San Francisco 1983
Dr. R. Adams Cowley, a trauma surgeon at University of Maryland Medical Center, is widely considered the “father of trauma medicine.” In his 1966 report to the National Academy of Science, he noted “Trauma, from accidents and violence, is the leading cause of death for Americans from the ages of 1 to 44.” Many years earlier, Dr. Cowley had coined the term “golden hour,” referring to the crucial span of 60 minutes following serious injury when lifesaving measures have the greatest potential for successfully reversing the trauma imposed on the body.
It was this concept of the golden hour that sparked the emergence of air ambulance programs throughout the country. Air transport offered the victim of traumatic injury or illness the opportunity to receive specialized medical care within that critical first hour following a trauma incident. Air ambulance services were generally established and provided by hospitals.
But Dr. Donald Trunkey, director of trauma services at San Francisco General Hospital in the early 1980s, wanted to take the air ambulance concept one step further. He envisioned a regional air ambulance service that was patient-centered and community-based, rather than hospital affiliated. He shared his vision with Tom Drohan, then president and CEO of McKesson Corporation. Mr. Drohan embraced the vision and helped fund a feasibility study to examine the concept more thoroughly. Despite mixed results, Trunkey and Drohan persevered.
Sadly, before the organization came to fruition, Tom Drohan lost his battle with cancer. His successor, Neil Harlan, set out to complete the project to honor his memory. Harlan designated Marvin Krasnansky, McKesson's vice president of corporate relations, to work with Bay Area hospitals to overcome the competitive nature in the air medical transport environment. Krasnansky played an important role in uniting competing hospitals around a shared vision.
Unlike the hospital-based systems whose mission was solely to return patients to their own facility, the service Trunkey and Drohan envisioned would serve all San Francisco Bay Area hospitals in a non-biased fashion, transporting patients to the facility that would render the most appropriate care. There was one dilemma that needed to be overcome – how could this air ambulance program serve the Bay Area in an apolitical way, offering non-competing service that would be cost effective to the patient? “We wanted to design a helicopter rescue system for the patient, not for the hospitals or physicians,” said Dr. Trunkey. Establishing the air ambulance program as an independent, nonprofit public benefit corporation offered the solution; it ensured that services would remain patient-focused and would allow the organization to seek philanthropic funding.
McKesson took the lead in fundraising, making significant contributions of its own and asking other corporations and foundations to follow its example. This was the largest philanthropic venture for the McKesson Foundation, which provided the majority of the start-up funding. Other major contributors during the start-up phase were Chevron, Wells Fargo, Bank of America, Del Monte Corporation, Irvine Foundation and numerous other entities. When the funds were secured and the operating model was finalized, CALSTAR (California Shock Trauma Air Rescue) was born as the first consortium program of its type in the United States.
Eventually, 20 San Francisco Bay Area hospitals participated in the planning process. Among them were teaching hospitals, trauma centers and medical pioneers, including San Francisco General Hospital; Ralph K. Davies Medical Center; University of California, San Francisco Medical Center; John Muir Medical Center; Stanford University Medical Center; Santa Clara Valley Medical Center and San Jose Medical Center.
Flight Operations Begin
CALSTAR began operations in 1984 with a leased helicopter, using space at Peninsula Hospital in San Mateo. Trying to find the best location for its regional helicopter air ambulance, CALSTAR operated from a number of locations during the first few years of its existence.
By 1985, CALSTAR had started its own Federal Aviation Regulations (FAR) Part 135 operation and add a second base in Watsonville the following year. However, the high cost of service resulted in mounting debt. As operating losses continued, the company found itself on the brink of failure. Limited internal management capability and operating systems added to the challenge.
The CALSTAR board of directors faced some difficult decisions. They reorganized the company and returned to a single-aircraft operation to reduce costs. During the restructuring process, nearly half of the employees opted to leave; those who stayed agreed to accept lower salaries to keep the organization afloat. Board chairman Michael Heil, an executive with San Jose Medical Center, managed operations while recruiting a new executive officer.
In 1987, the Board hired Joe Cook as president & CEO. Cook was a former Army pilot with field experience as well as management expertise who had turned around other organizations in financial turmoil. He mapped out a business plan to return CALSTAR to a financially viable position. Within a year, CALSTAR was out of crisis and on the road to solid financial ground.
Innovation Breeds Expansion
From its inception, CALSTAR was often called upon for unique situations. During the California floods of 1986, CALSTAR helicopters flew needed equipment to areas inaccessible by road. In 1989, following the Loma Prieta earthquake, CALSTAR was the one of the first on-scene at the collapsed Cypress Viaduct (a raised freeway in Oakland) and transported one of the few survivors. As CALSTAR's innovative responses continued to influence the region, expansion came naturally. Having learned a harsh lesson about the nature of expansion in its early years, CALSTAR chose new service areas and bases more carefully. Today, CALSTAR serves its expansive coverage area with a fleet of Eurocopter B0 105s, Bell 222s, MD 902 Explorers, Cessna 421s and an Agusta 109.
By the early 1990s after testing several locations, CALSTAR 1 found a home in Concord. More CALSTAR bases followed in steady succession. CALSTAR 2 opened in Gilroy in 1993, and CALSTAR 3 was added two years later in Auburn. With these three bases, CALSTAR became the largest regional air ambulance provider in Northern California.
CALSTAR 4 (Ukiah) began operations in 1998. The next year CALSTAR acquired a fixed wing aircraft and established CALSTAR 70 to manage long distance inter-facility transports. In 2001–2002, the company added CALSTAR 5 (Salinas), CALSTAR 6 (South Lake Tahoe) and CALSTAR 7 (Santa Maria).
In 2004, CALSTAR moved its operational headquarters from Hayward to McClellan Park in Sacramento. Three years later, the CALSTAR Emergency Patient Transport Center (CALCOM) was established at McClellan to coordinate CALSTAR's inter-facility transports.
In 2006, a need was identified for air rescue services in Solano County and along the heavily-traveled Interstate Highway 80 corridor between Sacramento and San Francisco. CALSTAR responded with its eighth helicopter base, CALSTAR 8 in Vacaville.
In 2008, CALSTAR saw an opportunity to enhance services in the rural, agricultural and mountainous regions of the state. Hollister was identified for future expansion as CALSTAR 9 to serve more of Monterey and San Benito Counties. CALSTAR 10 opened in Jackson in 2009 to serve Amador County.
In April 2010, Joe Cook retired as president and CEO of CALSTAR after more than 22 years of service. CALSTAR CFO Lynn Malmstrom was chosen to succeed Cook, and he pledged to uphold CALSTAR's excellent patient care and safety record. “Joe has set the bar high, and we intend to keep it there,” he said. “We have an outstanding team, and together we can keep the company thriving.”
Since beginning flight operations in 1984, CALSTAR has transported more than 40,000 critically injured or ill patients to hospitals and trauma centers throughout California and Northern Nevada. Guided by sound business practices, future growth will be determined by a number of factors, but community need for CALSTAR's life-saving services will remain a critical element in the decision-making process.