NTSB HEMS Public Hearing: The Most Dangerous Nursing Job—And I have It

Close of business today brought to an end to the first of four days of public NTSB hearings focusing on the safety of helicopter emergency medical services (HEMS).

The WSJ lead their story covering the hearings with the following here: (h/t @symtym–his blog here)

WASHINGTON — Emergency medical helicopter pilots had the most dangerous jobs in the U.S., racking up fatalities at a faster clip than loggers and other historically risky professions, according to a new study presented to federal air-crash investigators.

Thirteen crashes, 29 lives lost, all in the 365 days of 2008.

By simple deduction, I, therefore, have the most dangerous job in nursing.


Last year, the small rural ambulance service which served the area my parents live in couldn’t afford to stay in business. Now, if either of them need the advanced skill of a paramedic it will take and ambulance over 15 minutes to reach them.

That, quite simply, scares the shit out of me.

The closest hospital is over 15 minutes away, even with the use of lights and sirens.

That small hospital is over 35 minutes away by ground from the nearest cath lab, or trauma center.

They are nine minutes from the same advanced medical center by air.

The reality, however, is that the community my parents call home is actually very accessible compared to many of the residents of my state. My job is dangerous, and that is a risk I am willing and eager to take as the communities I serve need the advanced medical care we provide.

HEMS is dangerous.

HEMS is, without a doubt, VERY expensive.

But I ask you how much a few more afternoons quilting your mom is worth? What would you pay for few more rounds of golf with your dad?

Those few, precious moments, stolen from fate, are worth risking my life for. I willingly accept those risks because someday, it may be my mother that needs the expertise of a flight nurse. It may be my father I am called to save.

It is my hope that through these hearings, my peers, colleagues and friends will be safer in the air. That 2009 will be the year of Vision Zero.

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End of Shift

On search for Vision Zero, I came across this post from Rogue Medic discussing the conclusions Dr. Ira Blumen came to in discussing the danger associated with HEMS.

The conclusions and decisions which will inevitably be handed down in the following weeks will have a direct impact on my professional life. Here is to hoping, in the end, the title of ‘most dangerous job’ goes back to the crab fishermen.

edit: CNN’s Coverage of the hearings here.

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  1. Although I could never do what you do, I admire your love of your career and your dedication. Should I ever be in need of a flight nurse, I’ve no doubt I’d be in good hands if you were the one sent to my rescue. Have a safe year.

  2. What would you pay for few more rounds of golf with your dad?

    Everything I have.

    I know it’s rhetorical, but as soon as I read it it hit me again – I will never be able to play another round of golf with my dad. Ever. It’s been fifteen years, and it still rips.

    You, Greybeard, and all your contemporaries – you do a job that is both unbelievably dangerous and totally priceless. Thank you for that. Echoing enrico, be safe. My prayers are for a successful Vision Zero.

  3. Em,
    Thank you for what you do. Seriously. With figures like that, it’s just that much more amazing that you go in every day and plop yourself down in the flight seat every time you are called out. You’re risking your life to save others… How selfless is that?

  4. I love what you do…but….

    Medicare pays $10,000 for a flight for a patient that can simple go by ground and that justifies unnecessary flights which endangers many lives including yours and you know it…

    I’m a paramedic working 911 in a city suburb and we are busy running 3 trucks 24/7 with 2 medics plus a chase car. Our base station hospital occasionally transfers out patients like traumas, bleeds, or a STEMI but the decision to fly is the receiving hospitals decision regardless of the patient. Now our hospital doesn’t have a pad so we use a school up the road for landings. Now to get that patient from the school to the pad takes a 911 truck out of service to drive to the LZ, get the crew, drive back to the hospital, pick up the patient, drive back to the LZ, then finally clearing putting the truck back in service for 911 response. 45 minutes to an hour sometimes we lose a truck.

    So here are the last two patients we “flew”…

    1. A hand injury, stable vitals, no loss of PMS, but the MD felt it needed a hand specialist to evaluate the laceration. He walked. 911 truck out of service for 45 minutes. To make this even more interesting, the school had cones set up for some construction and instead of the pilot landing in the LZ he landed in the construction area because we had no direct communication with the pilot. On take off he almost clipped a light pole making the ground crew a little nervous to say the least and that was after slamming the ground from a downdraft. Ground transport to the same hospital by BLS would have been 20 minutes and billed at $400.

    2. A Triple A (AAA). 911 crew initially out of service for 30 minutes because of a inbound delay of flight crew. Pt was stable and ALS crew was available for transport to receiving hospital. 911 truck OOS for one hour and 15 minutes. Transport time to the receiving hospital L&S if 911 crew just did the transport…15 minutes in and 25 minutes back to 911 local.

    I want you in the air…you need to be in the air…but the reasons you are in the air a lot of time puts people at risk and delays patient care. A 3 minute flight is worthless if it takes 30 minutes on the ground. That is why we are fighting to stop the nonsense transports. We will never educate the public on not calling 911 for a blister but as professionals we need to make sure we are doing what is in the best interest of the patient and not jeopardizing our safety for a hospital to bill at a higher rate.

  5. MM-
    Totally agree.
    I have two words for you right off the top of my head without even thinking deeply about this:

    President Obama just signed into law the next huge step in our inexorable march toward Socialized medicine. The problems you point out will almost certainly get worse, rather than better.
    Get used to it. It’s the wave of the future.

  6. I cry every time I hear of another helicopter crash. There was one here several years back, lost the whole flight crew.

    But I also understand what you are saying. My community is at least 50 minutes by ground from a trauma center. Our local hospital, 20-25 minutes from here, just can’t do much, and even it is far away, too far in some cases.

    For major trauma, my biggest fear is that the weather won’t allow the bird to fly.

    I appreciate the risks you all take, and I understand why you take them. You really do make a difference- sometimes a life or death difference. And yes, it could be my family you’re flying.

    But I wish the risks weren’t so high.

    For what it’s worth… a couple of commenters have mentioned flying patients who don’t really need it. That doesn’t happen here. I don’t know why it doesn’t, but it doesn’t. Maybe it’s because the helicopters aren’t based here, so to get them at all is something of an effort?

  7. MM-

    good points.

    education about responsible use of air medical resources begins with the physicians, who ultimately sign the certificate of need/medical necessity. as a professional industry, we’ve done a poor job of that. going back to square one and educating from there down would go a long way towards eliminating unnecessary calls.

    think about how much time, effort and energy so many air medical programs have put into educating pre-hospital 911 crews when to request a helicopter over the years. what if we had put 25% of that effort into physician education?

    i’d be interested to know how the crew wrote the report up on call #1 and if it was reimbursable. should have gone by ground. as a side note, our program would not do scene or interfacility flights where there is no direct communication with the ground. that’s just added/unnecessary risk.

    call #2 demands a critical care interfacility team. imho, you’re asking for it to roll the dice and do it any other way. your local 911 crew (most likely) doesn’t have the meds or blood to manage the AAA patient who takes a nosedive.