What It Takes to Become a Certified Flight Nurse

What Is a Flight Nurse?

A flight nurse is a registered nurse with the training and experience to provide critical care in transport environments. This can be either rotor (helicopter) or fixed-wing, typically working alongside other medical providers such as paramedics, other nurses, respiratory therapists, nurse practitioners, or physicians; they're essential for providing top-level patient care when it matters most!

What Does a Flight Nurse Do?

Now that we’ve established what a flight nurse is, we should discuss what the flight nurse does. 

Flight nurses provide immediate care to their patients including assessment, triage, and treatment. 

These patients include some of the sickest patients you may encounter. 

Flight nurses are responsible for many things during their shifts. It typically starts with checking off the aircraft and their equipment, along with their partner for the shift. This also includes checking the expiration dates of their medications and equipment during their daily checks. As a flight nurse, you are expected to be ready to respond to a request within minutes of the call at any time during your shift. During a flight, you may have to assist pilots with navigation and be able to communicate via radio transmission. 

Patient care often includes similar duties found within the 

emergency department (ED) 

and 

intensive care unit (ICU)

, but care is provided in a much smaller compartment and in unpredictable situations at times. The scope of care is typically broader than what is found in the traditional ED and ICU. It still includes providing immediate care to your patient. You will still assess your patient and develop your treatment plan based on their triage/assessment. Overall, resources are less than what is found within the hospital setting. Flight nurses must be able to critically think and remain calm in any given situation. They must be always aware of their own safety as well as the safety of their crew and patient. They must be able to easily adapt and handle extreme environments and situations. Autonomy is an important attribute for flight nurses to have.

What Types of Patients Do Flight Nurses Work With?

Patients can range in age from the premature neonate to the frailest elderly. There are specialized programs that focus on certain populations, such as neonates, but this does not mean that as a flight nurse, you will never see this population of patients. There are times when those specialized teams may be unavailable, or your transport team may be the best option for the patient at that given time. You may transport patients on 

extracorporeal membrane oxygenation (ECMO)

, with 

ventricular assist devices (VAD), 

balloon pumps, 

etc. For the most part, these patients are going to be some of the sickest patients you will encounter, otherwise they wouldn’t need your specialty care. No matter the situation, the key is to be able to critically think about the situation you are in, as well as the type of patient, and devise your treatment plan based on that.

How Do You Become a Flight Nurse?

You must be a registered nurse and some companies require a BSN for hire. Typically, you must obtain at least 3-5 years of experience within the ED or ICU. Experience within both areas is looked at favorably. Immerse yourself in education and learning as much as possible, both prior to and after hire. You will be required to obtain an advanced certification within a specified time after hire (usually one year).

What Kind of Environment Do Flight Nurses Work In?

The environment consists of working in a smaller compartment alongside your partner. You will be providing care on scenes of medical emergencies as well as within the ED and ICU setting. There will be transfers from hospital to hospital. Flight nurses can work 12- or 24-hour shifts. You are expected to be available and ready to provide care any time of the day or night. This can be in the middle of summer when it is blazing hot or in the middle of winter when it is subzero outside. The changing environmental factors are probably the biggest change for most nurses to become accustomed to. The physical demands and stressors of flight must be considered as well. The vibration from the aircraft and changes in weather conditions can take more of a toll on your body than you would initially expect.

Is It Safe?

It is very safe. When you consider and look at previous crashes, the large majority are preventable. Most often they are secondary to pushing the limits of the aircraft or thinking that it won’t happen to me. This is where it is important to speak up as a member of that flight crew. It takes 

three to go, and only one to say no.

Meaning, all crew members must agree upon taking the flight. If one person feels uncomfortable, then the flight is not taken. Pushing weather is another hazard that has led to previous crashes as well. There are certain minimums that must be met before a flight can be undertaken and those minimums should be always enforced. Having great communication with your pilot and partner is important in these situations. Briefings with the crew occur at the beginning of every pilot shift to discuss the anticipated weather conditions during that shift.

Are There Any Special Certifications That Are Needed to Be a Flight Nurse?

The Certified Flight Registered Nurse (CFRN) is the preferred certification and will be required usually within one or two years after hire. 

Some states require nurses to hold an emergency medical technician (EMT) license to practice as well.

What Are the Ongoing Education Requirements?

Once you obtain your 

advanced certification

, you will have to obtain 100 hours of 

continuing education

over the next four years to recertify or sit for the exam again. You will also have to maintain PALS, ACLS, BLS, NRP, and an advanced trauma course (such as TNCC, ATLS, or TNATC). You will also be responsible for the company's required education. It is important to never stop studying and learning. The difficult patients you encounter should drive you to continue to learn and advance yourself as a flight nurse.

Is There a Network of Flight Nurses or People to Connect With?

There are a few societies such as the 

Association of Air Medical Services (AAMS), 

Air and Surface Transport Nurses Association (ASTNA), 

and 

Board of Certification for Emergency Nursing (BCEN), 

just to name a few, for networking possibilities. Conferences such as 

FlightBridgeED Air and Surface Transport (FAST) Symposium, 

Air Medical Transport Conference (AMTC), 

Critical Care Transport Medicine Conference (CCTMC), 

and 

National Teaching Institute (NTI) 

and 

Critical Care Exposition

 are all great resources for continuing education and networking as well.

A seasoned partner is one of the greatest people that can help you when you first enter the industry. Their experience and guidance are such an advantage. As a new flight nurse, you should really look for a mentor who is willing to take the time and help you develop and hone the skills necessary for success.

Suggestions for Studying for the Advanced Certification Exams?

