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Embark on a journey into the extraordinary life of Ty Demaria, a RACQ LifeFlight Rescue Flight Nurse and ICU Nurse in Brisbane.
LifeFlight Australia is a world leader in aeromedical care and Australia’s most diversified service, operating both a fixed-wing and rotary-wing fleet. The RACQ LifeFlight Rescue helicopter and jet crews provide a blanket of care for families across Queensland. Rural and remote communities in particular rely on the RACQ LifeFlight Rescue community helicopters and Air Ambulance jets to bring the hospital to them in their hour of need. Make sure to check out their website!
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Hi, I’m Ty Demaria, a Flight Nurse on board the Brisbane-based RACQ LifeFlight Rescue helicopter. I have over 13 years of Critical Care experience and I also work at the Royal Brisbane and Women’s Hospital ICU. When I’m not juggling two busy jobs, I have a wife and three young children that take up my spare time.
My nursing career started when I took the opportunity to complete my graduate year in a large tertiary Intensive Care Unit in Brisbane. After completing my ICU graduate program, I went on to study a post-graduate Critical Care Certificate specialising in Intensive Care.
With a couple of years of experience under my belt, I moved to London to work and travel. I always planned on living and working abroad and nursing gave me this opportunity. Following the two years overseas, I returned back to work in ICU, where over the next few years my career progressed and I worked in various clinical and educational roles. I have always enjoyed the dynamic and complex environment that critical care offers, although I was forever on the lookout for the next new challenge in my career.
When a position became available at RACQ LifeFlight Rescue in 2017, it was appealing because of its diverse and dynamic characteristics to a nursing role. The idea of combining my experience and skills in new and exciting environments outside of the traditional nursing role presented a fantastic opportunity.
I was fortunate to get the job as a casual fixed wing flight nurse, where the position entailed retrieving critically ill patients, both domestically and internationally. With no prior experience working in aeromedical retrievals, it was a valuable introduction.
Following a year working casually on board the RACQ LifeFlight Rescue Air Ambulance jet, a vacancy came up on the helicopter, which I jumped at. So, for the past 3 years I have embarked on a new journey in my career and have enjoyed every challenge as a Rotary Wing Flight Nurse.
I’m lucky to work with an incredibly skilled team of pilots, retrieval doctors and flight nurses who are all driven towards the same shared patient interest – providing the best possible outcome for the patient no matter where they are in regional or rural Queensland. The transition from the hospital setting to flight nursing has provided a level of excitement that is extremely difficult to match within the nursing profession.
What does a typical day look like?
There’s no such thing as an ordinary day at work on a rescue helicopter. The day can kick off immediately as you walk through the door. Whether it’s responding to the scene of a car accident or transporting a paediatric retrieval team to a critically ill child, you really can’t predict what will happen.
The day crew arrives at the Brisbane hangar, early in the morning, and immediately prepares for the day. The night crew will be offsite at the crew house unless they are out on a job. The operating retrieval team at Brisbane consists of a pilot, co-pilot, retrieval doctor and flight nurse. This crew composition differs from other RACQ LifeFlight Rescue helicopter operations in Queensland, who have a pilot, an Aircrew Officer and a QAS Intensive Care paramedic aboard the helicopter.
The shifts are 10 hour days and 14 hour nights, which can be physically fatiguing when we are busy like any shift work, and you can expect that you won’t get home on time every shift depending on what time of the day you are tasked or what type of task you are on. Inter-facility retrievals generally take up to 4 hours from start to finish, but there are many factors that impact this including the geographical location and complexity of the retrieval.
The day begins with the routine equipment checks of the medical bags and the equipment in the aircraft cabin to ensure all the equipment is serviceable. All crew will check that their helmet and harness is correctly fitted before any operation is commenced. The pilots will complete their side of the aircraft checks and there is an engineer onsite working and checking on the aircraft for routine daily and scheduled maintenance.
Once the morning checks are complete, we gather in our ops room for a pre-flight brief from the pilot. The brief covers any aircraft specific information, making sure everyone is current to fly and fulfil their role, any fatigue management concerns, and weather implications. The pilots will also discuss the standard emergency brief, discuss debrief points from recent missions and identify if there are key risks to consider for flying.
After the brief, the doctor and I will run through a scenario and do some training, this involves a rapid sequence intubation (RSI) on the mannequin or setting up equipment that I haven’t used as frequently. It’s important to be familiar with all the equipment in our packs.
RACQ LifeFlight Rescue crews are ready to respond to a mission at any time. Queensland aeromedical retrieval missions are coordinated and tasked by Retrieval Services Queensland (RSQ). They communicate directly to the pilot’s phone via LifeFlight’s Communications, Coordination and Control Centre.
