Pax Input (Medevac) - Split from ORNGE thread

[mattedfred]

I couldn't be bothered reading this entire thread but the following point popped into my head as I read some of the posts.

I know for a fact that pilots are federally regulated employees. Therefore the pilot is covered under the Canada Labour Code. Part II of the CLC includes the Right To Refuse Dangerous Work provision. It also includes the Right To Know and the Right To Participate.

Perhaps medics are federally regulated and are able to exercise their right to know, participate and to refuse dangerous work? Perhaps provincial regulations also permit the right to refuse dangerous work?

If one of my passengers asked to get off for any reason then I would let them deplane without question. If one of the crew members under my supervision exercised their right to refuse dangerous work then I would follow my employer's protocol and deal with the refusal accordingly (the actions taken depend on whether the aircraft is in operation or not).

[Tex North]

Skysix I'd like you to give some examples of situations where you would challenge the flight crews decision and choose to refuse a flight.

[Doc]

I don't understand the pissing match.
The pilots fly.
The medics well, they medic.
If the patient can't go. You don't go.
If the pilots say you can't go. You don't go.
What's this? Too simple?

Sorry medics, you have no call in the weather related/airport matters.
Sorry pilots, you have no say in the treatment of the patient side of things.

Medics, if you don't want to go, the door is always open.
Pilots, if you don't want to go, don't be pressured into making a bad decision. Stand on your hind legs and say.."no".

[skymedic]

Skymedic,

Interesting.

I must ask a couple questions though. What are you doing prior to a flight that lets you have the time, energy, and access to all the weather, SOP's, and conversations of the flight crew?

Do you not agree that if a flight is conducted in a legal manner it is safe? It is the flight crew's job to ensure the flight is conducted safely - that is their job, yours is to look after the patient.

You make reference to pilot error. How many patients die due to med error? How many people have lost their entire retirement to financial planner error? My point, is that people make errors, full stop. I fail to see how you as a medic sitting in the back doing your job prior to, or after departure is going to effect this phenomenon. If you do not trust your crews to conduct the flights in said "safe" fashion, then by all means vote with your feet and walk away. As I posted above in response to CD, the area of crew capability is entirely different, and one that is very deep and complex.

You very well may "know both jobs," but you cannot do both jobs at the same time - one will suffer, and as you get paid to medic, that is the one you should be prioritizing imho.


stl

Thank you for the intelligent reply!
1. Since I am also an FAA rated pilot, I routinely keep an close eye on the weather all shift. This is very easy to do with an Iphone these days. www.aviationweather.gov is a great site. Java tools are very useful. SOP's are on the shelf in the office, I have read them cover to cover.

2. My JOB is to come home safely at the end of each shift....That is what my job is....Taking care of patients is SECONDARY to MY safety and that of my partner and PIC. PERIOD!

3. HELL NO, just because it is legal, does not make one safe by any means. Was it legal for the Rotor craft to fly 500 below the clouds, then go IIMC and become inverted, nearly killing everyone on board, sure it was. Just because one has an instrument rating and current by no means makes one proficient.

4. Agreed, I cannot do both jobs at the same time, nor do I ever try. What i do is to make sure my head is on a constant swivel, and if something doesnt look right, feel right, then I stop what I am doing and check it out.....Now, if some EGO's cannot handle this, then get over it or find a new job. Again, I have ZERO problem turning down a flight, and as I said, nobody in mgt is going to question me unless the weather is severe clear, and I say it's 1/4 mile and 300ft ceiling......Having dual credentials scares them, and they know i have the FSDO on speed dial, so they don't even bother calling anymore to ask why the base turned a flight down.

5. Vigilance is key, for everyone. EGO's have NO place in Air-Medical operations...NONE....

Respectfully,

[skymedic]

Skysix I'd like you to give some examples of situations where you would challenge the flight crews decision and choose to refuse a flight.

Tex,

I will answer this for SKYSIX.

