Passenger seriously ill.
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Sorry Guppy, I have to respecfully disagree...it's very clear in the FARs that the pilot can deviate from the rules should he deem it neccessary.
For instance: An experienced CAT II pilot who missed his CAT II sim ride by a week might not be 'qualified' but we all know he can excecute the low approach. That condition wouldn't by any strech be considered unsafe, as a week later he would be doing those approaches on a regular basis.
So if he lands the aircraft, having the experience and ability to do so, but some little reg, rule, expiration date doesn't apply to him that day...sure he may be called on the carpet, but someone might live.
It's a judgement call and all SOPS and Rules can't fit all possible aviation scenarios.
For instance: An experienced CAT II pilot who missed his CAT II sim ride by a week might not be 'qualified' but we all know he can excecute the low approach. That condition wouldn't by any strech be considered unsafe, as a week later he would be doing those approaches on a regular basis.
So if he lands the aircraft, having the experience and ability to do so, but some little reg, rule, expiration date doesn't apply to him that day...sure he may be called on the carpet, but someone might live.
It's a judgement call and all SOPS and Rules can't fit all possible aviation scenarios.
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SNS3Guppy,
I am happy that its you and not me that gets to work with SAS ambulance services.Each to his own.If you're experienced in low vis ops but the paperwork isnt in order,then IMO,you are free to make whatever decision you think is best without regard to SOP.It may be that the doc on board advises that a return would be futile,in which case you continue.It is an emergency,albeit a medical one.Judgement over SOP.WE're paid to think like that.
I am happy that its you and not me that gets to work with SAS ambulance services.Each to his own.If you're experienced in low vis ops but the paperwork isnt in order,then IMO,you are free to make whatever decision you think is best without regard to SOP.It may be that the doc on board advises that a return would be futile,in which case you continue.It is an emergency,albeit a medical one.Judgement over SOP.WE're paid to think like that.
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I may be corrected by him but I don't think Guppy has any great issue if its a technical breach of the regs such as Pit Bull, 60 etc have mentioned.
A technical breach is clearly very different from doing something for which you are not trained or busting approach minima deliberately even if it is by a foot (eg we do a VOR/DME with a cloudbase 50' below MDA but because its a high MDA and we know the area, GPS etc and the bloke will most likely die if we don't we decide to bust it we decide in this case we can).
I suspect what Guppy is, quite rightly, getting at is that you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs. Our first responsibilty is always to fly the aircraft safely.
A technical breach is clearly very different from doing something for which you are not trained or busting approach minima deliberately even if it is by a foot (eg we do a VOR/DME with a cloudbase 50' below MDA but because its a high MDA and we know the area, GPS etc and the bloke will most likely die if we don't we decide to bust it we decide in this case we can).
I suspect what Guppy is, quite rightly, getting at is that you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs. Our first responsibilty is always to fly the aircraft safely.
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I suspect what Guppy is, quite rightly, getting at is that you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs. Our first responsibilty is always to fly the aircraft safely.
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Couldn't agree more Ashling...one person's 'danger danger Will Robinson' is another person's cake walk.
We have to know our limits and capabilities and judge accordingly. It's nice to see once is a while people put thier egos in check and say ' I don't know' or ' I am not qualified to do that, but I will point you to a guy that is' or ' I wont fly that approach, haven't done a low approach in years'
I have hired guys with this attitude, knowing they are the type to figure out what they don't know vs the guys that think they know everything...the latter usualy get caught at some time unprepared ofcourse...'student's' like myself tend to always seek the truth and be prepared with the answer...
Simply put, I agree with you guys that recognizing, a situation that could be beyond your capabilities, and avoiding it ahead of time is just good judgment. Your putting your ego in check, looking at the big picture, thinking what's best for the passengers, equipment, company...
Very altruistic and profesional.
With regard to going against the group, and saving the day...taking that low approach for instance...99 pilots might not be able to do what one pilot can...as evidenced by some posters in here about certain exceptional pilots in the sim, or accidents that were averted by departing from SOPs and making a non-typical solution to an non-typical problem.
