Critical care transport moves very sick patients in tight spaces, with few hands and little time. When something goes wrong in a helicopter, an airplane or a critical care ground unit, the questions are different from a hospital case. What could the crew reasonably do with the space, equipment and protocols they had?
A nurse expert who has done this work knows those limits from the inside. Here is what a transport review usually covers.
Why a Flight Nurse Expert
Transport nursing has its own training, protocols and pace. Crews often work under written protocols, with a physician available by radio or phone for medical control. A hospital nurse may not know how a flight crew is expected to prepare a patient for the trip, secure the airway, or manage drips and a ventilator in the air.
A flight nurse expert such as Rebecca Edwards, MSN, a critical care flight nurse, clinical educator and paramedic who also works as a legal nurse consultant, can explain what the crew should have done and what was simply not possible in the aircraft. The Air & Surface Transport Nurses Association (ASTNA) is the professional association for transport nurses and a good place to learn more about the specialty.
1. The Handoff and Patient Preparation
Many cases start at the sending facility. The expert looks at the report the crew received, what was known about the patient, and how the crew prepared for the trip. Was the airway decision made before departure, when it is safer? Were lines secure, drips labeled and the ventilator set?
For hospital transfers of patients with emergency medical conditions, federal EMTALA rules at 42 CFR 489.24 describe an appropriate transfer. Among other things, the sending hospital sends the available records, and the transfer is made through qualified personnel and transportation equipment, including necessary and medically appropriate life support during the transfer. The expert asks whether the level of crew and equipment matched the patient's needs.
2. Protocols and Medical Control
Most programs run on written protocols. The expert compares the care given with the program's protocols in effect on the date of the transport, not today's version. Did the protocol call for contacting medical control, and did the crew make that contact? Were the orders they received documented?
Many programs also seek accreditation. The Commission on Accreditation of Medical Transport Systems publishes accreditation standards for medical transport services. Not every program is accredited, but the program's accreditation status and its own policies help frame what was expected.
3. Monitoring in Transit
Transport records are often brief and written after the patient is delivered. The expert checks how often vital signs were recorded, how drips were adjusted, how the ventilator and airway were monitored, and how the crew responded to changes.
When the narrative is thin, device data can fill in the picture. Cardiac monitor, defibrillator and ventilator downloads often carry time-stamped readings that never made it into the written record.
4. Timing, Weather and Safety
Delay claims depend on the timeline: call received, launch, arrival at the bedside, departure and arrival at the receiving facility. The communications center log is usually the best source.
The aviation side has its own rules. FAA requirements for helicopter air ambulance operations are in 14 CFR Part 135, Subpart L, which includes a pre-flight risk analysis and the briefing of medical personnel. Decisions about whether and when to fly belong to the pilot and the operator. A good nursing review stays in its own airspace: it addresses clinical care and leaves aviation questions to an aviation expert.
5. Arrival at the Receiving Facility
The case does not end on the helipad. The expert compares the patient's condition on arrival with the condition at departure, reviews the report given to the receiving team, and checks whether the transport record was handed off.
Records to Request
For a complete transport review, request:
- The communications center or dispatch log with all times
- The transport patient care record
- Cardiac monitor, defibrillator and ventilator data downloads
- Medical control recordings or notes, if kept
- Program protocols and policies in effect on the date
- Sending and receiving facility records, including transfer forms
- Crew training and credential records, if they are at issue
A fair review looks both ways. Sometimes the record shows a crew doing everything right in a situation that could not be saved, and that answer matters just as much.
Learn more about Rebecca Edwards on LinkedIn.
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