PennSTAR delivers critical care in the air, across the region

The glow of a TV offers light to the subdued room, the low murmur of dialogue from a reality show about first responders trickling from the speakers, as three guys try to relax. An alarm tone from their phones pierces the room, the lights turn on, the room flickers to color, and the men, wearing bright red flight suits, jump into motion. Art becomes life.

“An intracranial hemorrhage at Chester County,” says flight paramedic Doug Simpson, BS, NRP, FP-C, as he reads from dispatch notes on a computer below the TV. Flight nurse Joe O’Leary, BSN, RN, CFRN, walks around the suite in Doylestown, gathering what will be needed for their flight. Pilot Eric Houghton heads to the helipad for the final preparations for takeoff.

A brain bleed demands immediate attention, triggering the call for the PennSTAR team to carry the patient to some of the best neurosurgical care in the world at the Hospital of the University of Pennsylvania.

PennSTAR, the critical care transportation service of Penn Medicine, is simultaneously one of the most visible and invisible pieces of the organization: visible because its helicopters are effectively billboards racing across the sky, yet invisible because it is a thread, not often seen, that ties the system together.

The crew’s suite adjacent to the Emergency Department at Penn Medicine Doylestown Health is one of two PennSTAR bases. The other is at Wings Airfield in Blue Bell. When Doylestown Health joined the University of Pennsylvania Health System in the spring of 2025, PennSTAR was able to move back into a hospital for the first time since the 1980s, giving the program more direct access to patients and clinical staff. PennSTAR now has a reach from the Poconos to Delaware, from the Jersey shore to Lancaster.

The phones buzz again. It’s time to go.

A golf cart carrying Simpson and O’Leary cuts through a damp, chilly breeze, traveling about a half mile from the Emergency Department to the helipad. They board the chopper, and its blades dissolve into a blur and the aircraft shudders as the rotors fight gravity. The helicopter rises slowly at first—the grass next to the helipad rippling like waves in a small lake—and then rapidly. Identifying landmarks provide context: the Northeast Extension, the Schuylkill River, the King of Prussia Mall.

When PennSTAR started flying in 1987, it was the second air medical program in Philadelphia. It began with one helicopter with a mission of critical care and accident scene transport in the tri-state area. PennSTAR now flies a pair of EC 145 twin engine helicopters—the workhorses of the medical flight industry—with a reach well beyond the Delaware Valley.

Since July 2025, PennSTAR has been integrated into the Penn Medicine Capacity Management Center—a centralized effort also encompassing the Transfer Center and hospital capacity management for Penn’s Philadelphia hospitals. These groups together aim to get patients the right care at the right time, especially when time is of the essence.

“Speed is a major advantage of helicopter medical transport, but it’s just as critical that these aircraft are capable of delivering intensive care, ensuring uninterrupted treatment from one location to the next, which is essential to improving patient outcomes,” said PennSTAR Interim Program Director Wayne Riddle, PhD, RN.

Many of the flights are between Penn Medicine hospitals in the system, ushering patients in need of critical specialized care to the exact right place—without the additional time and stress of navigating ground traffic in an ambulance. Other times, crews pick up patients at community hospitals in the region or directly from a trauma scene such as a car crash. PennSTAR also moves patients via its own ambulances stationed at Wings Field, at Penn Medicine Rittenhouse in Philadelphia, and in Doylestown, especially if weather conditions make flying unsafe.

“We are essentially caring for an ICU-level patient inside a small box. We don't have the resources that nurses and staff would have within a traditional ICU. Most of our equipment is located in bags.

We don't have cabinets to go to. We don’t have a pharmacy to walk to get our supplies,” said Riddle “The environment that we care for our patients [in] can be very unpredictable.”

While the helicopters are owned by Penn Medicine, they are flown and maintained by a company called Metro Aviation. It’s an arrangement that allows the health system to focus on the primary mission of providing medical care.

Before pilots are even considered by Metro Aviation, they are required to have built up at least 2,000 flight hours. Many of the pilots come from a military background, though there is an increasing trend in pilots who climb the ranks in civilian aviation flying charters and tourist routes—for example, Houghton spent many of his hours flying tours over New York City. Once hired, they are put through the training paces, which includes a stint on the only flight simulator for these helicopters, at Metro’s headquarters in Shreveport, LA.

Every PennSTAR flight is staffed by a flight paramedic and a flight nurse whose main qualifications include a background in emergency medicine and critical care. They must also have certifications or training in cardiac life support, pediatric advanced life support, flight nursing, and pre-hospital trauma life support—as well as comfort performing critical care in a space slightly larger than a phone booth, traveling upwards of 150 miles per hour, 2,000 feet above the ground.

O’Leary and Simpson both found their way into the air through the emergency care route, working in emergency departments and pre-hospital care. Each describes PennSTAR as their dream job.

“It’s a very challenging environment, these are extremely critical patients that you are managing without the multiple resources of a brick and mortar hospital,” said Robin Wood, PhD, MSN, CEN, vice president for System Capacity Management and Patient Flow.

12:58 p.m.: Meeting the patient and assuring safety

The helicopter hovers above the terracotta roof of Penn Medicine Chester County Hospital, Houghton negotiating with the wind as the skids touch the surface of the helipad. Within moments, O’Leary and Simpson are on the rooftop opening the clamshell doors on the back of the aircraft and pulling out the stretcher to push it down to the rooftop elevator bank.

As the elevator doors open on the first floor, it’s clear these guys are well known. Each turn in the hallway is met with another “Hey…How are you…Good to see you…” They smile and respond but never break stride toward the Emergency Department. They enter the patient’s room, push the stretcher alongside the patient’s bed, and the door closes. Inside, it’s a conversation with the doctor and the patient’s family while tubes and wires are unplugged from stationary equipment and then plugged into portable machinery stuffed into the stretcher.

This is the more orderly version of how patients are moved by air, but on-scene trauma is still a piece of the PennSTAR mission. This means that the crew can be called upon to respond to an event, such as a vehicle crash, that requires more improvisation.

“I think it’s important to understand that a lot of times we’re the first contact with Penn Medicine a lot of people have. And it's important that we bring our philosophy and our experience and our educations to the bedside,” said flight nurse John Buckwalter, RN, MBA.

Flying is second nature to the crew, but the same can’t be said for many of the patients and their families who are awash with trauma-induced stress. The crew does its best to allay fears in the few spare moments during the transfer. One key point of comfort for the anxious is that this highly trained flight crew is supported by a highly trained maintenance ground crew.

Inside a hangar at Wings Airfield in Blue Bell, the week before this call, the guts of a helicopter were on display. The main rotors had been removed and stored under a worktable, as had the tail rotor while a mechanic carefully worked on cables that run through the tail. Ladders on both sides of the helicopter rose to each of the engines, which were fully exposed as tangles of wires and cords and shafts and gears. This was a mandatory inspection that comes every 800 hours the aircraft is in flight. For the three weeks it takes to complete this inspection, Metro Aviation rotates in a backup helicopter from its fleet.

“They pull everything out here so that they can take a look at any components, any cracks, anything here in the structure,” said Wendell May, the aviation site manager for Metro Aviation.

Each part and each tool has a precise place. Everything is checked and rechecked, with photos taken at each step for reference. It’s a scene familiar to a health care industry that has borrowed much from aviation to develop a high-reliability safety culture. Once the helicopter is back in service, each pilot will also do a pre-flight inspection at the start of their shift, and that is layered on top of a more rigorous daily inspection by a mechanic. It’s redundant redundancy.

May says Metro Aviation’s goal is to make sure there are no concerns about how the helicopter flies so that the medical staff can fully focus on their mission in the back of the aircraft.

Jason Mann focused on one of the chairs pulled out of the helicopter. The mechanic was replacing a hook-and-loop fabric strip that held the seat cover on—just a tiny piece on a bigger part that has no impact on how the aircraft flies.

“We maintain the aircraft to zero defects,” since “they can’t pull off to the side of the road,” said Mann.  “We do our damn best to do it.”

Part of this methodical approach requires having the right people, and Mann has his pitch for people considering a maintenance role that comes with higher stakes.

“In aviation, this is the only job you can have where you directly impact somebody’s life, where it actually freakin’ matters. An airline, you get canceled, oh well, you missed your vacation. This, here, you’re saving somebody’s life,” Mann said.

Even with the careful redundancy built into the maintenance practices, the remote possibility that something could happen midflight remains. When one of the aircraft was returning with its crew to the base in Blue Bell in May of 2025, the tail rotor failed—an occurrence that is typically catastrophic: “We were nearly upside down at one point,” said pilot Bobby King. “I knew I had to land immediately.”

In the amount of time it takes the average person to read this paragraph, King called on decades of experience and training. He had practiced a procedure called autorotation while flying in the Army, a skill now needed to save his life, and the lives of the two crew members on board.

King turned the helicopter into the wind and used its aerodynamics to regain control. He spotted a landing spot, the front yard of a home, and used the height of trees to mark the exact moment to perform a flare—a bit like a parachutist might do just before hitting the ground, softening the impact.

The helicopter landed with only minor damage, and King and the crew walked away. One of them turned to King and said, “How did you do that?”

For King, overcoming the moment was a team effort.

“I’m very blessed at the job the crews did,” King said. “They kept their composure and their cool and they didn’t panic.”

King was recognized as the best of the best among his peers across the United States when he was named by the National EMS Pilots Association as the 2025 Pilot of the Year.

“There are pilots doing miraculous things every day in a helicopter…so I was quite honored to receive the award,” King said.

1:35 p.m. Touchdown on the road to recovery

O’Leary and Simpson are in the back of the helicopter with the patient as the helicopter rises and banks to the left, Chester County Hospital shrinking in the distance below. Ahead, a grey smudge on the horizon outlines Philadelphia’s Center City.

The pair reads vital signs and discusses treatment options over their headsets. They’re speaking clinically: Condensed sentences give each word more meaning. This is where the breadth of training and background kicks in.

“It's myself and my partner who are relying on our clinical judgment and our clinical expertise,” said Buckwalter, a flight nurse like O’Leary who regularly engages in a similar rapport with in-flight paramedics like Simpson. “We have physicians available to us to consult by phone if we need to, but they're not here.”

Each PennSTAR helicopter has space for much of the equipment that might be found in an ICU, from cardiac monitors, defibrillators, and ventilators, to ECMO devices that function as artificial heart and lungs. There’s also room for a stretcher and specialized doors on the back of the aircraft to quickly pull it on and off.

The carpet of reds and browns and oranges dissipates, as suburban plots become a checkerboard of white and black rooftops of rowhomes. Entire blocks flash by in heartbeats. The helicopter banks left, and the helipad atop the Hospital of the University of Pennsylvania’s Clifton Center for Medical Breakthroughs comes into view.

This is an approach owned by Penn, literally. Penn Medicine has the only instrument flight approach for a medical chopper in Philadelphia. This means the helicopter can fly in more challenging weather conditions that would otherwise require landing at an airport and transferring to an ambulance.

“When a patient needs care, that doesn't always happen when the weather is perfect,” May said.  “So having that capability, we are able to get the patient to the care, where other really no other programs could.”

It’s a quick trip down the elevator for O’Leary, Simpson, and their patient to neurosurgical ICU on the 10th floor, where a swarm of nurses takes over. Just 17 minutes have passed since they left Chester County Hospital.

Again here at HUP, the PennSTAR crew seems to know everyone, answering questions until the handoff is complete. The patient is now in the hands of the team best equipped to stop the brain bleed and chart a course toward recovery.

Within a few minutes, the pair is exiting the elevator on the roof, but before walking onto the helipad, O’Leary has a call to make. He is heard sharing some details about the patient and repeatedly saying, “You’re welcome.”

O’Leary always asks family members if they’d like an update once the patient is at their destination. In this case, a small act lends comfort to a family fighting through Philadelphia traffic to make it to their loved one’s bedside. The meaning of the act is clear on O’Leary’s face as he puts his flight helmet back on and pushes an empty stretcher out onto the helipad. Later, he would find out the patient made a full recovery.

“It’s the human side of the job where we want to make sure that we’re doing the best we can for the family and that their loved one is in good hands,” O’Leary said.

Moments later, the helicopter is back in the air, rising beyond the skyscrapers of Philadelphia and banking to the northwest toward Doylestown Health, the newest link in the Penn Medicine chain.

For this Bucks County community, bringing a PennSTAR base—and the full spectrum of advanced capabilities across all parts of Penn Medicine—represents a commitment to the absolute best in care. It is a direct link, tangibly and metaphorically, to a standard of leading-edge ideas and research with the daily care provided by community hospitals.

“The Doylestown community now has swift access to the multiple critical care services that Penn Medicine offers,” Wood said.

Below, the Schuylkill Expressway lies in its typical non-express state with traffic stacked along the approach to the city. Even at midday, trying to cut through that traffic with an ambulance, lights blazing and siren blaring, would be a journey of frustration and precious time lost.

“Everything is about speed and efficiency, right?” said Buckwalter. “The faster from the time you’re injured to the time you’re in an operating room makes a huge difference in the patient outcomes.”

Somewhere in that traffic is a family trying to get to the hospital. And somewhere else, someone is looking up, wondering where and why a medical helicopter is flying, only slightly aware of the latest life saved by diligence and medicine and engineering and mechanics.