UNFAMILIAR WITH NAV EQUIPMENT ABOARD HIS PA31; AIR AMBULANCE PLT IS LATE IN RECOGNIZING PRESSURIZATION FAILURE AND RETURNS TO DEP ARPT.

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ON A LIFEGUARD FLT FROM ZZZ TO ZZZ1; I GOT A CABIN ALT WARNING LIGHT PASSING THROUGH 10000 FT. I LEVELED AT 12000 FT AND NOTIFIED THE MEDICAL CREW OF THE SITUATION. BECAUSE THE CRITICAL CONDITION OF THE PATIENT; AND THE FACT THAT IN SPITE OF THE OXYGEN HE WAS RECEIVING; HIS PULSE/OXYGEN READING WAS DROPPING. THE FLT NURSE TOLD ME TO RETURN TO ZZZ. I NOTIFIED ATC OF THE PROB. HE CLRED ME TO RETURN DIRECT AT 12000 FT. I TOLD HIM I NEEDED LOWER AND STARTED A DSNDING TURN; AND TOLD HIM I COULD PROCEED VFR. (FORTUNATELY; THERE WAS GOOD MOONLIGHT TO ILLUMINATE THE HIGH TERRAIN.) DSNDING THROUGH 10500 FT; ATC ASKED ME TO CHK MY ALT; AND I REPEATED MY VFR INTENTIONS. HE THEN CLRED ME DIRECT VFR TO ZZZ. THIS WAS A PARTICULARLY CRAPPY FLT FOR ME. THE ACFT HAD A SUBSTANTIAL FUEL LEAK WHICH MAINT CHOSE TO IGNORE. THE PROP CTLS ARE GROSSLY MISALIGNED; AND THE ANTIQUATED LORAN HAD ALL THE LETTERS AND SYMBOLS WORN OFF THE CTL BUTTONS. WHILE CLBING OUT; I WAS CLRED DIRECT TO ZZZ VOR AT 17000 FT. BECAUSE I WAS STRUGGLING TO FIGURE OUT THE LORAN OP; I DIDN'T NOTICE THE CABIN ALT PROB UNTIL THE WARNING LIGHTS CAME ON. I SHOULD HAVE CAUGHT THE PRESSURIZATION SOONER. I USUALLY CARRY MY OWN GPS WITH TERRAIN AVOIDANCE FUNCTION TO BACK UP THE CRAPPY AVIONICS; BUT IT WOULDN'T WORK BECAUSE THE CIGARETTE LIGHTER WHICH I PLUGGED IT INTO WAS ALSO CRAPPED UP. I TURNED IN MY RESIGNATION TO THIS COMPANY THE FOLLOWING DAY. IN A 24-HR PERIOD; WE NEARLY KILLED 2 DIFFERENT PATIENTS BECAUSE OF OUR CRAPPY EQUIP.