Flight nurses and flight paramedics who carry out dramatic high-risk rescues in northern Nevada and California voted overwhelmingly today, April 22, 2026, to join the Transport Workers Union of America.
The air ambulance crews – who respond by helicopter and small plane to medical emergencies in remote, hard-to-reach areas, including alpine ski trails and desert highways – said they decided to unionize to seek better pay, benefits, and respect from their employer, REMSA Health.
“These critical first responders no longer have to fight their callous and dismissive bean-counting bosses alone,” Transport Workers Union International President John Samuelsen said. “The 165,000-member-strong TWU will fully engage to help them secure a first contract that improves their lives and livelihoods.”
One flight nurse said the emergency responders saw unionizing as the only way to get management to listen to them.
“We have been ignored when it comes to any executive-level decision making on things that directly affect us and the patients that we care for,” the nurse said. “We have had zero say.”
The flight nurses and flight paramedics have grown increasingly frustrated that their compensation and benefits do not reflect the level of responsibility, risk, and experience required for the job. In many cases, their benefits even fall short of what other employees in the same organization receive, despite their roles requiring far more education, experience, training, and certifications. Flight crews operate in one of the highest-acuity environments in healthcare, managing critically ill and injured patients while performing complex procedures in the confined, high-risk setting of an aircraft thousands of feet above the ground.
TWU International Organizing Director Angelo Cucuzza said REMSA Health wasted time and money on a campaign to dissuade workers from joining the TWU.
“REMSA’s union-busting actions failed miserably during this campaign,” Cucuzza said. “I hope, for their sake, the consultants they hired were on a contingency basis. The rehashed garbage they put out brought more workers to the TWU’s side, proving once again the boss is usually the best union organizer.”
The new TWU workgroup operates four helicopter bases, one fixed-wing base, and one critical care transport ambulance in Nevada and California. The pilots are represented by another union.
REMSA provides ground emergency services for Washoe County, Nevada. Care Flight is its air ambulance division