Frontline Medical Response

BY CAMERON HEKE

Jul 15, 2014

Those of us who live in Western Canada appreciate the traditional spirit of community service that permeates life in the Prairie provinces. One good example is the Shock and Trauma Air Rescue Service (STARS) organization, a non-profit helicopter air ambulance service that provides rapid and specialized emergency care and transportation for critically ill and injured patients. The service’s physicians, nurses, paramedics, and pilots work with a team of dedicated support staff and community partners to save lives. Approximately 550 people, including physicians, pilots, aircraft engineers, nurses, paramedics and support staff make up the STARS family. From bases in Winnipeg, Regina, Saskatoon, Calgary, Edmonton, and Grande Prairie, the STARS services extend from the eastern edges of British Columbia to eastern Manitoba.

OPERATIONS
The primary role of STARS is to provide care and rapid transportation to the critically ill and injured. In addition, the service is also called upon to aid the RCMP in search and rescue efforts.

Our helicopters land at rural hospitals (where there are helipads) or close to the scene of an emergency, such as on roadways, farm fields, industry worksites, and remote wilderness areas. Patients are typically in very critical condition, either from illness or injury, and roughly 60% of calls are from rural hospitals that need to transfer a patient to a major urban hospital, while the remainder involve lifting a seriously injured patient directly from the scene of an accident (such as a farm, worksite or roadway) and transporting them quickly to a hospital.

Two experienced pilots fly on every mission for added safety, and each is trained in the use of night visions goggles. A flight paramedic and nurse, each with critical care level training, are also on every mission, and physicians fly onboard when needed.

STARS operates a fleet of 11 helicopters, including eight BK117s and three AW139s. Each base has at least one BK117, while the faster AW139s are located in Calgary, Edmonton and Saskatoon. The additional helicopters allow for continuous 24/7 response at all the bases, even when aircraft require down time for maintenance. There were 2,686 emergency missions in 2013, and the service has flown more than 27,000 times since 1985.

Missions from bases in Alberta and Saskatchewan are coordinated directly through the STARS Emergency Link Centre, while in Manitoba missions are coordinated through the provincial Medical Transportation Communication Centre.

STARS bases were launched in the following years: Calgary (1985); Edmonton (1991); Grande Prairie (2006); Winnipeg (2011); and Regina and Saskatoon (2012)

PHYSICIAN INVOLVEMENT
A unique feature of the STARS program is the role of physicians. They are the key drivers of the service, and available 24 hours a day guiding and coordinating missions in all regions, either over the phone or directly within the helicopter. About 100 physicians are on staff, mostly part time, while also serving in hospitals.

“The doctors who treat patients inside critical-care centres and emergency rooms across Western Canada are the same doctors overseeing care in our helicopters,” notes Andrea Robertson, STARS President and Chief Executive Officer. “When our physicians aren’t working in hospitals or in our helicopter, they teach our paramedics and nurses. We hire highly trained and experienced critical care nurses and paramedics, then we add another nearly 100 hours of medical training, taught by a critical-care physician, before they treat patients. Their training is updated annually.”

AIR MEDICAL STAFF TRAINING
All STARS Air Medical Crew (AMC) complete a minimum 96 hours of ongoing training every year. The quality and quantity of training exceeds international accreditation standards, according to the Commission on Accreditation of Medical Transport Systems, and strategically meets pre-identified competencies. Participants must achieve a minimum grade of 80% on all exams. Annual education includes: quarterly patient simulation sessions; quarterly education rounds; monthly online education; a series of intensive day-long didactic, simulation, and skills station sessions that meet or exceed regular transport certifications; clinical rotations through Emergency Room, Operating Room, Intensive Care Unit, Pediatric ICU and other training as required on an ongoing basis.

STARS is dedicated to ongoing training and optimal delivery in high risk areas of airway and ventilation management; including insertion of breathing tubes, and other procedures to enable air to enter a patient’s lungs. In 2011, a full-day physician-developed course was introduced to maintain a dedicated focus on adult and pediatric airway management skills. The air medical crew complete pre-work and then participate in an eight-hour face-to-face session facilitated by transport physicians involving: lectures, skill stations, simulation scenarios, and a final examination. Maintaining patient safety and providing the highest quality care is a key goal.

