Airvans and patient transport

[chiles]

I want to start this question by stating that in no way am I asking if it is possible for CAP personnel to render medical care to anyone! Thank you, please drive through.

At a meeting in Florida I was part of a medical evacuation working group. I had a CAP colonel sitting next to me when they started talking about moving nursing home patients. It had occurred to me that CAP could probably use some of its air assets to move a few patients and I asked him about it. He told me that CAP did have a few Airvans that could move 6-8 people, assuming they could sit rather than lay and that the space isn't occupied by the Archer rig or something else. The question I pose to all you ES folks is this: Has using Airvans (and other air assets) to assist in the evacuation of ambulatory nursing home and hospital patients (assuming they were accompanied by qualified medical staff) been broached? If so, where has the discussion led and is it a feasible CAP mission to undertake?

Granted, we're not talking about a lot of patients here. However, removing the easy ones lets the medical teams deal strictly with the hard ones. Another caveat is that anyone who is too ill/injured to move will shelter in place. So, by removing some of the nursing home patients helps the teams focus on those patients that are not too ill/injured to move but are less than ambulatory.

Once again, I'm not saying we'd fly them and treat them. Just fly them like we fly the drug busters.

[_]

I'd think the cost of insurance alone would make it unfeasible.

An air van would have enough room for equipment and such.  I've seen medevac aircraft that were lear 35's and king air's with comparable interior volume. 

[Eclipse]

Evacuate them where?

I assume you're talking about real-time emergencies like Katrina where they are out of harm's way but need to relocate somewhere else for a while - in that case its not really an "emergency" per se, and there are more efficient ways to move groups of people, like commercial or military airliners.

An interesting idea, but even the GA8's don't have enough room to make it feasible, especially if the people need handlers in-flight.  If nothing else, were would they go to the can?

[flyerthom]

It has not been broached on the yahoo HSO group, nor was it ever mentioned when the Health Services Working Group was active under Dr Greenstone (I was a member). 

That being said, the Airvans and the Cessna 206's (if the third seats were in place) could probably be used effectively to transport walkie talkie patients or wheelchair capable (not in the WC but able to sit) who did not require active medical care. They would need to be transported to an area with the ability to handle them. I would say patients requiring evacuation with minimal assist such as those who would be transported by wheelchair vans for routine care. Assisted living or INF (Intermediate Nursing Facility) Patients. SNF (Skilled Nursing) or acute care would be out of the equation. Another rule out would be patients with Altered Mental Status like dementia or Alzheimer's. The safety risk to other patients and flight crew would to great and we do not want to be involved in physical or chemical restraints in the air.

It is doable, but the next question is; is it an effective use of resources? To answer that we need to ask:
How do we get the clients to the aircraft?
How does that detract from moving all the clients to the same location?
How do we track the clients?
How to we handle essential medical records so treatment can continue at the new location?
How do we deal ADL's and medications in route?
How do we deal with medical issues and panic in route?

EMS trains for this in ICS situations. It would be best to leave this there.

The bottom line is, it's possible but it is most likely not the most effective use of the resource. There would be to few patients to fly in the narrow window we have available. And among those few the safety window is even narrower.

A better use of our light hauling capability would be strike team transport and medical resupply. DMAT's could use us to fly Strike teams into areas to start their set up and assessments. We also could fly resupplies in when their caches become depleted. We also could fly their folks for damage assessments (and we have an excellent track record in damage assessment photography). We've done some resupply already - how many dog crates did we fly for Katrina? HSO's could do a world of good in liaison with DMAT and local EMS and medical services. 

[lordmonar]

The problem basically comes down to this:

if the situation is not life threatening, then CAP should not be doing it or it is a waste of a resource.

If it the situation IS life threatening, then we have to have provisions to provide medical care.

Until we work out the HSO liability issue...we will not be the best asset for patient transportation.

[PHall]

Which do you think would be more efficent?

A CAP Airvan moving 2 litter patients or a ANG C-130 moving 30?
And the C-130 has a Air Evacuation Medical Crew (2 Flight Nurses and 3 Medical Techs) and equipment aboard.

Unless there is a demonstrated, valid need for us to do this. It would probably be best for us to leave this kind of mission to those who are trained and equipped to do the mission right.

[sarmed1]

...just to point out a C-130 can be configured for up to 74 litter patients if all of the stantions are avaialble for use (round down a bit to place medical equipment on board), in a contingency up tp50 litters can be loaded cargo starpped to the floor.

CAP would not have to provide medical personnel to monitor the patients, local EMS could provide in flight care if needed.  An aeromedical trained crew is always prefered but not required (the biggest benefit to an AE crew is that they are trained in AC safety and emergency procedures and a little knowledge of how things like altitude adn other flight stressors effect certain patient conditions)

Sticking with the emergency evac mission, a CAP AC would be more useful in a remote area evac in a disaster, I am by far a piloting type but there are situations where a fixed wing ac is better than a rotar wing for some medevac missions...ie longer distance flight, IFR weather type issues....CAP would be able to fly into a remote field (or little airport) around severe weather post disaster to pick up a critical patient or 2 and transfer them to better care....or even fly in a specialized crew that can manage the patient via ground evac.

mk

[RiverAux]

Given our low inventory of airvans, it would be unlikely that we would have one close enough to the site to be of any use for emergency evacuations.  And as pointed out for non-emergency situations (well, not immediately life-threatening), other aircraft can do much more. 

