You're driving down the freeway at 4 pm.  Maybe you're headed home, to the store, to your kid's soccer game.  Where ever you're going, you're surely not planning on being aboard an air ambulance helicopter to be LifeFlighted at 150 miles per hour to the nearest trauma center. 

It's hard to imagine a passing tree, a fence post or stretch of freeway as being etched in one’s mind.  What we normally zip passed without noticing can suddenly and violently become the backdrop of a scene frozen in time where we might lay helplessly as everything around us stops too.  Sirens from rescue vehicles would quickly fill the air growing louder and louder, while people peering in your vehicle ask if you're capable of communicating.  “Are you okay? Are you awake? Don’t move. Help is on the way!” 

Then, a few minutes later, in the background the repetitive echo of helicopter blades tapping in the air until they become so loud nothing else can be heard.  Faces you don't know crowd around you as you are extricated from what was your car.  The view of the situation is abstract and limited as you go in and out of consciousness.  A neck brace and backboard keep you locked in place as you're wheeled off across the freeway lanes looking up at the sky and then at the inside of the helicopter that will help to save your life.

It's been a long time since air ambulance helicopters began landing on freeways, in back yards and on hospital roofs.  In the early days during the Korean and Vietnam wars, helicopter flight radically changed the statistics that showed correlations between battle wounds and death.  In World War II four out of every hundred wounded soldiers died after receiving medical treatment.  In Korea, helicopters cut the ratio of deaths to battle wounds in half to two per hundred.  In Vietnam helicopters were manned with medics, bringing the statistics to one death per one hundred wounded soldiers who received medical care. 

It was during the Vietnam War that some in the emerging field of EMS began to notice that, due to distance, trauma patients in rural American communities had lesser chances of survival than wounded soldiers on the battle fields of Vietnam.  That statistic is owed to helicopters and the pilots and medics who risked life and limb to move wounded soldiers to hospitals like the one we used to see on the television program M*A*S*H*. 

Years later in rural western Missouri, LifeFlight Eagle, Kansas City’s only nonprofit community air ambulance service, is providing what has been termed a mini-emergency room that arrives on the scene in minutes and whisks patients to specialty care.  When these air ambulances arrive on the scene, all those years of experience and time-tested practices arrive with them.

For all of us who don’t often consider the reality of an unexpected helicopter ride to a far-away hospital—ten minutes before we were supposed to arrive at a birthday party—there are special teams of people in cities across the nation who are nothing but prepared to respond to our need.  They are specially trained nurses, paramedics and pilots who stand by ready at all times to speed off to a scene or hospital up to 150 miles away.  There's quite a bit involved with making a helicopter available to a community – and no one knows that better than Ruby Mehrer, Director of Business Development for LifeFlight Eagle.

Mehrer, (pronounced Mayor) a 20-year veteran of flight nursing, has recently changed positions from chief flight nurse (or clinical manager) to director of business development to help lead LifeFlight Eagle to new levels of service for western Missouri's rural communities.  She has been tasked with new programs that will increase resources and eliminate out-of-pocket cost to patients.

Mehrer has stories from over a thousand missions, some exciting, some funny, some tragic.  But for all of her extraordinary activities over the last 20 years, you’d never know any of it happened, by her unassuming nature and genuine humility.

This quiet petite wife and mother of three is known and revered in special circles all over the States of Missouri and Kansas and other parts of the country.  It seems there isn’t an EMS agency, hospital or fire department that doesn’t know Ruby Mehrer as a leader and committed professional.  Beyond that she blends right in to everyday life.  A red head, her favorite music is country western—her favorite food is a hamburger—her favorite color is red, white and blue.  Going home each night to spend her free time doing family things with her husband and their children and grandchildren is what she likes best.

Originally from Rico, Colorado, a small mining town of 300 people in the mountains of southwest Colorado, Mehrer was raised by her father.  She and her older sister grew up in what some would call a genuine log cabin trimmed with all the basics, not including indoor plumbing or conventional heating.  She decided early on that life outside of Rico was possible and eventually moved to Kansas City.

