When the worst happens, the quickest way for a patient to receive care at a nearby healthcare facility may be a swift ride from a rotary wing air ambulance – a medical chopper. According to a new air medical study article published by Case Western Reserve University School of Medicine, the safest way for a patient to travel by helicopter is with a well-trained acute care flight nurse with experience working in the noisy, extreme environment of a medical helicopter.
Yet despite the fact that acute care flight nurses routinely care for some of the most seriously ill patients, in some of the most difficult care environments, there has yet to be a clear national consensus on the minimum training required for flight nurses just starting out.
In an effort to meet the growing need to transport patients from the scene or from hospital to hospital, researchers at CWRU’s School of Nursing have called for new training curricula for flight nurses. They have proposed new ideas that take the unstructured, unpredictable environment and need for quick thinking into account.
In a helicopter, there are certain medications and emergency room practices that cannot be performed or are not as effective as in other situations. Care often relies on visual cues and patient patterns.
One of the researchers, Andrew Reimer, a flight nurse and PhD graduate of CWRU’s School of Nursing, proposed that “knowledge about what works [in a helicopter environment] is limited” because flight nursing is a fairly new field of medicine.
Over the past 10 years or so, the field of flight nursing has really taken off. In 2003, there were 545 medical helicopters flying patients from 472 bases. Now, about half a million rotary-wing air ambulance transports take place each year. (Source: ADAMS, the Atlas and Database of Air Medical Services)
While the field of flight nursing has mainly expanded during the last decade, its roots go back to Air Force training programs in World War II. Above: students in a flight nurse training program during the 1940s.
Flight nurses require patently different skills from those used on the ground to access the patient’s physical signs during an air medical transport. The extremely loud, vibrating, alternately hot-and-cold interior of a chopper provides certain challenges in a patient care situation. It may, for example, be challenging to hear the patient’s heart beat over the sound of the engine, or distinguish a pulse from the constant vibrations caused by the rotor blades.
Many flight nurses learn how to work around the sub-optimal environment conditions inside a helicopter on the job, but Reimer thinks they should have greater training before they become airborne. He and Shirley Moore, the associate dean of research at the Frances Payne Bolton School of Nursing, have called for more training that focuses on the uncertain environment of the patient and crew.
The uncertainty affects patient care during major disasters, such as the recent earthquake and tsunami in Japan. Because of the sheer level of devastation, it proved difficult to transport people in and out of the worst-affected areas.
Every summer, flight nurses-in-training practice disaster scenarios like earthquakes, gas leaks and plane crashes at Case Western Reserve’s National Flight Nursing Academy. Reimer feels that these kind of simulations are essential to ensuring that new flight nurses can make quick, “second nature” decisions based on quick assessments of the patient’s needs while taking the care environment into consideration.
Reimer claims that under most current flight nursing training programs, “you can take an ICU nurse with 20 years of experience and put them in the helicopter to care for a patient, and the learning curve will be similar to someone with only two years of experience.” However, he feels that increasing the amount of environment-specific pre-flight training can improve the learning curve for new flight nurses.
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