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Lifeguard and TFR


jimbo2181
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What does everyone think about this? You fly into an active VIP TFR because you are dropping off patient at the hospital in that city. You are based 100NM away in another city.

 

Can you fly out of the TFR towards your home base under the lifeguard status?

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From a story that I have heard, no you cannot. Flying towards your base is not an emergency, so you may not fly.

 

The story that I have heard said that an EMS pilot got dinged because he flew through the VIP TFR transferring a patient to a hospital. When they investigated his case, they asked him if the client was in critical condition; he wasn't, so since this wasn't an emergency, the pilot shouldn't had flown through the TFR. I think that he got his license suspended for a month...

 

I guess that you could possibly fly though if you had to go to pick up a patient who is in a life threatening situation, because that would warrant an emergency.

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I always thought as an EMS pilot, what happens in the back of the helicopter should be of no concern to the pilot. It's just a matter of determining if the helicopter can legally and safely fly, even if there is a crate of puppies that are in critical condition in the back.

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We all know that the AIM is not regulatory, however here is what it says about the "Lifeguard" callsign:

 

Because of the priority afforded air ambulance flights in the ATC system, extreme discretion is necessary when using the term “LIFEGUARD.” It is only intended for those missions of an urgent medical nature and to be utilized only for that portion of the flight requiring expeditious handling.

 

In other words, you're stuck at the receiving hospital until the TFR expires.

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What does everyone think about this? You fly into an active VIP TFR because you are dropping off patient at the hospital in that city. You are based 100NM away in another city.

 

Can you fly out of the TFR towards your home base under the lifeguard status?

 

 

No you can't claim "Lifeguard" unless you need the emergency preferential status. RTB flights don't qualify.

 

You have serious problems in your scenario: You are required to be familiar with "all factors" (or something like that) and have a plan to accomplish the flight before you depart on each and every leg. If you didn't and don't, it's on you. The nature of your flight might allow you to operate within a TFR if you meet follow the rules, and EMS might not be allowed even then. Some TFRs include the threat of deadly force...

 

On the other hand, if it is a bona fide life and death emergency you have a moral obligation to react appropriately to the situation. That's how you know what's really and truly the right thing to do- it's the altruistic option you take when it could kill you.

Edited by Wally
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Lets make it a little more difficult. The TFRs state "Air Ambulance and Firefighting operations." Would you consider the return to your service area part of the air ambulance operation. If so how would you designate this on the call to ATC.

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Something interesting I learned during my research. We get priority over presidential traffic. Woot Woot.

 

In a response to an inquiry from ASRS, the FAA Air Traffic Procedures Division offered the following expanded interpretation of "Lifeguard" and "Priority Handling" terminology.

"The use of the term 'Lifeguard'...provide priority...Even the expeditious movement of Presidential aircraft or other special air operations are listed behind air ambulance priority in Order 7110.65...

"It is a fine line between normal operations and emergency operations, both for the medical personnel as well as for the controllers. While an emergency in the air traffic control world generally means that an aircraft (and therefore its occupants) are endangered, this distinction blurs significantly in air ambulance operations, in which the aircraft is fine but the occupant(s) may be endangered.

"Order 7110.65 requires the controller to '...give first priority to separating aircraft and issuing safety alerts as required in this order. Good judgment shall be used in prioritizing all other provision of this order...In conjunction with paragraph 2-4, therefore, any aircraft that identifies itself as a 'Lifeguard' flight...will and in fact, does, receive a very high priority in the air traffic system.' "

I highly doubt that will ever happen but it is good to know.

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From a story that I have heard, no you cannot. Flying towards your base is not an emergency, so you may not fly.

 

The story that I have heard said that an EMS pilot got dinged because he flew through the VIP TFR transferring a patient to a hospital. When they investigated his case, they asked him if the client was in critical condition; he wasn't, so since this wasn't an emergency, the pilot shouldn't had flown through the TFR. I think that he got his license suspended for a month...

 

I guess that you could possibly fly though if you had to go to pick up a patient who is in a life threatening situation, because that would warrant an emergency.

 

This guy should have got a lawyer. According to the AIM:

 

1. Civilian air ambulance flights responding to medical emergencies (first call to an accident scene, carrying patients, organ donors, organs, or other urgently needed lifesaving medical material) will be expedited by ATC when necessary. When expeditious handling is necessary, add the word “LIFEGUARD” in the remarks section of the flight plan. In radio communications, use the call sign “LIFEGUARD” followed by the aircraft registration letters/numbers.

