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If providing emergency care in a confined space at 28,000 feet sounds like an exciting challenge, this could be the role for you
Flight nurses work in the aeromedical environment, transporting patients to medical facilities via helicopter or fixed-wing plane. We are responsible for the safe transfer of our patients – either from the roadside or another medical facility – and are trained to perform emergency medical care in confined spaces.
Nursing Standard. 37, 8, 43-44. doi: 10.7748/ns.37.8.43.s18
Published: 03 August 2022
Flight nurses ensure patients are stabilised and prepared for transfer, and respond to medical emergencies during flight, while providing reassurance to the patient and their family.
I work on fixed-wing planes for an emergency retrieval service. Our assistance can be required any time of the day and we have a rota in place that allows for round-the-clock cover. We work primarily within the UK and the Channel Islands but my role also involves international travel – for example, we may be called upon to return a patient back to the UK who has become ill whilst on holiday abroad.
I have worked as a flight nurse and flight nurse coordinator – a more senior role where some of the duties and responsibilities are office based, such as writing policies, checking kit and ordering supplies. But when a transfer request comes in this takes priority and we respond immediately.
Each transfer starts with a handover from the transferring facility to establish the patient’s care needs and ensure we have the right team and skill mix in place.
We liaise with our operations department about departure timings, suitable airfields to fly to, weather conditions, and ensuring the ground transfer is in place. This allows you to bring your patient from the hospital to the airfield and vice versa. We then prepare for the flight, checking our kit to ensure everything is working properly and that any equipment we may need is loaded onto the aircraft, including oxygen and personal protective equipment.
We carry a standard kit for carrying out rapid sequence intubation (RSI), which includes drugs such as ketamine, fentanyl, midazolam and propofol. We also look at what other drugs may be needed for the patient. We then have a team briefing with the pilots and once any potential risks have been discussed, we board the aircraft to fly to the transferring facility. The flight time en route to the patient allows for preparation of required paperwork and further discussion between the medical team.
On arrival at the transferring hospital, we undertake a thorough assessment of the patient and highlight any concerns. We then prepare the patient for the flight, which might mean applying defibrillator pads in high-risk cardiac patients and optimising electrolytes.
Once the patient is ready to be transferred, they are safely secured onto an aircraft stretcher and loaded into the aircraft. If specific flight measures are required, we make the pilots aware of this – the pilots will not take off without checking with the medical team first.
We monitor the patient’s condition carefully throughout the flight, also providing reassurance and ensuring they are comfortable.
If there are changes in the patient’s condition, we use preventive strategies where possible. When you are flying at 28,000 feet, you have no one else to rely on, so these measures are vital.
For example, when transferring a patient with an ST-elevation myocardial infarction, their heart is already deprived of oxygen. Travelling at altitude could cause further oxygen deprivation, so supplemental oxygen is administered as a preventive measure and weaned accordingly.
On reaching the receiving facility, we ensure that the patient is handed over safely. All the patient’s paperwork from the transferring hospital is handed over and we provide staff with an update on their condition, including any problems or medical treatment provided during the flight.
We then ensure that the transfer documentation is up to date and correct, and hand over a copy to the receiving team.
Flight nurses work with a variety of other healthcare professionals. On some transfers you will work alongside a doctor, on others you will work with a fellow nurse or a flight paramedic.
Without our pilots, we wouldn’t get anywhere, and they are able to adjust their flying to ensure patient safety is maintained. For example, if the patient has a condition which means changes in air pressure need to be avoided, the pilot can carry out a sea-level flight, where air pressure inside the cabin remains the same as on the ground.
To ensure a smooth patient transfer, we also work closely with handling agents, airport fire services when required, and ground ambulances.
8am Arrive at the office. My day starts with attending our daily meeting. I then check emails and the kit I will need if a patient transfer call comes in.
9am A call comes in. The patient has been involved in a road traffic collision and has a severe traumatic brain injury, requiring specialist neurosurgical care. The patient is intubated and ventilated and needs cardiovascular support by means of vasopressors – drugs that elevate the mean arterial pressure by inducing vasoconstriction.
10.30am The medical team flies to the patient’s transferring facility.
11.15am We arrive at the transferring facility and perform a thorough patient assessment and prepare the patient for the aeromedical transfer.
12.30pm Once the patient has been stabilised for transfer, they are brought to the aircraft for the flight to the receiving hospital. During the flight, the patient’s overall well-being is monitored carefully, including pupillary reactions. I note a change in the patient’s pupils, so a bolus of hypertonic saline is given and sedation adjusted accordingly. As we fly at altitude, endotracheal tube cuff pressures require regular adjustment. All interventions are clearly documented.
1.15pm The patient arrives at the receiving facility. A thorough handover is given to staff receiving the patient, who is taken straight to theatre for pressure-relieving interventions.
2pm The medical team return to the aircraft and fly back to base.
2.30pm On arrival at base, the medical team clean the aircraft and all medical equipment and restock the medical kit, ready for the next flight. Documentation is completed in accordance with data protection law.
If no other flight request comes in, I continue with office-based tasks until finishing at 6pm.
We work with all types of patients, from those who are very ill on life support to those requiring a specialist intervention or elective surgery at another facility. We also care for patients requiring repatriation after becoming unwell or being injured on holiday, people with mental health issues and paediatric and neonatal patients.
Flight nurses in the UK are employed by private air ambulance companies, with the exception of some helicopter and emergency medical services (HEMS) organisations where nurses have an NHS role. As flight nurses are usually employed by the private sector, we are not on Agenda for Change pay scales, but the role is the equivalent of a band 6. Flight nurse coordinators are equivalent to band 7 and the chief flight nurse role the equivalent of band 8.
Flight nurses have to be ready to carry out emergency medical care, so a background in emergency or critical care nursing is necessary. At least three years’ post-registration experience is required, with at least two in critical care.
My background is in intensive care. I trained as a nurse in the Netherlands, qualifying in 2008. After specialising in intensive care, I moved to Switzerland, where I worked as an ICU nurse until 2016, before returning to my native Northern Ireland. I have worked in intensive care in the UK and Ireland ever since. In 2019, I was up for a fresh challenge, so joined the bank of flight nurses for an Exeter-based fixed-wing air ambulance company. I loved the job and the challenges that came with it and in 2020 I secured a role as a clinical coordinator and critical care flight nurse with Gama Aviation. Last year, I was promoted to clinical services manager/chief critical care flight nurse and am responsible for managing an emergency retrieval service.
The ability to work autonomously and make quick decisions in a confined, high-stress environment is a must, and practical skills such as cannulation and catheterisation are beneficial. Always expecting the worst is probably the best way to prepare for any flight nursing job.
My advice would be to gain a solid background in intensive care nursing and complete an intensive care course. You can also undertake transfer courses and modules to broaden your knowledge and skills, such as the diploma in retrieval and transfer medicine from the Royal College of Surgeons of Edinburgh and King’s College London’s basic course in aviation medicine.
The RCN critical care and flight nursing forum also has a lot of information, and it is a good idea to talk to a flight nurse to further understand what the role involves.
