Just as the body changes during scuba diving, the human body changes when flying thousands of feet above sea level in an air ambulance. This is why a flight nurse must receive special certification in order to give medical care while on an airplane. An air ambulance escort could be a Registered Nurse (RN) or a Paramedic who is trained in flight physiology. Besides training in emergency medicine, an air ambulance escort might have certification in other areas as well, such as being a Respiratory Therapist. This helps to care for patients with special needs such as patients on ventilators. Can you imagine the level of care and precision that a medically trained flight escort must have? In order to have an air ambulance escort these patients safely, these crew members, flight escort paramedics, and flight nurses, must have a timetable unlike any other. After all, many of these patients are being transported via ground ambulance to and from airports. However, in the case of a true emergency, if a patient is in the air and can be helped better on ground, the protocol is almost always to land the airplane at the closest airport and have emergency 911 paramedics take the patient to the closest hospital. This is because many of the procedures done to patients in emergencies are even more life threatening when the patient is up at a high altitude. Sometimes, minor adjustments can be done in the air- like changing the pressurization to accommodate the patient's reactions to the new environment of the air. Such things are just the tip of the iceberg when it comes to the special training that a flight nurse, paramedic flight escort, or any air ambulance escort must undergo.