Debra Yandell is chief flight nurse for Life Flight at OSF Saint Francis Medical Center. After receiving a Bachelor of Science degree in nursing from Bradley University, she began her career as an Emergency Department nurse. She became a flight nurse for the Life Flight Program in 1987 and chief flight nurse in 1996.
In her current position, Yandell’s duties include operational supervision, strategic planning, department organization and development, budgeting, marketing, and policy development and staffing for the program. She’s responsible for 20 employees and also functions as a staff member on the helicopter and ambulance transfers.
Some of her certifications include Certified Flight Registered Nurse, Trauma Nurse Specialist, Advanced Cardiac Life Support Instructor, Pediatric Advanced Life Support Instructor, Neonatal Resuscitation Provider, and CPR Instructor. Yandell is a lecturer for courses on trauma nurse specialists, basic trauma life support, pediatric advanced life support, and advanced cardiac life support.
Yandell lives in Peoria.
Tell about your background, family, etc.
I’m the second oldest of six children and grew up in a small rural farm community in southwest Illinois. I attended a private grade school, public high school, and graduated from Bradley University in 1978 with a Bachelor of Science degree in nursing. I began working at OSF Saint Francis Medical Center in 1976, initially as a patient care aide and later as a phlebotomist (lab tech). Following graduation from Bradley University, I began working in the Emergency Department at OSF Saint Francis Medical Center. My entire nursing career has been comprised of Emergency and Life Flight nursing.
Who and/or what influenced you to become a nurse?
That’s difficult to answer. Nursing is just something I’ve always wanted to do. There were no immediate family members or nurse role models that particularly impressed upon me to become a nurse. As a child, I recall being especially interested in taking care of my friends or younger siblings who were hurt at home or at school. I’d work my way through a crowd of kids around a fallen colleague to view the lacerated or broken limb. I grew up on a working farm and had the opportunity many times to observe the work of the veterinarian. I vividly recall a time when the vet left antibiotics-with a huge syringe and needle-for my father to administer later to a sick animal. With his assistance and observation, I was allowed to give the shot. The animal recovered from her infection, and I felt great. I was about 10 years old and was thinking, "I’m going to be a nurse. Nurses give shots, and people get better." The decision was made.
What’s different about emergency/trauma nursing compared to staff nurse?
In the Emergency Department (ED) setting, one doesn’t know how the day is going to unfold once it begins. Because patients of all ages, sizes, and diagnoses present to the Emergency Department, there’s an excitement about each day. Not knowing what the day will bring keeps the ED nurse challenged. She must have an extremely broad nursing background with proven skills, knowledge, and competencies to appropriately care for patients of all age groups. This is different than hospital staff nurses, who generally deliver care on a specific hospital unit-such as pediatrics, medical-surgical, oncology, or ICU-to a specific age group and medical diagnosis. Those patients remain on that specific unit for a period of time until discharge. Most ED patients are treated and released from the hospital following medical evaluation.
How have the duties and/or responsibilities of trauma nursing changed through the years?
Certainly, more ongoing education and certification courses are required. Newly graduated nurses are merely beginning to learn the nurse role. New medical equipment and procedures are continually being developed and introduced, and nurses must familiarize themselves with the indications, use, and interpretation of such equipment.
Tell about the Life Flight Program: its history, its purpose, etc.
The Life Flight Helicopter Program officially began in June 1984. OSF Saint Francis Medical Center was transferring patients by air before that time; in fact, the first recorded air transport of a patient to OSF Saint Francis Medical Center was in March 1967. At that time, the Peoria Journal Star helicopter was utilized to transport a neonate patient from Zion.
During the late 1970s and early 1980s, the Illinois Department of Transportation provided a Bell 206 Long Ranger helicopter for the transport of the critically ill or injured. Since that helicopter wasn’t completely dedicated to Emergency Medical Services and wasn’t always available, OSF Saint Francis recognized the need to provide its own dedicated helicopter service. With a helicopter and a medical transport team on site, the response time to the critically ill or injured would be minimized. In 1986, Saint Francis leased its first helicopter, also a Bell 206 Long Ranger, which was hangared at the hospital and staffed 24 hours a day.
