Laws for ambulance missions

[aerobat77]

ahoi !

as we know many bizjet operators in europe offer ambulance flights with a medical crew and a patient on a stretcher. this works in many cases in such a way that a doctor or a rescue service is contracted for the flight , brings the medical equipment , checks the condition of the patient ( airworthiness) and is paid for this by the airline company which carries out the mission and bills the insurance of this person for the flight.

in most cases this works fine, however i cannot find any regulations in eu-ops for ambulance flights via aircraft. basicly an ambulance flight seems to be nothing more than commercial passenger transport.

on the other hand the airline company is in most cases not a certified ambulance service and i,m wondering if just hiring a doctor and transporting a person in serious condition that needs medical treatment during the flight is without any further regulation.

for sure the transport of people in a health condition that dictates doctor treatment is basicly something that needs an approval by authority.

who has the final responsibility for the patient ? the hired doctor, the airline company ?

further ,when airborne, eu-ops states clearly that finally the pilot in command is responsible for all souls on board, but how can he be not being a physician and so unable to judge the health condition of the patient on board?

hopefully somoebody can bring some light in it how its regulated by law .

thanks in advance !

[Pace]

Aerobat

I do know a little about this as I was asked years ago to repatriate a dying man from Spain by a friend and his family in a twin engined piston.
I was concerned and checked the legal position.

The Captain has a duty of care to the PAX able bodied or otherwise.
Ie if anything happens to said PAX The Captain could theoretically be sued even if the family of the dying man give permission.
The Captain removes that duty of care insisting that the medical world approve his transport.
They would stipulate what equipment needs to be carried, what medication, what level of on board care etc.
Ie the doctors take on that duty of care from the Captain by stipulating the conditions required for the flight. As long as those conditions are met that is all that is required from flying a normal flight.
In my case I refused the flight which was lucky as the man died two days later. With the extra stress of the flight trying to do a favor for the family may have meant a dead PAX!

Medical work could involve anything from someone with a fractured foot to a dying man who needs intensive care and equipment so each case is unique

Pace

[aerobat77]

thanks much for the input pace !

where did you checked the legal position about this ?

i think that it may be a difference by law when you transport a dying family member to do a favour for a friend in a private manner or when an airline company does this commercially with an official bill for the transport .

the big question is : an airline company does not need any further approval beyond the obvious AOC for commercial flying when carrying out intensive care ambulance missions ?

and further from a pilots view who is just employed by the airline company - as a captain i do not have any further responsibility for the patient beyond performing a safe flight ?

we perform often such intensive care ambulance ( commercially) , and on the last flight with an infant in an inkubator and the mom also onboard i discussed with the colleque that it would be most probably not very pretty when the infant would die infront the eyes of the mother and if i would get away with this as the commander of the aircraft when you truly land with a dead body .

common sense dictates i cannot take the medical responsibility for the child , but we both do not have a definitive answer what the actual law is about this.

[Pace]

where did you checked the legal position about this ?

Was dating a female consultant dermatoligist at the time at the local hospital and she checked it out for me with their legal department.

Pace

[aerobat77]

:E

indeed it would be sometimes from an optical point of view a great idea to nail the nurse after the flight and then let her check the legal position about all this ambulance stuff.

seriously - so the medical response for the patient is fully at the onboard physician , correct ?

[Pace]

Yes from what I gathered from her even an AOC who have a jet fitted out for medical work have to shift that duty of care to a medical unit (ie Doctor or Hospital)

They are not qualified to determine what equipment or care needs to be on board to carry a particular patient and some of that equipment may be very specialized as maybe the Doctors/nurses onboard.

so the medical response for the patient is fully at the onboard physician , correct ?

Whatever the Hospital/ Doctor stipulates regarding medication, equipment, Expert attention etc must be onboard for the flight to occur.
In certain situations there may not be any care required onboard for the flight other than a stretcher to lie on.
But the duty of care will have been taken by the hospital/Doctor to stipulate that and not by a medically unqualified AOC operation or Pilot doing the flight as a favor.

Maybe this should be in the medical section for a more detailed opinion?

Pace

[aerobat77]

Yes from what I gathered from her even an AOC who have a jet fitted out for medical work have to shift that duty of care to a medical unit (ie Doctor or Hospital)


thats how it is mostly done. but now we can start to question who is in fact the company which actually carries out an airborne ambulance mission .

the medical unit chartering the plane or the airline company chartering a medical unit ?

just hiring a doctor for a flight may be not enough, even when he posseses the needed equipment since being an approved medical doctor as a physical person does not mean he/she is an authorized medical unit when i understand it right.

[Pace]

Aerobat

Most of these flights will be insurance repatriation. I would imagine the AOC with an air ambulance jet would have it basically kitted out as such and would give a price for the jet and crew and flying side.

