New horizons for Ontario’s Air Ambulance Service

    Air ambulance oOne summer in the late 1980s, when I was still in the early stages of my career in medicine, some emergency residents were given the opportunity to fly as paramedics in Ontario’s air ambulances.  As a licensed fixed wing airplane pilot with a background in aviation medicine with the Canadian Forces, I naturally jumped at the chance.  During that brief period, I gained an appreciation for the work of flight paramedics, and learned what it was like to take care of a critically ill patient in the back of a helicopter.  It was – and is – demanding, stressful work that requires a strong commitment on the part of everyone involved, including the pilots, paramedics, dispatchers and support staff.

    Since that time, the program has become a vital component of Ontario’s health care system, one that now involves helicopters, fixed wing airplanes and land ambulances, all operating under Ornge, a non-profit charitable organization.  Ornge, it’s also fair to say, has been through a lot recently – a financial scandal, official inquiries, and the political and media spotlight. Now, more than 25 years after I took that air ambulance helicopter flight, I have been given the privilege of moving the organization forward and mapping out a future direction for air ambulance in this province.  It is a significant undertaking, but one that energizes me and everyone on the Ornge team.

    That said, it has been a challenging time for the people at Ornge.  On May 31st, we lost four valued colleagues– Captain Don Filliter, First Officer Jacques Dupuy, and Flight Paramedics Chris Snowball and Dustin Dagenais — in the crash of an air ambulance helicopter in Moosonee.  While this loss has been devastating for our people, I have been struck by the resilience of our staff through the most difficult of circumstances.  They continue to show remarkable dedication to the patients we serve.

    To ensure each and every patient receives the best possible care, we continue to support our frontline staff with the proper systems and tools to do the job. To that end, we have come a long way already.  We have improved patient care with an interim interior for our AW139 helicopters and are committed to a permanent solution to further improve the paramedics’ work environment.  We have introduced certification examinations for our flight dispatchers, flight followers and medical call takers, and have purchased new dispatch software which will be implemented over the next year. This will significantly improve our ability to effectively manage our resources and to communicate with hospitals and ambulance services.

    With respect to transparency and accountability, we have introduced a wide variety of new measures including a conflict of interest policy, whistleblower protection and public reporting of executive expenses.  We are now submitting quality improvement plans and key performance indicator reports annually to the Ministry of Health and Long-Term Care as part of the reworked Performance Agreement with the Government of Ontario.  We have appointed a Patient Advocate to ensure questions and concerns over our service are addressed in a timely, professional fashion.  These are but a few of the many improvements already implemented.

    These improvements, however, are just the beginning.  There are many other longer-term, system-wide changes that require thoughtful consideration.  For example, to arrange a patient transport, a sending hospital often has to make multiple phone calls.  While there are a number of excellent resources in the system, particularly Criticall, which is the provincial coordinator of critical care and high acuity bed resources, reviewers such as the Chief Coroner have indicated that we need to integrate the system of transfer and transport to a much greater degree than we do now. As a former emergency room physician in a small town, I recognize that hospital staff are challenged managing a very sick or injured patient, and often have little time to navigate a complex system of transfer and transport.  We are working with our partners to simplify and streamline the process in an effort to improve customer service for our hospital stakeholders.

    We also need to establish our mission profile to make sure we deploy all our assets and people optimally across Ontario to provide the best service to the most people. Simply put, this means a system that ensures that each patient will receive the vehicle best suited to their needs. For example, you might think that a helicopter will always be faster than a land ambulance. Not so. Our analysis shows that land vehicles win the race within a 35 mile radius most of the time.

    By contrast, the helicopter is the choice from 35 miles out to about 130 miles. Beyond this, our fleet of fixed wing aircraft is the choice given that these airplanes fly twice as fast as a helicopter.  Understanding the mission profile is vitally important given the high demand for Ornge service and the vast reach of the air ambulance system from southern Ontario to the James Bay coast.  For issues like these, our approach is to be as collaborative as possible, and we are actively reaching out to our stakeholders in hospitals, EMS services, Central Ambulance Communications Centres and other agencies to ensure there is broad understanding of these ideas.

    In the early fall, we are convening a two day symposium with key partners and stakeholders aimed at developing our strategic plan for the next five years. That plan will dovetail with the foregoing initiatives, and will set the course for Ornge. It is indeed an exciting prospect.

    Though I look back fondly on those days 25 years ago, our focus is not on the past but on the future, as we continue to make progress on our goal of transforming Ornge into nothing less than an elite air ambulance operator.