BoostedNihilist wrote:SkyMedic wrote:I am going to continue to speak up or just not get in the aircraft to begin with and nobody will be going anywhere regardless if you think the flight can be done safely.
Well, this is a medic holding the flight portion of the mission profile hostage. "and nobody will be going anywhere" This is a person as a medic making the decision for the flight crew whether or not the flight takes off, because they believe the limit is being pushed.
This is different than simply refusing to board the aircraft because you believe it is unsafe and allowing another medic with higher personal limits to replace you on the mission, this IS making the no go decision for the entire crew. So, you are simply incorrect.
I will agree with you that
if the medical crew has the authority (granted by their operator as members of the flight crew and under defined SOP's) to decline a previously accepted flight or to order the termination of an ongoing flight - that
IS authority above the commonly accepted notion of the roles of PIC and other crewmembers.
flyinNM wrote:None of the medical types who have posted, at any time, in any post in this thread, has EVER said that they think that they should have the authority Only that they think they should be allowed to decline/terminate a flight.
See below - after reviewing the entire thread (and to save others the time of going back to the start and re-reading it) - I couldn't find a SINGLE instance of anyone (medical or aviation) saying the medical crew should EVER be allowed to override a
NOGO decision by the PIC.
BUT - key point - that only applies to operators who have already enshrined that specific and limited role away from the PIC and to the medical crew ("3:1 rule") AND received approval from the FAA (or Transport Canada) to do so in their OpSpecs.
SO I'LL SAY IT AGAIN - What, specifically, is the problem with such a policy?
sportingrifle wrote:Actually, the medics should have a say in the "no go" part of the decision; you can't force somebody to accept what they perceive to be a risky situation. Same goes for loggers in floatplanes, geologists in helicopters, etc. Most of these long time frequent fliers aren't stupid and know when we aviation professionals are pushing our luck. The only consequence of a bad decision here is that something doesn't happen.
The important thing is that only the pilot is involved in the "go" decision.
B-rad wrote:I think you missed his/her point. I read it as making the no go decision can have input from any side as maybe the pilot might try pushing their luck. I can remember times when it has helped me make a no go decision when the pax relived some of the pressure from me by letting me know there is no hurry. Sometimes when it's on the line, the little things can tip the scale. Just because I might be the pilot doesn't mean I discredit what other do know.
gypsymedic wrote: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.
Cat Driver wrote: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?
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.
Skysix wrote:I DO NOT think the med crew have ANY role in the "GO" decision.
But please clarify why they should be prohibited under all circumstances (extreme wording I know but to make the point) from making a NOGO decision? They don't get to make that decision before the pilot does (actually they do but purely on medical grounds and before the pilots are even activated) but only if the pilot has ALREADY MADE A GO DECISION that they (for whatever reason) disagree with. And there's nothing to say that at that point the entire team cannot come up with another way to get the patient moved. Which the pilot then has to approve or they don't fly!
Widow wrote: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.
Skysix wrote: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?
flyinNM wrote:Why are you so sure the nurses and paramedics are NOT part of the crew?
Why shouldn't the nurses and paramedics be considered as part of the crew?
What are the other issues being confused?
Why should the nurses and paramedics not be allowed to request the cancellation of a flight at or during it?
Again, all decisions were collaborative efforts in the information/gathering phase, so by the time the captain, as captain, had to make his final decision everyone was not only on the same page but in agreement. Doesn't take long at all when you work as a team instead of in opposition or isolation.
skymedic wrote:Nobody here is saying the medical crew would like to tell any of you guys what ILS, VOR, DME, RNAV approaches to fly during a flight, we are more than content to let you be the experts, all we ask is if the weather is questionable BEFORE lifting off the ground, to share that information so that we can make an INFORMED decision to either get on the aircraft or not.....It really is this simple....
the only thing I ask is to have the same respect shown when the medical crew is not comfortable in a given situation for whatever reason.....Most of the time it is simply because they are uneducated as to what is going on, and simply taking 5 minutes to explain something to them will go a long ways in having them " keep their mouths shut in the back" as one pilot earlier so elegantly stated.....
flyinNM wrote:if an 'accident chain breaking' method can be implemented and mostly seems to work here it
should be possible for it to work in Canada as well...
