It was a phone call that no one ever wants to receive, a call from my mother letting me know that my uncle had just passed away after being ejected in a motor vehicle accident. Despite the hard work of the first responders, EMTs and physicians in the ER, resuscitation efforts were unsuccessful. . The medical examiner ruled his passing as a result of blunt force trauma. This was the beginning of my interest in medicine, wondering if there was anything else that could have been done to save my uncle’s life. During my second year of at Texas A&M University, I took an EMT course to expose myself in emergency medicine as a first responder. I wanted to be a paramedic because I wanted to be the person that people look to in times of crisis. I did not want to be great at one thing, but be good at everything, a jack of all trades. A paramedic is someone who is counted on to perform in any situations for any patient populations. During one of my clinical rotations, I was dispatched to go on a high speed motor vehicle accident on the freeway. Upon arriving, there were 3 fatalities and 1 extremely critical patient. As the fire department worked frantically to extricate the patient, I heard a dull noise that kept getting louder and louder. I look to the sky and there was a small beam of light, then before I knew it a medical helicopter was on the ground. The police and fire department had shut the 4 lane freeway down to land the helicopter. Everyone had directed their attention towards the two people that exited the helicopter as they made their way to the scene of the mangled vehicle. The patient was extricated not too shortly after and loaded onto the stretcher, the “helicopter people” as I called them, intubated the patient right then and there, and quickly loaded the patient into the helicopter. As the helicopter spooled up, traffic all eyes were on the helicopter as they lifted from the scene and watch them disappear into the sky.
I was extremely impressed with the way they handled the patient, not to mention to have an entire freeway shut down just for THEM! I immediately wanted to know who those people were and how to become one of them. I found out that they are a part of Helicopter Emergency Medical Services (HEMS), and a typical crew configuration consists of a pilot, flight paramedic and flight nurse. Extremely interested, I realized that I had to be a paramedic with at least 3 to 5 years of busy 911 experience just to apply for a flight paramedic position. Extremely determined, I went through the paramedic academy and started working for a county service that had a population of over 660,000 people and 12 ambulances in service. Needless to say, we were doing an average of 10 to 15 calls a shift. I felt somewhat limited in my scope of practice as a paramedic and I went on to nursing school to become a nurse. Still extremely interested to be practice flight medicine, I went into the cardiovascular intensive care unit (CVICU) and was there for 3 years while continuing to work part time as a paramedic. Now, many have asked, why ICU and not ER? It’s because while HEMS is often associated with trauma, they are also requested to perform interfacility transfers. An interfacility transfer is where a patient is at a hospital where they do not have the resources or capabilities to handle the patient, and is needed to go to a facility where they can accommodate the specialties needed for the patient.
Eight years had passed since I first witnessed my first HEMS scene, and I have landed my first and only flight job. I am currently working as a flight nurse for Memorial Hermann Life Flight. Memorial Hermann Hospital is located at the Texas Medical Center in Houston, the largest medical center in the world. There are only two Level 1 trauma center in the city of Houston that has a population of over 6 million. The other level 1 trauma center does not have a helipad, therefore landing at another site and taking the patient there could mean wasting precious time that the patient may not have to spare. Memorial Hermann Hospital is one of the busiest trauma centers in the country, with Memorial Hermann Life Flight performing over 3500 patient care flights a year, easily the busiest HEMS in the nation.
The requirement for flight nurse at Memorial Hermann is that you have to be a nurse in an ICU for 3 to 5 years AND also to be a paramedic. The reason for the paramedic requirement is because of the trauma calls that we do with local EMS agencies. Although there is a flight paramedic, having the paramedic background will allow the flight nurse to switch into that “first responder” mode and be comfortable in any situation. The reason for ICU experience and not ER is that for interfacility transfers, often times the patients are extremely sick and critical and the ICU background is invaluable.
I love what I do and I could not imagine myself doing anything else. I love the autonomy that is in my scope of practice. I am able to perform a variety of skills, and it varies from flight programs. For Memorial Hermann Life Flight, I am able to perform intravenous / intraosseous insertions, needle decompressions, assists with chest tube insertions, Focused Assessment for Sonography in Trauma (FAST) exam, endotracheal / nasotracheal intubations, rapid sequence induction for intubation, surgical cricothyrotomy, 12 lead EKG interpretation, administration of narcotics, vasoactive medications and thrombolytics for STEMI, administration of blood products (PRBC and FFP), femoral line insertion, saphenous vein cutdowns and so much more, oh not to mention that I am performing these skills in a 6 million dollar helicopter going 150 miles an hour across the sky of Houston. I am able to perform all these skills under the protocol written by our medical director, Dr. “Red” Duke and we undergo yearly competencies and skill evaluations as well as annual cadaver labs to maintain proficiency. I am fortunate enough to be working for such a progressive HEMS program as we are one of the leaders in the industry and always performing studies and trials as medicine continues to evolve. The satisfaction that I get from my job is not about the glory or the fame, but for the one patient that I may be able to make a difference and get him/her to the hospital for definitive care.
Written for DIverseMedicine by our friend Flight Nurse Rick R.N. – http://www.mylifetime.com/shows/life-flight-trauma-center-houston