Standards of Flight Nursing

1. Professional Standards

Minimum Qualifications:

• Current general registration in the State or Territory where the air medical service is located.

• Relevant or substantial clinical nursing experience in an area of speciality appropriate to their role.

• Ability to demonstrate competency or currency in Advance Life Support (ALS), regardless of the scope of practice.

• Ability to practice independently in accordance with the standard protocols of the organisation or service.

• Ability to meet the physical expectations which include: ability to load and unload a stretcher from an aircraft with patient and equipment; physical ability to function and perform tasks in a confined environment; ability to tolerate the stresses of flight without physical impairment; physical ability to fit in a crew seat and standard restraint systems; ability to operate and utilise emergency exits; ability to life medical equipment and packs without assistance.

Additional Qualifications:

The knowledge and skills required of a flight nurse to operate within the pre-hospital and in-flight environment as a specialist/generalist nurse become extensions of sound generalist practice. In addition there may be a requirement by the employing organisation for an appropriate specialist background.

These may include: Intensive Care; Emergency; Obstetric; Coronary Care; Neonatal Intensive Care; Paediatrics; Community Health, Public Health, Palliative Care, Travel Medicine; Diving Medicine.

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The attributes of the flight nurse include the following:

• An advanced clinical knowledge and practice
• Demonstrates a comprehensive knowledge of aviation physiology and integrates this knowledge with clinical management
• Interprets complex situations
• Demonstrates a high level of assessment skills and triages appropriately
• Recognises the need for case-related skill mix
• A sound knowledge of stabilisation and transportation principles
• A holistic approach to patient needs
• Demonstrates effective communication skills
• Maintains a safe physical environment for all
• Adheres to standard infection control precautions
• Competent in crew resource management
• Works as a team member and also has the ability to work independently as a sole practitioner
• A sound knowledge of operational procedures and medico-legal requirements
• Responds to a continually changing environment
• Promotes professional development in self and others
• A sound knowledge of occupational health and safety requirements for the workplace environment
• Adheres to the relevant code of conduct and ethics
• Promotes cross-cultural sensitivity
• Competent in the operation of all equipment

The flight nurse shares the responsibility for maintaining a safe environment for all persons in and around the medical transport aircraft. This includes self, patients, crew members, other medical teams, ambulance officers and lay people. Performance is dependent on knowledge and understanding of general aircraft safety, Civil Aviation Safety Authority (CASA) rules and regulations pertaining to safety in and around the aircraft, specific features of the aircraft and specific organisational policies and procedures.

All flight crew, regardless of their primary responsibilities, must have a comprehensive knowledge and practical experience of aircraft safety procedures, equipment and emergency evacuation procedures relating to the type of aircraft they are flying in prior to commencing independent responsibility (with performance review annually).

• Relevant CASA rules and regulations
• Emergency procedures on ground and in water
• Identification, location and demonstrated usage of safety equipment: seat belts; patients' harnesses; fire extinguishers; raft; flotation equipment; survival equipment
• Survival training
• Radio procedures
• Ground operations
• Approaching aircraft
• Safety regarding patient care, procedures and equipment usage and stowage
• Loading and unloading the aircraft with reference to weight and balance regulations
• Depressurisation - fast/slow
• Use of oxygen
• Safe carriage of portable oxygen cylinders
• Uniforms - safety standards
• Ear protection
• Helmets
• Use of mobile phones
• Dangerous goods training
• Recognition of hazardous personal items
• Pre-flight safety brief to patients, relatives and accompanying medical crew
• Restraint of combative patients
• Crew resource management

The practice of flight nursing requires accurate and effective communication skills with individuals, groups and other health professionals to ensure the safe and efficient transportation of patients. Communication is an ongoing process and includes:

• Prioritisation of cases - assessment and triage
• Advice for stabilisation and patient preparation for flight
• Co-ordination of response with appropriate utilisation of resources
• Aircraft communication between crew members
• Radio/telephone usage - familiarity with all communication equipment, protocols and etiquette
• Communication with patient and family
• Medico-legal accountability and documentation
• Co-ordination of ground transport requirements
• Clinical handover of patient to the receiving centre staff

• The flight nurse must ensure a safe workplace for all personnel, patients and lay persons in accordance with Federal and State Occupational Health and Safety (OH&S) legislation and organisational policies.
• The flight nurse must undertake a pre-employment medical relevant to working in the aeromedical environment (including audiometry). This should be performed by a CASA-approved medical examiner and should be repeated as per industrial award or organisational policies.
• The flight nurse must report an injuries to self, patients or crew.
• The flight nurse must be given training in manual handling and hearing protection in relation to the aeromedical environment.
• The number of nurses undertaking aeromedical work for an organisation must be limited to ensure currency in operational and clinical practice.
• The flight nurse must adhere to industry infection control standards and specific policies of the organisation.
• The flight nurse must maintain current immunisation status as per organisational policy.

Education and staff development must be provided and documented for all full-time and part-time employees. These shall be specific and appropriate to the mission statement and scope of care of the aeromedical transport organisation and incorporate the following areas:

Orientation: a supernumary period of time which includes the following topics:

• Aviation physiology component
• Preparation and stabilisation of patients for transport
• Aviation safety and emergency procedures
• Dangerous goods
• Organisational policy and procedures

Continuing Education: must include:

• Aviation safety and emergency procedures and survival training (annual)
• Dangerous goods (biannual)
• Crew resource management (annual)
• Update of clinical speciality (ongoing)
• Ongoing clinical experiences specific to the speciality
• Skills maintenance programme reflective of scope of practice
• The flight nurse seeking out educational experiences to enhance professional abilities

Annual Performance Reviews: should include assessment of knowledge and skills in the areas of:

• Altitude physiology and stresses of flight
• Clinical management of patients
• Operational procedures
• Occupational Health and Safety policies and procedures
• Stress recognition and management
• Infection control
• Communication systems
• Equipment knowledge and application

Tertiary Education/Professional Development: flight nursing/aviation medicine should incorporate the following criteria:

• Evidence of collaboration/consultation with Flight Nurses Australia (FNA)
• Evidence that the primary focus is flight nursing
• Evidence that the assessment processes facilitate student learning
• Evidence that the course is at an appropriate professional and educational level

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