A Day in the Life of an Air Ambulance Nurse
by Dave Edner

About 3:00 a.m., my beeper goes off. Usually I'm within a few seconds and into the routine of calling the main office and getting dressed.
"Sorry to get you up so soon after your last flight, but Community has a patient to go. Is your partner with you?" Dispatch tries to sound apologetic; they know it’s our third flight this evening.
"Yeah, we're here. What we got?"
"There is a 62 year old male, Bob and his wife, Judy to go to Phoenix General. He's an acute MI for Dr. McLaughlin from Dr. Lipp. I think they've started TPA and Heparin. He was a post arrest, successfully defibed in the field by paramedics.
"Does he need a vent?"
"No, they say he's awake and my partner Cristy, a critical care veteran of many years asks what's up. As we jump into our flight suits (or is that fly into our jump suits), I fill her in. We load our gear into the car that the company provides and go.

Cristy and I arrive at about 3:15 a.m. and call dispatch to let them know that we were there. We split into two parts; one clinical (patient care), the other, paperwork. We received the report from the Charge Nurse together to insure that we didn't miss anything. With all the official stuff out of the way, we went to introduce ourselves to Mr. Howard and his wife.
Of course there's a form we need signed. On the last flight I did the paperwork, so this time Cristy gets the task. I don't think that anyone really dislikes that part of the job. It's essential that we tell an accurate story, but most nurses prefer patient care.
We're lucky because the amount of paper that we have to shuffle is considerably less than a Hospital's Intensive Care Unit or Emergency Room. I've asked the company to give us laptop computers, but the cost outweighs the gain, and then there's teaching everyone to use them. He says to call him Bob. His smile is unsure, eyebrows up in a question. I ask him how he feels right now. He tells me that he's OK. The pain's gone since the nurse gave him the pills under his tongue. I tell him that it’s important to let me know if there are any changes; or the pain returns at all.

During my assessment, I ask Bob and Judy if they have ever flown in smaller aircraft before. Not that our Cessna 421 Golden Eagle twins are small, but they're not your 747's. He answered, "yes", his brother was a private pilot, and they had spent some time aloft with him a few years ago. He says that he doesn't get airsick but his stomach seemed to be a little unsteady. I assure him that we have medicine for that if needed.

After checking that I have my monitors connected, and all the IV drugs are infusing at the correct rate, we call for ground transport. The same paramedics that took care of Mr. Howard at his home returned to the hospital to transport us to the airport. Cristy and I had been at the hospital for less than 30 minutes when they arrived. Once we got to the airport, our pilot Randy helps Judy into the copilot’s seat and secures her in. He gives her a little reassuring talk about the airplane and tells her that we would have good weather. The pilots are really extraordinary professionals. They must meet requirements that exceed all the airlines' requisites of certification and experience. They're often confronted by the tragedy of others and asked to squeeze a bag that provides the breath of life while flying the plane in rough weather. We, as nurses, have asked for this, but the pilots do it because they are willing to exceed their role to help others. Randy returns and directs the loading of the patient to the aircraft. Sounds good but what actually happens is that the pilot, nurse, and paramedics lift the special flat that the patient is on into the plane with the strength of their backs. Once on board, Randy goes to the pilot's seat, checks that Judy is secure and gets the aircraft ready to fly.

Cristy and I are in the back strapping Bob to the device used to hold the flat in place, connecting the oxygen, hanging IV's and securing the monitors. When all is stowed and ready, we tell Randy, and off we go. I sit beside Bob, Cristy is in the back by his feet facing forward and Judy is in the copilot's seat at Bob's head. Judy asks how it’s going, and I reply that he's doing great. We haven't had any chest pain since the hospital, and his heart rhythm is regular. He's breathing well, and in the air we’ll give him a little extra oxygen to help him feel comfortable. At 3:52 a.m. our wheels leave the ground. The acceleration causes everything in the aircraft to shift aft. It’s not hard to understand why so many nautical terms apply to aircraft. The problem of moving people and supplies by air can be reminiscent of sailing in rough water. We're lucky that the weather is good. Bob wouldn't tolerate much turbulence. Randy gently banks to the right to give a view of the town. Bob is facing aft on the flat and his head is up about 45 degrees. His head is in perfect position to look out the window and see the lights go by. The view of home at night is enough to give wonder to Bob. He looks out and for a moment the lines of his face are less pronounced, his eyes shine.

