Pax Input (Medevac) - Split from ORNGE thread

[Widow]

Chiming in late.

I agree with the assertion that workers from other industries who travel often by air have likely been exposed to a number of different styles of flying and decision making - which may, in fact, make them more disposed to saying "no go" when the pilot is willing to say "go". (I can remember several times my husband refused to fly, when others continued, only to hear horror stories about the flight afterwards). Of course, if the pilot says "no go", that should be the end of it.

But if a pax feels uncomfortable with a "go" decision, they have a right to express that concern. Just like a patient has a right to question a doctor's recommendation for treatment. The pilot (or doctor) should not feel threatened by the concern, it does not mean they are wrong. The pax (or patient) may not have enough information, or has had a relevant past experience, or may even have information that the pilot (or doctor) does not have. If a decision is questioned, the reasons for the decision should be explained. The pilot (or doctor) should consider their discomfort and re-evaluate the decision. This kind of professional response ensures the pax (or patient) feels safe and confident, allowing them to make a more educated personal decision.

TP 7087 - A Safety Guide for Aircraft Charter Passengers

Air operators and pilots are trained and qualified to evaluate the weather for any intended flight. However, if you have any question or doubt about the weather conditions, don't be afraid to ask.

Anyway, my non-pilot, seldom pax, possibly worthless, two cents.

[Posthumane]

EDITED

I'm curious which part of her post you disagreed with. Unless, of course, this was simply a personal attack which adds nothing to the discussion, in which case I recommend the mods remove it.

I think it's been fairly well established that only the pilots can say "go" and that if the medics feel uncomfortable taking off due to weather they can get off the plane. Also mentioned was the fact medics can cancel a flight if they feel a patient is unable to be moved, or for other medical reasons.

However, the fact that medics may need information about a flight to make their medical decisions has been kind of glossed over, I think. I don't know why there is such a backlash against including the medics in the flight planning. Pilots do not always know what information a medic requires to make his medical decisions. The same goes for medics providing information to the pilots. The situation that was mentioned by KAG earlier where the medics and pilots spend time together and are aware of each others' needs is ideal, IMO.

If a pilot simply treats the medics in the back as passengers, then the lack of input from them can cause problematic situations which would be avoidable with adequate communication. One example that was mentioned earlier was the transport of a baby at high cabin altitude to save fuel resulting in a medical emergency for the baby. In that case, either the pilot knowing an altitude restriction or the medic being aware of the pilot's intentions and refusing the flight as a result could have prevented the situation. Pilots need to be aware of medic's requirements and follow them if safe (if not, cancel the flight) and medics should be aware of pilot's requirements and use them to determine if transporting that patient on that flight is safe/necessary from a MEDICAL standpoint (risk vs reward).

There are other situations that could come up. For example, a patient might need to be moved but only in a low turbulence situation, so the pilot should be advised to plan a route with a lower likelihood of turbulence even if there is a fuel cost. Or, the pilot may have a choice between flying faster and refueling at the destination or more economically, and might want to know if the patient is time critical or not.

[rigpiggy]

There is one medico in MB that get's pissy if you shut off the intercom, she would then write you up in ywg, and get you called in, god forbid you have an operational conversation , or anything else without her.

[CuriousBystander]

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.

Ok Brewhouse - here's the low-down on what is a Flight Paramedic and how they differ from what you may be used to in MB (note the spelling of Paramedic).

Paramedics are a lot like Pilots when it comes to certification in that there are many kinds. For starters as Paramedics there are (and this depends on country/provence/state/territory) EMR, EMT-A, PCP, ACP, ACP(f), EMT-P, CCP, CCP(f), FP-C. Compare this to pilots: Student, Recreational, Sport, Commercial, ATP, fixed wing, rotorcraft, glider, etc. Then all your ratings and types, then PIC or FO...get the point. All are called pilots, all are called paramedic - but clearly that's not really all there is too it.

To reach the highest level of training (EMT-P, ACP(f), CCP etc.) takes many years of education and experience.

