Date: 201501
Aircraft: Helicopter
Operator: Air Taxi
Operating under: Part 135
Reporter organization: Air Taxi
Reporter function: Pilot Flying; Captain
Reporter qualification: Flight Crew Air Transport Pilot (ATP)
Human factors: Troubleshooting; Confusion
Anomaly: Deviation / Discrepancy - Procedural Published Material / Policy
Detector: Person Flight Crew
Contributing factors: Procedure; Company Policy; Human Factors; Manuals
Primary problem: Company Policy

Narrative: Not long ago; me and my crew were talking about the rare but potential flight request to transport prisoners from a State or County incarceration facility to a medical facility at the request of a prison official. The requests are sometimes to transport prisoners hurt for various reasons; or who are suddenly ill under the care of the prison officials; or who might have self-inflicted wounds by prisoners who have become suicidal.  In the discussion; the topic came up about the increased risk inherently associated with flying such a prisoner as a patient because many times the true nature of the patient/prisoner's mental status or anti-social personality is not known. If the call comes in; the program is expected to respond as if it were any other request. Discussing with the medical crew about the added risk with the medical crew of having such a patient/prisoner in a confined aircraft during flight; they said that it was no problem as they typically physically restrain the patient/prisoner to the litter to keep him or her from becoming a 'problem'. That is when a big red flag appeared in my mind. I was not aware they did that in the back of my aircraft; physically restrain a passenger with tie wraps to the aircraft; so that the person could not free him or herself in case of an emergency. As a PIC; I had a problem with that concept; but if I were to say no; then I would be creating all sorts of customer issues. My expectation would be to just go along with it; since this is how it has been done before by many HEMS [Helicopter Emergency Medical Services] operators responding to prisoner transport requests.I noted that there was no policy regarding prisoner transportation types of operations in our company's operating manual; or whether the practice of physically restraining individuals to the aircraft with handcuffs and\or foot-cuffs. It is one thing to chemically restrain a person under medical care; but a completely different thing to tie one to the aircraft using things other than approved seatbelts. In the airlines; there are clear policies about the transportation of prisoners; none of which allow a prisoner to be physically restrained to the aircraft. So; this matter caught my attention.When a pilot responds to such a request and first learns that the medical crew is going to restrain the patient/prisoner to the litter to control him as they come to the aircraft to load the litter is not the time for this flight team to work out the policy between them. Accepting the flight; might put the PIC in a very difficult position with regard to liability and FAA regulatory compliance; not accepting the flight might put the PIC in a difficult position with his 'customer' and where might acquiesce due to peer pressures of those who did it before; and due to a lack of clear policy in the operating manual; or from the FAA.This matter also presents itself when a patient transport (other than a prisoner transport) is one where the patient is being physically combative either before loading or after departure during flight. Is a medical crew to take it upon themselves to physically restrain a patient to the litter as the medical staff might to a patient in a bed in hospital? Should a PIC authorize such restraint prior to departure? Does the type of cabin make a difference (patient litter next to pilot station vs. patient litter in an isolated aft cabin)? Who has the owns responsibility of the patient's safety and care at this point the PIC? The Med-Crew? The certificate holder? The medical director? The prison?Since our operations are for-hire Part 135 common carriage operations (and not public use; private carriage operations); the policy should be clearly defined in the company's operating manual; and our flight crewmembers should not be put in a position to make up policy on the fly; because that leads to non-standard practices and where the medical crew expects one PIC to do it like the others PIC's have done it for them in the past.Developing a clear policy in the Operating Manual for the transportation of prisioners; or generally combative patients; both in the preflight acceptance stage and enroute states of flight; that include the use of physical restraints (handcuff/footcuff/tiewrap/velcro) of a patient/passenger's to the aircraft or litter); and to include the responsibilities and authorities of each individual.Also; ensure that all customer entities understand this policy so that they do not make promises or other commitments on behalf of the air carrier that is not in accordance with any policy or procedure subsequently adopted.PLEASE NOTE: This report if of a general safety concern and not specific to any singluar event; location; or individual. Therefore; the date; time; and aircraft tail number that are required to submit this report are not of significance to this report; but only added because the interface required that field be filled.




Synopsis: Helicopter pilot questions how to transport prisoners that may become or are combative during or before a flight.