Program History

By Casey Ping, STAR Flight Program Director

The STAR Flight  program began service in May 1985. At that time the program was a partnership between Travis County, the City of Austin EMS and the city, owned and operated Brackenridge Hospital. Travis County funded the aircraft, including aviation personnel (pilots and mechanics) and expenses. The Austin EMS department provided the flight paramedics, communications center and the medical equipment. Brackenridge Hospital provided the flight nurses, crew quarters and aviation facilities at the hospital (helipad and fuel system). The original focus of the program was to provide advanced life support to the rural areas of Travis County.

Each organization established a chain of command (Chief Pilot, Chief Flight Paramedic and Chief Flight Nurse) for their respective groups and retained full authority for their respective personnel, including maintaining separate training and clearance processes. Each entity had its own set of policies and procedures. This created situations in which conflicts developed between the various independent but interacting systems. While this worked during the early years, as the program flight volume increased and the complexity of the mission evolved, especially the addition of inter-facility transports and broader public safety missions, conflicts developed concerning the priorities of the various program partners. Each organization had its own ideas on the best way to solve these issues. This was further complicated by the fact that the City of Austin entered into the long-term lease agreement with the Seton Healthcare Network for the management and operation of Brackenridge Hospital. Seton immediately began looking for ways to better meet their air-medical needs. This introduced additional competing pressures on a flight program that was already one of the busiest in the nation. During this time, the City of Austin and Travis County were dealing with a rapidly expanding service requirement and population increases that required the STAR Flight  program to meet the demand within Travis County. Any excess resources, although limited, were to be used to meet the out-of-county demand. In 1998, STAR Flight  responded to 2500 mission requests with one staffed aircraft. This number is exceptional in the air-medical community, with most programs adding staffing of a second aircraft when they approach 1200 missions annually. Ultimately, the Seton Healthcare Network chose to outsource their air-medical services to a private vendor. The withdrawal of this partner and their flight nurse staff resulted in the City of Austin and Travis County being faced with a decision regarding the structure, staffing, mission and operation of STAR Flight . These discussions took place at the highest levels of the City and County governments. Their decisions forever changed the STAR Flight  program and have had significant and long lasting impact. The changes undertaken were to:

Create the position of program manager to manage the daily aspects of the STAR Flight  program with the goals of unifying program personnel and establishing a consistent mission and direction.

Bring all program personnel (flight paramedics, flight nurses, pilots, mechanics and communications personnel) under the management of Austin-Travis County EMS. This required the hiring of flight nurses to work directly for Austin Travis County EMS.

Undergo an independent assessment of program quality, leading to accreditation within two years by the Commission for Accredited Medical Transport Systems (CAMTS). This process provided a structured approach to review program structure and as a frame work to facilitate ongoing program improvement. Accreditation was achieved in 2001 with STAR Flight  becoming the first public safety program in CAMTS history to become accredited.

Develop a program-specific marketing strategy that would allow STAR Flight  personnel to develop relationships with the surrounding public safety agencies and medical community. These relationships are critical to the future success of the program.

Determining that STAR Flight  would remain a regional resource for Central Texas with the approval of the Travis County Commissioners Court.

These changes have resulted in significant improvement in the management of a complex air-rescue program and have created the environment that allows the STAR Flight  crews the ability to work with a common direction. The new structure allows the program to be proactive in the ever changing air-medical environment and to focus improvement efforts on the customers and patients we serve. The STAR Flight  program personnel feel that the changes outlined above have resulted in a significant improvement in the program for the patients as well as the public safety and healthcare professionals we interact with on a daily basis.

In 2008, STAR Flight  completed a business planning project. The results of that project included;

1. Decision to move ALL personnel to Travis County. This means that ALL program personnel are employees of Travis County, subject to the same policies, procedures and retirement benefits. Of Travis County.
2. Addition of 12 hour aircraft and crew. This resulted in 3 additional pilots, flight nurses and flight paramedics and 1 mechanic. In 2010 this resulted in an additional EC145 aircraft.

In 2012, after devastating 2011 wildland fire season, the Travis County Commissioners Court approved the purchase of the STAR Flight  4, a UH-1H Bell helicopter designed specifically for firefighting and disaster response.

