In Flight: The Art of Critical Care Above the Clouds

Stanford Medicine Life Flight plays a crucial role in transporting critically ill patients to specialized experts at Stanford Health Care. At the medical helm of this operation is Alfredo Urdaneta, MD, who ensures that high-quality medical care is delivered en route in the air.

Dr. Urdaneta, clinical associate professor and associate vice chair at the Stanford Department of Emergency Medicine, serves as medical director for Life Flight. Below, he peels back the curtain on what it means to plan for every aerial contingency for the only academic hospital-based flight program in California.

Describe Your Role

“Life Flight averages of 30 to 40 transports monthly. As the Medical Director, my primary responsibility is overseeing the medical care provided by Life Flight nurses during transport. Everything they do is under my medical supervision, even when I’m not physically with them during flights. I oversee the policies and procedures that ensure the nursing staff is well-equipped to handle a wide range of medical situations, from trauma cases to neonatal transports. And I lead ongoing training like quarterly sessions and just-in-time training to maintain our nurses' procedural competency.”

What are some of the challenges you face?

“Air transport introduces unique challenges that differ from ground ambulances or stationary hospital care. Vibration, noise, and turbulence can impact both patients and caregivers. Flight factors can definitely influence patient stability and even their emotional responses during transport.

Maintaining a calm environment is vital; if a patient becomes agitated, it can jeopardize the safety within the aircraft. We have to manage not just the medical aspects but also the emotional well-being of our patients. If they start to panic, it can create a dangerous situation for everyone on board.

Life Flight serves a diverse patient population, responding to emergency calls and facilitating transfers from other medical facilities. When the hospital's capacity is high, our focus shifts to critical cases that will benefit most from Stanford’s advanced care capabilities. This includes transporting patients with life-threatening conditions, such as cardiac and stroke patients.”

How has your background and military experience prepared you for the role?

“In addition to my clinical training in emergency medicine and intensive care, I am also a colonel in the U.S. Army Reserves with military experience as an aeromedical transport physician. In the military, I learned to provide care in resource-scarce situations. I was often the sole physician responsible for a vast area, which taught me how to make quick decisions and prioritize patient care.”

Looking ahead, what is next for Life Flight medicine?

There are a lot of opportunities to expand research within the LifeF light team and a strong desire to contribute to clinical studies. We want to engage our nursing staff more in research initiatives.

We also plan to broaden the nurses’ scope of practice and enable them to utilize advanced skills like ultrasound to enhance patient care. We want our nurses to practice with the most advanced skill set possible.

In the coming years, we also anticipate strategic investments including the possibility of a second aircraft that will hopefully allow us to support a larger catchment area.”