I digress, I'm supposed to be writing about things I've done in the the past, back to the time travelling...
Flying Medevac in Alberta, usually went like this.
( I'm fairly certain a lot of this has changed since I was there! )
Captains had phones issued by the Health Authority, and your working schedule was given to them by the company you worked for. When I was there, there was five different contractors providing planes and crews to the Health Authority. I think there might be two now. Each contractor might have one or two bases and each base had one or two planes. Bases in Alberta at the time were Medicine Hat, Calgary, Edmonton, Grande Prairie, Peace River, Slave Lake, Fort Mcmurray, High Level and Fort Vermillion.
They'd put out an email a couple times a day with all the different districts on-duty pilots for a given day and night period, for anyone to correct if there were mistakes. Each Medevac aircraft usually had at least two full crews on shift at any one time.
Some operators ran 12 hour day/night shifts and others ran a " rolling duty day " system. For the most part, most 24 hour medevac operations in Canada have moved to the day shift / night shift system as its backed up by a lot of science as to be the safer system in terms of managing Fatigue. In this system, you are assigned as either Day or Night shift and you can plan your life and sleep schedules accordingly.
In the old, dark days of medevac flying it was a bit different.
When I say old days, there are in fact still a few hold outs clinging to the Rolling Duty Day system. It used to the standard, and operated with the blessing of Transport Canada. Then again, at one point they also sanctioned smoking in pressurized metal tubes full of kerosene and humans, so just because it was once deemed safe by the almighty regulator doesn't mean much.
The Rolling Duty Day system basically worked by having a crew member come " on shift " on the first day of their rotation. Typically anywhere from 7-14 days in length. Once they were on shift they would essentially be on-call 24 hours a day, until their days-on elapsed. Once you got called out on a trip, you were considered rested and fresh, you could then give them 14 hours of your best efforts until you " dutied out ". At that point they had to give you " an opportunity for eight hours of prone rest ". This usually equated to nine hours off, one hour to drive home, get some food, take a shower, get eight hours of sleep and then be considered rested and fresh again, ready for the next call.
The biggest problem is your call could come in at 11 o'clock at night, just as you're laying your head down for some sleep after having been up all day, awaiting a call. Off you go, medevacking all night long, getting home at 1 PM the next day. You are then expected to sleep for eight hours, so you can do it all again at 10 pm. If every time you came fresh, you got called out right away, there's a certain rhythm to it you could adapt to, just like any other night shift worker. The problem is you'd come fresh at 10 PM after having slept all day, and then you wouldn't get called out till 5 AM the next day.
There is an inherent efficiency to this system, until you fall asleep in the plane or make some other fatigue induced blunder. As a company you need less crews for each airplane and no matter what time your customer calls looking for a trip, you always have a fresh crew on duty, ready to give them the full 14 hours of flying.
When you run a day/night shift, you run into overlap issues, a 6 hour trip comes up when the the day shift only has four hours left in their day. So you call the night shift in 4 hours early, and now their shift ends before the next days day-shift comes on. This can pile up with the shifts sliding each day till you've wiped out both crews and can't give the customer the 24 hour coverage you committed to when you were awarded the multi million dollar medevac contract.
Especially problematic is when you take the high road, put your faith in the science of fatigue, and commit to running additional crews on a safer shift system, and your competitor does not...well...it might not be your contract for long when the customer sees the bottom line dollar figure...
Either way, you were tied to that phone
The Company Phones were all preset from the authority, you really couldn't do much with them. Even the ring tones were all preset. As you can imagine, it was set to the alarming and jarring Klaxon type of alarm. I still set my ringtones on phones to that sound if I really want to get my pulse going.
Trips were a mixture of Advanced Life Support and Basic Life Support ( ALS / BLS ) types of trips. In Alberta at the time, we carried two different types of Medics in the back. One was like the Sith and the other was the Apprentice. I never could wrap my head around their different levels of accreditation, Medic, Paramedic, Nurse, Flight Nurse. I do know that one of them was senior and allowed to do a lot of things, the other not as much.
Different jurisdictions had different levels of medical personnel in the back. Some allowed single-medic trips, others had the junior/senior 2 crew setup and still others had senior/senior levels of crewing.
Patients were predominantly stable and low acuity. Some were even Ambulatory, that is, they could walk on and off the plane by themselves. If I had to give it numbers, I'd say 80% were awake, alert, in some form of discomfort ( even if it was simply caused by riding around in a King Air on a stretcher! ), but otherwise indistinguishable from a regular passenger. 10% were unconscious, stretchered, hooked up to machines. Another 10% were in very dire straits, had some form of traumatic injury or condition, were hooked up to breathing apparatus and had ( at least the appearance ) the chance that they may not survive the trip to the hospital.
