Thank you for your interest in the EAGLE III Helicopter Ride-Along Program

Applicants must meet the following criteria:

• Must be 18 years of age
• Must be employed or volunteer with a healthcare, law enforcement, or fire agency  

To initiate the application process, please fill out the application form, review and complete the Observer Confidentiality and Release Agreement, as well as the Ride Along Questionnaire. In addition to completing the online form, applicants will need to complete the Air Methods Waiver of Liability. This would need to be completed a minumum of 1 week prior to the ride-along experience. 

Applicants must also understand that completion of the application does not guarantee participation in the EAGLE III Ride-Along Program. Participation in the program, or a specific flight, will be determined based on total passenger and cargo weight, aircraft performance, and/or PIC decision.

When the completed information is received and accepted by EAGLE III, you will be put on a waiting list to be scheduled for your ride-along date. You will be contacted as these dates become available. Please be patient, as we will do our best to schedule your date as quickly and conveniently as possible.

Should you require further assistance, feel free to contact us at ridealong@eagle3.org.

Thank you again for your interest in this program, we hope it will be a rewarding and educational experience for you.

1. Ride-along participants must be at least 18-years-old and currently active in a pre-hospital or emergency/critical care field or a student of these fields above.
2. Applications will only be accepted when all materials are received.
3. Participation will be on an ‘observation basis only’ with no involvement with patient care responsibilities. Participants will be under the direct supervision of the flight crew and pilot.
4. Participants must keep all patient information confidential! Photo and video recording are prohibited during all legs of flight and while providing patient care. Photo and video recording are also prohibited while at referring facilities and/or scenes. Cell phones to be completely off during any flight, while in the presence of the patient, and while at a referring facility.
5. Riders will refrain from using social media to discuss their ride-along experience. This includes the use of Facebook, Myspace, Twitter, YouTube, and any other such social networking.
6. Ride-along participants must not have any physical, emotional, or mental condition that may compromise their well-being or the well-being of the patient, flight crew, pilot, or the completion of the mission. Examples of such conditions may include but are not limited to: a propensity for motion sickness; current sinus congestion; currently experiencing a communicable sickness or disease; uncontrolled anxiety attacks; uncontrolled claustrophobia, cardio or pulmonary or other conditions worsened by reduced atmospheric oxygen levels (e.g., higher altitudes); muscular/skeletal issues adversely affected by rapid accelerations or decelerations and sudden or rapid direction changes (positive or negative g-forces on the body); using medications having restrictions on use while flying as a passenger; using any controlled substances without a prescription; using any illegal drug or substance. If any of these or similar conditions exist, the participant must discuss these conditions with the ride-along program administrator to determine what reasonable accommodations, if any, may be available to allow participation in the program.
7. Orientation and safety training will be held on the day of the scheduled ride-along prior to any flights.
8. All participants are asked to dress appropriately in EMS uniform or dark cargo style pants, work shoes/boots, and a plain clean shirt (no logos.) Boots must provide ankle support. No low cut t-shirts. Absolutely no open-toed shoes/sandals, dress shoes with a heel, or tennis shoes will be permitted per safety standards.
9. Ride-along participants must be aware that aircraft weight limitations, the need for special teams, weather conditions, etc. may prohibit participation on certain flights.
10. We recommend bringing reading material or something to work on in the event the flight crew is involved in patient charting, etc.
11. Participants will be required to pay for their own meals. A microwave and refrigerator will be available should you choose to bring your own food. Breaks will be provided as schedule allows.
12. Please park in the parking lot at the front of the operation building. Upon entering that build the duty supervisor will direct you to the crew.
13. EAGLE III is not responsible for lost or stolen articles. Please place personal items in a secure location.
14. Following the completion of the ride-along shift, participants will be asked to complete and return the ride-along evaluation form. Questions and suggestions are welcome.
15. In order to accommodate many different agencies, EAGLE III may defer
    requests from individuals who live outside of our immediate referral area.
16. Once you have completed a flight with direct patient contact you will be unable to ride along in the future.

