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

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