We are the gap

Lifetime docudrama Life Flight is a mixed message for nursing

The March 2015 docudrama Life Flight: Trauma Center Houston has helpful information about what nurses do for patients, although it spends a lot of time on the nurses’ personal lives and general thoughts

March 2015 – This month the U.S. cable channel Lifetime aired a 6-episode “docudrama” called Life Flight:  Trauma Center Houston. The show focused on those who treat trauma victims for Memorial Hermann Hospital, especially on the regional helicopter rescue service Life Flight, which is staffed by nurses and paramedics. Most episodes spend time with a diverse group of flight nurses and paramedics, and we get a sense of how important their work is. We see them saving lives, and they do at times display technical knowledge and expertise. The show resembles the series by Terence Wrong that have aired on ABC over the past 15 years, most recently NY Med, Boston Med, and Hopkins, but it is better for nursing in that nurses, particularly flight nurses, receive more attention as serious professionals playing a life-saving role in care. And they have somewhat more opportunity to explain what they do. Unfortunately, many segments do tend to place an inordinate emphasis on the nurses’ personal lives and how their work affects them, as opposed to the more technical clinical information that we see physicians provide. For example, in the first episode aired on March 2, a burn unit charge nurse is able to display health knowledge in describing the care she provides to an electrocuted patient. But there is a big focus on the fact that her husband is also a burn unit charge nurse and how they manage their relationship. This kind of thing does not really demonstrate that nurses are highly educated health professionals. And the show is not great for hospital nurses. Once patients arrive at Memorial Hermann, in almost every case trauma surgeons receive the show’s attention and they narrate the course of care. Thus, although the nurses profiled generally appear to be engaging, articulate professionals doing vital work, to some extent the show represents a missed opportunity. Nonetheless, we thank Lifetime and the show’s executive producers Timothy Scott Bogart, Gary A. Randall, and Brad Bogart.

Burns

Smart dude

Thinking dynamically

Burns

The Life Flight docudrama is really a series of short portraits of specific health staffers as they handle particular patients. Most of these portraits start in the field and follow the patient back to Memorial Hermann, where surgeons get most of the attention.

One exception to that surgical focus occurs in the first episode, in which burn unit charge nurse Ashley Hubbard cares for a man who was electrocuted and badly burned, putting his leg is at risk. We see her efforts to find a bed for the patient. She also describes some of what the burn unit will do, “assessing his foot constantly” and doing a “two-hour dressing change.” He’ll be on a ventilator, and they will constantly monitor pulses in his leg, his heart, his vital signs, and his urine output. Ashley is married to another burn unit charge nurse, Jesse Cannizzo. Much of her time onscreen is devoted to how they share dinners in between shifts, talk about wound care and escharotomies while eating, cope with their schedules, and so on. That may be of some interest, but unfortunately it does little to improve viewers’ awareness of nursing skill and authority.

Later, Hubbard describes the staff’s efforts over some days to keep the patient balanced on fluids; he is also spiking fevers. They lose pulses to his foot, and so he must return to the OR, where surgeons amputate. The patient spends two months in an induced coma but does recover, with a new prosthetic leg. Overall, the surgeons do a lot more explaining of the patient’s care than Hubbard does, although she does at least note that “we” saved his life. 

Smart dude

Among nurses, flight nurses get virtually all of the show’s attention. In the first episode, flight nurse Tony Herrera and his paramedic partner (and of course a pilot) pick up and care for a very badly injured hit-and-run victim. Herrera reports some technical aspects of their observations and efforts for this patient, including that the patient was already intubated and diaphoretic. They also care for another patient who is involved in a bad car crash but seems to have a better outcome. CPR is in progress when they arrive on their “helo” to get this patient. They continue CPR en route to the hospital, and finally they get a pulse back. Later, a trauma surgeon at the hospital says he is amazed what they can do flying around above the city. The surgeon tells them “good job,” which means a lot to Tony’s paramedic partner, because according to him, trauma surgeons are “the big guys.” That scene is very unhelpful because it’s not just saying surgeons have more power; it’s saying they and their opinions matter more than other health professionals. That is incorrect. On the other hand, the paramedic also praises his partner Tony as a “smart dude.” 

The second episode, filmed at least partly on Cinco de Mayo, shows the work of several flight nurses. Flight nurse Kelly Bircher is part of a team that goes to a rural area to help a 7-year-old boy who has a partly severed left foot, the result of a garage door accident. She narrates and we see her intubating the boy, reporting vital signs and specifics about his condition to those back at the hospital, and providing pretty good psychosocial care, talking to the boy. Bircher also explains the value of the helicopter for a remote area victim like this who might otherwise bleed out. She admits that on her job she sees some bad things, but she also has a direct impact in that if she had not acted, a patient would have died; she delivers this information without really boasting. (Sadly, Kelly Bircher has since died.)

