In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Jeanne Yeatman, MBA, BSN, CEN, EMT.
This profile was published in the December, 2011 issue of HealthLeaders magazine.
"If [paramedics] know what happens in the helicopter, they can better prepare the next patient."
Coping with the emotional connection to patients is one of the biggest challenges nurses who work at Vanderbilt LifeFlight and similar air-medical programs face nationwide, says Vanderbilt LifeFlight Program Director Jeanne Yeatman, MBA, BSN, CEN, EMT.
"You are invited into people's lives at their worst moments, so you become emotionally connected to the patients that you serve," she explains. "When you see someone with burns over 90% of their body who is talking with you and you know that you are the last person they will talk to, there is no training for that—no book on what to say. That emotional wear and tear is difficult."
MedEvac helicopters are most often used to transport patients who are gravely injured from severe trauma or suffering from time-sensitive illnesses such as heart attacks and strokes. Each year, MedEvac helicopters transport approximately 400,000 patients and MedEvac planes transport roughly 100,000 patients over longer distances, according to the Association of Air Medical Services. Roughly 46.7 million Americans live more than one hour away from a Level 1 or 2 trauma center.
As a young child, Yeatman's interest in emergency medicine was piqued after she witnessed an air-medical transport when a neighborhood child was injured. After graduating nursing school in 1989, she secured a position working at Vanderbilt Medical Center's emergency department in Nashville, where she witnessed LifeFlight nurses in action. "I got to see some of the amazing things that they got to do," she says. "So, LifeFlight, for me, was a natural progression of my career."
Flight nurses take care of a spectrum of patients, so there is a lot of extra certifications and continuing medical education that all of the flight crews have to acquire, says Yeatman. For example, the minimum requirements to be a Vanderbilt LifeFlight nurse include: three years of ED/critical care experience, more than 640 hours of pediatric experience, emergency medical technician certification, and either certified critical care nurse, certification in emergency nursing, or certified flight registered nurse training, among other requirements.
Yet one area that flight nurses usually aren't trained on is compassion fatigue, says Yeatman.
"In the beginning, no one had that conversation with me and said 'when you go home and lash out at your family, it might be related to the job,'" explains Yeatman, who started her career as a flight nurse in 1993. "It is something that people don't like to talk about," she says, adding that the people who gravitate toward this profession have take-charge personalities.
They believe they can manage anything. But there needs to be more self awareness in the industry regarding compassion fatigue, she says. "Each person is impacted in a different way and it changes depending on where you are in life."
To help her staff of more than 150 professionals who average more than 3,000 trips annually cope with the daily rigors of the job, Yeatman has tried to build a level of self awareness about the acuity of patients that LifeFlight transports. For example, when a flight crew has performed CPR or there has been a patient death, Yeatman has found chaplain Ray Nell Dyer, MDiv, BCC, from Vanderbilt Children's Hospital who is willing to volunteer her time and reach out to that crew and offer emotional support.
Yeatman is also developing programs at LifeFlight to help improve care coordination among flight crews, paramedics, and ED staff. Vanderbilt LifeFlight is one of the largest academic medical center-based transport programs in the country; it covers an area within an approximately 130-mile radius of Nashville, has a greater than $10 million annual budget, and five helicopters, one airplane, and three transport ambulances.
About one year ago, Vanderbilt LifeFlight launched its iFly program, which strives to help paramedics and ED physicians and nurses learn more about care delivery during the "golden hour in trauma," Yeatman says. For example, the program enables a paramedic to go right from the scene of accident with the flight crew to the hospital. "They can watch the entire resuscitation and we take them into the ED," she says.
It allows them to see the full spectrum of care. Similarly, an ED nurse who has been taking care of a sick child, for instance, can accompany that child as LifeFlight transports the patient to a different hospital and the nurse can follow the care progression.
Often healthcare workers get focused solely on the type of care that they deliver and this program aims to remove that silo impact, says Yeatman. "If [paramedics] know what happens in the helicopter, they can better prepare the next patient," she explains. "They now understand better this is what they do in the helicopter, and this is why they do these things."
The goal is, ultimately, to take better care of patients by improving how paramedics, flight nurses, and ED physicians and nurses work together. "We are all part of the healthcare delivery team," Yeatman says, adding that many healthcare professionals, herself included, are experiential learners who learn best when they can get in there, see it, and visualize it.
Currently, there are two EDs and five counties involved in the iFly program. About 100 people have enrolled and 24 people have actually gone on a flight. Paramedics and clinicians do need safety training to go up in the air, which takes about an hour to complete, Yeatman says.
Some of the lessons participants have taken away from the program are simple things—procedures that paramedics can do on the ground to help speed care along, such as removing unnecessary clothing.
Another example is following sepsis protocols and administering early antibiotics or ensuring that treatment protocols for the STEMI (ST segment elevation myocardial infarction) program are adhered to so heart attack patients can get to the cath lab sooner, Yeatman explains. "The helicopter crew is very checklist oriented," she says. "If you get to step two before doing step one, then you have to go back and you may not get to step three."
One of the great things about the iFly program, Yeatman says, is it showcases how trauma care is delivered. In the room every person has a place to stand and a role in care delivery. "It is like a large symphony," she says. "What the program really allows is that individual to step inside the symphony and see how it works because everything is done in an organized fashion."
This article appears in the December 2011 issue of HealthLeaders magazine.
Carrie Vaughan is a senior editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
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