 

To me that reads carrying a patient regardless of condition. We are not doctors so how do we know patient condition. He could have have fought and should have fought that suspension.

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Prior permission is great, Falco, but once the patient is dropped off, the "Lifeguard" status is no longer applicable. The OP's question was to that issue, not whether he could depart the TFR using some other means.

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No you can't claim "Lifeguard" unless you need the emergency preferential status. RTB flights don't qualify.

 

Yes, you can.

 

The operation is a lifesaving operation. One may be empty, enroute to pick up a patient, or one may have a patient on board. Or, one may be expeditiously returning the aircraft for a crew change in order to keep it available to respond to another request. If the aircraft and crew are away from base, the aircraft isn't necessarily re-stocked or available to take a call. There may be duty issues for all involved, necessitating a fresh crew.

 

I'm presently doing firefighting. When I do lifeguard flights, I treat all my flying the same: patient on board or not. I don't make decisions based on patient condition or the state of an emergency. I make them based on what I'd do regardless of any other circumstances. I'm not there to treat the patient, I'm there to fly. Accordingly, I'm not concerned with the patient condition, the nature of the emergency, or any other details beyond specifics requested by the crew (nurse, medic, etc).

 

If the crew needs me to divert, then I do that, if it can be done safely. If I'm told the aircraft needs to return to it's home base, then I do that, if it can be done safely. If I'm told to go to a location to pick up a patient, then I do that, if it can be done safely. If I'm flying an air ambulance ship, once I'm enroute to where I've been directed, I'm a lifeguard.

 

If a patient isn't in back coding while I'm enroute back to the home office, that's not my concern, any more than if a patient is back there. I'm enroute where directed, part of an ambulance operation, and a return from a destination needs to be as efficient and expeditious as possible to make the aircraft available. If I'm enroute empty and get a request, to divert to pick up a patient, I don't suddenly become a lifeguard. I was already a lifeguard. If I'm doing an administrative transfer of a patient between hospitals, it's not as though I'm not a lifeguard, but suddenly become one when the patient codes. I was one before ever becoming airborne. I remain one. I don't shed that status.

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My experience is that I will be cleared out of TFRs for RTB from a patient transport. I have also been told to remain on the pad until cleared. I've never used the Lifeguard priority in a high security TFR to ask for a change in that instruction.

I think that I could argue and insist on the clearance if it was an emergency services issue, returning a critical resource to service. I think the Secret Service/FAA might review the situation if the request was granted a priority over another operation.

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IMO, once you've delivered your patient, you're no longer on Lifeguard status. (For whatever reason, they're changing the name of that soon, using Medevac instead, it will be in the new AIM). Back when the previous President spent more time in Crawford than DC, we regularly had to deal with his trips into Waco. We had a standard callsign and transponder code, and had no problems getting to the hospital, but I've been held on the hospital pad awaiting takeoff, until AF1 landed. I do agree that the patient's condition has no bearing on anything. I'm not a doctor, nor a nurse or even an EMT, and I have no idea what is going on with the patient, other than whether or not there is swearing and screaming coming from the back. I don't care. If I have a patient, or I'm enroute to pick up a patient, I use Lifeguard. But not after I drop off the patient. I don't need priority handling, I'm just another aircraft.

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Not an answer to the question, but still relevant:

 

http://www.faa.gov/about/office_org/headquarters_offices/ato/service_units/enroute/flight_plan_filing/General/ICAO_2012/media/AIM%20Changes%20for%20ICAO%202012.pdf

 

 

I would simply call the controlling agency and find out. There is more often than not a number to call. Additionally, depending on the nature of the TFR, presidential as an example, there are typically two rings. A 10nm and 30-35nm. The latter you can fly through with a simple FAA flight plan on file. I'm sure most are aware of that, but for those that are not, it's kinda handy...

