Getting above it all….Flight Nursing!

A serious motor vehicle accident has occurred in your suburban community, many seriously hurt, traffic clogged roads between the scene and the trauma center.

A man having a heart attack presents to a rural community hospital. He is given the best care available at that facility, but he needs the Cath Lab 100 miles away in the city.

Your retired grandparents are finally able to go on that Caribbean cruise. Unfortunately, the trail to the beach was a bit too steep and Grandma is now in an island hospital with a broken hip.

What do all three of these situations have in common? 

All will likely require the services of a flight nurse.

Flight Nursing

Flight Nursing is the provision of nursing care within the air transport environment. A flight nurse typically works in either a helicopter (rotor wing) or airplane (fixed wing) setting. They likely have a paramedic partner, though some organizations will pair the nurse with a respiratory therapist, another nurse, or occasionally a physician.  The medical team works closely with the pilots to get the patient safely to their destination.

Shifts

A flight nurse on a helicopter might work 12, 24 or 48 hour shifts at a base or hospital. They may be tasked with helping out with critical patients in the ER or ICU when not flying.  When notified of a flight they report to their briefing room or hangar to get whatever information is available about the patient, while the pilots plot a safe flight path and landing area. Sometimes conditions exist that might make a response unsafe. Weather, unfamiliar environments, crewmember illness, or maintenance issues are some of the reasons this might occur. Every mission must be accepted by all crewmembers in order to proceed. The common expression for this is: “Three to go, one to say no”. Dispatch to launch is often less than 10 minutes.

Fixed wing flight nursing is slightly different in that you’re not picking up a patient from the side of the road, but rather from a hospital with an ambulance providing ground transport at each end of the trip. The transport times are longer, sometimes by a couple hours, sometimes by a few days. The patients may be critically ill, requiring ventilator management, vasoactive medications, etc, but they should be stabilized prior to flight to the best of the sending facilities capability. The flight crew may assist in stabilizing patients for transport. Because of the logistics involved, dispatch to launch times might range from 30 minutes for a quick in-state hop to 24 hours for a long international flight requiring multiple fuel stops, crew changes, landing and overflight permits for multiple countries.  The logistics of planning for such missions using a very small aircraft are often more complex than the patient care aspect. “Do I have enough oxygen to care for this patient for 20-30 hours? What stops along the way can refill it?  Does the accompanying family member know there is no bathroom? How much do they weigh? How much luggage do they have?”

To become a flight nurse, the registered nurse should have 5 years of critical care experience. In the opinion of this author, a mix of ICU and ER is best, but most programs will consider a candidate with either. EMS experience is helpful and some states require flight nurses to maintain co-licensure as an EMT or Paramedic. Many programs have specialty teams for Neonatal and High Risk Obstetrical patient transport made up of staff with the appropriate background. Flight nurses enjoy an expanded scope of practice compared to their bedside colleagues and must be comfortable with the responsibility that comes with autonomy. Physician approved protocols define the scope of flight nurse practice for each organization. Some of the skills the flight nurse must master are advanced and surgical airway management, chest tube placement, arterial and central line access and escharotomy. Maintenance of these skills must be demonstrated frequently and quality care is maintained with regular case reviews and critiques by the medical director.

While clinical excellence is required for a flight nurse, interpersonal and communication skills are just as important. As every day is different with new opportunities and challenges, flight nurses must be extremely flexible and willing to adapt to new situations. The flight nurse interacts with people at some of the most stressful times of their lives, making tact critical.

Ultimately, most flight nurses find the rewards outweigh the downsides. The flight nurse gets to be the critical link between accident and surgery, between community hospitals and tertiary care. When you’ve been lying for a week in a hospital bed in Brazil or Barcelona, the flight nurse gets to walk in and say “Hi, we’re here to take you home.”

Travel assignments for Flight Nursing positions do pop up from time to time. These are usually at small rural hospitals where the flight nurse also does ER/ICU. Even such listings in places like Alaska and Montana.