I suspect this makes the other 99 pilots nervous, authorities nervous: With that said one pilot called on the carpet, even after saving the day...get's the dressing down, but get's off, because ultimately he saved lives through outstanding performance....not luck. Too bad the group tends to want to knock him down to thier level, when the end result is he averted a catastrophe...bruised group egos, culture issues, politics vs outstanding individual talent...
We have to know our limits and capabilities and judge accordingly. It's nice to see once is a while people put thier egos in check and say ' I don't know' or ' I am not qualified to do that, but I will point you to a guy that is' or ' I wont fly that approach, haven't done a low approach in years'
I have hired guys with this attitude, knowing they are the type to figure out what they don't know vs the guys that think they know everything...the latter usualy get caught at some time unprepared ofcourse...'student's' like myself tend to always seek the truth and be prepared with the answer...
Simply put, I agree with you guys that recognizing, a situation that could be beyond your capabilities, and avoiding it ahead of time is just good judgment. Your putting your ego in check, looking at the big picture, thinking what's best for the passengers, equipment, company...
Very altruistic and profesional.
With regard to going against the group, and saving the day...taking that low approach for instance...99 pilots might not be able to do what one pilot can...as evidenced by some posters in here about certain exceptional pilots in the sim, or accidents that were averted by departing from SOPs and making a non-typical solution to an non-typical problem.
I suspect this makes the other 99 pilots nervous, authorities nervous: With that said one pilot called on the carpet, even after saving the day...get's the dressing down, but get's off, because ultimately he saved lives through outstanding performance....not luck. Too bad the group tends to want to knock him down to thier level, when the end result is he averted a catastrophe...bruised group egos, culture issues, politics vs outstanding individual talent...
Last edited by Angels 60; 24th May 2008 at 02:45.
and what if the little 'home field doesn't have a hospital nearby for you below min apch??---look up the 'DECIDE model of aeronautical decision making and remake the scenario in a safe rational fashion---there are multiple safe option beside maintaining 250 to 5 to shoot an unstabilized below minimum aprch
PA
PA
It’s about remaining objective
A collation of SNS3Guppy’s posts on this thread would be a seriously good primer for a wannabe aeromedical pilot.
I thought that my company’s practice of telling the pilot (single pilot) the distressing nature of a retrieval contributed to unnecessary and unjustified panic among some aircrew.
Ring ring…
”We’ve got a (MED3, MED2), MED1 to Bloggsville a two year old girl has been run over by her father in the family car.” This sort of welcome to night shift never did anything for air safety.
PITHBLOT
I thought that my company’s practice of telling the pilot (single pilot) the distressing nature of a retrieval contributed to unnecessary and unjustified panic among some aircrew.
Ring ring…
”We’ve got a (MED3, MED2), MED1 to Bloggsville a two year old girl has been run over by her father in the family car.” This sort of welcome to night shift never did anything for air safety.
PITHBLOT
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Ashling,
Thank you for helping me interpret what SNS3Guppy is advocating.
You say:
But re-read what he actually said:
To me that indicates that even in an emergency situation,SNS3Guppy most certainly has an issue with a technical breach of the regs...
You go on to say:
If a pilots judgement leads him into a situation that is beyond his training and experience,then it would indeed be poor judgement.If his judgement entails a technical breach of the regs,the same corollary is not necessarily so.As someone said,FAR's entitle the skipper to take what action he deems appropiate in an emergency situation.
Thank you for clearing that up.Are you implying that a technical breach of the regs in an emergency situation is unsafe?
Thank you for helping me interpret what SNS3Guppy is advocating.
You say:
I may be corrected by him but I don't think Guppy has any great issue if its a technical breach of the regs
If the weather is below minimums and below the legal limits for the pilot, then it really doesn't matter how comfortable he feels,
You go on to say:
you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs.
Our first responsibilty is always to fly the aircraft safely.
Last edited by Rananim; 24th May 2008 at 15:18.
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FAR's entitle the skipper to take what action he deems appropiate in an emergency situation.
