Lifeguard and TFR

[aeroscout]

Whereas the AIM is not a rule or reg, for the purposes of enforcement it carries the same weight.

[Hotdogs]

Man you guys go down the rabbit hole on this stuff.

[Nearly Retired]

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

 

Avbug replied:

Absolutely untrue.

 

Okay Avbug, what part of

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...

...do you not understand?

 

No, the FAR's do not address HEMS flights. And yes, I know that the AIM is not regulatory, which is why I added "...and guidelines" to that sentence. Because even though the AIM is not regulatory, the FAA considers it accepted standards and practices which, if you do something contrary to them you better have a pretty good reason.

 

So if you want go around calling yourself "LIFEGUARD" all the time, knock yourself out. Just don't expect us to agree with you that it's correct.

 

Oh, and my reading comprehension is just fine, thank you.

 

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.

 

If you say so, sir.

[Falko]

@ 'Nearly Retired

 

keep in mind that Avbug knows it all and better than anybody else in this industry...

[Nearly Retired]

Falco:

keep in mind that Avbug knows it all and better than anybody else in this industry...

 

Yeah well, guys like him are really annoying to guys like me who really DO know better than anyone else!

[avbug]

Whereas the AIM is not a rule or reg, for the purposes of enforcement it carries the same weight.

 

Absolutely untrue.

 

The AIM carries no "weight" in enforcement. Enforcement is of the regulation. There is no such thing as a violation of the AIM, and one cannot be the object of enforcement action on the basis of the AIM.

 

One may be the subject of enforcement action based on the regulation only.

 

If an inspector decides that a pilot has violated a regulation, such as 91.13 (careless and reckless operation) based on a failure to adhere to standard procedures as outlined in the AIM, the inspector may initiate such action. The chances of success of such action are entirely dependent on the circumstance.

 

The AIM is NOT regulation. It is an outline of operating practices and information gathered from a number of publications and sources. Acting contrary to the AIM is not grounds for enforcement action, as the AIM is not enforceable. Regulations are enforceable, and the AIM is not a regulation.

 

Because even though the AIM is not regulatory, the FAA considers it accepted standards and practices which, if you do something contrary to them you better have a pretty good reason.

 

No, quite frankly, I don't.

 

If I elect to fly a nonstandard traffic pattern at a Class G airport, for example, I need to reason, nor do I need to explain myself. If I cause a safety issue, then I may be in need of legal counsel, but acting contrary to the AIM is not enforceable of it's own accord, unless it violates a regulation or is careless or reckless in nature.

 

When performing ag or fire work, I do a LOT of things that are contrary to the AIM, and not only am I on solid legal ground in doing so, it's expected, standard, and the FAA is quite understanding. No problem whatsoever. I've operated under powerlines, landed on closed runways, landed and departed airports without lighting, and a host of other actions ranging from operating with far less than VFR visibility in smoke to the dispensing of chemicals and dropping of objects in urban, built-up areas. I've been legally doing it since I was a teen, and I'll keep on doing it for a living for a long time to come.

 

If you say so, sir.

 

Of course I say so. I say correctly.

 

Okay Avbug, what part of

Quote

 

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...

...do you not understand?

 

I understand it perfectly well. You'd have to be a bloody idiot to take it literally to mean that if one is the second aircraft on scene at a disaster, one isn't an emergency aircraft or lifeguard, or to actually believe that if an ambulance is on scene and screaming for air evac, one isn't a lifeguard when transporting a critical patient from that scene. Of course, you've said as much, which is more than a little idiotic. You don't really believe that stupidity, do you?

 

To suggest that one isn't a lifeguard if one is the second on scene, or if someone else has responded to a scene is to exercise no judgement at all. As pilots, we're paid for judgement. Exercise some.

[tracon]

Avbug,

Regulations state the following~

 

"civilian air ambulance flights “LIFEGUARD.”

Air carrier/taxi usage of the “LIFEGUARD” call sign, indicates that operational priority is requested."

 

Since your so well versed in the regulations, then you should know where this is stated. The language is very specific,

in simple english it means you the PIC are requesting "Lifeguard Status" at which point you'll receive priority handling from ATC ahead of all other aircraft EXCEPT an inflight emergency. Now if you would like to debate that fact also be my guest, because that one is also stated in the regulations.

 

So if your simply moving an aircraft from one base of operations to another for no other reason than to relocate the aircraft, you are not entitled to Lifeguard status and shouldn't be requesting it.

Lifeguard status is intended for those operations where expeditious handling of aircraft is mandatory during life saving operations.

