The Definitive Guide for Future Flight Medics and Flight Nurses

Congratulations! It’s been a long, hard road of late night studying, begging your coworkers to swap shifts for class, and hastily changing after your shift only to drive straight to clinicals, but you made it! You’re a paramedic! I’m proud of you, and the world needs more of you. How do I know that? Because you are not satisfied yet. You want the sickest patients, the most difficult airways, the patients that even the doc in your local standalone ER doesn’t want; you want to be a Flight Medic.

Whether you are a brand new medic, fresh off of National Registry, or an experienced provider looking to expand you scope even further, this site is dedicated to you. My goal is to start by giving you a complete, authoritative, step-by-step guide to getting you into that helicopter, and maybe save you some time and mistakes along the way.

If you are a nurse, don’t run away! The process is remarkably similar, after all, and I’ll point out any minor differences along the way that apply specifically to you as a future Flight Nurse.

Step 1: Find the Right Job

Nope, I’m not talking about which flight company you want to work for; I mean the job you have now. If you are a paramedic, that absolutely means a busy 911 system. This is a must. You won’t be able to convince anyone of your critical thinking ability and your experience working for a transfer service. We both know that there are critical care transfer services that really have their stuff together, however, we both know that they tend to be the exception, not the rule. That being said, if you can find a service that runs both 911 as well as transferring out the occasional critical patient, then you can spin that to your advantage. The ratio of scene flights and interfacility transfers varies even from bird to bird within the different companies, but there will almost always be both.

You don’t want that cushy vacation station, or the retirement station. You want to get your hands dirty! Run all the nasty calls you can, perform all the skills you can. Experience with RSI and difficult airways is mandatory. Proficiency with cardiology is mandatory. When you’re on a helicopter, that airway and that 12-lead is probably going to be all you. Your partner will most likely be a RN and far more knowledgable than us on many different topics; odds are that airway/vent/12-leads are not one of those subjects, odds are that’s what you are expected to bring to the table. Get all of the experience that you can now. It’s a very real possibility that you will have to look for alternative employment and maybe take a pay cut if your current medical control doesn’t include these in your scope. Most companies require at least 3 – 5 years of experience in a busy 911 service.

If you are a nurse, we’re talking ED or ICU at a high level facility at a minimum. Think Level 1 and 2 Trauma Center just to begin. Some areas will hire you out of school and let you go straight to the ED; often you will have to work Med Surg to earn your place first. Do what it takes now to get the spot that’s going to set you apart later. Know that some flight services don’t have a preference on ED or ICU experience, some like to see a mix, and more than a few only care about ICU time, completely ignoring your ED experience. This is where the research in the later steps becomes very important, you don’t want to spend 5 years in the ED getting experience only to learn in your interview that they want someone with significant ICU experience.

Nurses have an ability to specialize in a way that very few medics do. This can help set you apart, if you don’t let it hurt you. If you can get experience in areas such as the Trauma ICU, Cardiac ICU, NICU, etc. you can show that you have additional knowledge that others hiring beside you might not. My only caution would be to not specialize to the detriment of your experience with other demographics. I love working with a partner who has worked for a period with peds, VAD’s, etc. I learn so much on those shifts. I have also worked with partners that ONLY have experience with peds, or VAD’s, etc. and are not only useless on the closed head injury patient on scene, they’re a danger to themselves and the patient. Just like with medics, most companies will require 3 – 5 years experience at a high level facility.

Step 2: Cement the Basics

So you have the right job, and you’re getting the right kind of experience. Yay! Now for a slightly less glorious step: build your foundation. If you’re a paramedic, that starts with your protocols. Get them down cold. Ice cold. Liquid Nitrogen in Terminator cold. When you go to interview and have to demonstrate your knowledge and skills in a scenario, you probably won’t be expected to answer like a flight medic, that wouldn’t be very fair, would it? What you will be expected to do is treat the patient following your current protocols at a bare minimum. While we’re studying our protocols every day, we need to make sure we have all off the bare bones certifications. If you chose the right job in Step 1, then most likely you already have these, but in the event that you don’t, you will need ACLS, BLS, PALS, and PHTLS/ITLS. If there are others in your area, take them too! Classes such as AMLS can really help build a firm foundation of knowledge. Oh, and did I mention to learn your protocols? Seriously, go read your protocols!

