On Wednesday, May 27, Dr. Homer Tien, Ornge Presidend and CEO, was invited as a witness for the House of Commons Standing Committee on Health in its Briefing on the Canadian Response to the Outbreak of the Coronavirus.
During the question and answer session, Dr. Tien had the opportunity to highlight Ornge’s COVID-19 response including surge planning initiatives for northern, indigenous communities as well as the importance of northern airports.
Please see his opening statement below, or view the entire proceedings on the Parliament of Canada’s website.
Good day. I want to thank you for the opportunity to address the Standing Committee on Health today for the briefing on the Canadian response to the outbreak of the coronavirus.
My name is Homer Tien. I’m the president and CEO of Ornge, the provider of air ambulance and critical care transport services to the province of Ontario. I assumed my role in January 2020 after serving as the
organization’s chief medical officer for five years. I’m a surgeon by training, and I was previously medical
director for trauma at Toronto Sunnybrook Health Sciences Centre where I still maintain a practice as a trauma surgeon.
I also spent 25 years in the Canadian Armed Forces and retired from the forces as a colonel in 2015 after
deploying multiple times to front line field hospitals in the former Yugoslavia and Afghanistan.
I’m here representing the more than 600 people who are part of the team at Ornge. We’re the largest air medical and critical care transport organization in Canada, and we conduct approximately 20,000 patient-related transports per year.
Ornge is an integral part of Ontario’s health care system, which is based on a hub and spoke model of care. In this model, patients are transported from smaller facilities in rural and remote communities to larger hospitals to receive a higher level of care. To preserve capacity for the next patient, these same patients are then repatriated back to their home hospital when appropriate and safe to do so.
More than 90% of our work is devoted to this type of inter-facility transport. To carry out our mission, we have a mix of helicopters, fixed wing aircraft and land ambulances staffed by highly-skilled paramedics and pilots. They are supported by aircraft maintenance engineers, communication officers, physicians and administrative staff. Our operations are based in 11 communities across Ontario with our head offices in Mississauga.
Today I would like to share with you the details of our operational response to COVID-19 and provide the committee with some ideas for consideration.
Caring for a patient effectively and safely in a mobile environment is challenging. It’s about safely and
efficiently getting the right patient to the right place with the right asset and crew at the right time. In the case of air transport, we even need a bit of luck with the weather.
COVID-19 has added entirely new complications to this mix. You need to optimize staffing to create surge capacity. You need to re-evaluate your personal protective equipment needs in order to reduce risk to staff and patients. If you think about, we’re operating within the confined space of an aircraft or a land ambulance, a little box, while that patient is coughing or being mechanically ventilated within a couple of inches from the paramedic.
As COVID-19 first began to unfold, our organization had three basic objectives—protecting our staff,
maintaining service delivery and planning for a surge. These objectives have informed every decision and every action we have taken.
As of May 15th, Ornge has transported 531 patients with either a confirmed or suspected COVID-19
diagnosis. Nearly half of these were transported by our critical care land ambulances, about 30% on our fixed wing aircraft, and about 20% in our helicopters. These were all terribly sick patients. Nearly half of these patients were intubated and being mechanically ventilated. I’m pleased to report that to date no Ornge staff members have tested positive for COVID-19.
I would like to spend some time on one particular aspect of our operation. Ornge is the agency responsible for transporting stretcher-bound patients in and out of rural and remote indigenous communities in the north many of which are only accessible by air. Our air ambulance crews respond regularly to approximately 30 nursing stations across northern Ontario performing more than 2,500 transports annually from these communities.
If one of these communities suddenly found itself with a number of severe cases of COVID-19, the local
health care resources would likely become overwhelmed quickly. This situation would lead to a sudden and immediate demand for air medical transport, and in order to protect the other people in the community, those exposed would need to be tested. Those tests would need to be processed quickly at labs in larger centres, but with commercial carriers ceasing or scaling back operations, this becomes much more challenging.
Planning for these scenarios has been a central focus at Ornge since the crisis began. Ornge is a tool for health equity, particularly for rural communities and remote indigenous communities. We realize that we need to be creative, innovative and thoughtful about how we use our capabilities in order to provide the needed access to care.
Since mid April, Ornge has been coordinating weekly logistical flights to transport samples from northern communities to the labs in the south for processing. To date, more than 2,000 COVID-19 testing samples have been transported via Ornge contracted aircraft. This has dramatically increased the speed of processing results which we all know is critically important to preventing the spread of COVID.
In addition, there’s been considerable interest in reducing unnecessary travel to hospitals, particularly to those in the south. For the past two years, Ornge, with its partners has been supplying point of care lab tests to remote indigenous communities in the northwest. This has allowed members of these communities to access the appropriate diagnostic care in their communities and avoid unnecessary transport to southern hospitals where they could be exposed to infection.
As well, there’s tremendous interest in telemedicine across the entire health care sector for the same reason. We’ve already been offering virtual consultations to northwest nursing stations in partnership with Thunder Bay hospital. Last month, Ornge began providing additional telemedicine support to the rest of Ontario in partnership with CritiCall Ontario, a provincial bed finding agency. Under this arrangement any physicians in any Ontario hospital can reach out to an Ornge emergency medicine physician, ICU physician or pediatrician to receive assistance in managing a patient 24/7. This service is not specific to COVID and can be used for patients with general, acute and other critical care needs.
We’re also working with some of our system partners to look at novel technological solutions. Specifically, we’re exploring remotely piloted aircraft systems (or drone) technologies for the purpose of improving health equity for northern communities. This could involve the delivering of critical medical supplies to nursing stations and the shipping of medical lab samples to health centres.
From a surge planning perspective, we’re tapping into our most valuable resource: our people. Ornge has solicited paramedic volunteers to form a COVID-19 Ornge-Surge response team. From across the province there are 46 Ornge paramedics have volunteered. They can be dropped of at any facility in the province to help with airway management and mechanical ventilation prior to transport. The teams deployment kit has the equipment and medications to be able to function independently and it includes the fully equipped airway management bag, a portable mechanical ventilator, monitors, medications and infusion pumps.
None of this could happen without the tireless dedication of our staff. Which is why they need whatever
support we can provide them during this stressful period. Whenever one of our crews transports a patient with a confirmed case of COVID-19, upon completion of that transport we automatically put them on an operational pause. The crew is taken offline temporarily in order to facilitate a debrief and a check on their personal needs and their anxiety levels. In doing so we’re hoping to take care of their mental well-being as well as their physical well-being.
The Canadian health care systems is one of the best in the world. Unfortunately, disasters like the COVID-19 pandemic reveal that our rural and remote communities are more vulnerable to disruption and care pathways then our more urban communities. Air ambulance and critical care transport services are nimble, operational focused organizations. We have the ability to innovate and adapt quickly to unconventional problems that affect access to care and health equity.
I’d ask leaders and health care organizations to just ask us if they have a problem and we will find a way to help.
Thank you to the committee members for inviting me to speak. I look forward to your questions and
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