What price a human life?
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What price a human life?
Recently I was tasked to complete a high priority medical job in my work as an aeromed. pilot. During the sequence of events that unfolded, I couldn't help but ask (myself) questions about the value we place on human life here in this country, and indeed in the 'Western' world, and the justification for this.
Put yourself in my shoes, and have a think about what you would have done, then put a loved-one into the patients place and see if you would change your answer or not.
I won't answer many questions on this one, but will post the eventual decision and outcome after some feedback.
Scenario:
1800 hours - Highest priority medical call advised to destination 'A', 400nm away.
A doctor is required to be carried in addition to the nurse, thereby reducing the fuel load able to be taken from departure airport.
'A' is an unsealed strip with no instrument approach or met reporting or forecasting facilities.
The area forecast indicates broken to overcast cloud over the greater part of the state, and local (to the departure airport) METARs indicate cloud and visibility below approach minima, let alone alternate minima.
The only suitable alternate for 'A' is 'B', some 500nm from 'A'. The departure airport isn't suitable as an alternate, as it itself requires an alternate.
Sigmets are current for severe icing. The SIGWX chart also indicates CAT along the track to and from 'A'.
The aircraft to be utilised is $X-million worth, and let's say runs 'crewed' at $2000/hour. In the LIKELY event that not only we do not become visual and land at 'A', but subsequently have to return to our departure point, and not getting visual, have to then continue to 'B', the bill for what looks very much an exercise in futility might be about $10,000. HOWEVER, in this eventuality, our complete crew would then also need to spend the following day in company funded accomodation (out of duty). The doctor, who is on call with the hospital local to the departure point, effectively becomes stranded away from his responsibilities, and with the pilot (me) then on days off, a second pilot (and perhaps entire crew) would need to be sent to take us all home, where the aircraft could be placed back onto standby, and nurse could go back on to duty that night.
Logistics then mean that the planned departure is delayed by 7 1/2 hours to0130, meaning should we 'launch', and end up as outlined above, it will be a max duty shift, and potentially either a duty overrun, or mercy flight due to extended duty.
During this delay, word is passed that there has been in excess of 50mm of rain on 'A's unsealed surface over 2 days, making it unusable, and an observer on the ground 50nm from 'A' has put the cloudbase in the area at "...about 200 metres mate..."
The doctor is keen to go, for the patients benefit of course, and arrangements are made for the patient to be transported by road to a sealed strip 'C', some 130nm (as the crow flys) away. 'C' has no instrument approach or met reporting/forecasting facilities either, and the MSA/LSALT is about 3 times as high as 'old mate's' guesstimate of the cloudbase midway between 'A' and 'C'.
Should the planned takeoff go ahead, approaches back into the departure airport, and most likely missed approaches, and subsequent flight to the alternate will be after about 14 hours 'awake', and this will be the third night in a row of 'late night ops', i.e., duty after 2330.
Do you go? Give it a shot for the good of humanity? Or call it quits and stay in bed..
Put yourself in my shoes, and have a think about what you would have done, then put a loved-one into the patients place and see if you would change your answer or not.
I won't answer many questions on this one, but will post the eventual decision and outcome after some feedback.
Scenario:
1800 hours - Highest priority medical call advised to destination 'A', 400nm away.
A doctor is required to be carried in addition to the nurse, thereby reducing the fuel load able to be taken from departure airport.
'A' is an unsealed strip with no instrument approach or met reporting or forecasting facilities.
The area forecast indicates broken to overcast cloud over the greater part of the state, and local (to the departure airport) METARs indicate cloud and visibility below approach minima, let alone alternate minima.
The only suitable alternate for 'A' is 'B', some 500nm from 'A'. The departure airport isn't suitable as an alternate, as it itself requires an alternate.
Sigmets are current for severe icing. The SIGWX chart also indicates CAT along the track to and from 'A'.
The aircraft to be utilised is $X-million worth, and let's say runs 'crewed' at $2000/hour. In the LIKELY event that not only we do not become visual and land at 'A', but subsequently have to return to our departure point, and not getting visual, have to then continue to 'B', the bill for what looks very much an exercise in futility might be about $10,000. HOWEVER, in this eventuality, our complete crew would then also need to spend the following day in company funded accomodation (out of duty). The doctor, who is on call with the hospital local to the departure point, effectively becomes stranded away from his responsibilities, and with the pilot (me) then on days off, a second pilot (and perhaps entire crew) would need to be sent to take us all home, where the aircraft could be placed back onto standby, and nurse could go back on to duty that night.
