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.