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Typical Monday—Not for this Flight Nurse

Today I hung up the lab coat of the Nurse Practitioner and replaced it with the tactical vest of the Flight Nurse. I don’t wear multiple hats, I wear multiple helmets!

It was a busy weekend in the emergency room where I work as a nurse practitioner. Although this series of shifts was awesome (yes I even loved taking care of the sniffles) it was great to be back the in the helicopter instead of watching it take off and land from the door way of the ER as I was doing when I took these photos:

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Survival Flight coming for patient

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Aero Med coming for another
patient the next day

Monday is never typical for us. The morning began with a transport in which we met the ambulance at the landing zone. While we were waiting, a car parked in the parking lot across the street. It gave us the opportunity for a PR moment. In reality, it was the chance to show our helicopter off to an adorable four year old boy named Zachary.

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Brad showing Zachary and his Dad
the “bus drivers seat”

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Not sure who was doing the teaching!

 

After our first transport and some lunch, we were launched on the first of two trauma calls. This was a scene flight in which we made the news. Here are the photos I took on the way to evaluate our patient who was in the back of the ambulance. I was actually in the ambulance taking care of the patient when the video posted was taken.

Multiple injuries in car/school bus crash
Posted: March 24, 2008 03:45 PM
Updated: March 24, 2008 10:01 PM
By Patrick Center and Emily Zangaro

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Our LZ was right in the
middle of the street

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The bus made it easy to
recognize where we were needed

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Amazing the amount of impact
a bus can take

 

This could have been so much worse than it really was. The kids on the bus were reportedly all okay.

Nate and I took this photo from the roof between flights. Although our job is serious, we do our best to laugh as much as we can. It was another good day to be me.

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Emily and Nate
nurse and doctor

 

Our third transport was an inter-facility trauma call. Another motor vehicle collision and another patient who needed the skill and care of a trauma center. I love trauma season. Although we are still waiting for trauma’s “Opening Day” it is beginning.

Tomorrow? Another day shift and our very anticipated Corporate Meeting.

Coffee Please?

Scene Flight of the Day, vBlog no. 5

Well, the day progressed well. I am finally over (I hope) my no flight streak.

Today started off with lots of sun and a scene flight up north. Link to Today’s View.

Somehow, all the stars were aligned and I was able to make today one for the personal multi-media record books. So, with a bunch of photos and TWO videos, here is how the flight progressed!
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Launched: Lots of times the crew on the ground will give us a major land mark to shoot for. We use this with radio contact and/or grid coordinates. Finding an LZ (landing zone) at night can be easier due to the multitude of flashing lights.

Today, our major landmark was a river and a dam.

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River with dam in lower left

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Dam close up

Circling the Landing Zone: This is video of us checking out the landing area. The guys on the ground kept telling us cross streets when we had a difficult time finding them. Sometimes they forget that we have no street signs to reference . . .

Patient Care: Our patient was a driver who was ejected after the car rolled. Many times, the medics on scene already have the patient packaged (backboard, straps, blankets) and in the ambulance waiting for us. They do an assessment, get vital signs, have the patient on the monitor and usually have at least one IV established by the time we get there. Today was no exception.

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Me (L) doing an assessment in
the back of the ambulance

 

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Checking meds and prepping to go to the aircraft

 

To the Aircraft: The great thing about scene calls are all the firefighters who are there to help. This patient had to be carried to the aircraft due to terrain and snow.

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Prepping to lift

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Good to be the nurse!

With any flight, it is a relief when the patient can talk, which this patient was able to. Our goal is to be off the ground in under 20 minutes or so and today, we made it out in a matter of minutes. The ride to the trauma center by ground would have been 45 minutes or so. By flying her, we made it in approximately 15. For those of you familiar with the Golden Hour, those 30 minutes could mean the difference between life and death.

At the Hospital: The patient was transported safely, to my relief—as this is my goal for every patient transport. It is all the better when you have a great crew.

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A photo of Tony, pilot, Me, flight nurse,
and Mark, flight physician.

The Cleanup: The actual patient transport is just part of the job. What we don’t usually talk about is the paperwork or the aircraft/equipment clean up. No, scrubbing blood is just not exciting, but has to be done.

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Post-Flight clean up in the hanger

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Another view

Back at the Hanger, Mini-vLog:

Thanks: Tony and Mark for a good day of flying. Gwen, Sandy, and Phil for keeping us straight while manning FlightCom. Oh, and props to Tony for taking the scene photos!

Flickr photo set here.

Change of Shift Volume Two, Number Seventeen, Murphy’s Law

You know Murphy’s Law, right? Anything that can go wrong, WILL?

The one day you are late for work, is the day you are one nurse short. You have extra patients, so the 9:00 meds are late from pharmacy. That is when you are told that patient 4 is on-call to the OR, two minutes before transport is there to get them. Then half a second after you realize that patient’s pre-op antibiotics aren’t there yet, your patient number six codes?

Murphy’s Law

Yeah, well, that is what happened yesterday to the very first video edition of Change of Shift. I will spare you the details, and instead, just start apologizing profusely.

I . am . so . sorry . . .

Without further delay, I belatedly bring you Mid-February, 2008’s edition of Change of Shift!

This week we have a “Fix It Yourself” theme. The entries tackled everything from nurse burnout to the environment to health insurance. So, as they say, let’s get it started (finally)!

Fix It

How can we take care of our patients if we don’t first take care of ourselves? Gregory at SharpBrains describes stress in Stress and Neural Wreckage: Part of the Brain Placticity Puzzle. As if they planned it, Mike from Nursing Health and Wellness submitted Techniques of Managing Stress which includes great suggestions for avoiding burnout.

Caroline, a nursing student concerned with the environment, has some great thoughts and suggestions for all of us in Nursing Students: Get Green! on her blog Brain Scramble.

The majority of the contributors dug into even meatier topics. ERMurse submitted a very informative post entitled RME: Rapid Mediocre Evaluation (aka: Rapid Medical Evaluation). ERNursey tackled the endless glut of flow sheets and documentation created in the name of patient safety by the behemoth we all know and love in Hello JCAHO.

 

Lasik

Raymond, over at Money Blue Book gives us an insider’s look at getting something more personal fixed—his eyes—in My Experience with Lasik Eye Surgery. Sagar presents solutions to two huge issues on the blog, Live Smarter which is part of the website Online Nursing Degree Directory, in the entries, 10 Ways to Fix Healthcare, and No Health Insurance? 10 Alternative Ways to Get Medical Care.

The “Fix It” theme continues over at Physician Entrepreneur. Dr. DeJesus writes about an initiative which pays primary care physician incentives for improving preventive care and its coordination in Doctors Get Bonuses for Raising the Bar.

 

Rx

NPs Save Lives gets a big HIGH FIVE from this Nurse Practitioner for not allowing a pharmacist to use the excuse, “We always do this though,” in her post Excuse Me?

Sometimes, according to Laura over at Adventures in Juggling, solving problems can be as simple as serenading a drug exposed newborn being weaned off of Morphine with Grammy winning song “Rehab” in her post, Isn’t it Ironic.

Wait, isn’t that a song too???

Two other contributors emailed entries discussing non-medical issues that reach us all. Freddie’s post Can the US Prevent a Starvation Crisis? from the blog with the same name. John at Truthful Lending also gives personal insight in The Biggest Scam Your Bank Gets Away With Every Day.

Mother Jones, who recently gave my nurse’s cap a prestigious 10/10, shares a bit of her bad day that ended well in, The New Job at her blog Nurse Ratched’s Place.

Faith, who writes at The Oracle takes us through something we have all stressed over, hands on testing, in her post Razzle Dazzle.

Wanderer, in What You Don’t Want to See, Part 2, spins a great visual with a case study flavor at his blog Lost on the Floor. His line, “Only thing was, it woke him out of a dead sleep…” was the best of the best.

 

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For the Kleenex section of this edition, I give you two entries. The first from Miss-Elaine-ious over at The Life and Times of a LongTerm Student, in her post Accidental Death. Caring for children is difficult for every one of us.