“When patient lives are on the line, learning from past experience is a critical component of doing things right. This is why STARS\\\' quality assurance program ensures physician-led case reviews are performed every time we help a patient. Every STARS\\\' mission is methodically examined and pertinent findings reported. We believe better patient outcomes result from ongoing case reviews, and we are committed to continuing this as an important part of how we operate.”

Doctor J.N. Armstrong is STARS’ Chief Medical Officer and Executive Vice President. He oversees all aspects of the medical program. As a helicopter pilot, his dual background gives him a unique perspective on the work of our organization.

“STARS has been almost 30 years in development,” says Armstrong. “But our main focus has never changed. It’s all about the patient, and we all work together as a team to provide the highest quality care in the safest manner possible.”

GOVERNANCE AND SERVICE AGREEMENTS
The organization has two volunteer Boards of Directors: the STARS Society (which is focused on operations), and the STARS Foundation (which oversees fund development efforts).

STARS has 10-year service agreements in each province the bases are located. Each base costs approximately $10 million per year to operate, and all costs and revenue are outlined in the organization’s annual report (www.stars.ca).

The three bases in Alberta are primarily funded by community contributions, with over 75% of costs paid through donations and fundraising campaigns, and the remainder paid by government. In Saskatchewan, the funding ratio is closer to 50% by government. In Manitoba, nearly all costs are paid by government. STARS is striving to increase private fundraising in Manitoba to reduce the burden on taxpayers.

FUNDRAISING
Major fundraisers include annual STARS lottery and calendar campaigns, major galas, and special events like CEO Rescue in the Rockies in Alberta, and Rescue on the Island in Manitoba. The Alberta lottery raised over $11 million net in 2014, and the annual Petroleum Services Association STARS and Spurs Gala raised $1 million.

Corporate donations are also well represented, with many company logos placed on the helicopters. Potash Corporation in Saskatchewan, for example, contributed $27 million toward the purchase of a new AW139 helicopter and base facility and hangar space. “PotashCorp helped us realize our vision of bringing this new helicopter and hangar to the people of Saskatchewan,” says Robertson. “Their commitment is the largest in STARS’ history.”

In spite of many successful fundraising efforts, and substantial corporate donations, STARS will still be challenged to maintain needed future revenue as mission volumes continue to increase. For instance, the older BK117s will soon need replacement. Fund development plans are being prepared to meet funding challenges.

INNOVATION

STARS was a pioneer in the use of on-board ultrasound, and recently incorporated a video laryngoscope as an advanced airway management adjunct. The use of a video laryngoscope further enhances airway management skills in a variety of clinical circumstances.
STARS implemented a program to have blood in place and ready for airborne administration at the Calgary, Regina and Saskatoon bases; and plans are now under way to expand the program to Edmonton and Grande Prairie by year’s end.

VIP INVOLVEMENT
Many former STARS patients – or Very Important Patients (VIPs) as we call them – volunteer their time and share their stories to help build greater awareness of the service’s need and benefits.

One former patient who volunteers with STARS is RCMP Constable Marcus Hirschfield. On 14 February 2013, his patrol car was struck at highway speed by a vehicle that had hit a patch of black ice and skidded toward him.

The impact was severe, breaking many bones. “The front of my car was annihilated,” he recalls, adding that, although his radio system wasn’t working, he was able to contact his coworkers on his portable radio and they rushed to the scene.

Extracting Hirschfield from the wreckage wasn’t easy. The dividing wall between the front and back seats – known by police as the ‘silent patrolman’ – made it difficult for the fire department. The mercury hovered at a frosty –30°C. In the meantime, STARS had been dispatched, and the helicopter landed on the highway before Hirschfield was out of the vehicle.

“The crew was able to stabilize me well enough to start administering morphine during the flight and after that things get a bit fuzzy,” he says. Hirschfield was transported to the University of Alberta Hospital and underwent surgery that afternoon. He spent more than three months as an outpatient, and has recently returned to work doing light duties.

Hirschfield volunteered as an ambassador during the 2014 STARS lottery campaign in Alberta, doing media interviews and sharing his story in the organization’s newsletter. “We are incredibly fortunate to have VIPs like Marcus share their stories,” says Deb Tetley with STARS Communications. “Our patients are certainly our greatest ambassadors, and the stories they share are an inspiration to all of us.”

At STARS, we continue to save lives from the Prairie sky.