Aeromedical Evac Manual B MD 005 000 FP 001

l B-MD-005-000/FP-001
COMMANDER 1 CANADIAN AIR DIVISION
AEROMEDICAL EVACUATION MANUAL
(ENGLISH)
(Supersedes CFACM 12-200 dated 1998-07-31)
Issued on the Authority of the Chief of the Defence Staff

Publiée avec l’autorisation du Chef d’état-major de la Défense
OPI: Aeromedical Evacuation Program Manager 2011-05-12

B-MD-005-000/FP-001
List of Effective Pages
Insert latest changed pages; dispose of superseded pages in accordance with applicable orders.
NOTE
The portion of the text affected by the latest change is indicated by a black vertical line in the
margin of the page. Changes to illustrations are indicated by miniature pointing hands, or black
vertical lines.
Dates of issue for original and changed pages are:
Original ................... 0 ................ 2011-05-12 Ch ............................ 3 ................

Ch ............................ 1 ................ Ch ............................ 4 ................
Ch ............................ 2 ................ Ch ............................ 5 ................
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B/C
B-MD-005-000/FP-001
Foreword
1. The Canadian Forces Aeromedical Evacuation Manual B-MD-005-000/FP-001 (CF AE Manual), is

issued on the authority of the Commander 1 Canadian Air Division.
2. The Canadian Forces (CF) are required to provide Aeromedical Evacuation (AE) support to military
operations nationally and internationally. As operations intensify and diversify, there will be a greater
need for deployable Aeromedical Evacuation Crew Members (AECMs) capable of working on a variety of
airframes.
3. This manual is intended to provide detailed guidance with respect to the CF AE system, aviation
physiology, clinical guidance, responsibilities and duties of AECMs, and aircraft systems/functions that
pertain to AE operations.
4. Inquiries and suggestions for change shall be forwarded through normal channels to the AE
Program Manager, Canadian Forces Aerospace Health Services Support Squadron, 1 Canadian Air Division
Headquarters, Winnipeg.
5. The CF AE Manual is effective upon receipt and supersedes Canadian Forces Air Command Manual
(CFACM) 12-200 dated 31 July 1998.
i/ii
B-MD-005-000/FP-001
Table of Contents
PAGE
CHAPTER 1 – THE CANADIAN FORCES AE SYSTEM – INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-1
AE Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-1

General Concept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-3
Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-4
Levels of Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-4
AE Personnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-6
ANNEX 1A – BIBLIOGRAPHY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1A-1-1
CHAPTER 2 – FLIGHT PHYSIOLOGY AND AEROMEDICAL EVACUATION. . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1
Section 1 – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1
Flight Physiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1
LAWS OF PHYSICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1
Atmosphere. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1
Gas Composition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1
Temperature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-2
GAS LAWS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-2
Boyle’s Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-2
Dalton’s Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-3
Henry’s Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-3
Charles’ Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-4
Section 2 – Stresses of Flight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-1
Decreased Partial Pressure of Oxygen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-1
Decreased Barometric Pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-1
Increased Noise Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-2
Decreased Relative Humidity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-3
Variation in Cabin Temperature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-3
Acceleration / Deceleration (G) Forces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-3
Vibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-4
Turbulence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-5
Poor Lighting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-5
iii
B-MD-005-000/FP-001
Contents (cont)
PAGE
Anxiety / Apprehension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-5

Factors Affecting Tolerance to the Stresses of Flight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-5
CHAPTER 3 – AIRCREW / FLIGHTLINE SAFETY AND REGULATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-1
Section 1 – Aircrew Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-1
Environmental Clothing and No-Go Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-1

Aeromedical Training (AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-2
Crew Duty Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-3
Crew Rest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-3
Non-Working Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-4
Alcohol Consumption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-4
Medical Restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-4
Section 2 – Flightline Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-1
Flightline Security and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-1

Safety Around the Aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-2
Vehicle Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-2
Refueling and De-icing Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-4
Section 3 – In Flight Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-1
AECM Personal Protective Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-1

Movement within the Aircraft Cabin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-1
Patient Safety In Flight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-2
Patient Injured In Flight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-2
Oxygen Availability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-2
CHAPTER 4 – AEROMEDICAL EVACUATION crewmember TRAINING & STANDARDS. . . . . . . . . . . . . 4-1-1
Section 1 – General Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1-1
Maintenance of Aircrew Categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1-2

AE Training and Maintenance of Currency for Augmentation AECMs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1-3
Section 2 – General Training Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2-1/4-2-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2-1/4-2-2
AESO and AETO Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2-1/4-2-2
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Contents (cont)
PAGE
Section 3 – AESO Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3-1
AESO Statement of Duties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3-1
Section 4 – AETO Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4-1/4-4-2
AETO Statement of Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4-1/4-4-2
Section 5 – MCD Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5-1
MCD Statement of Duties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5-1
Section 6 – Medical Specialist Team Member Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . 4-6-1
Section 7 – Other Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7-1
Proficiency and Category Checks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7-1

Support of Operational Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7-1
AE Equipment Standards and Procurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7-1
CHAPTER 5 – MISSION MANAGEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1
Section 1 – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1
Aeromedical Evacuation Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1

Mission Initiation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1
Aeromedical Evacuation Request Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1
Section 2 – Aeromedical Evacuation Coordinating Officer (AECO) . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2-1/5-2-2
AECO Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2-1/5-2-2
Section 3 – Patient Categorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3-1
Patient Priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3-1

Patient Classification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3-1
Patient Dependency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3-3/5-3-4
Section 4 – Composition of AE Crews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4-1/5-4-2
Section 5 – Medication Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5-1/5-5-2
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General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5-1/5-5-2
Security of Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5-1/5-5-2
Section 6 – Mission Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6-1
Aircraft Availability and Mission Timings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6-1

Load Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6-1
Section 7 – Briefings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1
GENERAL BRIEFINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1
The Pre-flight Briefing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1

Enroute Briefings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1
Prior-to-descent Briefing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1
Overwater Briefing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-2
EMERGENCY BRIEFINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-2
Special Instructions for Ditching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-3
SPECIAL BRIEFINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-4
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-4
LITTER BEARER BRIEF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-4
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-4
Section 8 – Preparation for Aeromedical Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8-1
Assuming Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8-2
Refusing Responsibility for a Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8-2
Section 9 – Emplaning and Deplaning Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9-1
Litter Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9-1
Ambulatory Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9-2
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Section 10 – Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-1
MISSION DOCUMENTATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-1
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-1
K1017 Flight Authorization and Record of Flight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-1
DND 417 Log Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-3
Core Environmental Allowance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-3
DND 883 Report of Patients Evacuated By Air (RPE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-6
PATIENT DOCUMENTATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-8
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-8
Electronic Charting SOPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-8
CF 2048 Patient Evacuation (PE) Tag. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-9
CF 2048A Patient Care Report (PCR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-12
DND 728 Document Transit Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-19
Section 11 – Medical-Legal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-1
Patient Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-1
Anti-hijacking Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-1
Restraint of Patients In Flight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-2
Immigration and Customs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-2
Patient Refusing to Complete an Aeromedical Evacuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-2
Unconscious, Incompetent or Underage Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-3
Military Patients Absent Without Authorized Leave (AWOL) Enroute . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-3
Transferring Prisoners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-4
Death In Flight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-4
REMAINING OVERNIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-5
Scheduled Remain Overnight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-5

Unscheduled Remain Overnight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-6
ANNEX 5A – DEPENDENCY AND COMPOSITION OF AEROMEDICAL CREWS. . . . . . . . . . . . . . . . . . . . 5A-1-1
ANNEX 5B – PATIENT POSITIONING AND LOAD PLANNING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-1
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Section 1 – CC130 E/H Patient Positioning and Load Planning Form . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-1
Use of the Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-1

Form Content. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-1
Special Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-2
CC130 E/H Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-3
Emergency Egress Routes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-1-4
Section 2 – CC130 H-30/J-30 Patient Positioning and Load Planning Form . . . . . . . . . . . . . . . . . . . . . . 5B-2-1
Use of the Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-2-1

Form Content. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-2-1
CC130 H-30/J-30 Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-2-3/5B-2-4
Emergency Egress Routes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-2-3/5B-2-4
Section 3 – CC144 Patient Positioning and Load Planning Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-3-1
Use of the Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-3-1

Form Content. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-3-1
CC144 Load Plan Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-3-3/5B-3-4
Use of the Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-4-1

Form Content. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-4-1
CC150 Load Plan Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-4-2
Use of the Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-5-1

Form Content. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-5-1
CC177 Load Plan Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5B-5-2
ANNEX 5C – CC130, CC144, CC150 AND CC177 PATIENT POSITIONING

AND LOAD PLANNING FORMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5C-1-1
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CHAPTER 6 – AIRFRAMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1-1/6-1-2
Section 1 – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1-1/6-1-2
Section 2A – CC130 Hercules (E/H Model) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-1
Troop Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-1
Patient Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-1
Variation in Aircraft Configurations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-2
EMERGENCY EXITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-2
Side Emergency Exit(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-4
Paratroop Doors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-5
Ramp / Ramp Door . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-7
Overhead Escape Hatches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-8
Hinged Windows. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-9
Crew Entrance Door . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-10
AIRCRAFT SYSTEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-13
Oxygen Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-13

Electrical Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-13
System Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-15
SAR Medevac Power Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-15
Cargo Compartment Intercommunication System (ICS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-17
ICS Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-17
Cargo Compartment Lighting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-19
Cargo Compartment Lighting Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-19
Comfort Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-22
Environmental Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-23
EMERGENCY EQUIPMENT AND AIRCRAFT SAFETY – EXTERNAL WALKAROUND. . . . . . . . . . . . . . . 6-2A-23
Forward Section of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-23

Right Side of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-23
Aft Section of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-24
Left Side of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-24
INTERNAL WALKAROUND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-27
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Emergency Equipment (Aircraft 130305-130333, 130336 and 130337). . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-27

Emergency Equipment (Aircraft130334,130335 and 130338 through 130342). . . . . . . . . . . . . . . . . . . . 6-2A-28
Emergency Equipment (Aircraft 130343 and 130344) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-29
Flight Deck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-30
Galley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-31
Cargo Compartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-32
EMPLANING AND DEPLANING PATIENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-34
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-34
Litter Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-34
Ambulatory Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-34
Litter Configurations and Use of Stanchions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-34
Litter Stanchion Support Brackets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-36
Litter Support Straps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-37
Emplaning and Deplaning Litters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-39
Repairs and Discrepancies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-40
Configurations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2A-42
Section 2B – CC130 Hercules (J Model). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-1
Troop Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-2
Patient Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-3
EMERGENCY EXITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-3
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-3
Chopping Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-8
Side Emergency Escape Hatches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-11
Paratroop Doors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-12
Overhead Emergency Escape Hatches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-14
AIRCRAFT SYSTEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-15
Oxygen Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-15

Electrical Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-15
Communication Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-15
Lighting Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-16
Forward Cargo Compartment Lighting Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-16
Aft Cargo Compartment Lighting Zone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-16
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COMFORT ITEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-18
Lavatories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-18
Galley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-18
Environmental Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-19
EMERGENCY EQUIPMENT AND AIRCRAFT SAFETY EXTERNAL WALKAROUND. . . . . . . . . . . . . . . . 6-2B-19
Forward Section of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-19

Right Side of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-19
Aft Section of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-20
Left Side of Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-20
INTERNAL WALKAROUND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-22
Flight Deck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-23

Crew Entrance Area Multi-Function LM Display Station. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-24
Cargo Compartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-25
Floor Rails. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-27
EMPLANING AND DEPLANING PATIENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-28
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-28
Litter Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-28
Ambulatory Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-28
Litter Configurations and Use of Stanchions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-28
Litter Stanchion Support Brackets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-28
Litter Support Straps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-29
Emplaning and Deplaning Litters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-30
Repairs and Discrepancies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-31
CONFIGURATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-31
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2B-31
Section 3 – CC150 Polaris (Airbus). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-1
Troop Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-1
Patient Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-1
Aircraft General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-3
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EMERGENCY EXITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-5
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-5
Passenger Doors (Type A) (1L/R, 3L/R) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-5
Slide / Raft (Type A Doors). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-10
Door Safety Strap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-12
Overwing Exits (Type III) (2L, 2R). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-13
Flight Deck Clearview Windows (Emergency Windows) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-15
Avionics Bay Hatches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-16
AIRCRAFT SYSTEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-16
Oxygen Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-16

Electrical Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-17
Communication Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-17
Lighting Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-20
TOILETS / LAVATORIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-22
Lavatories O, P & W. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-23

Lavatories Y & Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-23
Lavatory Service Unit (LSU). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-23
GALLEYS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-25
Galleys 1 & 1C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-26
Galleys 5, 6, 7 & 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-26
EMERGENCY EQUIPMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-27
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-27
Crew Oxygen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-33
Portable Oxygen Bottles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-33
Portable Oxygen Bottles with Disposable Masks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-34
Portable Oxygen Bottle c/w Smoke Mask and Disposable Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-34
Halon Fire Extinguishers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-35
Water Fire Extinguishers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-35
Fireman’s Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-36
Fire Axe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-36
Emergency Flashlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-36
Megaphone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-37
Emergency Locator Transmitters (ELT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-37
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Crew and Passenger Life Vests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-38
Supplementary Survival Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-39
Spare Passenger Life Vests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-40
Slide / Raft Survival Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-41
First Aid Kits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-41
Medical Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-41
Dangerous Cargo Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-43
Portable Breathing Equipment (PBE) for Crew. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-44
Emergency Passenger Oxygen System (EPOS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-44
EMPLANING AND DEPLANING PATIENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-45
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-45
CONFIGURATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-48
Passenger Seating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-48

Full Passenger Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-48
Combi / MRT P3 Configurations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-48
CC150-001 VIP Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-49
Combi Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-49
Patient Transport UNIT CONFIGURATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-51
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-51
Combi Configuration Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-52
Full Passenger Configuration Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3-56
Section 4 – CC177 Globemaster III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-1
EMERGENCY EXITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-5
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-5
Crew Entrance Door . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-6
Forward Emergency Escape Hatch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-8
Troop Doors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-9
Flotation Equipment Deployment System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-11
Maintenance / Ditching Hatch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-13
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PAGE
Chop Out Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-14
Ramp & Ramp Toes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-15
Clearview Windows. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-15
Ramp With Blowdown System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-17
Oxygen Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-18

Electrical Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-21
Communication Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-22
COMFORT ITEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-25
Lavatory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-25
Galley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-27
Environmental Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-28
Fire Extinguishers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-29

Escape Ropes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-30
Escape Ladders – Semi-Rigid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-31
Crash Axes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-32
First Aid Kits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-32
MA-1 Portable Oxygen Bottle with Recharge Hose & Quick-Don Mask / Smoke Goggles. . . . . . . . . . . . 6-4-33
Emergency Passenger Oxygen System (EPOS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-35
Survival Equipment Locker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-35
Aeromedical Evacuation System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-37

Modified Stanchion Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-37
CONFIGURATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-39
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-39
AE-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-40
AE-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4-41/6-4-42
Section 5 – CC144 Challenger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-1
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PAGE
Description. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-2
Danger Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-3
EMERGENCY EXITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-4
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-4
Passenger / Crew Door (Type I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-5
Passenger Door Operation – Exterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-7
Passenger / Crew Door Operation – Interior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-8
Right Overwing Emergency Exit (Type III). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-9
Cargo / Baggage Door. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-11
Oxygen System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-13

Electrical System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-14
Communication System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-15
Lighting System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-16
COMFORT ITEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-17
Cabin Furnishing Description & Layout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-17

Passenger Compartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-17
Seats & Divan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-18
Floor Coverings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-19
Folding Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-20
Lavatory – Wardrobe Compartment Lock Box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-21
Baggage Compartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-22
Flight Steward Station / Galley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-22
ENVIRONMENTAL SYSTEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-23
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-23
Temperature Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-23
Pressurization System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-23
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PAGE
General – CC144 Walkaround. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-24
Flight Deck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-25
Passenger Compartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-25
Baggage Compartment / Aft Equipment Bay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-26
Crew Portable Oxygen System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-28
Portable Fire Extinguishers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-29
Fireman’s Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-29
Crash Axe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-29
Emergency Flashlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-29
Emergency Escape Rope. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-29
Emergency Locator Transmitter (ELT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-30
Life Vests (Adult / Child) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-30
Life Raft (10 Person), Universal First Aid Kit & Survival Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-31
Lifepak 500 – AED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-33
Bracing Positions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-33
Stretcher Lift Systems – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-33

No-lift Patient Loading System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-34
2800 Series. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-35
Medevac Ramp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-38
AIRCRAFT CONFIGURATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-38
Spectrum 2800 Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5-38
Section 6 – CH146 Griffon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-1
Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-3
Danger Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-4
How to Approach a Rotary Wing Aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-4
CH146 EXITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-5
Crew Doors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-5

Sliding Cargo / Passenger Doors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-6
Acrylic Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-7
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AIRCRAFT SYSTEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-7
Oxygen Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-7

Electrical Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-7
Communication System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-8
Comfort Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-10
Baggage Compartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-10
Environmental Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-11
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-12
Fire Extinguishers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-13
Emergency Location Transmitter (ELT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-13
First Aid Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-15
Crash Axe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-15
Survival Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-15
Supplement Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-16
Immersion Suits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-16
Survival Vests / Life Preservers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-16
CONFIGURATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-16
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-16
AE CONFIGURATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-17
Side Mounting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-17

Cross-Cabin Mounting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-18
Floor Loading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-18
Litter Kit Components and Set Up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-19

Bracket Mountings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-19
Stanchion Bracket Mountings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-20
Litter Straps and Brackets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-20
Loading Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-21
Side-Mounted Litters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-21
Cross-Cabin Mounting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6-21
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Section 7 – CH147 Chinook. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7-1
Litter Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7-1
Section 8 – CH149 Cormorant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8-1
Litter Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8-1
Section 9 – CC115 Buffalo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9-1/6-9-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9-1/6-9-2
Troop Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9-1/6-9-2
Litter Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9-1/6-9-2
Aircraft General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9-1/6-9-2
ANNEX 6A – STRATEGIC AEROMEDICAL EVACUATION ASSETS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6A-1-1
ANNEX 6B – AIRCRAFT EMERGENCY EQUIPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-1-1/6B-1-2
Section 1 – Oxygen Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-1-1/6B-1-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-1-1/6B-1-2
Section 2 – Flotation Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-2-1/6B-2-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-2-1/6B-2-2
Section 3 – Fire Extinguishers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-3-1
PORTABLE AIRBORNE FIRE EXTINGUISHER (TYPE HALON 1211). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-3-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-3-1
Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-3-2
WATER FIRE EXTINGUISHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-3-4
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-3-4
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Section 4 – Medical Supplies / Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-4-1
General First Aid Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-4-1

Universal First Aid Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-4-2
First Aid Kit, Aircrew. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-4-3
Lifepak 500 – AED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-4-4
Section 5 – Emergency Locator Transmitters (ELTS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-5-1/6B-5-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-5-1/6B-5-2
Section 6 – Miscellaneous Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-6-1
Fire Axe / Crash Axe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-6-1

Emergency Flashlight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-6-1
Fireman’s Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-6-2
Section 7 – Personal Protective Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-7-1/6B-7-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B-7-1/6B-7-2
CHAPTER 7 – TACTICAL AEROMEDICAL EVACUATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1-1/7-1-2
Section 1 – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1-1/7-1-2
AEC Composition and Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1-1/7-1-2
Section 2 – Aircraft Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-1
Configuration Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-1
CC130 CONFIGURATION OPTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-1
Floor Load Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-1

Three- and Four-high Litter Load Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-1
Five-high Stanchion Load Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-2
CC177 CONFIGURATION OPTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-2
Three-high Tier Load. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-2
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Floor Load Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-2
CONFIGURATION PROCEDURES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-2
Floor Rail System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-2

Litter Support Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-3/7-2-4
Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2-3/7-2-4
Section 3 – Emplaning Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-1
EMPLANING A FLOOR LOAD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-1
Crew Positioning and Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-2
Emplaning and Securing Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-2
EMPLANING A THREE- OR FOUR-HIGH TIER CONFIGURATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-4
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-4
Crew Positioning and Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-5/7-3-6
EMPLANING A FIVE-HIGH TIER CONFIGURATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-5/7-3-6
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3-5/7-3-6
Section 4 – Deplaning Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4-1/7-4-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4-1/7-4-2
CHAPTER 8 – AEROMEDICAL EVACUATION CLINICAL CONSIDERATIONS . . . . . . . . . . . . . . . . . . . 8-1-1/8-1-2
Section 1 – AE Clinical Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1-1/8-1-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1-1/8-1-2
Section 2 – Patient Considerations for Aeromedical Evacuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-1
Altitude Restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-4
General Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-5
Pre-flight Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-5
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In Flight Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-6
In Flight Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2-7
Section 3 – General In Flight Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-1
Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-1

Oxygen Saturations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-1
Comfort Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-4
Intravenous Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-5
Blood Transfusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-6
Wound Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-7
Administer Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-8
STRESSES OF FLIGHT – GENERAL CONSIDERATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-8
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-8
Compensate for Changes in Barometric Pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-10
Compensate for Decreased Partial Pressure of O2 (PPO2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-12
Compensate for Decreased Humidity at Altitude. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-13
Compensate for Decreased Lighting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-13
Compensate for Increased Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-13
Compensate for Temperature Variation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-13
Compensate for Acceleration / Deceleration (G) Forces, Turbulence, Vibration . . . . . . . . . . . . . . . . . . . . 8-3-14
Compensate for Anxiety and Apprehension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-14
STRESSES OF FLIGHT AND CLINICAL CONSIDERATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-15/8-3-16
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3-15/8-3-16
Section 4 – Care for Neurological Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-1
General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-1
Vibration and G Forces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-1
Decreased Humidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-2
Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-2
AE Considerations for Neurological Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-2
Neurological Checks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4-3/8-4-4
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Section 5 – Care for Cardiovascular Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5-1
AE Considerations for Cardiovascular Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5-1
Section 6 – Care for Respiratory Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6-1
AE Considerations for General Respiratory Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6-2
Specific Measures for Ventilated Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6-2
Measures for Patients with Chest Tubes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6-3
Section 7 – Care for Hematologic Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7-1
AE Considerations for Hematologic Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7-2
Section 8 – Care for Ears, Nose and Throat (ENT) Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-1
EARS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-1

Increased Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-1
Patient Measures to Counter the Effects of Decreased Barometric Pressure on the Ear . . . . . . . . . . . . . . 8-8-1
Specific Measures for Ear Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-2
NOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-3

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Specific Measures for Patients with Nasal Injuries / Illnesses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-3
THROAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-4
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-4
Specific Measures for the Care of a Patient with Throat Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-4
MAXILLOFACIAL AND SINUSES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8-4

Specific Measures for the Care of a Patient with Maxillofacial or Sinus Issues. . . . . . . . . . . . . . . . . . . . . . 8-8-5
Section 9 – Care for Gastrointestinal Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9-1
AE Considerations for Patients with Gastrointestinal Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9-1
Motion Sickness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9-2
AE Considerations for Patients with Motion Sickness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9-2
Section 10 – Care for Genito-Urinary Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10-1/8-10-2
Vibration and G Forces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10-1/8-10-2

AE Considerations for Genito-Urinary Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10-1/8-10-2
Section 11 – Care for Orthopedic Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-1
Vibration and G Forces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-1
Variation in Cabin Temperature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-1
Decreased Humidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-1
Anxiety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-2
AE Considerations for Orthopedic Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11-2
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Section 12 – Care for Ophthalmic Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12-1
Decreased Barometric Pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12-1
Anxiety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12-1
AE Considerations for Ophthalmic Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12-2
Section 13 – Care for Infectious Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13-1/8-13-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13-1/8-13-2
Section 14 – Care for Chemical, Biological, Radiological and Nuclear Casualties . . . . . . . . . . . . 8-14-1/8-14-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14-1/8-14-2
Section 15 – Care for Mental Health Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15-1
Increased Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15-1
Anxiety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15-1
AE Considerations for Mental Health Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15-1
Section 16 – Care for Obstetrical Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16-1
AE Considerations for Obstetrical Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16-1
Section 17 – Care for Pediatric Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17-1
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PAGE
Increased Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17-1
Anxiety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17-1
AE Considerations for Pediatric Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17-2
Section 18 – Care for Decompression Illness (DCI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18-1
AE Considerations for DCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18-2
If DCS Occurs In Flight to a Patient or Crewmember. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18-2
Section 19 – Care for Burn Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19-1
Decreased PPO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19-1
AE Considerations for Burn Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19-1
Section 20 – Care for Diabetic Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-20-1/8-20-2
AE Considerations for Diabetic Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-20-1/8-20-2
CHAPTER 9 – INFECTION CONTROL GUIDELINES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1-1/9-1-2
Section 1 – General Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1-1/9-1-2
Section 2 – Handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2-1
Section 3 – Personal Protective Equipment (PPE). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-1
Masks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-1
Disposable Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-1
Goggles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-2
Disposable Face Shields. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-2
Disposable Gowns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-3
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MAINTENANCE / CLEANING OF PPE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-3
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-3
Flight Suit / Summer & Winter Flying Jackets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-3
Flight Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-3
Tactical Vest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-4
Helmet, Including Visor and Headset. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3-4
Section 4 – Health Canada / CDC Infection Control Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-1
Evolution of Isolation Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-1
ROUTINE PRACTICES / STANDARD PRECAUTIONS (TIER 1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-1
Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-1
Mask, Eye Protection, Face Shield. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-2
Gowns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-2
Patient Care Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-2
ADDITIONAL PRECAUTIONS (TIER 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-3
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-3
Airborne Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-3
Droplet Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-6
Contact Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4-6
Section 5 – Communicable Diseases of Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-1
ANTIMICROBIAL-RESISTANT ORGANISMS (ARO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-1
TUBERCULOSIS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-1
Multidrug-resistant Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-2
SEVERE ACUTE RESPIRATORY SYNDROME (SARS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5-2
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PAGE
Section 6 – Legal Implications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6-1/9-6-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6-1/9-6-2
Section 7 – Aircraft Disinsection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7-1/9-7-2
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7-1/9-7-2
Section 8 – Cleaning, Disinfection and Sterilization of Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . . 9-8-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8-1
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8-1
Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8-1
Section 9 – Waste Management Protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9-1
General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9-1
Chemical Toilet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9-3/9-9-4
ANNEX 9A – MAJOR INFECTIOUS DISEASES, PRECAUTIONS & VECTORS . . . . . . . . . . . . . . . . . . . . . 9A-1-1
ANNEX 9B – VENTILATION SYSTEM, AIRFLOW AND

OUTFLOW VALVE OF CF AE AIRCRAFT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9B-1-1/9B-1-2
ANNEX 9C – AIRBORNE PRECAUTIONS…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9C-1-1/9C-1-2
ANNEX 9D – DROPLET PRECAUTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9D-1-1/9D-1-2
ANNEX 9E – CONTACT PRECAUTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9E-1-1
ANNEX 9F – RECOMMENDED INFECTION CONTROL PRECAUTIONS

FOR ANTIMICROBIAL-RESISTANT ORGANISMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9F-1-1
Methicillin-resistant Staphylococcus Aureus (MRSA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9F-1-1

Vancomycin-resistant Enterococcus (VRE). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9F-1-1
Acinetobacter Baumannii. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9F-1-2
ANNEX 9G – RECOMMENDED METHODS OF AIRCRAFT DISINSECTION. . . . . . . . . . . . . . . . . . 9G-1-1/9G-1-2
GLOSSARY OF DEFINITIONS AND ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GL-1-1
Section 1 – Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GL-1-1
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Section 2 – Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GL-2-1
Distribution list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DL-1-1/DL-1-2
xxviii
B-MD-005-000/FP-001
LIST OF FIGURES
FIGURE TITLE PAGE
1-1-1 CF AE During the Korean Conflict............................................................................1-1-2

1-1-2 Phases of the Canadian AE System.........................................................................1-1-3
1-1-3 Canadian Forces AE Organization...........................................................................1-1-6
2-1-1 Gas Composition.......................................................................................................2-1-1
2-1-2 Boyle’s Law of Gas Expansion.................................................................................2-1-2
2-1-3 Table of Decreasing PP of O2 with Altitude.............................................................2-1-3
2-1-4 Nitrogen Escaping Solution When Released From Pressure................................2-1-4
3-1-1 Crew Duty Day Table (Air Mobility Fixed-Wing and Maritime Patrol)..................3-1-3
3-1-2 Grounding Periods Table..........................................................................................3-1-5
5-3-1 Patient Priority System Table...................................................................................5-3-1
5-3-2 Table of Patient Classification for Aeromedical Evacuation..................................5-3-2
5-3-3 Table of Dependency Category for Aeromedical Evacuation................................5-3-3/5-3-4
5-10-1 K1017 Form................................................................................................................5-10-2
5-10-2 DND 417 Flying Log Sheet.......................................................................................5-10-3
5-10-3 Core Environmental Allowance...............................................................................5-10-5
5-10-4 Report of Patients Evacuated by Air (RPE)..............................................................5-10-7
5-10-5 CF 2048 PE Tag..........................................................................................................5-10-11
5-10-6 CF2048A.....................................................................................................................5-10-13 to 5-10-18
5-10-7 DND 728 Document Transit Form............................................................................5-10-20
5B-1-1 CC130 E/H Load Plan.................................................................................................5B-1-3
5B-2-1 CC130 H-30/J-30 Load Plan......................................................................................5B-2-2
5B-3-1 CC144 Load Plan.......................................................................................................5B-3-2
5B-4-1 CC150 Load Plan.......................................................................................................5B-4-2
5B-5-1 CC177 Load Plan.......................................................................................................5B-5-2
5C-1-1 CC130 Patient Positioning & Load Planning Form E-H Model..............................5C-1-1
5C-1-2 CC130 Patient Positioning & Load Planning Form H-30/J-30 Model....................5C-1-2
5C-1-3 CC144 Patient Positioning & Load Planning Form.................................................5C-1-3
5C-1-4 CC150 Patient Positioning & Load Planning Form MP-1 & MP-2..........................5C-1-4
5C-1-7 CC150 Patient Positioning & Load Planning Form MP-7.......................................5C-1-7
5C-1-8 CC177 Patient Positioning & Load Planning Form.................................................5C-1-8
6-2A-1 CC130 Coming in for Landing in Nunavut..............................................................6-2A-1
6-2A-2 CC130 Emergency Exits............................................................................................6-2A-3
6-2A-3 Paratroop Door..........................................................................................................6-2A-6
6-2A-4 Ramp with Loading Ramps in Place........................................................................6-2A-7
6-2A-5 Crew Entrance Door..................................................................................................6-2A-10
6-2A-6 Location of Emergency Exits....................................................................................6-2A-12
6-2A-7 60 Hertz Frequency Power System..........................................................................6-2A-14
6-2A-8 SAR Medevac Power Supply...................................................................................6-2A-16
xxix
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LIST OF FIGURES (cont)
FIGURE TITLE PAGE
6-2A-9 Location of ICS in Cargo Compartment..................................................................6-2A-18

6-2A-10 Medical ICS Panel.....................................................................................................6-2A-18
6-2A-11 Cargo Area Lighting Controls...................................................................................... 6-2A-21 & 6-2A-22
6-2A-12 Emergency Equipment Placement by Airframe.....................................................6-2A-27
6-2A-15 CC130 Ladder Placement and Operation................................................................6-2A-35
6-2A-16 Four-high Litter Placement.......................................................................................6-2A-36
6-2A-17 Bracket Operation and Parts....................................................................................6-2A-37
6-2A-18 Attachment of Litter Support Straps to Overhead Supports and Litter
Support Strap Brackets and Sidewall Placement of Canvas Bags on
Aircraft Bulkhead................................................................................................6-2A-38
6-2A-19 Litter Strap / Bracket Use and Attaching Strap End to Floor Stud........................6-2A-40
6-2A-20 Engine Running Onload on the CC130....................................................................6-2A-41
6-2A-21 AE-1 Config (Stubby)................................................................................................6-2A-42
6-2A-22 AE-3 Config (Stubby)................................................................................................6-2A-43
6-2A-23 AE-4 Config (Stretch)................................................................................................6-2A-44
6-2A-24 AE-5 Config (Stretch)................................................................................................6-2A-45/6-2A-46
6-2B-1 First CC130J on Roll Out...........................................................................................6-2B-1
6-2B-2 CC130J Dimensions..................................................................................................6-2B-2
6-2B-3 CC130J Exits..............................................................................................................6-2B-3
6-2B-4 Cargo Door and Ramp..............................................................................................6-2B-5
6-2B-5 Emergency Exits – Ground.......................................................................................6-2B-6
6-2B-6 Emergency Exits – Water..........................................................................................6-2B-7
6-2B-7 Interior and Exterior Chopping Marks.....................................................................6-2B-8
6-2B-8 Crew Entrance Door..................................................................................................6-2B-9
6-2B-9 Operation of Paratroop Doors..................................................................................6-2B-13
6-2B-10 Communication System...........................................................................................6-2B-16
6-2B-11 Cargo Lighting Control Panels.................................................................................6-2B-17
6-2B-12 Lavatory.....................................................................................................................6-2B-18
6-2B-13 Emergency Equipment Locations on CC130J.........................................................6-2B-22
6-2B-14 Emergency Escape Light..........................................................................................6-2B-24
6-2B-15 Floor Rail System......................................................................................................6-2B-27
6-2B-16 Litter Support Straps................................................................................................6-2B-30
6-2B-17 Securing a Litter........................................................................................................6-2B-30
6-2B-18 AE-1 Configuration....................................................................................................6-2B-31
6-2B-21 AE-4 Configuration....................................................................................................6-2B-33/6-2B-34
6-2B-22 Paratroop Seating.....................................................................................................6-2B-33/6-2B-34
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6-2B-23 Cargo Arrangement..................................................................................................6-2B-33/6-2B-34

6-3-1 CC150 Polaris in Flight..............................................................................................6-3-1
6-3-2 Possible Polaris Configurations...............................................................................6-3-2
6-3-3 Table of CC150 Specifications..................................................................................6-3-3
6-3-4 CC150 Danger Areas.................................................................................................6-3-4
6-3-5 Full Deployment of All Raft / Slides and Escape Slides.........................................6-3-5
6-3-6 Passenger Door (Type A)..........................................................................................6-3-7
6-3-7 Type A Door with Pin Installed and in Disarmed Position.....................................6-3-8
6-3-8 Deployed Slide / Raft................................................................................................6-3-10
6-3-9 Slide / Raft Diagram..................................................................................................6-3-11
6-3-10 Door Safety Strap......................................................................................................6-3-12
6-3-11 Overwing Exit Diagram............................................................................................6-3-13
6-3-12 Initial Deployment of the Escape Slide...................................................................6-3-14
6-3-13 Initial Deployment of the Escape Slide...................................................................6-3-14
6-3-14 Full Deployment of the Overwing Escape Slide.....................................................6-3-15
6-3-15 Flight Deck Window and Escape Descent Device...................................................6-3-15
6-3-16 Avionics Bay..............................................................................................................6-3-16
6-3-17 PAX Emergency Oxygen..........................................................................................6-3-16
6-3-18 Satellite Phone..........................................................................................................6-3-18
6-3-19 Interphone Handset..................................................................................................6-3-19
6-3-20 Cabin Light Panels Above Door 1L in the PAX / COMBI Configs..........................6-3-20
6-3-21 Lavatory Layout Diagrams.......................................................................................6-3-22
6-3-22 LSU Diagram.............................................................................................................6-3-24
6-3-23 Galley Diagrams and Locations...............................................................................6-3-25
6-3-24 Combi Configuration and Emergency Equipment.................................................6-3-29
6-3-25 Legend for Emergency Equipment Locations........................................................6-3-30
6-3-26 Passenger Configuration and Emergency Equipment...........................................6-3-31
6-3-27 Table of Emergency Equipment Locations / Quantity Summary..........................6-3-32 & 6-3-33
6-3-28 Fireman’s Gloves.......................................................................................................6-3-36
6-3-29 Emergency Flashlight...............................................................................................6-3-36
6-3-30 Megaphone................................................................................................................6-3-37
6-3-31 Emergency Locator Transmitter..............................................................................6-3-37
6-3-32 Crew Life Vest............................................................................................................6-3-39
6-3-33 Passenger Life Vest...................................................................................................6-3-39
6-3-34 Supplemental Survival Kit........................................................................................6-3-39
6-3-35 First Aid Kit................................................................................................................6-3-41
6-3-36 Medical Kit.................................................................................................................6-3-41
6-3-37 Dangerous Cargo Container.....................................................................................6-3-44
6-3-38 EPOS Container Containing 20 Units......................................................................6-3-44
6-3-39 K-Loader Being Used to Load Patients....................................................................6-3-46
6-3-40 A Canadian K-Loader Off-loading Luggage Containers.........................................6-3-46
6-3-41 A CF Food Truck & Support Worker Arriving at the Right Rear Door...................6-3-47
6-3-42 High Deck Patient Loading Platform is Used to Load Patients at Ramstein AFB......6-3-47
6-3-43 PAX Configurations...................................................................................................6-3-48
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B-MD-005-000/FP-001
FIGURE TITLE PAGE
6-3-44 Safety Barrier Net......................................................................................................6-3-49

6-3-45 Smoke Curtain...........................................................................................................6-3-50
6-3-46 Partition Wall.............................................................................................................6-3-51
6-3-47 MC-1 Spectrum Config (Combi)...............................................................................6-3-52
6-3-55 MP-1 Spectrum Config (Pax)....................................................................................6-3-56
6-3-61 MP-7 Spectrum Config (Pax)....................................................................................6-3-59/6-3-60
6-4-1 CC177 Globemaster III..............................................................................................6-4-1
6-4-2 CC177 Engine Danger Areas....................................................................................6-4-3
6-4-3 Radome Danger Area...............................................................................................6-4-4
6-4-4 External Locations of the CC177 Emergency Exits.................................................6-4-5
6-4-5 Cabin Pressure Gauge..............................................................................................6-4-7
6-4-6 Crew Entrance Door..................................................................................................6-4-8
6-4-7 Forward Emergency Escape Hatch..........................................................................6-4-9
6-4-8 Troop Door.................................................................................................................6-4-11
6-4-9 FEDS Initiator.............................................................................................................6-4-12
6-4-10 FEDS Location at the LM Station.............................................................................6-4-13
6-4-11 Maintenance / Ditching Hatch..................................................................................6-4-14
6-4-12 Chop Out Areas and Some Emergency Equipment Locations.............................6-4-15
6-4-13 Clearview Window Operation..................................................................................6-4-17
6-4-14 Location of the Ramp Blowdown System Activation Switch................................6-4-18
6-4-15 The Ramp Blowdown System Activation Switch...................................................6-4-18
6-4-16 Emergency Oxygen System.....................................................................................6-4-19
6-4-17 Location of Aeromedical Evacuation Oxygen Therapeutic Outlets......................6-4-20
6-4-18 Aeromedical Evacuation 60 Hz Power Control Panel.............................................6-4-21
6-4-19 Power Receptacles....................................................................................................6-4-22
6-4-20 Aircraft Amperage Information................................................................................8-4-22
6-4-21 Main Lighting System and Ramp Lighting System...............................................6-4-23
6-4-22 Lighting Systems within the CC177.........................................................................6-4-24
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FIGURE TITLE PAGE
6-4-23 Crew Lavatory...........................................................................................................6-4-26

6-4-24 Galley.........................................................................................................................6-4-27
6-4-25 CC177 Location of Emergency Equipment.............................................................6-4-28
8-4-26 Fire Extinguisher Locations......................................................................................6-4-29
6-4-27 Fire Extinguisher Station..........................................................................................6-4-30
6-4-28 Semi-rigid Ladders – Location and Operation........................................................6-4-31
6-4-29 Crash Axe Locations.................................................................................................6-4-32
6-4-30 First Aid Kit Locations...............................................................................................6-4-33
6-4-31 Oxygen Bottle Locations..........................................................................................6-4-34
6-4-32 Survival Equipment Locker......................................................................................6-4-36
6-4-33 Stanchion Positions, Setup and Operation.............................................................6-4-38
6-5-1 CC144 Challenger with Crew Entry Door Open......................................................6-5-1
6-5-2 Table of CC144 Specifications..................................................................................6-5-2
6-5-3 Lateral View...............................................................................................................6-5-2
6-5-4 Danger Areas from Engine Intake / Exhaust & APU Exhaust................................6-5-3
6-5-5 Radome and FH Antenna.........................................................................................6-5-4
6-5-6 Aircraft Door Locations.............................................................................................6-5-5
6-5-7 Crew / Pax Door (Including External Handle).........................................................6-5-6
6-5-8 Exterior View of Passenger / Crew Door (Including Instruction Placards)...........6-5-7
6-5-9 Interior View of Passenger / Crew Door (Including Instruction Placards)............6-5-8
6-5-10 Internal and External Views of Overwing Emergency Exit
(Including Instruction Placards).........................................................................6-5-10
6-5-11 Opening the Passenger / Crew Door and the Right Overwing Exit......................6-5-11
6-5-12 Internal and External View of the Cargo Compartment Door...............................6-5-12
6-5-13 Passenger Drop-down Mask Location in Cabin......................................................6-5-13
6-5-14 Passenger Oxygen System Operation....................................................................6-5-14
6-5-15 Electrical Outlet (Left) Forward of Overwing Exit...................................................6-5-15
6-5-16 Satellite Phone in Rear Right Side Cabin, above the Folding Table.....................6-5-16
6-5-17 General Cabin Layout (Including FS Station Forward Right)................................6-5-17
6-5-18 Passenger Compartment..........................................................................................6-5-18
6-5-19 Diagram of the 3-place Divan and a Reclining Passenger Seat............................6-5-20
6-5-20 Wardrobe Left Side of the Lavatory........................................................................6-5-21
6-5-21 Flight Steward Station..............................................................................................6-5-22
6-5-22 CC144 Emergency Equipment Placement...............................................................6-5-24
6-5-23 Table of CC144 Emergency Equipment...................................................................6-5-26 & 6-5-27
6-5-24 Duo-Pak (Black Case) with Portable FS Oxygen Bottle & Brown Mask................6-5-28
6-5-25 Other Oxygen Sources in the Cabin Including a General-Purpose First Aid Kit....6-5-28
6-5-26 Crash Axe Mounted Behind Left Pilot’s Seat..........................................................6-5-29
6-5-27 Location of Crash Axe, Emergency Escape Rope (with Swivel Assembly)
and Emergency Flashlights................................................................................6-5-30
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FIGURE TITLE PAGE
6-5-28 Life Vest Locations....................................................................................................6-5-31

6-5-29 Universal First Aid Kit and Basic Survival Gear Located Under the Divan..........6-5-31
6-5-30 Life Raft Location and Operation.............................................................................6-5-32
6-5-31 Lifepak 500 and CPR Kit in Lower Mid-cabin Stowage Compartment.................6-5-33
6-5-32 Brace Positions on the CC144..................................................................................6-5-33
6-5-33 No-lift Patient Loading System with Spectrum Litter............................................6-5-34
6-5-34 Ramp Extender Partially Installed............................................................................6-5-35
6-5-35 No-lift Patient Loading System................................................................................6-5-35
6-5-36 Checking Spectrum Litter Housing Is In..................................................................6-5-36
6-5-37 No-lift Patient Loading System Litter Housing at Top of Lift.................................6-5-36
6-5-38 Sliding Feet around Cabin Door..............................................................................6-5-37
6-5-39 Sliding Patient on Ramp Extender...........................................................................6-5-37
6-5-40 Medevac Ramp Assembled and in Position to Receive Patients..........................6-5-38
6-5-41 AE-1 “Spectrum High Density” Configuration – 7 Seats, 2 Spectrum Beds........6-5-39
6-5-42 AE-2 “Spectrum Both” Configuration – 5 Seats, 2 Spectrum Beds......................6-5-39
6-5-43 AE-3 “Spectrum Right” Configuration – 6 Seats, 1 Spectrum Bed.......................6-5-39
6-5-44 AE-4 “Spectrum Extra Equipment” Configuration – 4 Seats, 2 Spectrum Beds....6-5-40
6-6-1 CH146 Griffon............................................................................................................6-6-1
6-6-2 Table of CH146 Specifications..................................................................................6-6-2
6-6-3 CH146 Dimensions....................................................................................................6-6-3
6-6-4 Danger Areas.............................................................................................................6-6-4
6-6-5 Griffon Crew Door (Right Side)................................................................................6-6-6
6-6-6 Cargo / Passenger Door (Right Side).......................................................................6-6-7
6-6-7 Cabin Inverter Power Outlets (Located Beneath the Centre Cabin Seats)...........6-6-8
6-6-8 Aft Compartment Comms Panel..............................................................................6-6-9
6-6-9 Comms Panel Diagram.............................................................................................6-6-9
6-6-10 Cabin Light (Centre Cabin).......................................................................................6-6-10
6-6-11 Baggage Compartment Door...................................................................................6-6-11
6-6-12 Heating (1) and Cooling (2) Vents............................................................................6-6-11
6-6-13 Thermostat Location Behind the Right Pilot Seat..................................................6-6-12
6-6-14 Emergency Equipment Locations (May Differ Between Sqns / Op Missions).....6-6-13
6-6-15 Fire Extinguisher Locations in the Cabin and Flight Deck.....................................6-6-13
6-6-16 ELT (Right Side of Cabin)..........................................................................................6-6-14
6-6-17 ELT Diagram..............................................................................................................6-6-14
6-6-18 First Aid Kit................................................................................................................6-6-15
6-6-19 Survival Kit................................................................................................................6-6-15
6-6-20 Common CH146 Configurations..............................................................................6-6-17
6-6-21 Side-Mounting – 2 Litters.........................................................................................6-6-18
6-6-22 Cross-Cabin Mounting – 3 Litters............................................................................6-6-18
6-6-23 Litter Setup Diagram.................................................................................................6-6-19
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FIGURE TITLE PAGE
6-6-24 Firewall Mountings with (1) and without (2) a Bracket..........................................6-6-19

6-6-25 Stanchion Assembly and Bracket Mounting..........................................................6-6-20
6-6-26 Strap Assembly.........................................................................................................6-6-20
6-7-1 CH147 Chinook..........................................................................................................6-7-1
6-8-1 CH149 Cormorant......................................................................................................6-8-1
6-9-1 CC115 Buffalo............................................................................................................6-9-1/6-9-2
6-9-2 Table of CC115 Specifications..................................................................................6-9-1/6-9-2
6A-1-1 Strategic Aircraft Configuration Table – CC150, CC144, CC177 and CC115.........6A-1-2
6A-1-2 Strategic Aircraft Configuration Table – CC130, CH146, CH147 and CH149.........6A-1-3/6A-1-4
6B-3-1 Halon 1211 Fire Extinguisher...................................................................................6B-3-3
6B-3-2 Water Fire Extinguisher............................................................................................6B-3-4
6B-4-1 General First Aid Kit..................................................................................................6B-4-1
6B-4-2 Universal First Aid Kit...............................................................................................6B-4-2
6B-4-3 First Aid Kit, Aircrew.................................................................................................6B-4-4
6B-4-4 Lifepak 500.................................................................................................................6B-4-4
6B-6-1 Fire Axe......................................................................................................................6B-6-1
6B-6-2 Emergency Flashlight...............................................................................................6B-6-1
6B-6-3 Fireman’s Gloves.......................................................................................................6B-6-2
7-3-1 Floor Loading Litters Tie-Down................................................................................7-3-4
8-2-1 Patients at Increased Risk with Flight......................................................................8-2-3 & 8-2-4
8-3-1 Table of Objective and Subjective Signs of Hypoxia.............................................8-3-2
8-3-2 Comparison Table of Signs and Symptoms of Hyperventilation and Hypoxia....8-3-3
8-3-3 Table of Specific Stresses of Flight and Patient Types Most Affected..................8-3-9 & 8-3-10
8-4-1 Glasgow Coma Scale Chart......................................................................................8-4-3/8-4-4
8-7-1 Table of Types of Hypoxia........................................................................................8-7-1
9-2-1 Table of Infection Control Guidelines:
Handwashing, Cleaning, Disinfection and Sterilization in Health Care..........9-2-2
9-8-1 Table of Reprocessing of Commonly Used Equipment in the AE Setting...........9-8-2
9-9-1 Table of Recommendations for Management of Untreated Infectious Waste......9-9-2
9A-1-1 Table of Infection Control Precautions by Clinical Presentation
(Acute Care Centres).......................................................................................... 9A-1-1
9A-1-2 Table of Infection Control Precautions by Specific Etiology
(Acute Care Centres)..........................................................................................9A-1-2 to 9A-1-4
9B-1-1 Table of Aircraft Airflow............................................................................................9B-1-1/9B-1-2
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CHAPTER 1
THE CANADIAN FORCES AE SYSTEM – INTRODUCTION
AE HISTORICAL PERSPECTIVE
1. Aeromedical evacuation (AE) began early in the history of aviation, originally as a method of
responding to air crashes. In 1910, only seven years after that first flight, a biplane was modified to carry a
litter patient. 1917 saw the arrival of the first aircraft specifically designed for AE use (a French Dorand ARII).
The main thrust of AE during this period was the rescue and treatment of a small number of patients by a
physician attendant.
2. In 1923, the Royal Air Force (RAF) began routine AE flights from bases in the Middle East and in
1925 the RAF acquired two dedicated AE transport aircraft, each capable of carrying 14 litter patients. The
formation of the Royal Flying Doctor Service (RFDS) in Australia followed in 1928. RFDS transported medical
practitioners into remote regions to give higher-level care; soon the aircraft were also used to transfer
patients back to regional centres.
3. This led to the evolution of the Flight Nurse as a multi-skilled health care provider.
4. By the midpoint of World War II, AE had become a safe and effective means of casualty transport.
The first United States Flight Nurses graduated in early 1943 and were soon working in New Guinea and the
South Pacific. Canadian nurses attended the formal United States Air Force (USAF) AE training in the same
year. The fundamental role of AE during World War II was moving large numbers of stable patients away
from the treatment facilities behind the battlefield to higher levels of care or their home country.
5. To overcome the physiological problems of flight a variety of countermeasures, including oxygen

delivery systems, blood plasma delivery kits, and chemically treated pads to counteract the cold, were
developed. These flights were staffed by Air Force flight nurses and medical specialists.
6. This system was so successful that it is essentially unchanged to this day.
7. During the Korean War, the helicopter was used as a means of rapid patient transport directly from
the battlefield to a treatment facility that could offer resuscitative surgery. Patients requiring higher-level
care after resuscitation were introduced into the fixed-wing AE system. The death rate from wounds among
UN personnel was about half that recorded for US troops during World War II. This decrease in death rate is
attributed to the wider use of antibiotics, new surgical techniques, the AE system and the use of helicopter
evacuation.
8. Canada participated in the air effort in the early stages of the Korean War; 426 Transport Squadron
was attached to the US Military Air Transport Service. Flying Officer Jean Drummond, a Royal Canadian
Air Force Flight Nurse flew many missions as part of Korean airlift operations in support of the USAF.
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B-MD-005-000/FP-001
Figure 1-1-1 CF AE During the Korean Conflict
9. During Vietnam the helicopter had come of age as a medical rescue platform; “dust-off” entered the
military lexicon. Casualties were often moved from the battlefield to a facility capable of offering definitive
surgery within 20 minutes of wounding.
10. The increasing incidence of small-scale military operations other than war has reduced the size
and capability of the health facilities placed forward necessitating a requirement for AE of less stabilized
patients. Patients are now transported over longer distances to receive resuscitative care. Many militaries
are now using specialized medical practitioners working from dedicated AE helicopters. This in turn has lead
to the development of a highly skilled, well-equipped AE system that can meet or exceed the standards of
care available within the peacetime civilian community.
11. The challenge for the future is finding a balance between formal training in aviation medicine, the
theory and practice of AE and the maintenance of clinical skills.
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GENERAL CONCEPT
12. AE has proven that timely and effective air transport of patients plays a significant role in the decrease
of morbidity and mortality rates. AE is considered a fundamental aspect of Health Services Support within
the Canadian Forces. The Canadian Forces Health Services (CFHS) are responsible for provision of patient
care. The Air Force, specifically 1 Canadian Air Division (1 Cdn Air Div) and 8 Wing have overall responsibility,
accountability and authority over the CF AE Program. As aviation technology has advanced so has the AE
system both in peacetime and wartime efforts.
13. AE is defined as, “the movement of patients under medical supervision to and between medical
treatment facilities as an integral part of the treatment continuum by air transportation” (AJMedP-2). AE is
a joint Health Services and Air Force responsibility, and is recognized as a peacetime and wartime role for
aeromedical evacuation crewmembers (AECMs) within the Canadian Forces.
14. Canada’s international policies, including those governing AE, are based on the principles of a
collective defense. As a member of the North Atlantic Treaty Organization (NATO), Canada is signatory
to the Standardization Agreements (STANAGS) dealing with AE. Other collective agreements dealing
with AE include the Air and Space Interoperability Council (ASIC) which involves the Air Force elements
of Australia, Canada, New Zealand, United Kingdom, and United States, and the Canada/US Integrated
Lines of Communication (ILOC) agreement which facilitates the movement of AE patients out of the various
theatres.
15. The AE system is comprised of three phases as described in Figure 1-1-2. These phases are linked
together by geography and the operational context.
Phases of AE Description
Forward The phase of medical evacuation that provides airlift for patients between point of injury or
illness and the initial point of treatment within the area of operations.
- responsibility of the deployed commander.
Tactical The phase of medical evacuation that provides intra-theatre air transport for patients
(Intratheatre) between medical treatment facilities within the area of operations.
- transport aircraft delivering supplies to forward assault airfields are re-configured for
back-haul/retrograde AE.
- interfaces with both the forward and strategic phases
Strategic That phase of medical evacuation that provides air transport for patients from medical
(Intertheatre) treatment facilities within the area of operations to medical treatment facilities outside the
area of operations, or between medical treatment facilities outside the area of operations.
-links tactical and domestic phases.
-sometimes called “Domestic AE” if the movement is within Canada.
Figure 1-1-2 Phases of the Canadian AE System
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PURPOSE
16. The purpose of the Canadian Forces AE System is to reduce time between injury/onset of illness and
start of definitive treatment, in order to maximize the availability of fit personnel for operations.
17. The capabilities of AE include:
a. reduction of time between injury or onset of illness and the start of surgery or definitive treatment;
b. increased speed and flexibility; and
c. the ability to move a large number of casualties at once.
LEVELS OF RESPONSIBILITY
18. Below are the levels of responsibility within the Canadian Forces:
a. 1 Canadian Air Division (1 Cdn Air Div) – The Air Division provides aircraft for AE operations. It
is also responsible for providing Aero Medical Training (AMT), Survival Evasion Resistance and
Escape (SERE) and AE training for medical members tasked to provide AE.
b. Canadian Forces Health Services (CFHS) – It is the responsibility of CFHS to provide fit and trained
AECMs in support of the AE Program.
c. 1 Canadian Air Division Surgeon (Div Surg) – As the senior medical advisor to the Commander of
1 Cdn Air Div, the Div Surg acts as the Aeromedical Evacuation Operations Officer for the CF. The
Div Surg is responsible to both CFHS and 1 Cdn Air Div for ensuring the success of the National AE
Program.
d. CF Aerospace Health Service Support Squadron – The 1 Canadian Air Division Surgeon office is
also known as the CF Aerospace Health Service Support Squadron (Aerospace HSS Sqn). The Div
Surg is the Officer Commanding (OC) of the squadron and is responsible for oversight of day-to-day
delivery of AE.
e. Chief of Air Staff Surgeon (CAS Surg) – The CAS Surg is designated as the Aerospace Medical
Authority (AMA) for the Department of National Defence and the Canadian Forces. The CAS Surg
is responsible for Strategic planning to ensure alignment between the needs of the Air Force
and Health Services Aerospace medical capabilities. This office maintains oversight of activities
associated with the generation of aerospace medical capabilities and issues regarding Aeromedical
regulations, standards, policies, programs and priorities.
f. Chief of Air Staff Medical Advisor Senior Staff Officer (SSO) AE – The CAS Surg SSO AE is
responsible to CAS Surg for strategic level oversight of AE capabilities. This entails vertical liaison
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with Medical and Air Force communities and horizontal liaison with tactical level (CF AE flight),
operational level (Air Div Surg), training (426 M Flight) and standards (TRSET) staff(s).
19. The responsibility for Aeromedical Evacuation Operations within the 1 Cdn Air Div Headquarters
is assigned as an operational tasking to the CF Aerospace HSS Sqn. In turn, AE is a primary role for the
members of the CF Aeromedical Evacuation Flight that is located at 8 Wing Trenton.
a. CF AE Flight, Commander (FC) – This Flight Nurse is the OC of the CF AE Flight and is responsible
to the 1 Cdn Air Div Surg. This Nursing Officer is responsible for the day-to-day delivery of AE,
ensuring that flight members are operational on the unit specific aircraft and clinically current.
b. Aeromedical Evacuation Standards Officer (AESO) – The AESO is responsible to their respective
chain of command for ensuring that all applicable flight standards are met. It is the responsibility
of this individual to implement the AECM standards and training program. A statement of duties
and responsibilities are outlined in Chapter 5.
c. Aeromedical Evacuation Training Officer (AETO) – The AETO is responsible to the AESO for
coordinating the training and ensuring the operational capability of AECMs. A statement of duties
and responsibilities are outlined in Chapter 5.
d. Aerospace Medical Programs (AMP) – The Flight Surgeon in this position is assigned the
responsibility of medical director to oversee the clinical standards for AE and Aeromedical Training
(AMT) additionally; this person advises the Aeromedical Evacuation Coordination Officer (AECO)
on medical concerns for AE missions in the units and provides validation to AE requests.
e. AE Program Manager (AE PM) – This Flight Nurse is responsible for coordinating the overall
AE system on behalf of Div Surg. This includes course loading for initial AECM and Forward AE
Specialist courses, Emergency Breathing System/Rotary Underwater Egress Training, Sea Survival,
SERE and AMT and the review, periodic validation and update of the various Qualification Standards
(QS) and other publications. Other responsibilities include monitoring the status of AE equipment,
identifying shortfalls, researching new devices and submitting airworthiness requests.
f. AE Coordinating Officer (AECO) – The AECO is responsible for the coordination of all strategic AE
in Canada and abroad. Other responsibilities include the maintenance of an AE mission database
and acting as a liaison with airlift tasking. The AECO is responsible to the AE PM.
g. Transport Rescue Standardization & Evaluation Team (TRSET) – Manned by a Flight Nurse, this
individual advises on the effectiveness of AE training, standards, and evaluation programs. The
position is responsible to the OC TRSET, the AE PM and the Div Surg for ensuring that AECMs are
operationally proficient.
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B-MD-005-000/FP-001
h. M Flight Commander (M FC) – The 426 (T) Training Squadron M Flight is headed by a Flight Nurse.
The M Flight is responsible for all forward AE, initial AE and requalification courses for CF nurses,
physician’s assistants and medical technicians from Regular and Reserve forces. Training is also
provided to physicians, nurses and technicians from a number of countries as part of the Canadian
Aerospace Training Project. 426 (T) Training Squadron is responsible to 1 Cdn Air Div Headquarters
A1 Training for the conduct of this training in accordance with the various QS.
Chief of Air Staff

Surgeon
Senior Staff Officer

Aeromedical Evacuation
CF Aerospace
426 (T) Sqn
HSS Sqn Comd
M Flight Commander
& Division Surgeon
Aerospace Medical Aeromedical Evacuation Aeromedical Evacuation

Programs Operations and Plans Program Manager Flight Comd
Medical Director
Transportation and
Rescue Standardization Aeromedical Evacuation
and Evaluations Coordinating Officer
SE 6-3
Figure 1-1-3 Canadian Forces AE Organization
AE PERSONNEL
20. The personnel resources for AE crews are drawn from all trained and operationally current
Aeromedical Evacuation Crewmembers (AECMs) within CFHS. The majority of these are located at the CF
AE Flight in Trenton. A standard crew compliment consists of one Flight Nurse (FN) and one Flight Medical
Technician (FMT). Additional AECMs, F Surgs and other Medical Specialist Team Members (MSTM) will
supplement this team where necessary.
21. AECMs must be competent to provide care in the air to one or more patients. As such they are
mandated to maintain clinical skills as well as flying skills to the level of their individual Scope of Practice
in accordance with Specialty Specification (SS). The level of care prior to evacuation will be maintained
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throughout the flight. During mission planning, any concern due to diagnosis or workload shall be reported
to the Medical Crew Director (MCD) as late reporting of possible issues will negatively impact mission
accomplishment. The MCD will then report any concerns to the AECO who will then augment the mission
as appropriate.
22. The MCD is appointed to oversee the planning and execution of each mission as per guidelines
in this publication. The selection of MCD is at the discretion of the AESO and CF AE Flight Comd. The
designation of MCD is a function of skill and experience that not all AECMs will necessarily attain.
23. The role of the F Surg or MSTM during an AE mission is to provide care that is beyond the scope of
the AECMs. They are responsible for the standard of care provided to the patient. F Surgs and MSTMs are
to be annotated on the Report of Patients Evacuated (RPE).
24. Patient numbers, dependency, patient acuity and the length of the flight will determine the
requirement for additional AECMs on board. This is a joint determination between the MCD and AECO/Div
Surg. During complex missions, with multiple and/or complicated patients it is advisable that the Critical
Care Nurse not act as MCD while engaged in patient care. An intensive care physician and other care
provider as needed shall accompany Dependency 1 patients during transfer/transport to and from hospital.
25. Two categories of AECM exist; those involved in active, day-to-day flying, and those posted into
non-flying positions. The primary role for all personnel posted to active AECM positions at the Canadian
Forces Aeromedical Evacuation Flight (CF AE Flt) in Trenton and 426 (T) Trg Sqn will be AE. AE will be
a secondary role for those AECMs not employed in designated flying positions. This pool of AE trained
members within the larger CFHS framework will ensure a robust, current, cadre of flyers are available for
both strategic and contingency operations as well as facilitate movement in and out of the AE Flight at all
rank and trade levels.
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Annex 1A
BIBLIOGRAPHY
1 Canadian Air Division Orders, Volume 1, General Administration
1 Canadian Air Division Orders, Volume 2, Flying Orders
1 Canadian Air Division Orders, Volume 3, Operations
1 Canadian Air Division Orders, Volume 4, Communications
1 Canadian Air Division Orders, Volume 5, Standards and Training
1 Canadian Air Division Orders, Volume 6, Air Maintenance
1 Canadian Air Division Orders, Volume 7, Operational Evaluation Assessment
1 Canadian Air Division Orders, Volume 8, Logistics
1 Canadian Air Division Orders, Volume 9, Intelligence
Aeromedical Evacuation Concept of Operations (Jan 2007)
B-GA-007-001/AF-001 Manual of Air Movements Volume 1, Organization & Operating Procedures
B-MD-010-000/FP-001, Aeromedical Evacuation Equipment Guide
CFACM (SMM) 60-2610 AECM Universal Checklist
CFACM (SMM) 60-2601 (1) Tactical Air Transport Procedures
CFHS Maintenance of Clinical Skills Program (MCSP)
CFHS P&G 6000-25, Patient Tracking
C-12-130-000/MB-001 AOI CC130
NATO STANAG 3204 AMD (Edition 7) Aeromedical (Mar 2007)
NATO STANAG 7112, Minimal Standards for Medical Equipment used in Aeromedical Evacuation
USAF C17A Technical Manuals
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Aerospace Engineering Program Management, EMT04.053, Technical Clearance for Aeromedical Evacuation
Equipment (August 2006)
Air and Space Interoperability Council (ASIC) 61/115/23 Minimum Standards for Medical Equipment Used in
Aeromedical Evacuations (Jun 2003)
Cummin and Nicholson. Aviation Medicine and the Airline Passenger. Oxford University Press Inc, New
York, 2002.
Davis, Johnson, Stepanek and Fogarty. Fundamentals of Aerospace Medicine 4th Ed. Lippincott Williams &
Wilkins, Philadelphia PA, 2008.
Holleran. Air and Surface Transport Nurse Association (ASTNA) - Patient Transport Principles and Practice
4th Ed. Mosby, Inc St., Louis MI, 2010.
Hurd and Jurnigan. Aeromedical Evacuation – Medical Management of Acute and Stabilized Patients.
Springer-Verlag New York, Inc., 2003.
Rainford and Gradwell. Ernsting’s Aviation Medicine 4th Ed. Hodder Arnold, London, 2006.
1A-1-2
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CHAPTER 2
FLIGHT PHYSIOLOGY AND AEROMEDICAL EVACUATION
SECTION 1
GENERAL
FLIGHT PHYSIOLOGY
1. An understanding of the effects of flight on the human body (flight physiology) is fundamental to
AE and patient welfare, and it allows AECMs to provide optimal patient care in the air environment. In order
to understand flight physiology, one must have a rudimentary knowledge of the atmosphere, its properties
and the laws of physics that govern the effects of altitude.
LAWS OF PHYSICS
ATMOSPHERE
2. Humans function in the atmospheric layer known as the troposphere. This layer is characterized by
weather phenomenon, a relatively constant rate of fall in temperature with increasing altitude, the presence
of water vapour, and the presence of large-scale air turbulence. The area from sea level to 3,050 metres
(10,000 ft) is known as the physiological zone. In this zone, the human body can adapt and survive without
protection. The area from 3,050 metres to 15,250 metres (50,000 ft) is known as the physiologically deficient
zone. The reduced atmospheric pressure in this zone provides inadequate oxygen to sustain normal
physiologic functioning; humans require protection and supplemental oxygen to survive.
GAS COMPOSITION
3. The gas composition of the atmosphere is 78 percent nitrogen (N2), 21 percent oxygen (O2) and 0.03
percent carbon dioxide (CO2), with minute quantities of other gases. Any change in these percentages has
a physiological effect on the human body, which may cause decompensation/deterioration in a patient.
Gas Symbol Volume (%)

Nitrogen N2 78.0840
Oxygen O2 20.9480
Argon A 0.9340
Carbon Dioxide CO2 0.0312
Neon Ne 0.0018
Helium He 0.0005
Hydrogen H2 <0.0001
Figure 2-1-1 Gas Composition
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TEMPERATURE
4. Atmospheric temperature decreases as altitude increases. The ozone layer acts as insulation,
protecting the earth from ionizing radiation and keeping heat close to the surface. With increasing altitude to
10,668 metres (35,000 ft) temperature decreases at an approximate rate of 2 degrees per 305 metres (1,000
ft) to a low of -55 degrees Celsius (oC).
GAS LAWS
GENERAL
5. The independent variables of temperature, pressure, volume and relative mass of a gas govern the
body’s physiologic response to atmospheric changes as the aircraft changes altitude. There are several
basic gas laws; four of which will be discussed.
BOYLE’S LAW
6. Boyle’s law states that at a constant temperature the volume of gas is inversely proportional to the
pressure exerted upon it. As altitude increases atmospheric pressure decreases. This change is greatest
closest to the earth’s surface.
7. On both ascent and decent, pressure changes affect any body cavity containing air (ears, sinuses,
lungs and gastrointestinal (GI) tract). On ascent, atmospheric pressure decreases allowing gases to expand
within body cavities. This normally causes no problems as swallowing can relieve the pressure, which vents
gas via the Eustachian tube. Difficulty occurs when the expanding gas cannot escape as it normally would.
This trapped gas can produce varying degrees of pain and possible injury. See example of expansion below:
760 mm Hg 380 mm Hg 187 mm Hg

Sea Level 5485 metres 10,980 metres
(18,000 ft) (36,000 ft)
   
1000 ml 2000 ml 4000ml
Figure 2-1-2 Boyle’s Law of Gas Expansion
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a. At 760 mm Hg (sea level) a balloon holds 1,000 ml gas;
b. At 380 mm Hg 5,485 meters (18,000 ft) the volume would increase to 2,000 ml; and
c. At 187 mm Hg 10,980 meters (36,000 ft) the volume increases to 4,000 ml.
DALTON’S LAW
8. Dalton’s law states that the total pressure of a mixture of gases is equal to the sum of the individual
or partial pressures of each gas in that mixture.
P = P1 + P2 + P3 + Pn
9. Dalton’s law explains the O2 deficiency experienced at altitude. While the O2 concentration remains
at approximately 21 % regardless of altitude, O2 tension or the partial pressure (PP) decreases as altitude
increases because the O2 molecules are farther apart. This reduced PP of O2 in the inspired air causes a state
of O2 deficiency in the blood, cells and tissues. This can be significant enough to cause impairment and is
known as hypoxia.
Altitude (ft.) Barometric PO2 in air PO2 in alveoli Arterial Oxygen

Pressure (mmHg) (mmHg) (mmHg) Saturation (%)
0 760 159 104 97
10,000 523 110 67 90
20,000 349 73 40 70
30,000 226 47 21 20
40,000 141 29 8 5
50,000 87 18 1 1
Figure 2-1-3 Table of Decreasing PP of O2 with Altitude

