Airvans and patient 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!