Air Ambulance Intel

[I fLy pLaNeS]

How is the job market right now in this sector? I've always wanted to do this type of flying, and now that I am furloughed I figure here's a chance to explore it again now that I have more experience. Thanks.

 

[HDA]

I am furloughed as well and was lucky enough to get a postition flying medical flights. It is a great job and the crews I work with are very good at what they do and very cool to boot! I like it alot.

The job market is tight. My company has no openings for fixed wing. You may have to relocate for a job because alot of the fixed wing positions are in smaller communities that dont have adequate trauma centers....thus the need for transport to larger facilities.

Good luck!

 

[avbug]

How's the job market in any sector? See an opening, apply. It's that simple.

Not sure what you mean by "now that I have more experience." Do you mean you tried to do ambulance work before, but couldn't because you lacked the experience? At 1750 hours you're not exactly highly experienced right now, either.

Without knowing your background, it's hard to make any statements or provide any counsel, save for very general comments. Ambulance flying can be broadly divided into administrative transports, and emergency flights. (Which can further be broken down for helicopters to include scene transports, which adds a whole new level of hazard and demand).

Administrative flights can be planned and executed about like any charter or corporate type flight. Unlike an airline operation, however, you're hired to use your judgement and experience in flight planning to decide how to make the flight safely, if it can be made safely, and to arrange all aspects of the flight.

Emergency flights often involve a critical patient with little notice, and you need to be able to make decisions that affect not only the safe outcome of the flight, but the medical decisions made on behalf of the patient. You need to do this with only the safety of the flight in mind, with the ability to disregard any external pressure.

A woman has been run over by her own truck. She slid off the road in a snowstorm. While standing outside her truck, the truck was struck by another vehicle and it went over here, pinning her and inuring her. She has been extricated and has experienced not only physical trauma, but a heart attack. Weather is low at the pickup airport, a rural field with minimal facilities. Weather is low at the destination airport, some 200 miles from the pickup field. Due to road conditions this woman cannot be transported by ambulance; it's up to you. If you don't pick her up, she will die. What do you do?

If any of that paragraph catches your attention aside from the weather at the pick up field and the destination, then you're paying attention to external pressures that can get you killed. None of it is relevant or important when it comes to making the right choice. You should be aware that the wrong choice will possibly kill someone, including you...and the right one might too. You don't have an option of not making a choice....choose one. Either you go, or you don't.

This isn't the kind of decision making that you have been doing at an airline. Nor flight planning. Nor taking care of the aircraft, making fuel decisions, or weather decisions beyond the simple and the mundane. With ambulance flying, it's all on you.

This doesn't mean you can't do it. You need to determine if you can meet the insurance requirements for the operator at hand, for the equipment at hand. I spoke with an operator last year who was looking at 4,000 hours plus for pilots in the King Air 200. He could insure for less, but wouldn't acccept less experience. He had a very low turnover rate, a very professional operation, and a respected one. I've seen others that hire at the bare bones 135 minimums. I worked for one myself, as my first multi engine job.

With your flight experience, you might find a king air job, or you might find a twin piston job, or even a single job in a Pilatus, or something along those lines. Get on Climbto350 and other internet sites and see what's open. Ambulance positions open up with some regularity, but then some operators have a high turnover and some don't. As a good rule of thumb, you're far better off working for an operator that has a low turnover.

Be very cautious about the particular operation. Many operators let their flights be dictated and run not by the pilots but by the medical personnel. The nurses tend to make a lot more money than the pilots, and their opinions tend to carry more weight. In such an operation, when a pilot makes a safety of flight decision and the nurse tries to countermand it, the safest and best choice is to walk away. Always be prepared to do that if the need be...and be prepared for that occasion to arise if you operate in the ambulance business for very long.

 

[340drvr]

.................
.......Be very cautious about the particular operation. Many operators let their flights be dictated and run not by the pilots but by the medical personnel. The nurses tend to make a lot more money than the pilots, and their opinions tend to carry more weight. In such an operation, when a pilot makes a safety of flight decision and the nurse tries to countermand it, the safest and best choice is to walk away. Always be prepared to do that if the need be...and be prepared for that occasion to arise if you operate in the ambulance business for very long.

