Pilots - All pilot qualifications are established by TC and are based on aircraft type. Pilots employed by air operators are also required to undergo specified training on a periodic basis as directed by the Canadian Aviation Regulations. Although most air ambulance flights are routine transfers of stabilized patients to higher care facilities, some are urgent missions with life or death consequences often conducted at night or in marginal weather. These types of operations place a great deal of stress on pilots, who require mature judgment to avoid allowing their sense of mission accomplishment to override this reason. Agencies contracting for air ambulance services may wish to specify requirements over and above the minimum required by regulation such as two pilots on all flights, additional training and experience, and the requirement for the air operator to maintain an approved list of those pilots authorized to fly aircraft supplied under the contract.

Medical Attendants - There are no Canadian Aviation Regulations specifying the conditions under which a medical attendant must be carried. Similarly, TC has no jurisdiction over the qualifications or training of medical attendants. The provincial authority or contracting agency should establish standards for medical personnel and clearly define the criteria for their employment. It is recommended that all air ambulance flights carry a flight or medical attendant. A medical attendant should be an able bodied person physically capable of assisting the patient to an exit in the event of an emergency and who will attend to the personal needs of the patient in flight.

There is often some confusion regarding the status of medical attendants and their responsibilities relating to the operation of the aircraft. It should be clearly understood that medical attendants are not normally crew members under the Canadian Aviation Regulations. They may be designated as crew members provided they receive approved flight attendant training. In this case, medical attendants may be assigned duties such as passenger briefing, evacuation, and look-out for helicopter landings, otherwise these functions remain the responsibility of the flight crew.

Training in the aviation environment is desirable for medical personnel involved in air ambulance operations. Depending on whether the attendant is part of a dedicated service or accompanies patients on an occasional basis this training will likely vary in length, but should at least include familiarity with the following:

  1. Meteorological weather conditions;
  2. Hypoxia;
  3. Hyperventilation;
  4. Effects of scuba diving;
  5. Effects of smoking and drugs;
  6. Hypothermia;
  7. G forces: positive and negative;
  8. Principles of protection against G force in an emergency landing or ditching;
  9. Patient evacuation;
  10. Turbulence problems with patient seat belt and traction devices;
  11. Effects of noise and vibration on the ill or injured;
  12. Difficulties encountered using "common" medical equipment in an aircraft environment;
  13. Helicopter emplaning and deplaning procedures;
  14. General aircraft safety rules (references: Helicopter Passenger, Transport Canada (TP 4363E) and A Safety Guide for Aircraft Charter Passengers, Transport Canada (TP 7087E); and
  15. In-flight patient care (reference: Health Canada, Medical Services Branch, Patient Care in Flight, Manual for Medical Services Personnel).

Dispatchers and Coordinators - Air ambulances are usually controlled by a formalized system which encompasses tasking, priorities, communications, operational control, etc. One of the keys to the effectiveness of these systems is the dispatcher or coordinator, used in this context as the air ambulance dispatcher, not the air operator's operations officer, although these positions may be combined. Often, however, air ambulance dispatchers are part of the land ambulance system and may not be knowledgeable about the aviation aspects of the service. Compounding this problem, many air ambulance flights are self-dispatched, particularly those of an urgent nature, thus the additional assistance that a pilot might receive from the flight operations manager may not be available. It is, then, imperative that the decision-making process leading to the dispatch of an air ambulance be clearly defined and understood by all involved. To this end, dispatchers should receive training in the following:

  1. Weather reporting system;
  2. Weather limits for applicable aircraft types;
  3. Aircraft performance and capabilities;
  4. Canadian Aviation Regulations as applicable; and
  5. Air operator tasking procedures.
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