I am aware of the inherent dangers of participating in the EAGLE III Ride-Along Program (the "Program") including, but not limited to, sudden death or injury caused by a helicopter crash, turbulence, rough landings, or other operations of the helicopter involved.

I am aware of the possibility of exposure to infectious diseases, specifically, but without limitation, those transmitted by blood (such as Hepatitis B and HIV) and air (such as Tuberculosis and Chickenpox) because of my participation in the Program. I am familiar with standard infection control procedures and will have gloves in my possession and will be aware of and know the location of other personal protection equipment that may be required by me to help prevent infection by infectious diseases. I will receive a preflight briefing and emergency evacuation training from EAGLE III and I understand the briefing and training given. During my participation in the Program and at all times, I agree to follow prudent procedures to minimize the risk of injury and infection by infectious diseases in accordance with my independent training and instructions by EAGLE III staff.

If I am injured in my participation in the Program, I hereby instruct EAGLE III to secure and/or provide appropriate medical care to me. 

While I am participating in the Program, I will acquire knowledge concerning the private matters of those with whom I come in contact, including, but not limited to, patients, families, fellow health care professionals, EAGLE III, and various other institutions and organizations. This relationship between me and those with whom I come in contact on a professional basis is considered strictly confidential and, therefore, I will not divulge any such private matters to anyone, except to EAGLE III and any other medical professional for the appropriate treatment of patients with whom I have come in contact with the Program.

I further agree to the following guidelines, which are not intended to be exhaustive:

1.             Regardless of my level of expertise in the medical field, I will remain an observer only and will not provide medical services to any patient during any patient transport during my participation in the Program.

2.             I will not discuss with anyone a patient's medical condition or any private matters learned or observed while participating in the Program except as allowed in this Agreement.

3.             I will not disclose or release at any time any patient information to the patient, to the patient's family, the media, or any legal professionals or anyone else, except as allowed in this Agreement.

4.             I will not view the medical or administrative records of the patient or of EAGLE III. 

5.             I will not remove, video, photograph, or photocopy any medical records pertaining to any patient transported by EAGLE III.

                I understand that a failure to comply with the above-stated guidelines or other guidelines that may be communicated to me by EAGLE III shall be considered grounds for my immediate dismissal from the Program.

                This Agreement is binding on me, my heirs and beneficiaries, personal representatives, successors and assigns, and anyone else claiming under or through me and inures to the benefit of EAGLE III, its successors and assigns, insurers and affiliated organizations.

                I certify that I have read this Observer Confidentiality and Release Agreement and that I understand its terms. I also acknowledge that it was my responsibility to contact the Ride-Along program director if I had questions about this Agreement or about the Ride-Along program, or about any other documents or agreements provided to me by Eagle III. I acknowledge that if I did contact the program director, that explanations and answers have been provided to my satisfaction.

                I understand that EAGLE III would not allow me to participate in the Program but for my execution of this Agreement, and I further understand that by executing this Agreement I am giving up certain rights I might otherwise have against EAGLE III including my right to file suit for personal injury and the right of my estate to file suit for wrongful death, among other things, and I willingly and knowingly waive those rights in exchange for the opportunity to participate in the Program.

I fully understand and accept the risks involved in the Program and wish to participate in the program because of the personal benefits the Program will provide to me, notwithstanding those risks.

ACCORDINGLY, I HEREBY RELEASE AND HOLD HARMLESS AEGIS GROUP, INC.  AND THEIR RESPECTIVE DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, SUCCESSORS, AND AFFILIATED COMPANIES, ATTORNEYS AND CO-SPONSORING HOSPITALS (ST. VINCENT AND BELLIN) OF AND FROM ANY AND ALL DAMAGES, CLAIMS, JUDGMENTS, AWARDS, COSTS, FEES, INCLUDING ATTORNEYS' FEES, AND ANY OTHER CLAIMS OF ANY NATURE WHICH MAY RESULT FROM OR BE RELATED TO MY PARTICIPATION IN THE PROGRAM WHETHER SUCH PARTICIPATION IS RELATED TO IN-FLIGHT ACTIVITY OR OTHERWISE.

