Critical Care in the Air - Frances Payne Bolton School of Nursing ...

MSN student Stephanie Steiner and Jonathan Sague, MSN ’06, prepare to pick up a patient.
14 The Frances Payne Bolton School of Nursing Case Western Reserve University

Critical
Care
Jonathan Sague, MSN ’06, remembers the adrenaline rush
he felt the first time he shadowed a helicopter transport
team during nursing school. “It was fun. When a call
came in, I’d get excited and think, ‘We’re going to go
help people,’” he said. These days, Mr. Sague, one of
the first graduates of FPB’s Acute Care Nurse Practitioner
(ACNP)/ Flight Nursing Subspecialty, leads critical care
transport teams for the Cleveland Clinic’s Emergency
Services and Critical Care Department. “It’s not all fun
anymore. It’s an enormous responsibility,” he said. “But I
was well prepared to take care of patients in all kinds of
unstructured environments in which conditions are not ideal.”
theAir in
FPB’S UNIQUE SUBSPECIALTY PROGRAM PREPARES
ACNPs TO LEAD ACUTE CARE TRANSPORT TEAMS
by Tim Tibbitts
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W
16 The Frances Payne Bolton School of Nursing Case Western Reserve University
When a call comes in, Mr. Sague and the nurse and paramedic on his team board their
helicopter and head out. A typical run takes the team to a local hospital in Northeast
Ohio to transport a patient to the Cleveland Clinic for care. They also fly to the scene
of emergencies as needed.
When the transport team arrives at the referring hospital, Mr. Sague receives a face-to-face
report from the referring physician and assumes responsibility for the care of the patient.
Throughout the flight, Mr. Sague monitors the patient, diagnoses changes in health status,
and prescribes medications and other interventions as needed. In the traditional flight
transport model, the referring hospital maintains responsibility for the patient until he or
she reaches the next hospital. On the other hand, Mr. Sague’s training as an ACNP
authorizes him to treat the patient from the moment of pick-up, closing a critical gap in
the continuity of care during the “golden hour”—the time in which an individual in a
serious accident could live or die based on whether or not he or she receives immediate
critical care. It was the desire to close this gap and empower nurses to provide full
diagnostic treatment to patients during transport that led to the creation at FPB of
the first-ever advanced-practice flight nursing program in the country.

“A staff nurse can maintain a pre-prescribed level of care, but with the nurse practitioner
model, you have a nurse providing ongoing diagnostic surveillance and adjusting the therapy
according to the response,” explained Chris Manacci, MSN ’03, ACNP, CFRN, director of the
subspecialty program at FPB and an acute care nurse practitioner in the Emergency Services
and Critical Care Department at Cleveland Clinic. “We’re eliminating prescription by proxy,
which is crucial because you can’t delegate judgment.”
The subspecialty program began as a concept analysis paper Mr. Manacci wrote for a class at
FPB, when he was a student in the MSN program. Mr. Manacci, who worked for seventeen
years as a flight nurse before deciding to pursue his ACNP at FPB, envisioned a program
designed to teach ACNPs to operate where they can’t control the variables—such as light,
sound, vibration, weather, and crowds. “With advice and support from my mentor and advisor
Professor John Clochesy, I took my idea to Dean Wykle, and she said, ‘Go for it.’”
In October 2002, FPB and MetroHealth Medical Center of Cleveland established the National
Flight Nurse Academy and the Flight Nursing Subspecialty with funding from the U.S.
Department of Health and Human Services. Since its inception, the program has received
additional funding from The Elisabeth Severance Prentiss Foundation, Parker-Hannifin
Foundation, and The Payne Fund; however, more funding is necessary to ensure the program’s
continued benefits to students and patients.
(Continued on page 18)
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Jonathon Sague and the critical care transport team assume responsibility for a patient.
18 The Frances Payne Bolton School of Nursing Case Western Reserve University
Due to increased need, the academy and the subspecialty program are expanding. In
2006, Cleveland Clinic Critical Care Transport joined the National Flight Nurse Academy
as a clinical affiliate. Mr. Manacci is directing the Cleveland Clinic’s new Critical Care
Transport Program, which will have a world-wide impact, and FPB flight nursing students
are now able to complete their internships at the Cleveland Clinic as well as at
MetroHealth Medical Center.
“The Critical Care Transport Program at Cleveland Clinic is essential to our community
and surrounding areas. We are able to provide care to patients that may not have gotten
the same level of care before the inception of this program. Our relationship with FPB has
enabled us to attract the absolute best nurses to provide care for better patient outcomes.
Without that collaboration, we would not have been able to move this program to the
advanced level so quickly,” said Claire M. Young, MSN, MBA, RN, chief nursing officer

at Cleveland Clinic. “This demonstrates that the future of excellent patient care is rooted
in collaborated efforts between academia and clinical sites. Dean Wykle was visionary
enough to see that this could work, and the results will continue to speak for themselves.”
“ We’re elevating the level of
service by elevating the
level of the provider.
”
The subspecialty is open to anyone pursuing an ACNP at FPB; it requires three additional
courses beyond the MSN curriculum, as well as a 600-hour internship in critical care
flight nursing.
In addition, registered nurses interested in pursuing an advanced practice nursing degree
can sign up for the program’s annual summer camp, a week-long, hands-on, interdisciplinary
training opportunity. This summer’s camp, featuring topics ranging from helicopter safety
and transporting infectious disease patients to landing zone preparation and working in
wilderness and remote areas, will be held in August 2008.
FPB’s is the only subspecialty program in the nation to train ACNPs to lead critical care
transport teams. Soon, however, it will not be the only such program in the world. In
December 2007, Case Western Reserve University and Aichi Medical University College
of Nursing in Japan signed a memorandum of understanding to begin replicating FPB’s
cutting-edge program in Japan, in a flight nursing program that will include Case Western
Reserve University’s name in its title.
Chris Manacci believes the impact of this program goes well beyond the goal of improved
patient care. “We’re transforming an entire culture by taking flight nursing from a staff
nurse level to a nurse practitioner level,” he said. “The purpose of this program is to provide
a level of service in this industry that hasn’t existed until now. We’re elevating the level of
service by elevating the level of the provider.”
The program and the work it prepares graduates to do are satisfying on a personal level as
well. “It’s a real privilege to care for vulnerable people at the time of their greatest need,”
Mr. Manacci said. Jonathan Sague agrees. “Being able to go out and apply the things I’ve
learned as a nurse practitioner—being armed with this new knowledge—is very satisfying,”
he said. “When you’re passionate about something, it’s not just a job. I’m very lucky to
wake up for work each day and look forward to the day ahead.”
The critical care transport team works in
tight quarters.
Jonathon Sague confers with Christopher Manacci
after the patient has been delivered.
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