[chiles]

The meeting had military personnel in it and we discussed their capabilities to airlift. The military and PHS reps said that they do not lift critical care patients without a lot of prior notice. However, they would focus on those patients who could not move on their own while letting civilian life flight handle the ICU types. The scenario called for a full evacuation, pre-Katrina conditions, of all patients in an area that hold a lot of hospitals but many thousands of nursing home patients who otherwise would have little way out (I know, nursing homes are supposed to have evac plans, and many are compliant. I've reviewed these plans. The problem is, they all rely on the same ambulance vendor). Anyway, the idea would be to have the locals move the patients to a rally point where flight crews, civilian and military, would receive patients with handlers (in the case of the kind of patients that would go aboard a CAP aircraft, handler), credential them and assign them to an air asset that had a set route outside the evac zone. There would be similar facilities at the receiving end to confirm reception and continue the evacuation and tracking process. I'm interested in if CAP can fill the roll of that flying step with a few aircraft in support of the larger mission and if it would have any value to the evacuation attempt as a whole.

[afgeo4]

CAP is already charged with medical transport as part of the disaster relief transport pilot mission. Transport pilots are authorized to fly medical equipment, organs/vital fluids/vips and medical patients.

I believe if you remove the left seats from 2nd and 3rd row, you may be able to accomodate a litter, if it can be properly secured, with a med tech in one of the right seats. I don't think the archer system can be easily removed, so you're losing some space.

Exactly what in our regulations prohibits us from transporting ambulatory patients as part of an evacuation? Ambulatory patients aren't classified as anything different than healthy evacuees in our books and we already know we get tasked with evacuating people (it was done in Louisiana).

The Cessnas and Airvans have a few things over other aircraft:
1. Their wide availability as CAP assets come from all over.
2. Their cost efficiency.
3. By using CAP aircraft we allow other aircraft to be used on higher priority missions.
4. Landing in small airports without special permissions.

Pretty important stuff... Now... do you think our Health Professionals can take initiative and design a flight surgeon/nurse/medtech ES specialties? We can use existing CAP wings and create appropriate aircrew wings.

[thefischNX01]

So it seems to me that there are two major things that are staring us in the face with this: Liability and Number of Aircraft.  The first issue can only be handled by national; so I won't touch that one beyond a simple suggestion:  perhaps we could partner with the US Public Health Service on this one: we fly and maintain the aircraft, and they supply and maintain a sqdn of flight nurses and/or paramedics.  Thus, we avoid the health liability and burden an already-licensed organization with that. 

However, the aircraft issue is easily solvable through the purchase of additional aircraft.  If this were to happen, I would suggest we not use the airvan.  Although standardization is excellent, an aircraft such as the Pilatus PC-12 is more suited to CAP's needs.  In addition to the 'sexy' factor that it would add to our fleet (face it, the reason fighter aircraft are the stars of the armed forces is because they look so gosh darn cool!) the Pilatus has the capacity to carry 2 liters plus the nurses and medical equipment.  Additionally, (depending on winds, fuel costs and other uncontrollable values) the aircraft only requires abou $600/hr to operate.  (figures taken from http://www.pilatus-aircraft.com/media/Pilatus-PC-12-Just-The-Facts.pdf sec. 2.9)

[RiverAux]

Hmm, less aircraft for our primary ES mission SAR or more aircraft for a mission that will probably only rarely be needed and cost 6times as much to operate?  Easy choice. 

[chiles]

If we're transporting ambulatory patients (those who can sit in a regular seat) prior to a hurricane strike, what other mission would the aircraft be required for? After the strike, I assume it'll be used for aerial surveillance and damage assessment as well as SAR, but before the hurricane strike, it should be fairly available, right?

[Eclipse]

The further you move from the ubiquitous 172, the less pilots you will have to fly.

One of the reasons are fleet is basic GA aircraft is because most of our pilots can maintain currency on their own.  Just look to how many GA-8 pilots we have to see how hard it is to get qualified on an airframe when there are less than 20 nationwide, and the people who have them guard them jealously.

[thefischNX01]

Hmm, less aircraft for our primary ES mission SAR or more aircraft for a mission that will probably only rarely be needed and cost 6times as much to operate?  Easy choice. 

True that...I actually don't advocate this mission for us; I was simply suggesting the best way to go about it in the event we did take it on.  IMO, it would require too much restructuring of our current fleet for a mission that we may only do once a decade.  Otherwise, it would just be half-assed and not worth it. After all, we would be retrofitting maybe 4 airvans to fly one patient at a time; without the proper safety equipment and no flight nurse/paramedic.  Again, just my opinion. 

EDIT: Although I would like to see a disaster air ambulance program like the one described implemented on the national level; IMO it should be handled by the USPHS and not USAF, USCG or CAP.

[chiles]

My original request was the feasibility of transpoting ambulatory patients. That is, patients not requiring litters or stokes or anything like that. They're nursing home/assisted living patients that have no other way to evacuate and maintain the level of care they need. This may include simply being on oxygen or a bag of pills a day. If they can sit down in a seat, can't you transport more than just the one you mention?

[SJFedor]

It'd be possible. It's allowed by regulation as part of our DR mission. However, on a large scale, it doesn't make sense. Plus, the regulation has the caveat that we can only be used when other means are not readily available. If there was a mass evacuation, I'm sure the state guards could task a cargo plane or two to move people much better then we could.

But yeah, I'd do it 

[thefischNX01]

My original request was the feasibility of transpoting ambulatory patients. That is, patients not requiring litters or stokes or anything like that. They're nursing home/assisted living patients that have no other way to evacuate and maintain the level of care they need. This may include simply being on oxygen or a bag of pills a day. If they can sit down in a seat, can't you transport more than just the one you mention?

