They didn't just save her life; they brought her back from the dead.
One minute, Catherine Fielding was taking in a brilliant June day from the back of a motorcycle on a country road in Butler County. The next thing she knew, she was lying on the pavement bleeding to death.
"I don't really remember a whole lot about the accident," said Ms. Fielding, 48, who lives in Gibsonia. "I do remember after the accident I was on the pavement. ... I just kept saying: 'My legs, my legs. I can't move my legs.' "
Her boyfriend, John Leddy, lost control of the motorcycle in a curve on Route 68 near Chicora on June 10, 2012.
"I guess I went spread-eagled into the guard rail and literally ripped my left leg off. I was bleeding out on the scene," Ms. Fielding said.
Ms. Fielding, who eventually lost two legs as a result of her injuries, doesn't remember her ride in the air ambulance operated by Allegheny Health Network's LifeFlight program. LifeFlight marked its 35th anniversary this year, making it the oldest hospital-based service in the Northeast and among the first cadre of such services in the U.S., according to the Association of Air Medical Services, an international trade group.
Ms. Fielding knows, however, that but for the quick ride to Allegheny General Hospital's trauma center, she wouldn't be among the living.
"If LifeFlight wasn't there as quick as they were, I would have died. I died three times; they brought me back," she said.
Getting critically injured patients like Ms. Fielding to lifesaving emergency care as quickly as possible without having to navigate Pittsburgh's network of bridges, tunnels, traffic and terrain was what a longtime Allegheny General nurse and supervisor, Mildred Fincke, started pushing for when she came back from a 1975 conference in Denver, where the first non-military hospital-based helicopter service had been founded three years earlier at St. Anthony's Hospital.
"I was very fascinated by this helicopter program and thought we needed something like that in Pittsburgh because we have this topography that's so lousy," said Ms. Fincke, 87, an Etna native who eventually became the hospital's vice president of nursing and at the time also served as president of a national emergency nurses association.
Amid initiatives to make Allegheny General the home of the first dedicated trauma intensive care unit in the state, get a nurse-practitioner program off the ground and upgrade emergency services all around, she enlisted the help of John Self, the LifeFlight coordinator for Hermann Hospital in Houston, Texas, to bring air medical transport to Pittsburgh.
Her supervisors were skeptical, telling her it would be expensive. "I know it is," Ms. Fincke says she told them. "But you have to think of the person who's going to be surviving."
She was so convinced of the need in Western Pennsylvania that she threatened to take the idea and herself to Mercy Hospital if Allegheny General wouldn't put up the money.
It took a few years, but she finally got a call one day from her boss, Harold "Hal" Sanders, a longtime vice president at the hospital who died in 2012.
"He called me at 4 p.m. and said 'Millie, you got your program. But if this doesn't go through, you better start looking for a new job,' " Ms. Fincke said. "I don't bet on anything. ... I knew we were going to have LifeFlight and we were going to be the first trauma center in Pittsburgh."
Birth of air ambulances
Ms. Fincke described the emergency services of 35 years ago as "archaic." It was an era before ambulance and rescue companies were ubiquitous in rural areas and before automated external defibrillators to treat cardiac arrest were commonplace.
A 1966 white paper by the National Academy of Sciences had called accidental death and disability, particularly from car crashes, "the neglected disease of modern society."
The paper, which called attention to the lack of coordinated response to injuries and the failure to adapt the military helicopter ambulances used in Vietnam and Korea to civilian needs, also "contributed substantially" to the development of the modern emergency-medical system and trauma care, according to the MedEvac Foundation, a charitable arm of the AAMS.
LifeFlight's arrival in Pittsburgh in 1978 with a single French Aloutte helicopter foreshadowed an era of explosive growth nationwide in air medical services.
By 1980, there were 32 helicopter emergency-medical programs ﬂying more than 17,000 patients a year, the AAMS says. By 1990, that number grew to 174 services with 231 helicopters ﬂying nearly 160,000 patients.
Today, there are about 800 medical helicopters transporting about 400,000 patients a year in the United States, according to the AAMS.
LifeFlight operates five helicopters out of five bases positioned strategically across Western Pennsylvania to reduce flight times to accident scenes or outlying hospitals. The service, composed of 18 pilots, 43 nurses and one chief flight nurse, seven dispatchers and eight mechanics, transports patients within a 130-mile radius that includes a population of 4 million people in Pennsylvania, West Virginia, Ohio and Maryland.