Once a task comes in and is accepted, we grab our drug pack and blood, then we are out the door within a matter of minutes. The operational requirement is that we are starting the helicopter engines within 15 minutes of accepting the task.
The missions we are often tasked to include Inter-Facility Transfers (IFTs) or Primary jobs, where we arrive at the scene of an incident to help a patient or patients.
We fly most shifts, day or night and it’s not uncommon to complete two or more tasks in a shift. If we aren’t out flying, there is time for mandatory competencies or exams that are required. There’s always plenty to do at the hangar like check the medical stores and certain days we wash the helicopter. Some days we are out all day flying, so finding time for lunch let alone attending to these duties is difficult. Once the night crew arrive, and if we are at the base, we handover and head home for the day.
Did you get any special training?
The induction training with LifeFlight is extensive and there are many competencies and standards that must be met prior to being able to fly. The training covers the introduction to pre-hospital and aeromedical retrievals, and aviation training for the aircrew side of the role.
The flight nursing orientation included a week of intensive training at the LifeFlight Training Academy. The program is used to train new LifeFlight Retrieval Doctors to get ready for the pre-hospital and retrieval environment. The week of training consists of lectures, skills stations, high fidelity scenarios and assessments.
Once all the required competencies and aviation training was complete, there was a supernumerary period of flying alongside experienced flight nurses before flying solo. LifeFlight has a focus on providing ongoing education and professional development with weekly in-house scenarios and case review audits, and run six-monthly mass casualty, paediatric and obstetric training days.
The aviation training for aircraft safety and procedures is a requirement as part of Australia’s Civil Aviation Safety Authority (CASA) regulations. Training activities include, aircraft emergency procedures, passenger briefing, and helicopter underwater escape training (HUET) – in the highly unlikely event of a helicopter crashing into water.
HUET involved hanging upside down, underwater, in a metal helicopter simulator, before having to safely find your way to the surface, under the guidance of LifeFlight’s experienced instructors – you even try it blindfolded, in an effort to simulate an emergency evacuation where vision is impaired.
Given the crew composition at the Brisbane base, the flight nurse role takes on additional aircrew responsibilities in the rear cabin. Training was undertaken for procedures in monitoring the engines during start up sequences, securing the aircraft cabin, and opening the aircraft doors in flight to provide negative clearances for the pilots by identifying obstacles when the aircraft is landing in confined areas. These skills were consolidated in practical sessions during static and airborne situations and are checked annually.
What kinds of aircraft do you travel on?
Day to day, I travel on the Agusta Westland 139 helicopter. This is a twin-engine helicopter that has exceptional operational capabilities for aeromedical retrievals. The AW139 is fitted and equipped with aviation approved patient stretchers and mobile monitoring systems that enable us to carry a full range of equipment. The aircraft can be configured for two stretchers and can transport the Mansell Neocot system for neonatal and paediatric retrieval teams.
What types of patients do you see & what is your role in their care?
We retrieve all patients from paediatrics to adults. The majority are adult patients with all types of conditions, commonly cardiac, complex medical and surgical, or trauma – they are often intubated and ventilated and on inotropes. Most transfers from the RACQ LifeFlight Rescue Brisbane base are inter-facility transfers to secondary or tertiary hospitals for definitive patient care. We also attend primary retrievals, including roadside accidents and a small number of search and rescue missions.
We also provide transport for paediatric and neonatal retrieval teams who operate out of tertiary facilities and retrieve patients within their own specialty. I work alongside a retrieval doctor to deliver the optimal and appropriate level of care for patients during the transfer process. This entails planning and pre-flight assessments, stabilisation of patients and assisting with complex procedures. During the flight, my responsibility is to monitor and maintain a safe environment for our patients and crew.
What unique clinical considerations do flight nurses need to make?
There is a multitude of clinical considerations to be made when placing a critically unwell patient in a confined helicopter cabin, mainly due to environmental factors, limited resources and the lack of support that is readily available in the hospital setting.
It’s integral to pre-empt expected deterioration and by doing so, plan for what deterioration may occur prior to departure. Providing treatment and interventions on the ground in a controlled environment is safer than at altitude in a helicopter. Depending on the patient condition, decisions around picking up a patient and taking them directly to hospital versus staying on scene to treat them are considered. Some patients require immediate transfer for definitive care where others without interventions will deteriorate during the flight.
The best strategy is to prepare for the worst, hoping that it won’t happen, and have all the resuscitation equipment prepared prior to transporting the patient. Before departure, roles should be briefed so if the patient deteriorates, each crew member knows their role. From my experience, being prepared makes the difference; resuscitating a patient at altitude, in a confined space with challenging communication is not ideal.
