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STARS ALLEVIATES PRESSURE ON ICUS WITH COVID-19 PATIENT TRANSFERS AS CASES SPIKE

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By the time most patients infected with COVID-19 need care from STARS, they are critically ill.

They are physically exhausted and can’t breathe on their own. For most, there is no treatment option for our crews but to intubate and prepare them for a mechanical ventilator to take over the job of breathing in an effort to save their lives.

“It’s heartbreaking to see how profoundly ill they are,” said Janice Kirkham, clinical operations manager, and flight nurse at the Calgary base. “Without intervention, they will likely die.”

When STARS is dispatched to care for and transfer these patients to intensive care units (ICUs), they’ve typically just arrived at their local hospital, after trying to manage their symptoms at home. When we arrive, our medical crews often intubate the patient, if they haven’t been intubated already. They are sedated and a tube is inserted into their trachea.

In a best-case scenario, we fly them to an ICU close to their hometown. Some may be flown to a hospital further away or even to another province because ICUs closer to home are full.

Ray Rempel, clinical operations manager, and flight paramedic at the Winnipeg base, doesn’t mince words about what happens next.

“It’s shocking what this virus is doing to people, even the young and healthy. By the time we see them, they are physically depleted, they’ve been separated from their family, then mechanically ventilated, and chemically sedated while medical staff help them survive,” said Rempel.

“They are often unresponsive for three weeks in hospital and if they wake up, they are in a state of delirium, surrounded by strangers wearing masks and wondering what has happened to them and when they might go home.”

If patients survive, often their other vital organs have been impacted and their muscles are wasting away from their bed-ridden state. Many have a long and difficult road of rehabilitation ahead.

From when the World Health Organization first declared COVID-19 a global pandemic in March 2020, to Sept. 30, 2021, STARS has cared for 525 patients with symptoms consistent with COVID-19 or known COVID-19-positive. That is 11.4 per cent of our total missions in that same timeframe.

We have cared for patients in small hospitals and medical centres, inside our helicopters, in ground and airplane ambulances, and we have provided phone and virtual consultations with doctors in medical facilities across the Prairies.

Some waves of the pandemic are busier than others, such as the case in the fall of 2020 when 18 per cent of our missions were COVID-19-related, compared with 12.5 per cent earlier that spring.  We saw another uptick in COVID-19-related missions during the fourth wave, or the “Delta wave” this past summer when, for a three-week period, one of every five patients we saw had COVID-19 symptoms.

On Sept. 24, we reached a one-day record, transporting six COVID-19 patients in one day.

Many of these days are tiring for our flight crews, particularly this past summer when the mercury soared to record temperatures. Underneath their mandatory head-to-toe personal protective equipment (PPE), our medical crews wear full fire-retardant flight suits, gloves, helmets, and masks, making the hot days uncomfortable.

“No one would be surprised to hear that our full equipment is warm on a typical day inside the helicopter, but when you add PPE and masks, it can be fatiguing for our crews,” said Kirkham. “We just make sure that we are taking breaks, eating and staying hydrated so we can care for the next patient.”

Following every mission with a suspected or confirmed COVID-19 patient, the inside of the helicopter undergoes a rigorous decontamination.

During decontamination, we wipe down all the walls, floor, and everything inside: seats, seatbelts, helmets, and every piece of equipment, whether it was used for the patient or not.

Rempel says the crews, like all health-care workers, are resilient and taking each day in stride.

“We’ve all come to learn that this pandemic is a marathon, not a sprint, and we have to pace ourselves,” he said. “The only difference is the finish line keeps moving.”

Rempel and his medical colleagues are honoured to be working on the frontline of the pandemic as a critical piece of the health-care system. Inter-facility transfers are common for STARS, as roughly half our missions typically involve moving patients from one hospital to another.

Occasionally, the need for STARS and how we operate looks different than usual.

In early summer of this year, for instance, dozens of Manitobans were sent to out-of-province hospitals for critical care and STARS was asked to assist. Rempel was among many flight crew members who jumped in to help.

“Health care in our country is in crisis,” said Rempel, referring to the effect that COVID-19 is having across Canada. “We have the skills and ability to make a difference for these patients and will continue to do that.”

While all six bases have been busier than normal thus far, Manitoba also added additional crews to assist on airplane ambulance missions, as part of our fee-for-service contract with the provincial government. This additional staffing meant that, at times, we had three aircraft operating during the day and two overnight in Manitoba.

