SQ221 Air Med One?

[flightleader]

In the wee hours on 17th July,I overheard rather interesting radio calls on MEL VHF. SQ 221 requested medical assistances upon arrival and priority for arrival.Estimated position of SQ was near Leigh Creek(LEC).A series of calls were exchanged and the lady controller reckon SQ would arrive SYD before curfew is over.Here is a bit of it:

Lady controller:" SQ 221,are you declaring Air Med One?"
SQ:" Err...is it possible?".

After abour a minute of silence,

Lady controller:" SQ221,are you declaring Air Med One?"
SQ:"Err........"
a/c A:" You got to be joking!"
a/c B:" Just declare it!"
SQ:" Other stations,mind your own business!"

The whole conversation made an impression that SQ had an urgent medical case on board but very reluctant to declare an emergency.Below are my questions,hope someone in the know could shed some light.

1) What is 'Air Med One'? Went through the Australia AIP but found nothing about that term.
2) Would 'Air Med One' condition overide a curfew without penalty?
3) At that position,wouldn't it be better to divert to MEL since it is nearer? Not questioning the crew decision here but as a point of discussion where $$ versus human life?

[Capt Claret]

Probably meant Med One - life saving type transport. Whereas Med Two is returning medical staff etc from a life saving type mission.

It's in the AIP, somewhere.

[SM4 Pirate]

So, did they go to MED 1?

SQ221 often (If I'm thinking right) has curfew "fringe" dispensation and can land between 5am and 6am on RWY 34L; but at MED 1 status I suspect they can land before 5am.

I would also suspect if they were closer to AD or ML than SY, declaring MED1 would initiate a diversion; so it's possibly a little more complicated than just saying "affirm MED 1". But if it truly were a MED 1 scenario and they didn't declare and divert then they could and should IMHO be found to be negligent.

The only thing that has higher priority than MED 1 is another MED 1 in front; usually we give as much track shortening as safely possible and cancel all speed restrictions etc.

[flyinggit]

The only thing that has higher priority than MED 1 is another MED 1 in front; usually we give as much track shortening as safely possible and cancel all speed restrictions etc. Today 03:47

I thought I read somewhere that MED 1 wasn't the highest priority. A/C in distress or perhaps hijacking had greater priority over MED 1. When you think about it MED 1 might mean a single person is in need or urgent assistance, an A/C that could crash (for various reasons & therefore would be in distress) could have a possible result of many in need of urgent assitance.
Just mt thoughts that's all

FG

[Howard Hughes]

The only thing that has higher priority than MED 1 is another MED 1 in front;
I thought Heads of State had priority over Med One!;)

[The Voice]

crikey Flyingit ..

that'd be a bad day for any controller if all that was happening at once!

It's in the AIP, somewhere along with the disclaimer, nothing in [the book] precludes the use of common sense by an operator .. or some such similar wording ..

[idb]

I was working a downstream sector for that flight and can shed some light. As part of the sequenced arrivals system for Sydney, early arrivals (not curfew dispensated) are issued feeder fix times at around 4am local in an attempt to ease congestion at the 6am open doors at YSSY. Even though SIA221 is curfew dispensated, they were running late , were arriving post 6am and therefore caught up in the sequenquenced arrivals program. Their alotted slot time meant a 10min slow down from their estimate for the feeder fix. When issued with their fix time (somewhere over Leigh Creek) the crew stated they had a sick passenger & had organised an ambulance through company channels to meet them on their arrival and could they get some priority reference their ten minute slow down. This was their first mention of any sort of onboard medical issue to ATC. As they were part of the sequenced arrival program to jump the queue they needed to declare their MED1 status if the situation required it. If not the ambulance would still be there 10 minute delay or not. This is what the controller was trying to solicit from the crew. A declaration of MED1 status was all that was required but it was akin to pulling teeth and the frustrations of others on freq became too much for them to contain themselves.
The crew subsequently declared MED1, where given appropriate priority, tracked direct YSSY, the sequence was rejigged, other arrivals were delayed to make room and all was sweet with SIA221 arriving 15 min earlier than scheduled. The system worked. All that was required was for the captain to declare the MED1 status.:ok:

[Howard Hughes]

You are indeed correct flyinggit aircraft subjected to unlawful intereference are the HIGHEST priority, followed by:

-Multi-engine aircraft that has lost an engine.
-Aircraft with radio failure.
-An aircraft which has declared a 'Mercy Flight'.
-Aircraft involved in SAR, 'Med 1' or under a 'Hospital' callsign.
-An aircraft operating under a 'Polair' callsign.
-Heads of State.