From http://www.studyworld.com/newsite/ReportEssay/Science/Physical%5CChanges_in_altitude_have_a_profound_effect_on_the_human-392968.htm.
HENRY’S LAW
10. Henry’s law states that the amount of gas which will dissolve and remain in solution is directly
proportional to the PP of that gas outside the solution if the temperature is held constant. Henry’s law
explains why nitrogen bubbles come out of solution at altitude as result of reduction in ambient pressure
which can lead to decompression illness (DCI). Reduction in atmospheric pressure causes nitrogen in the
blood to evolve to its gaseous state and form bubbles. These bubbles are normally carried by the blood to
the lungs for expiration.
11. DCI encompasses two diseases, decompression sickness (DCS) and arterial gas embolism (AGE).
DCS is thought to result from bubble formation in tissue, causing local damage. When bubbles lodge in the
tissue, it results in symptoms ranging from mild to severe such as joint pain, respiratory disturbance, skin
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irritations or central nervous system irregularities. DCS is rarely encountered below 5485 metres (18,000 ft)
but the incidence rate sharply increases as altitude and time of exposure increase. AGE results from bubbles
entering the lung circulation, traveling through the arteries and causing tissue damage at a distance by
blocking blood flow at the small vessel level.
Figure 2-1-4 Nitrogen Escaping Solution When Released From Pressure
CHARLES’ LAW
12. Charles’ law states that when pressure is constant, the volume of a mass of gas is proportional
to its absolute temperature. Therefore, the volume of gas will increase or decrease proportionally to the
increases or decreases in temperature. This law is evident by the decrease of gas pressure in an oxygen
cylinder taken from ground level on a hot day to 3,050 metres (10,000 ft) in an unpressurized aircraft. The
pressure gauge readings in an oxygen tank decrease as the temperature decreases.
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SECTION 2
STRESSES OF FLIGHT
GENERAL
1. There are eight stresses in the flight environment that impact humans while flying. Cumulatively,
these stresses can induce physiological and psychological fatigue in both patients and aircrew. The fatigue
of flying must be considered when planning the length and timing of AE missions. Understanding that one
or more of these stresses can exacerbate an existing patient problem, or create a new one, will assist the
AECM in anticipating and mitigating potential problems. The stresses of flight for consideration are:
a. Decreased Partial Pressure of Oxygen;
b. Decreased Barometric Pressure;
c. Increased Noise Level;
d. Decreased Relative Humidity;
e. Variation in Cabin Temperature;
f. Acceleration/Deceleration G forces/Vibration/Turbulence;
g. Poor Lighting; and
h. Anxiety and Apprehension.
DECREASED PARTIAL PRESSURE OF OXYGEN
2. The decreased partial pressure of oxygen at altitude provides an insufficient supply of oxygen to
the body’s tissues and leads to hypoxia. There are four types of hypoxia all of which can be compounded
at altitude by decreased partial pressure of oxygen: hypoxic, hypemic, stagnant, and histotoxic. The most
common hypoxia is hypoxic hypoxia. See Chapter 8 for a more indepth chart on the types of hypoxia.
DECREASED BAROMETRIC PRESSURE
3. Barometric pressure decreases rapidly from 760 mmHg at sea level to 380 mmHg at 5,485 metres
(18,000 ft). As a result of this decrease, the volume of gas doubles. This can become a serious problem
within any body cavity vulnerable to the trapping of gas. These cavities include the middle ear, sinuses,
teeth, lungs, and the abdomen. Additionally, surgeries or penetrating wounds to the eyes, neck, thorax,
abdomen, cranium, and lower extremities can cause air introduction causing irreparable damage to nerves
and surrounding tissues.
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4. The Impact of Barometric Pressure on Medical Equipment. Medical equipment that contains air
can also be adversely affected by gas expansion. Items such as MAST (Medical Anti-Shock Trousers)
garments, pressure infusers, and pneumatic splints may become excessively distended on ascent or may
not function as intended with volume loss during descent. Endotracheal tube cuff management presents a
particular problem. Cuff expansion at decreased barometric pressures can result in excessive pressure on the
tracheal mucosa and rapid decompression could theoretically lead to tracheal injury or rupture. Stoner
and Cooke demonstrated this in 1974 using an animal model and suggested that endotracheal tubes with
pressure-regulating valves on the pilot balloon or foam cuffs be used to avoid the problems related with
cuff expansion. Another recommendation is that saline be used to expand the cuff during aeromedical
evacuation because expansion would be minimal. Care must be taken when using saline expansion because
there is a variable and steep volume-pressure response curve in commonly used endotracheal tubes.
The endotracheal tube or tracheostomy tube cuff can be inflated with sterile saline using the “minimal
leak technique” to avoid tissue damage or air leak due to gas expansion and compression during all phases
of flight. If air is used, the cuff pressure should be checked and adjusted with changes in cabin altitude.
5. Medical equipment that contains air can be adversely affected by gas expansion (i.e. MAST trousers,
air filled bladders/cuffs, etc.) Finally, some research has been conducted on the performance of mechanical
ventilators at altitude. Special attention should be paid to the delivered tidal volume of transport ventilators
used during AE when the cabin pressure is decreased. While some ventilators have automatic compensation
(such as the Uni-Vent 754M), others do not and the delivered tidal volume and/or rate may change with
alterations in cabin altitude.
INCREASED NOISE LEVEL
6. High noise levels not only interfere with communication but also can lead to temporary (auditory
fatigue) or permanent (sensorineural) hearing loss. When noise cannot be controlled to a safe level, ear
protection devices such as earplugs, ear defenders, or an aircrew helmet should be worn.
7. Noise represents one of the more troublesome stresses encountered during AE operations. It
is defined as any sound that is unpleasant, distracting, or in some other way undesirable. Unprotected
exposure to noise can produce one or more of the following undesirable effects:
a. Degraded communications and patient evaluation;
b. Temporary auditory threshold shifts (auditory fatigue);
c. Permanent threshold shifts (sensorineural hearing loss); and/or
d. Fatigue.
8. Auditory fatigue induced by noise is frequently accompanied by a feeling of fullness, high-pitched

ringing, buzzing, or a roaring sound (tinnitus) in the ears. These symptoms usually resolve within a few
minutes of noise cessation but may take hours in some circumstances. Most of the significant symptoms
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of noise exposure, such as nausea, disorientation, and fatigue, in general occur with exposure to noise
levels in excess of those seen during AE missions. Nonetheless, AECMs and their patients will wear hearing
protection on those airframes that require hearing protection.
DECREASED RELATIVE HUMIDITY
9. One of the more subtle stresses of flight is a decrease in cabin humidity. As altitude increases and
air cools, moisture in the air decreases significantly. Thus, the fresh air supply drawn into the aircraft cabin
comes from a very dry atmosphere. This dry air replaces the moisture-laden cabin air such that the relative
humidity is less than 10% to 20% on most commercial flights.
10. Crewmembers, passengers, and patients are at risk to develop chapped lips, scratchy or slightly sore
throat, hoarseness, and general moisture loss. The patient with respiratory complaints or who is already
dehydrated may have more significant problems. Therefore, fluid intake of both the crew and patients
should be monitored to minimize problems with dehydration.
VARIATION IN CABIN TEMPERATURE
11. Ambient temperature decreases with increasing altitude at a rate of 2oC per 300 metres up to
10,670 metres (1,000ft up to 35,000ft), which is about 1oC per 100 metres. As a consequence, aircraft cabin
temperature fluctuates considerably depending on the temperature outside and the aircraft’s environmental
control systems. This is caused by the inability of aircraft temperature controls to respond rapidly and the
necessity to open aircraft doors at enroute stops. Inside aircraft temperature variations from 15oC or lower
to 25oC should be expected in winter flying, and in summer 20oC to greater than 35oC is not uncommon.
These wide variations require the medical crews to be aware of cabin temperature care/comfort. In addition,
there can be degradation of equipment performance at the extremes of temperature.
ACCELERATION / DECELERATION (G) FORCES
12. The G force (with g from gravitational) associated with an object is its acceleration relative to
free-fall. Newton’s first law of motion states that unless acted upon by force, a body at rest will remain at
rest; a body in motion will move at constant speed in a straight line. The G forces experienced during the
average AE flight are minimal. However, emergency situations can lead to an increase in G force activity (i.e.
rapid decompression, crashing/ditching etc.). G forces must be considered when deciding how patients will
be emplaned, positioned and secured. Acceleration and deceleration along the longitudinal axis (Fore/AFT)
is the most important G force to be considered in AE.
13. Human tolerances depend on the magnitude of the G force, the length of time it is applied, the
direction it acts, the location of application, and the posture of the body. While in flight, this causes significant
variation in blood pressure along the length of the subject’s body, which limits the maximum G forces that
can be tolerated. Positive, or ”upward” G, drives blood downward to the feet of a seated or standing person
(more naturally, the feet and body may be seen as being driven by the upward force of the floor and seat,
upward around the blood). G forces may cause the following:
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a. Grey-out, where the vision loses hue, easily reversible on levelling out.
b. Tunnel vision, where peripheral vision is progressively lost.
c. Blackout, a loss of vision while consciousness is maintained, caused by a lack of blood to the head.
d. G-LOC a loss of consciousness (LOC).
e. Death, if g-forces are not quickly reduced, death can occur.
14. The human body is better at surviving G forces that are perpendicular to the spine. In general, when
the acceleration is forwards (subject essentially lying on their back) a much higher tolerance is shown than
when the acceleration is backwards (lying on their front).
15. Aircraft safety regulations stipulate that each item of mass inside the cabin that could injure an
occupant be restrained when subjected to load factors seen during flight. This includes all medical equipment
and monitoring devices. Care should be taken to secure all equipment bags opened during flight to prevent
injury in the event of turbulence or during deceleration (landing).
VIBRATION
16. Vibration in the aircraft can originate either from the engine or from turbulent outside air. Vibration
is both annoying and fatiguing. Tolerance depends on factors such as the initial state of fatigue and physical
conditioning. The body responds to vibration by using muscle activity to maintain posture or to reduce
resonant amplification of body structures. Disturbances in visual acuity, speech, and fine muscle coordination
can result from prolonged vibration exposure.
17. Vibration, like noise, is inherent in all transport vehicles and may interfere with patient assessment
and some routine physiological functions. When in direct contact with a source of vibration, mechanical
energy is transferred, some of which is degraded into heat within those tissues that have dampening
properties. The whole body response to sustained vibration is a slight increase in metabolic rate that is
similar to mild exercise. Low-frequency vibration may also promote the onset of fatigue, irritability, and
motion sickness. In conjunction with the other stresses of flight, the overall effect is magnified.
18. Because there is little that the pilot or crew can do to eliminate or decrease the amount of vibration,
care should be taken in minimizing its effects. Patients should be properly secured, encouraged and assisted
with position changes, and provided with adequate padding and skin care. Special care should be taken
in the movement of neonates because they may be more susceptible to direct injury from both noise and
vibration. In addition, vibration may cause dysfunction of activity-sensing pacemakers although other types
of pacemakers should not be affected.
19. The potential effects of vibration extend to the equipment used during transport. Although evaluation
of several pulse oximetry units demonstrated their capability to function in the flight environment, they are
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sensitive to motion and may display artifact in patient readings. Similarly, non-invasive blood pressure
(BP) monitors will work well under most in flight circumstances; however, they are still subject to the same
accuracy limitations seen in the hospital.
TURBULENCE
20. Turbulence in flight can be physically dangerous and it can induce motion sickness, dizziness, and
severe anxiety. Constant and meticulous attention to the security of patients, AECMs, and supplies will
prevent injury and allay patient fears. Anti-emetics can be of benefit as long as they are taken as soon
as possible before the flight. During movement within the aircraft, AECMs and patients shall ensure they
always maintain one hand free in case of turbulence.
POOR LIGHTING
21. Lighting levels on certain AE airframes do not allow for good visual observation and assessment.
Also, AE flights often occur at night, and/or during inclement weather further reducing illumination in and
around the aircraft. For these reasons, the use of an approved shatterproof flashlight is essential to provide
proper monitoring of patients, medical equipment, medication delivery, and crew safety.
ANXIETY / APPREHENSION
22. The previous factors are further aggravated by the patient’s justifiable concerns about his/her
physical well-being, the unfamiliar surroundings, and the prospect of flying. Apprehension can manifest
itself in a diverse number of ways, none of which are conducive to optimum patient care. AECMs shall
attempt to alleviate apprehension by keeping patients well informed and by providing reassurance at all
times.
FACTORS AFFECTING TOLERANCE TO THE STRESSES OF FLIGHT
23. The end product of all the physiological and psychological stresses of flight associated with exposure
to altitude is fatigue. Performance degradation with loss of attention and decrease in reaction time can be
a significant contributor to a decrease in operational capability. This problem is often made worse by self-
imposed stress such as the use of drugs, exhaustion, alcohol, tobacco, and poor dietary habits.
24. Factors affecting patient and AECM tolerance to the stresses of flight are summarized by the acronym
DEATH as follows:
a. Drugs: The use of over-the-counter medications, misuse of prescription drugs, and use of stimulants
such as caffeine can cause insomnia, tremors, indigestion, and nervousness.
b. Exhaustion (fatigue): Exhaustion can lead to judgment errors, falling asleep on the job, attention
channeling, and changes in circadian rhythm.
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c. Alcohol: Using alcohol can cause histotoxic hypoxia, thus affecting efficiency of cells to utilize
oxygen, interfere with metabolic activity, and can result in a hangover.
d. Tobacco: Smoking tobacco exposes the body to nicotine, tar, and carcinogens; smoking two packs
of cigarettes per day results in eight to ten percent of the body’s hemoglobin saturated with carbon
monoxide.
e. Hypoglycemia (diet): Poor dietary intake can cause nausea, judgement errors, headache, and
dizziness.1
1 Genell Lee (ed.), Flight Nursing Principles and Practice, (Saint Louis: Mosby-Year Book, 1991).
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CHAPTER 3
AIRCREW / FLIGHTLINE SAFETY AND REGULATIONS
SECTION 1
AIRCREW REGULATIONS
1. AECMs are considered aircrew while so employed and are therefore subject to the same
administrative, medical, and discipline regulations as other aircrew members. This publication is not meant
to be all-inclusive and members should consult the 1 Cdn Air Div Orders, CFHS Policy and Guidance, 1 Cdn
Air Div Flight Surgeon guidelines and any other higher authority directives.
ENVIRONMENTAL CLOTHING and NO-GO ITEMS
2. AECMs shall adhere to 1 Cdn Air Div Orders, Vol 1, 1-006, OPERATIONAL DRESS and 1 Cdn Air Div
Orders, Vol 2, 2-007, Section 2, PERSONAL EQUIPMENT/PROTECTIVE CLOTHING, while engaged in flying
operations. This includes wearing dual layer unless waived by the Wing Commander/Commanding Officer
for environmental reasons. Flying gloves shall be worn by all crewmembers during engine start, take-off,
landing and during aircraft emergencies. Gloves should be worn while working in and around the aircraft
and removed while working with oxygen except in an emergency. All aircrew shall wear identification tags
around the neck, next to the skin on all flights.
3. During sustained overland operations where the lowest temperature is predicted to be below 0oC,
the following protective clothing or equivalent shall be carried by all crewmembers except those of ejection
seat aircraft:
a. parka and wind pants or winter flying suit;
b. toque or balaclava;
c. extreme cold weather mitts and liners; and
d. extreme cold weather boots, duffel socks and insoles.
NOTE
The requirements outlined in paragraph 3c are not mandatory for one-time
polar and trans-oceanic transits; however, they are applicable for arctic
sovereignty patrols.
4. In addition, the AECMs will have the following items in their possession prior to boarding any
aircraft for an AE mission:
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a. CF Identification card;
b. special area pass/flightline pass;
c. Aeromedical Evacuation Crewmember universal checklist (fixed wing) or appropriate helicopter

checklist;
d. CF issued Identification disks/ID discs;
e. flight jacket and gloves;
f. flashlight; and
g. reflective belt/vest.
h. For planned missions (includes training flights) outside of the local area, add:
(1) Geneva Convention card;
(2) passport; and
(3) immunization record.
5. AECMs will remove rings when working on or around the aircraft to prevent de-gloving injuries.
6. AECMs will not wear perfumes or colognes throughout an AE mission to minimize exposure to both
patients and crewmembers.
7. AECMs will not wear fingernail polish or fake nails due to infection control issues. Artificial nails or
chipped nail polish may increase bacterial load and impede visualization of the soil under nails.
8. A flashlight may be considered as “flight-safe” only when it is shatter proof, alkaline batteries are
used and the flashlight does not interfere with aircraft systems. Users are to be aware of the potential for
possible explosion during a rapid decompression and that the use of a flashlight may need to be discontinued
at any time at the direction of the cabin crew.
9. Headlamps may be used on CF aircraft with the following restrictions: use on the flight deck is
prohibited and use during critical phases of flight is prohibited (i.e., take-off, landing and emergencies).
Inform the flight crew that the Aeromedical Evacuation Crew (AEC) would like to use headlamps in flight.
AEROMEDICAL TRAINING (AMT)
10. All AECMs will comply with 1 Cdn Air Div Orders, Vol 5, 5-301 AEROMEDICAL TRAINING, CFAO 9-29
and A-MD-214-000/PT-001 Aeromedical Training for the Canadian Forces. Active aircrew must maintain an
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AMT qualification appropriate to their currently assigned aircraft type(s). Following initial AMT, recertification
courses are designed for specific aircraft types and are offered with and without hypobaric chamber training
as required.
CREW DUTY TIME
11. Crew Duty Day commences when the first crewmember reports for duty and ceases when the last
crewmember is released from duty. For direction on maximum crew duty time, AECMs shall refer to 1 Cdn
Air Div Orders, Vol 2, 2-003, GENERAL FLIGHT RULES, Annex B – AIR MOBILITY FIXED-WING AND LONG
RANGE PATROL.
Flying Activity Max Hours Planned Itinerary

Day (0800-1759 hrs) 18 141
Night (1800-0759 hrs) 16 12

CC177 Day 18 13
CC177 Night 16 11
Local Training 14 10
Figure 3-1-1 Crew Duty Day Table (Air Mobility Fixed-Wing and Maritime Patrol)
1 Includes: local continuation training and flights with two-pilot crews and an unserviceable auto pilot.
NOTE
CC130 Tactical Air Transport (TAT) operations and air refuelling missions
shall be conducted within the first 14 hours of the crew duty day.
12. The planned itinerary is taken as the time from first take-off to last landing. It does not include any
ground time prior to or post flight.
CREW REST
13. Crew Rest (CR) at home unit begins when the last crewmember is released from duty. CR away from
home begins when the last crewmember arrives at a suitable place of rest. CR should be a minimum of 12
hours unless operational environment dictates otherwise. AECMs shall comply with crew rest IAW 1 Cdn
Air Div Orders, Vol 2, 2-003, GENERAL FLIGHT RULES, Section 4 – CREW FLYING TIME/DUTY/REST/NON-
WORKING DAYS/SPECIAL LEAVE (RELOCATION).
14. Following crew days exceeding 14 hours and for flights commencing and terminating three or more
time zones apart, a minimum of 14 hours CR should be attained. Aircraft Commanders (AC), Squadron
COs, Detachment Commanders (Det Comds) and Airlift Control Element Commanders (ALCE Comds) may
declare a temporary reduced CR period that fits their operational needs provided that at least eight hours
of uninterrupted rest is assured. Regardless, it remains the AC’s responsibility to ensure that adequate
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CR is attained. In addition, ACs may declare unscheduled CR whenever they consider crew fatigue could
jeopardize the safety of the flight. When unscheduled CRs are declared, ACs shall report the circumstances
to the Squadron CO/Det Comd/ALCE Comd.
NON-WORKING DAYS
15. COs are responsible to establish flying schedules to specify working and non-working days IAW
1 Cdn Air Div Orders, Vol 2, 2-003, GENERAL FLIGHT RULES, Section 4 – CREW FLYING TIME/DUTY/REST/
NON-WORKING DAYS/SPECIAL LEAVE (RELOCATION).
16. Flying schedules do not conform to Monday to Friday weeks, therefore equivalent amounts of non-
working days are provided to flight crews. This equates to 9.6 days per month.
ALCOHOL CONSUMPTION
17. All AECMs shall adhere to 1 Cdn Air Div Orders, Vol 2, 2-007, SAFETY REQUIREMENTS, Section 1,
under PHYSIOLOGICAL RESTRICTIONS with regards to the consumption of alcohol in the performance of
their AECM duties. A crewmember is not to consume any alcohol for at least the period of 12 hours prior to
flying, and in no case less than eight hours prior to reporting for duty.
EXAMPLE:
A crewmember is scheduled for a local training flight at 1330 hours. The
crewmember reports for duty at 0730 hours. The last consumption of alcohol
permitted is no later than 2330 hours the day prior. Had the training flight
been scheduled for 1000, then the last consumption of alcohol permitted
would have been 2200 hours the day prior.
18. Any consumption of alcohol within a period of 24 hours prior to flying shall:
a. be of a moderate amount;
b. be consumed at a rate which, in combination with a period of sleep following consumption, will
ensure body clearance by the time of reporting to duty; and
c. not affect the subsequent flying performance based on a full Crew Duty Day period.
MEDICAL RESTRICTIONS
19. Guidance on medical restrictions is provided in FSG 300-01 TEMPORARY MEDICAL RESTRICTIONS-
FLYING OR SIMULATED ASCENTS for aircrew restriction regarding illness or injury, anaesthetics,
ophthalmologic examinations, drugs, self-administered drugs, blood donations, immunization,
desensitization, malaria prophylaxis, hypobaric and hyperbaric exposure.
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20. Aircrew shall not fly when unusually fatigued, or suffering from any illness or injury without the
prior approval of a medical officer. Any aircrew member may self-ground IAW 1 Cdn Air Div Orders, Vol 1,
1-246 AIRCREW GROUNDING AND UNGROUNDING. The only exception is unqualified Aircrew who are
undergoing training on a formal course of instruction, they shall only be grounded by a medical authority.
The following table outlines temporary restrictions but is not to be considered all-inclusive.
Condition Grounding period

Anaesthetic – general, spinal, epidural 7 days
Anaesthetic* – local 12 hrs
Anaesthetic – Major peripheral nerve blocks 7 days
Blood donation* 72 hrs
Desensitization* 36 hrs initial; routine injection 12 hrs grounding
until maintenance dose reached, then 4 hours
grounding
Eye exam cycloplegic refraction or dilated 24 hrs
fundoscopy*
Gas hut* 2 hrs
Hyperbaric exposure*: Diving rules of thumb – 12 hrs < 50 fsw4;
member is responsible to calculate actual 24 hrs min if > 50 fsw4
minimum surface interval (grounding period)
using CF Dive Tables3
Hyperbaric exposure: Aircraft ground Time and pressure dependent. See FSG 300-01
pressurization* Temporary Flying Restrictions.5
Hypobaric exposure < 3,048 metres (10,000 ft)* No restriction
Hypobaric exposure > 3,048 metres (10,000 ft) 18 hrs
Immunization* 36 hrs1 (including Yellow fever and Japanese
Encephalisis)
Influenza antiviral agents* (for prophylaxis only) 24 hrs for prophylaxis, MELs2 as for disease symptoms
Malaria prophylaxis* 24 hrs initial chloroquine, doxycycline,malarone,
primaquine
Nitrous oxide 72 hrs with/without local; and
7 days with general anaesthetic CF H SVCS P&G
4030-76
Figure 3-1-2 Grounding Periods Table
1 Aircrew are to report to the FS if they have any unusual reaction to immunizations. No restrictions are needed
after oral polio, certain oral anti-diarrhea vaccines i.e. Dukoral, immune globulin or the third and fourth typhoid
doses according to the Flight Surgeon Guidelines (FSG 1900-01 Medications and Aircrew).
2 Medical Employment Limitations.
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3 See B-GG-380-000/FP-002 Canadian Forces Dive Tables.
4 Pressure equivalent in feet of sea water.
5 The previous reference CFAO 34-35 is out of date and must not be used for these calculations.
21. Flight Surgeon authorization is required to resume aircrew duties for all medications and medical
procedures. The only exceptions are for those items in Figure 3-1-2 which are asterisked (*) and only if no
adverse effects were encountered.
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SECTION 2
FLIGHTLINE SAFETY
1. Ensuring a safe environment during an aeromedical evacuation mission depends on compliance to

basic safety rules dealing with both ground and air operations. All AECMs must be familiar with their Wing’s
flying orders and security orders that dictate the appropriate actions anytime they are on the flightline. It is
the responsibility of the aircrew to provide a safe environment for the patients and passengers under their
care. This section deals with the various aspects of ground safety.
FLIGHTLINE SECURITY AND SAFETY
2. The possibility of an aircraft hijacking or sabotage is real within the domestic and global realms.
Guidance and instructions for aircrew under hijacking or bomb threat situations are detailed in 1 Cdn Air Div
Orders, Volume 3, 3-205 HIJACKING AND BOMB THREATS – AIRCRAFT.
3. Flightlines are secure areas. Security of the flightline is the responsibility of all individuals authorized
to work on the flightline, including aircrew. Special area passes are issued for flightlines and regulated by
the WComd on 1 Cdn Air Div bases. These passes are controlled items. They are not left unsecured, and
are to be worn picture side out. Individuals not wearing a special area pass on the flightline should be
challenged to show it.
4. If there are individuals on the flightline who are unknown to the aircrew or are acting in a suspicious
manner, they should be challenged by the aircrew and their purpose on the flightline investigated. If there
is doubt about the individuals, they are reported to Wing Operations (WG Ops) or the Military Police.
5. There are entry control points on the flightline. General guidelines are not to cross solid lines, either
red or white. Aircrew must cross the lines at hash marks or openings in the continuity of the lines. If there is
doubt where to cross on the flightline, seek guidance from other flightline personnel.
6. Cameras are not permitted on the flightline without prior authorization. AECMs should request
authorization from WG Ops prior to taking any pictures.
7. Unaccompanied packages threaten flightline safety. AECMs are not to accept any package from
individuals unknown to them. If a suspicious package is found on or near an aircraft:
a. it is left untouched;
b. the package is isolated by assigning one person to keep people away from the area; and
c. report the suspicious package to the AC or to WG Ops.
8. WG Ops is responsible for the control and coordination of aircrews and the aircraft while on the
airfield. Prior to transiting the airfield, AECMs check with WG Ops for specific instructions for access to the
aircraft. WG Ops has the aircraft tail numbers and flightline spot numbers of all aircraft on the flightline.
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9. Foreign Object Debris (FOD) on the airfield can cause severe damage to the aircraft and possible
injury or death to individuals either in or outside the aircraft. FOD can be blown onto airfields, dropped from
vehicles or by individuals, or originate from the aircraft. All individuals transiting the airfield are responsible
for the removal and disposal in specified FOD containers. If the object appears to be part of the aircraft, it
should be given to the LM, servicing section, or WG Ops.
SAFETY AROUND THE AIRCRAFT
10. Safety in and around the aircraft is paramount. The wing area of the various aircraft poses
certain safety hazards and may cause injury, such as the Flaps, Slats, or Propellers. With the CC130 Hercules
and the CC177, the ramp is never walked under as severe injury may result. AECMs should exercise caution
when working within of a 3.6 metre (12 ft) circle-of-safety encircling around the aircraft wings, nose,
and tail.
11. Aircrew must become familiar with the danger areas of the aircraft that they will be flying on. Each
type of aircraft has identified danger areas; see Chapter 8 for specifics on each airframe. If testing of the
radar is occurring on the ground, it is cordoned off with cones and ropes.
12. Discrepancies such as fuel or hydraulic leaks, red flags left in place, or damage to the aircraft from
bird or lightning strikes, are reported to the AC, Load Master (LM), Flight Engineer (FE), or Wing Operations
(WG Ops).
VEHICLE CONTROL
13. WG Ops is responsible for vehicle and aircraft movement on the ramp of the airfield, while Air Traffic
Control (ATC) is responsible for all vehicle and aircraft movement on the active runways and taxiways of the
airfield. Vehicles are not permitted beyond the ramp or flightline without permission of ATC.
14. While AECMs do not drive on the flightline without a ramp driving course and orientation, it is
important to know basic safety aspects of driving on the flightline. Vehicle requirements are:
a. vehicles are checked for FOD prior to proceeding onto the ramp;
b. headlights are turned to the low beam setting;
c. the rotating beacon or the four way flashers are activated to indicate intent to move or actual
movement of the vehicle;
d. vehicles are required to be equipped with a functioning radio or are accompanied by a guide vehicle if
moving on taxiways and runways;
e. most ramp areas have a solid line (usually yellow) near the Hangar Line designating safe areas for
vehicles driving or parking that will not interfere with aircraft movement; and
f. it is important to see and be seen at all times.
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15. Vehicle movement on the airfield is kept to a minimum. The maximum speed of a vehicle within 15
metres (50 ft) of an aircraft is usually 6 km/h (4 mi/h). Emergency response vehicles may exceed the speed
limits in times of emergency while on the flightline but not within 15 metres (50 ft) of the aircraft.
16. Vehicles are not operated with the 15 metres (50 ft) of the aircraft without a qualified guide. Vehicles
are not allowed to park under any portion of the aircraft. Vehicles approach the aircraft with the driver’s side
toward the aircraft in a counter clockwise direction. This allows the driver to maintain eye contact with all
parts of the aircraft and decreases the possibility of collisions. Vehicles parked within 15 metres (50 ft) of the
aircraft will ensure:
a. positioning to prevent inadvertent collision with the aircraft and allow driving straight away from
the aircraft in an emergency;
b. the transmission is in the park or reverse position;
c. the emergency or parking brake is applied;
d. the engine is turned off;
e. keys will be left in the ignition; and
f. the driver remains with the vehicle or in the near vicinity.
17. During refueling, a fuel spill, or when refilling LOX, no vehicles shall operate within a 15 metre (50
ft) circle of an aircraft. If a vehicle is parked within the 15 metre (50 ft) radius, it can not be started or moved
until the operation is completed and the driver is instructed it is safe to move the vehicle.
18. Emergency vehicles such as fire or crash/rescue vehicles may be requested by the AC to provide
continuous coverage during all ground operations of an aeromedical evacuation. A crash/rescue vehicle
is usually on standby for arrivals and departures of aeromedical missions depending on local flightline
policy. A fire truck is required to be at its pre-determined position during refueling with patients onboard
the aircraft. Fire trucks usually approach the aircraft at the 10 o’clock position off the nose. Depending on the
wing/airfield policy, the pre-determined position for the fire truck may be the Firehall.
19. General guidelines for vehicle movement include:
a. aircraft always have the right of way due to their size and limitations on stopping and manoeuvring;
b. if an aircraft is observed taxiing too close to another aircraft, an obstruction such as a vehicle, or a
building, it is everyone’s responsibility to attempt to stop the aircraft;
c. maintain common sense and safety practices at all times; and
d. any person witnessing an unsafe act or violation of airfield regulations and procedures is required
to notify WG Ops.
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REFUELING AND DE-ICING OPERATIONS
20. The normal sequence for refueling for aeromedical evacuation missions is to:
a. deplane the patients;
b. refuel the aircraft; and
c. emplane the patients.
21. Concurrent refueling with patients onboard the aircraft may be done when:
a. there are periods of severe weather conditions;
b. where incapacitated passengers are carried;
c. inadequate terminal facilities on the flightline.
22. There are criteria that must be met when concurrent refueling is to take place. These criteria include:
a. all primary exits are to remain open, except for the exit closest to the fuel connection;
b. the ramp is open, deployed, and unobstructed when litter patients are onboard the aircraft;
c. seatbelts are off, tray tables are stowed (if available), and the foot area is unobstructed;
d. a fire truck is positioned at its pre-determined position; and
e. a minimum of two crewmembers will remain on the aircraft, one of whom is an AECM. They ensure
there is no smoking on the aircraft, no electrical switches are operated, and evacuate the aircraft
in a ground emergency. Only those systems, switches or electrical circuits needed to operate
equipment to sustain life may be turned on and used during refueling.
23. De-icing the aircraft occurs when there is a chance of ice build-up that would affect the operational
effectiveness of the aircraft. De-icing considerations:
a. fluid is very slippery so patients and passengers are emplaned prior to de-icing operations;
b. aircraft exits are closed;
c. power to the aircraft may be shut off so battery operated equipment may be required; and
d. brief patients to expect to hear a splashing noise.
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SECTION 3
In flight SAFETY
1. In flight safety is every aircrew member’s responsibility. All AECMs must be familiar with the
potential safety hazards on board the aircraft for which they are performing an aeromedical mission.
AECM PERSONAL PROTECTIVE EQUIPMENT
2. AECMs should remove rings when working with aircraft components to prevent de-gloving injuries.
Gloves are not to be worn when working with oxygen equipment.
3. Hearing protection such as a headset, helmet and/or earplugs, are used to prevent hearing loss or
damage on some CF airframes.
4. Flashlights are used by AECMs during periods of reduced visibility such as dusk, darkness, fog, or
rain, and improve the ability to see and also be seen. Flashlights should be shatter proof and kept on the
AECM’s person or readily accessible at the crew position. Flashlights with appropriate light filter may need
to be used when in small aircraft at night to prevent temporary light blinding of pilots. The Flying Squadron
should dictate whether a filter is required and the type of filter to be used.
5. Depending on local policies, AECMs may be required to wear a reflective belt or vest at all times
when working in the vicinity of active aircraft to reduce risk of injury.
6. AECMs shall adhere to 1 Cdn Air Div Orders, Vol 2, 2-007, PERSONAL EQUIPMENT/PROTECTIVE
CLOTHING and to 1 Cdn Air Div Orders, Vol 1, 1-006 FLYING CLOTHING.

MOVEMENT WITHIN THE AIRCRAFT CABIN
7. Seatbelts are required to be fastened while seated. They should be snug during take-off, landing,
or during emergency procedures. Once altitude is reached and the seatbelt sign turned off, seatbelts may
be loosened for comfort. If the seatbelt sign is illuminated, the AECM must speak with the aircrew if the
situation does not allow the AECM to be seated. Should an AECM need to remain standing to continue
patient care/monitoring, use litter straps to secure the AECM while they work with the patient. This is done
by putting one litter strap around the AECM’s waist, then taking a second strap and looping it through the
AECM’s waist strap then through the bottom metal loop at the end of the litter or around the frame of the
Patient Transport Unit (PTU) stretcher. Do this to both ends of the litter or stretcher. In the event that the
AECM is kneeling down, D-rings on the aircraft floor can be used for this purpose.
8. Movement in the cabin should be kept to a minimum. One hand is kept free at all times to provide
safety during turbulence or aircraft manoeuvres.
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9. Aisles and foot areas are kept clear of hand carried items. All hand carried items should be labeled
and stowed.
PATIENT SAFETY In flight
10. A minimum of two litter straps per litter patient are required for flight. The straps are secured
over the chest and thigh area to prevent soft tissue or organ injuries. Depending on patient condition/
injury or requirement for care, the location of litter straps may be adjusted. The straps may be ”fist“ loose.
Straps should be checked frequently and visually checked each time an AECM passes a litter patient.
11. Patients require assistance to ambulate around the cabin and for getting on or off the litters. Canes
and crutches are allowed for transiting the flightline or moving around the cabin when the aircraft is on the
ground. Canes and crutches may be used with extreme caution when the patient is emplaning up stairs,
ramps, or ambulating during flight.
PATIENT INJURED In flight
12. All preventive measures possible (i.e. safely placing and securing patients, checking equipment
for defects, etc.) should be undertaken to prevent in flight injuries. Initial treatment of any such injuries
sustained is a priority.
13. The incident must be entered in the patient’s records as well as the Record of Patients Evacuated
(RPE). This will assist in the future treatment and care of the patient and may serve to preclude
further injuries. In addition a CF 215 Flight Safety Incident Report will be submitted through the aircraft
commander.
OXYGEN AVAILABILITY
14. Per 1 Canadian Air Division Orders, Volume 2, 2-007 SAFETY REQUIREMENTS “when an aircraft
is at or above FL 250, all crewmembers shall have oxygen masks readily available and adjusted for quick
donning.” This means that AECMs shall have an oxygen source (i.e. MA 1 portable oxygen bottle, EPOS,
PBE, EEBDs) next to their crew positions or the immediate vicinity thereof (exception, the CC150 full pax
configuration).
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CHAPTER 4
AEROMEDICAL EVACUATION CREWMEMBER TRAINING & STANDARDS
SECTION 1
GENERAL REQUIREMENTS
1. The Initial AE Course is designed to provide Aeromedical Evacuation Crewmembers (AECMs) with
instruction and training in:
a. human physiological and psychological limitations in the aviation environment;
b. the impact of these limitations upon the AECM and patients;
c. techniques and equipment available to care for patients in flight and minimize the stresses of flight;
d. the principles and proficiency in aircraft safety and emergency escape; and
e. Human Performance in Military Aviation (HPMA) tier 1 training.
2. The initial AE Course will not provide AECMs with proficiency in survival evasion resistance and
escape (SERE) as per 1 Cdn Air Div Order Vol 5, 5-313 SURVIVAL EVASION RESISTANCE ESCAPE TRAINING.
AECMs are expected to seek relevant training at their home unit once they are qualified AECM.
3. The initial AE course does incorporate mechanisms and provisions which are intended to ensure
that applicable training objectives are met in accordance with the Qualification Standard (QS) approved by
the Office of Primary Responsibility (Training) (OPR (T)).
4. All AECMs are required to complete the initial Canadian AE course and unit specific training by
their AESO before they are considered Operational on those airframes that are taught at 426 (T) Training
Squadron. Those airframes not taught at 426 (T) Training Squadron will require, in addition to the above, a
familiarization flight, initial aircraft specific ground check, and an initial aircraft specific flight check.
5. Following initial training, all AECMs holding active flying positions must maintain an Operational
category on the aircraft type(s) designated by their unit, IAW with 1 Cdn Air Div Orders, Vol 5, 5-503
Annex F, Appendix 1 of AIR MOBILITY AIRCREW STANDARDS. All requests for waivers for AECMs must
be forwarded through TRSET and AE PM to 1 Cdn Air Div HQ IAW 1 Cdn Air Div Orders, Vol 5, 5-501
STANDARDS GENERAL – AIRCREW/PERSONNEL. See paragraphs 6 to 11 of this section for more
information.
6. Recertification for AECMs that have not flown in three years or more will be dealt with in accordance
with the guidelines provided in 1 Cdn Air Div Orders, Vol 5, 5-503, Annex F, Appendix 1 of AIR MOBILITY
AIRCREW STANDARDS.
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MAINTENANCE OF AIRCREW CATEGORIES
7. In the CF there are 3 levels of Aircrew Category:
a. Under Training;
b. Restricted; and
c. Operational.
8. To achieve the lowest level, Under Training (UT) an AECM must first successfully complete the initial
AECM course. An AECM is UT when they are completing initial upgrade training on a specific aircraft or
have not met all of the criteria of a restricted category.
9. When an AECM is Restricted, they are permitted to fly on live missions under direct supervision
of an AECM who is Operational. The AESO will recommend a Restricted Category when the AECM has
successfully completed all requirements as IAW 1 Cdn Air Div Order Vol 5, 5-503 Annex F Appendix 1, meets
all currencies IAW 1 Cdn Air Div Order Vol 5, 5-503, table 5-503.3, and completes further requirements IAW
1 Cdn Air Div Orders, Volume 5, 5-501, Standards General – Aircrew/Personnel.
10. Currencies are standards designed to prevent the erosions of knowledge and skill, ensuring that
personnel maintain a level of performance consistent with operational safety and minimum levels of
operational effectiveness. Completion of currencies is at the frequency defined in 1 Cdn Air Div Order Vol
5, 5-503, Table 5-503.3. Specific currencies have semi-annual, annual or biennial frequencies. An example
would be completion of CPR level C annually by all AECMs. If a currency item lapses or is incomplete, the
consequence affects either the AECM’s category (i.e. downgrade) or no flying permitted until the item has
been completed.
11. Restricted AECMs shall not work independently, but with an Operational AECM at all times until
a category upgrade. Restricted AECMs shall not be appointed Medical Crew Director (MCD) without prior
approval from 1 Cdn Air Div Transport & Rescue Standards Evaluation Team (TRSET). No more than one
Restricted Category AECM will be considered when calculating minimum crew.
12. AECMs will be granted Operational status on CC130 and CC150 upon completion of the initial AECM
course (AHUT) and the Unit/Flight Specific Orientation Training and meeting all requirements for Restricted
status IAW 1 Cdn Air Div Order Vol 5, 5-503 Annex F Appendix 1.
13. An Operational AECM will see a category reduction to Restricted when not all of the criteria for the
Operational status are met. An Operational AECM can conduct flying duties as an AE team member. An
experienced AECM can upgrade to MCD IAW 1 Cdn Air Div Order Vol 5, 5-503 Annex F Appendix 1.
14. To maintain an Operational Category, an AECM shall, IAW 1 Cdn Air Div Order Vol 5, 5-503 Annex F
Appendix 1:
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a. Maintain the requirements for restricted category;
b. Maintain at least the minimum flying hours required annually – operational or training missions.
Operational AE missions of any duration will count toward this requirement; whereas training
missions shall be a minimum of two hours in duration on fixed-wing airframes or 30 minutes in
duration on rotary-wing aircraft. Flying as an evaluator or instructor also meets this requirement;
c. Complete annual Unit/Flight continuation training;
d. Complete annual Ground Proficiency Checks (Air Mobility Instruction 60-0736, Air Mobility Check
Flight Manual); and
e. Complete biennial Flight Category Checks on Unit/Flight mandated airframe. Each subsequent
Flight Category Checks will be required every two years on each Unit/Flight mandated airframe.
The Flight Category Check must be completed on an airframe on which the AECM has successfully
completed an annual Ground Proficiency Check. Initial checks will be made as a Team Member.
Upon upgrade to MCD, the AECM will have both an initial Ground and Flight Check in the MCD
position on any aircraft the MCD candidate is currently operational on before being able to operate
independently as an MCD. After passing both Checks every subsequent Ground and Flight Check
will be done in the MCD position.
15. After the initial operational status is achieved each AECM requires a single Flight Check every 2
years to maintain status on all airframes that an Operational status is held.
EXAMPLE
An AECM graduates from the initial AECM course and after successfully
completing unit specific training is considered Operational on the CC150 and
the CC130. The Flight Check that was accomplished with 426 Sqn was done
on the CC150 on 24 June 2009 and their CC130 on 15 July 2009. Since the
CC130 was the last aircraft he or she received their Flight Check the next
required Flight Check will be 15 July 2011 (this recheck could be done on any
airframe the member is currently Operational on). After arriving to the CF AE
Flight the member passes their Flight Check on the CC144 on 3 September
2009. This “resets” their clock making their next required Flight Check on 3
September 2011 (which for this AECM could be done on either the CC130,
CC150 or CC144). The member would still need a yearly ground check on all
3 aircraft to maintain their Operational status on each aircraft.
AE TRAINING AND MAINTENANCE OF CURRENCY FOR AUGMENTATION AECMS
16. For personnel who are not posted to a base with an AESO/AETO and wish to maintain currency as
an AECM the followed tasks must be accomplished:
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a. Training Evaluation: AECMs must first receive support/approval of member’s supervisor prior to
initiating a training request. The member will, through their unit Training Officer, provide a training
plan to TRSET SE 6-3. The member’s file will be reviewed and the training plan will be validated
by TRSET SE 6-3. If the member’s file is not available then TRSET SE 6-3 will create one for the
member;
b. Training Plan Submission: Once the training plan has been approved, the unit Training Officer will
communicate with the CF AE Flight in order to coordinate the training. The member should plan
approximately two training periods per year to Trenton (from 1 to 3 days each) in order to meet the
annual training requirements (i.e. safety systems, ground proficiency check, flight check and flying
time on the identified airframe) and maintain an operational status;
c. Funding Request: CF Aerospace HSS Squadron has funding available to bring external AECMs to
Trenton for AE training and maintenance of currency. The member will, through their unit Training
Officer, provide a funding request including the type of training and a cost estimate for each training
period (i.e. accommodations, transportation, parking fees, meals, incidentals and other expenses)
to the CF Aerospace HSS Squadron/AE Program Manager for approval. All funding requests must
be approved prior to the activity taking place. Once approved, a fin code will be provided by the
CF Aerospace HSS Squadron/AE Program Manager; and
d. Questions: All questions regarding this issue should be directed to the AE Program Manager
at 1 Cdn Air Div HQ at CSN 257-5874.
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SECTION 2
GENERAL TRAINING POLICY
GENERAL
1. Canada’s international policies, including those governing AE, are based on the principles of a
collective defence. As a member of the North Atlantic Treaty Organization (NATO), Canada is signatory to
the Standardization Agreements (STANAGS) dealing with AE. Other collective agreements dealing with
AE include the Air and Space Interoperability Council (ASIC) which involves the Air Force elements of
Australia, Canada, New Zealand, United Kingdom, and United States and the Canada/US Integrated Lines
of Communication (ILOC) agreement which coordinates the movement of AE patients out of the various
theaters.
2. Guidelines for AE training policy are in accordance with standards and publications released by
NATO, CFHS HQ, and 1 Cdn Air Div HQ. These standards and publications provide guidance to 426 (T)
Transport Squadron and the AECMs at the CF AE Flight and should be utilized accordingly for direction.
For a more inclusive listing of directives and publications, refer to the following document: Statement of
Operating Intent: Strategic Aeromedical Evacuation.
3. All AECMs must abide by the Training and Standard requirements outlined in the 1 Cdn Air Div Orders,
Vol 5, 5-501, STANDARDS GENERAL – AIRCREW/PERSONNEL Section 1, GENERAL, 1 Cdn Air Div Orders,
Vol 5, 5-303, HUMAN PERFORMANCE IN MILITARY AVIATION TRAINING POLICY, Section 1, GENERAL, and
1 Cdn Air Div Orders, Vol 5, 5-503, AIR MOBILITY AIRCREW STANDARDS, Annex F, AIR MOBILITY MISSION
SPECIALIST QUALIFICATION AND CURRENCY REQUIREMENTS, Appendix 1 AEROMEDICAL EVACUATION
PERSONNEL QUALIFICATION AND CURRENCY REQUIREMENTS.
AESO AND AETO TRAINING
4. As a resource in their unit, AESOs must understand the Canadian AE system and be knowledgeable
of its governing regulations. Equally important, this individual must be competent to implement the AECM
standards and training program as this program determines the level of proficiency within the unit.
5. All AESO and AETO candidates shall complete the Central Flying School Flight Instructors Course
(FIC) within six months of assuming their duties and responsibilities. Additionally, AESOs and AETOs shall
attend the annual standards conference chaired by TRSET.
6. TRSET shall conduct the annual proficiency checks on unit AESOs in addition to the CF AE Flight
FC and the 426 Sqn M Flight FC. TRSET will be contacted prior to any evaluation being done on these
individuals by a unit or external personnel to get TRSET’s permission to do the evaluation.
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SECTION 3
AESO DUTIES AND RESPONSIBILITIES
1. The AESO holds a key position in the overall AE organization. The AESO provides the CF AE Flight
FC, 426 (T) Sqn M Flight FC and medical personnel with advice and information on AE issues and should be
consulted on all AE matters.
2. The CF AE Flight FC and 426 (T) Sqn M Flight FC are accountable for unit AE training and standards
within their sections. They shall appoint the AESO(s) and forward recommendations for the position
of AESO to TRSET, in writing, for approval of candidacy. For upgrade process refer to 1 Cdn Air Div Orders
Vol. 5, 5-503, Annex F, Appendix 1.
AESO STATEMENT OF DUTIES
4. The AESO is responsible for the duties at their Wing IAW 1 Cdn Air Div Orders, Vol. 5, 5-503, AIR
MOBILITY AIRCREW STANDARDS, Annex F, AIR MOBILITY MISSION SPECIALIST QUALIFICATION AND
CURRENCY REQUIREMENTS, Appendix 1 AEROMEDICAL EVACUATION PERSONNEL QUALIFICATION
AND CURRENCY REQUIREMENTS.
5. In addition to the guidelines provided in 1 Cdn Air Div Orders, the AESO shall:
a. ensure AE standards and regulations are maintained and enforced;
b. maintain an Aircrew Information File (AIF) IAW 1 Cdn Air Div Orders, Vol. 2, 2-002 PRE-FLIGHT
REQUIREMENTS;
c. maintain a Medical Information File (MIF);
d. monitor currency qualifications in accordance with this Chapter;
e. initiate, review and maintain Standards and Training Files on each AECM within the unit in
accordance with 1 Cdn Air Div Orders, Vol. 5, 5-501 and 1 Cdn Air Div Orders Vol. 5, 5-503, AIR
MOBILITY AIRCREW STANDARDS;
f. update CF AE Flight FC, 426 (T) Sqn M Flight FC and TRSET SE 6-3 on Wing specific issues;
g. liaise with the AETO with respect to unit specific training;
h. liaise with the AETO to ensure AE designated equipment and kits are maintained at the readiness
state;
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j. conduct proficiency checks for the unit specific aircraft on all AECMs and submit original paperwork
to 1 Cdn Air Div HQ, TRSET;
k. compile and submit the AECM Status Report to the CF AE FLT OIC, 426 Sqn AETF and AE PM on 01
March and 01 September of each year;
m. audit and submit Report of Patients Evacuated (RPE) to 1 Cdn Air Div HQ, TRSET and AE PM at CF
Aerospace HSS Squadron;
n. at a minimum, quarterly review and certify AECM Log Books in accordance with 1 Cdn Air Div
Orders Vol. 2, 2-202, Annex B – LOGGING AND RECORDING OF FLYING TIME ; and
p. attend the annual AESO training workshop/conference and other meetings/conferences as required.
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SECTION 4
AETO DUTIES AND RESPONSIBILITIES
1. The CF AE Flight FC and 426 Sqn M Flight FC, in consultation with their respective AESO, shall
appoint an AETO to coordinate the training and prepare AECMs for attaining an Operational status. AETOs
must possess the same in-depth knowledge of AE as the AESO.
AETO STATEMENT OF DUTIES
2. The AETO is responsible for the following duties at their unit:
a. assist in initiating, reviewing, and maintaining Standards and Training Files on each AECM at their
unit;
b. administer a unit orientation program to AECMs;
c. develop, update, and conduct unit specific training;
d. maximize training opportunities by liaising with Wing resources;
e. advise the AESO of AECM candidates who are ready for flight evaluation; and
f. attend annual AESO training workshop/conference and other meetings/conferences as directed.
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SECTION 5
MCD DUTIES AND RESPONSIBILITIES
1. Unit AESOs will select eligible AECMs with the concurrence of their respective FCs to assume MCD
responsibilities. The MCD candidate will then need a ground and flight check on any currently operational
airframe to assume MCD duties. Further direction is outlined in Air Mobility Instruction 60-0736, Aircrew
Check Guide and 1 Cdn Air Div Orders Vol. 5, 5-503, Annex F, Appendix 1. This designation is a function of
skill and experience that not all AECMs will necessarily attain.
MCD STATEMENT OF DUTIES
2. The MCD is responsible and controls the overall Aeromedical Evacuation mission management to
ensure a highly effective and safe medical evacuation. This position is held by designated AECM including
both Flight Nurses and Flight Medical Technicians. Medical specialists, including F Surgs, are responsible
for patient management and are not accountable for other mission requirements.
3. The MCD must possess an in-depth knowledge of the Canadian Aeromedical Evacuation system and
its governing regulations, and must have the ability to implement the AE standards while overseeing the
planning and execution of the mission.
4. Selection of the MCD is dependent on the mission profile and the AECM experience (including flight
and occupational experience).
5. The MCD is the contact person for all communication between the Load master, Flight Steward, and
Aircraft Commander. Any contact with the AECO or Div Surg regarding active AE will also be through the
MCD unless delegated.
6. In addition to the guidelines provided at the unit level, the MCD shall:
a. Review tasking message from AECO;
b. Manage AE Mission planning from Originating Medical Facility (OMF) to Destination Medical
Facility (DMF);
c. Contact OMF (through Aeromedical Evacuation Nurse Liaison Officer (AENLO) as appropriate) for
latest patient information when possible;
d. Ensure all pre-mission planning has been completed (including administrative planning prior to
leaving the unit for the flight line);
e. Coordinate requirement for additional AE crew/MSTMs and special mission requirements with
AECO;
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f. Ensure basic AE kit as well as any special medical equipment needed is pre-flighted;
g. Brief AECMs regarding all operational and medical mission requirements;
h. Ensure AE standards are maintained and regulations are enforced;
j. Coordinate hospital visit and split of team for aircraft setup and preparation of patient through
AENLO;
k. Complete load plans and nursing care plans as required;
m. Ensure transport of patient to flight line is done safely and with proper emergency equipment to
include clinical interventions for complications;
n. Ensure that the CF standard of care is adhered to during the mission;
p. Supervise emplaning and deplaning of patients to ensure all patients reach ground transportation
vehicles safely, complete with all medications, documentation and personal belongings;
q. Maintain active communication with AECO informing of timings, any changes and completion of
mission;
r. Compile and submit aircrew allowance forms to AESO along with all post mission paperwork
including any After Action Report (AAR)/lessons learned as required; and
s. Serve as a resource/subject matter expert (SME) for augmentees or MSTM.
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SECTION 6
MEDICAL SPECIALIST TEAM MEMBER DUTIES AND RESPONSIBILITIES
1. The F Surg is responsible to provide medical support to forward, tactical and strategic AE and
advise the chain of command on all aspects of health and the aerospace environment. Due to recent
operations there has been an increased requirement to appropriately select and prepare a wide variety of
patients for the austere environments of AE. Therefore the F Surg must possess a practical understanding
of the Canadian Aeromedical Evacuation system and its governing regulations, and sound knowledge of the
effects of AE on common medical conditions.
2. F Surgs and other Medical Specialist Team Members (MSTM) are responsible for the clinical care
of patients. Non Flight Surgeon MSTMs have patient management roles and are not accountable for other
mission management requirements. These are the responsibility of the MCD and AECMs, however during
AE missions, accompanying F Surgs are the medical authority for delivery of patient care for the patient(s)
they are accompanying. The F Surg may be consulted for other medical issues pertaining to the remaining
patient(s) onboard. During active missions it is essential to maintain a close working relationship with the
MCD. It is vital that the principles of Human Performance Management in Aviation (HPMA) are employed by
all personnel involved in the AE Mission. Annual HPMA training is highly recommended for all F Surg. The
mission starts at initial notification and ends when equipment is restocked upon return.
3. F Surgs are responsible for eight distinct roles in support of AE. These include:
a. initiating a request for AE;
b. patient screening;
c. case validation;
d. medical preparation of AE patients;
e. clearance for flight of AE patients;
f. the supervision and provision of inflight and circumflight medical care;
g. responsibility for the occupational health and aeromedical aspects of patient, crew and passenger
safety; and
h. provision of professional oversight for quality assurance.
4. Other health care providers are often responsible for initiating a request for AE, this is not solely a
F Surg responsibility. As part of screening, the F Surg will determine classification, movement precedence
and special medical needs. In the Canadian system, all patients are validated by a validating F Surg which is
usually the Div Surg or delegate. Concurrent with validation, the patient is stabilized to the greatest degree
possible and a transport care plan is established. When available, a F Surg at the OMF clears the patient
for flight.
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5. Flight surgeons may be responsible to provide additional support ranging from pre-mission advice,
medication prescriptions and pre-authorizing orders for in flight treatment to real time advice and orders to
in flight care providers by long-range comms during an active mission. F Surg taskings will be determined
by the AECO under auspices of the Div Surg. Selection of the F Surg is dependent on individual availability,
CO authorization and mission profile.
6. The F Surg may discuss any aeromedical issues or other matters surrounding the clinical care of
patients directly with the Div Surg or delegate at any time during an AE mission. The F Surg will discuss any
special mission requirements with the MCD. All other matters of a non-medical nature are to be directed to
the AECO or MCD as appropriate for the stage of the mission.
7. In addition to the guidelines provided at the unit level, when operating as a member of the AE Crew,
the F Surg shall:
a. liaise with the MCD;
b. contact the validating F Surg or equivalent whenever medically necessary;
c. contact Senior Medical Authority (SMA) or OMF for latest patient information when possible;
d. discuss medication requirements, orders, and transport care plan with the MCD and MSTM;
e. discuss the basic AE kit as well as any additional medical equipment needed for the patient’s
condition;
f. confirm there is a receiving physician via the MCD or AE Message;
h. contact DMF/receiving physician ;
g. participate in any and all crew briefings;
j. be familiar with AE approved medical kit and equipment;
k. provide routine and emergency medical care during the mission;
m. provide aviation medical advice;
n. offer in flight medical training to other crewmembers when applicable; and
p. chart an initial patient assessment, in flight care/observations as completed and a handover note
for the DMF.
8. Providing professional oversight of AE for quality assurance will include:
a. conducting quality assurance review of AE Medical care; and
b. communicating lessons learned to AE community and higher authority.
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SECTION 7
OTHER PROCEDURES
PROFICIENCY AND CATEGORY CHECKS
1. Proficiency and category checks shall be conducted at the frequency laid out in 1 Cdn Air Div Orders,
Vol 5, 5-503, AIR MOBILITY AIRCREW STANDARDS, Annex F, AIR MOBILITY MISSION SPECIALIST
QUALIFICATION AND CURRENCY REQUIREMENTS, Appendix 1 AEROMEDICAL EVACUATION PERSONNEL
QUALIFICATION AND CURRENCY REQUIREMENTS. Terms of Reference and Standards of Performance
expected of AECMs are contained in the Qualification Standard A-P8-057-HUT/PC-D00. AECMs will
be evaluated in two phases, a Ground Proficiency Check and a Flight Category Check. Direction on
the completion of these forms is promulgated under separate cover in the AMI 60-0736 AIR MOBILITY
CHECK FLIGHT MANUAL. The AESO shall be fully familiar with the content of Chapters 1 and 2 of
AMI 60-0736. Current copies of the Proficiency and Category Check forms can be found on the TRSET
website at http://trenton.mil.ca/Lodger/TRSET/index_e.htm. They are formal records of performance and
once completed the original shall be forwarded to 1 Cdn Air Div HQ/TRSET. The Ground Proficiency Check
shall be completed prior to attempting a Flight Category Check.
2. In preparation for a Ground Proficiency Check, the AETO will ensure all required training and unit
orientation is complete. The AETO will then notify the AESO that the AECM is ready for a proficiency check.
Based on AESO recommendations and TRSET concurrence select individuals will undergo MCD proficiency
checks.
SUPPORT OF OPERATIONAL REQUIREMENTS
3. In the event that the AE Flight cannot meet its AE operational requirement as directed by the CF
Aerospace HSS Sqn, the AESO, through the AE FC, must notify the AE PM and the AECO in writing. The
message must include the reason why coverage cannot be maintained and the estimated length of time of
non-operability. Another message is to be sent, to the above addressees, once the unit is back to operational
status.
AE EQUIPMENT STANDARDS AND PROCUREMENT
4. The flight environment presents certain challenges with respect to medical equipment usage.
The effects of the stresses of flight, the risk of a rapid decompression and the possibility for equipment
to cause electromagnetic interference (EMI), necessitates that medical equipment proposed for AE use
shall be rigorously tested prior to its procurement. This is done to ensure that the medical equipment does
not interfere with the aircraft systems and that the aircraft systems do not interfere with the medical
equipment (host/victim susceptibility). Equipment testing ensures airworthiness and safe reliable
performance in the air.
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5. For further direction on the type and use of medical equipment in flight and the airworthiness
process, consult B-MD-010-000/FP-001, Aeromedical Evacuation Equipment Guide. Information regarding
the airworthiness of medical and non-medical equipment is available from the AE PM and/or 1 Cdn Air
Div HQ, TRSET. All suggestions for purchase of new equipment must be staffed through AE PM IAW CAS
Med Advisor directives.
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CHAPTER 5
MISSION MANAGEMENT
SECTION 1
GENERAL
AEROMEDICAL EVACUATION OPERATIONS
1. Refer to 1 Cdn Air Div Orders, Vol 3, 3-108, AEROMEDICAL EVACUATION OPERATIONS.
MISSION INITIATION
2. Aeromedical Evacuation of a CF member may be initiated by any military member by contacting

the 1 Cdn Air Div Surg office. Each mission will be validated by the 1 Cdn Air Div Surg. Coordination is
through the AECO at the CF Aerospace HSS Squadron. Missions may also be initiated by any of the regional
Rescue Coordination Centres (RCC), especially in the case of rotary aircraft. The AE of non-CF members may
also be coordinated by the AECO after seeking appropriate approval.
3. The decision to airlift a patient is made by a Flight Surgeon (F Surg) after considering the patient’s
condition, the effects of the stresses of flight on this condition, and the ability of the originating medical
facility (OMF) to provide adequate, definitive care. The requesting physician shall initiate an AE by completing
an Aeromedical Evacuation Request Message in accordance with CFHS P&G 6000-25 Patient Tracking
and forward it to the 1 Cdn Air Div AECO. A requesting physician who is not flight surgeon qualified,
shall seek advice from a F Surg at the unit level. If a F Surg is unavailable, the AECO will facilitate liaison
between the requesting physician and the CF Aerospace HSS Squadron duty F Surg.
AEROMEDICAL EVACUATION REQUEST MESSAGE
4. In preparing the AE Request Message, the requesting physician must ascertain the following
information:
a. patient’s service number (SN), rank, name, military occupation (MOSID), and parent base/wing;
b. date of diagnosis, injury, and/or surgery – do not include International Classification of Diseases
(ICD) codes;
c. patient’s priority, classification and dependency;
d. patient’s location;
e. earliest and latest dates of desired patient movement;
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f. name, location, and contact numbers of the destination medical facility (DMF) and receiving
physician with bed availability date (usually in conjunction with W/B surg at destination);
g. name and location of next-of-kin (NOK), and whether they have been notified by the medical
authority requesting the aeromedical evacuation and would request to accompany the patient
on the flight;
NOTE
NOK and any accompanying escorts must be booked through National
Passenger Service Centre (NPSC)
h. AECM numbers and expertise required;
j. special equipment required for patient care and in flight monitoring;
k. flight requirements such as altitude restrictions; and
m. other information that impacts on the mission.
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SECTION 2
AEROMEDICAL EVACUATION COORDINATING OFFICER (AECO)
AECO Responsibilities
1. The AECO is responsible for coordinating all aspects of the AE mission including;
a. liaison with the requesting physician regarding information on the request message;
b. confirming aircraft availability and mission timings (through 1 Cdn Air Div A3 Airlift Plans/CAOC);
c. coordinating civilian aircraft if no military aircraft is available for the requested move time;
d. tasking the CF AE Flight to provide AECMs and equipment;
e. tasking any MSTM as required according to the CFHS and 1 Canadian Field Hospital policy;
f. ensuring AECM transport and accommodations for the duration of the mission (including
transportation to and from Trenton);
g. confirming bed availability through the receiving physician at the DMF;
h. coordinating transport of patient via ambulance to and from the fightline with medical escorts as
required;
j. ensuring patients are prepared for flight through communication with the OMF;
k. issuing the AE tasking message;
m. requesting equipment waivers for non-approved items through the AE PM if required;
n. maintaining AE database and statistics; and
p. ensuring all agencies are updated with relevant mission details as the planning progresses.
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B-MD-005-000/FP-001
SECTION 3
PATIENT CATEGORIZATION
PATIENT PRIORITY
1. The term “priority” refers to the urgency with which patients are to be evacuated based on their
diagnosis, prognosis, and the level of medical care available at the OMF. The priority system, in accordance
with STANAG 3204, ensures that seriously ill patients are moved before those whose condition is less
serious as depicted in Figure 5-3-1.
Priority Description
Priority 1 – URGENT Emergency patients for whom speedy evacuation is necessary to save life, to
prevent complications, or to avoid serious permanent disability.
Priority 2 – PRIORITY Patients who require specialized treatment not available locally and who are liable
to deteriorate unless evacuated with the least possible delay.
Priority 3 – ROUTINE Patients whose immediate treatment is available locally but whose prognosis
would benefit from air evacuation on routine scheduled flights.
Figure 5-3-1 Patient Priority System Table
PATIENT CLASSIFICATION
2. The patient classification will be determined by the requesting physician in consultation with
AECO. The term “classification” defines a patient’s requirement for space in the aircraft and for physical
assistance. It also considers the patient’s ability to egress the aircraft in the event of an aircraft emergency.
Once a classification is assigned, only a physician can downgrade it; however, an MCD may upgrade the
classification of a patient whose condition deteriorates in flight. In the latter case, the MCD would inform
the AECO (by phone patch if necessary) so that the appropriate resources are available at deplaning. Figure
5-3-2 details the criteria and in flight requirements for the different classification levels.
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Class Sub-Class Determining Criteria In flight Requirements

Class 1 1A - severe psychiatric patient - made-up litter
Neuro- - presents a danger to self, crew, or - pre-flight search
psychiatric aircraft - restraints applied
- sedated or other medication
- in hospital attire (pajamas)
- close supervision
- Mental Health specialist team member
required
1B - intermediate severity psychiatric patient - made up litter
- generally co-operative - pre-flight search
- has the potential to become dangerous - restraints available, not currently applied
or disruptive - sedated or other medication
- in hospital attire (pajamas)
- closely supervised
- Mental Health specialist team member
required
1C - mild severity psychiatric patient - seated for flight
- cooperative and proven reliable under - supervision
observation - Mental Health specialist team member not
required
Class 2 2A - immobile litter patient - litter
Litter - unable to move about on own volition in - equipment, observation and team
Patients an aircraft emergency augmentation as dictated by medical
other than - unconscious, elderly, full body casts, condition and number of patients
psychiatric infants in incubators
2B - mobile litter patient - litter
- able to egress the aircraft independently - equipment, observation and team
in an emergency augmentation as dictated by medical
- patients requiring special treatments or condition and number of patients
equipment, short casts, isolation, litter for - Get Up Seat (GUS)
comfort or safety
Class 3 3A - sitting patients, including handi-capped - equipment, observation and team
Sitting persons, who in an emergency would augmentation as dictated by medical
patients require assistance to escape condition and number of patients
other than - Get Down Litter (GDL)
psychiatric 3B - sitting patients who would be able to - equipment, observation and team
escape unassisted in an emergency augmentation as dictated by medical
condition and number of patients
- Get Down Litter (GDL)
Class 4 4 - walking patients, other then psychiatric, - equipment, observation and team
Walking who are physically able to travel augmentation as dictated by medical
patients unattended condition and number of patients
-Get Down Litter (GDL)
Figure 5-3-2 Table of Patient Classification for Aeromedical Evacuation
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PATIENT DEPENDENCY
3. The assessment of dependency recognizes the need to move patients who have been stabilized but
require skilled medical care to remain stable; possibly requiring intensive support in flight. Dependency levels
are used by the AECO and MCD to determine the number of AECMs, required skill sets and requirement for
augmentation by Medical Specialist Team Members (MSTMs).
Dependency Description
1 – High - patients require intensive support during flight
- ventilation; monitoring central venous pressure (CVP) and intracranial pressure
(ICP); cardiac monitoring
- unconscious or under general analgesia
2 – Medium - patients require regular, frequent monitoring
- combination of O2 administration; one or more IVs; multiple drains or catheters
- condition may deteriorate during flight
3 – Low - patients require nursing care
- simple O2 therapy; IV; catheter
- condition is not expected to deteriorate in flight
4 – Minimal - patients require minimal nursing care in flight
- assistance with mobility or bodily functions
Figure 5-3-3 Table of Dependency Category for Aeromedical Evacuation
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SECTION 4
COMPOSITION OF AE CREWS
1. The personnel resources for AE Crews are drawn from trained and operationally current AECMs
within CFHS. The standard AECM complement for strategic, operational and training missions is one FN
and one FMT. This team shall be augmented as required for operational deployments and when required by
patient acuity. Augmentation may be either additional AECMs and/or MSTMs.
2. All AECMs will have the requisite aircrew qualification status and clinical skills as outlined in 1 Cdn Air
Div Orders Vol 5, 5-503, Annex F, Appendix 1, AEROMEDICAL EVACUATION PERSONNEL QUALIFICATION
AND CURRENCY REQUIREMENTS and the CANADIAN FORCES HEALTH SERVICES (CFHS) MAINTENANCE
OF CLINICAL SKILLS PROGRAM (MCSP).
3. The MCD will ensure the AE Crew has all the needed skill sets to look after the patients. Composition
of AE Crews is relative to patient dependency and numbers are outlined in Annex A of this Chapter.
4. Patient numbers, dependency, patient acuity and the length of the flight will determine the
requirement for additional AECMs. This is a joint determination between the MCD, Div Surgeon and AECO.
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SECTION 5
MEDICATION MANAGEMENT
GENERAL
1. Patient medications must accompany the patient to the flightline and be handed over to the MCD
or AECM. Medications shall be of sufficient quantity to last for the entire mission with additional doses
for increased patient requirements or RONs. The AECO will ask for a 2-day supply when coordinating the
mission.
2. The MCD should question the OMF and patient to determine if the patient is self-medicating. If the
patient is self-medicating, the MCD or FN should verify the patient has their medications and when last
doses were taken.
3. Patient Controlled Analgesia (PCA) is becoming more prevalent. AECMs should be familiar with
any PCA pump brought on board and document its usage. As with any new piece of equipment the AECO
and AECMs is to ensure that if the system is not a piece that is airworthy that it gets the appropriate waiver
before flight.
4. Medications are given as ordered. Dosing schedule is maintained as close to that initiated at the OMF.
Medication administration times may have to be adjusted around aircraft take-off and landing. Medications
due before landing are given before descent; medications due while the patient is enroute to the Destination
Medical Facility (DMF) may be given before deplaning. Medications are documented in Universal Time
Coordination (UTC) and DMF local time. AECMs will annotate patient self-medication.
SECURITY OF MEDICATIONS
5. AECMs are responsible for the security of their assigned patient’s medication unless the patient is
self-medicating. The MCD will ensure the drugs are properly sorted and secured at all times. During RONs,
the medications may be locked in the aircraft as a last resort. If medications or IV fluids are left on the
airframe, there is the potential for medications becoming unusable due to extremes in temperature. Where
possible narcotics should be stored in a secured and controlled area.
6. Narcotic control is maintained as per the Pharmaceuticals Act and standard CF regulations.
Narcotics must remain with a FN and be double locked when on the ground and during flight. If there is
no secure area, they will remain with a FN at all times. A narcotic count will be completed at the
beginning and completion of each mission and when signing in and out of any facility in which they have
been stored.
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SECTION 6
MISSION PLANNING
AIRCRAFT AVAILABILITY AND MISSION TIMINGS
1. The AECO is responsible for determining aircraft availability and coordinating mission timings. The
AECO liaises with 1 Cdn Air Div A3 Airlift Plans/CAOC to ascertain the availability of opportune aircraft.
Should no opportune airlift be available, the AECO will request tasking for other aircraft as the patient
condition warrants. Use of opportune aircraft is preferred when time constraints can be met. Once the
aircraft has been identified, 1 Cdn Air Div Combat Airlift Tasks will provide the pertinent data (lift message)
to the AECO. Should the MCD disagree with the plan made by the AECO, he/she will voice his/her concerns
as soon as possible through their chain-of-command (i.e. crew duty times, airframe chosen for mission, etc.)
to give time to allow for discussion of possible changes in the flight plan.
LOAD PLANS
2. A load plan is prepared by the MCD for all multiple patient flights. The load plan promotes efficient
emplaning, in flight care and deplaning as well as ensuring that patient securing and egress in the event of
an emergency progresses in a safe, timely and efficient manner. Patients are identified on the plan by their
classification, rank and name. Also noted on the plan are empty litters, Get Down Litters (GDL), equipment
litters, seats for ambulatory patients and seats for AECMs as well as Get Up Seats (GUS) for 2B patients. See
Annex 5B for examples of Load Plans for CF airframes.
3. The type of aircraft used and the type of mission flown will influence other factors including:
a. total number of patients;
b. number and location of litters and seats;
c. numbers and locations of emergency exits;
d. numbers of AECMs and/or specialists;
e. airflow and traffic within the cabin;
f. amount of time available for reconfiguration and emplaning; and
g. prescribed method of securing patients and equipment.
4. When constructing load plans, the MCD must consider aircraft, mission and patient factors. Patient
factors include the priority, classification, dependency, diagnosis, and health status of each patient to be
transported. These factors will in turn influence a myriad of other factors including:
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a. most appropriate area in the cabin for the patient to be located;
b. type and amount of in flight care required;
c. need for special equipment and its location;
d. number and expertise of AECMs and/or specialists;
e. seat allocation of AECMs and/or specialists to ensure adequate cabin coverage; and
f. order and method in which patients will be emplaned and deplaned.
5. Litter patients may have special needs based on their classification, dependency and health status.
These factors will influence where the patient should be located in the aircraft and must be considered when
designing any load plan.
a. seriously ill (SI)/ very seriously ill (VSI). These patients are high dependency and therefore require
frequent monitoring and extensive care in flight. This type of patient should be allocated a litter
space in the most stable part of the aircraft, be at a comfortable working height and in full view of
the AECMs. The equipment litter, if used, will be in the immediate vicinity;
b. indwelling catheters, drains, and intravenous lines. Litter height/position must be adequate to
permit flow by gravity. Lines must be protected from inadvertent disconnection and obstruction
while being easily accessible for monitoring;
c. casts and stabilizing devices. Patients with casts and other devices should be placed to enable
the best monitoring while also protecting the limb from being jostled. Casts must not be in direct
contact with the airframe walls or stanchions to protect from vibration;
d. mental health (MH) patients. Psychiatric litter patients (1A, 1B) require frequent monitoring and
close supervision. When positioned in a tier configuration on certain airframes, they should be at
the lowest level and towards the rear of the aircraft (isolated from flight deck) and away from exits
and high traffic areas. They will be in sight of the AECM/MH practitioner;
e. infectious patients. The goal of caring for an infectious patient is to reduce cross contamination
to other individuals, either patients, passengers or crew. Their placement will depend on the
airflow within the airframe for airborne precautions or closer to the ground for droplet precautions
(although these patients do not need to be at the lowest level there will not be a patient below
them regardless). Consider using an empty litter above the patient to reduce spread of organisms.
Location of patients in relation to the washroom must be considered; and
f. backrests. Patients using backrests will require additional tier space in a CC130 or CC177 of one-
and-a-half to two litter positions above the patient to accommodate the additional height.
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6. Ambulatory/seated patients may have a requirement to lie down due to either difficulties at altitude
or simple fatigue during long flights. It is preferred that there is at least one Get Down Litter (GDL) reserved
for every five ambulatory patients. Additionally non-critical stretcher patients (2B) will require a Get Up Seat
(GUS) for portions of the flight as dictated by their medical condition. Normally the same ratio, one GUS for
every five 2B patients.The following guidelines provide direction for patient seating:
a. Mental Health (1C). These patients are seated so as to be observed by AECMs. They should not be
seated next to exits or near the flight deck;
b. epileptic patients. Patients should be seated away from any stimulus such as the propeller
movement or flickering lights;
c. casts and stabilizing devices. These patients should be seated to enable the limb to be supported/
elevated during flight. This may require an additional seat on the affected side. These patients
should not be near emergency exits as they cannot be depended upon to operate the exit in an
emergency. Air splints are not allowed in flight and crutches and canes will be used at the MCD’s
discretion and only with AECM assistance;
d. vision/hearing impaired. These patients should be seated near a person who can assist and
communicate with them; this can be an escort, passenger or other patient. Partially sighted patients
should be seated with an unobstructed view of the cabin where possible. Hearing impaired patients
will be given ear plugs on any aircraft that requires hearing protection;
e. parents with children. All children regardless of age will have a seat reserved for them. It is at
the parent and crewmembers discretion whether a child safety seat will be used in flight or not.
Children may be held by their parents for take-off, landing and during flight. If a child is held on their
parent’s lap, the child must be secured to the parent’s seat belt using a second, shorter securing
belt. This belt is passed through the adult’s seat belt and then around the child. Padding is placed
between the child and the securing strap. The use of a children’s car seat by passengers travelling
within the Air Transport Service is permitted, provided all the following restrictions are adhered to:
(1) the passenger provides the car seat(s);
(2) car seats may be stored according to the direction of the cabin crew (cannot block emergency
exits);
(3) car seats approved by the Canadian Standards Association may be used during take-off and
landing only if they are restrained with the aircraft seat belt; and
(4) infants may be held by an adult during turbulence. Refer to B-GA-007-001/AF-001 Manual of
Air Movements Organization and Operating Procedures Chapter 2, Section 2, para 71d; and
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f. infectious. Their placement will depend on the airflow within the airframe for airborne pre-
cautions. More specific requirements are covered in Chapter 9.
7. Load plan use in an emergency. The load plan also provides a graphic depiction of locations of
AECMs and patients in the event of an emergency landing/ditching. This will show seats for any litter
patients who can be seated (2B). Emergency exits will be identified for egress, one line for ditching and
another route for crash landing. Load plans are always briefed to the LM and/or Flight Steward, all AECMs
and MSTMs.
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SECTION 7
BRIEFINGS
GENERAL
1. Quality care relies on good, continuous communications between patients and caregivers. In the
AE environment, the communication process begins with patient briefings to build trusting relationships
and to reduce fear. Briefings can be delivered by different methods such as illuminated signs, information
cards, public address system, or individual briefings. Briefs fall into three broad categories; general briefings
provide routine information about the flight, emergency briefings provide information in the event of an
emergency and special briefings are given for those who may have special needs during the flight or to
discuss special circumstances occurring in flight.
GENERAL BRIEFINGS
THE PRE-FLIGHT BRIEFING
2. The Pre-flight Briefing is given prior to engine run-up and includes: a welcome to the flight; an
introduction to the crew; an explanation of safety regulations and precautions including a reminder of the
CF “no smoking or chewing tobacco” policy onboard military aircraft; location of emergency exits and
when they are to be used; the duration of the flight and anticipated stops; the available aircraft facilities;
and AECM assistance and approval is required prior to patients getting up from their seat or litter.
ENROUTE BRIEFINGS
3. Enroute Briefings are given at appropriate times throughout the flight and allow the AECMs to pass
on information such as the timing of meals, the possibility of turbulence, and changes to flight timings and/
or itinerary.
PRIOR-TO-DESCENT BRIEFING
4. The descent briefing takes place when the cabin crew notifies the AECMs that descent has begun.
The briefer will instruct patients regarding:
a. clearing their ears as required during descent by chewing movements, swallowing, blowing the
nose, valsalva manoeuvres, drinking fluids, and letting infants cry or nurse;
b. remaining seated until the aircraft has come to a complete stop and keeping the seatbelt fastened
until directed by the crew;
c. seeking deplaning direction and assistance from an AECM;
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d. the destination location;
e. remind patients of the location of the closest emergency exit;
f. the local arrival time and weather conditions;
g. the ground facilities available;
h. the transportation arrangements to the DMF; and
j. special instructions as the situation requires for mission completion.
OVERWATER BRIEFING
5. The overwater briefing deals with information specifically related to security in the event of a
ditching. This briefing is normally given by the LM or F Steward, is conducted on all flights that pass over a
large body of water and is initiated when the AC indicates that life vests should be distributed. Information
contained in this briefing includes:
a. reassurance that this briefing is a standard flight safety procedure and there is no cause for alarm;
b. the exits that can be used for ditching;
c. the number and location of life rafts;
d. a demonstration of how to don and inflate life vests; and
e. not to inflate life vests inside of the aircraft.
EMERGENCY BRIEFINGS
GENERAL
6. Emergency briefings are given only when the MCD receives notification from the cabin crew that
a difficult landing, crash or ditching is possible. The cabin crew will brief the MCD on the nature of the
problem, the time available to prepare for an emergency landing, and any special instructions. The MCD will
relay this information to the AECMs, who will in turn provide the following preparatory instructions to their
patients:
a. the nature of the emergency;
b. whether a patient or passenger will be used as an assistant;
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c. remove sharp objects (glasses or dentures), wrap them in a protective material and place them
into a pocket;
d. loosen restrictive clothing such as belts, collars, and ties;
e. don all available warm clothing for extra padding;
f. position seats in an upright position and add extra padding as available;
g. ensure seat belts and litter restraints are secure;
h. demonstrate how and when to assume the crash/ditch position applicable to the aircraft, stress to
assume this position when hearing one long bell;
j. the emergency exit(s) that can be used;
k. delegating what emergency supplies individuals are responsible to egress the aircraft with;
m. when to evacuate the aircraft; and
n. reassurance that assistance will be given.
SPECIAL INSTRUCTIONS FOR DITCHING
7. Additional instructions to be given to patients in the ditching situation that will enhance survivability
include:
a. how to don and inflate life vests;
b. clear directions given to inflate life vests once out of the aircraft and prior to entering the water;
c. shoes are loosened for removal once out of the aircraft (before using the slide or getting into the
raft);
d. location of emergency exits;
e. the number and location of life rafts;
f. not to inflate life rafts until after they have been thrown outside the aircraft; and
g. where needed, instructions that life rafts are to be secured to the aircraft prior to inflation to ensure
they do not drift away.
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SPECIAL BRIEFINGS
GENERAL
8. Certain patients, as listed below, will require information beyond that provided in the General
Briefings in order to address their special needs during flight, prevent problems, and to allay fears. These
briefings are normally delivered by the AECM assigned to these special patients and are given prior to
take-off.
a. blind/vision impaired. Ensure they are oriented to the surroundings and provide reassurance as
required. They should receive all the information as other patients and their escort or assistant will
need to be briefed on their duties as well;
b. hearing impaired. Ensure they are oriented to their surroundings and provide reassurance as
required. They should receive all the information as other patients and their escort or assistant will
need to be briefed on their duties as well;
c. parents with children. Provide instructions with regard to special safety and emergency regulations
such as letting the parent get out of the plane first so the child can be passed to them;
d. infectious. Provide information with regard to washroom facilities, mobility restrictions, cough
etiquette, hand washing, and waste disposal;
e. anxious or MH. These patients may require additional briefings and/or attention in flight to maintain
their orientation or just to reassure them. These will be done by the MH practitioner if there is one
available for the patient; and
f. language barriers. Patients that speak another language other than that of the crew should have
an attendant who speaks the appropriate language and can translate (if possible) with them for the
duration of the patient’s time in the AE system. All briefs will be given to the attendant who will then
brief the patient. All issues related to a possible language barrier should be briefed by the AECO to
the MCD with appropriate measures taken to ensure that an attendant is available where feasible.
LITTER BEARER BRIEF
GENERAL
9. Before emplaning or deplaning patients, the AECM will ensure that a litter bearer brief is accomplished.
This needs to be done even if all of the litter bearers are experienced at carrying litters to reduce confusion
and to ensure that everyone knows the plan of how the on/offload will happen.
a. remind all personnel that safety is paramount in any situation and that rushing or running could
cause injury to patients or to the litter bearers themselves;
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b. concerns about weather or reduced visibility; i.e. icing conditions, fog, reduced light, thus requiring
a slower pace;
c. signals that can be used in a high noise environment:
(1) STOP – Crossed arms above the head means that litter bearers are to stop where they are
unless they are in the propeller wash. If so, they are to continue towards the aircraft but stop
below the ramp extenders. If on the ramp already they are to continue onto the aircraft where
directed (there will be no stopping on the ramp);
(2) GO – Thumbs up means to continue at current pace onto the aircraft; and
(3) SLOW DOWN – Both hands moving in an up and down motion tells the personnel on the ground
directing the litter bearers to slow down the speed the bearers are coming to the aircraft;
d. when litter bearers are inside the aircraft, they will be directed by the MCD to an AECM who will
then direct them on how they are to assist in loading or unloading patients. This may be verbal or
non-verbal direction depending on the noise level inside the airframe;
e. the required number of litter bearers for on or offloading a particular patient;
f. the commands for doing any lifting or movement of a patient. For safety reasons, before each
command there will be a preparatory command, here are some possible examples:
(1) prepare to lift, lift;
(2) prepare to move, move;
(3) prepare to stop, stop;
(4) prepare to bracket, bracket; and
(5) prepare to lower, lower;
g. the direction the MCD wishes the patients to be orientated during the onload; and
h. what protective gear must be worn during the on/offload (e.g. gloves, hearing protection,
goggles, etc.).
10. More specifics on the commands and movements involved in the direction of a litter team are
highlighted in the B-MD-010-000/FP-001, Aeromedical Evacuation Equipment Manual.
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SECTION 8
PREPARATION FOR AEROMEDICAL EVACUATION
GENERAL
1. The success of an AE mission depends on thorough, well-coordinated pre-departure preparation

and planning.
2. All AECMs must be well rested and personally prepared when reporting for mission duties. This
includes the carriage of all no-go items and adherence to the aircrew regulations identified in Chapter 3.
3. Relevant equipment shall be gathered and pre-flighted in accordance with B-MD-010-000/FP-001.

