Healthcare delivery in remote communities

1992

By Joshua McNamara

As a trauma surgeon and Colonel in the Canadian Forces, Dr. Homer Tien gained a unique perspective on the challenges of delivering trauma care in isolated environments under difficult circumstances.

After a career spent serving as a General Surgeon and Medical Officer in locations such as Afghanistan, Bosnia and Herzegovina, Croatia, Myanmar and the Golan Heights, Dr. Tien retired from the forces in 2014 and joined Ornge, Ontario’s provider of air ambulance and related services, as Chief Medical Officer.  One immediate focus:  the dozens of fly-in only communities across Ontario’s far north where patients receive care in nursing stations.

“In the military, we treat patients in remote locations where there are limited resources,” says Dr. Tien. “We have to think about providing better support to the healthcare providers in those Ontario communities, prior to transport. I hope our strategies to improve our service to the north and how we support our stakeholders will reflect this.”

Dr. Homer Tien is the Chief Medical Officer at ORNGE.
Dr. Homer Tien is the Chief Medical Officer at ORNGE.

Dr. Tien joined Ornge from Sunnybrook Health Sciences Centre where he was Medical Director for the Tory Regional Trauma Centre, Canada’s largest trauma unit.   After more than a year on the job, Dr. Tien has been looking to apply much of what he has learned to the field of medical transport – particularly across the expanse of Ontario’s north.  Ornge paramedics perform approximately 18,000 patient-related transports annually in its fleet of helicopter, airplane and land ambulances, with approximately two thirds of these transports taking place north of Sudbury.

“As healthcare delivery evolves in Ontario, so does the role we play in serving northern communities,” says Dr. Tien. “Transport and access to care become even more important when patients need to get to a tertiary hospital for specialized medical care.”

Dr. Tien’s work complements other northern-focused initiatives underway at Ornge.  Ornge added an 11th AW139 helicopter based in Moosonee to serve the local community and surrounding communities along the James Bay Coast.  Ornge has also trialed the use of Night Vision Goggles (NVG) technology at its Sudbury base.  NVGs are light intensifiers, where ambient and cultural light is gathered and amplified to provide enhanced vision for the pilots, allowing them to “see” their surroundings clearly, even in almost total darkness – a common circumstance in the north where there are frequent nighttime trips across largely unpopulated areas and landings in communities where there is little cultural lighting. The trial was deemed a success, and the organization is preparing to roll out the technology to its entire helicopter fleet across the province.

In addition, Ornge has been working with Cochrane District EMS, hospitals along with Highway 11 corridor, and the trauma program at Health Sciences North to expand the use of modified scene response around Ontario using airplanes.  This will allow for an expedited transport of patients directly to the HSN trauma centre.   The goal of this initiative is to minimize the time from injury to definitive care among patients in the northeast and decrease morbidity and mortality.

Dr. Tien believes there are also opportunities for the sharing of knowledge and education.  To date, he has delivered a number of presentations to medical professionals in Health Canada-administered Nursing Stations during bi-weekly rounds on topics such as traumatic brain injuries, chest trauma, trauma overview, airway trauma and bleeding.

“Delivering rounds for nursing stations allows us to work more closely with our healthcare partners and assist smaller centres,” says Dr. Tien. Ornge has also begun using the Ontario Telemedicine Network (OTN) to better advise northern health centres to collectively help care for patients effectively.

Dr. Tien is also very interested in hearing from stakeholders – our referring hospitals – how Ornge can improve its service to them.  In response, stakeholders have been providing feedback on how Ornge can continue to help patients access the care they need expeditiously.

There’s always room for improvement,” says Dr. Tien. “We thank our stakeholders for providing us with their feedback. As a result, we’re looking at ways to minimize the information we’re collecting about our patients from hospitals or nursing stations in order to improve the speed of our dispatch process. We’re also providing a rapid estimated time of arrival (ETA) in the first call we have with health facilities.”

With Ornge’s evolving role, Dr. Tien believes there are more opportunities for Ornge to work with health care facilities in northern Ontario moving forward to analyze data for gaps and how to close them, providing advice on medical equipment and assist in training or education.

Joshua McNamara works in communications at ORNGE.