Logistics then mean that the planned departure is delayed by 7 1/2 hours to0130, meaning should we 'launch', and end up as outlined above, it will be a max duty shift, and potentially either a duty overrun, or mercy flight due to extended duty.
During this delay, word is passed that there has been in excess of 50mm of rain on 'A's unsealed surface over 2 days, making it unusable, and an observer on the ground 50nm from 'A' has put the cloudbase in the area at "...about 200 metres mate..."
The doctor is keen to go, for the patients benefit of course, and arrangements are made for the patient to be transported by road to a sealed strip 'C', some 130nm (as the crow flys) away. 'C' has no instrument approach or met reporting/forecasting facilities either, and the MSA/LSALT is about 3 times as high as 'old mate's' guesstimate of the cloudbase midway between 'A' and 'C'.
Should the planned takeoff go ahead, approaches back into the departure airport, and most likely missed approaches, and subsequent flight to the alternate will be after about 14 hours 'awake', and this will be the third night in a row of 'late night ops', i.e., duty after 2330.
Do you go? Give it a shot for the good of humanity? Or call it quits and stay in bed..
As a current Aero Medical pilot myself, deffinately, not! The flight nurse I am sure would not wish to go either after being informed of the situation. The Dr. however may wish to go, but usually have no idea of the criteria we have to observe for the flight.
If the flight really was Med 1 and was extremely urgent then from what you have said yes go. On condition that the aircraft is suitably equipped to fly in said conditions has the fuel to make it to somewhere to land in the event all goes to sh!t, pilot is feeling fine for the flight and is experienced in said conditions. A person’s life is priceless. Now on the other hand if this was one of those 'hey howabouta ride inta town mr pylat' flights then no.
For a real emergency I don’t mind my tax $ picking up the bill, you never know one day it may be you bleeding to death while someone else tries to figure out just how much you are worth.
What ever you did in this situation I would support. Only you have the exact details of the flight, the urgency in the voice of the guy on the other end of the phone, the knowledge of what YOU as a pilot could/ or could not do, the understanding of the conditions you where most likely to meet at the other end (not much point going if there is no chance of getting in). Something’s you just cant describe by typing in on a keyboard.
For a real emergency I don’t mind my tax $ picking up the bill, you never know one day it may be you bleeding to death while someone else tries to figure out just how much you are worth.
What ever you did in this situation I would support. Only you have the exact details of the flight, the urgency in the voice of the guy on the other end of the phone, the knowledge of what YOU as a pilot could/ or could not do, the understanding of the conditions you where most likely to meet at the other end (not much point going if there is no chance of getting in). Something’s you just cant describe by typing in on a keyboard.
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Go!!
I realise its a tough call but as you said, if it were my loved one...... I remember asking "old mate" about the weather one day and he told me vis was pretty good at around 1km......asked him another few questions and gathered from that it was really quite resonable and probably significantly better than that. Point is if he is not a pilot or have much met knowledge then from my experience his view may not be the most reliable. Who knows you might get over head and jag a hole.......if they are that sick then its gotta be worth having a crack!! If it was my loved one I would not sit on the ground and not even try!!
What price a human life?
Good call my friend. Tough, but good. If your management cannot organize to have well rested crew on hand for whatever operation may come up, the problem lies with them and whomever accepted their tender.
The responsibility, however, lies firmly with you and you exercised it with wisdom and integrity.
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If your management cannot organize to have well rested crew on hand for whatever operation may come up, the problem lies with them and whomever accepted their tender.
Nice thread also A31J, looking forward to hearing the outcome.
and this will be the third night in a row of 'late night ops', i.e., duty after 2330.
If A31J had launched and crashed at the end of a horrendously long, difficult duty, it would very much have been a failure of management at all levels.
For my money, as an ex ambo driver.
Cost is irrelevant.
Duty time is irrelevant.
Safety of the operating crew is paramount.
Take as much gas as possible and go to C. Give it your best shot. If you get in good.
If you miss out, you have done your best , without jepardising your crew.
In my view, a good result.
Whatever. Your decision was the right one. Its called comand perogative.
Maui
Cost is irrelevant.
Duty time is irrelevant.
Safety of the operating crew is paramount.
Take as much gas as possible and go to C. Give it your best shot. If you get in good.
If you miss out, you have done your best , without jepardising your crew.
In my view, a good result.
Whatever. Your decision was the right one. Its called comand perogative.
Maui
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If you as the captain believe (and can show cause if req.) that the flight can be conducted safely within the law then you have your answer.
Mercy flight..........mmm ....CP approved?, statement and forms filled out by suitable authority(read Dr).....mercy flight to extend duty period may be looked at by CASA if it is not a one off or proof unable.
Life as stated has no price but sound and carefull reasoning to the situation at hand with as much information as possible is a responsibility that has many flow on effects:
Task done and return safely
Task attempted and aborted due situations
Task cancelled due prevailing conditions
Task attempted with no info/bad info/poor judgement......BASI involvement.
You are the one to make the call
Make that call so that you can see the next sun rise and feel justified in what you have done.
Mercy flight..........mmm ....CP approved?, statement and forms filled out by suitable authority(read Dr).....mercy flight to extend duty period may be looked at by CASA if it is not a one off or proof unable.
Life as stated has no price but sound and carefull reasoning to the situation at hand with as much information as possible is a responsibility that has many flow on effects:
Task done and return safely
Task attempted and aborted due situations
Task cancelled due prevailing conditions
Task attempted with no info/bad info/poor judgement......BASI involvement.
You are the one to make the call
Make that call so that you can see the next sun rise and feel justified in what you have done.
Last edited by maxgrad; 20th Jul 2006 at 00:21.
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Whilst I am not a commerical pilot and work in management, my personal opinion would be not to go. If this flight was a standard passenger charter my guess would be that it would be a no-go from the start. Just because its a medical scenario does not mean that the safety standard for you, your crew and your aircraft is reduced. This is a harsh call because of the situation but as Wizofoz said, the price of one life is not risking the lives of three more.
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Have a definite decision premade regarding the MSA / Cloud base situation, stick on as much fuel as possible and get airborne, hoping for a lucky break. Don't bust minima, but do take a look, in the knowledge that you probably won't get in. Do not accept presonitis.
pb
pb
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In your line of work you are always going to have mercy flights. Unless you plan poorly and "always" have mercy flights, I can't see you getting in trouble for that. A human life is priceless and if it means that you bust duty by an hour or two or the doctor is stuck there for a day, it doesn't matter because one day it could be you lying there next to that collapsed Opal mine. Therefore, you go, but don't push things beyond your personal limits and of course those of the aircraft with respect to fuel and icing.
If mercy flights become a regular occurence and you feel like you're always the one there to save the day, then sure, it's a managment issue. Only you know the answer to that.
If a family member of mine died and I later found out that an aircraft was waiting a few hundred miles away but the pilot was near duty time there would be hell to pay!
If mercy flights become a regular occurence and you feel like you're always the one there to save the day, then sure, it's a managment issue. Only you know the answer to that.
If a family member of mine died and I later found out that an aircraft was waiting a few hundred miles away but the pilot was near duty time there would be hell to pay!
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Never having been an Aeromed pilot, I do not know what the personal pressure feels like, but my thoughts on this situaton are:
And
Should not be your concern
I would discuss it with your CP just to cover your own back side and let him take the resposibility of the expence if you do continue (I have been in this situation many times).
If the CP backed you up and provided the flight itself is safe (including fatigue issues) then I would go and 'ave a look', but remembering
Rules = Rules
Minimums = Minimums
And no-one will tell me otherwise
As callous as it sounds, you have no loyalty to the person on the gound. Yes, you do have a job to do, but you can only do that to within the best of your ability and within the regulations.
If it were my loved on on the ground, then as a professional pilot, I hope that I would understand the situation you faced.
Mono
The aircraft to be utilised is $X-million worth, and let's say runs 'crewed' at $2000/hour. In the LIKELY event that not only we do not become visual and land at 'A', but subsequently have to return to our departure point, and not getting visual, have to then continue to 'B', the bill for what looks very much an exercise in futility might be about $10,000.
