By James MacDonald
At the best of times, coordinating and carrying out critical care patient transports by air and land across the 1 million square kilometres of Ontario involves an abundance of real-time problem solving. Identifying the right crew and vehicle capable of providing the appropriate level of care, communicating with facilities, coordinating with paramedic services to provide ground transport from the airport, and watching weather patterns are just a few of the minute-by-minute tasks required to successfully complete a critical care transport.
When you add a global pandemic to the mix, the complexity of this process increases exponentially.
This is particularly significant when you consider the potential for a surge of COVID-19 patients within remote northern communities. Even a relatively small number of infected patients could quickly overwhelm small medical facilities such as nursing stations. This would likely lead to a sudden demand for aeromedical transport, with multiple patients requiring timely air ambulance service to a larger centre capable of delivering the care they need. With limited air resources available, this is no small task.
Such challenges have been a primary focus at Ornge, Ontario’s provider of air ambulance and critical care transport services. Aside from the day-to-day mission of providing Ontario’s patients with safe and timely access to health services, the onset of COVID-19 has resulted in a number of special projects and a considerable amount of surge planning – very little of it done in isolation. A number of system partners and allied agencies have collaborated with Ornge on innovative solutions to support the needs of communities across the province.
Any surge would undoubtedly put a strain on physicians as they cope with an influx of patients, while at the same time arranging for transports. In April, Ornge began providing additional telemedicine support for emergency or critical care patients through CritiCall Ontario. Under this arrangement, hospitals can reach out to Ornge Transport Medicine Physicians and Pediatricians through CritiCall to receive assistance in managing the patient as they await transport. This support is also available if transport is not immediately available due to weather or volume. It is not specific to COVID-19 – the service can be used for patients with general acute and critical care needs.
Another significant challenge in the north involves the transport of COVID-19 tests to regional and provincial laboratories, when commercial air carriers are decreasing services to small communities. Ornge has made a contracted aircraft available on specific weekdays and weekend days — when commercial carriers are unavailable — to transport COVID-19 tests from several northern communities to Toronto labs for processing. This allows for faster results, which is critical at this time for preventing further outbreaks.
Most COVID-19 transports performed by Ornge to date have been carried out by the organization’s Critical Care Land Ambulance (CCLA) program. Recognizing the need for critical care capacity in Southern Ontario at this time, Ornge has opened two temporary CCLA bases in Hamilton and Chatham-Kent to serve the Niagara Peninsula and Southwestern Ontario respectively. This resource provides timely transport for patients to tertiary care centres and timely critical care repatriations. In what is surely is a model of inter-agency cooperation, the Paramedic Services in each of these communities stepped forward with their support by providing facilities for ambulances and crew members. Ornge is also excited to be cooperating with Toronto Paramedic Services on a model for staffing an ambulance bus with Critical Care Paramedics to transport by land multiple intubated patients in southern Ontario.
Among the many lessons learned over the course of the past few months is the importance of supporting our own staff, particularly from a mental health perspective. Even with proper Personal Protective Equipment (PPE) and training, transporting COVID-19 patients can be unsettling for front line paramedics and pilots and their families. As part of a broader mental wellness program, Ornge has established a procedure where upon completing such a transport, the crew is automatically put on an ‘operational pause’. The crew is taken temporarily off-line in order to facilitate a debrief and check-in on their well-being.
A final piece involves leveraging the well-equipped and trained staff who are prepared for meeting today’s unique circumstances. The pandemic has accelerated Ornge’s plans for a Special Operations Team, one staffed with senior Critical Care Paramedics, which would be tasked with carrying out low frequency high acuity transports including those related to infectious diseases, but also Extracorporeal membrane oxygenation (ECMO), bariatric and other specialized cases.
Like other healthcare and first responder organizations, Ornge is proud of our staff in responding to the challenges presented by COVID-19, and doing so with professionalism, courage and compassion.
James MacDonald is Director of Communications and Public Affairs for Ornge