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Matthew Sanders, RN, spends some of his shifts checking equipment, reviewing protocols, watching the weather, keeping up with continuing education and…waiting. But when the radio crackles, Sanders races toward the rooftop helipad at Duke University Hospital in Durham, North Carolina, climbs aboard the helicopter and races toward a patient who needs immediate critical care.
“It’s a gamble every day,” Sanders said. “You never know if you’re going to go [to work] and have no transports all day...or go in and transport [patients] all day.”
In the US, an air medical helicopter responds to a call every 90 seconds. Flight nurses work as first responders, providing critical care to patients during air transport. Working as a flight nurse requires a rare combination of hospital-based critical care expertise and the ability to make rapid decisions in unpredictable environments.
There are just 5800 nurses in the US who hold the certified flight registered nurse (CFRN) credential, and there is a high demand for more RNs with experience in intensive care and emergency room settings who want to pursue this fast-paced, high-stakes career.
“We bring the [ICU] to the patient rather than caring for patients within the hospital,” explained Ashley O’Bara, BSN, RN, CCRN, CFRN, NREMT-B, nursing professional development specialist and safety officer for MedSTAR Transport. “Our role is to ensure there is no interruption in the level of care while patients are transported to facilities capable of providing definitive treatment.”
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Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape Nurse Career Satisfaction Report 2024 found that:
- 92% of nurses surveyed were happy with their career choice as a nurse.
- Almost three quarters of nurses in our survey would choose their career again in a do-over.
- About one third said that making a difference in patients’ lives is their biggest reward.
ICU on the Move
Unlike bedside nurses, flight nurses care for patients in transit. Helicopters can be dispatched to the scenes of accidents and injuries or be called to transport patients who have experienced a stroke, heart attack, or other life-threatening conditions and need immediate specialized treatments that aren’t available at smaller hospitals.
Just over half (54%) of air transports are transfers between facilities whereas 33% are scene responses, according to the Board of Certification for Emergency Nursing. Regardless of where the call originates, the goal is the same: maintaining the highest possible level of care until patients reach the hospital.
En route, flight nurses provide advanced therapies such as extracorporeal membrane oxygenation, intra-aortic balloon pumps, mechanical ventilation, vasoactive infusions, and other life-saving care — all while working in a confined space aboard a moving helicopter. Each transport team includes a pilot and two healthcare providers who provide critical medical care.
“In [a] helicopter, there is very limited room to move while managing ventilators, monitors, medications, blood products, and sometimes more than ten infusion pumps simultaneously,” said O’Bara. “Our patient interactions are brief but incredibly intense.
While ICU nurses may care for a patient over an entire 12-hour shift, we may only have 20-30 minutes with a patient. During that time, we must quickly understand their condition, stabilize them, safely transport them, and prepare them for the next phase of care.”
Even basic nursing assessments become more difficult once the helicopter leaves the ground. Timothy Curtis, MScDPEM, RN, CFRN, a flight nurse at the University of Chicago Medicine in Chicago, explained that it’s impossible to hear breath sounds in an aircraft because of the noise of the whirring blades, making it harder to identify conditions such as a collapsed lung. In a cramped cabin filled with engine noise and vibration, flight nurses rely on experience, planning, and constant reassessment to recognize subtle changes in a patient’s condition.
Rapid Care, Long-Term Plan
Few flight nurses enter the profession straight out of nursing school. Most programs require extensive experience in critical care settings like the ICU or emergency department to ensure that RNs have the experience and judgment needed to make rapid decisions in unpredictable environments.
“You’re looking for perspective and judgment,” Curtis said. “That comes through experience.”
Curtis started his career as a paramedic before becoming an RN and joining a flight team. The experience was critical for responding to the dynamic, time-sensitive calls in uncontrolled environments that flight nurses deal with during their shifts.
“Our teams must rapidly assess the patient, stabilize life-threatening conditions, make complex clinical decisions, and coordinate care with first responders and receiving hospitals,” O’Bara said.
Unlike providing bedside care in a hospital where RNs have immediate access to physicians, respiratory therapists, pharmacists, and other specialists, O’Bara noted that transport crews often function solo, relying on evidence-based protocols and clinical judgment.
Preparation starts before crews ever reach a patient. As helicopters head toward a scene, flight nurses are already discussing their approach, assigning responsibilities, and anticipating potential complications. Medication doses, equipment needs, and likely interventions are planned in advance so crews can focus on the patient rather than calculations when they arrive. The goal, according to Curtis, is to “respond…rather than react.”
Continuing education and advanced certifications are essential to ensure that flight nurses can perform advanced procedures like endotracheal intubation, needle thoracostomy, and surgical and needle cricothyrotomy when needed. Simulating medical procedures in helicopters is part of the ongoing training.
“We are crew members and not just riders,” Curtis explained. “What that really means is that not only are we comfortable working around the aircraft, particularly when the blades are turning, but we can also help…if something unplanned happens.”
Calm in the Chaos
Flight nurses work in environments designed to test their focus. When responding to a call for an injured hiker stranded in the wilderness during a snowstorm or a driver trapped in a vehicle on a sweltering August afternoon, flight nurses work with the whir of helicopter blades overhead, often while onlookers and first responders are watching. Flight nurses must assess injuries, determine priorities, and begin life-saving treatment before transport.
“It’s almost like sensory overload,” Sanders said.
The challenge isn’t simply making the right clinical decisions. It’s making them while filtering out distractions and remaining the calmest person at the scene.
“You have to kind of be a captain of the ship,” Sanders added. “[You have to] take over and help delineate and sift through everything that’s going on and get down to the critical pieces.”
Carrying the Weight
The clinical challenges are only part of the job. Flight nurses routinely encounter patients on the worst days of their lives. Severe trauma, catastrophic injuries, and critically ill children can leave lasting emotional impressions on the care team, even when flight nurses save lives. Sometimes the emotional impact doesn’t arrive until days or weeks later.
“You’re so focused in the moment on…your duties and the magnitude of what’s happening and just how devastating a situation it is,” Sanders said. “Sometimes it doesn’t really hit you until later.”
Like many healthcare organizations, Duke Life Flight offers counseling resources and peer support programs for employees. Within the flight program, colleagues also lean on one another, recognizing that the people who best understand the work are often those who have experienced similar situations themselves. That support system, Sanders said, is essential for anyone hoping to build a long career as a flight nurse.
Despite the challenges, flight nursing can be a fulfilling career and a chance to make an impact on patients and their families.
“My favorite part is being able to help people in the worst-case scenario and being a lifeline,” said Sanders. He added, hopefully, we’re offering patients a chance at life.
The experts cited in this article had no relevant disclosures.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
