skyward medevac

jenny talia · Post by **jenny talia** » Mon Mar 08, 2004 7:48 am

Just to flog it a bit more, I can only suggest to those of you NOT using the medevac status whilst flying a patient to show a bit more professionalism. You are being paid to transfer said patient from the Nurses station/ little hospital because said patients injuries are deemed too serious to be treated there. Therefore you need to get said patient to the bigger and better hospital, preferably asap. As was just mentioned, who are you to know said patient isn't going to take a downward turn. I can tell you now, that if this does happen and you have not called yourself medevac, you will have strips torn off you in court!
For those who are continuously B****ing about getting made to hold for the "other" medevac a/c (who, ACCORDING TO YOU, are not as serious as yours) re-read your own posts, and maybe you'll see that had you called yourselves medevac (not nessesarily priority) from the start, then you wouldn't be finding yourselves in the hold, and P***ing off a lot of people in the back in the process.

You may think that you are being polite, but in fact you are setting yourself up for trouble...... What ARE you going to do when you are 50 miles out and slowed down with all the breaks out and said patient, whom you have decided can wait a bit so the sched can get in ahead of you, starts convulsing, because you ASSUMED the patient had bumped his head in the bar while drunk, yet turns out far more serious??????????? Argue

confuzed · Post by **confuzed** » Mon Mar 08, 2004 8:32 am

[quote="jenny talia"]Just to flog it a bit more, I can only suggest to those of you NOT using the medevac status whilst flying a patient to show a bit more professionalism. You are being paid to transfer said patient from the Nurses station/ little hospital because said patients injuries are deemed too serious to be treated there. Therefore you need to get said patient to the bigger and better hospital, preferably asap. As was just mentioned, who are you to know said patient isn't going to take a downward turn. I can tell you now, that if this does happen and you have not called yourself medevac, you will have strips torn off you in court!
For those who are continuously B****ing about getting made to hold for the "other" medevac a/c (who, ACCORDING TO YOU, are not as serious as yours) re-read your own posts, and maybe you'll see that had you called yourselves medevac (not nessesarily priority) from the start, then you wouldn't be finding yourselves in the hold, and P***ing off a lot of people in the back in the process[end quote]

Ok, I AGREE that this is getting stretched out but this posting just drew me back in. Jenny, are you a complete idiot in real life or just pretend to be one on here?!?!? Have you ever flown a MEDEVAC or a patient in your life?!?? Here in Ontario, we are told whether or not to go as MEDEVAC by the people that dispatch us (MATC aka Toronto who takes the call from the nursing station and determines what course of action to be taken) or the medics on board if things have changed significantly enough. Just for your information, just because we have a patient on board that's deemed to be necessary to bring south doesn't mean that there's something wrong with them. They could just a be a patient transfer coming down to for a doctors appointment and you're telling me I should file that as MEDEVAC?? YAH! like that will happen. You then go on to babble on about us bitching about being put in a hold. Well that's what i'm talking about, why should we be bumped out of the way for something less serious (that still does not require the priority handling of a medevac status which is in itself a priority call sign. When aircraft use it properly it's supposed to raise some awareness that someone on board is REALLY in need of a doctor) like a kid with a broken thumb or some guy with a hook in his finger or whatever when our guy/gal say has taken a few too many tylenol or maybe got beat up pretty bad. The ACP medic is on board to take care of more things then you know, as they run quite a lot of different drugs to alleviate pain. If they deem that the patient is getting worse all we do is call up center and say "abc is now upgrading to medevac status" and they acknowledge that and now we have priority. It's not a matter of just because they're being sent on an airplane they need priority over everyone else and be called a medevac flight. If there were roads into most of these places, most of the trips we probably wouldn't get! It just means that it's out of the nurses up north's capability of dealing with it using the equipment that they have, or they want a doctor to take a look just in case. Have you ever been north and seen a real nursing station Jenny?? It has nothing to do with us thinking that we're being polite, it's just a matter of using common sense. Do you think that land ambulances go around all the time with their sirens and lights on with every patient like in the movies?? Not likely, they do patient transfers from geraldton, nipigon, wherever to places like thunder bay and they just continue on as normal without lights or sirens or whatever. However, enough said as some people just DON'T get it and are too closed minded to even consider it. That's ok, as we just do as we're told by the people who are CHARTERING US! not by what we think will sound cool on the radio. If the people in Toronto who are chartering us (or the medics in the back) want us to go medevac status we do, if not we don't. That's it for me on this one, as it's like beating your head against a brick wall.

