A FLIGHT TO SAFETY AND HEALING My Part in Bringing Helicopter Ambulance Service to East County
	DECEMBER 2005

by Gary D. Boyd
Photos by Russell Byrne

I was born and raised in Oakdale, California, a place with a big sign proclaiming it “The Cowboy Capital of the West.” As a youth I fit right into the culture of the area, since I lived on a 20-acre ranch and we raised cattle. My dad had been born and raised on an Arkansas farm, and during his whole life he loved to work and enjoyed owning animals.

I remember that I had a two-week break before leaving home to go to college. Dad figured that I was available to do some work during the interim so he bought 17 tons of hay on the ground. I spent the whole two weeks hauling the stuff in a pickup back to the barn.

My father never slowed down, or felt the need to take it easy. He was constantly working on the ranch and making improvements. I still own the property; one day I’ll retire there.

I was the second generation of Swedish immigrants on my mom’s side. As much as she was a homemaker, mom always believed that her place was also working out in the fields with the hands. She was the manager for our home, family, and farm.

A Life in the Medical Field
By the time I was college age, I knew that there would never be much of a living centering my life around a bunch of cows on 20 acres of dry-land California real estate. I attended Modesto Junior College, but didn’t know what I wanted to do with my future. My life turned a corner when I enrolled in an x-ray technical training program at Peninsula Hospital in Burlingame.

Following graduation I worked for several years as an X-Ray Technologist in Modesto, and then decided to get into management. I got a BS in Human Relations from USF and joined the staff of North Bay Hospital in Fairfield as a manager. It felt a little strange to be a 26-year-old kid who was managing a group of people, some of them twice my age.

After five years at North Bay, I learned that there was an opening at Scripps Hospital in La Jolla. I applied on a bet, figuring that I might at least get a trip to Southern California out of it. Nobody was more surprised than I was when I landed the job. Getting that position really was a long shot, but I hit it off with the Hiring Manager. It turned out that we had a lot of things in common.

I hired on as a Department Head, but decided to move into Hospital Administration, so I went back to school and wound up with a Master’s Degree in Public Health from San Diego State University. I brought my new credentials back to Northern California, and wound up in my present position as Senior Vice President at John Muir Mount Diablo Health System. I am in charge of Ancillary Services, including food services, radiology, pharmacy, plant operations, physical therapy, etc.

One of the most fulfilling things I’m doing these days is serving as part of the CALSTAR air ambulance service.

The Fateful Golden Hour
Medical emergency response professionals speak about the “Golden Hour,” which is a fanciful term for a grim fact. Research has shown that people’s chances of surviving a life-threatening trauma increase by up to 30 percent if they can get medical treatment within 60 minutes.

The American Trauma Society has identified personal wounds and injuries as the number one cause of death in the United States for persons under the age of 44. Acute trauma is responsible for the deaths of as many as 160 thousand men, women, and children in America every year. In other words, violent trauma kills someone in America every three seconds, or so. Almost twice that number suffers disabling injuries. The annual monetary burden of the death and injuries is estimated to be more than 110 billion dollars.

Many of these deaths could be prevented by rapid critical care transport. Tens of thousands of people have died beside American roadways and in remote areas for lack of the timely transportation that might have saved their lives.

In countless other cases people’s conditions have deteriorated beyond recovery while being transported for several hours by ground ambulance services, many of which lack the equipment and skilled personnel that might otherwise have saved the dying patient’s life.

Fortunately, twenty-two years ago a group of concerned Contra Costa County citizens and medical facilities brought together sufficient resources of will, technology, and wealth to do something wonderful about the challenge of the Golden Hour.

They began an airborne emergency rescue system in June 1983, and gave it the acronym CALSTAR — for CALifornia Shock Trauma Air Rescue. The service came about as a result of a vision that a physician named Dr. Trunkey had of an air ambulance program that could transport ill and injured patients from all over California, regardless of their ability to pay. They formed CALSTAR as a stand-alone nonprofit organization.

CALSTAR to the Rescue
Once launched, CALSTAR almost immediately began to stem the horrible toll of trauma deaths in California by providing emergency response within the Golden Hour to thousands of seriously injured victims.

John Muir Medical Center in Walnut Creek is one of the sponsoring hospitals. Sutter Roseville, and San Jose Regional Medical Center are the others. The three medical facilities provide some financial support to CALSTAR, and each is given a seat on the board of Directors.

My boss, Ken Meehan, is President of John Muir, and Chairman of the Board for CALSTAR. He got me involved in CALSTAR as his proxy to the Board of Directors. I represent Ken at CALSTAR meetings when he isn’t able to attend. A couple of years ago I was asked to serve, as well, on the CALSTAR Advisory Council, which is the fundraising arm that we were creating.

The CALSTAR mission statement is short and to the point: “To save lives, reduce disability, and speed recovery for victims of trauma and illness through rapid transport, quality medical care, and education.” CALSTAR earns no profits, and relies upon donations to make up the difference between their charges and actual expenses. They provide transport “to any critically ill or injured person regardless of age or ability to pay.”

CALSTAR is a key component in getting patients to treatment within the Golden Hour. John Muir Medical Center is the designated trauma center for the county, which means that a response team is on call 24/7 with doctors and nurses always prepared for action. Each helicopter carries a team of three people — the pilot and two nurses.

Unlike some other air ambulance services, CALSTAR staffs each medical flight crew only with RNs. All CALSTAR nurses are highly experienced in critical care before they join, and undergo an intensive six-week training program after being hired. After that they are required to become certified in critical care procedures, and within two years must receive their Flight Nurse Advanced Trauma Certification.

CALSTAR Services
CALSTAR’s home base is at McClelland Field in Sacramento, with six satellite bases scattered around Northern and Central California, each equipped with at least one helicopter and a standby-ready flight crew.

The local base is CALSTAR 1, located at Buchanan Field in Concord. The other Northern California bases are located at Gilroy, Auburn, Ukiah, Salinas, and South Lake Tahoe. An eighth base, and the newest one, is located in Santa Marie, near Vandenberg Air Force Base.

CALSTAR operates twin turbine high performance MBB BO-105 and Bell 222 helicopters. The helicopters have a great reputation for being quiet, reliable, and economical. The aircraft are the backbone of helicopter ambulance programs around the world.

Each CALSTAR base has a team that is ready to go 24/7, which effectively reduces travel time for the medical team to the helicopter to zero. Upon arrival at the destination medical facility, patients are transported from helicopter, to the emergency department, to the operating room in a matter of minutes.

Transportation of patients among medical facilities is another part of CALSTAR’s mandate. Increasing financial pressures on medical institutions and a shortage of trained staff to accompany the patient in transit produced significant transportation delays resulting in a decrease in the condition of patients, so in 1989 and 1991 the Federal Government passed OBRA/COBRA legislation that, among other things, placed the responsibility for patient transport on the shoulders of the sending hospital or physician.

In many cases the requirement for rapid transport of patients between two medical facilities, in full compliance with federal regulations, can only be met by CALSTAR’s services. CALSTAR has a Cessna 421 fixed wing aircraft at the McClellan headquarters base that is used for medical transport between distant areas.

Unlike most helicopter ambulance programs, CALSTAR does not contract for flight operations with an outside vendor, but operates under its own FAA Certificate and is directly responsible for all aspects of flight operations and aircraft maintenance.

Being both owner and operator means that CALSTAR can maintain tighter control over service of their equipment and training of their personnel, which leads to improved teamwork, more effective maintenance, and better communications — ultimately providing improved service for people in their hour of need.

CALSTAR’s goal is to provide the highest quality care to all patients at all times.

Coming in Time to Help
Our local base is CALSTAR One in Concord, which is equipped with crew sleeping quarters, a pilot, and two nurses. The Concord team, in most cases, begins scrambling as soon as the county EMS (Emergency Medical Services) call is received.

Activation or deactivation takes place after the helicopter is in the air. The final go/no go decision is made on the ground in conjunction with county EMS personnel who are first responders at the site on the basis of a quick evaluation and scoring system. If the score indicates that a trauma patient requires medical evacuation, the system is officially activated and CALSTAR continues to respond. In half of the cases, the standup is deactivated and the helicopter returns to base.

The disbursement of aircraft bases is very important for California patients, because most points in the region are only a ten minute flight from the closest base, which, allowing five minutes from the emergency call to lift-off, creates a to-the-scene response time as short as 15 minutes.

After landing at the scene of the incident, only ten minutes are generally required to spin down the helicopter rotors, place the patient on a backboard, and load him or her into the helicopter. The flight to the hospital typically takes another 15 minutes. The hospital is notified about the incoming patient 10 minutes before the helicopter is on the ground, so a team is waiting to whisk the patient directly to the trauma center.

The time from incident to operating room under ideal conditions can be as short as 45 minutes, beating the Golden Hour time frame. In the event that an activation takes place in an area where CALSTAR is already responding to another call, each county has protocols in place to determine the next “closest asset” that is obligated by law to respond.

CALSTAR is a wonderful asset for the community providing an important service. I’m proud to be associated with an organization that is saving the lives of California citizens on a weekly, sometimes daily basis.

You and your family members will hopefully never require CALSTAR services, but if you are involved in some terrible incident, you can be grateful that the rotors of a CALSTAR helicopter might begin turning before your trauma is five minutes old.

You can give thanks that if you ever have this kind of terrible need, a CALSTAR team will do everything they can to help you beat the Golden Hour time limit. In the event of some awful catastrophe, CALSTAR is prepared to give you or your family members every chance possible to recover from your injuries.

You and your family members can become part of the CALSTAR organization by purchasing an annual membership for $45. The membership provides protection for you and your family if any of you are transported by a CALSTAR ambulance, saving you the fee usually charged for the service. You will also be making a contribution to the CALSTAR organization. After all “The next life we save may be yours!” °

For information call 1-888-207-5433.