Then...
You lot in your big shiny jets!;)

Source : AIP ENR 10.1

[SM4 Pirate]

You "Terry Technical types" are unbelievable... I stand by what I said and the day I get a Hijack is the day I'll reconsider my priorities... geez. As for aircraft you can't talk to or ones likely to fall out of the sky, well durrrrrrr!

[Howard Hughes]

All that was required was for the captain to declare the MED1 status.
Interestingly on an aeromedical flight it is the medical crew who decide the medical status of the flight, the captain merely relays it to ATC!;)

PS: Do I qualify as a 'terry technical type'?:}

[desmotronic]

Interestingly polair only has priority when category red or where life is at risk, sure doesnt stop them trying though. Can remember plodair one evening after EN TWR was closed getting totally bent out of shape when told by ML to wait in the queue to get into EN CTR. Very unprofessional i thought and the nice lady controller wasnt having a bar of it! :}

[idb]

Forgot to mention that the aircraft was the A380 so his choice of alternates was limited. Even though they were only 250nm from Adelaide I don't believe it has been upgraded to A380 status leaving only Melbourne & Brisbane as the other alternates. At the time of the MED1 declaration I think it was about 650nm (direct) to Sydney and about 500 to Melbourne.

[Metro man]

Wasn't a good night up north either, Jetstar into DN requested an ambulance on arrival.

[fourgolds]

This type of exchange is indicative of a bigger problem.
While I have the utmost respect for our controller colleauges I have noticed a trend ( and particularly in the mentioned country) , where some controllers have a firm grip of the non essentials.
I reckon 90 % of foreign crews ( if the story you relate is correct) would have said ( what the F%^K is Air Med One ?) , and off course the next 10 min spent would be a useless banter between crew and atc ( when we all know what we are trying to achieve)

I guarantee you I can pull out little "notes" like this from every single country's AIP. The question is not one of trying to get things text book perfect and procedurally 100 % correct. Its about solving the problem, often referrred to as the big picture.

If the crew are struggling to understand your "code" and you are worried about litigation or procedure , then just say it in plain English !

" SQ Bla Bla , To give you priority handling for a medical emergency I require you to declare a medical emergency. "

"SQ Bla Bla .Thankyou ( non standard) , we are declaring a medical emergency.

As an Industry we are so busy dotting the (i) and crossing the (t) that no one is reading the sentence !!!

[max1]

I think you will find she was probably saying "Are you declaring a Med One" not "Air Med One".
Its not that unusual. Probably get 4-5 a year inbound from the Pacific and Tasman.
I check whether the sick one is a Kiwi, and if so put them in a holding pattern for a while :E

[oldbull youngbull]

"SQ 221,are you declaring Air Med One?"

Bit like asking Emirates if they require Rwy 34 or are they just requesting it. If you don't give it to them and something happens your ar$e is grass, just give it to em. Common sense really.

They've got a sick pax, they've organised an ambo...... Ahhh better get it on tape that they are med1 before I clear them. Ar$e guarding at it's worst :ugh:

[fourgolds]

Old Bull indeed , my point exactly.

[neville_nobody]

They've got a sick pax, they've organised an ambo...... Ahhh better get it on tape that they are med1 before I clear them. Ar$e guarding at it's worst

Yeahs that's all fantastic until something goes wrong and it goes to court. If you can stand up and say I did it as per the manual you are untouchable. The minute you start making stuff up you will get hammered and possibly sued.

Unfortunately that is just the way it is in today society. Yeah it might be arse guarding but the risk to do otherwise is really to great.

[LeadSled]

Neville Nobody,

Izzatso ---Not really, with all due respect I refer you to the Advance Airlines crash on runway (now) 34L at YSSY, and what the subsequent inquiry/legal action thought of the controller's actions, when the aircraft Captain said everything but "mayday".

A pedantic reliance on "the book" does not override a requirement for a proper exercise of professional expertise and judgment ---- and this applies in any field, not just aviation.

The "Nuremberg Defense" in not exactly a reliable defense.

Tootle pip !!

PS: Unfortunately, in particular when they find out otherwise the hard away, and very commonly in the Australian aviation community, many people believe your statement is an accurate description of the legal position.

[ferris]

As someone who "plain speaks" regularly, I think a few things need to be said. I can plain speak, because I am allowed to. In oz, it's not that simple. The situations we are talking about are not the big, standing in court after a mid-air type scenarios, they are the daily minutia that gets your arse in trouble on a local level ie. with your boss. If you don't follow the book, then you expose yourself to the range of being told off, formal recording of your transgression (which might bite you later on), disciplinary action or even dismissal. All on a local level. It's the culture in AsA. Before anyone starts with the "just get the job done" drivel- it'd be nice, but it's not the way things work. If your company SOPs say that you must fly the ILS if it's available, and you decide it would be nice to hand fly the arrival every now and then, what is going to happen to you? I'd hazard a guess at; any of the results previously mentioned. Having said that, there is a notable over-interest in the minutia (standards checking) in oz (IMHO). The reason being that there isnt a lot to pick on, so the culture is pretty tiresome.
Add to the mix a propensity for the ever-increasing practice of making statement's like "we are a bit low on fuel" "we have a sick pax" "we are running late, can we...." If ATC is expected to take the "just see the big picture and help out approach", pretty soon everyone is going to very pissed off with guys who seemingly can't manage their fuel getting the 'no delay, straight in' every time.
Priority declaration requests are standardised for a reason. The ATC who is making decisions based on what you tell him, is in the same boat as the Capt who has to weigh up the ramifications of declaring emergency. What seems "anal" stems from the same culture that has pilots fearing fuel emg declarations.

[fourgolds]

Lead Slead , well said . Again my point exactly.

[BuzzBox]

I completely agree with fourgolds. International operators wouldn't necessarily know what "MED1" means. They operate all over the world and can't possibly know every local procedure and phrase used in every country they fly to. It's about time certain controllers (and ASA) in Australia made allowance for that reality and applied some common sense. All the confusion could have easily been avoided if the controller had asked "are you declaring a medical emergency?"

[KeepItRolling]

Fourgolds et.al.

See Ferris' post regards ASA culture: it is spot on.

Common sense has very little application in ASA and the controller, by applying local procedures was not only covering their behind, but following the training provided.

[fourgolds]

OK , so as controllers and professionals you agree. As always its easy for us to identify where the problems are. Lets be sollution orientated. I can only hope that professional conduct and common sense will prevail and I hope that we all know when to call the line and when to throw away the books/ beraucratic arse covering and get the job done.
Striving for mediocrity is not the sollution.
Air Crews are not exempt from this mediocre behavior either. I continue to see exactly what is being discussed manifest itself in flight decks , as crews also make decisions in favour of covering their arses rather than allowing common sense to prevail. The "Fear culture" and "Big Brother" culture that is modern aviation is a very real threat to safety in itself.

The worst example I have heard of this is of a well known Australian Airline (that occured a few years back) was preparing to ditch off Perth as the city was fogbound and below cat 1 minima and they had no fuel to go anywhere else. Had it not been for a positioning crew member who told them to Autoland off a Cat1 ILS beam( without any protection and certification and breaking every bloody rule in the book) we would have had a ditching!!!

Blindly following rules and procedure is a huge threat. Common sense is the professionals burden. Doctors , Architects , Pilots , Controllers etc fit into this group for a reason. They are accountable people, may common sense prevail.

[Moniker]

Blindly following rules and procedure just a devils advocate comment here - isn't that what all the sim and drill stuff is for though? So that when in an emergency your focus is 'automatically' narrowed down to a particular course of action, which makes anything peripheral that much harder to focus on (think of?) .

[Keg]

Hard to make an assessment without all the information but it's serious enough to warrant an ambo but not serious enough to warrant a diversion. Can't have been that sick which would normally indicate to me that a slow down of ten minutes isn't going to be a major drama. What was the weather like in ADL and MEL? Reasonable for a diversion?

Another day in aviation I guess.

[Condition lever]

idb

Perhaps you might provide some further guidance from MATS.
I've just looked through AIP with no real luck in finding anything relevant.
Personally I think the ATC really confused the issue.
From my limited knowledge, MED1 (or Air MED1 or whatever else you want to call it) is something annotated on your flight plan prior to the flight.
What she should have asked for (and what the captain should have done from the start) was delare a PAN due to a medical issue with the passenger.
I get completely sick of the Yanks not using ICAO procedures - it is happening more and more here as well.

[Back Seat Driver]

Seems the Singapore AIP is the same as ours in respect of notifying urgent situations.
http://www.caas.gov.sg/caasWeb/export/sites/caas/en/Regulations_And_Guidelines/Rules_and_Regulations/ATS/AIP/enroute/enr1/ENR1.1.pdf?__locale=null
(Bottom of page 15)
9.2.2 The pilot also retains the option of initiating the communication using the urgency call “PAN-PAN” 3
times to alert all listening parties of a special handling condition which will receive ATC priority for
issuance of a clearance or assistance.
Why the SQ crew didn't advise ATC in the appropriate manner of a medical situation that would give them priority, was as unfortunate as why the Aus ATCer was asking if they were declaring "AIR MED 1", which had me looking it up in the AIP. (never heard of it before, but it is in the AUS AIP, though I doubt to be used as RT phraseology). As Condition Lever says, how about we all sing from the same Hymn Book.