We are more qualified for this role then your average RN (nurse). Only those RN's who have received extra training are of equal clinical levels as their CCP peers. This is by no means slagging nurses - there are many excellent flight programs that employ nurses that do a great job, but those RN's receive much extra training to function in this role.

So please - be aware that not all paramedics are created equal, and the flight paramedics you are ferrying around as your PAX are specifically trained and have specific experience relative to the role they provide.

Now there seems to be a great deal of medic bashing in this thread - it's pretty distressing to me as a flight paramedic. I am thankful that in my flight program here in Canada we enjoy a great relationship with our pilots. I would not want to work with many of the posters here though - we would just not get along. Wether you want to admit it or not, I need some input in how the aircraft is going to be flown. Period. Full stop.

Cabin pressure is the most important area where we need to have open dialogue. If I request a specific cabin and you can not provide it, then we have to talk about it, and I need to know about it before we depart.

I am not so interested personally in being in the "go/no go" loop because I trust my PIC/FO's. They have given me no reason not too. And I know they trust me to keep them in the loop re: infectious, psych, or other noteworthy patients. That's CRM - like it or not. And I know that if I did have an issue re: airmanship that my concerns would be heard and handled.

Now one last point - MEDEVAC's (please everyone - note the proper spelling) may be at the bottom of the pilots food chain and I understand why that is. But MEDEVAC's are for many paramedics and RN's at the top of theirs. Yes we are paid well. But enough with the bashing us over how much we make. Do I like that I make a good wage doing what I do? Of course I do. Do I like that my PIC and FO are paid substantially less then I am? No I don't like that at all. But that's not my fault. That's the fault of the airline industry. So why it needs to be brought up in this discussion is beyond me.

Thank for your time.

[skymedic]

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

Dude,

PLEASE, before you go quoting statistics, please have a general idea as to how statistics are supposed to be compared.....In the MBA world, (For the uneducated), that would be apples to apples, not apples to grapes.....Which is exactly the entertainment you just provided everyone......Furthermore, you so bravely highlighted in bold 37% are highly preventable......Well, guess what my friend, >80% of FW and RW crashes are Pilot error and are preventable......SO, you really should think before you speak again in the future....

Again, I will put my education (Graduate Level) and experience up with anyone, I really don't give a crap how many hours you have flown, honestly, If you cannot make sound go/no go decisions based on weather information that an 8th grader can understand, you have no business flying anywhere....Period....If you really want me to start using my education and throwing statistics around, I think all you high time pilots will regret the FACTS which, prove it is the >4000hr pilots which are parking them into the ground frequently in the last 10 years......

I mind my own business in the back until you one does something that puts my life at risk, then i speak up! It really is that simple....I have no problem telling mgt why I am not flying anywhere, I have the education, experience and ratings to justify my rationale! Not everyone does....Your job is to fly the aircraft, mine is to make sure I come home safely each flight and take care of the patient...I am sorry if anyones EGO takes a HIT to accomplish those goals...

Respectfully,

[Brewhouse]

CuriousBystander, just so we are on the same page here I was in no way trying to belittle Paramedic's. I was only pointing out that MB medevac companies do not, or did not use paramedic's we must not have any of the fancy ATP type paramedic's around here

I wouldn't say medevac pilots are on the very bottom of the barrel, most companys pay there medevac crews more than pilots flying the same equipment doing sched or charter work. In my opinion it is usually the schedule that makes people want to move on. Being called out of bed at 3am and being airborn in 30min starts to get old after awhile.

And to CuriousBystander and all the other spell checkers out there you will have to excuse my spelling after all I'm just a dumb bush pilot.

[short bus]

Speaking of egos, how does your's fit in the airplane with you?

[Cat Driver]

Maybe he has his ego on fast dial?

[short bus]

and furthermore,

If you really want me to start using my education and throwing statistics around, I think all you high time pilots will regret the FACTS which, prove it is the >4000hr pilots which are parking them into the ground frequently in the last 10 years......

