HAA Volunteer Application

Clinical Flight Crew Volunteer Application

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* 1. To volunteer for Haiti Air Ambulance you must have a minimum of 2 years of rotor wing air medical experience. You must be currently employed by, or have been employed within the last year by a rotor wing air medical service. CAMTS Accreditation is preferable. Current licensure in your home state, ACLS, PALS, BLS, and a trauma course are mandatory.

Your application will be reviewed, and potential candidates will asked to conduct a phone interview. Once that screening is complete, candidates will be asked to provide references and copies of all certifications and valid passport. A negative COVID test less than 72 hours old is required for entry into the country. Volunteers will be tested on arrival to HAA as well.

Haiti Air Ambulance provides transportation to Haiti, transportation while in country, housing and meals. Volunteers are responsible for any needed vaccinations, COVID testing, and repatriation insurance.

Volunteers are selected for their ability to operate in a highly uncontrolled environment with no back up resources available. Haiti Air Ambulance has broad Clinical Guidelines and provides care at or above US flight program standards, with RSI, chest tubes, U/S, HFNC, Revel ventilators, etc.

I understand the requirements to apply for a volunteer position with HAA

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* 2. Name:

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* 3. Phone

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* 4. Email

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* 5. I reside in

U.S.A

Canada

A Caribbean nation

Other (please specify)

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* 6. Have you volunteered with Haiti Air Ambulance in the past?

Yes

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* 7. If yes, when was the last time (month / year) you volunteered with Haiti Air Ambulance?

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* 8. Do you have at least 2 years of rotor wing air medical transport experience?

Yes

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* 9. Have you ever, volunteered, worked in, or lived in Haiti in the past?

Yes

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* 10. I am

Currently employed full time with a rotor wing air ambulance

Have been recently employed full time with a rotor wing air ambulance (within 1 year)

I am employed part time with a rotor wing air ambulance

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* 11. How many years experience total do you have with rotor wing air ambulance transport?

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* 12. My current (or most recent) rotor wing air ambulance employer is:

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* 13. Do you have a current Passport this is valid for at least 6 months?

Yes

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* 14. If you do not have a current Passport, are you in the process of obtaining one?

I have a valid Passport

I have applied for my Passport

I have not started the process of applying for my Passport yet

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* 15. I can commit to volunteering with Haiti Air Ambulance for a total of ________ days including travel days:

10 days

14 days

21 days or more

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* 16. I am licensed as a (select all that apply):

Registered Nurse

Nationally Registered Paramedic

Paramedic

Physician

Certified Flight Registered Nurse

Flight Paramedic - Certified

Respiratory Therapist

Primary Care Paramedic

Critical Care Paramedic

Advanced Care Paramedic

Other (please specify)

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* 17. I am current in the following certifications (select all that apply):

ACLS

BCLS

PALS

NRP / STABLE

Advanced Trauma Course (TPATC, ATLS, etc)

Basic Trauma Course (PHTLS, BTLS)

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* 18. Are you able to (check all that apply):

Purchase short term Medical Repatriation Insurance for your volunteer trip?

Provide a COVID-19 negative test completed 72 hours or less prior to travel to Haiti?

Obtain recommended vaccinations prior to traveling to Haiti?

Provide Haiti Air Ambulance with a current resume or CV?

Provide Haiti Air Ambulance with copies of current licenses and certifications?

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* 19. How did you learn of volunteer opportunities with HAA?

Word of mouth

Social Media

HAA Website

Other (please specify)

HAA Volunteer Application

Clinical Flight Crew Volunteer Application

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* 2. Name:

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* 3. Phone

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* 4. Email

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* 5. I reside in

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* 6. Have you volunteered with Haiti Air Ambulance in the past?

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* 7. If yes, when was the last time (month / year) you volunteered with Haiti Air Ambulance?

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* 8. Do you have at least 2 years of rotor wing air medical transport experience?

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* 9. Have you ever, volunteered, worked in, or lived in Haiti in the past?

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* 10. I am

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* 11. How many years experience total do you have with rotor wing air ambulance transport?

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* 12. My current (or most recent) rotor wing air ambulance employer is:

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* 13. Do you have a current Passport this is valid for at least 6 months?

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* 14. If you do not have a current Passport, are you in the process of obtaining one?

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* 15. I can commit to volunteering with Haiti Air Ambulance for a total of ________ days including travel days:

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* 16. I am licensed as a (select all that apply):

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* 17. I am current in the following certifications (select all that apply):

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* 18. Are you able to (check all that apply):

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* 19. How did you learn of volunteer opportunities with HAA?

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* 20. Briefly explain your interest in volunteering with Haiti Air Ambulance as a clinical flight crew member:

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* 21. What dates would you be available to come volunteer if selected?

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* 22. What is your flight-ready weight in pounds?