Originally interested in becoming a math teacher, Mehrer later experienced a scary delivery with her first child that led her to teach childbirth classes and eventually enter a nursing program.  She thought labor and delivery nursing would suit her interest but later decided on emergency nursing after being certified as an Emergency Medical Technician (EMT).  She became nationally certified as an EMT in 1974 and later completed one of Missouri’s  first paramedic classes in 1976, while working nights as a nurse’s aid at Columbia Regional Hospital’s intensive care unit in Columbia, Missouri.  Soon after that, she attended William Jewell College in Liberty pursuing a BSN in nursing, and during that time took a trip back to Colorado to visit her brother who happened to have a job that oftentimes had him flying in helicopters.  Her brother arranged a ride for her and as the helicopter took her up in the air she knew from that moment she wanted to be a flight nurse.

“I had a sense of euphoria and a feeling that I belonged there,” says Mehrer.  “I just felt from that moment that I was supposed to be a flight nurse.”

In 1981, Mehrer finished nursing school and worked in the emergency room at North Kansas City Hospital in North Kansas City, Missouri.  Then in 1984 she saw an advertisement announcing a need for nurses to join the new Research Medical Center air ambulance program, Research Eagle.  She jumped at the chance, submitting her application along with 400 other area nurses.  Of the four nurses picked for the new program, Mehrer was one.

Since then it’s all been up for Mehrer, literally.  During her career she’s seen the good, the bad and the ugly, including a gurney barreling down a hill into a ravine, much to the dismay of a new nurse who lost his grip on it just after the helicopter lifted from the hospital. Thankfully, the patient was safe inside the helicopter.   The “good ones” as she calls the successful missions, she has a hard time remembering, though there are many trauma, stroke and cardiac patients alive today because of the skill of this flight nurse and the speed of her helicopter.   She remembers with remorse a young man who, burned beyond recognition in a motorcycle accident, lived for a very short time after arriving at the hospital.   She saw her own son’s face in the burned face of this boy and all these years later she still mourns for that boy and a mother she didn’t get to meet. 

“Because it’s your job, you’ve got to separate yourself from the patients to be able to get the job done and move on to the next one,” says Mehrer.  “It doesn’t happen like that every time though.”

Mehrer also recalls a lighter memory from Valentine's Day 1985—also her husband's birthday.  “We had plans to go out that evening but I soon learned not to make plans on the days I flew.  Near the end of my shift, a patient went in to cardiogenic shock and we flew him to Research Medical Center in extremely critical condition.  While in flight I started dopamine to help his blood pressure and a few minutes later he started projectile vomiting.  While working in the emergency department, I had developed exceptional dodging skills.  I dodged and immediately hit the wall of the helicopter.  Another lesson learned!  Dodging gets you nowhere in a helicopter.  I was covered from head to foot.  We landed and I had to take him through the hospital to ICU with his supper all over me. It was that flight that taught me that the helicopter was part of a team that could save lives.  The patient that night was very near death when we picked him up but two weeks later, he walked out of the hospital.  He and his sweet little wife had more time to spend together.   We stayed in touch for quite awhile after he was discharged.”

Mehrer hasn’t limited her community service to just flight nursing either.  She is also the current president of the Missouri Emergency Medical Service Association, (MEMSA) which is an organization dedicated to improving emergency medical care in the state.  MEMSA is also involved in the testing of practical skills of those preparing to become emergency medical technicians or paramedics.  As well, Mehrer is the past chair of the Johnson County Kansas Emergency Medical Service Council, past chair of the Mid-America Regional Council Emergency Response (MARCER) Committee, participates in the Midwest Trauma Society, and sits on the State Advisory Council on EMS.  But that’s not all.  Mehrer is the chair of the Regional Emergency Medical Services subcommittee for 13 counties and also attends the state Pediatric Strategic Planning Committee.  All in all, she has been voted to a leadership position ten times during her career.  She also finds time to teach Advanced Cardiac Life Support and the Transport Nurse Advanced Trauma Course.  She is often asked to lecture on flight physiology and transport considerations.