Well said, avbug.
That "walk away" policy applies not only for air ambulance, but should be standard for all operations, charter, freight, corporate, 91/135/121. Just replace ".......nurses tend to make a lot more money......." with dispatcher/DO/boss/client/CEO as appropriate.

 

[I fLy pLaNeS]

Thank you for the thoughtful responses to my question. I realize this type of flying demands great responsibility; that’s one of the reasons I find it so interesting.

You’re correct, I have 1750 hours, and though it’s not much experience, I want to try. Thanks for the advice on what to look for in companies. That was very nice of you.

 

[007]

A woman has been run over by her own truck. She slid off the road in a snowstorm. While standing outside her truck, the truck was struck by another vehicle and it went over here, pinning her and inuring her. She has been extricated and has experienced not only physical trauma, but a heart attack. Weather is low at the pickup airport, a rural field with minimal facilities. Weather is low at the destination airport, some 200 miles from the pickup field. Due to road conditions this woman cannot be transported by ambulance; it's up to you. If you don't pick her up, she will die. What do you do?

At the outfit I'd like to get on with, they don't even tell you the circumstances of the patient. They only ask if the flight is possible.

 

[EdAtTheAirport]

IFP, there's good air ambulance, and bad air ambulance. The good operations are subsidiaries of hospital, or sole contractors, etc. They have set schedules, fairly good salary, and have built firewalls of some kind to keep the pilots from being pressured to fly. However, even with 5,000 hours at the time, I was a lowtimer there.

Then there's the other air ambulance: on-demand 135 charter stuff that takes the flights the "A" companies turned down. That kind of operation is no different than any other bottom-feeding 135 job. Imagine having your boss yelling at you: "That lady died because you didn't want to fly." (Disregarding the prospective flight into moderate icing, poorly lit, single strip NDB approach airport with a 30kt crosswind -- and btw you noticed the ancient RMI has been a little "sticky" in its needle pointing.) They're not all like that, but you get my drift.

I know of at least one, maybe two, pretty good operators if you're willing to live in the Boonies. If you PM me, I'll give you a Company. I have no idea if they're hiring, though.

 

[HDA]

Omniflight is opening a new base in Idaho. It will be staffed by 4 pilots and the aircraft is a PC-12. They are one of the good places to work. Check out the website.

Good luck!

 

[I fLy pLaNeS]

HDA- Thanks so much.

 

[hiropilot]

All very good info. I just started with an air ambulance company that was only helicopters and has added a king air for long range transports of burn patients. The key for me is the people are great, the schedule is excellent (7 on, 7 off) and as mentioned above, when the trip comes in, no details, just where the trip is to - pilot check the weather and determine if able to go. Chief pilot and DO both are very safety oriented and don't want anyone to go if there is slightest question of able to finish the trip.
Scenario...patient needs to be picked up, has severe burns over most of body and it will be at least two hours from facility to facility in transit. Start the trip and even knowing that weather is questionable for return, we go anyway. On way back, with the patient fighting for his life, weather goes to h**l in a hand basket and we have to land 100 miles away. Now it will be 1/2 hour or so to get ground transport to pick up patient and start towards burn center for another two hours of transport time. Patient dies enroute. I don't know about anyone else, but I don't like to think that I would have to live with that decision for the rest of my life.
Having a life in the balance adds a dynamic that most of us wouldn't ever have to consider for most any other trip we fly.
that's my $0.02 worth.

 

[avbug]

Are you describing a what-if situation, or are you describing what happened? Departing with a question as to whether you can return and then a death occuring on your aircraft as a result isn't a good decision, any more than departing into a condition that places your aircraft and crew in jeopardy.

 

[Prof. ATP]

At the outfit I'd like to get on with, they don't even tell you the circumstances of the patient. They only ask if the flight is possible.

In medical flying, the patient is already dead. When I flew LifeFlight the hospital's standard request was "Check the weather, call us back if it's OK." Never any mention of the patient.