For Rempel, his proudest moments have been being part of the crew that brought Manitobans home after receiving care in ICUs outside the province.

“Repatriation is the most rewarding work I’ve ever done,” he said. “Calling a family member from a patient’s bedside in another province to let them know their loved one is coming home stirs up a strong sense of pride.”

In Alberta, a peak of the pandemic struck this past summer, when ICUs reached capacity amid the Delta wave. With this came an increase in requests for inter-facility transfers: moving patients critically ill with symptoms consistent with COVID-19 or known COVID-19-positive between hospitals across the province from our three bases, to help alleviate the pressure on the health-care system. To accommodate the need, we’ve moved crews and helicopters around to be available where the need is greatest.

In Saskatchewan, we added a third helicopter and crew on two separate occasions at the provincial government’s request to help cope with similar capacity challenges, also on a fee-for-service model.

In many of these cases our crews moved around their respective provinces and even crossed provincial borders to help where needed.

At the same time, we continue to respond to other medical and trauma-related requests as we always have.

“On top of pandemic calls, we are still caring for patients with traumatic injuries, drownings, motor vehicle incidents and other unfortunate events, in addition to medical illnesses such as heart attacks and strokes,” said Dr. Jamin Mulvey, medical director at STARS, anesthesiologist, and emergency room doctor. “Our crews are doing a great job of keeping up and staying healthy.”

In the STARS Emergency Link Centre (ELC), keeping staff safe and available for duty is a top priority and several measures are put in place to achieve this. When the pandemic was declared, half of the communications specialists were moved to a back-up location, which is typically reserved for emergencies such as a fire or power outage at our main site. We also divided staff from the ELC into cohorts to limit exposure risk.

“Like many organizations, we only have a limited number of staff, and we couldn’t afford to lose anyone to infection or face an outbreak,” said John Griffiths, director of the ELC. “We continue to physically distance, mask up in common areas and count on our vaccines to ensure our staff is protected and we can care for the patients who need us.”

In addition to caring for patients, Tracey Steel, director of clinical operations, emphasizes the importance for our staff, from the administration team and corporate services, to engineering and operations, to take care of their physical and mental health. STARS has robust programs in place to help with this, including paid sick days, peer-to-peer support and an employee health and wellness program.

For Steel, learning and growing alongside other health-care providers as we witness the science evolve and battle the global pandemic together, has been inspiring. Highlights include an online education portal developed by our education team to share learnings, collaboration with other professionals and integrating best practices acquired by other organizations.

“We are learning so much about PPE, different medical interventions in transport and ways to permanently implement some of these best practices into our critical care,” she said.

“COVID-19 has impacted the whole organization. From our standard operating procedures to the way we meet as an organization, the pandemic has changed the landscape of the work we do.”

Amid several waves of the pandemic, the introduction of vaccines, strain on our health system and other developments over the past year and half, everyone has had to adapt.

The one constant is that STARS has remained on the frontlines of health care, caring for the critically ill and injured 24 hours a day.

That means in addition to caring for patients with COVID-19, or other illnesses such as heart attacks or strokes, we’ve continued to care for those who’ve sustained traumatic injuries, too.

None of this could happen without support from you.

“In these unprecedented times, our foundation team has been nimble in finding new and creative ways to fundraise in support of the mission and STARS’ ongoing commitment to excellence,” said Terri Strunk, chief fundraising and brand officer.

Strunk noted that although some in-person events were cancelled or reimagined, STARS was one of the first charities to hold a successful virtual concert shortly after the pandemic was declared.

On top of that, our lottery program has remained strong, and a large base of regular donors, both corporate and individuals, has kept us going.

“It is only because of the steadfast support of our allies that we have been able to do this important work. It’s clear that our donors care deeply about the health and well-being of people who live, work and play in their communities.”

Deborah Tetley

Deborah Tetley

Deborah is a journalist, who found a second life in MarComm as a leader and mentor thanks to an educational and thrilling ride at STARS, a beloved helicopter air ambulance non profit. My extensive career in journalism, coupled with my public relations, marketing and creative agency experience, allow me to showcase my skills in copywriting, editing, brand building, interviewing, strategy and storytelling.

Canadian Paramedicine

Canadian Paramedicine

Canadian Paramedicine provides a platform for exchanging ideas and innovative programs, emerging news, trends, research, politics, and association information affecting Paramedicine in Canada and around the world.

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