Simply because one thinks it's appropriate is not an adequate defense. You had better be right. And those reviewing your actions had better agree with you. You specifically cited the "FAR's," invoking the US regulation. Under US administrative law, you are guilty until proven innocent...your opportunity to explain and defend yourself comes during the appeal process after you have already been violated.
An action may be perfectly legal, but unsafe. An action may be perfectly safe, but not legal.
Unless it is legal AND safe, don't do it.
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I've spent much of my career in air ambulance and aerial firefighting, as well as other types of emergency services flying, and flying upon which lives and resources depend. Most of the time when I've flown, the call to fly hasn't been put out until a state of emergency exists. I've been called to pick up and move gunshot victims, chainsaw victims, car accident victims. I've been called out of the airplane and into the ambulance to put pressure on spurting blood, to ventilate victims, to administer CPR. I've worked for years on the ground as a firefighter and EMT. My flying back ground is varied, ranging from corporate to airline to agricultural to government.
In that time, I've flown into canyons burning out of control with explosions, fire, severe turbulence, nil visibility, numerous aircraft, a heavy load, minimal performance, and about as much pressure as you can get from those on the ground and in the air to deliver retardant to crews about to be burned over, houses about to be lost, you name it. I've been pressured to pick up patients in unimaginable conditions, and refused when I didn't deem it safe or legal, despite direct threats against my job, my career. I've even been told by an employer that the employer didn't care if I returned, only that I launched in order to show dispatch reliability.
Much of the time I've been on standby, it's been ready to go, sitting under the wing of the airplane with only a few minutes notice to be airborne and enroute. For years and years, with lives depending on the actions and decisions made on a daily, hourly, and minute-by-minute basis.
Something I learned long ago is that when things seem most critical, it's time to sit on your hands, count to ten, and evaluate what you're doing. I learned long ago that someone else's emergency isn't my emergency; if I wouldn't bust minimums without someone being sick, I won't do it with someone sick. If I wouldn't exceed other limitations or regulations without the perceived "emergency," then I wouldn't do it with the emergency. Unless you can divorce yourself from the perceived pressure of the "emergency," then you have no place operating the aircraft for that evolution.
Many moons ago I responded to a secondary school to a report of a student with a seizure. I crewed the ambulance with two women who lived in the small community to which we responded. Both seemed slightly flustered during the call, and were less than decisive or proactive in their treatment and assessment. During the debriefing, they both allowed that they found the situation uncomfortable, as they both knew the boy. They admitted they were unable to function effectively with this emotional attachment. Clearly their own emotional attachment to the situation was a liability to the patient and to the call; if one can't be objective and handle a situation on it's own merits, emergency or not, then one has no business being there.
Legal technicality? Hardly.
Suppose you return to make the approach. You're going to place the patient's alleged safety ahead of the "technicalities" of the regulation. You feel justified because you believe the regulation excuses you from following the regulation, due to your perception of this "emergency." You take the time to return, and fly the approach. Unfortunately, the weather has further deteriorated, and you're unable to complete the approach. Now you've cost the patient more time that could have been spent diverting to a useful alternate, you've placed the flight at risk as well as all the other passengers, you've used up additional fuel that might later be needed (remember, weather is below minimums), and you've broken the regulation...all for naught.
Have you acted professionally? No.
Youv'e acted impetuously, making an emotional judgment when you're paid to be better than that. You've acted foolishly.
I've flown for several companies in which the operations manual specifically addressed patient medical situations and stated flatly that they didn't constitute a safety of flight emergency, nor justify taking emergency action. I agree. One should certainly do what one can within the confines of safety and legality, but a patient's problem doesn't mean all bets are off or anything goes. People see a little blood and panic. People hear a patient is sick and feel pressured. What has changed? A little blood and someone's sick. Not justification making an emotional excursion from professional discretion. Stick to the plan, fly the airplane. Period.
Now, what would you know about someone's life depending on the outcome of your flight?
In that time, I've flown into canyons burning out of control with explosions, fire, severe turbulence, nil visibility, numerous aircraft, a heavy load, minimal performance, and about as much pressure as you can get from those on the ground and in the air to deliver retardant to crews about to be burned over, houses about to be lost, you name it. I've been pressured to pick up patients in unimaginable conditions, and refused when I didn't deem it safe or legal, despite direct threats against my job, my career. I've even been told by an employer that the employer didn't care if I returned, only that I launched in order to show dispatch reliability.
