Crew Configuration and Training

The medical crew on a rotor-wing craft can be configured in multiple ways: nurse-paramedic, nurse-nurse, nurse-physician, or nurse-respiratory therapist. The literature suggests that the addition of a physician to the crew does not add a significantly higher level of care to that already rendered by a flight nurse or flight medic, although there is a minority view that on-board physicians do improve patient care. 45 The most frequently used crew is nurse-paramedic because of their complementary skills. Since rotor-wing missions vary on the spectrum between scene flights and interfacility transports, a broad skill basis is essential in the medical crew. A comprehensive curriculum guide developed by a number of national air medical organizations under contract from the U.S. Department of Transportation is available to use for training medical flight crews.6 This curriculum covers all aspects of air medical care and is intended for use by paramedics, nurses, and physicians.

The medical flight crew needs to know how the environment on board an aircraft will affect the patient's illness and how to transport the patient safely in the relatively hostile environment of that aircraft.7 Since helicopters generally transport patients at about 1000 to 3500 ft, low barometric pressure with barotrauma is usually not a factor; but it could become a consideration if transportation were to occur over mountains. The noise, close quarters, vibration, and temperature changes of the cabin of a rotor-wing craft can have a marked effect on the patient's condition. Likewise, these factors make assessment of the patient more difficult. For example, measurement of blood pressure or ausculation of the lungs with a stethoscope is generally impossible during flight due to the noise and vibration.

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