In the second, Jennifer received gracious permission to repost the entry Definition of a Hero on her blog Days of My Life. Jennifer—thank you so much for passing this on. It was an amazing read.

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Thanks to Kim, the creator of Change of Shift for giving me the chance to host this week. She will be hosting the 6 March, 2008 edition of Change of Shift at Emergiblog! Submit your posts through Blog Carnival or to her at: er underscore kim at emergiblog dot com.

Thanks for visiting crzegrl.net, and thank you for your patience in the delay of this edition! The video, which I swear we did, will be posted as soon as I take care of my issue with Murphy.

UPDATE: Mark and I worked at this for HOURS and it took until today for Mark (and eventually his lovely wife!) to finally declare victory over Murphy and the tech demons.

I am happy to announce the very first, although belated, video version of Change of Shift! Of note? My Saab, aka: Sylvia is filthy because all washing her would do with the low temps is give her a fresh coat of ice, so back off Kev! Also, Code Blog was mentioned incorrectly as the next host blog. Thanks again Marky!

Flight Nurse: A Life of Training and Trauma

This is a paper written by John C. Lee, Jr., SRN from the east side of the country. I am grateful that he shared it with me, because he captured the desire to become a flight nurse and quite a lot of useful information for those interested in the field. Reprinted with permission.

Flight Nurse: A Life of Training and Trauma

As I have yet to begin my formal training for a nursing career, reflecting on a specific role within nursing is a guilty pleasure. However, I realize that in today’s world, it is never too early in an educational pursuit to think about long-term career goals. Without any experience in the field, this exercise is very much a reflection of what I currently feel based on my own thoughts and research knowledge. As with all things, life is dynamically fluid, and my future experiences will bring opportunities and changes in my career. For now I will let my mind fly toward the blue skies of a flight nurse.

Every few weeks, I pull into the parking area at CMMC to view the rays of sun dancing on the smooth shinny metal body of the Lifeflight helicopter. One day I was lucky enough to see the blades of the chopper slowly turning, getting faster and faster as I smelled the jet fuel and heard the wind whistle past my ears; out of the hospital, running past me were the nurses and paramedics in their blue jumpsuits and helmets. They hopped aboard, then flew off at top speed in their fully equipped flying emergency room, ready to land on the road or in a field to pick up a trauma patient in desperate need of care. I knew that both the helicopter and nurses would be operating at top speed to get the patient stable in the crucial “Golden Hour” and beat back death. The chance to fly, be a part of a highly trained team, along with being able to help stabilize and give a trauma patient the chance to live, seems like a career I would love. In my exploration into the world of a flight nurse, I found it to be a career built around a life of training and trauma.

The field of flight nursing was born out of trauma: the need to get critically ill patients to a hospital quickly in order to offer the best chance for survival. More specifically, World War II created this new career for nurses. According to Lambert & Lambert (2005):

When the war began it was thought that only cargo or bomber aircraft would be used to transport sick and wounded soldiers. Thus since enlisted men in the Medical Corps were taught first aid, it was not considered necessary to assign nurses to accompany the wounded while being transported in an aircraft. However this policy quickly changed with the establishment of a Nursing Division in the Air Surgeon’s Office for the development and special training of flight nurses. (pp. 34 -35)

Through each subsequent war, the need for flight nurses grew. Around 1971, the creation of emergency medical services, established the need for civilian flight nurses to transport the most critically ill and provide top-notch medical service in flight (Air & Surface Transport Nurses Association (ASTNA), 2007).

I quickly realized that a flight nurse is a lot more than just being a nurse, wearing a flight suit, and looking cool. Flight nursing combines the skills of intensive care, critical care, and emergency nursing. According to Scally (2002), “Some might argue that even more so than in other types of nursing, [in flight nursing] continuous training and experience matter” (p. 1). Flight nursing involves caring for the 10 percent of the most critically ill or injured patients across all specialties of medicine and disease process. Instead of just maintaining the patients during transport, flight nurses make onsite diagnoses and treatment decisions, providing care before the patients get to the hospitals (Scally, 2002). This requires an intense amount of training.