By Skip Gibbons, STAR Flight  Pilot, with help from Mark Wilson, Gordon Bergh, Frank Urias, Jim Allday, Bill Needles, Steve Janda, Ed Strout, and George Morgan

A lot of details blend when trying to recreate the opening days of STAR Flight . A few paramedics selected from City of Austin EMS (Gordon Bergh, Allan Boutwell, Robin Cope, Chuck Morrison, David Stone, Ed Strout, Clancy Terrill) teamed with a few nurses from Brackenridge Hospital (Valerie Calogero, Betty Parker, Donna McSwain, Sherry Stewart, Ellen Swan, Rick Waring, Mark Wilson) and a handful of pilots from Travis County (Larry Edwards, Skip Gibbons, Merlin “Spanky” Handley, Larry Stone) to fly the new EMS helicopters capably maintained by a contract vendor (Dave Simpson). This was the dawn of airborne EMS for Travis County and what a learning process it was!

Standards of operation that were customary in the EMS and hospital environments slowly, and sometimes painfully, evolved into standards that matched or exceeded those of the helicopter medical transport industry. The pilots started with a 6-day on, 3-day off schedule (12 hours shifts) with the paramedics working the standard 24-hour shift and the nurses responding from their normally scheduled shift as triage nurse in the Brackenridge Emergency Room. Shifts for all crewmembers today consist of 4 days on and 4 days off (12 hours shifts) commonly used in helicopter EMS. On top of that, our crews work as dedicated teams (pilot, paramedic and nurse) during those scheduled work assignments.

The paramedics and pilots were originally housed in a stark dorm room in the old nursing student dormitory on the I-35 frontage road. It had been unused for some time and was slated for eventual demolition, so the only occupants were the flight crew, one or two isolated office workers and a population of rodent residents. Homemade blowguns were used for recreation or self-defense, depending on your opinion of the rats. The original helipad was a concrete pad poured on the empty lot at the corner of 15th Street and I-35, directly in front of the old dormitory. The approach path into the helipad was along I-35 and then nearly vertical for the last 150 feet into the helipad. The patient was loaded into a retired ambulance and driven around the hospital to the ER. Within a year or so, a new helipad had been built on the west side of Brackenridge (adjacent to the ER) with living quarters below the helipad that housed both the flight crew and the Medic-3 ambulance crew. With a few modifications, we are still there today.

Initially, responses to calls were quite unique. The paramedic and pilot would respond alone to calls within Travis County and the nurse would join the crew on calls outside Travis County. Within a short time, the nurse would fly on hospital transfers as well. While the pilot and paramedic would respond from the dorm room near the old helipad on the east side, the nurse would have to run from the ER on the west side of Brackenridge, through the hospital, to join the crew at the running helicopter prior to lift-off.

It’s been quite a transition as our aircraft have changed over the years. Our original “big” ship was a Bell 206L3 Long Ranger, while using a Bell 206B Jet Ranger as the “backup”. Those aircraft did not have the modern customized EMS interior so common in the industry today. It wasn’t long before we saw the usefulness of a larger aircraft—a snorkeler who had been accidentally shot with a spear gun would not fit in the helicopter with the spear protruding from his chest and the emergency response crews were very uncomfortable trying to cut the spear off as they watched it pulse with each beat of the patient’s heart. In 1990 we enthusiastically put the new Bell 412 in service as the new “big” ship, replacing the Jet Ranger. We kept the Long Ranger as the “backup” and Travis County hired George Morgan as the Manager of Maintenance. George worked hours at the airport getting things squared away on the new aircraft prior to releasing it into service. Unfortunately, we didn’t have the external start “fox carts” we now use and the aircraft battery was partially drained during the crew prep phase at the old airport and subsequent flight to the Brackenridge helipad. On our very first call, a collision in the early morning hours on I-35 in Georgetown, the 412 after landing and shutting down WOULD NOT START. For weeks afterward, the media followed the 412 and the headlines read “did Travis County buy a lemon?” We solved the problem with the purchase of an external start cart and subsequent flights passed successfully and uneventfully. The 412 certainly enabled some unique positive experiences as well, like the baby delivered in-flight by Paul Kuper and Laura Criddle after the mother was injured in a vehicle collision. Also, the larger aircraft allowed three and four-patient transports that would have been impossible with a smaller aircraft.

The arrival of the 412 created opportunities for operational growth but highlighted the difficulties of maintaining and operating two different aircraft. Medical and rescue missions were drastically changed any time we moved from one aircraft into the other. The increased capability of the 412 expanded what the crews could do, from the number of patients to the amount of water that could be carried for aerial firefighting. The crews had to be trained on two different aircraft and the maintenance staff had to deal with keeping special tools, parts, equipment and training for each aircraft instead of the two same-type aircraft we use today.

