Features Commercial EMS
Celebrating STARS

Walking through the Shock Trauma Air Rescue Society’s hangar at Edmonton City Centre Airport, it is immediately apparent that this is no ordinary helicopter operation. More comfortably known as STARS, the organization is vitally tasked with the emergency transport of medical patients throughout Alberta.

The AgustaWestland AW-139 is a key part of the STARS fleet. Here, one lifts off during the AMTC conference in Minneapolis. (Photo courtesy Mark Mennie, STARS)

“Aviation [itself] isn’t what we do,” says Scott Young, director of aviation operations, as he leads me on a tour through the facility. “It’s a means to an end.” Indeed, the rooms lining the corridors of this unique outfit appear more in keeping with a hospital than an aircraft hangar. Were it not for pilots dressed in full flight gear moving about the hallways, the facility might be mistaken for a medical clinic. Among staff and crew carrying out the daily upkeep of specialized equipment and procedures, the mood is jovial and upbeat – until an operational dispatch call comes through the loudspeaker.

A STARS pilot for 13 years, Young is well positioned to explain the workings of what can suddenly become a bustling, urgent environment. “We are like firefighters,” he says, raising the veil on a lifestyle that sets STARS apart in the helicopter community. “You get woken up, [then] you have to plan and execute a flight.” In a business where delays are not merely an inconvenience, but may critically affect the outcome of a mission, the effort to minimize response time is taken very seriously. The time elapsed from the dispatch call to what Young calls “skids up” can be as short as eight minutes.

It’s a scenario that has played out close to 20,000 times since the unit’s first mission in 1985. Toasting 25 years of operation in 2010 and now operating out of three bases in Edmonton, Calgary and Grande Prairie, STARS is a crucial link in the so-called “Chain of Survival,” the other partners being local emergency medical services (EMS), dispatch centres, fire and police services, search-and-rescue organizations, and other emergency medical teams.

STARS paramedics, nurses and physicians are committed to providing the very best in emergency medical care. (Photo courtesy Mark Mennie, STARS)

Serving the province with five Eurocopter BK-117 helicopters, STARS has earned the trust of Albertans, flight by flight, over two and a half decades. In recent years, mainly through fundraising lotteries and calendar sales, that trust has translated to unprecedented financial support. However, through the latter half of the 1980s there was the threat, even amid the many lives being saved, that STARS itself might not survive. Dr. Greg Powell, president, CEO and founder of STARS, explains that shortly after its inception, STARS was operating “hand – to mouth.” By contrast, today the organization receives 75 per cent of its funding from donors – a fact that he finds staggering. “The initial and growing support never ceases to amaze me,” Powell says.

Such an impressive level of public engagement may be founded in the very mission of STARS and the values that Powell himself personifies. A recipient of the Order of Canada, Powell founded STARS in 1985 while serving as director of the Division of Emergency Medicine at Calgary’s Foothills Hospital. Realizing that Alberta had a significantly higher instance of trauma-related death compared with other major centres, Powell was convinced that something needed to be done. When an elective posting took him to Saigon, Vietnam, in the 1970s, he had been able to witness the efficiency of the helicopter as means to rapidly transport casualties. In 1985, Powell’s convictions were set in motion and in the years following his return to Canada, STARS was born.

Since the 1980s, the operation, its people and its challenges have changed. An aging helicopter fleet now serves an aging population, increasing demand on both crew and aircraft. And, with lives depending on the successful completion of each mission, there is no room for error. “The profile can be a little scary at times,” Young says. “The stakes are high, so you are always in the public eye. It’s a pretty good incentive not to make a mistake.”

To date, no fatal helicopter accidents have occurred while engaged in the provision of emergency medical services in Canada. It’s a reputation STARS helps to maintain, and owes to the commitment and skill of its crews. Young explains that there is no specific mould that pilots are drawn from, and that recruitment must take a number of factors into account.

Landing in remote areas, as in this mission in Kananaskis County, is a common occurrence for STARS helicopters. (Photo courtesy Mark Mennie, STARS)

“In the helicopter world there isn’t a lot of room for a junior guy,” he says, adding that given the importance of multi-engine experience, the military is a natural recruitment source. More significantly though, it’s the experience of working as part of a team that counts. “We always work as a crew, with two pilots, a paramedic, a nurse and sometimes a doctor. We all work very well and effectively as a crew. That’s not something you just pick up. It’s developed over time and experience. Having pilots come from a single-pilot operation, where they are used to making all of the decisions on their own can be a difficult transition for some people. Crew time is very critical for us.”