Oh...my bad!  I thought we were talking about something more serious.  Sorry. 

[sardak]

Here is a series of photos showing a litter patient being loaded into a C-182.  This was more than a few years ago.  It was a test to see if the litter and patient would fit, which they did.  We didn't secure the litter in the plane, so the plane never moved.

Faces and other identifying marks have been distorted to protect the dumb guilty innocent.

Mike

[sarmed1]

Have you ever seen the litter arrangement in the Bell 206 jet ranger.....patient on one side, feet up next to the pilot, the back is not much roomier than a 182.....

mk

http://rds.yahoo.com/_ylt=A0WTb_mH9ndH2wIAzkijzbkF/SIG=126dmrcgk/EXP=1199130631/**http%3A//www.pantonov.com/gallery/biaf-1999/P0001224

[SJFedor]

Have you ever seen the litter arrangement in the Bell 206 jet ranger.....patient on one side, feet up next to the pilot, the back is not much roomier than a 182.....

mk

http://rds.yahoo.com/_ylt=A0WTb_mH9ndH2wIAzkijzbkF/SIG=126dmrcgk/EXP=1199130631/**http%3A//www.pantonov.com/gallery/biaf-1999/P0001224

AirEvac Lifeteam uses that configuration. IMHO, it's horrible. God forbid the patient gets rowdy and starts kicking the pilot.

I've been on the pad more then a few times helping AE crews get patients out, etc. We had one that was CPR in progress, and I was baffled how they even managed to do it in the aircraft. You actually have to move the airway seat just to extricate the patient out. Real cumbersome.

[flyerthom]

Have you ever seen the litter arrangement in the Bell 206 jet ranger.....patient on one side, feet up next to the pilot, the back is not much roomier than a 182.....

mk

http://rds.yahoo.com/_ylt=A0WTb_mH9ndH2wIAzkijzbkF/SIG=126dmrcgk/EXP=1199130631/**http%3A//www.pantonov.com/gallery/biaf-1999/P0001224

AirEvac Lifeteam uses that configuration. IMHO, it's horrible. God forbid the patient gets rowdy and starts kicking the pilot.

I've been on the pad more then a few times helping AE crews get patients out, etc. We had one that was CPR in progress, and I was baffled how they even managed to do it in the aircraft. You actually have to move the airway seat just to extricate the patient out. Real cumbersome.

The A Star 350B is similar. Friday night the patient grabbed the pilots charts! The word for today is sedation...

[SJFedor]

The A Star 350B is similar. Friday night the patient grabbed the pilots charts! The word for today is sedation...

*cough* DeathStar *cough* 

Our flight service uses EC-145s and BK-117s, so the patient has no access to the "flight deck", even if they manage to flight off the two Flight RNs in the back. But our flight nurses usually intubate before they even get in the chopper if they think there's any chance of the patient getting rowdy.

[/topic drift]

But yeah, we could transport walkie talkies. Where we'd come into the fold a lot better would be a isolated, cut off town with only a small airport. NOLA and Katrina type stuff, 130s and bigger did the job a lot better then we ever could have, though, if we did it, I wouldn't have minded getting the hours doing that.

Besides, since we're doing transport, the pilots doing so would more then likely need to be Comm rated. With the Airvan, that's not such a big problem, since Comm was a requirement (no more), but they still kinda prefer Comm rated people, or people getting there quickly.

[sardak]

Have you ever seen the litter arrangement in the Bell 206 jet ranger.....patient on one side, feet up next to the pilot, the back is not much roomier than a 182.....

Here's how our local Air Life does it with their 407s.  The platform swings out and their litter is attached/detached to the platform, then it swings back in.  A backboard or full body vacuum splint can be strapped directly to their litter.  Only one patient per flight.

The patient's feet are alongside the pilot, but there is "kick guard" that is about as high as the pilot's shoulder.

Back to topic.

Mike

[BillB]

The USAF Surplus L-5 aircraft that went into the CAP inventory in the late 1940's and early 50's were all capable of carrying strecher patients. the left side of the aircraft swung down and a litter could be installed. This played hell with weight and balance until pilots got used to the tail heavy effect. I remember several instances in Florida when the L-5's were actually used for patient transport from small airports/ grass strips to major airports and hosiptal areas. So in the dim-dark past CAP was used for emergency patient transport. (these were the L-5's with inline engines, not the radial engines)

[O-Rex]

Patient transport is not really part of our mission.  Besides the liability issues previously mentioned, patient transport requires enroute patient care, which we are simply not geared for: There are other orgs better suited for the task.

[BillB]

When the L-5's were in use by CAP they were all USAF aircraft and so marked. The liability was USAF's, not CAPs. At the time the aircraft were in use there was no other air lift capability from the small airports or grass fields. Helicopters were not yet in civilian use. The next smallest aircraft for air transport were twin engine Beech's. While rarely used, CAP did furnish the air transport of patients when required. During this period the military and CAP did not have on-board medic personnel for air transport (see the old MASH TV shows for an example)

[afgeo4]

So it seems to me that there are two major things that are staring us in the face with this: Liability and Number of Aircraft.  The first issue can only be handled by national; so I won't touch that one beyond a simple suggestion:  perhaps we could partner with the US Public Health Service on this one: we fly and maintain the aircraft, and they supply and maintain a sqdn of flight nurses and/or paramedics.  Thus, we avoid the health liability and burden an already-licensed organization with that. 