AW139 helicopter cabins are not pressurised and therefore we operate below 10,000 feet and even at levels below this. There are inherent physiological changes for the seriously ill patients.
Hypoxia at altitude for a patient with respiratory failure is likely to be detrimental, like the patient with an expanding pneumothorax or the undifferentiated trauma patient. Discussions with the pilots regarding flying at lower altitudes safely above terrain before a flight is key to reduce potential problems that may arise inflight.
Other considerations for retrieving patients is those with psychiatric conditions or aggression, as it may pose a risk of harm to the crew and aircraft safety. At LifeFlight, we have standard operating procedures that guide the management of this particular patient group. Not all patients are suitable for aeromedical retrieval; some may require intubation for safe transport, however this is rarely needed and inherently exposes the patient to potential risks, therefore road transport may be a better option. This often involves lengthy discussions regarding the preferred mode of transport for these patients.
What are common misconceptions about flight nursing?
Not all flight nurses are midwives. I am asked this question often. There is no requirement to be a midwife for my flight nurse position.
What’s the most rewarding and difficult aspects of your work?
The most rewarding part of my role at RACQ LifeFlight Rescue is that I get to work with a highly skilled team of health care and aviation professionals, providing a lifesaving service for the Queensland community. This type of nursing work is difficult to replicate in any other nursing position in the hospital setting and I get to fly around in a helicopter helping people – it doesn’t get much better!
Some of the difficult aspects include the trauma and unfortunate events suffered by the patients we retrieve. Often these patients are complex and clinically challenging. That coupled with the environmental elements present unique challenges and limitations. There is pressure on performance and the role carries a high level of responsibility that is physically challenging in the confines of a moving aircraft.
How do you handle grief, trauma and death?
With a career in critical care, I have been continuously exposed to all of these and no matter how often I experience it, it will continue to have some personal impact on me. I believe that the most important factor in dealing with grief, trauma and death is my own self-care. I always take time to reflect, whether that is debriefing with colleagues or understanding that it’s ok to feel sad and upset.
I try to look after my health, with regular exercise and healthy eating, and most importantly I have someone I can talk to – this is my wife. I have found that it was important to develop management strategies to deal with this early in my career and using coping strategies has helped me to offset any negative consequences to my own personal health.
What skills or experiences do nurses need to work in flight nursing?
Rotary wing flight nursing is exceptionally competitive and we have a high retention of nurses at LifeFlight. It’s important to have substantial nursing experience to be considered for these positions. You need at least five years of critical care nursing experience – I would suggest that this is at a tertiary facility to gain the greatest exposure. It can be ED or ICU or a mix of both, and having experience in various clinical positions is likely to be beneficial.
You need to possess post graduate qualifications in critical care nursing and have current certification in adult and paediatric ALS. I would suggest completing relevant trauma courses (TNCC, EMST – as nurse observer, trauma traps etc) – great professional development looks good on the resume.
Basically, you need to have the requisite skillset and non-technical skills of an advanced autonomous critical care nurse as these will be tested in the most dynamic environments. Due to the environmental factors and limited resources, you must be able to expand your level of clinical expertise beyond that of a hospital-based nurse.
What do you wish you knew before you started flight nursing?
I wasn’t mentally prepared for how demanding rotary wing flight nursing would be and it would have helped if I had some aviation knowledge before I started.
Why should nurses consider a job with LifeFlight?
If you’re an experienced critical care nurse interested in a fulfilling and adventurous career change, then working for LifeFlight should be on your agenda. LifeFlight offers exceptional training and the opportunity to work alongside some of the industry’s most highly skilled and driven professionals. Working for LifeFlight provides an opportunity to make a real difference to the lives of our community and if you are seeking a new challenge outside of the traditional hospital role you won’t regret it.
Tips for applying?
- Your nursing experience is key
- Have your resume prepared – these positions don’t come up regularly
- The application process isn’t easy – start preparing for an interview early
- Make sure you meet the mandatory requirements for the role – no brainer!
- Having the desirable criteria may give you the best possible chance of landing the job and make you stand out from other applicants
- Have a genuine passion for this area of work
- Non-clinical skills are equally as important as the clinical skills
- Learn about LifeFlight the organisation for the interview
- Give it your very best. Good luck!
What’s next for your career?
I really enjoy going to work every day and relish the challenges of flight nursing. This role is unique like no other nursing position and it’s a privilege to be able to help our community; so I won’t be giving up my position anytime soon. I will be doing more study in the future, as shift work will reach its “used by” date as I age.