The doctor, who is on call with the hospital local to the departure point, effectively becomes stranded away from his responsibilities
I would discuss it with your CP just to cover your own back side and let him take the resposibility of the expence if you do continue (I have been in this situation many times).
If the CP backed you up and provided the flight itself is safe (including fatigue issues) then I would go and 'ave a look', but remembering
Rules = Rules
Minimums = Minimums
And no-one will tell me otherwise
As callous as it sounds, you have no loyalty to the person on the gound. Yes, you do have a job to do, but you can only do that to within the best of your ability and within the regulations.
If it were my loved on on the ground, then as a professional pilot, I hope that I would understand the situation you faced.
Mono
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I'm with Wizofiz and Maui on this - one life is not worth three, safety of the crew is paramount- you make your judgement solely on the safety of the aircraft and its occupants, not on extraneous matters of the doctor, the cost, the 'value' of the patient, the grade of medical emergency etc. Three emergency medical staff lives gone means they're no longer around to save any more lives.
I think people who live, work or travel out in remote and inaccessible regions should be prepared to accept the risk that emergency help may not always be available.
I don't obviously fully understand the capability of the equipment being used, but to me there are already too many links in a potential accident chain
- urgent pressure situation
- poor/unknown vis
- limited nav-aids
- icing
- crew fatigue
- large distances to alternates
I agree with those who think risking another 3 lives is senseless.
The other thing to consider - they can already move the patient by road 130nm, so given that you've already delayed 7 hours, that's a long way's driving down the track already.
A
I don't obviously fully understand the capability of the equipment being used, but to me there are already too many links in a potential accident chain
- urgent pressure situation
- poor/unknown vis
- limited nav-aids
- icing
- crew fatigue
- large distances to alternates
I agree with those who think risking another 3 lives is senseless.
The other thing to consider - they can already move the patient by road 130nm, so given that you've already delayed 7 hours, that's a long way's driving down the track already.
A
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Not available???
Andy RR
Your first sentence is WRONG WRONG WRONG!!!!!
People pay huge taxes, and expect reasonable support from essentail service providers in return. Not just within the J curve.
This post indicates that adequate resources are not properly provided in this case. Pilots should not have to consider anything except the job they are doing. Whether this will result in changes to the roster tomorrow or the next day is irrelevent. The managers should have considered this and made appropriate arrangements for crewing and equipment. It appears that they have not, and the pilots have to carry an extra burden because of their failure to provide.
Administrators have put a value on a human life but in this case it's irrelevent. In any case it is far more than $10,000.(more like a million)
There are two important pieces of information missing. What is the actual cloudbase in the destination area. We only seem to have an area forecast that says it MAY be low overcast. No-one knows if it actually is. It may be clear. Secondly, what would be the effect on the patient if you could not get back to base, and had to divert to B? What medical facilities are there? It seems the rostering and cost is considered more important.
If the patient is 400 nm away from base, it would be worth looking for another airmedical organisation 400nm beyond there where the weather at the departure point may be better.
If no better way can be found I believe you have a responsibility to go. You do not have the right to risk anyones's life. You may get your bum kicked by the beancounters, but that goes with the job. You have to live with what you do. Sometimes whatever you do is wrong.
And they say airmedical flying is the same as any other flying. It is not.
Your first sentence is WRONG WRONG WRONG!!!!!
People pay huge taxes, and expect reasonable support from essentail service providers in return. Not just within the J curve.
This post indicates that adequate resources are not properly provided in this case. Pilots should not have to consider anything except the job they are doing. Whether this will result in changes to the roster tomorrow or the next day is irrelevent. The managers should have considered this and made appropriate arrangements for crewing and equipment. It appears that they have not, and the pilots have to carry an extra burden because of their failure to provide.
Administrators have put a value on a human life but in this case it's irrelevent. In any case it is far more than $10,000.(more like a million)
There are two important pieces of information missing. What is the actual cloudbase in the destination area. We only seem to have an area forecast that says it MAY be low overcast. No-one knows if it actually is. It may be clear. Secondly, what would be the effect on the patient if you could not get back to base, and had to divert to B? What medical facilities are there? It seems the rostering and cost is considered more important.
If the patient is 400 nm away from base, it would be worth looking for another airmedical organisation 400nm beyond there where the weather at the departure point may be better.
If no better way can be found I believe you have a responsibility to go. You do not have the right to risk anyones's life. You may get your bum kicked by the beancounters, but that goes with the job. You have to live with what you do. Sometimes whatever you do is wrong.
And they say airmedical flying is the same as any other flying. It is not.
Last edited by bushy; 20th Jul 2006 at 07:32.
As an ex RFDS pilot my first thoughts on this scenario ran along the lines of : if you are going onto days off next duty cycle, consider calling one of the other pilots for the trip and swapping your days off with them to make it legal (if this is possible eg they aren't pissed etc), or calling the day shift in early (I am assuming if you are starting days off then the Day Pilot will just be coming off days off so will be well rested). This effectively removes the fatigue problem (short term of course). At all the bases I had the pleasure of working at we (pilots) always had an understanding with each other that we were prepared to do this if it was critical (not that we were remunerated for it of course). If you run out of pilots another base can always cover your area as required.
For those that haven't done it, as a professional Aeromedical pilot you do factor into the decision making process ramifications such as doctor/nurse and aircraft availability for future duties later. You have to be aware of the big picture. Ultimately 3 lives are worth more than 1. The cost of the operation is the perogative of the Doctor as the tasking authority. Factoring in the need to road transport the patient that distance does give a time window for the possibilities of weather improving (or getting worse). If these options were considered (and disgarded), then discuss with the doctor the possible implications of delaying departure for a first light arrival with a fresh pilot and the advantage of daylight, after explaining to the doctor the possible outcomes/success of the mission.
Ultimately, if you feel capable of doing the flight (fatigue considered), and the doctor wants to go, then go for a look, respecting your own personal limitations, and accepting the less than desirable outcome of a diversion if necessary. These decisions are the stuff the beancounters don't see.!!
For those that haven't done it, as a professional Aeromedical pilot you do factor into the decision making process ramifications such as doctor/nurse and aircraft availability for future duties later. You have to be aware of the big picture. Ultimately 3 lives are worth more than 1. The cost of the operation is the perogative of the Doctor as the tasking authority. Factoring in the need to road transport the patient that distance does give a time window for the possibilities of weather improving (or getting worse). If these options were considered (and disgarded), then discuss with the doctor the possible implications of delaying departure for a first light arrival with a fresh pilot and the advantage of daylight, after explaining to the doctor the possible outcomes/success of the mission.
Ultimately, if you feel capable of doing the flight (fatigue considered), and the doctor wants to go, then go for a look, respecting your own personal limitations, and accepting the less than desirable outcome of a diversion if necessary. These decisions are the stuff the beancounters don't see.!!
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1013.2
When doctors use the power of a mercy flight to CONTINUALLY have pilots bust duty hours it is a very big bad issue. Mercy flights are a last course issue.
Many doctors do not understand the aviation part of the job. They see a sick person or are given information on a patient and then decide to call an a/c out on task. They very very rarely take into consideration the details regarding the finer details of the task.
That is the Captain's domain.
Medivac drivers....how many times do you get a task to fly at night to a black hole approach and landing, many a time in crap Wx to see the patient walk happily up and board and to find out later that the patient just wanted a freeby or that the clinic nurse or aid got it wrong?
We are all human and mistakes get made.
Go nogo choices are hard to make but a good medivac pilot will step away from the emotional side and deal with facts.
Medivac driver's must be impartial to the task at hand and deal with the aviation side.
1013.2
Lets risk more lives and fly the task so as a loved one can be helped.
If the job can be safely down within the rules fine, if a mercy flight is called you better have all the boxes ticked.
When doctors use the power of a mercy flight to CONTINUALLY have pilots bust duty hours it is a very big bad issue. Mercy flights are a last course issue.
Many doctors do not understand the aviation part of the job. They see a sick person or are given information on a patient and then decide to call an a/c out on task. They very very rarely take into consideration the details regarding the finer details of the task.
That is the Captain's domain.
Medivac drivers....how many times do you get a task to fly at night to a black hole approach and landing, many a time in crap Wx to see the patient walk happily up and board and to find out later that the patient just wanted a freeby or that the clinic nurse or aid got it wrong?
We are all human and mistakes get made.
Go nogo choices are hard to make but a good medivac pilot will step away from the emotional side and deal with facts.