These issues led to the purchase of two EC135T1 helicopters in 1999. The new Eurocopter EC-135s enabled the maintenance crew to focus on parts and tooling for only one type of aircraft and allowed the flight crews to standardize the equipment and mission regardless which helicopter was in service.

Besides the aircraft changes, our hangar facilities have experienced the largest transformation since the “Early Days”. Dave Simpson and all subsequent maintenance technicians, including our current maintenance director, George Morgan, had to endure the deplorable conditions in the old hangar located at the old Robert Mueller Airport on 51st street. We actually rented only part of a large metal hangar that was essentially a shed with walls that we shared with several other airplanes...no insulation, no heat, a locally manufactured cage that served as parts storage and tool room, and the hangar access door which could be opened with a pocket knife. The maintenance office area was drafty, cold and leaked in the rain. In 1999, with a taxpayer supported bond, we moved into the state-of-the-art facility in which our maintenance and administrative staff currently operate. This facility, located in northeast Austin, houses both administrative and maintenance offices, a hangar which easily fits both helicopters along with a rescue boat or two, as well as housing and kitchen facilities for flight crews. It also contains an often-used training classroom and a storage area for Special Operations rescue equipment. Pocket knives and credit cards no longer work in the absence of actual keys. With the flight facility becoming a high security area, we now use electronic card readers for access.

STAR Flight  is widely accepted now as a lifesaving vehicle and is usually welcomed into the yards and neighborhoods of some very anxious and sometimes desperate people. Early days of the program, though, took some selling since the helicopter was actually going to reduce the number of ALS units physically located in the county. Medic-9, station at Hwy 71/FM 620 was changed to a BLS unit (Aid-16) as STAR Flight  was designated the county ALS response unit. Residents of the Hudson Bend/Lakeway area had come to rely on the short response time of Medic-9 bringing paramedics to their front door and were none too happy when they were told that the unit now bringing ALS to their homes was responding from downtown Austin. As STAR Flight  became a regular responder to the lake areas, people became more comfortable with its response times and even more pleased with the transport time to the hospital.

The program’s inaugural response was a great example of helicopter acceptance—or NOT. That flight was dispatched with Chuck Morrison (Flight Paramedic) and Skip Gibbons (Pilot) responding to a cardiac arrest at a rural home near Lake Travis. We were using a leased Bell 206 with no STAR Flight or EMS markings on the exterior. The elderly woman who had called 911 for medical assistance for her husband was not happy at all as the helicopter scattered her chickens upon landing. On the return flight, people actually threw rocks at us from the shores of Hippie Hollow on Lake Travis, assuming we were just sightseers. People are a little friendlier now.

It’s been quite a ride for STAR Flight  from 1985 to the present. Sometimes smooth, sometimes bumpy, but always interesting since that first flight.

By Jim Allday, STAR Flight  Clinical Manager ret.

In the summer of 1984 a decision was made between the City of Austin and Travis County to utilize a helicopter as a cost effective method of providing ALS care and transport to the rural areas of Travis County.

I was tasked with determining the medical crew staffing for this helicopter, additional equipment, supplies, and medication needs as well as additional training needs. I had no previous experience with air medical medicine, so I proceeded to contact many of the existing air medical services in the country to determine how they operated.

After much information was gathered and several hundred hours of conversations were conducted, we had arrived at a plan for this new air medical crew. Flight physiology, including transport medicine, along with an introduction to critical care medicine was provided. All of this was done to assist the crews in their ability to handle the higher acuity patient that is typically transported by flight teams.

Within a few months of the start of the program, Brackenridge Hospital requested we respond to some of the outlying hospitals for patient transfers to their facility. Some of the patients were truly beyond the capabilities of many of the EMS agencies at that time. The potential for non-traditional EMS interventions during transport might be needed. Brackenridge stated that they would be willing to send an ER nurse along for the flight. With that development, the Flight Nurses became a permanent fixture of the program.

STAR Flight  was a Travis County tax-payer supported program, so the initial focus was on calls originating within Travis County. What this meant was that a need for STAR Flight  within Travis County always took precedent over a call originating outside of Travis County, even if the Travis County call came after the out-of-county request. As STAR Flight ’s call volume increased, this diverting from out-of-county calls to in-county calls became more prevalent. As a result, our out-of-county customers began to lose confidence in our service completing their dispatched mission. Over the years, STAR Flight ’s expanded usefulness into rescue work, law enforcement assists, and fire suppression requests demonstrated that STAR Flight  was no longer a Travis County asset, but instead had become a Central Texas asset. With that realization, the program became less focused on Travis County needs and more focused on Central Texas needs. The result was a more patient-focused approach which meant that typically the first request for STAR Flight  would be honored first. So now sometimes the more distant, out-of-county patient would receive STAR Flight  more readily than the in-county patient, who may still be at a distance from definitive care, but was still closer to an ALS ground unit than the out-of-county patient.

In the late 1980s and early 90s, the need for a larger helicopter became evident as our patients were of a higher acuity requiring more devices, supplies, and medications to manage them. The need to have more room to work on more than one patient was obvious. We purchased the Bell 412SP and kept the Bell Long Ranger as our backup aircraft. We now were also capable of transporting FOUR patients at a time! With one moveable patient stretcher tray on each side of the aircraft, we could rapidly load two patients and within five minutes, could reconfigure the aircraft to handle four patients. It was now easier to handle two or more patients and with additional room for storage, we began stocking the aircraft with more equipment and supplies, including non-invasive and SaO2 monitoring capabilities for two patients.

During the 412 days, we also began to really expand our rescue capabilities, which translated into additional medical equipment, supplies, and packs so that we could bring medical treatment to the patient’s side wherever he/she might be.

In 1998, we took delivery of our current EC135 helicopters - two helicopters that were exactly alike except for their tail numbers! This made working out of either helicopter very easy. It also greatly facilitated aircraft change-outs. The EC135s were configured to allow for two patient transports.

In the fall of 1999, Seton Hospital outsourced many of its air-medical needs, resulting in the loss of the STAR Flight  Nurses. We immediately began staffing with two paramedics while evaluating our future staffing needs. With a review of national air medical programs and an informal survey of our local medical community, we elected to continue to have a nurse/paramedic medical crew configuration. Austin-Travis County EMS had never hired nurses, so new positions had to be created with a pay scale, job requirements, and job descriptions. In the spring of 2000, we hired and began training our first Austin-Travis County EMS Flight Nurses.

In the spring of 2001, STAR Flight  became the first public safety agency to attain Commission on Accreditation of Air-Medical Transport Systems (CAMTS) accreditation. This process afforded us the opportunity to review every aspect of the program and make some needed changes to improve the way that we operated. It was a challenge for the accreditation team as they encountered many unique program elements of our public safety service. This was a very proud accomplishment.

Over the last few years we have added some additional protocols to provide for better airway management and pain, agitation, and nausea management. We now will take patients directly to the burn center in San Antonio and to a closer trauma center in San Antonio or Temple when appropriate. We also take possible stroke victims to specified stroke centers when appropriate. In the coming year we hope to add alternative IV access capability and to enhance our ability to manage patients having an active MI, experiencing cardiac failure, or suffering from an aortic aneurysm. We now have the capability of providing warm IV fluids or blood (if started at a sending facility) for our patients to assist with re-warming and to reduce hypothermia. This has been very useful for rescue and trauma victims who have been exposed to cold temperatures for even short periods of time.

While STAR Flight  crews have always had the option of using a surgical airway in a patient who could not be intubated, the Cook-Melker kit offers an additional device to ensure a quick and patent airway.

The current STAR Flight  crews have extensive experience. The Flight Nurses range from 7 to 20 years’ experience and the Flight Paramedics range from 7 to 25 years. Current certifications maintained by the crews include: ACLS, PALS, BTLS, ABLS, ENPC, TNCC, and TPATC.

It’s been a tremendous learning process since 1985. We’re proud of the accomplishments we’ve made, and look forward to working with you in the years to come.

By Casey Ping, STAR Flight Program Director

STAR Flight  began operation in May of 1985, and as the name Shock Trauma Air Rescue (STAR) implies, there has been a public safety role since the program’s inception. In the early years this role was not clearly defined and was limited because of the capability of the program’s original aircraft.

STAR Flight  began service with a Bell 206L as the primary aircraft and its smaller sister, a Bell 206B, as the backup. These are the most common helicopters in general aviation today but have some substantial limitations when it comes to EMS and rescue operations.

During those early days the flight crews did not have specialized rescue training or equipment. The crews would literally make it up as it came along and did the best they could. While this is not the beginning of a model helicopter rescue program, there were successes. The program began to realize some of the limitations of the current operation and their aircraft. This prompted Travis County to replace the 206B with a larger and more capable Bell 412. The new aircraft offered substantial new capabilities that had not been available to date. Program personnel began to explore these capabilities and ways to improve the services delivered. To better understand and develop these capabilities, the public safety mission was broken into categories for further investigation and recommendations.

The Bell 206 aircraft previously operated by STAR Flight  had limited external load capability, especially in the medical configuration. The Bell 412 offered substantially increased capacity for both external and internal loads. This included the ability to transport fire personnel to difficult access areas and take an active role in fire suppression activities through aerial water drops. A Bambi Bucket was purchased and several aviation management personnel traveled to other areas of the United States to observe fire suppression activities to learn first-hand about their training programs. This program remains active today and the fire mission volume is dependent on those weather conditions that impact the frequency of wild land fires. STAR Flight  can provide both suppression and observation support at these incidents. Suppression activities are normally limited to daylight hours unless the pilot has been there during the day and there is a clear threat that justifies flying after dark. This is a decision that must be reached jointly by the Fire Incident Commander and the STAR Flight  pilot.

NOTE: Fire Missions are automatically approved within Travis County or at the request of a Travis County agency. Approval is required for missions outside of Travis County. This usually occurs while the requesting agency is still on the phone and has proven to be very timely. Most fire missions are considered Priority 3 and the on-duty aircraft can be diverted to higher priority missions (generally medical or rescue missions).

As stated earlier, STAR Flight  has always been involved in rescue operations, but it was clearly evident in the early days of the program that the crews had neither the necessary training nor equipment to offer a high degree of success and to effectively manage the risk of these missions. Because of these reasons, equipment was purchased and training provided to alleviate these shortcomings. Some flight crew members had previously been involved with helicopter rescue training which was being conducted in Kerrville as a result of the Comfort, Texas flood. The initial training was a partnership between the Kerrville Fire Department, the Texas Department of Public Safety (DPS) and Rescue 3 International.

In an interesting side note, it was during this time that there were significant issues between the partners (Travis County, Austin EMS and Brackenridge Hospital) about the program direction of STAR Flight . During this period the flight nurses were provided by Brackenridge Hospital, and while many of the flight nurses attended the initial rescue training, they were prohibited from further participation in rescue activities (training or operations) because of the liability concerns of their employer. This left STAR Flight  with some equipment and training but short of rescue personnel. Several options were considered, including partnering with the Austin Fire Department. AFD was not able to meet the staffing requirements, so members of Austin EMS Special Operations began to receive helicopter rescue training. Rescue 3 International provided crew chief training to the flight crew and helicopter rappel, water insertion and short-haul training for STAR Flight  and EMS Special Operations personnel. This system was a burden to Austin EMS because it required taking an EMS Special Operations ambulance out of service. The coordination of getting the EMS crew and helicopter together was cumbersome, requiring them either to meet at the helipad, en route or at the scene. Shortly thereafter the Seton Network decided to stop their direct partnership with Travis County for air-medical services and removed the flight nurses from the STAR Flight  program. This created the opportunity for STAR Flight  to hire flight nurses directly. Today flight nurses and flight paramedics receive the same public safety rescue training and are interchangeable in the roles of crew chief and rescuer.

In December 1998 the Travis County Commissioners Court decided to replace the aging Bell 412 and 206L models with the Eurocopter EC135. The EC135 had new technology as well as increased performance and efficiency. Several benefits of this acquisition included:

Two aircraft of the same type

No decrease in mission capability when the one aircraft was down for maintenance. The aircraft were designed with public safety air rescue missions in mind. This contributed to a decrease in preparation time (and quicker on-scene times) for rescue missions.

Over the next several years, STAR Flight  personnel continued to refine and expand the capabilities of air rescue and patient care in the rescue environment. This expertise has extended to include state-wide responses during significant flooding in partnership with Texas Engineering Extension Service (TEEX), the National Guard and Department of Public Safety. In this role, qualified paramedics and nurses are partnered with National Guard helicopter crews to perform a variety of air rescue operations during times of natural disasters (mainly flooding). This includes both a rescue and medical role.

Members of the STAR Flight  program are actively involved in teaching helicopter rescue both nationally and internationally. This allows program personnel to refine their skills, learn new things in a varied environment while sharing the successes STAR Flight  has had in the past.

Today the air rescue component of STAR Flight  remains a valuable resource for the citizens of Travis County and the Central Texas area. While actual rescue operations remain a small percentage of the total mission volume, it remains a viable tool to access, stabilize and extricate patients that may have had to otherwise wait considerable time.