Nurses, this goes for you guys too. While a nurse’s practice in a typical hospital isn’t nearly as protocol driven as most paramedics are, you do have protocols! Whether they’re written standing orders, or the standard of care treatments for your common critical patients, many of these are algorithm based. Think of how you treat a STEMI, or a Code Stroke. You will often follow similar, if not identical, algorithms that your physician obtains from his peers in the appropriate specialty. Keep an eye out and learn them, they’ll not only help you shine in your current job and in interviews, when you are a Flight Nurse you’ll often be providing a friendly reminder to the smaller and more rural facilities that may not have the resources to stay as current and cutting edge. When your patient wins, you win!

Nurses and paramedics will be expected to have the basic rhythms down pat; it should be basic ACLS, so review your provider manual if you need a refresher. When it comes to 12-leads, paramedics will be expected to have a fairly comprehensive knowledge, and nurses will be expected to have at least a foundational knowledge. How much is a foundational knowledge? Recognizing and categorizing MI’s at a minimum, and written tests and scenearios may even ask you to relate what you see on the 12-lead and explain where the clot is most likely. If you need a refresher, Bob Page’s 12-Lead ECG for Acute and Critical Care Providers has been a go-to book in EMS for teaching 12-leads for a number of years now.

Step 3: Advanced Certifications

Most flight services will be CAMTS (pronounced “cames”) certified. This is a certification for the flight service that sets certain standards ranging in topic from training to pilot experience to weather minimums. Think CAAS for you prehospital folks, or a baby version of the Joint Commission for our nurses out there. One of the CAMTS requirements is having an advanced certification for medical crew within 2 years of hire. So, if the requirement is to have the certification years after you get hired, why am I telling you to get it now? Because you’re a bad mamma jamma, that’s why! And quite frankly so are these tests. Every service has lost tens to hundreds of thousands of dollars, and uncounted man hours to failed investments in paramedics and nurses who simply could not obtain their advanced certification after they were hired. You want to show your future employer that they won’t have to worry about that, and you want to set yourself apart from the rest of your peers in the hiring process. Besides, when you get hired, there will be so much more to learn in your first couple of years in your new career, why add the extra stress on top of it?

I know it’s exciting, but don’t rush into this step. All of the resources available for you advanced certifications assume a baseline knowledge. Paramedics; I hope you kept your books. You really should continue reading them for the rest of your career. (Assuming you update them every once in a while) Once you have that foundation, you can start studying for your certifications.

What defines an advanced certification? Like SO many things prehospital, it’s going to vary a bit. For paramedics, the norm is to require either your FP-C (Flight Paramedic Certified) or CCP-C (Critical Care Paramedic Certified). Some flight services require both, some require FP-C, and some don’t care which. But you’re awesome and going to take both. You’re already studying, and the knowledge set between the two is roughly 95% the same. Yes the test is expensive, but you’ll be studying a couple hundred hours probably, just take them both while it’s fresh in your mind. And again, you’re setting yourself apart from the rest while preparing yourself for any requirements that the service you are applying to might have.

For nurses, your goal is going to be CCRN (Critical Care RN) and CFRN (Certified Flight RN.) We’re going to get both for the same reasons our paramedics are. Some flight services will allow you to count your CEN (Certified Emergency Nurse.) I would caution relying on this. Not all flight services will allow you to use this as an advanced certification, and there are a couple of topics that you might not be as prepared for with your CEN as compared to your CFRN, such as flight dynamics, safety, and some critical care topics.

So, where do you even begin to study for your advanced certs? For FP-C and CCP-C, you can get this information straight from the website here. IBSC Website. The primary references are going to be Air and Surface Patient Transport, Critical Care Transport Core Curriculum, and the CAMTS Guidelines. There are also additional resources recommended by the IBSC that, while helpful, are far less comprehensive and generally not necessary to pass if you use the resourcesabove and below, but I’ll include them in the resources at the end of the article.

So above is what the IBSC recommends, but you’re not here to follow the same road as everybody else. By combining the above reading and reference resources with focused practice exams that include rationale, you will be able to not only learn quicker, but isolate your weaknesses so that you can learn more efficiently. These two books, in order of preference, are going to be your bibles: The Aeromedical Certification Examinations Self-Assessment Test and Back To Basics: Critical Care Transport Certification Review. If you can answer the questions in these 2 books cold, then I guarantee you will breeze through your advanced certification exams.

I haven’t forgotten about our nurses! Here’s the really neat thing: it’s the same thing! There are extensive references listed on the official website that I’ll include at the end, however if you use the above books, (the ASTNA boos was actually intended to prepare you for the CFRN) along side the question and rationale books, you’ll be absolutely golden.

