getting out of bed for? Are you kidding me? You have to be joking...and if you are not, you should NEVER be the PIC of any medevac flight. Ever!

Fly safe all.

[Jack In The Box]

I'm surprised at all you people who think a pilot should not know. If I was called early in the am, I'd want to know why. If it were a drunk with a booboo, which a surprising amount are, unless my crew and I feel very well rested, I'd want him to wait until the morning.

Medical transportation has to be a team effort. Ambulance drivers are part of the team, so should Medevac pilots be.

Why should this surprise you? What qualifications as a pilot do you hold to decide whether the patient is in serious condition or not? You likely have no medical training (98% of pilots have none) and therefore have about as much business making a decision about any patient`s condition, as a flight nurse does telling us how to shoot the approach.

The key difference between medevac pilots and Ambulance drivers is almost ALL ambulance drivers are also EMT`s or paramedics themselves...again, giving them the right to be part of the "medical" team.

It never ceases to amaze me how some of "you" seem to think that because we are pilots, we can now diagnose a person`s medical condition?...to such an expert degree that we will decide if its worth getting out of bed for? Are you kidding me? You have to be joking...and if you are not, you should NEVER be the PIC of any medevac flight. Ever!

Fly safe all.

Wow, I felt that's an unnecessarily hostile post, flyinthebug.

I agree with you that I have 0 medical training and am not qualified to diagnose a patient. But that was not my point. My point has 0 to do with pulling to "boss card" of being pic. I agree with doc that the severity of night medevacs need to be brought into question publicly. But since that has not happened, and as I said before the chiefs will never allow it, I feel the pic must step up and take responsibility for it. And I don't feel it's as black as white as saying "legal/safe? Then go. If not, do not go." Risk will always exist, and it's degree will always vary with ambient conditions, crew preparedness, company culture, etc. my feeling is that our job is to minimize risk that is not necessary.
Personally, I think as the person responsible for the safe operation of the flight, I think it's fair to say "wait till morning" in the interest of minimizing unnecessary risk.

Anyone else care to agree/disagree?

PS sorry for the spelling...iPad keyboards are my nemisis

[flyinthebug]

Wow, I felt that's an unnecessarily hostile post, flyinthebug.

I just re read my post to you, and you are absolutely right and I apologize for my unnecessary tone. It wasnt intended as it came across. I was just hoping to impress upon you the fact that we have no right to "assess" any patient`s condition...and we should leave that to the experts...as we ask people to leave the flying part to us.

Again, I apologize for my tone in my previous reply to you.

Fly safe all.

[Jack In The Box]

Wow, I felt that's an unnecessarily hostile post, flyinthebug.

I just re read my post to you, and you are absolutely right and I apologize for my unnecessary tone. It wasnt intended as it came across. I was just hoping to impress upon you the fact that we have no right to "assess" any patient`s condition...and we should leave that to the experts...as we ask people to leave the flying part to us.

Again, I apologize for my tone in my previous reply to you.

Fly safe all.

No problem, I appreciate it. I figured you probably didn't mean it that way which is why I stated how I felt rather then getting defensive.

You're right, I appreciate it when medical staff leave the flying to me and don't try to get involved. However, let me ask you this: would it be unfair to ask a nurse if the trip could wait until morning?

[flyinthebug]

Wow, I felt that's an unnecessarily hostile post, flyinthebug.

I just re read my post to you, and you are absolutely right and I apologize for my unnecessary tone. It wasnt intended as it came across. I was just hoping to impress upon you the fact that we have no right to "assess" any patient`s condition...and we should leave that to the experts...as we ask people to leave the flying part to us.

Again, I apologize for my tone in my previous reply to you.

Fly safe all.

No problem, I appreciate it. I figured you probably didn't mean it that way which is why I stated how I felt rather then getting defensive.

You're right, I appreciate it when medical staff leave the flying to me and don't try to get involved. However, let me ask you this: would it be unfair to ask a nurse if the trip could wait until morning?

Thanks Jack.

Absolutely nothing wrong with asking that question IMO.
Cheers!
FTB

[teh1pilot]

You're right, I appreciate it when medical staff leave the flying to me and don't try to get involved. However, let me ask you this: would it be unfair to ask a nurse if the trip could wait until morning?

+1....I completely agree with that option. But the problem is the certain degree of separation between the hospital and the pilot. Unless the pilot actually goes in to the hosptial with the medics, the pilot will more than likely not talk to the nurses/doctors the entire duration of the trip. And if a pilot asks the dispatcher for the number to contact the nurse, dollars to donuts the pilot will never get the number out of them. It's not a matter of "the dispatcher is too lazy to give us the phone number", its really a matter of mitigating the argument that will most likely happen between the pilot researching the patient condition on wikipedia and the nurse requesting the transport.

