High-flying RNs
Jetting to scenes of medical crisis, flight nurses put their set of skills to the test to meet all sorts of emergencies

By Linda Childers
September 11, 2003

The California Shock Trauma Air Rescue helicopter ambulance arrived at the scene minutes after the car crash occurred on the busy highway.

Bryan Pond, RN, CCRN, CFRN (certified flight registered nurse), was one of two flight nurses dispatched to the scene. He watched his partner confer with the firefighters who had arrived first and were treating the driver. His partner looked up and sadly shook his head, indicating the woman had died.

Pond rushed to assist the sole passenger in the crash, a young boy who had suffered leg injuries. After assessing the boy's injuries, Pond gently lifted him into the helicopter to transport him to the closest children's hospital for further treatment.

"How is she?" the boy asked, looking back at the woman lying on the ground.
"Please tell me she's all right," the boy pleaded. "She's my foster mom and she's getting ready to adopt me. If anything happens to her, it will hurt much worse than my leg does."

Trained in virtually every emergency protocol and intervention, Pond, for the first time in his career, found himself at a loss for words.

The legions of flight nurses that care for patients thousands of miles above the ground find that each day brings a unique experience. Trained to think on their feet, flight nurses are required to have extensive nursing experience, including prehospital, emergency and intensive care, as well as extensive training in caring for critically ill patients in the airborne environment. Most flight nurses are required to have a minimum of five years critical care experience, and many retain their jobs as trauma or emergency room nurses, rotating their work in the hospital with their work in the air.

Pond has worked at CALSTAR for 3½ years, and is based in South Lake Tahoe, Calif. A former emergency room nurse from Texas, he transitioned to flight nursing hoping to find additional challenges and more autonomy.

"When you're in the air, it's just you and your nurse colleague caring for the patient," Pond said. "You need to be motivated and confident in your skills in order to be a successful flight nurse."

A typical day can yield cases that include ski accidents, car crashes and treating hikers who have become injured or lost in the mountains.

For trauma victims, medical treatment within one hour can mean the difference between life and death. The first hour after an accident or injury is commonly referred to as the "Golden Hour," and statistics show that treating trauma patients during this window of opportunity can prevent 20 percent to 30 percent of potential deaths and dramatically reduce hospital stays.

In the nearby mountains, Pond and his co-workers often are the first emergency response team to arrive on the scene. Their job is to stabilize and care for patients while transporting them to either Washoe Medical Center in Reno or Sutter Medical Center in Roseville, the area's closest trauma centers.

Pond works 24-hour shifts, two days a week for CALSTAR, and occasionally works shifts in the emergency department of a local hospital. In addition, he is required to do a clinical rotation each year in labor and delivery and the ICU to keep his clinical skills current.

No two shifts alike

It's 9 a.m. in Concord, Calif., and Mario Palmieri, MSN, RN, CFRN, is preparing to start his 24-hour shift as a flight nurse for REACH Air Medical Services.

Palmieri works two-sometimes three-shifts a week, and starts work each day never knowing what the day ahead will hold.

"You have to begin each shift mentally and physically prepared," he said. "On a typical day, we'll do three or four flights."

REACH flight staff in Concord respond to 911 calls in several local counties, handling everything from shootings and stabbings to auto accidents.

They also conduct hospital transport for adults, pediatric and neonatal patients.

"We work as jacks-of-all-trades," Palmieri said. "One flight you might be working on a patient who has suffered cardiac arrest and the next flight might be transporting an infant from a small rural hospital to a larger facility where they can get they specialized care they need."

Frequently, patients accepted by a hospital for routine care can deteriorate or develop complications that require immediate transport to another hospital for specialized treatment. Ground ambulance services are not usually staffed to provide the level of patient care that can be provided by flight nurses.

REACH crews begin their job the minute they receive an emergency call. Palmieri notes that safety is an integral part of their job, and that crews are in constant communication with their fire and medic colleagues on the ground to determine both the medical status of patients and the best location for landings.

Timing also is critical.

"Our goal on 911 calls is to go from down to wheels up in less than 10 minutes," Palmieri said.

Most of the flight nurses' work takes place once the patient is secured in the helicopter. Nurses function under an expanded scope of practice and can perform endotracheal intubations as well as administer various medications while in flight.

"We're performing many functions that a physician would normally perform in an emergency room setting," Palmieri said.

And while the job provides constant challenges, there are also emergency calls that take their toll on the nurses.

Palmieri remembers two calls in particular-the initial one was his first call as a flight nurse when he had a pediatric patient go into cardiac arrest. The second was when a teenager driving under the influence of alcohol crashed her car, killing all her friends on board.

"Those are the moments you turn to your partner for support," Palmieri said. "We work together out here as part of a team and that means working through situations that are both good and bad."

Career satisfaction

Kathy Ottenbreit, RN, CCRN, was content in her job as a critical care nurse. She had worked in the field for more than 30 years when she was approached by Cal-Ore Life Flight, an ambulance company that was setting up shop in her hometown of Crescent City, Calif.

"The company approached me several times about becoming a critical care flight nurse," Ottenbreit recalled. "They eventually persuaded me to come for a flight and I immediately fell in love with the job."

Cal-Ore is a small air and ground ambulance company that services the California-Oregon border. It doesn't respond to accident scenes, but rather transports critically ill patients from small rural hospitals to larger facilities.

Flight nurses work for Cal-Ore on an on-call basis and hold other jobs at local hospitals in the interim. Ottenbreit, the company's chief flight nurse, works full time at the company's base.

Ottenbreit marvels at the little miracles she sees in her job. For example, a patient who had a ruptured aortic aneurysm and should have died instead is recovering nicely.

Unlike her helicopter counterparts, Ottenbreit and her flight crews typically have a 25-minute flight time between facilities. On their plane is a mini-intensive care unit where they are prepared to handle just about any crisis that comes their way.

Although being a flight nurse is a change from working in a hospital setting, Ottenbreit has no regrets about changing jobs.

"Becoming a flight nurse rekindled my pride in my own critical care skills," she said. "My skills are vital to the well-being and safe transport of the patient. It is a nursing job that demands my best, but also gives a lot back. I may feel tired after a busy day, but never drained."