A couple brief words of caution. First, don’t sacrifice keeping a firm foundation to learn critical care. You’re smart enough to see how that’s simply robbing one hand with the other. And secondly, most of us don’t use all of these concepts every day, especially before we get our first flight job, so be sure to review regularly, even after you pass your test.

ProTip: If you will be testing for your FP-C and CCP-C, go ahead and purchase a membership to the IAFCCP. It’ll cost you $100, but will discount each test $100, so it’ll immediately pay for itself, and the second test will save you $100 bucks.

Step 4: Build Relationships

Call it human nature, call it tribalism, call it what you want, we all trust those that we know more than the ones that we don’t, and your job is to convince the hiring manager, clinical lead, medical director, and anyone else that you meet to trust you with the job, their time, and their reputation.

If you are a paramedic working in a busy 911 service like we already discussed, then you should have a pretty clear understanding of which HEMS (Helicopter EMS) providers service your area, and where they are based. Ideally you have the easiest “in” in building relationships with the air crews, as you already run into them on scenes and at hospitals. Don’t just call a number to follow up, only to ask vague questions like, “how’d they do?” Go to them. When they get back, bring them food and ask if they have just a couple of minutes. Explain to them your goal, what you have accomplished so far, and ask if you can ask for their honest opinion after calls to keep improving. Keep in mind, the best thing you can do to impress them is rock it during your patient handovers with the flight crews. They’ll remember you.

There are more ways to get to know your local flight crews as well. Often times, once you start to build these relationships, many of the larger flight services can actually offer you an internship program, where you train beside them, often following what is essentially the new hire process. When you’re bringing snacks over to the flight crew, ask them if they offer anything like that. Most flight services can also offer to let you third-ride with them, depending on which airframe they fly, patient weight, etc.

If you are a nurse, depending on your department, you may not regularly see a flight crew. You may need to grab a paramedic in the ER and ask them which helicopter services are in your area. The guys and gals on the ground should really have a pretty solid grasp of who services the area. Once you are armed with the list of helicopters in your area, grab some snacks or pastires and go visit. Same as above, ask for their advice. Most of us love to talk, Type A’s and all, so tell the what you’ve done and ask them what they would do from here. This is also a good oppertunity to ask what type of experience they prefer, whether ICU or ED. Remember the internship programs and third-rider programs, they may forget to mention it, so don’t be afraid to ask.

Don’t forget your relationships at your current job as well. Getting to know your supervisors, educations, FTO’s, etc can also lead you places and provide oppertunities with flight crews and programs that they know as well. If you continue to grow professionally, you may even get the oppertunity to start building relationships with flight crews as peers as you perform duties in QA, for example.

Step 5: Provide Added Value

The vast majority of HEMS providers rely on voluntary calls from customers (ground EMS and hospitals) who have a choice in who they call, so public relations is huge for them. One of the ways that they can PR is through education, whether classes for CE or for card courses, such as ACLS, PALS, etc. Having this experience will show that you not only have a similar mindset and are enthusiastic to teach and improve, but also most likely have a baseline knowledge above the average nurse or paramedic. This will also be an oppertunity to build those relationships in the leadership of your current job.

Don’t get focused on the future and lose sight of the present. Constantlly improving in your job performance with a positive attitude will allow you to promote and grow professionally, allowing you to gather more and more valuable experience to place on an equally impressive resumé when it’s time to start applying.

Step 6: Make It Happen!

Depending on a multitude of factors and where you started, you may or may not have finished the above steps when you start getting to that magical 3-5 years of experience mark. While the above steps are ordered, please don’t wait to apply just because you haven’t gotten your instructor certifications yet, or becuse you haven’t passed your advanced certification. While following the above steps will absolutely place you above the vast majority of your peers, both in clinical ability and in perceived value in an interview, not having performed all of the above steps in entirety will not disqualify you from being hired. Don’t put it off forever, but that’s not an excuse not to try your best to complete the above steps in time.

If you’re still reading, thank you. Not for reading, but for furthering our profession. We need more dedicated people such as you in our field, and every ounce of enthusiasm from those pushing our field forward rejuvinates the rest of us as well. Good luck, and be safe!

References and Resources:

Future Flight Medic’s Recommended Resources (FP-C, CCP-C, CFRN, CCRN, CEN):

IBSC Recommended Resources (FP-C and CCP-C):

IBSC Additional Resources (FP-C and CCP-C):

Additional Links: