Helicopter paramedic nurse Jacqueline Zbären – providing emergency care in inhospitable terrain

“Most of my missions stand out in some way or another due to the nature of helicopter operations. They often entail emergencies either on a mountain or in inaccessible terrain, or otherwise involve serious patterned injuries or time-critical medical conditions,” explains Jacqueline Zbären, a helicopter paramedic nurse working in the Bernese Highlands in Switzerland.

“Something that has made quite the impression on me is that major accidents can occur in the most unremarkable day-to-day activities, like biking or getting groceries, or else during a simple day trip in the mountains. Healthy individuals of any age can suddenly develop life-threatening diseases, like pulmonary embolisms and heart attacks, or trip and sustain major injuries,” adds the 37-year-old, who works at one of the 12 helicopter bases of Swiss Air-Rescue (Rega) distributed across the country.

“Having witnessed how someone’s life can change abruptly has increased my awareness of my own health and well-being.”

Time is of the essence

“The team in the helicopter is made up of a pilot, a doctor and a paramedic nurse, and the operations centre we’re in touch with over radio. When we receive the emergency notification, when the weather permits take-off, we have as little as 5 minutes to be ready to be airborne. During winter and summer tourist seasons, the base I work at is open 24/7 and shifts can last 24 or 48 hours.

“In primary missions, which are almost 90% of the operations of our helicopter base, we rescue or deliver the first medical assistance on the scene of an accident, while secondary missions involve relocating a patient from one health-care facility to another. In all our operations, the decisive factor is time.

“I’ve always known I wanted to work in the medical field, and I chose the nursing profession because it offered a wide variety of specialization options. The emergency setting fascinated me, which is why I specialized in anaesthesia after my 4-year nursing degree and then proceeded to a 2-year training to become a paramedic nurse. After working for 8 years in paramedicine, I switched to helicopter rescue operations about a year ago, after completing a Helicopter Emergency Medical Services Technical Crew member training.

“The biggest difference from working in a hospital is that in many hospital settings, you have several patients for whom you are responsible. As a paramedic nurse, you have only 1 or 2 to focus on, and while the care is limited in time, it is very intense.”

Managing the unpredictable

“The most defining elements of my work are its unpredictability and the diversity of my tasks. We can be requested to fly to the scene of a car accident, to rescue someone injured in the mountains or to transfer critical-care patients.

“I can be discussing expected medical needs with the emergency physician en route, but then the situation on the ground turns out to be entirely different. Or else, in rare cases, I am required to leave the doctor at a scene while the pilot and I must leave for another mission where I have full autonomy.

“In flight, I oversee medical, technical and operational tasks. I care for the patient’s well-being in close dialogue with the doctor, assist the pilot by operating the navigation devices and radio, and handle the hoist to lower down the doctor or a helicopter rescue specialist from the Swiss Alpine Club when we cannot land.

“I have to slip in and out of various roles and mindsets – I may be thinking of the medical equipment needed upon landing, then help the pilot reach our destination, and moments later think strategically about how best to transport the patient to the helicopter.

“We undergo continuous training to hone our medical, technical and operational skills and, above all, to be prepared for every eventuality.”