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When requesting takeoff/landing and route clearance is any priority given to Emergency Services IE air ambulances, firefighting rigs, S&R etc. I'm assuming even though these services rise to the level of life or death, they are not treated with the same urgency as an air emergency but I don't know that for fact.

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    $\begingroup$ They are not treated as an in-flight emergency, but they are given priority handling by ATC. Usually this means that they will not reroute the flight around traffic and hold other traffic to give them an earlier landing spot or get them into the pattern ahead of other aircraft. I don't know what regulations there are though for handling these flights. $\endgroup$ – Ron Beyer Jan 24 '17 at 18:44
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I work as a fixed-wing pilot for a hospital-based Air Ambulance program. Let me add my experience to the ATC orders accurately cited by Pondlife's answer: the MEDEVAC call sign (the old "Lifeguard" is still used when filing the flight plan) indicates a need for priority handling.

ATC is often helpful in providing us with priority routing. This includes giving us direct clearances, moving us up in the landing que, allowing us an unrestricted approach speed, and otherwise expediting our flight. However, ATC does not always provide priority handling, and I have often experienced ground delays of 5-10+ minutes as ATC apparently prioritizes other traffic, including air cargo and the like. This is rarely a big problem as patients are typically stable, but it can be frustrating when priority handling is expected.

However, if medical staff determine that a patient is in critical condition, we will announce this to ATC—typically accompanied by a request for a specific clearance or change to a previous clearance. This announcement re-iterates our need for priority handling and indicates the urgency of the situation. In this way we can work with ATC to best care for the patient. We will often make such an announcement when checking on with approach control for their information with no specific accompanying request. Occasionally, however, we will need to request such priority handling because ATC has issued us speed restrictions or delaying vectors to put us behind other traffic. ATC is very good at working with us when we do need the priority handling.

In other words, ATC usually automatically gives us priority handling, but when they don't—and we need it—we ask for it and they are very good at working with us to provide the priority handling.

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    $\begingroup$ can imagine why a large cargo aircraft would get priority over a non-critical medical flight. A 5 minute delay on getting it out of its parking spot can cause more delays along the line as someone else may already be waiting to park there, causing queues on the taxiways. $\endgroup$ – jwenting Jan 25 '17 at 12:07
  • $\begingroup$ @jwenting These are usually small feeder cargo aircraft that I have in mind. $\endgroup$ – J Walters Jan 25 '17 at 13:42
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    $\begingroup$ @ChrisW Declaring pan-pan would be an option for communicating an urgency situation. However, that option seems best reserved for use in situations outside of our normal sphere of operations, but would certainly be appropriate for a non-medevac flight to use in the case of medical emergency. More importantly for us, our ops manual does not direct us to use that phraseology. $\endgroup$ – J Walters Jan 25 '17 at 17:59
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    $\begingroup$ @ChrisW Pan-Pan (or even Mayday) is more likely to be used by non-emergency-services flights (i.e. normal airline flights, normal GA flights, etc.) when there's a medical emergency. It's kind of assumed that a Medevac flight has a medical emergency... otherwise they wouldn't be using the callsign "Medevac" in the first place. $\endgroup$ – reirab Jan 25 '17 at 19:34
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    $\begingroup$ @CGCampbell Yes, that is correct. But it is worth noting that a patient need not be aboard to warrant the callsign and accompanying urgency. The callsign is also for use whilst enroute to pick up a patient. I do not, however, use the callsign on an empty return flight after dropping off a patient. $\endgroup$ – J Walters Jan 26 '17 at 2:54
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In my experience, yes they will hold for emergency related vehicles. I fly out of KPNE often, where a lot of the Philly Police and Emergency choppers are kept. I have been held for their takeoff before. I don't know if this is regulation or simple courtesy but I can assure you it happens.

On a similar note, I once spoke to the designer of the Philly Bravo airspace about this very issue. He explained that when the airspace was redesigned (a few decades ago now) the shelves were deliberately placed so that all of the hospital helipads were accessible without entering the bravo. Basically the emergency choppers can come and go with out clogging ATC for clearance in and out of the Bravo.

In uncontrolled airspace this is not really an issue and emergency helicopters will rarely go into class A. So this leaves you with Class B, C and D departures and arrivals. In the case of Philly the helicopters are stored at a less busy airport outside of the bravo for operations commonly under the shelf. This most likely varies heavily from place to place and their may be arranged understandings in different Bravo's.

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(I'm assuming you're asking about the US, based on your profile.)

The FAA's ATC orders section 2-1-4 has a list of aircraft operations that should be given priority, including emergency service flights, but an aircraft in distress always has the highest priority:

Provide air traffic control service to aircraft on a “first come, first served” basis as circumstances permit, except the following:

[...]

a. An aircraft in distress has the right of way over all other air traffic

[...]

b. Provide priority to civilian air ambulance flights (call sign “MEDEVAC”). Use of the MEDEVAC call sign indicates that operational priority is requested. When verbally requested, provide priority to AIR EVAC, HOSP, and scheduled air carrier/air taxi flights. Assist the pilots of MEDEVAC, AIR EVAC, and HOSP aircraft to avoid areas of significant weather and turbulent conditions. When requested by a pilot, provide notifications to expedite ground handling of patients, vital organs, or urgently needed medical materials.

Other flights that get priority are presidential ones, search and rescue etc.

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    $\begingroup$ presidential flights would likely lead to a temporaty NOTAM and closed airspace around the time of arrival and departure (and in extreme cases presence), the ultimate priority clearance as he'd be the only aircraft in the pattern :) $\endgroup$ – jwenting Jan 25 '17 at 12:09
  • $\begingroup$ @jwenting Yeah, when I read this I was thinking 'priority' is quite the understatement to describe handling of Presidential transport flights. They get a TFR to mostly shut down the airspace and movement of everyone else on the field stops. $\endgroup$ – reirab Jan 25 '17 at 19:37
  • $\begingroup$ However, even under a 'Presidential TFR', a justified MEDEVAC flight can still fly, yes? $\endgroup$ – CGCampbell Jan 26 '17 at 2:47
  • $\begingroup$ @CGCampbell I'd guess if it were critical enough, but they'd no doubt try to accommodate through other means (maybe get an air force gulfstream in with a military crew. $\endgroup$ – jwenting Jan 26 '17 at 7:16
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    $\begingroup$ @CGCampbell If you look at the text of VIP TFRs, air ambulance flights typically are or could be authorized. For example FDC 7/5997: medevac/air ambulance flights on active missions; or FDC 7/7287: approved air ambulance flights. [...] All emergency/life saving flight (medical/law enforcement/firefighting) operations must coordinate with ATC prior to their departure [...] to avoid potential delays. $\endgroup$ – J Walters Jan 26 '17 at 19:42

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