[Capt Claret]

Condition Lever

When flying Airmed for NTAMS it occasionally happened that the routine transfer would upgrade to Med1. This was extremely helpful in bypassing military routing requirements around Tindal and Darwin

[Condition lever]

CC

Sure - you were a med cat a/c already - different situation.
RPT should declare a PAN.
Pretty dissappointed with the Australian ATC in this instance.
Completely confused the issue with non-relevant terminology - IMHO.

[bushy]

If innappropriate, rigid rules are applied in a case like this, and this is harmful to the patient, I believe the courts would not be sympathetic. People are expected to be able to think, and to do it. Not helping,because of a technicality could be construed as obstruction.
I sympathise with the ATC'ers who have to risk their jobs to do the right thing. I have had to do that myself more than once.

[toolish]

I thought med1 and 2 where reserved for RFDS etc, if you have a medical emergency then tell them that "we have a medical emergency and require......"

[oldbull youngbull]

The minute you start making stuff up you will get hammered and possibly sued.



Nev, OK, in the above scenario, what of my actions would you sue me for?

Blindly following rules and procedure is a huge threat. Common sense is the professionals burden. Doctors , Architects , Pilots , Controllers etc fit into this group for a reason. They are accountable people, may common sense prevail.


Yep! Agree. I'm willing to account for my actions in these scenarios.

At this stage of my career I reckon I'll take my chances with ASA if they want to 'go' me over non-standard phraseology and the use of common sense :ok:

[Veruka Salt]

Fourgolds post summed it up well.

The SQ crew would have no idea what "Med 1" or "Air Med 1" means, nor would most foreign airlines flying into Oz (my own employer included).

[neville_nobody]

No everything will be fine if everything ends happily. Which in aviation is about 99.99% of the time. It is the 0.01% time when you may end up in court.

In this example say the person died on board and it was deemed by the coroner that if they had flown at max speed and no delay the person's life could have been saved. That is when they will start going through things with a fine tooth comb and asking why wasn't procedure followed which could possibly lead to lawsuits.

For those who are arguing for a laissez-faire approach to following rules are you seriously telling me that if by your actions or lack thereof a lawyer isn't going to be putting you on the stand and asking if you are familiar with the company's manuals and if you are why you didn't follow what is written even though there is a copy on your flight deck?

Now my point is that if you did as per the procedures you can then point the finger at the writers of the manual or whatever. If however you did your own thing you are basically on your own. You will have to be explaining why you did what you did and what tested methodology you used to come up with that decision. Can be done but it will interesting to say the least.

For those talking about a Nuremburg defense not being applicable after a read of wikipedia it would seem that it would be after a particular ruling in the USA.

[dodgybrothers]

toolish, I agree. Ambos and rfds I thought were the only ones able to declare that category. But, obviously there is some room to move.

[FL400]

Has anybody here thought to read the docs?

A quick browse of AIP and the CARs reveals:

MED1/2 is not restricted to RFDS: MED1 is for transporting a sicky or proceeding to pick up a sicky, MED2 is returning medical people after transporting a sicky.

9.2.2 The pilot also retains the option of initiating the communication using the urgency call “PAN-PAN” 3
times to alert all listening parties of a special handling condition which will receive ATC priority for
issuance of a clearance or assistance.

The above paragraph is indeed in the Australian AIP under the title Weather Diversions so doesn't relate to this situation.

PAN should only be declared when there is a threat to the safety of a flight, ship or person on board or in sight of the aircraft (no mention of medical contidions... unless their condition threatened the aircraft e.g. instantaneous combustion)

Mercy flights are for flights where life is at risk and compliance with regulations is not possible. Where compliance is not a problem, aircraft should declare SAR/HOSP/FFR/MED - these aircraft will be afforded priority by ATC.

HOSP (Hospital aircraft) is a for international aircraft where carrying an ill passenger.

I think the docs are your friend ;)

As to what response you'd get from an international by saying 'are you declaring yourself a hospital aircraft?', well I have no idea.

[Back Seat Driver]

You are slightly in error. If you re-read my earlier post you will see that the AIP ref 9.2.2 is from the Singapore AIP
This was to demonstrate the same requirements re AUS v SIN. But as you say, it or similar, appears in the Australian AIP, and indeed it does in the Weather Deviations section you refer to.
However may I also refer you to:
AUS AIP GEN 3.6_ 6.6
6.6 Phraseology. Standard phraseology exists for the declaration of abnormal and emergency operations, ie PAN and MAYDAY. Pilots are reminded that timely use of these phrases will get the level of response required. The use of non-standard terminology can lead to misinterpretation of a pilot’s requirements. This does not preclude ATS requesting confirmation of a pilot’s requirements.