Requirements to be a flight nurse vary from state to state and program to program but nationally, all flight nursing programs require RN’s to have two to three years of critical care experience and advanced cardiac life support and pediatric advanced life support certificates. Other requirements may include a neonatal resuscitation program, a nationally recognized trauma program, and transport nurse advanced trauma courses. Certifications such as critical care registered nurse, certified emergency nurse, or certified flight registered nurse may also be required. Some states also require nurses to be paramedics or at least emergency medical technicians (ASTNA, 2007).

To meet my goal of becoming a flight nurse will require hard work, a huge time commitment, much training, and exposure to trauma. Aside from the possible adrenaline rush, what draws me to this career is the opportunity to learn so many varying and broad based skills. Through my short time being a lowly EMT-B, I have developed a great desire to continue to learn life-saving techniques and trauma skills. Along with the typical protocols, I will be forced to make diagnoses that will impact the patient for good or bad.

On a broad based level, I am already on a flight path toward my goals. As a voluntary EMT-B, I realize just how important it is to keep learning and moving forward with continuing training. In the next month, I will be taking a course in pre-hospital trauma life support for EMS providers. I am currently involved with volunteer work at Tri-Town Rescue, and have had exposure over the past several weeks ranging from traumatic motor vehicle accidents to working on a patient in full cardiac arrest. This summer I may even train for my EMT – intermediate level certificate.

In the short-term, I will focus my education in these areas along with graduating with my BSN. In the long-term, I will look for opportunities to meet the requirements needed in the critical care unit to learn and hone my technical skills along with my interpersonal skills. Through all this, I will continue to train and train and train toward my goal of applying for and securing a job as a flight nurse. This will not be an easy task. According to the ASTNA (2007), there are about 3,000 civilian flight nurses in the United States. There are more nurses wanting to be flight nurses than there are jobs. According to Scally (2002), “Turnover in most flight nursing programs are very low. However, you can find a job as a flight nurse if you’re willing to move to any area of the country as jobs become available, be persistent, and continue to obtain more advanced training” (p. 2). I am finding out that anything worthwhile in life is a process of persistence.

Once I reach this highly specialized goal, what kind of money can I command? Research from Salary.com (2007), shows that the median expected salary is $56,326 for a flight nurse. The range is from a low of $52,184 to a high of $64,804. In comparison, the median expected salary for an emergency room nurse is $56, 226, with the range at a low of $51,106 to a high of $61,644. Initially, I was shocked to see that at the median range the salary difference is approximately a hundred dollars. All this extra training for what seems such a small amount of pay? This can be attributed to two factors. The first is that in general nursing salaries are low compared to other high-end professions, and the second is the simple theory of economics: supply vs. demand. With so many willing nurses and so few slots available, the market controls salaries. In the end, it is not the appeal of money, it is the professional challenge that draws many nurses to flight nursing.

I know for me it is the overall challenge of nursing that draws me toward the profession, with a long-term horizon of critical care flight nursing. Hudson (2001) states, “Flight nursing has the intensity of ICU with the urgency of an emergency department. It is the ultimate challenge, the relationships formed are professional, yet intensely intimate at the same time” (p. 230). I can think of no other job that allows room for both professionalism and intimacy. This is why I can allow my mind to fly toward the skies of flight nursing. Whatever my career in nursing brings, I am sure it will bring challenges, relationships, professionalism, and intimacy. I can only hope that time and persistence will bring a flight helmet and jumpsuit to me.

References

Air & Surface Transport Nurses Association. (n.d.). ASTNA answers frequently asked questions. Retrieved February 19, 2007, from http://www.astna.org/FN-FAQ.html

Hudson, J. (2001). Trauma junkie: Memoirs of an emergency flight nurse. Buffalo, NY: Firefly Books.

Lambert, V. and Lambert C. (2005). The evolution of nursing education and practice in the U.S. In J. Daly, S. Speedy, D. Jackson, V. Lambert, & C. Lambert. (Eds.), Professional nursing: Concepts, issues, and challenges (pp. 34-35). New York: Springer Publishing Company.

