Incapacitated Persons-on-Board an Air Ambulance

[Pierre Argh]

The Air Ambulance based at the airfield where I work had been scrambled on a "Red Call"... then after picking up one, suffered an engine problem and diverted back into us for a precautionary landing...

All down safe and well; then afterwards the Fire/Rescue Team Commander commented that it would have been "extremely useful" for them to have known that one of the persons-on-board was incapacitated (stretcher case and on drips) as, had the aircraft crashed, their approach/rescue strategy would have been different.

We have locally agreed a procedure where the air ambulance crews advise us when extra passengers are stretcher cases etc... and are trying to spread this "good idea" further around the Helimed/SAR world... any thoughts?

[SilsoeSid]

Wouldn't the aircraft be using the suffix 'A' on the call to ATC.
(I dont know which country you are in.)

Perhaps ATC should have passed it on!

But as I can see your profile says Occupation - ATCO. I suspect the reason you blame the aircrafts crew is fairly clear.

:rolleyes:
SS

[Farmer 1]

"Communication", that's the word. Prevents all sorts of problems.

[Pierre Argh]

Silsoesid... a serious post, not an attack and your response is a bit heavy?

Yes the pilot does adopt the callsign suffix A... but he uses that from initial scramble, through pick and until drop-off at hospital... so in itself it is no indication of the status of the patient.

Indeed ATC passed on the number of persons onboard to the crew commander but had no information on the state of the patient.

Get the chip off your shoulder... why I should blame the crew I don't know (please enlighten me to the reason?) I never mentioned the pilot's part in this... but would add that in the post-incident discussion he agreed totally with the point that was being made, and has been instrumental in spreading the word across his company....

I draw you attention to the post that followed yours... thank you Farmer 1... "communication, that's the word, prevents all sorts of problems"... didn't they teach you that in the Army, Sid?

[SilsoeSid]

WOW :ooh:

Now there's something to chew on.....right then.

In order.

Are you unaware as to the normal crew composition for the air ambulance working your area?
Here (UK) it would normally be 3 so information about an incoming Air Ambulance with suffix 'A' with 4 pob should spark something like, " A passenger on an Air Ambo 'A', must be a casualty."
Sid says - Expect the worst!

You said "why I should blame the crew I don't know (please enlighten me to the reason?)"
But your locally agreed procedure is for the crew to now inform you of the status of the casualty. Therefore, you saw the fault/problem being in this case that the crew did not inform you in this incident of the casualties status. To be honest, who would?
Sid says - If it had crashed, I believe you'd be talking a different kettle of fish anyway which pales that side of the argument into insignificance.

IMHO Farmer1's post of ""Communication", that's the word. Prevents all sorts of problems." Could be construed
as meaning that ATC, ie YOU, didn't spark on this occasion!


"communication, that's the word, prevents all sorts of problems"... didn't they teach you that in the Army, Sid?
Sid says - I don't think that message ever got passed on. :ok:


;)
SS

ps The ATC people where I am are the finest and most helpful around, so I have no axe to grind on that one my friend, before you go off on that track.




Just realised on the way up the stairs, the thread title,

Incapacitated Persons-on-Board an Air Ambulance


Silly me :rolleyes:

Nice one Pierre. :ok:

[Farmer 1]

Sid,

Please, find a darkened corner, sit down, take a few deep breaths, and count to ten.

Pierre is not pointing any fingers here, he is merely trying to prevent a preventable event from happening again.

Quote:

"...are trying to spread this "good idea" further around the Helimed/SAR world... any thoughts?"

In my first post, I made the subtle hint that the simple answer might be to improve communications, which was why I mentioned the dreaded word. In the incident referred to, I guess the pilot informed ATC of his POB, but I suggest he should also have mentioned the fact that it included one patient on a stretcher.