As for his own recruitment to STARS, Young jokes that he himself arrived by somewhat unconventional means. “I bet the farm a couple of times,” says Young. Motivated by the desire to be there for people “on their worst day ever,” he was a reserve pilot with Edmonton’s 408 squadron when he was singled out for a job at STARS early in his flying career. “There was an opening – some of the other reserve pilots at 408 were with STARS. For some reason they asked me if I was interested in applying, even though I was a very junior pilot.”

The unique demands placed upon STARS crews calls for highly developed decision-making ability – when human lives are on the line, the pressure builds. Given the nature of the missions, a temptation to press on into inclement weather can be as insidious as it is compelling. While a 2005 study identified that in many helicopter EMS accidents in the United States, crews had pushed on into marginal situations out of concern for their patients, since Day 1, STARS has made it an official policy not to divulge patient information to pilots during dispatch.

“It’s one of our commandments,” says Young. “We need to make sure we can do the mission safely,” adding that a “worst nightmare” call will inevitably involve a child. “We don’t need that pressure, so we always assume when we get a call, it’s critical. We try to remove ourselves from that pressure because we can’t let patient [condition] dictate or drive our acceptance decision. We can either do it safely and legally, or we can’t. If we say we have to decline for weather, that’s the end of it.”

A member of the STARS air medical crew prepares for a mission departing from the Grande Prairie, Alta., base. (Photo courtesy Mark Mennie, STARS)

Once it is determined that the mission can be accomplished safely, however, pilots are informed of what to expect of the patient’s situation and condition. It’s all part of a process designed to keep safety at the highest level of priority. And this practice doesn’t end when the rotors stop spinning: after every mission, STARS crews go through a debrief, the goal of which is continual performance improvement. In the event that a mission has involved a child, or multiple casualties, a more intensive process known as a Critical-Incident-Stress debrief (CISD) takes place. It’s work that may take its toll on the emotional health of crews.

“At the time, everything is good,” says Young, “but a few days or even a week later, something can trigger a reaction. We want to make sure our crews are OK.”

As the critical demands on STARS increase, the organization strives to work with the best technology available. Currently STARS is the only helicopter EMS operation in Canada using night-vision goggles (NVGs), a technology it has employed for the last six years, forging a significant improvement in mission effectiveness and safety during night operations. Young, who flew with NVGs in the military, admits the transition wasn’t easy for some STARS pilots.  But while there was resistance to the introduction of NVGs from a few, those objections were short-lived. Says Young: “I dare you to try and take them away from those pilots now.”

As successful as the BK-117 EMS platform has been at STARS, the organization foresees expanding the defined “safety envelope” in which missions can be conducted as the only practical way to take on further capacity. That safety envelope, says Young, is significantly defined by icing conditions that confine hard IFR operation in the Canadian Prairies to three or four months of the year. The key to expanding capacity will be the AgustaWestland AW-139. “It is the only de-iced aircraft in its category, short of going to an S-92.”

Faster, with longer range, equipped for flight into known icing condition and designed to FAR 29 standards, the AW-139 is a true Category ‘A’ helicopter and is central to STARS’ future plans. “At any point during the takeoff or landing,” Young says, “if an engine is lost, you could either land safely, or overshoot and fly away.”

The AW-139 is set to play an important role as the organization evolves to meet an ever-growing need. In October, the Government of Saskatchewan announced that it had entered into discussions with STARS to implement Helicopter EMS (HEMS) from bases in Saskatoon and Regina. Yet even as STARS’ circle of influence expands, it faces the loss of one of its bases, merely blocks from Edmonton’s Royal Alexandra Hospital, with the impending closure of Edmonton City Centre Airport. Removed from the proximity of a major care centre for Northern Canada, it remains to be seen how STARS will evolve. But as Powell explains, the debate really isn’t about STARS at all.

“Where the people want us, we are happy to participate,” he says. But on the decision as to which airports should be shut down and which should stay open Powell says, “We don’t get involved in that. We stay focused on doing what’s best for patient care.”

“We use helicopters . . . we don’t need runways,” Young adds, and though he does admit that there will be some operational and financial impact, he isn’t worried. “We have time to figure out where we are going to go next . . . in a perfect world, we wouldn’t be needed at all,” he laughs.

Not only is STARS needed, but indications are that the organization will continue to thrive. And Albertans will be grateful to know that the striking red helicopters, so often to be seen cutting through the vast and crisply cold prairie skies, are likely to be around for decades to come.