On a sunny spring day, a helicopter takes off from UPMC Mercy Hospital in Pittsburgh’s Uptown neighborhood. The whir of the blades echoes across the nearby Monongahela River as the aircraft makes it way into the sky.
Good Question! listener Ryan Morden can hear the helicopters from his Friendship home. He thinks they’re transporting patients from West Penn or UPMC Children’s Hospital.
“It’s funny how that’s a fairly routine occurrence,” Morden said. “Was there ever a time when helicopters flying overhead at low levels in neighborhoods was a new and exciting thing?”
Every day someone is helicoptered through the skies of Pittsburgh. But that wasn’t always the case. The idea of transporting a patient via helicopter wasn’t considered here until 1978 when an emergency department nurse at Allegheny General Hospital named Millie Fincke returned from a medical conference in Colorado and asked her bosses to create an air medical transport unit in Pittsburgh. St. Anthony Central Hospital in Denver had started the first civilian, hospital-based medical helicopter program in the U.S. a few years before, and Fincke thought the service would be beneficial for Pittsburgh.
“The one thing I could say about Millie was that it was really impossible to say ‘no’ to this woman,” said Cece Peterson, a registered nurse with Life Flight at Allegheny General Hospital. Fincke hired Peterson in 1981 to be part of the program. “She convinced the board that this could happen in Pittsburgh and this could be done safely.”
Modeling the operation off of St. Anthony’s and other air transport services in the western and southern United States, Fincke convinced the board of a helicopter program’s efficacy. Soon, the Life Flight program took off at AGH. It was the first of its kind in the northeast.
But not everyone in Pittsburgh was convinced. Some city council members objected to the aircraft landing within the city limits for safety reasons; neighbors near AGH felt the helicopters frequently visiting the helipad would be too loud.
“There were city council members who thought we were just going to fall out of the sky at a moment’s notice,” Peterson said. “There was a group of people in the North Side who wanted to drive us out because we make noise.”
Then there was the public. Peterson said many people didn’t understand why helicopters were necessary or how they’d interact with ambulances and law enforcement. The first few years brought challenges and growing pains.
“It was all frontier,” she said. “We were sort of making it up as we went along.”
Public education became a priority, Peterson said. Up until then, most Pittsburghers had only watched medical helicopters on shows like M*A*S*H or during news coverage of the Vietnam War. Life Flight nurses and pilots attended community barbeques and fairs and brought the helicopter with them. They’d answer questions about their services and invite children into tour the aircraft.
“But part of us doing that in communities is so that if a child sees us in the course of our duty, I want them to have some concept of, ‘oh, it’s a nurse, maybe she’s nice,’” Peterson said.
The majority of the pilots back then were Vietnam veterans, equipped to handle Pittsburgh’s tricky topography. With guidance from the American College of Surgeons and other national emergency services program, Life Flight developed protocols and trainings for how to handle critical care patients.
STAT MedEvac flies into the scene
A few years later, the region’s second medical air transport program, STAT MedEvac, got off the ground. Now the organization, run by The Center for Emergency Medicine of Western Pennsylvania, operates 17 sites from Maryland to Ohio. They’re the largest single-branded non-profit air medical program, and locally they’re the helicopters used by UPMC.
Don Goodman, vice president of the organization, said when he began in 1988, the program had two helicopters: one at Mercy Hospital and one at Westmoreland Hospital.
“Next thing I know we had a third base site and a fourth base site and a fifth,” he said. “And people walking around are out there saving lives every day and … it just became part of who I was.”
Now, there’s a communications center on the 13th floor of UPMC Presbyterian Hospital in Oakland that helps dispatch emergency services and relay information about patient condition. Jim Houser, senior director of medical operations with STAT MedEvac, said the runs range in complexity.
“It may be as quick as just stabilizing all the way up to some advanced procedure,” he said. “Perhaps the patient is having difficulty breathing and we have to do some type of advanced airway management where we actually sedate put the patient.”
For this reason, the onboard crew is made up of specialists who are ready for any situation. Between mechanics, pilots, administrative workers and medical staff, STAT MedEvac has about 350 full time employees.
But the cost of these specialty services can be also be sky-high. A recent NPR and Kaiser Health News investigation found that bills for these flights can cost between $28,000 and $97,000. The price tag for STAT MedEvac and Life Flight rides depends on the patient's insurance coverage.
Life Flight medical director Dr. Matt Poremba says staff spends a lot of their time preparing for the unpredictable using simulations.
“The flight crew undergo significant training days throughout the course of the year,” Poremba said. “We send them through some of the more complicated transports.”
He described a recent training day when they created a scenario with a woman 36 weeks pregnant undergoing distress. During the simulation, though, trainers threw in a curveball, he said, and asked her to only speak Spanish.
“We did learn that some of our flight crew can actually speak Spanish,” he laughed. “But I thought it was a good insight to them to know how we’re going to take care of these patients who may not speak English.”
This training comes in handy when there is a serious car accident or a shooting a rural area, nurse Cece Peterson said. The crew must be prepared for any situation.
“We’re picking up this person who’s basically a puzzle and saying, ‘OK, I think this is what’s wrong with them,’” she said.
Both Life Flight and STAT MedEvac employees said the majority a helicopter crew’s day is spent transporting patients between hospitals. Houser estimated inner-facility runs accounted for about 80 percent of trips, while scene runs was about 20 percent of the time.
“Typically a car accident, that’s the first thing everybody thinks of when you think of a medical hospital going to the scene of an accident,” he said. But really, most of the flights are to take critical care patients from one hospital to another, usually for specialized care.
“It’s a calling”
Most pilots working in emergency medicine programs are military veterans, STAT MedEvac’s director of operations John Kenny said. They’re individuals who already love to fly and already have a passion for service.
“The job itself is like any other job, it can become a bit routine,” Kenny said. “But every now and then it throws you a curveball and you have to be ready to make quick decisions.”
The on-board medical personnel typically join flight crews after working in hospital emergency departments or ICU’s. That was the case for Peterson, who said she loves the rush of swooping into an accident scene and immediately caring for a patient.
“I get to see people on the worst day of their lives and I have the opportunity to do something to make it just a little bit better.”