Salary.com. (n.d). Salary.com nursing salaries. Retrieved February 19, 2007, from http://www.salary.com/sitesearch/layoutscripts/sisl_display.asp?searchtextvalue=ed+nurse&Image1.x=0&Image1.y=0

Scally, R. (2002). Flight nurses: Nursing’s high altitude calling. Spotlight on nurses. Retrieved February 19, 2007, from http://www.nursezone.com/student_nurse_center/default.asp?articleId=9674

Luck is Where Preparation Meets Opportunity

This page, part of crzegrl.net, is a chronological collection of posts titled: “Becoming a Flight Nurse.” Flight Nursing is a unique specialty in the nursing world as there is no one way to get there. Each flight nurse brings a unique set of experiences and skills with them on each mission. Although openings for flight nurses are coveted and rare, they do exist.

I approached my quest to be the one in the flight nurse’s seat believing that, “Luck favors a prepared mind,” and “Luck is where preparation meets opportunity.” I also knew that, “the squeaky nurse (aka–the PIA nurse with creds and the right personality) gets the job.”

It is my hope that my experiences and the information I present will inspire you in your quest to become a better nurse, because that is what being a Flight Nurse is about, becoming the best of the best. I also hope to encourage you to approach Nursing as a profession instead of just a job. When I was a new flight medic, I asked one of my sergeants if he still got scared when the mission bell rang.

He stopped and purposefully turned, looking me in the eye, “Emily, the day you are no longer afraid is the day you need to quit.”

Being a professional is about the quest to always be better, respect your skills, but know your limitations.

I’m still scared.

Thank You

Patrick—for always encouraging my crazy ideas. Mom—for picking me up, over and over. B.J.—for keeping me sane by being insane. The Club—for reminding me why I do what I do. SFC Rodriguez—for not just wearing both EFMB and Aircrew Member badges, but lighting the torch in a young impressionable PFC. Ben, Sarah & Kate—for giving me reasons to move home. My Aero Med Family—for supporting this even though I am ‘the new girl.’

I could never be me without you all.

Introduction

USAAA

Introduction

One day in 1998, I called my mom, as I still do, the morning after my first bad flight as a Medic in the U.S. Army. The training accident made the Associated Press ticker and the front page of at least two papers as far away as Florida and Michigan.

He was 19 years old, engaged and a father. I was left alone with him as another flight medic and the flight physician prepped to transfer him to the ER at a level one trauma center in San Bernardino County. His heart, beating strongly about 85 times a minute, sped up to the mid 100s and almost instantly slow down to nothing. The monitor squiggles stopped.

At the time I didn’t realize that was the classic response for a heart no longer controlled by the brainstem. His brain herniated. The young soldier died right in front of me and there was nothing I could do.

I will never forget that afternoon as long as I live.

Lansing State Journal

Lansing State Journal, 20 June 1998

“Emily, you need to never do anything else with your life,” was my mother’s response. At 24 years old, I understood to my soul that she was right.

Orlando Sentinel

Orlando Sentinel, 20 June 1998

Seven years passed between my last mission as a flight medic and my first mission as a flight nurse. Never once during those intervening years did I lose track of what mom said to me that morning. Never once did I forget that soldier, my first patient.

Over the past four years, sharing my life through this blog has been a natural extension of who I am. Being able to now write about my life as a flight nurse has brought everything full circle.

Thanks to the many of you whom have taken the time to ask me about becoming a flight nurse. Your questions have motivated me to attempt another long term goal, writing a book. For now, it will be saved here as part of my blog: a multi-media version of both who I am and what being a flight nurse is all about.

“Becoming a Flight Nurse” is Live!

After much work, I am happy to announce that “Becoming a Flight Nurse” is up!  Many of you have written to me asking great questions about what it takes to become a flight nurse.  Surprisingly there just isn’t much written on the subject.

What is “Becoming a Flight Nurse?”

It is part blog, part website, part book.  It is a work in progress.  A collection, if you will, of stories, photos, videos and more information about being a flight nurse than you can shake an ET Tube at.

Patrick, thanks for not laughing at me when I told you I was going to write a book someday.

B.J., it has begun.

So, without further adieu:

Becoming a Flight Nurse