The AEC is responsible to ensure completeness, serviceability and operability of the equipment. Calculations
must be made for patient oxygen requirements in accordance with the SMM 60-2610-1 and 60-2610-3 AECM
Universal Fixed Wing and Universal Rotary Wing expanded checklists, taking into consideration the need
for emergency oxygen, increased patient requirements at altitude, mission delays, etc., leaving adequate
reserves for the mission duration. A 20% reserve is recommended. An additional calculation should include
the amperage required for all AE equipment that will need to be plugged in while in flight. The equipment
weight must be tallied and provided to the LM.
WARNING
As a minimum, AECMs will ensure a cardiac monitor/defibrillator with battery
support pack, battery operated suction unit, hand-held resuscitator, portable
O2 source, medication kit, and publications kit are carried during every fixed
wing AE mission.
4. It is the responsibility of AECMs to ensure that the equipment is secured on the aircraft and accessible
for in flight care and emergencies. Under no circumstances will medical equipment be placed in front of an
emergency exit which could block or impede a speedy egress.
5. All AECMs are expected to know emergency procedures and a verbal review of the procedures
shall be conducted by the MCD. Review of SMM 60-2610-1 and 60-2610-3 AECM Universal Fixed Wing and
Universal Rotary Wing expanded checklists and determining the roles involved during medical emergencies
is a must.
6. The MCD is responsible to ensure that there is adequate supplemental oxygen support, such as
walk-around bottles, for the AECMs to complete the mission. Normally, all oxygen requirements will be
coordinated through the Wing ALSE in conjunction with the load master (CC130 or CC177). The AECMs
must ensure that the oxygen supply designated for them has been adequately filled and is in working order.
7. The MCD or designated AECM should monitor interphone (headset during all phases of flight). The
MCD will be on headset (interphone) during critical phases of flight to include take-offs, landings and in
flight emergencies. The MCD will notify the flight crew when going off headset.
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ASSUMING RESPONSIBILITY
8. Once the AECM accepts responsibility for a patient’s care, they remain responsible until the
patients are handed over to another equally or higher skilled individual.
9. AECMs will take receipt of medical records; routine and PRN medications, patient-care supplies, and
the patient’s personal baggage. He/she should verify that self-medicating patients have a 2-day supply of
their medications on their person.
10. Prior to emplaning, the AECM should discontinue medical equipment attached to the patient and
transfer it to equipment brought by the AE crew so that medical equipment belonging to the OMF can
be returned to them. Similarly, AE equipment is swapped for transport equipment prior to deplaning the
patient.
11. The MCD will request that the transferring agency vehicle not leave the vicinity of the aerodrome
until the aircraft has departed in case one or more patients has to be returned to the OMF as a result of a
mission delay or cancellation of the flight resulting from mechanical problems, weather, or a significant
deterioration in the health status of one or more patients.
12. Should there be a delay after the AEC has received the patients; consideration should be made to get
patients to a hardened facility. During this time all patients will still be under the care of the AEC. The rule of
thumb is:
a. if more then 1 hour, ambulatory patients should be taken to a holding area (i.e. airport waiting area,
nearby clinic, etc.); and
b. if more then 3 hours, litter patients should also be taken from the aircraft, possibly back to their
originating facility (depending on travel time and transport factors).
REFUSING RESPONSIBILITY FOR A PATIENT
13. The MCD can refuse responsibility for any patient that cannot be safely transported with a validated
reason. These reasons could include:
a. deterioration of health status;
b. unexpected/unanticipated health condition;
c. insufficient patient preparation for flight;
d. insufficient equipment and/or supplies;
e. insufficient crew numbers and/or expertise; and/or
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f. aircraft issues such as inability to maintain altitude restrictions.
14. When refusing responsibility for a patient, the MCD will contact the AECO to assist with problem
solving and coordination of additional resources. If the patient’s health status is in question, a flight surgeon
should also be contacted to:
a. make decisions about the patient’s fitness and preparation to fly;
b. provide additional orders if new and/or unexpected problems were identified;
c. reassess the patient if possible; and
d. determine whether the F Surg or another physician should accompany the flight.
15. All activities and decisions related to refusing responsibility for a patient will be documented on the
Patient Care Report (PCR) and on the RPE.
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B-MD-005-000/FP-001
SECTION 9
EMPLANING AND DEPLANING PRINCIPLES
GENERAL
1. The emplaning and deplaning phases of an aeromedical evacuation flight can be hazardous for both
patients and AECMs due to environmental and patient factors. AE may take place during the night and in
inclement weather. Patients can be awkward and heavy to carry especially if medical equipment is loaded
on the same litter. Ambulatory patients also require attention when emplaning and deplaning to ensure they
board the aircraft safely.
LITTER PATIENTS
2. General Principles. When litter patients are transported on aeromedical evacuation flights, the
following general principles are adhered to for emplaning and deplaning:
a. a minimum of two litter straps are used to secure a patient to a litter;
b. litter patients are carried on and off the plane and secured into the litter support system with their
feet facing the flight deck. Some patients may be transported head first depending on the medical
condition. This is at the discretion of the F Surg or MSTMs with the concurrence of the MCD;
c. an off-load plan is prepared for flights involving large numbers of litters, or those with multiple
destinations, so that patients being off-loaded first are placed appropriately;
d. seriously ill patients are emplaned last and deplaned first to minimize the time spent onboard the
aircraft and to reduce the possibility of transfer delays; and
e. spotters must be utilized if ramp extenders are not in place or not adjacent to each other (CC130/
CC177).
3. The number of litter bearers used is at the discretion of the AECMs, provided the carries are done
safely. It is recommended to use a four-person carry when:
a. the weather is inclement;
b. the litter is carried over long distances;
c. the litter is heavy and/or there is multiple equipment in use;
d. the patient is emplaned or deplaned on a commercial ambulance stretcher;
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e. the H-tank oxygen cylinder is emplaned or deplaned; and
f. a three- or four-person carry will be used for a patient emplaned or deplaned with the NATO Backrest
at a 30 degree angle (litter patients will not be emplaned or deplaned with a backrest at a 90 degree
angle).
4. A four-person lift will also be used whenever AECMs are lifting an occupied litter above the waist.
AMBULATORY PATIENTS
5. Ambulatory patients must be protected from injury when emplaning or deplaning from an aircraft.
The area in and around the aircraft can present many hazards and the patient may be unfamiliar with the
layout of the cabin particularly if a tactical aircraft is used. Patients in lower limb casts or stabilizing devices
must be assisted on and off the aircraft. Use of canes and/or crutches is at the MCD discretion as these
aides may make the patient unstable and therefore jeopardize her/his safety. At the MCD’s discretion these
patients could be emplaned/deplaned on a litter to improve safety. Children may be carried on and off the
aircraft but are secured for take-off, landing, and during flight into a seat or on an adult’s lap by the method
described in this Chapter, Section 6, paragraph 6e.
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SECTION 10
DOCUMENTATION
GENERAL
1. The purpose of documentation used in the Aeromedical Evacuation system is to facilitate the
movement of patients through the system in a rapid, orderly manner, ensure the continuity of care,
and provide the reporting and recording of pertinent medical data. Records also provide statistical and
operational data. From this data, the requirements for the aircraft type are determined; the required
numbers of medical personnel are identified; and budget requirements for the system are forecast.
2. Documentation arising from an Aeromedical Evacuation mission has been divided into two
categories: mission documentation and patient documentation.
MISSION DOCUMENTATION
OVERVIEW
3. Mission documentation may include the K1017 Flight Authorization and Record of Flight, the DND
417 Log Book, the Core Environmental Allowance form, and the Report of Patients Evacuated by Air (RPE).
K1017 FLIGHT AUTHORIZATION AND RECORD OF FLIGHT
4. General information about the K1017:
a. it is the responsibility of the aircraft navigator or first officer to complete a K1017 for every mission
flown. The K1017 is stored in the Squadron Operations section;
b. information found on the K1017 includes the type of flight, its date(s), its destination(s), and the
timings of each leg. The K1017 is important to AECMs because it signifies the approving authority
for the flight and verifies which AECM flew and for how long. For these reasons, the MCD should
confirm that the service number (SN) and biographical data of each AECM is correct. The K1017
number is recorded on the RPE, and the DND 417 Logbook; and
c. it should be noted that not all aircraft will use the K1017. In the event there is no K1017, local
procedures will be followed when completing mission administration.
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Figure 5-10-1 K1017 Form
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B-MD-005-000/FP-001
DND 417 LOG BOOK
5. AECMs document each flight in their personal DND 417 Logbook and complete according to
1 Cdn Air Div Orders, Vol 2, 2-002, Annex B, Logging and Recording of Flying Time. Information to
be recorded includes the date(s) of the flight, the aircraft type and tail number, name of the aircraft
commander, mission type, the total flying hours, and any significant details regarding the mission. It is
suggested that the K1017 number be documented as well. The flying hours on each page of the logbook
are totaled so they can be brought forward to the next page.
6. The log books are certified by the unit AESO quarterly and in designated flying units the log books
are certified monthly. Log books will also be certified on posting.
Figure 5-10-2 DND 417 Flying Log Sheet
CORE ENVIRONMENTAL ALLOWANCE
7. AECMs shall submit a claim for casual aircrew allowance in accordance with 1 Cdn Air Div Orders
Vol 1, 1-280, CORE ENVIRONMENTAL ALLOWANCE FOR HEALTH SERVICES PERSONNEL. Personnel in
designated aircrew positions shall receive continuous allowance IAW 1 Cdn Air Div Orders Vol 1, 1-247
AIRCREW ALLOWANCE and will not be required to fill out this form.
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8. To complete:
a. Part A Member Information requires the member’s SN, Rank, Surname (last), First name with
Initials, and their unit.
b. Part B Entitlement determines either continuous or casual allowance, to be circled and signed by
the member.
c. Part C Unit authorization details start date, cease date and the total number of days in that month
that the member flew.
d. Part C will generally be completed by the aeromed unit’s AESO to attest that the member did fly on
the days shown on the form.
e. Part D and E are completed by the member’s Orderly Room.
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Figure 5-10-3 Core Environmental Allowance
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DND 883 REPORT OF PATIENTS EVACUATED BY AIR (RPE)
9. An official copy of the RPE is located on the TRSET website. The RPE shall be completed within 7
days of mission completion as follows:
a. mission date is the first date flown;
b. mission details:
(1) aircraft details include the type of airframe flown on (CC130, CC150, etc), the aircraft’s tail
number and the K1017 number used for that portion of the mission. If the mission flies over
multiple days on different aircraft with various cabin crews this section could have several
entries; and
(2) AEC details list each crewmember’s last 3 digits of their SN, their rank and name in the
corresponding line;
c. mission itinerary:
(1) arrival/depart times and place section shows the mission’s complete itinerary. Depart time
starts when the team takes off from their home Wing to start their mission. The mission is
completed when the AEC returns to their home Wing. Include the UTC time factor in the same
line as Place for the location mentioned (the number of hours ahead of or behind GMT);
(2) times lists the total time in flight for each leg as well as the ground times between each sortie.
These timings should be to a single decimal point using the Computation of Flying Time table
2-003, B-1 in 1 Cdn Air Div Orders, Vol 2, 2-002, Annex B Logging and Recording of
Flying Time;
(3) patient loads details the number of litter and/or ambulatory patients that are on board the
aircraft when you depart that particular location; and
(4) total hours are the sum of the mission itinerary hours. The total time that the AECMs were
away from their home Wing;
d. patient details include patient information including the patient’s last 3 digits of their SN, rank, last
name, their classification while in the AE system (i.e. 1A, 2B, etc), their patient priority, the patient’s
home base, whether they required a Remain Over Night station, and the patient’s Destination
Facility. Do not include any ICD codes on this form as any patient specifics like diagnosis will be
sent via encoded email.
e. problems encountered/action taken are unexpected challenges that occurred during the mission.
This does not include patient condition changes unless it directly affected the mission. If patient
condition does cause a mission irregularity then state that the patient conditioned changed, and
how it affected the mission. State what action was taken to deal with the problem encountered.
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f. signature section details who each patient was handed over to. If there are multiple legs, multiple
entries are required.
Figure 5-10-4 Report of Patients Evacuated by Air (RPE)
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PATIENT DOCUMENTATION
OVERVIEW
10. Patient documentation may be the only method of communication between medical facilities caring
for the patient, so it must accurately reflect the complaints, symptoms, medications, and care the patient
received enroute. Electronic charting and the Canadian Forces Health Information System (CFHIS) will be
used when appropriate hardware and software are available.
11. Patient documentation includes the CF 2048 Patient Evacuation (PE) Tag, Patient Care Report and
DND 728 Document Transit and Receipt as well as others that can be used to record patient data throughout
the flight such as intake and output records, neurological nursing records and in flight nursing care plans.
The latter forms will not be discussed, as completion of these remains the same whether in the air or at a
static facility. These documents should remain with the patient as part of their medical chart.
ELECTRONIC CHARTING SOPs
12. The MCD shall assign each patient’s flash drive to a care provider.
13. In flight charting shall be done by typing clinical notes and flow sheets on the available laptops and
saved on the patient’s flash drive.
14. Two (2) copies of the patient’s clinical notes shall be printed out PRIOR to landing. Each care provider
who has made an entry into the patient’s medical record SHALL sign their respective notes and entries.
15. One (1) copy shall accompany the patient to the admitting hospital.
16. One (1) copy shall be given to the accepting GDMO who shall give it to his/her local CFHS Health
Records Section to be scanned into CFHIS.
17. The MCD shall collect the patient flash drives at the end of the mission and store them IAW current
standards used for the paper copies. The MCD shall delete the information from the flash drive once she/he
has confirmed that the information has been properly scanned into the patient’s CFHIS file by the receiving
Clinic.
NOTE
There is no longer a requirement to send a paper copy of the patient’s AE
chart along with the post mission report to the 1 Cdn Air Div Surg since this
information is available to in CFHIS.

18. AE charting can be done electronically using currently available software and hardware.
18. This will improve patient safety by ensuring that all charting is typed and legible.
20. These notes will be scanned into CFHIS at the receiving CFHS Clinic so they are secure and available
for ongoing patient care.
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CF 2048 PATIENT EVACUATION (PE) TAG
21. The PE Tag is a NATO document.
22. Once initiated, the PE Tag is “Protected B” and must be labeled as such as well as handled and
stored properly throughout the flight.
23. The PE Tag will be initiated by the OMF (if military) for each AE patient. If a patient is being evacuated
from a civilian MTF, complete a PE Tag prior to picking up the patient, or start one upon receipt of the patient.
24. The completed PE tag is a legal medical document and will become part of the patient’s CF 2034
(Medical Record).
25. The PE Tag must be reviewed and signed by a medical officer every 24 hours and/or after each RON.
If the AEC is unable to see a MO while on the road, calling the appropriate F Surg to get a “verbal order” that
continuance of the flight is necessary for the patient’s well-being. This will be documented on the PE Tag as
well as the RPE.
26. Completion of the front (refer to Figure 5-10-5):
a. name, rank, service number, armed forces the member belongs to;
b. evacuation unit – unit individual is being evacuated from;
c. age, priority, classification – self explanatory;
d. diagnosis & surgical procedures:
(1) write out all diagnosis(es), and
(2) include dates with surgical procedures applicable to the diagnosis;
e. category:
(1) check ONE at top line,
(2) check either lying (litter) or sitting (ambulatory),
(3) check isolation or observation if required;
f. medical orders/diet – completed by medical officer or equivalent at OMF and signed;
g. destination – DMF;
h. ship/cabin berth – not applicable for AE;
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j. aircraft tail number & type, i.e. CC130 – 465; and
k. tier litter number – actual litter position on aircraft, ie. G-3.
27. Completion of treatment and progress report (back) (refer to Figure 5-10-6):
a. name, service number – self-explanatory, and must be completed; and
b. time:
(1) all entries must be annotated in both ZULU (Z) and destination LOCAL (L),
(2) date can be written at top or in front of each entry, i.e.
21 1000 EST (L)

21 1500 Z
NOTE
If destination changes, cross out local time with a single red line and put new local time:
21 0900 CST (L)

21 1000 EST
21 1500 Z
28. Notes: Clear, concise and only what is required. Minimal charting to include:
a. emplaning note – provides a baseline for all in flight charting;
b. in flight notes:
(1) changes in condition,
(2) treatments provided, and
(3) medications given;
c. deplaning note – summarizes condition on deplaning and how well patient tolerated flight.
29. If more room is required, either another PE Tag can be used, or another piece of paper, however, the
name, service number and Protected B must be clearly visible and documented on the attachment. It must
also be stapled or affixed to the initial PE Tag to ensure it becomes part of the patient’s chart.
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Figure 5-10-5 CF 2048 PE Tag
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CF 2048A PATIENT CARE REPORT (PCR)
30. Figure 5-10-6 is the Patient Care Report utilized on day-to-day AE missions. It may be filled out by
hand or electronically. All pages require physician and/or AECM signatures.
31. The completed PCR is a legal medical document and will become part of the patient’s CF2034
(Medical Record). The PCR will be scanned into CFHIS at the end of each mission.
32. The PCR must be reviewed and signed by a medical officer or equivalent every 24 hours and/or
after each RON.
33. The PCR is “Protected B” and must be handled and stored properly throughout the flight.
34. Minimal charting to include:
a. emplaning note – provides a baseline for all in flight charting;
b. in flight notes:
(1) changes in condition,
(2) treatments provided, and
(3) medications given;
c. deplaning note – patient condition and how patient tolerated flight.
35. All entries must be annotated in both ZULU & destination LOCAL.
36. Date can be written at top or in front of each entry.
37. Distribution of copies as follows:
a. one copy is returned to the AE unit for AESO to check. It is then scanned into CFHIS; and
b. a second copy goes with the patient to the DMF.
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Figure 5-10-6 CF 2048A Patient Care Report – Sheet 1 of 6
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Figure 5-10-6 Sheet 2 of 6
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DND 728 DOCUMENT TRANSIT FORM
38. DND 728s are used to control/track the medical documents (CF2034, X-Rays, etc), medications and
baggage of patients evacuated by air.
39. This document is to be initiated by the OMF but in the event this is not done it should be initiated by
the MCD at the flightline.
40. DND 728s are in triplicate and are distributed as follows:
a. White/first copy (stapled to RPE and given to the unit AESO);
b. Yellow/second copy (given to the person receiving the handover); and
c. Pink/third copy (given to the person receiving the handover to be returned to the AE unit when
equipment is eventually returned).
41. Ensure they are addressed to the destination hospital; classification is designated and labeled
protected. Ensure all documents listed are those which have been received, and annotate as received at the
flightline including the mission number. The destination signature will be that of the person receiving the
documents at the termination of the mission.
42. Handover at destination facility will include having them sign that the documents have been
received, and the MCD will retain the white copy to forward with the RPE to the AECO. This will ensure that
all individuals involved in the transfer have a copy and can track where the documents have gone.
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Figure 5-10-7 DND 728 Document Transit Form
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SECTION 11
MEDICAL-LEGAL
GENERAL
1. Knowledge of legal principles is important for AECMs. AECMs are placed in a unique environment
where immediate access to consultation is not available. All AECMs should be thoroughly familiar with the
legal aspects of patient care with respect to AE operations. Further, detailed information on any specific
area, or individual cases, should be obtained from the Judge Advocate General’s Department.
PATIENT PROPERTY
2. AECMs have the duty to safeguard and take precautions that personal property will not be lost,
stolen, damaged, or destroyed.
3. Where possible, valuables should be turned over to the patient’s NOK or sent via registered mail to
the DMF. NATO instructions state all AECMs are responsible for patient belongings if loaded on the plane.
Luggage concerns are to be dealt with IAW 1 Cdn Air Div Orders Vol 3, 3-204, Security Airhead. If there
is no other person to take the valuables, AECMs will take personal valuables ensuring that a DND 728 is
completed and signed.
ANTI-HIJACKING PRECAUTIONS
4. The CF Air Mov Sqns/Sects will conduct pre-flight screenings measures. When there are no Air Mov
personnel, AECMs shall ensure that all patients under their care undergo screening to ensure that prohibited
items IAW 1 Cdn Air Div Orders, Vol 3, 3-204 Annex A Passenger Articles Not Allowed Aboard
Military Aircraft Or In Secure Passenger Areas are not permitted into secure passenger areas.
5. Items that are not permitted in carry-on luggage include, but are not limited to, the following:
a. strike anywhere matches;
b. flammable liquids and flammable aerosols except for medical and toiletry articles such as deodorant
spray, hair spray, insect repellent, shaving cream etc.;
c. explosives, including fireworks, flares etc;
d. any sharp pointed object or an instrument that can cut slice or puncture including knives, blades, or
multi tools (i.e. LeathermanTM and GerberTM etc);
e. firearms (unless a stated and approved operational or exercise requirement exists);
f. replica or antique weapons; and
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g. sports equipment that could be used as a weapon such as golf clubs, tennis racquets, ice skates,
baseball bats, etc.
6. Consult B-GA-007-001/AF-001 MANUAL OF AIR MOVEMENTS ORGANIZATION AND OPERATING

PROCEDURES Chapter 3 Annex A.
RESTRAINT OF PATIENTS In flight
7. AECMs are authorized to take any action felt necessary for the safety and well-being of the patient
or others. AECMs and MSTMs are to utilize all possible therapeutic measures before restraints are used
within the context of flight safety and patient safety. Restraint of the patient is justified and required if
aircraft operation is jeopardized or if the patient is a danger to themselves or others.
8. Severely mentally ill or 1A or 1B classification should be accompanied by MH professional. The

MH MSTM has the skill set for routine and emergency care of MH patients on the ground or in the air. The
MH MSTM will be responsible for direct patient care to the limits of their Scope of Practice during the AE
(including assistance in application of restraints and observation) and will ensure the MCD is advised and
aware of patient issues.
9. Once the restraints are applied, they must remain on for the remainder of the flight. Should an
aircraft emergency situation arise, removal of the restraints is left at the discretion and judgement of the
AECMs and the MCD.
IMMIGRATION AND CUSTOMS
10. All immigration and customs documentation must be completed prior to landing in a foreign nation
or returning to Canada.
11. Individual parties are responsible for their own actions and that these do not jeopardize any other
crewmember. If an AECM knows or has reason to believe that the patient is in possession of illegal items,
it is that crewmember’s duty to report the facts to the appropriate authority whether that is Customs and
Immigration authorities or the AC. This is the same duty imposed on any other person. AECMs should make
every effort to resolve these issues with either the member or the AC before the arrival of Customs officials.
12. AECMs will not sign a “Customs Declarations” for any patient. For those patients unable to sign (i.e.
unconscious), AECMs will annotate “patient unable to sign” and notify the Customs Officer. The personal
luggage may be impounded until patient, legal guardian or NOK can sign. Customs officers may allow for a
small hygiene kit to accompany patients to the MTF.
PATIENT REFUSING TO COMPLETE AN AEROMEDICAL EVACUATION
13. In the event of a patient refusing to complete an AE flight, the MCD is not required to take independent
action and should request and obtain assistance from the AECO. Refusing flight and refusing treatment are
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two separate issues. The AECO will advise on how to proceed and notify the various chains-of-command. It
will need to be determined if the patient is competent to make this informed decision.
14. The situation should be carefully documented on the report of patient evacuation (RPE). As well, an
after action report shall be forwarded to the AE PM within 48 hours of returning to home unit.
15. CF H Svcs Gp Policy and Guidance 4030-57 Consent to Medical Treatment deals with the patient’s
right to refuse care. This policy should be followed when a patient refuses to complete an aeromedical
evacuation.
16. The Courts have repeatedly reaffirmed the patient’s right to refuse treatment even when it is clear
that such treatment is necessary to preserve health or life of the patient. In the same way as valid consent
to treatment must be informed, so it may be argued a refusal must be similarly informed. Patients must be
informed of the consequences to their health and to their military careers of leaving the ailment untreated.
Any discussion about treatment decisions must be conducted with sensitivity. Notes should be made
about a patient’s refusal to accept recommended treatment. Form CF 2029 Declaration of Release from
Responsibility must be used to record the reasons for, and circumstances surrounding, refusal of treatment.
UNCONSCIOUS, INCOMPETENT OR UNDERAGE PATIENTS
17. Patients unable to sign for their own consent for care should be accompanied by their legal guardian
and if this is not possible, consideration should be given to obtaining consents for care by the OMF. The
MCD reviews the accompanying paperwork (such as consents for care) for completeness prior to flight.
18. CF H Svcs Gp Policy and Guidance 4030-57 Consent to Medical Treatment should be used as a
guide in these circumstances and form CF 2010 Consent to Investigate, Operative or Treatment Procedures
should be filled in appropriately.
MILITARY PATIENTS ABSENT WITHOUT AUTHORIZED LEAVE (AWOL) ENROUTE
19. Should a military patient go missing at an enroute stop when the flight is ready to continue; AECMs
should check the terminal first. The MCD should notify the airport/station authorities, the AC and the AECO.
The AECO will notify the receiving MO/physician at the DMF.
20. In the event that the member is not located, AECMs will resume their mission. If the terminal is
a military facility, the military police and the medical personnel of the base will be notified. AECMs will
deplane the patient's record and baggage to responsible medical personnel and receive a DND 728 or other
acceptable documentation to verify release of the patient’s items. Checked baggage of persons not on board
will not be transported on aircraft as per 1 Cdn Air Div Orders Vol 3, 3-204 para 13, Security Airhead.
21. If the terminal is a civilian installation, consult with the AC to determine the preferred procedure and
notify the AECO. Documentation will be packaged and sent to member’s unit upon the AEC returning to their
unit; patient possessions to be off-loaded as above.
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22. The MCD must ensure that the PCR tag is completed and annotated of the patient’s absence. A
report of the incident will be completed and forwarded with the RPE to AE PM/AECO, CF Aerospace HSS
Squadron.
TRANSFERRING PRISONERS
23. Prisoners may be transferred for medical problems. Prisoners must have non-medical escort(s).
Escort(s) may or may not be representatives of the Military Police, depending on the criminal charges laid
against the prisoner.
24. It is important for AECMs to receive a proper briefing on the prisoner to enable the MCD to brief the
AC. AECMs are never to sign any documentation nor take responsibility for a patient prisoner other than
for medical treatment. The MCD will ensure the escort(s) understands their responsibility to accompany the
prisoner all the way to the DMF.
25. Coordination is required between the AECO, MCD, AC and military/civilian police escorts regarding
the most recent regulation regarding the possession of weapons on an aircraft. Guidance may be derived
from 1 Cdn Air Div Orders Vol 3, 3-107 TRANSFER OF FEDERAL PRISION INMATES and Vol 3, 3-109
CARRIAGE OF DANGEROUS GOODS.
26. While handcuffs may be used while in flight, a prisoner will never be restrained directly to any part
of the aircraft.
DEATH IN FLIGHT
27. In the event of a “cessation of vital signs,” AECMs will follow the ABCs of assessment and attempt
to resuscitate the patient. Standard life support measures in accordance with the caregiver’s scope of
practice will be undertaken (including for example effective Cardiopulmonary Resuscitation (CPR), airway
support, intravenous access, medications, transcutaneous pacing, and rhythm monitoring). Resuscitation
efforts will be continued unless the patient is in asystole or pulseless electrical activity (PEA), and
REMAINS SO persistently, patient is unresponsive to resuscitative efforts, for at least twenty (20) minutes
while resuscitative efforts continue, if providers become physically unable to continue or medications and
supplies are depleted.
28. Should the resuscitation effort be ineffective, AECMs will inform the AC that vital signs are absent
(VSA). The AC may elect to continue the mission as scheduled or divert to a destination capable of handling
the patient/deceased. Generally the flight will continue to its intended destination. When flying an overseas
mission, every effort should be made to land at the nearest NATO military facility. The AECO should also
be contacted as soon as possible. In other countries, the Canadian Embassy or their representatives will be
contacted by the AECO for instruction and assistance.
29. It is imperative to understand why a patient “does not die in flight”. The patient cannot be declared
dead without the presence of a medical officer/physician. Should there be a physician onboard; the patient
will be declared dead only once the aircraft has landed. The reason is that in the event of a death in flight,
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the aircraft will be “impounded” for the duration of the investigation normally conducted by the coroner.
Such a delay could have repercussions on the aircraft and aircrew’s availability for other missions. If the
aircraft is the possible cause of the patient’s death then the AC should make the call whether to impound
the aircraft at the off-load station.
30. In the case of a “DO NOT RESUSCITATE” (DNR) order, the AECO will notify the MCD and obtain the
necessary DNR documentation and orders signed by the patient or a legal guardian and a MO or civilian
physician. Individualized DNR orders will be documented on the PCR as an order and co-signed by the F
Surg. The MCD will brief the AC and AECMs.
31. The MCD will be responsible to maintain accurate records for official reports. The nursing notes
record the efforts in resuscitation and time of “cessation vital signs” shall be completed on the PCR and the
RPE. The MCD will request that a medical officer and/or coroner, ambulance and chaplain meet the aircraft.
The physician meeting the aircraft will be provided with complete details for the preparation of a death
certificate including name, rank, diagnosis, suspected cause of death (if known), date and estimated time of
death, planned itinerary (OMF to DMF), and whether a F Surg or other physician was on the aircraft at the
time of death.
32. Once the patient has been pronounced dead, the MCD will complete the records, and obtain the
name, rank, and SN of the medical officer for documentation on the RPE. If a physician cannot meet the
aircraft, AECMs may be required to accompany the body to the MTF. It will be necessary to notify the
coroner who will, in turn, request that reports be prepared as required in that area. The AECO can assist
with this. All of the deceased’s belongings will be off-loaded with the body and a receipt should be obtained
(DND 728).
33. The MCD will notify the AECO, who will inform the DMF and the OMF and others. Current regulations
and local policies determine who else should be notified by AECO. Information for the AECO will include the
patient’s name, rank, SN, and all the information pertaining to the place where the deceased was off-loaded.
AECMs must maintain a complete and accurate record of the entire situation so all necessary information
for recording in official reports will be available.
34. The immediate nursing care before and after death will follow the principles of physical and spiritual
support similar to what is done in any health care facility. It is necessary to ensure that the body is clean
and in correct alignment, then covered with a clean sheet. Any catheter (intravenous, nasogastric or other)
should be left in place until an examination has been conducted by the coroner. The manner in which a
deceased patient is carried during the remainder of the flight should be discussed with the AC and cabin
crew, for example, it may or may not be advisable to move the deceased to another part of the aircraft.
REMAINING OVERNIGHT
SCHEDULED REMAIN OVERNIGHT
35. In the AE itinerary, there may be instances where a scheduled stop (remain overnight or RON) is
required to accommodate distance, crew duty and/or refuelling stops. The AECO usually coordinates all
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requirements and ensures the patient has a bed in an appropriate facility for overnight care. Before leaving
the aircraft, the AC has the responsibility to secure quarters for crew and coordinate take-off time for the
next day. The duties of the AECMs after the RON are the same as for any mission day.
36. Although it is the responsibility of the AECO to pre-arrange a RON, AECMs are responsible to ensure
the facility is adequate for the patient(s) overnight. Should a facility be deemed unacceptable the MCD will
immediately contact the AECO to determine the next plan of action. The patient(s) should be briefed about
the MTF stay. The MCD is responsible to ensure AECMs accompany the patient(s) to the overnight facility,
chart on the PCR, and give report to the ward receiving the patient(s) and sign over required records,
medications, or equipment.
37. Special diets and supplies (if required) should be ordered before leaving the hospital to allow for
the facility to prepare for the next day. AECMs are responsible to secure drugs and narcotics at the hospital
pharmacy and equipment in a secured area if charging is required for the batteries.

38. The ward should also be informed of the aircraft estimated time of departure the next day. In most
cases, transport (military or civilian ambulance) will have been pre-arranged by AECO, but AECMs are
responsible to go to the facility the next day and obtain an updated patient status report. The entire team
may not be required at the MTF. At least one AECM should report directly to the aircraft in order to
accomplish a pre-flight of the equipment.
UNSCHEDULED REMAIN OVERNIGHT
39. A change in weather, patient condition, or some aircraft mechanical difficulty may necessitate an
unscheduled stop. If there is not a military hospital at the stop where remaining overnight or emergency
landing is made, civilian facilities will be utilised.
40. For all unscheduled RONs, AECMs should contact AECO for further instructions. To RON with
patients at a civilian MTF is a last resort and is done only when no military accommodations are available.
The MCD will notify the AECO, the OMF and DMF. The AECO may assist the MCD in notifying the specific
MTFs.
41. Accommodating unexpected patients may impose a hardship on any MTF, especially a small one.
If the MTF staff is unable to provide the additional nursing care required AECMs will augment MTF staff to
maintain patient care. This will interfere with proper crew rest and will likely affect the continuation of the
mission. The situation should be evaluated liaising with the AC and AECO.
42. The AC is responsible for securing quarters for the crew and for coordinating take-off time. The MCD
will inform the patients of the reasons for the delay, the estimated time of delay, arrangements made for
their housing, and the departure time. During unscheduled RON, the AECMs duties are the same as for a
scheduled RON.
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ANNEX 5A
DEPENDENCY AND COMPOSITION OF AEROMEDICAL CREWS
1. AECs will consist of flight nurses and/or medical technicians specially trained in aeromedical
evacuation duties, supplemented where necessary by medical officers and other ancillary medical personnel.
AECMs are, whenever possible, to fly as constituted crews and are to be trained on all medically relevant
aspects of the aircraft type on which they are to operate.
2. There are four levels of dependency which are described below:
a. level 1 – High; requires intensive support during flight (i.e. ventilation, monitoring of CVP, ICP, etc,
or continuous cardiac monitoring);
b. level 2 – Medium; requires regular frequent monitoring for a condition that may deteriorate in flight
(i.e. oxygen administration, one or more IVs, multiple drains and/or catheters, etc.);
c. level 3 – Low; condition that is not expected to deteriorate in flight but requires some nursing care
(i.e. simple nursing care similar to a general hospital ward); and
d. level 4 – Minimal; minimal nursing care but may require assistance with mobility or bodily functions.
3. The recommended minimum scale for staffing aeromedical crews for Dependency 4 patients and
excluding Class 4 patients who require no escorts is:
a. 1-10 patients – 1 AECM;
b. 11-20 patients – 2 AECMs (if possible one should be a nurse);
c. 21-40 patients – 3 AECMs (if possible at least one should be a nurse); and
d. 41-60 patients – 4 AECMs (if possible at least two should be nurses).
4. Additional requirements are:
a. for Dependency 1 patients the AEC shall include:
(1) for 1 or 2 patients: a physician trained in intensive care medicine and who has received training
in aviation medicine;
(2) for 3 or 4 patients: a physician trained in intensive care medicine and an additional physician,
at least one of whom has received training in aviation medicine;
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(3) for each patient: a nurse trained in intensive care nursing; and
(4) a technician competent to maintain aeromedical life support equipment.
b. for Dependency 2 patients the AEC shall include:
(1) a physician trained in aviation medicine; and
(2) for up to 10 patients and for each additional 10 patients: a flight nurse and a FMT.
c. for Dependency 3 patients the AEC shall include a flight nurse.
5. Additional trained medical personnel may be assigned when, in the opinion of the dispatching
medical officer, the condition of any of the patients warrants this.
6. For more information, refer to STANAG 3204 (7th Edition), Annex D.
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ANNEX 5B
PATIENT POSITIONING AND LOAD PLANNING
SECTION 1
CC130 E/H PATIENT POSITIONING AND LOAD PLANNING FORM
USE OF THE FORM
1. This load planning form was made specifically for the non-extended, stubby or legacy CC130. It was
created with assistance of the CC130 LM TRSET section with the intent that the form would reduce confusion
by being immediately recognizable to both LM and AEC positions.
FORM CONTENT
2. The lined boxes to the left and right of the aircraft frame are intended for dual use by either indicating
placement of ambulatory or litter patients. Should the sidewall seats be used instead of the sidewall litter
positions then patients could be placed in positions L1 through L15 or R1 through R15. L indicates left side
and R indicated right side placement. Should the sidewall litter positions be used, patients will be placed
in the bolded boxes that indicate those litter tiers (i.e., C, D, I, L, M or P) and the extra “seats” would be
ignored (seats at positions L5, L6, L11, R5, R6, and R11).
NOTE
Some positions in the sidewall litter tiers are currently being taken up by
survival equipment and cannot be used for patients. Check with LM to see
which are usable if those positions are needed.
3. Centre line litter tiers are also indicated by the letters A, B, E, F, G, H, J, K, N, and O.
NOTE
On aircraft 338-342 some of the bars for attaching patient hanging straps are
missing making tiers E and G unusable for litter patient placement.
4. The numbers down the centre of the tiers indicate which position in a tier a patient is placed in. The
#1 indicates the top position and the #5 indicates the lowest position.
5. Another important symbol is the small circle with an “X” through it to indicate the location of an
electrical outlet. This is intended to help the AEC to better plan placement of a frequency converter/electrical
cable assembly set (ECAS) or the Medevac Power Supply.
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SPECIAL PATIENT INFORMATION
6. In the bottom right corner of the CC130 E/H model Load Planning Form is a section with symbols
that can be used at the AEC’s discretion for indicating special patient types to improve crew communication.
Just add the associated symbol beside the patient’s name where they are placed on the form.
EXAMPLE
A cardiac patient is in litter tier H at the #3 position. In addition to the patient’s
name, rank, and classification a small heart would be appended either before
or after his or her demographics.
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Figure 5B-1-1 CC130 E/H Load Plan
CC130 E/H EXAMPLE
7. The following information is drawn from Figure 5B-1-1. This Figure is an example of how a Load
Plan could be drawn up.
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8. Starting with the litter positions, in tier G the diagonal line across a tier indicates that equipment is
secured to the floor on the CC130 and not placed in a litter space.
9. In tier E in the second position is patient Corporal Willis a 2B. Two litter spaces below him is a Get
Down Litter (GDL) in position four. This could be used in an emergency or if an ambulatory patient would
like to lie down.
10. In tier A in position two is the emergency equipment litter. Below that in position three is patient
Private Angle a 2A and at the bottom of the tier is the H-tank.
11. The rest of the AECMs are aligned on the right side of the aircraft starting at seat R7 with a TM,
Captain Marin. Beside Captain Marin is ambulatory patient Corporal Paul in seat R8 a 1C. Note beside
Corporal Paul’s name is the small “P” with a circle around it which is his Special Patient identifier from the
“Special Patient Information.” To Corporal Paul’s left is the MCD, Sergeant Mavin, in R9. Beside the MCD
is a Get Up Seat (GUS) for Corporal Willis, the 2B, if the patient would like to sit or if there is an emergency
and he needs to be relocated. In the last seat forward of the wheelwells is TM Lieutenant Lapointe in R11.
12. In the set of seats aft of the right wheelwell are two MSTMs co-located by their critical care patient,
Private Angle. Captain Winfrey, an MSTM is in seat R13 and Major Thomas, another MSTM is in seat R14.
EMERGENCY EGRESS ROUTES
13. Also indicated on the Load Plan are the routes of egress should there be a crash landing or ditching.
14. The crash landing route is indicated by a solid line and takes the entire AEC out of the right paradoor.
15. The ditching route is indicated on the form by a dashed line. Captain Marin (TM), Corporal Paul (1C),
Sergeant Mavin (MCD), Corporal Willis (the 2B who would be seated in the GUS at R10 prior to impact) and
Lieutenant Lapointe (TM) would all egress the aircraft through the centre overhead escape hatch. Captain
Winfrey (MSTM), Major Thomas (MSTM) and Private Angle (2A) are all slated to egress through the aft
overhead escape hatch.
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SECTION 2
CC130 H-30/J-30 PATIENT POSITIONING AND LOAD PLANNING FORM
USE OF THE FORM
1. This load planning form (Figure 5B-2-1) was made specifically for the extended or stretch CC130.
FORM CONTENT
2. The lined boxes to the left and right of the aircraft frame are intended for dual use by either indicating
placement of ambulatory or litter patients. Should the sidewall seats be used instead of the sidewall litter
positions then patients could be placed in positions L1 through L24 or R1 through R24. L indicates left side
and R indicated right side placement. Should instead the sidewall litter positions be used, patients will
be placed in the bolded boxes that indicate those litter tiers (i.e., 1, 4, 5, 8, 9, 12, 17 or 20) and the extra
“seats” would be ignored (seats at positions L5, L6, L11, L16, R5, R6, R11, and R16).
NOTE
Some positions in the sidewall litter tiers are currently being taken up by
survival equipment and cannot be used for patients. Check with LM to see
which are usable if those positions are needed.
3. Centre line litter tiers are also indicated by the numbers 2, 3, 6, 7, 10, 11, 13, 14, 15, 16, 18, 19, and
21. Litter tier 21 is rotated 90 degrees from the other tiers but for simplicity and to reduce confusion this is
not indicated on the load planning form.
4. The numbers down the centre of the tiers indicate which position in a tier a patient is placed in. The
#1 indicates the top position and the #5 indicates the bottom-most position.
5. Another important symbol is the small circle with an “X” through it to indicate placement of an
electrical outlet. This is intended to help the AEC to better plan placement of a frequency converter/ECAS
or the Medevac Power Supply.
6. On the right side of the CC130 H-30/J-30 model load planning form is a section with symbols that
can be used at the AEC’s discretion for indicating special patient types to improve crew communication.
Just add the associated symbol beside the patient’s name where they are placed on the form.
5B-2-1
B-MD-005-000/FP-001
Figure 5B-2-1 CC130 H-30/J-30 Load Plan
5B-2-2
B-MD-005-000/FP-001
CC130 H-30/J-30 EXAMPLE
7. The following information is drawn from Figure 5B-2-1.
8. In the centre of the aircraft tied down to the floor where tier 13 would be is the aeromedical evacuation
equipment. Aft of that where tier 18 would be is the H-tank secured to floor. The presence of a diagonal line
indicates items in that area are secured to the floor vice being secured in a litter position of a tier.
9. Forward on the right hand side in the Evans seats is Sergeant Mavin the MCD in seat R7. Aft of him
is Corporal Paul in R8, a 1C (note the “P” with a circle around it, this Special Patient symbol, indicates the
patient is a mental health or psychiatric patient). Seat R9 is a GUS that would be used by patient Corporal
Willis, the 2B, if he wished to sit down on in an emergency. Beside the GUS in R10 is Lieutenant Lapointe a
TM.
10. In the side wall litter tier number 9 contains the survival equipment in top position and below it in
position #3 is Corporal Willis, a 2B. In position #4 is the GDL should there be a medical emergency or if a
patient wishes to lie down. The bolded outline around tier 9 indicates that those 4 positions could be used
as a sidewall tier.
11. In sidewall litter tier 17, in position #2 is the emergency equipment and immediately below that
Private Angle the 2A.
12. In the aft-most set of Evans seats are the rest of the AEC. In seat R21 is Captain Winfrey, an MSTM.
Major Thomas another MSTM in seat R22 and Captain Marin a TM in seat R23.
13. Also indicated on the Load Plan are the routes of egress should there be a crash landing or ditching.
14. In the event of a crash all AECMs and patients would use the right paradoor. This is indicated on the
form by a solid line.
15. Should a ditching occur, Sergeant Mavin (MCD), Corporal Paul (1C), Corporal Willis (the 2B) would
be moved from the sidewall litter position to the GUS in R9, Lieutenant Lapointe (TM) would all use the
centre overhead escape hatch. Private Angle (the 2A patient would have to be removed from his position
in tier 17), Captain Winfrey (MSTM), Major Thomas (MSTM) and Captain Marin (TM) would use the aft
overhead escape hatch.
5B-2-3/5B-2-4
B-MD-005-000/FP-001
SECTION 3
CC144 PATIENT POSITIONING AND LOAD PLANNING FORM
USE OF THE FORM
1. This form (Figure 5B-3-1) is intended to be used on all models of the CC144. The top figure on
the form can be used for AE configurations 1, 2 and 4. The lower figure would be used for the AE-3
configuration. These configurations are indicated in this manual, Chapter 6, Section 5, Figures 6-5-41
to 6-5-43.
FORM CONTENT
2. The Spectrum bed configurations are indicated on the form by S1 or S2. Because the No-Lift
mechanism requires bed S1 to be in place, this Spectrum position will be in-place on all litter patient moves
on the CC144. To show which patient’s are seated in which position on the aircraft write the patient’s name,
rank and classification in the appropriate S1 or S2 litter position in the centre of the form.
3. Since the CC144 community looks at seating on the CC144 as either L1 through L4 or R1 through
R4, all seating on the form is also indicated thus to improve communication. The first row of seats at
approximately FS350 is not usually in place on AE missions. During one litter patient airlifts on the CC144
there may be a seat at the L2 position as indicated on the lower of the figures. To illustrate, if a crewmember
is seated at that L2 position, in one of the boxes in the centre of the form, write in L2 on the small space
provided to the left of the box and then write in the crewmember’s name and position in the box. If NOK is
seated in the row write in the name of the person seated there. If an ambulatory patient is in this position,
as in para 2 above, write in their name, rank and classification.
4. Row 3 can indicate not only the seat at position R3 but also the 3 seats that comprise the divan
(indicated on the form as 3a through 3c).
EXAMPLE
So if a crewmember was seated on the divan in the 3a spot then he/she would
be indicated on the form as seated in L3a in the centre boxes as described
above.
5. Also shown on the form by a small circle with an “X” in the centre are indicators for where electrical
outlets are located. This is on the form to show where equipment may be plugged in in flight. These
electrical plugs are in addition to those that are part of the Spectrum beds.
6. In the centre of the CC144 load planning form is a section with symbols that can be used at the AEC’s
discretion for indicating special patient types to improve crew communication. Just add the associated
symbol beside the patient’s name where they are placed on the form.
5B-3-1
B-MD-005-000/FP-001
Figure 5B-3-1 CC144 Load Plan
5B-3-2
B-MD-005-000/FP-001
CC144 Load Plan Example
7. The following information is drawn from Figure 5B-3-1. The configuration used in the example is the
AE-2. To reduce confusion, the unused aircraft figure at the bottom of the form has been crossed out.
8. In the Spectrum beds are both litter patients. In S1, the Spectrum bed on the right side of the CC144
is Private Angle a 2A. Since this patient is the more critical of the two he was placed in S1 as it is last loaded
and first off-loaded on this aircraft. Across from him on S2 is Corporal Willis a 2B.
9. All of the seated positions are filled with the AEC. In R3 is Lieutenant Lapointe a TM and across from
her is Sergeant Mavin the MCD in R4. Seated on the divan are the MSTMs, Captain Winfrey seated in L3a
and Major Thomas in L3b. The only open seat, L3c on the divan, could also be used as a GUS for Corporal
Willis, the 2B, in case of emergency landing.
10. In case of a crash landing the entire AEC will use the Passenger/Crew Door. This is indicated by the
solid line.
11. Should a ditching occur the entire AEC will use the Overwing Emergency Exit. This is indicated by
the dashed line.
5B-3-3/5B-3-4
B-MD-005-000/FP-001
SECTION 4
CC150 PATIENT POSITIONING AND LOAD PLANNING FORMS
USE OF THE FORM
1. The load planning forms for the CC150 were created to mirror the configurations most used by the
CF (i.e. full passenger configuration). These configurations can be found in this manual, Chapter 6, Section
3. Configurations MP-1 through MP-7 (Figures 6-3-55 to 6-3-61) are illustrated separately because of the
differences in seating for each configuration.
FORM CONTENT
2. The CC150 Spectrum bed units are indicated on the forms by S1 through S6. To show which litter
patient is placed where write the patient’s name, rank and classification in the spaces provided in the centre
of the Forms.
3. To indicate where ambulatory, crewmembers and NOK are seated, find the appropriate row
(indicated on the form by numbers 1 through 9) and seat (as indicated by seats A through K) and write the
corresponding seat on the spaces to the left of the boxes provided in the centre of the Forms. Just as the
litter patients are indicated on the form so are ambulatory by their name, rank and classification. NOK and
AEC will be indicated by name and position (i.e., MCD, TM or MSTM). The shaded seats on the forms are
there as the mirror those seats that are reserved for AEC in the various CC150 configurations. If more seats
are needed then those “reserved” on the configuration discuss it with the cabin crew during Crew Brief.
Some seats are reserved for cabin crew as indicated by the seats with the black dots.
4. Also shown on the form by a small circle with an “X” in the centre are indicators for where electrical
plugs ins are located. This is on the Form to show where equipment may be plugged in in flight. These
electrical plugs are in addition to those that are part of the Spectrum beds.
5. In the centre of all of the CC150 load planning forms is a section with symbols that can be used
at the AEC’s discretion for indicating special patient types to improve crew communication. Just add the
associated symbol beside the patient’s name where they are placed on the form.
5B-4-1
B-MD-005-000/FP-001
CC150 LOAD PLAN EXAMPLE
6. The following information is drawn from the top diagram in Figure 5B-4-1. The configuration used
in the example is the MP-5. To reduce confusion, the unused aircraft at the bottom of the form has been
crossed out.
5B-4-2
B-MD-005-000/FP-001
7. The first Spectrum bed, S2, is currently being used as a GDL should a medical emergency occur or
if Corporal Paul, the 1C, wishes to lie down. S1 is currently occupied by Corporal Willis, the 2B, and S3 is
occupied by Private Angle, a 2A. S4 is also not occupied. The “n/a” in the S5 position indicates that the bed
is unused on this Load Plan.
8. In row 3 is Corporal Paul in 3K (note beside his name is the “P” with a circle around it, the Special
Patient identifier for mental health patients). Beside him is the MCD, Sergeant Mavin, in 3J. In row 4 are
both MSTMs Captain Winfrey in 4D and Major Thomas in 4E. Also in row 4 is the GUS at 4J for Corporal
Willis, the 2B. Behind the MSTMs in row 5 are Lieutenant Lapointe in 5D and Captain Marin in 5E; both are
working as TMs on this mission.
9. Should a crash landing occur, Sergeant Mavin (MCD), Corporal Paul (1C) and Corporal Willis (the 2B
would be seated at seat 4J prior to impact) will all exit through the forward right Passenger Door (also called
1R by the cabin crew). Captain Winfrey (MSTM), Major Thomas (MSTM), Lieutenant Lapointe (TM), Captain
Marin (TM) and Private Angle (2A) will exit through the left forward Passenger Door (the 1L door). This is
indicated on the form by a solid line.
10. In a ditching, the same egress routes will be used as in para 9 above. The ditching route is indicated
on the form by a dashed line.
5B-4-3/5B-4-4
B-MD-005-000/FP-001
SECTION 5
CC177 PATIENT POSITIONING AND LOAD PLANNING FORM
USE OF THE FORM
1. This form (Figure 5B-5-1) is indicated for use on all Canadian Forces CC177s. There are two
configurations used on the CC177 which are illustrated in this manual, Chapter 6, Section 4, paragraphs 69
to 73.
FORM CONTENT
2. AE-1 (Figure 5B-5-1) uses those 3 litter stations that are built into the walls of the aircraft. Those
positions are generally set up in those positions that are indicated by tiers G, I, and K because of the
placement of the therapeutic oxygen connectors in the right wall of the aircraft. These positions are the
bolded tiers on the form. Placement of the tiers can either be close to the centre line (allowing use of the
seats on the side walls) or nearly flush with the aircraft walls (allowing for more space in the centre but
making the seats in that area of the side wall unusable).
3. The AE-2 configuration will be built using the Litter Station Augmentation Set. This allows for the
use of the full 12 litter stations. Thus tiers A through F, H, J, and L could be used.
4. The numbers down the centre of the tiers indicate which position in a tier a patient is placed in.
The #1 indicates the top position and the #3 indicates the lowest position.
5. Sidewall seats are indicated on the form by the small boxes in Figure 5B-5-1 that are numbered 1
through 27. These seats correspond to the boxes outside of the airframe in Figure 5B-5-1 that are numbered
L1 through L27 and R1 through R27. L indicates left side and R indicated right side placement.
6. Another important symbol is the small circle with an “X” through it to indicate placement of an
electrical outlet. This is intended to help the AEC to better plan placement of a frequency converter and
ECAS.
7. In the bottom right corner of the CC177 load planning form is a section with symbols that can be
used at the AEC’s discretion for indicating special patient types to improve crew communication. Just add
the associated symbol beside the patient’s name where they are placed on the form.
5B-5-1
B-MD-005-000/FP-001
CC177 LOAD PLAN EXAMPLE
8. The following information is drawn from Figure 5B-5-1. The configuration used in the example is
the AE-1.
5B-5-2
B-MD-005-000/FP-001
9. In the upper litter position #1 in tier K is the emergency equipment. Below the equipment in position
#2 is patient Private Angle, a 2A. In tier I #2 position, is Corporal Willis, a 2B, and below him is the GDL. This
GDL could be used in a medical emergency or if Corporal Paul, the 1C, wished to lie down. In the area where
tier G would be set up is the AEC’s equipment. As indicated by the diagonal line, the equipment is tied to
the floor and not secured in a tier.
NOTE
The placement of the tiers, indicated in Figure 5B-5-1, would have to be in
the more centreline positions. If it were in the position that sits closer to
the sidewall, the seats on the right side would not be usable. This could be
shown on the form by a diagonal slash through those unusable seats.
10. On the right side of aircraft to facilitate patient observation is Captain Winfrey, an MSTM (in seat R5)
and Major Thomas in seat R6. Seat R8 is the GUS for Corporal Willis, the 2B, should he wish to sit up or
in an emergency. In R9 is Captain Marin, a TM, in R10 is Lieutenant Lapointe, beside her is MCD, Sergeant
Mavin, and in R12 Corporal Paul (a 1C). Note that there is a Special Patient identifier, the “P” with a circle
around it, to indicate he is a mental health patient.
11. Should a crash landing occur, the AEC will use both the left sided Crew Entrance Door and the right
side Forward Emergency Escape Hatch. This is indicated by a solid line on the form.
12. In a ditching, the AEC will use the left and right side forward Flotation Equipment Deployment
System (FEDS). This is indicated on the form by a dashed line.
5B-5-3/5B-5-4
B-MD-005-000/FP-001
ANNEX 5C
CC130, CC144, CC150 and CC177 Patient Positioning and Load Planning Forms
Figure 5C-1-1 CC130 Patient Positioning & Load Planning Form E-H Model
5C-1-1
B-MD-005-000/FP-001
Figure 5C-1-2 CC130 Patient Positioning & Load Planning Form H-30/J-30 Model
5C-1-2
B-MD-005-000/FP-001
Figure 5C-1-3 CC144 Patient Positioning & Load Planning Form
5C-1-3
B-MD-005-000/FP-001
Figure 5C-1-4 CC150 Patient Positioning & Load Planning Form MP-1 & MP-2
5C-1-4
B-MD-005-000/FP-001
5C-1-5
B-MD-005-000/FP-001
5C-1-6
B-MD-005-000/FP-001
Figure 5C-1-7 CC150 Patient Positioning & Load Planning Form MP-7
5C-1-7
B-MD-005-000/FP-001
Figure 5C-1-8 CC177 Patient Positioning & Load Planning Form
5C-1-8
B-MD-005-000/FP-001
CHAPTER 6
AIRFRAMES
SECTION 1
GENERAL
1. The CF has no dedicated airframe for AE; therefore all AE missions utilize either opportune aircraft
(those available and not tasked) or retrograde missions (patients are loaded for return journey after cargo/
personnel are off loaded). The number of patients, their medical condition, complexity of care required and
the length of overseas flights will dictate the most suitable aircraft for strategic AE.
2. Ambulatory and non-critical patients can be carried in numbers indicated by current patient-
caregiver ratios as outlined in STANAG 3204 AMD Aeromedical Evacuation, Edition 7. The number of
Patient Transport Units (PTU) and stretcher platforms, trained AE staff, MSTMs and ancillary AE equipment
available dictates the maximum number of patients, critical and non-critical that can be airlifted by the CF
on any one mission. AE SMM 60-2610 AECM Universal Checklists and Technical Orders further outline
characteristics of each aircraft with respect to Aeromedical Evacuation.
6-1-1/6-1-2
B-MD-005-000/FP-001
SECTION 2A
CC130 HERCULES (E/H Model)
Figure 6-2A-1 CC130 Coming in for Landing in Nunavut
GENERAL
1. The CC130 Hercules is a well known AE aircraft in the CF and NATO inventories. It is a medium-range,
multipurpose aircraft primarily used to carry cargo and troops but may be configured to carry patients in
either a tactical or strategic AE role.
TROOP CONFIGURATION
2. When configured to carry troops, seating is available down the centre of the cabin and along each
sidewall. There are a total of 92 seats onboard the regular length or “stubby” CC130 Hercules: 78 regular
seats plus an additional 14 if the seat attachments over the wheel-well walls are utilized. When not in use,
sidewall seats are rolled-up and strapped in place against the sidewalls or disassembled and stored on the
aircraft. The centre and wheel-well seats are rolled and stowed against the fuselage. All seats are equipped
with safety belts. Installation and stowing instructions are on placards located on the left wheel-well wall of
the cargo compartment. Refer to Annex 6A for specifics by model.
PATIENT CONFIGURATION
3. The CC130 can be configured in several different patterns to provide a combination of seats and
litters to suit the needs of a particular mission; however, litters are not to be placed in front of the paratroop
doors or under the centre overhead hatch. Sidewall litter positions are not considered as blocking the
paratroop doors.
6-2A-1
B-MD-005-000/FP-001
VARIATION IN AIRCRAFT CONFIGURATIONS
4. There are various models of the Hercules aircraft in the CF inventory. These aircraft modifications
influence the total numbers of litters and seats available. AECMs should ascertain which model they are
flying on prior to flight if at all possible.
EMERGENCY EXITS
GENERAL
5. There are 10 exits on the CC130 (11 on “H” and later models). Of these, 7 (8 on the ”H” models) are
considered emergency exits.
a. Each exit is designated as primary or secondary exit for ground or ditching.
6. Characteristics of emergency exits on the CC130:
a. Can be opened from the inside and the outside;
b. Have emergency escape lights co-located; and
c. Are outlined in yellow on inside and black or grey on outside.
7. The primary exits for ground egress are:
a. Crew entrance door;
b. Left side paratroop door; and
c. Right side paratroop door.
8. The primary exits for ditching egress are:
a. Forward overhead hatch;
b. Centre overhead hatch; and
c. Aft overhead hatch.
9. Chopping areas are cornered in yellow or black (may be covered by insulation), and are located
above the paratroop doors. Areas are designated a Chopping Area because bulkhead in these areas has no
Hydraulics, Electrical, or Oxygen lines running through it. These are used if primary/secondary exits cannot
be opened.
6-2A-2
B-MD-005-000/FP-001
Figure 6-2A-2 CC130 Emergency Exits
6-2A-3
B-MD-005-000/FP-001
SIDE EMERGENCY EXIT(S)
10. General.
a. secondary exit(s) for ground egress or ditching;
b. one on right side on all models; and
c. one on left side on ”H” models.
WARNING
The side emergency escape exit shall not be used in heavy seas or in a nose-
down attitude.
11. To open:
a. prior to opening check for:
(1) FISH – no water visible (high seas);
(2) FAN – the propeller blades are not spinning; and
(3) FIRE – area prone to fires due to proximity to engines.
b. remove seat netting;
c. firmly grasp hatch to prevent it from falling when release handle is activated;
d. rotate (or pull) release handle as indicated;
e. move bottom of exit inward until clear of sill;
f. lower door until pins at top of door are clear; and
g. remove exit and place out of egress path.
12. To replace:
a. lift exit and align top pins with holes in upper sill;
b. lifting up, push in bottom of exit;
6-2A-4
B-MD-005-000/FP-001
c. hold exit firmly in place rotate (or pull up) handle to the locked position; and
d. replace seat netting.
NOTE
There are two (2) different types of exits depending on model.
PARATROOP DOORS
13. General.
a. primary exits for ground egress;
b. one on each side of aircraft; and
c. each has an emergency escape light and a door warning light.
14. To open:
a. ensure area is clear of hazards by looking out door window;
b. ensure quick-release pin is in the stowed position as shown in Figure 6-2A-3 panel A and not in the
locked position as in panel C;
c. rotate latch handle 90 degrees counter-clockwise to unlock the door;
d. using upper door handle, pull door inward to place door in track;
e. grasp lower door handle and lift door until it clicks into place;
f. use clean and jerk method;
g. on forward side insert the quick release pin into the locked position to lock door in place; and
h. keep hand on door until pin is in place.
WARNING
Ensure feet are kept clear of paratroop doorsill when operating the paratroop
doors. If the counter mechanism fails, the paratroop door will fall and may
cause injury to personnel.
6-2A-5
B-MD-005-000/FP-001
Figure 6-2A-3 Paratroop Door
6-2A-6
B-MD-005-000/FP-001
15. To close:
a. keeping one hand on door, remove quick release pin from the locked position;
b. ensure pin is placed into the stowed position;
c. on forward side of door release locking mechanism (pull inward);
d. lower door under control;
e. ensure feet are out of the way;
f. rotate handle down to lock door; and
g. ensure door warning light is off.
WARNING
When the door is open, the quick-release pin shall be placed in the locked
position. The quick-release pins shall not be in the locked position during
flight with the door closed.
NOTE
Do not slam door into place when closing.
RAMP / RAMP DOOR
Figure 6-2A-4 Ramp with Loading Ramps in Place
6-2A-7
B-MD-005-000/FP-001
16. General.
a. The ramp allows for easy entrance and exit of cargo and litters;
b. NOT an emergency exit, but can be used if open and unobstructed;
c. Cannot be opened from the outside;
d. Has ground loading ramps to assist in emplaning patients/vehicles (while loading litters the loading
ramps will be adjacent to each other);
e. The loading ramps are stored on the ramp door when not in use;
f. Ramp controls are located aft of the left paratroop door; and
g. Ramp door warning lights will be located either forward or aft of the right paratroop door depending
on model. On “H” (stretch) models ramp door warning lights are located in the Lavatory area.
OVERHEAD ESCAPE HATCHES
17. General.
a. Three in aircraft (Forward, Centre & Aft);
b. Hatches are primary exit for ditching;
c. Forward and Aft are the same size and weight;
d. Centre Hatch is heavier (approximately 40 lbs or 18 kg), centre ring that can be jettisoned, held to
aircraft by bungee cords, for emergency depressurization or for venting of fumes;
e. Forward overhead hatch is located on the flight deck;
f. Centre overhead hatch is located aft of the wheelwells and is only accessible from right side via the
escape ladder. Escape ladder installed for overwater missions, cargo load dependent; and
g. Aft overhead escape hatch is located on left side on the ramp.
18. To open overhead escape hatches:
a. firmly grasp and support hatch with one hand;
b. release handle is always forward of hatch;
6-2A-8
B-MD-005-000/FP-001
c. pull handle down, hatch will fall inward; and
d. place hatch out of egress path.
19. To replace:
a. align pin with aft hole;
b. push hatch up into place;
c. holding hatch securely in place, push handle up to locked position; and
d. carefully remove hand that is holding hatch.
WARNING
With the escape ladder installed, it is impossible to exit from the centre
escape hatch using the left hand side of the ladder.
HINGED WINDOWS
20. General.
a. Not emergency exits, cannot be opened from outside; and
b. One on each side of the flight deck.
21. Opening hinged windows:
a. remove securing pin;
b. with one hand holding window, push releasing mechanism; and
c. swing window open until in the locked position.
22. To close:
a. with one hand on window, release the lock mechanism;
b. swing window to closed position, ensuring window snaps into place; and
c. replace locking pin.
6-2A-9
B-MD-005-000/FP-001
CREW ENTRANCE DOOR
Figure 6-2A-5 Crew Entrance Door
23. General.
a. Located aft of the flight deck, left side aircraft forward of 245 bulkhead;
b. Door is primary exit for ground egress;
c. Door warning light, forward of door below galley floor; and
NOTE
When the sub-floor is down in the crew entrance area, the door warning light
will not be visible.
6-2A-10
B-MD-005-000/FP-001
d. Emergency escape light located above.
WARNING
The crew entrance door should not be opened from the outside unless there
are no crew onboard.
24. Opening door from inside:
a. ensure area outside door is clear by knocking loudly on door;
b. grasping lanyard and door firmly, rotate the release handle to open;
c. alowly lower the door with lanyard, keep it under control at all times;
d. hook lanyard loop on door frame lock hook; and
e. step on stairs to ensure they are fully down.
25. To close:
b. unhook lanyard and use to raise door;
c. grasping both lanyard and door firmly, rotate handle to lock door; and
d. check to ensure door warning light is out and carefully release hand holding door until sure it is
locked.
WARNING
After closing and latching the crew door, visually check both retaining hooks
to ensure they fully engage the eye-bolts on the doorframe.
26. To open from the outside:
a. ensure area is clear by knocking on the door;
b. stand to one side, hold door firmly with right hand;
c. rotate handle toward door;
d. lower door under control; and
e. hook lanyard loop on door frame lock hook.
6-2A-11
B-MD-005-000/FP-001
27. To close door from outside:
f. unhook the lanyard and stow it so it will not interfere with operation;
g. walk the door up and hold in place; and
h. rotate latch to locked position.
Figure 6-2A-6 Location of Emergency Exits
6-2A-12
B-MD-005-000/FP-001
AIRCRAFT SYSTEMS
OXYGEN SYSTEMS
28. Information on the CC130 Liquid Oxygen System can be found in the CC130 Aviation Life Support
Equipment Training Manual (CTM A-P9-531-S09-001); and
29. There is no therapeutic oxygen. It must be brought onboard.
ELECTRICAL SYSTEMS
CAUTION
Only medevac equipment authorized by the CF Aromedical Evacuation
Equipment Manual and other equipment authorized by 1 Cdn Air Div HQ
shall be powered from the 60 Hz Frequency Power System. A 60 Hertz (Hz)
Frequency Power System is provided to convert 400 Hz aircraft generator
output to 60 Hz power (House hold current). Its primary purpose is to
power medevac equipment but the system can also be used to power other
equipment such as a laptop computer.
30. The CC130 is equipped with the following electrical systems:
a. The 60 Hz Frequency Power Supply System, which is an integral system; and
b. The SAR Medevac Power Supply, which is a walk-on power unit that can be installed temporarily as
a mission kit. It supplies power through a specially designed extension cord kit.
31. The 60 Hz Frequency Power Supply System consists of a 400 to 60 Hz frequency converter, a power
distribution panel, a power control panel and three outlets. These components are described as follows (See
also Figure 6-2A-7):
a. Frequency Converter. Located on the electrical control and supply rack (ECSR), the 60 Hz Frequency
Converter converts the Aircraft power 400 Hz to 115 VAC/60 Hz (household current). The frequency
converter is capable of sustaining a continuous 15-ampere load;
b. Power Distribution Panel. Located beside the frequency converter on the ECSR, distribution panel
distributes the power to the outlets. It also provides circuit breaker protection for each outlet circuit
(A in Figure 6-2A-7);
c. Power Control Panel. Labelled 60 Hz FREQUENCY CONVERTER CONTROL PANEL and located on
the flight deck in the ACSO station side panel. It controls the entire 60 Hz Frequency Converter
System; it has an 115V/60Hz outlet with the panel. This panel is the responsibility of the Flight
Engineer (FE) to control (B in Figure 6-2A-7); and
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d. Outlets (3). In addition to the outlet at the ACSO station discussed at sub-para c. above, there are
two outlets located in the right-hand side of the cargo compartment, one at FS 384 and one at FS
637. Each cargo compartment outlet features an indicator, placarded 115VAC 60HZ POWER that
illuminates green whenever power is available at that outlet (C in Figure 6-2A-7).
NOTE
The indictors at the control panel and the cargo compartment outlets are
NVG compatible.
CAUTION
The total combined load of all three outlets shall not exceed 15 amperes or,
as placarded, a total appliance rating of 3500 watts.
Figure 6-2A-7 60 Hertz Frequency Power System
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System Operation
32. The 60 Hz Power Supply System is normally turned off when it is not required. When a mission
requires household power, the system should be turn on prior to start of the mission by the FE. Ensure on
pre-flight check of the aircraft that this has been done by locating a power outlet; the 115VAC/60HZ placard
on the lens should be illuminated. If not, the Loadmaster (LM) or FE should be informed and the system
turned on.
NOTE
With the CONVERTER POWER CONTROL switch set to on, the 115VAC/60HZ
indicator at each outlet should illuminate. If the CONVERTER POWER
CONTROL switch is on and the115VAC/60HZ light is not illuminated a any of
the power outlets; report this to the LM or FE for further investigation.
SAR Medevac Power Supply
33. The SAR Medevac Power Supply is used primarily to augment the 60 Hz Frequency Power Supply
System. It consists of two (2) components:
a. SAR Medevac power converter (A in Figure 6-2A-8). When required, this converter is plugged into
the aircraft power supply and converts the 400Hz system to 115V 60Hz (household current). The
converter is installed on specially designed mounting brackets on the right-hand side of the cargo
compartment. The control panel consists of a power switch, a PWR IND light, a three prong 60Hz
outlet and two circuit breakers. It is the responsibility of the Sqn that fly the aircraft to maintain and
service the converter; and
b. The Medevac Power Supply Extension Cord Kit. This kit contains two extension cords; one 6 metres
in length and one 17 metres in length also a power bar outlet with four (4) hospital grade outlets.
The outlets are protected by a ground fault circuit interrupter (GFCI). There are 4 bolts provided in
the kit to secure the power bar to the stanchion pole. The kit is contained in a protective case for
ease of storage and transport. This kit is kept with the AE unit and is responsible to maintain and
service.
6-2A-15
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Figure 6-2A-8 SAR Medevac Power Supply
CAUTION
The medevac power supply extension cords shall only be used with the
115VAC, 60 Hz outlet on the SAR Medevac Power supply. The extension
cord plugs shall not be adjusted or otherwise modified to fit into 28 VDC or
115VAC, 400 Hz, utility plugs in the aircraft. Injury to personnel or damage to
equipment could result.
CAUTION
The CC130 Power Converter is capable of handling up to 10 Amps of
equipment at any one time. AECMs will ensure that this maximum Amperage
is not exceeded as damage to the Converter or equipment could occur.
NOTE
There is no change to the power supply system on the CC130E. It will continue
to use the SAR Medevac power supply as the primary power source. There
are in addition other power outlets on both “E“ and “H“ model aircraft; these
are not to be used under any circumstances without prior approval.
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CARGO COMPARTMENT INTERCOMMUNICATION SYSTEM (ICS)
34. The cargo compartment ICS is comprised of five control panels that collectively accommodate 12
headset cord connectors. Attached to the cargo compartment intercom junction box (J-box) located at FS
250 is the Forward Loadmaster ICS panel. Branching from the J-box are three lines: one to dual Medical
ICS panels at the 245 bulkhead, one to a LH Observer/Aft Loadmaster ICS panel at FS 692 and one to a RH
Observer ICS Panel at FS 692.
35. The cargo compartment ICS control panels are similar in appearance to those on the flight deck. On
all aircraft, the cargo compartment ICS can monitor all interphone and radio traffic and transmit to all ICS
stations internally.
ICS Configuration
36. The service provided by the ICS to the cargo compartment crew stations is described as follows (see
Figure 6-2A-9 for location in cargo compartment):
a. Forward Loadmaster Station. The forward loadmaster station accommodates two interphone
(INPH) headset cord connectors. It also features an external/parallel call button with a placard
reading “ICS CALL”, housed inside a protective sleeve and located above and to the left of the
headrest. The button is pushed up to activate. This is to allow the loadmaster ready access the call
feature in an emergency.
b. Aft Loadmaster Station. This station does not have a dedicated ICS control panel; it uses an INPH
headset cord connector attached to the LH Observer ICS control panel. This station features an
external/parallel call button located above and left of the headrest. The purpose and operation of
the external call button is identical to the one at the forward loadmaster station.
c. Medical Station. The medical station has dual ICS control panels capable of handling up to five
INPH headset cord connectors. This station also features a two-position medical team isolation
switch labelled MED and NORMAL. With the switch set to NORMAL, the two medical ICS panels
provide full two-way communication with all other ICS stations. With the switch set to MED, the
medical team continues to monitor all ICS traffic but any medical team transmission will be heard
only by other medical ICS station personnel. This “privacy” feature allows the medical team to
converse without interfering with other ICS stations (see Figure 6-2A-10).
d. LH Observer Station. The LH Observer station ICS panel is located just forward of the L/H paratroop
door. It has a total of three INPH headset cord connectors.
e. RH Observer Station. The RH Observer Station ICS panel is located just forward of the RH paratroop
door. Two ICS INPH headset cord connectors are located just aft of the paratroop door.
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NOTE
The only ICS that the Medical Crew will utilize will be the Medical Station. If
there is a need to use any other stations it must be first be approved by the
Loadmaster or Aircraft Commander
Figure 6-2A-9 Location of ICS in Cargo Compartment
MEDICAL TEAM
ISOLATION SWITCH
NORMAL: Allows internal