Despite all of these volunteer community service commitments, Mehrer loves LifeFlight Eagle the best. 

It’s the intense decision making, quick interventions and the thinking on your feet she says that attracted her to the program and has kept her with it all these years—“the flying and the challenging patients.”  Her steadfast personality glows a bit as she says this while narrating the story of LifeFlight Eagle’s progress from the days when it was called the Spirit of Saint Joseph LifeFlight providing mostly trauma care in the beginning, up to the present day program which includes a lot more high-tech equipment to provide high specialty in-flight care to stroke, cardiac, obstetric patients and other critically ill or injured patients.  The intense training requirements that must be met by flight nurses and paramedics were designed in large part by Mehrer after she became the chief flight nurse or clinical manager in 1988.  Today LifeFlight Eagle’s pre-hire requirements for new flight nurses and paramedics include five years of critical care or advanced life support ambulance experience, respectively. Additional requirements include Advanced Cardiac Life Support, Basic Trauma Life Support, Pediatric Advanced Life Support, Neonatal Resuscitation and 4 – 6 weeks of flight training.  The nurses are sent to the Transport Nurse Advanced Trauma Course within the first year of employment.  Additionally there is constant recurrent training for the medical crew so that they are prepared to handle any critical patient they may encounter. 

While she says she misses the flying and the patient care these days, Mehrer feels she made the right decision in transitioning to business development.

“The opportunity was there and I saw that I could help the program more extensively by making the change,” says Mehrer.  “As clinical manager my duties were more and more in the office with less and less flying and without consistent work in the air I felt that I was rusting out a bit and perhaps was not as sharp as I wanted to be.  So I relinquished flying for full time business development.  I still miss it though.  I never lost the feeling of euphoria each time we lifted. ”

Even so, Mehrer has kept all of her certifications up-to-date despite the fact that most of her energy is now devoted to finding new ways to lower or eliminate transport costs for patients. 

“Back in the beginning, the programs in Kansas City worked differently,” says Mehrer.  “It began in Kansas City back in 1978 with Spirit of Saint Joseph LifeFlight at Saint Joseph’s Health Center.  Next came Research Eagle and this created a little competition in the area—I say competition because the expense in running an air ambulance program is very high.  In those days we were charging $225 for a flight plus $7 per mile which didn’t begin to cover expenses.   Essentially, we were flying billboards then and the hospitals were willing to take the loss.”

Things have changed a lot in the past 20 years.  Today’s national average for an air ambulance transport is $9,000 and the hospitals are no longer able to absorb losses from helicopter programs.

“Saint Joseph’s Hospital and Saint Luke’s Hospital partnered in 1986 and that program became the Spirit of Kansas City LifeFlight.  Children’s Mercy was actively involved with LifeFlight at that time as well—covering the cost of its patient transports. Then in 1996 Life Flight and Research Eagle merged to form LifeFlight Eagle, which became its own stand-alone nonprofit organization.  The hospitals—Saint Joseph Health  Center, Saint Luke’s Hospital, Research Medical Center and Children’s Mercy Hospital named representatives to made up LifeFlight Eagle’s Board of Directors.

“Today we have three helicopters,” says Mehrer, “one located at Kansas City’s municipal downtown airport, one at Harrisonville and one at Blue Springs.  We’re now looking to expand by placing a new helicopter in northern Missouri.”

The program serves 32 counties in western Missouri from the Iowa border, south to Springfield and west to Columbia.  It also can reach as far west as Junction City, Kansas.  To date LifeFlight Eagle has subsisted on fees for services rendered but is now preparing to launch a new membership program that will eliminate cost for patients while relieving the organization of volume dependency.  Mehrer says the new LifeFlight Eagle membership program is already creating a warm and valued community partnership within the service area.

