Key Responsibilities and Required Skills for Air Ambulance Nurse

🎯 Role Definition

An Air Ambulance Nurse (Flight Nurse) is a registered nurse with advanced critical care skills who provides safe, high-quality pre-hospital and inter-facility aeromedical patient care in rotary- and fixed-wing environments. The role requires autonomous clinical decision-making under time pressure, expert management of advanced life support, coordination with flight crews and receiving facilities, adherence to aviation safety and weight/balance limitations, and rigorous documentation and quality improvement participation. Ideal candidates are experienced ICU/ED nurses with certifications in ACLS, PALS/NRP, and transport/flight-specific credentials (CFRN, CCRN preferred).

📈 Career Progression

Typical Career Path

Entry Point From:

Emergency Department (ED) Registered Nurse with 2–5 years of critical care experience
Intensive Care Unit (ICU) or Cardiac Care Unit (CCU) Registered Nurse with ventilator and vasoactive medication experience
Critical care transport (ground) nurse or paramedic transitioning to aeromedical roles

Advancement To:

Flight Nurse Lead / Clinical Lead
Aeromedical Program Manager or Clinical Coordinator
Regional Transport Director or Director of Clinical Services
EMS/Transport Medical Director (with additional medical qualifications)

Lateral Moves:

Critical Care Ground Transport Nurse
Emergency Department Charge Nurse / Clinical Educator
Hospital-based ECMO or Shock-Trauma Transport Specialist

Core Responsibilities

Primary Functions

Rapidly perform comprehensive primary and secondary assessments in pre-hospital, inter-facility, and in-flight environments, synthesizing physical exam, monitoring data, and collateral information to prioritize life-saving interventions and transport decisions.
Independently manage advanced airway procedures during transport, including endotracheal intubation, ventilator initiation and settings adjustment, failed airway rescue techniques, and troubleshooting ventilator alarms in noisy, vibration-prone aircraft environments.
Administer and titrate continuous infusions of vasoactive medications (e.g., norepinephrine, epinephrine, vasopressin), sedation and analgesia (e.g., propofol, midazolam, fentanyl), and antiarrhythmics while monitoring hemodynamic response and documenting titration rationale and endpoints.
Initiate and manage invasive vascular access including central lines, intraosseous (IO) access for pediatric or hemodynamically unstable patients, secure peripheral IVs under challenging conditions, and troubleshoot catheter-related complications during flight.
Provide comprehensive blood product management including remote transfusion initiation, pre-transfusion compatibility checks, monitoring for transfusion reactions, and documentation of blood administration during critical transport missions.
Deliver pediatric and neonatal critical care during aeromedical transport, including neonatal resuscitation (NRP), neonatal ventilator support, appropriate medication dosing, temperature management, and family communication for vulnerable populations.
Perform emergency procedures such as needle decompression, chest tube management, pericardiocentesis assistance (as local protocols allow), and rapid stabilization of traumatic, burn, or multi-system-injury patients before and during air transport.
Coordinate patient care with flight crew (pilot/co-pilot), flight paramedic, sending and receiving facility clinicians, and medical control to optimize time-sensitive decisions, landing zones, flight routes, and handoff planning.
Conduct pre-flight and post-flight equipment and medication checks, ensure all monitors, ventilators, infusion pumps, and emergency kits are flight-ready, and document inventory control and equipment discrepancies to maintain transport readiness.
Adhere to aviation safety protocols including helmet and harness use, securement of patients and equipment for turbulence, weight and balance calculations, and compliance with FAA/CAA and local aeromedical regulations.
Triage and stabilize multi-patient or mass-casualty incidents within the constraints of aeromedical operations, prioritizing evacuation sequencing, resource allocation, and rapid communication with incident command and receiving hospitals.
Provide compassionate, clear communication with patients and family members regarding clinical status, transport rationale, expected timelines, and anticipated outcomes while maintaining patient privacy and emotional support during high-stress transfers.
Perform thorough and timely electronic medical record (EMR) documentation of clinical assessments, interventions, medication administration, physiologic trends, and physician orders, ensuring legal, billing, and quality assurance requirements are met.
Collaborate with medical oversight (physician medical director) for protocol-driven and physician-directed care during transport, seeking guidance for complex therapeutic decisions and adhering to local scope-of-practice and delegation agreements.
Participate in clinical quality improvement initiatives, including case review, root cause analysis, adverse event reporting, and implementation of process changes to improve patient outcomes and operational safety.
Serve as a preceptor and educator for new flight staff and clinical partners, delivering hands-on training in aeromedical physiology, in-flight critical care techniques, simulation scenarios, and company protocols to maintain clinical competency across the team.
Maintain readiness for austere-environment care including landing zone scene safety assessment, extrication assistance, environmental exposure management (hypothermia/heat illness), and improvisation of care when standard resources are limited.
Implement and maintain infection control practices in the transport environment, including isolation procedures, appropriate PPE selection in confined aircraft cabins, and safe handling/disposal of biohazardous materials.
Participate in service operations such as schedule flexibility for nights/weekends/holidays, on-call responsibilities, and rotational assignments to cover high-demand shifts or temporary base relocations as operational needs require.
Execute structured handoffs to receiving clinical teams with a focused SBAR (Situation, Background, Assessment, Recommendation) style report, facilitate timely transfer of care, and ensure continuity of care through clear directives and documentation.
Monitor aircraft environmental factors (altitude physiology, cabin pressure, oxygenation changes), apply appropriate oxygen therapy and ventilation adjustments for altitude-related physiologic changes, and modify care plans based on anticipated in-flight physiologic impacts.
Administer and manage advanced monitoring modalities such as continuous cardiac monitoring, invasive arterial blood pressure, end-tidal CO2, point-of-care glucose, and bedside ultrasound (as credentialed) to guide resuscitation and transport decisions.
Ensure regulatory compliance with credentialing, privileging, and continuing education requirements; submit required paperwork for flight hours, case logs, and competency assessments to maintain operational eligibility.
Lead or contribute to emergency drills, simulation training, and cross-discipline briefings to reinforce team coordination, human factors awareness, and consistent adherence to safe aeromedical practice.
Support program-level logistics including supply chain oversight, medication rotation, controlled substance accountability, and vendor liaison for aircraft-specific equipment procurement and maintenance.
Provide professional representation of the aeromedical service in interfacility meetings, community outreach, disaster response planning, and peer reviews to strengthen referral relationships and public trust.