The purpose of helicopter transport is to minimize the out-of-hospital time for a critically ill or injured patient. Once the decision is made that a patient’s needs surpass the capability of the transferring hospital and/or physician, a patient is transferred to a tertiary or higher level care facility. Depending on the patient’s overall condition, a medical decision is made for air versus ground (ambulance) transfer of the patient. Patients warranting helicopter transfer generally are sicker and require urgent or emergent treatment at the tertiary facility. During the 1970s, before routine helicopter transport was common, many patients died of their injuries or illness en route or soon after arrival to the receiving facility. The time delays-some up to two to three hours-were much too significant for the patient to survive.
How has it changed through the years?
Life Flight started out as a one-helicopter, leased Visual Flight Rules (VFR) operation. The program upgraded the aircraft in 1989, moving from a single engine VFR helicopter operation to a twin-engine Instrument Flight Rules (IFR) operation. IFR-equipped aircraft enable us to safely fly with the lowest weather minimums allowed by the Federal Aviation Administration. A state-of-the-art cockpit contributes to Life Flight’s ability to bring the latest technology to the critically ill or injured patient. In July 2002, we purchased two twin-engine Bell Model 230 aircraft.
The staff has grown from a start-up staff of three pilots, three flight nurses, one mechanic, and three dispatchers to the current staff of six pilots, 17 flight nurses, three flight paramedics, three mechanics, and eight dispatchers. To date, Life Flight has transported more than 18,000 patients since its inception in 1984-all with a perfect safety record.
With the growth of the air medical industry, the development of high-tech equipment specifically engineered for the air medical environment made it more convenient for the crew to work in a smaller, confined space. The medical protocols have radically multiplied and changed as more treatment options have been developed and instituted for patients. The highly trained and skilled medical crews are now doing interventional procedures once performed only in the hospital arena. Because of this, the medical equipment transport packs have also bulged over the years with required medical supplies. Required regulations and licensing by the Illinois Department of Public Health are done yearly. In the early years of air medical transport, there were none.
Under what circumstances would someone be Life Flighted, as opposed to taken by ambulance? Who makes those decisions?
Patients whose diagnoses require transfer to a tertiary care facility with out-of-hospital time minimized are generally Life Flighted when possible. Examples include patients who’ve sustained multiple trauma from a motor vehicle crash, a patient who’s had a heart attack and requires the skill and technique of an interventional cardiologist to save heart muscle, a stroke patient whose outcome may be improved if the life-saving procedure is initiated within three hours of symptoms, a premature infant born too early and whose needs require a high level neonatal nursery, or a pediatric patient whose medical crisis and unstable condition requires a pediatric intensivist and immediate transport to the Children’s Hospital of Illinois. Certainly this isn’t an exhaustive list, but I think you understand the seriousness of the conditions. The transferring physician makes transport decisions as to which patients need transfer and by what means.
When you’re not in flight, what are your duties?
As team leader for the flight program, my duties consist of the day-to-day operational supervision of the program, strategic planning, department organization and development, budgeting, marketing, policy development, and compliance with established regulatory agencies.
Is it more stressful to be a nurse on a Life Flight transport than in the ED on the ground? Why or why not?
Because the transport team is making independent interventional decisions for the patient in preparation for the transport environment, clearly there’s more stress in that situation than working as a staff RN in the ED. In the ED, the nurse is one team member of a group of individuals collaboratively working to care for the patient. In the transport arena, many times it’s only the transport team-two individuals-who make the decision of what the patient will need prior to putting the patient in the helicopter or the ambulance. And these decisions must be correct, as the air transport environment isn’t the type of environment to be conducting full patient resuscitations. The space is confined, with vibration and excessive noise making communication difficult at times. The transport teams are experts at recognizing patients who may need certain treatments before putting them into the transport environment.
