The fastest way to the hospital may be a helicopter ride. The safest way is with a well-trained acute-care flight nurse with expertise in working in the cramped, noisy, vibrating and extreme hot and cold environment on board the aircraft.

To meet the growing demand to fly patients from an accident or disaster scene or from one hospital to another, researchers from Case Western Reserve University’s Frances Payne Bolton School of Nursing call for new competencies and training for flight nurses.

Andrew Reimer, a flight nurse and PhD graduate of the nursing school, and Shirley Moore, the associate dean of research at the Frances Payne Bolton School of Nursing, outlined these goals in the Journal of Advanced Nursing article, “Flight Nursing Expertise: Towards a Middle-Range Theory.”

The researchers propose a theory that takes into consideration the unstructured medical environment and the need for fast thinking. Flight nurses must work in a cramped environment where it is hard to reach the patient.

Some medications and practices of the emergency room are ineffective or cannot be performed, and care often relies on visual cues and patient patterns.

Because flight nursing is a relatively new field of nursing, Reimer said, “The knowledge about what works is limited.”

In the past decade, the profession has taken off. According to the Atlas and Database of Air Medical Services (ADAMS), in 2003, there were 545 helicopters transporting patients from 472 bases. By 2007, the number increased to 810 helicopters from 664 bases. Now about 500,000 patient transports take place annually.

Reimer combined a review of research literature with his on-the-job observations to develop this new theory of flight nurse expertise.

Nurses need different skills from those used in a hospital to access a patient’s physical signs, he found. For example, nurses may have difficulty hearing a patient’s heart beat in the noisy environment, or distinguishing a pulse from the vibrations from the rotor blades.

Many flight nurses learn how to work around those obstacles while on the job, but Reimer wants them to know how before they become airborne.

All these environmental factors combine to influence the flight nurse’s in-air decisions, Reimer said.

The researchers are calling for more training that focuses on the uncertain environment of the patient and crew.

That uncertainty also plays a role in patient care during a major disaster, like the earthquake that shook Japan in March. Because of the devastation, it was hard for people to get in and out of the stricken areas.

Christopher Manacci, director of the nursing school’s flight nurse program and also a practicing flight nurse, trains Japan’s flight nurses through a program at Aichi Medical University. He has traveled several times to the country to train the nurses, and most recently in February before the earthquake and tsunami.

Some of those acute-care nurses have attended the nursing school’s annual National Flight Nursing Academy camp for disaster training. Manacci’s work is part of Japan’s efforts to be prepared for earthquakes and other natural disasters and to provide care for an aging population that lives in rural mountainous