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In-flight service

Flight nurses also work in airplanes on a nonemergency basis, transporting patients from a hospital in one city to another, either to move them closer to home or to a hospital that provides specialized treatment.

Elizabeth Boston, RN, flies on a part-time basis for U.S. Air Ambulance based in Stewart, Fla. The 39-year-old nurse also has a full-time job as a paramedic and a part-time job as a nurse in the emergency room of Martin Memorial Hospital South, north of Miami.

Boston, who began flying for the company in 2000, flies on Learjets and a Sabreliner. She said patients generally are well enough to be transferred, but too ill to travel by commercial airline. They also have the financial resources—or good health insurance—to pay for the trip.

Hip fractures, leg fractures, head injuries, heart problems and patients on ventilators are common, Boston said. Generally speaking, they can’t walk, need oxygen and require other types of noncritical medical care.

Boston helped transport one patient with a bad case of meningitis from South America to Ontario, Canada, and has traveled to Grenada, Central America, the Bahamas and throughout the United States, although most trips allow little or no time for sightseeing.

“Others I know of have gone to India and they get to stay for several days, but some areas of the world they won’t send a woman because it’s too dangerous,” she said.

Boston said she receives $250 per flight plus an extra $75 for a second patient and an additional $50 if she’s gone for more than 12 hours. Food and a room are provided if she has to stay somewhere overnight.

She said she used to hate to fly, but now it’s become second nature. “Trusting and knowing your pilot is a big part of it,” she said. “I definitely have to trust who I’m flying with or I don’t go.” >>

Another nursing service provided by air ambulance companies is escorting patients who are too sick to travel alone, but not so ill that they require special transportation. For these people, air ambulance companies and a growing number of airlines provide escorts on commercial flights.

In 2001, American Airlines became the first commercial airline to offer nursing escorts for passengers. The nurse consults with the passenger’s physician before the flight and sits with the patient. Passengers must pay for the nurse’s first-class ticket, usually at a discount, along with an hourly fee that begins at $90 an hour. Some nurses are on the airline’s payroll while others work as independent contractors.

Karen Hamilton, RN, a certified flight nurse for Aeromedical Transport Specialists Inc., said some companies offer no more than a handholding service when it comes to what she calls “first-class escorts,” lacking onboard medical equipment and supplies.

“It [has] always been my philosophy that that is the wrong way to do these types of transports because anything can happen to any patient at any time,” said Hamilton, who owns the company with her husband, Jeff Hamilton.

She said the company, based in Washington, D.C., takes $15,000 to $20,000 worth of equipment along on each first-class escort, including a cardiac monitor, continuous pulse oximeter and a noninvasive blood pressure monitor.

Boston also has done commercial escorts and generally prefers working as a flight nurse instead, although she admits she enjoyed flying first-class. She once escorted a woman to California who had hip replacement surgery. She couldn’t walk, so Boston had to wheel her on and off the plane, help her to the bathroom and take care of her luggage.

“Sometimes you get stuck with a very large patient and you’re by yourself,” she said. “You have to know what you’re getting into.”