Much of the time I've been on standby, it's been ready to go, sitting under the wing of the airplane with only a few minutes notice to be airborne and enroute. For years and years, with lives depending on the actions and decisions made on a daily, hourly, and minute-by-minute basis.
Something I learned long ago is that when things seem most critical, it's time to sit on your hands, count to ten, and evaluate what you're doing. I learned long ago that someone else's emergency isn't my emergency; if I wouldn't bust minimums without someone being sick, I won't do it with someone sick. If I wouldn't exceed other limitations or regulations without the perceived "emergency," then I wouldn't do it with the emergency. Unless you can divorce yourself from the perceived pressure of the "emergency," then you have no place operating the aircraft for that evolution.
Many moons ago I responded to a secondary school to a report of a student with a seizure. I crewed the ambulance with two women who lived in the small community to which we responded. Both seemed slightly flustered during the call, and were less than decisive or proactive in their treatment and assessment. During the debriefing, they both allowed that they found the situation uncomfortable, as they both knew the boy. They admitted they were unable to function effectively with this emotional attachment. Clearly their own emotional attachment to the situation was a liability to the patient and to the call; if one can't be objective and handle a situation on it's own merits, emergency or not, then one has no business being there.
Legal technicality? Hardly.
Suppose you return to make the approach. You're going to place the patient's alleged safety ahead of the "technicalities" of the regulation. You feel justified because you believe the regulation excuses you from following the regulation, due to your perception of this "emergency." You take the time to return, and fly the approach. Unfortunately, the weather has further deteriorated, and you're unable to complete the approach. Now you've cost the patient more time that could have been spent diverting to a useful alternate, you've placed the flight at risk as well as all the other passengers, you've used up additional fuel that might later be needed (remember, weather is below minimums), and you've broken the regulation...all for naught.
Have you acted professionally? No.
Youv'e acted impetuously, making an emotional judgment when you're paid to be better than that. You've acted foolishly.
I've flown for several companies in which the operations manual specifically addressed patient medical situations and stated flatly that they didn't constitute a safety of flight emergency, nor justify taking emergency action. I agree. One should certainly do what one can within the confines of safety and legality, but a patient's problem doesn't mean all bets are off or anything goes. People see a little blood and panic. People hear a patient is sick and feel pressured. What has changed? A little blood and someone's sick. Not justification making an emotional excursion from professional discretion. Stick to the plan, fly the airplane. Period.
Now, what would you know about someone's life depending on the outcome of your flight?
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Rananim
I agree that if an emergency is serious enough you can deviate from SOP, Regs etc in order to effect a safe outcome. I have said exactly that in an earlier post. However your response must be proportinate to the emergency. I don't have the FAR in front of me but I would be very surprised if you can suddenly do whatever the hell you like just because a fuel pump/generator/passenger has a problem.
A medical emergency does not threaten the safety of the aircraft so it is important that in your response to it you do not allow yourself to compromise safety of flight. So if the "technical breach" is in the order of missed item in the sim due to no fault of yours and you are in current line practise then I see no problem. However if you define a "technical breach" as busting MDA/DA then I do see a very big problem as this situation does not warrent it. Other situations may warrent it but not this one.
I agree that if an emergency is serious enough you can deviate from SOP, Regs etc in order to effect a safe outcome. I have said exactly that in an earlier post. However your response must be proportinate to the emergency. I don't have the FAR in front of me but I would be very surprised if you can suddenly do whatever the hell you like just because a fuel pump/generator/passenger has a problem.
A medical emergency does not threaten the safety of the aircraft so it is important that in your response to it you do not allow yourself to compromise safety of flight. So if the "technical breach" is in the order of missed item in the sim due to no fault of yours and you are in current line practise then I see no problem. However if you define a "technical breach" as busting MDA/DA then I do see a very big problem as this situation does not warrent it. Other situations may warrent it but not this one.