I understand that EAGLE III provides services to patients that are private and confidential and that I must respect and maintain the privacy rights of EAGLE III’s patients. I understand that it is necessary, in the rendering of EAGLE III’s services, that patients provide personal information and that such information may exist in a variety of forms such as electronic, oral, written, or photographic and that all such information is strictly confidential and protected from improper use and disclosure by federal and state laws.

I agree that I will comply with all confidentiality and security policies and procedures set in place by EAGLE III during my experience as a student/guest/trainee with EAGLE III. If at any time I knowingly or inadvertently breach the patient confidentiality or security policies and procedures, I agree to notify the Privacy Officer of EAGLE III immediately.

I also understand that I may be exposed to other confidential or proprietary information of EAGLE III and I agree not to reveal any of that information to anyone at any time.

In addition, I understand that a breach of patient confidentiality will result in the immediate revocation of the privilege to gain clinical experience or observe the activities of EAGLE III. Upon termination of this privilege for any reason, or at any time upon request, I agree to return any and all patient confidential information in my possession. I understand that any patient or confidential information that I see, hear, or obtain while a student/guest/trainee will stay here at EAGLE III when I leave at the end of my ride-along shift.

I agree to abide by all policies or my privilege to participate in clinical activities or otherwise observe EAGLE III activities will be revoked.

I,{name},request permission to ride along in an Air Methods Corporation helicopter. In consideration for being granted permission to ride in an Air Methods Corporation helicopter, I hereby indemnify, hold harmless, release, and discharge Air Methods Corporation and any of its officers, employees, and agents from any and all claims, losses, or liabilities to me, my employer, my assigns, my heirs, my executors, and personal representatives now and forever, by reason or on account of injury to myself or my property, whether by reason of accident, intent or neglect during such time that I am in a vehicle or aircraft owned or operated by Air Methods Corporation, or in the company of an officer, employee, or agent of Air Methods Corporation who is discharging his/her duties, and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullest extent allowed by law.

In addition, I agree to indemnify and hold harmless Air Methods Corporation, its employees, agents, and assigns for any and all claims, losses, or liabilities which arise as a result of my conduct, whether it be intentional, negligent, or accidental while I am a participant in the Ride-Along Program, including, but not limited to such times that I may be in an Air Methods Corporation helicopter or in the company of an officer, employee, or agent of Air Methods Corporation while she/he is acting or discharging his/her duties on behalf of Air Methods Corporation.

I further agree to abide by all rules and regulations applicable to the Ride-Along Program. I have been advised, and am aware of the risks and dangers associated with emergency medical transport, and I am aware that such activities include the risk of injury and even death and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to my property and me. I agree to respect the confidential nature of all information with regard to patients and transports and to comply with the confidentiality policies and procedures established by Air Methods Corporation which have been provided to me. I understand that Air Methods Corporation provides emergency medical services to patients and will respect the privacy rights of the patients.

I assume all risks of death, injury, loss, or damages to my person or property, whether due to accident or neglect, and neither I nor any of my representatives shall have any claim against Air Methods Corporation, its officers, or employees, by reason of my death, injury, loss, or damage.

IN SIGNING THIS AGREEMENT, I CERTIFY THAT I HAVE CAREFULLY READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Every reasonable effort will be made to try an accomodate your request for dates. Many factors contribute to whether a helicopter flight can occur. As such, we cannot gaurantee that your choice of dates can be accomodated. 

My signature on this form certifies that this ride-along application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. I further understand that a condition of my acceptance and continued participation in the Ride-along program is that I must agree to adhere to the rules and guidelines of the program, known or unknown tome at this time, and that I will abide by the directions and instructions given to me by the flight crews and pilots while on missions. By signing and submitting this application, I agree to the foregoing condition of participation and I agree to abide by and adhere to all rules and guidelines of the program presently known by me or disclosed to me in the future.