Looking Up with Strength and Courage: Ashley Piccirilli’s Story

Just after her lunch break, and only a week into her new construction job, Ashley Piccirilli was 13 feet deep in a trench packing gravel around a sewer pipe when a shout above her caused her to look up. “I heard ‘watch out!’ and I think that ultimately helped me to keep breathing as my airway opened with my head back,” recalled Ashley. Immediately a side wall of the trench caved in as thousands of pounds of dirt crashed into Ashley from left to right, covering her with about six feet of dirt. “It felt like a hug that was too tight. I took shallow breaths and stayed calm. I knew they would dig me out and I just waited.”

Thirty minutes later after digging with an excavator and then by hand, Ashley was pulled from the earth where an ambulance crew from Northampton Fire Rescue worked to stabilize her as they transported her the 20 minutes to Springfield to the region’s only level 1 trauma center at Baystate Medical Center.

“I remember I was telling the paramedics that it was hard for me to breathe,” Ashley said. “They were asking me what my name was, and I don’t even know if I answered.”

Traumatic injuries can be caused by various blunt or penetrating forces outside the body, including car crashes, falls, and gunshots. Treating major traumatic injuries takes coordination across many specialties and from a care team specifically trained to handle traumatic injuries. Baystate Medical Center is the only American College of Surgeons verified level 1 trauma center in western Massachusetts, providing the highest level of surgical care for the most severely injured trauma patients. This level of care is available 24/7 and on this Tuesday afternoon, with the ambulance call coming in, a trauma team of surgeons, emergency medicine physicians, registered nurses, respiratory therapists, and others were ready to receive Ashley when she arrived.

The ABCs of Trauma

“We got a prenotification before the arrival of her ambulance, and we knew that she had low blood pressure and a significant crush injury,” remembered Dr. Kristina Kramer, associate trauma medical director and trauma and acute care surgeon at Baystate Medical Center. “We didn’t have her name, she arrived as a ‘Jane Doe.’ But that isn’t uncommon with trauma patients when a traumatic injury can happen anywhere and the timing of receiving that care is critical.”

One of the nurses in the trauma bay caring for Ashley that day was Caitlin Millett, BSN, RN, TCRN. Later, when Baystate Health social workers were able to identify Ashley, Caitlin would be surprised that she knew her patient as her fitness trainer from about a decade before. “I didn’t recognize her with her injuries,” said Caitlin. “We were keeping her alive second by second. I couldn’t believe she had vitals. It was all-hands-on-deck.” As a trauma and emergency team of more than 10 fought to maintain Ashley’s vitals, they worked to quickly identify the severity of her internal injuries.

Dr. Kramer noted that Ashley had external scrapes and bruises but no large external signs of injury. Surgery would need to be performed and the team quickly cleaned the dirt covering Ashley’s body to prep for the operation. “There are surgeries that are scheduled, where a surgeon knows before what operation they will do. And then there are those done in an emergency, like in Ashley’s case, when the surgery is performed to identify the injury and save the life,” said Dr. Kramer.

Although Ashley doesn’t remember much after entering the ambulance, as she was going into surgery, she recalled the comforting face and voice of Dr. Kramer. “I opened my eyes,” Ashley said, “and Dr. Kramer was above me saying ‘we’re going to take care of you.’ And I remember nodding my head yes.”

“There is what is called the ABCs of trauma assessment,” explained Dr. Kramer. “Airway, breathing/oxygenation and circulation which are our first steps in determining the extent of injury to direct patient care.” Dr. Kramer and the surgical team knew Ashley had a collapsed lung from her X-ray and immediately put a chest tube in to drain the air and fluid out of the lung. She had 10 broken ribs including all the ribs on her left side, a broken left clavicle, and a ruptured spleen.

The most troubling and urgent issue was that Ashley had significant internal bleeding, even after her spleen was removed, and finding the source was imperative. What they found was Ashley’s vena cava, one of the largest veins that carries blood to the heart from other areas of the body, had been severely injured. “When we realized what had happened, I was able to stop the bleeding temporarily with my hand. We called for additional help from anesthesia, nursing, and other surgeons,” Dr. Kramer said. “She arrested during that time, her heart stopped, but we were able to restart it very quickly after opening her chest. With the additional trauma surgeons, we put a clamp on the large vein, and then were able to close it up to stop the bleeding.”

Ashley was then transferred to the Surgical Trauma Intensive Care Unit (STICU) with an endotracheal tube to assist with her breathing with the plan to have a second surgery the next day to treat her other injuries and reconstruct her chest.

