Hems Question
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Hems Question
Could anyone answer the following question which was posed during a recent interview, does anyone have any thoughts as to the correct response?
"The weather forecast predicts a front crossing the area of operation during the early afternoon. You are tasked to collect a casualty and deliver them to a specific hospital, during the flight to the hospital your track means you will encounter the front and the weather conditions are deteriorating below operational minimums what is your course of action?"
The paramedic informs you that the casualty may die if they are not deliverd to the specific hospital you are routing to?
"The weather forecast predicts a front crossing the area of operation during the early afternoon. You are tasked to collect a casualty and deliver them to a specific hospital, during the flight to the hospital your track means you will encounter the front and the weather conditions are deteriorating below operational minimums what is your course of action?"
The paramedic informs you that the casualty may die if they are not deliverd to the specific hospital you are routing to?
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Maybe what they were getting at is why would you take off knowing that your going to hit a wall or thats how the question reads to me, i.e if theres definate doubt that you would get there then the medics would rather know that before you lifted than tell them en-route, if the weather changes en-route and it's not safe to continue then turnaround, land put them on a land ambulance or go to another hospital but don't kill two more people for the sake of one who could well die anyway. Theres always an alternative.
Thats the advice I was given anyway, and thats the answer I'd give.
Thats the advice I was given anyway, and thats the answer I'd give.
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People have got to hospitals for hundreds of years without a helicopter so why endanger the crew for the sake of it..... Remember it's the patients emergency, no need to make it yours as well.
Avoid imitations
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It's a risk assessment question. Is the perceived risk to the aircraft and human contents greater than the risk to the patient being driven by road ambualnce?
(I don't normally spell ambulance like that but someone else will possibly be along any minute and she does).
(I don't normally spell ambulance like that but someone else will possibly be along any minute and she does).
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The answer to the question depends on the specifics of the situation. It is quite possible that you could do the job if the aircraft is suitably equipped and you can carry holding or alternate fuel if required. The outcome for the patient is irrelevant, and has zero bearing on the decision to go or not. The attitude maintained by the crew needs to be that we will go if we can do so safely and legally. If not, there are always alternatives. The employer would be looking for your knowledge of the rules, ability to apply them and whether or not your attitude is suitable - not too far left or right of centre. Bad weather is not a barrier, just an important consideration.
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My two cents.....
The patient condition should have no bearing on the decision to go or otherwise. I personally don't ask the med crew as to the specific condition of the patient before hand or enroute as it should have no bearing on the decisions I make about the safety of the acft and those aboard.
Returning to the receiving hospital is a different story of course.... altitude restrictions, etc.
No one ever died from pressing
......not!
Your new boss would like your answer Muckholio.
GU
The patient condition should have no bearing on the decision to go or otherwise. I personally don't ask the med crew as to the specific condition of the patient before hand or enroute as it should have no bearing on the decisions I make about the safety of the acft and those aboard.
Returning to the receiving hospital is a different story of course.... altitude restrictions, etc.
No one ever died from pressing
......not!Your new boss would like your answer Muckholio.
GU
Last edited by Goggle Up; 22nd Mar 2009 at 09:20.
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The only thing worse, from a patient's viewpoint, than not taking off to transport them to the hospital is to take off only to return to base before reaching the scene due to deteriorating weather. Once you say you're coming the ground responders are counting on that commitment; they may cancel ground transport and they may do things (or defer things) to the patient in anticipation of your arrival. If you call them twenty minutes into your flight to tell them that you're not coming after all they're going to be not amused.
Never take off unless you know for a fact that you can complete the flight.
Never take off unless you know for a fact that you can complete the flight.
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Good sound answers. I agree with revolutionary, if you cannot be sure of getting to destination don't take the patient, having to land on in a field and trying to jack up land crew (possibly differnt amb. service area to boot) if v tricky and takes time. Cabin cools, medics start worrying, patient knows something isnt right etc etc. Being VFR narrows your options. HEMS could be called but you might then be pushing on into God knows what conditions and they are not really there to allow 30 minutes of grobbling around at low level at 40 kts.
Even if IFR you then have fuel considerations plus getting cabbie from airport to hospital arranged.
Leave patient in cosy hospital, go get coffee watch England v Scotland and wait for front to pass.
Even if IFR you then have fuel considerations plus getting cabbie from airport to hospital arranged.
Leave patient in cosy hospital, go get coffee watch England v Scotland and wait for front to pass.
