Levels of Medevac?

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lownslow
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Levels of Medevac?

#1 Post by lownslow » Sun Feb 21, 2016 8:18 pm

Hey Navcanada folks, are there different levels of medevac flights? I find that when I'm filing a flight plan I sometimes get asked if it's a hospital flight or a medevac flight as if those are somehow two different things. There are also times when enroute my patient's status will change and I have to upgrade my call sign to medevac which about half the time triggers from ATC, "Are you priority medevac?" Aren't all medevac flights priorities? Now as near as I can tell there are three different statuses: hospital (whatever that means), medevac, and priority medevac (whatever that one means).

So what gives? Is this a thing now and if so, what do I need to know to correctly file?
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Re: Levels of Medevac?

#2 Post by RunwayWindAltimer » Sun Feb 21, 2016 10:56 pm

You are correct, all medevac flights are priority. Medevac = hospital, though medevac is the correct phraseology.
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Re: Levels of Medevac?

#3 Post by ahramin » Sun Feb 21, 2016 11:50 pm

I remember having this discussion here 10 years ago lol. You are correct, only medevac exists as radio phraseology in Canada. Most medevac operators in Canada use the medevac callsign anytime the aircraft is in the air, even empty, so some air traffic controllers have taken it upon themselves to invent priority medevacs so they know who to put in front when there are three medevacs landing at the same time.

When asked if I was a priority medevac, I usually answered that I thought medevac was priority, which got the point across ok.

As usual, TC doesn't care so you are pretty much free to do whatever you want though.
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Re: Levels of Medevac?

#4 Post by NotDirty! » Mon Feb 22, 2016 6:46 am

TC AIM wrote:3.16.8 Item 18: Other Information
NOTE:
Use of indicators not included under this item may result in data being rejected, processed incorrectly or lost.
Hyphens or oblique strokes should only be used as prescribedbelow.
INSERT “0” (zero) if no other information; OR
Any other necessary information in the sequence shown hereunder, in the form of the appropriate indicator selected from those defined hereunder, followed by an oblique stroke and the information to be recorded.
STS/ Reason for special handling by ATS, e.g. a SAR mission, as follows:
ALTRV: for a flight operated in accordance with an altitude reservation;
ATFMX: for a flight approved for exemption from ATFM measures by the appropriate ATS authority;
FFR: for fire-fighting;
FLTCK: for a flight check for calibration of NAVAIDs;
HAZMAT: for a flight carrying hazardous material;
HEAD: for a flight with Head of State status;
HOSP: for a medical flight declared by medical authorities;
HUM: for a flight operating on a humanitarian mission;
MARSA: for a flight for which a military entity assumes responsibility for separation of military aircraft;
MEDEVAC: for a life critical medical emergency evacuation;
NONRVSM: for a non-RVSM capable flight intending to operate in RVSM airspace;
SAR: for a flight engaged in a search and rescue mission; and
STATE: for a flight engaged in military, customs or police services.
So ICAO has two different special handling categories, but as far as I know there is no callsign for STS/HOSP. I am not sure if ATC will treat you any differently, and I am quite sure that this is something that is not explained very well.
ahramin wrote:I remember having this discussion here 10 years ago lol. You are correct, only medevac exists as radio phraseology in Canada. Most medevac operators in Canada use the medevac callsign anytime the aircraft is in the air, even empty, so some air traffic controllers have taken it upon themselves to invent priority medevacs so they know who to put in front when there are three medevacs landing at the same time.

When asked if I was a priority medevac, I usually answered that I thought medevac was priority, which got the point across ok.

As usual, TC doesn't care so you are pretty much free to do whatever you want though.
I fly air ambulance flights all the time, and will only file MEDEVAC if we actually have a need for priority. The other operators out there who file it for every leg are the reason ATC will ask if you're a Priority MEDEVAC, just to differentiate you from the guys who I once heard on a training flight calling themselves CALLSIGN TRAINER 10 MEDEVAC.
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Re: Levels of Medevac?

