Edwin Drummond, RN, never knows what kinds of cases he’ll see as a flight nurse. He might treat a young man who has lost his leg in a motorcycle accident or an elderly woman who fell down a flight of stairs or a child with severe burns. But as he straps on his helmet and steps aboard the whirring helicopter, there is one thing he does know: Someone’s life will depend on him.

With such widely varying challenges and tremendous life-and-death responsibility, a career in flight nursing or medical transport nursing isn’t for everybody. But for those nurses with the right training, experience and personality, the soaring rewards can’t be beat.

“When you fly to the scene [of an accident or other emergency], everyone’s waiting for you, and you get to intervene and save a life,” says Drummond, an African- American flight nurse for Washington Hospital Center’s MedSTAR Transport emergency medical helicopter service in Washington, D.C. “When it goes well, it makes you really feel good.”

Air medical transport dates back to 1870 when hot air balloons were used to evacuate wounded soldiers during the siege of Paris in the Franco-Prussian War, according to a history compiled by Washington Hospital Center. Later, the U.S. military’s use of planes and helicopters in World War II, the Korean conflict and Vietnam led to the development of air transportation systems for civilian medical needs. In 1972, St. Anthony’s Hospital in Denver, Colo., began “Flight for Life,” the first dedicated hospital-based air transport service. Today more than 300 such services in the United States help save people’s lives.

The standard flight crew on a medical transport helicopter or airplane typically includes a pilot, a paramedic and a nurse; additional crew can be added when necessary. A small percentage of air transport services employ doctors as part of their flight crews. The crews transport patients from one hospital to another as well as fly to scenes of accidents and disasters.

A Rising Demand

Demand for flight nurses is growing, says May Wykle, RN, PhD, FAAN, FGSA, dean of the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, which in 2002 launched the nation’s first degreed program for training flight nurses. With the reorganization of the health care industry, fewer medical facilities offer critical care and trauma services, Wykle notes. As a result, more air medical personnel are needed to transport patients to centers that offer specialized care.

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Today’s air transport services are more than just fast ambulances, says Professor John Clochesy, RN, PhD, FAAN, FCCM, one of the directors of the university’s National Flight Nurse Academy. Instead of just maintaining the patients during transport, advanced practice flight nurses make onsite diagnoses and treatment decisions, providing care before the patients get to the hospitals.

Adds Wykle: “The whole idea is to get treatment started as soon as possible.”

In this role, flight nurses have greater autonomy than hospital nurses. Working under protocols, they decide which medications to give, how fast to give them and what other treatment to provide.

“We don’t have a physician in the back of the helicopter telling us what to do,” says Robert Sanchez, RN, a flight nurse and outreach and education coordinator for AeroCare in Lubbock, Texas, a service owned by Covenant Health System. “We have to take our knowledge base and put that to use.”

This independence is a key drawing point, believes Ann Lystrup, RN, BSN, CFRN, CEN, CCRN, a flight nurse for the University of Utah Medical Center in Salt Lake City and president of the Air & Surface Transport Nurses Association (ASTNA).

In contrast to many specialties hit hard by the nursing shortage, flight nurse job openings attract lots of applicants. “It’s very competitive because it’s a dream job,” explains flight nurse Pauline “Butch” Ignacio, RN, BSN, MBA, CCRN, CFRN, NNP, perinatal and neonatal clinical coordinator for Guardian Air in Flagstaff, Arizona.

Getting Your Career Off the Ground

Most flight nursing programs require a license as a registered nurse, at least two to three years of critical care experience and/or an Advanced Cardiac Life Support certificate and Pediatric Advanced Life Support certificate, according to ASTNA. In addition, the association says, some flight services may require completion of a neonatal resuscitation program, a nationally recognized trauma program and certification as a Critical Care Registered Nurse (CCRN), Certified Emergency Nurse (CEN) or Certified Flight Registered Nurse (CFRN). Some states also require flight nurses to be certified as Emergency Medical Technicians (EMTs) or paramedics.

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“The more well-rounded you are, the better,” Ignacio agrees. She is a certified paramedic, a neonatal nurse practitioner and has experience working as a critical care nurse in the ICU and with coronary patients. She also earned an MBA to get a solid business background for management.

MedSTAR Chief Flight Nurse Allen Wolfe, RN, CFRN, TNATC, advises nurses interested in air medical transport to get ICU experience in larger hospitals, where there are more opportunities to work with sicker patients and better technology than in small hospitals. ICU settings provide broader experience than emergency rooms, he adds.

Flight services themselves train their staffs in how to work aboard helicopters and planes. But conferences also offer hands-on training, such as the Critical Care Transport Medicine Conference in the spring and the Air Medical Transport Conference in the fall. Case Western Reserve University, meanwhile, offers a summer training camp through its National Flight Nurse Academy. Open to nurses, physicians, pilots, firefighters and paramedics, the camp provides training exercises to prepare teams for treating critical patients in unstructured environments, such as those following disasters.

It takes more than the right training and experience, though, to thrive in flight nursing. Nurses must also have the confidence to carry out and live with their decisions. Afterward, it’s OK for nurses to question themselves as long as that questioning is productive, Lystrup says. They can’t let that self-questioning eat them alive.

Sanchez believes most flight nurses are Type A personalities. They are driven high-achievers who relish the challenges that come from never knowing what the next case will bring.

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They must also be able to work well as a team with their colleagues. “The attitude of ‘I’m the nurse, so we’ll do it my way’ can be disastrous,” says Wolfe, who oversees 16 paramedics and 24 nurses at MedSTAR.

In addition, flight nurses must be able to comfort patients and families under stressful conditions–a skill that requires quick thinking, excellent communication and empathy. Drummond recalls arriving at an accident scene involving a mother and her two-year-old son. Their injuries were mostly superficial, but the mother was upset and the boy was inconsolable. Knowing the child needed to be close to his mom, Drummond had the two of them placed on the same stretcher and the boy calmed down. “As a father of four, I knew what that child needed,” he recalls.

Leaving Your Comfort Zone

Even for nurses who have what it takes to thrive in flight nursing, the sheer responsibility can be daunting at first. Wolfe recalls his first flight 13 years ago: “I was so nervous I put my helmet on backward.”

Drummond remembers being “petrified” on his first flight. But all the training and his years of experience in the ICU enabled him to make the right decisions for his patient, he adds.

Wolfe says it takes most flight nurses about a year to get comfortable with flying. But that comfort must never turn to complacency, he warns. Safety is paramount, and the entire crew must stay on guard against danger. Nurses and paramedics on board, for instance, help the pilots look for any obstructions to be avoided when landing at accident or disaster scenes.

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And nurses must never believe they know it all. There’s always more to learn, Lystrup stresses, and continuing education is a top priority. When they are not flying, flight nurses spend time updating and expanding their skills through lab work, courses and conferences. They also teach other local medical professionals at smaller medical facilities, fire departments and ambulance services, and they instruct police and fire officials on how to help prepare emergency sites for helicopter landings.

Professionalism is critical, not just in how flight nurses treat their patients and co-workers, but in how they interact with everyone they encounter–from police officers to hospital emergency room doctors. Flight services compete with one another for business and they are judged by the conduct of their crews. “When you’re a flight nurse, you’re a walking advertisement for your program,” Ignacio says.

Diversity in the Skies

Statistics on the number of racial and ethnic minority nurses employed as flight nurses are difficult to find, but minority nurses who work in the field say the percentage is tiny. Wolfe says he knows of only three African-American male flight nurses, himself included, and they all work for MedSTAR.

The low numbers may be related to the fact that there are relatively few nurses of color in critical care nursing, where most flight nurses work before taking to the skies, Sanchez points out.

As in other nursing specialties, achieving more racial and cultural diversity in the flight nursing workforce will greatly enhance the profession’s ability to serve patients from a wide range of backgrounds. Sanchez says his Spanish speaking skills are helpful because his service flies to a lot of U.S./Mexican border towns where patients often don’t speak English. “It’s a lot easier to put people at ease when you’re able to converse with them and they know you understand and you’re not just guessing at what they’re saying,” he comments.

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Ignacio, who is of Filipino descent, advises nurses considering a possible career in flight nursing to learn as much as possible about the field to decide whether it’s right for them. “Don’t just get stars in your eyes,” she cautions. “Don’t do it just for the flight suit and for the glamour.”

Nurses should make sure they’re prepared to deal with the stress of never knowing what might happen next, and that their families can accept the risks. Despite the industry’s keen attention to safety, accidents can happen. “I have lost friends,” Ignacio says. When evaluating potential employers, she emphasizes, be sure to check flight services’ safety track records and consider the financial viability of the programs.

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