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Nearly a year earlier, the Director of Trauma Services
at San Francisco General Hospital, Donald Trunkey, M.D.,
had approached Tom Drohan, President and Chief Executive
Officer of the McKesson Corporation, and painted a vivid
picture of his dream. Mr. Drohan was convinced of the
need for this regional air ambulance service and a feasibility
study regarding this concept was conducted. Although the
findings of the study were lukewarm, Dr. Trunkey pressed
on, soliciting the participation of major hospitals throughout
the San Francisco Bay Area. It was theorized that the
air ambulance would not be successful without the support
of all of the regional hospitals. Dr. Trunkey and Mr.
Drohan wanted this program to be a regional transport
system, and over twenty hospitals participated in the
development stages of CALSTAR. Unlike the current trend
of hospital-based systems whose mission was solely to
return patients to their own facility, CALSTAR would serve
all of the tertiary care centers in the San Francisco
Bay Area. Sadly, before this project could be started,
Tom Drohan passed away from cancer. His successor, Neil
Harlan, set out to complete the project in his honor.
Marvin Krasnansky, Vice President, Corporate Relations
for McKesson, worked with the hospitals to overcome the
competitive nature in the air medical transport environment,
and was prominent in ensuring the conception of CALSTAR.
This regional air ambulance program would serve all hospitals,
in a non-biased fashion, transporting patients to the
facility that would render appropriate care. There was
one dilemma that needed to be overcome. "How could
CALSTAR 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," according to Dr. Trunkey. San Francisco General Hospital
was integrally involved in the formation of CALSTAR. Ralph
K. Davies Medical Center, a pioneer in the field of microsurgical
reimplantation, was one of the foremost participants.
The University of California, San Francisco Medical Center,
as a teaching hospital, identified a need for this type
of program in the Bay Area. Numerous trauma centers were
prominent in the development of CALSTAR: John Muir Medical
Center, Stanford University Medical Center, Santa Clara
Valley Medical Center and San Jose Medical Center. Nearly
all of the hospitals in the San Francisco Bay Area and
surrounding communities had some input or affiliation
with the project.
McKesson took the lead in fundraising, with significant
contributions of its own and by approaching other corporations
and foundations asking them to follow McKesson's 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. CALSTAR was designed to provide both scene transport
and interfacility transfers to tertiary care centers.
With the goal of becoming a statewide service, the name
California Shock/Trauma Air Rescue (CALSTAR) was selected.
CALSTAR completed 235 flights in the first year of operation.
The concept was now a reality.
CALSTAR was the first consortium program in the United
States. The founding Member Hospitals were Brookside Hospital,
John Muir Medical Center, Pacific Presbyterian Medical
Center, San Francisco Medical Center, Santa Rosa Community
Hospital, St. Helena Hospital University of California,
Queen of the Valley Hospital, Ralph K. Davies Medical
Center San Jose Medical Center, Peninsula Hospital and
San Francisco General Hospital. Ironically, Stanford University
Hospital had withdrawn from participation in CALSTAR and
formed its own, independent hospital-based, program that
began operation one month before CALSTAR. "Stanford's
leaving was very troubling because it undercut the philosophy
of CALSTAR" according to Mr. Krasnansky. It was also
a great disappointment that the City of San Francisco
would not allow helicopters to land within the city limits.
All landing zones required a subsequent ground transport
to the hospital. This ordinance still hampers the delivery
of patients to major specialty centers in San Francisco.
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CALSTAR started with a single BK117 under contract from
Helicopter Air Transports in June of 1984. The first base
was located at Peninsula Hospital in San Mateo, California.
Trials were conducted to find the optimal location for
this regional helicopter air ambulance. CALSTAR operated
from a number of locations within the first few years
of existence. CALSTAR started its own Federal Aviation
Regulations (FAR) Part 135 operation by 1985 and added
a second BK117 in 1986 that was based in Watsonville,
California. But CALSTAR had expanded too rapidly without
doing proper market development. As a result, operating
losses began to mount.
Over the next year CALSTAR was on the brink of failure.
Limited internal management capability and systems added
to the challenge. The CALSTAR Board of Directors was faced
with some difficult decisions. In order to cut costs,
the program returned to a single-aircraft operation, replacing
the BK117s with a single AS355 Twinstar. Only half of
the CALSTAR staff opted to remain with the organization.
The devotion of the remaining staff was remarkable. This
dedication was illustrated by 11-year veteran flight nurse
Rose Gaither, RN, CEN, CCRN, CFRN, "CALSTAR is like
an extended family...being part of this lifesaving team
means more than a paycheck to me. This job takes us to
the extremes of life and death. Being a Flight Nurse for
CALSTAR is the best job I have ever had," she says.
The staff stood by the company during this difficult time
and took a voluntary pay cut to keep CALSTAR alive. The
challenges of these difficult times resulted in a cohesive
bond that continues to hold the CALSTAR family together.
The Board of Directors reorganized the corporate structure.
Michael Heil, the Chairman of the Board and an executive
at San Jose Medical Center, took an active role in ensuring
the survival of CALSTAR. Volunteering his own time, he
took over operation of CALSTAR while a search for new,
permanent management began. CALSTAR sought more support
from its member hospitals. San Jose Medical Center and
John Muir Medical Center provided critical additional
financial support to keep CALSTAR flying. "During
this transition the staff worked together as a committee
to maintain standards and safety", stated Tim Tatman
an 11-year CALSTAR pilot.
The executive search was successful with the appointment
of Joseph F. Cook as the new President and Chief Executive
Officer of CALSTAR in 1987. Mr. Cook mapped out a business
plan to bring CALSTAR through its financial crisis and
move it back to its original vision. MBB recognized CALSTAR
as a pioneer in the field of air medical transport and
supported the consortium as the model of the future and
assisted by providing flexible terms during the aircraft
transition. The rebuilding began. Within a year, CALSTAR
was out of crisis and on the road to solid financial ground.
Although CALSTAR's most visible innovation was in its
consortium structure and regional vision, CALSTAR has
been a pioneer in other areas. Most of CALSTAR's initial
flight nurse training was provided by the University of
California, San Francisco Medical Center. CALSTAR performed
neonatal and high risk obstetric patient transports utilizing
specialty teams from UCSF. During a time when most hospitals
would not dream of transporting pediatric patients without
a physician, CALSTAR pioneered nurse/nurse transports
of pediatric patients in the Bay Area. Children's Hospital
Oakland worked closely with CALSTAR developing a stringent
quality assurance program. Through this relationship the
quality of pediatric transport service greatly improved.
CALSTAR opened the door for other providers. Children's
Hospital Oakland is now able to draw on a wider range
of resources for transport of their pediatric patients.
As a public benefit corporation, CALSTAR has served it's
community in numerous ways. During the floods of 1986,
CALSTAR flew much needed equipment to areas that were
inaccessible by road. In 1989, during the Loma Prieta
Earthquake, CALSTAR was one of the first on-scene at the
collapsed Cypress Structure and transported one of the
few survivors. CALSTAR completed many interfacility transfers
while transport by ground ambulance was impossible. While
the telephone lines were down, CALSTAR was able to assist
by relaying information and responding to life threatening
emergencies via their radio communications. CALSTAR also
was on standby during the Oakland Fire. In addition to
our day-to-day lifesaving missions, CALSTAR has always
strived to serve the community as an air ambulance and
in any way necessary.
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Another innovative facet of CALSTAR was it's early utilization
of Crew Resource Management (CRM). CRM had been standard
operating procedure at CALSTAR since its inception. The
Flight Nurses at CALSTAR have always had input regarding
flight operations. According to Susie Mautz, RN, BSN,
CEN, CCRN, CFRN, an 11-year CALSTAR veteran, "We
were not hired for our ability to say 'yes' to a flight,
we were hired for our ability to say 'no' and the decision-making
capability to recognize the difference." As a Federal
Aviation Regulation Part 135 operator, the pilots were
CALSTAR employees, therefore CALSTAR was able to establish
CRM from its inception. CRM has been instrumental in enabling
CALSTAR to maintain its impeccable fifteen-year safety
record. "CALSTAR has always taken a team approach
to safety," said Jennifer Prevost an 11-year CALSTAR
pilot.
While watching expenditures and holding onto its market
share, CALSTAR stabilized. CALSTAR was able to add an
additional aircraft in 1991. Because of its low direct
operating cost and versatility, the BO105CBS was selected
as the second aircraft . This aircraft was a back-up for
the operation at South Valley Hospital in Gilroy. CALSTAR
opened a second base at Buchanan Field in Concord, California
on a 12-hour basis in 1993. The BO105 would prove to be
the aircraft of choice for CALSTAR and the AS355 Twinstar
was replaced with a BO105LS one year later. With two bases
of operation a need for a third aircraft was identified.
A third BO105 was acquired in 1994 as a back-up to mitigate
downtime.
In 1995, CALSTAR was selected through a Request for Proposal
to support the new Sutter Roseville Medical Center, which
had just become a Level II Trauma Center. A fourth aircraft,
a BO105LS, was added in Auburn, California, at the base
of the Sierra Nevada Mountains. In 1995, CALSTAR became
the largest air medical provider in Northern California
and revenues exceeded expenditures for the following two
fiscal years.
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While this result was achieved primarily by relying on
small donations and patient billing, CALSTAR had lost
sight of its corporate sponsors. In order to strengthen
its financial position, solidify it's future as a public
benefit corporation, and lower our cost to the patient,
CALSTAR has turned back to its roots. It was recognized
that a relationship with its corporate sponsors and initial
contributors had been pivotal to the success of CALSTAR.
Measures were taken to reestablish corporate sponsorship
and donations. McKesson was contacted and was pleased
to rekindle the relationship. "Having been so involved
in the birth of CALSTAR, we are proud to see how well
it has grown over the past few years and how many lives
have been saved in the process. We wanted to make an investment,
once again in CALSTAR, to ensure more lives can be saved
in the future," says Marcia Argyris, President of
the McKesson Foundation.
CALSTAR began to revive the Corporate Sponsorship Program.
The Chevron Corporation stepped to the plate and CALSTAR
was able to establish CALKids, a fund for pediatric patients
and their families with no means of reimbursement and
a mechanism through which state of the art pediatric equipment
is procured. CALKids proved to be a success and many families
benefited through this grant. According to Ken Johnson,
Program Officer for Chevron Corporation, "Chevron
is pleased to invest in its community and support life-saving
missions such as the one performed by CALSTAR." As
they proclaim in their commercials ... "Chevron People
Really Do Care."
CALKids has thrived with additional support from Toys
'R Us and other corporations throughout Northern California.
The original grant request to Toys 'R Us addressed an
interest in funding to support CALKids. Too much medical
jargon was utilized in the first grant request, causing
a rejection. A subsequent phone call clarifying the definition
of neonatal, pediatric and high-risk obstetrics resulted
in further discussions and eventual funding. Toys 'R Us
then joined the proud family of CALSTAR Corporate Sponsors.
Ronald McDonald also recognized the importance of supporting
CALSTAR. McDonald's contributed to CALSTAR through a grant
from Ronald McDonald House Charities of the Bay Area (RMHC). "Ronald McDonald House Charities of the Bay Area
was impressed with the mission of CALSTAR's CALKids program
and we wanted to contribute to the lifesaving efforts
it has frontiered," says Bob Schiff, a McDonald's
owner/operator and president of the local RMHC chapter.
"Providing CALSTAR with emergency medical and training
equipment satisfied our mission of helping children in
need. It was a perfect match."
Contributors to CALSTAR were recognized with the placement
of their logos on the aircraft or equipment. Following
the RACQ CareFlight model in Australia and Auckland Rescue
Helicopter Trust in New Zealand, CALSTAR formulated parameters
under which corporate logos could be placed on the aircraft.
CALSTAR established a minimum contribution standard. CALSTAR
followed the lead of programs like STARS in Canada in
acquiring corporate sponsors and donations.
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CALSTAR is exploring areas of California that are currently
under-served and would benefit from the addition of an
air medical transport provider. CALSTAR is also in the
process of expanding into alternative means of transporting
patients, including fixed-wing and critical care ground
ambulance.
CALSTAR has grown and changed over the past 15 years.
CALSTAR covers Northern California from bases in Concord,
Gilroy and Auburn. CALSTAR has completed more than 9,000
missions since the first patient transport in September
of 1984. Many valuable lessons have been learned about
our patients, our company and our mission. As the largest
provider serving Northern California we feel as strongly
today about our mission as we did 15 years ago ... "You
still gotta be sick to fly with us."TM Thanks to
all of those that have helped make this vision a reality
and stuck with us over the past 15 years. According to
Joseph Cook, President and CEO, "CALSTAR started
as a great experiment, today, it can serve as the operational
model for the future of our industry. CALSTAR will continue
it's life-saving mission, following the vision of our
founders, striving every day to provide the highest quality
medical care in the most cost effective way possible."
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