Air Ambulance Service Under Review

[rock_shoes]

What are you using to gauge their success?

Lack of an inquiry showing failure does not indicate success.

29 years of operation without such an inquiry rearing its ugly head should be considered a success of sorts. I'm no more a fan of the big red PR monster than you are, but the amount of expansion from inception to now indicates those with the decision making power have considered them a success up until this hiccup in Manitoba.

[Arctickat]

29 years of operation without such an inquiry rearing its ugly head should be considered a success of sorts. I'm no more a fan of the big red PR monster than you are, but the amount of expansion from inception to now indicates those with the decision making power have considered them a success up until this hiccup in Manitoba.

Or those with the power were given high profile high paying jobs by STARS when he retired from government as a reward for assisting with their expansion.

http://www.stars.ca/news-and-events/media/news-releases/release.html?id=7

What disturbs me in this is that the Dr. Wheeler has identified the problem as a lack of education. STARS response was "But our flight teams in all of our bases have the same education." All this means to me is that the entire STARS organisation needs to be looked at because that comment is simply an admission of culpability to me, not a defense.

Edited March 5, 2014 by Arctickat

[mobey]

29 years of operation without such an inquiry rearing its ugly head should be considered a success of sorts. .

See this is an assumption on your part.

The lack of an inquiry does not indicate a lack of inadequacy. It also does not measure success.

STARS is such a PR powerhouse in this province, what doctor would sign his name too it?

[rock_shoes]

Or those with the power were given high profile high paying jobs by STARS when he retired from government as a reward for assisting with their expansion.

http://www.stars.ca/news-and-events/media/news-releases/release.html?id=7

What disturbs me in this is that the Dr. Wheeler has identified the problem as a lack of education. STARS response was "But our flight teams in all of our bases have the same education." All this means to me is that the entire STARS organisation needs to be looked at because that comment is simply an admission of culpability to me, not a defense.

See this is an assumption on your part.

The lack of an inquiry does not indicate a lack of inadequacy. It also does not measure success.

STARS is such a PR powerhouse in this province, what doctor would sign his name too it?

The plot thickens. That, Arctickat, is a very interesting and relevant circumstance. I'm 100% with you in regard to the training situation. If the Alberta and Manitoba operations are using the exact same training program it seems it took a less STARS struck Manitoba eye to take an objective look at operations.

Mobey, I'm with you on the STARS PR ridiculousness. As I said, I'm no more a fan of the organisation than you. I just refuse to throw the medics/nurses under the bus without seeing the evidentiary review.

[Arctickat]

Agreed Rock...the medical staff I know personally are highly competent and qualified. I would let any one of them treat me or my children....just not in a helicopter. I'm simply not convinced that the helo is the best option when my ambulance can make it to the city in 120 minutes doing treatments enroute when it takes a patient almost 200 minutes to get there when the helo takes them, (Depending on what treatments the flight crew provide upon arrival.)

[rock_shoes]

It would appear STARS Manitoba is back flying.

http://news.gov.mb.ca/news/index.html?archive=&item=30120

I didn't see any mention of the results from Dr. Wheeler's service review. Here's hoping his findings actually come to light and this isn't just swept under the rug thanks to STARS PR power.

[Arctickat]

Here is a link to the news article which includes the review

http://www.cbc.ca/news/canada/manitoba/don-t-put-stars-back-in-air-victim-s-father-urges-1.2563844

[rock_shoes]

All I can say is wow.

http://www.documentcloud.org/documents/1061486-final-report.html#document/p2

Based on Dr. Wheeler's report STARS Manitoba needs a complete re-tool from stem to stern. New training program, new dispatch criteria, new continuing competency plan, new physician training on transport criteria... Essentially the only thing Dr. Wheeler hasn't recommended is a new helicopter!

Wheeler’s recommendations:

· STARS should redesign its training program and certification process for its crews in line with other Canadian provinces and immediately supplement its crews with experienced flight personnel for a minimum of six months.

· STARS should review its pediatric training with an emphasis on airway assessment and management.