I have never flown an air ambulance, and the A suffix is new to me. However, I do know that on occasion, the aircraft position ambulance crews and others to bases where they are short staffed, so an extra person on the POB list does not necessarily mean there is a casualty on board.

Is it the job of ATC to query the state of health of those on board, even with an air ambulance? That question is debatable, but in the event, there might not be time enough to ask the question. The thing is, there should be no need, he should know the answer without having to ask it.

Everyone, most of all the rescue crews, need to know the facts - all of them. Communicate - that's the way to do it.

Quote:

""communication, that's the word, prevents all sorts of problems"... didn't they teach you that in the Army, Sid?
--------------------------------------------------------------------------------

Sid says - I don't think that message ever got passed on."


I think that says it all.

[NickLappos]

Yes, I suppose knowing this would have made his job easier. But so would knowing, ahead of time, how many of the capacitated would be injured in the mishap and would become incapacitated.

What about rescue involves not being able to deal with stretcher patients?

Sounds like he will next ask that you to be sure they had an orange vest on, IMHO.

[John Eacott]

Sounds like he will next ask that you to be sure they had an orange vest on, IMHO

Nick, surely you must know by now that that's absolutely mandatory :p ;)

[BigMike]

Whats the big deal? Im sure the pilot would have given the total POB on board when declearing a problem, then concentrated on flying the aircraft. The condition of the patient was not that relevant at all, and something that was not a priority to pass on to ATC, when faced with a possible engine failure, and emergency landing.

BM

[SilsoeSid]

Farmer,

Nick and Mike are more concise than I am, and say it a lot clearer.

In an emergency the pilot MUST primarily fly the aircraft. Niff naff like telling the rescue crews about the crew composition and the state of the casualty comes way down the list!

If you have the ability to, all well and good, but when faced with an engine problem, pob should be enough and anything else considered a bonus, although probably irrelevant if there is a crash.

Surely a rescue crew would deal with the incident however it is when they get there!

One thing relavant in this case that I did learn in the Army, was that ;

'No plan survives contact with the enemy!'


SS

[Pierre Argh]

Mike, Nick, Sid your comments noted, just a couple of replies...

I am quite aware of the composition of the crew of an air ambulance, we have an excellent liaision with the local unit, but the unit uses the callsign suffix A from scramble to drop-off... so whilst it indicates the flight's emergency status, that alone is not sufficient indication of a casualty onboard?

secondly... the unit SOP is to pass POB every time it lifts, thus the matter of the pilot having more to think about (which I totally agree with) during an emergency is not an issue?

thirdly... the casualty on an A category flight might easily be "walking wounded". Of course, we would assume that any extra people above normal crew composition couild be a causalty... BUT the point made by the Fire Fighter was that he would use a different approach & rescue strategy if he knew in advance that there was an incapacitated person onboard. Not all crashes end in fatalaties, and this small change to SOP might, just might, improve the chances of survival... of both the casualty AND the firefighter?

Finally... Sid, I am angry that your, frankly, unhelpful responses have spoiled a thread that I started simply in the "hope" of spreading a good idea that we sincerely believe to be a Flight Safety positive measure... (an opinion that has been endorsed by the company providing the Air Ambulance Service)... but if you thought it a daft idea I'd have been quite interested to hear your reasoned arguement... I haven't heard any yet?

[SilsoeSid]

Pierre,

I think you may have mountained this molehill pretty well here.

To return to your initial post;

"All down safe and well; then afterwards the Fire/Rescue Team Commander commented that it would have been "extremely useful" for them to have known that one of the persons-on-board was incapacitated (stretcher case and on drips) as, had the aircraft crashed, their approach/rescue strategy would have been different."

All I am saying is that if the aircraft had indeed crashed, then the Fire/Rescue Team Commander would have to assess the situation as it is once he/she reaches the scene and not pre-assume the condition of those on board.

A 'walking wounded' casualty prior to the crash, could easily turn out as something else afterwards. Likewise, one incapacitated casualty beforehand, could also equally end up as many Incapacitated casualties. But you won't find out for sure until you get there.

