Health sources in Manitoba tell CBC News there is growing concern over the STARS air ambulance program and patient management, as several cases are currently under clinical review by the province.
A government official confirmed that several cases involving STARS — which stands for Shock Trauma Air Rescue Society — are currently undergoing a clinical review, although there has been no public mention of the clinical reviews or complaints until the CBC News I-Team asked about it.
"We look at what therapies, treatments were given to a patient in the sequence, and we look at that to review if they were appropriate [and] can we learn from them," said Gerry Delorme, the province's executive director of health emergency management.
The helicopter ambulance service recently came under fire when Morgan Moar Campbell, a two-year-old boy, suffered brain damage after being deprived of oxygen during a transfer in May.
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A STARS crew picked the child up in Brandon on May 2 for a flight to the Children's Hospital in Winnipeg.
The toddler was sedated and had a breathing tube inserted in his throat, but the tube became dislodged during the transfer.
His case is being reviewed by Manitoba Health.
Boy's case not 1st critical incident
CBC News has learned that Morgan's case is not the first critical incident involving STARS.
Last year, STARS transported a patient from a small health-care facility in Manitoba to a tertiary hospital. The patient suffered a critical incident or an "unintended event that … results in a consequence to him or her that is serious and undesired."
Currently, every STARS mission is reviewed in some capacity, either internally by STARS or in the form of informal quality assurance reviews by Manitoba Health. Those reviews cover overall service, not just clinical care.
But in addition, the province has received several complaints from Manitoba hospitals regarding STARS missions. Those complaints have led to a number of clinical reviews.
"We haven't got complaints from the public on this issue, we haven't got complaints from the patients on this issue," said Delorme. "We do have some concerns that have been raised … from facilities."
Delorme described those hospital complaints as "normal."
The province says the STARS program is relatively new and it has been tweaking and improving its processes since it launched in Manitoba.
As for the quality assurance reviews, done for every case, the province says those are are standard procedures done to ensure up-to-date standards and policies.
On Wednesday, the NDP government faced questions about STARS from opposition MLAs.
"There has now been a second critical incident reported, and I think we have to be very concerned about the quality of care being provided on the air ambulance service," said Liberal Leader Jon Gerrard.
Said Cameron Friesen, the Progressive Conservatives' health critic, "If there has been investigations that have taken place in the province with respect to STARS, where are the recommendations with respect to those things?
"Manitobans deserve a high degree of confidence in this service, and the minister clearly today has questions to answer."
Friesen said his party has asked Health Minister Theresa Oswald to comment on why there was no disclosure of the previous critical incident, and whether there are other incidents Manitobans don't know about.
"None of these incidents are ever taken lightly," Premier Greg Selinger told MLAs during question period.
STARS reviews cases
STARS is a non-profit helicopter rescue service that provides emergency care and transport from three bases in Alberta, two in Saskatchewan and one in Manitoba. It has been in operation since 1985.
A spokesperson for the organization told CBC News that every case is reviewed by two pairs of eyes: the first is a peer review by another nurse or paramedic, and the second review is done by a STARS physician.
A STARS air ambulance crew consists of a critical care nurse, an advanced life-support paramedic and two pilots.
Manitoba contracted the organization to provide emergency services in the province during the floods of 2009 and 2011.
In February 2012, the province signed a 10-year service agreement with STARS to provide emergency medical services at a cost of $10 million per year. Saskatchewan followed suit and launched operations in that province in April 2012.
STARS has a foundation and charity that shares the operations costs with the provincial government. It relies on community fundraising, corporate sponsorships and individual donations.
Emergency referral physicians also fly with the STARS crew on approximately 20 per cent of responses and are available for telephone consultations during every mission.