With a mandate to deliver life-saving critical care transport to over 14 million patients across more than one million square kilometres of Ontario’s vast and diverse geography, Ornge plays a vital role in the province’s healthcare system. From remote First Nations communities in the north to urban trauma centres in the south, Ornge’s 14 bases – equipped with eight fixed-wing 12 rotor-wing aircrafts, and 13 land ambulances  –  provide over 20,0000 emergent and non-urgent medical transports per year to patients with critical care needs. These services bridge the gap between location and access, ensuring that all Ontarians, regardless of geography, can receive timely, specialized care. 

The Pharmacist’s Role in Safe and Effective Medication Use at Altitude 

 As the clinical pharmacist overseeing Ornge’s medication use processes, I play a central role in supporting and advancing safe and effective practices across the organization. My main responsibilities span medication safety policy development, aligning medical directives with best practice evidence for the medications Ornge administers, or designing drug information or online education to support advanced care and critical care paramedic continuing education needs. Additionally, during periods of critical drug shortages, I have led the implementation of inventory monitoring communications and contingency protocols to uphold patient care standards. 

 Recognizing the complexity of high-alert medications-the most harmful medications when used in error-coupled with the stressful and challenging environments that Ornge’s patient care takes place. I have created policies that govern Ornge’s practices across the province. These policies include every stage of the medication use process for these medications – from storage, labelling, transport, prescribing, preparation, administration, and patient monitoring. For example, to minimize errors while urgently administering medications, Ornge has standardized medication orders, IV pump concentrations, dosing, mixing IV formulations, and administration protocols. Since I began working at Ornge in 2014, I have had the opportunity to continuously implement these safeguards to mitigate medication errors by analyzing Ornge’s error data against national safety guidelines from the Institute of Safety Medication Practices (ISMP).  

Through this comprehensive medication safety framework and the continuous pursuit  for quality improvement, my work as a pharmacist has supported Ornge in achieving and retaining its status as “Accredited with Exemplary Standing” from Accreditation Canada since 2018, signifying our commitment as healthcare-systems pharmacy professionals to providing high-quality air ambulance and critical care transport services to Ontario’s patients..   It also highlights the transformative thinking required to re-imagine best practices for patient safety at altitude, in high stress environments, or wherever patients need us to go to deliver innovative, safe, high-quality patient care. 

Central Operations: Regulated Pharmacy Technician Excellence from the Ground Up

To maintain a province wide reach, each base must be ready at a moment’s notice. This includes maintaining a consistent and safe supply level of medications, medical supplies, and equipment. Supporting these efforts is Ornge’s central pharmacy, and equipment is based out of the warehouse in Oakville, Ontario. It’s here that regulated pharmacy technician Catherine Dawes supports frontline operations and patient care throughout the province. From this hub, she procures, prepares, and distributes medications and supplies to Ornge bases across the province. She ensures helicopters, planes, and ambulances are stocked with the medications required for high-acuity patient transport. 

Catherine meticulously maintains inventory and drug distribution across broad geography while adhering to cold chain, stability, and storage requirements. She communicates critical drug shortages, coordinates restocking, and responds to urgent resupply requests in real-time. Her role is also vital in working collaboratively to design and implement many of the safeguards we have introduced in the past decade. Her expertise regarding high alert medication storage, standardizing packaging and labelling that work to minimize the chance of mediations errors for patients during transport is truly invaluable. 

A recent career highlight for her included being awarded the national Pharmacy Technician of the Year from the Canadian Association of Pharmacy Technicians for her work during the COVID-19 pandemic with Ornge. She was recognized for travelling with Ornge paramedics to remote regions in Ontario where she conducted screening and administered COVID-19 vaccinations in Indigenous communities.  

Our work exemplifies how collaborative healthcare-systems can extend beyond four walls to mobile, high-risk healthcare environments. It is through our teamwork and collaboration that we are successful as a healthcare-systems pharmacy team in ensuring medications are always clinically appropriate, safely handled, and readily available across Ornge’s operations. From implementing and evolving high alert medication standards and safeguards to managing inventory in a complex environment, we maintain system integrity and ensure it follows each patient care journey throughout the province. Teamwork is what allows Catherine and I to demonstrate that healthcare-systems pharmacy happens anywhere healthcare happens – even thousands of feet in the air.