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Guppy,
If the chances of survival are not greatly increased by the return option,then the justification(to break the reg) isnt there.Just how you ascertain that in 5 minutes is the problem and in this regard,your argument carries more favor.I never said it was an easy decision to make.All I said was that the decision isnt automatically made for you if the crew are cat 3 experienced but only cat 1 certified.I'm not a doctor but as I understand it,if the patient can be kept alive,the effectiveness of clot-busting drugs is very much time-dependent.
Where is Sudden Winds..he started all this anyways.
If the chances of survival are not greatly increased by the return option,then the justification(to break the reg) isnt there.Just how you ascertain that in 5 minutes is the problem and in this regard,your argument carries more favor.I never said it was an easy decision to make.All I said was that the decision isnt automatically made for you if the crew are cat 3 experienced but only cat 1 certified.I'm not a doctor but as I understand it,if the patient can be kept alive,the effectiveness of clot-busting drugs is very much time-dependent.
Where is Sudden Winds..he started all this anyways.
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Pugilistic Animus - I think you will find that Longflights is the latest pseudonym for our old friend ssg, Angels 60, tankdriver45 et al. The folks over at http://www.pprune.org/forums/showthread.php?t=328287 had this to say of him. I wouldn't take any notice of any nonsense he comes up with.
I don't actually believe he's for real. Surely, no-one's that stupid.
Seldom have I heard anyone display the depths of their ignorance with such total conviction. The only downside is that there are others who might believe what he says through their own inexperience. The reasoning behind some of his statements would have made the Monty Python crowd very proud of him. He certainly sounds like he believes them himself and thats scary!
Seldom have I heard anyone display the depths of their ignorance with such total conviction. The only downside is that there are others who might believe what he says through their own inexperience. The reasoning behind some of his statements would have made the Monty Python crowd very proud of him. He certainly sounds like he believes them himself and thats scary!
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SNS3Guppy
I have never been involved in the sort of work that you have ie ambulance work.
What springs to mind here is the comparison with Doctors or surgeons. They are professionals to and have to be emotionally detached from their patients.
The same goes for the police attending road accidents.
I am sure at the start they are emotionally involved and the sights they see must give them nightmares for days, but then they become more desencitised and more able to get on with their job in the way that they are trained to.
Your work must be the same to a certain extent. Emotional descisions are rarely the correct descisions and the most satisfactory outcome for all is to do your job with a clear head and not muddled by emotional concerns.
Regretfully some you loose but that is life ? and I am sure you will agree with that.
Pace
I have never been involved in the sort of work that you have ie ambulance work.
What springs to mind here is the comparison with Doctors or surgeons. They are professionals to and have to be emotionally detached from their patients.
The same goes for the police attending road accidents.
I am sure at the start they are emotionally involved and the sights they see must give them nightmares for days, but then they become more desencitised and more able to get on with their job in the way that they are trained to.
Your work must be the same to a certain extent. Emotional descisions are rarely the correct descisions and the most satisfactory outcome for all is to do your job with a clear head and not muddled by emotional concerns.
Regretfully some you loose but that is life ? and I am sure you will agree with that.
Pace
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I infer that there is a body of thought that says a 'return' in this scenario represents a clouded / emotional decision wherein concern for the casualty causes a failure of judgement and the aircraft is put at risk.
What I can't figure out is the apparent viewpoint that the casualties safety is a null factor. We have the viewpoint that you shouldn't even think about a rule violation, even if its safe. Well to my mind thats not 'good' judgement, but rather its an absence of judgement. If anything, its an emotional fear of breaking a rule that is preventing any judgement from being exercised.
I also find it rather difficult to believe that any experienced pilot can honestly say they've never had to choose which of a pair of mutually contradictory rules/SOPs etc they have to break.
Let me restate (as I did in my earlier response) that for almost all circumstances the considered decision in the scenario above would be to continue. But rather, I'm more interested in the general principle, and in any case I'm sure that one could come up with any number of scenarios where the decision was much less clear cut.
My contention is the following:
"It is acceptable to expose a larger number of people to a small risk in order to reduce the risk to a smaller number of people."