[Nearly Retired]

Avbug:

You'd have to be a bloody idiot to take it literally to mean that if one is the second aircraft on scene at a disaster, one isn't an emergency aircraft or lifeguard, or to actually believe that if an ambulance is on scene and screaming for air evac, one isn't a lifeguard when transporting a critical patient from that scene. Of course, you've said as much, which is more than a little idiotic. You don't really believe that stupidity, do you?

 

Oh, Avbug. It’s not about what I believe. It's not even about what you've been doing for years under whatever misconceptions you happen to hold. I was merely pointing out what guidance the FAA has given us when it comes to the “LIFEGUARD” callsign. So chill with the insults, pops. Like you, some of us have been around the block a time or two, and I don’t need to be chastised by some arrogant, PTS-suffering, gonna-kill-myself-and-my-pax White Knight. Oh wait- you’re an older helicopter pilot- you know everything. Sorry, I forgot.

 

I *think* that the FAA is under the illusion (delusion?) that this ain’t Viet Nam anymore, where medics on the battlefield with bullets zinging by their heads and bleeding grunts in their arms are “screaming for an air evac.” I *think* the FAA understands that civilian, commercial EMS helicopters are almost never first on the scene, and that accident victims are stabilized by the ground med crews before being stuck in the for-profit helicopter for a ride to the E.R. So, going by the FAA guidance then no, you’re not “LIFEGUARD” while en route to the scene but you are (obviously) “LIFEGUARD” leaving the scene. I don’t think anyone has argued anything to the contrary. Except you.

 

But anyway, that’s beside the point. Your contention, Avbug, is that any time you’re in the helicopter it is to be considered “LIFEGUARD,” even it you’re just RTB because there is the possibility of another flight (mission?) to which you must respond because by God, you are an AIR AMBULANCE! The rest of us here have just been trying to point out that the FAA seems to differ with your opinion. Meh- whatever.

 

That’s what's fascinating about aviation, no? Even when stuff is in black and white (as it is in this case), you can’t get two pilots to agree on anything…and you usually can’t get two FSDO’s to agree on anything either. It's a beautiful thing.

 

Nevertheless, if the FAA ever investigated civilian-me because I made AF1 divert because I was requesting priority handling by my use of the “LIFEGUARD” callsign, I’d want to make damn sure I actually had a patient onboard and wasn’t just inbound to a “hot LZ” where there was already a perfectly serviceable ground ambulance or two present. You might feel such an action was completely defensible. Me, I’m not so sure and I don't want to find out.

 

That is all.

[avbug]

Since your so well versed in the regulations, then you should know where this is stated. The language is very specific,

in simple english it means you the PIC are requesting "Lifeguard Status" at which point you'll receive priority handling from ATC ahead of all other aircraft EXCEPT an inflight emergency. Now if you would like to debate that fact also be my guest, because that one is also stated in the regulations.

 

I'm very well versed with the regulations, thanks.

 

One does not need to use the callsign "Lifeguard" to request priority. One does not need to declare an emergency to request priority. One may be required to provide a written report any time priority has been requested, or granted.

 

ATC does not have the option of assigning a lower priority or denying priority to a Lifeguard flight. I've had it happen, oddly enough, in a few cases when ATC didn't fulfill their end.

 

I've also used Lifeguard to gain access to airspace for direct transit that were initially denied. I've overflown "Area 51" and cut through the test and training range during some busy red flag activities, thanks to some gracious cooperation by the military controllers, while using a Lifeguard call sign. I've been moved to the front of the line with 20 or more aircraft holding, and given priority for departures or arrivals. ATC is generally very good about it.

 

I've been present a few times when the President has arrived, an on almost every occasion I've stayed on the ground. On each occasion nothing moved during the TFR, although medical, fire, and other operations were authorized. The only aircraft in the air on the few occasions I've been present during a presidential TFR were the Presidents' aircraft. I did do medevac during the Olympics and flew when the President and Vice President were in the area, and we were under a VIP TFR. I was required to have a specific authorization and background check before being allowed to fly then, as did all our crew members. We had one pilot who was grounded because of that requirement. I very much doubt that I'll ever be in a position to require The President to delay arrival, but then a transit through the same airspace doesn't delay the President. The Secret Service isn't concerned that another aircraft is in their: they simply need to know what it is and that it's vetted.

 

I did have a return to base on one of those days in which we were stopped, and all of our equipment was removed from the aircraft, and inspected. They didn't question my decision to return, and I didn't question their decision to inspect.

