Some very wise words indeed on this very emotive topic.
I am a flight medic with a substantial amount of time in the role, and a pilot as well; based in Australia. The biggest risk I see is the 'Mission Focus', which I have seen in the Community based helicopter services (compared to the Government operation). These community based machines have some commonality with the US EMS model, in that their income is task-based - they charge a fee-for-service, the more they fly, the better the income stream, the less they have to dip into donations or contract fees for wages and other costs. They are also more cost-aware, operating to a lower budget with less-ideal aircraft
The idea that 'We have to go' has several facets.
'The community expects...' ie the community funds the machine by donation or subscription and they expect to see it working; or when Mrs Bloggs boy Joe breaks his watchcamacallit there is a perceived expectation that the 'community' machine will be there 'saving lives'. Reality is that the 'community' per se doesn't particularly give a rats bum about how much the machine flies. Some major sponsors would have an interest, but the organisation should be keeping them informed of the realities of the show rather than fantasizing to try and 'sell' the 'product'.
'We save lives'...the whole 'life-saving' thing in an aeromedical sense is mostly nonsense. Rescues - certainly, the flood rescues in 2011 demonstrated the unique value of RW assets in that setting, but aeromedically, not so much. Fact is after 20+ years in the emergency medicine game, I can say with a degree of authority that while pre-hospital provision of medical care does reduce pain and arguably decrease morbidity and length-of-stay in hospital, true life saving is pretty rare. True life-saving in aeromed even rarer. What does make a difference is decreasing the time taken to get a person from a scene to definitive care and RW can do this - but often it is as quick to road as it is to fly and much less delay in packaging and preening. In more remote areas, FW is more often the better choice to get to a suitable centre. Why is there so much inter-hospital stuff done by RW in the USA? Wouldn't road transport be much cheaper and easier?
'Time is critical' yes, but not THAT critical. In my organisation, the initial medical decision revolves around firstly what level of care is required (medical team [nurse + doctor], +/- paramedic, +/- specialist [surgeon, anaesthetist, obstetrician etc], then the platform best suited to the circumstances (road ambulance, boat, FW, RW). Once a decision is made on that basis, then the go / no-go is purely the pilots decision. It is a simple matter of 'Is the flight able to be completed safely' when all the operational aspects (weather, range, light, etc) are considered. The patient condition does not come into it; there are no variable levels of safety (those "I would go for a critical child but not for a sprained ankle" scenarios). Once a 'Go' decision is made, the only additional considerations that are made is the urgency of the departure, whether there are any flight & duty time constraints and whether the urgency of the task means it is acceptable to exceed them. The medical crew does not engage in any Go/No Go discussion with the pilot as has been alluded to in this topic, that is the pilots job; just as the pilots don't put their two cents worth in about the medical aspects of the task. I cannot conceive of debating a no-go with a pilot as someone suggested in this topic of we 'primadonnas in the back'.
If only we had NVGs / Twin turbines / Autopilots / yada yada. Drawing a line operationally about what the aircraft and crew can and cannot do needs to happen well before the tasking comes in. All aircraft and all operations have limits. Sometimes you have say no.
As far as shift work goes, we do 4-on, 4-off (2 days 0700 - 1700, 2 nights 1700-0700) and it works well for us. We also have a no-blame fatigue system where any team member can elect to call in fatigued without discussion on causes. Better to suck-up some inconvenience in rostering than have a crew member working fatigued in an environment as unforgiving as aeromedical,
A very difficult and contentious topic is HEMS; many issues, many egos, a long way to go before any real solutions I think.
Last edited by Al Fentanyl; 7th Jan 2013 at 15:13.