 

[Say Again Over]

Having a life in the balance adds a dynamic that most of us wouldn't ever have to consider for most any other trip we fly.
that's my $0.02 worth.

Yes, it's hard to put that information aside when the patient roles up in an ambulance and your company is stupid enough to put a distraught family member in the right seat with you.

I flew my share of transplant teams and expediting was even worse than normal air ambulance missions.

Many missions require leaving with no idea about actual weather conditions, it's just part of the program when there is no instrument approach at the destination. Maybe not the best paying job in the world but very rewarding.

 

[avbug]

Yes, it's hard to put that information aside when the patient roles up in an ambulance and your company is stupid enough to put a distraught family member in the right seat with you.

It had better not be hard to put the safety of flight first.

I spent a lot of time in ambulances as a firefighter-EMT working on people, as well as flying them from A to B. On occasion I met a volunteer EMT who had emotional issues, once in a while because they knew the victim. I invited them to leave. You're no good if you can't be objective and place the safety of flight, and therefore the needs of the patient, first.

One of the most important things you can say when asked to take an ambulance trip, is NO. Being able to say in the interest of safety, despite any other tales of need and woe, is critical to your longevity and that of the patient.

There are no "hiropilots" in EMS flying. Being a hero will get you killed. It does no good rushing a medical patient to the hospital and killing them on the way.

I flew my share of transplant teams and expediting was even worse than normal air ambulance missions.

I also flew my share of transplants in turboprops and turbojets...and there was never any "expediting." Every flight a normal, routine flight. It can be done quickly, safely, but the pressure on the pilot should be zero. On one occasion, while preparing to fly the approach into Mountain Home, Idaho at night, we determined that the weather had worsened. We had no de-ice, and with hoar frost forming and freezing fog, the airplane would be unsafe when the crew returned from the hospital with a heart. The heart was waiting down there for us, the crew on board. We advised them we were cancelling and went home. Our decision making process did not include the patient, did not include the heart; it included what we knew we could safely do as pilots.

I've done a lot of emergency flying, medical, fire, law enfocement, emergency supplies, etc. I've flown people who were desperate to quickly reach a dying relative to spend the last few minutes. One things I learned long ago is that fast hands kill. If you wouldn't do something on a bright, sunny, calm, clear day with nothin to do but loaf around, then don't do it on an emergency flight.

Do you know that most jurisdictions have laws preventing emergency vehicles such as fire engines and ambulances from exceeding the speed limit by 10 mph...on their way to the scene? True enough...because there have been too many crashes of emergency vehicles on their way to the scene...creating new emergencies, and not only failing to help out at the scene, but causing more casualties, more victims.

We don't need that in an air ambulance situaiton.

If you find yourself saying "I wouldn't normally do this, but this is an emergency," then you should see a big, red flag waving over your head and know that you're in error. If you wouldn't normally do it, then don't do it.

Many missions require leaving with no idea about actual weather conditions, it's just part of the program when there is no instrument approach at the destination. Maybe not the best paying job in the world but very rewarding.

How is this legally justified under Part 135?

You've at least got an area forecast. The destination may not have a terminal forecast...but you've got something to go on, and certainly must have something to meet your 135 requirements.

I always found I had enough time on the way to the airplane to file and brief, including establishing an alternate, while the medical crew arrived and boarded...to do it right. I knew others who subscribed to the panic mentality..."It's an emergency. Just go!" Very, very wrong.

When I flew LifeFlight the hospital's standard request was "Check the weather, call us back if it's OK." Never any mention of the patient.

This is how it should be.

 

[Say Again Over]

while the medical crew arrived and boarded...to do it right. I knew others who subscribed to the panic mentality..."It's an emergency. Just go!" Very, very wrong

I have a hard time believing you were cool and collected about anything considering how defensive you are on your self imposed pedestal that you make for yourself.

Maybe I didn't live in your perfect world, in my 135 experience, rules were broken, the key to safety in my opinion is not necessarily following all the rules and regulations, but knowing your own limitations. With 10+ years experience in 135, I have yet to see an operator that doesn't occasionally break the rules.