Meanwhile, social workers had been able to identify Ashley, but the team had not been able to reach family members while Ashley was in surgery. It would be Dr. Kramer who was the first one to connect with Ashley’s mother. “She did not know that Ashley had any kind of accident and I wanted her to know right away that she was being cared for. I told her Ashley was safe, that she was really sick in the ICU, but doing much better,” said Dr. Kramer. As Ashley’s family and friends gathered to support her at the hospital, her healthcare team got to know her better and began to understand the personality and spirit that would help her overcome her injuries.

The Drive to Get Better

At the time of her accident, Ashley was a personal trainer with a bachelor’s degree in kinesiology from the University of Massachusetts Amherst. She had just graduated from warrant officer candidacy school for the Army National Guard and had taken the construction job for the short term to gain additional skills as she applied to Army flight school. “I was 32 years old and was in the best shape of my life, then to go to zero,” said Ashley. Yet Dr. Kramer notes her fitness played a role in helping her survive her injuries. Ashley credits her military training in staying calm through the whole ordeal and for giving her the focus she needed to achieve her goals. Innately, she is a positive person - full of optimism, thankfulness, and the drive to get better. With all that, Ashley began her amazing recovery.

She received critical care in the ICU for a week. With a breathing tube in place, she communicated with caregivers and family with pen and paper. She then spent three weeks further recovering from her injuries in the Intermediate Care (Intercare) Unit, a step-down unit from the ICU to treat trauma and surgical patients.

“How far are you going today?”

Tammie Beaulieu, RN, was the first nurse to care for her on South Wing 5, the Intercare Unit. “She had such a great spirit. She was always willing to do what we asked. She wanted to do whatever she could to get better,” said Tammie. On the unit, she started eating solid foods and, with the help of physical and occupational therapy, she began to strengthen her mobility and ability to walk. “My cardiovascular strength was the biggest hurdle. Just being able to walk to a room a couple of doorways down the hall and back, was excruciating, tiring, and exhausting,” Ashley recalled.

But she was driven.

“On our unit, 10 laps equal a mile,” Tammie noted. “When we told her that, it was all the incentive she needed. Every day, all of us nurses would see her walking and ask ‘What lap are you on? How far are you going today?’ She would have a big smile, happy that we were cheering her on.” Ashley said her care providers motivated her and kept her going. “I got to two miles in the morning and a couple in the evening which really helped in my recovery – it kept my lungs working,” she said.

“She was just the best patient,” said Tammie. “If she had a step back, like if she had an infection, she never called it that, she would say ‘this is a sidestep, but we’ll get through it.’”

Ashley said the positivity was a two-way street. “It was their optimism that helped me get better,” she said. “I was there for a month, and I felt like they never had a bad day, they were always cheerful and happy. Everybody was so motivated to be there,” Ashley said. “They gave me everything I needed and went above and beyond.”

Because of Ashley’s dedication and physical work in the hospital, she was able to be discharged directly to home without first going to a rehabilitation facility. She went home with a PICC line (peripherally inserted central catheter) to receive antibiotics and a wound vac to help her wounds heal. At home, she received care from visiting nurses and an occupational therapist to make sure she could safely manage her tasks at home. During her recovery, she came back to Baystate Medical Center to walk outside around the hospital with some of the nurses who cared for her. “She was so dedicated and Baystate felt like her home away from home,” said Caitlin, one of her fellow walkers.

Climbing Mountains and Taking to the Sky

Ten months after she was discharged from the hospital, Ashley climbed Mount Washington. A year after her accident, she passed the Army Physical Fitness Test (APFT), which requires the ability to do pushups, sit-ups, deadlifts, sprint-drag-carry, a plank, and a two-mile run in an allotted time. Passing this test was required to get back to flight school.

Today, Ashley is a U.S. Army warrant officer with the Massachusetts National Guard and after graduating from Army flight school, she pilots the UH-72 Lakota and the UH-60 Black Hawk helicopters from Barnes Air National Guard Base in Westfield, MA. Part of this piloting involves medical evacuation transportation, and she hopes in this work she is able to give back to the caregivers who saved her life.

Ashley appreciates the joys in the everyday as she attends her nieces’ and nephews’ birthday parties, hugs her two beloved dogs, and spends precious moments with her family and friends. When she thinks back to her accident she says, “I’m never going to be what I was before, but I’m a different me – I’m a different kind of strong.”

“The reason she survived is because of her strength physically and mentally and the teamwork of all the different people that were involved in her care – it’s never one person,” said Dr. Kramer. “For trauma in particular there are so many different pieces that must work seamlessly together from pre-hospital providers to the emergency department and operating room teams, to care team on the units after surgery, to rehabilitation and home care. Everyone came together.”

“I felt that they were the most caring of people. After every speed bump and every hurdle, they were right there to give me that motivation and say, ‘it’s okay, we’ll get through this,’” Ashley said. “Everyone who was there to care for me gave me what I needed to survive. I owe them my life, I really do.”