While I think there are some rather cut and dry trips, there are also grey areas that aren't so clear cut. For example, a patient has a deep laceration to their forearm. If a pilot were to hear that after being woken up at 3 AM, they could very easily jump to the conclusion that the patient could wait until morning. However, little did the pilot know that patient has a high risk of losing that arm (time sensitive), or runs a very high risk of infection. Given the hypothetical situation a pilot should chose to go or not go based off of what they heard the condition is, this situation could have very easily changed a patients life forever because the pilot just simply doesn't have the medical background to understand the gravity of the situation. This is why pilots aren't supposed to know a patients condition, because regardless of whether you think it will happen or not, a pilot will always fly a trip differently if they knew what was laying on the stretcher behind them. We as pilots should, under every circumstance, fly a trip the same way every time. Check weather, evaluate flight crews condition,the planes condition, etc. to limit the risks of the trip at that particular time. Throwing in another factor that could effect a flights outcome, like knowing a patients condition, is only going to cause problems....and big ones at that.

So to summarize, while asking a nurse if it can wait until morning is great in theory, unfortunately its not a very practical option. Since the dispatcher will more than likely not hand out a hospital unit's phone number, by the time the pilot googles the number, tracks down the right unit's phone number, calls them, and has a discussion with the nurse if the patient can wait or not.....valuable time may have been wasted. It would have been much easier, and in most cases safer, to just accept the fact that the professionals have asked for our help(as pilots and dispatchers) to move a patient. Unless there is a legitimate reason not to do the trip, it doesn't matter which, stop complaining that your beauty sleep has been interupted and grab a cup of Joe. And by legitimate, I mean if your decision is ever questioned, you don't need to worry about getting canned for said decision. I don't understand how a trip can't be black and white though. It shouldn't matter if you are flying a King Air 200 flying medevacs, in your personal plane to go visit your family, or PIC on an full A380. If the safety of the mission is in question, you limit the risks, and if after limiting those risks you still feel unsafe to do so, listen to your gut and turn down the trip.

[lostaviator]

I guess a night rating isn't sufficient anymore?

[CFR]

A night rating is of little value on those nights where, while it is VFR, there is no moon or there is a high overcast and the area is so sparsely settled there are no lights on the ground. This can make discerning a horizon difficult/impossible.

[rapid602]

Interesting all the pioints of view on medivacs .... There is good reading here. I just wanted to add about the waste of Government money here. I think Doc mentioned that.

I started doing Medivacs with Bearskin in the mid late 80's and then for a company out of Sault Ste. Marie. There were some trips that we did in the middle of the night that I am sure could have waited till after we had our morning coffee.

But you have to wonder when we took a trip in our C500 from Toronto to LasVegas to Toronto and the passenger walked onto the aircraft with bookin hand, in street clothes and a friend, and we flew then home with nassel prongs and I think the O2 was set at like 2 Litres.

BTW she said her son in law was a doctor. And we had to have a nurse ... Huge waste of $$$

Fly safe all.

[lostaviator]

True.

Stay a head of your plane people.

I have seen some very infuriating cases of system abuse. Patient missed the sked, pretend OD's... The list goes on. At the same time I have an understanding for how the "decision" is made. Phones calls from nursing stations to doctors, receiving departments etc. In the end - it's not my job to decide if this person needs to be medevac'd right now.

I fully expect the medic to disclose any information to me that is of importance to my flight planning, as well as my health (cabin pressure, TB, MRSA, etc). Nurse/Medic is a part of your team and CRM applies. They should decide if they are good to go on the patient side, and then I will decide if I am good to go on the flight side.

We are all professionally trained to fly at night, in IMC and trained to make a proper go decision. While flying at night into remote areas adds to the work load, keep both heads in the game and never sit there fat dumb and happy at 3am.....

[Doc]

I don't think it happened a night, but since somebody opened the "government waste of money" can of worms, I know for a FACT that ORNGE flew a PC12 from Sioux Lookout to Toronto Island, EMPTY, to pick up two flight paramedics, who would NOT take a taxi, and fly them all the way too Buttonville, then returned EMPTY to Sioux Lookout.
Yup, really happened.

[sky's the limit]

If it makes you feel any better Doc, last summer once a week in August I flew 60 pizza's 105nm one way to a fire camp and came back empty... $3500/hr for the machine plus fuel, 2.2hrs round trip. No other cargo.

[grimey]

Tell him they were crap from Pizza-Pizza, make him really scream.