8-Sep-2011 Source: Ornge
On its 6:00 p.m. broadcast on September 6th, 2011, CTV Toronto aired a story with respect to Ornge’s service in Ontario. The story not only contained outdated and incorrect information but also omitted essential facts and was misleading. Ornge has notified CTV of these errors and has asked for a full apology from the network.
We want to set the record straight on a number of issues to ensure our stakeholders and members of the public have all the facts. Below is a letter to staff from Rainer Beltzner, Chair of the Ornge Board of Directors and Tom Lepine, Ornge Chief Operating Officer which addresses many of the issues.
To all Ornge Staff:
Last evening, a story on CTV news aired with respect to Ornge’s service in Ontario. The story contained outdated, out of context and incorrect information, and some important facts were omitted.
The Facts
Auditor General’s Audit:
The Auditor General is auditing Ornge as part of a regularly scheduled, five year cycle and not as result of the issues raised in the CTV story. The last time the air ambulance program was audited was 2005 while it was still under the Ministry of Health.
On November 22, 2010 we were informed that our scheduled audit would be happening soon and we have complied fully with every request we have received from the Auditor General’s office.
We can expect the final report to be publically available by the end of this year.
CPR in the AW139 Aircraft:
CPR can be done more effectively in the new aircraft with proper positioning of the stretcher which, depending on patient size and condition, can be done in less than 20 seconds.
The AW139 helicopter is currently being used in helicopter EMS (HEMS) operations in 16 countries around the world and we are proud to be one of them.
The medical interior was designed by frontline Ornge paramedics and a transport medicine physician to ensure that the design met Ornge standards and Ornge operating practices. Countless hours were spent by both front line staff and management to customize these interiors, and we are monitoring and improving any unforeseen issues as they arise. Ornge is aware of concerns raised by paramedics regarding CPR and has implemented both a short term and longer term permanent solution.
The short term solution involves releasing the stretcher and placing the patient in a transverse (or across the cabin) position and lowering the stretcher manually allowing more room to perform CPR. While the stretcher must be lowered manually, CPR can begin immediately as the patient is lowered into the down position. Ornge is also purchasing automatic CPR machines that will perform CPR on patients; the paramedic would not have to physically perform cardiac compressions. These devices have already been tested and evaluated by Ornge and will be available to us shortly.
The permanent solution is already being worked on and involves some design changes that will allow the patient to be transported in the “down/transverse positionâ€. This would resolve the issue of larger patients and allow the paramedic to perform CPR during any phase of flight. As with any pre-hospital cardiac arrest, performing uninterrupted CPR has been identified as challenging, each situation has its own unique challenges – our environment is no different.
Bariatric (Overweight) Patients:
In our S-76 – the maximum weight of patient and equipment was 500 lbs. This aircraft had no true bariatric capacity.
In our AW139, in standard configuration, the maximum weight of patients plus equipment is 400 lbs. In the bariatric configuration, there is no weight limit – which is a significant improvement from the S-76. Weight is only limited by the ability of the local land EMS stretchers to accommodate patients in cases where a patient is picked up and dropped off at an airport. »
Weight is one aspect, however, patient girth and the ability to safety fit and transport the bariatric patient on a stretcher must also be considered. The AW139 stretcher lift system is rated for patients weighing up to 330lbs. For patients weighing more than 330lbs, the procedure is to switch to the bariatric configuration which is has unrestricted weight limits.
All of this was communicated to CTV News prior to air.
As I mentioned in the interview segment of the report, the change from one aircraft configuration to the other takes minimal time and is a simple procedure.
Helicopter Launch Criteria
The new helicopter launch criteria, which was referenced in the news story, was actually put into practice as a result of the audit by the Auditor General in 2005, and has been fully supported by our Medical Advisory Committee and the Ministry of Health and LongTerm Care.
In the past year, Ornge has been cancelled from scene calls more than 3,400 times before arriving at the scene by the Central Land Ambulance Communication Centre (CACC) or responding paramedic crew. These numbers, coupled with the AG recommendation and the often competing requests for service that we receive, were the primary reasons for instituting the changes. Our model leverages a transport medicine physician to determine the priority of each call, based on the information available at that time. 3
Ornge will be on pre-alert and not launch if the land crew is within 10 minutes to patient contact. In the meantime the helicopter and crew should have all checks completed and be waiting in the aircraft with one medic awaiting the launch call from OCC.
It is important to note that Ornge’s Medical Advisory Committee will be monitoring the updated criteria and they have a direct reporting mechanism into the Board of Directors. Patient care and quality issues go directly to the board.
This too was communicated to CTV News.
Overview of Ornge’s purchase of new aviation assets as sent to Paul Bliss by email:
To continue meeting the needs of transport medicine, Ornge completed a private placement bond offering of $275 million in 2009 to facilitate the purchase of cutting-edge aviation assets, including AW139 rotary wing aircraft, Pilatus PC 12 fixed-wing aircraft, and related base and ground facilities.
Ornge has engaged in a capital re-fit of its aircraft, hangars and corporate office without requiring additional money from Ontario or its taxpayers. Specifically, Ornge’s new and more cost-efficient business model was made possible by securing low-cost financing from the private sector without requiring any additional or special funding from the Government and without the benefit of any Government guarantee.
In 2009, a special purpose trust (Ornge Issuer Trust), the sole beneficiary of which is Ornge, issued $275,000,000 principal amount of 5.727% debentures due June 11, 2034 that currently enjoy a AA- (stable) rating from Standard and Poor’s Rating Services, a credit rating equal to that assigned to the Government’s debt and the highest rating enjoyed by non-government issuers in Ontario.
When Standard and Poor’s upgraded the rating from AA negative to AA stable on October 8th, 2010, the rating agency issued the following statement: “The outlook revision reflects our assessment of the company’s strong support from the province, essentiality of the service it provides, and healthy financial results. The ratings on Ornge reflect what we view as the strong continuing support from Ontario, status as sole supplier of essential services that are highly integrated with the provincial health system, healthy financial results, excellent record of flight and medical operations, and adequate liquidity.“
It is important to note that these aircraft were purchased to replace the aging fleet of Sikorsky S-76 that were more than 25 years old, operated by a third-party carrier and increasingly grounded/out-of-service on account of maintenance requirements.  No taxpayer’s dollars were used to purchase these new aircraft and they were financed entirely by the private sector. 4
Motorcycle:
As part of a fundraising initiative for the Ornge Foundation, which raises private sector donations for the work of Ornge, and as a way to raise awareness for the work we do, AgustaWestland – the manufacturer of our helicopters – paid for a custom motorcycle to be built for Ornge by Orange County Choppers.  No taxpayer dollars were used to purchase this motorcycle or any of the public relations activities related to its use. It has been a visible presence at public events and has helped raise our profile among potential donors. Moreover, the reveal of the motorcycle was done publicly at the CN Tower and at a Toronto Blue Jays game in September 2009, which was attended by a variety of media including CTV Toronto and representatives of the Ministry of Health and Long-Term Care (Ontario).
The Ornge Foundation is similar to any hospital foundation and raises money for specialized transport medicine equipment and training, as well as research and development initiatives. The donation was made long after our procurement process was completed – as part of a standard solicitation of donations from all major suppliers to Ornge.
Boat:
While Ornge has never owned a boat, J Smarts, a separate legal entity from Ornge and a registered charity, owned a ski boat from 2007-2009.  At the time of purchase, it was intended to be used for the delivery of a youth program for water safety. The strategy for the program delivery changed in 2007, the boat was put into storage, and it was sold in 2009 with four hours of usage on the engine. No taxpayer dollars were used to purchase this boat, and it was never used in a recreational manner.
Conclusion
Over the past few weeks, we have responded to all questions raised on numerous topics about our operations. We have made every effort to respond to these inquiries in a transparent and open fashion.
We have achieved much in our short history and should be proud of all that we have accomplished since inception.
We realize you may have additional questions or concerns and we are more than happy to address them. We are in the process of creating an “Ask Tom†email address for questions to Chief Operating Officer Tom Lepine. It will be available shortly. In the meantime, you can send questions to info@ornge.ca or speak with your Operations Manager, Director or a member of Corporate Communications. We will continue to monitor media coverage and will keep you updated on any new developments.
On behalf of Ornge, the Board of Directors and the more than 21,000 patients we transport each year, I want to personally thank you for all of the accomplishments we have achieved together over the past five years. We have much to be proud of.
Rainer Beltzner, Chair of the Board
Tom Lepine, Chief Operating Officer