Part of flying Medevac involves some form of training on medevac specific flight issues. The main one is the actual loading and unloading of a stretchered patient. The plane itself had some equipment installed inside to receive a flight stretcher and there was some form of ramp or " diving board " as we called it, for loading the stretcher into the plane.
A King Air is a decent sized plane for medevacs, not too big that its uneconomical and not too small that it cant handle the patient, stretcher, medical machines, patient companion, luggage and medics.
Still, the door width on a King Air is only 24-26 inches wide. There is a small hydraulic ram that helps lower the door softly, called a damper, and it takes away 2 inches of door width. Some carrieres had retrofitted the damper to be removable during loading, giving that extra 2 inches of width. And trust me on this one, you need every inch you can get.
If a person was either too heavy to be lifted on the stretcher from the ambulance ground stretcher to the loading ramp, or, they were too wide in girth to fit through the door opening, they were then classified as a " Bariatric " medevac. Most of the provincial medevac contracts specified a weight limit that automatically bumped them up into bariatric territory once exceeded. Sometimes, being classified as a bariatric meant that they would have to bring in a larger and much more expensive aircraft to move you, or it simply meant a change in the loading equipment and manpower required for the loading and offloading. All of the above require more money spent by the health authority to move you to the destination where care was to be given.
There's many reasons why a patient would move by medevac aircraft in the first place. Some of the reasons are actually bureaucratically induced, others are simply physics. Since Canada has single payer health care, where the government looks after the health needs of its citizens as a right, it is also held to the standard that every citizen is entitled to ( roughly ) the same level of care, regardless of where they choose to live.
Sometimes, in the case of remote communities without road access, this means flying them out to big city hospitals for surgeries or other specialized care. Other times, the regional governments have crunched the numbers and concluded that it is simply not practical or economical to have an MRI machine or other specialized equipment or specialists in every town and makes more sense to move people to the machine. If that person is unable to travel on their own, or care is needed by a medical professional enroute, or they are not physically able to board a commercial aircraft, then they might be flown to the health centre by a medevac plane.
I've moved patients with all manner of ailments. My lowest acuity passenger was someone travelling to the big city for an orthotic shoe fitting. I know, it sounds ridiculous to spend 10,000 dollars plus on a shoe fitting appointment, but there are many places in this country where these things might happen. If you need orthotic shoes to work, and the government is bound to provide them for you, you cant simply have the mobile shoe-van pop round to some arctic locale.. On the other end of the scale, people with missing limbs, or other grievous injury where the hours saved by moving them by plane most likely resulted in them living instead of dying.
As a pilot, we used to be given patient details to include on our paperwork. We would see names, injuries/illnesses and other info. Eventually they realized we weren't sworn and trained health care professionals and likely shouldn't be seeing this personal and privileged information, so it soon stopped. Later still, it was realized, that flight crew may even let the state of the patient influence their decision making in regards to flight safety, based on the nature of the injury and be influenced to take more risk. Eventually, most jurisdictions moved to a red/yellow/green classification and that was all you were told.
Medevac aircraft get priority handling by Air Traffic Control, and you would often get asked by ATC " are you priority today? " before they bumped the commercial planes out of the queue to get you in or out first. They understood that even though we are " medevac " on the radio, the orthotic shoe fitting appointment lady may not need to have 250 people on the Lufthansa plane delayed on the taxiway so you can depart first. If you were " red " however, you could tell them you were priority and they would go out of their way to speed you along.
Most of the time, regardless of priority level, being a " medevac " call sign, meant you rarely had to fly time-consuming Arrival or Departure procedures. You were almost always cleared " direct ", making flight planning a breeze, haha!
Anyhow, hope you enjoyed a little bit of time travelling with me. I’ve been thinking about getting back into doing a little blogging to get back in the habit of writing regularly. Since I’ve started this blog, I’ve worked for several companies, most demanded that I not post or share pictures, stories, tec, publicly. Not to burn any bridges, but enough time has passed that I feel comfortable sharing some of the pictures and experiences from those days.
Even this post, actually, has been sitting in my drafts folder for several years. I’m now doing a very different type of flying, but still committing Commercial Aviation on a regular basis. Hopefully I find the discipline and interest to keep this going.
Take Care!
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