However, the aircraft issue is easily solvable through the purchase of additional aircraft.  If this were to happen, I would suggest we not use the airvan.  Although standardization is excellent, an aircraft such as the Pilatus PC-12 is more suited to CAP's needs.  In addition to the 'sexy' factor that it would add to our fleet (face it, the reason fighter aircraft are the stars of the armed forces is because they look so gosh darn cool!) the Pilatus has the capacity to carry 2 liters plus the nurses and medical equipment.  Additionally, (depending on winds, fuel costs and other uncontrollable values) the aircraft only requires abou $600/hr to operate.  (figures taken from http://www.pilatus-aircraft.com/media/Pilatus-PC-12-Just-The-Facts.pdf sec. 2.9)

Pilatus won't happen.

1. It is a platform that isn't useful for SAR duties with its wing under fuselage and high speed.
2. CAP regulations specifically state that CAP will not use aircraft rated for more than 8 passengers. It is strictly prohibited. The Pilatus seats 9.

[chiles]

While I understand there are other organizations better suited, the entire reason this was even broached was that the number of people requiring evacuation overwhelmed those very organizations. Putting walkie/talkies into an airvan with a nurse seemed like a possible extension of the CAP ES mission. Does CAP incur too large a liability if they transport a walkie/talkie with a nurse responsible for them (who is not a CAP member). It seems to me like it'd be the same as any other transport mission. I'd also like to point out I'm not talking about demented or otherwise mentally unstable patient either. Just those elderly in nursing homes who require too much assistance to live on their own but not so much that they are bed bound or require locking up.

[RiverAux]

I would suggest that if we were to do evacuations, we would probably be able to handle more patients using our vans (of which we have twice as many as we do airplanes).  Since we're talking genrally about ambulatory people our capacity in the vans is also much higher.  Could take at least 2 stetchers without the seats were it necessary. 

[FW]

My original request was the feasibility of transporting ambulatory patients. That is, patients not requiring litters or stokes or anything like that. They're nursing home/assisted living patients that have no other way to evacuate and maintain the level of care they need. This may include simply being on oxygen or a bag of pills a day. If they can sit down in a seat, can't you transport more than just the one you mention?

One problem with providing patient airlift is our current FAA exemption.  I don't think we're allowed to transport anyone other than a CAP member or government official from point A to B; even during a declared emergency (CAPR  60-1).  Also, there are organizations like "Mercy Airlift",  "Angel Flight",  and the "Corporate Angel Flight Network" doing this mission every day at no expense to the taxpayer or patient(the pilot or corporation donates time/aircraft/fuel).  These organizations have thousands of volunteer pilots and aircraft at their disposal 24/7.  It is the mission of these bodies to transport anyone in need;  including, during emergencies.  
BTW: if anyone is interested in volunteering, go to www.angelflightne.org, or any of the other angel flight sites for more info.

[afgeo4]

My original request was the feasibility of transporting ambulatory patients. That is, patients not requiring litters or stokes or anything like that. They're nursing home/assisted living patients that have no other way to evacuate and maintain the level of care they need. This may include simply being on oxygen or a bag of pills a day. If they can sit down in a seat, can't you transport more than just the one you mention?

One problem with providing patient airlift is our current FAA exemption.  I don't think we're allowed to transport anyone other than a CAP member or government official from point A to B; even during a declared emergency (CAPR  60-1).  Also, there are organizations like "Mercy Airlift",  "Angel Flight",  and the "Corporate Angel Flight Network" doing this mission every day at no expense to the taxpayer or patient(the pilot or corporation donates time/aircraft/fuel).  These organizations have thousands of volunteer pilots and aircraft at their disposal 24/7.  It is the mission of these bodies to transport anyone in need;  including, during emergencies. 
BTW: if anyone is interested in volunteering, go to www.angelflightne.org, or any of the other angel flight sites for more info.

Where did you get that from?

[BillB]

The regulation allows flights for members of the news media with permission from National.

[afgeo4]

A few months ago I saw an article in the Volunteer about a CAP aircrew flying a family out of Louisiana or Mississippi as an evac flight. The pic was on the front cover too.

[FW]

CAPR 60-1 Attach. 2 is where the FAA exemption is listed.  We can provide transport for non members or property provided the mission is an AFAM "A" or non reimbursed mission B or C.   So, I stand corrected.  However, I still think the other orgs. are better able to handle this mission unless we have a large scale disaster.  

[sarmed1]

...sorry bored at reserve duty..... (its an Aerovac squadron so appropriate)
It would be interesting to have some one look at what the contingency capability of using the GA-8 airframe for litter evacuation.   ie its an airframe immediately available at a disaster site available for tasking, it might be nice to know what can be done so it doenst have to be invented on the fly, or outright declined becuase no one knows if it is or isnt really feasible.

The web site shows a 2 litter configuration? 
But what if (and yes I realize thats a very big if) CAP was called upon to do such a mission.
-How would you do it?...are there hard points on the floor you could cargo strap a litter to?
-How much space does the archer take up and there by decreasing the patient capability (space)  & weight load (and crew beyond pilot) can it be removed..if so how long does it take and/or does it require special technician type capabiliyty. (or to put it back afterwards)
-How about seat removal?
-Could you safely secure oxygen beyond a bunch of D-type tank bottles?
-Is there any power options that you could run 110VAC, how much...ie medical equipment....cardiac monitor, ventillator, IV pump. suction? or are you limited to device battery power?

mk

[PHall]

You can pretty much cross the Airvans off your list, period.

The ARCHER equipment can not be removed unless ordered by the NOC.
It's not a decision that an IC can make.

The Airvans are a National asset and they're the ones calling the shots.
And with all the money that they've thrown at this project, they're not going to want to damage the systems by putting them in and taking them out all the time.

