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STAR Flight (Shock Trauma Air Rescue) is the Air Operations Division of Travis County, Texas.  It is a public safety air rescue program that is unique because it performs critical transport, firefighting, rescue, and limited law enforcement support.  STAR Flight is based in Austin and serves not only the citizens of Travis County, but also 19 other counties within a 75-mile radius.  The majority of the calls are to assist those who are experiencing medical problems or suffering from traumatic injuries from motor vehicle crashes or other activities.  When requested, STAR Flight regularly transports very sick patients in rural hospitals to larger, better-equipped hospitals.

STAR Flight is dispatched through the same 911 systems as fire and ambulance services, and many times several services are dispatched at the same time.  The program is utilized within the county as a first response Advance Life Support (ALS) ambulance.  This means that many times a STAR Flight aircraft may arrive on scene in rural areas before the ground ambulance does.  Any high-priority medical request call that will take ground units more than twenty minutes arrival time triggers automatic dispatch of aircraft to the scene.  This is the main reason why STAR Flight is unique from other EMS air operations.  Most air programs are not requested until an emergency unit arrives at the scene and determines that a helicopter is needed.  Travis County’s goal is anytime a call for assistance comes through, an ALS trained responder is on the scene within 20 minutes.  For “scene calls” STAR Flight responds directly to where the emergency occurs, using their three Eurocopter EC145 helicopters.  Each aircraft has a pilot, crew chief / hoist operator, and rescue person on board.  

STAR Flight partners with pediatric and neonatal specialty transport teams from Austin area hospitals. They can transport pediatric and neonatal specialty team members to outlying hospitals in the Central Texas region, to assist in the care and transport of sick or premature babies and children. The specialty transport teams are not employed by STAR Flight; they are employees of their respective hospitals.  These crews have flight uniforms that they change into when they are called upon to do a transport.  Once the patient has been stabilized, they, along with the neonatal or pediatric transport team members, are flown directly back to the hospital where specialized care can be continued. In this way, specialized Neonatal or Pediatric ICU-level care can begin upon arrival at the outlying facility and continued all the way to the NICU / PICU.  The EC145 also has enough space to allow a parent or family member to travel with the child.

When STAR Flight is called on by local fire departments to assist firefighters on the ground with wild fires, they are able to assist in two different ways: (1) by providing direct aerial fire suppression, and (2) by serving as an air attack coordinator that assists ground firefighters by providing information about the fire such as direction of travel, hot spots, threatened structures, and areas that firefighters may need to address immediately.  Direct aerial suppression is the most common service, and that is the primary job of STAR Flight 4 (SF4), a Bell UH-1H Huey that was recently added to the fleet as the primary fire attack helicopter.  SF4 has a fixed Isolair belly tank that can hold up to 325 gallons of water, about three times the amount of the EC145s’ 130-gallon Bambi buckets.  The fixed tank offers safety advantages for use in urban environments and can hold fire retardant.  By using a suction hose, the pilot can fill the tank from multiple water sources such as lakes, ponds, a fire apparatus, or using the STAR Flight pumpkins: 4,800-gallon transportable water tanks.  SF4 can transport additional firefighters (hand crews), increasing access to wildfires or disasters in remote or difficult terrain. The Huey has also retained the use of a cargo hook.  In the event there is a problem with the Isolair tank, they can still deploy a 350-gallon Bambi bucket.
Many houses are located in dense, heavily-treed areas which are very prone to fires and difficult to protect.  STAR Flight’s priorities on a fire are to first save and protect life, then property and environment.
Travis County and its surrounding area are commonly referred to as “Flash Flood Alley,” due to the probability for rapid flooding in a short amount of time.  There are also large lakes and rivers that are popular for recreational boating and other water sports.  This poses challenges for EMS and rescue crews, as in some places access is difficult.  STAR Flight has proven its ability to arrive on the scene and deploy highly-trained medical personnel where needed.  These deployments take place both on land and in the water.
Crews are able to access a patient from the air, either by hoist or short haul, and to then get the patient to an area that is suitable for the helicopter to land.  The crew then can load and transport the patient to the nearest trauma center.

STAR Flight rescue personnel are trained to operate safely when extricating patients from high-hazard environments, including cliffs, swift water, and confined areas.  All medical crews spend many hours training quarterly each year to maintain their proficiency.
When performing a water rescue, crewmembers will dress out in water rescue gear.  While enroute, the crew gathers more information from dispatch or from on-scene crews so that they can plan accordingly.  Upon locating the victim at the scene, the rescuer is lowered into the water to gain access to the victim.
 
For a victim in lake water, a rescuer may be deployed directly into the water to locate, assess and begin medical care of the victim.  If the victim is located in swift water, crews may take a slightly different approach.  Due to the extreme danger swift water poses, the rescuer can be moved to the victim’s location using the hoist or a “short haul” technique.  The victim is secured and moved (with a rescuer still attached) to a safe location where medical care can be initiated.  These rescues are typically done during flash flood events.

Central Texas is home to very diverse and beautiful outdoor recreation areas.  Some are remote and rugged, such as Enchanted Rock State Park.  Even Austin has rugged wilderness areas within its city limits that are popular places for hiking, rock climbing, and mountain biking.  A number of individuals each year become lost or injured within these areas and need rapid extraction and medical treatment. 

STAR Flight also engages in missions that might seem surprising.  For example, it provides limited support to the Austin Police Department Bomb Unit.  The unit’s bomb robot can crawl into the cargo area of the Huey.  That gives the bomb unit the ability to deploy their men and equipment to any area in the county as quickly as possible.  Another unique mission of SF4 is to assist the Texas Parks and Wildlife Department in clearing trees and brush from greenbelt areas and preserves.  A remote cargo hook made for grappling trees is used.

Funding for the STAR Flight program comes from county taxpayers, as it is a public safety agency.  STAR Flight operates under Part 135 rules, which allow it to generate some revenue that offsets tax dollars.  Unlike the EC145s, the Huey is not setup to generate any revenue, all costs associated with it comes from the STAR Flight budget.  During disasters that are reimbursed by federal funding, STAR Flight can be reimbursed for its cost.  Currently it cost each taxpayer just under $2 per person, per year to fund.  This is much different from the financial models of other EMS programs that operate under a per-patient basis.

STAR Flight crews work three days on the line, and a fourth day is used to take care of administrative work.  The three days consist of a day, swing, and night shift and the crews always work the same schedule with each other.  For increased safety, both pilots and crews fly with Night Vision Goggles (NVG) that increase situational awareness by providing a better view of the landing area and surrounding obstacles.  The use of NVG helps crews stay more comfortable and relaxed on night missions, which cuts down on crew fatigue. 

Another safety element is the Outerlink tracking system, which allows STAR Flight to stay in constant communication with dispatch.  It offers voice, text, satellite tracking, and efficiency diagnostics for all aircraft.  Every 30 seconds the aircraft position is updated in the system.  There is also the capability to track weather and provide updates to crews on the scene.  In the event of loss of radio contact, communications can be made through text message.  Texts are transformed into voice messages for the crew to hear.

Within the last year the Circuit of Americas (COTA) Formula 1 racetrack opened in the Austin area.  STAR Flight contracted with COTA to provide emergency response to events on the property.  Certain events, such as Formula 1 and Le Mans auto racing and MotoGP motorcycle racing, require an aircraft to remain on the property during the event.  STAR Flight has a doctor that maintains the medical center at the track and any medical emergency involving staff or spectators will go to that medical center.  In the event of an on-track emergency, the doctor will respond to the scene and determine if the patient needs transport to a local trauma center or to the onsite medical center.

All aircraft are equipped with onboard flight management equipment and a hoist camera.  The hoist camera is always active anytime the hoist is in use, giving instructors the ability to critique rescues without being onboard the aircraft.  The crew chief onboard the flight is also the hoist operator, and the rescue person is trained in both swift water and high angle rescues.  

All STAR Flight aircraft are maintained by full time mechanics.  The mechanics are able to do all of the maintenance except deep engine repair.  Turbomeca handles that. 

The history of STAR Flight has an interesting progression.  In 1985, STAR Flight initiated operations with a contract-leased Bell 206B, which was eventually replaced with a larger, more powerful Bell 206 L3.  This aircraft was capable of transporting one patient and was staffed by two medical personnel.  In 1990, a Bell 412 SP was added to the fleet.  This much larger, more powerful aircraft greatly enhanced the public safety mission by adding multiple-patient transport, rescue and short-haul capabilities, and firefighting with a suspended Bambi Bucket.  This was the primary, frontline aircraft for eight years, with the 206 serving as a backup.  In 1998, two Eurocopter EC135s were acquired and in early 2006, STAR Flight proudly introduced two Eurocopter EC145 multi-role aircraft, custom outfitted by Metro Aviation.  These aircraft are single-pilot IFR, capable of transporting two patients, and equipped with color-weather radar, dual-electric cargo hooks, a wheeled gurney, and a Goodrich electric rescue hoist.  This gives the ability to quickly reconfigure for a variety of missions, including firefighting, rescue, and scene response.  It can also transport a multiple member specialty team and an isolette.  In 2013, the UH-1H Huey was acquired for the sole purpose of fire support duties.

With 27 years of accident-free flight operations behind it and a long future in front of it, STAR Flight and its proud crews have become an indispensable asset to Travis County and the Central Texas area.
 

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