Levels of Medevac?

[lownslow]

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?

[RunwayWindAltimer]

You are correct, all medevac flights are priority. Medevac = hospital, though medevac is the correct phraseology.

[ahramin]

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.

[NotDirty!]

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.

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.

[Braun]

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.

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.

[lownslow]

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.

[PostmasterGeneral]

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.

[kevenv]

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.

[awitzke]

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?

[Braun]

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.

[awitzke]

Yes, I can see how that makes sense. Considering they only have two aircraft based here. Fair point.

[photofly]

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".

[Braun]

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.

[SuperchargedRS]

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.

[Cessna driver]

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

[SuperchargedRS]

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.

[awitzke]

It could mean the difference between sitting in a hold at 12000 feet, number 7 to land or being given priority to land.

[NotDirty!]

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

[wingandaprayer]

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.

[Ruddervator]

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!