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"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."
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."
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