By Dr. Homer Tien

I started my career as a medical officer with the Canadian Armed Forces.   On any given day during the Canadian mission in Afghanistan, land, rotor wing and fixed wing ambulances responded to a variety of traumatic and medical incidents.    Our prehospital response was widely regarded as excellent:  Canadian military prehospital providers were trained and equipped to a set standard, were supported with linked information and communication systems, and each response was well coordinated and appropriately prioritized by a central dispatching authority.   The net result was that all Canadian soldiers in Afghanistan, including those working at remote Forward Operating Bases, had timely access to routine and emergency health care.  As well, our small hospital in Kandahar was always able to treat the influx of casualties, because patients were being efficiently decanted back to their front-line units or to Canada.

As the new CEO for Ornge, I’m excited about the prospect of Emergency Health Services (EHS) Modernization, as announced by Ontario Health Minister Christine Elliot in November 2019.   Improving the integration of emergency health services and reducing hallway medicine will benefit patients, and I’m confident that Ornge can play a key role.

While Ornge’s primary responsibility is to provide timely and safe air ambulance transport of critically ill and injured Ontarians, our capabilities could be applied to greater advantage.  We have the expertise and information infrastructure to help ensure that medically stable patients also receive well-coordinated, safe and timely transportation, and we are uniquely positioned to contribute to improved health equity for remote Northern Indigenous communities.

Ornge’s footprint is province-wide with helicopter, fixed wing and land ambulance bases in communities such as Thunder Bay, Kenora, Sioux Lookout, Sudbury, Timmins, Moosonee, Ottawa, Toronto, Mississauga, Peterborough and London.  Adult and paediatric emergency and critical care physicians are immediately available for consultation 24/7.  We employ support personnel who perform aviation safety audits, inspect medical equipment and provide medical education and oversight, including for our contracted fixed wing service providers that transport low acuity, medically stable patients across the province.

Transportation of medically stable patients is a key area of focus for EHS Modernization.  There would be value in standardizing and managing the performance of the mainly privately owned non-emergent stretcher transport services.  Ornge is experienced in this regard through its current work with aero-medical transport providers. We are also well positioned to work with health system partners to develop a centralized dispatch model for non-emergent transports and to improve accountability.

While EHS Modernization discussions take place, Ornge is not standing still.  We’re developing a portal for electronic booking of medically stable transfers using the Provincial Transfer Authorization Centre (PTAC) platform, and are already using PTAC as a way of updating facilities on their patient’s Estimated Time of Arrival.  Ornge is also working with partners to improve health equity in remote Indigenous communities.

Many of the health equity issues in northern Indigenous communities are related to geography, availability of key medical expertise, and timely supply of key medical consumables.  With community, regional and provincial partners we have worked to provide 24/7 emergency telemedicine services to remote Nursing Stations, and supply point-of-care laboratory testing capabilities. In the course of a two year period, multiple enhancements to provision of care within the patient’s own community were achieved and unnecessary transports were potentially prevented for nearly 500 patients. Other innovative solutions are also being discussed including remote tele-mentored diagnostic ultrasound, advanced resuscitation training for practitioners, and just-in-time drone delivery capability for critical medical supplies.

It’s serendipitous that lessons learned on the front line of military care are being so readily applied within the changing dynamics of health care modernization in Ontario.

Dr. Homer Tien is the President & CEO of Ornge.