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I have to agree with Avbug. You are not a medical expert, so you do not know what the medical status of the patient actually is. And legally, you may not be able to discuss what you know of the patient's condition because of the patient privacy laws. I have had may 'stable' patients start to go south during flight. When returning to base, I am lifeguard because I am putting myself back into position for another flight if it becomes required. The company has been inspected many times by the FAA and TSA with no issues on its use of lifeguard. As far as leaving a TFR, ask. The worst they can do is say 'no'. Surprisingly, it has been my experience, they generally will say yes. After all, if things go wrong, they could be the one riding in the back of your machine in a horizontal position and they know it. What many people don't know is that in may states, ground ambulances are not allow to speed or run stop signs/lights. But they do it every day and they never get a ticket. Why? Because no LEO is going to write a ticket on the vehicle that could save his life someday.

 

As for the medevac call sign, I believe that is a change on the ICAO flight plan form only. Using Medevac for priority and Hospital for inter hospital transfers.

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I would be curious to know how the FAA views EMS helicopters that are returning to base empty.

 

Out in the Gulf of Mexico the FAA routinely held that hurricane evacuations were not "emergency" situations as far as the aircraft and pilot were concerned. IOW, just because there was imminent danger to life and limb of the oil workers, it did not warrant exceeding flight and duty time limitations under part-135. Ergo, hurricane evacuations now start earlier than the oil companies would prefer.

 

And so we come to a helicopter that happens to be assigned to a hospital and is returning to said hospital empty after dropping off the patient at a different hospital. Does the FAA still consider this aircraft to have "Lifeguard" status (and the special considerations that go with it) because it "might be needed" to fly another "mission" at some point in the future? Somehow, part of me doubts it. But truthfully, that particular argument has probably not come up yet.

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An emergency situation isn't necessary to be a lifeguard aircraft, or to be afforded lifeguard status.

 

When I operate as a lifeguard, I don't do so based on my intimate knowledge of the condition of a patient in the back of the aircraft. I've had calls that ranged from chainsaw injuries to the face to gunshot victims, burn patients, cancer patients, new-borns, and once a movie star who demanded a medevac flight because, as it turned out, he felt he had an acne problem that warranted an immediate expedited trip to his dermatologist.

 

I don't get into the patient state or condition. Nor have I ever asked "is this one really important?" I don't care. When operating as an air ambulance, it's NOT the pilot's concern to deal with patient condition.

 

Enroute to pick up a patient, the patient is not yet on board. Say the flight is enroute to the scene of a multiple-casualty incident involving a car crash. On-scene medics have identified a case of severe head trauma, and are requesting an immediate medevac transport of the patient to an advanced care facility. Vital statistics are given, the company elects to dispatch the aircraft, and the pilot is given the coordinates. He goes.

 

The pilot doesn't know the patient's, and doesn't need to know the patients condition. He knows that he's been dispatched from A to B. He knows he's operating as an air ambulance. Who would argue that he isn't operating a lifeguard flight, simply because the patient isn't on board yet? Ought he simply hold off picking up the patient, take his sweet time, because there's nobody on board except crew? Of course not. It's critical that he gets to the scene as soon as possible. He doesn't know why. He doesn't care. He's a lifeguard flight that's been dispatched to do a job.

 

Once the patient is on board, he's a lifeguard flight. He transports the person to the care facility. Suppose it's not a critical patient, however. Does an emergency need to exist to be termed a "lifeguard" flight? Of course not. A patient need not be aboard at all.

 

I've transported medical supplies, parts of people (organs, skin, bone, etc), and medical cultures and samples that had to be somewhere quickly. I operated as a lifeguard. In some cases, we were transporting blood samples that were part of an upcoming organ transfer. Crossmatching the samples was necessary before anybody got cut open, but there was a timeline involved. I didn't know the time line, nor did I know the people, nor did I ask questions about such things. I knew that I was sent from A to B, and that was all I needed to know. Medical issues were the speciality of the medical personnel, and safety of flight was my speciality. With "Air Ambulance" stenciled clearly on the outside of the aircraft in reflective letters, the fact that I was a medevac was clear to an observer. With my use of the lifeguard call sign, my status as a medevac was clear to a listener.

 

I have had times when we were cancelled enroute to a location. Perhaps the patient crashed and couldn't be transported, perhaps the patient died. I don't know. I know I was diverted or cancelled, and at times I've notified ATC that I'm no longer a lifeguard. In other cases, I didn't bother, but simply turned around and returned to my departure point.

 

If I was enroute to a location and was turned around by the company (or more often than not, by ATC after being contacted by the company) to pick up some necessary piece of equipment, a medical sample, or even another medical person, then my status hadn't changed. I was still enroute to pick up a patient: I was only returning to get something, and my demand at the destination was still the same. I was still a lifeguard, still with no patient on board, and still very much deserving of the use of the lifeguard status.

 

Conversely, I've had administrative transports of individuals that were not critical, and were only being moved by air ambulance because of the higher level of direct care we could provide. We were not in a state of emergency. I've had such flights develop into an urgent condition: the patient begins to experience chest pain, for example, and while I was flying airways or an arrival, I immediately notified ATC that I was now a lifeguard and requested direct. I don't think I've ever been denied in such a circumstance.

 

If the aircraft is a life-saving aircraft, being out of service usually isn't much of an option save for mechanical problems or safety-of-flight related issues (weather, crew fatigue, etc). Returning the aircraft to it's home base is just as important a function as dispatching to the original scene; the aircraft is expected to be available for the next emergency function. The pilot doesn't know what that is, or when. Law enforcement, ambulance, and fire equipment and personnel don't know when the next call will be; availability around the clock is essential, and expected.

 

As for comparing GOM flights with HEMES operations, note the differences in regulation that apply. One is not the same as the other.

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An emergency lifeflight situation isn't necessary to be a lifeguard aircraft

 

Jimbo is correct in his post stating "LifeGuard is afforded priority over Air Force One.

avbug is wrong in his statement claiming lifeguard status will be offered to non emergency aircraft. Can it be done "yes" but only is the pilot lies and tells atc he's "lifeguard".

 

Aircraft enroute to to the scene are considered "LifeGuard" only if the pilot claims lifeguard status which is a valid use of the term and at that time they are afforded priority handling.

 

Can a helicopter be dispatched to an emergency from his current location where it's sitting or just dropped off a patient within the current TFR "Yes" because your considered "LifeGuard" enroute to the scene.

 

The last thing Air Force One would want to be responsible for for is delaying "LifeGuard" since it would make international headlines that the president was responsible for someones death do to the fact he couldn't or wouldn't allow his aircraft to be delayed a few extra minutes to land behind an aircraft attempting to save someones life.

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What does everyone think about this? You fly into an active VIP TFR because you are dropping off patient at the hospital in that city. You are based 100NM away in another city.

 

Can you fly out of the TFR towards your home base under the lifeguard status?

 

Yes, you could misuse the ”LIFEGUARD” status to do so, but it’s not necessary.

 

Each VIP TFR under 91.141 has its own unique “Operating Restrictions and Requirements” published in the NOTAM. FAR 91.141 makes clear that no flight operations are allowed contrary to those restrictions and requirements. Below is an example of a VIP TFR for Johnstown. In order to operate you must meet one or more of the four criteria in a timely manner, prior to operating in the TFR.

 

Your status as ”LIFEGUARD” is only grounds for authorization or approval for operational priority by ATC within the TFR. If you fall within the NOTAM criteria and request then receive authorization, you can enter and/or exit based on your request. Moreover air ambulance flights have been granted their returning to base (exit VIP TFR) notwithstanding an urgent nature, in order to position for their next mission, just ask.

 

Assuming “LIFEGUARD” status without timely authorization or approval to enter or exit the VIP TFR, under the required criteria, may land you as an unknown aircraft penetrating the TFR, as in the second NTSB case. Thereafter, trying to justify your action after the fact to avoid enforcement action.

 

91.141 Flight restrictions in the proximity of the Presidential and other parties.

No person may operate an aircraft over or in the vicinity of any area to be visited or traveled by the President, the Vice President, or other public figures contrary to the restrictions established by the Administrator and published in a Notice to Airmen (NOTAM)...

 

Federal Aviation Administration vs. WILLIAM ARTHUR LEE, NTSB No. EA-5219

In the case at issue, a genuine issue of material fact exists with regard to whether respondent operated an aircraft contrary to the restrictions established by the Notice to Airmen (“NOTAM”).

 

Example:

Operating Restrictions and Requirements:

TFR type VIP - Johnstown/Shanksville, PA - ARTCC: ZOB - Cleveland Center

No pilots may operate an aircraft in the areas covered by this NOTAM (Except the flight operations listed below:).

