This is the medical interior of the STARS H145 helicopter. It’s a flying intensive-care unit, and every surface must be sanitized and decontaminated after every mission in which we’ve flown a patient with a suspected or confirmed case of COVID-19.

Safety of patients, allies and crews remains paramount 

As the number of COVID-19 cases across Western Canada spikes, STARS is seeing a surge of infected patients requiring urgent critical care and transport.  

In the first week of November, slightly more than 18 per cent of all STARS missions across the Prairies were related to patients with confirmed or suspected COVID-19.  

At one of our bases, crews carried and treated four patients with COVID-19 in 24 hours.  

“We have hit a new peak,” said Tracey Steel, interim senior director of clinical services. “These are critically unwell patients in respiratory distress. Many have high fever and sepsis, which is the body’s life-threatening response to infection that can lead to tissue damage, organ failure, and death,” she said.  

Eighteen per cent is a significant increase from the early days of the pandemic when 12.5 per cent of all our missions were COVID-19 related. The frequency of this type of mission leveled off to 7.5 per cent in late summer before climbing again in the fall. Much of the spike stems from the increasing number of transfers between hospitals involving COVID-19 patients, including moving patients to smaller ICUs to keep hospitals from reaching capacity. 

“The health-care system right across the Prairies is feeling the strain of COVID-19 and STARS has also been impacted,” said JN Armstrong, chief medical officer, STARS. 

With the recent jump in cases, the safety of our air medical crew, pilots and patients remains at the forefront of every decision we make. That means enhanced personal protective equipment (PPE) measures for our teams and strict PPE removal procedures, also known as doffing. For non-presumptive cases, the minimum PPE requirements are gloves, a surgical mask, eye protection and gowns, where practical, said Dr. Jamin Mulvey, a transport physician and member of STARS’ COVID-19 clinical communication working group.  

Following every mission with a suspected or confirmed COVID-19 patient, the entire inside of the helicopter undergoes a rigorous decontamination, a process which can take up to an hour to complete, said Steel.  

“Once we leave the patient at hospital, our crews remain in standard PPE for the flight back to base until the aircraft is decontaminated,” she said.   

“During decontamination, we wipe down all the walls, the floor and everything in it: the seats, seatbelts, our helmets and every piece of equipment inside, whether it was used for the patient or not.”  

Crews then launder their flight suits and shower, so they are ready for the next patient who needs help.   

“It is a lot of work, and it can be fatiguing, but we remain very cautious and vigilant,” said Steel, noting that although crews are accustomed to treating patients with a range of infectious diseases, there is no room for complacency.    

“This is the work we do on a regular basis, and we use best practices. But this is a novel virus for us, so there is a level of concern.”  

The organization-wide effort to ensure necessary policies, procedures and supplies are in place will remain as long as the pandemic continues, said Dr. Mulvey.  

“We have good resources, adequate supplies of PPE, and redundancy programs in place in case there is a PPE shortage.”  



As agencies throughout the world battle the corona virus, many patients have benefited from international cooperation, shared learnings and best practices. In that spirit of cooperation, the STARS education team has created an online portal where other medical organizations can access information on a variety of COVID-19-related topics. For more information, visit stars.ca/covid19clinical