#5 Post by Braun » Mon Feb 22, 2016 8:09 am

NotDirty! wrote:
TC AIM wrote:3.16.8 Item 18: Other Information
NOTE:
Use of indicators not included under this item may result in data being rejected, processed incorrectly or lost.
Hyphens or oblique strokes should only be used as prescribedbelow.
INSERT “0” (zero) if no other information; OR
Any other necessary information in the sequence shown hereunder, in the form of the appropriate indicator selected from those defined hereunder, followed by an oblique stroke and the information to be recorded.
STS/ Reason for special handling by ATS, e.g. a SAR mission, as follows:
ALTRV: for a flight operated in accordance with an altitude reservation;
ATFMX: for a flight approved for exemption from ATFM measures by the appropriate ATS authority;
FFR: for fire-fighting;
FLTCK: for a flight check for calibration of NAVAIDs;
HAZMAT: for a flight carrying hazardous material;
HEAD: for a flight with Head of State status;
HOSP: for a medical flight declared by medical authorities;
HUM: for a flight operating on a humanitarian mission;
MARSA: for a flight for which a military entity assumes responsibility for separation of military aircraft;
MEDEVAC: for a life critical medical emergency evacuation;
NONRVSM: for a non-RVSM capable flight intending to operate in RVSM airspace;
SAR: for a flight engaged in a search and rescue mission; and
STATE: for a flight engaged in military, customs or police services.
So ICAO has two different special handling categories, but as far as I know there is no callsign for STS/HOSP. I am not sure if ATC will treat you any differently, and I am quite sure that this is something that is not explained very well.
ahramin wrote:I remember having this discussion here 10 years ago lol. You are correct, only medevac exists as radio phraseology in Canada. Most medevac operators in Canada use the medevac callsign anytime the aircraft is in the air, even empty, so some air traffic controllers have taken it upon themselves to invent priority medevacs so they know who to put in front when there are three medevacs landing at the same time.

When asked if I was a priority medevac, I usually answered that I thought medevac was priority, which got the point across ok.

As usual, TC doesn't care so you are pretty much free to do whatever you want though.
I fly air ambulance flights all the time, and will only file MEDEVAC if we actually have a need for priority. The other operators out there who file it for every leg are the reason ATC will ask if you're a Priority MEDEVAC, just to differentiate you from the guys who I once heard on a training flight calling themselves CALLSIGN TRAINER 10 MEDEVAC.
Yeah this is pretty accurate. I have seen medevac aircraft specify they didn't need priority(why call yourself medevac then?) and medevac aircraft ask for city tours. As a controller I do everything possible to expedite medevac aircraft and it is frutrating when it is all for nothing. I hope there will be a change that will help clarify who is urgent and needs priority vs a/c that don't because clearly some operators are not using medevac responsibly.
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Re: Levels of Medevac?

#6 Post by lownslow » Mon Feb 22, 2016 8:35 am

So what I'm getting is, "I'm doing it right but ATC is wary of the jerks out there," which is what I suspected was happening.

Thanks all.
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Re: Levels of Medevac?

#7 Post by PostmasterGeneral » Mon Feb 22, 2016 9:14 am

My company SOP's state that were to file as a medevac even when empty. Apparently, the government wants the airplane to be handled as a priority at all times, in case there is another call pending. Stupid logic in my books, but hey I just fly the thing. I don't write the policies.
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Re: Levels of Medevac?

#8 Post by kevenv » Mon Feb 22, 2016 9:31 am

PostmasterGeneral wrote:My company SOP's state that were to file as a medevac even when empty. Apparently, the government wants the airplane to be handled as a priority at all times, in case there is another call pending. Stupid logic in my books, but hey I just fly the thing. I don't write the policies.
And my company "SOP's" state that I give priority to medevacs. I don't care, nor do I inquire about, passengers/patients. If you use it you will not be delayed. You may not be number one but you certainly won't be delayed.

A number of years ago there was a horrific traffic accident in the middle of the night (I found this out after the fact). I received info on 4 medevacs (2 jets a king air and a helo) inbound IFR all arriving at the same time and all calling themselves "Medevac". It was IFR weather at destination (serviced by FSS). It mattered not to me who went first so I asked them who absolutely positively had to be number one. They sorted it out and I made it happen.
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Re: Levels of Medevac?

#9 Post by awitzke » Sun Feb 28, 2016 2:40 pm

ahramin wrote:I remember having this discussion here 10 years ago lol. You are correct, only medevac exists as radio phraseology in Canada. Most medevac operators in Canada use the medevac callsign anytime the aircraft is in the air, even empty, so some air traffic controllers have taken it upon themselves to invent priority medevacs so they know who to put in front when there are three medevacs landing at the same time.

When asked if I was a priority medevac, I usually answered that I thought medevac was priority, which got the point across ok.

As usual, TC doesn't care so you are pretty much free to do whatever you want though.
I noticed this with Ornge. They seem to always have the Medevac tag even when empty. As someone who tries to give way when I can to Medevac aircraft since you would assume they are carrying a critical patient, when they have the tag all the time it kinda defeats the purpose, no?
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Re: Levels of Medevac?

