Sky-high learning: Nursing students join elite pediatric transport crew
- Two ECU nursing students became the first undergraduate externs on the ECU Health Maynard Children’s Hospital Transport Team, caring for critically ill children during air and ground transports.
- The ECU-ECU Health nurse extern program gives nursing students hands-on experience in pediatric critical care and emergency transport.
- The experience prepared students for careers in pediatric critical care nursing while expanding healthcare training opportunities in eastern North Carolina.
This summer, two East Carolina University undergraduate nursing students elevated their education. Literally.
Samantha Williams (right) was one of the first two undergraduate nursing students selected to be part of air and ground ambulances with ECU Health Medical Center’s nurse extern program.
December graduate Samantha Williams and May grad Bailey Blalock were the first two Pirate undergraduates selected to be members of the ECU Health Maynard Children’s Hospital Transport Team, moving very sick kids to Greenville from across eastern North Carolina in ambulances — both on the ground and in the air.
In 2023, the College of Nursing partnered with ECU Health to broaden, and deepen, relationships to educate entry-to-practice nurses and continue the educational careers of nurses already at the bedside. Part of the partnership was the establishment of a nurse extern program, which got ECU nursing students qualified to perform basic nursing skills in clinical settings so they could get hands-on experience in their future profession and refine their post-graduation plans.
We sat down with Samantha and Bailey to learn more about the excitement and learning opportunities their summer jobs offered.
East Carolina University: Tell me about the program.
Williams: We were the first externs to be placed with the Children’s Transport Team, which transports both pediatric and neonatal patients mostly from outside facilities to our pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), peds (pediatric) floor, children’s ED (emergency department) — any of the pediatric units at ECU Health. We do that by air and by ground.
ECU: Did you ride together or were you on separate vehicles?
Williams: The helicopter can only hold so much weight, so we were never on the same shift because we always have two nurses or a nurse and a respiratory therapist on board. Adding two externs would be way too much. At the start, I was on day shift and Bailey was on night shift, and then we switched.
ECU: When they came to you and said, ‘I know you think you’re just going to be at the bedside, but …’ What did you think?
Williams: When I interviewed for the extern program I mentioned the PICU and the NICU because I wanted the pediatric population, but I also wanted the ICU and critical care aspect. They called me a few weeks later telling me, ‘Oh, you got children’s transport.’ I didn’t even know what it was. I was kind of upset and then I did a little bit of research and thought, ‘This is going to be a great experience.’
Blalock: When I first found out I googled it and obviously the helicopter comes up first. I thought the wording was wrong, like they have definitely gotten something wrong. I really didn’t believe it until I actually got there.
ECU: Did you have to have any extra training? Had you been on a helicopter before?
Blalock: I hadn’t been on a helicopter before. We both had to do helicopter safety training. We had like a checklist to go through with the flight crew to make sure we knew the safety procedures and things like that. But other than that, that’s all the extra training I got. I don’t know about you, Sam.
Williams: Same thing. I had a two-hour lecture with the pilot that went through things specific to the helicopter. And then a checklist of safety protocols such as where the emergency kit is located.
Samantha Williams shows a Pirate hook in front of one of the helicopters she rode during her nurse extern rotation with ECU Health.
CON: Did you do procedures, or just monitor and help the flight nurses out?
Williams: We had to get our Nurse Aide II certification. We have to follow like the nurse aide scope of practice. The most I’ve been able to like help with is unloading the stretcher and gathering all the supplies needed for each patient. When we get in the room, set up the patient on the monitor, like attach the EKG leads, blood pressure cuff — stuff like that. And the nurses have also taught me how to use like their IV pumps that are specific to the helicopter because it’s a whole different setup in there. Also, I learned how to set up the high flow oxygen equipment for the first time, so that was pretty cool.
Blalock: We had more autonomy when we were on the ground as opposed to either in the ambulance or on the helicopter. Those two places we weren’t allowed to touch the patient, really. But when we were in a hospital, whether that be Carteret or ECU Health, we were able to do those kinds of things.
ECU: Riding the ambulance has its moments too, right? Things moving and jostling around?
Blalock: The ambulance is geared toward the exact population they’re getting and patients who were in one facility and transferring to another.
Williams: Watching the nurses that we follow, it’s amazing how they can place an IV in a little, premature baby in a moving ambulance on the highway.