transmission over the ICS.
MED: Allows the medical

team to converse among
themselves without
interfering with other
stations.
Figure 6-2A-10 Medical ICS Panel
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Cargo Compartment Lighting
37. The cargo compartment lighting consists of dome lights, floor lights, ramp loading lights and a
utility light located under the flight deck floor.
38. Dome Lights. The dome light housings are divided into the following four areas: forward, centre,
aft and the ramp. The switches for the forward (CARGO AREA DOME LTS FWD) and centre (CARGO AREA
DOME LTS CTR) dome lights are on the PA auxiliary control panel control on the LH aft side of the 245
bulkhead (see Figure 6-2A-11). The switches for the aft (AFT CARGO DOME LT) and ramp (RAMP LIGHTS)
dome lights are located on the AFT fuselage junction box control (AFJB) (see Figure 6-2A-11, sheet 2).
39. Night-vision Goggle Compatible Lighting. The dome lights controlled by the CTR CARGO
AREA DOME LTS CTR switch and the dome lights controlled by the AFT CARGO DOME LT switch are
NVG-compatible (green).
Cargo Compartment Lighting Controls
40. Forward Cargo Area Dome Lights. The CARGO AREA DOME LTS FWD switch has the following three
positions and functions:
a. CLEAR – provides a clear white light;
b. OFF – provides no lighting; and
c. RED – provides a red light that is not compatible with night-vision goggles.
41. Centre Area Dome Lights. The CARGO AREA DOME LTS CTR switch has the following three positions
and functions:
a. CLEAR – provides a clear white light;
c. NVG – provides a green light that is compatible with night-vision goggles.
42. Aft Cargo Area Dome Lights. The AFT CARGO DOME LT switch has the following three positions and
functions:
a. WHITE – provides a clear white light;
c. NVG – provides a green light that is compatible with night-vision goggles.
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43. Ramp Area Dome Lights. The RAMP LIGHTS dome lights switch has the following three positions
and functions:
a. WHITE – provides a clear white light;
c. RED – provides a red light that is not compatible with night vision goggles.
44. Floor Lights. Red coloured lights are flush-mounted along each side and several inches above the
cargo compartment floor. On aircraft 130332 through 130342, there are 13 lights, 7 on the RH side and 6 on
the LH side. On aircraft 130343 and 130344, there are 21 lights, 11 on the RH side and 10 on the LH side. All
the lights are controlled by a three-position, FLOOR – BRIGHT, OFF, DIM, switch located on the PA auxiliary
control panel aft of the 245 bulkhead.
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Figure 6-2A-11 Cargo Area Lighting Controls (Sheet 1 of 2)
6-2A-21
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Figure 6-2A-11 (Sheet 2 of 2)
COMFORT ITEMS
45. Urinals on CC130 aircraft are located as follows:
a. if still in place, those located on the 245 bulkhead are wire locked closed due to the erosion caused
by liquid leaking beneath floor covering; and
b. functional urinals are on left and right side walls aft of the paratroop doors on the ramp, normally
the urinal on the left is used in ”E” and ”H” models and the right side urinal in stretch ”H” models.
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46. Chemical toilet with privacy curtain is co-located with the urinal on the left sidewall aft of the left
paratroop door on the ramp on “E” and some "H" Models, and on the right side wall aft of the right paratroop
door on some “H” models;
47. There are gallon water containers located on each side of the CC130 depending on model. Each
water container holds 2 gallons of water.
48. The galley on CC130 aircraft includes:
a. functional sink;
b. oven;
c. plug in units for hot water/coffee; and
d. trash can.
ENVIRONMENTAL SYSTEMS
49. Airflow. The airflow moves from aft to forward, top to bottom. The air circulates approximately
every three minutes. Changes in aircraft temperature can be requested through the LM.
EMERGENCY EQUIPMENT AND AIRCRAFT SAFETY – EXTERNAL WALKAROUND
50. When performing an external walkaround of the aircraft, personnel should be aware of a number of
safety concerns and emergency equipment features.
FORWARD SECTION OF AIRCRAFT
51. Radome. If radome is operating, remain 40 ft (or 12m) away due to radiation emissions occurring
during operation. A pylon should be placed at the 40 ft (or 12m) mark as an indication that the radome is
being tested; to be safe approach aircraft from the 10 o’clock position.
RIGHT SIDE OF AIRCRAFT
52. Liquid oxygen (LOX) vent. Beware of leaking LOX due to its highly flammable/explosive nature.
53. Right hand side emergency exit:
a. can be opened from outside; and
b. hash marks outline exit.
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54. Wings:
a. circle of safety is 12 ft (or 3.6m) from wing tips, nose, and tail of the aircraft;
b. be aware of prop warning line, designates propeller location;
c. propellers have mesmerizing effect when operating; and
d. life rafts are visible on bottom side of wing when flaps fully extended.
55. External markings for emergency equipment:
a. fire extinguisher; and
b. universal first aid kit.
56. Right paratroop door:
a. can be opened from the outside;
b. hash marks outline exit; and
c. chopping areas above the door are offset from those inside to prevent accidentally chopping into
other person.
AFT SECTION OF AIRCRAFT
57. Ramp:
a. 50 ft (or 15m) is the minimum safe distance aft of the ramp when the aircraft is operating; and
b. hazard area. Do not walk under ramp when closed.
58. Aft overhead escape hatch:
b. recessed D-ring for opening.
LEFT SIDE OF AIRCRAFT
59. External markings for emergency equipment.
b. hand axe.
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60. Left paratroop door:
other person.
61. LOX overboard drain. The LOX overboard drain is located forward of left paratroop door.
62. Centre overhead escape hatch:
a. can be opened from the outside; and
b. has recessed D-ring for opening.
a. universal first aid kit; and
b. fire extinguisher.
64. Auxiliary power unit exhaust vent:
a. located forward of the left wheels; and
b. hazard area due to the extreme heat expelled in this area.
65. Wings. Same as on right side of aircraft. Circle-of-safety 3.6 metres (or 12 ft) from wing tips.
66. Wheelwells. Hazard area due to hydraulics.
NOTE
If one hydraulic system is activated others could accidentally activate at the
same time.
67. Left side emergency exit (if present):
68. Crew entrance door. Hazard area. Never stand in front of the door when it is closed.
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a. hand axe;
b. first aid kits; and
c. fire extinguisher.
70. Ground power unit outlet. Ground power unit is loud and a potential source of electrical shock, walk
around the unit.
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INTERNAL WALKAROUND
EMERGENCY EQUIPMENT (AIRCRAFT 130305-130333, 130336 and 130337)
1. CPI/FDR
2. HAND AXE (3 places)
3. HALON 1211 FIRE EXTINGUISHER (5 places)
4. MEDICAL KIT (4 places)
5. LIFE-RAFT RELEASE HANDLE (4 places)
6. ESCAPE ROPE (3 places)
7. EMERGENCY ESCAPE LIGHT (7 places) NOTES
8. EMERGENCY HATCH (4 places) 1. Life-preservers are stowed, two aft of the right
9. OXYGEN BOTTLE AND SMOKE MASK (5 places) wheelwell and one aft of the left wheelwell and
10. STANCHION LADDER seven on the top bunk. Passenger life-preservers
11. DRY CHEMICAL FIRE EXTINGUISHER (as required) are stowed on the safety equipment
12. FIRE GLOVES (2 places) stowage rack.
13. LIFE-RAFT (4 places)
14. EMERGENCY TIE-DOWN KIT (3 places) 2. A quick-don oxygen mask is stowed at each crew
15. RESTRAINING HARNESS (2 places) position in the flight deck and one each aft of the
16. UPPER BUNK RESTRAINING STRAP paradoors.
17. SAFETY EQUIPMENT STOWAGE RACK (2 places)
18. no longer applicable 3. The flight deck restraining harness is stowed on
19. SURVIVAL EQUIPMENT the lower bunk adjacent to the navigator station.
Figure 6-2A-12 Emergency Equipment Placement by Airframe
6-2A-27
B-MD-005-000/FP-001
EMERGENCY EQUIPMENT (AIRCRAFT 130334,130335 and 130338 through 130342)
1. CPI/FDR
3. HALON 1211 fire extinguisher (5 places)
7. EMERGENCY ESCAPE LIGHT (7 places)
8. EMERGENCY HATCH (4 places) NOTES
9. OXYGEN BOTTLE AND SMOKE MASK (5 places) 1. Seven Life-preservers are stowed on the top bunk,
10. STANCHION LADDER two aft of the right wheelwell and 1 aft of the
11. DRY CHEMICAL FIRE EXTINGUISHER left wheelwell. Passenger life-preservers (as
12. FIRE GLOVES (2 places) required) are stowed on the safety equipment
13. LIFE-RAFT (4 places) stowage rack.
14. EMERGENCY TIE-DOWN KIT (3 places)
15. RESTRAINING HARNESS (2 places) 2. A quick-don oxygen mask is stowed at each crew
16. UPPER BUNK RESTRAINING STRAP position and aft of each paratroop door. Smoke
17. SAFETY EQUIPMENT STOWAGE RACK (2 places) goggles are located with the oxygen masks.
18. no longer applicable
19. CPI/ELT 3. The flight deck restraining harness is stowed on
20. SURVIVAL EQUIPMENT the lower bunk adjacent to the navigator station.
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B-MD-005-000/FP-001
EMERGENCY EQUIPMENT (AIRCRAFT 130343 and 130344)

2. HALON 1211 fire extinguisher (5 places)
6. EMERGENCY ESCAPE LIGHT (7 places)
7. EMERGENCY HATCH (5 places)
NOTES
8. OXYGEN BOTTLE AND SMOKE MASK (5 places)
1. Life-preservers are stowed, two aft of the right
9. STANCHION LADDER
wheelwell and one aft of the left wheelwell and
10. DRY CHEMICAL FIRE EXTINGUISHER
seven on the top bunk. Passenger life-preservers
11. FIRE GLOVES (2 places)
(as required) are stowed on the safety equipment
12. LIFE-RAFT (4 places)
stowage rack.
13. EMERGENCY TIE-DOWN KIT (3 places)
14. RESTRAINING HARNESS (2 places)
2. A quick-don oxygen mask is stowed at each crew
15. UPPER BUNK RESTRAINING STRAP
position in the flight deck and one each aft of the
16. SAFETY EQUIPMENT STOWAGE RACK (2 places)
paradoors.
17. no longer applicable
18. CPI/ELT
3. The flight deck restraining harness is stowed on
19. SURVIVAL EQUIPMENT
the lower bunk adjacent to the navigator station.
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FLIGHT DECK
71. Starting behind the left seat (generally the AC position) on the bulkhead and going clockwise around
the Flight Deck, emergency equipment is located as follows:
a. Fireman’s mitts;
b. Pilot’s oxygen recharger hose;
c. Pilot’s portable oxygen walkaround bottle with smoke mask;
d. Pilot’s quick-don mask with regulator;
e. Pilot’s smoke goggles;
f. Co-pilot’s oxygen recharger hose;
g. Co-pilot’s portable oxygen walkaround bottle with smoke mask;
h. Co-pilot’s quick-don mask with regulator;
j. Co-pilot’s smoke goggles;
k. Crash axe;
m. FE’s quick-don mask with regulator;
n. FE’s smoke goggles;
p. ACSO's quick-don mask with regulator;
q. ACSO's smoke goggles;
r. Crew life vests x7 (upper bunk);
s. Aviator’s mask attached to regulator (x2) lower bunk;
t. Restraint harness;
u. Emergency flashlight (Upper bunk);
v. Forward overhead escape hatch;
w. Escape rope;
6-2A-30
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x. Emergency Escape Light (EEL);
(1) 3 positions (off, on, armed): when armed will come on with >2.5G deceleration, if removed
from bracket, or total power loss in aircraft;
y. Life raft release handles; and
WARNING
Pull the life raft release handles through their full travel to ensure complete
ejection and inflation of the life rafts.
z. Crew door jettison handle.
GALLEY
72. Emergency equipment is located in the galley as follows:
b. EEL;
c. Door warning light;
d. General purpose first aid kit;
e. Emergency flashlight;
(1) Operation: comes on automatically when removed from bracket
f. Halon fire extinguisher;
WARNING
Although Halon 1211 has low toxicity, its decomposition products can
be hazardous. On decomposition Halon 1211 has a sharp acrid odour.
Crewmembers should wear supplemental oxygen including full face/eye
protection when using a Halon to combat a fire. The area must be well
ventilated after use.
g. Portable oxygen walk around bottle with smoke mask;
h. Smoke mask extension tubing;
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j. Oxygen recharger hose extension tubing; and
k. Dry chemical fire extinguisher (primarily used for brake fires).
CARGO COMPARTMENT
73. Emergency equipment is located in the cargo compartment as follows:
a. On the 245 Bulkhead:
(1) Oxygen recharger hose;
(2) Halon fire extinguisher;
(3) Crash axe; and
(4) Oxygen shut off valve.
b. Forward of the Right Wheelwell:
(1) Aviator’s masks with regulator (x2);
(2) Survival equipment rack (Arctic, desert, basic, 20 passenger life vests);
(3) Right side emergency escape hatch; and
(4) EEL (escape hatch).
c. Aft of the Right Wheelwell:
(2) Oxygen recharger hose;
(3) Emergency flashlight;
(4) Crew life vests (x2);
(5) Universal first aid kit;
(6) Chopping area (above paradoor); and
(7) Right paratroop door.
d. Aft of the Right Paratroop door:
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B-MD-005-000/FP-001
(1) Door warning lights x3 (Right Paratroop Door, Ramp and Ramp door);
(2) EEL (right paratroop door);
(3) Quick-don mask with regulator;
(4) Life raft release handles; and
(5) Third set of life raft release handles located on the top of the wings.
e. Ramp area:
(1) Survival equipment (ramp door);
(2) Aft overhead escape hatch;
(3) Escape rope;
(4) EEL (aft escape hatch);
(5) Halon fire extinguisher; and
(6) Crash axe.
f. Aft of the Left Paradoor:
(3) Left paratroop door.
g. Aft of the Left Wheelwell:
(1) EEL (left paratroop door);
(2) Door warning light;
(3) Portable walkaround oxygen bottle with smoke mask;
(4) Crew life vest;
(5) Universal first aid kit;
(6) Restraint harness;
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(7) Emergency flashlight;
(8) Halon fire extinguisher (left wheelwell);
(9) Fireman’s gloves;
(10) Centre overhead escape hatch;
(11) Escape rope; and
(12) EEL (centre overhead escape hatch).
h. Forward of the Left Wheelwell:
(1) Universal first aid kits (x2);
(2) Survival equipment rack (basic, arctic, desert, 20 PAX life vests and 3 Infant cots); and
(3) Portable walkaround oxygen bottle with smoke mask (just aft of the 245 Bulkhead).
EMPLANING AND DEPLANING PATIENTS
GENERAL
74. Throughout emplaning and deplaning, the MCD (or the MCD’s representative) will direct the process
to ensure it occurs expeditiously and safely.
LITTER PATIENTS
75. Litter patients should be emplaning and deplaning through the CC130 ramp, if at all possible. Under
unusual circumstances litter patients may be loaded or unloaded through the paratroop door as long as
there is sufficient help to accomplish the load safely.
AMBULATORY PATIENTS
76. Ambulatory patients may be emplaned or deplaned in any manner as long as it is done safely.
Patients using support devices (i.e. canes, crutches, etc) must be assisted to reduce opportunities for injury
while moving onto and off of the airframe.
LITTER CONFIGURATIONS AND USE OF STANCHIONS
77. The CC130 can be configured to position litters down the centre of the cabin, along the sides of the
cabin, or both depending on the number of patients anticipated. The forward-most side litter stanchions
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remain in place at all times as they are utilized to hang troop seating when litters are not carried. Centre litter
stanchions (eight in all) are stored at the 245 bulkhead and must be installed if litter tiers are required in the
centre of the cabin. To remove these litter stanchions from their storage position the operator pushes up on
the stanchion which compresses an internal pin, while sliding the footplate free of its retaining bracket on
the floor with your foot. Centre litter stanchions are locked into place by compressing the top pin inserted
into the ceiling socket marked for litters, and sliding the foot plate into a bracket on the aircraft floor.
Figure 6-2A-15 CC130 Ladder Placement and Operation
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LITTER STANCHION SUPPORT BRACKETS
78. Each centre stanchion support strap should be equipped with five litter stanchion support brackets
(as seen in Figure 6-2A-16) and each side stanchion should have four brackets. Although litter patients are
normally carried four high, the fifth litter stanchion support bracket on the centre tiers allow an additional
litter to be installed should one be needed. All litter stanchion support brackets must be tested preflight by:
a. inspecting the stanchion bracket to ensure all components are present;
b. disengaging the locking pin by lifting-up on the lever at the front of the bracket;
c. sliding the bracket up and down the stanchion ensuring free movement;
d. releasing the lever and sliding the bracket up or down the stanchion until the locking pin seats itself
into a position;
e. all rubber grommets and pads should be intact to ensure security of the litter once the bracket is
enclosed; and
f. the locking mechanism should be intact and functioning properly.
Figure 6-2A-16 Four-high Litter Placement
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LITTER SUPPORT STRAPS
79. There are 20 centre litter support straps stowed in boxes (“hog’s trough”) near the ceiling of the
aircraft, and 12 side litter support straps that should be stowed in canvas bags located along the fuselage as
shown in Figure 6-2A-17, panel B. Before litters are emplaned all straps must be removed from their stowage
areas and are attached to the overhead supports. When attaching straps to the overhead supports the free
end must be facing the back of the buckle as shown in Figure 6-2A-18, panel A, facing the aisle and must be
four inches (minimum) to six inches (preferred) long to ensure it does not slip from the buckle. Each strap
must also be visually inspected for integrity and that it is of sufficient length to reach a floor fitting which is
shown in Figure 6-2A-19, panel G. Straps must be threaded through the retaining clip on the overhead bar.
Ensure the shorter litter support straps are used in the wheelwell area. The shorter straps cannot be used in
those areas forward or aft of the wheelwell area, as they will not reach the floor of the aircraft and cannot be
secured.
Figure 6-2A-17 Bracket Operation and Parts
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Figure 6-2A-18 Attachment of Litter Support Straps to Overhead Supports

and Litter Support Strap Brackets and Sidewall Placement
of Canvas Bags on Aircraft Bulkhead
80. Centre litter support straps should be equipped with five support brackets and side litter support
straps with four. The positioning of these brackets must correspond to the positioning of the brackets on
the litter stanchions. Each bracket on each litter support strap must be tested to ensure that the locking
mechanism at the rear (see Figure 6-2A-17, panels C, D & E) is functioning to prevent the brackets from
slipping down the straps with the weight of a loaded litter. This testing procedure includes:
a. inspecting the strap bracket to ensure all components are present;
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b. disengaging the locking mechanism by lifting-up on the two levers at the rear;
c. sliding the bracket up and down the strap ensuring free movement;
d. releasing the levers; and
e. ensuring the bracket does not slide up or down the strap when weight is added.
EMPLANING AND DEPLANING LITTERS
81. When a litter is emplaned, the handles are placed into the brackets on the stanchion poles and the
adjacent litter support straps. Litters are always loaded from the top litter to the lowest litter and removed in
reverse order because of patient safety concerns. The litter is secured for flight by locking all four brackets
as shown at Figure 6-2A-19, panel H. Once all litters in the same tier have been loaded, the latch at the
bottom of each litter support strap is attached to the stud on the floor, and the strap is pulled tight as shown
in Figure 6-2A-19, panel G. When deplaning the litter, the catch of each bracket is disengaged. The litter
handles are lifted out of the brackets and the litter carried off the aircraft.
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Figure 6-2A-19 Litter Strap / Bracket Use and Attaching Strap End to Floor Stud
REPAIRS AND DISCREPANCIES
82. The LM is responsible for coordinating the repair and/or replacement of defective or missing litter
stanchions, litter support straps, and brackets. The MCD is responsible for notifying the LM of the need for
this service. In a tactical AE situation, AECMs are responsible for the serviceability of their equipment and
for re-configuration of the cabin once the cargo has been offloaded. See Chapter 7 of this Regulation for
specifics on operating in a tactical environment.
6-2A-40
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Figure 6-2A-20 Engine Running Onload on the CC130
6-2A-41
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CONFIGURATIONS
Figure 6-2A-21 AE-1 Config (Stubby)
6-2A-42
B-MD-005-000/FP-001
Figure 6-2A-22 AE-3 Config (Stubby)
6-2A-43
B-MD-005-000/FP-001
Figure 6-2A-23 AE-4 Config (Stretch)
6-2A-44
B-MD-005-000/FP-001
Figure 6-2A-24 AE-5 Config (Stretch)
6-2A-45/6-2A-46
B-MD-005-000/FP-001
Section 2B
CC130 HERCULES (J Model)
Figure 6-2B-1 First CC130J on Roll Out
GENERAL
1. The CC130J is a greatly improved airplane with the performance and capability to prove it. Compared
to the earlier CC130E, the maximum speed is 21 percent higher, climb time is reduced by up to 50 percent,
cruising altitude is up to 40 percent higher, and range is up to 40 percent longer.
2. The CC130J, the stretched/advanced version of the Hercules, offers operators 55 feet of cargo
compartment length – an additional 15 feet over the original “short” aircraft. The additional 15 feet is
provided by inserting a 100-inch forward and an 80-inch aft plug to the fuselage. This translates into 30
percent more usable volume for increased seating, litters, pallets, or airdrop platforms. This additional
capability provides significant advantages when transporting personnel or delivering priority cargo by
reducing the number of sorties needed to complete the mission.
6-2B-1
B-MD-005-000/FP-001
Figure 6-2B-2 CC130J Dimensions
TROOP CONFIGURATION
3. The CC130J can be configured in the same manner as the CC130E/H. It has several different patterns
to provide this such as down the centre of the cabin and along each sidewall. It has the capacity of 128
combat troops and 92 para troops. When not in use, sidewall seat are rolled-up and strapped in place
against the sidewall or disassembled and stowed in the aircraft. All seats are equipped with safety belts.
6-2B-2
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4. The CC130J can be configured with multiple combinations of seats, litters and cargo to suit the
particulars of the mission; however, litters are not to be placed in form of the para troop doors or under the
centre overhead escape hatch. Sidewall litter positions are not considered as blocking the paratroop doors
EMERGENCY EXITS
GENERAL
5. There are 11 exits on the CC130J of these 8 are considered emergency exits. Each emergency exit
has a designation as either a primary or secondary exit for ground or ditching.
Figure 6-2B-3 CC130J Exits
6. Characteristics of emergency exits in the CC130J:
a. Can be opened from the inside and the outside;
6-2B-3
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b. Have emergency escape lights co-located; and
c. Are outlined in yellow on inside and black or grey on outside.
b. Left side paratroop door; and
c. Right side paratroop door.
a. Forward overhead hatch;
b. Centre overhead hatch; and
c. Aft overhead hatch.
9. Also there are two (2) emergency exits in the flight deck windows but as these cannot be opened
from the outside they are deemed not true emergency exits.
10. To open the flight deck windows:
a. opening hinged windows;
b. remove securing pin;
c. with one hand holding window, push releasing mechanism; and
d. swing window open until in the locked position.
11. To close the flight deck windows:
a. with one hand on window, release the lock mechanism;
b. swing window to closed position, ensuring window snaps into place; and
c. replace locking pin.
12. The ramp is considered an exit while it is open but again as it cannot be opened from the outside it
is not considered an emergency exit.
6-2B-4
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a. has ground loading ramps and auxiliary truck loading ramps to assist in emplaning patients/vehicles
(while loading litters the loading ramps will be adjacent to each other);
b. The loading ramps are stored on the ramp door when not in use;
c. Ramp controls are located aft of the left paratroop door; and
d. Ramp door warning lights are located in.
Figure 6-2B-4 Cargo Door and Ramp
6-2B-5
B-MD-005-000/FP-001
Figure 6-2B-5 Emergency Exits – Ground
6-2B-6
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Figure 6-2B-6 Emergency Exits – Water
6-2B-7
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Chopping area
13. Chopping areas are cornered in yellow or black (may be covered by insulation), and are located
above the paratroop doors. Areas are designated a Chopping Area because bulkhead in these areas has no
Hydraulics, Electrical, or Oxygen lines running through it. These are used if primary/secondary exits cannot
be opened (see below).
Figure 6-2B-7 Interior and Exterior Chopping Markings
6-2B-8
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Figure 6-2B-8 Crew Entrance Door
14. The characteristics of the Crew entrance door are:
a. Located aft of the flight deck, left side aircraft forward of 345 bulkhead;
b. Door is primary exit for ground egress;
c. Door warning light, forward of door below galley floor; and
d. Emergency escape light located above.
6-2B-9
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WARNING
The crew entrance door should not be opened from the outside unless there
are no crew onboard.
15. To open door from inside:
a. ensure area outside door is clear by knocking loudly on door;
b. grasping lanyard and door firmly, rotate the release handle to open;
c. slowly lower the door with lanyard, keep it under control at all times;
d. hook lanyard loop on door frame lock hook; and
e. step on stairs to ensure they are fully down.
16. To close:
a. unhook lanyard and use to raise door;
b. grasping both lanyard and door firmly, rotate handle to lock door; and
c. check to ensure door warning light is out and carefully release hand holding door until sure it is
locked.
WARNING
After closing and latching the crew door, visually check both retaining hooks
to ensure they fully engage the eye-bolts on the doorframe.
17. To open from the outside:
a. ensure area is clear by knocking on the door;
b. stand to one side, hold door firmly with right hand;
c. rotate handle toward door;
d. lower door under control; and
e. hook lanyard loop on door frame lock hook.
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18. To close door from outside:
a. unhook the lanyard and stow it so it will not interfere with operation;
b. walk the door up and hold in place; and
c. rotate latch to locked position.
Side Emergency Escape Hatches
19. The characteristics for the side emergency escape hatch are:
a. secondary exits for ground egress or ditching;
b. one on each side of the aircraft forward of the wheel wells
c. each has an emergency escape light
WARNING
The side emergency escape hatches shall not be used in heavy seas or in a
nose down attitude.
20. To open:
a. prior to opening check for:
(1) FISH – no water visible (high seas);
(2) FAN – the propeller blades are not spinning; and
(3) FIRE – area prone to fires due to proximity to engines.
b. remove seat netting;
c. firmly grasp hatch to prevent it from falling when release handle is activated;
d. rotate release handle as indicated;
e. move bottom of exit inward until clear of sill;
f. lower door until pins at top of door are clear; and
g. remove exit and place out of egress path.
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21. To replace:
a. lift exit and align top pins with holes in upper sill;
b. lifting up, push in bottom of exit;
c. hold exit firmly in place rotate handle to the locked position; and
d. replace seat netting.
Paratroop Doors
22. The characteristics of the paratroop doors are:
a. primary exits for ground egress;
b. one on each side of aircraft; and
c. each has an emergency escape light and a door warning light.
23. To open:
a. ensure area is clear of hazards by looking out door window;
b. ensure quick-release pin is in the stowed position and not in the locked position (see Figure 6-2B-9,
panel B, numbers 1 and 2);
c. rotate latch handle 90 degrees counter-clockwise to unlock the door (see Figure 6-2B-9, panel C,
number 3);
d. using upper door handle, pull door inward to place door in track (see Figure 6-2B-9, panel D, number
4 below);
e. grasp lower door handle and lift door until it clicks into place (see Figure 6-2B-9, panel E);
f. use clean and jerk method;
g. on forward side insert the quick release pin into the locked position to lock door in place; and
h. keep hand on door until pin is in place
6-2B-12
B-MD-005-000/FP-001
WARNING
Ensure feet are kept clear of paratroop doorsill when operating the paratroop
doors. If the counter mechanism fails, the paratroop door will fall and may
cause injury to personnel.
B C
D E
Figure 6-2B-9 Operation of Paratroop Doors
6-2B-13
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Overhead Emergency Escape Hatches
24. Characteristics of the overhead emergency escape hatch:
a. Three in aircraft (Forward, Centre & Aft);
b. Hatches are primary exit for ditching;
c. Forward and Aft are the same size and weight;
d. Centre Hatch is heavier (approximately 40 lbs or 18 kg), centre ring that can be jettisoned, held to
aircraft by bungee cords, for emergency depressurization or for venting of fumes;
e. Forward overhead hatch is located on the flight deck;
f. Centre overhead hatch is located aft of the wheel wells and is only accessible from right side via the
escape ladder. Escape ladder installed for overwater missions, cargo load dependent; and
g. Aft overhead escape hatch is located on left side on the ramp.
25. To open overhead escape hatches:
a. firmly grasp and support hatch with one hand;
b. release handle is always forward of hatch;
c. pull handle down, hatch will fall inward; and
d. place hatch out of egress path.
26. To replace:
a. align pin with aft hole;
b. push hatch up into place;
c. holding hatch securely in place, push handle up to locked position; and
d. carefully remove hand that is holding hatch.
WARNING
With the escape ladder installed, it is impossible to exit from the centre
escape hatch using the left hand side of the ladder.
6-2B-14
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AIRCRAFT SYSTEMS
OXYGEN SYSTEMS
27. There is no therapeutic oxygen. It must be brought onboard.
ELECTRICAL SYSTEMS
28. As it stands presently there is no capacity to plug in any equipment into the air craft power. There
is 115V plug-ins with the 3 prong outlets but as they still carry 400 Hz they will overheat and burn out the
equipment. Therefore all medical equipment should be run of battery power.
COMMUNICATION SYSTEMS
29. There are two intercom and auxiliary PA control panels in the CC130 aircraft, located as follows:
a. Left 245 bulkhead aft of the crew entrance door – a hand-held mike for PA announcements is located
here.
b. Aft of the left paratroop door – a switch is provided here so that the PA system can be used with the
headsets.
30. Aircrew headsets plugged into these intercom panels allows for communication between all aircrew
as well as communication with ground agencies via radio/phone patch. Headset must be worn by the MCD
during critical phases of flight, including take-offs and landings The MCD or a designated AECM should be
on A/C interphone (headset) for all phases of flight.
31. To be heard on the overhead speakers, a switch on the flight deck must be turned on.
32. Additional headset plug in to the right of the stowage area for the litter stanchions, approximately
1/4 of the way down from the ceiling on the 245 bulkhead, as well as aft of the right paratroop door.
6-2B-15
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Figure 6-2B-10 Communication System
LIGHTING SYSTEMS
33. The cargo compartment is divided into the forward and aft cargo compartment lighting zones.
Normal, NVIS (night vision), and covert lighting are used in the cargo compartment.
Forward Cargo Compartment Lighting Zone
34. The forward cargo compartment lighting control panel, located on the side wall adjacent to the 345
bulkhead, provides control for all cargo compartment lighting from the 345 bulkhead to the wheel well area.
The following lights are included within the forward cargo compartment lighting zone:
a. Forward cargo lighting control panel and oxygen regulator panels edge lighting; and
b. Forward cargo compartment dome and floor lights.
Aft Cargo Compartment Lighting Zone
35. The aft cargo compartment lighting control panel, located on the left side of the cargo compartment
aft of the paratroop door, provides control for all cargo compartment lighting between the wheel wells and
6-2B-16
B-MD-005-000/FP-001
the ramp and cargo door, to include the ramp loading area. The following lights are included within the aft
cargo compartment lighting zone:
a. aft cargo lighting control panel and the oxygen regulator panels edge lighting;
b. aft cargo compartment dome and curb lights;
c. jump platform lights;
d. jump lights; and
e. ramp loading, dome, floor, and door uplock inspection lights.
WARNING
Personnel should not look directly into the infrared light source at a maximum
intensity and should maintain a minimum of 10 feet from energized IR lights
to prevent possible eye discomfort or damage.
Figure 6-2B-11 Cargo Lighting Control Panels
36. The lighting is controlled by the loadmaster if there is a requirement for a change the MCD will
consult with the loadmaster and the loadmaster will make the necessary adjustments.
6-2B-17
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COMFORT ITEMS
LAVATORIES
37. There is one lavatory in the aircraft it is located in the tail on the right side. It is a flush-type chemical
lavatory. It will be the LM’s responsibility to set up. There are 2 urinals located on the 345 bulkhead one close
to the doorway and one further down on the bulkhead. These are disabled, wired shut and not to be used.
Figure 6-2B-12 Lavatory
WARNING
The lavatory is not to be used to dispose of sanitary napkins, trash or other
objects.
Galley
38. The CC130J galley had been updated and moved to better facilitate working in the aircraft. The
galley is now on the flight deck proper, behind the pilot’s position. There is a microwave oven, a coffee
6-2B-18
B-MD-005-000/FP-001
maker and ovens to make hot meals and beverages. The panel/floor that was in the old galley’s floor and
was situated over the crew entrance door has been completely removed.
39. Airflow. The airflow moves from aft to forward, top to bottom. The air circulates approximately
every three minutes. Changes in aircraft temperature can be requested through the LM.
EMERGENCY EQUIPMENT AND AIRCRAFT SAFETY EXTERNAL WALKAROUND
NOTE
As the CC130J is new to the CF fleet there are ongoing modifications to bring
the aircraft to a standardized level. Therefore, different tail numbers will have
different setups. It is recommended that when going to the aircraft to pre-
flight there should be a Team walkaround to ensure a full knowledge of the
aircraft equipment and their locations. Presently there are only 2 CC130Js
that have been modified to full Canadian configuration and are primary
aircraft for deployments. The remainder are undergoing modifications but
have a combination of “stock” configuration and Canadian configuration.
40. When performing an external walkaround of the aircraft, personnel should be aware of a number of
safety concerns and emergency equipment features.
FORWARD SECTION OF AIRCRAFT
41. Radome. If radome is operating, remain 40 ft (or 12m) away due to radiation emissions occurring
during operation. A pylon should be placed at the 40 ft (or 12m) mark as an indication that the radome is
being tested; to be safe approach aircraft from the 10 o’clock position.
RIGHT SIDE OF AIRCRAFT
42. Liquid oxygen (LOX) vent. Beware of leaking LOX due to its highly flammable/explosive nature.
43. Right hand side emergency exit:
6-2B-19
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44. Wings:
a. circle of safety is 12 ft (or 3.6m) from wing tips, nose, and tail of the aircraft;
b. be aware of prop warning line, designates propeller location;
c. propellers have mesmerizing effect when operating; and
d. life rafts are visible on bottom side of wing when flaps fully extended.
45. Right paratroop door:
another person.
AFT SECTION OF AIRCRAFT
46. Ramp:
a. 50 ft (or 15m) is the minimum safe distance aft of the ramp when the aircraft is operating; and
b. hazard area – do not walk under ramp when closed.
47. Aft overhead escape hatch:
b. recessed D-ring for opening.
LEFT SIDE OF AIRCRAFT
48. External markings for emergency equipment.
b. hand axe.
6-2B-20
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49. Left paratroop door:
another person.
50. LOX overboard drain. The LOX overboard drain is located forward of left paratroop door.
51. Centre overhead escape hatch:
a. can be opened from the outside; and
b. has recessed D-ring for opening.
52. Auxiliary power unit exhaust vent:
a. located forward of the left wheels; and
b. hazard area due to the extreme heat expelled in this area.
53. Wings. Same as on right side of aircraft. Circle-of-safety 3.6 metres (or 12 ft) from wing tips.
54. Wheelwells. Hazard area due to hydraulics.
NOTE
If one hydraulic system is activated others could accidentally activate at the
same time.
55. Left side emergency exit:
56. Crew entrance door. Hazard area. Never stand in front of the door when it is closed.
a. hand axe; and
b. fire extinguisher.
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58. Ground power unit outlet. Ground power unit is loud and a potential source of electrical shock,
walk around the unit.
INTERNAL WALKAROUND
NOTE
As the time of publication there are two CC130J that are fully configured to
Canadian standards, the remainder are in various stages of modification to
the standard. It is advisable to do a thorough walkaround, any questions
should be directed to the LM.
Figure 6-2B-13 Emergency Equipment Locations on CC130J
6-2B-22
B-MD-005-000/FP-001
FLIGHT DECK
59. Starting behind the left seat (generally the AC position) on the bulkhead and going clockwise around
the Flight Deck, emergency equipment is located as follows:
a. Pilot’s quick-don mask with regulator;
b. Pilot’s smoke goggles;
c. Pilot O2 walk around bottle;
d. O2 recharge hose;
e. Co-pilot’s quick-don mask with regulator;
f. Co-pilot’s smoke goggles;
g. Co-Pilot’s O2 walk around bottle;
h. O2 recharge hose;
j. Augment Crew Station quick-don mask with regulator;
k. Augment Crew Station smoke goggles;
m. Crew bunk O2 regulator (2) no masks or hoses;
n. Crew life vests x10 (upper bunk);
p. Restraint harness;
q. Emergency flashlight (Upper bunk) may or may not be there;
r. Forward overhead escape hatch;
s. Escape rope;
t. first aid kit (2);
u. Emergency Escape Light (EEL);
(1) different then old EEL now green light with Red “PULL EMERGENCY LIGHT” handle, no
selector switches but operates the same way, will turn on if there is a loss of aircraft power,
>2.5 G deceleration or if you remove it from its bracket.
6-2B-23
B-MD-005-000/FP-001
Figure 6-2B-14 Emergency Escape Light
v. Life raft release handles; and
WARNING
Pull the life raft release handles through their full travel to ensure complete
ejection and inflation of the life rafts.
w. Crew door jettison handle.
CREW ENTRANCE AREA MULTI-FUNCTION LM DISPLAY STATION
60. Emergency equipment that is located in this area is as follows:
b. EEL;
c. Door warning light and;
d. Dry chemical fire extinguisher (primarily used for brake fires); and
e. Halon fire extinguisher.
WARNING
Although Halon 1211 has low toxicity, its decomposition products can
be hazardous. On decomposition Halon 1211 has a sharp acrid odour.
Crewmembers should wear supplemental oxygen including full face/eye
protection when using a Halon to combat a fire. The area must be well
ventilated after use.
6-2B-24
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CARGO COMPARTMENT
61. Emergency equipment is located in the cargo compartment as follows:
a. On the 345 Bulkhead:
(2) Crash axe;
(3) Oxygen shut off valve;
(4) Oxygen recharger hose; and
(5) Walkaround bottle quick-don mask and smoke goggles.
b. Forward of the Right Wheelwell:
(1) First aid kit (3);
(2) Quick don mask with smoke goggles with regulator (x2);
(3) Extra regulator hose (connected to second regulator);
(4) Right side emergency escape hatch; and
(5) EEL (escape hatch).
c. Aft of the Right Wheelwell:
(1) Walkaround bottle with quick-don mask and smoke goggles;
(2) O2 recharge hose;
(4) Right paratroop door.
d. Aft of the Right Paratroop door:
(1) Door warning lights x3 (Right Paratroop Door, Ramp and Ramp door);
(2) EEL (right paratroop door);
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B-MD-005-000/FP-001
(4) Life raft release handles; and
(5) Third set of life raft release handles located on the top of the wings.
e. Ramp area:
(1) Aft overhead escape hatch;
(3) Escape rope;
(4) EEL (aft escape hatch);
(5) Halon fire extinguisher; and
(6) Crash axe.
f. Aft of the Left Paradoor:
(3) Left paratroop door.
g. Aft of the Left Wheelwell:
(1) EEL (left paratroop door);
(2) Door warning light;
(3) Portable walkaround oxygen bottle with smoke mask;
(4) Halon fire extinguisher (left wheelwell);
(5) Centre overhead escape hatch;
(6) Escape rope; and
(7) EEL (centre overhead escape hatch).
h. Forward of the Left Wheelwell:
(1) first aid kit (3).
6-2B-26
B-MD-005-000/FP-001
NOTE
The safety/survival equipment is located in the forward section of the aircraft
in two (2) black triwalls as there has to be a modification to install the survival
racks in the forward section. Each triwall is marked with its contents on the
lid.
NOTE
The pax life vests, infant cot and the remainder of the first aid kits are also
stored in the black triwalls.
Note
Some airframes have the emergency flashlight mounts installed but the
lights are not mounted as of yet, other airframes are still awaiting the install.
Otherwise, the flashlights are held in the black triwalls.
FLOOR RAILS
62. The CC 130J is equipped with a floor mounted rail system that includes 4 rows of rails that are
permanently attached to the floor. The rails have a release latch that allows the user to pull the rail out of
the floor and flip it over to expose the wheels. The rail is then snapped back in place.
Figure 6-2B-15 Floor Rail System
6-2B-27
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GENERAL
63. Throughout emplaning and deplaning, the MCD (or the MCD’s representative) will direct the process
to ensure it occurs expeditiously and safely.
LITTER PATIENTS
64. Litter patients should be emplaning and deplaning through the CC130 ramp, if at all possible. Under
unusual circumstances litter patients may be loaded or unloaded through the paratroop door as long as
there is sufficient help to accomplish the load safely.
AMBULATORY PATIENTS
65. Ambulatory patients may be emplaned or deplaned in any manner as long as it is done safely.
Patients using support devices (i.e. canes, crutches, etc) must be assisted to reduce opportunities for injury
while moving onto and off of the airframe.
LITTER CONFIGURATIONS AND USE OF STANCHIONS
66. The CC130J can be configured to position litters down the centre of the cabin, along the sides of the
cabin, or both depending on the number of patients anticipated. The forward-most side litter stanchions
remain in place at all times as they are utilized to hang troop seating when litters are not carried. Centre
litter stanchions (eight in all) are stored at the 345 bulkhead and must be installed if litter tiers are required
in the centre of the cabin; the remainder are placed along the left forward sidewall behind the troop seats.
To remove these litter stanchions from their storage position the operator pushes up on the stanchion which
compresses an internal pin, while sliding the footplate free of its retaining bracket on the floor with your
foot. Centre litter stanchions are locked into place by compressing the top pin inserted into the ceiling socket
marked for litters, and sliding the foot plate into a bracket on the aircraft floor.
LITTER STANCHION SUPPORT BRACKETS
67. Each centre stanchion support strap should be equipped with five litter stanchion support brackets
and each side stanchion should have four brackets. Although litter patients are normally carried four high,
the fifth litter stanchion support bracket on the centre tiers allow an additional litter to be installed should
one be needed. All litter stanchion support brackets must be tested pre-flight by:
a. inspecting the stanchion bracket to ensure all components are present;

b. disengaging the locking pin by lifting-up on the lever at the front of the bracket;
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c. sliding the bracket up and down the stanchion ensuring free movement;
d. releasing the lever and sliding the bracket up or down the stanchion until the locking pin seats itself
into a position;
e. all rubber grommets and pads should be intact to ensure security of the litter once the bracket is
enclosed; and
f. the locking mechanism should be intact and functioning properly.
LITTER SUPPORT STRAPS
68. There are 36 litter support straps stowed in canvas bags on the side wall of the fuselage also in the
wheel well area and the forward section of the cargo compartment in boxes in the centre (“Hogs Trough”)
area. The litter support straps are to remain attached to the over head support at all times. If there is a
requirement for the litter support strap to be removed then the MCD will consult with the Loadmaster and
follow their direction. Each strap when attached to the overhead support should have the buckle facing
outwards to ensure that a visual inspection is possible. There should be at minimum 10cm and maximum
15cm to ensure that it will not slip out of the buckle. If there are discrepancy then the Loadmaster it to be
informed.
WARNING
Removing the straps from the centre “Hogs Trough” must be done so with
extreme caution as there are avionics, power lines and flight controls in, on
and around these boxes. If in doubt contact the LM and they will assist in
the removal.
69. Centre litter support straps should be equipped with five support brackets and side litter support
straps with four. The positioning of these brackets must correspond to the positioning of the brackets on
the litter stanchions. Each bracket on each litter support strap must be tested to ensure that the locking
mechanism at the rear is functioning to prevent the brackets from slipping down the straps with the weight
of a loaded litter. This testing procedure includes:
a. inspecting the strap bracket to ensure all components are present;
b. disengaging the locking mechanism by lifting-up on the two levers at the rear;
c. sliding the bracket up and down the strap ensuring free movement;
d. releasing the levers; and
e. ensuring the bracket does not slide up or down the strap when weight is added.
6-2B-29
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Figure 6-2B-16 Litter Support Straps
EMPLANING AND DEPLANING LITTERS
70. When a litter is emplaned, the handles are placed into the brackets on the stanchion poles and the
adjacent litter support straps. Litters are always loaded from the top litter to the lowest litter and removed in
reverse order because of patient safety concerns. The litter is secured for flight by locking all four brackets.
Once all litters in the same tier have been loaded, the latch at the bottom of each litter support strap is
attached to the stud on the floor, and the strap is pulled tight. When deplaning the litter, the catch of each
bracket is disengaged. The litter handles are lifted out of the brackets and the litter carried off the aircraft.
Figure 6-2B-17 Securing a Litter
6-2B-30
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REPAIRS AND DISCREPANCIES
71. The LM is responsible for coordinating the repair and/or replacement of defective or missing litter
stanchions, litter support straps, and brackets. The MCD is responsible for notifying the LM of the need for
this service. In a tactical AE situation, AECMs are responsible for the serviceability of their equipment and
for reconfiguration of the cabin once the cargo has been off-loaded.
CONFIGURATIONS
GENERAL
72. The CC130J’s extra length allows for more tiers to be placed on the aircraft. The maximum number
of patients that can be loaded is 97, this is shown in Figure 6-2B-19. There are 4 configurations that have
been developed be used in combination with passengers and cargo. During mission planning it is the
responsibility of the MCD to contact the LM to confirm configuration issues. In cases where there are
multiple movements (i.e. cargo, pax and/or patients) going on then the MCD may have to reconfigure their
load plan based on those factors. Here are the 4 configurations:
NOTE
Even though there are 4 official configurations, flexibility is required as most
time the medevac mission will be added onto an existing mission.
a. Configuration AE-1 provides 30 litter spaces, 53 patient/passengers seats, and 9 crew seats. The
number of Aeromedical evacuation crewmembers governs seat availability;
Figure 6-2B-18 AE-1 Configuration
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b. Configuration AE-2 provides 97 litter spaces and 10 crew seats. The number of Aeromedical
evacuation crewmembers governs seat availability;
c. Configuration AE-3 provides 20 litter spaces, 53 patient/passengers seats, and 9 crew seats. The
number of Aeromedical evacuation crewmembers governs seat availability; and
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d. Configuration AE-4 provides 60 litter spaces, 53 patient/passengers seats, and 9 crew seats. The
number of Aeromedical evacuation crewmembers governs seat availability.
Figure 6-2B-22 Paratroop Seating
Figure 6-2B-23 Cargo Arrangement
6-2B-33/6-2B-34
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SECTION 3
CC150 POLARIS (AIRBUS)
Figure 6-3-1 CC150 Polaris in Flight
GENERAL
1. The CC150 Polaris is a two turbo-fan engine, the third being the APU, medium range aircraft. CC150s
are utilized both to transport personnel and haul cargo and therefore have several configuration variations.
Two of the configurations used for AE are the full passenger and combination passenger-cargo models.
Patient Transport Units (PTU) and litter platforms are routinely installed on these two models (see strategic
aircraft configuration table at the end of this section).
TROOP CONFIGURATION
2. The Polaris in the passenger configuration can carry 192 pax seated in regular airline seats. The
Combi configuration is able to carry 60 pax in the rear third of the aircraft. In this configuration, the passenger
area is sealed off from the cargo compartment during flight.
3. Either NATO litters and/or PTU may be used to transport patients. NATO litters may be secured to
a PTU via specially designed brackets or to specially designed stretcher platforms that are secured onto
folded over passenger seats. A limited number of seats can break forward, and a fixed number of stretcher
platforms are available. This restricts the number of platforms/litters that can be emplaned.
4. Only the full passenger airframe has the front end loading capability to allow for transport of critical
care patients and “bulky” patients with multiple and/or cumbersome pieces of medical equipment. In order
to on and off load these stretcher patients the forward left bulkhead must be removed. PTUs are installed in
the business class and front economy class sections forward of the lavatories, to separate the medical area
from duty passengers.
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5. Combi configurations can be utilized only for non-critical and ambulatory patients. PTUs can be
installed in the rear pax area, however it is impossible to load a litter patient safely on a combi CC150 and
therefore the patient has to be able to go sit in the Sky Chair or be able to walk 10 feet to the bed. The rollers,
rails and pallets in the cargo area constitute a tripping hazard when transiting through this area with a
stretcher and the 48.3 cm (19”) door makes it impossible not to angle the patient on the stretcher. Stretchers
cannot be safely loaded through the rear entrance due to limited turning radius.
6. Loading and unloading stretchers requires a power supplied vertical lift mechanism to bring the
stretcher and medical attendants level with the doors while protecting them from the elements. A Tunner
K-Loader may be used if a covered food truck is unavailable. Maximum AE capacity on the Airbus (pax
configuration) is 6 PTU and 6 stretcher platforms, for a total of 12 litter patients. Maximum litter capacity
on the combi-configured aircraft is 6 PTU beds/platforms. If more then one stretcher platform is going to
be used then the AECO and/or MCD will need to inform the Air Canada techs immediately as the aircraft
only has one stretcher platform as part of its normal inventory. The extra stretcher platforms would need to
be drawn from other CC150s and returned at the end of the mission. There are a total of 6 platforms: 1 per
aircraft (5 aircraft) and 1 spare. The PAX configuration is best suited for large volumes or unstable patients.
Figure 6-3-2 Possible Polaris Configurations
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AIRCRAFT GENERAL INFORMATION
Engines Two turbo-fan General Electric

Cf6-80C2A2
Engine Thrust 52,000 lbs per engine
Maximum Take-off Weight 346,185 lbs (CF uses 346,200)
Maximum Dry Weight 251,400 lbs
Maximum Landing Weight 273,400 lbs
Maximum Payload 65,000 lbs
Fuel capacity with ACT installed (Additional Centre Tank) 118,000 lbs or approx 18,000 US gal
Density of fuel will affect this.
Fuel Consumption Taxi – 600 lbs
Long Range Cruise – 10,500 lbs/hr avg
Landing Gear Tricycle – Truck type
Crew Compliment – Full Pax Config – 2 Pilots, LM, 2FS, 3FA, AME
– Combi Config – 2 Pilots, LM, FCM, 1FS, 1FA, AME
– MRTT – TBA
Manufacturer Airbus Industries, Toulouse, France
Aircraft Type CC150 Polaris Aircraft / Airbus A-310
Short & medium range, wide-bodied transport aircraft
Engines Safe distance from idling engines are:
25 ft (or 7.6m) in front and 180 ft (or 55m) behind
Radome Safe distance from an operating radome: 24 ft (or 7.3m)
Wing Span 144 ft (or 44m)
Overall Length 152 ft & 4 in (or 46m)
Height of Cabin floor 14 ft (or 4m)
Cruising Speed 860 km/hr
Maximum Operating Altitude 41,000 ft
Maximum Take-off Weight 346,185 lbs (CF uses 346,200 lbs)
9 Emergency Exits 4 Type “A” Doors, 2 Type “III” Doors,
2 Flight deck Windows & 1 Avionics Bay Door
Evacuation Alert System (EAS) Designed to alert crewmembers to initiate an evacuation
(Warning horn)
Emergency Lighting System (ELS) Provides illumination of various areas of the cabin in the
event of power failure
Lavatory Smoke Detection System Warning lights (Red) in the cabin and flight deck are
combined with the Call System chimes
CF Seating layout 194 (30 Business Class, 164 Economy Class)
Full passenger configuration 190 seats for passengers, 4 designated crew seats
(except CC150-001)
60 Economy Class
COMBI configuration 56 seats for passengers, 2 designated crew seats.
Figure 6-3-3 Table of CC150 Specifications
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Figure 6-3-4 CC150 Danger Areas
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EMERGENCY EXITS
GENERAL
7. The CC150 Polaris has 6 doors:
a. 4 Type A doors each with an associated Slide/Raft; and
b. 2 Type III doors each with an associated Escape Slide.
Figure 6-3-5 Full Deployment of All Raft / Slides and Escape Slides
PASSENGER DOORS (TYPE A) (1L/R, 3L/R)
8. The 4 Type A doors located in the forward and aft section of the aircraft, are plug type doors,
connected to the fuselage by means of a support arm and guide arms. Doors open upward and outward,
parallel to the fuselage in the forward direction. They are operated by interior and exterior handles.
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9. This double-wide door is designed as a passenger entrance door as well as an emergency exit. On
the inner bottom portion of the door, there is a container which houses a slide raft. The door itself can be
opened from either the inside or the outside of the aircraft.
10. Each cabin door is equipped with an internal warning system. It warns the operator when the
evacuation system-arming lever is armed, thus preventing inadvertent slide deployment when the door is
operated. By lifting the door control handle 3 to 4 degrees a flashing red light and a buzzer are energized.
Both are located close to the arming lever. A push button allows the system to be tested irrespectively of the
arming lever and the door configuration.
11. This exit is considered a primary means of egress for both crash landing and ditching.
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Figure 6-3-6 Passenger Door (Type A)
12. Non-emergent opening. Prior to opening the door, ensure the arming lever is in the disarmed
position and the safety pin installed:
a. look outside for any signs of danger or obstruction.
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b. grasp the assist handle on the side of the door frame with one hand, and with the other hand grasp
the door control handle and slowly lift it to the full up position; and
c. still holding the assist handle, push the door outwards and forward until it lock in the open position
by means of an integrated locking device/gust lock.
Figure 6-3-7 Type A Door with Pin Installed and in Disarmed Position
NOTE
To prevent damage to the fuselage, a rubber stop is installed behind the
support arm. The door will automatically lock at the end of its forward travel
by an integrated locking device. A damper actuator assembly is located
behind the support arm, which will slow the travel of the door in windy
conditions.
13. Closing. Close Type A doors as follows:
a. be sure to grasp the assist handle with one hand and depress the gust lock with the other;
b. pull the door aft until it is in front of the frame and then pull the door inwards;
c. lower the door control handle fully and then check the door locking indicators at the top of the door;
and
d. the word LOCKED should appear through the viewing window and is green in colour. If any red is
showing or if the word UNLOCKED appears, open the door and close it again.
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14. Emergent opening. Always look outside for signs of danger or obstruction prior to opening door.
When the door is armed, lifting the door control handle more than 3 to 4 degrees initiates a self-open
feature:
a. to ensure quick opening of the door push the door outward and forward with the palm of both
hands;
b. the damper actuator forces the door to the fully open position and the slide drops from its container
and self-inflation commences; and
c. immediately reach to lower right side of doorsill and pull red manual inflation handle. This
ensures no time is lost if slide fails to inflate automatically. If handle pulled when slide is inflating
automatically, no adverse effects will occur.
NOTE
All cabin crew will immediately pull the red manual inflation handle that is
located in the lower right side of the door sill. This is to ensure no time is lost
if the slide failed to inflate automatically. If the handle is pulled when the slide
is inflating automatically, no adverse effects will occur.
15. Outside operation. To operate Type A doors from the outside:
NOTE
Indications for opening from the outside are labelled on each door next to the
exterior door control handle.
a. knock on window to announce intent to open door.
b. push the flap in to connect the exterior control handle to the locking mechanism;
c. grasp the control handle;
d. lift the door control handle fully up and the door will move outwards; and
e. with your other hand, push door forward until the integrated locking device/gust lock engages.
NOTE
As there is no means to see if the slide raft is armed prior to opening, a safety
feature has been built in. If someone attempts to open the door from the
outside, the arming lever automatically moves to the disarmed position and
the door opens without slide deployment.
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SLIDE / RAFT (TYPE A DOORS)
16. The slide/raft is located in a hard container fixed on the lower part of the door. It is a dual lane slide,
which may be used for crash landing evacuations and also may be used as a raft for ditching. As a raft, it
has a capacity of 67 passengers for normal use and 83 passengers for overload use.
17. When the door is in the armed position and opened, the slide/raft will inflate automatically in
approximately 5 seconds. If it fails to inflate, there is a red handle located on the right side of the girt bar
that may be pulled to manually inflate the slide/raft. Inflation is achieved by means of an air-aspirator jet
pump, which uses outside ambient air to fill the slide/raft. The jet pump is operated by compressed air in a
cylinder contained in the slide/raft container. A pressure gauge is visible on the outside of the container to
determine its serviceability.
18. Once the slide/raft is inflated, two bags are suspended from it on a strap. One bag contains a survival
kit and the other a canopy kit for the raft application. In the event of a night-time evacuation, an integral
lighting system is activated when the slide/raft is deployed and powered by means of a battery stored on
the slide/raft itself.
Figure 6-3-8 Deployed Slide / Raft
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Figure 6-3-9 Slide / Raft Diagram
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DOOR SAFETY STRAP
19. When the door is in the open position and stairs are not in place, the door safety strap shall be
installed. The strap is made of nylon ad is black and yellow in colour. To install, grasp the black loop from
the aft door-frame and pull forward to fasten hook. This strap is intended as a visual indication only and was
not designed as a restraint device.
Figure 6-3-10 Door Safety Strap
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Overwing EXITS (TYPE III) (2L, 2R).
Figure 6-3-11 Overwing Exit Diagram
20. These two doors are used for emergency purposes only and mainly during crash landings, as it is
equipped with an escape slide only. There is a life line located under the seat adjacent to each door or in the
overhead bin above each door.
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21. This exit is considered a secondary means of egress in a ditching.
22. Only maintenance personnel will open this door in non-emergency situation.
NOTE
Each cabin door is equipped with an internal warning system. It warns the
operator when the evacuation system arming lever is armed, thus preventing
inadvertent slide deployment when the door is operated. By lifting the door
control handle 3 to 4 degrees, a flashing red light and a buzzer are energized.
Both are located close to the arming lever. A push button allows the system
to be tested irrespectively of the arming lever and the door configuration.
23. Emergent opening. During the door opening, the escape slide drops out of its container and the
automatic inflation is initiated. The slide is single lane, 7 metres in length and takes approximately 5 seconds
to inflate.
a. look out window to assess conditions prior to opening;
b. slide arming lever has been set to the armed position and the safety pin stored;
c. remove protecting cover;
d. hold on assist handle on top of the door;
e. lift up the control handle;
f. push door outwards; and
g. immediately reach to lower right side of doorsill and pull red manual inflation handle. This
ensures no time is lost if slide fails to inflate automatically. If handle pulled when slide is inflating
automatically, no adverse effects will occur.

Figure 6-3-12 and 6-3-13 Initial Deployment of the Escape Slide
6-3-14
B-MD-005-000/FP-001
Figure 6-3-14 Full Deployment of the Overwing Escape Slide
FLIGHT DECK CLEARVIEW WINDOWS
24. Two sliding windows provide an alternative emergency escape route for the flight deck crew. Four
escape descent devices for emergency evacuation from the flight deck. There are two above each sliding
window. Each device may be used through either window. The cable length is 33 ft (10 m) and the user
weight range is from 100 lbs up to 250 lbs (45.4 Kg up to 113.5 Kg).

NOTE
The flight deck clearview windows can be opened from the inside and as
such are not considered emergency exits.
Figure 6-3-15 Flight Deck Window and Escape Descent Device
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AVIONICS BAY HATCHES
25. The main bay access hatch is located in the flight deck compartment floor, behind the left seat.
26. The avionics hatch gives access to the ground. It is mechanically operated and can be opened from
the inside or the outside. A ladder is stowed near the door.
Figure 6-3-16 Avionics Bay
AIRCRAFT SYSTEMS
OXYGEN SYSTEMS
27. On the CC150 Polaris, the fixed oxygen systems are divided in two separated subsystems;
a. A gaseous system for the flight deck; and
b. A chemically generated oxygen system for passengers and cabin crew.
Figure 6-3-17 PAX Emergency Oxygen
6-3-16
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c. Passengers. Each oxygen panel on the passenger service unit (PSU) contains one chemically
generated oxygen unit. It will provide approximately 15 minutes of oxygen once activated, it cannot
be turned off and the entire system must be replaced once the aircraft returns to the ground. The
number of oxygen masks in each panel is identified on the doorstop of each panel. Generally
2 masks are contained the centre (right and left locations) and 3 are contained in the outerboard right
and left containers.
d. The oxygen system can be activated by three methods:
(1) If the cabin altitude exceeds 14,000 ft (+/– 500 ft), the masks drop automatically;
(2) Electrically, deployed by the AC by activating a switch in the flight deck; and
(3) Manually, unlocking the panel inserting a manual release tool (MRT) into a small hole in the
oxygen panel.
NOTE
To initiate oxygen flow to a specific mask, the mask must be pulled down far
enough to release a pin, which activates the oxygen-generating unit.
NOTE
Chemically-generated oxygen systems in all lavatories have been disabled
and are no longer functional.
WARNING
Once activated, the generator gets very hot; do not touch with bare hands.
ELECTRICAL SYSTEMS
28. An overview of the Spectrum bed system and its integrated electrical system is described in
B-MD-010-000/FP-001, Aeromedical Evacuation Equipment Manual.
29. There are 115 VAC/60 Hz plugs at various locations throughout the aircraft (3 duplexes in the forward
area of the business class section).
30. There is a satellite phone located on the flight deck beween the pilots. This phone is availible for use
if the MCD is requred to contact the AECO or a Flight Surgeon. To use the phone the MCD will cosult the LM
and the LM will inform the AC.
31. There are four interphone handsets in the main cabin; one located at each of the Type A doors. These
handsets allow any one of the positions to communicate with the flight deck or any other position over the
intercom system. There is also a capability of making Public Announcements (PAs) from any of the stations.
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The call system alerts crewmembers of incoming calls by means of a chime system over the main cabin
speakers and by use of indicator lights.
Figure 6-3-18 Satellite Phone (right)
NOTE
Figure 6-3-19 depicts the PURS station handset.
6-3-18
B-MD-005-000/FP-001
Figure 6-3-19 Interphone Handset
a. Input Priorities of the Passenger Entertainment System
1st Flight Deck

2nd Cabin Crew
3rd Tape Reproducer
4th Passenger Entertainment System
b. Each call station has three white lights on top marked CAPT, PURS and ATTN. If the AC were to call
a specific station, the CAPT light would illuminate at that station. If the Load master were to call
a specific station, then the PURS light would illuminate. If any other station calls, the ATTN light
would illuminate at the station being called.
c. Once the handset is removed, on the bracket itself there are six more buttons used to make calls to
specific stations. The Interphone handsets vary slightly, in that there is no need to have a button to
call your own station.
d. To call a specific station, remove the handset, depress the button for the station desired and await
a reply. In the centre of these buttons there is a small green light. If the communication system is
currently being used, the green light of the station concerned is illuminated at all stations.
e. To make a PA pick up the handset, depress the PA button, press the flap on the handset and speak.
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f. When a call is made to any station, crewmembers are notified by a high/low chime that is broadcast
over the cabin speakers. In addition to this signal, one of the three lights at the top of the handset
will illuminate, to indicate where the call is originating. For example, if the LM wishes to call the rear
(3L/R), the PURS light would illuminate on both rear handsets. To receive the call, lift the handset,
press the push to talk flap and speak.
NOTE
If a call is being placed while a PA is being given these lights will not illuminate.
g. When the CAPT presses the ALL ATTENDANTS call from the flight deck, a high/low chime is heard,
the CAPT light illuminates over all handsets and the red light in the centre of all area call light panels
will illuminate. Once the call is received at any station the red light is cancelled.
h. This communication system makes it possible to speak to any station in the cabin of the aircraft on
the intercom system.
LIGHTING SYSTEMS
Figure 6-3-20 Cabin Light Panels Above Door 1L in the PAX / COMBI Configs
32. Main Cabin Lighting. A network of fluorescent light fixtures throughout the main cabin provides
the cabin lighting system. The cabin lighting panel is located at the load master position above the assist
handle. It consists of different push-button(s), each containing an integral light, which illuminates to indicate
what setting has been selected. The required light intensity for each area can be controlled independently.
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a. The lighting can be controlled in each of the three sections of the aircraft. These are as follows:
(1) “BC” refers to Business Class Section rows 1 to 5;
(2) “YCF” refers to Economy Class Front rows 6 to 9 which go to the centre lavatories; and
(3) “YCR” refers to Economy Class Rear rows 11 to 28 centre lavatories to the rear of the aircraft.
b. Different light intensities can be chosen for each of the three sections: 10%, 50%, 100% can be
selected. The push button representing the selection chosen will illuminate by means of integrated
light. If no light is present in any of the three push-button(s) relating to a particular section, either
the bulb is burnt out or the lighting has been turned off. To regain lighting, the push-button must be
depressed again.
c. The push-buttons on the lower portion of this panel are marked “1”,”2” & “3”. This refers to the
specific track of lighting in the main cabin as follows:
(1) “1” – Controls the lighting strip under the lateral overhead bins and under the centre overhead
bins;
(2) “2” – Controls the lighting strip above the lateral overhead bins; and
(3) “3” – Controls the lighting strip on the centre ceiling.
d. If any or all of the lighting strips are energized, the push-button(s) will illuminate. These strips are
common to all three sections of the aircraft.
e. There is also a lighting panel at door 3L controlling the economy class rear section and the AFT
galley that operates in a similar manner as the ones above.
33. Entrance Lighting. An ENTR push button on the lighting panel turns the fluorescent lamps on at
the forward and aft entrance and galley areas to 100% illumination intensity. Different intensities can be
obtained by depressing the ENTR push button to 10%, 50% and 100%.
34. Emergency Lighting. The emergency lighting system provides illumination of various areas of the
aircraft in the event of normal power failure. The areas provided for are as follows:
a. 1 emergency exit light in each over wing exit doorframe;
b. 20 ceiling lights distributed throughout the main cabin;
c. exit signs at the exit areas for a total of six;
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d. exit lights above each door;
(1) low intensity floodlights located close to each exit approximately 24 inches above the floor;
and
(2) floor proximity low intensity floodlights located below passenger seats on a full passenger
configuration and floor track lighting on a COMBI.
TOILETS / LAVATORIES
Figure 6-3-21 Lavatory Layout Diagrams
35. The CC150 aircraft is equipped with six lavatories in the full passenger configuration; one in the
front just outside the flight deck, Lavatory “A”, three in the centre of the aircraft lettered from left to right
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Lavatory’s “O” “P” & “W” and two in the rear “Y” on the left & “Z” on the right. On a COMBI configuration
there are only three, “A”, Y” & “Z”.
36. All of the lavatories have the same basic features. Each has a door, which may be unlocked from the
outside in the event of an emergency. There is a flush toilet, mirror, washbasin, waste basket and storage
areas. There is also a dispenser unit where items such as toilet paper, sanitary napkins, airsick bags and
hand-towels are readily available to the passengers. These lavatories also include assist handles in case of
turbulence. No oxygen availability in lavatories – system has been disabled.
37. Lighting is obtained from two sources. A dome light is located in the ceiling of each lavatory and is
illuminated whenever the aircraft is on ground power or APU, and when the aircraft engines are running.
The second source of light is two fluorescent tubes, which run down each side of the mirror. When the
aircraft is connected to a power source, the lights are at 50% intensity until the door is locked. At that time,
the lighting intensity increases to 100%.
LAVATORIES O, P & W
38. Lavatories O, P & W have the same characteristics as lavatory “A” except that the doors are bi-fold
type and they are equipped with diaper change tables. The doors open inward and have special opening
procedures in the event of an incapacitated passenger. If the door will not push inward, first you must unlock
the door by sliding the lock to the unlocked position. On the top and bottom of the door, there are two levers.
You must pull the upper lever down ¼ turn and lift the lower lever up ¼ turn. Once this has been done, the
door will swing outward. If you still cannot access the trapped passenger, a pip pin is installed on the inner
lavatory wall. This retains a small closure device that holds the door inward. By pulling the pin, you can
open the door fully outward and attend to the passenger.
LAVATORIES Y & Z:
39. The features in lavatories Y & Z are similar to the others except that they are modified slightly to
accommodate the handicapped passengers.
40. The door is slightly larger and opens outwards to allow a passenger utilizing the Sky Chair to enter.
The interior of the lavatory has a tilt mirror, assist handles, enlarged toilet flush button and an enlarged
attendant call button. Lighting is always at 100% in theses lavatories.
LAVATORY SERVICE UNIT (LSU)
41. There is an LSU in each Lavatory. It has a speaker, fresh air outlet, attendant call button, electrical
razor outlet, and an information panel, which has a “Return to Seat” sign in English and French.
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Figure 6-3-22 LSU Diagram
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GALLEYS
Figure 6-3-23 Galley Diagrams and Locations
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GALLEYS 1 & 1C
42. Galley 1 is located at the forward end of the aircraft and is equipped with numerous components to
aid in the meal and beverage service to the passengers and crew. These components are:
a. Refrigerator;
b. Three coffee makers;
c. One hot cup (for boiling water);
d. Three convection ovens (each hold 32 passenger meals);
e. Refrigerated storage compartments for 4 large food carriers (each one will hold 39 hot meal trays
or 52 sandwich trays);
f. Trash compactor (do not put liquid in these);
g. Ice drawer;
h. Sink with water faucet;
j. Electrical panel with circuit breakers and switches;
k. Working light;
m. Storage areas; and
n. Pull out shelves to increase counter space.
43. Galley 1C is also located at the front and is designed as an auxiliary galley it does not have any
electrical service or a refrigeration capability. There is storage for two large food carriers and various
other small storage compartments for utensils and accessories for meal and beverage service. (full pax
configuration only).
GALLEYS 5, 6, 7 & 8
44. Galley 5 is located directly behind row 28 DEF at the rear of the aircraft. This provides stowage
for two food carriers and various storage compartments. It has no refrigeration capability and only one
electrical outlet. It has a work area light in the ceiling that is controlled from a switch in galley 7. This galley
contains the Video System.
45. Galley 6 is located in the rear on the right hand side, and provides storage for:
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a. 6 food carriers (5 which have refrigeration capabilities);
b. the 7th food carrier position houses a trash compactor;
c. 4 convection ovens;
d. 4 coffee makers;
e. 2 hot cups;
f. sink, water faucet & shut off valve;
g. refrigerated compartments;
h. storage compartments; and
j. work light in ceiling over the sink, controlled by a switch in the galley.
46. Galley 7 is located in the rear on the left hand side and provides storage for;
a. 7 food carriers (6 which have refrigeration capabilities);
b. 3 convection ovens;
c. 3 coffee makers;
d. 2 hot cups;
e. sink, water faucet & shut off valve;
f. storage compartments(safe); and
g. work light in ceiling over the sink, controlled by a switch in the galley.
47. Galley 8 is located aft center of this area. It contains 2 compartments. On the combi configuration,
the right compartment contains 5 portable breathing equipment (PBE) for crew use.
EMERGENCY EQUIPMENT
GENERAL
48. This portion of the guide is designed to allow a ready reference of information; however official
publication that contains any of the following information will supersede this regulation. Annex 6B also
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contains further information on some items. The CC150 is fully equipped to meet the latest Federal Aviation
Administration (FAA) requirements for EMERGENCY conditions, including passenger evacuation.
49. The SAFETY of passengers and crewmembers in case of an emergency is enhanced by the
development of interior materials, which are fire proof and non-smoke producing, and by the wide-bodied
features such as:
a. two aisles running through the full length of the cabin;
b. wide cross aisles;
c. four double width EXITS for two abreast evacuation;
d. two emergency EXITS located over the wings;
e. attendant stations located at each exit to assist passenger evacuation;
f. one evacuation slide/raft or slide for each exit; and
g. emergency Alert System.
50. The quantities and locations of the following equipment are as per CFACM 60-150-0950 (CC150
Polaris LM/FCM/FA/FS Checklist). Figures 6-3-24, 6-3-25 and 6-3-26 provide an overview.
6-3-28
B-MD-005-000/FP-001
Figure 6-3-24 Combi Configuration and Emergency Equipment
6-3-29
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Figure 6-3-25 Legend for Emergency Equipment Locations
6-3-30
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Figure 6-3-26 Passenger Configuration and Emergency Equipment
6-3-31
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Item Full Pax Combi 15001