The way I read the question.....the aircraft has not departed base yet.
My answer would be to determine when the flight could be made after frontal passage and weather within minimums could be expected, provide the estimated time, advise the tasking authority of that and remark I would monitor the weather and report being able to make the flight as soon as I could.
If the question meant an enroute situation.....it is arrange ground transport and meet that unit at the nearest point to the destination possible or divert to the nearest best medical facility and wait for ground transport there.
Continuing on in deteriorating weather below minimums is not an option.
People are going to die.....all you can do is your best....and go home at the end of your shift to fight with the wife and beat the kids....I mean fuss with the kids and beat the wife.
My answer would be to determine when the flight could be made after frontal passage and weather within minimums could be expected, provide the estimated time, advise the tasking authority of that and remark I would monitor the weather and report being able to make the flight as soon as I could.
If the question meant an enroute situation.....it is arrange ground transport and meet that unit at the nearest point to the destination possible or divert to the nearest best medical facility and wait for ground transport there.
Continuing on in deteriorating weather below minimums is not an option.
People are going to die.....all you can do is your best....and go home at the end of your shift to fight with the wife and beat the kids....I mean fuss with the kids and beat the wife.
Ignoring the fact that you should not take off in this situation, I am deeply concerned you were even asked, as this situation should never arise.
Back in 1987 we proposed a 'Chinese Wall' between flight crew and medical crew. The flight crew should never make any decision based on the patient's condition nor the sequelae of not launching. Equally the medical crew should never pressurise the flight crew nor be involved in go:no go decisions. We never allowed the pilot access to any information about the patient.
Although this has given cause to some amusement (especially when the medical crew are pilots or vice versa!) it has certainly avoided several potentially difficult situations over the years and, at least in the UK, I would hope all operations are practicing it.
It also means that the flight crew make en route decisions as if they were not on a medical flight. Any thought to press on despite weather or serviceability issues is potentially lethal. And if the hospital so much as wimpers, the organisation's medical director should perform a delicate operation on the miscreant without anaesthetic.
Back in 1987 we proposed a 'Chinese Wall' between flight crew and medical crew. The flight crew should never make any decision based on the patient's condition nor the sequelae of not launching. Equally the medical crew should never pressurise the flight crew nor be involved in go:no go decisions. We never allowed the pilot access to any information about the patient.
Although this has given cause to some amusement (especially when the medical crew are pilots or vice versa!) it has certainly avoided several potentially difficult situations over the years and, at least in the UK, I would hope all operations are practicing it.
It also means that the flight crew make en route decisions as if they were not on a medical flight. Any thought to press on despite weather or serviceability issues is potentially lethal. And if the hospital so much as wimpers, the organisation's medical director should perform a delicate operation on the miscreant without anaesthetic.
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I would have discussed with the medics about a suitable alternative hospital away from the front. Very unusual for there to be no alternative destination, even with specialist patients. Again have to think about the time to diversion hospital against land transport to original destination.
Would definitely agree (from the doc in the back perspective) that not launching if unlikely to make a difference and risk crew is correct decision
Would definitely agree (from the doc in the back perspective) that not launching if unlikely to make a difference and risk crew is correct decision
But Bob if you start talking to the medical crew about an alternate you are allowing them to influence your decision. The answer comes back 'well hospital X could be OK but they dont have a 64 slice scanner so are you sure we cant just press on'. You dont know what a 64 slice is, you are being bamboozled, and you obviously want to help the patient.
With an experienced medical crew and a relatively inexperienced flight crew the dye is cast. Pressure is on and decisions are made for medical reasons. I saw this time after time in the US in the 1980s.
No, sorry, I firmly believe in a complete Chinese wall. If I am the pilot I TELL the crew we are diverting (ignoring the fact that I am going to be b****** for getting into that position in the first place). If I am the doctor, I merely acknowledge and start redoing the handover to wherever I am told I am going.
Homonculus
With an experienced medical crew and a relatively inexperienced flight crew the dye is cast. Pressure is on and decisions are made for medical reasons. I saw this time after time in the US in the 1980s.
No, sorry, I firmly believe in a complete Chinese wall. If I am the pilot I TELL the crew we are diverting (ignoring the fact that I am going to be b****** for getting into that position in the first place). If I am the doctor, I merely acknowledge and start redoing the handover to wherever I am told I am going.
Homonculus
