The Manitoba government's suspension of STARS air ambulance flights in the province, in light of a recent patient death, has prompted tough questions about the service.
The Shock Trauma Air Rescue Society was temporarily suspended on Sunday on the advice of medical professionals, after a female patient died shortly after being transported by a STARS aircraft to a Winnipeg hospital last week.
Officials are investigating the woman's death as well as two other "critical incidents" involving STARS transports, Health Minister Erin Selby announced late Monday.
As well, the province is having an external review look at 15 other cases.
On Tuesday, Selby was asked by reporters why STARS was allowed to continue operating after the first two critical incidents.
"Medical doctors advised us at that time to put some more procedures in place. Those procedures were put in place," she said.
"Now, if they weren't followed, that's a concern, and that is why after this third critical incident, we had serious concerns those procedures were not being followed."
Patient had cardiac arrest
According to the province, the female patient went into cardiac arrest late in the evening on Nov. 28 and was taken from somewhere in the province's Southern Health Region to Winnipeg for further care.
The woman had been cleared for takeoff, but died after landing in Winnipeg.
Officials say they are now investigating the woman's death to determine what sort of oxygen she was given and whether it was adequate.
More specifically, investigators will determine what, if anything, happened on board that had an impact on the woman’s death.
Gerry Delorme, Manitoba Health's executive director of health emergency management, said on Monday that based on the three critical incidents involving STARS, "basic medical practices and basic medical advice appears not to have been followed."
Founded in Alberta in 1985, STARS operates a helicopter air ambulance service in Manitoba, Alberta and Saskatchewan.
In 2011, the Manitoba government signed a 10-year agreement with the society that would see the helicopter and its crew provide support to the province.
The province's annual operational budget for STARS is $12 million, which covers costs for the service itself as well as dispatch and other costs to keep it running 24 hours a day, seven days a week, according to a government spokesperson.
Since signing the agreement, the air ambulance service has flown nearly 700 missions in the province, resulting in more than 430 patient transports.
The current suspension only applies in Manitoba, and the province's review could take several weeks.
Former patient's dad grateful for STARS
Among those who are grateful for STARS is Allan Houle, whose 25-year-old son, Michael, was killed in a crash in Sandy Bay, Man., last year.
Houle said a STARS helicopter picked Michael up in Sandy Bay, a remote community that is a one-hour drive away from the nearest airstrip.
"They put everything on Mike to keep him basically alive," he said, adding that the STARS crew did what they could while Michael was in their care.
Michael Houle later died in a Winnipeg hospital, but his father said it's vital to have a helicopter ambulance that can travel quickly to remote communities like Sandy Bay.
"The quickest way to get there is pretty vital, so I feel sorry for the people that are going to suffer taking a longer trip into the hospital," he said.
STARS spokesperson Colin Fast said the service is fully co-operating with the province's review, and he's confident it will get the green light to continue operating in Manitoba.
"We've flown hundreds of patients during the past 2½ years," Fast said Tuesday.
"I think it made a real difference in a lot of people's lives, and that's something that we've heard from a lot of former patients ourselves."
Backup plan in place
Meanwhile, Selby assured Manitobans that a contingency plan is in place to deal with cases that require an air ambulance.
Lifeflight and a basic air ambulance service will be expanded into Manitoba's southern communities. Manitoba Health currently operates 24 basic air ambulances and two Lifeflight jets that are staffed by a physician, according to officials.
The health minister would not comment on what could happen if the STARS review goes poorly for the air ambulance service.
Selby defended the government's decision to bring STARS to Manitoba in the first place, and she said it's too early to say if the province would get out of its contract.
She pointed to the hundreds of successful patients STARS crews and aircraft have transferred, as well as the vital role the service played during the 2009 flood.
"Up until this time … the doctors who were in charge of looking at the STARS service had all assured us that we were providing a safe transport for patients," she said.
"When their opinions changed, when they had some concerns, we acted immediately."
Restrictions imposed earlier this year
The other two critical incidents involving STARS involve an adult patient in February and an incident in May involving two-year-old Morgan Moar Campbell, who suffered brain damage after being transported on a STARS flight from Brandon to Winnipeg for care.
Morgan was sedated during the flight and had a breathing tube inserted in his throat. The tube somehow came out while he was being moved from the helicopter to an ambulance in Winnipeg, the toddler's parents have said.
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On Tuesday, a provincial government spokesperson told CBC News that six dispatch restrictions were placed on STARS after the first critical incident:
- All transports involving children less than 12 years of age must be done with a physician on board the STARS aircraft. The only exception to this would be scene-response cases, which fall into the auto-launch criteria. There was a physician on board during the 2nd and most recent critical incident.
- STARS will only be dispatched to calls beyond the 50-minute helicopter emergency medical services zone (such as a location like Brandon) if Lifeflight is on another call elsewhere and if the patient is believed to be stable enough for transport by a nurse/paramedic team. The exception to this condition would be certain types of emergent transport, and/or the inability to reach the Lifeflight physician for triage purposes.
- Calls outside the STARS’s fly radius must be triaged by a Lifeflight physician. STARS must implement the medical direction provided by the Lifeflight physician.
- All calls must be triaged by a Manitoba physician, and the STARS Emergency Link Centre will not be involved in the co-ordination of any Manitoba inter-facility transports. If the STARS physician or medical director is unavailable, the Lifeflight physician will triage the call and approve the mission, if appropriate.
- Any call that may result in the transport of neonatal patients must be immediately triaged by the Health Sciences Centre (HSC) neonatal transport team.
- Physician consultations, bed locations services and any other services offered by STARS that do not have the express permission of the emergency medical services branch of Manitoba Health may not be conducted.
(Source: Province of Manitoba)