Healers & Builders 2021: Flight medics and nurses provide crucial rural lifeline
Editor's note: This is one in a series of stories on Healers and Builders, citizens who will heal, safeguard and push forward the greater Las Cruces area in 2021.
LAS CRUCES – Sitting in the cabin of their helicopter, Sam Dominguez and Alicia Bricker, a flight medic and flight nurse based out of Las Cruces, said their jobs have gotten a lot busier during the coronavirus pandemic.
“The volume all across southern New Mexico has ramped up,” Dominguez said.
Dominguez gestured across the tarmac and explained the small passenger plane, an air ambulance based in Carlsbad, had flown in and out of Las Cruces International Airport three times that day already.
Air medical services helped connect patients in small rural New Mexico facilities to larger, more specialized hospital systems in cities before the pandemic began in March. During the pandemic, it’s provided a crucial lifeline in a state with scant rural hospital acute or intensive care capacity.
The services are used to rapidly transfer patients, using a helicopter or small plane, when an ambulance on the ground won't be fast enough. Their supervisor said while they transfer COVID-19 patients, they deal with myriad situations.
Dominguez and Bricker work for Native Air Ambulance, a division of Air Methods. Native Air has bases not just in Las Cruces and El Paso, but also in Alamogordo, Deming, Roswell, Carlsbad, Silver City and Hobbs.
Their helicopter fits a three-person medical team: a flight medic, flight nurse and pilot. There’s just enough space in the rest of the cabin to fit a patient lying down, and that’s a tight fit even before equipment bags and a blood cooler are added into the mix.
“I found out about flight nursing while I was in nursing school,” Bricker said. A family friend told Bricker “nurses fly in helicopters in the military.”
Bricker didn’t want to join the military, she said. Still, after working for several years as an emergency room nurse, she said she never shook that interest in flight nursing. She gained experience and applied. She's been a flight nurse for three years.
Dominguez has also been a flight medic for three years, after working as a search and rescue technician. He's been an EMT for 15 years.
“We don’t actually do rescues like you see on TV where a hoist comes down,” Zach McGinnis, the base's supervisor, said.
Instead, their medical chopper swoops in to the scenes of accidents on the interstate or a patient who has had a stroke or heart attack at their home in a rural place like Hatch. After the helicopter lands on scene, the medical team spends no more than 10 minutes stabilizing them before the patient is strapped in and they’re in the air once more, racing the patient to the nearest hospital in a city such as Las Cruces.
The helicopter can transport patients between any two hospitals with helipads, and where a patient ends up will depend on what type of care they need. Some need to be transferred from a rural hospital if specialized care isn't available, for instance.
“It’s our job to know which (hospital) is the best one at the time and the closest one,” McGinnis said. Specialists tend to be centralized in big cities and remain scarce in rural New Mexico.
While in the air, Dominguez and Bricker said they still administer critical care to patients. Common procedures can include administering medication or an IV bag, controlling bleeding, intubating patients and reassessing patients to make sure bleeding or an injury hasn’t progressed.
“We try to do the most invasive things on the ground, but bad scenarios could happen (in the air) and we’re prepared to take care of business,” Dominguez said.
After spending five years as an ER nurse working under doctors, Bricker said as a flight nurse she’s had to become comfortable with making decisions on her own.
Dominguez also said it’s not uncommon to see air medics and nurses standing crouched over a patient to treat them while in flight.
“There’s a lot of movement even in the air,” Dominguez said. “It’s quite literally a flying ICU.”
The teams work long hours. McGinnis said medic and nurse duos are on call for two 24-hour shifts, separated by a full 24-hour break, before getting five consecutive days off before their shifts start anew. Pilots get a bit more consistent rest — they work seven 12-hour shifts, either during the day or night, in a row before getting a full week off.
McGinnis said the medic and nurse teams are trained in only some of the helicopter's operational mechanisms, as a means of preventing flight decisions from being made based on the wellness of the patient.
Typically, the helicopters try not to stray 150 miles from their base. But the team said that as hospitals in El Paso have teetered on the brink of capacity due to COVID-19, transfers to Tucson and Albuquerque have sometimes become the only options.
Albuquerque itself is two hours each way, the team said, much longer than the 25-minute flight to El Paso.
Dominguez recalled a recent experience in which he and Bricker transported an older patient to Albuquerque who had been waiting for admittance to a hospital in El Paso for 48 hours but was denied.
McGinnis said COVID-19 patients aren't a major transport for them. But even when the team is not explicitly transferring COVID-19 patients, precautions must be taken in the chopper's cabin.
Besides donning their typical flight suit, helmet and mics, Dominguez said the whole team now wears N95 masks at all times, not just while with a patient. It’s a piece of equipment they weren’t using commonly before this year.
“(Before), if we wore a mask it was because maybe we were going to do a certain procedure or afraid that we were going to get exposed to something,” Dominguez said. “Right now we are considering everyone exposed.”
But when transferring someone who they know is infected, Dominguez said the team wears “hazmat suits” inside the helicopter to give themselves maximum protection.
“We work in a very small, very highly specialized environment. There are not a lot of flight paramedics in the world, not a lot of flight nurses,” McGinnis said. “If one of us gets sick and we have to go away from work for two weeks to quarantine, then an area can be without that provider for a substantial period of time.”
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