My experience includes neonates, transplant teams and normal transport stuff, predominantly in New Mexico, Colorado and Arizona. Many airports have no instrument approaches, and with MEA's from 10,000 to 16,000 feet, most reports were useless, were there ways to do it legally, yes.

As far as the speed limit on an emergency vehicle, thanks for filling me in, on my last transplant, a heart for a senator, the police car was doing 90MPH all the way to the airport, the town was Tupelo, MS if you'd like to report them.

Sorry, I didn't live in your perfect world and think you may be just a bit naive for thinking there is one, I am a long way from ambulance operations now and still haven't found it.

 

[avbug]

My experience includes neonates, transplant teams and normal transport stuff, predominantly in New Mexico, Colorado and Arizona. Many airports have no instrument approaches, and with MEA's from 10,000 to 16,000 feet, most reports were useless, were there ways to do it legally, yes.

I operated ambulance in the same area and always found a way to do it legally, in compliance with the regulation. It's a shame you were unable.

Sorry, I didn't live in your perfect world and think you may be just a bit naive for thinking there is one, I am a long way from ambulance operations now and still haven't found it.

Perhaps. In my many years of aerial firefighting emergency operations, law enforcment surveillance and emergency operations, and air ambulance/air evac emergency operations, etc...I suppose I never found the need to panic and break rules like you did. Chances are I did it a lot longer and a lot more than you, over a substantially wider area of operations...but perhaps given a few more years of experience I'll learn to place imagined needs above the safe and legal operation of the aircraft, too.

But I doubt it.

Maybe I didn't live in your perfect world, in my 135 experience, rules were broken, the key to safety in my opinion is not necessarily following all the rules and regulations, but knowing your own limitations. With 10+ years experience in 135, I have yet to see an operator that doesn't occasionally break the rules.

You advocate violation of the regulation. Interesting.

I found that operating by the premise that while one may be safe but not legal, and legal but not safe...operating legally and safely all the time offered the best protection to the customer, employer, and to me.

You can justify your illegal operation any way you like. It's wrong, of course. Justification is the narcotic of the soul. You, apparently, are an addict.

A professional, on the other hand, knows when to say no...if it's unsafe or illegal, that's the time. You apparently never figured that out. Pity.

 

[Say Again Over]

professional

Panic? How do you assume that I've panicked, I don't ever recall panicking in my experience as a pilot, maybe you can refresh my memory. As I said, in my experiences in 135 operations, there were no operators that I worked for the complied fully with regulations. I really don't think you have a clue what a real professional is, I have had a very successful career and can receive recommendations from all still in business.

You can justify your illegal operation any way you like. It's wrong, of course. Justification is the narcotic of the soul. You, apparently, are an addict

Please state the name of the air ambulance companies you worked for, chances are that I am familiar with them, I was in that area from 81 to 96, I would be curious to know what companies in that area were complying fully with regs.

 

[avbug]

Based on what you've said, you wouldn't know them. Compliance seems somewhat outside your realm of experience, and your personal preference.

 

[EdAtTheAirport]

I operated ambulance in the same area and always found a way to do it legally, in compliance with the regulation. It's a shame you were unable.

Yeah I'm curious which operator you worked for also, with the level of sanctimony you're displaying. I know that turf pretty well too. Perhaps you didn't have the same challenges that the rest of us had.

 

[avbug]

I'm not going to cite the employers here; other than to state they're no longer in business.

Even in uncontrolled operations in Class G under Part 135, operating rules and regulations apply...even on dirt airstrips on the reservation, they still apply.

If you find compliance with the regulation to be sanctimony, you've got a serious problem.

 

[JediNein]

If you do emergency transport long enough, you'll either destroy yourself or learn to live with death.
One thing that has helped in dealing with critical cases, never follow up.

The dude you did CPR on, don't follow up to see if the guy survived the night. The heart transport, don't research to find out if the surgery was successful. That critically ill child on the way to a treatment, don't follow up.

Don't follow up. You can't. You shouldn't (patient privacy). Many times, you don't want to know the results.

Best o'luck!

 

[Say Again Over]

Based on what you've said, you wouldn't know them. Compliance seems somewhat outside your realm of experience, and your personal preference

Great answer Avbag, if you don't have anything intelligent to say, attack the poster, isn't this the same thing that you criticize so many other posters about?

Sorry, I have no need to stoop to your level.

 

[avbug]

No doubt. You're too busy breaking regulations. You call this a personal attack. You not only stipulate that you have broken the regulation on a regular basis, but defend your practice. Truth hurts...but so could your recklessness.

Don't blame others for your unprofessionalism.

 

[Say Again Over]

I'm afraid you miss the point avbug, when your company knowingly decides not to comply with the regulations, it doesn't necessarily reflect on the airman, like I mentioned earlier, I really doubt if there was a 135 operation in that era that was doing everything by the book, but I could be wrong. Another thing, regulations don't necessarily make an operation safe, it's up to a professional airman to do that.

 

[avbug]

I worked for companies that refused to comply with the regulation...absolutely. However, I refused to permit this. If the company couldn't comply with weather, maintenance, personnel, training, operational, or other requirements, I refused to fly, or operated the flight in accordance with the regulation.

I found that when an employer complained, it was very easy to hold the regulation over them. "You mean you're asking me to knowingly violate a regulation?" The answer, of course, was always "no." On one occasion when it came to butting heads, I left a carefully drafted letter on the owner's desk detailing the intended illegal operation. I was immediately called in and asked why I had put it in writing. They didn't like seeing thaft in writing. The subject never came up again.

I've certainly seen operators who would pencil whip a repair and push it back out of the hangar. I would write it up and push it right back in again. I'm also a mechanic and inspector with a significant background in that area, including twice as Director of Maintenance...I don't have ANY tolerance for fooling around in that respect.

I proposed a scenario at the outset of this thread regarding a woman who has been run over by her own truck after leaving an icy road, getting out,and being hit by another vehicle also leaving the road...and then subsequently suffered a heart attack. I was called on that flight, and told that if I did not pick up the patient, the patient would die. After consulting weather, which was scarce on the reservation, I determined that due to low visibilities, freezing rain, and weather at the destination airport, the flight would not be safe. I determined there was no point in taking a flight to save a life, and killing the patient enroute.

I was pressured by the owner, who visited the pilot quarters in person, who threatened to fire me, in front of the other pilots. As the senior pilot, I refused, and each pilot in turn also then refused. The Director of Maintenance (also a pilot), the only other available company officer, was then sent to the pilot quarters, in an effort to pressure me to take the flight. I continued to refuse.

I waited until the early morning hours when the ETA for the flight would have been to the destination, then rechecked the current weather. It had worsened as predicted, including a report of the only aircraft to land at the destination during that period, which was described by those on scene as "a flying ice cube." A funnel cloud or tornado had been reported west of the field.

I called the owner at home and reported what I had found, reiterated that the right decision had been made, and hung up. I saw all sorts of things take place, particularly on the reservation. I do hold a standard which is very simple; not everything that is legal is safe, not everything that is safe is legal; and if it's not legal and safe, the flight doesn't go.

I've quit jobs over the principle, and won't hesitate to do it again. Without principles, there is no integrity, and without integrity, one can hardly be a professional. I've met many who disagree, who are willing to bend the regulation by baby steps or leaps and bounds...I know quite a few who can't speak for themselves now because they are dead. Others who have been violated. Others who got away with it...and probably continue not to do so.

I choose not to.

The regulations are written in blood, and stand to be respected for a reason. They are neither capricious, nor arbitrary, nor should they be treated as such. The regulations protect more than they restrict. If I don't think a flight is legal or safe, I'll refuse it, or come up with a way to do it that is safe. I flew out of Chinle when it was dirt (it's paved now). On more than one occasion I required a patient to be moved to Window Rock, for example, due to the runway condition at Chinle. I flew to Window Rock, flew the approach, and picked up the patient for transport to ABQ. Upon return, I was able to verify the runway had frozen and could support the airplane, and returned the patient or crew to Chinle. Never without doing so legally, and safely.

To do otherwise would be careless and reckless. I've spent much of my career doing activities in demanding conditions, such as aerial firefighting, and I understand mission demands and requirements very, very well. I also know that there is no mission that MUST be flown, and I know when to say yes, and when to say no. When it comes time to say no, it's not a decision that's open for debate, and there is NO room for arguement. It's a done deal. If an employer cannot live with that, the employer can find someone else; it's a principle on which I do not bend.

 

[Say Again Over]

As the senior pilot, I refused, and each pilot in turn also then refused.


Do you think you are the only one that has turned down a flight? Maybe you want a medal or something, pull your head out of the sand mate, anyone that has come up through the GA ranks has had to do this kind of stuff, whether air ambulance, freight etc, you must think you are special, it’s called paying your dues.

I've quit jobs over the principle

Great, actually most people do quit jobs over principle, that hardly qualifies you for anything, and again, most everyone has had to do this but for some reason you think you are special.

I flew out of Chinle when it was dirt (it's paved now). On more than one occasion I required a patient to be moved to Window Rock, for example, due to the runway condition at Chinle. I flew to Window Rock, flew the approach, and picked up the patient for transport to ABQ. Upon return, I was able to verify the runway had frozen and could support the airplane, and returned the patient or crew to Chinle. Never without doing so legally, and safely.



Here again you assume that you deserve an award for being safe, and yes I am familiar with every airport available in that area, I operated an MU2 Marquise out of Showlow into the the old airport at all hours of the day and night, do I think I’m special, ah, NO.

The bottom line is you are not half as special as you think you are, take a chill pill mate, the more you write, the more you embarrass yourself.

 

[I fLy pLaNeS]

Thanks a lot everyone. You've been very informative.

 

[avbug]

Here again you assume that you deserve an award for being safe, and yes I am familiar with every airport available in that area, I operated an MU2 Marquise out of Showlow into the the old airport at all hours of the day and night, do I think I’m special, ah, NO.

There you go again. More assumptions. I said nothing about being special. Merely complying with the regulation.

If you find compliance with the regulation to be trick, fancy, and special...well...at least your consistently unprofessional. You advocate breaking regualtions...and find following them to be "special." Again...how enlightening.

Great, actually most people do quit jobs over principle, that hardly qualifies you for anything, and again, most everyone has had to do this but for some reason you think you are special.

You assume too much. Again, I said nothing about that being a "special" trait or act. In fact, I would expect it from any responsible adult professional. Anybody but you, who openly embraces illegal operation. Again...perhaps you really do find doing one's job responsibly and adhering to the regulation to be unusual or unique...but that would be your own personal problem.

Do you think you are the only one that has turned down a flight?

No, I don't, and I said no such thing. Not even a hint. Again with the assumption on your part.

You stipulated that all operators act illegally. That may or may not be. I don't. You stipulate that you break the regulation. I don't. You find that special...that says a lot about you.

anyone that has come up through the GA ranks has had to do this kind of stuff, whether air ambulance, freight etc, you must think you are special, it’s called paying your dues.

Anyone that has come up through the ranks has had to do what? Turn down flights or break regulations? Turning down flights isn't paying dues. It's being responsible. Breaking regulations isn't paying one's dues either. It's just stupid.

 

[ALIMBO]

Wow you need to quit the assumption BS your making yourself look even more stupid than people already think you are. I don't think it was an accident that your "friends" died avbug they just couldn't put up with a dbag like you anymore and there only way out was "accidentally" dying in a plane crash.

 

[avbug]

Wow you need to quit the assumption BS your making yourself look even more stupid than people already think you are. I don't think it was an accident that your "friends" died avbug they just couldn't put up with a dbag like you anymore and there only way out was "accidentally" dying in a plane crash.

Congratulations. You just went a little too far. Your true character and your true colors show.

I believe I'm done with you, and with the thread.