A progressive curriculum in air medical transport for nursing and paramedic students☆☆☆

Article Outline

• Background
• Partnership
• Program overview
• Challenges
• Results
• Conclusion
• Copyright

Since the origin of the helicopter, people from all walks of life have been intrigued by it and its practical uses. It is no surprise that so many health care professionals are curious about the helicopter as means for medical transport. The real surprise is how early this interest develops, often during the very first years of college education.

Limited exposure to the flight environment often is enough to spark students' interest during the early years of prehospital or nursing education. Interactions with the flight crew while working in EMS or a hospital often confirm the desire for a career in air medical transport. Some students, however, have no way to completely visualize what a career in air medical transport would be like.

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Background 

Carilion Life-Guard 10 covers areas of Virginia, Tennessee, West Virginia, and North Carolina. The program began serving this region from its Roanoke, Va., base in 1981 as a part of Carilion Patient Transport Services. Since 1990, a Bell 412 IFR aircraft has carried out scene and interhospital missions with a nurse/paramedic medical team. Traditionally, hospital-based flight programs engage in many activities with prehospital EMS, including ride-along options for the EMS community as a vital public relations tool.

Soon after the inception of Life-Guard 10, prehospital personnel in the area developed an interest in rotor-wing transport. The program typically received requests for ride-alongs, although a system to formalize this opportunity had not yet evolved. Life-Guard 10 administrators strongly believed this experience should be offered only to those students willing to accept the challenges of an intense, fast-paced academic course as a prerequisite. This restriction not only would separate curious thrill-seekers from serious and dedicated inquirers but also would allow for a better overall experience for a few students instead of spreading the flights out among many. In addition, the safety risk around the aircraft would be lessened by the training the students would have received first. Over several years, a 2-part program was developed that included a didactic course followed by a 1-semester externship.

In 1992, the College of Health Sciences in southwestern Virginia partnered with Carilion Life-Guard 10 to offer a 1-semester elective that focused on flight physiology and the transport of various patients using the Air Medical Crew National Standard as a guideline. This option was offered to senior paramedic students during their third semester. One student from this class was chosen each year to participate in a formal ride-along internship during his or her fourth and final semester.

Radford University also is located in southwest Virginia, approximately 50 miles from Roanoke. In a rural setting between the Blue Ridge and Allegheny mountains, the School of Nursing is the only university-based program in the area offering both bachelor's and master's degrees since 1973. During the nursing students' senior year, the Adult II nursing course focuses on critical care nursing for 1 semester.

Students rotate through multiple critical care settings, providing direct patient care along with a staff preceptor. Senior students in good academic standing (3.0 GPA or above) may submit proposals for an undergraduate independent study in an area of interest. This formal proposal outlines the study, perceived outcomes, and implications for future use by the student. Emergency nursing and flight nursing are areas that students often choose for an independent study.

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Partnership 

The College of Health Sciences, Radford University, and Carilion Life-Guard 10 have combined their efforts to establish the “Introduction to Air Care” course. Common goals of the Radford University School of Nursing and the College of Health Sciences Paramedic program resulted in a joint venture for these students. In addition, Carilion Life-Guard 10 is able to offer a team-based learning environment to the students that realistically reflects their nurse/paramedic medical team configuration.

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Program overview 

When the program began, the flight crew was responsible for teaching the course, often while on duty. However, scheduling duty crew with teaching responsibilities became more difficult, and the syllabus was changing. Initially, 1 crewmember was selected as an instructor for the 2-credit, 40-hour, 1-semester course. By combining paramedic and nursing students in the class, the course intends to reflect an actual orientation for new medical crewmembers. Changes to the syllabus were made, however, to emphasize the differences between ground and air transport and between hospital and prehospital care, and simulated practice exercises were added.

Although the didactic training reflects a medical crewmember's orientation, the program's goal is not competency. Given the limited amount of time, many topical content areas are presented as a general overview, and the externship is kept to 40 hours (see Table 1).

Table 1.

The purpose of the course is to be more informational than instructional—to give students the means to appreciate all aspects of a career in air medical transport and enable them to determine how to pursue it in the future.

Additional learning is achieved through various class discussions assigned throughout the semester, such as weekly discussions from http://www.flightweb.com and the FlightMed emailing list, CRM: The Crash of Flight 232, and specific crashes researched from http://www.ntsb.gov.

Practical experiences include various patient scenarios and flight following using a latitude/longitude map while listening to actual recordings of radio communications between the pilot/medical flight crew and the dispatch center. Students are expected to be able to activate the postaccident/incident plan (PAIP) at any given point. The students develop an appreciation for the dispatchers and their essential contribution to the program.

In culmination of the semester, nursing and paramedic students are teamed, with direct physician oversight, for a final practical scenario performed in the helicopter while flying. Students wear actual flight suits and helmets to increase the element of realism.