If you're going to throw around statements like this, back them up with actual facts or stats please, otherwise you're just flapping your yap.

also,

Your job is to fly the aircraft, mine is to make sure I come home safely each flight and take care of the patient...I am sorry if anyones EGO takes a HIT to accomplish those goals...

you're half right here, it's our job to fly the machine, and we're the ones responsible for getting us and YOU home safely each flight. You sitting in the back have no hand in that and I think you really need to get over yourself.

I have no problem telling mgt why I am not flying anywhere, I have the education, experience and ratings to justify my rationale!

yeah? well i stayed in a holiday inn express last night!!

[skysix]

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[Bede]

I always treated my medics as crew members. We got along great.

Skysix,
I had to agree with some of the points you made earlier, but I would seriously hesitate having you as part of my crew. Perhaps this is the root cause of the problems you have been having. I'm not trying to be a jerk, but offer you some pointers for personal reflection. Don't go around slagging pilots on a pilot forum (for which you non-pilots are always welcome). Don't spout off about your education. I'm pretty sure I have more of that than you do, but I don't use that to try to gain credibility. The fellow you just quoted was just trying to make a point that we all (medical professionals included) also make mistakes. Try to keep the emotions out of this and make sound, rational statements. BTW Are you a CCP?

[skysix]

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[skymedic]

and furthermore,

If you really want me to start using my education and throwing statistics around, I think all you high time pilots will regret the FACTS which, prove it is the >4000hr pilots which are parking them into the ground frequently in the last 10 years......

If you're going to throw around statements like this, back them up with actual facts or stats please, otherwise you're just flapping your yap.

also,

Your job is to fly the aircraft, mine is to make sure I come home safely each flight and take care of the patient...I am sorry if anyones EGO takes a HIT to accomplish those goals...

you're half right here, it's our job to fly the machine, and we're the ones responsible for getting us and YOU home safely each flight. You sitting in the back have no hand in that and I think you really need to get over yourself.

I have no problem telling mgt why I am not flying anywhere, I have the education, experience and ratings to justify my rationale!

yeah? well i stayed in a holiday inn express last night!!

Shortbus,
Seriously, the last 50 HEMS crashes in the U.S.A have come from pilots whose MEAN flight hours > 4000. This comes directly from looking at the NTSB factual reports available for your viewing pleasure online. http://www.ntsb.gov

Cheers.

[skysix]

.

[skymedic]

I always treated my medics as crew members. We got along great.

Skysix,
I had to agree with some of the points you made earlier, but I would seriously hesitate having you as part of my crew. Perhaps this is the root cause of the problems you have been having. I'm not trying to be a jerk, but offer you some pointers for personal reflection. Don't go around slagging pilots on a pilot forum (for which you non-pilots are always welcome). Don't spout off about your education. I'm pretty sure I have more of that than you do, but I don't use that to try to gain credibility. The fellow you just quoted was just trying to make a point that we all (medical professionals included) also make mistakes. Try to keep the emotions out of this and make sound, rational statements. BTW Are you a CCP?

Bede,

Unless you have a Ph.D and or >2 Masters Degrees, you do not have more education than I do......

For that poster to throw out medical stats and want to compare them is asanine and just proves the lack of education. AGAIN, for the record people, one must compare apples to apples.....For example, if you want to compare whether or not flying is safer than driving, one must compare a given number of flight hours versus drive hours or journeys for each. That would be comparing apples to apples.....

I have no doubt reading your posts you got along well with your medical crew. You sound like a very educated and reasonable individual. From the responses on this forum, I would say you fall into the statistical outlier category.... Which is sad actually.

Respectfully,

[sky's the limit]

What are the pro's and con's of having a defined (written) policy that encourages (ie: no immediate consequences) all members of a team (pilots and medcrew) to have the ability to terminate/decline a flight at any time for any reason. Colloquially referred to as the "One to say NO rule" or the "51% rule"

Would it clarify the discussion to paste an example of such a policy from an aviation company that uses it?