 

1. All IFR arrivals or departures to/from airports within this TFR.

 

2. Approved; law enforcement, fire fighting, military aircraft directly supporting the United States Secret Service (USSS) and the office of the Vice President of the United States, and MEDEVAC/air ambulance flights.

 

3. Aircraft operations necessitated for safety or emergency reasons.

 

4. Aircraft that receive ATC authorization in consultation with the air traffic security coordinator (ATSC) via the domestic events network (DEN).

 

Federal Aviation Administration vs. BRUNO L. JACQUET, NTSB No. EA-5616

FAA and Secret Service personnel performed TFR watch at the Chicago Terminal Radar Approach Control (TRACON) facility on August 5, 2010. The TFR watch consisted of two FAA air traffic controllers, a supervisor, a TRACON operations manager, and members of the Secret Service monitoring aircraft activity around the TFR via radar.

 

The TRACON operations manager, observed an unknown aircraft penetrate the TFR from the north. Upon entering the TFR, the aircraft was flying a heading of approximately 160 degrees—a southeasterly heading. The TRACON broadcast over

the emergency frequency for the aircraft to contact air traffic control (ATC), and the aircraft, identified as N471KP, contacted ATC shortly thereafter. ATC provided N471KP a heading to take the aircraft out of the TFR as quickly as possible. N471KP penetrated the TFR by 5nm.

 

Respondent landed at South Bend, Indiana, and called ATC. During the phone conversation, respondent informed the controller he was aware of the TFR but thought his aircraft was outside of the TFR because of the display on his GPS.

 

As the pilot-in-command, respondent was responsible for keeping his aircraft out of the TFR. He knew of the NOTAM and had access to ATC and the FSS in order to prevent this incursion.

 

However, respondent chose primarily to rely on a GPS product from a private company. Unlike in the cases where we found a pilot relied on incorrect information provided by the FAA or other appropriate government agency, we decline to extend this doctrine of reasonable reliance to a GPS system produced by a private company.

Edited by iChris
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Avbug wrote:

As for comparing GOM flights with HEMES operations, note the differences in regulation that apply. One is not the same as the other.

 

Err, which specific regulations are you referring to? I went through 91 and 135 and couldn't find a distinction between regular ol' helicopters and helicopters with "air ambulance" painted on the side. I do know the difference between a police or fire department helicopter (public use) and a hospital-owned helicopter (commercial operator).

 

Then again, not being an EMS pilot there are probably rules and regs about such that I'm unaware of.

 

Enlighten us?

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Hey may be referring to A021 OPS Specs. There was some contention a few years back about an operator in the GOM that would reconfigure the cabin from pax configuration to a med bed for night flights. The FAA got interested because they weren't specifically "Air Ambulance."

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avbug is wrong in his statement claiming lifeguard status will be offered to non emergency aircraft. Can it be done "yes" but only is the pilot lies and tells atc he's "lifeguard".

 

Aircraft enroute to to the scene are considered "LifeGuard" only if the pilot claims lifeguard status which is a valid use of the term and at that time they are afforded priority handling.

 

No, avbug is not wrong.

 

As an air traffic controller, you have no idea what or who is in my aircraft. None. Nor will you know. You know my callsign only. If I call myself a lifeguard, then as far as your'e concerned, I'm a lifeguard. I do not need to discuss what's on board, the patient condition, the urgency of the mission, or any other details. Lifeguard.

 

I don't know the patient's condition. I don't care. It's not my concern. Is the patient dead? Did that change the nature of the flight? I don't know. I don't care. I'm a lifeguard.

 

Am I enroute to pick up a patient? Am I not a lifeguard simply because the patient isn't on board yet? Of course I'm a lifeguard. The purpose for me being, my reason for drawing breath, and the essence of the existence of the air ambulance aircraft is to go get someone, provide timely medical treatment with an advanced level of healthcare, while reducing transit time and trauma. Part of that mission is carrying the patient. Part of it is going to get the patient. Part of it is going back to get another.

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So...here is an excerpt from section 4-2-4 of the Aeronautical Information Manual concerning the use of callsigns.

b. Air Ambulance Flights.