Another flight nurse who appears in several episodes is Sam “Catfish” Miller. In the first episode, we see Miller at the Life Flight base, frustrated because the crew is not getting any calls. The producers also choose to show him chatting amiably and at some length about his own positive qualities and his general outlook on things. He repeatedly states that he doesn’t see himself as “a hero.” Other episodes focus on Miller’s struggle to qualify for the Life Flight program’s minimum weight and his reluctance to join his colleagues on a sky diving adventure (he eventually does). In the fourth episode, Miller provides some health care, helping a motor vehicle accident victim. He explains:

Catfish: Life Flight’s biggest contribution to this patient is simply getting him back to the hospital in a very short amount of time. In addition to that, we are the gap between the emergency room and the scene, we’re the ones that gather all the information and take it to the doctors and give them a visual vision of what happened.

That’s pretty good, except for Miller’s suggestion that only the physicians need the information, as if his nursing colleagues at the hospital don’t (1) also need the information and (2) make just as big a contribution to care as the physicians do. But he speaks fairly well about the patient’s injuries, which include lacerations and deep bruises.

In the sixth episode, flight nurse Rick Liang is shown bringing a pediatric patient back to the hospital. He describes the boy’s status in technical terms, discussing “positive end-tidal,” “waveforms,” lows SATs, and bradying. We also see him placing a breathing tube and bagging the patient. Once they get to the hospital, though, only the physicians seem to matter. The flight crew does stay to provide information and answer questions, like when CPR started.

Thinking dynamically

One segment in the third episode involves flight nurse Denise Davis and her partner, flight paramedic Aaron Young. Their patient has been thrown from his motorcycle in a crash. Davis says the main thing they are looking for is “what injury’s gonna kill ya first.” After they quickly get him into the helicopter, Young provides most of the narration. They try to raise the patient’s blood pressure. At the hospital, one of the ED physicians appears to thinks the leg will need to be amputated—and that the flight medics should have put a tourniquet on the injured leg. 

Davis: So according to our protocols and according to our guidelines and according to what’s right for the patient, we should not have put a tourniquet on there, it wouldn’t have made a difference in his outcome.

Young: We looked at the leg, made an assessment, it was not actively bleeding, it did not require a tourniquet. It’s a yucky-lookin’ leg, but it’s not actively bleeding. I don’t know what [the ED physician’s] thinking is.

The patient goes to surgery, but the leg can’t be saved. The patient loses his leg from above the knee, which reduces function. 

Later, Davis and Young must do a “flight review” in front of all of the flight crews about whether they should have put a tourniquet on this patient. This seems to be like a morbidity and mortality conference. The review will involve the demanding Dr. “Red” Duke, founder of Life Flight. At the review, Aaron notes that “trauma services” thought they should have applied a tourniquet. But both flight crew members note that they saw no bleeding, nor did EMS before them. They did give the patient blood, though, and Duke points out that that’s when the patient blew a clot. The idea seems to be they should have anticipated there would be bleeding requiring a tourniquet after they gave the patient blood. Duke says it’s important to think dynamically; if I do this, what will happen? This seems like a judgment call, and there is room for interpretation of the scenes we see, but they will likely suggest to viewers that physicians know more about trauma care than nurses do. However, it seems likely that senior trauma nurses would have had a perspective comparable to Duke’s on these issues, with a focus on critical thinking rather than simply following protocols. Apparently the patient did ultimately get a prosthetic leg and, with much physical therapy, will be able to walk again.

The last episode has a portrait of an aspiring Life Flight nurse. Kara Kelly is an emergency nurse at Memorial Hermann, but she has evidently been getting some ICU experience and a paramedic’s license, looking to join Life Flight. Catfish Miller warns Kelly that flight nursing will be hot, with missing equipment, and there will be only one other nurse there to help her. But she says bring it on, which he finds “feisty.” Later she consults Tom Flanagan, the executive leader of Life Flight—and himself a former flight nurse, although the show does not make that clear, which it really should have, so the public can see that nurses can be health care leaders. Flanagan emphasizes the risks of the work. But Kelly seems determined.

On the whole, this docudrama is considerably more helpful than Terence Wrong’s work because nurses are often at the center of the story and they are able to show some life-saving expertise. There are some unfortunate elements, including the precious time consumed by personal issues that don’t convey much about nursing, as well as the occasional suggestion that physicians are the ultimate authority. But we thank the creators for highlighting this important part of nursing.