No problem, it has been somewhat entertaining.

To take the quote above and answer your question: When it comes to flying the airplane or helicopter, you are NOT part of the crew. There needs to be no new "policy that encourages all members of the crew to have the ability to terminate/decline a flight" - it ALREADY exists, the only part you and your cohort can't accept is that you are not part of said "crew." Nor should you be. Despite Skymedic's protests.

This does not preclude co-operation between pilots and Medics, this does not preclude the safe operation of the aircraft, and once again (and for the last time), there are several issues/topics that are being confused here on both sides of this debate.

Regards,

stl

[sky's the limit]

Unless you have a Ph.D and or >2 Masters Degrees, you do not have more education than I do......

Skymedic,

I think you are losing the plot here, and no matter how many times you sign your posts "respectfully," you are showing little, if any.

You have no idea what Bede's education is, and I caution you about trotting out your claims of qualifications around here. There are some pretty amazing individuals who frequent this site - you'd do well to keep that in mind.

stl

[hz2p]

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[skysix]

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[skysix]

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[skysix]

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[short bus]

nope, that isn't going to cut it. you started off by stating:

I think all you high time pilots will regret the FACTS which, prove it is the >4000hr pilots which are parking them into the ground frequently in the last 10 years......

which I then asked you to back up with real facts and you respond with:

the last 50 HEMS crashes in the U.S.A have come from pilots whose MEAN flight hours > 4000.

Taking a very small section of aviation and basing your argument that all crashes are caused by experienced drivers doesn't work. If you make an all encompassing statement like that you'll have to back it up with stats of flight ops at all levels worldwide, not by the results of one small segment of US aviation. I seem to remember reading a study that was also discussed on here at one point that statistically the pilot most likely to have an accident was a person around the 1000hr mark. I'll see if I can dig that up.

[skysix]

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[skymedic]

Unless you have a Ph.D and or >2 Masters Degrees, you do not have more education than I do......

Skymedic,

I think you are losing the plot here, and no matter how many times you sign your posts "respectfully," you are showing little, if any.

You have no idea what Bede's education is, and I caution you about trotting out your claims of qualifications around here. There are some pretty amazing individuals who frequent this site - you'd do well to keep that in mind.

stl

No offense, But you are clearly not understanding the situation...I can prove my education, and SKYSIX will back me up on this one! As far as respect is concerned, Respect is earned, not given, so when most of the EGO maniacs remove their malignant attitudes towards CRM and stop parking them into the ground frequently, I might be swayed!

Most Respectfully,

[skymedic]

nope, that isn't going to cut it. you started off by stating:

I think all you high time pilots will regret the FACTS which, prove it is the >4000hr pilots which are parking them into the ground frequently in the last 10 years......

which I then asked you to back up with real facts and you respond with:

the last 50 HEMS crashes in the U.S.A have come from pilots whose MEAN flight hours > 4000.

Taking a very small section of aviation and basing your argument that all crashes are caused by experienced drivers doesn't work. If you make an all encompassing statement like that you'll have to back it up with stats of flight ops at all levels worldwide, not by the results of one small segment of US aviation. I seem to remember reading a study that was also discussed on here at one point that statistically the pilot most likely to have an accident was a person around the 1000hr mark. I'll see if I can dig that up.

Shortbus,

Please actually stop and process what I write next time before responding....I am specifically talking about the small subsection of air-medical! That is my world, I certainly am not talking about 1000 hr Robbie pilots or 250 hr FW CFI wonder boys....This is a PROVEN fact, go spend the time looking through the NTSB site, write down the amount of hours every single pilot had who parked one into the ground, and the MEAN is >4000hrs my friend....I just happen to of done this for my MBA graduate project.....So, I know WTF I am talking about here....I am NOT speaking of the entire aviation world, strictly Air-medical operations.....

APPLES TO APPLES people, this is called descriptive and inferential statistics......

CHeers,