Blalock: It’s incredibly different than a floor nurse. They (transport nurses) have so much autonomy when they are transporting patients that regular floor nurses would not have. It was interesting to see them do things that I have never seen a nurse do.
Williams: There’s no doctor, there’s no nurse practitioner most of the time there to make orders, so it’s really these nurses making the calls based on their clinical judgment.
ECU: What did you learn in the classroom that you brought to this experience? Skills you wondered if you’d ever use and then you got there and were really glad to know?
Blalock: My last semester went heavy on diabetic ketoacidosis (a life-threatening complication of diabetes) which was very prevalent, especially this time of year in the pediatric population. Kids who didn’t know they have diabetes, but they go to the beach or the lake for the summer, and manage it poorly while on vacation. It gets really bad, of course, and they end up needing to be transported to ECU Health Medical Center. So, my knowledge about DKA came in handy because I saw it so much and knowing exactly what the nurses were doing and being able to connect those dots in my head was very good for me.
Williams: I saw a lot of DKA patients over these few weeks. Another experience I had during my externship was transporting a pediatric patient with a midline shift from a subdural hematoma. This past semester in med-surg, we talked a lot about different types of hematomas, how they can cause increased intracranial pressure, how they lead to brain shift and herniation, and how to monitor neuro status.
We picked the patient up from an outside emergency department and transported him by air back to our facility. During transport, we were constantly monitoring his neurological status and watching closely for signs of increased intracranial pressure. He started to decompensate, which was concerning and showed just how quickly these patients can change.
He remained stable for the remainder of the flight, shortly after arriving to the children’s ED, he needed immediate attention. It was a great reminder of how important it is to recognize subtle neurological changes early and how critical the Children’s Transport Team’s role is in getting pediatric patients in the region to a higher level of care quickly and safely. It was also incredibly interesting to see concepts I had recently learned in the classroom come to life while caring for a real patient.
Bailey Blalock was one of the first two ECU College of Nursing nurse externs to help with patient care in ground and air ambulances this summer.
ECU: What was a situation you went into or what was one of those things where you thought, ‘I can’t believe this is happening in front of me’?
Williams: We went to pick up a pediatric trauma patient from Carteret Health Care Emergency Department and we knew on the transport there was the kid’s age and that he had a head injury, but we didn’t really know anything else. Sometimes you get a lot of information from these outside hospitals and sometimes not. When we got there, he was in worse shape than we expected.
I was just shocked about like the state of this kid because we didn’t know what we were walking into. The parents were very distraught, mom was crying at the bedside. And this was only my third air transport but seeing how the nurses handled it in previous situations and how calm they were, I was able to still get the kid on the monitor and reassure the mom that he was going to be safe on the flight to Greenville. We lifted the kid to the Maynard Children’s Hospital emergency department and he had family from Greenville there right after we got him settled into his room. It was really cool seeing him get from one place to the next place and be OK, even after a lot of trauma, and it was a good reminder of how important it is to stay calm in situations like this and just be there for the patient and their family, even when everything feels overwhelming.
Blalock: We went to go pick up a neonate from a hospital that didn’t have a NICU. They only had a nursery and no nurses were trained for emergencies. We went to go pick up this kid because he was having trouble breathing. Sats were low, that was all that we knew. Like Sam said, sometimes we get a good amount of information, sometimes we get none. When we arrived and the baby’s oxygen sats were like in the 50s, 60s on high, high flow oxygen. Come to find out, the kid had a tension pneumothorax, and no provider or physician really did any digging into that because they knew that ECU Health was on the way, I guess. The flight nurse did a needle decompression, which was very interesting to see because that is not something a floor nurse would be able to do. Then we lifted the kid and all was well. But to see the transport nurses immediately be able to do their thing changed my perspective.
ECU: What are you going to take away from this? Did it change what you thought you were going to do after graduation?
Blalock: Being a part of the Children’s Transport Team made me incredibly grateful and blessed to have been able to go to ECU and to be put in clinical at ECU Health. There are so many resources that I have taken for granted because you don’t realize that other places don’t have them. They don’t have as many nurses, they don’t have the equipment, they don’t have a NICU, they don’t have a peds ED, they don’t have people who have specialized in things like pediatric emergency care.
Williams: It really has confirmed my plans. Ever since I had an experience in the PICU, I kind of fell in love with both the pediatric population and the ICU acuity. I knew I wanted those two things in my nursing career and this has only confirmed that I definitely belong in pediatric critical care.