Prior planning may well prevent p1$$ poor performance, but keep in mind the previous comment that no plan survives contact with the enemy.


As a Flight Safety issue, I think you may be taking this IMHO, too far.

When you said;
"BUT the point made by the Fire Fighter was that he would use a different approach & rescue strategy if he knew in advance that there was an incapacitated person onboard."

If there is a crash, don't they assume on the way there that the people on board are incapacitated anyway??
At least they did when we used to simulate an emergency/crash on return from a sortie in order to assist the fire crews in their training.


Yes, I agree, the local procedure is a good idea and hopefully crews can pass on the relevant information, if it is relevant, and there is the time and safe opportunity to do so.

The Flight Safety point to be made here is that in an emergency, the priority is for the aircraft to be flown.

My reasoned argument is this;
There is no point in getting the information across and then crashing the aircraft in doing so, as that information then becomes irrelevant.



SS

[Pierre Argh]

Sid

we seem close to agreement. I concur that hopefully crews can pass on the relevant information, if it is relevant, and there is the time and safe opportunity to do so.The Flight Safety point to be made here is that in an emergency, the priority is for the aircraft to be flown.There is no point in getting the information across and then crashing the aircraft

If you read my posts I am NOT suggesting a call as part of the emergency messge but passing it as a matter of course... then, for the sake of a simple, short additional RT call, made when all is under control... the Fire Crew have a bit more information that might be useful when it all goes wrong and save a life... there are no guarantees in a crash situation, and plenty of surprises...

I am sure the rescue teams keep an open mind approaching the scene, but removing a patient on a stretcher will probably requruire commiting an extra firefighter into the crash, and doing that early might just make the difference... seconds don't count in practices, but they do in real-life.

Question for Helimed teams... I know there are restrictions on aircraft equipment paramedics are allowed to operate... can they use the radio? If not, might it not make sense to train them to be able to put out an emergency message... makes CRM sense?

[TeeS]

Bonjour Pierre

“Egxx, this is Helimed xxA. We have carried out a precautionary engine shutdown and are returning to you for a single engine landing. Three crew and one stretcher case on board.”

Sounds simple enough to me and I can’t quite see why your post received so many heated replies.

Personally, I would rather do the radio call myself. It enables me to convey the level of urgency and also allows the crew to get on with their prime task of preparing the aircraft and patient for the landing.

Cheers

TeeS

[SilsoeSid]

Hi TeeS,

You forgot the main points from the title and initial post, "incapacitated (stretcher case and on drips)".

Because you could have a stretcher case fully 'with it' and not on drips,..... couldn't you?

So with your call, the Fire/Rescue Team Commander hasn't really gained what I think Pierre is after.

Maybe this is it;
“Egxx, this is Helimed xxA. We have carried out a precautionary engine shutdown and are returning to you for a single engine landing. Three crew and one stretcher case on board. Casualty is incapacitated and has 3 drips fitted, 2 of which are connected onto the roof of the aircraft and the rear paramedic is holding the other. 2 drips are inboard connected to the left arm, one of these is held by the paramedic and the remaining drip is connected to outboard, right arm.
Please repeat wind direction!”

:E
SS

[Brian Abraham]

This is a bit off thread but I was amused when I found communication only extends so far. When declaring a pan or mayday to be asked number of souls and fuel. Was left wondering why we put those details on flight plan.
Just a point of amusment. Good for you Pierre in asking the question - no such thing as a stupid question.

[SilsoeSid]

No such thing as a stupid question.
But there will always be a lot of stupid answers to provoke that thought process!!

;)
SS

[Farmer 1]

Sid,

Please take this as constructive criticism, which is what it is meant to be - you seem to have a problem with communication.