#10 Post by Braun » Sun Feb 28, 2016 2:49 pm

awitzke wrote:
ahramin wrote:I remember having this discussion here 10 years ago lol. You are correct, only medevac exists as radio phraseology in Canada. Most medevac operators in Canada use the medevac callsign anytime the aircraft is in the air, even empty, so some air traffic controllers have taken it upon themselves to invent priority medevacs so they know who to put in front when there are three medevacs landing at the same time.

When asked if I was a priority medevac, I usually answered that I thought medevac was priority, which got the point across ok.

As usual, TC doesn't care so you are pretty much free to do whatever you want though.
I noticed this with Ornge. They seem to always have the Medevac tag even when empty. As someone who tries to give way when I can to Medevac aircraft since you would assume they are carrying a critical patient, when they have the tag all the time it kinda defeats the purpose, no?
Yes and no. Sometimes repositioning flights are medevac as well so the aircraft can return to base and be ready to fly out when needed. I am sure this is abused by some but I can still understand the importance of an empty a/c being designated as medevac.
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Re: Levels of Medevac?

#11 Post by awitzke » Sun Feb 28, 2016 2:54 pm

Yes, I can see how that makes sense. Considering they only have two aircraft based here. Fair point.
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Re: Levels of Medevac?

#12 Post by photofly » Sun Feb 28, 2016 3:17 pm

awitzke wrote: I noticed this with Ornge. They seem to always have the Medevac tag even when empty. As someone who tries to give way when I can to Medevac aircraft since you would assume they are carrying a critical patient, when they have the tag all the time it kinda defeats the purpose, no?
My experience is different around here. Sometimes you hear "LifeFlight 1 Medevac", and sometimes you hear just "LifeFlight 1". Sometimes you hear "LifeFlight 1 Medevac, callout is cancelled, returning, LifeFlight 1".
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Re: Levels of Medevac?

#13 Post by Braun » Sun Feb 28, 2016 3:25 pm

photofly wrote:
awitzke wrote: I noticed this with Ornge. They seem to always have the Medevac tag even when empty. As someone who tries to give way when I can to Medevac aircraft since you would assume they are carrying a critical patient, when they have the tag all the time it kinda defeats the purpose, no?
My experience is different around here. Sometimes you hear "LifeFlight 1 Medevac", and sometimes you hear just "LifeFlight 1". Sometimes you hear "LifeFlight 1 Medevac, callout is cancelled, returning, LifeFlight 1".
Having worked those guys on a regular basis I can truly say they are exceptional professionals and have had 0 issues with this operator. At least the helicopter guys anyways. They always cancel when they are not requiring the medevac status as you have stated.
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Re: Levels of Medevac?

#14 Post by SuperchargedRS » Sun Feb 28, 2016 3:54 pm

I fly medevac for work, we're medevac for all flights enroute to the patient and, of course, with the patient onboard. All repositioning flights are just normal, no medevac

The patients status does not effect the fight nor dictate how I operate, we always make best possible time and always identify as medevac, except for the above mentioned repositioning / back to base flights.
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Re: Levels of Medevac?

#15 Post by Cessna driver » Sun Mar 06, 2016 1:07 am

Generally when flying TO the patient, the medevac tag is attached and when patients are on board. In AB at least, pilots dont always know the status of the patient when filing the FP so most just use medevac, empty legs have no tag
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Re: Levels of Medevac?

#16 Post by SuperchargedRS » Sun Mar 06, 2016 10:59 am

Cessna driver wrote:Generally when flying TO the patient, the medevac tag is attached and when patients are on board. In AB at least, pilots dont always know the status of the patient when filing the FP so most just use medevac, empty legs have no tag
As in the medical status of the pt?

What does that matter? Do you fly differently or shoot your approach lower if the pt is going to code or something?

For us it might as well be boxes, we don't give operational control to people in the back of the plane, that's how medevac gets very dangerous.
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Re: Levels of Medevac?

#17 Post by awitzke » Tue Mar 08, 2016 3:07 pm

It could mean the difference between sitting in a hold at 12000 feet, number 7 to land or being given priority to land.
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Re: Levels of Medevac?

#18 Post by NotDirty! » Tue Mar 08, 2016 3:22 pm

SuperchargedRS wrote: As in the medical status of the pt?

What does that matter? Do you fly differently or shoot your approach lower if the pt is going to code or something?

