From: jmaynard@oac.hsc.uth.tmc.edu (Jay Maynard)
Newsgroups: rec.aviation
Subject: Re: Air Lifeline experience
Date: 31 Aug 1992 02:26:06 GMT
Organization: UT Health Science Center Houston

In article <20gngxr.rkaplan@netcom.com> rkaplan@netcom.com (Richard Kaplan) writes:
>However, in general, the commercial pilot is trained to handle the
>aircraft ^^^^^^^^^^ in a more precise manner and has demonstrated
>these skills to an  objective examiner.  That's why the private/commercial
>distinction is there.  It is unwise for AirLifeline and/or
>the pilot himself to be the judge of whether a given private
>rated pilot is competent to handle commercial-level risk
>management.

I'll grant that a commercial-rated pilot has been trained and has demonstrated
ability to handle the aircraft in a precise manner. I was not aware that the
commercial training/test standards required training in risk management; to
the contrary, I had always understood that that was something even the
lowest-time student needed and (supposedly) got. The two are not necessarily
related.

Caveat: I reserve the right to be wrong about the commercial training, as I'm
only a 160-hour private...If I am, please correct me.

>Your analogy is not fair because even though you are not paid as
>a paramedic, you are still trained, licensed, and equipped to
>the same standards as a paid paramedic.  A better analogy would
>be (independent of volunteer/paid status) between a BCLS
>(Basic Cardiac Life Support) ambulance and an ACLS (Advanced
>Cardiac Life Support) ambulance.  Sometimes the former can 
>handle a situation just as well, but if a patient is in 
>certain heart rhythms when the ambulance arrives on scence
>(e.g. V. fib) the ACLS ambulance has a tremendously higher
>chance of reviving the patient.

(Ever heard of EMT-D? :-) (If you wanna discuss that, let's do it offline.)

It is precisely this analogy (BCLS vs. ACLS) that I find fault with. I don't
think it's fair at all to compare the commercial to ACLS, because the skills
aren't different, just refined, unlike ACLS, which is a whole new set of
skills layered on top of BCLS. (For the uninitiated, BCLS is CPR and a few
other skills, where ACLS adds drug therapy and electrical defibrillation to
the arsenal.)

>IMHO AirLifeline is inappropriate for a 
>critical patient or for any time-sensitive medical mission.
>An air ambulance or a ground ambulance moving fast would
>be more appropriate.  It's just not worth risking additional
>injury or illness.  Moreover, an acutely ill patient is
>much better off in an appropriately equipped ground ambulance
>at 60+ MPH than in a non-medically equipped airplane at
>150+ MPH.  

I can't argue this one, for the critical patient; I'd hate to have a patient
who needs medical care in a 172. Where the only issue is rapid transport,
though, such as organs or urgently needed drugs, though, there's little need
for an additional person to come along and monitor and treat the patient...
and that's the issue I see here.

>If the issue is a medically stable patient needing urgent
>transport for transplant surgery, see my comments regarding
>commercial/Part 135 operations above.  Moreover, the 
>cost of air ambulance service pales in comparison to the
>cost of transplant surgery.

This much is true. The mere thought of the bill for a transplant makes me
cringe. (It's even worse than owning an airplane! :-)

This assumes that an air ambulance is readily available, however. I have no
experience in this area, but is it really good to wait for an air ambulance
past when someone in a Bonanza could have had them there? (Assuming that
transport in a Bonanza is appropriate for that patient.)

>If the issue is semi-urgent transport of medical cargo
>(rarely is such a need an "emergency" except some organs
>for transport, and then see the paragraph above), THEN
>there may be a quite appropriate role for AirLifeline
>and the private pilot.  However, this still does not 
>justify the private pilot's lowering his weather
>minimums.

...and I'll be the first to go along with that statement. After all, the pilot
isn't going to do the patient any good if neither he nor the cargo makes it to
the destination. Still, I don't see that a part 135 operation is magically
better; indeed, there may be _more_ pressure on the commercial operation to
complete the mission in order to being in the bucks. You only have to read the
aviation press to find many examples of that problem. Lowering one's weather
minimums because of the urgency of the mission is inappropriate for _any_
pilot. 
-- 
Jay Maynard, EMT-P, K5ZC, PP-ASEL | Never ascribe to malice that which can
jmaynard@oac.hsc.uth.tmc.edu      | adequately be explained by stupidity.
 "Keep in mind that Amateur Radio As We Know It Today will cease to exist
            at midnight tonight." -- Dave Newkirk, WJ1Z
Newsgroups: rec.aviation