Pax Input (Medevac) - Split from ORNGE thread

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sportingrifle
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Pax Input (Medevac) - Split from ORNGE thread

Post by sportingrifle »

Split from thread found here: viewtopic.php?f=54&t=61466
KAG wrote:Also a medic should have NO say in the go/no go decision, they should be informed after its been made.



Actually, the medics should have a say in the "no go" part of the decision; you can't force somebody to accept what they perceive to be a risky situation. Same goes for loggers in floatplanes, geologists in helicopters, etc. Most of these long time frequent fliers aren't stupid and know when we aviation professionals are pushing our luck. The only consequence of a bad decision here is that something doesn't happen.

The important thing is that only the pilot is involved in the "go" decision.

Cheers.
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Re: ORNGE...say you didn't...

Post by sky's the limit »

sportingrifle wrote:Actually, the medics should have a say in the "no go" part of the decision; you can't force somebody to accept what they perceive to be a risky situation. Same goes for loggers in floatplanes, geologists in helicopters, etc. Most of these long time frequent fliers aren't stupid and know when we aviation professionals are pushing our luck. The only consequence of a bad decision here is that something doesn't happen.

The important thing is that only the pilot is involved in the "go" decision.

Cheers.

I couldn't disagree with you more.

When Medic's start taking my opinions on treatment, and Geo's ask me where the next drill hole should be, then we'll talk. We are paid to make these decisions, there is no room for uninformed perceptions - ESPECIALLY by those who've been around it just long enough to be dangerous.

stl
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Re: ORNGE...say you didn't...

Post by 2.5milefinal »

-delete-
...stl said it better
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Re: ORNGE...say you didn't...

Post by B-rad »

sky's the limit wrote:
sportingrifle wrote:Actually, the medics should have a say in the "no go" part of the decision; you can't force somebody to accept what they perceive to be a risky situation. Same goes for loggers in floatplanes, geologists in helicopters, etc. Most of these long time frequent fliers aren't stupid and know when we aviation professionals are pushing our luck. The only consequence of a bad decision here is that something doesn't happen.

The important thing is that only the pilot is involved in the "go" decision.

Cheers.

I couldn't disagree with you more.

When Medic's start taking my opinions on treatment, and Geo's ask me where the next drill hole should be, then we'll talk. We are paid to make these decisions, there is no room for uninformed perceptions - ESPECIALLY by those who've been around it just long enough to be dangerous.

stl
I think you missed his/her point. I read it as making the no go decision can have input from any side as maybe the pilot might try pushing their luck. I can remember times when it has helped me make a no go decision when the pax relived some of the pressure from me by letting me know there is no hurry. Sometimes when it's on the line, the little things can tip the scale. Just because I might be the pilot doesn't mean I discredit what other do know.
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Re: ORNGE...say you didn't...

Post by sky's the limit »

B-rad wrote: I think you missed his/her point.
No, I didn't. I just don't agree - at all.

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Post by skysix »

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Re: ORNGE...say you didn't...

Post by bandaid »

As a paramedic who has done years of medevacs I can tell you that I relied on the pilots to decide whether it was safe to fly or not. I can also say that I have had the shit scared out of me numerous times and on one occassion told the pilot that I would never ever fly with him again. To my knowledge he has never done another medevac.
I am not so pompous to think that I know more than a pilot about what they feel is safe to fly in. The only thing that I can see would benefit the pilot is if he/she had no idea at decision time what we were dispatched to so as he/she would not feel pressure to make the "go" call.
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Re: ORNGE...say you didn't...

Post by sky's the limit »

skysix wrote:

Glad I don't fly with you - attitudes like that are dangerous.
Don't worry - you never will.

So you think it's dangerous? Based on your 3600hrs "in the back?" You, I'm afraid, are confusing several points, and I can assure you your perspective is one based on a very narrow cross-section of experiences. Your pilots' are not, nor are mine. That "dangerous" attitude has kept me and all of my customers safe for many years working in places I'm sure you would have some difficulty envisioning.
skysix wrote: There is a difference between all three of what is legal, what is safe, and what you think can do because of your skill, education. experience and training.
Well, at least you seem to agree on one point - however I suspect your intent with that statement is somewhat different than mine reading it.

skysix wrote: And before you ask, I've been medcrew since 1993, 3600+ hours 'in the back' in more than a dozen types and with many different operators in YT, NT, NU, BC, AB, SK, ON, PQ, WA, OR, ID, CA, NV, AZ, UT, CO, NM
I'm not asking, because quite frankly, it really doesn't matter.