· STARS should be limited to transporting pediatric patients only in trauma scene responses.

· STARS should have on board medical personnel from Children’s hospital for all pediatric inter-facility transfers.

· STARS Manitoba and Manitoba dispatch Centre should establish a pediatric medical oversight model for triaging and dispatching pediatric patients.

· Further intensive training of STARS crews in advanced airway management should be done immediately.

· Video laryngoscopy should be included in STARS skill set for crews.

· Until STARS has well-trained crews, physicians should be onboard all missions with airway and ventilation issues.

· STARS should limit its transport of pediatric patients to trauma scene responses, and not carry out routine patient transfers between facilities, while it reviews its pediatric training. Emphasis should be on pediatric airway assessment and management.

· STARS should review its physician orientation process to increase the understanding of the advantages of different transport modalities.

· STARS orientation should include a set number of fly-alongs with crews.

· A dedicated, local Quality Improvement director should be established.

· STARS should express its commitment to be a quality organization and back up its commitment with action and accountability.

· STARS should develop a Crew Resource Management culture.

· All dispatching of air medical transports should go through central provincial dispatchers who will determine the most appropriate mode of transport.

· The patient should go by the faster means possible.

· A feasibility and cost analysis of building hospital helipads should be done for all Southern Manitoba hospitals.

· A comprehensive maintenance of competencies program should be established and monitored for STARS crews.

· STARS crews should be rotated through more high volume programs including other STARS bases and Manitoba Lifeflight.

· Quality control must improve because “overall, an emphasis on creating and maintaining a culture of quality is missing.”

Edited March 14, 2014 by rock_shoes

[triemal04]

I don't know anything about that part of Canukistan <cough> I mean Canada, or the politics that may or may not be involved, but I've got a couple of honest questions.

While Dr. Wheeler is the medical director for the BC Air Ambulance and has more experience with flight medicine than most doctors, what makes him the de facto expert? How and why was he chosen for this review? Is he a "name" as far as Canadian paramedicine (or medicine in general) goes? The reason I ask is that often when a review like this is taking place, multiple people are often involved so that multiple viewpoints can seen and to cut down on the potential for bias. It seems odd that only one person was picked, so if any of you can shed some light on that it'd be great.

A STARS spokesman has said that Dr. Wheeler was flat out wrong about a couple of the cases mentioned; running out of epi was one. Was that ever resolved, or is there the possibility of it being a case of "this guy said that" and "I think what happened was"?

The spokesman also mentions, and Dr. Wheeler confirms, that he had very limited time to look at all the evidence and finish his review. A spokesman saying this is one thing, but the person writing the review agreeing? That's concerning.

It doesn't matter to me one way or another, just seems like there are some oddities here.

Edit: he does have a good CV, so that's a partial answer, but not a full one.

Edited March 15, 2014 by triemal04

[systemet]

I think it's probably fair to say that Dr. Wheeler is an expert, based on his credentials. But, as you've pointed out, he is only one expert. There is also a clear and obvious conflict of interest here, in that he runs the BCAS program, which has a coverage area that overlaps with STARS bases in Alberta. To some extent, these services are in competition, and the potential for STARS to expand further can't have been overlooked.

I haven't met a lot of people from the BCAS CCT, or from ON ORNGE CCP programs. I'm sure they're excellent people, and it sounds like their training programs are very rigorous. I have met a lot of people from AB STARS, interacted with them on calls, and benefited from training programs offered from them. I found them to be extremely well-trained, knowledgable and competent, and have learned a lot from them.

Of course, my opinion is somewhat meaningless, as I am not an expert. It's also hard to compare the training between the different locations without having taken the training. There are a lot of unanswered questions here, that make it difficult to present an informed opinion.

-----------------------------

On another note entirely, the US audience may be interested to see that the discussion here is revolving around the provision of a single RW to a geographic area roughly the size of Texas (*albeit very sparsely populated), and whether this is even beneficial versus FW. Not a narrative likely to be explored stateside any time soon.