Quote is from Air Wolf – great tv series from the 80’s. If you haven’t seen it – you should.
STARS courtesy Dr Mike Betzner
STARS IS COMING TO SASKATCHEWAN
The Alberta-born organisation is expanding their horizons east-ward to Saskatchewan and Manitoba. You can read all about Saskatchewan STARS here. Dr Dennis Nesdoly from STARS [Shock Trauma Air Rescue Society] a former colleague of mine came to give us a talk today.
A bit of transport History
Interestingly enough – Saskatchewan Air Ambulance began in 1946 – which is the longest serving non-military air transport service in the world! Right now they have 3 King Air B200 aircraft that are available 24/7. They are crewed by specially trained nurses and paramedics who have an average 10 years of experience. Adding HEMS [helicopter emergency medical service] will enhance the already excellent air transport.
Courtesy Dr Dennis Nesdoly
Most of STARS’ journey has been ~ 5000 feet at 240 kph, but many sentinel events occurred in the classroom, politician’s board rooms and at public events.
- Started in 1985 in Calgary and 1991 in Edmonton.
- Sim program started in 1999
- STARS has five helicopters:
- STAR-1 operates from the Calgary Base
- STAR-3 operates from the Edmonton Base
- STAR-2 serves as a back-up aircraft for both bases
- STAR-4 is a support aircraft, providing parts for the fleet
- 2008 STARS Critical Care and Transport Academy was inaugurated.
- 2010 became official “Red” patient transfer service by Alberta Government with fixed funding for the next 10 years
- The agreement with Saskatchewan was reached in April 2011 [but was in the works even before I came to Saskatchewan in 2009]
- AW139 bought by STARS in 2005 and is getting equipped. We’re going to get one – price tag roughly $30 million a piece. With a larger range and capacity [ 2 patients, bariatric patients] – these things are sexy!
the AW139 from STARS Lottery website
The STARS Model:
It’s more than just a helicopter that transports sick people. STARS is a top-rate organisation. I was fortunate enough to have trained with them during my residency in Calgary.
Physician driven – Some of the smartest doctors I know have been instrumental in the evolution of STARS.
Inter-disciplinary – The RN’s and Medics that work there take walked away from their collective agreement to work there. They are a great group of professionals – so too are the pilots, the maintenance crew and the rest of the organisation. EVERYBODY attends “morning huddle” – it’s a lesson in how a team should function.
the mobile sim bus
Innovation and Education – As far as I know, STARS was the first non-military operation to have pilots use night-vision goggles. Other innovations include in-flight blood analysis and ultrasound. The simulation program at STARS is similar to ours with one major difference – They created the first Mobile Simulation Program in North America. I think that this is perhaps what is going to make the biggest impact here. The ability to take simulation training out to rural settings is invaluable!
Blended model of funding – When it started it was with volunteer docs, pilots and medics. The public, private industry and later government are instrumental stakeholders that keep the birds flying.
Community Spirit – Few things have galvanised community spirit as well as these Red BK’s. The colour is a unique shade of red and garners as much brand awareness as Coca-Cola. This is important – as fund-raising is the biggest part of STARS. (I think that they’re going to have to make it green though)
The Eurocopter BK 117:
•Manufactured in Germany and Japan
•Maximum Weight – 3 200 kg
•Maximum Speed – 280 km/hr
•Normal Cruise Speed – 240 km/hr
•Maximum Operating Altitude – 15,000 feet
•Maximum Range – 580 km
“Hot loading” – The back doors open while the chopper is running [allows for ideal scene time of 8 minutes for scene calls]
•Crew composition varies across the world
•At STARS it’s usually Nurse/Paramedic
•routine physician on flight is uncommon [~ 20% of flights have flight doc]
•Research shows docs help especially with procedures [chest tubes, pacers, complex ventilated patients e.g]
Types of Missions:
- Scene calls – go out to ‘farmer’s field’ where the truck rolled over.
- Inter-Facility Transfer – go get sick patient from a rural hospital.
- Literature suggests that 3-8 lives saved /100 calls. Generally HEMS patients are critically ill.
- the best HEMS transport service are ones that are integrated into hospital EMS
- Missions should be dispatched within medical guidelines established by regional EMS
NOT EVERYTHING NEEDS A CHOPPER:
•HEMS should be dispatched only for seriously injured patients who are salvageable
•Not justified if flight does not reduce transport time unless providing equipment or skills
•Patient should be transported to nearest appropriate hospital
Criteria for transport:
– Distance too great for ground ambulance
– Time critical Patient condition
– Patient requires critical care support
– Inaccessible location
– Use of ground would compromise ground coverage [i.e. take an ambulance away from it’s community]
STARS Emregency Link center looks just like Jack Bauer’s CTU – ok maybe with less t.v. screens and a safer back server room. But a single phone call to STARS activates the Chain of Survival by linking together local emergency services (RCMP, Fire, Search and Rescue, Dive Team), emergency physicians, hospital personnel and appropriate emergency transportation providers (EMS, Rotor Wing, Fixed Wing) into the initial call. During flight the communication center follows the flight position and gives directions, distances, and scene coordinates
STARS has a long history of safe flight. This exists solely because of a culture of vigilance and safety:
Perhaps the biggest factor is ensuring the impartiality of the pilot. Pilots are blinded to the particulars of the case. They decide whether a flight can be safely made based on weather and light alone. Other important aspect of safety include:
- crew training
- daily craft inspections
- properly stowed equipment and secured patient
- limits on work hours
STARS is a non-profit charitable organisation. It takes a HUGE amount of money to keep operations going – in fact >75% of operations staff is dedicated to fund-raising [in addition to 500 volunteers]
Saskatchewan Strategy and Timelines:
- Recruiting a Base Medical Director for Saskatoon
- Patient referral system
- Helipad infrastructure
- Receiving sites
- Top 10 Referral facilities
- EMS integration / outreach
Building the operation in Saskatchewan:
- Regina base – spring 2012 (Regina International Airport)
- Saskatoon base – late 2012 (Saskatoon International Airport)
- Recruiting Saskatchewan team:
- Air Medical Crew (paramedics and registered nurses)
- Aircraft engineers
- Integrating with local first responders and health care providers