By Grant Scollay

Ornge operates critical care ambulances, airplanes and helicopters that are mobile intensive care units (ICU).  Like all ICUs in Ontario, we are facing new and significant challenges during this COVID-19 pandemic.  Ornge has been forced to adapt to these unique challenges – the most significant being the uncertainty, the acuity and the volume of patients.

For Ornge, like all frontline services, early 2020 was fraught with uncertainty.  What would our role be in fighting this pandemic?  How would we as an organization cope with industry wide PPE shortages, red-lining hospital capacity and surging patient numbers?  Nearly a year later, our role is clear and focused.

The surge of seriously ill COVID-19 patients in Ontario continues to push health care resources to the extreme.  One of the most important tools has been bed equalization, or load balancing.  In partnership with CritiCall Ontario, Ornge coordinates the dispatching of COVID-19 transports from hospitals across the Greater Toronto Area (GTA) to balance ICU capacity across the region, preventing the system from becoming overloaded. Stable patients who can be transported with Advanced or Primary Care paramedics are dispatched to local Paramedic Services. For patients who require Critical Care or ICU level support, Ornge’s fleet of ambulances, specifically within the GTA, have been utilized heavily as part of the ‘decanting’ process.

More recently, Ornge deployed its newly formed Surge Response Team (SRT).  The SRT played a pivotal role ensuring ICU patients were safely and efficiently transported from Mackenzie Health in Richmond Hill to the new Cortellucci Vaughan Hospital.  In just over 9 hours, this highly coordinated effort between hospital resources, York Region Paramedic Services and Ornge saw 12 ICU patients transported.  This joint operation serves as another example of how Ornge critical care resources continue to support our healthcare partners in addressing the capacity concerns in our hospitals.

Early in the pandemic, it became clear that Extracorporeal Membrane Oxygenation (ECMO) would be an important tool for managing the most severely ill COVID-19 patients.  As a result, University Health Network – Toronto General became a frequent destination of the critical care ambulances in the GTA.  Critical care ambulances from Ornge, and the Critical Care Transport Unit at Toronto Paramedic Service (a partnership with Ornge), saw a significant increase in patients going for ECMO consideration.  These patients are often being transported because traditional therapies offered by community or regional hospitals were not effective.  Ornge paramedics face the daunting task of continuing to provide this high level of care, in far less space and with fewer human resources.

Other COVID-19 challenges needed to be addressed with ingenuity.  First, questions regarding the spread of droplets within aircraft could not be answered, requiring research to be conducted within our unique environment; research that has been completed and is pending publication.  As well, Ornge addressed issues related to providing PPE to paramedics for operations in the extremes of weather common in Ontario’s North.  Finally, COVID-19 has also seen a demand to have patients transported in the prone position.  While proning patients improves oxygenation, it poses many challenges in transport, requiring changes in both process and equipment to ensure patient safety as equipment used during transport was not designed to be used with patients laying on their stomachs.

Ornge has been flexible in its response to the needs of hospital partners, redeploying and adding capacity within its land ambulance fleet around the GTA and Ontario.  A temporary Critical Care Land Ambulance has been based in Chatham-Kent, and other units redeployed daily first to Hamilton (in 2020), and then Oakville beginning in early April of 2020.  An additional critical care ambulance will be added to Ornge’s online fleet on a temporary basis, based in Mississauga, to continue to aid with patient transports and any potential surges being forecasted in the coming weeks and months. This was challenging as Ornge is simultaneously leading the vaccination efforts of 31 remote Indigenous communities, a multi-organization effort known as Operation Remote Immunity.

Even as we share staffing resources with Operation Remote Immunity and continue to add critical land ambulance capacity to our operation, Ornge Paramedics continue to put up their hand to volunteer to assist, recognizing the importance of the moment.

Uncertainty regarding COVID-19 remains; new variants are on the horizon and the next challenges are unknown.   Ornge will continue to meet new challenges head-on.  As COVID-19 increases the acuity and the demands on critical care within the province, Ornge has evolved to meet the high expectations placed on them by our patients, as well as remaining a trusted partner with Ontario’s hospitals.

Grant Scollay is a Paramedic for Ornge’s Critical Care Land Ambulance program.