The SQ flight was an RPT flight, it cannot be nor ever was a SAR/HOSP/FFR/MED flight due to the very nature of it being an RPT flight. If the Flight required priority handling then the only proper thing for the crew to do was to declare the PAN.
(Of course the proof in the pudding would be if on arrival at YSSY, did they unload the sick pax into the ambulance as a priority before unloading all the other pax?) - I don't know.
As you say "the docs are your friend" - maybe you should take them out to dinner more often.

[FL400]

Okay I'm learning quite a lot here so if people don't mind I will keep this discussion going.

Checked out GEN 3.6 para 6.6 and the bit you quoted. My only problem with this (and I would be interested in yours and others' views on this) is that it only mentions 'abnormal and emergency conditions' which I take to mean as they are alluded to in the CAR section on MAYDAY/PAN/SECURITY. The CARs say that PAN is only to be declared when the safety of the aircraft, ship or person on board is in jeopardy.

Also why can a RPT flight not be SAR/HOSP/MED/FFR?

The docs are not your friend when you take them out for dinner - they never pay their fair share and you end up with bolagnaise sauce throughout the most used pages.

[Back Seat Driver]

From AIP Definitions: as you are already aware-
Medical Flight: A flight providing transport of medical patients, personnel, and/or equipment, prioritised as follows:
MED 1: An aircraft proceeding to pick up, or carrying, a severely ill patient, or one for whom life support measures are being provided.
MED 2: An aircraft proceeding to pick up medical personnel and/or equipment urgently required for the transport of a MED 1 patient, or returning urgently required medical personnel and/or equipment at the termination of a MED 1 flight.

see AIP ENR 1.10 Flight Planning, Appendix 2 (top of AIP page 614) it says
STS/ for special aircraft handling; eg, STS/MED 1, STS/MIL SPEC REQ.

MED 1 etc. is an entry on the flight plan to notify ATC as quoted above.
It is the reason for the flight. (just as an RPT flight remains an RPT flight even if somebody gets sick and requires urgent medical attention). On an RPT flight with an ill pax/crew on board, a decision is made as to the actions required to safeguard that persons well-being as much as is possible within operational limitations. If that decision requires ATC to provide the aircraft with additional services or priorities then the appropriate method of advising of those requirements is with a PAN call. You then bypass the queue for priority handling.
It is a formality to advise ATC of your need for special handling.
regards

[Awol57]

This is probably one of those instances where you are used to doing one thing so perhaps ask the wrong question. I deal daily with MED1 and MED2 flight both planned and upgraded on the run (the responsibility rests with the captain to determine the status). I work at a tower and deal primarily with RFDS and a rescue helicopter. If someone had a sick person on board I would probably straight away ask if they needed MED1 priority as that is something I deal with day in and day out. If that caused some confusion maybe I would then go back and ask if it was a medical emergency etc etc.

I guess the point I am trying to make is, that I am sure the controller wasn't trying to make life hard, but if he/she deals with MED flights frequently, that is the first thing that will pop into mind.

EDIT: Back Seat Driver posted as I did. I have often had flights upgrade (and downgrade back unfortunately) to MED1 in flight or whilst taxiing. These haven't been prefixed with PAN though each instance was a RFDS or RESCUE helicopter.

[Back Seat Driver]

I personally have nothing but the higest regard for our ATC Bretheren, and understand your concerns 57.
The point of this thread, to me, is that SQ221, as a foreign carrier would have had no idea what "AIR MED 1" meant, and hence the confusion on the night. I've had my share of medical emergencies on long haul RPT services and the term was new to me. (never had the fortune to fly for the RFDS etc.) By the same token PAN PAN has absolutely no meaning in the United States. They would just ask if you are declaring an emergency ie. medical/ low fuel or whatever.

[oldbull youngbull]

Nev,

Your subsequent posts get harder to understand?

On another note, there is a big difference between speaking english and speaking Australian. I would not like to be in the ATC's shoes who did not direct track an aircraft and a pax died, all because the aircrafts techies did not utter the magic words. (whatever the magic words are, depending on which country you are transitting).

Now I don't think techies would tell you they had a sick pax onboard if they were referring to a person who had a cold.

My point: I'm not asking techies for a diagnosis or prognosis, you tell me you got sick pax, you go direct wherever you want. It's then up to your company to justify your actions and I'll be quite happy to justify mine. :ok: