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Stars canada
The Journal of Emergency Medicine, Vol. 16, No. 4, pp. 669 – 670, 1998 Copyright © 1998 Elsevier Science Inc. Printed in the USA. All rights reserved 0736-4679/98 $19.00 1 .00
PII S0736-4679(98)00051-1
CAEP Issues STARS CANADA D. Gregory Powell,
MD, FRCPC
Reprint Address: Dr. G. Innes, CAEP/ACMU, Suite 104, 1785 Alta Vista Drive, Ottawa, Ontario, Canada K1G 3Y6
Twelve years ago, many Canadians died from illnesses and injuries that would have been survivable had earlier treatment been available. In 1985, Kyle and Powell showed that preventable trauma deaths were 50% higher in Alberta than in other regions with organized trauma systems. At the time, there was no dedicated helicopter ambulance service in southern Alberta. These facts prompted several Calgary emergency physicians to band together and look for methods of improving survival. Their efforts were further motivated by a young woman who died as a result of post-partum hemorrhage during a prolonged ground ambulance trip. Coupled with the tragedy of unnecessary death was the recognition that time to definitive care is a primary determinant of outcome. The concept of the “golden hour” gained prominence and time was measured from the onset of illness or injury, rather than from when the patient reached hospital. Prehospital care and rapid transport became critical issues. Alberta STARS (Shock Trauma Air Rescue Society) had a humble beginning. One BK117 twin-engine helicopter with canvas seats and no medical equipment was leased from a small aviation company that was willing to take risks. Hospital-based medical crews were scrambled from available emergency department and ICU staff, and carried all necessary equipment and supplies, including oxygen, on each mission. Pilots on pager standby were scrambled to the helicopter from home. But delays to lift-off were significant and the system had to be changed. To enable direct response to scene calls, pilots were moved to the helicopter base and medical crews made accessible at the hospital within 5 minutes. Later, all personnel moved to the airport on a 24-hour basis. The volunteer spirit was intrinsic to the conception of
CAEP Issues is coordinated by Grant Innes,
MD,
STARS and remains important today. Emergency physicians contributed their time, and hospitals provided staff at no added cost. Within months, a group of paramedics volunteered to be on immediate call, 24 hours a day. The spirit was contagious and, by 1988, ICU and emergency department (ED) nurses joined the team. Now a volunteer team, including critical care flight nurse, flight paramedic, and emergency physician were available, as needed, for all flights. But volunteerism didn’t extinguish the need to raise money. The Alberta government provided partial funding through an hourly service fee for the flight time attached to each mission. This didn’t cover expenses and, before long, the initial group was $250,000 in debt. The STARS Board approached the Lions Club, who generously arranged a $50,000 loan and a $50,000 donation. Because the helicopter company, ALC Airlift Canada Inc., was willing to carry a heavy debt load until further funding could be obtained, STARS survived. At first the donations were small and infrequent, but as the service became known to Albertans, particularly rural Albertans, the donations grew. Small communities held raffles, auctions, “dine and dances,” and livestock sales to raise funds for STARS. The organization flourished and grew, and eventually, STARS upgraded to a medicallyequipped Eurocopter BK-117 helicopter (Figure 1). Government played an interesting role from the outset. Their initial response to the helicopter program was to discourage its use. This was initially problematic, but became less of an issue when, by the mid 1990s, STARS had progressed to the point that government payments accounted for less than 25% of annual revenues. Corporations, service clubs, calendar sales, lotteries, fundraising events, and many individual donations from around
of the Canadian Association of Emergency Physicians (CAEP) 669
670
Figure 1. A scene flight in southern Alberta.
the province made up the bulk of STARS income. With time, our volunteer programs became more sophisticated, now involving hundreds of volunteers who actively raise funds and promote STARS at a grass roots level. In 1990, at the request of Edmonton receiving hospitals, STARS was asked to duplicate its service in NorthCentral Alberta. Edmonton service began with a small Eurocopter BO-105 capable of daytime operations only. Gradually, STARS overcame many obstacles, including government resistance and opposition from private, forprofit, fixed wing air ambulance services. In 1993, a larger, medically-configured BK-117 made its Edmonton debut. Today, 90% of Albertans are within the operating range of STARS’ two blood-red, medically-equipped helicopters. Medical crews are now paid an honorarium, about 1/3 to 1/2 of their industry standard wage. To assure clinical competency, crew members must be emergency physicians, ICU or ED nurses from tertiary care institutions, or paramedics working in busy urban Advanced Life Support services. The STARS organization has put significant effort into strengthening the chain of survival. Patients’ lives often depend on smooth integration of the links in the chain. The STARS Emergency Link Centre (ELC) was established to support this need. ELC is an advanced communication centre offering a 1– 800 (“one call does it all”) system for remote callers who need to transfer patients rapidly to our major referral centres. The 1– 800 number is available to anyone who needs it emergently. In 1996, the Nova Scotia government invited STARS to expand service to Halifax. With the encouragement and support of Emergency Health Services and the Nova Scotia government, the program was inaugurated in May of that year, using a Sikorsky S-76 helicopter from Canadian Helicopters Corporation (Figure 2). STARS
D. G. Powell
now services all of Nova Scotia and Prince Edward Island from its third base of operations. STARS provides more than just rapid, sophisticated air rescue. At all three bases there is an extensive outreach program that takes education to rural areas, providing an understanding of the issues surrounding air transport and emergency medical care. In addition, the STARS Foundation supports and conducts research into aeromedical emergency care and cost-effectiveness. For the people of STARS, the most rewarding part of the program is the tremendous gratitude we have received from the public. The advent of a rapid, responsive pre-hospital care system has dramatically changed medical care for rural Canadians. It is clear to all of us involved why our medical colleagues and the citizens we serve are so adamantly and actively supportive of our efforts. Editor’s note. Dr. Powell is the Chief Executive Officer of Shock Trauma Air Rescue Society (STARS) and the STARS Foundation. As well as being the founder, a director, and a flight physician, Dr. Powell remains the driving force behind the organization’s ongoing success. STARS is a milestone in Canadian emergency medicine and an invaluable health resource to critically ill or injured patients in five Canadian provinces. STARS Foundation and STARS (Canada) are registered charities. Charitable donations may be made to either entity at Box 570, 1441 Aviation Park NE, Calgary, Alberta, TZE 8M7. STARS Foundation-charitable no.: 89509 4761 RR0001; STARS (Canada)-charitable no.: 89109 1696 RR0001. CAEP Issues welcomes contributions from Canadian emergency physicians Address contributions or questions to: Grant Innes MD, c/o CAEP/ACMU, Suite 104, 1785 Alta Vista Drive, Ottawa, Ontario, K1G 3Y6. Phone: (613) 523-3343; Fax: (613) 523-0190; E-mail: [email protected]
Figure 2. A night trauma flight in Alberta.
PII S0736-4679(98)00051-1
CAEP Issues STARS CANADA D. Gregory Powell,
MD, FRCPC
Reprint Address: Dr. G. Innes, CAEP/ACMU, Suite 104, 1785 Alta Vista Drive, Ottawa, Ontario, Canada K1G 3Y6
Twelve years ago, many Canadians died from illnesses and injuries that would have been survivable had earlier treatment been available. In 1985, Kyle and Powell showed that preventable trauma deaths were 50% higher in Alberta than in other regions with organized trauma systems. At the time, there was no dedicated helicopter ambulance service in southern Alberta. These facts prompted several Calgary emergency physicians to band together and look for methods of improving survival. Their efforts were further motivated by a young woman who died as a result of post-partum hemorrhage during a prolonged ground ambulance trip. Coupled with the tragedy of unnecessary death was the recognition that time to definitive care is a primary determinant of outcome. The concept of the “golden hour” gained prominence and time was measured from the onset of illness or injury, rather than from when the patient reached hospital. Prehospital care and rapid transport became critical issues. Alberta STARS (Shock Trauma Air Rescue Society) had a humble beginning. One BK117 twin-engine helicopter with canvas seats and no medical equipment was leased from a small aviation company that was willing to take risks. Hospital-based medical crews were scrambled from available emergency department and ICU staff, and carried all necessary equipment and supplies, including oxygen, on each mission. Pilots on pager standby were scrambled to the helicopter from home. But delays to lift-off were significant and the system had to be changed. To enable direct response to scene calls, pilots were moved to the helicopter base and medical crews made accessible at the hospital within 5 minutes. Later, all personnel moved to the airport on a 24-hour basis. The volunteer spirit was intrinsic to the conception of
CAEP Issues is coordinated by Grant Innes,
MD,
STARS and remains important today. Emergency physicians contributed their time, and hospitals provided staff at no added cost. Within months, a group of paramedics volunteered to be on immediate call, 24 hours a day. The spirit was contagious and, by 1988, ICU and emergency department (ED) nurses joined the team. Now a volunteer team, including critical care flight nurse, flight paramedic, and emergency physician were available, as needed, for all flights. But volunteerism didn’t extinguish the need to raise money. The Alberta government provided partial funding through an hourly service fee for the flight time attached to each mission. This didn’t cover expenses and, before long, the initial group was $250,000 in debt. The STARS Board approached the Lions Club, who generously arranged a $50,000 loan and a $50,000 donation. Because the helicopter company, ALC Airlift Canada Inc., was willing to carry a heavy debt load until further funding could be obtained, STARS survived. At first the donations were small and infrequent, but as the service became known to Albertans, particularly rural Albertans, the donations grew. Small communities held raffles, auctions, “dine and dances,” and livestock sales to raise funds for STARS. The organization flourished and grew, and eventually, STARS upgraded to a medicallyequipped Eurocopter BK-117 helicopter (Figure 1). Government played an interesting role from the outset. Their initial response to the helicopter program was to discourage its use. This was initially problematic, but became less of an issue when, by the mid 1990s, STARS had progressed to the point that government payments accounted for less than 25% of annual revenues. Corporations, service clubs, calendar sales, lotteries, fundraising events, and many individual donations from around
of the Canadian Association of Emergency Physicians (CAEP) 669
670
Figure 1. A scene flight in southern Alberta.
