United Express Facepalm

[derg]

I'm not necessarily sure it's something I'd have a penis-measuring contest about concerning if a flight is "lifeguard" or not. Isn't it largely between dispatch and ATC and not necessarily initiated by the crew?

We asked for an expedited arrival into JFK one morning because some lady decided to have a cardiac, approach demanded that we declare a "medical emergency" so we could get expedited, but I don't know if we were considered a "lifeguard" flight or not. Really don't care, but it was certainly fun flying the speed of heat below 10K!

 

[SeanD]

I'm not necessarily sure it's something I'd have a penis-measuring contest about concerning if a flight is "lifeguard" or not. Isn't it largely between dispatch and ATC and not necessarily initiated by the crew?

We asked for an expedited arrival into JFK one morning because some lady decided to have a cardiac, approach demanded that we declare a "medical emergency" so we could get expedited, but I don't know if we were considered a "lifeguard" flight or not. Really don't care, but it was certainly fun flying the speed of heat below 10K!

I think I remember that. I pulled up the flightaware data. You all were certainly hauling some ass if its the one I'm thinking of.

 

[scooter2525]

I'm not necessarily sure it's something I'd have a penis-measuring contest about concerning if a flight is "lifeguard" or not. Isn't it largely between dispatch and ATC and not necessarily initiated by the crew?

I initiate it

 

[inigo88]

Every patient deserves to get to the hospital as expeditiously as possible. I never know anything about the patient when I file the flightplan nor do I care what the traffic is going to be. I file "Lifeguard" because I'm an ambulance and I'm going to get there as quickly as I can. I don't anyone would argue with me that air ambulance flights with patients on board are overusing the status. Now pilots that file it on an empty return flight...that's not right.

Believe it or not I think a lot of professional paramedics and EMTs would argue with you on this point. The emergency medical transport industry is actually under very tight oversight by the governing hospitals in many areas, and has many protocols and SOPs regarding exactly how fast they are allowed to respond to a call based on the extent of the patient's injuries. Often if there are multiple patients, they are triaged and the ones with the most significant injuries are given priority treatment! So while it is nice to say from a customer service standpoint that everyone in an ambulance deserves to get to the hospital as quickly as they can, this is simply not how the system works. If you have a minor non-life threatening injury and a guy down the block is a major trauma patient or is in cardiac arrest, guess who gets the closest ambulance?

The response codes differ by geographic region, but a general example for the west coast is:

Code 1 - At your convenience
Code 2 - Urgent (Obey traffic laws. No lights/sirens.)
Code 3 - Emergency! (Use lights and sirens. Do not obey traffic laws.)

Surprisingly the vast majority of EMS calls are "code 2." If the patient is stable and non-life threatening, the ambulance driver tries to get the patient to the hospital as expeditiously as possible but will still wait at red lights and drive the speed limit. EMS calls are further broken down into Basic Life Support (BLS) or Advanced Life Support (ALS), depending on how involved the care the patient is receiving. Are they on an ECG? Receiving oxygen? IV? Intubated? Is there a paramedic or nurse administering narcotic drugs? This all affects how the transport is categorized and how fast they're allowed to take the patient to the hospital.

Also in the EMS system there are usually two types of transports: 9-1-1 calls and inter-facility transports. From what I can tell by reading posts from Boris Badenov and other air ambo pilots, Fixed Wing air ambulance is essentially inter-facility transports between two facilities very far away... while the actual initial 9-1-1 type responses taking trauma patients to the hospital is all done by the rotorwing side of the industry. Fixed wing transports might be of the "critical care" type, with a bunch of ALS equipment, but if the patient is resting comfortably with pain being managed with appropriate meds and everything is stable, then it is not a life-threatening emergency. You would not see an ambulance driving on the wrong side of the road into oncoming traffic with lights and sirens for that kind of patient. In fact ambulances in my area don't use lights and sirens for interfacility transports AT ALL, unless their condition is deteriorating and the situation is degenerating from an urgent transport (code 2) into an actual emergency (code 3).