1. PHI INDIANA crash, Temp/Dewpoint even, Night conditions, Pilot steps outside to look around, tells crew " lets go take a look" 300ft above the ground, they fly right into a fog bank and crash into garage and house!

2. Known or forecasted windy conditions which exceed SOP's and common sense....One only has to look to the most recent crash in Nevada.

3. Wisconsin crash, .. running back to base underneath weather, CFIT ( Big HILL)

4. Duty time regulations and or crew rest if needed

5. Flying over the desert at night, no moon, VFR, no more lights, = no ground reference..Time to turn around! ( done this one many times before NVG's)

6. Known potential for bad weather at destination and possible alternate landing site which would be unacceptable for a patient.

7......Etc......etc...etc....

Respectfully,

[skysix]

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[skysix]

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[skysix]

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[Bede]

With respect to the Right to Refuse Work, there is a caveat that you are not covered if the risk is part of the job. I know of a couple FA's who wouldn't fly when there were any MEL's on the airplane. It went to arbitration and they lost.

[Bede]

skymedic and skysix,

I think this pilot slagging contest should come to an end. I think if the medical industry were as open as the aviation industry with respect to disseminating and investigating human errors, we would find a bunch of medics, nurses and doc's who have screwed things up.

There are far more deaths as a result of medical error than there are deaths as a result of pilot error.

[Morav]

I think this whole argument has more to do with medics wanting to choose whether or not they "feel" like flying at any given time.

Yes, I am completely serious.

There are a certain bunch of medics I know that will give their left arm to stay at base in front of that 40" plasma TV all night long. Of course every work place has their rotten apples, and such should be dealt with on an individual bases through proper protocol. Thats including lazy medics and bad pilots. As mentioned no body is putting a gun to your head. If you seriously think your life is in danger don't get on board, I sure wouldn't

skysix, the only out come of your *cough*left wing agenda *cough*, I mean idea of medics having the authority to turn down flights would result in fewer patients getting moved, Medevac costs skyrocketing and an operation no safer. The majority of medics on board are not qualified to make those go no go flight decisions. Just because you have ridden in the back several times doesn't make you either.

I also have an idea that will solve your problem with pilots being ill informed of certain medical conditions affected by flight. Why not just require Medevac pilots to take a beefed up course in Flight Physiology. You guys can even teach it to us!

What's next? Do you want to be involved with the signing off of maintenance inspections too? Should we all be required to hold hands and sing "Kumbaya" before every departure? Would that make you feel all warm and fuzzy inside?

[Johnny#5]

Thats cause they earn 4 times what the pilots make...

They need to sit down in the back, shut up, and do their job.

[Jean-Pierre]

significant fog (to the ground)

Oh snap!@!! All the way to the ground?! My moms got medivaced once and the pilots was like there's fog there. but the medical peeps was like the fog is at 2000 feet so it's a'ight. He told the pilot it was cool. Thank god they call the shots on that one cause the pilot was fassy boi and my moms would be dead now. Maybe it was you yah??

What if the medics told that boss to pay more to the pilots then they could get the good ones not the battys. Proper old timers not the punk a$$. And give them pay by the year not by the hour. Aint Mcd's yo. better ya?

[rigpiggy]

http://www.cmaj.ca/cgi/content/full/170/11/1678

just a recap

Medical Malpractice Kills More Than 24,000 Canadians Each Year

As many as 24,000 Canadian patients die each year due to “adverse events” (medical code words for medical malpractice).

What are we going to do about it?

A report published by the Canadian Medical Association Journal entitled: "The Canadian Adverse Events Study: the incidence of adverse events in hospital patients in Canada" confirmed the findings of similar studies in the United States, Australia, the United Kingdom, Denmark and New Zealand.