[SilsoeSid]

Pardon!!









couldn't let that one get away now could I?
:E
SS

http://www.unoriginal.co.uk/gallery/gallery2/signs32%20-%20Opinion%202.JPG

Just because it doesn't match yours, is no concern of mine!!

;)
SS

[Farmer 1]

Ah, well, I tried hard, failed miserably. I should make a good officer.

[diginagain]

Don't take it to heart Farmer 1. Sid might mean that the 'communication' failure may be more one of 'reception' rather than 'transmission'.;)

[HELOFAN]

Sorry not sure if I am in the adult version of Rotorheads......?

[ec135driver]

Gentlemen, Horses mouth here!

I believe I was the pilot on the flight in question (incident occurred on 09/08/05 at a large military/civil airfield in the SW)

I did not declare a patient because there was NOT one on board. We were 4 up instead of the usual 3 as we were carrying an observer (a senior A&E nurse)

Received excellent service from ATC and got a lovely warm feeling as the airfield fire service followed us down to our dispersal.

So there you are! that's what actually happened

Still I have to agree with PA that if anyone has a similar problem, a mention of the composition of the crew/pax may at least help the emergency services to prepare mentally for what they may have to deal with.

[SilsoeSid]

Excellent,

Thanks ec135driver for the true story.

It would appear that the breakdown in communication on this thread was the initial post!

"All down safe and well; then afterwards the Fire/Rescue Team Commander commented that it would have been "extremely useful" for them to have known that one of the persons-on-board was incapacitated (stretcher case and on drips) as, had the aircraft crashed, their approach/rescue strategy would have been different."


;)
SS

Unless of course Pierre is referring to a different incident, in which case I take this post back!(and also note a couple of AA engine problems around!!)

[RobboRider]

Speaking as a flight physician on a resue helicopter service for five years and one of those who would be coming to get aforementioned Incapacitated Stretcher Case plus any other crew who might be injured - this whole thread is a w:mad: k.

There is catagorically no way that knowing or hearing the words "incapacitated stretcher case on board" from the pilot is going to assit in being prepared for what might be found when the rescuers arive.

Incapacitated means nothing in a medical sense (it is not a "real medical word" it's a laymens term for something that means nothing or everything." It may mean a broken ankle through to a ruptured aneurysm. If it was going to make a difference you might like to know a hundred different details that actually mean something and then just as quickly disregard them when everything changes at the bottom of the slope.

"Stretcher Case" also means nothing (except maybe the rescuers can bring one less stretcher cos he has his own :-) since any patient of the above mentioned wide group will be on the stretcher rather than sitting in the seat. It was our standard practice to put almost all patients "incapacitated" or otherwise on the stretcher)

And what difference is there going to be in his condition (not to mention the crew) between one second before the impact to one second after the impact. Is the rescue crew going to change their equipment or their plan because one pax started out pre-crash already unwell).

As in inbound rescurer I would be interested to know there was a patient on board but really beyond that the rest is immaterial.

I suspect someone was having a bad hair day and needed a patsy to make a noise about.

Now back to some useful stuff!
:ok:

[Thud_and_Blunder]

Ah, but I'm sure everyone meant well. Probably. Even Sid :cool:

Could do with being stretchered off the aircraft here sometimes - it was 44 deg when I landed nearly 2 hours ago (it's 1130 now).

[SilsoeSid]

Crikey, 1130 !!!!

Is that Celcius or Farenheit ?

The planet orbiting HD46375 has an average temperature of 2070 degrees Fahrenheit (1130 degrees Celsius).
Source (http://science.nasa.gov/headlines/y2000/ast30mar_1.htm)

So now we know which planet you are on T&B!!
Unless you are based on a volcano as when magma escapes from the mantle it can be around 1130 degrees Celsius.

More than likely an early stack because of the temperatures and you are supping some vintage Elveden Ale! Because some had a gravity of 1130 degrees with an alcohol content of around 11.25%.
Source (http://www.beer-pages.com/protz/features/independents.htm)


:p
SS