When a prisoner needs to be transported by air for medical reasons, facilities in the US call upon private companies that have contracted with the US Federal Bureau of Prisons to provide this service. Karen Appold asks CSI Aviation how it performs these missions.
Con air ambulance
Transporting US prisoners with medical issues When a prisoner needs to be transported by air for medical reasons, facilities in the US call upon private companies that have contracted with the US Federal Bureau of Prisons to provide this service. Karen Appold asks CSI Aviation how it performs these missions
“In 2009, the Federal Bureau of Prisons (BOP) awarded four blanket purchase agreements (BPAs) to provide air ambulance and air charter services,” says Chris Burke, public affairs specialist,
BOP . The four BPA holders are CSI Aviation of Albuquerque, New Mexico; Air Planning LLC, of Salem, New Hampshire; Sierra West Airlines, of Oakdale, California; and Inflight Medical Services, based in Naples, Florida. Burke added that there is currently an ‘open solicitation’ in progress for air ambulance/charter services. However, BOP institutions may also use other methods of acquiring air ambulance services, Burke continued: “Companies interested in providing these services may market themselves to individual institutions, who can then determine the most beneficial acquisition method.” According to Michele Martinez, vice-president
of sales and operations at CSI Aviation: “Many prisons are in rural areas where limited
many prisons are in rural areas where limited commercial air service is available
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commercial air service is available, so the only mode of transportation is by chartering an aircraft.” Only a limited number of prison facilities have in-house medical services, so prisoners held elsewhere must be transported to a prison facility that can provide treatment. Most flights are for prisoners who need immediate medical attention, and because flights are typically organised at short notice and depend upon bed space at a medical facility, commercial flights are not an option. In addition, many prisoners require in-flight medical care that cannot be provided when using a commercial flight; such medical flights require the use of an air ambulanceconfigured aircraft with an in-flight medical crew. “Ongoing communication with the medical staff and flight crew is crucial for the overall success of each mission,” explained Stephanie Carroll, operations co-ordinator at CSI Aviation. A licensed medical staff member from the prison may accompany the passenger, or the air carrier will provide a flight nurse or flight physician certified for basic life support (BLS), advanced cardiovascular life support (ACLS) and ventilator use, or a medical flight attendant with the
minimum of an emergency medical technician (EMT) qualification may attend the patient. “All medical personnel are experienced physicians, registered nurses, respiratory therapists, and/ or paramedics with extensive training in areas such as flight physiology, and they are certified in advanced cardiac life support and advanced trauma life support,” Carroll says. A close look at CSI Aviation CSI Aviation transports approximately seven to 10 prisoners with medical issues each month. The company also has agreements in place with several government agencies and corporations to provide air ambulance flights, medical evacuations, and in-flight medical services worldwide. “We are an aviation management company specialising in urgent air charter
The US Federal Bureau of Prisons’ contracts for the medical transport of prisoners should not be confused with the Justice Prisoner and Alien Transportation System of the US Marshals Service’s (pictured), which moves prisoners between prisons, courthouses, etc. and is more commonly nicknamed ‘Con Air’
US Marshals Service
many prisoners require in-flight medical care that cannot be provided when using a commercial flight
requirements for more than 30 years,” Martinez said. “We work 24/7/365, so we are available at a moment’s notice.” CSI Aviation, which charters and leases aircraft from Federal Aviation Administration-certified Part 135 or Part 121 air carriers, has provided a variety of medical flights for prisoners over the years, including air ambulance flights, medical evacuations, and on-demand air charter flights with medical personnel. Flights vary from eastwest coast-to-coast missions, interstate flights, or from US cities to international destinations. Aircraft used range from smaller turboprops such as the Piper Navajo to business jets such as the Gulfstream V. The most frequently adopted planes are King Airs and Learjet 35s. “These are the most common aircraft types configured for air ambulance [use] and typically they are the most cost-effective for these types of missions,” Carroll explained. “They are suitable for the distance needed for most requirements and meet the number of passengers needing to be transported.” In-flight treatment and medical conditions vary, said Martinez: “Some [patients] may require BLS services, while others may need ACLS.” Sometimes, when a psychiatric patient needs transportation, only nurse supervision is required. Complexities of flight arrangements Many levels of co-ordination are required for an inmate’s medical transfer. For example, >>
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because flights are typically organised at short notice and depend upon bed space at a medical facility, commercial flights are not an option
there is co-ordination with the facility, CSI Aviation, and the air carrier in terms of routing, flight details, and in-flight medical requirements. Details on the patient’s condition must be relayed to the in-flight medical staff, as well as the ground ambulance staff. There is also co-ordination and communication with the ground support staff at each of the departure and arrival airports. “We are in constant communication with the air carrier, prison facilities, and airports,” Martinez said. Almost all flights are requested at short notice. CSI Aviation, which specialises in designing and implementing complex air transportation programmes, has arranged for flights in as little as two hours. Challenges are having the right aircraft available to meet the needs of the mission at a cost-effective price for the customer. Oftentimes, an aircraft will have to leave from another city, which adds to the flight time and also increases the cost. “We have access to many types of aircraft, so we are not restricted to one geographical region or one specific aircraft type,” Martinez said. “Because we’ve been in business for more than 30 years, we have developed long-standing relationships with air carriers worldwide, so we are capable of finding an aircraft option for any urgent requirement.” Transporting prisoners There is no difference in the level of treatment or care for a prisoner or non-prisoner flight, said CSI Aviation. And although prison staff or guards always accompany a prisoner for any inmate
Michele Martinez, vice-president of sales and operations at CSI Aviation: “Many prisons are in rural areas where limited commercial air service is available, so the only mode of transportation is by chartering an aircraft.”
medical transfer, typically they are not restrained in-flight. If a passenger is restrained, he or she will be handcuffed. The number of guards varies depending upon the number of patients that are being transported. This can range from two to four guards – a general rule is two guards per inmate. Guards are employed by the federal government and are trained to handle prisoners. Most daily missions consist of transferring inmate patients who are in end-of-life stages due to terminal cancer or other terminal diseases, but others consist of transferring inmates with psychiatric conditions, heart conditions, bariatric (obesity) issues, HIV, skin conditions, or respiratory problems, as well as individuals who are quadriplegics and paraplegics. Treatments given in-flight include ventilator management, oxygen, tracheotomy management and wound care. To save money, some facilities may piggyback on each other, so CSI Aviation may make multiple stops at different airfields to pick up patients going to the same medical facility. The co-ordination between the air carrier and multiple facilities requires constant communication and logistical support in order to maintain flight schedules. For the transfer of inmate patients on life support, the degree of medical care requires further planning and communication with the facility, medical staff, and air carrier prior to flight and in-flight.
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“We have transferred morbidly obese inmates, which proves to be very challenging because many are unable to walk on their own”
In some case, an obese patient who could not be transported by any other mode has required air transport due simply to their size. “We have transferred morbidly obese inmates, which proves to be very challenging because many are unable to walk on their own,” Carroll said. “We have had to find suitable aircraft to transport these patients and coordinate with the airfield and air carrier on how to safely board the patient to the aircraft. We must also ensure that the receiving facility and airfield has the proper equipment to deplane the patient and that ground transportation can accommodate the patient to complete the transfer to the medical facility.” It’s all part of the job for those flying on behalf of the US Federal Bureau of Prisons.
although prison staff or guards always accompany a prisoner for any inmate medical transfer, typically they are not restrained in-flight