I spent three years as a Life Flight pilot flying MU
-2s, Conquests, Cheyennes, and Citations. I assure you that we were "Lifeguard" whether we were carrying patients or organs. We were "Lifeguard" when we were rushing outbound to the outlying airport to pickup the patient and we were "Lifeguard" when we had the patient on board for the return flight.
We were even "Lifeguard" a few times when we didn't need or want to be "Lifeguard". The controllers got so used to our call signs being associated with Lifeguard that there were times when we were doing training flights and ATC initiated the Lifeguard call for us. Each time we told them that we were negative Lifeguard today and they replied "roger, Lifeguard..." After a few times of telling them that we weren't Lifeguard we just gave up and took the priority.
Lifeguard flights get special handling and priority on departures, routes, and arrivals. You basically tell them what you want and if there's any way possible, ATC will give it to you. It's like running around in an ambulance with the lights and siren. ATC is very accommodating.
I had the opportunity to take a controller along with us on a "Fam(iliarization) Ride". Some controllers had been questioning our need for priority handling and we offered them a chance to ride along on a "typical" mission. The trip that I flew this guy on was wild. The patient "crashed" mid-flight and the medical team had blood and stuff all over the cabin. They were hitting him with the paddles. It was really intense. We ended up making a "balls to the wall" straight-in approach against the traffic at SLC
during the evening rush. ATC had aircraft backed up from SLC
to Mormon Mesa until we were down and clear. Needless to say, that poor controller saw first hand what can happen during a Lifeguard transport. I guess that he put the word out, from that time on we always got what we wanted from SLC
ARTCC and like I said in the beginning - we got it even when we didn't want it.