That, is my point. I know everyone wants to be "involved" these days, and feel part of the team, but I'm afraid there's considerably more to it than that. If you don't have the confidence in your flight crews to make the proper decisions that won't "kill you," then I suggest you either choose another employer or look for a ground job. Pilots kills medics....?

You're welcome for all those flights you've taken in abject safety since 1993...

stl
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Re: ORNGE...say you didn't...

Post by Doc »

skysix wrote: Glad I don't fly with you - attitudes like that are dangerous. You know what the #1 killer of Flight Nurses and Flight Paramedics is? Not HIV or cancer or heart attacks etc, but PILOTS!
There is a difference between all three of what is legal, what is safe, and what you think can do because of your skill, education. experience and training.

Flaming over - education begins. Giving the benefit of the doubt here - I doubt that the original poster meant that the med crews were actually making GO decisions (and I am not talking about MEDCOM - that's a whole 'nother story) but perhaps that is how you read it.

The important thing is that only the pilot is involved in the "go" decision.
That's why there are MANY programs that have a "One to say no" rule. In general, Canadian programs are safer than US ones - and one of the reasons is most are 2 pilot operations.

As sportingrifle said - you can't force a worker to accept what they perceive as unsafe conditions. I will conceed that many 'paramedics' in the outer reaches of Ontario and central Canada are inexperienced in flight/aviation regs/aviation weather etc, but not so sure that applies to the ORNGE RW crews. I am also 50% sure that they have no understanding of what the skills and abilities of their individual pilots are - that is something that it is up to YOU to change.

Don't tell me that as a pilot on frequent MEDEVAC flights you don't know who the med crews are that you would want to treat your kids - and those you would drag your bleeding carcass off the aircraft to avoid. Rockstars and Posers exist in all professions. It is up to the professional in one area to educate the professional in another area about whatever components of their particular expertise they feel the other is unaware of and needs to understand better.

Medcrews are capable of learning the reasons why you think that weather is flyable - and what the regs / OpSpecs allow and how to read METAR/TAF/CARS etc. That said - many have little desire to do so. So if one of the latter is continually hesitant and ducking flights - educate them. Or go up the chain and recommend that they receive career counselling. No management wants to have a medic that is so scared of flying they are not doing their job at a peak level. Or to constantly be turning down flights. But be prepared for Medcrews doing the same up their chain of command about cowboys and .. runners. Educating them about what differentiates safe flying from the above might just save your ass. As will apologising to the crews (and explaining the rationale) when you occasionally find yourself exceeding their comfort zones.

Now about MEDCOM...or PFCC in Alberta

Where to begin....

They are not always medical (at least at the level of the MedCrews) and are almost never aviation. What their job is - is to keep their customers: the sending Doc's or fire dept's (who want nothing more than a problem to be out of their facility/area) hospital managers (who want time consuming or high risk patients somewhere else) and the bean counters (who when given any input, want to minimise costs,to their budgets - the hell with everyone elses - and often do not know the costs of the other aspects of the entire operation).

So think of what they are saying on the radio as somewhat less important than ATC. 'Cause they'll dump it all back on your 'decision' to accept the flight if anything goes pearshaped. What they really are supposed to be doing is to facilitate the coordination of air and medical assets and the expressed needs of the hospitals/areas they serve. So when they say the want you to go from A to B and do whatever, they are actually (im)politely asking you to do so if it is legal, safe and prudent and also asking the med crew to accept responsibility for the care of that patient and maintain it for the projected flight profile - again if it is within their scope of practice (legal), training/experience (safe) and in the best interests of the patient to do the transport is the SUGGESTED manner (prudent).

I personally have no problem in reminding them of this. And I am one of the medcrews who will call you on minimums when I see you break them, or when you start to .. run / exceed bank angles etc. Just as I expect you to call me out if I decide to transport an infectious pt without telling you and providing any education or safety gear needed for the loading/flight, a trauma who is leaking all over the airframe, a SARS pt without adequate filtration on his exhalations, or if I decide to defibrillate without checking with you first etc.

I expect you to brief me on your intended route, altitude/cabin, weather enroute and at the destination/alternate and fuel status. I expect you to be willing (when and if requested) to adjust your flightplan for the patients needs (direct/priority approach, rate of climb, altitude/cabin, MEDICALLY suitable alternate etc). And I expect all of us to communicate professionally and in a timely manner and to follow CRM principles.

And before you ask, I've been medcrew since 1993, 3600+ hours 'in the back' in more than a dozen types and with many different operators in YT, NT, NU, BC, AB, SK, ON, PQ, WA, OR, ID, CA, NV, AZ, UT, CO, NM
WOW! You must be a GOD! All that time. In the back. Since 1993! I'm really impressed, let me tell you! You don't even need pilots. Hell, there's nothing you need. The keys are in the airplane. Have at it. I've seen big egos before. Congrats, you win the prize. Believe me when I tell you. I know more (so do many of the pilots here, that you just insulted) about whether of not a flight should go or not than you will ever know. Remain in the back of the airplane, and do YOUR job. Let the guys in the front do their job. Medevac flying is one of the most dangerous segments of aviation. You tell us where and when you want to go. We'll tell you if we can or cannot get the job done for you. You can't fly. I can't start a central line. And stop blowing your horn. Nobody's listening.
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Post by skysix »

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Re: ORNGE...say you didn't...

Post by 2.5milefinal »

bandaid :D

3600 hours in the back. Well I have over 5000 hours in the front, flying medevacs, if I do a little reading does that make me qualified to help out in the back?
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Re: ORNGE...say you didn't...

Post by Vlakvark »

Doc, what about a flightmedic that is also a Pilot?
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Re: ORNGE...say you didn't...

Post by Doc »

skysix wrote:
bandaid wrote:The only thing that I can see would benefit the pilot is if he/she had no idea at decision time what we were dispatched to so as he/she would not feel pressure to make the "go" call.
Try a really fast simple color card system. Pilots throw down first. Say Green for a YES (no issues at all with the weather/aircraft/fuel/duty time and lots of alternates available), Red for a NOGO. Yellow = some concerning things about the planned transport profile - let's discuss. Then Medics do the same. Green = no issues with patient condition (no need to do the flight right away but does need to go), Red = patient not suitable to fly (coding, about to deliver, too unstable etc), Yellow = let's discuss.

ANY red = NOGO. Two yellows = NOGO. Yellow/green = both sides replan the mission - may end up going to a different pickup pointy and grounding the crew to the patient or getting a different recieving hospital or delaying (with phone advice to the sending) until weather improves or whatever. Two Greens = load up.

For 90+% of flights it only adds 10 seconds to the preflight. Works best when med crews actually talk to sending first (dispatch LIES - or 'forgets' important info) and know their area/providers capabilities
The guy in the left seat is the Captain. A flight is not run by a committee. It's not a democracy. Our ears are open.....but your job is in the back. Interference with the crew's duties would be severely frowned upon in my cockpit. If we can safely get your flight done, we will. If we can't, we won't. BTW, need any help with that pesky IV?
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Re: ORNGE...say you didn't...

Post by Doc »

Vlakvark wrote:Doc, what about a flightmedic that is also a Pilot?
And I did a year and a half in med school. What's your point?
He is either the medic, or he's the pilot. Pick one.
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Post by skysix »

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Re: ORNGE...say you didn't...

Post by Doc »

skysix wrote: Try a really fast simple color card system. Pilots throw down first. Say Green for a YES (no issues at all with the weather/aircraft/fuel/duty time and lots of alternates available), Red for a NOGO. Yellow = some concerning things about the planned transport profile - let's discuss. Then Medics do the same. Green = no issues with patient condition (no need to do the flight right away but does need to go), Red = patient not suitable to fly (coding, about to deliver, too unstable etc), Yellow = let's discuss.
If you actually DO this, you're way more balled up than even I thought you were??? And, I thought you were pretty balled up! Is this how it's done at Ornge? "Gee kids, lets take a vote on it..."? Please tell me you're yanking on our chains here? I'd be tossing in a red card every time you were on board.
I can just see some poor new co-pilot throwing in the only red card. You'd be off my airplane somewhere really nice this time of year. ZKE, perhaps? On a Friday night?
If your crew ever forgets to put the gear down.....it'll be in protest.
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Post by skysix »

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Re: ORNGE...say you didn't...

Post by square »

The red/yellow/green card system is pretty misguided, not to mention dangerous. You're saying that flight safety should be compromised for patient care. I know you don't mean you want to risk the 4 healthy lives onboard for the 1 sick one, but bartering the go/no-go decision with the severity of the patient sets up a pretty slippery slope.
I expect you to brief me on your intended route, altitude/cabin, weather enroute and at the destination/alternate and fuel status. I expect you to be willing (when and if requested) to adjust your flightplan for the patients needs (direct/priority approach, rate of climb, altitude/cabin, MEDICALLY suitable alternate etc). And I expect all of us to communicate professionally and in a timely manner and to follow CRM principles.
I'm sorry but I thought MEDEVACs were time sensitive? Rate of climb doesn't matter to you in a pressurized aircraft, you don't know what the fuel burns at different altitudes in different aircraft are, and why you'd need to know the route I have no idea.. you go from one departure to another arrival with airways inbetween. Big waste of time isn't it? I can see the 'direct approach' request being helpful sometimes.... but other times (tailwinds with poor CRFI's or short runways, etc) it could leave very little room for error or flat out lead to disaster.

I just think it's an all around bad idea for medics to be in on flight safety decisions.. just like passengers aren't in on them. We know you want to travel to the destination and we know you want to stay safe, none of that really needs reiterating, you're not exactly qualified to understand what the safety concerns are and you are in a very strong position to guilt trip people into doing things they would not otherwise do.

Maybe you have some knowledge of flight operations but does every medic? If we implement the card system do medics now have to pass a groundschool and go through the checklists? And how much preflight time are we going to devote to explaining every painstaking detail of the NOTAMS, ATIS, METAR, TAF, GFA, ops specs and minimums to the medic, when he still won't be qualified to understand them or have input..
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Re: ORNGE...say you didn't...

Post by Isis »

I'm unfamilliar with the different types of aircraft used to fly medevacs across Canada, but I know that space is at a premium inside my aircraft; no extra space for egos.

Someone mentioned CRM. I consider the medics I fly with to be very valuable resources. Why not keep them in the loop? We're a team.

That being said, our individual roles are defined and just as they don't ask me to empty the bed pan, I don't ask them to de-ice the airplane, but when I'm about to make a decision that affects all of us I'd be a fool not to use that resource and get their input. Yes, it's not a democracy, the final decision is mine, but I want it to be informed.

Why can't we all just get along?
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Re: ORNGE...say you didn't...

Post by Doc »

skysix wrote: I count myself lucky to have had only the dozen or so incidents that I have had. 24 friends and acquaintences I flew with no longer are alive. ALL BECAUSE OF BAD PILOT DECISION MAKING. And some of those WERE the pilots.
I've been doing this (for a living) since 1973. I've known maybe 4-6 persons who perished in aircraft. Perhaps you should keep your feet firmly planted on the ground. That way, you can always steer the big bus all by yourself, make all the decisions, your way. And, I'm sure, always be correct.
And, I'm outta here...
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Post by skysix »

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Re: ORNGE...say you didn't...

Post by Doc »

One comment, then I really must be off.
Take it for what it's worth, but it made sense to me.

A helicopter crew was taking a doctor into a jungle strip to pick up an injured hiker. The weather was the pits.
The crew asked..."How hard do you want to try to get in....?
Doctor....."Just as hard as you'd try to get in to pick up a loaf of bred..."
Think on it.
You can either get in....or you can't. It's that simple.
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