Some of the findings include:


• As many as 24,000 patients die each year due to “adverse events”.
• 87,500 patients admitted annually to Canadian acute care hospitals experience an adverse event.
• 1 in 13 adult patients admitted to a Canadian hospital encounter an adverse event.
• 1 in 19 adults will potentially be given the wrong medication or wrong medication dosage.
• 37% of adverse events are “highly” preventable.
• 24% of preventable adverse events are related to medication error.
• The most common areas for an adverse event to occur was surgery followed by medicine related errors.
Our study showed that an estimated 7.5% of patients admitted to acute care hospitals in Canada in the fiscal year 2000 experienced 1 or more AEs. We found that 36.9% of these patients were judged to have highly preventable AEs


Air and space transport accidents 777 1/354,319odds/yr 1/4,608 lifetime


I'll take my chance with the pilots

[Doc]

Hospitals. I you weren't really sick going in, you will be really sick coming out!

[rigpiggy]

Oculus Tauri Medicus

[Johnny767]

Maybe you should pay attention in CRM next time. Anything about using all sources of information available and involving all who are involved with the conduct of the flight (like flight attendants) ring a bell - or did you sleep through that part.

And that was deliberately harsh because I am truly mystified at the source of this attitude - and have never seen it so forcefully expressed by a group of pilots before. And while MEDEVAC pilots may be near the bottom of the food chain in Canadian aviation - there are some experienced pilots who've been around a while that apparently think the same way.

If this discussion is a lost cause and we are (myself included) resorting to insults and deliberately provocative and final statements - perhaps it's best left to cooler heads on another day.


It is telling that when Medical Doctors road in the back, there wasn't any issue. Now that it is Paramedics, it is an issue.

Looks like a little power grab, no doubt your Ontario Union has been powerful.

You are not part of the "Crew," end of story. "Crew" on an Aircraft have an active role in the operation of the Airplane. Somehow I don't see how a Paramedic fits that description, unlike a flight attendant.

CRM doesn't include passengers. Not sure how you interpret that as an insult?

You want a say in where the Aircraft diverts to? I would hope those issues are thought through ahead of time. Pilots have no idea of suitability of Medical facilities.

It is no different that speaking to the owner of the Falcon 900 and saying; "Doesn't look good for LaGaurdia today, any preference on Newark or White Plains if we miss the approach?"

That is not CRM, this is Customer Service, comes with the job.

You won't find ONE fixed wing Pilot that aspired to fly Medivacs for a career. Like the choice of words, or not, it is low on the "food chain." The experience level is directly correlated to the state of the industry. The Pilots you are flying with, are sending resumes out - guaranteed. In the 35 years I've been in Aviation, together with the Pilots I've met along the road. Medivac flying provided some necessary experience in the Log Book, a few gruesome (sometimes funny) stories - that's it.

[sky's the limit]

As Bede says, I think this one has drawn to a conclusion...

I'm just flabbergasted that there are two people making this kind of fuss - if I felt that way about my job, I'd walk out the door and take up pottery full-time. In all seriousness, I would.

I alluded to medical malpractice earlier, and thanks to whoever posted those stats, rather telling. Bottom line, you guys sit in the back, regardless of your supposed qualifications as long time passengers or even pilots. I sit and watch the fine folks at Pacific Coastal Airlines fly me around the BC Coast in winter all the time in the 1900's, Shorts, and SAAB's, hasn't even crossed my mind to say something to them, or to take any vested interest in the flight - I buy a ticket end of story.

You sit in the back, do your job (which has ZERO to do with the airplane) and we'll all be a big happy family. Skymedic said there's no room for ego's in medivacs..... well partner, I hate to break it to you, but just because there's somebody sick in back doesn't make your flight anything special. Next time you're out this way you're welcome to come flying with us for a day.

stl

[Doc]

Johnny767....good post. And oh, so true.
"Power grab" is exactly what it's become.
I've flown medevacs. Hated it. Way too many patients were transported at the tax payers expense an hour after the last sked!
Now, I'm appalled at the abuse of the term "medevac" on every transmission made by "Pulse".....like anybody buys the fact that EVERY single leg you guys fly "priority".