the province made up the bulk of STARS income. With time, our volunteer programs became more sophisticated, now involving hundreds of volunteers who actively raise funds and promote STARS at a grass roots level. In 1990, at the request of Edmonton receiving hospitals, STARS was asked to duplicate its service in NorthCentral Alberta. Edmonton service began with a small Eurocopter BO-105 capable of daytime operations only. Gradually, STARS overcame many obstacles, including government resistance and opposition from private, forprofit, fixed wing air ambulance services. In 1993, a larger, medically-configured BK-117 made its Edmonton debut. Today, 90% of Albertans are within the operating range of STARS’ two blood-red, medically-equipped helicopters. Medical crews are now paid an honorarium, about 1/3 to 1/2 of their industry standard wage. To assure clinical competency, crew members must be emergency physicians, ICU or ED nurses from tertiary care institutions, or paramedics working in busy urban Advanced Life Support services. The STARS organization has put significant effort into strengthening the chain of survival. Patients’ lives often depend on smooth integration of the links in the chain. The STARS Emergency Link Centre (ELC) was established to support this need. ELC is an advanced communication centre offering a 1– 800 (“one call does it all”) system for remote callers who need to transfer patients rapidly to our major referral centres. The 1– 800 number is available to anyone who needs it emergently. In 1996, the Nova Scotia government invited STARS to expand service to Halifax. With the encouragement and support of Emergency Health Services and the Nova Scotia government, the program was inaugurated in May of that year, using a Sikorsky S-76 helicopter from Canadian Helicopters Corporation (Figure 2). STARS
D. G. Powell
now services all of Nova Scotia and Prince Edward Island from its third base of operations. STARS provides more than just rapid, sophisticated air rescue. At all three bases there is an extensive outreach program that takes education to rural areas, providing an understanding of the issues surrounding air transport and emergency medical care. In addition, the STARS Foundation supports and conducts research into aeromedical emergency care and cost-effectiveness. For the people of STARS, the most rewarding part of the program is the tremendous gratitude we have received from the public. The advent of a rapid, responsive pre-hospital care system has dramatically changed medical care for rural Canadians. It is clear to all of us involved why our medical colleagues and the citizens we serve are so adamantly and actively supportive of our efforts. Editor’s note. Dr. Powell is the Chief Executive Officer of Shock Trauma Air Rescue Society (STARS) and the STARS Foundation. As well as being the founder, a director, and a flight physician, Dr. Powell remains the driving force behind the organization’s ongoing success. STARS is a milestone in Canadian emergency medicine and an invaluable health resource to critically ill or injured patients in five Canadian provinces. STARS Foundation and STARS (Canada) are registered charities. Charitable donations may be made to either entity at Box 570, 1441 Aviation Park NE, Calgary, Alberta, TZE 8M7. STARS Foundation-charitable no.: 89509 4761 RR0001; STARS (Canada)-charitable no.: 89109 1696 RR0001. CAEP Issues welcomes contributions from Canadian emergency physicians Address contributions or questions to: Grant Innes MD, c/o CAEP/ACMU, Suite 104, 1785 Alta Vista Drive, Ottawa, Ontario, K1G 3Y6. Phone: (613) 523-3343; Fax: (613) 523-0190; E-mail: [email protected]
Figure 2. A night trauma flight in Alberta.