Pax Input (Medevac) - Split from ORNGE thread

[skysix]

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[Lurch]

I just think it's all around bad idea for medics to be in on flight safety decisions.. just like passengers aren't in on them.

Amazing, truly amazing. One big difference - PAX are paying customers. MedCrew (should be) team members.

Should Flight Attendents also have a say on their flights?

Lurch

[AuxBatOn]

If a crew member (any) has concerns, observations, I think it's okay to bring it to the attention of the PIC. If the decision is then made to go/no-go, no more arguing should take place or get out of the aircraft if you the said crew member is unhappy.

[skysix]

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[skysix]

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[gypsymedic]

Wow. Some pretty heated opinions over something that we SHOULD have a lot of agreement on.

MEDEVACs are different. They require COOPERATION between crew members. Hey, if we can't arrive at a consensus on how to safely transport a patient, we don't go... That decision sometimes requires collaboration on flight profile, and how it will affect the patient. The buck stops with the Medical crew when it comes to patient safety, and patient safety is sometimes tied to aircraft performance. I don't need a commercial licence to figure out how a planned cruise at a given altitude with a given cabin pressure will affect my patient... I know because I am educated in transport medicine, and I know what I need to effect a safe transport.

The reference to *if* a flight attendant should have a no-go decision on a PAX flight demonstrates a lack of awareness of the issues at stake with MEDEVAC. There is no parallel. Flight attendants are not responsible for providing complex patient care in a dynamic environment to someone who is already compromised. Let's remember; The folks who are the reason for the flights, the PATIENTS, rely on us to work well together, to make good decisions, or don't get involved. The first tenant of Medicine is "first, do no harm". If we can't assure a basic level of safety based on the patient requirements, we should not (can not) subject them to a harmful experience.

I know that the PIC is the ultimate decision maker for the flight, and I would never argue that. For you pilots out there, please understand that the patient relies on me to ensure their medical needs are met. Consider one fight I remember to a remote Arctic location for a baby. High pressure, gotta get there (pilots should have NEVER had that pressure applied). They initially said no, but dispatch pressured them into taking it, and we had trouble landing, as the strip was well below minimums. Missed two approaches, orbited for 45 minutes, waiting for weather that was supposed to clear, shot another approach and got in (still below legal minimums). Picked up the patient, headed back to the receiving hospital, and I noticed the cabin pressure was well above what the patient would safely tolerate. Asked over coms about it, and was informed we only had enough fuel to fly at max cruise altitude, not enough fuel to fly lower (and obtain the requested cabin pressure). Baby arrested in flight twice, suffered a hypoxic episode due to airway compromise and oxygenation issues secondary to cabin pressure. That baby is now brain injured, and will never be "normal" again. *IF* we left the baby in the community, they probably would have been fine.

I say again... MEDEVACs are different... The flight crew in "the back" needs information, and will make the decisions on the patients behalf based on information from YOU. If someone fails to provide that to me, and there is a negative outcome, rest assured that I will be the FIRST to testify at the Coronors inquest. If the PIC wants the decision for how the flight will affect the patient, I suggest they spend 6 years to get the proper medical education to do so. Otherwise, accept the fact that this is a team sport, and we all need to play well together to ensure a safe transport.

[sky's the limit]

I say again... MEDEVACs are different... The flight crew in "the back" needs information, and will make the decisions on the patients behalf based on information from YOU.

Nobody is saying otherwise.

Passing of information is something that indeed should be done, but to sit with a Medic or any other pax and discuss go/no-go decisions is absurd. Does that mean there's zero flow of information and the crew in the back is sitting in the dark wondering what's going on? Of course not, but when it comes to the flying decisions, those are made by the Capt, with inputs from his F/O, dispatch, wx briefings etc, end of story.

Committees don't fly airplanes or helicopters.

As I said in a much earlier post, I think there are a number of issues being confused here, hence the argument, but to suggest pax, medics, or flight attendants should have input into flight decisions is just wrong.


stl

[bandaid]

To be clear, I do very few medevacs anymore. I worked for 4 1/2 years out of Prince Rupert in the early 80's. I was up in weather that was stupid scarey and it simply would not be allowed today. we flew in aircraft that today would not be certified for use in medevacs. I then spent just short of 13 years in a town in the rockies, again we flew in weather that was insane and likely would not be indorsed for flight these days. I have nothing but admiration for the 99.9% of the pilots that I flew with. In the end what I realised is that it was never my emergency, I did nothing to warrant a risky flight and all I want to do at the end of my shift is to go home to my wife and kids.
The card system? You're joking, right? I am not a pilot. I defer all flight decisions to those that are best suited to make them. Too many cowboy medics and pilots have been killed doing risky flights in bad conditions. Remember your families, do not become a martre for people that you have never met.

[Cat Driver]

This is a very interesting discussion.

After reading through it it highlights some rather important issues.

First there has to be a clear understanding of the simple fact that even though medevac flights have their own unique problems with a patient which can only be the responsibility of the people in the back who are trained to care for patients the fact remains.

MEDEVAC FLIGHTS ARE FLOWN UNDER EXACTLY THE SAME RULES AS ANY OTHER FLIGHT

An airplane is not flown by a committee, an airplane is flown by the crew and the go no go decision should be made based on all the information that is available to said crew.

The people in the back are part of the crew in the sense that they may have needs for the patient that has to be part of the crew decision to fly and such needs must be included in the decision of go no go.

Why are all you people arguing about such a simple concept?

[Johnny767]

I had a brief stint, doing Medivacs. Back then the Medical crew were ER Doctors and Nurses, not Paramedics and EMT's. Not ONCE did the Medical team raise an eyebrow to the operation of the Aircraft.

I personally always had a very simple outlook, I wasn't going to KILL five people to SAVE one.

Reality is, from a Pilots perspective flying Medivacs is the bottom of the food chain. Something no Pilot plans to do for very (damn) long.

...exception to our Helicopter friends.

Verse, the top for the Paramedics. Looks to me like the Paramedics/EMT's are sticking their nose, where is doesn't belong.

And worse yet, Pilots are allowing it.

[Isis]

An airplane is not flown by a committee, an airplane is flown by the crew and the go no go decision should be made based on all the information that is available to said crew.

The people in the back are part of the crew in the sense that they may have needs for the patient that has to be part of the crew decision to fly and such needs must be included in the decision of go no go.

Why are all you people arguing about such a simple concept?

Well said, Mr. Cat Driver!

[skysix]

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[skysix]

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[bandaid]

Well said Cat. I have on more than one occassion asked for a maximum height due to being in a depressurized aircraft with complications with either patient or supplise. I do agree that this argument is kind of lame. We may have some input but unltimately, the decision is that of the pilots.

[Cat Driver]

skysix what I am saying is Medevac flights require two very separate set of skills for the duties and responsibilities to perform their tasks which is saving lives.

Therefore both the medical people and the pilots are part of the crew because a Medevac can only be called a Medevac if both trained crews are present.

Therefore the concerns of both parties are relevant to the successful outcome of the trip.

Each should feel free to express their concerns and make for a safer flight.

In aviation such thinking is commonly called airmanship and without good airmanship a flight is not safe.

Note:

The above is only my take on this subject and not necessarily correct.

[skysix]

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[skysix]

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[reality check]

Or at least that is one way to look at it.

You sir, severely overestimate your function. After reading this thread that fact has become rather obvious. Perhaps you should save us all the trouble and just go to flight school.

If you were in the back of my aircraft you'd be lucky to have a headset with a complex like that. Your function is NOT to save flight crews from themselves, it's to look after the patient.

[Cat Driver]

reality check, I have been giving skysix some slack here in an attempt to point out that there are concerns that the medical people have that should be included in the planning of the flight.

The final decisions are for the flight crew..period.

If the medical part of the crew think the decisions made by the crew are unsafe then do not fly with them and have the company examine exactly what is going on.....

[reality check]

I know you have Cat Driver, I just have to shake my head on this thread.

[reality check]

Skysix,

You need to re-read these posts. Notice anything?

Sky's the Limit

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....

....Committees don't fly airplanes or helicopters.

Doc

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....

....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

Cat Driver


MEDEVAC FLIGHTS ARE FLOWN UNDER EXACTLY THE SAME RULES AS ANY OTHER FLIGHT

An airplane is not flown by a committee, an airplane is flown by the crew and the go no go decision should be made based on all the information that is available to said crew....

....
If the medical part of the crew think the decisions made by the crew are unsafe then do not fly with them and have the company examine exactly what is going on.....

[Johnny767]

The Medical Team, in the back of any Aircraft I ever flew, were...

Passengers

...not Crew.

To think they become part of the CRM formula is taking things to an extreme.

[skysix]

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[sky's the limit]

What I have a problem with is those FEW who deliberately keep the medcrew in the dark, who refuse to modify a plan for patient considerations, and who think that the med crew have no buisness in even questioning why the pilot chooses to do things a certain way.

This isn't what you've been talking about, with all due respect.

You've been suggesting that Med crews have input into FLIGHT DECISIONS. Any good crew will keep the people in the back informed, that is professional courtesy, but there's no reason why a Med crew should "question why the pilot chooses to do things a certain way." None.

stl

[skysix]

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