Dawn Heeger

I have 7 years aero-medical experience working as a Medical Case Manager and Flight Nurse for a medical assistance companies. My role as a case manager includes reviewing medical reports, liaising with medical teams abroad, communication with patients and their families, determining a patient’s fitness to fly and by what means and arranging hospital admissions in the UK. In my spare time, I work as a medical escort to repatriate patients from abroad back to the UK, or back to their
country of origin.

Previous work experience

After qualifying in 2004, I worked in the NHS on a Coronary Care/Medical Assessment Unit for 6 months to consolidate my training before transferring to Critical Care where I worked full-time until 2011. During this time, I did a rotational programme that included six months on a Neurology Critical Care and a further six months on a Cardio-Thoracic HDU. I worked as a bank nurse on Critical Care from 2011 until 2017.

How did I get into medical case management/flight nursing?

While working in Critical Care at the Royal County Hospital in Brighton, I met nurses who worked as medical escorts. They were doing global repatriations by commercial aircraft and air ambulance. At this time, I’d only been qualified about 3 years and felt I needed a couple more years to feel confident to do this type of lone-working My training as a medical case manager was done on the job over a five day period. It included the basics of aviation physiology as well as the logistics of repatriations i.e. wheelchair assistance, stretchers, oxygen onboard etc. Over the past 7 years this initial training has been supplemented by ongoing study days, articles, discussions with colleagues and networking.

Education

• Clinical Considerations in Aeromedical Transport (CCAT) 2014
• RCN Flight Nurse study day (annual) and CCAT study day (annual)
• Intermediate Life Support (ILS) (annual)
• Manual Handling (annual)
• Safeguarding Adults and Children (every 2 years)

What do I enjoy most about being a flight nurse?

Spending time with people in what is probably some of the worst moments of their life is one of the most rewarding parts of the job. You want to get people home to their families!

What were my most challenging repatriations?

My more challenging repatriations have usually been due complex logistical and resource problems, leading to nightmare journeys.

I was repatriating a patient from Australia with a new diagnosis of pulmonary fibrosis. Medical clearance had been granted on the basis that the patient would need the maximum oxygen rate available on board, 4L/min, for the long journey back to the UK. In total six cylinders were provided by the airline. However, the second cylinder brought to me felt rather light in weight. The dial showed that the cylinder was only half full. An inspection of the remaining cylinders confirmed by worst nightmare……two of the remaining four cylinders were not full either!! After much discussion with the Cabin Services Manager and pilot, I titrated the oxygen to provide the patient with the minimum oxygen amount to maintain adequate oxygen saturations that did not compromise the patient. I knew we could use the emergency oxygen onboard. However, should there be an emergency onboard this would not be the best option. Alternatively, the plane would have to be diverted! Long story short…..we got back safely using the cylinders provided.

Other scenarios include almost losing a patient in Frankfurt Airport with only minutes to catching the connecting flight! Imagine the paperwork…..! Also, finding that no stretcher fitted onboard an aircraft from Paris to Manila and having to manage the patient in an airport hotel while trying to arrange an admission in a Paris hospital.

What important character traits are needed as a flight nurse?

• common sense
• able to think on your feet
• be practical
• assertiveness
• excellent communications skills
• sense of humour!

Top Tips

• experience the role of the Medical Case Manger to have a complete picture of medical assistance
• bank bursts of sleep when on long-haul repatriations
• only accept a repatriation if you’re 100% happy with the medicine, rest time, safety, security and logistics – ASK QUESTIONS!