flight medicine . . .

Started by Arctic Char
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Arctic Char

Arctic Char

Full Member
15+ Year Member
hi everyone, i have a question about the nature of "flight medicine". is this something that someone can explicitly make a career out of, or is it merely one aspect of the greater duties of an EM doc (at an appropriate facility)? and if the latter, what is the nature of the work, schedule rotations and responsibilities?

i have flight training (recreational), and simply can't think of anything cooler than spending my shift both seeing patients and flying in the air. how cool would that be!!?!

thanks for any insight you can offer.

cheers
 
MtMed said:
hi everyone, i have a question about the nature of "flight medicine". is this something that someone can explicitly make a career out of, or is it merely one aspect of the greater duties of an EM doc (at an appropriate facility)? and if the latter, what is the nature of the work, schedule rotations and responsibilities?

i have flight training (recreational), and simply can't think of anything cooler than spending my shift both seeing patients and flying in the air. how cool would that be!!?!

thanks for any insight you can offer.

cheers
Click to expand...

Answering as a former flight surgeon and a present EP.

They have nothing to do with each other.

Most flight surgeons are active duty officers doing flight physicals and taking care of the demonstrably healthiest populations in the world. Boring. The free flying and the people are nice however. A few civilian physicans (specialty unimportant) choose to be aviation medical examiners for the FAA, doing qualification physicals for civilian pilots, professional or amateur. A few interesting diseases that you'll rarely see (bends, air-gas embolism).

EM docs take care of the demonstrably sickest populations. Exciting. The patients vary in niceness and you don't get to fly.

EPs in the AF in my day were rarely able to get an active flight slot despite being qualified since they weren't able to provide continuing care. May be different now, for all I know.
 
Which flight medicine are you talking about?

Air medical transport: Yes, you can be involved with this as an emergency physician. Either you're a medical director or you can fly with a select few flight services that hire attending physicians. There are only a handful in the country. MCW, Cleveland LifeFlight, and some service in Michigan (I can't remember the name) are the only ones I'm familiar with who fly attending physicians.

Aerospace/Space Medicine: Yes, you can also become involved in this, but only after a fellowship (2 years). The UTMB-NASA Johnson Space Center space medicine fellowship has in the past taken emergency medicine physicians into its fellowship program. One of those graduates is now an astronaut (trained in EM at Denver, fellowship at UTMB-NASA JSC, now on schedule to fly on the shuttle).
 
Most HEMS systems don't use physicians -- I think only about 5%. I don't believe outcomes have ever been shown to improve by having physicians on board -- most of the advantage of HEMS seems to be in moderately head injured patients, and that advantage seems to stem from the airway skills of the HEMS crew. But whether nurse, EMT, physician -- I don't think any data shows that any combo is appreciably better. So an attending on board the aircraft is probably prohibitive, from a cost perspective. Now, in Cincinnati where I am, the residents all fly -- it's more of a benefit to us than it really seems to be to M&M. However, a couple of our attendings do fly on a regular basis just because they are involved with HEMS here. But it's probably a relatively rare situation -- I think you'd have some difficulty finding a physician position incorporating HEMS. To be honest, most of the flights are not all that cognitive -- it is mostly IV, airway, transport. It is fun to fly, but I don't think you'll find too many places willing to pay an attending salary for you to do this. 🙂

-endo
 
It's AeroMed in Grand Rapids, MI. Michigan's only full-time physician staffed helicopter service. And yes, a PGY-3 EM resident qualifies as flight physician, and they get paid! They fly to the 2 major hospitals in town: Butterworth/DeVos for trauma and peds respectively and Blodgett for the regional burn center. I did my internship there in GR. Pretty cool residency, good people, definately check it out.
 
endo said:
Most HEMS systems don't use physicians -- I think only about 5%. I don't believe outcomes have ever been shown to improve by having physicians on board -- most of the advantage of HEMS seems to be in moderately head injured patients, and that advantage seems to stem from the airway skills of the HEMS crew. But whether nurse, EMT, physician -- I don't think any data shows that any combo is appreciably better. So an attending on board the aircraft is probably prohibitive, from a cost perspective. Now, in Cincinnati where I am, the residents all fly -- it's more of a benefit to us than it really seems to be to M&M. However, a couple of our attendings do fly on a regular basis just because they are involved with HEMS here. But it's probably a relatively rare situation -- I think you'd have some difficulty finding a physician position incorporating HEMS. To be honest, most of the flights are not all that cognitive -- it is mostly IV, airway, transport. It is fun to fly, but I don't think you'll find too many places willing to pay an attending salary for you to do this. 🙂

-endo
Click to expand...
A little old, but...

Rhee, KJ, et al. Is the flight physician needed for helicopter emergency medical services? Ann Emerg Med, 15(2):174-177.

The question of whether physicians are cost effective in helicopter emergency medical services (HEMS) transport remains an unresolved issue. During a four-month study period, all physician-specific contributions to medical care were recorded by means of a questionnaire that was completed by the flight physician and the flight nurse after each flight. In the judgment of the nurse, the flight physician made a unique and important contribution to the care of the patient in 38 of 174 flights (22%) completed during the study. Judgment, the most common contribution, was cited on 29 flights (17%). Both skill and judgment were contributed on seven additional flights (4%), and skill alone on only two flights (1%). Judgment was exercised most frequently in making diagnoses, initiating critical medical treatments, and determining destination. The cost to this program of providing physicians is approximately $85,000 per year, or 7% of an annual budget of approximately $1.2 million. Flight physicians make a substantial and important contribution to patient care in HEMS operations, exercising critical judgment regarding diagnosis, medical treatment, and disposition in 22% of transports. The benefits of this contribution far outweigh the 7% program cost.
 
The University of Chicago also has a life flight program run by the 2nd year residents as flight physicians on board. It is covered by EM residents around the clock, and does ICU transports and/or scene responses.
 
just what i was looking for, thanks everyone. i should have mentioned that i have been an active member of the aerospace medical associateion for 5 years. i just was unclear about HEMS in the context of hospital work and a career.

thanks again everyone, great feedback
 
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