 

There's no hero or "white knight" syndrome here. It's very basic. Emergency services, to include aerial fire, ambulance, and law enforcement, are there for a reason. An air tanker flying to a fire is generally afforded a direct route: it's going to a fire. One doesn't expect the air tanker to take a circuitous route back to the tanker base on a load-and-return to get more retardant, simply because it isn't carrying more retardant. The speed to the fire and the speed on the way back is part of the turnaround time that affects fire behavior, and is a big part of the reason that the tanker is being used. An air ambulance doesn't simply become vital after picking up the patient: it's ability to expedite to the scene or to the pickup point is vital, too. A heart team enroute to harvest an organ isn't simply on a lark until the heart is onboard. They're in a turbojet airplane going fast for a reason; they're a lifeguard flight on the way to harvest the organ, and they're a lifeguard flight on the return, too. I have never seen a case where this has been questioned, and one would need to be a bloody idiot to do so.

 

Likewise, a helicopter enroute to the scene of a multiple-vehicle incident to pick up a trauma victim at the request of a basic life support unit on scene is also a Lifeguard flight. They are not lazily taking their time getting to the scene. They are not without need of priority. If they were a ground ambulance, they'd be lights and sirens to the scene of an accident; the lights and sirens afford them priority on the ground, and in the air, it's done with the use of the Lifeguard callsign. There's really no need to question their status as a Lifeguard flight while enroute to pick up the patient, any more than there is enroute to the hospital with the patient.

 

After the patient has been delivered, there's room for judgement on whether subsequent flights are considered lifeguard operations or not. I've done it both ways. As far as I'm concerned, however, there's full justification for using lifeguard priority in getting back to a base, especially if the act is expediting the availability of the aircraft for the next call. In many cases, in fact most, air ambulance returns to the home location are not expedited, and priority is not requested. Again, as previously stated, the circumstances dictate.

 

I've already indicated that I've had flights with patients on board that did not constitute a need for priority, and which didn't use the Lifeguard call sign, and I've had flights that became a lifeguard enroute. I've also had flights that by technicality, the Lifeguard status could have been discontinued enroute, but for which I did not.

 

It's important to note here that pilots are generally discouraged from being involved with the patient. I don't want to know the patient's name, status, or condition, nor do I make safety of flight decisions based on the patient. One shouldn't. If it's not safe without the patient, then it's no safer with the patient, and the pilot's duty is to ensure safety of flight. With this in mind, the pilot doesn't get to make the call that the trip requires additional priority, generally: if the patient's on board, it's usually a lifeguard flight (hard to make that case for the actor with acne enroute to his dermatologist). When a high-level-of-care, rapid transport of a patient between the scene and care facility or between care facilities is needed, the time getting to the patient is just as critical as the time with the patient. One is a Lifeguard flight. I have no problem with the use of the callsign during that time, and I very much doubt you'll find anyone (official) who does. Someone has been the subject of enforcement action for using a Lifeguard callisign enroute to pick up a patient on-scene? I don't think so.

 

As for returning to one's base after dropping the patient, it's a judgement call (for which we're paid). There are certainly times when it's appropriate, and there are times when it's not necessarily so. I have no issue, however, with those who use priority in returning to their base, particularly when they're an active in-use resource that's available for another call.

[Fred0311]

I'll add the disclaimer that I know nothing on the subject but trying to follow your logic here, if a flight is lifeguard while return to base to insure availability shouldn't the actor with acne of been turned down? Because at that point it's not an emergency and it limits the availibilty of the aircraft for actual emergencies. Or for that matter turn down any flight that isn't necessary for survival since those are pretty much charter flights that could keep you from responding to the highway pile up or transplant case. And of course the pilot doesn't concern theirself with the patient status for reasons of safety so this would fall on the dispatcher I guess.

Edited September 11, 2012 by Fred0311

[nightsta1ker]

I'll add the disclaimer that I know nothing on the subject but trying to follow your logic here, if a flight is lifeguard while return to base to insure availability shouldn't the actor with acne of been turned down? Because at that point it's not an emergency and it limits the availibilty of the aircraft for actual emergencies. Or for that matter turn down any flight that isn't necessary for survival since those are pretty much charter flights that could keep you from responding to the highway pile up or transplant case. And of course the pilot doesn't concern theirself with the patient status for reasons of safety so this would fall on the dispatcher I guess.

 

Turning down flights is like turning down free cash handouts. Its up to the paramedics to determine if a life flight helicopter is necessary, not the life flight company. They are contractors. If they get the call, and they can execute the flight safely, they will take it. The company exists to make money. If they save lives in the process good for them. Now, if two calls come in, and only one aircraft is available, I am sure the decision will be made on which call should take priority.

