Personnel Management

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Flight Nurse Training by Bonnie Garrison, RN, CCRN, BSN

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Each member of the medical crew for AirEvac in Phoenix undergoes an extensive training program before being selected for one of the most active hospital-sponsored helicopter programs in the nation.

In the aeromedical indust ry today, rapid growth, both geographically and technologically, has been especially demons t ra t ed the past 11/2 years. To meet the rapidly advancing and changing goals of the industry, specialized training is required for the flight nurse who, in many instances functions as senior medical officer while in-flight, recognized as an extension of the base hospital Medical Director. L

The flight nurse functions in a f requent ly uncontro l led envi ronment , interacts with multiple levels of medical practice, and manages many different critical patient scenarios (i.e., neonate, pediatric, adult with varied conditions). The flight nurse must be ready for any of these scenarios and must be highly competen t in complet ion of assessments and managemen t of each. Every year, more and more expectat ions are given to the nurse; therefore the training must reflect this ever-changing, ever-advancing, i ndependen t role.

The nation's first hospi tal-based fixed wing medical service began in 1969 in Phoenix (Air Evac) and the first hospi ta l -based helicopter medical service was established in

1972 in Denver (Flight for Life). Both of these programs flew with flight nurses as senior medical officers. As the number of programs increased, the demand for flight nurses increased. As training was not always available, nurses were pulled from the ER's and ICU's. From their exl~eriences, several sjecific needs were identified. In Phoenix, our flight nurses identif ied the following areas:

1. Didactic lectures involving the following systems/areas (all critical care medicine) a. Cardiovascular (including EKG

- 12 lead, advanced dys rhy thmia interpretat ion).

b. Respiratory c. Metabolic d. Renal (including fluids and

lytes) e. Neuro (including autonomic

nervous system) f. GI g. Obstetrics h. Gyneco logy i. Neona to logy j. Pediatrics k. Env i ronment

1. Burns 2. Stings 3. Bites

4. Poisons 5. Hypo/hyper the rmia

1. Behavioral emergencies m. Hemato logy n. Multiple t rauma/or thopedics o. EMS system/Pre-hospi ta l

medicine p. Effective communicat ion skills q. Detailed altitude

physiology/stresses of flight r. Map reading/navigat ion s. Radio communicat ions t. Equ ipment u. Pharmacology v. Interpreta t ion of x-rays w. Public Relations x. Assert iveness training y. Disaster managemen t and

triage z. Coping with stress and grief aa. Aircraft safety.

2. Clinical Experience in the following areas: a. Helicopter b. Fixed wing c. Paramedic/f ield d. ICU/CCU e. ER/trauma room f. Neona te ICU g. Pediatric ICU h. Neuro ICU i. Labor and delivery

HOSPITAL AVIATION, JANUARY 1985 5

Personnel Management...

j. OR for intubations k. Skill labs to perform the

following skills: 1. Intubation: oral and nasal 2. Cr icothyrotomy 3. Central lines 4. Cu tdowns 5. Transthoracic pacemaker 6. Needle thoracos tomy 7. Chest tube insert ion 8. Pericardiocentesis 9. Tongs 10. Set-ups for arterial

l ine/Swan Ganz ( thermodilution) CVP

11. Splinting labs a. C-spine b. Extremity c. MAST pants

1. Dispatch m. Autopsy observat ion

From these needs, a training p rogram was created with didactic and clinical experience in te rwoven t h roughou t the course. In order to meet the goals of the course, specific pre-requisi tes must be identified and adhe red to, which include:

Minimum Requirements: 3 year critical care

experience as RN

ACLS Certification Recent critical care course

or equivalent CCRN within one year of hire No previous back injury Must pass flight physical Meet weight s tandards

Preferred Requirements: ACLS instructor Both ER and ICU/CCU

experieince CCRN prior to hire Previous flight nurse

experience

Through these pre-requisites, a basic knowledge of entry has been established. The major goals of the Flight Nurse Training Program are to: (1) Enhance didactic knowledge, (2) Provide a "pract i t ioner" level of practice, (3) Broaden scope of practice for an RN, allowing for i ndependen t decision making, (4) to produce an effective, efficient, highly skilled flight nurse who has incorpora ted the didactic material into the clinical setting, and (5) To provide safe, highly skilled patient care and funct ion as a pat ient advocate.

After the Flight Nurse Training

AirEvac graduated 8 new f l ight nurses f rom its t ra ining program in 1984. The program is conducted on an " 'as-needed" basis, and is avai lable to candidates f rom other aeromedica l services.

Program has been completed, the prospect ive flight nurse must successfully pass a final exam, final moulage stations, and an oral board.

Future plans include college accreditation and SBN accreditation for pre-hospital emergency nurse practicioners.

During the Flight Nurse Training Program, the participants are assigned a flight nurse and paramedic preceptor to encourage, guide, reinforce, and expand knowledge and clinical skills. They are a vital componen t to the successful complet ion of the course and serve as a part of the lecturers (which are composed of flight nurses, paramedics, pilots, dispatchers, physicians, clinical specialists, educators).

After the Flight Nurse Training Program has been successfully completed, cont inuing educat ion must be maintained to ensure adequate performance of skills to update didactic and clinical information, and to per form quality assurance in the form of chart reviews and case presentat ions. The flight teams present a large part of the lectures, which enhance their professional roles.

Recognition of the flight nurse for involvement above and beyond the normal expectations is accomplished th rough the clinical advancement p rogram which is voluntary in nature. Three levels have been identified and progresses to Level III, increased skills, communi ty involvement , teaching, and educat ion are necessary. Research is also a vital componen t as one progresses to Level III.

In summary , after a detailed interview process, a 10-week 486 hour flight nurse training program, successful passing of weekly exams, oral boards, final moulage stations and a final writ ten exam (on a strictly synthesis level), the flight nurse is ready to enter the new, innovat ive, sophisticated, exciting world of flight nurs ing which functions on a practit ioner level. The flight nurse must maintain skills and cont inuing educat ion and is recognized by a clinical advancement p rogram specifically tailored to flight nursing. He/she is a new breed of nurse, in a new branch of the ex tended role of nursing and one that will cont inue to grow and expand.

6 HOSPITAL AVIATION, JANUARY 1985

Personnel Management . . .

FLIGHT NURSE DUTIES NON-FLIGHT STATUS

1. Involvement and attendance of AZNA and Network meetings and legislative process.

2. Assist in preparation for and lectures of Flight Nurse Training Programs, and CE meetings.

3. Assist with creation and maintenance of library (both Air Evac's and NFNA).

4. Research for ASHBEAMS and NFNA.

5. Article preparation 6. Case presentations emphasizing

educational presentations and quality assurance.

7. Preparation for educational programs, ACLS instructor class preparation, community lecture preparation, inservice data

information for billing. 8. Patient chart completion;

narrative. 9. Helicopter maintenance after

every flight (daily) which includes cleaning, taking inventory and stocking aircraft, oxygen, check medication outdates, check equipment, repair and maintenance of equipment.

10. Patient follow-up by phone and in person, dispatch coordination of times, flights, follow-up.

11. Physician follow-up. 12. Participation in revision of

policies and procedures. 13. Paramedic follow-up. 14. Develop standards of practice for

flight nurses 15. Skills maintenance. 16. Public relations visits

emphasizing quality care and patient referrals to SHS facilities.

17. Daily random chart review, and quality assurance reviews with ongoing critiques.

18. Continuing education requirements.

19. Research labs, grand rounds. 20. Paramedic meetings 21. Assist as time permits in ED, CCU

(GSMC and DSH), PICU, Neonate nursing, OB, and working with physicians for skills maintenance, (i.e., x-ray interpretation, EKG interpretation, etc.

Bonnie Garrison, RN, CCRN, BSN, has been a flight nurse for 3 years with AIREVAC, which flies 2 helicopters and 2 airplanes for Samaritan Health Service in Phoenix, AZ. Ms. Garrison has 15 years experience in critical care medicare, was a coordinator for critical care courses on a collegiate level for 3 years, and is currently Education Coordinator for AIR EVAC.

Some things seldom change. . . •..others often do

. . . that's w h y hospita l -sponsored aeromedical services are taking advantage of aeromedical program reviews.

During the past four years, a number of changes have altered the appearance of the hospital sponsored aeromedical scene. Issues such as shared services, competition, addition of a second aircraft, fixed-wing transport, staffing levels, operational procedures and safety have become more complex.

These issues increase management burden at a time when management resources have frequently been limited

duCto cost constraints. Keeping pace with technological changes, operator capabilities, safe operating practices and admi;qstrative policies can become a major challenge while under the pressure of daily operations.

In keeping with sound management principles, many programs are taking time to evaluate where they are, how their performance levels measure up and what kind of service they are receiving. And many are finding it appropriate to involve outside professional assistance in this analysis.

Today, such assistance is available in the form of an aeromedical program review.

Aviation Consulting, Inc. of Manhasset, New York and Aviation/Hospital Consultants of Orem, Utah have combined experience and skills to provide a professional analysis of both administrative and operational aspects of an aeromedical service. For a detailed proposal regarding this new service and how it can benefit your aeromedical program, contact:

Aeromedical Program Review Aviation/Hospital Consultants 53 West 1800 South Orem, Utah 84058 801-226-3060

HOSPITAL AVIATION, JANUARY 1985