Secondary Functions

Assist with operational data collection, case logging, and submission of clinical outcome metrics to support performance reporting and accreditation audits.
Support periodic audits of equipment checklists, medication inventories, and controlled substance logs and implement corrective actions to maintain readiness.
Participate in multidisciplinary committees focused on clinical governance, safety, and process improvement for the aeromedical program.
Deliver targeted in-service training sessions on new protocols, equipment upgrades, and lessons learned from case reviews to maintain team competency.
Provide flexible support for non-transport clinical duties during low-demand periods, such as ED support shifts, critical care float assignments, or disaster response standby.

Required Skills & Competencies

Hard Skills (Technical)

Advanced cardiac life support (ACLS) — mastery of advanced arrhythmia recognition, defibrillation/cardioversion, and ACLS algorithms under transport conditions.
Pediatric Advanced Life Support (PALS) and/or Neonatal Resuscitation Program (NRP) — competent pediatric and neonatal resuscitation and dosing.
Certified Flight Registered Nurse (CFRN) or equivalent aeromedical certification preferred — knowledge of flight physiology, aircraft safety, and in-flight care constraints.
Critical care nursing certifications such as CCRN, TNCC, or SANE (as applicable) — strong ICU/ED critical care skills and ventilator management.
Advanced airway management skills — endotracheal intubation, difficult airway protocols, supraglottic device placement, and confirmation via ETCO2 monitoring.
Ventilator management and mechanical ventilation troubleshooting in transport settings — initiation and adjustment of modes and alarms.
Vasoactive medication initiation and titration — familiarity with pump programming and safe delivery in noisy/unstable environments.
Pediatric and neonatal dosing competency and weight-based medication calculation accuracy.
Point-of-care ultrasound (POCUS) for critical transport decisions (cardiac view, FAST/eFAST) — when credentialed by program.
Blood product administration and remote transfusion protocols — compatibility checks, monitoring for reactions, and documentation.
Invasive procedures under field conditions — IO access, chest tube management, arterial line monitoring insertion/maintenance as allowed by program.
Proficiency with transport monitors, portable ventilators, infusion pumps, and electronic medical record (EMR) charting for transport medicine.
Controlled substance handling and inventory management compliant with DEA/Local regulations.
Flight risk assessment and weight and balance calculations for safe patient/equipment placement.

Soft Skills

Calm and decisive clinical decision-making under high-stress, time-critical conditions.
Exceptional verbal and written communication skills for concise handoffs and multidisciplinary coordination.
Strong teamwork and collaboration with pilots, flight paramedics, sending/receiving clinicians, and ground services.
High situational awareness and risk assessment capability in dynamic environments.
Compassionate patient and family communication with cultural sensitivity and emotional intelligence.
Adaptability and problem-solving when resources are limited or unexpected complications arise.
Teaching and mentoring aptitude for precepting new staff and leading in-service trainings.
Professional integrity, accountability, and strong ethical judgment.
Resilience and stress tolerance for irregular schedules, frequent travel, and exposure to traumatic cases.
Attention to detail for accurate documentation, medication dosing, and equipment checks.

Education & Experience

Educational Background

Minimum Education:

Current, unrestricted Registered Nurse (RN) license in jurisdiction of practice; Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) acceptable per employer.

Preferred Education:

Bachelor of Science in Nursing (BSN) strongly preferred.
Advanced degrees (MSN, DNP) or additional certifications in critical care/transport are advantageous.

Relevant Fields of Study:

Nursing (BSN, ADN)
Emergency Medicine / Critical Care Nursing
Aeromedical or Prehospital Care courses and certifications
Advanced practice or health administration (for leadership tracks)

Experience Requirements

Typical Experience Range:

3–7+ years of progressive critical care nursing experience (ICU, Cardiac ICU, ED, Trauma OR), with demonstrated competence in ventilator, vasoactive, and invasive monitoring management.

Preferred:

5+ years critical care/ED experience with prior transport experience (ground or air), demonstrated clinical leadership, and flight-specific certifications (CFRN or equivalent) or completion of employer flight orientation.
Documented experience in pediatric/neonatal critical care for programs that transport these populations.