You’re part of a fixed-wing flight transport team called to pick up a 32-year-old male who’s been involved in a paragliding accident in Puerto Rico. Upon landing, you see an ambulance at the end of the tarmac. As you exit your plane, the ambulance pulls up and the crew opens the back door of the rig. They pull the patient out on a stretcher and hand you a folder of X-rays, saying, “He’s all yours.”
After four days of intensive training in the Air Medical Crew Core Curriculum course, my team was given that scenario as a group assignment on the last day of class. We were given a folder of radiology films and briefed on our patient’s vital signs and our assessment findings. We conducted a quick “field interpretation” of his X-rays and presented our interventions, along with our concerns and specific accommodations for transporting this unstable patient to Florida in a Learjet.
This was no ordinary class. Offered to nurses and other medical personnel interested in flight medicine—either on emergency response helicopters or fixed-wing transports—it included safety briefings, aircraft orientation, and worst-case-scenario land survival instructions. Among other activities, we visited with a helicopter crew and watched someone try to ignite a Nomex flight suit with a magnesium fire (it really will not burn). Lectures included transport considerations for specific patient populations including trauma, shock, neurologic injury, and burns. Flight physiology was discussed in depth. All in all, it was probably the coolest class I’ve ever taken—and I learned far more than I’d ever expected.
Just a few of the things I didn’t know:
- At altitude, because of Boyle’s law, a simple pneumothorax may become a tension pneumothorax.
- Pneumocephalus can be detrimental—or fatal.
- The pressure in an endotracheal tube (ETT) cuff will increase, potentially resulting in airway ischemia.
- Because of Dalton’s law, the fraction of inspired oxygen (FiO2) required by your patient will change and can be precisely calculated based on altitude and barometric pressure.
I’m certain the patient in our scenario made it back to the United States safely. My team, which was comprised of two nurses and three paramedics, caught the important injuries on the X-ray films we’d been provided. We knew, based on our assessment findings, which problems were emergent and required intervention before the flight, as well as how our various scopes of practice would dictate the actions taken. We knew exactly how much oxygen we’d need for the flight, based on the elevation we’d be flying at, and how many canisters that would require.
To be honest, this class was one that I initially hesitated to take and nearly talked myself out of several times, as difficulty scheduling time off from work led to large obstacles of money and time. But I loved every moment of the course. I especially loved the focus on collaboration, and the reminder that the boundaries of the nursing profession are almost limitless. Whether or not I find my career going airborne, the week left me recharged. And along with everything else I learned, I appreciated the sense of priority conveyed by the first and foremost rule of flight medicine: