LIFE GUARD INTERNATIONAL, INC.
March 25th, 2015
RE: SB 327
Chairman Hardy and Members of the Senate Health and Human Services Committee,
For the record, my name is Donna Miller.
I am a Nevada Citizen. I am also the President of Life Guard International – Flying ICU, a Nevada owned and
operated Fixed Wing Air Ambulance. And I am a Nevada Flight Nurse with 17 years of critical care
experience, including 14 years of aeromedical experience.
I am supporting Senate Bill 327 which provides Patient Protection to Nevada’s vulnerable critically
ill and injured citizens on board of an air ambulance aircraft, by requiring certain minimum
qualifications for the flight crew members; and by increasing the minimum number of attendants
required to accompany a patient.
Just like a Ford Van is converted into a ground ambulance, an aircraft is converted into an air ambulance.
ROTOR WING AIR AMBULANCES are helicopters converted into flying emergency rooms; and are utilized for
example to transport a critically injured accident victim from a remote location - such as a highway or
canyon - to the closest trauma center.
FIXED WING AIR AMBULANCE are airplanes converted into flying intensive care units; and are utilized for
example to transport medically unstable, critically ill and injured patients from one hospital to a higher level
of care hospital, usually in another city or another state, when distance or time makes it impractical to
transport the patient by ground ambulance or by helicopter. Airplanes are basically a bridge between two
ERs or two ICUs.
Accordingly, both helicopters and airplanes are equipped with a medical stretcher, specialized medical
equipment, and a full assortment of drugs and medications.
The typical air ambulance patient could be an unstable emergency-type patient or a complex-ICU-type
patient. Although in the hospital (a stable environment) such patient would be cared for by an entire team of
professionals (such as doctors, nurses, respiratory therapists, etc.), outside of the hospital this patient is care
for by the accompanying transporting flight team only.
This team must be able to continue the same treatments; and provide the same level of care the patient was
receiving in the Hospital ER or ICU. In addition, because exposure to environmental factors that are unique
to air transport may complicate the illness or injury, this team must also be capable to independently
respond to any foreseen and unforeseen changes in patient’s condition.
And I cannot imagine of a more isolated medical environment in the United States than an air ambulance.
Unlike a hospital or clinic where if a patient takes a turn for the worse additional medical personnel,
support, and equipment are seconds away; a patient being transported thousands of feet in the air has no
additional medical support available. These patients are wholly dependent on the training, experience and
skill of the flight team transporting them.
This flight team must be capable of handling a wide range of life threatening situations quickly, safely,
efficiently …and alone.
Therefore, the flight crews training, skill and experience can make THE DIFFERENCE BETWEEN LIFE AND
DEATH.
Currently, the State of Nevada requires a Flight Nurse to be onboard with every patient. This Flight Nurse
must be an EMS-RN (Emergency Medical Services Certified RN). To obtain an EMS-RN certification, a nurse
must have current RN License; current BLS, ACLS, PALS, PHTS certifications; and about 12 hours of training
preparing the nurse to work in the pre-hospital field.
However, NO nursing experience; NO critical care experience; and NO specific air medical/flight physiology
training is required. THIS IS UNSAFE.
A nurse without experience is not allowed to care for a complex ICU patient in a hospital where resources
and additional medical support are readily available. Why would we expect that a nurse without experience
will safely and efficiently care for a patient in the back of an airplane - alone?
 Section 3 of SB 327 improves patient safety by requiring additional training and experience
for the medical team treating patients onboard an aircraft. Accordingly, a flight nurse would
require an RN license issued by the Nevada State Board of Nursing; an EMS-RN certification
issued by the Nevada State Board of Nursing; and an air ambulance attendant endorsement
issued by the health authority.
Although I have been referring to the “flight team”, there is no requirement for a “team”. Currently the State
of Nevada requires a single EMS-RN to be onboard the aircraft. NO additional medical team member is
required on an inter-facility air ambulance transport for example. THIS IS UNSAFE.
In-flight medical situations often arise which can overwhelm a single EMS-RN, no matter how experienced
or skilled that person is. For example, if a patient has a cardiac arrest on the airplane, it is impossible for a
single medical crew member to perform CPR for an extended period of time, along with intubating the
patient, and administering cardio-active medication.
 Section 3 of SB 327 improves patient safety by requiring that every patient transported by air
ambulance at a minimum be staffed by both an EMS-RN and a Paramedic.
In addition, Nevada currently has a two-tier licensing system for air ambulances. Northern Nevada is
governed by the State EMS Health Division and Southern Nevada is governed by the Southern Nevada Health
District (SNHD). Under this two-tier system air ambulances can choose to be licensed either by the State
EMS or by the SNHD in order to pick up patients throughout the state. Because the two agencies have
differing safety requirements for their licenses; and because one is less restrictive than the other, air
ambulances can chose to be licensed by the less restrictive system.
This two tier system frustrates the legislative intent of allowing counties with large populations the
authority to develop their own medical safety regulation; and it takes away their authority to enforce them which defeats the purpose of giving the authority to begin with.
 Section 7of SB 327 allows the State EMS and SNHD to set and enforce their medical safety
licensing requirements within their jurisdictions.
Thank you for allowing me to speak. I would be happy to answer any questions you might have.
Donna Miller
Donna Miller, RN, EMSRN, CMTE
President/ CEO
Cell: 702-335-3027
Efax: 702-446-3177