[SAR-EMT1]

If this was listed above I missed it...

When was the last time CAP transported a pt in an aircraft?

What about organs or blood?

I imagine (but have no info to back this up) its been years maybe decades since we moved an actual patient. (Alaska might be the exception)

Second question: (semi related)
Anyone think Clinic Augmentation for EMTs/PAs/Nurses/MDs etc might be possible under VSAF? ... What about serving on C-130 medevac teams?

[RiverAux]

I think the volunteer had an article about blood transport last year.  That slacked off quite a bit after the 1980s when commercial services started doing it. 

[SAR-EMT1]

Exactly. Pt transport by CAP does not exist anymore.
Blood or organ maybe but not pt. transport.

[Eclipse]

Anyone think Clinic Augmentation for EMTs/PAs/Nurses/MDs etc might be possible under VSAF? ... What about serving on C-130 medevac teams?

No - VSAF will never include anything operational.

We can't do that today as full members on a A-mission.

[SJFedor]

The web site shows a 2 litter configuration? 
But what if (and yes I realize thats a very big if) CAP was called upon to do such a mission.
-How would you do it?...are there hard points on the floor you could cargo strap a litter to?
-How much space does the archer take up and there by decreasing the patient capability (space)  & weight load (and crew beyond pilot) can it be removed..if so how long does it take and/or does it require special technician type capabiliyty. (or to put it back afterwards)
-How about seat removal?
-Could you safely secure oxygen beyond a bunch of D-type tank bottles?
-Is there any power options that you could run 110VAC, how much...ie medical equipment....cardiac monitor, ventillator, IV pump. suction? or are you limited to device battery power?

I'll go point by point on this, since others may be curious as well.

1. I would imagine that Gippsland sells litters that hooks into the existing seat hooks on the floor, unless that picture is just one of those "you could do this if you pay out the butt to get it approved" type things.

2. The system weights ~150lbs, plus another 7.2 for the window beneath. It takes up the right side 3rd back seat area, but w/ the optics system going to the floor, unless you want people stepping on it, it makes another seat space unusable. So, the standard configuration for the airvan is 6 pax, 2 front, 2 behind the pilot/copilot, the unit, and then 2 behind the unit. It can be removed, but is not permitted to be removed, as echoed by someone else, unless NOC approves it. Even so, it requires qualified ARCHER personnel to do the removal. Dunno how long it takes, I'd think no more then 20-30 min though. If I ever see it done, I'll time them. 

3. The seats pop out really easily, takes maybe 30 seconds to pop one out.



Just stick the red thingys in, pull inboard, and it pops right out. You can learn more about it by going to the NHQ page and looking through the GA-8 course in the CAP University page.

4. Not sure what you mean by "secure", as in can we strap in an O2 generator, or "secure" as in get ahold of more. The plane doesn't have an O2 system in it, so if we're transporting anyone on O2, that'd be an issue where they'd need to bring their own. Besides, I'd hope that, in the highly rare event we do anything like this, if they're on more then a nasal cannula, they're being transported by someone else.

5. Dunno about electrical options. The aircraft systems themselves are a 12/14 volt system on 2 busses. Not sure what the ARCHER system is as far as voltage, I'll be glad to find out. But there are hookups in the back for the ARCHER system, so I'd imagine that, if need be, something could be come up with to convert it to usable power. Again, if we're moving anyone on more then a NC, especially an intubated patient, they'd probably be better off taking a ride on a whirly bird or another, better equipped, fixed wing bird.

Hope that helps!

[SARMedTech]

As soon as you start using the word "patient" to describe anyone that would be added to a CAP ES mission flight, you should tuck that one in a drawer filed "Nebba Gonna Happen." If National wont authorize EMTs in the field, they are not going to authorize, let alone pay for and take the liability of patients on a CAP aircraft. Someone mentioned flying patients on oxygen. Do you really want CAP pilots flying around with explosive cylinders in their A/Cs? And that photo array of putting someone in a CAP plane on a litter...just because you can cram them in there, doesnt mean its a good idea. If you have a patient on a litter, by definition they are not ambulatory. I dont think CAP ever wants to go wheels up with someone considered a "patient" on board regardless of whether that person can sit up or not. Besides, old people, let alone old sick people, like to throw clots whilst in flight. If that happened, you couldnt belly flop that plane fast enough to switch from carrying a patient to carrying a corpse.

Also, there are about 7,000 commissioned officers in the USPHS. Less than 200 of them are members of the Corps "strike teams." I dont think they are going to want to waste those minimal resources flying Grandma to Boca.

[SARMedTech]

Have you ever seen the litter arrangement in the Bell 206 jet ranger.....patient on one side, feet up next to the pilot, the back is not much roomier than a 182.....

mk

http://rds.yahoo.com/_ylt=A0WTb_mH9ndH2wIAzkijzbkF/SIG=126dmrcgk/EXP=1199130631/**http%3A//www.pantonov.com/gallery/biaf-1999/P0001224

AirEvac Lifeteam uses that configuration. IMHO, it's horrible. God forbid the patient gets rowdy and starts kicking the pilot.

I've been on the pad more then a few times helping AE crews get patients out, etc. We had one that was CPR in progress, and I was baffled how they even managed to do it in the aircraft. You actually have to move the airway seat just to extricate the patient out. Real cumbersome.

The A Star 350B is similar. Friday night the patient grabbed the pilots charts! The word for today is sedation...

