03/07/2014 12:07 EST | Updated 05/07/2014 05:59 EDT

Air ambulances fly again in Manitoba following government review

WINNIPEG - The Manitoba government has given the green light to STARS air ambulance service to resume flying, three months after a patient's death raised concerns about potentially improper oxygen levels.

The non-profit agency, which has operated for years in Alberta and Saskatchewan without being grounded, has agreed to upgrade its equipment, increase training and work with a new oversight panel that includes the dean of medicine at the University of Manitoba.

"STARS and Manitoba Health worked co-operatively and effectively to resolve issues of medical concern, and that has resulted in a number of changes," Health Minister Erin Selby said Friday.

What remained unclear is how much blame STARS should bear for 16 cases that were part of an external review by Dr. Stephen Wheeler, medical director of air ambulance services in British Columbia.

A copy of Wheeler's report was released Friday, but with many specific findings removed.

The only death that was under review — that of a woman who had a heart attack last November and died after being transported by STARS to a hospital — was due to an "underlying medical condition," Selby said.

Another case had "no significant issues," although the circumstances were redacted in the report. Another was criticized because a STARS employee had photographed the patient during a rescue.

Wheeler did find problems with oxygen delivery in some cases.

"A common theme ... is a lack of appreciation of what constitutes a difficult airway and a lack of sophistication in dealing with airways and maintaining oxygenation," his report reads.

It points to a lack of training as a key problem at STARS.

"Compared to other air medical transport programs across the country, its training program ... is remarkably brief and cannot provide the necessary amount of training required for modern, complex, critical-care transports."

STARS has agreed to upgrade its equipment. New ventilators are to have oxygen sensors for the first time. Oxygen tank regulators will have built-in alarms for when levels get too low.

Crews also are to undergo more training alongside crews from other provinces.

STARS CEO Andrea Robertson would not discuss details of the review and focused her comments on working with the province.

"Today is about moving forward and getting us very positively back in the air ... and we're very, very confident that we're going to provide very high quality patient care," she said.

As of noon Friday, STARS was allowed to respond to emergency calls. The plan is to eventually restore full service, including patient transfers between hospitals.