Life-Saving Transport and Care Through STARS and RNSPs

Residents of the Canadian prairies are all familiar with hearing the whirring sound of a helicopter overhead and know that when they look to the sky and see a red helicopter with STARS inscribed across the side in bold white letters, that the team within are playing a major role in saving the life of an individual nearby.

Tracey Steel, RN

STARS is a non-profit critical care transport provider in Western Canada and serves rural and remote parts of Manitoba, Saskatchewan, Alberta and parts of British Columbia with six bases and eleven helicopters. Each helicopter is equipped with a four-person team including two pilots, one Registered Nurse (RN) and one Critical Care Paramedic.

Tracey Steel, RN was hired as both a flight nurse and a manager when the Saskatoon STARS base opened in 2012. Tracey spent eight years in her management role before becoming Director of Clinical Operations for all STARS bases. Her role now includes overseeing clinical operations at all six bases including all the air medical crews, with the occasional flight shift mixed in as well.

Given the large population of Saskatchewan residents living in rural and remote communities, STARS responds to both 9-1-1 scene calls and inter-facility transports. Tracey shares that STARS is an ideal critical care transportation option for the Prairies as, “We can go anywhere. If we had to land on Circle Drive, or a farmer’s field, in the right circumstance, we could. We can land anywhere.” This is especially helpful given the number of rural accidents, northern incidents and rural hospital transports the team tends to. There may even be times when STARS is called upon to assist the RCMP with search and rescue as eyes in the sky.

The RNs who are a part of this dynamic team, are able to practice in this role because of Registered Nurse Specialty Practices (RNSP). Though most of the RNs joining the STARS air medical crew come with previous experience in the Emergency Room (ER) or Intensive Care Unit (ICU), they are all required to receive six months of critical care training by STARS. This training includes gaining competencies in RN Specialty Practices such as using and running ventilators, advanced airway practices, performing ultrasounds, assisting with central line placements, cardiac management, critical care medications and more. Tracey stresses that it takes a certain type of person to be a member of this team, not only because of the work they do, but the training required, “The training is extensive, and there’s a lot of ongoing continuing education.” This is all for good reason though, as Tracey highlights that, “It’s a high consequence environment. You have to be proficient.”

It is because of this extensive ongoing training that their teams are so successful. All RNs and paramedics are cross trained which allows them to be proficient on-site, in transit and in all aspects of the care they provide. Tracey says when it comes to in-flight care, “You need all hands-on deck. That’s why we work in a team of two, and certainly they compliment each other really well, the two professions.” These two-person air medical crews put the STARS model to practice in that all responsibilities and roles in the back of the helicopter are shared - there is no one leader.

To ensure their continued success, regular ongoing training takes place with days dedicated to areas of care that require additional time and specialist instructors. Tracey highlights that these types of skills are ones that a Registered Nurse would not have right out of university. “In order to remain skilled and provide high quality care for these critically ill patients, we have a very robust education program.” Each year, every member of the team is required to complete 100 hours of mandatory training, with specialized training days specific to airways, ventilators, pediatrics, trauma, cardiac, medical, ultrasounds and advanced obstetrics and delivery. She says that these types of specialized training days help to optimize treatment and care provided by the team.

While in flight, the team references critical care medical protocols for guidance in terms of medications and treatment, putting their RNSPs into practice during every call. They also have close communication with an on-call transport physician for anything that may fall outside of this reference guide and to help coordinate the receiving destination for patients. These transport physicians play a key role in the STARS model and in the team’s success as the air medical crew operates under their medical guidance. The transport physician is available to fly with the air medical crew 24/7 if required for specialized procedures or if they require an additional set of hands such as a mass casualty incident (MCI).  From hands on education days to scene calls, the physicians are involved every step of the way, it’s a coordinated effort by all team members.

All in-flight practice is evidence-based, with research playing a large role in the care they provide, learning from other helicopter emergency transports around the world and other health care professionals who share medication or treatment options that may be of use to the team. The STARS crew is always adding and removing specialty practices to their repertoire as patient needs and health care practices change and evolve. Regular reviews of the equipment and protocols take place, with a large focus on what the latest research is showing for in-flight procedures. A medical leadership team meets frequently to ensure the most appropriate equipment is being used, training is being implemented and additional competencies are incorporated as needed.

The process required for becoming and remaining a member of this specialized team may sound rigorous but given the situations the STARS air medical crew are presented with, it is necessary. Tracey emphasizes that, “In the hospital you have a lot of support services. You have RT and you have lab and you have ECG. You’re doing all that stuff on your own. You’re the lab, you’re the ECG, you’re the EMS. You’re the ICU nurse, you’re the emerg nurse. You have to do it all because it’s just you and your partner and you have to be competent in a number of skills.” This statement alone emphasizes the importance of RNSPs in the model utilized by this organization. Without them, STARS would not exist in Saskatchewan the way it does today.

Now when you look to the sky and see the red STARS helicopter, think about Tracey and the other skilled health care professionals that have achieved a level of training and expertise that makes this life-saving air transportation we are able to rely on when we need it most possible.

“In the hospital you have a lot of support services. You have RT and you have lab and you have ECG. You’re doing all that stuff on your own. You’re the lab, you’re the ECG, you’re the EMS. You’re the ICU nurse, you’re the emerg nurse. You have to do it all because it’s just you and your partner and you have to be competent in a number of skills.” Tracey Steel, RN

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