Beginning experience revealed that “worst case scenario” training provided a better learning situation, so this concept has been used repeatedly. To show students the limitations of night flying, the scenario takes place at 1900 hours. Scene response and interhospital transports are simulated during the exercise. The students are tested on their performance of patient assessment and intervention in the air medical environment. Several events are included as part of their scenarios—a medical emergency, mechanical problem, and weather change. Students then are faced with the realization that they have to work with whatever supplies they brought for the expected transport time.

While 1 student team is in the air, another group (under the direct supervision of the dispatcher) simultaneously communicates by radio to the pilot and medical flight crew. Students are responsible for activating the PAIP, including communications to update appropriate personnel. In addition, they are expected to use the latitude/longitude map to determine where the aircraft should be based on the last set of coordinates and ground speed given in the last position report. The pilot intentionally cannot reach the dispatch center before the emergency landing, therefore testing the students' reactions in a crisis situation.

During debriefing after these practical exercises, the students have revealed a great appreciation for the differences in air/ground transport, prehospital/hospital care, and the significant responsibility of the dispatch center.

After completing the final practicum, students who earn a 3.0 or better in this course (and in their basic curriculum) are invited to interview for the externship offered during the next semester. The student interview, outlined in Table 2, is almost identical to the process used for any open position for a medical flight crewmember.

Table 2.

The interview panel includes various flight paramedics and nurses, dispatchers, pilots, and managers.

A unique part of the interview process includes assessing the students' interpersonal and public relations skills. This element holds the utmost importance in selecting the most qualified candidate. The medical flight crew will not depend on the chosen student for patient care skills, but the student will be flying with them on a regular basis and will be viewed as a representative of the program. The student's interpersonal skills are evaluated while performing the patient assessment, interventions, and flight preparations. At the same time, several other “players” enter the scenario to add multiple forms of pressure to the situation, which include anything from quickly changing weather to argumentative health care providers.

Although the students understand that the dramatization is done specifically to test their self-control and assertiveness, the exercise is very dependable in pulling out their true underlying qualities. Successful interview candidates participate in the externship and fly approximately 40 hours during the semester, taking part in all of the flight crew's daily activities. Students complete a daily report plus documentation on each patient transport. At the end of the externship, each student selects 1 transport experience to present at a peer-reviewed meeting.

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Challenges 

Initially, program administrators hoped that, by having paramedics and nurses learn together while still students, territorial issues could be resolved before they had a chance to fully develop. Combining the students as a team at the onset of the course experience should not be underemphasized. Initially, territorial issues regarding levels of training and education did surface, and the building of the paramedic/nurse partnership has become a secondary goal of the course. The final practical scenario has become as much a test of teamwork as a test of knowledge. Today, the concept of the paramedic and nurse as partners is applied on a daily basis in the classroom.

Another challenge was how to teach students who had different levels of educational preparation. Even though the course was offered only to senior paramedic and nursing students, their levels of training were diverse. The senior paramedic student has extensive clinical training, whereas the senior nursing student has the advantage of a broader theoretical foundation. Comparing the two groups did not seem fair, nor did it seem logical to expect either to perform on their own. Ideally, the paramedic students would have taken a prerequisite critical care class, and the nursing students would have taken an EMT class. Because time did not allow this, administrators again decided to depend on teamwork.

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Results 

Benefits for students seem obvious, but the participating flight program and higher learning institutions benefit as well. Students have the opportunity to explore (or reject) career options. Most students in this experience become more determined to meet their goals of careers in air medical transport. With their choices confirmed, the students are able to develop a realistic plan for achieving their goal. The program also prepares students for a formal interview process. When a flight crew position becomes available, the student's expectations and frame of reference should be more realistic.

A course comprised of 2 types of students has obvious potential for territorial issues, as described. Using students from different learning institutions could have the same potential for conflict, but in this area, the success could not have been greater. The willingness of the students in both the paramedic program and the baccalaureate nursing program to work together benefits each. These educational institutions are able to offer a unique experience to deserving students. This partnership has significant impact as the need for nurses and paramedics continues to expand. Developing a team partnership for nurses and paramedics in other health care environments requires further exploration.

Educating future nurses and paramedics supports the appropriate use of helicopter transport services. Many of these students will find themselves in the position of arranging or transporting a patient from their facility or from the scene. With the knowledge gained through this course, they will be better equipped to make decisions regarding transport. They also will be more efficient at preparing the patient for the transport itself.

Implementing an educational program supports healthy public relations in the community. Medical flight crewmembers appreciate the opportunity they have been given to practice in this selective field. In sharing this opportunity with students, the individuals and facilities involved gain a greater appreciation for the knowledge, critical thinking, and interventions required.

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Conclusion 

Instructors often learn as much as the students in a teaching environment. The on-duty flight crew faces a constant learning environment. In this program, students affect those around them and rekindle the desire to learn, no matter how experienced the instructors. Time and time again, we appreciate that we can learn many things from students as they learn from us.