Medicine Meets Aviation: Flight For Life Staffing

It's not quite "The Right Stuff" meets "E.R.," but staffing a real-world Flight For Life air medical transport helicopter does require a special blend of skills and qualities that add up to "aviation medicine."

Flight For Life Wisconsin made 1,420 patient transports in 2005, hospital-to-hospital as well as from trauma scenes like automobile accidents. On each flight were medical personnel who've passed a rigorous set of testing, training, checks and certifications. One of the things setting Flight For Life apart from ground ambulance service is the availability, on staff and on board, of nurses, physicians and paramedics who are fully prepared to do their jobs in flight.

"There's a big screening process," said Steven S. Andrews, MD, EMT-P, Medical College of Wisconsin Assistant Professor of Emergency Medicine and Flight For Life Wisconsin Medical Director, who has made about 100 of the emergency flights.

"You have to have at least five years of nursing in critical care/emergency room," said Dr. Andrews, "and there's a three-hour interview process that looks at ability to think on your feet and many other things. And in the end, there's very little nursing turnover and not much paramedic turnover, either. There may be turnover of one nurse a year, from both the Milwaukee and Illinois sites."

"A Unique Role"
Claire M. Rayford, RN, started with the program as a flight nurse nearly 20 years ago. She's now retired from that job after making more than 200 flights, and serves as the Flight For Life Wisconsin Professional Relations/Marketing Manager. In discussing the program and the people who make it happen, she hit on some of the reasons staffers stick with such a seemingly high-stress job.

"Our mission is to transport patients with highly qualified medical personnel," Rayford said. "That is our specialty. That is a unique niche in the health care market. You may have a nurse or a physician who works in a hospital environment, but we take them out of the hospital environment and put them in a transport environment and that's different.

"To be on your own, as a team, working outside of an institution where you have a lot of help and resources, you're limited to the resources that you have flying at fifteen hundred feet above the ground. You can't just go get something that you need; it has to be there with you. So it's a very unique role that you offer that isn't offered elsewhere. You're really a flying intensive care unit.

"It's not only the specialized intensive care unit-level capability equipment that you have in the helicopter. You have the expertise of the people in it bringing that ICU environment to the scene or to another hospital, and you're continuing to see that the patient is maintained in that flying environment all the way until they get to their destination."

ICU/ED Background Just a Start
Overall, Flight For Life has about 60 people on staff. Some fly out of the Milwaukee base, which has physicians on staff, and some fly on the second helicopter serving the state based in McHenry, Illinois. Flight nurses (7 in Wisconsin, 5 in Illinois) are generally full time. Each helicopter has a full-time pilot and ground mechanic, and more than a dozen paramedics serve with each base at any given time.

Finding the right people to fill the nurse and physician staff slots is a big job in itself (the paramedics have full-time jobs with local fire/emergency departments and rotate in to Flight For Life, also after meeting certain background and certification requirements).

"If you're looking at nurses you're looking for a combination of both intensive care and emergency department background," Rayford said, "and if they've had the additional experience of working on a volunteer rescue squad of some kind. That's also important because working in a pre-hospital environment is so different from working in a hospital setting. It's really helpful coming in if they already have some training working with their local ambulance first response agency and also have certifications such as advanced cardiac life support training, certified emergency nurse or trauma nurse specialist, those types of things. We ask if they've done any public speaking or taught classes or led Sunday school, things that you might not think about for other jobs as a nurse.

"We like to know that they're comfortable interacting with the public, because that is such a large component of Flight For Life. And we do a lot of education, so they have to be comfortable getting in front of a crowd and talking or giving formal and informal tours of the helicopter."

Key is "Getting the Aviation Piece"
Rayford acknowledged Barbara Hess, the first Flight For Life Wisconsin program director, who collaborated with Joseph Darin, MD, then chairman of the Medical College of Wisconsin Department of Emergency Medicine. In an article for Air Medical Journal (Jan.-Feb. 2005), Rayford wrote that Hess "understood that a program's core must be based on strong principles of excellence in safety, patient care, and customer service."

"The thing that surprised me the most when I began flying is the melding of aviation and medicine," Rayford said. "When you pick your flight medical crews, you're picking the most experienced, most qualified paramedics and nurses, and you have the physicians coming out of the emergency residency programs so you know you're getting a physician with a high level of medical training.

"You pick them knowing they already have a lot of experience in patient care. The key is getting that aviation piece of it, so that the person understands primarily how to be safe around an aircraft, how to work in a very small environment, how to think on their feet and make quick judgments and decisions. It's up to you, you and your partner, and possibly medical control if you're not flying with a physician and you have the time to radio back in.

"To me and to a lot of nurses going into this field, it's the next level beyond working in a critical care environment such as an emergency department or an intensive care unit. You've worked in those settings for a while and have a drive to do more. You may not want to work on a hospital floor and ask 'what's left?' This is the next level."

"They Don't Teach You That in Nursing School"
There are many aspects to staffing Flight For Life that go beyond simply putting a qualified clinician in the air and flying, Rayford said, adding that medical staff have to be expert clinically and also act as ambassadors for both the helicopter and the campus.

"You need to be a diplomat, and need to meld with other teams at a referring institution or a fire department agency and make them feel comfortable," she said. "You may have thought the job was taking all those skills you learned at a trauma center and just doing them in the air. It's not just that. It's also working with the pilots to help them look for other aircraft as you're flying, or when you're entering a landing zone to watch out for wires and other hazards, or working the radio. They don't teach you that in nursing school.

"As a practitioner, one of the things that I really enjoyed was the ability to interact with patients in a way that is especially meaningful. They're the sickest of the sick. I always really enjoyed being able to interact with family members and letting them know how their loved one did on the flight. In fact, we used to have patient and Flight For Life crew reunions every so often, which is probably going to happen again on Flight For Life's 25th anniversary.

"I used to send Christmas cards to family members that I got to know when I was flying and some still keep in touch. One patient whose baby was in utero at the time of our transport was a high-risk obstetrics patient - she sends me a little picture of her daughter every year. She's now going to be 21, so that's a long relationship with a girl who wasn't even born when I met her mom. Those are the kinds of things that are a nice benefit of the job."

Dan Ullrich
HealthLink Contributing Write

Some information for this article provided by Flight For Life.org.

See the March 15, 2006 issue of HealthLink to read the first section of this two-part article: Intensive Care in the Air: Flight For Life.