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Put restrictions on STARS flights, report urges

Flight crew on the province's Shock Trauma Air Rescue Society helicopter ambulance service won't be able to fly kids under 12 from hospital to hospital until they have the proper backup in place at Children's Hospital.

The recommendation is one seven made in a report released Wednesday by the province on allowing the helicopter emergency service back to full flights. The report and its recommendations are the work of the province's clinical oversight committee on STARS led by University of Manitoba dean of medicine Dr. Brian Postl.

"No pediatric inter-facility transfers are going to happen before that pediatric transport team is in place," Health Minister Erin Selby said.

Air-ambulance report

What the it says about transporting children hospital to hospital:

The needs of children must always remain paramount to any emergency medical service.

They require highly specialized services and generally are low volume, relative to adult needs.

In 2011-12 there were 449 pediatric transports (48 by air). This increased to 792 in 2012-13 with 417 transported by air. The vast majority are Northern Region with Children's Hospital as the main destination. The majority of these calls would be in the neonatal age group and they are well-served by a pediatric transport team.

A similar model is proposed for children (to age 12) involving physician and staff of Children's Hospital. The on-call pediatric intensive-care unit attending could serve as a medical consultant regarding the dispatch decision of this team which would include the pediatric respiratory therapist, ICU nurse and ICU physician if required.

This would free up money to provide and support a pediatric transport team for helicopter emergency services and (fixed-wing) LifeFlight needs.

This is an essential recommendation and STARS should not be involved in inter-facility transport of children under the age of 12 until it is put in place.

A process is already in place for neonatal flights, and STARS is allowed to fly children to hospitals from emergency scenes, such as vehicle collisions.

STARS was temporarily suspended from flying all medical flights last Dec. 2 following the death of a woman after an inter-hospital flight in late November. It was the third serious case in a year involving the Alberta-based helicopter air-ambulance service. One included a case in May last year involving two-year-old Morgan Moar-Campbell, who was being flown to Winnipeg from Brandon on a STARS helicopter for tests following a seizure. The boy was in an induced coma and could not breathe on his own. When he landed in Winnipeg, it was discovered his breathing tube had become dislodged, depriving him of oxygen and severely damaging his brain. His case is the subject of a lawsuit.

On March 7, STARS was allowed to fly again by the province, but only in response to emergency scene calls. STARS was allowed to resume adult hospital-to-hospital flights July 2 when the enormity of this summer's flood threat was determined.

Postl said in the report there have been "serious issues in communication" between STARS and health department officials since STARS started flights in Manitoba about three years ago.

"This has existed for many reasons, but I note there is opportunity for improvement in the formal structure for communication," Postl said. "I would recommend an operations-liaison committee be established and they meet monthly or more frequently at the call of the chair. Agendas should be focused on information sharing and problem solving."

The panel recommended STARS pursue Canadian Medical Association accreditation and that it be integrated into the province's 911 emergency medical services system through Brandon's Medical Transportation Coordination Centre. The centre coordinates the dispatch of all rural and northern emergency medical services in the province.

As well, Manitoba Health is to complete the transfer of the STARS service purchase agreement to the Winnipeg Regional Health Authority, effective Aug. 1. This process has been underway for several months and is intended to give STARS medical crews experience in Winnipeg's emergency medical system.

STARS spokesman Cam Heke said STARS will comply with each of the recommendations.

"We strongly feel that by working with the medical community in Manitoba we can provide a world-class helicopter EMS service right here in Manitoba," Heke said.

The recommendations apply to only Manitoba and STARS operations.

STARS has been dispatched to 721 missions and has transported 486 patients since 2011.

The Manitoba government awarded STARS a 10-year contract, worth about $10 million per year, in 2013, a move criticized by the province's former auditor general, Carol Bellringer, last March for not following the province's public tendering principles and policies.

The not-for-profit STARS is also funded through corporate, community and individual donations.


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