 

 

[avbug]

We refused to transport the actor with acne. He threatened a law suit and was very irate; we told him point blank that we were available for patients in need and that he could quite easily charter a flight for his needs.

 

We did a lot of administrative transports involving moving someone from one hospital to another. Not all of them were life or death, by any means; far more aeromedical flights aren't, than are.

 

Turning down flights is like turning down free cash handouts. Its up to the paramedics to determine if a life flight helicopter is necessary, not the life flight company.

 

Actually, often it's not. The originating agency or personnel make the request, and the ambulance company responds. The request may have been a doctor request in a rural clinic, or it may have been a medic or law enforcement officer on scene.

 

Typically about 50% of ambulance flights actually pay. That is, about 50% don't actually get paid. It's illegal to turn down a flight based on the patient's ability to pay, but I've seen it happen a lot. I'd never work for an operator that engaged in that practice, but I worked in one geographic area in which we were the ONLY operator that always responded to requests. Others always prefaced their call with a request for patient insurance information. If they didn't like the payment potential, they'd call back and advise that the aircraft just had a mechanical issue, or was going on another call. I've seen it happen a lot.

 

We were financially successful even at a 50% pay rate, and still did the job for less than the competition. We went on a lot more calls, too. Reputation can help or hurt, and operators that were known to play the insurance and pay game got far less calls for medical flights than we did. I liked to think of it as what goes around comes around.

Edited September 11, 2012 by avbug

[Fred0311]

 

 

Turning down flights is like turning down free cash handouts. Its up to the paramedics to determine if a life flight helicopter is necessary, not the life flight company. They are contractors. If they get the call, and they can execute the flight safely, they will take it. The company exists to make money. If they save lives in the process good for them. Now, if two calls come in, and only one aircraft is available, I am sure the decision will be made on which call should take priority.

 

I understand it's a buisness but was trying to play devils advocate because the post I was responding to made it sound as if aircraft availibilty is the priority so it can save lives. If its being used for things other than saving lives availibilty isn't that much of a priority. But it is good to hear the prima Donna was denied his acne treatment.

Edited September 11, 2012 by Fred0311

[tracon]

I'm very well versed with the regulations, thanks.

 

ATC does not have the option of assigning a lower priority or denying priority to a Lifeguard flight. I've had it happen, oddly enough, in a few cases when ATC didn't fulfill their end.

 

Oh So Wrong~

 

FYI: your knowledge of the regulations are rather lacking since your claiming ATC didn't provide you with the "Lifeguard" priority handling you requested and was wrong in doing so..

 

"Lifeguard" aircraft can be and are assigned a lower priority based on two separate scenarios listed in the regulations and ATC doesn't need to know what's happening in your aircraft when doing so. It's clear your not as well versed in the regulations as you preach and are unaware of the the very reason you didn't receive priority handling in accordance with the regulations.

 

As I've stated before I'll let you look up and read the regulation, because in doing so it becomes a teaching moment in which you'll learn why you didn't receive priority handling as "Lifeguard". Plus being forced to research and find the information yourself it will hopefully become committed to memory making you a more knowledgeable pilot.

 

1~ Can I deny Lifeguard status? NO

2~ Can I assign a lower priority without knowledge of whats happening in the aircraft? YES

 

Enjoy your day and flame away

[avbug]

As I've stated before I'll let you look up and read the regulation, because in doing so it becomes a teaching moment in which you'll learn why you didn't receive priority handling as "Lifeguard".

 

Were you there? You don't know why I wasn't given priority. There was not an aircraft in distress being given priority, and a high traffic flow didn't preclude giving me priority.

 

As I said, in most cases, ATC is quite accommodating. Not all.

[tracon]

ATC does not have the option of assigning a lower priority to a Lifeguard flight. I've had it happen, oddly enough, in a few cases when ATC didn't fulfill their end.

 

I didn't need to be there nor would any other controller or knowledgeable pilot familiar with the regulations, to know your quote shown above is false.

 

Making false statements like this shows a lack of understanding of the regulations, the atc system or a combination of both and is misleading to student pilots that frequently read these post.

[avbug]

When an aircraft in distress is not a factor and traffic congestion isn't a factor, ATC doesn't have the option of assigning a lower priority to a lifeguard flight. It's happened.

 

I've had the same thing happen enroute to a fire.

 

Again, ATC is usually very good about it. Not always.