Qty Qty Qty
O2 bottle complete 7 1-fwd left 5 1-fwd left storage 7 1-fwd left
with (c/w) compartment compartment compartment
disposable mask 1-fwd face lavatory Z 1-fwd face lavatory 1- aft right overhead
2-aft left storage Z bin
compartment 2-aft left storage 2-aft left storage
1-fwd face lavatory Y compartment compartment
2-fwd left overhead 1-fwd face lavatory 1-aft left overhead
bin Y bins
2-fwd left overhead
bin
O2 bottle c/w 3 1-flight deck 3 1-flight deck 3 1-flight deck
disposable 1-fwd right stowage 1-fwd right storage 1-fwd right overhead
and smoke mask carrier compartment bin
1-aft right storage 1-aft right storage 1-aft right storage
compartment compartment
Halon fire 5 2-flight deck 5 2-flight deck 5 2-flight deck
extinguisher (1-avionics bay) (1-avionics bay) (1-avionics bay)
1-fwd right storage 1-fwd right storage 1-fwd right storage
compartment compartment compartment
1-fwd face lavatory W 1-aft right storage 1-door 2R overhead
1-aft right storage compartment bin
compartment 1-overhead bin 1-aft right storage
compartment
Water fire 3 1-fwd left storage 2 1-fwd left storage 3 1-fwd left storage
extinguisher compartment compartment compartment
1-aft left storage 1-aft left storage 1-aft left storage
1-fwd face centre 1- door 2L
closet overhead bin
Emergency 9 1-each jump seat 7 1-each jump seat 9 1-each jump seat
flashlights position position position
Megaphone 2 1-fwd left storage 2 1-fwd left storage 2 1-fwd left storage
1-overhead bins 1-aft left overhead 1-overhead bins
bins
Emergency 2 1- overhead bin (Aft 1 overhead bins 2 1-aft right overhead
Locator right) bin
Transmitter 1- fwd right stowage 1-fwd right stowage
carrier carrier
6-3-32
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First aid kits 3 1-overhead bin 2 1-fwd left 3 1-overhead bin

(fwd left) overhead bin (fwd left)
1-overhead bin 1-fwd right 1-overhead bin (center
(centre left) stowage carrier left)
1 overhead bin aft left) 1-overhead bin aft left)
Fire axe 2 1-flight deck 2 1-flight deck 2 1-flight deck
1-aft right storage 1-aft right storage 1-aft right storage
compartment 2 compartment 2 compartment 2
Fireman’s gloves 1 flight deck 1 flight deck 1 flight deck
Pax life vest 1 under each seat 1 under each seat 1 under each seat
Supplementary 4 Centre overhead bins 3 2-overhead bins 4 Centre overhead bins
survival kit (2 fwd/2 aft) (centre aft) (2 fwd/2 aft)
1-fwd right
stowage carrier
Spare pax life 16 overhead bins 8 overhead bins 16 overhead bins
vests 8 Fwd left 8 Aft left 8 Fwd left
8 Aft left 8 Aft left
Medical kit 1 overhead bins 1 overhead bins 1 overhead bins
Aft left Aft left Aft left
EPOS N/A N/A 60 1-aft right centre N/A N/A
overhead bin
fwd left and right
centre overhead
bins
PBEs N/A N/A 5 5 Galley 8 N/A N/A
3 DC kit
Figure 6-3-27 Table of Emergency Equipment Locations / Quantity Summary
CREW OXYGEN
51. A quick-don O2 mask is located at door 1L crew position (except A/C 01). There are 4 additional quick-
don O2 devices in the flight deck (at each position).
52. A two-mask chemically generated oxygen unit is installed above each Cabin Attendant seat.
PORTABLE OXYGEN BOTTLES
53. Portable oxygen bottles are provided in the flight deck and cabin to be used as:
a. Protective (smoke mask) O2 bottles for crewmembers during emergencies (3); and
b. First Aid O2 bottles for therapeutic purposes (7 total).
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PORTABLE OXYGEN BOTTLES with disposable masks
54. Locations of portable oxygen bottles on the full passenger model (7 total) are as follows:
a. 1 – fwd left storage compartment;
b. 1 – fwd face lavatory Z;
c. 2 – aft left storage compartment;
d. 1 – fwd face lavatory Y; and
e. 2 – overhead bins.
55. Locations of portable oxygen bottles on the combi model (5 total) are as follows:
b. 1 – fwd face lavatory Z;
c. 2 – aft left storage compartment; and
d. 1 – fwd face lavatory Y.
PORTABLE OXYGEN BOTTLE C/W SMOKE MASK AND DISPOSABLE MASK
56. Locations of portable oxygen bottles c/w masks on the full passenger model (3 total) are as follows:
a. 1 – flight deck;
b. 1 – forward most outer bin, right side; and
c. 1 – aft right storage compartment.
57. Locations of portable oxygen bottles c/w masks on the combi model (3 total) are as follows:
b. 1 – fwd right storage compartment; and
c. 1 – aft right storage compartment.
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HALON FIRE EXTINGUISHERS
58. Locations of halon fire extinguishers on the full passenger model (5 total) are as follows:
(1) (1 in avionics bay)
b. 1 – fwd right storage compartment;
c. 1 – fwd face lavatory W; and
d. 1 – aft right storage compartment.
59. Locations of halon fire extinguishers on the combi model (5 total) are as follows:
(1) (1 in avionics bay)
b. 1 – fwd right storage compartment;
c. 1 – aft right stowage carrier; and
d. 1 – overhead bin located above 20AB.
WATER FIRE EXTINGUISHERS
60. Locations of water fire extinguishers on the full passenger model (3 total) are as follows:
b. 1 – aft left storage compartment; and
c. 1 – fwd face centre closet.
61. Locations of water fire extinguishers on the combi model (2 total) are as follows:
a. 1-fwd left storage compartment; and
b. 1-aft left storage compartment.
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FIREMAN’S GLOVES
Figure 6-3-28 Fireman's Gloves
62. A pair of special fireman’s gloves is located on the aircraft They are designed to protect the hands
while handling super-heated pieces of metal.
63. Location of fireman’s gloves on the full passenger and the combi models (1 total) is as follows:
a. 1 – flight deck, in a storage compartment on the left hand side of the aircraft behind the pilot’s seat.
FIRE AXE
64. Locations of the fire axes in both full passenger and combi models (2 total) are as follows:
a. 1 – flight deck; and
b. 1 – aft right storage compartment.
65. Although storage compartments that contain safety equipment are identified with labels on the wall,
those containing the fire axes ARE NOT, as they could be used as a weapon during a hijacking.
EMERGENCY FLASHLIGHTS
Figure 6-3-29 Emergency Flashlight
66. Locations of the emergency flashlights on the full passenger model (9 total)are as follows:
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a. 1 – each jump seat position
67. Locations of the emergency flashlights on the combi model (7 total)are as follows:
a. 1 – each jump seat position.
MEGAPHONE
Figure 6-3-30 Megaphone
68. Locations of the megaphones on the full passenger and combi models (2 total) are as follows:
a. 1 – fwd left storage compartment; and
b. 1 – aft left overhead bin.
69. The megaphone is designed to broadcast voice to a large crowd or over loud noises. It is battery
powered and has a pistol grip handle. Housed on the handle is a volume push-button that is pressed to
use. Speak into the microphone and to increase volume, simply speak louder. Due to its design, little or no
feedback will be encountered.
EMERGENCY LOCATOR TRANSMITTERS (ELT)
Figure 6-3-31 Emergency Locator Transmitter
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70. Locations of the ELTs on the full passenger model (2 total) are as follows:
a. overhead bins.
71. Locations of the ELTs on the combi model (2 total) are as follows:
a. 1 – fwd right stowage carrier; and
b. 1 – overhead bins.
72. The model is RESCU 406 (SE); it may be used on land or in water to transmit a distress signal to
search facilities. There is a four-position rotary switch on the unit: OFF, SELF TEST, ARM (armed), and
XMT (transmit). It is powered by a 12 volts battery that is contained within the unit. The ELT transmits on
three frequencies: Civilian 121.5 MHz, Military 243.0 MHz, and SARSAT 406.028 MHz. Once deployed, it will
automatically transmit on all frequencies. Once it has been deployed it will transmit for a minimum of 50
hours on civilian and military frequencies and a minimum of 24 hours on SARSAT frequency.
73. To deploy on water, break tape holding cord wound on lanyard card and pull clear of ELT. Tie cord
securely to the life raft. Make sure that the four-position switch is in the ARM position (visible on the switch
at the antenna base). Place the unit in the water beside life raft and the remainder of the process is automatic.
After approximately 10 seconds, a flashing LED light will be visible at the transparent bushing cover located
on top of the transmitter cover. After approximately 5 minutes, the antenna will automatically deploy to the
upright position. Effective transmission of the emergency signals does not occur until the antenna is in the
upright position.
74. To deploy on land, move the unit to the highest point nearby for best transmission. Manually set the
four-position switch to XMT mode. With hand over antenna, break tape holding antenna and allow antenna
to erect. For best transmission, crouch bellow the level of the antenna base, or stand clear about 30 ft (10 m).
75. To temporarily interrupt transmission, set the four-position switch to the OFF position. To resume
transmission on water, set the four-position switch to the ARM or XMT position. To resume transmission on
land, set the switch to the XMT position.
CREW AND PASSENGER LIFE VESTS
76. Locations of crew and passenger life vests on the full passenger and combi models are as follows:
a. 1 – under each seat.
77. The crew and passenger life vests are of the same design and have the same features except for the
colour. The passenger life vest is yellow and the crew life vest is orange.
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Figure 6-3-32 Crew Life Vest Figure 6-3-33 Passenger Life Vest
SUPPLEMENTARY SURVIVAL KIT
Figure 6-3-34 Supplemental Survival Kit
78. Locations of the supplementary survival kit on the full passenger model (4 total) are as follows:
a. overhead bins.
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79. Locations of the supplementary survival kits (SSK) on the combi model (3 total) are as follows:
a. 2 – overhead bin; and
b. 1 – fwd right stowage carrier.
80. This kit is commonly referred to as the SSK and contains high-energy candies and 8-10 water
desalinizing kits. The candies are CHARMS and provide quick energy. There is also one bottle of motion
sickness medication.
81. Each of the water desalinizing kits contains a plastic container for water treatment and eight
individually packaged charcoal tablets. To treat the water:
a. Fill bag with water to the line and add broken charcoal tablet;
b. Roll the top of the bag over and fasten closed;
c. Agitate for approximately 1 hour;
d. The water will turn blackish in colour and will be ready to drink;
e. Open the small spigot at the bottom of the bag and remove water; and
f. When empty, rinse out bag and repeat process.
82. Each tablet will treat one pint of water (500mL), therefore each kit will treat 8 pints. If the bag develops
a hole, a small piece of repair tape is provided in the container. Detailed instructions are provided on the
equipment itself.
SPARE PASSENGER LIFE VESTS
83. Locations of spare passenger life verts on the full passenger model, in two pouches containing 8
passenger life vests each (16 total) are as follows:
a. overhead bins (forward and aft-most left overhead bins).
84. Location of spare passenger life vests on the combi model, in one pouch containing 8 passenger life
vests (8 total) is as follows:
a. overhead bins, located above 27AB.
85. These would be used to replace faulty or damaged life vests after a ditching.
6-3-40
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SLIDE / RAFT SURVIVAL KIT
86. A survival kit is secured by a nylon cord on the under side of the Slide/Raft, adjacent to the reservoir
and valve assembly.
FIRST AID KITS
Figure 6-3-35 First Aid Kit
87. Locations of the first aid kits on the full passenger model (3 total) are as follows:
a. overhead bins, located in 1AB, 11AB, and 27AB.
88. Locations of the first aid kit on the combi model (2 total) are as follows:
a. 1 – overhead bin located in 27AB; and
b. 1 – fwd right stowage carrier.
89. The first aid kits are a standard purpose kit. The kits are witness wired to readily show if they have
been opened. Anytime that one is opened, an entry is to be made in the cabin defect log by the LM.
MEDICAL KIT
Figure 6-3-36 Medical Kit
6-3-41
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90. There is one medical kit carried on the aircraft. It provides medical staff (including AECMs) with
certain items that are not carried in the general first aid kits. The contents are:
a. 1 EA First Aid Book;
b. 5 EA Patient Information Records;
c. 3 EA yellow coloured seals;
d. 1 EA tourniquet;
e. 1 EA splint;
f. 1 EA adult sphygmomanometer;
g. 1 EA dual head stethoscope;
h. 1 EA CPR ventilator (one-way valve and O2 adapter);
j. 1 bottle aspirin;
k. 1 bottle oral glucose;
m. 1 EA ventolin inhaler;
n. 4 EA Benadryl 50 mg tablets;
p. 1 EA Benadryl 50 mg/ml vial;
q. 2 EA Epinephrine (1:1000) Single dose ampoule;
r. 2 EA 1CC syringe with needle;
s. 2 EA 3CC syringe with needle;
t. 1 EA 60CC syringe with needle;
u. 1 EA 50% Dextrose (50CC injection); and
v. 1 pair latex gloves.
91. Location of the medical kit on the full passenger model (1 total) is as follows:
a. aft left overhead bin.
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92. Location of the medical kit on the combi model (1 total) is as follows:
a. bin above 27AB.
93. The kits are initially sealed with a green seal. Once opened, they are to be sealed with one of the
yellow seals contained within and an entry is made in the cabin defect log by the LM.
DANGEROUS CARGO KIT
94. The kit is designed to be used by the crew, to ensure they have the means required to deal with
certain airborne emergencies. This kit is usually only carried on the combi model. Taskings for the dangerous
cargo kit is normally carried out by Mov Winnipeg (1 Cdn Air Div Winnipeg / A4 Mov 2) on the Dangerous
Cargo Load List; however, the DC Kit is carried at all times on the Combi/MRTT/MRT(P3), located at
row 27AB.
95. The equipment and quantities incorporated in the Dangerous Cargo Kit consists of the following:
a. 2 x high pressure O2 bottles c/w smoke mask;
b. 3 x personal breathing equipment (PBE);
c. 1 x pry/crow bar;
d. 1 x wire/strap cutting shears;
e. 1 x pair fireman’s gloves;
f. 1 x utility knife;
g. 1 x whisk broom & dust pan;
h. 6 x heavy duty plastic bags and marking labels;
j. 1 x 1.5 cu. ft. bag of multizorb;
k. 1 x 25 lb sand bag;
m. 25 x yellow sonic bonded absorbent pads;
n. 5 x multizorb socks; and
p. 1 x chemical resistant suit with over boots.
6-3-43
B-MD-005-000/FP-001
Figure 6-3-37 Dangerous Cargo Container
PORTABLE BREATHING EQUIPMENT (PBE) FOR CREW
96. Locations of the PBE on the combi model (8 total) are as follows:
a. 3 – Dangerous Cargo Kit; and
b. 5 – Galley 8 (which is between Galley 6 and 7 the aft-most part of the aircraft).
97. The CF is mandated to provide smoke and fume protective devices to passengers and aircrew when
transporting Dangerous Cargo on CF aircraft.
EMERGENCY PASSENGER OXYGEN SYSTEM (EPOS)
Figure 6-3-38 EPOS Container Containing 20 Units
98. Locations of the EPOS on both the passenger and combi models are as follows:
a. 2 – first centre overhead bins; and
b. 1 – right aft centre overhead bins.
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NOTE
There are 20 per bag, for a total of 60 onboard.
GENERAL
99. Loading patients onboard the CC150 may be a challenge depending on the internal/external resources
the AECMs have at their disposal; keeping in mind the doorway is approximately 4.2 metres (14 feet) off the
ground. There are, however, several methods to load/off load patients and the AECMs need to be aware of
the safety principles during the planning phase, as well as the execution phase.
100. One of the simplest methods is to have the ambulatory patients emplane via the stairwell. Keep in
mind there are many stairs to climb and the patient(s) could overexert themselves; caution should be used if
this method is chosen. Another variant is to use the Sky Chair to assist patients up/down the stairwell. This
chair is stowed in 2 parts and must be assembled prior to use. It also has two armrests, 3 safety belts and a
brake (to lock wheels). Its design allows it to be used inside the cabin as well as a loading/off loading device
for patients/passengers with decreased mobility. Every CC150 has one. If unsure of its location or assembly,
consult a flight steward/attendant (FS/FA) or the LM.
101. Other means of loading patients (2A/2B) involve the use of a “K-loader” (used for pallets) catering
truck or High Deck Patient Loading Platform (USAF) to raise the patient litter to any of the Type A doors:
the distance from the ground to the door sill is 14 feet. Be cautious of the rollers usually on the K-loader’s
platform (these can be flipped over on most models). The patient is also exposed to the environment (rain,
wind, snow etc.). Extra personnel will be required to do a safe transfer of patients from ground level up onto
the K-loader. See Figure 6-3-39.
a. minimum of 8 personnel to do transfer from ground to floor of K-loader;
b. minimum of 2 personnel will travel on the K-loader while it is being raised (1 must be an AECM);
c. patients will never be driven from any point on the back of K-loader as it is only to be used to raise
and lower patients from an aircraft;
d. personnel will not stand while the K-loader is being raised or lowered;
e. rollers on the surface of the K-loader that are in the route of travel will be turned over (if able); and
f. emergency equipment will be accessible (can be in the aircraft or with ground support).
6-3-45
B-MD-005-000/FP-001
Figure 6-3-39 K-Loader Being Used to Load Patients
Figure 6-3-40 A Canadian split level K-Loader Off-loading Luggage Containers
102. In a similar fashion, one can use a “rising ambulance” High Deck Patient Loading Platform (HDPLP).
These vehicles are safer then the K-loader, as the patient is sheltered from the elements in the rear cabin/
box of the truck. There are no tripping hazards when using this vehicle. When formulating an emplaning or
deplaning plan, the MCD should discuss the plan with the LM and seek his/her assistance for the logistical
issues such as acquiring the services of the catering truck/ambulance or K-Loader. Use of the catering truck
in the most optimum method of emplaning or deplaning 2A/2B patients.
6-3-46
B-MD-005-000/FP-001
Figure 6-3-41 A CF Catering Truck & Support Worker Arriving at the Right Rear Door
Figute 6-3-42 High Deck Patient Loading Platform (HDPLP) Used to Load a Patients at Ramstein AFB
6-3-47
B-MD-005-000/FP-001
CONFIGURATIONS
PASSENGER SEATING
103. The seat rail arrangement permits maximum flexibility in the seating layout. Double aisles are
provided which extend continuously throughout the length of the aircraft. The Business Class section is a 6
seat abreast layout and the Economy Class is an 8 abreast layout until the last 4 rows which are 7 abreast.
Figure 6-3-43 PAX Configurations
FULL PASSENGER CONFIGURATION
104. There are a total of 194 seats (30 Business Class seats from rows 1 to 5 and 164 Economy Class seats
from row 6 to 28): 190 of these seats are for passengers and 4 are designated for the crew.
COMBI / MRT P3 CONFIGURATIONS
105. There are a total of 60 economy class seats from row 20 to 28: 58 for passengers and 2
designated for crew. The Dangerous Cargo Kits previously located at Seat 27AB have been re-located
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into specially-designed carriers that fit into Galley 5. If the Combi is in tanker mode – 30 economy class
seats are available from row 24-28. Consult loadmaster for confirmation on the number of seats
available for use.
CC150-001 VIP CONFIGURATION
106. There are a total of 149 seats: 16 state room seats, 8 crew seats, and 125 seats are used for the
passengers on a normal basis.
NOTE
Side seats are to be used only as a last resort on CC150-001.
COMBI CONFIGURATION
107. In the combi moded there is one seat available and two for the ACSOs’ use during flight. These seats
are locked just forward of the upper cargo area net and smoke curtain by means of four Cargo Loading
System (CLS) locks.
108. Cabin attendant seats aft of cabin doors 1L/R facing forward are removed; there is no change for the
other seats. The use of the 2 seats forward of door 1L facing aft will not be used in this configuration. The
LM will sit in the flight deck for take-off and landing
109. Safety Barrier Net. The net is comprised of straps and strap fittings. There are 6 quick connect/
disconnect fittings to install the net for take-off and landing.
Figure 6-3-44 Safety Barrier Net
6-3-49
B-MD-005-000/FP-001
CAUTION
The barrier net must always be installed when cargo is transported.
110. Smoke Curtain. The smoke curtain has zippers, snaps and Velcro.
Figure 6-3-45 Smoke Curtain
NOTE
All snaps, zippers and Velcro must be done up and zipper lock gasket installed
when cargo is transported.
111. Partition Wall. The partition wall divides the cargo section and passenger cabin with a sealed, fixed
partition with blow out panels and a door. There is a fixed handle on the cargo side of the door and a
removable handle on the passenger cabin side of the door (handle is stored in the overhead bin closest to
the partition wall door).
CAUTION
Do not push or lean on the panels. If panels are rendered unserviceable, this
will result in mission delay or cancellation.
NOTE
Door is to be locked for take-off, landing and in flight by the LM.
6-3-50
B-MD-005-000/FP-001
Figure 6-3-46 Partition Wall
PATIENT TRANSPORT UNIT CONFIGURATIONS
GENERAL
112. There are several configurations possible for installing the Spectrum unit on the CC150; depending
on the number of units required and the aircraft configuration (Full pax or Combi). The units can be
installed on either side (right/left) or in the centre aisles. Also there are breakdown passenger seats that
accommodate the stretcher Bed System (see B-MD-010-000/FP-001 Aeromedical Evacuation Equipment
Manual). Configuration requirement should be communicated ASAP to Wing Ops in order to get it installed
in a timely fashion by the Air Canada technicians. Diagrams detailing various Spectrum configuration
patterns follow.
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COMBI CONFIGURATION OPTIONS
Figure 6-3-47 MC-1 Spectrum Config (Combi)
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6-3-53
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6-3-54
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6-3-55
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FULL PASSENEGR CONFIGURATION OPTIONS
Figure 6-3-55 MP-1 Spectrum Config (Pax)
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6-3-57
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6-3-58
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6-3-59/6-3-60
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SECTION 4
CC177 GLOBEMASTER III
Figure 6-4-1 CC177 Globemaster III
GENERAL
1. Current use of this aircraft by allies indicates the use of NATO litters works well for both stable and
stabilized critical care patients.
TROOP CONFIGURATION
2. When fully configured for troop transport, the CC177 has 27 troop seats along either side of aircraft
(for a total of 54 side walls seats) plus 48 centre line seats (for a total of 102 on the aircraft).
3. The CC177 comes with 3 integral litter stations that are stowed on the aircraft walls, which each
hold 3 patients for a total of 9 litters which can be quickly configured by 2 AECMs. Patient load for this
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aircraft varies according to the number of tiers utilized and number of litters in each tier. The Litter Stanchion
Augmentation Set (LSAS) comprises 9 additional stanchions that can hold 3 patients each, for a total of 27
patients. The maximum stanchion litter load is 36 litter positions (additional litters may be floor loaded).
4. Floor loading involves loading litters side-by-side and longitudinally on the floor. All cargo rollers
are inverted to form a flat floor. A maximum of 60 NATO litters comprised of 8 rows of six litters plus 12 on
the ramp can be loaded. This method of loading should be utilized on any operation where minimal ground
time is critical (i.e. Tactical/MAJAID/MASCAL).
6-4-2
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Figure 6-4-2 CC177 Engine Danger Areas
5. At full thrust, engine danger areas are 762 metres (2,500 ft) aft and 7.6 metres (25ft) forward of CC177
engines. At idle, the engine danger area is 61.5 metres (202 ft) aft and 4.5 metres (15 ft) forward of engines.
6-4-3
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Figure 6-4-3 Radome Danger Area
6. Operating radome danger area is 15 metres (50 ft) in a partial circle as shown in Figure 6-4-3 above.
6-4-4
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EMERGENCY EXITS
Figure 6-4-4 External Locations of the CC177 Emergency Exits
GENERAL
7. General Information:
a. there are 7 exits provided for ground evacuation: Crew Door, Forward Emergency Escape Hatch,
Troop Doors (2), Maintenance Ditching Hatch; Ramp Blowdown (primary exit for Aeromed missions),
and Flight Deck Clearview Windows (2). As the Flight Deck Clearview windows cannot be opened
from the outside they are deemed not to be true emergency exits.
b. there are 5 exits provided for ditching (4 Feds and the Maintenance Ditching Hatch); and
c. four additional chop out areas are available for ground evacuation.
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8. Each exit on the CC177 is either designated as a primary means of ground egress, a primary means
of ditching egress, or a secondary means of egress for ground and ditching.
a. the crew entrance door;
b. the forward emergency escape hatch;
c. the left troop door; and
d. the right troop door.
a. the 4 operating Flotation Equipment Deployment System (FEDS).
11. The maintenance/ditching hatch is a secondary means of egress for both ground and ditching.
12. Locations are designated as Chop Out Areas because the bulkhead in those areas has no Hydraulics,
Oxygen or Electrical lines running through them. These are used if primary/secondary exits cannot be used.
CREW ENTRANCE DOOR
13. The crew entrance door is a manually operated door, with built-in stairs and handrails, located on
the forward left side of the aircraft. The door opens outward from the top and is hinged at the bottom. It
should be opened or closed by the LM. The door is outlined in yellow on the inside and black on the outside.
It is a primary means of egress in a ground emergency.
14. To open exit:
a. verify the area is clear and unobstructed before opening door from the inside;
b. check the cabin pressure gauge reads in the safe (green) range;
c. lift the (blue) lock handle;
d. flip the (green) latch handle to full up position; and
e. push the door out using the handrails until the step rests on the ground.
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B-MD-005-000/FP-001
Figure 6-4-5 Cabin Pressure Gauge
WARNING
Verify cabin pressure gauge reads in the safe (green) range prior to opening
the crew entry door. If no gauge mounted coordinate with the flight deck to
verify the r p (pressure changer) is zero and an additional exit is open prior
to opening the crew entry door.
6-4-7
B-MD-005-000/FP-001
Figure 6-4-6 Crew Entrance Door
WARNING
Verify area is clear before opening door from the inside.
CAUTION
Do not use the retractable lower steps to close crew entrance door from the
outside.
FORWARD EMERGENCY ESCAPE HATCH
15. The forward emergency escape hatch is a manually operated door located on the forward right
side of the cargo compartment aft of the forward LM’s station. This plug type hatch is completely removed
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from the aircraft when opened. Pulling the operating handle can open it externally or internally. An escape
rope is stowed near the upper right side of the hatch. The hatch is outlined in yellow on the inside. It is a
primary means of egress in a ground emergency.
16. To open exit:
a. pull operating handle up to its locked position;
b. pull- top of door will open inward, while bottom will remain in place; and
c. with free hand, grasp lower fixed handle and lift hatch.
Figure 6-4-7 Forward Emergency Escape Hatch
TROOP DOORS
17. The troop doors are manually operated plug type doors located aft on each side of the aircraft. Tracks
on each side of the door provide guidance for opening and closing with assistance from a counterbalance
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mechanism. It can be opened externally or internally, but should not be closed from outside the aircraft.
An escape rope is stowed aft of each door. The doors are outlined in yellow on the inside. They are a
primary means of egress in a ground emergency.
18. To open exit:
a. rotate the door locking handle down to the unlock position;
b. rotate the door-operating handle. This moves the door inboard on the tracks away from the jamb
stops; and
c. GENTLY, lift the door to the full open position. A spring latch/uplock mechanism will engage to keep
the door open. An audible click can be heard when this happens.
19. To close exit:
a. push up on the troop door;
b. with your free hand pull the manual release handle and lower the door to the closed position;
c. depress the operating handle release push-button and rotate the operating handle until the door
moves outboard against the jamb stops; and
d. rotate the locking handle to the locked position.
6-4-10
B-MD-005-000/FP-001
Figure 6-4-8 Troop Door
FLOTATION EQUIPMENT DEPLOYMENT SYSTEM
20. The Floatation Equipment Deployment System (FEDS) is a ditching egress system incorporating life
rafts. When activated, the FEDS pyrotechnically severs the upper fuselage skin of the cargo compartment
and ejects the skin outwards, producing four hatch openings. Once the hatch openings are cut, a life raft
(with survival pack) is ejected through three of the four openings. The left aft opening has provisions for,
but is not equipped with a raft. Each raft automatically inflates after ejection. The rafts remain attached to
the aircraft with a tether at the openings. Access from the floor or ramp of the cargo compartment to the
openings is by semi-rigid ladders contained in a canvas wrap below each hatch. The FEDS is activated
by any one of seven firing initiators. Two of the initiators are electronically protected and must be armed
before they can be activated. They are a primary means of egress in a ditching. There is also an external
deployment actuator located forward of the wing on the top of the fuselage.
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Figure 6-4-9 FEDS Initiator
21. In the event of an emergency, the FEDS initiator can be located as follows:
a. One at the Maintenance/Ditching Hatch;
b. One at the Forward LM’s Station;
c. Four co-located at the FEDS Hatches; and
d. One located outside aft of Maintenance/Ditching Hatch.
22. To fire the initiator, pull out the quick-release pin, turning the handle 90 degrees, and pull downward.
The quick release pins on the Maintenance/Ditching (M/D) hatch and forward LM station initiator handles are
solenoid guarded. The guards can be released if the FEDS panel at the LM and pilots stations are set to arm.
If the switch is armed all 4 hatches can be fired from 1 location (LM or Pilot). The other five initiator handles
do not require system arming.
23. Each FEDS has a semi-rigid ladder co-located with it. To deploy ladder, pull on the ladder release
handle and step out of the path of the falling ladder. Secure ladder to floor of aircraft and use to get to feds
opening.
NOTE
After pulling the ladder release handle, ensure personnel are clear of the
falling semi-rigid ladder.
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B-MD-005-000/FP-001
Figure 6-4-10 FEDS Location at the LM Station
MAINTENANCE / DITCHING HATCH
24. The Maintenance/Ditching Hatch is a plug type hatch located on the top of the aircraft and is hinged
inward on the aft edge. Access to this hatch is through the crew bunks in the crew rest area. The hatch
can be opened by means of a single unlatch/open handle. An escape rope is stowed near the hatch for
emergency egress. The hatch is outlined in yellow on the inside. It is a secondary means of egress for
ground evacuation and ditching.
25. To open exit:
a. place left hand on hatch and with right hand rotate handles forward 90 degrees to the open position;
and
b. slowly lower the hatch.
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B-MD-005-000/FP-001
Figure 6-4-11 Maintenance / Ditching Hatch
CHOP OUT AREAS
26. There are four chop out areas in the cargo compartment, two forward on either side (FS 524) and two
aft on either side (FS 1340). There are no electrical, hydraulic or oxygen lines running through these areas.
The areas are outlined in black on the inside. The marking are slightly offset to prevent injury if areas are
being utilized simultaneously from inside and outside the aircraft. The chop out areas are NOT considered
an emergency exit.
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B-MD-005-000/FP-001
Figure 6-4-12 Chop Out Areas and Some Emergency Equipment Locations
RAMP & RAMP TOES
27. The cargo door and ramp system consists of the cargo door, ramp, and ramp toes (extensions). The
ramp can only be opened and closed from within the aircraft. The ramp is a downward opening, non-plug
type door, hinged at the forward edge. Four ramp toes are hydraulically actuated to form an extension of the
ramp. When not in use, the ramp toes are detached from the ramp and stored on the cargo door. The toes
can be attached to the ramp in any combination, but during AE missions, the left and right outboard toes
will be stowed on the cargo door, to facilitate emergency ground egress.
CLEARVIEW WINDOWS
28. Since the pilot and copilot’s clearview windows can only be opened from inside the aircraft they are
not considered emergency exits. An escape rope is stowed near each window for emergency egress.
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29. To open exit:
a. first depress and move the window lock latch handle aft to unlock;
b. then push in the crank handle outboard to engage, and
c. rotate to open the window.
30. To close exit:
a. push the crank handle outboard to engage and rotate until the window is closed; and
b. depress and move the lock latch handle forward to lock.
CAUTION
When the sun visor is installed, move the visor to its aft stop prior to opening
the clearview window. This will preclude any riding condition or interference
between the visor and the clearview window moulding.
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B-MD-005-000/FP-001
Figure 6-4-13 Clearview Window Operation  
RAMP WITH BLOWDOWN SYSTEM
31. In the event of a ground evacuation, the ramp may be lowered using the ramp blowdown system.
Two ramp blowdown control panels are located in the cargo compartment, one at the aft left LM station and
one at the forward LM station. This activation will be accomplished by the LM. Only as a last ditch measure
will an AECM perform this function.
32. To activate:
a. the arm switch must be held in ARM position until the ramp switch is placed in the DEPLOY position;
and
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b. the ramp will lower to the ground and the emergency lights will illuminate.
Figure 6-4-14 Location of the Ramp Blowdown System Activation Switch
Figure 6-4-15 The Ramp Blowdown System Activation Switch
AIRCRAFT SYSTEMS
OXYGEN SYSTEMS
33. Emergency oxygen system. In the event of an aircraft emergency, oxygen can be supplied to
passengers via an automatic oxygen dispenser. Fourteen mask containers are provided on each side of the
aircraft. Each container has two masks except the most forward and aft containers. They have three each for
a total of 60 masks. The 48-centreline seats are supplied oxygen via two flexible hoses attached to the seat
modules.
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34. Once the emergency oxygen system is activated the mask container door will unlatch, the cabin
lights will come on full bright, a warning horn will sound, the NO SMOKING and SEAT BELTS signs will
illuminate and the RETURN TO SEAT message in the lavatory will not light up, persons in lavatory are to
remain in the lavatory until the emergency is secured. A short lanyard connects the mask to a release pin.
When the mask is brought to the face for use, the lanyard pulls the pin and allows the flow of oxygen to the
mask.
Figure 6-4-16 Emergency Oxygen System
35. Oxygen containers are just above and left or right of the side wall seats.
36. Aeromedical evacuation oxygen therapeutic outlets. The therapeutic outlets allow oxygen hook-up
for patients requiring therapeutic oxygen. The system consists of two 75 litre liquid oxygen tanks. Oxygen
is supplied through two 50 psi regulators. The regulators are redundant and provide 100 LPM to any one of
the outlets or 60 LPM to all five (5) outlets simultaneously.
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NOTE
To calculate the total litres in a liquid oxygen system multiply the total litres
of liquid oxygen by 804 equals the total litres of gaseous oxygen.
37. There are a total of five (5) AE oxygen therapeutic outlets in three (3) locations, all forward on the
right fuselage:
a. Two Forward right utility outlet panel (FS 545);
b. One at the next aft utility outlet panel (FS 768); and
c. Two at the 3rd aft utility outlet panel (FS 673).
38. Check with the LM to ensure oxygen is ON and for total quantity. Check passenger and Auxiliary
quantity gauge and HALO/THERAPEUTIC oxygen gauge pressure, at the forward LM station; verify with
the LM that the HALO/THERAPEUTIC Regulator lever is on. The two HALO/THERAPEUTIC regulators with
manual override are located on the Forward Load master Station Oxygen Control Panel.
Figure 6-4-17 Location of Aeromedical Evacuation Oxygen Therapeutic Outlets
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ELECTRICAL SYSTEMS
39. Aeromedical evacuation system 60 Hz power. The AE system 60 Hz converter provides power to the
aircrew laptop computers and to AE equipment. Controls are located at the forward LM station Aeromedical
System Panel. Each aircraft is equipped with a primary converter.
40. Power Receptacles. There are six (6) electrical accessory outlet panels located in the cargo
compartment:
a. Two Forward, left and right;
b. Two Mid-Cabin, left and right; and
c. Two Aft, left and right.
41. 115-volt AC 60 cycle and 200 volt AC 50-400 cycle outlets are located on the left side of the outlet
panels to power aeromedical equipment. The 28 VDC outlets located on the right of the outlet panels are not
used for AE. If more amps are needed onboard the CC177, an avionics frequency converter can be utilized.
In this configuration, the frequency converter will add an additional 20 amps to the side it’s connected too.
Figure 6-4-18 Aeromedical Evacuation 60 Hz Power Control Panel
6-4-21
B-MD-005-000/FP-001
Figure 6-4-19 Power Receptacles  
AIRCRAFT AMPERAGE CAPABILITY

CC-177 30 amps (AE 60 Hz System)
20 amps per side (400 Hz System)
Figure 6-4-20 Aircraft Amperage Information
WARNING
To avoid overloading the 60Hz converter and causing converter to fail. Do not
exceed 30 Amps draw.
42. The communication system is controlled by the LM. All overhead briefings are accomplished by
the LM.
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LIGHTING SYSTEMS
43. Emergency evacuation lighting consists of a main system and a ramp system.
44. The main system provides emergency lighting to the main cargo area, flight deck area, crew rest
area, aisle, lavatory, storage area, galley area, exit doors, and escape hatches. It also includes EXIT signs
located over the crew entrance door, forward emergency escape hatch, left and right troop doors, FEDS,
escape hatches, maintenance/ditching hatch, top of stairway, and left side and right side of the ramp.
45. The ramp system provides emergency lighting to the aircraft ramp and cargo door area only during
emergency ramp blowdown activation.
Figure 6-4-21 Main Lighting System and Ramp Lighting System
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46. There are several lighting systems in the cargo compartment. They can be turned on/off and dimmed
by the load master. They include:
a. Fluorescent lights;
b. Incandescent light;
c. Red/Tactical light; and
d. Curb lights.
 
Figure 6-4-22 Lighting Systems within the CC177
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COMFORT ITEMS
LAVATORY
47. The crew Lavatory is located in the forward section of the cargo compartment adjacent to the survival
equipment locker. The door opens into the cargo compartment and includes the following:
a. Emergency oxygen mask container;
b. MA-1 portable oxygen bottle with quick-don mask;
c. Smoke goggles;
d. Recharger hose;
e. Emergency light;
f. 110 VAC/60Hz electric razor outlet;
g. Emergency call button; and
h. Smoke detector.
48. The locked door can be opened from the cargo compartment by sliding the “LAVATORY OCCUPIED”
indicator to the open position.
6-4-25
B-MD-005-000/FP-001
 
Figure 6-4-23 Crew Lavatory
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B-MD-005-000/FP-001
GALLEY
49. The galley is located in the forward section of the cargo compartment forward of the flight deck
stairs. It is a self-contained unit. The Galley is the LM’s responsibility. Some of its features include:
a. Faucet and Sink;
b. Refrigerator and Freezer;
c. Oven;
d. Two gallon Hot/Cold beverage containers (2); and
e. Cup and Tray Storage.
 
Figure 6-4-24 Galley
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50. Heating and cooling functions in the cargo compartment are controlled by the LM.
EMERGENCY EQUIPMENT
Figure 6-4-25 CC177 Location of Emergency Equipment
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FIRE EXTINGUISHERS
51. Fire extinguishers are located as follows:
a. 2 – in the Flight Deck, left and right side;
b. 1 – in the Crew Rest Area, Inboard face of right hand avionics rack; and
c. 6 – in the Cargo Compartment, as follows:
(1) 2 – forward left and right;
(2) 2 – mid cabin left and right; and
(3) 2 – aft left and right.
Figure 6-4-26 Fire Extinguisher Locations
6-4-29
B-MD-005-000/FP-001
Figure 6-4-27 Fire Extinguisher Station
ESCAPE ROPES
52. The escape ropes are made of cotton to allow for gripping. The ropes are located at tevery emergency
exit inside their designated pouch. This design aids in rope deployment. All other escape ropes are contained
in storage pouches. The ropes are anchored at one end to the aircraft structure by a metal bracket.
53. There are 10 escape ropes, each stowed at or near an emergency exit for ditching or ground
evacuation. The ropes are installed as follows:
a. 1 – by the Maintenance/Ditching Hatch;
b. 2 – Aft of Left and Right Troop Door;
c. 2 – in the Flight deck, above each Clearview Window;
d. 4 – by the FEDS Hatches; and
e. 1 – Aft of Forward Emergency Escape Hatch.
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ESCAPE LADDERS – SEMI-RIGID
54. There are four semi-rigid escape ladders, one stowed at each FEDS hatch area. These ladders are
stowed in canvas wrap containers approximately one foot below each hatch. Pulling down on a release
handle on the fuselage sidewall, directly below each ladder, will cause the ladder to fall to the floor. The
attachment bar located at the end of the ladder is placed over a tiedown ring and secured with the quick
release pin. The attachment of the FEDS ladder to the cargo floor is designed for one-person operation.
When exiting through the aft hatches, the individual faces aft. When exiting through the forward hatches,
the individual faces forward.
NOTE
After pulling the ladder release handle, ensure personnel are clear of the
falling semi-rigid ladder.
Figure 6-4-28 Semi-rigid Ladders – Location and Operation

 
6-4-31
B-MD-005-000/FP-001
CRASH AXES
55. There are two crash axes on the aircraft. One at the forward right chop out area and the other
mounted on the forward right bulkhead in the crew rest area. There are stowage positions for an additional
three axes at the other chop out areas.
 
Figure 6-4-29 Crash Axe Locations
FIRST AID KITS
56. There are a minimum of six (6) first aid kits installed in the aircraft. Stowage racks are provided in
the cargo area for the additional 20 kits.
a. 2 – in the Crew Rest Area mounted on the forward right avionics panel;
b. 1 – aft of the Crew Entrance Door;
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B-MD-005-000/FP-001
c. 1 – aft of the Forward Emergency Escape Hatch;
d. 1 – forward of the Right Troop Door; and
e. 1 – mid-cabin left side.
Figure 6-4-30 First Aid Kit Locations
MA-1 PORTABLE OXYGEN BOTTLE WITH RECHARGE HOSE & Quick-don MASK / SMOKE GOGGLES
57. Each bottle is attached to a quick-don mask and smoke goggles and located next to a recharger hose.
58. There are ten MA-1 portable oxygen bottles installed aboard the aircraft:
a. 2 – in the Flight Deck, left and right side;
b. 1 – in the Crew Rest Area, left side;
c. 1 – in the Lavatory;
d. 1 – forward LM Station; and
6-4-33
B-MD-005-000/FP-001
e. 5 – in the Cargo Compartment:
(1) forward right;
(2) mid-cabin right;
(3) aft right;
(4) mid-cabin left; and
(5) aft left.
Figure 6-4-31 Oxygen Bottle Locations  
6-4-34
B-MD-005-000/FP-001
EMERGENCY PASSENGER OXYGEN SYSTEM (EPOS)
59. The EPOS are located under each sidewall seat and behind each centreline seat. The EPOS can
provide oxygen for 5-60 minutes depending on breathing pattern and activity.
SURVIVAL EQUIPMENT LOCKER
60. The survival equipment locker is located near the crew entrance door in the cargo compartment. It
has space for survival equipment, life preservers, and hazardous materials kit.
6-4-35
B-MD-005-000/FP-001
Figure 6-4-32 Survival Equipment Locker
6-4-36
B-MD-005-000/FP-001
AEROMEDICAL EVACUATION SYSTEM
61. Litter Support Provisions. The CC177 has an integral capability of three litter stations capable of
moving nine litter patients. With additional stanchions brought on board, maximum capacity is 12 litter
stations capable of moving 36 litter patients.
WARNING
The integral stanchion arms should face inboard as depicted in the
configuration manual and/or the loading manual to facilitate connections
between the stanchions and the aircraft.
62. Three AE litter stanchions, each designed to accommodate three litters, are stowed on the forward
sidewalls in the cargo compartment.
63. Each station has structural hardpoints to secure stanchions and electrical/oxygen hook-ups. Each
station is a freestanding design of two stanchions with each stanchion consisting of a base with two floor
attachment fittings. A horizontal and a diagonal brace connect the two stanchions. Cantilever arms attach
to the vertical stanchions to support the litters. Litter station utility panels are connected to AE utility outlet
panels, providing each litter position with a patient call button, reading light and drop down emergency
oxygen mask (Figure 6-4-48).
64. There are positions for 12 AE utility outlet panels, one at each station. Pushing the patient call button
results in illumination of the button to indicate the litter position, illumination of a station indicator light
on top of the utility panel, illumination of the nurse call light at the forward LM station control panel and a
chime will sound over the PA system.
65. There are also 4 drop-down emergency masks in the utility panel (two on the top one, one for a
medical provider).
66. The top litter position has a maximum capacity of 250lbs and the lower two positions can hold up to
275 lbs. This capacity includes the weight of the patients, medical equipment and weight of the litter.
NOTE
With the usage of the backrest, the drop-down emergency mask may not
deploy; brief patients accordingly.
MODIFIED STANCHION USE
67. To Set Up: modified stanchions are NOT set pairs and can be used with any other. The stanchions are
positioned over the cargo floor hardpoints then secured by depressing the button on the floor attachment
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B-MD-005-000/FP-001
fittings and pushing down. The aft bottom portion of the diagonal brace is secured first, then the aft portion
of the horizontal brace. The two forward points of each brace are then coupled and secured to the forward
stanchion. The utility panel secures to two brackets on the aft stanchion and secured with a minimum of
one quick release pin. The electrical and emergency oxygen line are extended to the associated aeromedical
utility outlet panel and connected.
68. To Break Down: reverse of setup. Ensure stanchions are replaced on the fuselage as pairs with the
bottom of stanchions facing forward.
 
Figure 6-4-33 Stanchion Positions, Setup and Operation
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B-MD-005-000/FP-001
CONFIGURATIONS
GENERAL
69. There are positions for 12 AE stations in the cargo compartment. Six on the left and six on the right.
Each station has hardpoints for mounting stanchions inboard or outboard. With all 12 stations set up in the
inboard hardpoints, 54 seats will be available along the sidewall. Centreline seats may be used if stations
are set up in the outboard hardpoints, however, sidewall seats at the location of the station WILL NOT be
available. Stanchions will be set up with cantilever arms facing inboard.
70. On AE missions, configure the aircraft during pre-flight, per AEC’s Load Plan. If litter stanchions are
installed in the outboard configuration, the adjacent sidewall seats cannot be used and patient egress must
be considered.
71. Roller conveyers will be stowed, unless required for comfort/baggage pallets. Rollers on the ramp
will be stowed during patient emplaning and deplaning operations. Available litter stations and ambulatory
seating will depend on the aircraft cabin’s mission configuration.
6-4-39
B-MD-005-000/FP-001
AE-1
72. The AE-1 configuration offers 9 litter spaces and a total of 54 seats. A minimum of 10 seats are
required for AECMs. Two HCU 6/E pallet positions are available in the cargo ramp aerial delivery system
(ADS) rails. Referenced from United States Air Force Instruction (AFI) AFI 11-2AE Vol #. Addenda A 27 MAY 2005 Chapter 5.
Quantity Weight Station Moment

References 5, DD Form 365_4 (Steward's Eqipment)
Water container (Igloo) 3 75 358 2.7
Std 2 gal liquid containers 1 25 260 .7
Hot cup 1 3 260 .1
Kit, passenger service 1 10 280 .3
Blanket, large 6 21 280 .6
Pillows, large w/case 6 12 280 .3
Blankets, small 54 54 dist (744) 4.0
Pillows, small w/case 54 27 dist (744) 2.0
Expendable supplies 10 260 3
Pax info cards 102 3 280 .1
TOTAL 240 11.1
Reference 6, DD Form 365_4 (Emergency Equipment)

LPU-6/P life preservers (infant cot) 7 28 280 .8
A/C lifr preservers 110 165 280 4.6
Protective clothing kit (PCK) 1 36 280 1.0
Parachutes 4 112 280 3.1
Emergency Passenger Oxygen System (EPOS) 102 204 280/dist 15.1
(744)
Protective Breathing Equipment (PBE) 13 68 280 2.0
Oxygen Bottle, Portable 7 42 dist (744) 3.1
Survival Items (Vest, ML-4, CWU-16/P) 4 each 112 280 3.0
TOTAL 815 34.0
Reference 7, DD Form 365_4 (Extra Equipment)

60 Hz Backup Converter 1 43 252 1.1
Publicationa Box/Aircraft Armor 1/1 107/1125 400/217 4.0/24.4
TOTAL 1275 29.5
K I G
NOTES:
1. This AE configuration provides 9 litter spaces and a total of 54 seats. 48 centerline seats may be added if the litters are installed at x=88; however sidewall
seats next to litters will not be available. The number of seats offered for ambulatory patients is normally 44; however, the number of aeromedical
evacuation crewmembers (AECM) govern the number of seats available. The final litter configuration and AECM seating will be determined by the
Medical Crew Director (MCD). AECM seat locations may vary in the cargo compartments based on patient/cabin observation requirements. Additional
seats maybe required for emergency equipment and litter patients based on patient medical conditions.
2. Seats are numbered (front to rear) for identification and are referred to as seat one left or seat one right, etc. Litter tiers are identified alphabetically
starting right to left from the rear to front.
3. ADS and logistic rails and roller conveyors are stowed except for the baggage pallet position. Baggage pallets will be loaded in the cargo ramp ADS rails.
4. Inboard ramp toes will be installed in the low position with rollers and guide rails installed. Outboard ramp toes will be installed in the high position with
rollers removed and stowed.
5. The 60 Hz backup converter will be installed. Additional medical eqipment may be installed.
6. Time to configure with two people in 25 minutes.
6-4-40
B-MD-005-000/FP-001
AE-2
73. The AE-2 configuration offers a comfort pallet, 36 litter spaces, and a total of 54 seats. A minimum
of 10 seats are required for AECMs. Two HCU 6/E pallet positions on the cargo ramp are available in the
ADS rails. Referenced from United States Air Force Instruction (AFI) AFI 11-2AE Vol #. Addenda A 27 MAY 2005 Chapter 5.
Quantity Weight Station Moment

References 5, DD Form 365_4 (Steward's Eqipment)
Water container (Igloo) 3 75 358 2.7
Std 2 gal liquid containers 1 25 260 .7
Hot cup 1 3 260 .1
Kit, passenger service 1 10 280 .3
Blankets, large 6 21 280 .6
Pillows, large w/case 6 12 280 .3
Blankets, small 54 54 3 (744) 4.0
Pillows, small w/case 54 27 dist (744) 2.0
ATGL 1 3620 391 141.5
Expendable supplies 10 260 3
Passenger information cards 102 3 280 .1
TOTAL 3860 152.6
Reference 6, DD Form 365_4 (Emergency Equipment)

LPU-6/P life preservers (infant cot) 7 28 280 .8
A/C life preservers 110 165 280 4.6
Protective clothing kit (PCK) 1 36 280 1.0
Parachutes 4 112 280 3.1
Emergency Passenger Oxygen System (EPOS) 102 204 280/dist (744) 15.1
Protective Breathing Equipment (PBE) 13 68 280 2.0
Oxygen Bottle, Portable 7 42 dist (744) 3.1
Survival Items (Vest, ML-4, CWU-16/P) 4 each 112 280 3.0
TOTAL 959 38.1
Reference 7, DD Form 365_4 (Extra Equipment)

Aeromedical Station 9 594 634/937 49.7
60 Hz Backup Converter 1 43 252 1.1
Publicationa Box/Aircraft Armor 1/1 107/1125 400/217 4.0/24.4
TOTAL 1869 79.5
K I G C E A
Comfort
Pallet
L J H F D B
NOTES:
1. This AE configuration provides 36 litter spaces (high density) and a total of 54 seats. 48 centerline seats may be added if the litters are installed at x=88;
however, sidewall seats next to litters will not be available. The nimber of seats offered for ambulatory patients is normally 44; however, the number of
AECMs govern the number of seats available. The final litter configuration and AECM seating will be determined by the MCD. AECM seat locations may
vary in the cargo compartments based on patient/cabin observation requirements. Additional seats maybe required for emergency equipment and litter
patients based on patient medical conditions. The 60 Hz backup converter will be installed. Additional medical eqipment may be installed.
2. Seats are numbered (front to rear) for identification and are referred to as seat one left or seat one right. Litter tiers are identified alphabetically starting
right to left from the rear to front.
3. ADS rails, logistic rails and roller conveyors on the main cargo floor are stowed except for the comgort pallet position. Baggage pallets will be loaded in
the cargo ramp ADS rails.
4. Inboard ramp toes will be installed in the low position with rollers and guide rails installed. Outboard ramp toes will be installed in the high position with
rollers removed and stowed.
5. Time to configure with two people in 25 minutes.
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SECTION 5
CC144 CHALLENGER
Figure 6-5-1 CC144 Challenger with Crew Entry Door Open
GENERAL
1. The CC144 Challenger is a twin-engine, long-range pressurized aircraft. It is primarily used in roles
such as electronic warfare, passenger movement, and can be used for strategic and domestic AE.
TROOP CONFIGURATION
2. The CC144 is able to carry a maximum of 11 passengers.
3. The CC144 is the smallest of the strategic aircraft and therefore can carry less patients, medical
members and equipment. This airframe has a shorter range and requires stops for refueling and oxygen
replenishment on any overseas mission. This increases transit times and may cause increased stress for
some types of patients due to multiple take-offs and landings. It is however, more cost effective than larger
aircraft when transporting one or two patients and is often more available.
4. There are several models of CC144. The 600 & 601 models can be configured for use as AE
aircraft. Spectrum beds purchased for use on the CC144 have been modified for this airframe and are not
interchangeable with the older models of Spectrum beds used on the CC150. The CC144 has the capability
to transport up to 2 Spectrum beds or up to 11 seats (this includes the Flight Steward position). There are
four AE configurations that can be used depending on the number of Spectrum beds and MSTMs required.
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5. Loading and off-loading of stretcher patients requires the use of either a specialized loading
mechanism provided by the transport unit manufacturer, or a ramp to emplane the patient. Care and caution
must be used while entering and exiting the aircraft while the no-lift patient loader is attached. The patient
loader is attached to the Spectrum bed of the right side of the aircraft; left side patients must be manually
transferred to the left Spectrum bed once inside the aircraft. When loading two litter patients, the left patient
is loaded and then the right. Patients and MSTMs will be exposed to the elements for several minutes unless
this process takes place inside a hangar.
DESCRIPTION
6. The CC144 Challenger Aircraft is a pressurized long-range, wide-bodied corporate jet powered by
two turbo-fan engines. It is known in the civilian aviation world as a Challenger CL 601-2A12. This aircraft
was designed to carry up to 11 passengers in spacious comfort over long distances.
Manufacturer Canadair (Bombardier Aerospace) Quebec, Canada

Engines Two 40.7kN (914lb) General Electric CF-34-1A turbofans.
Wing Span 19.61m (64ft 4in)
Overall Length 20.85m (68ft 5in)
Height 6.30m (20ft 8in)
Passenger Door (height off ground) 1.62 m (5 ft 4in)
Maximum Take-off Weight 19550 kg (43,100 lbs)
Cruising Speed 851 km/hr
Maximum Operating Altitude 41,000 ft
Range with Maximum Payload 6236km
Production quantity 134
Landing Gear Tricycle – Truck type
Figure 6-5-3 Lateral View
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DANGER AREAS
7. Dangers areas include the engines, the Auxiliary Power Unit (APU), the High Frequency and multiple
antennas along the belly of the aircraft, the radome and the passenger door. See diagrams that follow.
Figure 6-5-4 Danger Area from Engine Intake / Exhaust & APU Exhaust  
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Figure 6-5-5 Radome and FH Antenna
EMERGENCY EXITS
GENERAL
8. The CC144 has accesses that can be used by crew for various tasks:
a. the passenger door;
b. the avionics bay door;
c. the right overwing emergency exit;
d. the cargo bay door; and
e. the aft equipment bay door.
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9. AECMs primarily use the passenger door, the right overwing exit, and the cargo bay door. See
Figure 6-5-6 for visual references. The passenger/crew door (primary ground egress) and the right overwing
exit (primary ditching and secondary ground egress) are used in case of emergencies.
 
Figure 6-5-6 Aircraft Door Locations
PASSENGER / CREW DOOR (TYPE I)
10. The passenger door, which is the main entrance/exit, is located at the front of left-hand side of the
fuselage. The door, which incorporates integral stairs with a retractable top and bottom step and two folding
handrails, opens outwards and downwards. Stairway lighting is provided in the risers of the stairs and at
the threshold area, and is controlled by BOARDING LIGHT ON/OFF switch/light at the forward flight steward
console. Dimensions: 91 x 178cm (36 x 70in). This is the primary means of ground egress in an emergency.
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Figure 6-5-7 Crew / Pax Door (Including External Handle)
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Figure 6-5-8 Exterior View of Passenger / Crew Door (Including Instruction Placards)
PASSENGER DOOR OPERATION – EXTERIOR
11. The door is key operated, and the exterior handle rotates upwards to unlock (open) and downwards
to lock (close) the passenger door. Exterior handle operating instructions are on a placard on the exterior
door area: “PUSH AND TURN HANDLE TO OPEN. PULL DOOR.”
12. To open:
a. the push plate (trigger) ejects the door handle from the recess, unlocking the latch mechanism and
opening the pressurization flap;
b. the exterior handle is then rotated to the OPEN position (counter clockwise 45°), unlatching the
upper middle rotary latches; and
c. the door is then pulled out (using the pressure flap opening as a grip) and will gradually descend.
13. To close and lock:
a. the door is manually pushed up and gas springs retract the door to the latched position; and
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b. the exterior handle is rotated to the closed position (locking the upper middle rotary latches) and
then stowed (simultaneously locking latch mechanism and closing the pressurization flap).
Figure 6-5-9 Interior View of Passenger / Crew Door (Including Instruction Placards)
PASSENGER / CREW DOOR OPERATION – INTERIOR
14. The interior door handle rotates downwards to lock and upwards to unlock the passenger door. The
door handle is marked “HANDLE” and opening instructions are placarded on the door.
15. To open:
a. lift handle; and
b. push door out firmly to arms length under control.
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16. To close:
a. grasp assist handle, pull door fully closed and hold;
b. push door handle down;
c. stow external handle; and
d. check indication marks.
CAUTION
Maximum load capacity of door is 454 kg (1,000 lbs). Maximum number of
people permitted on the stairway is 4.
RIGHT Overwing EMERGENCY EXIT (TYPE III)
17. On the right side of the passenger compartment, above the wing, an overwing exit is installed. The
exit opens inward and provides access to the upper wing surface. It can be released from inside or outside
the aircraft. An escape rope (life line) is provided and located midway on right hand side of door. This exit
is a primary means of egress for ditching and a secondary means of egress in a ground emergency.
18. To open:
a. remove protective cover;
b. pull quick release; and
c. pull exit.
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Figure 6-5-10 Internal and External Views of Overwing Emergency Exit (Including Instruction Placards)
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Figure 6-5-11 Opening the Passenger / Crew Door and the Right Overwing Exit
CARGO / BAGGAGE DOOR
19. The cargo door is located on the left side on the aft fuselage, below the engine pylon. The door locks
and requires a key. The Air Maintenance Engineer (AME) usually will operate this door from the ground
level. Because of the difficulty in reaching this exit in an emergency it is not considered an emergency exit.
20. To open:
a. PUSH trigger to eject handle;
b. turn HANDLE; and
c. push inwards and then PUSH upwards.
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Figure 6-5-12 Internal and External View of the Cargo Compartment Door
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AIRCRAFT SYSTEMS
OXYGEN SYSTEMS
21. Oxygen for the passengers is supplied by Chemox canisters to the passenger drop-down masks in
the cabin, in the event of cabin depressurization. The oxygen masks are installed in overhead compartments
and are available at all passenger seats, in the lavatory and at both flight attendant stations. All oxygen
compartment doors will open to present the oxygen masks automatically if cabin altitude reaches
approximately 13,600 +/- 600 feet. When the oxygen compartment doors open, the passengers will pull the
oxygen mask to their face, pulling the lanyard and pin from the generator. This initiates the flow of oxygen
to the passenger’s oxygen mask, which should last approximately 15 minutes. See Figure 6-5-13 for location
of the drop down mask boxes:
Figure 6-5-13 Passenger Drop-down Mask Location in Cabin
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Figure 6-5-14 Passenger Oxygen System Operation
ELECTRICAL SYSTEM
22. There are two 60 Hz 110V electrical outlets on the CC144 located aft of the bulkhead on the right and
left sides (forward of the right overwing emergency exit) suitable for medical equipment. There are two 400
Hz 110V outlets located left side cupboard/galley. And finally there is one 60 Hz 110v outlet in the lavatory,
for use of razors only. The max amperage that can be drawn is a total of 15 amps.
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23. In order to get power to the 60 Hz 110V outlets, the power inverter switch must be in the ON position.
The inverter switch is located on the left side of the FS station in the most rearward cabinet. Once the
inverter is on, a hum will be heard and felt. The inverter is usually turned on in the pre-flight phase, however
if no power is available in the cabin electrical outlets, the inverter could be OFF. Another location to verify is
the Entranceway/Galley light control panel. On the bulkhead wall in the FS station; there is a master switch
for cabin power.
Figure 6-5-15 Electrical Outlet (Left) Forward of Overwing Exit
COMMUNICATION SYSTEM
24. AECMs have access to the satellite phones located in the cabin. They are located on the right and left
of the mid-cabin section and the third is located on the right side wall forward of the right Aft seat. These
phones can be use for communicating with land-based agencies and with other phone positions including
the flight deck (use option #2).
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Figure 6-5-16 Satellite Phone in Rear Right Side Cabin, above the Folding Table
LIGHTING SYSTEM
25. The emergency lighting system consists of floodlights for illumination of the passenger cabin, the
passenger/crew stair and service entrance section, lighted exit signs at the cabin ceiling, mid-wall and floor
levels, exterior evacuation floodlights at the doors and overwing exit, and an escape path lighting system
at floor level. The system is powered by four 28 volt DC rechargeable battery packs that supply power for
approximately 15 minutes when fully charged.
26. Features of the emergency lighting system are as follows:
a. crew door: EXIT sign, green luminous exit sign, overhead light;
b. floor lighting: green luminous seat light + spectrum bed (right side only);
c. overwing exit: EXIT sign light, green luminous sign; and
d. exterior of aircraft: right side 2 forward of wing, 1 on wing. Left side 1 forward of crew/pax door.
27. An emergency flashlight is located in the holder on the right side wall of the circuit breaker panel
located in the flight compartment.
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COMFORT ITEMS
CABIN FURNISHING DESCIPTION & LAYOUT
28. The cabin is comprised of the entrance area, the passenger, lavatory and the baggage compartments.
The general furnishings in the passenger compartment consists of fuselage sidewall panels, window area
reveals and blinds, side ledges, dado panels, bulkheads, floor covering, tables, racks, entrance furnishings,
a headliner and a Lavatory/storage area. See Figure 6-5-17.
Figure 6-5-17 General Cabin Layout (Including FS Station Forward Right)
PASSENGER COMPARTMENT
29. This compartment is the main location where AECMs will execute their duties in flight. The patients
and essential medical equipment will be co-located throughout this area.
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Figure 6-5-18 Passenger Compartment
SEATS & DIVAN
30. The passenger seats are fully adjustable single seats arranged in facing pairs or on opposite sides
of the folding tables. The seats are easily removable to accommodate different seating configurations. The
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seat back is fully reclinable, controlled by a hydraulic recliner control button located on the inboard armrest.
A lever located on the end of the armrest allows for lateral, fore and aft movement of the seat up to 15.54 cm
(6 inches). The amount of movement is dependant on the location of the stop blocks along the track on the
floor. A compartment below the seat cushion houses a life vest. Access is provided by a removable Velcro
tape. Every seat has its own lap belt (single point seat belt).
31. A three-seat divan (couch) is installed on the aft left side of the passenger compartment. The divan
has fixed armrests and built-in storage cabinets located at each end. They each incorporate an ashtray, drink
holder and house a headphone jack (outlet) and plug-in meal tray receptacle. The two intermediate fold-
up armrests, housing plug-in meal tray receptacles can be found in the middle area of the divan. They are
designed to be stowed flush with the back cushions. The divan base comprises two storage compartments
each containing emergency and survival equipment. A lap type seat belt is provided at each seating position.
FLOOR COVERINGS
32. The floor of the aircraft is generally covered with a thin-layered commercial carpet. Be careful not
to spill any bio-waste on the carpet. If a bio-waste spill occurs, clean it as directed in the 1 Cdn Air Div
Orders, Vol 1, 1-264 Aircraft Disinfection. As Transport Canada (TC) is not trained or equipped to
handle hazardous biological material, flight medical crew will ensure that all used medical supplies, bodily
fluids, blood, or other hazardous materials related to the MEDEVAC are removed from the aircraft prior to
return to base (RTB). The AC is to ensure that the aircraft is clean of all such material prior to the departure
for RTB. In the unlikely event that an aircraft is diverted prior to a medical clean up, the AC must quarantine
the aircraft upon arrival at the diversion airfield until suitable arrangements can be made.
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Figure 6-5-19 Diagram of the 3-Place Divan and a Reclining Passenger Seat
(Note Location of Mid-cabin Stowage Cabinet Between the Divan and the Seat)
FOLDING TABLES
33. Three folding tables are provided in the passenger compartment. Each table is housed in a cabinet.
The inboard leaf of each folding table hinges upward to rest against the tabletop. The table assembly then
pushes in and slides down along the tracks on the inside of the cabinet to be stowed.
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LAVATORY – WARDROBE COMPARTMENT LOCK BOX
  Lock Box 
Figure 6-5-20 Wardrobe Left Side of the Lavatory (Note Location of Lock Box; a Lock is Not Provided)
34. There is a metal box fixed in the top of the wardrobe compartment drawer to store goods that need
to be kept secured i.e. narcotics or valuables. The space available is small but documents as well as small
containers could fit inside of it. This is a good place to store valuables or restricted items such as narcotics
that do not require refrigeration.
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BAGGAGE COMPARTMENT
35. The baggage compartment is located aft of the lavatory in the pressurized cabin. The compartment
contains a baggage rack, on the right side of the compartment, with a clothes hanging bar and restraining
nets. There is a smoke detector in this compartment mounted behind a header panel in the baggage
rack opening. The compartment is small and when the old wooden medevac ramp is stored within it,
approximately 50% space is available. Maximum weight in the compartment is 182kg (400lbs).
FLIGHT STEWARD STATION / GALLEY
36. The Flight Steward (FS) has a unique working area located in the Bar/Galley area. The seat is
facing forward, but it can also be reconfigured to face rearward for use by a MSTM in the air ambulance
configuration. See Figure 6-5-21.
 