Because of the priority afforded air ambulance flights in the ATC system, extreme discretion is necessary when using the term “LIFEGUARD.” It is only intended for those missions of an urgent medical nature and to be utilized only for that portion of the flight requiring expeditious handling. When requested by the pilot, necessary notification to expedite ground handling of patients, etc., is provided by ATC; however, when possible, this information should be passed in advance through non-ATC communications systems.

1. Civilian air ambulance flights responding to medical emergencies (first call to an accident scene, carrying patients, organ donors, organs, or other urgently needed lifesaving medical material) will be expedited by ATC when necessary. When expeditious handling is necessary, add the word “LIFEGUARD” in the remarks section of the flight plan. In radio communications, use the call sign “LIFEGUARD” followed by the aircraft registration letters/numbers.

2. Similar provisions have been made for the use of “AIR EVAC” and “MED EVAC” by military air ambulance flights, except that these military flights will receive priority handling only when specifically requested.

EXAMPLE-

Lifeguard Two Six Four Six.

3. Air carrier and Air Taxi flights responding to medical emergencies will also be expedited by ATC when necessary. The nature of these medical emergency flights usually concerns the transportation of urgently needed lifesaving medical materials or vital organs. IT IS IMPERATIVE THAT THE COMPANY/PILOT DETERMINE, BY THE NATURE/URGENCY OF THE SPECIFIC MEDICAL CARGO, IF PRIORITY ATC ASSISTANCE IS REQUIRED. Pilots must ensure that the word “LIFEGUARD” is included in the remarks section of the flight plan and use the call sign “LIFEGUARD” followed by the company name and flight number for all transmissions when expeditious handling is required. It is important for ATC to be aware of “LIFEGUARD” status, and it is the pilot's responsibility to ensure that this information is provided to ATC.

 

Notice that the FAA even goes so far as to parse what they mean by "responding to medical emergencies." They note that it would be "first call to an accident scene..." Civilian EMS helicopters are almost never the first ones to an accident scene. Seems like the FAA does *not* consider a helicopter to be "LIFEGUARD" if a ground ambulance is already on-scene. Seems like returning to base would *not* constitute a medical emergency.

 

Curious.

 

Nevertheless, Avbug feels that any time he is flying in his helicopter that is painted up as an "air ambulance" he is entitled to "LIFEGUARD" status and is always to be afforded expeditious handling no matter what the "mission," because even returning to base empty means that there *could* be another medical emergency pending in the near or distant future.

 

Interesting.

 

I've met a lot of pilots in my life who've had their own "take" on the rules and regs and guidelines that apply to us, and over the years I've heard some mighty strange interpretations indeed. This guy Avbug is right up there. White Knight Syndrome much, Av?

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Seems like the FAA does *not* consider a helicopter to be "LIFEGUARD" if a ground ambulance is already on-scene.

 

Absolutely untrue.

 

In addition to having flown for a number of ambulance operators in rural and urban environments, as well as overseas, I've been an EMT for a number of years, including six years of operating on ground ambulances, and doing fire/rescue and extrication. I've got a fairly good handle on what constitutes an emergency. I have no intention of appealing to the FAA to determine when an emergency exists. Furthermore, the FAA has held on numerous occasions that there is no way to detail or account for all situations that dictate an emergency, and that crew members are expected to exercise good judgement.

 

If a medevac is called to the scene of an incident, the medevac isn't there simply to expedite carriage of a patient. The medevac is there because the medical personnel have assessed the patient and determined that a higher level of care is required. The air ambulance operation provides that. There is NO requirement that the aircraft be first on scene. Moreover, transportation by air is common from one city to another, one hospital to another, not involving scene response. These are very much lifeguard flights. It's common, for example, for an air ambulance fixed wing to respond to an airport where the crew will be picked up by an ambulance, and taken to a hospital. There, the crew will prepare the patient, who is transported by ground ambulance to the airport, where the fixed wing medevac carries the patient to another airport. This is a lifeguard flight.

 

The AIM is not a "rule or reg." Perhaps you don't know this. Now you do.

 

How much medevac and air ambulance have you done?

 

Nevertheless, Avbug feels that any time he is flying in his helicopter that is painted up as an "air ambulance" he is entitled to "LIFEGUARD" status and is always to be afforded expeditious handling no matter what the "mission," because even returning to base empty means that there *could* be another medical emergency pending in the near or distant future.

 

Your comprehension lacks, as I stated exactly the opposite. Learn to read.

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