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Flying high to save lives


Flight nursing offers rewards that few other nursing jobs can match. Across the globe, patients are transported from accident scenes or between healthcare facilities every day. Most medical transport is provided either by a hospital or other healthcare entity or by a stand-alone program. Both types of organizations hire flight nurses. The focus of the mission depends on the location and type of aircraft used. Flight nurses may work on helicopters (rotor-wing aircraft) or airplanes (fixed-wing aircraft).

Military origins

The field of flight nursing originated in the military, which provided specialized training to Army Air Corps nurses during World War II so they could accompany wounded soldiers during transport from forward surgical hospitals to tertiary facilities. Today, military flight nursing is a highly specialized practice area within the armed forces branches.

As the civilian air medical transport industry evolved, civilian flight nursing gained prominence. Large tertiary-care hospitals and trauma centers began stationing helicopters on their rooftops to provide fast access to a higher level of care. In the United States today, nurses provide patient care during transport on more than 800 helicopters and scores of airplanes.

A demanding field

Flight nursing requires excellent communication and critical-thinking skills. The ability to communicate effectively and show leadership in a stressful environment is just as critical as providing proficient care. Flight nurses must be able to interact with various individuals and disciplines within the healthcare, public safety, aviation, and law enforcement communities.

The physical demands are daunting, too. The stressors of flight, fatigue, environmental extremes, and physical exertion can take a toll. Some organizations require flight-nurse applicants to pass a pre-employment physical agility test. Many have height and weight requirements that applicants must meet and maintain while employed.

Helicopter vs. airplane transport

Most, if not all, helicopters are capable of performing “scene” work—landing at an accident scene for quick access to patients. They can also perform transports between healthcare facilities.

Airplanes, on the other hand, can perform transports only between airports but are capable of longer-distance transports than helicopters and generally have a greater ability to fly in marginal weather conditions.

Depending on the employer, flight nurses may be called on to perform both helicopter and aircraft transport or they may be limited to one transport mode. The typical patient varies with the transport mode. Helicopter-scene flights generally involve the care of trauma patients (usually adults). Helicopters or airplanes may be used to transfer adults or children with myriad illnesses or injuries between healthcare facilities. (See Special flight-transport patients.)

Career options, requirements, and roles

The typical flight nurse is an experienced clinician with at least 3 years of critical-care experience and certifications in cardiac, trauma, and pediatric acute care. Nurses interested in flight nursing generally have two avenues—join the military or build a strong résumé and explore the job market for flight nursing.

Having a broad background in critical-care or emergency nursing is the best background for a flight nurse. Other near-absolute requisites include pediatric experience, prehospital/emergency medical services (EMS) experience, and leadership experience (such as a stint as a charge nurse).

Scores of advanced certifications exist, including Advanced Cardiac Life Support (ACLS). All nurses interested in working as flight nurses must complete training in ACLS, pediatric advanced life support, and the Emergency Nurses Association’s trauma nursing core course.

Specifics of a flight nurse’s role depend on the type of aircraft, the employer, and the rules, regulations, and culture of the employer organization. All flight nurses must act as an integral part of the aviation operation. The pilot commands the aircraft; organizational and federal regulations determine exactly what the flight nurse’s role encompasses.

Advanced skills required

Subspecialties of flight nursing are highly technical and specialized. Flight nurses must have such advanced skills as airway management, central venous access, and tube thoracostomy. These skills are taught during orientation and are maintained throughout continuing education. Common training practices include the use of human patient simulators, cadavers, and animal laboratories.

Rapid sequence induction/intubation (RSI) to promote endotracheal intubation is perhaps the most common skill flight nurses perform. Administering a sedative/hypnotic and a neuromuscular blocker enhances endotracheal tube placement—but carries some risk. What’s more, RSI can be challenging outside the hospital environment.

Many procedures in the flight nurse’s skill set fall within the advanced practice nurse (APN) job description. This is a unique facet of flight nursing: Most flight nurses in the field today aren’t APNs but use APN skills every day.

A team endeavor

Medical transport is a team en­deav­or that requires the use of every available resource to accomplish the transport safely. All flight nurses must be thoroughly familiar with the specific aircraft, emergency procedures, egress, basic survival skills, navigation, and altitude physiology.

Be aware that flight nursing can be risky; the incidence of accidents involving MedEvac flights has risen lately. Most flight nurses understand that they’re working in a high-consequence environment. If you’re considering a career in flight nursing, consider the potential risk and decide if it’s acceptable to you.

Flight nursing offers the opportunity to use critical-thinking skills, function within advanced practice parameters, and care for critically ill or critically injured patients in a dynamic environment. It’s a career path worth considering for any nurse who wants to reach higher career heights.

Kevin High is President of the Air/Surface Transport Nurses Association. He has more than 23 years’ experience in acute care and 13 years’ experience as a flight nurse with Vanderbilt LifeFlight. As Trauma Program Manager for Vanderbilt University Medical Center in Nashville, Tennessee, Mr. High works with the EMS and air medical agencies that serve Vanderbilt as liaison and educator. He is also a member of the Vanderbilt University faculty, teaching trauma care, airway management, EMS, and air medical transport. Past recipient of Vanderbilt’s Rosamond Gabrielson Staff Nurse of the Year Award, Mr. High was named AAMS Medical Crew Member of the Year in 2003. He speaks to organizations and groups across the United States and Canada and works as a consultant on issues germane to transport and emergency medical care.

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