Nationwide, helicopter air ambulance programs are a key vehicle in delivering thousands of trauma victims to trauma centers within the "Golden Hour". Frequently, patients accepted by a hospital for routine care can deteriorate or develop complications requiring immediate transport to another hospital for specialized treatment. Ground ambulance services are not normally staffed to provide the level of patient care required of many critically ill patients. Commitments to county emergency services often limit ground ambulance availability. Patient time outside the hospital environment and the level of patient care required, are important transport considerations.

Critical Care Transport requires medical staff to maintain proficiency in a myriad of patient disciplines. Federal OBRA/COBRA legislation passed in 1989 and 1991 place the responsibility for patient transports clearly on the sending hospital physician. Yet, a lack of physicians and nurses for transports at the sending facility can cause significant delays in transporting patients to receiving hospitals for urgently needed specialty care. As the medical industry continues to face increased competition and pressure to limit charges, median patient condition prior to transport continues to deteriorate. This results in a need for immediate rapid transport of patients between hospital facilities that frequently can only be met by helicopter ambulance.


COMPANY & MISSION:
CALSTAR is a stand alone 501(c)(3) nonprofit organization founded in June 1983.
The mission of the company is:
"To save lives, reduce disability and speed recovery for victims of trauma and illness through rapid transport, quality medical care and education."


COMPANY OBJECTIVES
A. To provide a medical transportation system available on a 24-hour basis that brings rapid, on-site medical care to critically-ill and/or injured patients.
B. To transport those patients from the scene or from community medical facilities to specialized treatment centers for definitive care.
C. To specialize in the air transport of pediatric patients.
D. To provide the Northern California medical emergency services community with specialized education and training in the initial resuscitation, stabilization and transportation of critically ill and critically injured patients.
E. To provide a cooperative, nonprofit health care organization model to be utilized in other parts of California and the nation.
F. To provide county emergency medical services (EMS) agencies of California, assistance and input in developing appropriate helicopter ambulance utilization regulations, coordinated with other county EMS prehospital care resources.
G. To provide educational programs for training first and second responders in helicopter operations, pre-hospital care and preparation of critical trauma patients for transport to trauma centers. Education and familiarization programs are also available for departments of both sending and receiving hospitals.


MEDICAL CONTROL, PROCEDURES & QUALITY ASSURANCE
Medical Control is provided by CALSTAR's Medical Director. Nurses provide care under CALSTAR's Medical Control in accordance with the California Nurse's Practice Act of 1974. Care is provided in accordance with company procedures, protocols and standardized procedures (expanded roles). All of the medical care provided by CALSTAR comes under close scrutiny in the organization's Quality Assurance Program which is protected under Section 1157.5 of the California Evidence Code. Medical Control for "911" scene transports is established by agreement with each county.


AVIATION AUTHORITY
Most helicopter ambulance programs contract for flight operations with an outside vendor. CALSTAR operates under its own FAA Part 135 Air Carrier Certificate and is directly responsible to the FAA for all aspects of flight operations and aircraft maintenance. This enhances safety through tighter control of crew training and aircraft maintenance, resulting in improved crew teamwork, reduced aircraft downtime, improved management and better communications.

CALSTAR operates a fleet of Eurocopter MBB BO-105, and Bell 222 helicopters. These twin turbine helicopters combine high performance and quietness of operation with reliability and economy. All aircraft are modified with special medical interiors, high skid gear, high intensity search lights and over 20,000 radio frequencies for communications with any agency. A Cessna 421 airplane is also available for long-haul and all-weather transports.

THE ORGANIZATION
A. Organizational Model
CALSTAR was the first public nonprofit helicopter ambulance supported by a consortium of corporations and hospitals in the nation. CALSTAR's organizational model was developed to avoid the cost inefficiencies inherent in many hospital based helicopter ambulance programs. Helicopter ambulance programs operated by single hospitals invariably become loss leaders for those institutions with other patients subsidizing the revenue loss. CALSTAR was designed in anticipation of continuing cost containment trends in health care reimbursement that are impacting existing helicopter programs. As insurers have attempted to reduce payments for patient transportation by adopting more stringent medical necessity criteria, or capping payment rates, single hospital programs face termination, consolidation, or shared support relationships similar to CALSTAR.
B. Flight Crew
A Pilot and two critical care Flight Nurses (RN's) make up the normal CALSTAR flight crew. Pilots have a minimum of 3000 hours of turbine helicopter flight time. Flight Nurses have three to five years experience in either an intensive care unit or emergency room and many have prehospital care experience prior to joining CALSTAR. All Flight Nurses undergo an intensive course (didactic & clinical) in aeromedical transport, pediatrics, basic trauma life support and prehospital care prior to commencing flight duties. Flight Nurses are required to maintain certification as a Certified Flight Registered Nurse (CFRN), Critical Care Registered Nurse (CCRN), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).
C. Basing
CALSTAR's flight crews respond from fixed bases in Auburn, Concord, Gilroy, Salinas, Santa Maria, South Lake Tahoe and Ukiah California. CALSTAR' s headquarters, administration, maintenance and training facilities are at McClellan Park, California. Temporary bases are sometimes used during seasonal weather or to meet unusual mission requests.
D. Education & Training
To enhance safety in "911" scene operations CALSTAR provides a comprehensive training program in aircraft operations to fire departments, law enforcement or other first responding agencies in the "911" emergency system throughout California. This training includes such subjects as: aircraft safety, patient preparation for transport, landing zone selection and control and patient loading requirements. Programs in preparation and receiving of aeromedical patients are available to all hospitals using CALSTAR. Similar programs in helicopter operations as well as education and training on the management of critically ill/injured patients are provided to EMS ground ambulance responders throughout CALSTAR's area of operations.
E. Additional and Specialized Transportation
CALSTAR provides helicopter transportation for medical teams and supplies. Member hospitals may also participate in the development of specialized transportation programs for neonatal, transplantation or cardiac patients requiring special equipment and medical personnel.
F. Corporate Structure
California Shock Trauma Air Rescue (dba) CALSTAR, is a California nonprofit public benefit corporation founded in 1983. Planning and development funding was provided by the McKesson Corporation and other Bay Area organizations. Ongoing support funding is provided by public and corporate contributions and member hospitals. The CALSTAR organizational structure will support many member hospitals as well as corporate and individual members. CALSTAR manages the majority of the components of the program and subcontracts some for economic reasons. Organizational components include:

1.   Administration
2.   Medical Direction
3.   Program Management
4.   Aircraft Maintenance
5.   Medical Operations
6.   Flight Operations
7.   Dispatch
8.   Finance
9.   Receivables/Collection
10. Media/Public Relations
11. Quality Assurance/Research

G. Governance
The CALSTAR Board of Directors is composed of representatives from hospital and corporate members who have provided financial support for the company. The Board oversees the organization to ensure that sound business, medical and aviation practices are followed. This group works with management to establish short and long term goals consistent with the mission of the company and its program objectives.

ACCOMPLISHMENTS
Since CALSTAR commenced flight operations in August of 1984, over 15,000 Critically injured or ill patients have been transported on an emergency basis to hospitals throughout Northern California. Today, approximately 75% of these flights are in support of Northern California's "911" emergency services network. Approximately fifty percent of CALSTAR's flights have been transports of children. Safety has been a key objective of the program. To date, CALSTAR has flown over 12,000 accident/incident free flying hours in the performance of its mission.


CALSTAR is fully accredited by CAMTS

What does being fully accredited by CAMTS represent in the medical transport industry?

CAMTS  is an organized forum made up of professionals from every aspect of the medical  transport industry. To be CAMTS accredited acknowledges CALSTAR as a medical transport program demonstrating overall quality of service.  CALSTAR is proud to be formally recognized as a program of excellence and one with the highest of standards.

CALSTAR is one of 78 services to be accredited by the Commission on Accreditation of Medical Transport Systems.  CAMTS accreditation is a voluntary process wherein medical transport services are able to verify their adherence to quality standards.

Who is the Commission on Accreditation of Medical Transport Systems? The Commission is a non-profit organization dedicated to improving the quality and safety of medical transport services. CAMTS is a consortium of 14 member professional organizations, each of which is represented on the CAMTS Board of Directors.

Member organizations include:
Aerospace Medical Association
Air Medical Physicians Association
American Academy of Pediatrics
American Association of Respiratory Care
American College of Emergency Physicians
Association of Air Medical Services
National Air Transportation Association
National Association of Air Medical Communications Specialists
National Association of State EMS Directors
National EMS Pilots Association
National Flight Nurses Association
National Flight Paramedics Association

To learn more about CAMTS, please visit their website at: www.camts.org