If I was planning on continuing the flight and the nurse (or any other passenger) said that the flight was canceled due to flight safety, there would be a huge problem. This is where every pilot reading this thread is getting their feathers up.
I guess all I can say is that sort of problem, where pilots worry that the nurse or paramedic will make a "flight safety" statement to management and possibly get you in trouble even though you were totally correct (or worse, go running to the FAA right away) is exactly what the policy is supposed to prevent. By making it a company SOP that if anyone calls it off then it is scrubbed, no questions asked, no justification required, there is no need for any forms or incident reports or meetings where anyone has to explain themselves over a single incident.
That said, the safety committee (with management, aviation, medical, maintenance, admin and management reps) WILL look for developing patterns. Usually this is quarterly or less frequently if there are few reports to look at. That will also protect the pilots. Say a particular nurse always scrubs - those trips only will be looked at. If the CP agrees the Wx was OK guess who will be sent on a training session or counselled? Also prevents personality conflicts being escalated into job action in the same manner. Names that appear together often get flagged and both are privately interviewed to see why they continually appear on the same cancellations. More often than not - it is the medical crew member who gets further attention.
CD wrote:Just to clarify my point from a few pages ago and add to your post above, the type of operation I was thinking about is F/W where the air operator employs the crew for the aircraft (PIC, FO, CMA) and the passengers are the patient and any additional medical personel required. So in some operations, one of the folks in the back actually is a member of the crew. At the company that I was familiar with, all of the crew members worked well together and respected each other's roles. The operator's cabin medical attendants received the applicable training required by the aviation regulations and the company also conducted joint ground training with all of their crew members. There was never any question regarding the authority of the PIC -- however, the crew resource management was also effective at the company so I don't recall ever hearing about the sorts of issues being brought up here.
maxalt wrote:We realised to stay in the game we had to be the best at it. No errors, include everyone. I was clear with everyone that going out in the middle of the nite into less than perfect conditions was a team event, everyone has input, if the medics had something to say speak up. They never interfered with my decision making process, they offered what they had and if I could use it in my decision I would, same as I would from a mechanic or FSS, ATC or anywhere else I could get information that could help.
skymedic wrote:1. Nobody is trying to tell you how to fly the plane, or what approach to make IFR...
2. The medical crew has trepidation regarding weather because so many have been parked into the ground as a result of poor weather decisions...
3. The medical crew only wants to know the weather for 2 reasons....
a. To determine if they are even going to step foot on the aircraft with you.
b. Is there any potential weather at the destination site which would force us to the alternate, thereby potentially having major negative consequences for the patient.....
skymedic wrote:I was NOT trying to show anything about FLIGHT SAFETY......I was giving an example on how poor decision making can lead to an adverse outcome for a patient. I NEVER said anything about the flight being done unsafe.......
The only time I ever get involved with aviation stuff is BEFORE the flight, to determine whether or not I am even getting on the aircraft to begin with......I have NEVER stated medics having input post takeoff would change the statistics....NEVER....What I did state is that CRM should be a proactive technique used before every flight and especially when weather is marginal, thus allowing the medical crew to make an informed decision PRIOR to takeoff whether or not they want to get on the aircraft....IF they choose NO, they alone bear the burden to explain their position to management.
flyinNM wrote:
What makes them crew - note not FLIGHT crew - is that they are designated as such by their employer in many systems, the same employers that the pilots report to. In those circumstances they are not charter passengers, but co-workers. So, in that case, what is the issue with allowing them also to have the ability to terminate or turndown a flight. Not to OK a launch or say how it should be conducted minute by minute, but just the ability to say NO after the "go/nogo" decision has been announced as a GO by the PIC, and the "that's enough of this $#!+ lets call it off and go back" call at anytime during the flight (note not request, but activation of a policy that mandates return).
Please help me to understand why this, the original (way back near the start of the thread) concept being discussed, is such a threat or so disrespectful to the pilots here? Just as a medical crewmember might feel uncomfortable with weather the multi-thousand hour ex freight dog from the arctic KNOWS he can fly safely and legally the pilot might feel uncomfortable with the walkon but seemingly stable psych patient or the kid with all the funny colored red spots on his skin. After all, he doesn't want to bring measles or meningitis home to his own kids.
