Peter Block Column
Views for a
Diary of a
Angels With Rotary
Quality Service in the Toughest Places
--Barb Serrano knows nothing
about quality and participation. But, if quality springs
from workers who love their work, feel autonomous and hold
themselves and their coworkers accountable for providing
outstanding service —then Barb Serrano knows
As the head, high-risk obstetrics nurse for the
Arizona-based AirEvac, Serrano’s 12-hour shifts are
always unpredictable. Serrano, a respiratory therapist and
a pilot must work together to bring their patients the
finest medical care, often under the worse possible
conditions in remote desert locations.
1969, AirEvac was formed in response to the need for rapid
transport of rural Arizona patients—it was the
nation’s first civilian hospital-based, 24-hour
medical air emergency transport service. AirEvac is one of
the fastest-growing air medical transport providers in the
country and is a wholly-owned subsidiary of Petroleum
Helicopters Inc.—the world’s largest commercial
helicopter provider. With over 250 employees in Arizona,
the company has managed to create a true espirit de corps
with open, honest and authentic communication. From a
careful and rigorous selection process, to monthly
“chart meetings,” the focus of all employees is
to continue to provide a high-level of service. The
rewards—jobs people love, respect from their peers
and saved lives.
--Five minutes into a
conversation with Serrano and one knows they are talking
with someone who loves what she does and does it well. News
for a Change Editor Bill Brewer recently had the privilege
of speaking with Serrano about her experiences with
AirEvac—the stress and success of the flight nurse
what one might call angels with wings.
NFC: What exactly does AirEvac do?
Serrano: Arizona has many remote areas. We have lots
of Indian reservations here and lots of open desert. In a
lot of those remote places there are very tiny hospitals
and clinics. Unfortunately lots of those people out there
are very high-risk patients when it comes obstetrics. We
fly to these outlying facilities when there is a patient
with a problem. Actually most of these places don’t
even do deliveries, so when there’s going to be a
delivery, we’ll fly out and actually do the delivery.
Then bring the patient, the mother and the baby back to
Phoenix with us.
NFC: You work on a team?
Serrano: I’m kind of the person in control.
There’s also a respiratory therapist and the pilot.
We don’t fly with doctors. In the state of Arizona,
the people that work for AirEvac practice under what is
called an extended scope. I can go out and do a delivery. I
can administer medication. I can decide what medication to
give, perform a minor medical procedure because I’m
practicing under an extended scope of my practice. The
pilots are not involved with the medical care. They try to
help us out when they can, but usually they are there just
to fly the aircraft.
NFC: Are you always with the same three
Serrano: No. No, it changes all the time.
NFC: Is that bad or good?
Serrano: It’s actually good. We have a very
specialized team. There aren’t a lot of us. For the
maternal team, there are five maternal nurses. We usually
work 12-hour shifts. I think there are probably about 10
different respiratory therapists we work with. So, we work
with a couple different people, but it’s not like
there’s a big, huge variety of them.
NFC: What’s the hardest thing about working on
Serrano: Well, I’d say the most difficult and
the most challenging thing is when a call comes in from one
of these outlying hospitals to our dispatcher. The incoming
caller will say, “We have this patient that has a
certain problem.” Then the dispatcher will relay that
message to a perinatalogist-a high risk obstetrician-that
is on call. They will then decide what’s going on
with the patient and if the teams needs to be sent. Then
they will call us back and say, “OK, launch the
maternal team to get this patient.” Then, when we
hear the sound—it’s like an alar—we are
launched for the flight and have seven minutes to be in the
air. The challenging part is, you never know what
you’re going for. You never know what kind of patient
you’re going for. You never know where you’re
going to go. You always have to be ready to think on your
NFC: Do you ever get frustrated with the people you
Serrano: No, not with the people I work with. We
work very well as a team. That is one of the key factors in
this job: You have to be a team player.
think something that is frustrating for me is the way they
practice medicine in many of these outlaying areas. I just
want to say, “What do you think you are doing out
here?” That kind of stuff is frustrating. However,
you never act that way. You might think those thoughts, but
you keep them to yourself. We just try to do the best with
what we have to work with. We stabilize our patients and
get them moved as quickly as we can.
NFC: So what do you do when things go wrong?
Serrano: Well, if you get into a situation where you
are in over your head, the first thing we do is what we
call “patch.” That’s where you call back
to the dispatch center and the perinatalogist and tell them
what’s going on; tell them you need a certain doctor.
Then theperinatalogist will call you and you can tell them
--They teach you to always
have a plan; try to have a plan so that when you call us,
you can tell us what your plan is and then we can work with
it. But yes, it has happened to me before where I’ve
gotten out to these remote little areas and something is
vastly wrong and I’ve had to reroute flights,
I’ve had to take people into other facilities for
NFC: Do you ever talk about how, as a team, you
could have done this better?
Serrano: We do. We have debriefing committees if
there’s a stressful flight. You can talk to somebody
or they will have group meetings that are actually
mandatory that you go to and talk about stressful
--Several years ago there was
a train derailment and all the helicopters for AirEvac were
dispatched to that scene. I also have all the certification
to do trauma patients. So I was one of the nurses on the
ground triaging patients and it was an all night
affair—running up and down a dry riverbed, pulling
people out of the train and trying to assess their injuries
in the dark. There were probably 20 helicopters flying in
and out. That was an overall stressful thing. Fortunately
there was only one fatality. After that we did have a big
debriefing meeting for everybody that was involved. It also
involved the FBI because it was under investigation by
--We’ve had massive car
accidents. People come over the border here illegally. They
will pile a bunch of people in a van and the van rolls over
and then there are moms and kids and everybody scattered
all over the place. That is very stressful for the crews
that handle those kinds of flights. Then they’ll have
debriefings for them.
NFC: Do you discuss how to improve your
Serrano: Yes. We have meetings every month, which
are mandatory for everybody. We call it chart review. We
pull a couple of flights and we discuss them all with the
medical directors who are there. We discuss how the flight
was handled, what was done, whether you did a good job and
what could you have done differently. Everybody’s
flights are picked apart. Lots of times it ends up with
applause because people did such a good job. Then, other
times, they will say, “Why did you give this much of
a drug when, maybe, you should have given this much of a
NFC: How do those meetings make people feel?
Serrano: It is constructive criticism. It is a
learning thing for everybody. I don’t think there are
hard feelings at all. The interview process and the hiring
process for AirEvac is very arduous. It seems like there
are only certain people who can get through it. If you can
get through it, you will be part of the team without any
problem at all.
NFC: If you are going to apply this to other
businesses or even hospitals, could you foresee problems
with how people work together in hospitals?
Serrano: Yes. I work part-time at a hospital too. I
am in a nursing pool. There are so many things that I see
happening in the hospital that I think, “Wow, I sure
wouldn’t want this to happen at AirEvac.”
Nobody is willing to help you out. It is not a real team
effort at all.
NFC: So, in a hospital, one of the differences is
that it is not as much a life and death situation?
Serrano: Not even that. It is just that,
“It’s not my patient. It is your patient. You
handle it.” Where at AirEvac it is everybody’s
patient. We all work together to have the best outcome that
NFC: What makes the selection so unique that you are
able to get 75 people that can work as an interchangeable
team, at any time, with everybody getting along and also
doing good work?
Serrano: Well, everyone must have a minimum of three
years of experience in their specialty field. I had to come
with a minimum of three years experience, not just working
in any old labor and delivery—in a high-risk
obstetrical unit. If you have the experience and can apply
it to the job, you are granted an interview. The interviews
are panel interviews, which I think are a little bit
intimidating. There are usually several medical directors,
several people that work for the company and usually a
couple of people that work in the same type of position you
are applying for. I remember my interview was in a
boardroom at one of the big long tables and at the end of
the table was my pad of paper, pencil and a glass of water.
Everyone else sat at the other end. The interview was
probably about an hour and a half long. The medical
director gave me all kinds of scenarios and situations. He
wanted to know what I would do. He portrayed the part of a
doctor who was not happy. He portrayed the part of a
patient who was having a baby and screaming at me,
“What am I going to do?” They wanted to see how
I reacted and how I thought.
--Once the interview is over,
you get to sit down and take a written test. The written
test is very difficult. If you pass and they decide to hire
you, you have three months of training. Six weeks is
didactic—classroom—you learn to do your job all
over again, along with extra training that you will be
expected to do. We go to the operating rooms in the big
hospitals. We work right with the doctors. We do
deliveries. We do all of those things to get this
experience, and then we start flying. We fly for about six
weeks with someone else. After three months, they conduct
oral boards. It is basically your interview all over again.
This time you better have all the right answers and say the
right stuff—if you do it all right, you get your
wings and you can fly.
NFC: What is the best part of your job?
Serrano: I would say that the best part of my job is
the autonomy that we have and the respect that we
get—the respect from everybody. When we go into a
facility that has called us to do a transport, they are so
glad to see us. We walk in and people think, “Oh, we
can relax. AirEvac is here.” It is kind of like a
hero thing. We get great respect. My nursing job that I
work at—a labor and delivery here in the
valley—it is a high-risk obstetrical place. I fly
patients in there when I’m flying. When I am working
it seems like they’ll say, “This is a very sick
patient. We can give this patient to Serrano because she is
a flight nurse for AirEvac. She can do
NFC: Then the other thing you said was
Serrano: Autonomy because we are really extensions
of the doctors’ hands. Since we don’t fly with
doctors, we are basically the doctors when we are doing a
transport. That is why they are very picky about who they
hire. I think it is a great honor to be selected to work
for the company when that is how it works.
NFC: Why can’t this be created in other health
Serrano: I don’t know. I think that there are
a lot of people in health care that still just go to work,
try to do as little as they can and take as many breaks as
possible, get paid and go home. I think if everyone had the
attitude that people at AirEvac have, health care would be
NFC: Would you agree that attitude is created by the
Serrano: Right—attitude is created by the
environment. Plus, I think you have to really like what you
do. I am somebody who loves what I do.
NFC: Even the 12-hour shifts?
Serrano: Even the 12-hour shifts; sometimes we even
work 24-hour shifts. You can work a 24-hour shift when the
person who is going to relieve you gets sick and you have
to stay. You say, “Well, OK, I’ll take a shower
and maybe someone can bring me some clean underwear.”
Otherwise, you just do it—it is just part of a job
and we don’t mind it at all.
NFC: Do you think you are ever going to get tired of
Serrano: Oh yes. I don’t know if I will ever
get tired of it. I actually work with a guy who has been
flying with AirEvac since the company started in 1969. He
is a neonatal flight nurse. He said, “You never get
tired of it, but your body is going to get tired of
it.” Flying is a big stressor—the noise, the
vibration and the heat here in the summertime—it can
really take a toll on you. I think that jumping in and out
of airplanes and helicopters is something that you
can’t do when you are 60 years old. I’m 40. I
love it now and I am sure that I will love it for another
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