Bird's-eye View
RNs in aviation-related careers keep their practice solidly grounded in strong patient care skills

By Scott Williams
March 26, 2004

Dwayne Howerton likes to joke that he has no fear of heights: It’s gravity that scares him. Yet, as often as 10 times in a single day, this nurse and paramedic climbs into a helicopter and takes to the skies.

Howerton, RN, is a 33-year-old certified flight registered nurse for CareFlite, a Dallas/Fort Worth-area emergency air ambulance service that, among other things, provides accident victims with quick access to emergency care via helicopter.

“I have a big passion for flying and I have a big passion for taking care of people who are sick, and there’s not another job that combines the two better than this,” said Howerton, who became a nurse in 1995 and has been with CareFlite for four years.

Many probably have never pondered combining aviation and nursing. But nurses have several aviation-related careers from which to choose that combine nursing with flying or, at least, provide close proximity to people who do.

In addition to working as a flight nurse on emergency air rescue calls, nurses can work for air ambulance services that transport patients by plane to hospitals near their homes or to health care facilities that provide specialized care.

Nurses also can work for airlines or air ambulance services as escorts for people who require a nurse to travel with them on commercial airlines. Other career options include working in an airport clinic or employment as an occupational health nurse for an airline.

The genesis for Howerton’s career came right before his high school graduation when his grandfather was injured in an auto accident on the way to graduation weekend. A helicopter airlifted him to a hospital and Howerton credits the quick access to medical care as contributing to his survival.

“It planted the seed for me to get into medicine at some point and was sort of the seed for air medical,” he said.

Howerton said there’s no way to predict how many calls will come in on a given day. Some days go by without any calls, while on others as many as 10 come in. He said he averages about three to four calls a day.

Once on the scene, his job is to support emergency medical personnel on the ground until the patient can be placed in a helicopter, which is set up like a miniature emergency room.

“Anything we can do on the ground or in the back of an ambulance we can do in the back of a helicopter,” he said. “We’ve been trained to take care of those things and perform our skills in a helicopter just as well as we can perform them standing in a room.”

Once the patient is in the helicopter, Howerton’s primary duties are to make sure an airway is established and initiate more IVs. He also gives a patient report to the hospital, telling it what has been done and what might need to be done once they arrive. After landing, the patient is taken to the emergency room, where Howerton gives another report, answers questions and, sometimes, meets with family members.

To work as a flight nurse for CareFlite, nurses must be licensed paramedics and have five years’ nursing experience working in the intensive care unit or emergency room (and preferably both) in a tertiary hospital with a Level I or Level II trauma center. Nurses also must complete an advanced cardiac life-support class, pediatric advanced life-support class, neonatal resuscitation program and an advanced trauma life-support class.

“I think primarily what gets you in the door is showing them that you have the motivation to go out and do the things they require for you to get the job,” Howerton said.

Camille Crim, marketing director for CareFlite, said the pay scale for flight nurses in the industry is $16 to $30 an hour, with $23 an hour being the mid-range. She said CareFlite doesn’t pay flight nurses less than $23 an hour because the company requires that they have experience.

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.”

Ground support

Carolyn Schjaerve, RN, represents another aviation-related career, albeit a ground-based one.

Schjaerve, 61, is a nurse manager for the medical clinic at San Francisco International Airport, which provides health care services to airport/airline employees, nearby companies and airline passengers.

The SFO Medical Clinic has eight examination rooms and sees 40 to 50 patients a day. The clinic is always staffed by at least one doctor and registered nurse, as well as an X-ray technician, medical assistant and four receptionist/administrative assistants. The clinic is run by St. Mary’s Medical Center, a division of Catholic Healthcare West.

“You never have the same day twice; it’s full of surprises,” said Schjaerve, who has been at the clinic for 25 years. “You always have different patients walking in.”

Along with pilot physicals and physicals for people applying for permanent residence visas, the clinic sees employees who have taken sick or been injured on the job.

The clinic also treats passengers who become sick or injured during a flight, and provides counseling, medicine and shots for people preparing to travel outside the country.

Schjaerve said passengers often come to the clinic suffering from vomiting and diarrhea or injuries from climbing in and out of the courtesy van. Other common problems are bladder infections, blocked ears and heart problems. Schjaerve even has delivered a baby on the waiting room floor. “You name it, we’ve seen it,” she said.

High morale

Morale at the clinic is high, she said, and people hired to work there tend to stay for many years.

“There’s no attrition in this clinic,” she said. “When they get here, they stay here. They love it.”

Schjaerve said to work in the SFO Medical Clinic, nurses must be certified to conduct breath-alcohol tests, administer drug tests and be qualified in audiometry and spirometry. They also have to pass a basic life-support class and advanced cardio life-support class.

Many airlines employ occupational health nurses and run their own clinics.

Lynn Zonakis, RN, a certified occupational health nurse, is a general manager for Delta Airlines responsible for overseeing six Delta clinics and planning and delivering health care to Delta employees.

Zonakis, 48, said nurses who work for Delta and other airlines have to have more than clinical skills. They also need to be able to manage programs, educate employees and managers on health care issues, act as a liaison between the two and provide case management via telephone.

“An occupational health nurse who sees him or herself solely as a clinician—and there are many who do—is not nearly as effective in the corporate arena,” she said.

Nurses conduct FAA-mandated hearing and drug tests and manage work-related injuries. But their focus is more on corporate wellness and helping employees return to work after an injury or illness, rather than clinical treatment of patients, Zonakis said.

Zonakis said occupational health nurses who work for airlines make between $42,000 and $65,000 annually, and salaries for nurse managers begin at about $50,000 and exceed $70,000 at the upper end.

Little travel is involved in the job, she said, and Delta screens out employees whose primary goal is to get a job with good travel benefits.

“The challenge to management is to identify applicants that first and foremost are occupational health nurses and occupational health case managers,” Zonakis said, “and secondarily enjoy the environment and benefits of working in the aviation industry.”

Contact Scott Williams at ScottWilliams21@msn.com.