In 2015, after years of preparation, I landed the job of my dreams working as rotor-wing flight paramedic. During my time practicing critical care medicine flying over mountains and deserts, I have never once had a day where I felt as if I “was going to work”. The career of a flight paramedic is one many dream of, and for good reason. There have been a few times in life where I have felt more stretched and more rewarded than when flying. The way one steps into this career, however, is not straightforward.

There are a few basic requirements one must meet before being eligible to apply for most flight jobs. The Commission on Accreditation of Medical Transport Systems (CAMTS) has set the requirement that any medical provider must have a minimum of three years experience prior to being hired by an accredited agency. Many of the best and safest flight agencies in America are accredited by CAMTS, although companies are able to operate without this accreditation. It is also required that licensure is held in the state or states in which one will be based, or at least meet qualifications to become licensed. Finally, some require that critical care certification is held prior to being hired or be attained within a certain time period.

After applying, the first step in the interview process is usually an invitation to test. During testing, candidates generally go through a rigorous process of examination. The process I went through involved a written test and an oral board. Though I can only speak to this test, I assume most other exams are incredibly difficult as well. Questions were far beyond the scope of the NREMT exam, encompassing advanced pre-hospital medicine, pathophysiology, lab values, ventilator settings, and ICU level knowledge. The hiring exam for my company was the same for both nurses and medics, though the passing score for medics was 10% lower than that set for nurses. A unique characteristic about this exam is that it consisted of a variety of multiple choice, fill in the blank, and short essays, so scoring to some extent was subjective.

Those who scored high enough on the written were invited back for an oral board interview. The panel was made up of company managers as well as active flight crew members. Many of the initial questions were basic interview material: 

  • Tell us about yourself.
  • Why do you want to be a flight paramedic?
  • What have you done to prepare for this position?
  • How do you deal with stress?
  • How does your wife and family feel about you flying?

Questions then transitioned to medical scenarios similar to this:

  • You are treating a septic patient with the following vital signs: BP 80/40, HR 115, SpO2 92%, and RR 30. Despite 2 liters of fluid, the patient remains hypotensive. What is your vasopressor of choice and why?
  • You are in a rural area about 90 miles from the nearest hospital. You have been called for a 36-year-old in preterm labor. There are no additional resources besides your partner. How will you treat this patient? 
  • The same patient then delivers and the infant has an APGAR of 4, is cyanotic, and not breathing. The mother also has extensive vaginal bleeding. How will you care for both patients?
  • You are treating a 45-year-old male with chest pain. This is his 12-lead, what is your interpretation and how would you manage this patient?

My preparation for this interview process started years prior. I began studying up on paramedic basics, went to one of the local hospitals and became certified in Neonatal Resuscitation alongside the NICU and PICU nurses, was promoted to Field Training Officer and took on interns. I even met a flight medic who worked for the company I was trying to get on with and pestered him to teach me how to use their ventilators. I talked with one of the company managers and asked what material I should be studying. He directed me to the Air and Surface Transport Nurses Association’s (ASTNA) Patient Transport Principles and Practice textbook. I purchased the book, read the chapters I did not feel comfortable in, and then built study guides off of them. In all, I estimate I spent hundreds of hours directly preparing to test and interview.

Through my preparation, I came across a couple unexpected coincidences. The program coordinator of NRP was surprised and impressed a paramedic had taken the time to seek certification and mentioned this to a friend of hers who happened to be the CQI coordinator at the flight agency. Also, I realized that one of the members on the interview panel had written a chapter in the ASTNA book and we were able to discuss this during the interview. In my opinion, anyone seeking employment in air medical transport should learn all they can about the company they want to work for, study, then study some more. Doing so not only provides the knowledge for testing, but I suspect a few strokes of luck might arise as well.

Gaining employment is only the first step in working as a flight paramedic. From there most agencies will have weeks to months of orientation. Mine started out with a three-week academy where we went over everything from helicopter operations to cardiac emergencies to wilderness survival while also doing clinical rotations in an emergency department and various ICUs. After this came a couple months of probation where I ran every call and wrote every chart. During this time we went through regular testing which culminated in high-fidelity scenarios with our medical director.

Though the process is long and trying, the reward of caring for your first patient in the air is incredible. There is one final piece of advice, the most important, I would like to leave with you. Before you even open the first page of your textbook, take time to sit down with your family, spouse, or significant other and lay out what the journey is before you both. Every flight has some level of calculated risk. Every moment you spend in class is time away. To gain any satisfaction through career aspirations, those closest need to be in full support. 

Best of luck. 

Ariel Wai, EMT-P, FP-C