Schlem · Post by **Schlem** » Mon Mar 08, 2004 12:36 pm

Confuzed wrote:

Just for your information, just because we have a patient on board that's deemed to be necessary to bring south doesn't mean that there's something wrong with them. They could just a be a patient transfer coming down to for a doctors appointment and you're telling me I should file that as MEDEVAC??

Are you telling me that in Ontario, an air ambulance will be dispatched to a community just to take someone out for a doctor's appointment?

Why would they waste a plane and crew on a simple transfer that could be done by a sched service? So while you are transfering someone for an appointment, another person gets in an ATV accident but has to wait and have his medevac trip delayed because a plane wasn't available...

...sounds to me like Ontario has much more serious issues then pilots using a "medevac" tag!

Using one operator as an example... all appointment transfers are done with their sched service and all medevacs are done in their dedicated air ambulances with RN's. Medics are only on the plane as secondary medical crew if/when needed. This operator was also recognized as one of, if not, the best aeromedical operator in North America.

That's ok, as we just do as we're told by the people who are CHARTERING US! not by what we think will sound cool on the radio.

If you think using a "medevac" tag on the radio sounds cool then you should get your ego out of the cockpit and think of the person on the stretcher behind you that you are responsible for. Some of you seem to convey the feelings that you have hunks of meat in the back rather then real people.

Maybe now we can understand why Skyward got the NW Ontario contract over an Ontario operator if all Ontario operators think like you.

confuzed · Post by **confuzed** » Mon Mar 08, 2004 1:38 pm

[quote]Are you telling me that in Ontario, an air ambulance will be dispatched to a community just to take someone out for a doctor's appointment? Why would they waste a plane and crew on a simple transfer that could be done by a sched service? So while you are transfering someone for an appointment, another person gets in an ATV accident but has to wait and have his medevac trip delayed because a plane wasn't available...[end quote]

I've been on my way repositioning back to base and got called to take a mother to winnipeg to see her baby which was already there. Nothing wrong with the mother, just taking her there. Most of the air ambulance flights don't have sched transferring capability and a dedicated air ambulance aircraft. We don't fly with RN's or doctors on board, only medics. Either primary care or advanced care depending on how many medics are on board and what their qualifications are. I never said that you sound cool using the tag medevac, but sometimes I wonder if others do. Just to let you know. Only use the term if "required".

bandaid · Post by **bandaid** » Mon Mar 08, 2004 1:58 pm

I don't mean to seem uncaring but I have a hard time getting around the fact that someone would use an airevac resourse to get a well mother to her child. Isn't that what a charter is all about. I guess it all revolves around who's paying the bill and the greed of the carrier involved.

Sulako · Post by **Sulako** » Mon Mar 08, 2004 2:15 pm

As an Air Ambulance, we fly people to/from doctor's appointments all the time. I fly in Ontario.

I fly a dedicated Air Ambulance turboprop, and we generally don't file medevac. If the patient is code 3 or 4 and it looks like we might be held up in the air for a while, we will upgrade to medevac so we can get down on the ground sooner, or maybe pick up our IFR a little faster while going to pick 'em up, but that's not very common.

I have yet to see a stable patient go sideways on us in the aircraft with no notice. Most of our patients have either been stable for hours (if not days) before the flight, or they are unstable throughout the entire flight.

I guess the bottom line is that we don't file medevac unless our patient is circling the drain and it looks like we might be held up if we didn't alert ATC to our medevac status.

To me, medevac = priority. I have never heard someone in the air saying they were medevac but not priority. I have only heard about that through this series of posts.

clearmyside · Post by **clearmyside** » Mon Mar 08, 2004 2:23 pm

confuzed, well done i am with you on this topic.

carrying a mom to her baby on an air ambulance is not the carrier' greed or choice, that is part of the system we all voted for and pay taxes for. the carrier only flies and does as MATC says. THAT's A FACT.

Everyone else: we'll just have to let MATC or Transport decide when the inevitable happens and a "medevac" repositioning to base empty delays a real one and the patient gets harmed. NO sympathy for those f@#$!&s up front then!!

Red1 · Post by **Red1** » Mon Mar 08, 2004 3:12 pm

This is sort of an interesting post. I have flown medevacs through out SK, MB, and Ont. When I worked in SK, we called everything a medevac, that’s what the company wanted so that’s what we did. ATC would ask us when coming in from the North if we where priority or not, this would depend on the patient. Flying in Ontario, is a different story. We only use the Medevac on a priority 4 call (maybe priority 3); this is what Medcom mandates. The problem is each province has a different system. When I was in SK if you told me you had a code 4 case, I wouldn’t know what the hell you where talking about (of course SK is a little behind the times). Some provinces use flight nurses, some paramedics, and in the case of SK sometimes they don’t use anybody. So I think you have to understand where the Skyward airplane is coming from. In MB they use the medevac call sign anytime they are carrying a patient, that’s just what is done. While in ONT the medevac call sign is reserved for priority calls. So when in Rome ………

What would be nice is some national standards, either one way or the other.

Go Guns · Post by **Go Guns** » Mon Mar 08, 2004 5:10 pm

What would be nice is some national standards, either one way or the other.

That's probably the best comment I've heard in this thread regarding the issue. It sounds like each province has their own way of dealing with "medevacs". I would hazard a guess that none of these procedures are written in stone anywhere, but have simply become the standard over the years. In reading the AIP and the CAR's I've yet to come across anything that says "You may only file as a "medevac" when the Ontario government says so"

I would be curious to hear an international pilots view on this issue.

CD · Post by CD » Mon Mar 08, 2004 7:01 pm

Here's my 2 cents on the system in Ontario:

The patient transfer and air ambulance system is integrated in Ontario. The priority calls are normally handled by the dedicated air ambulances (the "Bandage" fixed and rotary wing aircraft) and include trauma and critical care calls. Patient transfers, those involving transporting stable patients from one health care facility to another, is usually undertaken by chater companies under contract to the Ontario Ministry of Health.

The goals of the OAABHP are to strive to improve patient care during transport, to provide access of all levels of care (primary, advanced, and critical) to all residents of Ontario, and to facilitate flight paramedic mobility and education throughout the Province. The OAABHP is now the largest program in North America providing aeromedical transport. Our centralized dispatch center (MATC), dispatches over 22,000 calls per year utilizing medical algorithms that ensure that the right aircraft is dispatched with the right level of care to meet patient needs.

Ontario Air Ambulance Base Hospital Program

Ontario Air Ambulance System

As for the use of the term "Medevac", when Whistler 797 (SK76 in YQT) calls up using the term medevac, they are enroute to an accident scene or from the scene to the pad at the hospital and they get priority handling. We would rarely hear the term used by other aircraft unless the Bandage aircraft were not available or were already tasked.

<B><I>MEDEVAC</B>
An expression used to request ATS priority handling for a medical evacuation flight based on a medical emergency in the transport of patients, organ donors, organs or other urgently needed life-saving medical material. This expression is to be used on flight plans (FP) and in radiotelephone communications if a pilot determines that a priority is required.</I>

Glossary for Pilots and Air Traffic Services Personnel

TP 10839 - Guide to Air Ambulance Operations (1998)

It is interesting that each province handles these things independently. One would think that there whould be some national standard...

clearmyside · Post by **clearmyside** » Mon Mar 08, 2004 7:58 pm

cd thank you for your post. very informative and factual. i hope that everyone will use this as a standard (in ontario at least) and use the term 'medevac' responsibly.

ahramin · Post by **ahramin** » Thu Jul 01, 2004 2:03 pm

An update on the medevac status saga.

Yesterday center asked our medevac friends from whitehorse if they were a priority medevac. The response?

"Yes, we have a patient on board."

Best answer i have heard yet.

confuzed · Post by **confuzed** » Thu Jul 01, 2004 6:42 pm

bang head man, isn't that brutal......still goes against what the whole point of that call sign, but whatever. Stupid is as stupid does I guess. Here's an update for you ahramin (I think that's your handle anyways). You don't hear this term being slagged and falsely used in Ontario as much these days. I've heard center ask if a flight from a different province was priority, they said "no" and center dropped the medevac callsign on them. It's just craziness sometimes. Maybe in other parts of the country the trips that are done are GENIUNE sick people that deserve the call MEDEVAC, who knows. I believe here (someone can back me up on this or correct me), a code 4 (which is when we use MEDEVAC status) is when there's risk of loss of life or limb. That's a serious enough reason that someone needs to get to a hospital NOW! However, if someone is coming down cause they fell in their boat and sprained their ankle doesn't require us to have priority over everyone else. But again, like I've said arguing about this with some people is like... bang head

zzjayca · Post by **zzjayca** » Fri Jul 02, 2004 10:56 am

Straight from the horses mouth.

For ATC a MEDEVAC is a MEDEVAC is a MEDEVAC. There is no such thing as a priority medevac. The term medevac means priority service is required.

However, we are also aware that pilots abuse this term far too often and we will ask if priority service is required, especially if there is more than one medevac inbound to an airport. And yes, if a pilot tells me he doesn't need priority service, I will delete the medevac status from his flight plan in our system and will no longer include medevac in my transmissions to the aircraft.

ahramin · Post by **ahramin** » Fri Jul 02, 2004 1:53 pm

Not every controller does it your way zzjayca. In fact i have never met a controller who does it your way.

J.P.WISER · Post by **J.P.WISER** » Fri Jul 02, 2004 6:07 pm

Didn't this post start with calling yourself a medevac when there is no patients on board and the aircraft was returning to base? If there are patients on board you are a medevac that's what you are being contracted to do. My question goes back to the start if you are not carrying any patients and are just returning to the main base than are you a medevac? And if you do call yourself a medevac why?

confuzed · Post by **confuzed** » Fri Jul 02, 2004 8:38 pm

J.P.WISER wrote:Didn't this post start with calling yourself a medevac when there is no patients on board and the aircraft was returning to base? If there are patients on board you are a medevac that's what you are being contracted to do. My question goes back to the start if you are not carrying any patients and are just returning to the main base than are you a medevac? And if you do call yourself a medevac why?

bang head J.P.....I hope you never get into the medevac business dude, really I don't. Just because you have a patient on board doesn't mean that you're necessarily a MEDEVAC status. Yes you're DOING what's called a MEDEVAC flight, but you don't need priority with EVERY patient. When you call up to center, fss, whoever as ABC MEDEVAC that indicates that you have someone that is SERIOUSLY ill (loss of life or limb is how i've heard our medics describe it) and requires IMMEDIATE attention. It's the same deal as when you go to the hospital in ER. If you're not that serious you sit there and wait a few hours. If you're really serious they look at you first. Well, up on a reserve if a patient isn't that serious then they can send them out on the sched. If they need to be seen within 4 hours, then they call an Air Ambulance flight to come up and get them. If they're REALLY messed up, then you require priority. When we pick up a patient they're most of the time stable for transport and we won't even leave until they are. That's why it can take up to 4 hours sometimes while waiting for the medics to get the patient ready for transport. Again, just to recap for you, patient on board DOESN'T necessarily mean you have to file as medevac status since you may not always need priority. Does that help at all??

ahramin · Post by **ahramin** » Fri Jul 02, 2004 9:40 pm

An easy way to figure it out is like this: If the ambulance is going to go lights blazing and sirens blaring all the way to the hospital, it is a medevac. If they are not, it is not.

Hence the term skedevac for medevacs taking patients in to meet appointments, and emptyvac for taking no one back.

oldtimer · Post by **oldtimer** » Fri Jul 02, 2004 10:05 pm

Schlem and others wrote that he had a hard time believing they would medevac a patient out for a doctors appointments etc. I remember a few years ago, I was involved with a rinky dink startup air carrier in Alberta, before they went to contract carriers, and we had many discussions with people in the medical field and it was an eye opener. The cost of operating a hospital is right through the roof. As an example, when they built a new hospital in Pincher Creek, they had to leave it sit unused but fully operational for 6 months just to make sure there were no operational snags in the building. The problem of getting doctors to live in small town Canada is a real serious problem. I have read in the newspapers where towns and districts are going to incredable lengths to entice doctors to come to their little communities but all the doctors, nurses and technicians want to live in the cities and work out of the huge (and very well equipped) hospitals. Doctors also told us that the trama of moving a well prepared patient is not quite as severe as one might think so the most cost effective method of patient care is to move them by air ambulance. This is done all over the world. The most critical time is when the patient leaves the hospital until he/she can get back into another hospital.
Sure, there are abuses to the medevac call sign, just like we have cue jumpers and other sots of obnoxious people. Just get used to it cause you cannot change it. Some provinces, such a B.C. determine when you are a medevac priority and when you are not. In our organization, I would like to think we all play by the rules. We try to instill a sense of professionalism in our crews. A professional is someone who does ordinary things extaordinarly well. Many provinces handle the situation differently. When I was with a company in Calgary, we had a situation where our Lear was dispatched to Kelowna on a medevac priority and the ambulance system called ATC to advise that since we did not have a patient on board, the crews were to take a taxi to the hospital. ATC then questioned our medevac priority. We told them that in 20 minute, discuss it with the coroner. The doctor, who was the head of the organ transplant team was there to harvest a heart. Shit hit the fan and it was months before everyone settled down. From there on, a medevac was a medevac, no questions asked. I used to operate as a medevac many times with no patient on board. We had the trama team who were rushing to help a small town hospital who had a patient that was beyond their capability to handle. For the most part, we were just the flight crew. If the doctor said medevac, we were medevac. That is the way it should be. many times the regular sched carriers will refuse to handle a medical tansfer because of liability and other concerns. That is why patients are transported by air ambulance.

J.P.WISER · Post by **J.P.WISER** » Sat Jul 03, 2004 8:07 am

Confuzed wrote;

bang head J.P.....I hope you never get into the medevac business dude, really I don't. Just because you have a patient on board doesn't mean that you're necessarily a MEDEVAC status.

I think you misunderstood what I mean. What I meant to say is if you do not have a patient on board the aircraft and you are returning to your base after droping of someone at a hospital why do you use the term medevac???
If you re-read my post you will see that it was a 2 part question.

I wrote;

If there are patients on board you are a medevac that's what you are being contracted to do. My question goes back to the start if you are not carrying any patients and are just returning to the main base than are you a medevac? And if you do call yourself a medevac why?

confuzed · Post by **confuzed** » Sat Jul 03, 2004 4:05 pm

well then wiser, my apologies. We don't use the term medevac repositioning back to base, only when we have a seriously ill patient on board. Just because we do have a patient on board though, we don't always file as medevac status just if the conditions warrant it.

J.P.WISER · Post by **J.P.WISER** » Sat Jul 03, 2004 5:58 pm

No sweat it sounds like you use the term the way it was suppose to be used.

Winglet · Post by **Winglet** » Sat Jul 03, 2004 7:53 pm

Over the last 5 years I have worked for an air ambulance in MB and ATS...I can only tell you have how I have seen medevacs handled. Again this is only in MB.

When I worked for the AA we didn't distinquish between a priority and non-priority medevac within the company...it went by codes. Keeping in mind a patient's condition can change at any time. We did northern medevacs as well as international (I'm sure someone can guess who I worked for). When we were going into the states I found they definately had two types of medevacs in their minds. Especially US Customs. Often you can't get into certain airports after hours unless you explain how dire the situation is and how a 2 hr drive in an ambulance might affect the patient. Even then quite often they will refuse. And overseas is MUCH worse. Closed is closed medevac or not.

Several years ago I used to see the term medevac abused especially going into YYZ at night. I haven't seen this with the particular company I worked for in years.

However, now I work in FSS for a relatively busy MB airport. We are a medevac hub and see several a day...to say the least. Oh...and I can tell you that two medevacs can estimate at the same time...it happen today.

I have 2 points to make here...
When a pilot files as a medevac...there is no priority option on the FP. Medevac is a remark and is written as #. That is our symbol for a medevac...ie CFABC/#...that's all we use. However when you call us up as a medevac and
a) we have traffic for you close to the airport for arrival,
b)an a/c handed over from centre or
c)someone backtracking on an IFR clearance
we might ask you if you are a priority to
a)have the VFR traffic slow it down for you to get off, etc,
b)call ACC and see if they want us to hand back the IFR inbound or
c) call ACC and see if they want us to cancel the IFR clearance for the guy ahead of you. They WILL ask us if you are priority most of the time if there is traffic. That's just the way it works here.
This lets us know if you can wait for the a/c ahead of you to finish his backtrack, depart and wait for separation or if it is that urgent that you need those 2-5 minutes. I understand what everyone is saying about the definition of medevacs but this is the way it is handled in my "neck of the woods". Again this is only here and I don't know how other places treat it...maybe lilfsssister will let us know how they treat it where she is, if she reads this.

Secondly, just so you know. We usually get a strip printed automatically when you FP is filed with the FIC if it is VFR and it will only say the call sign. Medevac is a remark on a flight plan. Therefore I do not know you are a medevac unless you tell me. Your initial call up should be "XXXX radio, this is FABC medevac" from then on we are required to call you by your callsign followed by medevac on every transmission...intuitively to let all the other a/c maintaining their listening watch to realize no matter when they come onto the MF that you are a medevac. However...if you do not let me know you are a medevac then I won't let everyone else know that. I have had a couple of situations where I didn't know someone was a medevac until they want priority over someone else and let me know with an edge that they are a...here we go..."priority medevac".

Just my 2 cents and a little whine