Today’s civilian flight nurse evolved out of the need to meet patient needs where they exist–in a pre-hospital environment. She/he represents a new breed of nurses who’ve taken to the sky to bring the highest quality Medical Care to the critically ill or injured.

Becoming a flight nurse can be fraught with untold stress and challenge as a fledgling flight nurse will tell you. The most heard phrases are: ‘It’s scary; it’s a lot to get your act together, or I didn’t see anything but the patient.’ A new nurse can wait for hours in anticipation of that first call. It is check and recheck the medical supplies to make sure all that is required in the field is in place. In nervous gesture, she may scratch down the dosage on her cheat sheet while her mind loads up with: “Will I save a life? How will I deal with triage (setting priorities)? What if I mess up? What if I forget something really important? Dear God will I make it? What if I can’t? When the call finally comes, and she lifts off, there is a prayer on her lips: “Lord, give me the strength to do what I need to do. Let me do no harm.”

The flight nurse knows that she takes on a great deal of responsibility for the life of others. At the same time, she is in the spotlight for all to see, criticize, and hold accountable, praise or support. It is not always easy to feel supported in the field because the environment can be chaotic and demanding. All she has is herself and the best possible medical training. Support will have to come later.

Each time a flight nurse goes into the field, she must be cognizant of her surroundings (what personnel are on the scene, where is the family, who is most critically injured, what decisions must be made quickly). Even if the nurse is trembling with fear, she cannot allow herself to be overwhelmed at the scene because so many are depending on her critical medical expertise. Oftentimes, the victim will be unconscious and healing has to start with family members who are devastated. A loved one is on the verge of death or may never walk or speak again. While the victim is of primary concern, family or significant others cannot be forgotten. A kind word, squeeze of the hand, and a brief explanation of what is going on helps to assuage a sense of isolation of helplessness.

A quick look at some studies related to helicopter medevac are probably in order to discuss how the industry is progressing. We all know that safety and helicopter accidents claiming lives are of paramount importance. In light of the high number of accidents, I think it is a fair question to ask is helicopter medevac as profitable as one might think? There are indications that only a small number of patients actually benefit from helicopter transfer because EMS providers may summon a helicopter even though the patient’s condition may not warrant their use. A helicopter may not always be the fastest way to the hospital, because of problems of being able to land nearby. A study found that 22.8% of patients possibly benefited from helicopter transport. 33.5% of those transported by helicopter were discharged from the emergency department. 85% of patients were considered to have minor injuries. Of the patients transported by helicopter 33% were discharged from the ER and not admitted to the hospital. Given the increasing cost of medical care, it is timely to question whether or not medical helicopters are really in the best service of those in need who more than likely are located in rural areas. Years ago, E.V Kuhlman said, “For the ill-informed, helicopter medevac is not a money maker.” Given the high cost of launching and operating a service, insurance and possible lawsuits that may come as a result of accidents, is it really profitable? Eckstein M, Jantos T, Kelly N, et al. Helicopter transport of pediatric trauma patients in an urban emergency medical services system: A critical analysis. J Trauma 5:340–344, 2002.

It’s early Monday morning and you’re on your way to work. It’s a morning just like any other on I-70 with bumper to bumper commuters heading for Denver.   Somehow, you’re running later than usual. Ahh, but it’s oh so easy to press down on the accelerator to give Betsy that little extra push. Suddenly, in front of you a deer pops out of nowhere. Your first instinct is to slam on the brakes or swerve out of the way to spare the poor deer. Maybe you do a little of both with the catastrophic result of rolling your vehicle, and sending your life crashing down the next ravine. The deer bounds off leaving a heap of mangled metal, shattered glass, and your body catapulted against an immovable rock. It’s not what you expected, but you won’t be able to verbalize that for a while. Who will take time out of their busy schedule to come to your aid? What will they do? Will they know who to call? Will help get there in time to stop the bleeding or prevent your frail life from reducing itself to the state of a vegetable? Where will you be taken? Which hospital is best equipped to deal with your injuries? These are only a few of the questions that you as a concerned citizen should ask yourself about the emergency medical services (EMS) that exist in your community.

More than likely, a trucker will spot your dilemma, and quickly radio the State Patrol. The State Patrol, in turn, will dispatch a call the closest ambulance service. At the same time, a helicopter is put on standby. This kind of response network is what is referred to as an Emergency Medical Service System.

In the “old days,” anyone who was unfortunate enough to have catastrophic accident or coronary, braced themselves for what was most likely inevitable — death. An ambulance was dispatched to remove the dying victim, and take him/her to a “funeral parlor.” No one really expected survival much less a productive life. Another “unlucky” statistic would be recorded, and quickly forgotten because no one knew how to deal with the inadequacies of medical intervention. Things were much simpler in the early days; medicine didn’t cost much. It didn’t do much either — at least not for the critically ill or injured.