I didn't mean to make this such a long post, but I think you guys brought up a very good point about "Lifeguard" being overused, and it may worth adding an additional level of priority to the ATC system. It doesn't make sense for blood couriers, angel flights and low priority inter-facility transports to be "parting the red sea" in the same way that a multiple gunshot wound victim would be in the back of a helicopter, which isn't talking to anyone because they're low level VFR anyway.

It's hard to leave ego out of an aviation discussion, but I'm genuinely not trying to say rotorwing EMS is better than fixed wing or that air ambulance is better than part 121 lifeguard flights, or that not all patients deserve professional and expedient care. But I think it couldn't hurt to get dispatchers more training on the subject, or for companies to consult medical professionals to figure out how fast they actually need stuff, because I think the blanket overuse of "Lifeguard" will eventually be like "crying wolf" to ATC.

I think it couldn't hurt to have separate words in the ATC glossary for "Urgent, do not ground stop me or hold me" vs. "Life-Threatening Emergency, there is a dying patient in the back and I need to get where I'm going NOW!"

I don't actually work in EMS so guys like I_Money or MikeD can surely elaborate, or correct my examples if they're wrong.

 

[MikeD]

I don't actually work in EMS so guys like I_Money or MikeD can surely elaborate, or correct my examples if they're wrong.

That's pretty much on. There aren't a ton of times when a FW aircraft will need Lifeguard status, but those times that they will need it, they should be accomodated. Things like a patient being taken somewhere for a transplant who is on some kind of life support, etc. Interfacility is mostly stable patients, but not always. It just depends on teh particular situation. However the other way around, you won't find helos doing interfacility......not worth it financially nor worth the removing of a 911 asset from service.

 

[derg]

I think I remember that. I pulled up the flightaware data. You all were certainly hauling some ass if its the one I'm thinking of.

That's probably it! Boards, gear, flaps on schedule! Wuuuuuuu TANG!!

 

[derg]

I initiate it

Cool! But I have "minions" in comfortable office chairs in an operations center to do that for me!

 

[pete2800]

No one's blaming you, but it's patently ridiculous that a "Lifeguard" flight is being flown by guys who don't even know that they're a Lifeguard till someone tells them. Granted, most of the really critical stuff is flown by some badasses in helos under VFR, but I've had at least a few flights where I, and, more importantly, my crew thought that the situation was very serious. When the callsign is abused, it's inevitably going to be taken less seriously. It seems to me that there ought to be a medical equivalent of "Pan-Pan" vs. "Mayday".

And when was the last time anyone heard anyone use Pan-Pan?

 

[scooter2525]

Cool! But I have "minions" in comfortable office chairs in an operations center to do that for me!

While you and I sling it out on the front line.

 

[I_Money]

Inigo890 - very well written post. The government actually wants less than 10% of calls to use lights and sirens. I have done some critical care transport (including stab wounds) and never actually felt like I needed the light and sirens. Only 1 correction to MikeD HEMS does a lot of interfacility, it is the money maker in the industry, not sure the exact figures but I believe across AM it is something like 70%

 

[MQAAord]

In 1998 I was hit head-on in Chicago. I was able to get out of the car and walk over to the other car and give the lady who hit me a scolding, so I wasn't hurt so bad I couldn't walk & bitch.. but I was taken to the hospital for the massive welt on my head and injuries to my arm & knee. I would NOT have wanted sirens blaring for my ride in that ambulance, it just was not necessary to put that kind of risk (with alarming other drivers and the possibility of causing ANOTHER wreck) for my minor injuries.

 

[murphfly]

I think it couldn't hurt to have separate words in the ATC glossary for "Urgent, do not ground stop me or hold me" vs. "Life-Threatening Emergency, there is a dying patient in the back and I need to get where I'm going NOW!"
I don't actually work in EMS so guys like @I_Money or @MikeD can surely elaborate, or correct my examples if they're wrong.

I agree that not all flights in a FW are critical flights. But the base I fly out of does not have a hospital, only a clinic, so they're limited on what they can do. Therefore many flights are flown out to hospitals with higher care and since there is no RW based there and the FW has a better ETA(because we're based a mile from the clinic), guess who gets the call? Also, just because the flight may be an interfacility transfer doesn't mean the patient isn't critical or becomes critical during the flight. Plenty of times the med crew will tap me on the shoulder and tell me not to accept any delays. I feel using the term "Critical Lifeguard" in this circumstance would be acceptable.

Like I said before I file "Lifeguard" with a patient on board. Why? Because I don't get information about the patient's condition before I file. Why don't I get that? The company doesn't want me making decisions about the flight based on the patient's status.

Just wondering why you're explaining to me how calls are accepted and ambulances dispatched? I have nothing to do with that. I get flight info, patient weight, and complete the flight with Lifeguard status. Am I overusing the status?

 

[Dugie8]

No, you're doing exactly what should be done. The needs of the patient, be them known or unknown at the time, are what is important. Not what people think will make them seem "learned" by pontificating about status.

 

[dasleben]

No, you're doing exactly what should be done. The needs of the patient, be them known or unknown at the time, are what is important. Not what people think will make them seem "learned" by pontificating about status.

Most importantly, if you're not a trained medical professional who's qualified to determine a patient's condition and need for medical care, you should file with the appropriate callsign. If you're expected to file "Lifeguard," and something happens to the patient while you're not using it (and not receiving priority handling), I couldn't even begin to imagine the legal hell that'd be brought down on you.

 

[WestIndian425]

Organs that need priority handling are always flown 135. I mean Angel Flight has even used the LifeGuard call sign - that makes me laugh!!! It is like me putting lights and sirens on to drive to the emergency department for work.

I don't remember what exactly we were carrying at the time, but it was definitely a priority handling organ...and we're 121.

 

[USMCmech]

I agree that not all flights in a FW are critical flights.

I would think that the "lifeguard" status is most useful when flying to a major hub and there is flow control in effect. Critical patient or not, if an airliner or other FW airplane is carrying something critical enough to warrant the lifeguard status then they do not need a 90 minute EDCT wait.

For helos, the lifeguard status is mostly pointless. Most of the time they are VFR, and ATC already knows who they are and what they are doing. Any patient that is critical enough that 2 minutes would matter is likely already beyond help anyway.

 

[dasleben]

Any patient that is critical enough that 2 minutes would matter is likely already beyond help anyway.

I'd like to hear a doctor's input on that, because I don't think that's true.

 

[I_Money]

I work in the emergency room - I can honestly say +/- 2 minutes isn't going to make a difference. It takes longer than that to get people to the CT scan in most hospitals.

 

[Krystal]

I dont know how other airlines work but at the two that I have worked for, dispatch is notified in the planning process that a plane is going to go LIFEGUARD. If we arent given the information, we dont file them as such. On occsion, I will get a captain that calls to say that they have blood, corneas, vaccines, etc. we do not use LIFEGUARD in those circumstances. LIFEGUARD is for vital organs and for patients who are traveling for time sensitive medical treatment (Though I have not had any dying patients on any of my flights)

I DO think it is ok for running organs on 121 operations. What if the organ is in SFO and the recipient is in NYC? Im no helicopter dispatcher but it would seem that you would need to do a fuel stop or 3 and it would take 4 times as long. yah, I suppose you could charter a plane, but what if there isnt one available or it will take a couple of hours to coordinate? Well, there is a plane departing for the east coast on XYZ airline in 20 minutes....

 

[MQAAord]

We carried a lot of eyes for some reason at Eagle. Blood and eyes are what I saw in our cargo the most. Lifeguard callsign was not used for transport of eyes or blood.