I would equally imagine that the medical side would be by specialized medical units who would supply their own price to complete the total price package for the flight?
I can remember flying to the USA where a section of a 747 at the back had been rented to transport a very sick passenger.
There was an elaborate amount of kit and two Doctors and a nurse.
I spoke with one of the Doctors who traveled around the place just doing aviation contracts.
Maybe someone who flies for an air ambulance can give more detail or correct anything I have said which is wrong?

Pace

[aerobat77]

Most of these flights will be insurance repatriation. I would imagine the AOC with an air ambulance jet would have it basically kitted out as such and would give a price for the jet and crew and flying side.
thats correct. in most cases ( at my company) an authorized medical unit is contracted for a given flight . the final bill ( aircraft + medical crew+equipment) for the insurance is issued by the AOC holder , the medical unit issues a bill to the aircraft company for its service .

in thic case the carry out company seems to be the AOC , not the medical unit.

we have just the stretcher , anything else , including physician and paramedic, is provided by the medical unit.

we talk business aviation ambulance flights with a turboprop , with mostly intensive care conditions, not stretcher transports in an airliner on a normal scheduled flight.

long story short conclusion : my main worry was if i, being employed at the aoc and acting there as pilot in command , am fully free of any medical responsibility for the patient on board.

but the clear and logical answer seems to be - yes.

thanks very much so far pace !

[Pace]

but the clear and logical answer seems to be - yes.

Yes because the duty of care has been transferred away from yourself to the medical unit.
When I looked into this it was for a very good friend who had a dying relative who s sole wish was to return to their hometown in the UK.
The family were happy to take the risk and give me a letter absolving me from any blame if the worst happened on the flight.
Infact even such a letter was not 100% watertight! The only way was for his Doctors to approve the transportation which they would not do so I did not touch the flight friend or no friend. He died the day after I was supposed to fetch him.
Ok mine was a non money making private flight but the principal holds true

Pace

[merlinxx]

check your in country bunch, great folks www.drf.de

[aerobat77]

drf is another story since they use mainly helicopters. helicopters used for rescue are under medical authority laws . so drf is a authorized medical unit for sure. simulatany they are holder of an AOC for their ambulance aircrafts .

thanks you all for the inputs !

[merlinxx]

Helios only, negative they op fixed wing also. I think I should know having supplied Int'l Flt Ops support to Deutscherettungsflugwacht Lears:ugh:

[aerobat77]

thats interesting . are you sure ?

so the learjet d-cccb is just painted in their colors but not under their own operation ?

Foto Deutsche Rettungsflugwacht Learjet 35A D-CCCB (http://www.flugzeugbilder.de/show.php?id=1162753)

[Pace]

Deutscherettungsflugwacht Lears

Merlin

I think if you can spell and pronounce that lot you would qualify for both roles :ok:

Pace

[gaunty]

Pace and others got it pretty right.

The AOC holder simply supplies the mode of transport and satisfied the consequent reasonable aviation safety protocols, it is the medical team who have the legal responsibilities for the patients health and wellbeing enroute. For routine transfers a responsible medical team will make a careful assesment prior insfoar as the patient is sufficiently stable before they accept medical responsibility and until this is transferred to the destination facility.

For real life threatening emergencies they must then make the difficult call the same way they do with regular ambulances in whether and/or when they move the patient at all.

It all gets messy if the aeromedical patient, (as distinct from a regular ambulance), expires en route which rarely happens as a proportion of flights, there is then the question of coronial jurisdiction. Not such a problem if it is intrastate but becomes so if interstate or overseas, given the differing legislation and protocols.

I suspect in these cases the patient is still technically "alive" when he is wheeled into the hospital emergency area. Keeps everything simple.

The elephant in the room is always the family who are desperate for their kin to be right, but have the potential to be pit vipers if it all goes wrong.

What does concern me and ther is a example extant at the moment is that the regulator appears to allow a lower standard of operation for medevac than for passenger carrying operations. Daily they, the public we consider to be uninformed, are being carried in non transport category equipment. my question I guess is are they or their family being informed that the equipment being used does not meet the same standards of the regular "public" transport. The regulator at last is moving towards removing the diferences and increasing the standards towards RPT, but in the meantime?

[transilvana]

Hi folks

Every country has different rules and exceptions to apply for medical flights, you should check yours. Normally, for medical evacuations, a doctor must be on board, company will sign a release of responsability form and flight will take place.

FTL will also be different, normally you get an exception approval letter from your CAA.

From my experience you never know what is going to happen on board unless there is a critical pax, with that you choose the best suitable airports on route that may have good emergency services nearby. In a couple of ocasions many years ago I had to divert and land, once pax was saved, on the other nothing could be done.

Also watch out for dead/alive repratiation pax. I mean when they try to scam you a dead pax that is supposesly alive because insurance covers alive repratiation but not dead one. I´ve had this once and a couple of colleagues had it too, and by the way, always Brits (sorry my beloved brits but it´s statistics 100%). Those are really good stories I can tell you for a beer,