Trial program brings specialized mental health care to air ambulance transfers

By James MacDonald

As a Registered Nurse working at nursing stations in Ontario’s northern First Nations communities, Richelle Robinson experienced first-hand the challenges of providing care to people in crisis in a location with few local resources available.

“Unfortunately, because we didn’t have the ability to do effective mental health care and follow up within the community, they needed to go out of the community to get a more thorough assessment, then maybe set up with longer term treatment plans,” says Robinson.  “Perhaps they were suicidal and needed to remain with us under care and watch. If that is the case, they would sometimes remain in the nursing stations for several days while we waited for a transfer.”

Today, as a specialized Mental Health Nurse, Robinson is playing a key role in a new program intended to improve availability and quality of care for patients who need to leave their community for follow up and treatment.

A graduate of Trent University’s Registered Nursing program, Robinson is one of the first members of a mental health transport team dedicated to Northern Ontario. The program, which launched on April 19 as a one-year trial, is managed by Ornge, Ontario’s air ambulance and critical care transport provider, and is based at the Thunder Airlines hangar in Thunder Bay. This team will only perform mental health-related transports.

According to the Canadian Mental Health Association, in any given year, one in five people in Canada will personally experience a mental health problem or illness. Systemic inequalities such as racism, poverty and discrimination can result in worsening mental health symptoms, especially if mental health supports are not readily available.

In Northern Ontario communities located off the road network, hundreds of mental health patients each year require an air medical transfer. The effective transportation of mental health patients requires timely availability of aircraft and specialized staff.

“Based on our experience providing transport services to Ontario’s remote north, we recognize the significant burden of mental illness in Northern and First Nations communities, and the need for these patients to receive timely and expert care,” says Dr. Bruce Sawadsky, Chief Medical Officer for Ornge. “With the launch of this trial, our goal is to bring mental health expertise to the patient in transport and increase the quality of care provided.”

The team, which will be available from 9:00 a.m. to 9:00 p.m. seven days a week, is comprised of a Registered Nurse who is experienced and specially trained in mental health care, as well as trained security personnel with experience in a healthcare setting. There will also be a Primary Care Flight Paramedic on board the aircraft during transport.

“With the bed-to-bed service that we’re doing, we will go into wherever they are – the hospital or a nursing station – and do our assessment first.  That gives me an opportunity to get the story from the client as well as to develop a quick rapport,” says Robinson. “With my skills, I am able to perhaps address some of the anxieties that they’re having and act as an ally for them as we’re doing the transfer.”

To ensure the safety of the patient and crew members on board the aircraft, the Registered Nurse and security personnel have completed specialized training, including non-violent crisis intervention and de-escalation. The Registered Nurse will carry psychiatric medications and will be capable of administering them to the patient if necessary.

“At the end of the transfer, the team can have a discussion about what we experienced and what we saw, what I noticed in terms of body language and behavior,” says Robinson.  “It gives us an opportunity to share what we know and offer a few teaching points that in future will ensure more trauma-informed care is being provided.”

Hospitals and nursing stations can access the team through Ornge’s patient booking process.  The usage will be analyzed over the next year.

“My hope is that we will be reducing wait times on transfers, because having these individuals sitting in an emergency department or a nursing station for hours and days on end is really not in their best benefit,” added Robinson. “And so if we can reduce that time and get care to them sooner, that’s really what we’re hoping for.”

James MacDonald is the Director of Communications and Public Affairs at Ornge