In times past, when flying medevac, I used the lifeguard callsign with, and without a patient on board.

The purpose of the lifeguard callsign (nee, "medevac' today) is to notify ATC of the nature of the flight and to streamline the flight to minimize delays.

Many, if not most medevac flights are not emergencies, and yet with a patient on board, allow legitimate use of the callsign.

I have done a lot of medevac flights, however, that involved multi-casulaty incidents, and required multiple return trips for patients. In those cases, the flight was expedited from pickup to delivery, but also a return without a patient, given that I had more to pick up.

I've flown through the middle of a very traffic-dense red flag exercise with Nellis Range Control's assistance in such cases, lifeguard each way, and priority handling, and woiuld absolutely do it again in a heartbeat. Good luck finding a soul at the FAA who would fault the decision.

Further, I've used the callsign with non-critical patients on board, and on administrative transports. The mere fact that the patient is on board with a complement of emergency medical professionals, and not on a ground ambulance or a charter, is reason enough to accept that the patient may need more support.

I learned the hard way, a long, long time ago, when transporting a patient without a nurse or medic, on what was supposed to be a simple pickup and drop for a patient who had been to a hospital for some testing. I was dispatched to return the patient, who was not advetised as being in need of any medical support. I didn't use the callsign. The flight was to a remote location on a very large Indian reservation, and enroute, the patient lost consciousness and I had to divert. Turns out the patient was being seen for heart complications. I made the divert with the patient, a mere passenger at the time, in the front seat next to me, working on the passenger (now patient) as I diverted.

I didn't make that assumption again. The fact that someone was being transported in a medical aircraft, whether I was told they were simply a passenger on a charter flight or not, made it a medevac flight. I've had patients code or otherwise take a turn enroute on a number of occasions with everything from an axe to the face to gunshot wounds, burns, etc, and I make zero assumptions when it comes to carrying someone on a medical aircraft, regardless.

Likewise, that aircraft may no longer have a patient on board, but it's still a medevac aircraft, either returning to base, or going to another scene or location for a pickkup or transport, and when it returns to service as available after a drop, it may be needed again shortly thereafter. That the patient was just dropped doens't negate the nature of the aircraft, operation, or the potential next. I lost track of the number of times, as I approached a duty limit, I had to rush the aircraft to the next pilot to take another call, or to a meeting point for the next pilot, or in some cases, I had to get out and let someone take the aircraft from there, to another call. Simply because you think you know the aircraft has dropped their patient, don't assume that aircraft isn't needed somewhere either for hot standby, at a scene, at a pickup, or for any number of other reasons, right away, and that callsign is legitimately used to recognize that flight.

Same thing when going to a fire. Over the years, there have been hundreds of occasions when I wasn't carrying retardant, but repositioning for any number of reasons, and used the callsign "Tanker xxx," and/or advised ground/clearance/tower of a fire dispatch. Enroute to the Yarnell Hill fire, I contacted Luke Approach and was given a vector around Luke's airspace. The Mic was hot and I heard one controller tell another "that's a fire aircraft," and I was subsequently cleared direct. The Yarnell Hill fire turned into the largest loss of firefighter life at the time, in many years, and we were busy. When the dispatch came through, the fire was so meager that I had to circle it to spot a whisp of smoke between the scree rocks on the back of the ridge where it started. That didn't turn it into going big, and I never assumed. The callsign is there to be used, and every dispatch was taken seriously, as it should be. You may not be seeing the whole picture. I was in the thick of it most of the time, and I seldom did.

 

I guess if ATC is suspecting that people are doing this on purpose. I’ve had to unintentionally do similar things when a passenger changes their destination. I don’t know if there was an actual flow, but I had a last minute change from OAK to SFO when SFO was busy, but the controllers made it work.

​​​​​​​90% of the time EDCTs are pretty conservative and half way to your destination, you start getting shortcuts. That’s when that tactic apparently worked.

 

Sure, I flew medevac too. But in this case it was not in any way medical in nature. Just a dirtbag who wanted to avoid a delay because he was more important than everyone else. How do I know? I was on board the aircraft flying as SIC. We had words over it both in the cockpit and later on the ground. I told the captain not to do it again. He did it again a week later and I parted ways with the company.

I put it out of my mind until I heard the call sign again over the radio recently and then a thread here reminded me to ask the question.

I've done some of the same stuff you did it sounds like. Repeatedly got cleared over Groom Lake and could look down on it. Got escorted a few times through when we were critical medevac. Saw no saucers but got some great private airshows. I love flying medevac, except for the med crews, who so many of them need mental health evals themselves. Never flew with just a patient though. That seems like, and given your experience, a big liability.