Bob asks the usual questions about how high, fast and long it takes to get to Phoenix. He seems to be more comfortable about flying now that we're off the ground. Judy turns around to ask how he's doing. Cristy and I both tell her about his regular heartbeat and good oxygenation. He hasn't had any pain and seems too busy looking out the window to worry about anything at the moment. She seems relieved and returns to her view of out the front window. As we gain altitude, I ask Randy to keep the cabin’s attitude as close to sea level as he can. This insures that Bob will get the highest concentration of oxygen without putting an O2 mask on. The mask has an uncomfortable claustrophobic feel and can make the patient wonder if he is sicker that he thought The airport that we left from is just above sea level, and Phoenix is at about 1,100 feet. Once we are at altitude, Randy will slowly bring our cabin altitude up to Phoenix level. We'll land without noticing a difference. For Bob, the altitude change can have profound effects. It's the lack of oxygen in the heart muscle that causes pain, just like when you run too hard and your legs hurt.

The 02 Saturation monitor is usually sensitive enough to alert us before we get into trouble. Along with the 02 Sat, we use monitors that take vital signs every 15 minutes and give continuous readouts of EKG. We could do this more frequently if we needed to, but the pneumatic cuff can be pesky to your arm. Once at altitude, the flight becomes quiet. Randy talks with the air traffic controllers and Judy while Bob looks out the window. "It’s sure black out there between the towns. Seems like you'd see the roads or somethin."

Shortly the excitement wears off, and Bob drifts into sleep. His pain gone, the drone of the engines soothes him into the rest that he needs. Cristy and I look at the monitors, then at each other. At the moment, we agree that he's OK, but we both know better than to let our guard down. Bob awakens as we touch down at Sky Harbor in Phoenix at 4:40 a.m. As Randy taxies to the terminal, Cristy and I prepare Bob and his gear for the ambulance trip to the hospital. Randy tells Judy that she’ll get off after we get Bob out. We go with the patient, they're ours till relieved by the appropriate registered nurse or medical team. The paramedic crew in Phoenix is already here and once the engines stop, they pull up to the rear of the aircraft. We've met most of them and have a lot of admiration for the responsibility they carry. They're efficient at transferring Bob to the gurney and secure him down with 4 sets of straps. Judy is helped from the aircraft by Randy and after a brief moment with Bob, is placed in the front of the ambulance. I assist in the ambulance as Cristy checks to see if we forgot anything in the aircraft. I've seen the same paramedic crew 3 times in the last 2 days. We subtly joke with each other as we go about our respective tasks. I tell Bob that he's lucky that he got this crew because the driver at least usually tries to miss the potholes. Bob's looking very good and hasn't complained of any discomfort or shortness of breath. His rhythm and pressure have been stable and his color is good. Cristy gives the paramedics a short report and the all-important paperwork. The trip is only about 8 minutes running code 1 (without lights and siren).

At 4:52 a.m. we unload Bob at the Emergency Room door and stop by the desk to find that he is a direct admit to the CCU. Bob, his belongings, Judy, the paramedics, Cristy and I all head down the hall. As we enter the CCU the nurse at the disk smiles (she's seen us already today, too) and says room 1414, it's ready. Betty will be in for report right away. Cristy gives report to Betty as the paramedics and I assist Bob to bed.

Once the paperwork is done, Cristy and I say good-by to Bob and Judy. Well ask how he did the next time we're here, and if we can visit for a few minutes. The paramedics have taken all of our gear to their rig and wait to take us back to Sky Harbor. On the way back I ask to stop at a fast food place and buy a round of shakes for everyone. We pat ourselves on the back and confirm our team spirit. Once at the airport, it only takes a few minutes to load and secure our gear. I make a list of the equipment used and what we'll need to restock when we return to base. Randy walks out of the terminal just after we get secured. He says that we'd better get some sleep; dispatch has plans for us. I guess I'd better restock ASAP!

Courtesy of Paul Edner, Dave Edner's brother