Actually 2 words...Versed and Sux. This is standard protocol for a patient who becomes combative in flight. Do you really want such a person on board and who is going to monitor a patient sedated with hypnotic and a paralytic and where are you going to put the lifepak cause with a sedated patient, you arent going to feasibly, let alone legally get off the ground without it. Do you really want to take any responsibility for a pharmaceutically paralyzed patient with a hose down their windpipe. The liability for such a thing for air ambulance jets runs into the 10s of thousands each flight and thats not counting the cost of monitoring and resuscitating gear on board. I wouldnt do this with anything less than a Phillips MRX and I dont think National is going to spring form $80k a pop for that particular piece of gear.

Actually, perhaps the word for the day should be "BK-117." There isnt a better rotary wing patient mover on the planet. Each one is a mobile ICU and the clamshell doors make it a craft actually meant for moving sick people.

This whole thing is the worst idea since I wanted to put STOMP pack carrying medics in the field with GTs. Again I say "nebba gonna happen."

Maybe all of this would be better off with the USCGAUX with a MPIC on board. Its easier to stop a cabin cruiser mid move than it is a fixed wing. (Just joking of course about evac'ing a patient on a civilian water craft). By the way, what does the AUX Air fly?

[SarDragon]

Do you really want CAP pilots flying around with explosive cylinders in their A/Cs?

Explosive? The airbag in your car is more likely to explode than a medical O2 cylinder. The carry-around cylinders that folks with COPD, and others,  tote around are pretty rugged.

PM me if you'd like more detailed info.

[SARMedTech]

Do you really want CAP pilots flying around with explosive cylinders in their A/Cs?

Explosive? The airbag in your car is more likely to explode than a medical O2 cylinder. The carry-around cylinders that folks with COPD, and others,  tote around are pretty rugged.

PM me if you'd like more detailed info.

The exaggeration was to prove the point that if you start putting tank breathers on CAP planes, youre going to need more than a litter and a NC.

[SARMedTech]

But while we are on the subject:




Preamble Information
AGENCY: Federal Aviation Administration (FAA), Department of
Transportation (DOT).


ACTION: Final rule; request for comments.

SUMMARY: We are adopting a new airworthiness directive (AD) for certain oxygen reserve cylinders. This AD results from mandatory continuing airworthiness information (MCAI) originated by an aviation authority of another country with which we have a bilateral agreement to identify and correct an unsafe condition on an aviation product. The MCAI describes the unsafe condition as:

This Airworthiness Directive (AD) is issued following information concerning the risk of high-pressure oxygen cylinder tearing with sudden emptying. These cylinders are used for missions at high altitudes or to ensure respiratory air for passengers feeling sick.

It has been demonstrated that the material characteristics of the Aluminum Alloy 5283 (AA5283) from which the cylinders are manufactured deteriorate in the course of time and may possibly lead these oxygen cylinders to tear and abruptly vent aboard an aircraft.

This unsafe condition requires immediate action due to the risk of oxygen cylinders exploding on board an aircraft and creating a fire hazard. This AD requires actions that are intended to address this unsafe condition.




DATES: This AD becomes effective January 28, 2008.

We must receive comments on this AD by March 11, 2008.

[SJFedor]

As soon as you start using the word "patient" to describe anyone that would be added to a CAP ES mission flight, you should tuck that one in a drawer filed "Nebba Gonna Happen." If National wont authorize EMTs in the field, they are not going to authorize, let alone pay for and take the liability of patients on a CAP aircraft. Someone mentioned flying patients on oxygen. Do you really want CAP pilots flying around with explosive cylinders in their A/Cs? And that photo array of putting someone in a CAP plane on a litter...just because you can cram them in there, doesnt mean its a good idea. If you have a patient on a litter, by definition they are not ambulatory. I dont think CAP ever wants to go wheels up with someone considered a "patient" on board regardless of whether that person can sit up or not. Besides, old people, let alone old sick people, like to throw clots whilst in flight. If that happened, you couldnt belly flop that plane fast enough to switch from carrying a patient to carrying a corpse.

Also, there are about 7,000 commissioned officers in the USPHS. Less than 200 of them are members of the Corps "strike teams." I dont think they are going to want to waste those minimal resources flying Grandma to Boca.

Considering we (pilots) are required to use supplemental oxygen above certain altitudes, I wouldn't worry too much about any form of explosions. Here's some of the neat toys we get to play with:

http://www.sportys.com/pilotshop/pages/oxygen.cfm

Pretty similar to what we use in the ED, cept that aviation oxygen is a little different, they fill the bottles w/ very little, if any, moisture in them, so that they're not as susceptable to freezing at high altitudes. That's why we can't use medical O2 for aviation supplemental O2.

Actually 2 words...Versed and Sux. This is standard protocol for a patient who becomes combative in flight. Do you really want such a person on board and who is going to monitor a patient sedated with hypnotic and a paralytic and where are you going to put the lifepak cause with a sedated patient, you arent going to feasibly, let alone legally get off the ground without it. Do you really want to take any responsibility for a pharmaceutically paralyzed patient with a hose down their windpipe. The liability for such a thing for air ambulance jets runs into the 10s of thousands each flight and thats not counting the cost of monitoring and resuscitating gear on board. I wouldnt do this with anything less than a Phillips MRX and I dont think National is going to spring form $80k a pop for that particular piece of gear.

Actually, perhaps the word for the day should be "BK-117." There isnt a better rotary wing patient mover on the planet. Each one is a mobile ICU and the clamshell doors make it a craft actually meant for moving sick people.

Standard RSI, as far as I've ever seen, has been etomidate as an induction agent, and sux as an NMB. I've seen people tubed w/ fentanyl and versed (head traumas), versed and roc, and a few other combos, but never versed and sux. Guess it could happen though.

I like the EC-145s better, although they're just modified newer-generation 117s anyway. I think the 145s have just a little more room in the rear as well, and a few more ponies in the noisemaker.

Funny this comes up, my hospital's helicopter service did a fly-in for an exercise we were doing. Did you know that, at least my service, has sirens on the helicopter? Seriously, they did a pass at about 400 AGL when they were coming in, and, no lie, they had a siren. The things I learn...

[SARMedTech]

Gotta love sirens on a helo. Though in academy class today we did actually see a sickening video of a SUV speeding into an interstate LZ and smashing into a medevac.

Speaking of sirens...heard the new Federal Rumbler yet? I hate sirens for POV response vehicles, but if they were legal in IL i think I would have to have a Rumbler.

[SJFedor]

Gotta love sirens on a helo. Though in academy class today we did actually see a sickening video of a SUV speeding into an interstate LZ and smashing into a medevac.

Speaking of sirens...heard the new Federal Rumbler yet? I hate sirens for POV response vehicles, but if they were legal in IL i think I would have to have a Rumbler.

I have, a few of the PDs around here are starting to use them. They're the hawtness <3

My lord, what a topic drift we've hit...

[sarmed1]

sorry I meant secure as in tie down.....AF wise we use a 3x3x3 10L liquid oxygen unit....cargo strapped to the floor.

as far as electrical we have a frequency converter that takes C-130 power and changes it around to regular medical equipment power.....I dont remmeber off hand what type of juice is coming thru the outlet...12 or 24 Volt or something else entirely.

The thought that really sparked this was a discussion about other airframes used as "oppurtune" evac platforms.... as in not a dedicated aerovac aircraft, especially being in a unit that doesnt actually have its own aircraft.  When we pull alert duty we may be flying in whatever asset the AF deems most usefull and available to complete a mission.
I know guys that have flown on anything from C-5's to a generals lear jet.  The idea of that if a CAP aircraft like the GA-8 was available especially during an AFAM (ie large scale DR) could it be tasked for such a mission.  (I wasnt really seriously believing that a CAP "medical crew" would work the mission)

on the semi related note:
The clinic augmentation would be more feasible than aerovac augmentation.
The biggest stubling block would be a-getting CAP civilian medical quals matched up with AF quals, b-verifying & maintainig requireds skill abilities, then c-getting oriented to the unit operations.  Its a possability but one that would require a lot of work and time commitment. 

As far as the aerovac world, currently the AF requires a 5 skill level for technician types, 6 week aerovac school at Brooks, then 6-8 training missions plus check ride and closed book testing just to be considered basically qualified.  RN's are the same except for the 5 skill level.

The BK-117 is an ok aircraft but still tight, and limited to patient size and weight.  When I lived in San Antonio the service I worked for used Bell 412 's (basically Huey's) they have since moved to a newer faster airframe sadly.....But You couldnt beat the 412 for space and capacity.  We were basically unrestricted by weight. (if you could close the door you could fly them)  It was capable of carrying 4 litters plus crew plus a passenger up front.
I know of one mission they actually flew 5 patients, 2 were peds (like 5&7) foot to foot on the litter.  Its IFR capable and I believe oxygen equipped.

mk

[SARMedTech]

On a non-related note: I dont think CAP clinic augmentation is at all feasible. As I say, I spent my first few months on this forum arguing for medical teams in the field. I know just from trying to keep up my CEU's  for my EMT license that the first thing a hospital or clinic is going to say is "Ok. Come help us. And by the way, wear your agency's issued photo ID so we know who is covering your liability.  What's that you say? They don't cover liability? But youre an EMT for the Civil Air Patrol."

Seriously though, and trying to come back to our original heading, there are serious federal, state and liability requirements for moving patients in an airframe. I think it would be great if it could happen. Ive not yet had the pleasure of being in an airvan, but I just dont see anyway its going to happen in the near future.

[SAR-EMT1]

I think (but not sure) the original question was something like:  Can / does / would CAP transport patients;
PROVIDED:
a) non-CAP medical personnel and equipment is onboard
b) tasked by AF or ARC or similar (money on ARC)
c) pt. is non-critical and at least 'semi-ambulatory'

- Discuss

* sideline: Fedor, if memory serves, you are an ER nurse/tech/towelboy
If YOU could design a medevac setup around the Gippsland what would itbe ? 

And to some extent I am amazed my dear Mr Fedor as to why being a medic and a pilot that you arent currently working as a Medevac pilot.

[SAR-EMT1]

Have you ever seen the litter arrangement in the Bell 206 jet ranger.....patient on one side, feet up next to the pilot, the back is not much roomier than a 182.....

mk

http://rds.yahoo.com/_ylt=A0WTb_mH9ndH2wIAzkijzbkF/SIG=126dmrcgk/EXP=1199130631/**http%3A//www.pantonov.com/gallery/biaf-1999/P0001224

AirEvac Lifeteam uses that configuration. IMHO, it's horrible. God forbid the patient gets rowdy and starts kicking the pilot.

The A Star 350B is similar. Friday night the patient grabbed the pilots charts! The word for today is sedation...

Maybe all of this would be better off with the USCGAUX with a MPIC on board. Its easier to stop a cabin cruiser mid move than it is a fixed wing. (Just joking of course about evac'ing a patient on a civilian water craft). By the way, what does the AUX Air fly?

Couple things:

1) CGAux Air flies whatever the pilot owns. The CG Aux doesnt hold title to ANY aircraft. They just have a blanket liability policy for pilots and a system for official flight orders. The bird could be anything from a crop duster to a 182 to a 206 to a Lear.Only rule is that the bird must be inspected and signed off by the Coast Guard and must adhear to maint. standards. The pilot must attend part of the CG pilot training course too.

2) The Air Evac Rangers Ive seen all have a floor to ceiling plastic wall completely seperating the pt
(and his arms and feet) from the pilot. But still VERY cramped. 

... Why the frick cant everyone just go back ot the Huey?

[SJFedor]

- Discuss

* sideline: Fedor, if memory serves, you are an ER nurse/tech/towelboy
If YOU could design a medevac setup around the Gippsland what would itbe ? 

And to some extent I am amazed my dear Mr Fedor as to why being a medic and a pilot that you arent currently working as a Medevac pilot.

I'm hopefully headed there. Just need a few thousand more turbine rotary hours....

I'm one of those awesome ER techs you read about, and to boot, I'm a GA-8 driver as well!

Depending on the type of patient you're carrying, I would probably think of carrying 1 patient, 2 if you really had to. Install the litter on the right side of the aircraft, with the feet right behind the co-pilot seat. Remove the seat directly behind the pilot and move it back to the next position rear, still on the left side, so the person is sitting about next to the person's chest. Leave the seat all the way in the back in place as an airway seat, and you can probably get away with leaving a 2nd seat sitting next to the airway seat. That would be ideal, and leave room for all the other neat toys we'd need (LP/Zoll, lots of O2, portable sx, vent, plus some other oddities.

If you had to run two patients, best setup would probably be how Gippsland has their "setup" done:


Problem is, access to the patient isn't that great, and you only have seating for 1 med crewmember (access from the copilot seat to the rear is EXTREMELY limited and extremely tight), unless you want to install the seat in the far back, which you'd need to remove and install every time you load or unload. Plus, the only real storage space you have is the aft cargo bin, which can only hold 50lbs of stuff, and that'll get max'ed out really quickly.

2) The Air Evac Rangers Ive seen all have a floor to ceiling plastic wall completely seperating the pt
(and his arms and feet) from the pilot. But still VERY cramped. 

... Why the frick cant everyone just go back ot the Huey?

I think there's a divider but it doesn't totally isolate (otherwise it would occlude the pilot's view out the left side), but you know that where there's a way, some patient will find it. I've had to go on the pad multiple times to assist the AE crews (usually when a patient is crapping out) and getting a patient out of that chopper, esp. with CPR in progress, is a PROCESS. I believe they have to actually lift or remove the airway seat cushion to slide the tray back and rotate out.

The Sikorsky S-76's are gorgeous, too. I remember looking into one of the NJ State Police ones back when I worked in PA, talk about ROOMY.

[SAR-EMT1]

You know Fedor.. there are fixed wing medevac services.

[SJFedor]

You know Fedor.. there are fixed wing medevac services.

I know



But you asked my thoughts on if I could design one for use. So, that's what I came up with.

[JohnKachenmeister]

The regulation allows flights for members of the news media with permission from National.

NOT from point "A" to point "B."   The flight must return to the airport of departure.

[BlueLakes1]

And to some extent I am amazed my dear Mr Fedor as to why being a medic and a pilot that you arent currently working as a Medevac pilot.

I've been in EMS since 1994, a Paramedic since 1997, and I'm a pilot as well. I've got my Commercial ASEL, and I'll have my AMEL as soon as the weather clears enough to take a checkride. (Hey, Fedor's even flown with me!) I'm often asked the same question, why not fly air ambulance? Well, my reasons are...

1. It would cost an arm and a leg for me to go get my helicopter license, and timebuilding would be painfully expensive. Unfortunately, at 33 I'm too old to try to let Uncle Sam teach me to fly helos now.

2. Air ambulances operate under 14 CFR Part 135, whether fixed wing or rotary. I'm in a position now where I have enough time to start applying for Part 121 carriers (airlines) as soon as I finish my multi engine ride, but I don't have enough time to fly PIC on a Part 135 ticket. Some fixed wing operators do hire SICs, but the pay is bad, and you get a lot less flight time than you would at a Part 121 carrier, so you're looking at a much longer time until you're eligible to upgrade. My next door neighbor was flying SIC on a King Air for a local air ambulance, and I was getting more time flying in CAP than he was at work.

3. I just don't really like the air ambulance environment in my local area. When I first got into EMS, there were a total of four aircraft in the state, all hospital based and each operated by a different hospital. There's been a proliferation of providers and aircraft since then, the number of operators has changed a bit due to some buyouts and mergers, but there are closer to 20 aircraft now. Because of the large numbers of providers vying for calls, there is a lot of PR work that goes into the job. Most comes from education, offering ACLS/PALS/PHTLS/ITLS, etc., and some from going out and doing face-to-face PR. I've got no problem with that, but I don't like teaching classes regularly, and I didn't get into EMS to kiss babies. I've avoided becoming a flight medic for those reasons, although I've had offers. While I think there would be a lot less of it for the fixed wing pilots, it's just not a business I have any interest in getting involved in.

Now, if anyone knows anyone in HR at any regional airlines, drop me a line. 

[SJFedor]

...(Hey, Fedor's even flown with me!)...

And lived to talk about it! 

[BlueLakes1]

...(Hey, Fedor's even flown with me!)...

And lived to talk about it! 

Ouch...I see how it is!

[SJFedor]

...(Hey, Fedor's even flown with me!)...

And lived to talk about it! 

Ouch...I see how it is!

Bah, you're an awesome pilot. I had zero pucker factor flying with this guy.