Few nurses will have the opportunity to provide first aid to Spider-Man while he fights supervillians, or to monitor David Blaine's vital signs while he is entombed beneath the streets of Manhattan. For a set nurse like Kathy Cossu, RN, it comes with the territory.

"I have worked on more than 100 movies and 65 TV shows, and at least 40 commercials," Cossu reports from the Connecticut set of "Revolutionary Road," where she counts Leonardo DiCaprio, Kate Winslet, and Kathy Bates among her potential patients. "Caring for the cast and crew entails being observant of any potential danger, and triaging, treating, and monitoring anyone on set." Actual lengths of such responsibilities may vary, from a one-day commercial shoot or supervision of a stunt, to providing full-time care for 150 – 200 actors and crew members over a 6-month movie production.

As manager of Kathy's Medical Production Company, Cossu also trains paramedics, EMTs, and RNs to work as set medics. She counsels directors and actors on medical terminology, script realism, and performance. Based in New York City—backdrop of countless movie, television, and commercial shoots—Cossu frequently encounters the same crews on Big Apple projects. "Working with the New York crews has been a rewarding experience," she says, praising the family atmosphere and diverse talents they possess.

Cossu broke into the entertainment industry via a chance meeting with a patient who worked on the soap opera "Another World." It gave Cossu—then a med/surg nurse at St. Vincent's Hospital in New York—the chance to fulfill a dream. "We are all fans of one show or another, one actor or actress. As a child, I watched 'Another World' with my grandmother. Like all of us, I wanted to go to the set and feel the magic of what I watched for years." She became the technical advisor on that show shortly thereafter.

"There are many aspects of a technical advisor," explains Cossu. "You have to work with the director, read the script, critique all the medical terminology, work with the actors, and set up the medical set. You also must know when to take dramatic license." Characters cannot perform the Heimlich maneuver or CPR inaccurately, "as the viewing audience will take it as gospel. A surgeon having his mask down in the OR, however, can be cheated, since the average viewer will not identify with him." Dialogue provides the spark of realism for viewers in that context.

After "Another World," Cossu started working as a set medic on television shows and feature films such as "Jacob's Ladder," "Bonfire of the Vanities," and "The Fisher King." Work in the film-production mecca of New York City was plentiful, which became problematic. "As it was impossible for me to work on more than one show at a time and the nurse I had been working with moved away, I took over the production company and began training medical personnel to work on set."

Building a unique business

As nursing specialties go, the realm of set nurse is a small one, providing entrepreneurs like Cossu a chance to build a unique niche business. When she started out, no specialized training was required, though she did obtain EMT certification to better communicate with the EMTs she trained and to gain "street experience." Cossu also learned set protocols, including how to avoid straying into the shot.

In addition, she secured representation with the entertainment union IATSE for herself and her employees, which places their pay and benefits on par with that of other industry technicians and craftspeople. And Cossu bought an ambulance service so she could lease authentic vehicles to film productions. As her business grew, she realized that she might need to work a short-duration shoot while serving full-time on a longer project, so she made plans to train others to work on sets and provide coverage during schedule conflicts.