TRANSPORT

jmccrn · Oct 30, 1998

The crew can be different depending on the helicopter service. I think a common crew is a nurse and paramedic, but I have also seen a crew consisting of a respiratory therapist and nurse, as well as an ER resident and a nurse.

UK2USA · Mar 17, 2004

I work for a paediatric transport team in the UK. We transport by land or air within the UK and internationally to a paediatric ITU. Our crew composes of:

1 ITU qualified Dr.

1 nurse with PICU experience and transport qualifications

1 Driver (for the rapid response vehicle - if going by land)

1 pilot and co-pilot (for all helicopter and fixed wing flights)

Hope this helps.

I WOULD LIKE INFORMATION ON AIR TRANSPORT NURSING. WHO IS ON BOARD? WHAT ARE THE DIFFERENT TYPES OF AIR TRANSPORT?

PA-C in Texas · Mar 17, 2004

Most of the crew configurations I have seen involve a Paramedic and an RN. If it is a response to an emergency scene, the Paramedic is in charge. If it is an inter-facility transfer, the RN is in charge unless the patient goes into full arrest (at which point the Paramedic takes contol). I moonlight about once a month for a chopper service, and I am always responsible for patient care unless for some odd reason a physician is riding with me.

qanik · Mar 26, 2004

"If it is a response to an emergency scene, the Paramedic is in charge. If it is an inter-facility transfer, the RN is in charge unless the patient goes into full arrest (at which point the Paramedic takes contol)."

I have to say I have been flying for the last 9 years with multiple programs and have never heard of such a thing. I currently am the chief flight nurse at a large teaching facility and sit on many of the National Transport commitees and still have never heard of such a thing. The majority of crew configurations are Nurse/Paramedic about 85-90% Then RN/RN, RN/RT and finally RN/ED resident. You work as a team, no one is in control over the other. It is true that the paramedic usually is more experienced on scene and the nurse more comfortable in the ICU etc. We all operate under SOP's (standard operating procedures) that are apporoved by the state you work in. Most programs the medic and nurse can peform all the same procedures. Why would a paramedic take control during an arrest? (no offense to a medic as I have been one for 16 years). Again the only way a crew can function is as a team and if there are still programs out there where one crew member is a "bag holder" then it is time to move into the 21st century and find a new program.

Qanik

Most of the crew configurations I have seen involve a Paramedic and an RN. If it is a response to an emergency scene, the Paramedic is in charge. If it is an inter-facility transfer, the RN is in charge unless the patient goes into full arrest (at which point the Paramedic takes contol). I moonlight about once a month for a chopper service, and I am always responsible for patient care unless for some odd reason a physician is riding with me.

PA-C in Texas · Mar 27, 2004

"If it is a response to an emergency scene, the Paramedic is in charge. If it is an inter-facility transfer, the RN is in charge unless the patient goes into full arrest (at which point the Paramedic takes contol)."
I have to say I have been flying for the last 9 years with multiple programs and have never heard of such a thing. I currently am the chief flight nurse at a large teaching facility and sit on many of the National Transport commitees and still have never heard of such a thing. The majority of crew configurations are Nurse/Paramedic about 85-90% Then RN/RN, RN/RT and finally RN/ED resident. You work as a team, no one is in control over the other. It is true that the paramedic usually is more experienced on scene and the nurse more comfortable in the ICU etc. We all operate under SOP's (standard operating procedures) that are apporoved by the state you work in. Most programs the medic and nurse can peform all the same procedures. Why would a paramedic take control during an arrest? (no offense to a medic as I have been one for 16 years). Again the only way a crew can function is as a team and if there are still programs out there where one crew member is a "bag holder" then it is time to move into the 21st century and find a new program.
Qanik

I am really glad that works so well for you. I know that at the local air service, RN's cannot perform invasive procedures other than IV lines etc. unless they are also a paramedic. They prefer for one of their medics to also be a flight nurse (probably for billing purposes), but it just goes back to training. If you are a great pre-hospital nurse, it is by virtue of the fact that you have had good experience and continuing education, not that you graduated from nursing school. Paramedic education IS prehospital and emergency care. I just really have a problem with a non-paramedic RN's dropping a tube in the field when they probably haven't had any supervised OR time, and their education in airway management consists of ACLS and maybe a one-week "class" on intubation. I just don't see that non-paramedics (or NON-physician,NP,PA) have a lot to offer on scene calls when you have the option of carrying two medics instead of one. If you happen to be both, good for you.

qanik · Mar 27, 2004

Brian,

I think you really need to expose yourself to the aeromedical field a little better. You might want to do some research and literature searches on the topic. The success rate for aeromedical intubations throughout the country is at 97%. That is with both the nurse and the paramedic intubating. You will not find any literature to support a medic has better sucess rates then a flight nurse. Now again I will say that I have been a medic longer then a nurse and have dropped alot of "tubes" in my life. BUT on the other hand, I have no idea what State you practice in but to think someone would let a nurse on a helicopter with a week of "unsupervised tubes" would be ridiculous. And remmeber how many tubes did you have when you started? Our State (Illinois) has very specific rules and regs. A new nurse or paramedic no matter how much experience will receive 12 weeks of orientation. In that time they will meet specific State set criteria. Airway They will spend 2 -8 hour days in the EMS department learning the basics. They then will go to the OR for 2 weeks and be paired with a CRNA or MD. In that time they must get 20 live intubations. Then during orientation they will have to get another 10 supervised scence intubations. After orientation they must get 5 live intubations every quarter either on the aircraft or in the trauma room/OR. Then there is QA. If you miss a tube (medic or nurse) it is reviewed by the commitee. If there is a valid reason- Horrible trauma, vomiting etc it is followed and an education process in done. If there is not an exceptable reason you will be placed on probation and will be sent back to the ED and OR. You miss another one you will be asked to find another job. WE obviously live in different States as our EMS act with regards to a helicopter staffing sates "The specialized emergency vehicle will be staffed at a minimum with at least one registered nurse." Why in the world would a nurse not be able to perform an advanced procedure (chest tube, central line, intubation, RSI, art line etc.) again I will say it is what is written in your SMO's that dictate what the medic and nurse can and can't do. As I have said before our nurse and medics can give all the same drugs (over 100) and perform all the same procedures. This is the way almost all aeromedical providers practice in this country- I do sit on the U of M CCEMT-P board and the ASTNA board so I do get both sides of the picture.

Regards

Qanik

I am really glad that works so well for you. I know that at the local air service, RN's cannot perform invasive procedures other than IV lines etc. unless they are also a paramedic. They prefer for one of their medics to also be a flight nurse (probably for billing purposes), but it just goes back to training. If you are a great pre-hospital nurse, it is by virtue of the fact that you have had good experience and continuing education, not that you graduated from nursing school. Paramedic education IS prehospital and emergency care. I just really have a problem with a non-paramedic RN's dropping a tube in the field when they probably haven't had any supervised OR time, and their education in airway management consists of ACLS and maybe a one-week "class" on intubation. I just don't see that non-paramedics (or NON-physician,NP,PA) have a lot to offer on scene calls when you have the option of carrying two medics instead of one. If you happen to be both, good for you.

PA-C in Texas · Mar 28, 2004

Brian,
I think you really need to expose yourself to the aeromedical field a little better. You might want to do some research and literature searches on the topic. The success rate for aeromedical intubations throughout the country is at 97%. That is with both the nurse and the paramedic intubating. You will not find any literature to support a medic has better sucess rates then a flight nurse. Now again I will say that I have been a medic longer then a nurse and have dropped alot of "tubes" in my life. BUT on the other hand, I have no idea what State you practice in but to think someone would let a nurse on a helicopter with a week of "unsupervised tubes" would be ridiculous. And remmeber how many tubes did you have when you started? Our State (Illinois) has very specific rules and regs. A new nurse or paramedic no matter how much experience will receive 12 weeks of orientation. In that time they will meet specific State set criteria. Airway They will spend 2 -8 hour days in the EMS department learning the basics. They then will go to the OR for 2 weeks and be paired with a CRNA or MD. In that time they must get 20 live intubations. Then during orientation they will have to get another 10 supervised scence intubations. After orientation they must get 5 live intubations every quarter either on the aircraft or in the trauma room/OR. Then there is QA. If you miss a tube (medic or nurse) it is reviewed by the commitee. If there is a valid reason- Horrible trauma, vomiting etc it is followed and an education process in done. If there is not an exceptable reason you will be placed on probation and will be sent back to the ED and OR. You miss another one you will be asked to find another job. WE obviously live in different States as our EMS act with regards to a helicopter staffing sates "The specialized emergency vehicle will be staffed at a minimum with at least one registered nurse." Why in the world would a nurse not be able to perform an advanced procedure (chest tube, central line, intubation, RSI, art line etc.) again I will say it is what is written in your SMO's that dictate what the medic and nurse can and can't do. As I have said before our nurse and medics can give all the same drugs (over 100) and perform all the same procedures. This is the way almost all aeromedical providers practice in this country- I do sit on the U of M CCEMT-P board and the ASTNA board so I do get both sides of the picture.
Regards
Qanik

Hi, my name is not Brian, but thanks anyway. The laws in Texas state that for an emergency vehicle to be classified as a mobile intensive care unit, or an emergency vehicle, a Paramedic must be onboard. I started out as a Paramedic eight years ago and then went on to get a Bachelors degree in Emergency Health Sciences and then a Master of Physician Assistant Studies. I also retain my paramedic license and CCEMT-P and FP-C certifications. I am aware of the data that you are pushing, but I would also like to say that in my state, it is very uncommon for an RN to be on a chopper unless they are also a Paramedic. I cannot speak for other states, but I have to wonder if the data is an accurate reflection of the success rates of RN's intubating. My initial point remains, however, that if you are a competent flight nurse, it is by virtue of additional training that is not provided in the two year sorority indoctrination you went through, but rather because you have extensive education beyond your ADN. The doc who finally convinced me to go to medical school (he is also an EMS medical director) was talking to me the other day about the Paramedic vs. RN debate, and we decided that we will let RN's come play on the ambulance or in the chopper when RN's allow Paramedics to practice in the ER at their skill level. It is getting to where you have to be an RN before you can do anything in health care, and I think that is dangerous.

Of course I get to practice at a little more advanced skill level than the rest of my colleagues while flying (ie. diagnostic peritoneal lavage, chest tube as opposed to needle thoracentesis, etc.), but I can't imagine an RN who isn't an ENP doing any of that (or a Paramedic for that matter).