"There are thousands of people who have been saved by it," said James Palafoutas, Allegheny General's director of pre-hospital operations, including LifeFlight. Mr. Palafoutas' niece is among that number, transported by a LifeFlight helicopter after an ATV accident.
Cathy Fackovec, vice president of operations for Allegheny General, said about 30 percent to 40 percent of LifeFlight's approximately 2,400 flights a year are from the scenes of traumatic injury.
The rest are hospital-to-hospital transfers taking patients to get specialized services or procedures that aren't available at their local facility.
With more than 70,000 flights in 35 years, Ms. Fackovec says, LifeFlight has never had a crash or other incident that resulted in a serious injury, and the focus on safety has only increased, with better equipment like night-vision goggles and ground-proximity warning systems available.
A lot of reward
LifeFlight is the first, but not the only medical helicopter service in the area -- UPMC utilizes STAT MedEvac, a carrier operated by the Center for Emergency Medicine of Western Pennsylvania, a multi-hospital consortium. However, what sets LifeFlight apart, according to Allegheny General, is the composition of its flight crews and their training. LifeFlight puts two registered nurses on each helicopter, whereas a nurse-paramedic pairing is more common for other air medical services.
"Our nurses have to have five years of critical-care experience before they can even qualify for this job. ... I have an excellent group of people to work with. It makes it easier to roll new things out," said Peter S. Martin, LifeFlight's medical director since 2002. "We're critical-care transport. It's not just flying in a helicopter."
Before being considered for the job, applicants must be registered nurses with either a pre-hospital nursing certification or a paramedic certification. They are also required to have an alphabet soup of other credentials: ACLS (Advanced Cardiovascular Life Support), PHTLS (Pre-Hospital Trauma Life Support) and PALS, (Pediatric Advanced Life Support). Dr. Martin said additional advanced nursing certifications, such as flight nurse or critical care, are preferred and it's rare that LifeFlight hires candidates without them.
Consequently, the jobs are hard to get and rarely come open except by retirement.
Of the 43 nurses currently with the program, only six have been hired in the last 11 years, Dr. Martin said.
"It's not just a job, it's an honor," said Elaine Hruby, 51, of Belle Vernon, who has been a LifeFlight nurse since 1995 and works out of the Rostraver base. "I learn something every day."
The experience requirements give LifeFlight's nurses the flexibility to begin treating patients on the scene or in the air as they see fit.
"We are very autonomous. We can treat the patient and get them situated without having to call back," said Kellie Chapman, a 45-year-old flight nurse from Carnegie who was transporting a farmer injured in an accident in Indiana County to Allegheny General last month.
The flight nurses work two 24-hour shifts a week, eating and sleeping at the bases spread throughout the area, and have to be prepared to jump into the helicopter at a moment's notice.
"There's a sense of excitement, anxiety," said Kim Marshall, a 42-year-old LifeFlight nurse from Cranberry. "The hardest part is in the middle of the night when it wakes you up. You really have to go from being fast asleep, sound asleep, to being ready in five minutes and saving someone's life."
The pilots and maintenance crew for LifeFlight's helicopters are provided by Metro Aviation, based in Shreveport, La.
"It's got ups and downs," said Michael McCann, a 58-year-old retired Army pilot, giving the standard joke about flying helicopters for a living.
Mr. McCann, who has been with LifeFlight for 25 years and was working out of the Greensburg-Jeannette Airport last month, said unlike many other civilian flying jobs, he might be taking off for somewhere completely new at any time of day or night, in varying weather conditions, and landing in a wide variety of settings -- from cornfields to rooftops to highways.
"There's a lot of reward in this job, knowing that we're making a difference," Mr. McCann said. "We get to see a lot of people that we've flown."
As Ms. Fielding was recuperating from her injuries, which required more than 30 surgeries and months in the hospital, she says a LifeFlight crew member did just that, stopping into her room and presenting her with a hat.
"They call me their little miracle," Ms. Fielding said. "Without them I wouldn't be here."
A few days before Christmas, Ms. Fielding was packing up her car, which she can drive herself with no special equipment despite her two prostheses, for a trip to her winter house in Ocala, Fla. There, she can load her grandchildren on her scooter for a trip to a neighbor's pool, and the weather causes her less nerve pain.
"I'm alive and I do just fine," she said. "I was independent before the accident and I still am."
Some people in the therapy groups she has participated in take the loss of a limb as the end of the world, but Ms. Fielding, a office worker, called her current life "a gift."
"You can't be promised every day. You never know what tomorrow's going to bring," she said.
Robert Zullo: firstname.lastname@example.org or 412-263-3909.