“Everywhere we go in rural western Missouri to talk about membership, residents are highly interested and supportive of the plan.  Something a lot of metro-area residents have never had to think about is how they would get to the hospital if they became seriously ill or critically injured. There are over 20 hospitals in the Kansas City area and an ambulance rarely has more than a 10-15 minute drive to the closest one.   When you live 30 miles or more from specialty care, the use of an air ambulance can make the difference between life and death.  So far we’ve done a very good job of providing speed and high specialty care when it is needed.  Now we’re adding affordability.”

Mehrer says this and other new programs are based on the philosophy that tragedy and illness should not be followed by financial hardship.

“Nobody gets up in the morning thinking they’ll be getting on a helicopter to go to the hospital—but it happens,” says Mehrer.  “We know that our presence gives whole communities a sense of comfort and security that would not otherwise be there, as well as the knowledge that they’re in good hands when we take off with their loved ones on board.”

When asked about other differences between the old days and today, Mehrer responds, “Back in the beginning, we were all thrilled to be a part of the flight crew.  It was a new industry and exciting to be involved in—it still is for me.  It's much more usual now and more people have the opportunity to fly so I don’t know that the mystique is necessarily there anymore—that may be true about any new thing.  Flight nursing was not a job.  It was part of my identity.  Today I think staff members look at the service in a much more established way.  Certainly they’re better trained from the beginning but I guess it’s the mystique that may be at least somewhat diminished.”

When asked about pilots, Mehrer says, “Every pilot thinks he's the best and that's just what he should think.  They’re incredibly skilled leaders who we entrust our lives and the lives of our patients to. “

Mehrer says LifeFlight Eagle is planning for a long future in Kansas City and western Missouri.  Since the combination of the two programs in 1996, LifeFlight Eagle has not been subsidized by the hospitals.  Through skillful management, it is a fiscally sound organization.    But, as Mehrer says paradoxically, LifeFlight Eagle has had to depend, so to speak, on other’s tragedies to create flight requests so that they could pay the bills at the end of the month in order to be there for next months tragedies and illnesses.  By contrast, an organization such as a fire department doesn’t have to wait around for a fire to be able to meet the payroll and as Mehrer looks down the road five to seven years she sees rising fixed costs and changes in health care coverage pushing the organization in a new direction, but one she believes is better for the community as a whole.

“I have to be sure we remain a program known for high quality.  We're like a center of excellence in the air ambulance world.  To keep the program on the successful track we’ve always been on, expansion is vital.  Naturally, a lot goes in to placing a helicopter in an area because of the significant cost.

“It’s really something to see how expensive it is to put the program in place, with mechanics, pilots,  nurses, paramedics, staff training, medical equipment, helicopters, and so on.  I really believe that community partnership with programs like membership will be a huge positive leap for all concerned – and that’s basically everyone.  Membership can eliminate the out of pocket expenses for a person transported by LifeFlight Eagle.  We’re not just treating patients from our perspective.  We’re treating families and communities too.  That means meeting needs beyond the critical care aspect.”

LifeFlight Eagle produced a new documentary film this year.  Portions of the film have aired on KMBC Channel 9 and film presentations are available.  Mehrer was involved from start to finish in the filming process from research and interview coordination to scripting to holding queue cards on a dark cold night while rotor blades spun overhead making it that much colder.

“It was a great experience and I think people in western Missouri have been surprised at what they didn’t know about LifeFlight Eagle,” says Mehrer.  “I think they’re quite proud of the hometown community service whose name they all recognize but perhaps don’t know too much more about.  We’re really excited to share this film with them.”

In closing, Mehrer wished to make one last comment. 

“Don’t make us come and get you!” she says.  “Eighty percent of the transports we do are avoidable, whether they are trauma or illness related.  Take care of your health and be safe and cautious in daily life, especially on the roads.

“I love my job, but it’s often bitter sweet to be fulfilled by the skills which are necessary to save lives—when prevention would have done the job.  And membership can also be part of that prevention program—prevention from financial hardship if we are needed.  In any case, those in need can be sure when they have LifeFlight Eagle transport them, they have the very best.”

To contact Ruby Mehrer email ruby@mylfe.org