How are nurses recruited to serve on Life Flight? Are there adjustments they must make, i.e., carrying pagers?
Because flight nursing is a relatively new and challenging environment in which to practice nursing, recruitment isn’t necessary. Interested nurses and even nursing students who aspire to become transport nurses contact flight programs inquiring as to the prerequisites and a course of study. Turnover is relatively low, and there are plenty of interested candidates when positions arise. Flight nursing is an "above and beyond" type of job. Transport personnel must maintain seven certifications and attend a significant number of continuing education programs and advanced practice labs yearly. All of the additional course requirements are above and beyond the normal duty hours. Transport personnel are issued pagers, and they’re required to be on call at times.
OSF expanded its Life Flight Program to include the purchase of two helicopters. Describe the changes that have occurred that make it necessary for the additional helicopter.
Until July 2002, Life Flight was served with one leased helicopter, which was based at the hospital. Serving as backup to that helicopter was the continuing service of the State of Illinois Department of Transportation helicopter, which was based at the Peoria Regional Airport. Gov. George Ryan ceased the operation of the state- supported helicopter service in July 2002. Since Life Flight was utilizing the state-funded service for about 250 patient transports per year, we knew there would be a need to add an additional helicopter to maintain the current number of patient transport requests to OSF Saint Francis Medical Center. Plans were then made to purchase aircraft. By Sep-tember 2002, two hospital-owned helicopters were serving the north central Illinois region.
What’s the cost of transportation by helicopter? How does this compare with ambulance transports? Is it typically covered by insurance?
Patients are charged a flat lift-off fee and patient loaded mile fee. Helicopter transport costs are expensive, and costs are significantly higher than ambulance transports, but again, recall the primary reason for helicopter transport-it’s fast, with patients arriving at the destination facility in less than half the time it would take to transfer by ground ambulance. When asked this question, I frequently respond, "What’s the price for the saving of a life?" When you see better patient outcomes, with patients returning to their families and the workforce, it’s good. Life is precious and sacred. Whatever we can do to restore it to its God-given purpose is our mission and our passion. Yes, insurance providers cover costs for helicopter transports provided there was medical necessity.
Tell some of the statistics of Life Flight patients.
The last seven consecutive years have been record-breaking transport years for the Life Flight Program. Life Flight is the busiest helicopter operation in the State of Illinois and the only hospital-based flight program with more than one aircraft.
The number one killer of Americans today is heart disease, and this is reflected in our flight statistics as well. Approximately 38 percent of annual transports are patients with a cardiac diagnosis. Transports for children consume about 20 percent of our flights. Trauma is the number one killer of Americans under the age of 40, and about 16 percent of all transfers are of patients with a trauma diagnosis. Other obstetrical, medical, and neurological diagnoses make up the remaining numbers of patients transported by Life Flight.
Tell us about Life Flight’s upcoming 20th anniversary celebration.
Life Flight is planning a 20th anniversary celebration June 13 at the OSF Saint Francis Center for Health. We’re inviting patients and families of those transported by Life Flight through the years, as well as the general public. The aircraft will be on display, with a photographer taking pictures of families beside the helicopter. Our neonatal and maternal transport teams will be there, as well as the rest of our crew. And the highlight: There will be hourly drawings for free helicopter rides for three lucky people.
What else would you like our readers to know?
Life is good. Life is precious. Life is sacred. Life and health are blessings we often take for granted. Protect and value life at all costs, and make wise decisions regarding your health and your safety. I’ve seen firsthand broken bodies, torn flesh, and disfigurement from motor vehicle crashes. I’ve seen firsthand the pain, anguish, and overwhelming sense of hopelessness, despair, and loss on the faces of parents and families of loved ones who’ve experienced a health crisis. Unlike popular TV shows that portray good endings, not all patients who transfer by helicopter survive. We know that real life is much different. Your life is worth investing in, so make the best choices you can now to secure a healthy future. TPW