Crew 
Headset 
 
Figure 6-5-21 Flight Steward Station
6-5-22
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GENERAL
37. The air conditioning and pressurization system provides temperature and pressure regulated air for
ventilating and pressurizing the flight compartment and passenger cabin. Exhaust air, from the cabin and
flight compartment areas, is used to ventilate and pressurize the under-floor compartments containing the
avionics equipment, before being dumped overboard through two outflow valves.
TEMPERATURE CONTROL
38. The flight compartment and the cabin have independently-operated temperature control systems.
Each controller subsystem is dedicated to an air-conditioning pack. Variable control is provided to select
cabin and flight compartment air temperature in automatic, standby and manual mode. The controls are
located on the flight deck and at the aft of the cabin next to the right seat (for the cabin temperature).
PRESSURIZATION SYSTEM
39. The airplane is pressurized by bleed air supplied and distributed by the air-conditioning system.
Pressure is maintained by electronically/pneumatically governing the rate of outflow of cabin air through
the two outflow valves. The pressurization system automatically maintains the cabin pressure through all
phases of flight.
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EMERGENCY EQUIPMENT
Figure 6-5-22 CC144 Emergency Equipment Placement
GENERAL – CC144 WALKAROUND
40. In this section, the main aircraft emergency equipment accessible to AECMs, along with their
location, will be described starting from the flight deck through to the aft portion of the aircraft.
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FLIGHT DECK
41. The following emergency equipment is located on the flight deck:
a. Fire extinguisher (located behind the right pilot seat);
b. Crash axe (located on rear wall behind the left pilot seat);
c. Quick-don mask with smoke goggles (pilot/co-pilot);
d. Emergency Flashlight (pilot/co-pilot);
e. Life vest under seat (pilot/co-pilot);
f. Portable oxygen bottle with mask (located in AME stowage compartment – left);
g. General first-aid kit (located in AME stowage compartment – left);
h. Fire Extinguisher (located on the left side of FS jump seat);
NOTE
This fire extinguisher may vary in location in different tail numbers but is
close to FS’s jump seat
j. Fireman’s gloves (located in AME stowage compartment – right); and
k. Drop down masks for AME and FS.
PASSENGER COMPARTMENT
42. The following emergency equipment is located in the passenger compartment:
a. Life vest (PAX) located under every seat and 3 located under divan;
b. Life raft (6 or 10 pers) located by right over wing emergency exit or under divan;
c. Universal first-aid kit (located under divan);
d. Basic survival kit (located under divan);
e. Lifepak 500 AED (located mid cabin stowage cabinet);
f. CPR kit (located mid cabin stowage cabinet);
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g. Therapeutic oxygen (walk-around bottle), located mid cabin stowage cabinet;
h. Aviox Duo-pax (chemical oxygen collocated with therapeutic oxygen);
j. Escape rope (located in dado panel under over wing emergency exit);
k. Drop down masks for crew/patients/passengers; and
m. Fire extinguisher to right side of door frame leading to the lavatory.
BAGGAGE COMPARTMENT / AFT EQUIPMENT BAY
43. The following emergency equipment is located in the baggage compartment/aft equipment bay:
a. Emergency locator transmitter (ELT); hard mounted, not retrievable; and
b. Black box (flight deck voice flight data/recorder); should not be removed by crew.
Flight Deck (√) Notes

Left Side
Pilot life vest under seat
Quick-Don Mask with smoke goggles
Communications headset
Crash axe behind pilot seat
Emergency flashlight
Right side
Co-pilot life vest under seat
Halon extinguisher behind co-pilot seat – 3 total
Quick-Don Mask with smoke goggles
Emergency flashlight
Flight Engineer Station
Portable O2 with smoke mask/goggles
General First aid kit
Drop down mask (x1) 24 total
Fireman’s gloves
Flight Steward Station
Electrical outlet 400 Hz 110v (x2)
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Halon extinguisher in stowage compartment – 3 total (Note: this fire

extinguisher may vary in locations in different
tail numbers but is close to FS’s jump seat)
Passenger Compartment
Emergency “Exit” sign at top of bulkhead
Emergency floodlights cabin ceiling, main crew door, overwing exit
Exit lights cabin centre ceiling, mid-wall, floor path
Main Crew Entrance Primary Ground Egress exit
Left side
Electrical outlet 60 Hz 110V (x1) 3 total
Drop down mask (x10) Above wing site non-functional
Life vest under divan (x3)
Spare life vest under divan (x4)
Basic Survival kit under divan
Life raft under couch seat (6 pers). Optional – for full pax
Universal First Aid Kit
Left side mid-cabin cabinet
Automated External Defibrillator (AED) Front door
Portable O2 with yellow nose mask (top flap) Dedicated to Flight Steward
Aviox bottles (top panel) Dual cylinder – 10-12 min capacity
CPR kit *Make sure Spectrum end table clear of centre
console
Lavatory & Tail
Call Bell
Smoke Detector
ELT in luggage compartment – hard mounted
Black box
Electrical outlet 60hz 110V (x1) 3 total
Right side
Halon extinguisher behind last seat – 3 total
Emergency escape hatch (overwing) Primary Ditching Egress exit
Secondary Ground Egress exit
Life Raft (6 or 10 pers) with survival kit For overwater flights
Escape rope Behind dado panel
Electrical outlet 60hz 110V (x1) 3 total
Drop down masks above seats (x10) units (22 units total). Above
wing site non-functional
Figure 6-5-23 Table of CC144 Emergency Equipment
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CREW PORTABLE OXYGEN SYSTEM
44. AECMs have access to an AVIOX DUO-PAK, portable chemical oxygen system. It is usually located
in the top of the stowage compartment immediately forward of the divan. This portable system can be used
by AECMs in the event of an emergency. Co-located with the DUO-PAK, is a small green portable oxygen
bottle referred to as the FS oxygen bottle.
45. There is another oxygen bottle with smoke mask located in the AME storage compartment for use
by the AME.
Figure 6-5-24 Duo-Pak (Black Case) with

Portable FS Oxygen Bottle & Brown Mask
Figure 6-5-25 Other Oxygen Sources in the Cabin

Including a General-Purpose First Aid Kit
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PORTABLE FIRE EXTINGUISHERS
46. Three hand-operated fire extinguishers containing Halon 1211 are provided. They are located:
a. In the flight deck behind the right pilot’s seat;
b. In the passenger cabin compartment to the forward and to the right of the lavatory door; and
c. Beside the FS’s jump seat.
FIREMAN’S GLOVES
47. In the CC144, the fireman’s gloves are located in the AME stowage compartment (right side).
CRASH AXE
48. The crash axe is used to cut through the inner panels to expose outer fuselage components in case
of a fire. The crash axe is most useful to break through the ceiling (thinnest part of the fuselage) for egress
purposes. You cannot break through windows with this device.
Figure 6-5-26 Crash Axe Mounted Behind Left Pilot’s Seat
EMERGENCY FLASHLIGHTS
49. Emergency flashlights are contained in a bracket mounted to the aircraft. Locations as chart above.
EMERGENCY ESCAPE ROPE
50. The emergency escape rope is stowed behind the dado panel under the Right Overwing Emergency
Exit (marked with EMERGENCY ROPE INSIDE). The rope is knotted at one-foot intervals and is approximately
3.3 metres (11 feet) long. A 5 cm (2 inch) diameter ring and swivel assembly is attached to one end of the
rope, which bolts to an existing bracket at the base of the emergency exit door. See Figure 6-5-27.
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Figure 6-5-27 Location of Crash Axe, Emergency Escape Rope

(with Swivel Assembly) and Emergency Flashlights
EMERGENCY LOCATOR TRANSMITTER (ELT)
51. This is located in the aft tail section of the aircraft. This ELT is hard-mounted in the fuselage and
is not easily accessible. To reach the ELT, open the Aft Equipment Bay door and climb into the tail of the
aircraft. In case of an emergency the ELT will automatically start transmission. Crew will not retrieve this ELT
in case of an emergency.
LIFE VESTS (ADULT / CHILD)
52. A life vest for each occupant of the flight compartment and the cabin is provided. The crewmembers’
life vests are stowed in a pocket beneath each crewmember’s seat. The passenger life vests are stowed
under each passenger seat. Additional life vests are stowed under the divan.
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Figure 6-5-28 Life Vest Locations
LIFE RAFT (10 PERSON), UNIVERSAL FIRST AID KIT & SURVIVAL KIT
53. See Figures 6-5-29 and 6-5-30.
Figure 6-5-29 Universal First Aid Kit and Basic Survival Gear Located Under the Divan
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Figure 6-5-30 Life Raft Location and Operation
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LIFEPAK 500 – AED
54. Onboard the Challenger aircrafts, the FSs have been trained and are certified to use this device. The
image below shows the location of the AED and the CPR kit in the mid-cabin stowage cabinet. This cabinet
is located immediately forward of the divan. This device can also be used by AECMs.
Figure 6-5-31 Lifepak 500 and CPR Kit in Lower Mid-cabin Stowage Compartment
BRACING POSITIONS
55. See Figure 6-5-32.
Figure 6-5-32 Brace Positions on the CC144
STRETCHER LIFT SYSTEMS – GENERAL
56. There are two stretcher lift systems that can be used with the CC144. The “No-lift patient loading
system” made by Spectrum is the system of choice. If the “No-lift patient loading system” fails the pre-flight
check at 412 Squadron the Medevac Ramp will be used to assist with litter loading.
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NO-LIFT PATIENT LOADING SYSTEM
57. The “No-lift patient loading system” is assembled and operated by the AME but AECMs are
encouraged to help as it takes more then one person to put it together. The maximum lifting weight of the
no-lift system is 450 lbs. This system requires compressed air and 28 volt DC power source to operate (it is
generally connected to the base of the Spectrum bed).
Figure 6-5-33 No-lift Patient Loading System with Spectrum Litter
WARNING
Do not attempt to load patients into or out of the aircraft without 2 people
inside the aircraft to receive the patient and 4 personnel on the ground to
steady the patient during the lift.
WARNING
Do not push the stretcher past the black indicator arrow on the side of the
No-lift patient loading system. If the stretcher is pushed past the arrow, the
stretcher will catch the transition table when lifting, causing severe damage
to the loader/stretcher or throwing the patient from the stretcher.
WARNING
To ensure stretcher is locked into position, visually check that the end plates
are latched.
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Figure 6-5-34 Ramp Extender Partially Installed
Figure 6-5-35 No-lift Patient Loading System
2800 SERIES
58. Patient loading instructions (litter patients):
a. Remove locking pin and push ”Push to Lock and Release Stretcher” button inward, and rotate
stretcher lock plate down;
b. Load patient and Spectrum litter on the “No-lift patient loading system” ensuring that the Spectrum
litter guide goes into the “No-lift patient loading system” litter guide housing. Do not slide Spectrum
litter past the black arrow on the “No-lift patient loading system”. See Warnings for “No-lift patient
loading system” at left;
c. Lift patient/Spectrum litter using the “No-lift patient loading system” remote. Normally controlled
by the AME;
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d. Once at the top, slide stretcher (with patient’s head oriented forward) forward on to the ramp extender
and medical system until stretcher pins engage forward stretcher lock plate in the Spectrum bed
base. Be careful not to tip the patient off of the stretcher when sliding patient through cabin door;
e. Adjust stretcher until aft stretcher lock plate can be engaged;
f. To engage stretcher lock plate, push “Push to Lock and Release Stretcher” button inward, and
rotate stretcher lock up until locking hooks engage the stretcher lock plate, release button and insert
locking pin; and
g. Check to ensure stretcher is secured by visually ensuring the lock button has extended back into
original position and the locking hooks have fully engaged the stretcher locking plate.
Figure 6-5-36 Checking Spectrum Litter Housing Is In
Figure 6-5-37 No-lift Patient Loading System

Litter Housing Loading at Top of Lift
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Figure 6-5-38 Sliding Feet around Cabin Door
Figure 6-5-39 Sliding Patient on Ramp Extender
59. Patient deplaning instructions (litter patient):
a. remove locking pin and push ”Push to Lock and Release Stretcher” button inward, and rotate
stretcher lock plate down;
b. slide stretcher outward onto the ramp extender and patient loader. Be careful when sliding patient
through cabin door and ensure that Spectrum litter guide goes into the “No-lift patient loading
system” litter guide housing;
c. ensure that the Spectrum litter is slid forward until the end of the litter closest to the aircraft is inline
with the black arrow on the “No-lift patient loading system”;
d. lower stretcher and patient using “No-lift patient loading system”;
e. transfer patient from Spectrum litter to awaiting ambulance stretcher; and
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f. once Spectrum litter is returned to the Spectrum platform, re-engage the stretcher lock plate, push
“Push To Lock and Release Stretcher” button inward, and rotate stretcher lock up until locking
hooks engage the stretcher lock plate, release button and insert locking pin.
MEDEVAC RAMP
60. The ramp is a TC design consisting of wood flooring and covered with anti-skid surfacing agent.
The frame is composed of metal posts and a short metal railing. The AME is responsible to assemble and
position the ramp; however AECMs are encouraged to assist with this, as the assembly and installation
requires multiple people to complete safely. The ramp is to be positioned on the passenger/crew door stairs
(third from top as indicated on the ramp itself). After the No-Lift Patient Loading System was purchased, TC
retained only 1 of the ramps for unusual conditions or special requests. Due to weight restrictions on the
AC, both systems cannot be carried at the same time (the ramp takes up most of the baggage compartment).
Figure 6-5-40 Medevac Ramp Assembled and in

Position to Receive Patients (Note the
Top of the Ramp Sits on the Third Step
From the Top) Assembly Instructions
are Found Written on the Ramp Itself
AIRCRAFT CONFIGURATIONS
SPECTRUM 2800 MODEL
61. The Spectrum 2800 is the transport system that is used by the CF in the CC144 aircraft. It has integrated
oxygen, suction, electric and compressed air system as well as a lighting system and a removable stretcher.
This system is described in the B-MD-010-000/FP-001 Aeromedical Evacuation Equipment Manual in detail.
6-5-38
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Figure 6-5-41 AE-1 “Spectrum High Density” Configuration – 7 Seats, 2 Spectrum Beds
NOTE
Personal baggage and medical equipment will be significantly restricted in
this configuration. Longer reconfiguration times and decreased aircraft range
should be expected.
Figure 6-5-42 AE-2 “Spectrum Both” Configuration – 5 Seats and 2 Spectrum Beds
Figure 6-5-43 AE-3 “Spectrum Right” Configuration – 6 Seats and 1 Spectrum Bed
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Figure 6-5-44 AE-4 “Spectrum Extra Equipment” Configuration –

4 Seats and 2 Spectrum Beds
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SECTION 6
CH146 GRIFFON
Figure 6-6-1 CH146 Griffon
GENERAL
1. The CH146 Griffon is a short range multi-purpose helicopter primarily used to transport troops,
cargo and perform SAR duties. It can also be configured for AE in a forward or tactical role. The CH146 is a
non-pressurized, twin-engine, single rotor, multi-purpose aircraft. The Griffon can operate in a wide variety
of environmental and climactic conditions, and does not require pre-made landing zones. For a more in-
depth understanding of the CH146 Griffon, refer to C-12-146-000/MB-002.
TROOP CONFIGURATION
2. The Griffon can be configured for 12 seats.
3. The Griffon can be configured to carry a maximum of six litters with room for only one seat. This
configuration will not be used for AE as the single crewmember will be unable to egress the aircraft quickly.
The usual AE configuration is 3 litters on the left or right side with room for 5 seats. Patient placement in this
configuration limits access to the patients while in flight.
6-6-1
B-MD-005-000/FP-001
Manufacturer Bell Helicopter

Engines 2 Pratt & Whitney PT6T turbofan engines
Rotor Length 46 ft / 14 m
Rotor Height 11 ft 5 in / 3.5 m
Airframe Length 46 ft / 14 m
Maximum Gross Weight 11,900 lbs or 5400 kg
Usable Load 5,000 lbs or 2270 kg
Cruise Speed 130 kts / 240 km/h
Cabin Cargo Compartment 220 cu ft / 6.23 cu m
Baggage Cargo Compartment 28 cu ft / 0.79 cu m
Max Speed 140 KIAS / 260 km/h
Max Speed with side door open 100 KIAS / 185 km/h
Max Range 400 nm / 740 km
Figure 6-6-2 Table of CH146 Specifications
6-6-2
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DIMENSIONS
Figure 6-6-3 CH146 Dimensions
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DANGER AREAS
4. Dangers areas include the main rotor, tail rotor, chaff/flare dispensers, as well as the “nitesun”
searchlight when installed.
Figure 6-6-4 Danger Areas
HOW TO APPROACH A ROTARY WING AIRCRAFT
5. Rotary wing aircraft pose additional safety concerns for their users when the aircraft is “powered
up” due to the rotor hazard, wash and debris they generate. As depicted in the diagram above the red areas
are to be avoided when aircraft rotors are powered-up. Additional considerations when approaching these
aircraft are weather/visibility, terrain slope and time of day. Prior to approaching any rotary wing aircraft,
obtain the attention of an aircrew member (onboard the aircraft) and request authorization to proceed to the
aircraft. The following steps are universally acceptable:
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B-MD-005-000/FP-001
a. Wait for a “thumbs up” from the pilot or helo crewmember before approaching;
b. If you do not get a “Thumbs Up,” do not approach;
WARNING
Do not approach a rotary wing airframe unless you get a thumbs up from one
of the front end crew or FE.
c. Approach from the front (between the 10 and 2 o’clock positions) and load or enter from either side
door. Never approach from uphill; and
d. Keep your head low and crouch when passing under outer portion of the rotors.
6. Procedures to approach helicopters at night are the same as during daylight, but it may take longer
to get the aircrew’s attention. Wait for the “thumbs up” and do not shine vehicle lights or flashlights into the
flight deck area or into crewmembers’ faces.
7. An important safety principal to remember is that eye and ear protection will be worn when working
around rotary wing aircraft just as for fixed wing EROs.
CH146 EXITS
8. As in the other airframes AECMs utilize, there are primary exits for ground egress and ditching:
a. the sliding Cargo/Passenger doors are a primary exit for ground egress and secondary for ditching;
b. the cargo area acrylic windows are primary means of egress for ditching; and
c. the Crew doors are secondary for both ground egress and ditching (usually more difficult to access
during an emergency from the main cabin).
CREW DOORS
9. To open:
a. from the outside, pull handle downward and pull door outwards (see Figure 6-6-5 arrow #1). In the
event of an emergency, the entire door can be jettisoned by pulling the emergency jettison handle
(downwards) located forward of the door (see Figure 6-6-5 arrow #2). To allow door to be jettisoned,
the aft handle must be also opened;
b. from the inside, use the pull handle or the jettison handle on the forward edge of the door to jettison
the door while inside the aircraft; and
c. the Hash marks located around the doorframe indicate an emergency exit (Figure 6-6-5 arrow #3).
6-6-5
B-MD-005-000/FP-001
Figure 6-6-5 Griffon Crew Door (Right Side)
SLIDING CARGO / PASSENGER DOORS
10. The sliding cargo/passenger compartment door opening measures 4 ft 7 in x 7 ft 8 in (1.40m x

2.34m). The door consists of 2 segments: a sliding door and a hinged door panel.
11. To open:
a. pull the L-shaped handle downwards (Figure 6-6-6 arrow #1)
b. move the sliding door to the rear of the aircraft; and
c. the hinged door panel can then be swung open by pulling the handle embedded in the doorframe
(Figure 6-6-6 arrow #2)
6-6-6
B-MD-005-000/FP-001
Figure 6-6-6 Cargo / Passenger Door (Right Side)
ACRYLIC WINDOWS
12. In case of an emergency, the windows of the sliding door can be pushed out simply by applying
pressure (approx 25-30lbs) to any one of the marked corners of the acrylic window (Figure 6-6-6 arrow #3).
The windows are held in place by a dual-sided rubber seal, allowing the window to be pushed into the cabin
or pushed-out of the cabin in an emergency. As with the crew doors, the hash marks indicate an emergency
exit (Figure 6-6-6 arrow #4).
AIRCRAFT SYSTEMS
OXYGEN SYSTEMS
13. There is no integral oxygen system in the CH146 Griffon.
ELECTRICAL SYSTEMS
14. A cabin inverter is available for powering equipment requiring up to 115 volts/60 Hz such and
supplys up to 12 amps for medical equipment and the hoist. The four outlets for the cabin inverter are
located on the lower portion of the rear bulkhead. See Figure 6-6-7.
6-6-7
B-MD-005-000/FP-001
15. There are a few limitations with the cabin inverter that must be considered while performing mission
planning. The cabin inverter is not normally equipped on the CH146 and must therefore be requested
prior to flight. Though the CH146 has a back-up generator, it is intended solely for powering critical flight
systems required to perform an immediate landing. Medical equipment will not be supplied power in such
circumstances; the equipment should continue to function due to the internal battery. Time constraints may
not afford the medical team the opportunity to properly connect equipment to the aircraft. For the above
reasons, it may be more efficient to power medical equipment with batteries rather than the cabin inverter.
Figure 6-6-7 Cabin Inverter Power Outlets (Located Beneath the Centre Cabin Seats)
COMMUNICATION SYSTEM
16. The CH146 communication system has 4 radio frequencies with the following capabilities: 2 V/UHF
(channels 1-2), one Ultra High Frequency (channel 3) and one High Frequency (channel 5), not installed on
all airframes. The aircrew will always be utilizing channels 1-3 during the flight.
17. Four communication panels are located in the cabin (two on each side). This system allows the team
to remain aware of the tactical situation by monitoring aircrew chatter. It also allows for communication with
the other crew (FE, Pilots and AECMs). The comms panel allows the AECMs to isolate their conversation
from that of the aircrew, thereby allowing the team to perform their job without interfering with aircrew
operations and protecting private medical information from non-medical personnel. When operating on
the CH146, AECMs should be wearing an approved helmet with integrated headset/microphone. As per the
CC130 comms system, there is a push-button to allow the user to talk. Due to the noise in the airframe, one
needs to keep the microphone very close to one’s mouth in order to be heard clearly.
18. It may also be possible to have a patient on headset (if one is made available), this will greatly
aide in communicating with the patient during flight. AECMs are to ensure that all crewmembers are aware
when a patient is on a headset.
6-6-8
B-MD-005-000/FP-001
Figure 6-6-8 Aft Compartment Comms Panel
19. There are several portions of the panel pertinent to AE ops, as described below (see also Figure 6-6-9):
a. Master Volume (#1);
b. Channel Selector – channels 1-3 will remain in the ‘on’ position (#2);
c. Remains in NORM (click to talk) at all times, except in the event of an emergency (#3);
d. Normally kept on ICS – by selecting PVT the AECMs completely isolates their conversation from the
aircrew (#4); and
e. Always kept on MIC 1 (#5).
Figure 6-6-9 Comms Panel Diagram
20. During a medical emergency, it is recommended that PVT be selected, with dial #3 switch to VOX
(voice activated). This will allow AECMs to free up both hands without interrupting the communication flow.
6-6-9
B-MD-005-000/FP-001
LIGHTING SYSTEMS
21. The pilot controls crew compartment lighting. Any lighting change requests should be sent to the
pilots via the FE. The cabin compartment is lit by three 28-VDC lights located on the roof of the compartment:
one in the centre cabin and the two others are located in the right/left aft sections.
Figure 6-6-10 Cabin Light (Centre Cabin)
COMFORT ITEMS
22. There is no integral comfort items associated with the CH146. AECMs will need to bring those items
required by patients.
BAGGAGE COMPARTMENT
23. The baggage compartment door is located on the right side of the tail section. The baggage
compartment has limited storage space, and cannot be accessed during flight. When the door is opened,
compartment lights will automatically illuminate provided that there is power running to the non-essential
DC bus. This area can be used to store non-essential equipment, belongings or other aircraft gear. The litter
kits and extra seats, for example, are stored in this area. The FE has the key to access this compartment. To
open; turn handle clockwise until door unlatches. Maximum weight is 400lbs.
6-6-10
B-MD-005-000/FP-001
Figure 6-6-11 Baggage Compartment Door
ENVIROMENTAL SYSTEMS
24. The CH146 operates in climactic extremes, ranging from -40oC to 52oC. To regulate its environment,
the Griffon has both a heating and ventilation system. Engine-bleed air is combined with outside air to
regulate heat, whereas cooling is accomplished by cycling RAM air through the interior. Heat is cycled
through the interior via vents in the floor (see Figure 6-6-12 arrow #1). Interior ventilation is accomplished
by passing RAM air through 16 individually adjustable air vents (see Figure 6-6-12 arrow #2).
Figure 6-6-12 Heating (1) and Cooling (2) Vents
6-6-11
B-MD-005-000/FP-001
25. A thermostat located behind the pilot’s seat regulates temperature in the CH146. If AECMs have any
temperature related concerns they should be conveyed to the FE. AECMs should not adjust the temperature
without prior approval from FE or Pilot.
 
Figure 6-6-13 Thermostat Location Behind the Right Pilot Seat
EMERGENCY EQUIPMENT
GENERAL
26. This section will familiarize you with the CH146 emergency equipment, as well as protective clothing
that may be required.
27. The following equipment is located on the Griffon:
a. 2 Halon 1211 fire extinguishers;
b. an Emergency Location Transmitter (ELT);
c. a crash axe;
d. a commercial first aid kit; and
e. a basic survival kit.
6-6-12
B-MD-005-000/FP-001
Figure 6-6-14 Emergency Equipment Locations

(May Differ Between Sqns / Op Missions)
FIRE EXTINGUISHERS
28. There are two hand-held fire extinguishers for use in the flight deck/cabin areas of the aircraft. One
extinguisher is located on the left doorpost at the front of the passenger cabin, while the other is located on
the floor to the right of the pilot’s seat. Each extinguisher is mounted in a quick release bracket and includes
a safety ring pin to prevent accidental actuation.
 
Figure 6-6-15 Fire Extinguisher Locations in the Cabin (White) and Flight Deck (Red)
EMERGENCY LOCATION TRANSMITTER (ELT)
29. Located directly behind the flight deck right side door post is the 4000-10 ELT. In the event of a crash/
forced landing, this will assist the Rescue Coordination Centre (RCC) with their efforts to locate the crash
site. The device is fully portable and should be removed from the aircraft prior to egress/ditching.
6-6-13
B-MD-005-000/FP-001
Figure 6-6-16 ELT (Right Side of Cabin)
30. To activate the ELT once safely away from the aircraft, screw in the antenna, move the switch guard
and flip the switch. Please note that the antenna must remain detached and safely stowed during flight
operations and may only be mounted once the ELT has been removed from the aircraft. During normal
operations, the ELT is connected to an antenna of the aircraft.
 
Figure 6-6-17 ELT Diagram
6-6-14
B-MD-005-000/FP-001
FIRST AID KIT
31. A first aid kit (white plastic box) is located on the left doorpost, directly below the fire extinguisher.
This kit conforms to civilian aviation standards, and is intended for dealing with rudimentary medical
situations only, and is by no means sufficient for AE operations. If loading patients into the left half-litter kit
the first aid kit will need to be temporarily removed to allow for proper loading as it may be damaged during
loading if left in place.
Figure 6-6-18 First Aid Kit
CRASH AXE
32. The crash axe is located on the interior of the right hinged door panel behind the right pilot’s seat.
SURVIVAL KIT
33. There is a basic survival kit located on the aircraft at all times. The locations depend on the squadron
and type of mission flown. It could be located in the main cabin or in the tail boom cargo compartment.
There may be additional survival kits depending on the terrain/environment the mission is flow in, i.e. arctic
and desert kits.
Figure 6-6-19 Survival Kit
6-6-15
B-MD-005-000/FP-001
SUPPLEMENTAL EQUIPMENT
34. In addition to the standard emergency equipment, the following may be required for participation
on a Griffon flight depending on the area of operations.
IMMERSION SUITS
35. Should any portion of the flight be scheduled to last more than 20 minutes over water where water
temperature is less than or equal to 13oC, or where the combined water/air temperature is less than 31oC,
immersion suits will be worn in the helicopter. Patient requirements may be waivered due to medical
circumstances.
36. Crewmembers are sized for their suits at the ALSE shop, and will receive more detailed instructions
on suit usage at that time.
SURVIVAL VESTS / LIFE PRESERVERS
37. Survival Vests will be worn as dictated by mission requirements. Should life preserver attachments
be deemed necessary for the mission, an Emergency Breathing System (EBS) will also be carried on each
crewmember.
CONFIGURATIONS
GENERAL
38. This section will familiarize you with the various AE configuration patterns that can be used on the
CH146 Griffon. The Griffon can be configured for a variety of roles: troop carrier, cargo/supply transport, AE,
casevac, or close support (tactical with weapons).
6-6-16
B-MD-005-000/FP-001
 
Figure 6-6-20 Common CH146 Configurations
39. Of the above configurations, the configuration least likely to be encountered by AECMs is the
Emergency MEDEVAC setup. In this scenario, six stretchers (three to a side) are loaded in the rear and a
helicopter-trained medical attendant takes the FE position. This configuration will only be used in a mass-
casualty situation. There are three major drawbacks to this setup. First of all, medical care will be at its
absolute minimum due to the lack of space to store medical supplies/equipment. Secondly, personnel
trained to load/unload helicopters will be required at both ends of the flight, as there will be no room to
carry such personnel onboard the aircraft. Finally, emergency egress is rendered virtually impossible due to
overcrowding in the rear cabin.
AE CONFIGURATIONS
40. There are three main configurations specific to AE operations: side mounting, cross-cabin mounting.
and floor loading.
SIDE MOUNTING
41. In the side mounting configuration, 1-3 litters are carried parallel to left and/or right door. With
litters mounted on only one side of the aircraft, there is room for 2 AECMs as well as 2 ambulatory patients
along the transmission box. The ambulatory patients should require minimal care as it will be difficult
to reach them.
6-6-17
B-MD-005-000/FP-001
Figure 6-6-21 Side-Mounting – 2 Litters

Note: There may be a Central Seat Facing Aft (Usual Strategic Configuration)
CROSS-CABIN MOUNTING
42. In the cross-cabin mounting, 1-3 litters are loaded across the back of the cabin immediately in
front of the pylon island. An AECM is usually seated in the forward cabin, facing rear. Ambulatory patients
usually will not be transported this way because of the inability to care for them, as the available seats are
inaccessible to the AECMs in this configuration (in the right and left aft cabin).
Figure 6-6-22 Cross-Cabin Mounting – 3 Litters
FLOOR LOADING
43. In the floor load configuration, a maximum of 2 litters can be loaded side-by-side. The litters will
require collapsible handles in order for both to fit in the aircraft lengthwise. In a single litter floor load, a
regular canvas NATO litter is acceptable as the handles are positioned in the creases of the doors.
6-6-18
B-MD-005-000/FP-001
LITTER KIT COMPONENTS AND SET UP
44. The Griffon litter kit consists of six litters, 2 stanchion assemblies, 12 support brackets, 4 litter strap
assemblies, and 12 litter straps and 1 single attendant seat.
45. The litter (Figure 6-6-23 #1) is secured to the helicopter by a support bracket attached to the rear
firewall (Figure 6-6-23 #2) and a stanchion assembly on the inside (Figure 6-6-23 arrow #3), and by brackets
attached to two strap assemblies on the outside (Figure 6-6-23 #4). The patient is held firmly in place via
litter straps (Figure 6-6-23 #5).
 
Figure 6-6-23 Litter Setup Diagram
BRACKET MOUNTINGS
46. Position the four pins of the bracket into the upper portion of each hole and slide down to lock
into place. See Figure 6-6-24.
Figure 6-6-24 Firewall Mountings with (1) and without (2) a Bracket
6-6-19
B-MD-005-000/FP-001
STANCHION BRACKET MOUNTINGS
41. See Figure 6-6-25.
Figure 6-6-25 Stanchion Assembly and Bracket Mounting  
NOTE
In the central position along the stanchion, brackets can be placed in either
the upper or lower portion of the mountings for minor adjustments. In both
the upper and lower positions, the bracket positions are fixed.
LITTER STRAPS AND BRACKETS
Figure 6-6-26 Strap Assembly
6-6-20
B-MD-005-000/FP-001
48. The strap hook (Figure 6-6-26 arrow #1) connects to a D-ring in the floor. These straps, except for
securing to the floor of the aircraft, function in a manner similar to the litter straps used on the CC130.
Strap tension can then be adjusted by pulling the strap tight at the floor mount. Brackets can be raised and
lowered by opening the lower/upper bracket locks respectively (Figure 6-6-26 arrow #2). Pressing the safety
catch and squeezing the handle located on the lower portion of the bracket allows for free movement up and
down.
LOADING PATIENTS
49. There are multiple ways to load litter patients onto a CH146. These procedures are appropriate when
the crew is able to take their time when emplaning patients. Please note as long as the safety principles are
applied to loading and unloading, other methods are acceptable.
SIDE-MOUNTED LITTERS
50. Once approval has been given to the AECMs by the CH146 Crew to approach the aircraft, the AECMs
may begin loading procedures. Prior to emplaning any patients the AEC will ensure that medical supplies
and equipment are at the aircraft. AECMs may use bystanders or medical/non-medical personnel to load
litters onto the aircraft. Remember that loading and off-loading must be done under the supervision of at
least one AECM. The FE can be briefed on the positions in which the litter will be loaded. See Figure 6-6-21.
51. AECM #1 is position at the forward strap location, outside the aircraft. AECM # 2 is positioned at the
AFT strap location to assist with loading and to secure the litter handles into the brackets and straps to the
floor once loading is complete. A helper will get inside the aircraft and assist the FE with loading the litters.
52. Patients are loaded top to bottom with their heads forward and feet aft. To load a litter, rest the head
portion of the litter on the aircraft floor and advance it forward until the rear portion of the litter can be slid
through the door opening. Then proceed to realign the litter in a neutral position. On a word of command or
hand signals from the FE, raise the litter to the appropriate stanchion position. Secure brackets in place and
continue with the next litter.
53. After all litters have been loaded, AECM #1 will make his/her way into the cabin and provide medical
coverage while AECM #2 secures litter straps into the floor D-rings. AECM #2 should then proceed with a
final security check of the brackets and straps and close the cargo/passenger door. See Figure 6-6-21.
54. Deplaning of patients in this configuration is the reverse of the preceding steps.
CROSS-CABIN MOUNTING
55. In this technique loading of an equipment litter and patient litters should be quicker than the side
mounting configuration due to the increased availability of workspace.
6-6-21
B-MD-005-000/FP-001
56. Bring patients’ feet first to one side of the aircraft. Then rest and advance the feet-portion inside the
width of the aircraft until handles are in approximate positions on the stanchions. Prior to placing the litter
in the brackets, position an AECM on both sides of the aircraft, as well as 2 support personnel inside (one
of which can be the FE). Four personnel are required due to the limited space in the cabin as patients will
need to be lifted above the waist. On a word of command or hand signal of the FE, raise the litter to the
appropriate litter position. AECMs should then secure brackets and straps once completed.
6-6-22
B-MD-005-000/FP-001
SECTION 7
CH147 CHINOOK
Figure 6-7-1 CH147 Chinook
GENERAL
1. The CH147 is a true multi-role, vertical lift platform. With tandem rotor this medium-lift helicopter’s
primary mission is the transport of troops, ammunition, fuel, supplies and artillery. It has a secondary role
of humanitarian support including Medevac. The CH147 is capable of handling useful loads up to 24,000
pounds (10,886 kg) and a maximum gross weight of up to 50,000 pounds (22,668 kg). The Chinook has been
in service since 1962 when it was deployed to Vietnam.
TROOP CONFIGURATION
2. Maximum troop capability is 33.
LITTER CONFIGURATION
3. The Chinook can carry up to 24 litters.
6-7-1
B-MD-005-000/FP-001
Manufacturer Boeing
Engines Honeywell 55-GA-714A engines, 4,733 shp (3,529 kW) each
Airframe Length 52.0 ft. (15.9 m) Incl. Rotors – 99.0 ft. (30.18 m)
Max Gross Weight 50,000 pounds (22,668 kg).
Mission radius 200 nm (370.4 km)
Max Speed 170 kt (315 km/h)
Max Range 330 nm (611 km)
6-7-2
B-MD-005-000/FP-001
SECTION 8
CH149 CORMORANT
Figure 6-8-1 CH149 Cormorant
GENERAL
1. The CH149 Cormorant is a medium-lift helicopter primarily used for Search and Rescue (SAR)
operations within Canada. It can be configured for the transport of patients for AE in support of SAR
operations. For a more in-depth understanding of the CH149 Cormorant, refer to the aircraft flight manual
EU02X503A.
TROOP CONFIGURATION
2. The Cormorant can be configured for 16 passengers or ambulatory patients. In this transport
configuration there is an additional seat for the Flight Engineer and 2 for AECMs or SAR Techs.
LITTER CONFIGURATION
3. Up to 12 litters may be flown at a time. This configuration leaves a seat for the FE and 2 additional
seats for medical personnel.
6-8-1
B-MD-005-000/FP-001
Manufacturer AgustaWestland
Engines 3 General Electric T700-T6A1 turboshafts
Airframe Length 74 feet, 10 inches (or 22.81 metres)
Maximum Gross Weight 32,188 lbs (or 14,600 kg)
Usable Load 12,000 lbs (or 5,443 kg)
Max Speed 192 mph (or 309 km/h)
Max Range 863 mi (or 1,389 km)
6-8-2
B-MD-005-000/FP-001
SECTION 9
CC115 BUFFALO
Figure 6-9-1 CC115 Buffalo
GENERAL
1. The CC115 Buffalo, procured in 1967, is one of Canada’s primary search and rescue (SAR) aircrafts that
will fly in almost any weather. The Buffalo can take-off and land on even the most rugged terrain and in
areas as short as a soccer field. The short take-off and landing (STOL) capabilities of the CC115 have kept
it in use in the Rocky and Coastal Mountain ranges. At 24 m long the Buffalo is small enough to service the
rough and mountainous terrain on Canada’s West Coast.
Troop Configuration
2. Maximum troop capability is 41 troops.
Litter Configuration
3. Can carry up to 24 litters.
Manufacturer De Havilland - Canada

Engines Two 3 060 hp GE turbine engines
Airframe Length 24 m
Maximum Speed 416km/h
Maximum Range 2240 km
Max take-off weight 2727 kg
Max service ceiling 9,450 m
6-9-1/6-9-2
B-MD-005-000/FP-001
ANNEX 6A
STRATEGIC AEROMEDICAL EVACUATION ASSETS
1. Figures 6A-1-1 and 6A-1-2 are general guidelines to use when planning strategic aeromedical
evacuation missions in the Canadian Forces. Each section is meant to detail information that is specific
to each aircraft. None of the information is all inclusive and mission requirements may force changes as
needed.
2. Currently the Patient Transport Unit (PTU) in use by the CF is the 2800 and 2900 series Spectrum
Aeromed bed system on the CC150 and the CC144.
3. Increasing ambulatory seats in most airframes will cause a decrease in the number of litter positions
available or vice versa.
NOTE
The maximum number of crew is not usually a factor in larger aircraft.
Equipment loads on the smaller airframes will impact the maximum crew
complement. Consult with the flying unit before developing an AEC to ensure
there is appropriate space (i.e. bringing 7 AECMs on the CC144 would leave
no room for patients).
6A-1-1
B-MD-005-000/FP-001
Aircraft Type CC150 CC150 CC144 CC177 CC115

Full pax config Combi pax-cargo
AE Crew 1 MCD, 1 TM 1 MCD, 1 TM 1 MCD, 1 TM 1 MCD, 1 TM 1 MCD, 1 TM
composition plus plus plus plus plus
augmentation augmentation as augmentation augmentation augmentation
as required required as required as required as required
Patient 1-6 1-6 (NOTE: 1-2 9 litter Litter positions
Transport Units no CC pts due positions +27 – 2-3 (in SAR
(PTU) to loading another with Configured)
problems) extensions
Additional Max 6 Max 4 but none None Floor load Floor Load
stretchers with all 6 PTU in 48+12 litters on
place ramp
Total litter load 12 6 2 Stanchions – 24 Litters with
36/48 or floor 6 seats
load – 60
Number of CC 6 0 2 3 (up to 12 with 1 (in SAR
patients LSAS) configuration)
Additional Based on Based on AECM/ Based on Based on Based on
Ambulatory AECM/pt ratio pt ratio AECM/pt ratio AECM/pt ratio AECM/pt ratio
Stretcher - Left front - Amb pts may - Stretcher - Loaded Loaded
loading door after enter through loader can only through aft through aft
removal of fwd rear exit be used for cargo ramp cargo ramp,
left bulkhead - No litters right side PTU - Each litter A/C typically
- Amb pts may through rear - Left side station has in a SAR setup
enter through stretcher 3 hardened which reduces
rear exit pt must be litter positions the litter load
- No litters transferred from with limited to as little as 3
through rear right side to left adjustability patients.
PTU once inside - CC pts will
aircraft need extra
- Right side positions due
patient is to equipment
loaded last in a needs
Ref:
2 pt load C-12-115-000/MW-000
Figure 6A-1-1 Strategic Aircraft Configuration Table – CC150, CC144 , CC177 and CC115
6A-1-2
B-MD-005-000/FP-001
Aircraft Type CC130 CC130 CH146 CH147 CH149

Stubby Stretch/J
AE Crew 1 MCD, 2 1 MCD, 2 Minimum 1 1 MCD,1 1 MCD plus
composition TMs plus TMs plus MCD plus TM plus augmentation
augmentation augmentation augmentation augmentation as required
as required as required as required as required
Patient NIL NIL NIL NIL NIL
Transport Units
(PTU)
Additional Floor load Floor load Max 3 Max 24 Max 12
stretchers 15 litters 18 litters
Total litter load Stanchions – 72 Stanchions – 97 3 as AE (6 24 litters 12 (with max
(62 on tanker or floor possible but load only 1 seat
config) or floor load – 18 no room for for attendant)
load – 15 AECMs) or
floor load 2
Number of CC 4 (3 on tanker 6 1 4 2
patients config)
Additional Based on Based on Based on Based on Based on
Ambulatory AECM/pt ratio AECM/pt ratio AECM/pt ratio AECM/pt ratio AECM/pt ratio
Stretcher -Loaded -Loaded -1-2 patients -Adding litter -A/C is typically
loading through aft through aft can be floor positions in a SAR setup
cargo ramp cargo ramp loaded if reduces max which reduces
-A single -A single necessary to ambulatory max litter load
critical care critical care reduce ground capability as to as little as 2
patient can patient can times litters replace pts
take up to 5 take up to 5 -Patients are seats
litter positions litter positions loaded through -Patients are
depending on depending on the side cargo loaded from
equipment equipment doors a ramp at the
-A/C numbers rear
338-342 are
missing 2 bars
for hanging
patient straps
at tier E and
G on the right
side
Figure 6A-1-2 Strategic Aircraft Configuration Table – CC130, CH146, CH147 and CH149
6A-1-3/6A-1-4
B-MD-005-000/FP-001
ANNEX 6B
AIRCRAFT EMERGENCY EQUIPMENT
SECTION 1
OXYGEN EQUIPMENT
GENERAL
1. For oxygen equipment, please see B-22-050-278/FP-000 Manual of Aviation Life Support Equipment
and Techniques dated 04-15-2009, Part 5 – Oxygen Masks.
6B-1-1/6B-1-2
B-MD-005-000/FP-001
ANNEX 6B
SECTION 2
FLOTATION DEVICES
6-PERSON INFLATABLE LIFE RAFT
GENERAL
1. For flotation devices, please see B-22-050-278/FP-000 dates 04-15-2009, Part 3 – Personal Flotation
and Part 8 – Life rafts.
6B-2-1/6B-2-2
B-MD-005-000/FP-001
ANNEX 6B
SECTION 3
FIRE EXTINGUISHERS
PORTABLE AIRBORNE FIRE EXTINGUISHER (TYPE HALON 1211)
GENERAL
1. The fire extinguisher has 1-A, 5-B, C fire ratings, and is extremely effective in combating “B” and
“C” class fires. Also, because of its high boiling point, it provides a modest “A” extinguishing rating and a
reduced thermal shock. Its high insulating property makes it safe for use on electrical equipment carrying
up to 100,000 volts. These considerations, plus the absence of corrosive substances or residue, make it ideal
for use on or in the following types of fires:
a. Class A − ordinary combustibles like paper, wood and cloth;
b. Class B − flammable liquids like gas, oil and paint; and
c. Class C − electrical equipment like computers, circuits and motors.
WARNING
Halon 1211 chemical concentrate can be toxic. Avoid exposure to
concentration in excess of 2 percent by volume.
2. The fire extinguisher is charged with a quantity of liquid fire extinguishing agent,
bromochlorodifluoromethane (CBrC1F2), or Halon 1211. It is pressurized with dry nitrogen (N2) to 100 psi
(6.90 bar), to ensure expulsion pressure in extreme cold weather.
3. The fire extinguisher consists of a cylinder assembly incorporating an operating head, which
comprises a machined aluminium valve assembly with a swivel-up lower carrying handle, a squeeze down
upper handle that acts as an operating lever on the valve plunger, a rated orifice, discharge nozzle, and a
pressure gauge.
4. Halon 1211 is a safe agent in normal use. ULC has given it the same life hazard classification as
carbon dioxide (Class 5). Halon 1211 is fast and efficient. It interferes chemically with the combustion process
of the fire by taking the active radicals out of circulation, which stops the various reactions of the fire itself.
This is known as ”chain-breaking” and is normally accomplished in a few seconds. The combining of Halon
1211 with these fire radicals produces some breakdown products also known as products of decomposition.
These products are hydrogen halides. Traces of free halogens are sometimes detectable; however, these
6B-3-1
B-MD-005-000/FP-001
components are normally formed only in very small quantities (parts per million), levels well below those
which are considered hazardous.
5. The products of decomposition of Halon 1211 in a fire have a characteristic sharp, acrid odour even
when present in concentrations of only a few parts per million. This is, in reality, a built-in safety warning
which will alert users to ventilate or leave the area. This built-in warning system lessens the chances of
adverse reaction to the usual problems associated with a fire, such as smoke and fumes, carbon monoxide
in unacceptable concentrations, oxygen depletion, and superheated air. These hazardous results of the
combustion process of the fire itself are often not noticed until too late. Likewise, overexposure to and
excessive use of all chemical extinguishants, including Halon 1211, shall be avoided.
6. The fire extinguisher has a safety blow-off protection for the high pressure generated in extremely
high temperature situations, by the gauge bourdon tube. The extremes of either high or low temperature in
which the Canadian Forces (CF) often operate dictates providing additional data to verify fire extinguisher
pressure. Decal, NSN 7690-21-880-9205, is provided to allow personnel to determine correct gauge pressure
as influenced by temperature.
OPERATION
7. The valve is activated by breaking the pull-tite seal or witness wire, then removing the pullout pin
and squeezing the operating lever and carrying handle together. The valve stem assembly inside the valve
is pushed down and the pressurized nitrogen charge forces the extinguishing agent through the pickup
tube, around the stem assembly, through the valve assembly and out the discharge nozzle. Releasing the
pressure from the operating lever and carrying handle allows the valve stem to reseat, sealing any remaining
contents inside the cylinder. It is used on the CC130, CC150, CC144, and CH146. Halon 1211 is also used on
the CC177, however, the bottle is an orange/yellow color and the bottle is shorter and wider.
6B-3-2
B-MD-005-000/FP-001
Figure 6B-3-1 Halon 1211 Fire Extinguisher
8. Operate the fire extinguisher as follows:
a. hold the fire extinguisher upright and pull on the pullout pin to break the nylon pull-tite seal or
witness wire;
b. ensure the pullout pin is completely disengaged from the valve handle;
c. stand at least 6 feet (2m) away from the fire, and aim the discharge hose or nozzle at the base of the
flames;
d. hold the fire extinguisher firmly and squeeze the operating lever to discharge the extinguishing
agent;
e. spray the extinguishing agent using a sweeping side to side motion aimed at the near base of the
fire;
f. after the fire is out, step back and watch for possible re-ignition. Never turn your back to the fire;
and
6B-3-3
B-MD-005-000/FP-001
g. after use, immediately return the fire extinguisher to the fire hall, regardless of the amount of
extinguishing agent used. Ensure all applicable documentation is included.
WATER FIRE EXTINGUISHER
Figure 6B-3-2 Water Fire Extinguisher
GENERAL
9. The water fire extinguisher is only good on Type A fires (normal combustibles). It is on the CC150
only and has the following restrictions:
a. temperature range effective above -70°C;
b. discharge range of approximately 20 ft; and
c. discharge duration of approximately 30-45 seconds of continuous discharge.
NOTE
There is a glycol mixture included in the extinguisher to ensure the unit
doesn’t freeze in cold weather.
10. The extinguisher is charged by means of a small CO2 cylinder contained in the handle.
11. To operate:
a. turn the handle in the clockwise direction. (This pierces the cylinder charging the extinguisher);
b. aim the extinguisher at the base of the flame and depress the thumb valve; and
c. place your thumb or finger over the nozzle to form a spray instead of a steady stream.
NOTE
If you get extinguishing fluid in your eyes flush immediately with water.
6B-3-4
B-MD-005-000/FP-001
ANNEX 6B
SECTION 4
MEDICAL SUPPLIES / EQUIPMENT
GENERAL FIRST AID KIT
GEneral FIRST AID KIT

NSN 6545-21-862-5225
Figure 6B-4-1 General First Aid Kit
1. The General First Aid Kit can be found on the CC130 and CC150. Its contents are as follows:
a. Adhesive Tape, Surgical;
b. Bandage, Adhesive;
c. Bandage, Muslin x2;
d. Case, First Aid Kit;
e. Compress and Bandage x2;
f. Dressing, First Aid, Field;
g. Glove, Patient Examining and Treatment;
h. Pad, Povidone-Iodine Impregnated x5;
j. Pin, Safety;
6B-4-1
B-MD-005-000/FP-001
k. Pocket Guide, First Aid, St. John’s Ambulance; and
m. Scissor, Bandage.
UNIVERSAL FIRST AID KIT
UNIVERSAL FIRST AID KIT

NSN 6545-21-116-9813
Figure 6B-4-2 Universal First Aid Kit
2. The Universal First Aid Kit is used on the CC130. Kit Contents:
a. Adhesive Tape, Surgical x2;
b. Bandage, Adhesive;
c. Bandage, Gauze x6;
d. Bandage, Muslin x3;
e. Case, First Aid Kit;
f. Dressing, First Aid, Field x13;
g. Glove, Patient Examining and Treatment;
h. Insect Repellent, Personal Application;
j. Mask, Mouth, Resuscitator;
6B-4-2
B-MD-005-000/FP-001
k. Pad, Non-adherent x18;
m. Petrolatum, White, USP x2;
n. Pin, Safety x2;
p. Pocket Guide to First Aid, St. John’s Ambulance;
q. Scissor, Universal;
r. Splint, Universal x6; and
s. Water Purification Tablets.
FIRST AID KIT, AIRCREW
3. This first aid kit is found on the CC177 aircraft. Contents are as follows:
a. Container, Cloth, 6650 Kit;
b. Eye Dressing Kit;
c. Pad, Povidone-Iodine 1.375” x 2”;
d. Instruction Card, ART. Respir;
e. Contents List, 6650 Kit;
f. Instruction Sheet, First Aid;
g. Tape, Transpore, 1” x 1.5 yd;
h. Dressing, Field, Camo, 4” x 7”;
j. Bandage, Compress, 2 x 2, 4’s;
k. Bandage, Gauze 2” stretch, 2/box x2;
m. Bandage, Triangular, Single unit box;
n. Bandage, Gauze Petrolatum 3 x 36, 6 @ 12 pk per case x3;
p. Gloves, Patient Exam, Size Large x4;
6B-4-3
B-MD-005-000/FP-001
q. Razor, Surgical Prep (5’s);
r. Bandaid, Adhesive, 3” x 3/4” x18; and
s. Bag, Dental Prosthesis.
Figure 6B-4-3 First Aid Kit, Aircrew
LIFEPAK 500 – AED
Figure 6B-4-4 Lifepak 500
4. Onboard the CC144 Challenger aircrafts, the FSs have been trained and are certified to use this
device. The image below shows the location of the AED and the CPR kit in the mid-cabin stowage cabinet.
6B-4-4
B-MD-005-000/FP-001
ANNEX 6B
SECTION 5
EMERGENCY LOCATOR TRANSMITTERS (ELTs)
GENERAL
1. For Emergency Locator Transmitter and Radios, please see B-22-050-278/FP-000 dated 04-15-2009,
Part 9 – Radios.
6B-5-1/6B-5-2
B-MD-005-000/FP-001
ANNEX 6B
SECTION 6
MISCELLANEOUS EQUIPMENT
FIRE AXE / CRASH AXE
Figure 6B-6-1 Fire Axe
1. The axe can be used for cutting through aircraft interior walls to expose fires so that they can be
fought. The handle of the axe is rubber insulated and can withstand up to 24,000 volts of electricity. It is
found on the CC130, CC150, CC144, CC177 and CH146.
EMERGENCY FLASHLIGHT
Figure 6B-6-2 Emergency Flashlight
2. These flashlights are contained in a bracket mounted to the aircraft wall and are not connected to
the aircraft power supply. They are powered by means of a battery and the serviceability can be tested by
means of a red flashing light on the flashlight itself. If no flashing light is visible, advise the LM/FS who will
inform the aircraft technician. This system is found on the CC130, CC150, and CC144.
3. The flashlight is of an explosion-proof design. A strong beam of light is broadcast from the flashlight
and will last between 30 and 240 minutes depending on the discharge life of the battery.
6B-6-1
B-MD-005-000/FP-001
4. To utilize the flashlight, remove it from the stowage bracket and the light will come on automatically.
If required to be used during a daytime emergency and you want to save the battery, just unscrew the
bottom cap. A connector is then visible which you just disconnect, to save for future use.
FIREMAN’S GLOVES
Figure 6B-6-3 Fireman's Gloves
5. They are designed to protect the hands while handling super heated pieces of metal. They can be
found on the CC130, CC150 and CC144.
6B-6-2
B-MD-005-000/FP-001
ANNEX 6B
SECTION 7
PERSONAL PROTECTIVE EQUIPMENT
GENERAL
1. For Personal Protective Equipment, please see B-22-050-278/FP-000 dated 04-15-2009, Part 2 – Flying
Clothes.
6B-7-1/6B-7-2
B-MD-005-000/FP-001
CHAPTER 7
TACTICAL AEROMEDICAL EVACUATION
SECTION 1
GENERAL
1. This chapter deals with the contingency/tactical airlift of casualties by AECMs. AECMs need to be
familiar with SMM-CC130J-1 section 17 and SMM 60-2631 chapter 3 for AE configurations for ops on the
CC130J and SMM 60-177-0960 chapter 17 for ops on the CC177.
2. As per the Report of 7th meeting of the NATO AMDP (June 2010): “The phase of medical evacuation
that provides intra-theatre air transport for patients between medical treatment facilities within the area of
operations.”
AEC COMPOSITION AND PREPARATION
3. The tactical AEC normally consists of five operationally current AECMs with further augmentation
as the situation dictates. AECMs receive their initial tactical training on their basic aeromedical evacuation
course and possible requalification training prior to deployment in a tactical environment.
4. All AECMs must have, as a minimum, the following items when proceeding on a tactical mission:
a. all NO-GO items outlined in Chapter 3;
b. indicated environmental equipment (arctic/desert gear) and personal protection equipment (kevlar/
framentation vest, etc); and
c. additional kit as dictated by the mission, for example ballistic eyewear, CBRN gear, fragmentation
vest, weapons, or helmet.
7-1-1/7-1-2
B-MD-005-000/FP-001
SECTION 2
AIRCRAFT CONFIGURATION
GENERAL
1. Tactical AE utilizes the back-haul capability of tactical airframes. Therefore, before patients can be
emplaned the cargo compartment must be configured for patient transport. Configuration is the responsibility
of the LM. However, the AEC will assist the LM and ensure that an appropriate configuration is utilized. Refer
to aircraft-specific SMM for further instruction (CC130J: SMM 60-2631, CC177: SMM 60-177-0960).
CONFIGURATION OPTIONS
2. There are two different configuration options that can be utilized in a tactical situation as dictated by
the following two factors:
a. time available. The time available for re-configuration will be determined by the AC based on the
time remaining until the scheduled take-off and the duration the aircraft can remain safely on the
ground before becoming an enemy target; and
b. patient factors. These include the number, classification, diagnoses, and health status of the patients
being moved.
CC130 CONFIGURATION OPTIONS

FLOOR LOAD CONFIGURATION
3. When there is an actual or high probability ground threat, strapping litters directly to the floor is the
safest and most expedient way to reconfigure, load, and secure patients. The stanchion ladder is stowed
when using this configuration and equipment is secured where space is available. Should cargo remain
on board during a tactical AE, the number and placement of litters will change; however, patients should
always be placed aft of the cargo to facilitate emergency egress. The maximum floor load configuration for
tactical aeromedical evacuation is 12 litters and 23 seats. The H-30 aircraft maximum load is 18 litters and
48 seats.
THREE- AND FOUR-HIGH LITTER LOAD PLAN
4. When time is available the litter support elements may be utilized (stanchions and litter support
straps). Litters are loaded on the centre stanchions with four litters per tier. Depending on the model and tail
number, litter and seat capacity will vary:
a. tail numbers 130305 to 130337 have a maximum load of 40 litters and 29 passenger seats;
7-2-1
B-MD-005-000/FP-001
b. the CC-130 Tanker Conversion (aircraft numbers 130338 to 130342) can carry a total of 32 litters and
29 passenger seats. The removal of the airframe’s right sided litter strap support ceiling bar at flight
station 450 to 460 does not allow for litter set up at areas G and J; and
c. the H-30 (stretch) models have a maximum of 52 litters with 48 passenger seats.
FIVE-HIGH STANCHION LOAD PLAN
5. This configuration is similar to the four-high litter load plan except that tiers are loaded five litters
high. This configuration should only be used in extreme situations as there is a risk for both patients and
crew injury when a loaded litter is installed into the first litter position. Additionally, enroute nursing care is
very difficult to deliver. When this configuration is used:
a. tail numbers 130305 to 130337 have a maximum load of 50 litters and 29 passenger seats;
b. the CC-130 Tanker Conversion (aircraft numbers 130338 to 130342) can carry a total of 40 litters and
29 passenger seats. The removal of the airframe’s right sided litter strap support ceiling bar at flight
station 450 to 460 does not allow for litter set up at areas G and J; and
c. the H-30 (stretch) models have a maximum of 65 litters with 48 passenger seats.
CC177 CONFIGURATION OPTIONS
THREE-HIGH TIER LOAD
6. Using the 3 litter tiers built into the walls of the CC177, a litter load of up to 9 patients can be moved.
The Litter Stanchion Augmentation Set includes an additional 9 litter stanchions bringing the total litter
spaces available to 36.
FLOOR LOAD CONFIGURATION
7. Litters are positioned side-by-side and placed on the cargo area floor, with the patient’s head toward
the rear of the aircraft. A total of 48 litter patients can be floor-loaded on the CC177. This is comprised on 8
rows of two groups of three litter patients. The first row starts at FS 360. An additional 12 litter patients can
be placed on the ramp for maximum capacity of 60 litters.
CONFIGURATION PROCEDURES
FLOOR RAIL SYSTEM
8. The CC130 ”E”/”H” models have a removable floor rail system for the loading and unloading of
cargo. The cargo area floor should be configured with all rollers removed and stowed. A floor onload can be
7-2-2
B-MD-005-000/FP-001
accomplished with the centre two columns of rollers removed, if time constraints become critical. Similarly,
a tier load can be accomplished if the aisle rails are removed when time constraints are critical. With the ”J”
model, the rollers need only to be flipped so that the roller side is down.
9. The floor rail system on the CC177 may need to be flipped so that the roller side is down to facilitate
the safe onload of patients. Seek assistance from the LM to flip the rollers as needed.
LITTER SUPPORT COMPONENTS
10. Careful attention to the number and serviceability of litter support components (stanchions, straps,
and brackets) is critical. One missing or non functional component may be the decisive factor in whether
a patient can be airlifted or not. It is the responsibility of AECMs to ensure all litter support components
are serviceable prior to an AE mission. For detailed information refer to the information in the Aircraft
Operating Instruction CC130 Hercules Aircraft C-12-130-000/MB-001 on how to configure the CC130. Chapter
6 of B-MD-005-000/FP-001 also contains some basic direction on configuring the CC130. Refer to aircraft
Technical Orders for CC130J and CC177.
EQUIPMENT
11. Due to the limited time available for emplaning and the limited space available for stowage, only
equipment deemed absolutely necessary to provide appropriate and safe care should be loaded. The specific
coordination between participating agencies is essential. If special equipment is carried, consult with the
LM/FE prior to the mission to ensure that your equipment is in a proper location and will not interfere with
aircraft or patient/passenger safety or egress.
12. If special medical equipment is carried, the following is a suggestion where to locate the equipment.
Regardless of where you place your equipment it shall not be positioned where it jeopardizes safety. Consult
with the LM prior to the mission to ensure that your equipment is in a safe location and will not interfere
with the rest of the mission.
7-2-3/7-2-4
B-MD-005-000/FP-001
SECTION 3
EMPLANING PROCEDURES
1. Tactical emplaning may be very different from the “controlled” peacetime loading procedures.
Speed is critical to ensure the aircraft, its crew, and patients are protected from possible enemy assault. The
procedures used will differ depending on whether the floor or stanchion configuration is used. Due to the
limited ground time, the ground medical personnel are responsible to ensure that the patients are emplaned
in the following priority:
a. A – ambulatory;
b. D – deferred;
c. I – immediate; and
d. E – expectant.
2. Upon landing in the tactical zone, time and hostile situation permitting, one Flight Nurse and 1 Flight
Med Tech should deplane the aircraft and receive a patient brief from the OMF personnel. Patient manifest,
documentation, medications, etc, will be handed over to the FN/FMT at this time. The FN/FMT will assess
the patients ensuring that they have been properly prepared for flight. They will confirm that a security
check has been performed on all patients. The FMT will further ensure that aircraft approved stretchers are
being used. The FN will confirm the emplaning order with the OMF representative. The FN/FMT will give a
litter bearer brief, as needed, prior to returning to the aircraft. The FN will give a brief summary to the MCD
with regards to the patient load, emplaning order and any other pertinent details. A spotter from the ground
support team will position himself/herself approximately 50 metres aft of the aircraft and controls traffic in
and around the aircraft during emplaning.
3. Two ground loading ramps are positioned together to assist in safely emplaning litters. When
emplaning on a single ramp, it is difficult for the aft-most litter bearer to visualize the ramp and therefore
creates a safety hazard. Personnel loading the aircraft must be given clear direction on what is expected of
them.
EMPLANING A FLOOR LOAD
GENERAL
4. The AC will inform the MCD of the amount of secure time available for emplaning. In pressure
situations, and with engines running, AECMs should be able to load and secure 15 litters and 22 ambulatory
patients in less than 15 minutes. AECMs may leave the aircraft to perform duties as needed at the discretion
of the AC and MCD after evaluating the tactical situation at the airfield. While operating in a tactical
environment all AECMs must have a complete understanding of their positioning and duties if emplaning is
to be managed safely and efficiently.
7-3-1
B-MD-005-000/FP-001
CREW POSITIONING AND DUTIES
5. Load masters. One LM is positioned inside the aircraft on the left side of the ramp on a headset. This
LM assists the MCD with patient loading and communicates with the AC. The LMs primary duty is to ensure
that loading is accomplished quickly and safely. At the LM direction the loading may have to stop because
of a change in the tactical situation or because of an unsafe practice.
6. MCD. The MCD is positioned at the top, centre of the ramp controlling emplaning activities. When
the aircraft and AECMs are ready to emplane litters, the MCD gives the initial signal, a “thumbs up” with
hand straight up in the air, to the ground support spotter in order to initiate the patient emplaning sequence.
The MCD controls the speed of emplaning as well as traffic flow inside the aircraft to ensure patients are
loaded right to left and forward to aft.
7. Other AECMs. AECMs position themselves on the right side of the cargo compartment, one at each
location where the foot of the litters will be positioned. Each AECM will instruct litter-bearers where to place
the litters and direct them off the aircraft via the left side aisle. After placement each AECM is responsible
for securing litters to the floor of the aircraft as per paragraph 8 below. In order to prepare the aircraft for
emplaning, cargo tie-down straps are installed in the cabin of the aircraft. It is recommended that AECMs
prepare their tie-downs prior to landing so that time is not wasted accomplishing these tasks on the ground
EMPLANING AND SECURING PROCEDURES
8. Litters are brought on in a continual stream and at a speed that allows safe yet expedient processing.
The AECMs will instruct the litter-bearers where to place the litters and direct them off the aircraft via the left
side aisle. If space allows, the litters can be placed in 4 rows of 3 litters (CC130) and 8 rows of two times three
litters (CC177) starting from the right and extending to the left side of the aircraft. In an emergency, where
needed, an additional 3 litters (CC130) and 12 litters (CC177) may be secured to the ramp of the aircraft.
These patients should be hemodynamically stable enough to withstand the flight at the angle created by
the ramp. If possible, load those patients who are the most serious or require frequent observation and/
or enroute care, on either the right or left side of a row of litters in order to facilitate in flight care, as those
patients in the middle of a row will be difficult to access. Secure the litters to the aircraft floor using the
following procedures:
a. one litter: centre litter over aircraft floor centre. Use one tie-down device at each end of the litter.
Connect clamp end of device to a tie-down ring and run strap webbing over the litter handles,
wrapping once around each handle. Attach the hook on the ratchet end of the tie-down ring on the
other side of the litter. Remove slack from strap webbing, and ratchet the tightening device. Repeat
process at the other end of litter;
b. two litters: place litters side-by-side, and align inboard litter handles over aircraft floor centre. Use
two tie-down devices at each end of the litters. Connect clamp end of tie-down devices to a tie-
down ring and run strap webbing over both inboard handles, then over respective outboard handle.
Do not wrap strap webbing around any handles. Attach the hook on the ratchet end of the tie-down
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B-MD-005-000/FP-001
devices to a tie-down ring. Remove slack from strap webbing, and ratchet the tightening device.
Repeat process at other end of litter; or
c. three litters: place litters side-by-side and centre inboard litter over aircraft floor centre. Use two
tie-down devices at each end of the litters. Connect clamp end of tie-down devices to a tie-down
ring and wrap strap webbing once around applicable paired litter handles, then over respective
outboard handle. Do not wrap strap webbing around outboard handles. Attach the hook on the
ratchet end of the tie-down devices to a tie-down ring. Remove slack from strap webbing, and
ratchet the tightening device. Repeat process at the other end of litter.
9. For minimum security, the foot end of all litters must be secured prior to take-off. If time permits,
handles at the head of the litters are secured in the same manner. When tying down the head end of a
litter AECMs can also do a limited assessment which may be as simple as talking to the patient to determine
the patient’s level of consciousness and the patency of his/her airway.
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Figure 7-3-1 Floor Loading Litters Tie-Down
EMPLANING A THREE- OR FOUR-HIGH TIER CONFIGURATION
GENERAL
10. Because of the possible number of litters that will need to be loaded and potential time constraints
it is recommended that tier onloads be done with a minimum crew of five. This can be reduced as needed if
only one side will be loaded.
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CREW POSITIONING AND DUTIES
11. Load masters. The positioning and duties for the two LMs are the same as for the floor configuration.
12. MCD. The location of the MCD is at the top and centre of the ramp. The duties of the MCD are the
same as for the floor load configuration except that patients are loaded on the CC130 in accordance with the
following patient flow pattern:
a. from the top to the bottom of the tier;
b. from forward to aft of the aircraft; and
c. alternating from the right to the left tiers or vice versa.
13. Other AECMs. Two AECMS are positioned next to the first empty litter tier on the right side and two
AECMs are on the left side of the aircraft. One of each pair is positioned at the forward end of the tier and
the other at the aft end. As litter bearers approach with a loaded litter, both AECMs hold or place the litter
support straps out of the way so that the inner litter handles can be placed into the litter stanchion brackets.
The litter support straps are brought back into position, the outer litter handles are placed into the brackets
on the litter support straps, and these brackets are locked into place. This procedure continues until the tier
is filled. At this time, AECMs secure the litter support straps to the floor stud and tighten the support strap
to reduce litter movement. The AECMs move aft to the next tier to restart the process on the new tier. For
minimum security prior to take-off, litter handles must be locked into the brackets on the litter support straps
and these straps must be locked onto a floor stud. If time permits, the brackets on the litter stanchions are
also secured prior to take-off.
EMPLANING A FIVE-HIGH TIER CONFIGURATION
GENERAL
14. The procedure for this configuration is the same as for the three/four-high tier configuration. All
AECMs must exert extreme caution when loading a litter into the uppermost position as this litter must
be lifted high above the head. The opportunity for an injury to occur to either a patient or an AECM when
employing this configuration is a reality.
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SECTION 4
DEPLANING PROCEDURES
GENERAL
1. The deplaning of patients at the end of a tactical AE normally takes place in a secure, controlled
environment where the standard deplaning procedures contained in this manual can be, and should be,
followed. See Chapter 5, Section 9, ”Emplaning and Deplaning Principles”.
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CHAPTER 8
Aeromedical evacuation CLINICAL CONSIDERATIONS
SECTION 1
AE CLINICAL CONSIDERATIONS
GENERAL
1. This chapter sets minimal standards for care in the air. It is not intended to be all inclusive, nor
replace provincial best practice care standards. AECMs are expected to provide care based on their scope
of practice, level of knowledge, training and skill. This chapter shall be used in conjunction with Ernsting’s
Aviation Medicine, (4th Ed) 2006, Chapter 56 – Aeromedical Evacuation: Medical Aspects. Patient care
practice will be guided by Potter and Perry’s Fundamentals of Nursing.
2. The primary goal of AE is to meet actual and potential health care requirements in the air while
maintaining an optimal level of care. In order to accomplish this, the AECM must:
a. continue to provide (as a minimum) the same level of care the patients are receiving at the OMF;
b. compensate for stresses of flight; and
c. manage medical complications.
3. Initial and routine care interventions will be ordered by a Flight Surgeon (F Surg) and urgent/
emergency interventions can be ordered by a physician/AECMs/MSTMs IAW their scope of practice.
4. The 3 types of AE care interventions are:
a. Continuity of Care: Interventions designed to continue the care begun at the OMF to maintain or
improve the patient’s health condition (e.g. IV fluids, NG tubes, medications). These interventions
are not linked to the AE mission and would be required even if the patient was not being transported;
b. Stress of Flight: Interventions designed to compensate for one or more of the stresses of flight or to
enhance the patient’s comfort and protect his/her privacy/modesty. These interventions are directly
linked to the AE environment and might not have been necessary if the patient was not transported
by air; and
c. Complications: Interventions implemented in response to an in flight medical complication.
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SECTION 2
PATIENT CONSIDERATIONS FOR AEROMEDICAL EVACUATION
GENERAL
1. When initiating an AE mission, the AECO must take into consideration the patient fitness, risks, care
required, operational capabilities and cost advantages of military AE versus other transportation options.
Each mission is validated by the 1 Cdn Air Div Surg prior to initiation. Patients selected for AE must be
cleared by a CF F Surg prior to flight. In cases where this is not possible, a CF F Surg will discuss the patient
with the medical authority looking after the patient.
2. “There are a number of fundamental principles that should be remembered when AE is proposed
for any patient:
a. AE should offer a clear advantage to the patient. This will often be obvious when more sophisticated
medical care is required urgently, but sometimes the advantage of AE has to be weighed against
the benefits of maintaining medical care on the ground and the potential complications of AE.
b. AE of itself is not a therapeutic procedure, although, like many therapeutic procedures, it does have
its own side effects and complications.
c. Although there are no absolute contraindications to AE, some conditions place a heavy load on the
AE escort team and can be anticipated to cause difficulty. The AE of these patients needs careful
planning and preparation.
d. It is better to anticipate problems and prepare for them before flight than to be surprised by them
at 30,000 feet in the back of a dark, noisy, vibrating aircraft. Assume ‘Murphy’s Law’ applies, i.e. if
anything can go wrong, it will. Therefore, prepare for it!
e. Patients should be reassessed regularly throughout the AE process. This must often take place in
less than ideal circumstances.
f. Time spent checking and preparing AE equipment before flight is never wasted.
g. The type of aircraft and the composition of the escort team will be determined by the number and
clinical condition of the casualties and the distance they need to be moved.
h. AE is straight forward, as long as you remember that humans were designed for living on, or very
near, the surface of the Earth.”
From Ernsting’s Aviation Medicine, (4th Ed) 2006, Chapter 56 – Aeromedical Evacuation: Medical Aspects, page 814.
8-2-1
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3. There are no absolute contraindications to AE. Each case must be judged on its merits, weighing the
advantage of AE of the patient against the possible harmful effects of the flight. A calculated risk is involved
in moving certain types of patients. The following types of patients will be accepted only when there is no
other suitable means of transport:
a. patients with highly infectious or communicable diseases. Appropriate precautions will be taken
for the protection of the crew and other occupants;
b. sick or wounded whose general condition is such that they may not survive the flight; and
c. patients contaminated by CBRN prior to decontamination.
NOTE
All aircrew shall wear a Chemical, Biological, Radiological and Nuclear
Defence (CBRN) protective ensemble when passengers or cargo have been
CBRN contaminated.
4. Patients with any of the following conditions require special consideration in selection for AE:
a. infectious;
b. trapped gas;
c. wired jaws;
d. advanced pregnancy;
e. respiratory compromise;
f. cardiac compromise;
g. severe anaemia;
h. orthopedic casts:
j. post-operative;
k. psychiatric disorders; and
m. decompression illness/sickness.
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Patients At Increased Risk With Flight

Condition Considerations Pre-flight/In flight Requirements
Infectious a. pathogen agent involved a. appropriate infection control precautions
b. infectious stage of communicable b. appropriate placement and AECM
disease assignment
c. treatment received
Trapped Gas a. any body cavity with actual or a. delay mission until trapped gas absorbed
potential trapped gas b. if the mission cannot be delayed, a cabin
altitude restriction at the same altitude of
the OMF
c. adjuncts to prevent trapped gas
(nasogastric tubes or drainage
apparatus) initiated at the OMF
d. MCD alerts requesting physician to the
need for such adjuncts
Wired Jaws a. risk of aspiration a. supervised by a person who is
(inter maxillary competent and equipped to remove
fixation) the fixation materials as the situation
dictates
b. wire cutters
c. suction available
d. consider pre-flight anti-emetic
Advanced a. beyond the 8th month a. emergency delivery bundle
Pregnancy b. incubator and infant supplies
c. protect modesty if delivery in flight
Respiratory a. unaided vital capacity less than a. O2 therapy
Compromise 900 mls (adult) b. ventilator must accompany patient
Cardiac a. less than 10 days post-infarct a. O2 therapy
Compromise b. less than 5 days without b. cardiac and vital sign monitoring
symptoms c. cardiac medications available
c. ejection fraction less than normal d. defibrillation available
d. heart failure e. electrocardiogram (ECG) and lab work
within 24 hours
Severe Anaemia a. less than 2.5 million RBCs per a. O2 therapy
mm3 b. Recent blood work drawn (not greater
b. Hgb: less than 8g/dL (80g/L) than 72 hour beforehand)
Orthopedic Casts a. less than 48 hours old a. risk of cast damage if not completely dry
b. risk of circulatory compromise to
affected limb from swelling if injury/
surgery less than 48 hours prior to flight
c. bivalve new casts (less than 48 hours
old) prior to flight
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Post-Operative a. less than 10 days post-op a. altitude restriction and pressurized

b. invasive procedure aircraft required (if surgery is less than
c. greater than 24 hours post chest 24 hours, OMF ground level altitude
tube removal restriction is required)
b. monitored closely
c. adjuncts to prevent trapped gas
(nasogastric tubes or drainage apparatus)
initiated at the OMF
d. MCD alerts requesting physician to the
need for such adjuncts
e. pain medication
f. for chest tube removal an x-ray is
required 24 hours after removal to ensure
no residual trapped gas or recurring
pneumothorax.
Psychiatric a. past psychiatric illnesses a. restraints (physical or chemical) available
Disorders b. fear of flying or in use
b. PRN medications are available
c. patient should be observed on the ground
long enough to assess the reliability or
need for restraints
d. security escort may be required
Decompression a. requires clearance by diving a. as close to sea level cabin altitude
Illness/Sickness medical officer or F Surg restriction
b. 100 % O2 via aviators mask
c. immobalize painful joints
Figure 8-2-1 Patients at Increased Risk with Flight
ALTITUDE RESTRICTIONS
5. The decision for an altitude restriction or the need to provide supplemental oxygen or both should
be based on patient requirements. Most fixed-wing aircraft normally used for AE must fly lower than their
normal cruising altitude to maintain lower cabin pressurization. Flying at lower altitudes increases fuel
consumption, decreases range and increases the probability of turbulence. Inappropriate use of altitude
restriction can result in lengthened flight, increased fuel stops, increased crew requirements and inflate
mission costs.
6. For example, individuals with low O2 saturation (less than 90%) at sea level will probably demonstrate
hypoxia at or above 2,000 ft without appropriate measures. Most often this can be managed by supplemental
oxygen without altitude restriction.
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GENERAL CONSIDERATIONS
7. Prior to mission departure. AECMs are expected to review the patient’s clinical condition and
plan appropriate care; anticipating the problems caused by cabin altitude. Minimum mission information
includes:
a. diagnosis;
b. priority, classification and dependency;
c. current and past medical/surgical history;
d. physician orders;
e. dietary requirements;
f. special considerations with regard to medical condition and the stresses of flight;
g. equipment and medical supplies, including oxygen;
h. requirement for MSTMs;
j. aircraft type/configuration and cabin altitude; and
k. mission itinerary.
PRE-FLIGHT ASSESSMENT
8. Performance of a patient assessment permits the evaluation of the current patient condition and
provides the AECM an opportunity to identify potential/actual patient problems and the interventions
required prior to transporting the patient. A minimum assessment includes:
a. clinically focused patient assessment including the system involved and a complete set of vital
signs;
b. IV lines, drains, dressings, cast and other interventions;
c. medications and supplies for mission duration; and
d. applicable documentation and signed orders.
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In flight CONSIDERATIONS
9. Standards of care are maintained in the flight environment by providing specialized care relating to
the stresses of flight and the patient’s medical condition(s). Some general principles of patient assessment
and management during the AE mission may include:
a. plan patient care to conserve energy and avoid fatigue (both patient and caregiver);
b. maintain ongoing monitoring, patient care and documentation related to the patient’s clinical
condition;
c. perform regular inspection of dressings, casts, restraints and skin condition of immobilized patients;
d. reinforce dressings only; dressings will not be changed in flight unless hemorrhage is suspected
and requires treatment;
e. perform repositioning and hygiene measures (skin care and mouth care) at a minimum every 2
hours on the immobilized patient;
f. ROM exercise every two hours if patients cannot adequately change position (if space and F Surg
orders allow);
g. ensure all tubes and drains are functioning and secured :
h. administer medications and treatments as ordered;
j. ensure meals are as close to regular meal times as possible, keeping in mind changing time zones;
k. assist with eating PRN;
m. ensure special diets if required;
n. all monitors are secured to be observable;
p. ensure AECM seats are located to effectively monitor and treat patients;
q. ensure injured limbs are easily accessible for inspection;
r. maintain cabin cleanliness, security, and coverage (situational awareness) at all times, covering for
one another when necessary;
s. communicate:
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(1) with other AECMs, MSTMs and aircrew (as appropriate) to keep them informed as the mission
progresses and when changes occur; and
(2) with patients and NOK to answer questions, keep them informed as the mission progresses,
establish and maintain rapport and alleviate anxiety; and
t. be aware of the location of emergency equipment and ensure it is easily accessible at all times (load
planning consideration).
In flight COMPLICATIONS
10. AECMs should intervene independently during an in flight medical complication/ emergency IAW
the established Standards of Care/Standards of Practice, and within the Scope of Practice of the attending
AECMs and MSTMs.
11. In the event that a patient’s condition does not respond to intervention and/or when AECMs can no
longer provide a safe level of care, the MCD should do the following:
a. assign one or more AECMs to remain with the patient and continue to provide stabilizing care
appropriate to the patient’s condition;
b. brief the AC;
c. request an altitude restriction if this could improve the patient’s condition;
d. request a phone patch so that advice and/or verbal orders can be obtained from a military or civilian
physician (obtain the name and phone number of the physician for documentation purposes);
e. request an unscheduled landing at the nearest military or civilian airfield in proximity to a medical
facility capable of handling the patient;
f. request that a military or civilian physician/F Surg meet the aircraft to determine whether the patient
should be deplaned and admitted to a ground-based facility or continue the flight with additional
orders and/or physician accompaniment; and
g. request an ambulance crew capable of managing the patient’s condition, meet the aircraft.
12. In the event that a patient’s condition does not respond to intervention and/or when AECMs can no
longer provide a safe level of care AECMs should do the following:
a. remain with the patient and continue to provide stabilizing care in accordance with their scope of
practice and appropriate to the patient’s condition:
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B-MD-005-000/FP-001
(1) ABCs;
(2) IV access;
(3) O2 therapy with re-breather mask at a flow rate to keep reservoir bag inflated;
(4) vital signs (VS) and O2 saturation monitoring; and
(5) continuous cardiac monitoring;
b. maintain cabin coverage;
c. bring emergency equipment and supplies to the location of the patient and secure them in place;
and
d. document the assessments taken and interventions provided on Patient Care forms.
13. If a patient is deplaned following a medical complication/emergency:
a. his/her medications, records, and personal belongings should be deplaned and signed for via
DND 728;
b. the MCD will provide the admitting MTF with contact information for the AECO;
c. the MCD will contact the AECO and provide similar information about the admitting hospital; and
d. an AECM may stay with the patient at the admitting MTF at the discretion of the MCD and AECO.
14. If a patient continues on the flight following a medical complication/emergency, the MCD should:
a. have the patient deemed fit to fly by a Flight Surgeon;
b. notify the AECO of the change in the patient’s condition and if additional crew are required;
c. request the AECO notify the DMF of changes required in the destination arrangements; and
d. ensure all assessments and interventions are documented on the Patient Care forms and mission
deviations are documented on the RPE.
15. Death in flight is covered in Chapter 5, Section 11, paragraphs 27 to 34 of this publication.
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SECTION 3
GENERAL In flight CARE
VITAL SIGNS
1. As for any other patient, vital signs (VS) are a baseline assessment. A change in VS may be the first
indication a patient’s condition is deteriorating. VS include temperature, pulse, respiration, blood pressure,
oxygen saturation and pain level. VS shall be performed and recorded as ordered or at a minimum, pre-flight,
at cruising altitude, every 2 hours, prior to descent, as needed, and after any patient or aircraft event. Vital
signs shall be taken more often if patient condition deteriorates, particularly under the following conditions:
a. pyrexia (fever);
b. irregular/abnormal heart rate;
c. suspected or known infection;
d. dehydration;
e. decreased oxygen saturation;
f. administration of certain drugs (i.e. cardiac drugs, analgesia medication);
g. seriously ill (SI)/very seriously ill (VSI) patients; and
h. head injuries.
2. The use of electronic monitoring devices has become standard for all missions. If the electronic
monitoring device is not serviceable, blood pressure can be monitored by palpation method. The reading
may vary up to 10mm Hg when compared to auscultation but provides a trend for comparison in flight and
is charted as a systolic pressure only.
3. Mercury glass thermometers shall not be used in flight due to potential for breakage.
OXYGEN SATURATIONS
4. Blood saturation, normally 98% at sea level, is reduced to 87% at 3,050 metres (10,000 ft) (Lee, Flight
Nursing Principles and Practice (St. Louis: Mosby Year Book, 1991)) creating a condition of mild to moderate
hypoxia.
5. Monitoring patient’s oxygenation saturation with a pulse oximeter will indicate decreases/changes
much sooner than relying on signs and symptoms.
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6. Signs and symptoms of hypoxia are numerous and classified as objective signs (seen by an observer)
and subjective symptoms (felt by hypoxic individual). Prolonged poor oxygenation and hypoventilation will
eventually result in clinical signs of cyanosis. This is a late finding and requires urgent 100% oxygenation.
Objective signs Subjective symptoms

Confusion Confusion
Tachycardia Headache
Seizures Stupor
Dyspnea Insomnia
Hypertension Dizziness
Bradycardia Blurred vision
Arrhythmia Tunnel vision
Restlessness Hot and cold flashes
Slouching Tingling
Unconsciousness Numbness
Hypotension (late) Nausea
Cyanosis (late) Euphoria
Euphoria Anger
Belligerence
Change judgment/personality
Low SaO2
Figure 8-3-1 Table of Objective and Subjective Signs of Hypoxia

Adapted from Lee, Flight Nursing Principles and Practice, (St. Louis: Mosby Year Book, 1991), 7.
NOTE
Should anyone experience unexplained hypoxia, don an oxygen source,
warn other crewmembers and verify cabin altitude.
7. The goal is to maintain oxygen saturation at or above 92% for most patients. If a patient experiences
hypoxia, initial treatment is 100% O2. Once patient is stabilized, start to titrate O2 down to use the least
amount of O2 for a minimum saturation of 92%. High flow, 100% O2 is wasteful due to the limited supply and
is only required for only a small percentage of patients.
8. When hypoxia is suspected, the following are required:
a. 100% oxygen;
b. assess patient and get a set of VS;
c. troubleshoot equipment if O2 saturation not increasing; and
d. request to decrease cabin altitude if no improvement with treatment.
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B-MD-005-000/FP-001
9. All aeromedical patients have the potential for requiring oxygen in flight and as such AECMs can in
their clinical judgement apply oxygen as needed to maintain patient saturations above 92%. A physician can
write more specific orders as desired. Should a physician wish to limit application of oxygen on a patient
due to the patient’s clinical condition this will be documented on the patient’s Patient Care form in the orders
section. Changes in patient oxygen requirements or placement of oxygen on a patient will be documented
on the patient’s Patient Care form at a minimum.
10. Hyperventilation (increased rate and depth of respirations) may cause a state of hypocapnia that
leads to many of the same symptoms as hypoxia.
Comparison of Signs and Symptoms of Hyperventilation and Hypoxia

Sign/Symptoms Hyperventilation Hypoxia
Onset of symptoms Less rapid Rapid (altitude dependent, may
also be gradual)
Muscle Activity Spasmodic Flaccid
Appearance Pale Cyanotic (very late finding)
Tetany Present Absent
Breathlessness X X
Dizziness X X
Dullness and Drowsiness X X
Euphoria X X
Fatigue X X
Headache X X
Poor Judgement X X
Lightheadedness X X
Faulty Memory X X
Muscle in-coordination X X
Numbness X X
Deteriorated performance X X
Increased respiratory rate X X
Delayed reaction time X X
Tingling X X
Unconsciousness X X
Blurred vision X X
X represents the sign/symptoms of the condition
Figure 8-3-2 Comparison Table of Signs and Symptoms of Hyperventilation and Hypoxia
Adapted from Lee, Flight Nursing Principles and Practice, (St. Louis: Mosby Year Book, 1991), 9.
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NOTE
Symptoms are similar for hypoxia and hyperventilation although causes are
different. Treat any patient as hypoxic and encourage patient to slow down
respiration rate.
COMFORT MEASURES
11. Patient packaging for multi-hour transport requires careful attention to ensure there are no
complications related to the transport itself. These include pressure sores, any further injury, and
dislodgement of catheters or kinking of tubing. Stabilization of extremity fractures and possible spinal
immobilization are as vital as pain management. Maintaining optimal patient comfort during flight is each
AECM’s responsibility.
12. Ambulatory patients generally require minimal assistance for comfort however attention must be
paid to multiple issues. They should be observed for signs of fatigue and pain. These patients should be
encouraged to stand and stretch during flight and ambulate during enroute stops. Fluids and food should be
offered frequently. Patients may need assistance with toileting in the aircraft environment. Get down litters
(GDL) if possible, will be carried for seated patients in the event they become fatigued or their condition
deteriorates.
13. Litter patients who are able to sit for short periods should be encouraged to do so to reduce venous
stasis and fatigue. Get up seats (GUS) will be allocated for litter patients able to sit for short periods regardless
of length of flight.
14. While patients are flying in the strategic system they will have at a minimum, a litter mattress,
sheets, blankets and pillows to reduce the discomfort of a hard litter. If a litter patient must remain on a litter,
a backrest should be provided unless contraindicated. Additional padding in the form of rolled towels or
pillows can be used to provide support or position limbs to reduce fatigue.
15. All patients shall be assessed for adequate pain management and offered/provided pain medications
on a regular basis as well as other pain relieving measures (i.e. heat/cold therapy, positioning, etc).
16. Decreased humidity affects everyone but especially patients with respiratory problems. Adequate
oral and parenteral fluids are required to counteract the effects of low humidity. Water and juice should be
readily available and offered every two hours. Encourage patients to keep hydrated by drinking clear fluids
if possible or adjust IV rates as required.
17. For comatose patients, eye drops or ointment are used to protect the cornea from drying.
18. Humidified oxygen will be used for all patients requiring high flow oxygen, especially those with a
tracheal tube or tracheostomy.
19. Cabin temperature fluctuation can affect all patients and lead to either hypo or hyperthermia. Both
conditions increase metabolic demands for oxygen and fluids. Temperature can be controlled to some
extent by relaying requests to the LM or Flight Steward. Blankets and warm/cold fluids will help.
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20. Assess toileting needs to limit the impact on the patient during missions. Brief patients on lavatories,
urinals, bedpans and modesty curtains to ensure elimination needs are met in a timely manner.
21. AECMs should implement the following interventions to protect patient privacy and modesty when
feasible:
a. install modesty curtains whenever assisting litter patients with personal interventions; and
b. install tier dividers when at altitude.
22. Anxiety can be accumulative and can impact vital signs and patient temperament. Anxiety can be
relieved by keeping the patient informed, reassurance and if necessary, medication.
23. Increased barometric pressure may cause abdominal discomfort in some patients. Encourage
ambulation, when possible, and limit gas-producing foods.
24. Decreased lighting, in some aircraft, may lead to patients requiring more assistance with activities of
daily living and ambulation. In addition, communication may be more difficult with patients who are unable
to communicate verbally.
INTRAVENOUS THERAPY
25. To prevent complications with IV devices:
a. plastic solution containers are preferred for flight, being easier to handle and secure, non-breakable
and able to expand and contract;
b. glass bottles shall only be used if they can be vented (integral venting rod or vented IV administration
set) and then only as a last resort. Non-vented bottles do not allow for air expansion at altitude.
This may lead to fluid being forced out of the bottle, improper drip rates and breakage during rapid
decompression. To vent a glass bottle with an integral venting rod, insert a 16-18 gauge needle into
the venting rod through the stopper and tape in place. This will allow for air expansion and escape.
Also, secure glass bottles at the foot end of the litter to prevent inadvertent injury in the event of
breakage.
c. pressure infusers may not maintain a constant flow rate. During ascent the bladder expands and
will increase the IV flow rate; on descent, the pressure decreases so the infuser may require more
pumping. Careful monitoring is required.
d. position IV bags and lines to facilitate flow;
e. position IV bags away from the aircraft fuselage to maintain fluid temperature;
f. mark IV bags to monitor the desired rate and observe carefully, especially after ascent and descent.
Re-evaluate drip rates when reaching altitude;
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g. infusion pumps are mandatory for infants, children, certain medications and all central lines;
h. use only vented drip sets; non-vented sets will collapse and prevent fluid flow;
j. keep drip chamber at a minimum half full;
k. tape connections to prevent disconnection during flight; and
m. pliable, plastic volutrols may be used. Fill metering chamber and then clamp off between the bag
and chamber.
BLOOD TRANSFUSIONS
26. Routine blood transfusions in flight should be avoided; however, if blood or blood products
are administered, the blood must be packaged for transport according to the Canadian Blood Services,
appropriate guidelines must be followed and emergency equipment must be available.
27. The following procedure will be followed if blood needs to be administered in flight:
a. ensure that the there is an order on the patient’s Patient Care form that is specific about which type
of blood product will be transfused. Cross matched blood is preferred, uncross matched blood
requires a specific order;
b. prior to take off validate that the blood is the correct type, Rh, and has been screened (if unscreened
it requires an order);
c. administer any ordered pre-transfusion medications;
d. with another AECM, preferably a nurse, check the blood component against the patient’s information
(verbally if possible);
(1) spelling of patient’s name on the blood unit paperwork matches that patient’s name;
(2) type of component;
(3) compatibility of component with patient’s blood group and Rh type;
(4) expiration date on the unit;
(5) check the unit for abnormal coloration and/or appearance;
e. prepare Y-type administration set;
f. close both roller clamps;
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g. spike a bag of NS on one of the Y-sites and prime the tubing ensuring the filter is submerged;
h. spike the unit of blood or blood component on the second Y-site;
j. perform a complete set of baseline vital signs to include temperature;
k. initial transfusion should not exceed 15cc/hr for the first 15 minutes to reduce the severity of a
possible transfusion reaction;
m. after the initial 15 minutes the AECMs can start the transfusion at the directed rate, however, the
unit must be finished infusing within 4 hours;
n. vital signs will be checked every 15 minutes for the first hour and then every 30 minutes thereafter;
p. calculate the amount transfused if the patient requires intake and output.
28. Vital signs will include a temperature for all patients receiving a blood transfusion. Signs and
symptoms of a transfusion reaction vary by severity:
a. a mild transfusion reaction may include a rise of <1 degree Celsius, minimal itching, localized
urticaria and/or chills;
b. a moderate reaction may have a >1 to 2.5 degree Celsius rise in temperature above baseline, itching
resolved with antihistamines, urticaria unresolved with antihistamines, and/or chills with fever that
is unresolved with antipyretics; and
c. a more severe transfusion reaction will have a >2.5 degree Celsius rise in temperature; progressive,
confluent, or extensive urticaria; shock, hypotension; cyanosis; hemoglobinuria; dyspnea; back
(flank) pain.
WARNING
Do not add any medications to a patient’s transfusion set or to the unit
of blood.
29. If a patient develops a transfusion reaction the first action is to stop the transfusion. Discontinue the
transfusion from the patient but keep the Y-site intact (for later testing). Alternatively, consider removing
and collecting all tubing and starting a second line. Flush the patient’s IV site and give any medications that
are ordered for a transfusion reaction.
WOUND CARE
30. Wounds will be dressed to provide comfort, control bleeding, and prevent contamination from
debris (particularly important in AE environment). Wet dressings will be replaced with dry, sterile dressings
pre-flight to prevent heat loss and reduce the risk of infection. Dressings are reinforced only and will not be
changed in flight unless hemorrhage is suspected and requires treatment.
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31. Unless ordered or required more frequently, AECMs will assess dressings (minimum): pre-flight,
when maximum cabin altitude is reached or 30 minutes after take-off, 30 minutes prior to descent and every
2 hours during longer flights.
ADMINISTER MEDICATIONS
32. AECMs require a F Surg’s order prior to administering scheduled and PRN medications. These orders
will be recorded on the Patient Care forms. AECMs can take a verbal order from a F Surg via phone patch
(scope of practice permitting), if a patient requires a non-urgent medication for which there is no order.
Approved AE protocols may also be used.
33. AECMs should continue the dosing schedule initiated at the OMF during transport; however,
administration times may have to be adjusted around aircraft take-off and landing times. OMF personnel
should give medications that are due before take-off. AECMs should give medications due before landing
prior to descent and those due while the patient is scheduled to be enroute to the DMF before deplaning.
34. If patients are self-medicating at the OMF, they can continue to do so during transport. However,
AECMs shall be aware of when the medication is due and confirm that the patient has taken it. The patient
may need assistance to determine the correct time to take their medication if there is a time zone factor.
35. AECMs will document medications in both Zulu and destination local time on the Patient Care forms.
36. Patients on continuous therapeutic O2 will have a physician’s order that should include flow rate,
concentration (venturi mask), and means of delivery. Whenever AECMs deliver therapeutic O2, they will
document on the Patient Care forms:
a. the maximum cabin altitude (MCA);
b. the patient’s blood O2 saturation level (SpO2) before and after O2 is initiated;
c. the amount of O2 delivered and by what means (nasal cannula, mask); and
d. the patient’s response to O2 therapy.
STRESSES OF FLIGHT – GENERAL CONSIDERATIONS
GENERAL
37. While it is beyond the scope of this document to detail each and every clinical condition, an overview
of each body system and effects of the stresses of flight are presented with considerations.
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38. Critical care (CC) factors are also beyond the scope of this document; however, AECMs will be
involved in critical care missions. It is important to realise that while critical care patients are subject to the
same stresses of flight as other patients, their responses may differ due to the altitude effects on underlying
pathology. Stabilized CC patients are often unable to compensate for small changes that may not affect
other patients, leading to significant health problems at altitude.
Stresses of flight, their countermeasures and the impact on the overall airlift mission
Flight Stressor Patient most impacted Countermeasure Flight Consideration
PP O2 Cardiopulmonary Supplemental oxygen Amount of O2 available in
Disease, Anemia, Trauma, and altitude restriction*. flight is limited
Burn Patients, the Elderly, *Increased fuel required,
and Neonates. longer flying time,
routing changes
Barometric Pressure Postoperative, Trauma, Decompression tubes, *Increased fuel
Orthopedic, Any Trapped Heimlich valves, altitude requirement, longer
Gases and Ear/Nose/ restriction*, monitor flying times, routing
Throat (ENT) Patients balloons/cuffs or fill with changes
saline.
Variation in Cabin Newborn/Pediatrics, Dress warmly, blankets, Some aircraft (CC150,
Temperature Burn, Postoperative, medication, dosage and CC144, CC177) have
Trauma, Elderly, and placement on airframe. much better temperature
Cardiopulmonary. control than others
(CC130)
Humidity Postoperative, Pregnant, Humidify high flow,
Pediatric, Burns, Elderly, endotracheal tube
Pulmonary Disease, and (ETT) and tracheostomy
Comatose Patients. oxygen and eye/mouth
care.
Noise Psychiatric Patient, Hearing protection, Some aircraft (CC150 and
Newborn and Patients that medications and special CC144) have less noise
need Heart/Breath/Bowel briefings. than others (CC130 and
Sounds Monitored. CC177).
Poor Lighting Eye Problems, Patients Use flight approved Some aircraft (CC150,
with Canes/Crutches, flashlights. CC177 and CC144) have
Trauma Patients and better light than others
Patients that Need Close (CC130).
Monitoring.
Anxiety Psychiatric, Trauma, and Good communication Need to keep aircraft
Cardiac Patients and and briefings, safe, may restrain a
Any Patients with Fear of medications and patient in the air that
Flying. restraints if needed may not be restrained on
the ground.
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G-Forces Pregnancy, Cardiac, Supplemental oxygen, Discuss takeoff profile

Postoperative, Trauma, small frequent meals, with AC, many aircraft
and Brain Injury placement on airframe. can take off at a less
(Sensitive to Forward steep incline than they
Acceleration) normally do.
Vibration Psychiatric, Orthopedic, Medications, extra Some aircraft have
Postoperative and padding, and patient less vibration (CC150
Trauma Patients. position in aircraft. and CC144) than other
Aircraft.
Fatigue (Over All All Patients and Crew Hydrate, supplemental Integral to long distance
Result of Stresses of oxygen, small frequent AE.
Flight) nutritious meals, rest.
Figure 8-3-3 Table of Specific Stresses of Flight and Patient Types Most Affected
Adapted from table 10.3, page 138, “Aeromedical Evacuation: Management of Acute and Stabilized Patients”.
COMPENSATE FOR CHANGES IN BAROMETRIC PRESSURE
39. Patients should be awakened for ascent and descent so they can perform one or more of the
pressure-equalizing manoeuvres described below to avoid complications due to pressure changes in the
middle ear. Unconscious patients need to be observed closely during descent as they can not indicate a
problem verbally.
a. Ascent:
(1) move the lower jaw;
(2) chew gum;
(3) yawn; and
(4) swallow (with or without food for adults or children; breast/bottle feeding or use of a soother
for infants);
b. Descent:
(1) as for ascent;
(2) Valsalva Manoeuvre (VM) (blowing out of the nose with the nostrils closed);
(3) Toynbee Manoeuvre: (swallowing with the nostrils closed); and
(4) Bag-Valve Mask (BVM) procedure (placing the mask over the patient’s face and having them
swallow while the AECM squeezes the bag).
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WARNING
Performing the VM on ascent will worsen the effects of pressure changes on
the middle ear and increase ear pain.
WARNING
VM is contraindicated for the following patient conditions:
a. hypertension;
b. cardiac conditions;
c. recent eye surgery or injury, glaucoma, detached retina;
d. nasal surgery, mid-face fractures;
e. acute head injury;
f. increased intra-cranial pressure; and
g. aneurysm.
WARNING
Patients who are at risk of sinus problems will require pre-flight decongestants
and an order for additional PRN doses prior to descent.
WARNING
A patient with potential for or history of dental or sinus pain should have
an altitude restriction and the AC should be asked to slow the rate of any
descents. If equalization issues emerge during decent, ask the AC to re-
ascend and slow the descent rate further.
40. To avoid GI complications due to gas expansion at altitude, AECMs should implement the following
interventions:
a. Eating:
(1) encourage patients to eat slowly;
(2) avoid heavy meals; and
(3) avoid gas forming foods (carbonated beverages, beans, cauliflower, etc);
b. Relieve Gas Pressure:
(1) encourage belching or passing flatus;
(2) abdominal massage; and
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(3) safe level of physical activity for diagnosis (i.e. change position on litter, stand with assistance,
utilize toilet facilities/bedpan);
c. Decrease Diaphragmatic Crowding:
(1) elevate the head of bed (HOB) (if condition allows); and
(2) loosen clothing to permit full chest expansion.
41. For IVs, a rapid decompression can cause:
a. tubing to dislodge from IV containers and venous catheters;
b. air and excessive fluid to be forced into the patient; and
c. blood to back up into the IV tubing.
42. Initial interventions to manage IV devices after a rapid decompression (when it is safe to move about
the cabin) include:
a. clamping tubing;
b. assessing IV site for clotting and/or infiltration;
c. assessing IV container and administration set replacing them as needed;
d. clearing the tubing of air and/or blood as necessary; and
e. resuming the infusion.
43. To prevent complications with the air-filled cuffs or balloons of medical devices (i.e. ET tubes,
tracheotomy tubes) sterile water or saline can be substituted for air or the pressures monitored.
44. AECMs should anticipate increased drainage on ascent due to gas expansion (i.e. chest tube
drainage system). Ideally the patient can be instructed to open the ostomy bag on regular basis. For ostomy
products without a vent, AECMs may create a vent by puncturing the collection bag with a pin/needle
near the top of the device.
COMPENSATE FOR DECREASED PARTIAL PRESSURE OF O2 (PPO2)
45. The following interventions are used to reduce patient O2 demands while at altitude:
a. minimize and consolidate activity to reduce metabolic O2 demands;
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b. reduce anxiety levels; and
c. prevent shivering or fever.
COMPENSATE FOR DECREASED HUMIDITY AT ALTITUDE
46. The following interventions are used to counteract the effects of decreased humidity at altitude:
a. humidify high flow therapeutic O2, especially if the patient is being ventilated or has a tracheotomy
b. apply eye drops/lip balm every 2 hours as needed;
c. increase fluid intake by offering fluids frequently or increasing IV rate (if ordered); and
d. monitor intake and output as required.
COMPENSATE FOR DECREASED LIGHTING
47. To compensate for reduced lighting in or around the aircraft, AECMs should:
a. use an operationally approved flashlight;
b. assist patients when moving on the flight line and about the cabin; and
c. not rely solely on visual assessments.
COMPENSATE FOR INCREASED NOISE
48. The following interventions are used to mitigate for increased noise levels in and around some
aircraft:
a. provide ear plugs and instruct on their use;
b. perform patient assessments and briefings prior to engine start up;
c. utilize written communication and hand-gestures in flight (aircraft specific); and
d. utilize electronic or ultrasonic monitoring devices.
COMPENSATE FOR TEMPERATURE VARIATION
49. The following interventions are used to mitigate unstable cabin temperatures and drafts:
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a. plan for and provide additional blankets when needed;
b. provide cold or hot fluids PRN;
c. request FE or AC to increase or decrease cabin heating/cooling;
d. insulate bare skin from metal components; and
e. assess temperature of unconscious and critically ill patients frequently.
COMPENSATE FOR ACCELERATION / DECELERATION (G) FORCES, TURBULENCE, VIBRATION
50. The following interventions are used to mitigate acceleration/deceleration, (G) forces, turbulence
and vibration effects. Skin breakdown especially can be exacerbated by vibration.
a. be aware of pressure points (occiput, shoulder blades, elbows, coccyx, back of calves, and heels)
and assess tissue over pressure points frequently; and
b. protect the patient’s skin by:
(1) preventing direct skin contact with the litter, litter support system, or any part of the aircraft;
(2) padding litters with a litter mattress;
(3) padding bony prominences;
(4) providing skin care if litter patients are unable to get up; and
(5) encouraging frequent position changes and use of the GUS if physician orders and condition
allows.
51. AECMs should assess the functioning and security of equipment and patient care adjuncts frequently
to ensure that straps have not loosened or settings altered.
52. AECMs should anticipate the need for anti-emetics and the increased need for analgesics. Ensure
adequate coverage for both by requesting PRN orders, and by administering anti-emetics and analgesics as
required.
COMPENSATE FOR ANXIETY AND APPREHENSION
53. The following interventions are used to decrease anxiety and apprehension:
a. establishing a rapport with patients pre-flight;
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b. keeping patients well informed (e.g. itinerary changes);
c. providing constant reassurance particularly if turbulence or poor weather are experienced; and
d. all agitated patients will be assessed for hypoxia.
STRESSES OF FLIGHT AND CLINICAL CONSIDERATIONS
GENERAL
54. Patients may be more susceptible to physiological stresses of flight as a result of underlying medical
conditions and may require particular interventions to prevent complications or maintain homeostasis.
Cumulative stress can exacerbate any patient’s condition. Each patient is unique, thus AECMs will exercise
professional judgement in deciding which planning details, assessments, and interventions apply.
55. The following section addresses each system and the interventions/considerations required. The
interventions are not exhaustive and individual patients may require additional details. In non-emergent
situations, AECMs will begin with the least invasive intervention, escalating as required based on the
patient’s response.
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SECTION 4
CARE FOR NEUROLOGICAL PATIENTS
GENERAL
1. There are varied neurological conditions ranging from spinal cord injuries, herniated nucleus
pulposus (HNP), laminectomies, discectomies, head injuries, and convulsive disorders. At a minimum care
will include: ongoing monitoring of level of consciousness, Glascow Coma Scale, motor function and sensory
evaluation, behaviour evaluation to identify problems in the non-verbal patient, and seizure precautions.
2. It is important to recognize that battlefield casualties may have had some form of Traumatic Brain
Injury (TBI) that may not have been assessed.
DECREASED PPO2
3. Lower levels of O2 cause brain cell and tissue ischemia which produces cerebral edema and increased
intracranial pressure (ICP). This leads to hypoventilation and further hypoxia. Hypoxia aggravates seizure
disorders; ensure familiarization with seizure protocol.
4. Penetrating head injuries, skull fractures and severe facial fractures may introduce trapped air into the
cranium, causing increased ICP. Patients with decreased level of consciousness, inability to follow directions
or physical disability are at increased risk for ear block. Valsalva manoeuvre (VM) is contraindicated as it
increases ICP.
5. Intracranial air is one of the rare areas of gas expansion that can be potentially devastating. Whether
it is from a penetrating injury, surgery, or diagnostic study, the presence of intracranial air requires close
monitoring of the air transport patient. If the patient needs to be moved, cabin pressure equivalent to
the point of origin or some method of equalizing pressure within the cranial vault shall be considered. In
addition, the presence of a cerebrospinal fluid leak from the ears or nose has the theoretical potential for
drawing in air or bacteria during ascent/descent.
VIBRATION AND G FORCES
6. Theoretical implications regarding patient positioning during take-off and landing centre around the
impact these forces have on blood pooling and central hemodynamics. Head position toward the front or
rear of the aircraft may affect ICP and cerebral perfusion pressure although there is no scientific evidence
to support this as a clinically significant problem. Increased intracranial pooling of blood during take-off
may transiently increase intracranial pressure if the head is pointed to the rear. When the head is positioned
to the front of the aircraft, a decreased cerebral perfusion pressure may occur due to pooling in the lower
extremities with a decrease in venous return and mean arterial pressure. These are mostly theoretical
concerns; patient and environmental factors may dictate head first versus feet first transport.
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7. Increases in ICP may occur in patients who experience motion sickness, vomiting and/or
disorientation.
8. Patients with hypothalamus involvement are more susceptible to temperature variations. Hypo/
hyperthermia increases O2 requirements and shivering may increase ICP.
DECREASED HUMIDITY
9. Patients with decreased corneal reflex will require eye care/lubrication.
NOISE
10. Constant noxious noise contributes to an increased ICP.
AE CONSIDERATIONS FOR NEUROLOGICAL PATIENTS
11. AECMs should be conscious of the following neurological patient considerations:
a. patient condition: conduct a thorough pre-flight evaluation;
b. supplemental O2 and O2 saturation level monitoring;
c. altitude restriction;
d. appropriate medications;
e. patient positioning: critically ill patients are positioned at the most stable part of the aircraft to
reduce vibration;
f. positioning of bed: head of bed elevated if not contraindicated;
g. O2 saturation levels: if the patient becomes combative assess the O2 saturation levels, O2 requirements
and the need for sedation;
h. patient thermal requirements: keep patient normothermic or hypothermic (as ordered) – provide
extra blankets and/or control cabin temperature;
j. patient hydration: encourage fluids, increase IV as ordered and monitor intake and output;
k. vibration, propeller movement, flashing lights may stimulate seizure activity;
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m. immobile patients are susceptible to pressure point injuries;
n. proper spinal immobilization; and
p. Valsalva Manoeuvre is contraindicated.
NEUROLOGICAL CHECKS
12. Neuro vital signs are warranted for some patients. Neuro vitals include pupil size, level of
consciousness, motor grip and sensory responses. While many of these patients may be under the care
of a critical care team, AECMs shall be familiar with the Glascow Coma Scale and be able to perform this
assessment when required.
GLASGOW COMA
Eye Opening Score
Spontaneous eye opening 4
Eye opening on command 3
Eye opening to painful stimulus 2
No eye opening 1
Best Verbal Response

Answers appropriately (oriented) 5
Gives confused answers 4
Inappropriate response 3
Makes unintelligible noises 2
Makes no verbal response 2
Best Motor Response

Follows command 6
Localizes painful stimuli 5
Withdrawal to pain 4
Responds with abnormal flexion to 3
painful stimuli (decorticate)
Responds with abnormal extension 2
to painful stimuli (decerebrate)
Gives no motor response 1
Figure 8-4-1 Glascow Coma Scale Chart
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SECTION 5
CARE FOR CARDIOVASCULAR PATIENTS
GENERAL
1. The various cardiovascular conditions range from myocardial infarction, valve problems,
cardiomyopathy, coronary artery disease, to trauma. At a minimum, care will include ongoing cardiac
monitoring and implementing measures that decrease the workload on the heart.
DECREASED PPO2
2. Decreased partial pressure of oxygen predisposes patients to hypoxia, increasing myocardial

workload which may cause arrhythmias, chest pain and myocardial infarction.
3. Gas expansion in the GI tract may cause diaphragmatic crowding which can decrease tidal volume
and venous return (lowering the pre-load on the heart).
4. In the patient with poor myocardial function, myocardial perfusion may be improved during
acceleration by positioning the patient with their head facing aft of the aircraft. More likely, however, the
patient with congestive heart failure or volume overload will benefit from a head-forward position to avoid
more central blood pooling (increased preload) during take-off. As with head injury, these are mostly
theoretical concerns and the transient nature of the acceleration pattern may be far outweighed by other
patient and environmental factors.
5. Excessive heat may cause patients to become hypertensive, increasing O2 requirements. Hypothermia
(shivering) increases O2 demands and increase workload on the heart.
DECREASED HUMIDITY
6. May lead to dehydration, which increases heart rate and O2 demand and can contribute to
hypotension.
AE CONSIDERATIONS FOR CARDIOVASCULAR PATIENTS
7. The following considerations are particular to cardiovascular patients:
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B-MD-005-000/FP-001
a. possible altitude restriction (<6000ft);
b. ACLS trained personnel on aircraft;
c. MSTMs accompanying the patient such as Medical Officer or F Surg;
d. appropriate medications;
e. patient placed in stable area of aircraft at a convenient working level near an oxygen source and the
emergency equipment;
f. encourage fluid intake or increase IV rate appropriate for patient's clinical condition;
g. ECG and lab work (acid-base balance, arterial blood gases, electrolytes, etc.) within 24 hours;
h. activity level (ability to ambulate and stairs);
j. minimize and consolidate activity to avoid increased myocardial workload;
k. straining and the VM are contraindicated as it may cause dangerous arrhythmias;
m. litter patients should have a backrest and/or semi-fowler position;
n. discourage smoking (consider nicotine patches); and
p. monitor intake and output.
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SECTION 6
CARE FOR RESPIRATORY PATIENTS
GENERAL
1. Many respiratory patients are already fatigued by their own respiratory efforts on the ground. The
additional stresses in flight may cause rapid decompensation.
DECREASED PPO2
2. Decreased partial pressure of oxygen exacerbates possible oxygenation deficiencies due to

compromised respiratory system and diminished cilliary action.
3. Intrathoracic air presents a special consideration because it is contained within a fixed space.
Patients with an asymptomatic pneumothorax can develop significant decompensation with gas expansion
inside the thorax. An untreated pneumothorax should be moved at the same altitude as the OMF. Under
these circumstances, the AEC should have the capability to provide definitive treatment should the patient’s
condition change. The safest approach is to insert a chest tube with an appropriate collection system and
ensure the chest tube is effective before flight.
4. In a patient requiring air transport, the chest tube should be left in place before flight even if it could
otherwise be removed. A minimum of 24 hours should elapse between chest tube removal and flight. If
not, the patient will have to be moved at OMF altitude and the AEC would require the capability to provide
definitive treatment should the patient’s condition change. An expiratory chest x-ray showing no evidence
of pneumothorax is also required. In addition, an occlusive dressing should be applied to the puncture site.
5. All patients with chest tubes should be connected to a rigid, non-glass collection system with a
Heimlich or other one-way valves designed to be utilized with chest tubes.
NOTE
Some of the newer chest drainage systems have an internal one-way valve
and in those systems a Heimlich valve will not be used. Check with the
manufacturer’s guidelines before using chest drainage systems.
6. The decrease in barometric pressure may cause spontaneous pneumothorax in any susceptible
patient.
7. GI tract gas expansion may cause diaphragmatic crowding leading to lower tidal volumes.
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8. Vibration may increase need for suctioning. Take -off and landing may cause diaphragmatic crowding.
DECREASED HUMIDITY
9. The effectiveness of cilliary action is decreased and secretions are thickened in the drier cabin
environment. Patients requiring high-flow oxygen should receive humidified oxygen.
AE CONSIDERATIONS FOR GENERAL RESPIRATORY PATIENTS
10. AECMs will consider the following things:
a. smokers should have the patch ordered for long flights if they are litter bound/plane bound (i.e.
cannot smoke between layovers).
b. altitude restriction;
c. maintain O2 saturation at ordered level or a minimum of 92%, titrating O2 delivery. Patients with
chronic obstructive pulmonary disease (COPD) should be administered low-flow oxygen therapy
(1 to 2L/min) via nasal cannula or 24% to 31% Venturi mask to regulate the delivered oxygen
concentration;
d. supplemental high flow, ETT and tracheostomy O2 is given humidified;
e. maintain normal body temperature;
f. keep patient well hydrated;
g. provide back rest or elevate patient’s head (to decrease diaphragmatic crowding);
h. monitor ET tube cuff pressure and placement; and
j. NG tube if needed.
SPECIFIC MEASURES FOR VENTILATED PATIENTS
11. Ventilator specific concerns:
a. ventilator settings should be adjusted by a qualified individual in order to ensure effective respiratory
function;
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b. a minimum of one anaesthesiologist/intensivist on the mission and two critical care nursing
officers for each ventilated patient;
c. AECMs pre-flight ventilator function;
d. mouth care and skin care, as required;
e. sedation during flight as required;
f. a heat moisture exchange filter;
g. may be restrained (chemically or soft restraint) to prevent self-extubation (restraints will not be
attached to the aircraft);
h. assess for causes of agitation (hypoxia, pain, abdominal discomfort, etc.);
j. AECMs ensure ventilator properly interfaces with the aircraft;
k. each ventilated patient has a dedicated suction and manual resuscitator assigned; and
m. other monitoring devices such as a cardiac, vital signs and pulse oximetry.
MEASURES FOR PATIENTS WITH CHEST TUBES
12. Special considerations for chest tube care:
a. water seal chamber must be checked after each descent as water from the water chamber may be
drawn into the collection chamber diluting the patient’s accumulated fluids;
b. Heimlich valve may be required on older systems. It is prudent to have a replacement Heimlich
valve when caring for a patient with a chest tube; the Heimlich valve that is not working can be
cleared by ensuring both ends are filled with sterile saline or sterile water and soaked horizontally.
After a short period of soaking, suction is hooked to the outlet (down stream) and should clear the
obstruction, rendering the Heimlich functional again;
c. in case of disconnect, do not clamp chest tube, reconnect as quick as possible to a new drainage
system;
d. use chest drainage system approved for flight;
e. occlusive dressing over insertion site;
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f. recent chest x-ray (within 24 hrs);
g. drainage marked and charted pre-flight, during flight and post-flight;
h. check suction control frequently as evaporation in flight may occur which changes the amount of
suction delivered. Suction control is adjusted to maintain minimal bubbling;
j. ensure all connections are taped, tubing is not kinked or hanging below the draining unit, the chest
drainage system remains below the level of the chest; and marking level of collection in chamber;
k. if continuous suction is required ensure that it can be provided in flight;
m. document air leaks or bubbling at the water seal;
n. chest x-ray 24 hours post chest tube removal before flight; and
p. occlusive dressing applied to wound site after removal.
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SECTION 7
CARE FOR HEMATOLOGIC PATIENTS
GENERAL
1. It is important to note that acute blood loss or drop in hemoglobin has a different clinical significance
than a chronic condition, but both decrease the amount of oxygen delivered to the tissues.
DECREASED PPO2
2. Decreased partial pressure of oxygen may compromise underlying hypoxias. There are four types of
hypoxia that affect patients and may occur simultaneously depending on the pre-existing condition of the
patient.
Types of hypoxia Physiologic response Causes

Hypoxic Reduction in the amount of O2 transferred Atelectasis
Decreased partial pressure of O2 in lungs or Pulmonary edema
reduced O2 diffusion across alveolar capillary COPD
membrane
Hypemic or anemic Reduced O2 carrying capacity of blood due to low Anemia
blood volume or hemoglobin content Smoking
Hemorrhage
Carbon monoxide
Stagnant Reduced blood flow through body tissues due to Shock
malfunction of the circulatory system Circulatory failure
Postural changes
Histotoxic Hindered O2 utilization by body tissues Cyanide poisoning
Carbon monoxide
Drugs
Figure 8-7-1 Table of Types of Hypoxia

3. Vibration and G forces may increase bleeding/bruising and risk of dislodging a clot (Deep Vein
Thrombosis or DVT).
4. Anemic patients are sensitive to cold; shivering increases oxygen demand.
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DECREASED HUMIDITY
5. Dehydration causes an increased chance of developing DVT.
AE CONSIDERATIONS FOR HEMATOLOGIC PATIENTS
6. Special considerations for hematologic patients are as follows:
a. altitude restrictions are required for low hemoglobin < 8 g/dL (80g/L), RBC count < 2.5 millions/mm
within 72 hours flight;
b. O2 saturation monitoring;
c. oxygen therapy;
d. blood transfusions are not routinely undertaken in flight but if done, blood storage must comply
with the Canadian Blood Services;
e. sickle cell crisis may be life threatening; patient will require O2, altitude restriction (4,000 ft), pain
medication and hydration;
f. prevent bumping/bruising; and
g. keep patient warm.
8-7-2
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SECTION 8
CARE FOR EARS, NOSE AND THROAT (ENT) PATIENTS
EARS
1. The most commonly experienced problem, barotitis media (know as ear block) occurs with the
middle ear. On ascent, expanding trapped air usually escapes easily and the only thing noticed is a periodic
“popping” due to movements of the tympanic membrane as pressure equalizes. On descent, equalization
of pressure through the slit-like outlet is much more difficult and a negative pressure can build up in the
middle ear. As negative pressures increase it causes inflammation and petechial hemorrhage. Blood and
fluid are drawn into the middle ear cavity, which if unresolved can lead to perforation. Barotitis media leads
to a decrease in hearing, tinnitus, pain and possible vertigo and nausea.
2. During an upper respiratory infection (URI), congestion of the outlet makes clearing more difficult or
even impossible. The pressure in the middle ear on descent may then become so low relative to the outside
pressure that exudation and hemorrhage may take place and ultimately the eardrum may burst.
3. The implications of gas expansion and barotitis media are less clear for the comatose, psychotic,
or disoriented patient. Do not forget to evaluate those patients who have been nasotracheally intubated
or who have nasogastric tubes in place because they are prone to develop edema and Eustachian tube
dysfunction. Patients should be observed for evidence of increased irritability or agitation during descent,
which may accompany the discomfort associated with increased middle-ear pressures. Direct examination
of the tympanic membrane for significant retractions may rule out this problem.
INCREASED NOISE
4. Increased noise can lead to tinnitus (ringing in the ears), mild to severe pain, fatigue, temporary to
permanent hearing loss without proper hearing protection.
PATIENT MEASURES TO COUNTER THE EFFECTS OF DECREASED BAROMETRIC PRESSURE ON THE EAR
5. Patients can take the following measures to counter the effects of decreased barometric pressure on
their ears:
a. on ascent – swallow/yawn (do not Valsalva);
b. on descent – VM (blowing nose with nostrils closed) normally advised but relatively contraindicated
in the following conditions:
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(1) hypertension – marginal contraindications unless forced high pressure and holding breath for
a LONG time;
(2) cardiac conditions;
(3) recent eye surgery/injury;
(4) glaucoma, detached retina;
(5) nasal surgery, mid-face fractures;
(6) acute head injury/elevated ICP; and
(7) cerebral aneurysm.
c. for these patients the Toynbee manoeuvre may be tried – swallow with nostrils squeezed shut; or
BVM – swallow while mask is being squeezed.
d. patients who are sleeping should be awakened on descent to clear ears;
e. consider prophylactic mild nasal vasoconstrictors (nasal decongestant spray) for patients with
upper respiratory tract infections;
f. pre-flight order for decongestants; and
g. if necessary, request AC to re-ascend to higher altitudes to clear ear block, followed by gradual
descent (this may not be possible due to weather, flight plan, fuel, etc).
SPECIFIC MEASURES FOR EAR PATIENTS
6. Specific measures for ear patients are as follows:
a. pre-flight patient brief on various techniques to clear the ears;
b. assess for symptoms of upper respiratory tract infection;
c. pre-flight oral or topical decongestants if indicated;
d. consider delaying transport of a patient or an altitude restriction for patients who cannot equalize
ear pressure;
e. request slow descent from AC;
f. hearing protection;
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g. assist patients with clearing of the ears;
h. request the AC re-ascend if the patient cannot clear the ears;
j. unconscious patients cannot clear their ears, evaluate on descent or have AC descend slowly, a pre-
flight myringotomy (small incision in the tympanic membrane) can be performed by an Ears, Nose
and Throat (ENT) specialist to allow for equalization of air in ears;
k. document care provided in flight; and
m. reassess the patient after landing and refer to F Surg if required.
NOSE
7. Barometric pressure changes may create a sinus block (barosinusitis) when any obstruction in
the nasal passage is present. When considering the AE patient, barosinusitis may occur in patients with
abnormal nasal pathology or inflammation such as facial trauma or nasal instrumentation (intubation,
nasogastric tubes).
8. These patients are usually affected on descent, but can also be affected on ascent and aircrew
should avoid further climb if pain is noticed on ascent. The frontal sinuses are most frequently affected
(70%) followed by the maxillary sinuses. The best approach to this condition is knowledge and prevention.
Symptoms can range from a mild sense of fullness to severe excruciating/incapacitating pain. Treatment is
the same as for an ear block – a gentle Valsalva or blowing nose.
DECREASED HUMIDITY
9. Decreased humidity can cause drying of the mucous membranes, thicken secretions, and increase
the risk of nose bleeds.
10. Vibration effects in facial fracture patients can cause pain and increased bleeding.
SPECIFIC MEASURES FOR PATIENTS WITH NASAL INJURIES / ILLNESSES
11. Specific measures for patients with nasal injuries/illnesses are as follows:
a. if an air-filled balloon is in place to apply nasal pressure, fill it with normal saline prior to flight.
Pressure is not released without a physician present;
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b. an altitude restriction;
c. decongestants as required pre-flight;
d. provide fluids every hour in flight; and
e. Valsalva is not performed for post-op nasal surgery, mid-face fractures or acute head injury patients.
An altitude restriction and pre-flight decongestants are recommended.
THROAT
GENERAL
12. Pharangeal injuries less than 72 hours from injury may require a tracheostomy prior to flight. This is
dependent upon the severity of the injury and the patient's clinical condition.
DECREASED HUMIDITY
13. Decreased humidity causes drying of the mucous membranes that causes pain or discomfort.
SPECIFIC MEASURES FOR THE CARE OF A PATIENT WITH THROAT ISSUES
14. Specific measures for the care of a patient with throat issues are as follows:
a. maintain hydration;
b. pain medications;
c. anti-emetics;
d. saline or other gargles; and
e. airway management tools.
MAXILLOFACIAL AND SINUSES
15. Barometric pressure changes may cause gas to become trapped in the sinuses and teeth causing
pain.
16. Barodontalgia occurs when trapped air in abscesses, dental fillings, or cavities expands, resulting
in severe pain during ascent. This is an uncommon problem and can be confused with barosinusitis
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involving the maxillary sinuses. In the case of barodontalgia, only one tooth is usually involved whereas
several of the upper teeth on the affected side are symptomatic with maxillary barosinusitis. Therapy is
limited to descent and pain control with appropriate follow-up.
DECREASED HUMIDITY
17. Decreased humidity causes drying of the mucous membranes that causes pain or discomfort.
18. Vibration may increase pain and exacerbate the underlying condition as well as increase the potential
for nausea and vomiting.
SPECIFIC MEASURES FOR THE CARE OF A PATIENT WITH MAXILLOFACIAL OR SINUS ISSUES
19. Specific measures for the care of a patient with maxillofacial or sinus issues are as follows:
a. tooth pain may occur on ascent for patients who have had recent dental work or diseased teeth
where trapped gases are present. These patients should not fly without an altitude restriction and
until the diseased tooth has been evaluated and treated;
b. if the jaw has been immobilized or wired shut:
(1) ensure wire cutters or scissors are available (attached to patient);
(2) suction is readily available;
(3) ensure patient and AECMs know how to operate quick release mechanisms or how to cut
wires;
(4) pre-flight anti-emetics given to prevent vomiting;
(5) liquid diet may be required; and
(6) elevate the head or have patient sitting in seat.
c. patients with sinus difficulties due to upper respiratory conditions such as colds, allergies, or
chronic or acute sinusitis are at risk for sinus block on descent. In flight care includes:
(1) brief patient to notify AECMs if symptoms such as pain, burning sensation, tenderness over the
affected sinus, bloody or mucopurulent discharge, teary eyes, sucking or crackling noise in the
sinus area occur;
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(2) pre-flight medications such as decongestants or analgesia;
(3) ensure the head is elevated if clinical condition permits;
(4) provide fluids and humidify oxygen;
(5) treatment involves re-ascent, administer decongestant, and nose blowing; observe for bleeding
or drainage, descend slowly while observing for bleeding or drainage and relief of pain or
pressure. On landing, the patient should be evaluated by a F Surg, or civilian ENT specialist;
(6) if the mission is in progress and patient continues, coordinate slow descents with the AC and
provide decongestants. Discuss with F Surg the need for an altitude restriction; and
(7) a gentle VM or gentle nose blowing may be done to open the sinus os. If not effective, increase
the level of forced expiration to effect.
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SECTION 9
CARE FOR GASTROINTESTINAL PATIENTS
GENERAL
1. The injured, diseased or post-op abdomen is vulnerable to complications during AE. Gases that
expand with altitude are continually present within the GI system. This can pose difficulty for transport
whether the patient has a direct intestinal disease or a general acute illness. Adequate drainage of both air
and intestinal contents must be assessed before, during and after flight.
DECREASED PPO2
2. Decreased gastric motility is related to decreased PPO2.
3. Gas expansion may cause abdominal bloating and discomfort, decreased lung expansion and
volume, nausea and vomiting, and may require nasogastric decompression.
4. A common irritating, embarrassing, and potentially serious problem is bowel flatus. This expands
rapidly and, if it cannot be passed, may lead to severe pain, a decrease in blood pressure, and/or loss of
consciousness. Chewing gum, air swallowing, and drinking carbonated drinks all increase flatus, as do
various foods.
5. Barogastralgia (gas expansion in the gastrointestinal tract) is rarely serious with cabin altitudes less
than 10,000ft (3,045m) where gas expansion is typically 1.5 times the volume at sea level. In patients with
gastrointestinal problems such as bowel obstructions, ileus, or motility problems, the amount of expansion
may be excessive and produce symptoms of discomfort, abdominal pain, belching, flatulence, nausea,
vomiting, shortness of breath, and, in extreme cases, vagal symptoms. Pre-flight placement of a nasogastric
tube, if not already done, should be accomplished in these patients and be left unclamped during flight. The
pregnant patient, in particular during the third trimester, may also be at higher risk of having discomfort
related to gastrointestinal gas expansion.
DECREASED HUMIDITY
6. Patients who are NPO require monitoring and IV therapy for fluid replacement.
AE CONSIDERATIONS FOR PATIENTS WITH GASTROINTESTINAL ISSUES
7. AE considerations for patients with gastrointestinal issues are as follows:
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a. frequent use of toilet facilities for some conditions;
b. special diet;
c. aspirate NG tube pre-flight to verify patency/location;
d. be aware of tube feed protocols (residuals);
e. do not clamp NG tube;
f. intra-abdominal pressures may be monitored by critical care team;
g. additional colostomy supplies (more frequent bowel movements from gas expansion);
h. diaphragmatic pressure due to gas expansion – elevate head;
j. vented NG tubes will only be used; and
k. NG tube displacement may occur due to vibration.
MOTION SICKNESS
8. Many factors predispose patients to motion sickness. Motion sickness can debilitate a healthy
individual and therefore can compound medical complications in a patient. Symptoms may include apathy,
headache, pallor, diaphoresis, nausea and vomiting.
AE CONSIDERATIONS FOR PATIENTS WITH MOTION SICKNESS
9. AE considerations for patients with motion sickness are as follows:
a. history of motion sickness;
b. prophylactic anti-emetics;
c. advise patient to restrict head movement;
d. fixate on horizon or other stationery object;
e. cool cloths to neck and forehead;
f. decrease cabin temperature; and
g. place on litter if available.
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SECTION 10
CARE FOR GENITO-URINARY PATIENTS
1. Vibration may dislodge kidney stones resulting in pain and hematuria.
AE CONSIDERATIONS FOR GENITO-URINARY ISSUES
2. AE considerations for patients with genito-urinary issues are as follows:
a. empty and measure urinary catheter drainage bags prior to flight;
b. anti-emetics;
c. encourage fluids hourly if not contraindicated;
d. hydration status for patients on fluid restriction requires careful monitoring to prevent dehydration
in flight;
e. input and output measurement;
f. O2 available if gross hematuria occurs from stone dislodgement;
g. patients with urinary catheter should be positioned mid-tier to allow for adequate drainage flow;
and
h. renal patients should be positioned in a stable part of the aircraft, near toilet facilities.
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SECTION 11
CARE FOR ORTHOPEDIC PATIENTS
GENERAL
1. Orthopedic trauma comprises a significant percentage of injuries at any time; extremities are less
well protected during many activities. Injuries include not only fractures and dislocations but soft tissue
injuries including tendon and nerve damage, loss of tissue and vascular injury. Orthopedic emergencies
include compartment syndrome, fat emboli and concealed hemorrhage. Orthopedic complications are most
prevalent 72 hours after injury/surgery.
2. Sitting in cramped conditions for long periods of time may cause a DVT. This in turn increases
risk of pulmonary emboli (PE). Symptoms include pain in calf or behind the knee that may increase with
standing or ambulating, feeling of pins and needles (parasthesias), swelling, warmth at the site, or skin
discoloration. Encourage fluids, ambulation, as well as stretching and flexing of calf muscles to reduce the
risk of developing a DVT. Consider requesting prophylactic anti-coagulation prior to flight.
3. Any long bone or pelvic fracture has the potential for developing fat emboli. These occur generally
12-72 hours after injury. Symptoms are similar to other emboli with the cardinal sign of a petechial rash on
the chest.
DECREASED PPO2
4. Decreased partial pressure of oxygen exacerbates the effects of hemorrhage, shock, anemia and low
hematocrit.
5. Vibration and G Forces may affect alignment and or positioning of set fractures and increase pain.
There is an increased risk of dislodgement of various emboli because of vibration. External fixators can lead
to increased pain from vibration if not padded well.
6. While awaiting emplaning patients may sweat under casts and then when the patients go to altitude
the limb may become cold.
DECREASED HUMIDITY
7. May alter hydration status of the patient and can increase skin dryness and breakdown over a period
of time which results in increased itching under casts. Dehydration leads to an increased risk of developing
DVTs.
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ANXIETY
8. Although musculoskeletal injuries are rarely fatal, they often result in long-term disability leading to
anxiety about the future and body image concerns which decrease their coping mechanisms.
AE CONSIDERATIONS FOR ORTHOPEDIC PATIENTS
9. AE considerations for orthopedic patients are as follows:
a. casts should not rest on aircraft frame or bulkhead as it increases the effects of vibration;
b. litter patient placed with affected extremity to aisle for assessment or to airframe side to protect
from being struck (MCD discretion);
c. large casts and fixators may require extra litter space;
d. do not anchor extremities to any portion of aircraft;
e. pad and elevate extremities with pillows or blankets for comfort and alignment;
f. no hanging free weights in flight;
g. ensure stability of external fixation devices;
h. traction devices are not to be attached to any portion of aircraft;
j. air splints shall not be used in flight;
k. any cast that is less than 48 hours old must be bivalved;
m. immobilization of limbs/patient exacerbates venous stasis and swelling may result. Range of motion
(ROM) exercise, position changes, and frequent assessment of the limbs are required;
n. pad/insulate the litter with blanket rolls to support the limbs, maintain optimal alignment, and avoid
contact with aircraft structures;
p. patients with full body casts require close monitoring to relieve abdominal gas expansion. Consider
an NG tube in flight;
q. observe for symptoms of fat emboli release;
r. monitor capillary refill and skin temperature;
s. crutches, canes and walkers will be used for emplaning, deplaning, and in flight at the MCD’s
discretion. However, these devices will not be used if there is turbulence; and
t. do not place orthopedic patients by emergency exits
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SECTION 12
CARE FOR OPHTHALMIC PATIENTS
GENERAL
1. The naked eye has little protection from projectiles and concussive forces. Although proper eye
protection may reduce the risk of ocular injury, compliance with these protective devices is unpredictable.
Eye problems may not be apparent in unconscious or heavily sedated patients.
DECREASED PPO2
2. Decreased partial pressure of oxygen increases intraocular pressure and vasodilatation due to
hypoxia which may aggravate retinal hemorrhage, detached retina and glaucoma. Patient’s oxygen
saturation should be frequently assessed.
3. Any increased pressure may cause pain and reduce blood flow to the eye. Penetrating eye injuries
and post-op surgery patients may have trapped air in the globe, which expands at altitude, leading to pain
and/or extrusion of eye contents. With closed penetrating injuries, air is normally reabsorbed in three days.
Post-op eye surgery, gases may persist for three to nine weeks.
4. Motion sickness and vomiting will increase intraocular pressure and pain. Appropriate antiemetic
should be offered.
DECREASED HUMIDITY
5. Excessive drying results in corneal irritation and abrasions especially in comatose patients or
patients who are unable to close eyes completely.
ANXIETY
6. Two factors increase anxiety levels in ophthalmic patients, eye patches and disability concerns.
Patients with eye injuries often wear a patch, shield or dressing to both eyes to minimize eye movement
which can cause significant disorientation and anxiety. Most will also be extremely anxious about potential
permanent disability due to permanent changes/loss of vision.
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AE CONSIDERATIONS FOR OPHTHALMIC PATIENTS
7. AE considerations for ophthalmic patients are as follows:
a. anti-emetics;
b. altitude restriction (2000 ft);
c. eye lubrication;
d. low flow O2 to maintain O2 saturation levels;
e. place patient on high flow O2 immediately if increased pain, pressure, decreasing visual acuity, etc.,
reduce cabin altitude and divert if pain does not subside within a few minutes;
f. if a bacterial or viral infection is suspected the concerned eye will not be patched;
g. patients with retinal detachment and penetrating eye injuries may require bed rest and bilateral eye
patches for transport. The patient also may be required to keep their head still to prevent further
injury;
h. Valsalva is not performed by any patient with an eye injury, post-op eye surgery, or eye disorders
such as glaucoma; and
j. position ophthalmic patients away from exits and place by an able-bodied person, good eye towards
the aisle.
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SECTION 13
CARE FOR INFECTIOUS PATIENTS
GENERAL
1. Any AE patient may have an infectious condition whether it is diagnosed or not at the time of
transport. All patients shall be treated with Routine Practices/Standard Precautions regardless of diagnosis.
Highly infectious patients will not normally be evacuated.
2. Depending on the infectious agent/infected area, care and impact of the stresses of flight will vary.
Refer to Chapter 9 – Infection Control Guidelines for measures.
8-13-1/8-13-2
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SECTION 14
CARE FOR CHEMICAL, BIOLOGICAL, RADIOLOGICAL AND NUCLEAR CASUALTIES
GENERAL
1. The first priority for CBRN casualties is decontamination. Cross contamination of the aircrew or
aircraft is another concern. Once decontamination is complete, further precautions will depend on the agent
and patient’s condition. Appropriate measures will be taken to reduce the impact of the substance. The
aircraft, equipment, and personnel will require decontamination post-mission. No decontamination exists
for biological agents.
8-14-1/8-14-2
B-MD-005-000/FP-001
SECTION 15
CARE FOR MENTAL HEALTH PATIENTS
GENERAL
1. It is preferable to have Mental Health practitioner trained in Team Management of Disruptive

Behaviour (TMDB) present for any level 1 classification AE patient. These specialists are trained to assess
mood and behaviour, offer verbal intervention, provide suicide intervention and apply restraints. When
planning a mission with MH patients, the MCD will ensure a psychiatric emergency take down approach is
briefed and roles assigned to all AECMs and MSTM present.
DECREASED PPO2
2. Alcohol and drug abuse patients may have pre-existing histotoxic hypoxia. Hypoxia exacerbates
restlessness and agitation.
3. The effects of vibration and turbulence may act as stimulus and precipitate symptoms and fears.
DECREASED HUMIDITY
4. Heavily sedated patients cannot self-hydrate; medications may become concentrated and pose risk
for increased action/toxicity.
INCREASED NOISE
5. Contributes to cumulative stress, may act as stimulus and precipitate symptoms and fears.
ANXIETY
6. Disorientation and fears are increased by the unknown and uncertainwilvironment especially if
restraints are used.
AE CONSIDERATIONS FOR MENTAL HEALTH PATIENTS
7. AE considerations for mental health patients are as follows:
a. prior to each take off search and confiscate all sharp objects and items such as lighters, etc. that
may be used to harm self or others;
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b. briefings and rapport to decrease anxiety;
c. pre-flight anxiolytic agents should be ordered and administered as required;
d. if patient is restrained, check proper application of restraints pre-flight, then security and circulation
checks are completed at a minimum every 30 minutes and documented on patient documentation;
e. encourage fluids;
f. treat agitated patients as hypoxic until proven otherwise;
g. maintain medication regime;
h. consider bringing medications that can be used to counteract psychoactive drugs (for possible
adverse reactions);
j. substance withdrawal patients are at risk for delirium tremens if untreated and should not be
transported in the initial 72 hours;
k. litter patients should be placed low in tier and away from flight deck;
m. 1C patients will not be situated next to exits, O2 shut off valves or cargo;
n. 1C patients will be positioned on the lowest litter tier and away from the flight deck;
p. items permitted for the patient to keep include:
(1) less then $25.00;
(2) rings, watches;
(3) wallet with identification;
(4) glasses; and
(5) harmless toiletries.
q. medicated patients are ambulated with assistance and AECM and/or MH MSTM accompany patients
at all times; and
r. remove sharp items from meal trays.
8-15-2
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SECTION 16
CARE FOR OBSTETRICAL PATIENTS
GENERAL
1. Obstetrical patients are not normally carried within the CF system; however these patients may
require evacuation in response to emergency situations. Any such mission would normally be augmented
by appropriate obstetrical MSTMs. Complications that arise during pregnancy have many causes; some
are related to the pregnancy itself, others to pre-existing medical conditions, and some are attributed to
the fetus. Most obstetrical in flight emergencies can be treated only with supportive measures during flight
(positioning, monitoring, IV fluids, O2). Definitive treatment will require diversion to an airfield near a medical
facility with obstetric capabilities.
DECREASED PPO2
2. Pregnancy causes an increase in cardiac workload with a decrease in diaphragmatic excursion.

Decreased partial pressure of oxygen causes lower placental O2 resulting in fetal hypoxia. Pregnancy
induced anemias may also lead to hypemic hypoxia.
3. Gas expansion may cause pain in an already crowded abdomen. Displacement of the diaphragm
decreases lung expansion. Compression of the vena cava may cause a decrease in circulating blood volume
that leads to stagnant hypoxia.
4. Vibrations and G forces may cause uterine irritability and excessive fetal movement. Vibration may
also lead to urinary frequency and discomfort.
DECREASED HUMIDITY
5. Dehydration is a major precipitating factor in pre-term labour.
AE CONSIDERATIONS FOR OBSTETRICAL PATIENTS
6. AE considerations for obstetrical patients are as follows:
a. perform a thorough assessment of mother and fetus/newborn;
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b. ensure monitoring includes O2 saturation;
c. elevate head of bed with backrest;
d. position patient either left or right side-lying (to increase venous and placental blood flow);
e. position patient near lavatory;
f. fasten seat belts below abdomen;
g. be aware of altitude restriction;
h. encourage fluids, IV rate is increased if patient if NPO; monitor urine output; and
j. encourage ambulation to decrease the risk of DVT.
8-16-2
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SECTION 17
CARE FOR PEDIATRIC PATIENTS
GENERAL
1. Although not normally carried with the CF system, an infant or child could be transported on an
emergent basis with a physician and/or appropriate pediatric MSTMs. Consent for care is obtained by the
AECO or the requesting physician. Infants have critical anatomic and physiological differences from adults
and are more susceptible to the stresses of flight.
DECREASED PPO2
2. Infants and children are more reactive to hypoxia and will become hypoxic earlier than an adult.
3. Infants and children are subject to difficulty clearing ears on descent (encourage infants and young
children to drink fluids or suck on a pacifier on descent, and crying clears the ears naturally). Abdominal gas
expansion may restrict diaphragmatic movement, especially if the infant or child is supine.
4. Temperature variations can have a significant impact on infants and young children due to the large
body surface and an immature thermo-regulatory system.
DECREASED HUMIDITY
5. Infants and children are more susceptible to dehydration.
INCREASED NOISE
6. Infants and children are susceptible to high noise levels causing increased agitation, irritability and
fatigue.
ANXIETY
7. Increased anxiety may occur due to unfamiliar surrounding and fear of strangers. Usually the fear of
flying is low for children.
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AE CONSIDERATIONS FOR PEDIATRIC PATIENTS
8. AE considerations for pediatric patients are as follows:
a. brief guardians on in flight expectations;
b. encourage infants and young children to drink fluids or suck on a pacifier on descent, and crying
clears the ears naturally. Older children should blow their nose, drink fluids or eat, do the VM or the
Toynebee manoeuvre to clear their ears;
c. elevate head of bed to decrease diaphragmatic crowding;
d. consider NG tubes to decompress gastric distension;
e. increase cabin temperature for infants and young children;
f. provide extra blankets to maintain warmth;
g. axilla temperatures may be taken. Unstable cabin temperatures may affect skin probe temperature
readings;
h. carefully monitor intake and output in infants and children;
j. encourage fluids;
k. IV and/or tube feedings must meet fluid needs and are maintained on an infusion pump;
m. cut ear plugs in half or use cotton to fit smaller ear canals;
n. wake patient for ascent and descent;
p. provide rest periods during flight where child is not stimulated by the activity around them;
q. explain your actions to the child in a manner appropriate to his/her age;
r. use approved car seats for older infant or young children and secure IAW B-GA-007-001/AF-001,
Manual of Air Movements Vol. 1 Organization and Operating Procedures, Chapter 2, para 71.
The use of a children's car seat by passengers travelling within the Air Transport Systems is
permitted, provided all the following restrictions are adhered to:
(1) the passenger provides the car seats;
(2) car seats may be stored either under the seat in front of the passenger, or secured with the
aircraft seat belt in a window seat (except at emergency exits);
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(3) car seats approved by Canadian Safety Association may be used during take-off and landing
only if they are restrained with the aircraft seat belt; and
(4) infants may be held by an adult during turbulence.
s. seat guardians close to patient if on a litter, and next to patient if seated;
t. involve guardian in the in flight care if possible; and
u. if the guardian or caregiver wants to hold the patient in flight, place a pillow between them, and
loop a litter strap through the adult's seat belt and then around the patient and pillow.
8-17-3/8-17-4
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SECTION 18
CARE FOR DECOMPRESSION ILLNESS (DCI)
GENERAL
1. DCI encompasses two diseases; Decompression Sickness (DCS) and Lung Overexpansion Injuries.
DCS is explained below, however, the various forms of lung overexpansion injuries (air gas embolism (AGE),
pneumothorax, mediastinal emphysema, and subcutaneous emphysema) are not covered in this section.
The most serious of pressure related injuries is AGE, a leading cause of death among scuba divers.
2. Decompression sickness (DCS) relates to complications associated with evolution of gas from tissues
and fluids of the body undergoing depressurization. DCS most commonly refers to a specific type of scuba
diving hazard but may be experienced in other depressurization events such as flying in unpressurised
aircraft, especially after a rapid decompression. In addition, arterial gas embolism can occur in a patient who
has escaped or been extricated from a submerged vehicle.
3. DCS is classified either by symptoms or according to body system. Body system classification
contains five to six categories ranging from local effects to cerebral, spinal and pulmonary. Symptomology
classification Type I “bends” involves only the skin, musculoskeletal system, or lymphatic system while
Type II involves the other organs (such as the central nervous system). Type II DCS thus usually has worse
outcomes. The usefulness of this classification in the initial assessment has been questioned as neurological
symptoms may develop after the initial presentation and both Type I and Type II DCS are treated the same.
4. DCS may arise either in flight or during exposure to reduced atmospheric pressure in a hypobaric
chamber. When the partial pressure of nitrogen in the inspired air falls with ascent to altitude, nitrogen can
come out of solution as gas bubbles and be carried by the blood to tissue sites. The formation of bubbles
in tissues and venous blood has multiple mechanical and physiologic consequences resulting in ischemia,
infarction, edema, cell death and pain. Recent SCUBA diving may predispose the individual to the onset of
DCS at lower altitudes.
5. DCS may present as a peripheral or central neurological abnormality. Peripheral neurological

abnormality presentations include the bends, creeps, and staggers. Central neurological abnormality
presentation includes the staggers. Some studies have shown that subtle central neurological abnormalities
are the most common form of “aviator’s bends”. Symptoms such as vagueness and decreased mental
functioning may be observed. Many signs and symptoms (S&S) of DCI are non-specific and may mimic
other maladies.
6. Some symptoms of DCS are:
a. Bends: characterised by a deep-seated pain in a joint or limb, or in a combination of joints and

limbs, due to the existence of nitrogen bubbles in a joint space;
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b. Creeps: characterised by localized itching, tingling sensations due to the existence of nitrogen
bubbles under the skin;
c. Chokes: occur when nitrogen bubbles form in pulmonary tissues. Symptoms include a deep-
seated substernal pain; feelings of chest constriction; difficulty with deep breathing; and a dry, non-
productive cough; and
d. Staggers: can be characterised by paralysis, paraesthesia, anaesthesia, and seizures due to the
existence of nitrogen bubbles in the central nervous system.
AE CONSIDERATIONS FOR DCS
7. AE considerations for DCS are as follows:
a. usually moved as an urgent supine patient, classification 2A (to undergo hyperbaric treatment);
b. 100% O2 via aviators mask throughout the flight;
c. frequent vital signs and neurological assessment;
d. sedation and analgesia as required;
e. immobilize painful joints;
f. cabin altitude restriction as close to sea level as possible; and
g. ideally, a F Surg should accompany.
IF DCS OCCURS In flight TO A PATIENT OR CREWMEMBER
8. If DCS occurs in flight to a patient or crewmember, proceed as follows:
a. administer 100% O2 via aviators mask;
b. support ABCs;
c. place on a litter;
d. contact a F Surg via phone patch to discuss the patient management, symptoms, response to
oxygen, and whether or not the mission may be continued; and
e. if symptoms do not resolve arrangements should be made to land at a facility where hyperbaric
therapy can be administered.
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SECTION 19
CARE FOR BURN PATIENTS
GENERAL
1. Military service poses unique burn risks for sailors, soldiers, airmen and airwomen. Two factors
impact burn patients: pulmonary insufficiency and hemodynamic stability. Pulmonary insufficiency
occurs from a number of mechanisms; asphyxia, carbon monoxide and thermal injury and hemodynamic
stability is compromised due to profound circulatory changes hence secure airways and fluid resuscitation
are vital.
DECREASED PPO2
2. Decreased partial pressure of oxygen will exacerbate oxygenation deficiencies due to compromised
respiration and carbon monoxide poisoning. This hypoxia can extend tissue damage.
3. Burn patients are at an increased risk for ileus therefore decreased barometric pressure increases
gastric distension and discomfort.
DECREASED HUMIDITY
4. Decreased humidity further exaggerates fluid loss in the compromised system.
5. Variations in cabin temperature may expose the patient to the effects of hypothermia due to the loss
of natural insulation and skin integrity. The autonomic temperature regulatory functions are affected with
severe burns.
AE CONSIDERATIONS FOR BURN PATIENTS
6. AE considerations for burn patients are as follows:
a. ensure airway management;
b. monitor fluid replacement/resuscitation, often large volume;
c. maintain strict intake and output;
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d. use a urinary catheter with urometer;
e. monitor requirement for narcotics and anxiolytics;
f. use space blankets or other cover to keep the patient warm;
g. request the AC increase the cabin temperature as needed;
h. reinforce dressings only, no in flight dressing changes;
j. clean linens help to decrease pain from air currents and may reduce contamination during transport;
and
k. consider burn specialized MSTMs if burns are significant.
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SECTION 20
CARE FOR DIABETIC PATIENTS
AE CONSIDERATIONS FOR DIABETIC PATIENTS
1. Although the movement of a diabetic patient is infrequent in the CF AE system, it is important that
AECMs are aware of possible considerations in their care. Watch for aggressive or behavioural changes;
rapid respirations; tachycardia; pallor, diaphoresis, headache, hunger, thirst, polyuria, fever, dizziness,
fainting, seizures, and coma.
2. If the patient is using a personal glucometer, it should be checked for airworthiness. If the brand/
model is not airworthy, the AECO/AECM either seeks a waiver for its use or uses an approved glucometer.
On a daily basis, it is important that the results be compared to the one the patient does use before the
flight.
3. AECMs will consider the following as well:
a. glucose check orders;
b. diabetic medications including sliding scale insulin;
c. some form of refrigeration should insulin be required;
d. maintain the patient on some type of fluid replacement (i.e. oral or IV as needed); and
e. the i-STAT may also be used to check the patient’s glucose.
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CHAPTER 9
INFECTION CONTROL GUIDELINES
SECTION 1
GENERAL CONCEPTS
1. The substantial participation of the Canadian Forces on the international scene, the lack of diagnostic
tests available in various theatres of operations, and the necessity for quick AE, may increase the risk of caring
for undiagnosed infectious patients. These elements have highlighted the need for increased knowledge
with regard to infection control guidelines. Consequently, every patient being considered for AE should be
assessed for infectious potential and handled in accordance with the guidance provided in this chapter.
2. All medical personnel within the AE environment will implement Health Canada Routine Practices
coupled with Transmission-based (Additional) Precautions and/or Centres for Disease Control (CDC) and
Prevention Guidelines for Isolation Precautions. That said, not all Health Canada / CDC recommendations
can be implemented within the air environment as described in the following pages.
3. This chapter summarizes Health Canada (1999) and CDC (2007) Infection Control Guidelines. AECM’s
should refer to the respective web sites for current and detailed information (http://www.phac-aspc.gc.ca/
index-eng.php and http://www.cdc.gov/). Because of the ever-changing nature of these sites it would be
impossible to maintain the exact URL for each. Simply do a search for the most current Infection Control
guidelines on each website Search function. Healthcare providers must remain cognizant that universality
of infection control measures worldwide may not be implemented due to legal and cultural differences.
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SECTION 2
HANDWASHING
GENERAL
1. Handwashing is the single most important procedure for preventing infections. Yet, data has
demonstrated that healthcare workers’ compliance with hand washing is often poor.
2. There is controversy over whether antiseptics or soap should be used. Contrary to common belief,
antiseptics are not necessarily harsher on skin than bland soap. Waterless antiseptic hand rinses are
superior to soap and water in reducing hand contamination. They are very useful in situations where access
to appropriate handwashing facilities (e.g., sinks, hand towels) may be limited. They require less time, act
faster, and irritate hands less than antiseptic handwash or plain soap and water. However, they are not
effective if hands are soiled with dirt or heavily contaminated with blood or other organic material. Soap
and water is recommended for visibly soiled hands. If soap and water are unavailable, hands must first be
cleansed with detergent-containing towelettes (any baby wipe or personal hygiene product that contains
detergent). Refer to your unit AESO for CF approved products.
3. For all patients, hands must be washed:
a. after any direct contact with a patient, before contact with the next patient. Direct Contact refers to
hand contact with the patient’s skin;
NOTE
The need for handwashing after casual contact unrelated to patient care, such
as a handshake or holding the hand of a patient, and patient care is difficult
to define. For casual contact or social contact that involves direct contact
between the skin of the health care providers and the patient, consider the
likelihood of the patient’s skin being heavily colonized or colonized with
significant organisms, the extent of the contact (e.g., handshake, hug vs.
holding patient for a prolonged period), and whether or not the patient is
immunocompromised.
b. before any contact with immunocompromised or critical care patients;
c. before performing invasive procedures;
d. after contact with blood, body fluids, secretions and excretions and exudates from wounds;
e. after contact with items known or considered likely to be contaminated with blood, body fluids,
secretions, or excretions (e.g., bedpans, urinals, wound dressings);
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f. before putting on gloves and immediately after removing gloves;
g. between certain procedures on the same patient to prevent cross-contamination between different
body sites;
h. before preparing, handling, serving or eating food, and before feeding a patient when hands are
visibly soiled; and
j. after personal use of toilet or wiping nose.
4. Hand lotion may be used to prevent skin damage from frequent hand washing. However, compatibility
between lotion and antiseptic products, and lotion’s potential effect on glove integrity should be checked.
Refer to your unit AESO for CF approved products.
5. Artificial nails or chipped nail polish may increase bacterial load and impede visualization of soil
under nails. Consequently, the use of fingernail polish and artificial nails will be avoided.
6. The efficacy of a hand wash depends on the time taken and the technique. The recommended hand
washing technique is outlined in the following table:
Procedure Rationale
Remove jewellery before handwashing procedure.
Rinse hands under warm running water. This allows for suspension and washing away of the
loosened microorganisms
Lather with soap and using friction, cover all The minimum duration for this step is 10 seconds,
surfaces of the hands and fingers. more time may be required if hands are visibly soiled.
For antiseptic agents 3-5mL are required. Frequently
missed areas are thumbs, under fingernails, backs of
fingers, and hands.
Rinse under warm running water. To wash off microorganisms and residual hand
washing agent.
Dry hands thoroughly with single-use towel or Drying achieves a further reduction in number of
forced air dryer. microorganisms.
Reusable towels are avoided because of the potential
for microbial contamination.
Turn off faucet without re-contaminating hands. To avoid re-contaminating hands.
Figure 9-2-1 Table of Infection Control Guidelines:

Handwashing, Cleaning, Disinfection and Sterilization in Health Care
From Volume 24S8, ISS.1188-4169, Canada Communicable Disease Report, Health Canada published December 1999.
.
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SECTION 3
PERSONAL PROTECTIVE EQUIPMENT (PPE)
GENERAL
1. All AECMs shall have the personal protective equipment (PPE) detailed in this section readily
available for the performance of their duties.
2. The unit AESO will ensure that PPE available meet these requirements.
MASKS
3. Masks are recommended to prevent the transmission of infectious agents through the air. They may
also prevent acquisition of some infections that are spread by direct contact with the mucous membranes
because they may prevent personnel from touching their eyes, nose, and mouth until after they have washed
their hands and removed the mask.
4. Masks may be used for a maximum period of time as stated by the manufacturer. However, they
must be changed earlier if they become wet, interfere with breathing, are damaged, crushed or visibly
soiled.
5. Surgical masks have been designed to resist fluids to varying degrees depending on the material in
the mask. They are used with droplet precautions, and potentially with contact precautions.
6. High-efficiency masks such as disposable N95 respirator protect AECMs from inhaling respiratory
pathogens transmitted via the airborne route (e.g., active tuberculosis (TB), Multidrug-resistant tuberculosis
(MDR-TB), Severe Acute Respiratory Syndrome (SARS), measles, varicella, etc.). These masks must, as a
minimum, filter particles of one micron in size, have a 95% filter efficiency, and provide a tight facial seal
(less than 10% facial leak seal). Because minimizing face seal leakage is fundamental for proper protection,
AECMs must be fitted and educated regarding the proper way to wear the mask by a certified technician.
a. N95 respirator will not be reused once it is removed;
b. masks must not be allowed to dangle around the neck; and
c. AECMs will discontinue the use of their N95 respirator during in flight aircraft emergencies if oxygen
masks are required (e.g., smoke in the cabin, sudden cabin decompression).
DISPOSABLE GLOVES
7. The use of gloves is not a substitute for handwashing, but an additional measure. Since hands can
become contaminated through glove defects or during glove removal, it is recommended that hands be
washed before and after use of gloves.
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8. Health Canada recommends purchasing gloves with the Canadian General Standards Board
certification mark, which ensures that voluntary national standards are met during manufacturing. However
some types of glove materials are not available in certified brands. In such instance, guidance from 1 Cdn
Air Div Surg Office should be sought.
9. Disposable, good quality medical gloves made of vinyl, nitrile, neoprene or polyethylene serve as
adequate barriers, particularly when latex allergies are a concern.
10. If latex gloves are chosen, low protein and un-powdered gloves should be selected.
11. Non-latex gloves should be available for individuals with latex sensitivity.
12. Vinyl gloves should be used for short tasks or for tasks in which there is minimal stress to glove
material.
13. Latex gloves represent a fire/flash hazard and should not be worn during ground or in flight
emergency situations.
GOGGLES
14. Goggles should be made of clear polycarbonate plastic with side and forehead shields. These should
be optically clear, anti-fog and distortion-free.
15. Directly vented goggles may allow penetration by splashes or sprays and consequently, are not
recommended.
16. Indirectly vented goggles provide the most reliable eye protection from splashes, sprays, and
respiratory droplets, and are recommended for infection control purposes.
17. Goggles are to be cleaned with detergent and water, dried, and disinfected with 70% alcohol or
soaked in 1% hypochlorite solution for 20 minutes and then rinsed and dried.
18. Safety glasses do not provide the same level of splash or droplet protection as goggles. Their use is
not recommended.
DISPOSABLE FACE SHIELDS
19. To provide better face and eye protection from splashes and sprays, face shields should have crown
and chin protection and wrap around the face to the point of the ear, which reduces the likelihood that
a splash could go around the edge of the shield and reach the eyes. Disposable face shields for medical
personnel made of light weight films that are attached to a surgical mask or fit loosely around the face
should not be relied upon as optimal protection.
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DISPOSABLE GOWNS
20. Various sizes of gowns shall be available. AECMs shall be aware of the size that fits them. Gowns
will be:
a. clean and non-sterile;
b. fluid resistant; and
c. fire retardant (flammability of fabrics).
21. Gowns represent a fire/flash hazard and should not be worn during ground or in flight emergency
situations.
MAINTENANCE / CLEANING OF PPE
GENERAL
22. AECMs should adhere to the described cleaning procedures for the following items:
FLIGHT SUIT / SUMMER & WINTER FLYING JACKETS
23. Machine washing and dry cleaning are approved for cleaning the flight suit / summer and winter
flying jackets.
a. if low temperature water is used for laundry cycles, chemicals suitable for low temperature washing
at the appropriate concentration should be used;
b. high temperature washes (> 71.1o C) are necessary if cold water detergents are not used;
c. fabric softener shall not be used since it will interfere with the fire retardant characteristic of the
flight suit / jacket fabric; and
d. machine drying or hanging clothing on a clothes line is a suitable method for drying.
FLIGHT GLOVES
24. If heavily soiled, flight gloves will be exchanged for new ones.
25. If lightly soiled, proceed as per para 23a, however, because of the leather component of the flight
gloves, machine drying is not recommended.
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TACTICAL VEST
26. If made of nylon, proceed as per para 23a. For other material, guidance should be sought through
the 1 Cdn Air Div Surg office or Wing Aviation Life Support Equipment (ALSE).
HELMET, INCLUDING VISOR AND HEADSET
27. Guidance should be sought through Wing Supply and in conjunction with your Wing ALSE section.
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SECTION 4
HEALTH CANADA / CDC INFECTION CONTROL GUIDELINES
EVOLUTION OF ISOLATION PRECAUTIONS
1. Universal Precautions were developed with the primary purpose of protecting the health care worker
from exposure to blood borne pathogens, and were based on the principle that it was not possible to know
which patients harboured blood borne pathogens. They do not address however, the potential transmission
from body substances of asymptomatic colonized patients. To address this concern, a new isolation system
called Body Substance Isolation was created, in which barrier precautions were tailored to the activity
performed rather than the diagnosis. This system extended barrier precautions to all direct contact with
blood, body fluids, secretions and moist body substances, and with non-intact skin. The principles of Body
Substance Isolation were that all persons are at risk of acquisition of organisms from inoculation of mucous
membranes and non-intact skin. The goal was to prevent transmission by preventing contamination of the
healthcare worker’s hands.
2. Universal Precautions and Body Substance Isolation did not address the potential for organisms to
contaminate the patient’s immediate environment. As a result, a two-tier system was developed consisting
of Routine Practices (or Standard Precautions), which must be applied to all patients at all times, regardless
of diagnosis or infectious status, and Additional (transmission-based) Precautions for specific infections that
warrant additional measures (e.g., airborne, droplet, and contact).
3. Routine Practices (CDC Standard Precautions) and Transmission Based Precautions for Preventing
the Transmission of Infection in Health Care are a set of guidelines that Health Canada / CDC recommends
be used by all healthcare workers to prevent the transmission of microorganisms. Since AECMs provide
care in less than ideal conditions, their ability to comply with Health Canada / CDC guidelines may be
compromised. Furthermore, these guidelines were written for acute, long term, ambulatory and home care
settings. Although most of the guidelines can be applied to the AE environment, some are not appropriate
(mostly airborne precautions). Consequently, the CF AE system tailored the Health Canada / CDC infection
control guidelines to better suit the challenges imposed by the AE environment. All AECMs should follow
the following principles to ensure consistency in infection control practice.
ROUTINE PRACTICES / STANDARD PRECAUTIONS (TIER 1)
GENERAL
4. This section recommends practices for the routine care of all patients, and incorporates previous
precautions (Universal Precautions and Body Substance Isolation).
GLOVES
5. The following guidelines indicate when gloves must be worn:
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a. are not required for routine patient care activities in which contact is limited to a patient’s intact
skin;
b. should be worn for contact with blood, body fluids, secretions and excretions, mucous membranes,
draining wounds or non-intact skin (open skin lesions or rash);
c. should be worn for handling items visibly soiled with blood, body fluids, secretions and excretions;
d. should be worn when the healthcare worker has covered, skin lesions on the hands;
e. should be changed between care activities and procedures with the same patient after contact with
materials that may contain high concentration of microorganisms (e.g., after handling an indwelling
urinary catheter or suctioning an endotracheal tube).
f. should be removed immediately after completion of care, at point of use and before touching clean
environmental surfaces; and
g. hands should be washed immediately before and after using gloves.
MASK, EYE PROTECTION, FACE SHIELD
6. The mask, eye protection and/or face shield should be worn when appropriate to protect the eyes,
nose and mouth during procedures and patient care activities likely to generate splashes or sprays of blood,
body fluids, secretions or excretions.
GOWNS
7. Gowns should be used during procedures and patient care activities likely to generate splashes or
sprays of blood, body fluids, secretions or excretions.
PATIENT CARE EQUIPMENT
8. When possible, dedicated patient care equipment that will not be shared between patients should
be considered for critical care, infectious and immunocompromised patients.
9. Reusable equipment that has been in direct contact with the patient should be cleaned before use
in the care of another patient. Items that are routinely shared should be cleaned between patients with
disinfectant wipes. A routine cleaning schedule should be established and monitored for items that are in
contact only with intact skin, if cleaning between patients is not feasible
10. Bedpans will be encased in a plastic bag. Careful removal of the plastic bag is essential to prevent
cross contamination. Bedpans will be wiped down between patient use with disinfectant wipes; and
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11. Cleaning, disinfection and sterilization procedures are described in Section 8 “Cleaning, Disinfection
and Sterilization of Medical Equipment.”
ADDITIONAL PRECAUTIONS (TIER 2)
GENERAL
12. Additional precautions are necessary for certain pathogens or clinical presentations. These
precautions are based on method of transmission and are necessary for infections transmitted by the
airborne or large droplet routes. They may be indicated for patients with certain highly transmissible or
epidemiologically important microorganisms transmitted by direct or indirect contact. Refer to Annex 9A
for precautions to be taken with various communicable diseases and clinical presentation. Further guidance
can be sought through the 1 Cdn Air Div Surg office or Directorate of Force Health Protection.
13. Additional precautions should be taken not only when these pathogens are identified, but also
empirically for clinical syndromes in which the pathogens are likely causes, until the specific etiology is
known. Some microorganisms may be transmitted by more than one route, necessitating more than one
type of transmission precaution.
14. Patients should understand the nature of their infectious disease and the precautions being used
during their transport.
AIRBORNE PRECAUTIONS
15. Airborne transmission refers to dissemination of microorganisms by aerosolization. Organisms are

contained in droplet nuclei (small airborne particles, <5µm, that result from evaporation of large droplets) or
in dust particles containing skin cells and other debris that remain suspended in the air for long periods of
time. Such microorganisms are widely dispersed by air currents and inhaled by susceptible hosts who may
be some distance away from the source patient. Control of airborne transmission is the most difficult, as it
requires control of air flow through special ventilation systems.
16. Patients diagnosed or suspected of a disease transmitted via the airborne route should not be
airlifted due to the lack of adequate engineering controls within the aircraft (e.g., absence of high-efficiency
filter within the ventilation system), absence of specially designed isolator within the CF AE system, and
the increased risk of contamination to the crew. Civilian air-ambulance services have specially designed
isolation capabilities and can be contracted.
17. In the event that such patients must be airlifted due to the local situation, the following guidance
should be followed:
a. airlift shall occur on a dedicated flight with limited crew and with no other patient(s) or passengers
onboard;
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b. patients known to be infected with the same virus (identified by culture or rapid antigen test) may
be airlifted on same flight. Patients with active tuberculosis or multi-drug resistant tuberculosis
(MDR-TB) should not be airlifted on same flight, as strains and levels of infectivity may be different
(See Section 5, paragraphs 4 to 9 for TB transportation guidelines);
NOTE
HIV infected patients going for evaluation of a new undiagnosed pulmonary
process will be transported as routine and airborne precautions.
c. patient placement: isolate the patient to the greatest extent possible. Patient placement should be
in a low traffic area, downwind in the airflow circulation cycle. As a general rule, the patient should
be close to the outflow valve and the washroom. Unfortunately, the outflow valve and washroom
may be at different ends of the cabin. The Medical Crew Director (MCD) will need to use judicious
thinking for best-suited position. See Annex 9B for information on the airflow in various airframes
used in AE.
d. if a litter patient, position in the lowest position in the tier and avoid positioning other patients in
the tier. If space is limited, only patients known to be infected with the same virus may share a tier
(except active TB and MDR-TB);
e. ambulatory patients should be seated next to the sidewall;
f. cargo/passenger compartment: all crewmembers including MSTMs will wear a N95 respirator for
the entire mission. Other members of the cabin crew do not need to be fit tested for a N95 respirator
but the mask should not have noticeable gaps. The N95 respirator will not be removed to eat or
drink while in the cargo/passenger compartment;
g. the flight deck crew in aircraft with forward to aft airflow do not require N95 respirator unless in
the cargo/passenger compartment. The N95 respirator does not need to be fit tested but should not
have noticeable gaps;
h. the flight deck crew in aircraft with aft to forward airflow and aircraft with mixing of cargo/passenger
compartment air and flight deck air will wear a N95 respirator for the entire mission. The N95
respirator does not need to be fit tested but should not have noticeable gaps;
NOTE
CC177 crewmembers in the flight deck and crew rest area can remove the
N95 respirator as long as the door to the cargo compartment is closed and
the environment system is operating in the “high-flow” mode.
j. flight deck crew may optionally use the aircraft oxygen supply and wear the aviator mask with the
regulator set at 100%;
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k. eye protection (goggles, face shield) / gloves / gown should be worn as per routine practices
guidelines;
m. consideration must be given to the need for “PPE breaks” during long missions. Personnel will
need to use the lavatory and have meals; removal of respiratory protection is unavoidable. An
area “upwind” (depending on cabin air flow) and as far as possible from the patient, should be
designated for this purpose. Since space can be an issue on some airframe, a minimum distance of
2 metres (6 feet) from the patient is recommended;
n. patient should wear a surgical mask during transport;
p. patients requiring oxygen (1-5 LPM) will wear a surgical mask over the nasal cannula. Patients
requiring higher levels of oxygen may require a cabin altitude restriction or may wear a non-
rebreather oxygen mask with a viral exhaust filter attached;
q. ventilators and hand-held resuscitators should have a HEPA filter or equivalent filtration of airflow
exhaust;
NOTE
High PEEP settings may not be possible using a HEPA filter.
r. ventilation tubing connections will be secured and in-line (closed) suctioning used;
s. suction device exhaust should not be vented into the cabin without HEPA or equivalent filtration.
Portable suction devices should be fitted with in-line HEPA or equivalent filters;
t. upon mission termination, all exits and doors are opened and the interior of the aircraft is aired out
after the mission is complete. This may be done at home unit but AECMs and all crewmembers
must continue to wear masks until airing-out is complete. Cleaning should be postponed until
airing out is complete.
NOTE
No one will enter the aircraft without a N95 respirator until the aircraft is
aired-out.
NOTE
The need for N95 masks will be issued on the AE tasking message. The MCD
will coordinate N95 requirements with the aircraft commander and medical
support personnel. Pre-mission planning includes sufficient number of N95
respirators to meet mission requirements, including replacements due to
contamination, damage, and limits of the respirator. Planning should also
include extra N95 respirators for ground support personnel.
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u. for detailed information and recommendations with regard to TB patients refer to Section 5
“Communicable Diseases of Interest/Tuberculosis.”
v. a visual card for airborne precautions within the AE environment is provided in Annex 9C.
DROPLET PRECAUTIONS
18. Droplet transmission is a form of contact transmission but requires special considerations. Droplet
transmission refers to large droplets, ≥5μm in diameter, generated from the respiratory tract during
coughing, sneezing, or during procedures such as suctioning. These droplets are propelled a short distance,
< one metre, through the air and deposited on the nasal or oral mucosa of the new host. Large droplets do
not remain suspended in the air. Special ventilation is not required since true aerosolization does not occur.
19. Patient placement: A one metre spatial separation between infected patients and other patients or
passengers is recommended. Patients known to be infected with the same organism (identified by culture
or rapid antigen test) may be grouped together unless acquisition of different strains of the microorganism
is a concern.
20. Positioning will be dependent of the aircraft flow. Medical equipment litter will be positioned at least
one meter above infected patient, space permitting. As a general rule, any equipment within one metre from
infected patients will be considered contaminated.
21. A surgical mask should be worn by all healthcare workers if within one metre of patient. For care of
patient with rubella or mumps, a mask is not needed if the healthcare worker is immune.
22. Eye protection (goggles, face shield), gloves and gown should be worn as per routine practices
guidelines.
23. The patient should wear a surgical mask during transport.
24. Once the patient is off loaded the one meter space around the patient needs to be disinfected as per
1 Cdn Air Div Orders Vol 1, 1-264.
25. A visual card for droplet precautions within the AE environment is provided in Annex 9D.
CONTACT PRECAUTIONS
26. Contact transmission occurs when transfer of microorganisms results from direct physical contact
between an infected or colonized individual and a susceptible host (body surface to body surface). Indirect
contact involves passive transfer of microorganisms to a susceptible host via an intermediate object, such as
contaminated hands that are not washed between patients, or contaminated instruments or other inanimate
objects in the patient’s immediate environment.
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27. Patient placement: a one metre spatial separation between infected patients and other patients or
passengers is recommended. Patients known to be infected with the same organism (identified by culture
or rapid antigen test) may be grouped together unless acquisition of different strains of the microorganism
is a concern.
28. A mask should be worn as per routine practices guidelines.
29. Gloves:
a. should be worn when entering the patient’s designated bed space. A one metre “zone” around the
patient bed is to be considered as the patient’s designated bed space; and
b. should be removed before leaving the patient’s designated bed space.
30. Gowns:
a. should be worn if clothing or forearms will have direct contact with the patient; with frequently
touched environmental surfaces or objects; and if increased risk of the environment being
contaminated (e.g., diarrhea, drainage from wound, colostomy or ileostomy not contained by
dressing); and
b. should be removed immediately outside of the one metre zone.
31. Handwashing. Remove gloves and wash hands with waterless antiseptic hand rinse before leaving
the patient’s designated bed space. When visibly soiled, hands should be washed with soap and water (or
detergent-containing towelette) before using waterless antiseptic hand rinse.
32. Equipment and environment:
a. patient care equipment (e.g., blood pressure cuff, pulse oximeter, etc) should be dedicated to the
use of that patient and should be cleaned and disinfected before use with another patient. Personal
effects should not be shared with other patients; and
b. disposable patient care equipment is recommended. The unit AESO will ensure that disposable
patient care equipment (e.g., blood pressure cuffs, ECG cables, pulse oximeter finger probe, linen,
etc) meet the specific criteria associated with the AE environment.
33. A visual card for contact precautions within the AE environment is provided in Annex 9E.
NOTE
While operating in the AE environment: prior to patient emplaning, a detailed
plan will be devised with the AEC and a designated clean area outside the 1
metre patient bed space perimeter will be set up. This clean area will have all
supplies readily available to adhere to the needed precautions.
9-4-7/9-4-8
B-MD-005-000/FP-001
SECTION 5
COMMUNICABLE DISEASES OF INTEREST
ANTIMICROBIAL-RESISTANT ORGANISMS (ARO)
GENERAL
1. The extent of the emergence of antibiotic resistance is the result of intensive and inappropriate
use of antibiotics, both in hospital and in the community. Colonization with ARO occurs most frequently
in critical care units, which bring together critically ill patients who have less resistance to colonization, in
a setting of heavy exposure to antibiotics and frequent hands-on care by healthcare personnel. With most
microbes, colonization is far more frequent than symptomatic infection (disease).
2. Predisposing factors for acquisition of ARO include antimicrobial therapy, severe illness, prolonged
hospital stay, intensive care admission, surgery, and invasive procedures/devices.
3. Routines practices and contact precautions are recommended for infection or colonization with
organisms such as Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococcus
(VRE), Acinetobacter baumannii, or other organisms resistant to a wide spectrum of antibiotics. See Annex
9F for recommended measures for these organisms.
TUBERCULOSIS
GENERAL
4. Tuberculosis (TB) is caused by infection with Mycobacterium tuberculosis. It affects one third of
the world’s population. The bacteria usually attack the lungs, but TB bacteria can attack any tissue, such
as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB is usually transmitted
by exposure to airborne droplet nuclei produced by people with pulmonary or laryngeal disease, during
expiratory efforts such as coughing and sneezing. People nearby may breathe in these bacteria and become
infected however, not everyone infected with TB bacteria becomes sick. People who are not sick have what
we called latent TB. People with latent TB infection do not feel sick, do not have symptoms, and cannot
spread TB to others however latent TB infections can progress to active TB.
5. Patients with pulmonary TB responding to treatment (known drug sensitivity and clinical signs of
improvement) may be safely transported on any aircraft without respiratory protection when all of the
following criteria are met:
a. negative sputum smears on three consecutive days (smears collected at least 24 hours apart);
b. at least two or more weeks of chemotherapy completed with appropriate medication; and
9-5-1
B-MD-005-000/FP-001
NOTE
Patients with laryngeal TB will receive at least 30 days of chemotherapy with
appropriate medication regardless of smear status.
c. patient is not coughing.
6. Routine Practices and airborne precautions must be used if the above criteria are not met or in
undiagnosed pulmonary infectious disease processes in which TB is suspected.
7. The use of cough suppressants may be indicated for patients with active TB or MDR-TB who are
actively coughing.
8. Ventilated patients pose the highest risk to the AECMs, crew and passengers. Routine Practices and
Airborne precautions are to be used regardless of the smear status. HEPA filters or equivalent will be used
with ventilator, hand-held resuscitator, and suction apparatus.
9. Guidance should be sought through the Directorate Force Health Protection with regard to AECM
post-mission follow-up (requirement for Personal Protective Devices (PPD)).
MULTIDRUG-RESISTANT TUBERCULOSIS
10. Multidrug-resistant TB is resistant to any combination of anti-microbials that includes Isoniazid and
Rifampin (the two most effective anti-TB drugs). MDR-TB arises in areas where TB control is poor, such as
developing countries.
11. Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is
extremely difficult to treat and cases have been confirmed worldwide.
12. Follow routine and airborne precautions for these patients.
13. Guidance should be sought through the Directorate Force Health Protection with regard to AECM
post-mission follow-up (requirement for PPD).
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
GENERAL
14. SARS is a respiratory illness that is spread through close contact with an infected person. Those
persons living in the same household, providing care to someone with SARS, or having direct contact with
respiratory secretions and body fluids of an infected person are most at risk for contracting the disease.
SARS appears to be transmitted primarily by large droplet spread, although surface contamination and
possibly airborne spread may play a role. Recent data suggest that the virus may remain viable on dry
surfaces up to 24 hours.
9-5-2
B-MD-005-000/FP-001
15. The SARS virus is stable in feces (and urine) at room temperature for at least 1 to 2 days. It is more
stable (up to 4 days) in stool from patients with diarrhea.
16. Routine practices with airborne and contact precautions are recommended. For more details, refer
to CF H Svcs Gp Policy and Guidance 4410-20, Respiratory Protection Measures for Pandemic Influenza
(Including for Human Cases of Avian Influenza) and Other Respiratory Disease Presentations.
9-5-3/9-5-4
B-MD-005-000/FP-001
SECTION 6
LEGAL IMPLICATIONS
GENERAL
1. All AECMs and MSTMs are responsible for complying with routine and additional precautions. There
are no hierarchical exceptions to precautions, and everyone has a responsibility to monitor his or her own
practice as well as the practice of other care providers.
2. According to the International Health Regulations of the World Health Organization (WHO), (2005),
each Member State is responsible to decide which diseases are quarantined. That said, the Canadian
Quarantine Act (2006) does not identify diseases requiring quarantine. Instead, contextual factors are taken
into considerations and at the discretion of quarantine officers located at various Canadian airports, special
attention is given to:
a. cholera;
b. plague;
c. smallpox;
d. yellow fever;
e. Severe Acute Respiratory Syndrome (SARS);
f. pandemic influenza type A; and
g. viral hemorrhagic fevers (e.g., Lassa, Marburg, Crimean-Congo, Ebola, etc.).
3. Of importance to AECMs is Article 19 of the Canadian Quarantine Act, which states:
Where a person in charge of any aircraft arriving in Canada from a place outside Canada…,
he shall, prior to arrival,… send by radio to the quarantine officer,… any illness among the
persons on board the aircraft, other than air sickness, or resulting from an accident that might
have occurred during the flight, with detail of such illness including the existence of fever, skin
rash, headache, backache, jaundice, diarrhea, vomiting, chills or abnormal behaviour…
4. It is therefore essential that AECMs report promptly to the aircraft commander any of the above
signs and symptoms observed among patients, passengers or crewmembers. Careful consideration of the
patient’s medical condition vs. signs and symptoms of communicable disease is essential.
9-6-1/9-6-2
B-MD-005-000/FP-001
SECTION 7
AIRCRAFT DISINSECTION
GENERAL
1. The transport of live insects aboard aircraft arriving from vector-borne disease endemic areas
into non-endemic areas can have serious health and economic consequences. As such, the WHO stresses
the importance of aircraft disinsection in preventing the spread of various vector-borne diseases. Aircraft
disinsection refers to the measures taken to kill the insect vectors of disease and agricultural pests present
in aircraft.
2. As per Article 27 of the WHO International Health Regulations, Member State shall disinsect aircraft
using methods and procedures recommended by the WHO, unless a competent authority determines that
other methods are as safe and reliable. Competent authority being defined as an authority responsible for the
implementation and application of health measures under the International Health Regulations. Disinsection
products currently in use by IHR signatory countries (including Canada) are permethrin derivatives and
d-phenothrin. Annex 9G describes the methods recommended for aircraft disinsection by the WHO. For
more information on aircraft disinsection refer to http://whqlibdoc.who.int/hq/1995/WHO_PCS_95.51_Rev.
pdf.
3. Transport Canada does not require the disinsection of aircraft arriving in or departing from Canada.
However, Canadian registered aircraft must comply with the disinsection requirements of other countries.
Consequently, AECMs must be familiar with disinsection policies and procedures so they can:
a. explain to patients what to do during and after disinsection;
b. recognize and differentiate the signs and symptoms associated with the patient’s medical condition
versus the disinsection product; and
c. recognize side effects passengers and crewmembers may experience.
9-7-1/9-7-2
B-MD-005-000/FP-001
SECTION 8
CLEANING, DISINFECTION AND STERILIZATION OF MEDICAL EQUIPMENT
GENERAL
1. Appropriate cleaning, disinfection and sterilization of patient care equipment are important in
limiting the transmission of organisms related to reusable patient care equipment. Decisions concerning
the appropriate processes, methods or products are complex, given the many types and compositions of
medical devices. AECMs will follow 1 Cdn Air Div Orders Vol 1, 1-264 for aircraft disinfection upon mission
completion. AE equipment cleaning and disinfection will be carried out IAW B-MD-010-000-FP-001.
DEFINITIONS
2. Cleaning: The physical removal of foreign material, e.g., dust, soil, organic material such as blood,
secretions, excretions and microorganisms. Cleaning physically removes rather than kills microorganisms.
It is accomplished with water, detergents and mechanical action. Cleaning is always essential prior to
disinfection or sterilization. An item that has not been cleaned cannot be assuredly disinfected or sterilized.
3. Disinfection: The inactivation of disease-producing microorganisms. Disinfection does not destroy

bacterial spores. Disinfection usually involves chemicals, heat or ultraviolet light.
4. Sterilization: The destruction of all forms of microbial life including bacteria, viruses, spores and
fungi. Carried out by local clinics, according to a robust CF policy and monitoring system.
MEDICAL EQUIPMENT
5. Equipment used in patient care is classified into three categories:
a. noncritical: items that either touch only intact skin but not mucous membranes or do not directly
touch the patient;
b. semi-critical: items that come in contact with non-intact skin or mucous membranes but ordinarily
do not penetrate them; and
c. critical: items that enter sterile tissues, including the vascular system.
NOTE
Figure 9-8-1 provides information associated with the reprocessing of
equipment used in the AE settings.
9-8-1
B-MD-005-000/FP-001
6. Contaminated reusable patient care equipment should be bagged for cleaning and disinfection at
home unit.
7. Mattresses (e.g., Spectrum, roll-up) and pillows will be cleaned and disinfected using EPA-registered
disinfectants that are compatible with the materials to prevent the development of tears, cracks, or holes in
the covers.
Process Equipment Examples of Items Products or Methods

Cleaning All reusable equipment Bedpans, urinals, and Quaternary ammonium
Some items may measuring containers compounds
require low level Stethoscopes
disinfection Blood pressure cuffs
ECG cable 3% hydrogen peroxide
Pulse oximeter finger
probe Refer to 1 Cdn Air Div
Spectrum bed units Orders Vol 1, 1-264
Cleaning followed by Some semi-critical items Electronic thermometers Alcohols
intermediate level of
disinfection Hypochlorite solutions
Accelerated hydrogen
peroxide 0.5%
Cleaning followed by Semi-critical items Laryngoscopes/blades 2% glutaraldehyde
high level disinfection Respiratory equipment
(LSP, hand-held 6% hydrogen peroxide
resuscitators, masks)
Chlorine or chlorine
compounds
Cleaning followed by Critical items Major procedure tray Steam under pressure
sterilization Dry heat
Figure 9-8-1 Table of Reprocessing of Commonly Used Equipment in the AE Setting
8. NATO litters: Grossly contaminated canvas/black nylon litters should be discarded. If body fluids
(e.g. blood, vomit, feces, saliva, semen) have contaminated surfaces, they are to be cleaned immediately
after dealing with the medical needs of the patient. Care must be taken to avoid splashing or generating
aerosols during the clean up. The procedures to follow are:
a. appropriate personal protective equipment is to be worn for cleaning a blood spill:
(1) gloves are to be worn during the cleaning and disinfecting procedures,
(2) if the possibility of splashing exists, a face shield and gown must be worn,
9-8-2
B-MD-005-000/FP-001
(3) for large blood spills, overalls, gowns or aprons, and boots or protective shoe covers must be
worn; and
(4) personal protective equipment is to be changed if torn or soiled, and removed before leaving
the location of the spill;
b. before applying a disinfectant, spill areas must be cleaned of obvious organic material such as
blood. Organic material consumes hypochlorites and other disinfectants and thus degrades their
ability to disinfect;
c. excess blood and fluid capable of transmitting infection is to be removed with disposable towels.
Discard the towels in a plastic-lined waste receptacle;
d. after cleaning, the area is to be disinfected with a low level chemical disinfectant (e.g., chemical
germicides approved for use as “hospital disinfectants”, such as quaternary ammonium compounds)
or sodium hypochlorite (household bleach). Concentrations ranging from approximately 500
to 5,000 ppm of sodium hypochlorite (1:100 to 1:10 dilution of household bleach) are effective,
depending on the amount of organic material (e.g., blood or mucus) present on the surface to be
cleaned and disinfected.
NOTE
Manufacturers’ recommendations for dilutions and temperatures of chemical
disinfectants approved for use as hospital disinfectants must be followed.
e. sodium hypochlorite or chemical germicide is to be left on the surface for at least 10 minutes;
f. the treated area is then to be wiped with paper towels soaked in tap water and allowed to dry;
g. the towels are to be discarded in a plastic lined waste receptacle;
h. hands must be thoroughly washed after gloves are removed; and
j. the stretcher should be rinsed following this decontamination.
9. In Canada, antimicrobial products that are labelled for use in health care facilities or on medical
devices and are produced for the purposes of disease prevention and health preservation are regulated as
drugs under the Food and Drugs Act and Regulations. As such, only disinfectant with a drug identification
number (DIN) should be used. Your unit AESO will ensure that products used meet this requirement.
10. Soiled linen should be handled with a minimum of agitation and shaking. Heavily soiled linen should
be rolled or folded to contain the heaviest soil in the center of the bundle.
9-8-3
B-MD-005-000/FP-001
11. Soiled linen will be bagged in a leak proof bag upon mission completion and brought back to the
AE unit for disposal as per the CF H Svcs C policy. The only indication for a second outer bag is to contain a
leaking inner bag.
12. Linens from persons with a diagnosis of hemorrhagic fevers (e.g., Lassa, Ebola, Marburg) requires
special handling. Guidance from the Directorate of Force Health Protection should be sought prior to moving
these patients.
13. Refer to Hand Washing, Cleaning, Disinfection and Sterilization in Health Care, Health Canada (1998)
for further guidance with regard to environmental cleaning associated with routine, airborne, contact, and
droplet precautions.
9-8-4
B-MD-005-000/FP-001
SECTION 9
WASTE MANAGEMENT PROTOCOL
GENERAL
1. The management of waste generated in health care settings has been the subject of much debate
in recent years. Waste generated in health care settings is no more hazardous than household waste. Data
demonstrate that household waste contains 100 times more pathogenic organisms than medical waste. The
categories of human biomedical waste generated in health care and their respective handling disposal are
identified in Figure 9-9-1. Italics represent waste associated with the AE environment.
2. Blood-soaked waste has received much attention. Increased concern over blood borne pathogens
has resulted in the erroneous extension of blood borne pathogen precautions to treat all body/fluid waste
has potentially infectious. Items soaked or dripping with blood, contained in an impervious plastic bag
before being sent to the landfill, pose no threat to the public health. Special treatment (e.g., incineration) of
blood soaked waste is not required, and has enormous cost and environmental implications.
3. There are three common methods of waste disposal for biologic waste in Canada:
a. landfill: It is acceptable to dispose specific categories of waste in a properly managed landfill

provided there are procedures in place to protect workers and the public from contact with the
waste;
b. sanitary sewer: The sanitary sewer is an acceptable method of disposal of blood, suctioned fluids,
excretions and secretions. The disposal of such liquids into sanitary sewers must conform to
municipal sewerage by-laws and provincial regulations and legislation, and
c. incineration: Incineration is the process that converts combustible materials into non-combustible
ash, achieving a reduction of 90% by volume or 75% by weight. The treatment residue may be
disposed of in a landfill.
9-9-1
B-MD-005-000/FP-001
Waste Category Examples Colour coding packaging¹ Handling disposal

Anatomic Tissues Sealed impervious Incineration,
Organs containers crematorium
Body parts
Microbiological Diagnostic specimens Autoclaving bags and Incineration or
Laboratory cultures plastic waste holding decontamination by
Vaccines bags for general waste autoclave for landfill
Blood/body fluids From phlebotomy bottles Sealed impervious Sanitary sewer if
From drainage collection containers permitted by local
units or suction regulatory authorities
containers or incineration
Sharps Needles Puncture resistant sharps Incineration
Blood syringes containers
Lancets
Clinical glass
Isolation Lassa fever Transport Canada Incineration
Marburg virus disease approved, sealed,
Ebola virus disease impervious container.
* local public health
authority must be
contacted
Other Gloves Impervious waste Landfill
Sponges holding bags or double
Dressings bag
Suction catheter
Ventilator circuit
Surgical drapes soiled
or soaked with blood or
secretions
Figure 9-9-1 Table of Recommendations for Management of Untreated Infectious Waste

¹ Biohazard symbol is required on all packaging for incineration; colour coding varies provincially and regionally.
4. As a general rule, biomedical waste generated on AE missions will be handled as per Figure 9-9-1,
off-loaded with the patient to be taken for disposal at the patient’s Destination Hospital. If unable to send the
biohazardous waste with the patient it will be brought back to the AE unit for disposal as per CFHS policy.
5. Disposal of biomedical waste can become an issue when aeromedical evacuations cross international
boundaries. Strictly enforced international sanitary regulations are designed to prevent the spread of
agricultural, animal and human diseases between countries. In case of an unscheduled diversion, the MCD
must coordinate with the aircraft commander that the applicable health authority is contacted to ensure that
the aircraft will be authorized to land. As per Article 28 of the International Health Regulations (2005), airport
9-9-2
B-MD-005-000/FP-001
authorities at the unscheduled destination airport shall be notified as early as possible before arrival. The
AC will be responsible for this notification.
6. Biomedical waste may need to be retained until suitable facilities exist for its disposal, however
biomedical waste cannot be stored forever. For example, an AE unit stationed for an extended period of
time in an area where the local sanitary system is not equipped to deal with biomedical waste could be
problematic. Consequently, guidance from the AECO must be sought WRT the procedures to follow.
CHEMICAL TOILET
7. It is erroneous to assume that all blood, body fluids, secretions and excretions can be safely disposed
of in the aircraft chemical toilet. For instance, some disinfectants used in chemical toilets are effective in
killing or inactivating specific types of microorganisms, while others are effective against all types. The
efficiency of chemical disinfection depends on various factors, including:
a. the kind of chemical used;
b. the amount of chemical;
c. the contact time and extent of contact between the disinfectant and the waste;
d. the organic load; and
e. the operating temperature, humidity and pH.
8. AECMs must confirm the chemicals used are effective to inactive the waste discarded prior to
discharge in the local sanitary sewer, regulations permitting.
9. In the event where only one washroom is avail to all (pts, crew, passengers), all lavatory surfaces
will have to be disinfected between infectious disease patient and crew/passengers with a hospital-grade
disinfectant, with adherence to the manufacturers minimum contact time. Ideally, the disinfectant should
have some residual activity.
9-9-3/9-9-4
B-MD-005-000/FP-001
ANNEX 9A
MAJOR INFECTIOUS DISEASES, PRECAUTIONS & VECTORS
1. Figures 9A-1-1 and 9A-1-2 are taken from Routine Practices and Additional Precautions for Preventing
the Transmission of Infection in Health Care (1999) Tables 6 & 7 http://www.phac-aspc.gc.ca/publicat/ccdr-
rmtc/99vol25/25s4/index.html.
Clinical Findings Precautions Infective Material

Abscess Major: Contact Pus
Minor: Routine
Burns, infected
See abscess
Common Cold Adult: Routine Respiratory secretions
Peds: Droplet + Contact
Conjunctivitis Adult : Routine Eye discharge
Peds : Contact
Cough, fever, upper respiratory tract Adult: Routine Respiratory secretions
infection Peds: Droplet + Contact
Cough, fever, pulmonary infiltrates Airborne Respiratory secretions
in person at risk of TB
Diarrhea Adult: Routine Feces
• Acute diarrhea of likely infectious Peds: Contact
cause
• Suspected Clostridium difficile Contact
Encephalitis Adult: Routine Feces

Peds: Contact Respiratory secretions
Gastroenteritis
See diarrhea
Hemorrhagic fever (Ebola, Lassa, Droplet + Contact Blood and bloody body fluids,
Marburg, etc) (Airborne + Contact if pneumonia) respiratory secretions
Pneumonia Adult: Routine Respiratory secretions
Rash, compatible with scabies Contact if extensive, otherwise Routine plus Mite
gloves and gown for direct patient contact
Rash (maculopapular) with fever Airborne Respiratory secretions
and coryza
Rash (petechial/purpuric) with fever Adult: Droplet if Neisseria meningitis Respiratory secretions
suspected, otherwise Routine
Peds: Droplet
Rash (vesicular) with fever Airborne + Contact Respiratory secretions and
exudates
Wound infection
See abscess
Figure 9A-1-1 Table of Infection Control Precautions by Clinical Presentation (Acute Care Centres)
9A-1-1
B-MD-005-000/FP-001
Microorganism Precautions Infective Material

Acinetobacter baumannii Routine + Contact. Add Droplet
if pneumonia is suspected with
productive sputum
Anthrax Routine Lesion drainage
Antimicrobial Resistant Contact Infected or colonized secretions,
Organisms (ARO) excretions
Ascariasis Routine
(roundworm)
Calicivirus (e.g., Norwalk) Adult: Routine Feces
Peds: Contact
Chickenpox Airborne + Contact Lesion drainage, respiratory
(varicella-zoster virus) secretions
• Fever with vesicular rash
• Susceptible contact Airborne Respiratory secretions

Cholera Adult: Routine Feces
Peds: Contact
Clostridium difficile Contact Feces
Dengue Routine (mosquito-borne)
Ebola Droplet + Contact Blood and bloody body fluids,
(Airborne + Contact if pneumonia) respiratory secretions
Escherichia coli Adult: Routine Feces
(pathogenic strains) Peds: Contact
German measles
See Rubella
Giardia Adult: Routine Feces
Peds: Contact
Haemophilius influenza type b Adult: Routine Respiratory secretions
Peds: Droplet
Hantavirus Routine Infection acquired from rodents
Hepatitis A, E Adult: Routine Feces
Peds: Contact
Hepatitis B,C,D and other Routine Blood and certain other body
unspecified non-A, non-B fluids
Hookworm Routine
HIV Routine Blood and certain other body
fluids
Influenza Adult: Droplet + Contact Respiratory secretions
9A-1-2
B-MD-005-000/FP-001
Lassa fever Droplet + Contact Blood and bloody body fluids,

(Airborne + Contact if pneumonia) respiratory secretions, possibly
urine and stool
Leprosy Routine Nasal secretions
Lice (pediculosis) Routine plus gloves for direct Louse
patient contact only
Malaria Routine Blood
Marburg virus Droplet + Contact Blood and bloody body fluids,
(Airborne + Contact if pneumonia) respiratory secretions
Measles (Rubeola) Airborne Respiratory secretions
• Fever, coryza,
maculopapular skin rash
• Susceptible contact Airborne Respiratory secretions

Methicillin resistant S. aureus
(MRSA)
See ARO
Mumps Droplet Saliva
Mycobacterium non- Routine
tuberculosis (atypical)
Mycobacterium tuberculosis Airborne Respiratory secretions
• Confirmed or suspected
pulmonary, laryngeal
• Extra-pulmonary: Routine
meningitis, bone, joint
infection, draining lesions
• PPD skin test positive Routine
with evidence of current
pulmonary disease
Mycoplama pneumonia Adult: Routine Respiratory secretions
Peds: Droplet
Norwalk agent
See Calicivirus
Pertussis (Whooping cough) Droplet Respiratory secretions
Plague Routine
• Bubonic (lymphadenitis)
• Pneumonic (cough, fever, Droplet • Pneumonic (cough, fever,
hemoptysis) hemoptysis)
9A-1-3
B-MD-005-000/FP-001
Rabies Routine Saliva

Roundworm
See Ascariasis
Rubella Droplet Respiratory secretions
• Acquired (fever,
maculopapular rash)
• Congenital (congenital Droplet + Contact Respiratory secretions, urine
rubella syndrome)
Rubeola
See Measles
Salmonella Adult: Routine Feces
(including Salmonella typhi) Peds: Contact
SARS Routine + Droplet + Contact Respiratory secretions and body
Airborne fluids
Scabies Contact – for extensive or Mite
Norwegian (crusted) scabies only
Tapeworm Routine
Tetanus Routine
Tinea Routine Organism in skin or hair
(Ringworm, athlete’s foot)
Tuberculosis
See Myocobactrerium
tuberculosis
Typhoid/parathyphoid fever
See Salmonella
Typhus fever Routine Insect-borne
Endemic – fleas
Epidemic – lice
Vancomycin resistant Contact Infected or colonized secretions,
enterococcus (VRE) excretions
Vancomycin resistant Contact Infected or colonized secretions,
Staphylococcus aureus excretions
(VRSA)
Varicella
See Chickenpox
Whooping cough
See Pertussis
Figure 9A-1-2 Table of Infection Control Precautions by Specific Etiology (Acute Care Centres)
9A-1-4
B-MD-005-000/FP-001
ANNEX 9B
VENTILATION SYSTEM, AIRFLOW AND OUTFLOW VALVE OF CF AE AIRCRAFT
1. During flight, the aircraft cabin becomes an enclosed environment. Fresh air is supplied into the cabin
from the engines, and is circulated by the ventilation system. One exchange of air removes approximately
63% of airborne organisms suspended in that particular space. Although ventilation capacity is dependent
on aircraft type, most large commercial aircraft provide approximately 15 to 20 air exchanges per hour
compared to 12 air exchanges per hour for most office building.
2. The use of recirculated air may reduce the air quality due to the recirculation of aerosolized
contaminants. To mitigate this, most airliners have installed high-efficiency particulate air (HEPA) filters in
their recirculation systems. These filters remove dust, vapours, bacteria, fungi, and viral particles with, in
general, an efficiency of 99.7% at 0.3 microns. CF aircraft used for AE do not have HEPA filters.
3. Figure 9B-1-1 provides data WRT aircraft ventilation and airflow.
Aircraft Ventilation Airflow

CC177 See note 4 Aft to forward
CC150 Recirculates cabin air Circumperipheral¹
CC144 Recirculates cabin air Circumperipheral and longitudinal² (aft to forward)
CC130 Recirculates cabin air Top-down and longitudinal (aft to forward)³
Figure 9B-1-1 Table of Aircraft Airflow
1 Circumperipheral: air enters the cabin from overhead distribution outlets and flows downwards in a circular
pattern towards the outflow vents along both sidewalls of the cabin near the floor.
2 Longitudinal: air circulates from the aircraft midsection to outflow valves either fore or aft.
3 The flow of cabin air can be reversed aft ward by opening the safety valve located in the rear of the aircraft. This
however, would prevent aircraft pressurization, necessitating an altitude restriction.
4 Recirculating fans in cargo compartment direct front to back when turned on, however, the airflow directed aft
is at the compartment ceiling and will eventually flow forward along the cabin floor. In normal operations, cargo
compartment air recirculates through a non-HEPA filter, and then mixes with flight deck air. 100% ambient air
(RAM air) is available if required when “hi-flow” is selected on the flight deck environmental control panel.
9B-1-1/9B-1-2
B-MD-005-000/FP-001
ANNEX 9C
AIRBORNE PRECAUTIONS
AIRBORNE
PRECAUTIONS
PATIENT PLACEMENT
3 Dedicated flight
3 As close as possible to outflow valve

MASK
3 N95 mask for medical team
3 Surgical mask for patient
GOWN / GLOVES / HANDWASHING

3 Routines Practices / Standard Precautions

PATIENT TRANSPORT
3 Draining skin lesions to be covered
9C-1-1/9C-1-2
B-MD-005-000/FP-001
ANNEX 9D
DROPLET PRECAUTIONS
DROPLET
PRECAUTIONS
PATIENT PLACEMENT
3 physical separation > 1 metre
3 lowest part of a tier

MASK
3 surgical mask, upon entry into patient’s bed space
(1-2 metres)
3 surgical mask for patient
EYE PROTECTION / GOWN / GLOVES /

HANDWASHING
3 Routine Practices / Standard Precautions

MEDICAL EQUIPMENT PLACEMENT
3 > 1 metre from patient’s bed space
3 never below patient
9D-1-1/9D-1-2
B-MD-005-000/FP-001
ANNEX 9E
CONTACT PRECAUTIONS
CONTACT
PRECAUTIONS
PATIENT PLACEMENT
3 physical separation > 1 metre
3 privacy curtain around bed space

GOWN
3 If clothing or forearms in direct contact with
the patient or frequently touched environmental
surfaces or objects
3 Upon entry into patient’s bed space (1 metre)
3 Removed before leaving the patient’s bed space
GLOVES
3 Upon entry into patient’s bed space (1 metre)
3 Removed before leaving patient’s bed space

HANDWASHING
3 With antiseptic hand rinse before leaving the
patient’s bed space
9E-1-1
B-MD-005-000/FP-001
PATIENT CARE EQUIPMENT

3 Dedicated to the patient (if possible)
3 Cleaned and disinfected before reuse with
another patient
3 Place contaminated reusable equipment in a
plastic bag for transport to soiled utility area
PATIENT TRANSPORT
3 Cover colonized / infected areas
9E-1-2
B-MD-005-000/FP-001
ANNEX 9F
RECOMMENDED INFECTION CONTROL PRECAUTIONS FOR

ANTIMICROBIAL-RESISTANT ORGANISMS
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)
1. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain

antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin,
penicillin and amoxicillin. Risk factors for MRSA acquisition include invasive procedures, prior treatment
with antibiotics, prolonged hospital stay, stay in intensive care or burn unit, surgical wound infection, and
close proximity to a colonized patient. Transmission is usually through the hands of healthcare staff.
2. MRSA infections that are acquired by persons who have not been recently (within the past year)
hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as Community
Acquired MRSA (CA-MRSA) infections. Staphylococcal or MRSA infections in the community are usually
manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.
3. Recommendations: Routine practices and contact precautions.
4. Further recommendations:
a. patients with MRSA pneumonia: add airborne precautions; and
b use of waterless alcohol-based antiseptic cleaning solutions is recommended. If there is visible

soiling, hands should be washed with soap and water before using the waterless alcohol-based hand
rinse. If soap and water are unavailable, cleanse hands first with detergent-containing towelettes to
remove visible soil.
VANCOMYCIN-RESISTANT ENTEROCOCCUS (VRE)
5. Enteroccocci are bacteria that are normally present in the human intestines and in the female genital
tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin
is an antibiotic that is often used to treat infections caused by enterococci. Most VRE infections occur in
hospitals.
6. VRE is transmitted by direct or indirect contact of hands or skin with infectious feces, urine, wound
drainage, or with areas of colonized skin. The major route of transmission is the hands of healthcare staff
following contact with patients with VRE or their immediate environment. Usually, this is associated with
inadequate handwashing.
9F-1-1
B-MD-005-000/FP-001
7. VRE colonization has been related to antibiotic therapy, duration of hospital stay, neutropenia,
malignant disease, organ transplantation, proximity to another case and sharing staff with another case.
Skin colonization with VRE is more frequent in patients with diarrhea or incontinence.
ACINETOBACTER BAUMANNII
9. Acinetobacter baumannii is widely distributed in nature and is commonly found in water and soil. It
usually infects those with compromised immune system, such as the wounded, the elderly, children, burn
victims, or those with immune disease. It is particularly common in patients who are intubated and those
who have multiple intravenous lines or monitoring devices, surgical drains, or indwelling urinary catheters.
It is a frequent cause of nosocomial (i.e., hospital-acquired) pneumonia. It can cause various infections
including skin and wound infections, bacteremia, and meningitis.
10. Colonisation poses no threat to people who are not ill, but colonized healthcare workers and visitors
can carry the bacteria into neighbouring wards and other medical facilities. Acinetobacter baumannii can
survive on dry surfaces, including those difficult to control such as cell phones and keyboards, for up to 20
days.
12. Further considerations:
a. add droplet precautions if pneumonia is suspected with productive sputum; and
b. use of waterless alcohol-based antiseptic cleaning solution is recommended. If there is visible

soiling, hands should be washed with soap and water before using the waterless alcohol-based hand
rinse. If soap and water are unavailable, cleanse hands first with detergent-containing towelettes to
remove visible soil.
9F-1-2
B-MD-005-000/FP-001
ANNEX 9G
Recommended Methods of AIRCRAFT DISINSECTION
1. The transport of live insects aboard aircraft arriving from vector-borne disease endemic areas into
non-endemic areas can have serious health and economic consequences. Accordingly, the World Health
Organization (WHO) highlights the importance of aircraft disinsection in preventing the spread of various
vector-borne diseases.
2. Aircraft disinsection refers to the measures taken to kill the insect vectors of disease and agricultural
pests present in aircraft.
3. Article 27 of the International Health Regulations (WHO), states that Member States (Canada being
one) shall disinsect aircraft using methods and procedures recommended by the WHO, unless a competent
authority determines that other methods are as safe and reliable. Competent authority being defined as an
authority responsible for the implementation and application of health measures under the International
Health Regulations.
4. The most recent WHO recommended methods for aircraft disinsection are:
a. blocks away: takes place after the passengers have boarded, the doors have been closed and prior to
take-off. The aircraft is treated with crewmembers walking through the cabin discharging approved
single shot aerosols at the prescribed dosage. Passengers should be advised prior to disinsection
to close their eyes and/or cover their faces for a few seconds while the procedure is carried out if
they feel that it may cause them any inconvenience;
b. pre-flight and top-of-descent spraying: similar to the blocks away method, except that the aircraft
are sprayed on the ground prior to passengers boarding. This allows overhead lockers, wardrobes
and toilets to be opened and properly sprayed with an aerosol containing a residual insecticide.
Pre-flight spray is followed by a further in flight spray carried out at “top-of-descent” as the aircraft
starts its descent to the arrival airport; and
c. residual spraying: involves the regular application of a residual insecticide to internal surfaces of
aircraft except in food preparation areas, at intervals based on the duration of effectiveness. In
addition, spot applications are made to surfaces that frequently cleaned.
5. Refer to the various squadrons for their respective method and product used as well as Material
Safety Data Sheet (MSDS).
9G-1-1/9G-1-2
B-MD-005-000/FP-001
GLOSSARY OF DEFINITIONS AND ABBREVIATIONS
SECTION 1
DEFINITIONS
For the purpose of this publication, the following definitions apply:
Aeromedical Evacuation (AE)

The movement of patients under medical supervision to and between medical treatment facilities as
an integral part of the treatment continuity by air transportation.
Aeromedical Training (AMT)

Academic and practical training in aviation physiology; topics include, hypoxia, hyperventilation,
trapped and evolved gases, vision and aviation stress management.
AE Crew (AEC)
An AEC is composed of one Flight Nurse and one Flight Med Tech brought together in order to
complete an AE mission.
AE Crewmember (AECM)
An AECM is a Flight Nurse or a Flight Med Tech who has successfully completed the AE Course and
is either under training, operational or restricted on the aircraft chosen for the AE mission.
Air Maintenance Engineer (AME)

Generally a civilian member with duties similar to the Flight Engineer.
Aircrew Information File (AIF)

A unit file containing official and informational aircrew information. This information is passed from
TRSET to the AESO, who then ensures that all AECMs review and “sign off” the entire AIF before
commencing flying operations.
Atmosphere Absolute (ATA)

The absolute pressure of a gas or liquid (confined) is the total pressure it exerts on the Earth's
surface and includes the effect of atmospheric pressure. At sea level the ATA is 1. If a diver descends
10 meters (33 feet) in water, the ATA pressure is 2. The ATA pressure increases by one for every 10
meters (33 feet) descended.
Aviation Life Support Equipment (ALSE)

ALSE is a broad spectrum of equipment (personal and aircraft specific) procedures, and training for
protection of aircrew and passengers engaged in aviation activities.
GL-1-1
B-MD-005-000/FP-001
Caution
Used to emphasize an operating procedure, which, if not strictly observed, could result in damage
or destruction of equipment, loss of mission effectiveness or long-term health hazards to personnel.
Combined Air Operations Centre (CAOC)

The CAOC is located at 1 Cdn Air Div and coordinates all 1 Cdn Air Div air resources. It operates on
a 24-hour basis and tasks aircraft required for AE during silent hours.
Critical Phases of Flight

The critical phases of flight include engine start, take-off, ascent up to 3,048 M (10,000 feet), descent
below 3,048 M (10,000 feet), and landing. It is during these phases that aircraft incidents and
accidents are more likely to occur and when many of the stresses of flight will have maximum
impact on patient conditions.
Decompression Illness (DCI)

Decompression illness includes both decompression sickness (DCS) and arterial gas embolism
(AGE) that may result from a reduction in ambient pressure. While bubble formation - either in situ,
in tissues or embolic is widely accepted as the initiating event in decompression illness, secondary
effects have also been described.
Decompression Sickness (DCS)

Condition resulting from a decrease in ambient pressure acting on tissues with absorbed inert gas
(N2, He, Ar), whereby the dissolved inert gas in the tissues and circulatory system evolve from
solution to form bubbles that interfere with normal tissue function. Symptoms may be mild (joint
only) or serious (involving the central nervous system).
Destination Medical Facility (DMF)

The DMF is the medical facility that will receive a patient for definitive care or rehabilitation at the
termination of an AE mission.
Do Not Resuscitate (DNR)

A written order instructing health-care providers not to attempt cardiopulmonary resuscitation.
Domestic AE
The movement of patients by air within North America.
Effective Performance Time (EPT)

EPT denotes the amount of time an individual is able to perform useful flight duties in an environment
of inadequate oxygen.
EICAS – Engine Indicating and Crew Alerting System
An integrated system used in modern aircraft to provide aircraft crew with aircraft engines and other
systems instrumentation and crew annunciations.
GL-1-2
B-MD-005-000/FP-001
Electromagnetic Interference (EMI)

All electrical equipment gives off electromagnetic emissions to some degree. These emissions
can be radiated emissions (the amount of EMI emitted by the equipment during its operation) or
conducted emissions (the amount of noise put on the power line by the device). Radiated emissions
interfere with other electrical devices that are sensitive to EMI. Conducted emissions affect other
items connected to the same power source.
Flight Engineer (FE)

The Flight Engineer is the aircraft systems expert onboard.
Flight level (FL)

A nominal altitude designation in aviation (in hundreds feet).
Flight Medical Technician (FMedTech or FMT)

A FMT is a Qualification Level 5 Medical Technician or above who has successfully completed the
AE Course at 426 (T) Squadron.
Flight Nurse (FN)

A FN is a Nursing Officer who has successfully completed the AE Course at 426 (T) Squadron.
Flight Surgeon (F Surg)

A F Surg is a Medical Officer who has successfully completed CF F Surg course (or NATO equivalent).
Floatation Equipment Deployment System (FEDS)

The FEDS is a ditching egress system incorporating life rafts of the CC177.
Forward AE
The phase of medical evacuation that provides airlift for patients between point of injury or illness
and the initial point of treatment within the area of operations.
- responsibility of the deployed commander.
Get Down Litter (GDL)

A litter set aside for ambulatory patients so they can lie down should they become fatigued during
long flights.
Get Up Seats (GUS)

A seat set aside for litter patients that are able to be seated in case of an emergency or who would
like to sit for a portion of the flight.
Gravitational (G) Forces

G forces describe the effects of acceleration and deceleration and the resultant inertial force (which
occurs in a diametrically opposite direction) on the human body. The detrimental effects of G forces
GL-1-3
B-MD-005-000/FP-001
normally take place in high performance aircraft or space vehicles, but can be experienced in any
aircraft during emergency situations. Acceleration can be of short, intermediate, or long duration
and can occur in six different directions.
Greenwich Mean Time (GMT)

See Universal Time Coordination (UTC) also know as “Zulu” time.
Hyperventilation
Hyperventilation is a condition in which pulmonary ventilation is greater than that required to
eliminate the CO2 produced by body tissues. It is characterized by dizziness, tingling of the extremities,
and, in acute cases, unconsciousness.
Hypoxia
Hypoxia is a phenomenon that occurs when there is an insufficient supply of oxygen to the body’s
tissues that could eventually lead to loss of function or death.

Litter Station Augmentation Set (LSAS)
An additional 27 litter capability for the CC177. Must be brought on board prior to the mission.
May
Used to convey that something is permissible or possible.
Medical Crew Director (MCD)

The MCD is an operational FN or FMT who is tasked to lead an AEC during an AE mission. The MCD
is responsible for the mission management that occurs during an AE mission.
Medical Information File (MIF)

A unit file containing official and informational medical information pertaining to AE such as new
procedures and recent medical articles. This information is passed from TRSET to the AESO, who
then ensures that all AECMs have read the information.
Medical Specialist Team Member (MSTM)

A medical care provider that has been selected by the AECO to augment an AEC with particular skills
the AEC needs to perform a mission.
NATO STANAG
The North Atlantic Treaty Organization abbreviation for Standardization Agreement, which sets
up processes, procedures, terms, and conditions for common military or technical procedures or
equipment between the member countries of the alliance.
Note
Is used when it is desirable to highlight a procedure, technique or practice.
GL-1-4
B-MD-005-000/FP-001
NPO
Nil per os, from Latin, means “nothing by mouth“ (fasting).
Originating Medical Facility (OMF)

The facility that originally requests an AE mission.
Patient Controlled Analgesia (PCA)
Refers to a process where patients can determine when and how much medication they receive,
regardless of analgesic technique. However, the term is more commonly used to describe a method
of pain relief which uses disposable or electronic infusion devices and allows patients to self-
administer analgesic drugs, usually intravenous (i.v.) opioids, as required.

Patient Transport Unit (PTU)
A self contained bed unit that provides life support and assistive modalities such as oxygen, suction
and electrical power for equipment.
Personal Protective Equipment (PPE)

Equipment used to protect a caregiver from potentially infectious organisms (e.g. gowns, gloves,
masks, goggles, etc.) as well as ALSE equipment used to protect AECMs in the flight environment
(e.g. walk-around bottles, vest, helmet, etc.)
PRN
Pro re nata, from Latin, means “as required”.
PSI
A unit of measurement for pressure levels denoting pounds per square inch.
QS
Quantum satis, from Latin, means “sufficient quantity”.

Rapid Decompression (RD/rapid D)
An unexpected drop in the pressure of a sealed system such as an aircraft cabin.
Remain Over Night (RON)

A scheduled or unscheduled overnight stop during any portion of an AE mission.
Security Screening
The process of examining personnel, baggage and freight to ensure no unauthorized materiel is
introduced into a secure area. This includes metal detection screening of personnel, x-ray or hand
search of baggage or other items introduced into a secure area.
GL-1-5
B-MD-005-000/FP-001
Seriously Ill/Injured (SI)

A seriously ill or injured member is a patient with an illness or injury of such a severity that there is
cause for immediate concern but the member’s life is not in immediate danger.
Shall
Will be construed as being imperative.
Strategic AE
That phase of medical evacuation that provides air transport for patients from medical treatment
facilities within the area of operations to medical treatment facilities outside the area of operations,
or between medical treatment facilities outside the area of operations.
- links tactical and domestic phases.
- sometimes called “Domestic AE” if the movement is within Canada.
Tactical AE
The phase of medical evacuation that provides intra-theatre air transport for patients between
medical treatment facilities within the area of operations.
- transport aircraft delivering supplies to forward assault airfields are re-configured for back-haul/
retrograde AE.
- interfaces with both the forward and strategic phases.

Time of Useful Consciousness (TUC)
The amount of time an individual is able to perform flying duties efficiently in an environment of
inadequate oxygen supply. See also EPT.
Toynbee Manoeuvre
A technique used to equalize ear pressure by pinching the nostrils with the thumb and forefinger
and swallowing.
Universal Time Coordination (UTC)

UTC is a high-precision atomic time standard with uniform seconds defined by International Atomic
Time (TAI), from the French name “Temps Atomique International“, is otherwise known as “Zulu”
time or “Greenwich Mean Time” (GMT). Time zones around the world are expressed as positive or
negative offsets from UTC.
Valsalva Manoeuvre (VM)

The Valsalva Manoeuvre is a method used to equalize pressure between the middle ear and ambient
air. It is accomplished by initiating a forced expiration through a semi-closed glottis accomplished
by keeping the lips closed and the nostrils pinched between the thumb and forefinger.
GL-1-6
B-MD-005-000/FP-001
Very Seriously Ill/Injured (VSI)

A very seriously ill or injured member is a patient with an illness or injury of such a severity that the
member’s life is in immediate danger.
Vital signs (VS)

Measures of various physiological statistics including, but not limited to: body temperature, pulse
rate, blood pressure, oxygen saturation and respiratory rate.
Warning
Is used to emphasize an operating or maintenance procedure, practice, condition or statement,
which, if not strictly observed, could result in injury to or death of personnel.
Will
Shall be construed as being imperative.
GL-1-7/GL-1-8
B-MD-005-000/FP-001
SECTION 2
ABBREVIATIONS
For the purpose of this publication, the following abbreviations apply:
1 Cdn Air Div 1 Canadian Air Division BM Bowel movement

BVM Bag-Valve Mask
ABC Airway, breathing and circulation
AC Aircraft Commander C Celsius
ACLS Advanced cardiac life support CA community acquired (infection)
ACSO Air Combat Systems Officer CAOC Combined Air Operations Centre
(formerly called Navigator) CAS Chief of the Air Staff
AE Aeromedical Evacuation CBRN Chemical, biological, radiological
and nuclear
AE PM AE Program Manager
CCNO Critical Care Nursing Officer
AEC AE Crew
CDC Centres for Disease Control
AECM AE Crewmember
CF Canadian Forces
AECO AE Coordinating Officer
CFAO Canadian Forces Administrative
AED Automatic External Defibrillator
Order
AESO AE Standards Officer
CFB Canadian Forces Base
AETO AE Training Officer
CFHIS Canadian Forces Health Information
AGE arterial gas embolism System
AIF Aircrew Information File CFHS Canadian Forces Health Services
ALCE Comds Airlift Control Element CFI Chief Flight Instructor
Commanders
CFP Canadian Forces Publication
ALSE Aviation Life Support Equipment
CO Commanding Officer
AMA American Medical Association
COPD Chronic obstructive pulmonary
AME Air Maintenance Engineer disease
AMT Aeromedical Training CPR Cardiopulmonary resuscitation
AOC Air Operations Centre CR Crew Rest
ARO Antimicrobial-resistant organisms CST Central Standard Time
ASIC Air and Space Interoperability CVP Central venous pressure
Council
ATA Atmosphere Absolute DAT Diet as tolerated
ATC Air Traffic Control DCI Decompression Illness
GL-2-1
B-MD-005-000/FP-001
DCS Decompression Sickness FMT Flight Medical Technician

Det COMD Detachment Commander FN Flight Nurse
DIN Drug identification number FO First Officer
DND Department of National Defence FOD Foreign Object Debris
(Canadian) FS Flight Steward
DMF Destination Medical Facility FSG Flight Surgeon Guidelines
DNR Do not resuscitate
DVT Deep vein thrombosis G Gravitational forces
g/dL grams (g) per deciliter (dL)
EA Each GDL Get Down Litter
EBS Emergency Breathing System GI Gastro-intestinal
ECAS Electrical Cable Assembly Set GMT Greenwich Mean Time
ECG Electrocardiogram GUS Get Up Seats
EICAS Engine Indicating and Crew Alerting
System HEPA High efficiency particulate air
ELT Emergency Locator Transmitter Hgb Hemoglobin
EMI Electromagnetic Interference HOB Head of Bed
ENT Ear, Nose and Throat HPMA
Human Performance in Military
EPOS Emergency Passenger Oxygen Aviation
System HSS Health Services Support
Hz hertz
EPT Effective Performance Time

EST Eastern Standard Time
IAW In accordance with
ETA Estimated Time of Arrival
ICDA International Classification of
ETD Estimated Time of Departure
Diseases, Adapted
ETT Endotracheal tube
ICP Intracranial pressure

IHR International Health Regulations
F Surg Flight Surgeon
ILOC International Lines of
FAA Federal Aviation Administration
Communication
FAES Forward Aeromedical Evacuation
IV Intravenous
Specialist

FC Flight Commander
LM Load Master
FE Flight Engineer
LSP Life Support Products
FEDS Floatation Equipment Deployment
System LSU Laerdal Suction Unit
Fl Flight Level LOX Liquid Oxygen
FIC Flight Instructor Course LPM Liters per minute
FL Flight Level LSAS Litter Station Augmentation Set
GL-2-2
B-MD-005-000/FP-001
MAST Medical Anti-Shock Trousers PCR Patient Care Record

MCA Maximum Cabin Altitude PE Pulmonary emobulus
MCD Medical Crew Director PE Tag Patient Evacuation Tag
MCSP Maintenance of Clinical Skills PEA Pulseless electrical activity
Program Peds Pediatric
MDR Multidrug-Resistant Tuberculosis PEEP Positive end expiratory pressure
PP Partial pressure
MH Mental Health PPD Personal Protective Device(s)
MIF Medical Information File ppm Parts per million
mls millilitres PPO2 Partial pressure of oxygen
mm millimetre PPE Personal Protective Equipment
MMEP Major Medical Equipment PRB Progress Review Board
Procurement
PRL Primary Reserve List
MO Medical Officer
PRN Pro re nata (latin)
MRSA Methicillin-Resistant
PSU Passenger Service Unit
Staphylococcus Aureus
PTU Patient Transport Unit
MSDS Material Safety Data Sheets
MSTM Medical Specialist Team Member
QS Quantum satis or Quantum sufficit
MST Mountain Standard Time
MTF Medical Treatment Facility
RAF Royal Air Force
RBC Red Blood Cell(s)
n/a not applicable
RCC Rescue Coordination Centre
NATO North Atlantic Treaty Organization
RD/rapid D Rapid Decompression
NG Nasogastric
RFDS Royal Flying Doctor Service
NOK Next of Kin
ROM Range of Motion
NPO Nil per os (latin)
RON Remain Over Night
NPSC National Passenger Service Centre
RPE Report of Patient Evacuation
NS Normal saline
RUET Rotary Underwater Egress Training

RW Rotary Wing
O2 Oxygen

OC Officer Commanding
S&S Signs and symptoms
OMF Originating Medical Facility
SARS Severe Acute Respiratory

Syndrome
P&G Policy and Guidance
SCUBA Self-contained underwater
PAX Passenger
breathing apparatus
PCA Patient Controlled Analgesia
SERE Survival Escape Resistance Evasion
GL-2-3
B-MD-005-000/FP-001
SI Seriously Ill/Injured
SN Service number
Sqn Squadron
SSO Senior staff officer
STANAG Standardization Agreement (NATO)

TB Tuberculosis
TBI Traumatic brain injury
TM Team Member
TMDB Team Management of Disruptive
Behaviour
TRSET Transportation Rescue Standards
Evaluation Team
TUC Time of Useful Consciousness

UN United Nations
URI Upper respiratory infection
U.S. United States (of America)
USAF United States Air Force
UTC Universal Time Coordination

VHC Valve, hose and communication
VM Valsalva Manoeuvre
VRE Vancomycin-Resistant Enterococci
VS Vital signs
VSA Vital signs absent
VSI Very Seriously Ill/Injured
WComd Wing Commander

WG Ops Wing Operations
WHO World Health Organization
XDR Extensive Drug Resistant Tuberculosis
Z zulu – Greenwich Mean Time (GMT)
GL-2-4
B-MD-005-000/FP-001
DISTRIBUTION LIST
Cas Med Adv/SSO AE

Div Surg/AE PM and AECO
TRSET SE 6-3
CF AE Flt
426(T) Sqn M Flight
DL-1-1/DL-1-2

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l B-MD-005-000/FP-001

COMMANDER 1 CANADIAN AIR DIVISION

AEROMEDICAL EVACUATION MANUAL

(Supersedes CFACM 12-200 dated 1998-07-31)

Issued on the Authority of the Chief of the Defence Staff

OPI: Aeromedical Evacuation Program Manager 2011-05-12

List of Effective Pages

Dates of issue for original and changed pages are:

Original ................... 0 ................ 2011-05-12 Ch ............................ 3 ................

Page No. Change No. Page No. Change No.

Page No. Change No. Page No. Change No.

1. The Canadian Forces Aeromedical Evacuation Manual B-MD-005-000/FP-001 (CF AE Manual), is

AE Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-1

ANNEX 1A – BIBLIOGRAPHY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1A-1-1

CHAPTER 2 – FLIGHT PHYSIOLOGY AND AEROMEDICAL EVACUATION. . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1

Section 1 – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1

Flight Physiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1

LAWS OF PHYSICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-1

GAS LAWS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1-2

Section 2 – Stresses of Flight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-1

Anxiety / Apprehension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2-5

CHAPTER 3 – AIRCREW / FLIGHTLINE SAFETY AND REGULATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-1

Section 1 – Aircrew Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-1

Environmental Clothing and No-Go Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1-1

Section 2 – Flightline Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-1

Flightline Security and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2-1

Section 3 – In Flight Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-1

AECM Personal Protective Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3-1

CHAPTER 4 – AEROMEDICAL EVACUATION crewmember TRAINING & STANDARDS. . . . . . . . . . . . . 4-1-1

Section 1 – General Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1-1

Maintenance of Aircrew Categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1-2

Section 2 – General Training Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2-1/4-2-2

AESO Statement of Duties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3-1

Section 4 – AETO Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4-1/4-4-2

AETO Statement of Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4-1/4-4-2

Section 5 – MCD Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5-1

MCD Statement of Duties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5-1

Section 6 – Medical Specialist Team Member Duties and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . 4-6-1

Section 7 – Other Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7-1

Proficiency and Category Checks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7-1

CHAPTER 5 – MISSION MANAGEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1

Section 1 – General. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1

Aeromedical Evacuation Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1-1

Section 2 – Aeromedical Evacuation Coordinating Officer (AECO) . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2-1/5-2-2

AECO Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2-1/5-2-2

Section 3 – Patient Categorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3-1

Patient Priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3-1

Section 4 – Composition of AE Crews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4-1/5-4-2

Section 5 – Medication Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5-1/5-5-2

Section 6 – Mission Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6-1

Aircraft Availability and Mission Timings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6-1

Section 7 – Briefings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1

GENERAL BRIEFINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1

The Pre-flight Briefing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-1

EMERGENCY BRIEFINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-2

SPECIAL BRIEFINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-4

LITTER BEARER BRIEF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7-4

Section 8 – Preparation for Aeromedical Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8-1

Section 9 – Emplaning and Deplaning Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9-1

MISSION DOCUMENTATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-1

PATIENT DOCUMENTATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10-8

Section 11 – Medical-Legal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-1

REMAINING OVERNIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11-5