Medivac driver's must be impartial to the task at hand and deal with the aviation side.
1013.2
Lets risk more lives and fly the task so as a loved one can be helped.
If the job can be safely down within the rules fine, if a mercy flight is called you better have all the boxes ticked.
When you live....
Originally Posted by wrongthong
I'm with Wizofiz and Maui on this - one life is not worth three, safety of the crew is paramount- you make your judgement solely on the safety of the aircraft and its occupants, not on extraneous matters of the doctor, the cost, the 'value' of the patient, the grade of medical emergency etc. Three emergency medical staff lives gone means they're no longer around to save any more lives.
Nobody has suggested that the flight should go if any element of the wx/fuel/fatigue mix is not 100% safe - the question being asked is "how much money is too much to spend attempting a flight which will more than likely not result in a successful pickup?".
As monopole says - "rules = rules" - these protect the lives of the 3 emergency medical staff along with the judgement of the PIC who must decide if 14 hours awake is too much.
I agree totally with those who say that you should go and have a look no matter what the cost (in $).
The only other question I have for A31J is about the consequences of the plane and staff being stranded in 'B' - does this diminish the ability of the organisation to provide full cover the next day(s) until the next duty becomes available? If so then my answer may be different.
UTR.
PS when are you going to tell us the answer?
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Maxgrad is right.
What price a human life..... certainly Not 3 human lives..
Perhaps I can offer a different perspective.
I am a Medical Specialist (with trauma and resuscitation experience) and a Private Pilot (IFR).
Let me start with this: Aeromedical is waaaayyy overrated and misunderstood by the majority of my medical colleagues.....
There is a certain drama and immediacy to Aeromed evac that often leads well-meaning Docs and Nurses to 'demand' it when it's really not necessary. The 'ER' Syndrome - after the US TV Drama
There are numerous cases I can recall where aircraft have been requested and were simply not required - just convenient (which is maybe OK, but not at the price of crew safety).
Now, the crew (without the benefit of Medical Knowledge) must trust the judgement of the Doc making the call - that's only reasonable. But just as the flight crew would not suggest what medical treatment might be required, nor should the Doc be able to impose pressure to break the principles of good airmanship.
The Command Prerogative is just that - what benefit is there in trading 3 lives for one (which is by no means guaranteed in any case)?
Police, Firefighters and other rescue workers accept a DEGREE of risk, and are accordingly equipped, but you would not expect a firefighter without BA to enter a burning chemical factory, or an unarmed police officer to confront an armed gang..........why should we expect a pilot to take similar risks? Hollywood heroics work great in the movies, not in the real world.
Furthermore, If I read it correctly, there was a 7 1/2 hour delay. I must assume (perhaps wrongly) that some form of overland transport could have achieved the transfer in that time anyway....was this considered?
What price a human life..... certainly Not 3 human lives..
Perhaps I can offer a different perspective.
I am a Medical Specialist (with trauma and resuscitation experience) and a Private Pilot (IFR).
Let me start with this: Aeromedical is waaaayyy overrated and misunderstood by the majority of my medical colleagues.....
There is a certain drama and immediacy to Aeromed evac that often leads well-meaning Docs and Nurses to 'demand' it when it's really not necessary. The 'ER' Syndrome - after the US TV Drama
There are numerous cases I can recall where aircraft have been requested and were simply not required - just convenient (which is maybe OK, but not at the price of crew safety).
Now, the crew (without the benefit of Medical Knowledge) must trust the judgement of the Doc making the call - that's only reasonable. But just as the flight crew would not suggest what medical treatment might be required, nor should the Doc be able to impose pressure to break the principles of good airmanship.
The Command Prerogative is just that - what benefit is there in trading 3 lives for one (which is by no means guaranteed in any case)?
Police, Firefighters and other rescue workers accept a DEGREE of risk, and are accordingly equipped, but you would not expect a firefighter without BA to enter a burning chemical factory, or an unarmed police officer to confront an armed gang..........why should we expect a pilot to take similar risks? Hollywood heroics work great in the movies, not in the real world.
Furthermore, If I read it correctly, there was a 7 1/2 hour delay. I must assume (perhaps wrongly) that some form of overland transport could have achieved the transfer in that time anyway....was this considered?