In other words I'm saying that the safest course of action is the one that reduces the expected number of fatalities. As such I believe that the well being of the casualty should form a consideration.
Lets take it to extremes. If it genuinely is not acceptable to increase the risk to the flight even slightly, then you shouldn't consider a return even if its CAVOK, on the grounds that the remaining passengers will be subject to 2 takeoffs and 2 landings for a single journey. Take offs and landing accounting for the most accidents, its apparent that we've doubled the risk to the rest of the passengers...
What about if was a 2 hour flight, but with a convenient regional airport 60 miles on the nose. Only snag is it would be a non precision approach. Which of course are statistically far more risky that an ILS....
My point is that there is NO course of action that is less risky than just continuing to the original destination. So, even if there is no need to break any rule, or any minimum, the 'no risk' adherents shouldn't be medically diverting under any circumstance.
We're paid to exercise judgement, not abdicate responsibility.
pb
What I can't figure out is the apparent viewpoint that the casualties safety is a null factor. We have the viewpoint that you shouldn't even think about a rule violation, even if its safe. Well to my mind thats not 'good' judgement, but rather its an absence of judgement. If anything, its an emotional fear of breaking a rule that is preventing any judgement from being exercised.
I also find it rather difficult to believe that any experienced pilot can honestly say they've never had to choose which of a pair of mutually contradictory rules/SOPs etc they have to break.
Let me restate (as I did in my earlier response) that for almost all circumstances the considered decision in the scenario above would be to continue. But rather, I'm more interested in the general principle, and in any case I'm sure that one could come up with any number of scenarios where the decision was much less clear cut.
My contention is the following:
"It is acceptable to expose a larger number of people to a small risk in order to reduce the risk to a smaller number of people."
In other words I'm saying that the safest course of action is the one that reduces the expected number of fatalities. As such I believe that the well being of the casualty should form a consideration.
Lets take it to extremes. If it genuinely is not acceptable to increase the risk to the flight even slightly, then you shouldn't consider a return even if its CAVOK, on the grounds that the remaining passengers will be subject to 2 takeoffs and 2 landings for a single journey. Take offs and landing accounting for the most accidents, its apparent that we've doubled the risk to the rest of the passengers...
What about if was a 2 hour flight, but with a convenient regional airport 60 miles on the nose. Only snag is it would be a non precision approach. Which of course are statistically far more risky that an ILS....
My point is that there is NO course of action that is less risky than just continuing to the original destination. So, even if there is no need to break any rule, or any minimum, the 'no risk' adherents shouldn't be medically diverting under any circumstance.
We're paid to exercise judgement, not abdicate responsibility.
pb
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My contention is the following:
"It is acceptable to expose a larger number of people to a small risk in order to reduce the risk to a smaller number of people."
"It is acceptable to expose a larger number of people to a small risk in order to reduce the risk to a smaller number of people."
In other words I'm saying that the safest course of action is the one that reduces the expected number of fatalities. As such I believe that the well being of the casualty should form a consideration.
when one undertakes a flight as a passenger, one knowingly accepts the fact that the flight takes place above the surface of the earth, where access to medical personnel, armed police, friendly bank tellers, and the expectation of religious counseling for personal issues is somewhat removed, nigh impossible in most cases. This is a given. One knows that one may indeed experience a heart attack, or a pulled groin muscle, or a chipped fingernail, and have no way of dealing with it. This is what the passenger accepts with the purchase of a ticket to ride.
One does not undertake a flight as a pilot, nor as a passenger, with the expectation of fatalities, and one does not make a decision based on the number of expected fatalities I do not elect to take an ILS vs. a VOR because one might produce more fatalities than another, and I do not accept a flight to an airport which is illegal or unsafe (such as one below minimums) on the basis of the number of fatalities.
If one would not make that decision without a sick passener one board, one must NOT make that decision with a sick passenger on board. The sick passenger has changed nothing; your mission is to make a professional judgement based on both what is legal and what is safe. An act may be safe, but not legal, and an act may be legal, but not safe. Unless the act is both legal and safe, it's unacceptable. Period.