For us it might as well be boxes, we don't give operational control to people in the back of the plane, that's how medevac gets very dangerous.
You are absolutely correct, I do not change the way I fly based on the condition of the patient. I do, however, make use of the priority of the patient to decide whether or not to file MEDEVAC. Usually I know before departure what kind of priority this call is, so I file accordingly; on occasion, the paramedic(s) inform me that we need to upgrade to a higher priority, which we will communicate to the land ambulance dispatch, and ATC if an upgrade to MEDEVAC is appropriate. Once again, I will not change the manner in which I fly my plane, but if requesting a higher priority allows me to jump to the head of the line, then I will do so, knowing that somebody with appropriate medical knowledge thinks that minutes could save life or limb. I don't use the callsign lightly, and I certainly don't respond to every "advise ready to copy holding clearance" with "uhhh... we're now upgrading to MEDEVAC priority!"

YMMV
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Re: Levels of Medevac?

#19 Post by wingandaprayer » Tue Mar 08, 2016 9:06 pm

In my experience, the only time we'll ask if a medevac flight's a priority is if we're dealing with more than one. Since we don't know the urgency of the flights, we ask in order to sort out who goes first.
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Re: Levels of Medevac?

#20 Post by Ruddervator » Thu Mar 10, 2016 10:55 am

TC AIM wrote:3.16.8 Item 18: Other Information
NOTE:
Use of indicators not included under this item may result in data being rejected, processed incorrectly or lost.
Hyphens or oblique strokes should only be used as prescribedbelow.
INSERT “0” (zero) if no other information; OR
Any other necessary information in the sequence shown hereunder, in the form of the appropriate indicator selected from those defined hereunder, followed by an oblique stroke and the information to be recorded.
STS/ Reason for special handling by ATS, e.g. a SAR mission, as follows:
ALTRV: for a flight operated in accordance with an altitude reservation;
ATFMX: for a flight approved for exemption from ATFM measures by the appropriate ATS authority;
FFR: for fire-fighting;
FLTCK: for a flight check for calibration of NAVAIDs;
HAZMAT: for a flight carrying hazardous material;
HEAD: for a flight with Head of State status;
HOSP: for a medical flight declared by medical authorities;
HUM: for a flight operating on a humanitarian mission;
MARSA: for a flight for which a military entity assumes responsibility for separation of military aircraft;
MEDEVAC: for a life critical medical emergency evacuation;
NONRVSM: for a non-RVSM capable flight intending to operate in RVSM airspace;
SAR: for a flight engaged in a search and rescue mission; and
STATE: for a flight engaged in military, customs or police services.
At the company I worked for, the designation of HOSP or MEDEVAC was dependent on the ambulance priority code. The ambulance priority is measured on a 4 point scale. Very briefly, 0-2 is non urgent. Think of an ambulance with a patient on board with no lights or sirens. Code 3 is urgent, lights on and no siren. Code 4 is urgent, threatening life or limb. Priority 4 ambulances use lights and sirens.

So, what does this mean for an aircraft? It means that in the company I worked for, we interpreted the urgent codes 3 and 4 to mean MEDEVAC. We would use MEDEVAC if we were en route to pick up an urgent patient, or if we had an urgent patient on board. Many Captains would also opt to use MEDEVAC if they had an infant in an incubator, regardless of priority. Unfortunately, we weren't always aware of the patient's priority prior to loading them on the plane, and sometimes in flight their condition deteriorates or the medic disagrees with the original priority code.

So what about HOSP? This is where things get hazy. When I had a friendly meet and greet with a Toronto ACC controller, she said that HOSP indicates no special priority. A controller will be aware that a HOSP flight could spontaneously upgrade to MEDEVAC at any time. The application of the HOSP code seems to be inconsistent, though. I once tried to use HOSP while leaving Ottawa, and Montreal Centre repeatedly asked me if I was MEDEVAC. I suppose it doesn't get used often.

Hope that helped!
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Re: Levels of Medevac?

#21 Post by Cessna driver » Fri Mar 11, 2016 11:57 am

SuperchargedRS wrote:
Cessna driver wrote:Generally when flying TO the patient, the medevac tag is attached and when patients are on board. In AB at least, pilots dont always know the status of the patient when filing the FP so most just use medevac, empty legs have no tag
As in the medical status of the pt?

What does that matter? Do you fly differently or shoot your approach lower if the pt is going to code or something?

For us it might as well be boxes, we don't give operational control to people in the back of the plane, that's how medevac gets very dangerous.

Yes as in medical status,

No to flying any differently, its more of a do they need to get them on the ground, without being vectored to timbucktoo type of scenario, the planes are flown following every CARs regulation, the MEDEVAC tag is to avoid delays
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Re: Levels of Medevac?

#22 Post by PostmasterGeneral » Sat Mar 12, 2016 9:34 am

Is there any regulation which states that speed restrictions (250/1000 and 200/10nm) can be waived in the event of a life saving mission, for example if the patient is "code blue"? Couldn't find anything in the CARs.
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Re: Levels of Medevac?

#23 Post by SuperchargedRS » Sat Mar 12, 2016 11:44 am

Hmmm


We fly with a flight medic and nurse, if you're being flown on our plane you're on our stretcher and that is the only place for our pt, meaning we are not a normal pax charter operation, the price of admission on our flights is quite high and I'm not talking money.

If we are inbound to pickup a pt, or inflight with a pt, we are medevac, period.

I do not have a MD after my name, the ATC controller does not have a MD after his name and has ZERO business trying to figure out "how medevac" we are, if I say medevac I expect priority as if the person in the back is a infant on it's last breath, it is not my place as a pilot, their place as a controller, or even my medical crews place to put a diagnosis on the pt, or decide how worthy of priority they are, medevac = priority
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Re: Levels of Medevac?

#24 Post by digits_ » Sat Mar 12, 2016 12:20 pm

SuperchargedRS wrote:Hmmm


We fly with a flight medic and nurse, if you're being flown on our plane you're on our stretcher and that is the only place for our pt, meaning we are not a normal pax charter operation, the price of admission on our flights is quite high and I'm not talking money.

If we are inbound to pickup a pt, or inflight with a pt, we are medevac, period.

I do not have a MD after my name, the ATC controller does not have a MD after his name and has ZERO business trying to figure out "how medevac" we are, if I say medevac I expect priority as if the person in the back is a infant on it's last breath, it is not my place as a pilot, their place as a controller, or even my medical crews place to put a diagnosis on the pt, or decide how worthy of priority they are, medevac = priority
Sure, so what if there is another medevac flight arriving at the same time ? Let's say you are first because you arrived 10 sec earlier. The other guy actually has a patient on it's last breath, you are transporting a non critical patient. Would you keep your first spot, or would you talk to the other crew and figure out who is the most critical ?

On a more philosophical note: you as PIC are responsible for the safe operation of the flight and for your passengers. Would that not imply that you would need to know the status of your passenger ? I am aware that it might not make a difference, and that for safety you should think about them as boxes. But think about it for a moment: if a passenger is having a stroke, you would usually divert to a nearby airport and probably declare a mayday (distress that required immediate assitance with the threat of loss of life). Back to the medevac: medevac gives you priority, but not over other medevac flights. If your passenger is dying in the back, would that not require you, legally, to declare a mayday for priority handling ? But before you can do that, you need to be aware of the state your passenger/patient is in.

I am sure there is some sort of regulation that would contradict this, but I couldn't find anything...
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Re: Levels of Medevac?

#25 Post by Cessna driver » Sat Mar 12, 2016 12:31 pm

digits_ wrote:
SuperchargedRS wrote:Hmmm


We fly with a flight medic and nurse, if you're being flown on our plane you're on our stretcher and that is the only place for our pt, meaning we are not a normal pax charter operation, the price of admission on our flights is quite high and I'm not talking money.

If we are inbound to pickup a pt, or inflight with a pt, we are medevac, period.

I do not have a MD after my name, the ATC controller does not have a MD after his name and has ZERO business trying to figure out "how medevac" we are, if I say medevac I expect priority as if the person in the back is a infant on it's last breath, it is not my place as a pilot, their place as a controller, or even my medical crews place to put a diagnosis on the pt, or decide how worthy of priority they are, medevac = priority
Sure, so what if there is another medevac flight arriving at the same time ? Let's say you are first because you arrived 10 sec earlier. The other guy actually has a patient on it's last breath, you are transporting a non critical patient. Would you keep your first spot, or would you talk to the other crew and figure out who is the most critical ?

On a more philosophical note: you as PIC are responsible for the safe operation of the flight and for your passengers. Would that not imply that you would need to know the status of your passenger ? I am aware that it might not make a difference, and that for safety you should think about them as boxes. But think about it for a moment: if a passenger is having a stroke, you would usually divert to a nearby airport and probably declare a mayday (distress that required immediate assitance with the threat of loss of life). Back to the medevac: medevac gives you priority, but not over other medevac flights. If your passenger is dying in the back, would that not require you, legally, to declare a mayday for priority handling ? But before you can do that, you need to be aware of the state your passenger/patient is in.

I am sure there is some sort of regulation that would contradict this, but I couldn't find anything...

In AB atleast, patient details to the pilot are generally left out as to avoid the crews doing something faster/cutting corners due to a sick/dying patient. It is preferred that crews fly the same way regardless of patient status
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