First, look at the content outline and understand the content that is being tested. This content can be found on the BCEN website along with other useful resources. At FlightBridgeED, we are committed to your success in passing the advanced certification exam on the first attempt. We offer a full review course as well as resource materials and practice exams to ensure that success.

What is CRITICAL CARE medicine and how is it different from regular pre-hospital emergency medicine?

According to the American College of Physicians, critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease ("Critical care medicine", 2022).

Generally speaking, emergency medicine is focused on the rapid assessment and treatment of acute illness and injury. Critical care medicine is conducted in very structured and controlled settings for the sickest of the sick who require a precise regimen of treatment over a longer period of time from a multitude of specific medical disciplines.

An understanding of pre-hospital emergency medicine AND critical care medicine is required to be an effective flight nurse. FlightBridgeED was created to bridge the gap in nursing training by augmenting traditional RN education and expanding knowledge into pre-hospital/scene response knowledge.

Overview of the content you will need to MASTER in order to successfully pass your flight nurse (CFRN) exam:

Safety and Transport

Aircraft operations, aerodynamics, aircraft performance, emergency procedures (e.g., fire, de-pressurization, IIMC), landing zone operations, obstacle avoidance procedures, survival techniques, weather patterns, refueling operations, personal wellness (e.g., fatigue, fitness for duty), hazard reporting, communication and radio operations, safety and restraint systems, pre-flight check, passenger briefing, risk assessment, night vision goggle operation (NVGO), GPS and navigation.

Flight Physiology

Gas laws, hypoxias, stressors of flight, altitude injuries, time of useful consciousness (TUC), pressurized versus unpressurized aircraft cabins.

Airway, Anesthesia, and Analgesics

Airway assessment, anatomy, and physiology, pharmacology, passive oxygenation, failed airway, surgical airway, mechanical ventilation, alternative airway devices, peri-intubation arrest, special airway considerations (e.g., tracheostomy), tube confirmation and monitoring, airway suctioning, waveform capnography monitoring, non-invasive positive pressure ventilation.

Medical Emergencies

The endocrine system, adrenal system, renal system, metabolic, sepsis, infectious disease, toxicology, blood products, gastrointestinal, lab values (e.g., CBC, coag, BMP, ABG, cardiac panel), advanced medical assessments, treatment modalities, invasive line procedures, radiographic interpretation, respiratory system (e.g., Krebs cycle, oxyhemoglobin disassociation curve, intrathoracic pressure).

Neurological

Neurological assessment, seizures, altered mental status, cerebral ischemia (e.G., large vessel occlusion), neuroprotective strategies (e.g., positioning, hemodynamics, EVD management), cerebral hemorrhage, traumatic brain injury, spinal cord injuries, neurological diagnostics (e.G., ct scan), lab values (e.g., coag panel, BMP), pharmacologic agents, monitoring equipment (e.g., ICP monitor).

Cardiac

Multi-lead interpretation, anatomy, mechanical support device (e.g., Impella, ECMO, VAD, IABP), acute coronary syndromes (ACS), cardiogenic shock, heart failure, infectious cardiac disease (e.g., pericarditis, endocarditis, valvular disease), arrhythmias, hypertensive crisis, hemodynamic instability, chronic cardiac conditions, vascular disorders (e.g., AAA, thoracic dissection), electrophysiology, cardiac diagnostics (e.g., ultrasound, cardiac echo), lab values (e.g., cardiac panel), pharmacologic agents.

Trauma and Burns

Trauma/burn diagnostics (e.g., CT X-ray, ultrasound), lab values, pharmacologic agents, monitoring equipment, surgical interventions, blood product administration and management, the lethal triad of trauma, fluid resuscitation, burns (e.g., thermal, electrical, chemical, radiological, fluid resuscitation), toxic inhalation injuries.

Maternal-Fetal and Neonatal

Maternal-fetal and neonatal diagnostics (e.g., tocodynamometer), lab values, pharmacologic agents, monitoring equipment, complications of delivery (e.g., cord prolapse, placental abruption), multiple-birth, pre-eclampsia and eclampsia, premature rupture of membranes (PROM), maternal, neonatal.

Pediatric

Pediatric diagnostics, lab values, pharmacologic agents, monitoring equipment, airway disease (e.g., croup, RSV), nonaccidental trauma, fluid/electrolyte replacement, metabolic emergencies (e.g., DKA), special needs (e.g., developmental delays, autism spectrum, hematology-oncology), high-tech (e.g., home vent), infectious disease (e.g., meningitis, re-emergent diseases), airway and ventilator management.

Professional Considerations

Common accreditation standards, research design, methodologies, and terminology, privacy considerations, JUST culture, evidence-based medicine, ethical considerations (e.g., end of life considerations, DNR), gamut metrics, caregiver PTSD and suicide risk.

Information courtesy of the Board of Certified Emergency Nursing (BCEN). The CFRN logo and the CFRN and BCEN acronyms are the sole property of the BCEN.

Here is a heavily requested podcast with some great points to get your career started. Give it a listen!

The FlightBridgeED Podcast - Season 7 (2018)

Episode 146 - The Steps To Becoming A FLIGHT NURSE w/Kelly Miller

This is our second in a series of two unique podcasts that takes a look at the road to becoming a Flight Nurse. I am joined by Kelly Miller, Regional Clinical Manager for the Midwest Region of Air Methods Corporation. We have received numerous podcast requests on the topic of: What is the best way to achieve the position of Flight Nurse. Kelly comes with a diverse experience level as a nurse in the ED, ICU, and flight nurse in the HEMS industry, with his current role as a Regional Clinical Manager. Take a journey with us as we dive into the best way to obtain a flight position and be prepared for these challenging clinical positions.