Flight nurse

A flight nurse is a registered nurse who specialises in the field of providing comprehensive pre-hospital, emergency critical care, and hospital care to a vast scope of patients. The care of these patients is generally during aeromedical evacuation or rescue operations aboard helicopters, propeller aircraft or jet aircraft. On board a rescue aircraft you would find a flight nurse accompanied by flight medics and respiratory practitioners, as well as the option of a flight physician for comprehensive emergency and critical transport teams. The inclusion of a flight physician is more commonly seen in pediatric and neonatal transport teams.[2] A critical care flight nurse must be able to deal with all age groups with broad critical emergencies. With no physicians on site the nurses scope of practice is expanded. The critical care experience is transferred over to a flight nurse with impacting factors such as altitude and changes in pressure, gravitational forces, and weather (Mazur, R., 2018). Some patients may experience exacerbation's because of factors related to the cabin environment including hypoxia, limited mobility, gas expansion, and risk of injury related to turbulence and resources with definitive care are limited (Rotta, A. T., 2020). Aeromedical evacuation crews coordinate coordinate with other organizations to plan for the safe and timely care and evacuation of patients. Crews must be prepared for patients suffering from trauma and mental health illnesses (An, 2018).

For the 1953 film, see Flight Nurse (film).
The first United States Navy flight nurse, Jane Kendeigh[1]

Roles and duties

A flight nurse is required to complete a copious amount of duties each and every call out. Listed below is a comprehensive list of these duties and responsibilities:

  • Flight nurses perform as a member of an aeromedical evacuation team on helicopters and propeller or jet aircraft
  • Responsible for planning and preparing for aeromedical evacuation missions
  • Expedite mission and initiate emergency treatment in absence of Flight Physician
  • Provide in-flight management and nursing care for patients
  • Evaluate individual patient in-flight needs
  • Liaison between medical and operational aircrews and support personnel to promote patient comfort
  • Responsible for maintaining patient care, comfort and safety
  • Care for patients with both medical and traumatic issues
  • Request appropriate medications, supplies and equipment to provide care to patient
  • Must have training in mechanical ventilation, hemodynamic support, vasoactive medications and intensive care skills
  • Specialised clinical skills in union with knowledge, theory, education and expertise in hospital and pre-hospital environments are required [3]
  • Perform advanced medical procedures without supervision of a doctor such as intubation, ventilator management, chest tube insertion, intra-osseous line placement, central line placement, intra-aortic balloon pump management, management of pacing devices, titration of vasoactive medications, pain management, administration of anaesthetic medications for intubation, and in some cases, emotional and family care [2]

Education

National requirements for most flight nurse programs include:

Additional requirements may include:

Helpful, but may not be required:

  • EMT or EMT-P (paramedic) certification with field experience (some states require flight nurses to be certified as EMTs or EMT-Ps)[2]

Simulations programs

  • Simulation programs to prepare flight nurses have been shown to adequately mimic real world scenarios, In a study conduct at Case Western Reserve University's flight nurse program students reported that the flight simulator had felt like an actual rotor cuff transport. Additionally, heart rates were tracked to measure the stress response and rates were increased from 77 before the simulation to 100 at the peak, at the conclusion HR resolved to 72, the p value was <0.001.[4]

Credentialing
  • Certified Emergency Nurse (CEN)
  • Certified Flight Registered Nurse (CFRN)
  • Critical Care Registered Nurse (CCRN)[2]

Types

Civilian
  • Works for hospitals, federal, state and local governments, private medical evacuation firms, fire departments and other agencies.[2]

Military
  • Army Air Force Evacuation Service
  • Member of aeromedical evacuation crew
  • Senior medical member of aeromedical evacuation team on Continental United States (CONUS)
  • Works in intra-theatre and inter-theatre flights to provide in-flight management and nursing care
  • Plan/Prepare aeromedical evacuation missions and prepare patient care facilitation plan[5]

In Australia

Australia has an estimated 20% of land recognised as desert with a rather small population density. Providing health care to these remote rural towns can prove to be quite laborious. Australia provides a number of organisations that flight nurses are under employment of.[3]

In United States

In the United States there are approximately 550,000 people who require emergency or standard medical transport every year.[6] Situations involving the need for patients to travel via air transport include patients who have been involved in a bad accident and require transport to an intensive care, patient needs a transplant, or a stable patient who has a medical condition that wants to move closer to family. Flight nursing also plays a critical role in transporting a critically ill patient who lives in a rural community to a hospital that has the resources necessary to provide the care needed to the patient. Teams involved in the air transport of a patient can include nurse/nurse, nurse/paramedic, nurse/physician, nurse/respiratory therapist, or paramedic/paramedic, depending on the needs of the patient.[7] When transporting a patient who is on vasoactive medications or vasodilator medications, the nurse is responsible for titrating the drips to maintain the hemodynamic parameters within the ordered range and the critical care needed for the patient.[8]

See also

References
  1. "Angels of the Airfields: Navy Air Evacuation Nurses of World War II | Naval Historical Foundation". www.navyhistory.org. Retrieved 2016-05-18.
  2. Jones, Joy; Young, J S (2004). "Soaring to New Heights as a Flight Nurse". Critical Care Nurse. ISSN 0279-5442.
  3. Brideson, G (2015). "Images of flight nursing in Australia: A study using institutional ethnography". Nursing and Health Sciences. 18 (1): 38–43. doi:10.1111/nhs.12225. PMID 26235106.
  4. Kaniecki, David M.; Hickman, Ronald L.; Alfes, Celeste M.; Reimer, Andrew P. (2017-05-01). "Response of Flight Nurses in a Simulated Helicopter Environment". Air Medical Journal. 36 (3): 131–134. doi:10.1016/j.amj.2017.02.005. ISSN 1067-991X. PMID 28499683.
  5. US Air Force ROTC. "Flight Nurse". Archived from the original on 2008-06-09. Retrieved 2008-06-05.
  6. "Fact Sheet and FAQs". AAMS. Retrieved 2020-06-26.
  7. van Lieshout, Erik Jan; Binnekade, Jan; Reussien, Elmer; Dongelmans, Dave; Juffermans, Nicole P.; de Haan, Rob J.; Schultz, Marcus J.; Vroom, Margreeth B. (2016). "Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial". Intensive Care Medicine. 42: 1146–1154. doi:10.1007/s00134-016-4355-y. ISSN 0342-4642. PMC 4879164. PMID 27166622.
  8. "How to Become a Flight Nurse: Duties and Outlook". Western Governors University. Retrieved 2020-06-27.

Further reading
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