I've heard the "Circle the airport till the freezing rain stops...." stories. I'd consider doing that....like NEVER!

Sorry guys.....but you are "passengers".

[Cat Driver]

I bet there are a lot of pilots who would just LOVE flying with that guy who not only has a pilots license but has his phone on speed dial to call the FAA if he thinks you are going to do something dangerous.

I know I would really appreciate having such an expert helping me fly my airplane.

[KAG]

I have done medevacs’s for 5 years for 3 companies across Canada and the territories. 2 of the companies I didn’t really know the medics as they would rotate in and never asked questions, wanted zero input, they trusted us to do our jobs.
Voyageur was different. They had a very tight working relationship with our medics; we spent 12 hours a day in a hangar waiting for a call or sharing a King air. We would share the WX at destination, they would share patient info. They would advise us of special needs (keeping sea level cabin, make it rough, ETC) or if a new destination was in order, and we all got along.
Never once did they try to interject into the decision making of the go/no go decision, but would point out if you did something they never saw before or you did something stupid.
I’ll say it again; they never tried to influence the go/no go decision; That is the pilot’s job.
They trusted us because even though we were relatively junior, we never broke mins, .. run or flew over weight. If we did, even once, we were fired on the spot. There was never any pressure to accept a trip.

Skymedic, you may have a few ratings, that does not supersede the pilots knowledge of all things weather/decisions related. I may have taken a CPR course, it doesn’t mean I can start critiquing you on how to intabate (sp) an infant.

[Brewhouse]

Just a question,

I flew medevac's in MB for 6 years, we had registered nurses, and once in awhile doctors on board. It was my understanding that Paremedics were the guys and gals who drove the ambulances at our destinations. Are these "medics" flying on medevacs in other provences and what not the same as the Paremedics in MB? In 6 years I remember twice having a Paremedic on board with an OB nurse for a maturnity flight, and this was only because a second nurse was not availible.

Unless the rules have changed in the last few years MB health required at min. a nurse on medevac flights.

[mcrit]

I eluded to medical malpractice earlier,

Not sure how to take that. You are a part time doctor and you managed not to foul up, or you are a patient that escaped (ie eluded) being the victim of a bad doctor? Perhaps you meant alluded?

Sorry, that's the 4th time I've seen that error in the last 2 days.......needed to vent.

[bandaid]

Brewhouse, In B.C. their are (I'm guessing here) probably 6 or so designated airevac King Air 350's that are contracted by the B.C. ambulance Service to do medivacs with paramedics on board. It has been my experience that the pilots fly the planes and the only feed back that they wanted from us was, as previously stated, any special precautions that may pertain to our patient.
The old addage that a little knowledge is a bad thing is what I see here. Some need to concentrate more on their patient and less on the instruments in front of the pilots.

[aeroyt]

To all the pilots that fly Medevac's- if you fly so as to not scare or make any one uncomfortable in the back, then you are doing your job correctly. Some times things happen and you cannot do that, so if you have a chance let the folks in the back know without scaring them any worse then they are, or interfering with your job, then do it as soon as possible. It does not matter whether they are Passengers, medics, or pt's fly that way and you will do a good job. To all medics, Docs, and flight Nurses- do your job to the best of your training and if you need to let the front know you have a special need then let them know without interfering with the operation of the aircraft. The PIC is in charge; even though he may not be the highest paid person on board, He/She is still in charge and responsible for the flight to its completion. The PIC needs a lot of info in order to complete his job.

My credentials for this post are as follows 20,000 plus hours as a pilot, 13 years as a medevac pilot, and 50 years in aviation. That has been my goal for flying any and all types of flights. Pilot in command is not open for a vote by anyone other then the management of the company employing them. So if you have a problem with the PIC up front then the time do deal with that is before any flight, and not after being dispatched.