So some communication occurs, agreement is not forthcoming and two options exist. Someone feels pressured but goes anyway, or they don't and bitch up the chain of command. Crap rolls downhill and someone always wears it - hint, never the dispatchers or managers who set up the crew to fail in the first place. A defined, automatic, no-further-questions asked cancellation policy with regular trend review and education as opposed to punishment reduces the number of times these situations occur/escalate.
And even dreaded "for profit" systems (I work in one) have adopted this concept. Despite the loss of revenue from those refused flights. Because they are still cheaper than the costs of a crash or a flight crew incapacitated or dying due to an acquired illness.
CD wrote:Jastapilot wrote:...at NO TIME was a medic considered part of the CREW. And, at NO TIME did a medic THINK they were part of the crew. Team:Yes, Crew:No. And yes, there is a difference. Think about it.
As you note, there is a difference. In Canada, it will depend on who the employer of your 'medic' is. If they are assigned to duty on board the aircraft by the air operator, they are a crew member. If they are not employed by the air operator, they are a passenger. The Regulations are quite clear about the fact that there are only two types of occupants on board the aircraft:
"crew member" - means a person assigned to duty in an aircraft during flight time; (membre d'équipage)
"passenger" - means a person, other than a crew member, who is carried on board an aircraft; (passager)
101.01 - Interpretation
The crew member will receive initial and annual training provided by the air operator in accordance with the CARs. The passenger doesn't.
skymedic wrote:We will NEVER know how many accidents could have been prevented if the medical crew was given current weather information BEFORE TAKE OFF! That would mean before they even leave quarters.....PLEASE UNDERSTAND THIS NEXT POINT! I am not stating, medical crew have anything to do with telling pilots how to fly before, enroute, descent, landing....The entire point here is, good CRM would involve letting the medical crew know what the weather is and to let them decide if THEY ( the med crew ) want to physically get in the aircraft with you.......Again, they will have to be able to justify this turn down to MGT if questioned.........
We have NO desire to tell you guys how to fly the aircraft, all we want to know is what the weather is doing, so we can make a decision for our own best interests. NOTHING MORE.....We could care less what RNAV, ILS, VOR, DME, approach you fly into the hospital or airport, we just dont want to be part of any idiot making poor decisions thinking they can beat the weather back to base, or we can get in and out before the weather moves in, etc......This has been PROVEN to have killed quite a few people lately.....I have NO doubt all those pilots thought they were making great decisions before they punched into the clouds, went inverted, and parked it into the mountains!
flyinNM wrote:Thanks for posting the actual CAR section. There ARE flight companies that employ the medical staff, assign them to the aircraft as part of the flight crew, and provide them with the required CARS training. Some assign more flight duties than others (but never final authority - that's the PIC).
SO.... IN THOSE COMPANIES - what is the issue (if any) and WHY, with the medical crew having (per a written SOP) the ability to decline a flight over the PIC's initial acceptance, or cause it to end/return to base while in flight? Remember - that is part of their assigned flight duties by the operator as a flight crew member. Same as the SIC has assigned (different) duties and so on.
skymedic wrote:WE only want to know PRE-Flight what the weather is going to be for the entire duration of the flight to and from.....END OF STORY! All I want to know is should I get on the aircraft with you. The med crew has NO direct influence over the safety of the PIC, You, as PIC have DIRECT control over the safety of every person on board the aircraft. Your decision making process from dispatched until shut down has the potential to affect whether or not, I make it home to see my family.
BoostedNihilist wrote:PLEASE show me where in this ENTIRE thread that I stated my argument was for wanting the MEDICAL CREW to have a say in how the flight portion was performed? NEVER did I state that once....
Yes, you have, here is an example
SkyMedic wrote:I am going to continue to speak up or just not get in the aircraft to begin with and nobody will be going anywhere regardless if you think the flight can be done safely.
Well, this is a medic holding the flight portion of the mission profile hostage. "and nobody will be going anywhere" This is a person as a medic making the decision for the flight crew whether or not the flight takes off, because they believe the limit is being pushed.
This is different than simply refusing to board the aircraft because you believe it is unsafe and allowing another medic with higher personal limits to replace you on the mission, this IS making the no go decision for the entire crew. So, you are simply incorrect.
But this one also might apply...
