Features Commercial EMS
Power to Care

Tupperware is one of the handiest inventions ever created for those on the go, and when you’re flying for Ontario’s not-for-profit transport medicine organization Ornge, it’s an essential part of your daily survival kit.

The AgustaWestland AW-139 is a popular choice for EMS applications. (Photo courtesy Ornge)

How essential is it for rotary pilots and medics in this organization? “Critical,” pilot Jean-Luc Laroche says, smiling, as he hustles to his seat in the cafeteria of the Sudbury Regional Hospital, a steaming bowl of homemade soup recently heated up in the microwave waiting for him. The Sudbury, Ont.-based pilot is sitting with fellow pilot Andre Bertrand, and it’s time for lunch – or more accurately, time for a break in a day with no set schedule, where eating quickly between calls takes on a “now or never” level of importance.

By the time I join the pair for lunch after waiting patiently in line, Laroche and Bertrand are, to my amazement, almost done. “Sometimes, it can be just like this,” Laroche says, packing up his plastic bins. “I don’t know if that was good or not, but it’s in.”

Lunch finished, the pilots head back to the landing pad and their new AgustaWestland AW-139, where medics Dennis Quenneville and Michael Steinman are waiting. It’s time to attend to any number of calls this afternoon. “It’s just the nature of the job,” says Laroche. “You never know what you are going to do. You could be flying VFR in the morning, something completely different in the afternoon.”

Case in point, prior to our brief lunch break, we had travelled to a small community approximately 75 nautical miles south of Sudbury where a man was suffering from a traumatic injury. Minutes earlier, an emergency call to Toronto via Sudbury to transport a pediatric patient was in the offing.

En route from the Sudbury base, Quenneville explained the nature of the call was quite serious. Upon arriving at the heavily wooded site following a 30-minute flight, it was apparent setting the helicopter down would be difficult – the location left few options for safe landing, other than two potential cottage docks in an adjacent lake. It became a moot point when the call was cancelled, and the crew returned to Sudbury to complete the Toronto call. The OPP later confirmed the 69-year-old patient was pronounced dead at the scene after an excavator accident.

An Ornge Awakening
From helping the severely injured following serious car crashes on Ontario’s most northerly roads, to dealing with critical care cases in remote parks, to patient transfers between medical facilities, it’s all part of the Ornge mandate. And it’s a responsibility every member of the more than 400 Ornge employees across the province holds in the highest regard.

The AW-139 "is like a Sikorsky S-76A on steroids," says pilot Jean-Luc Laroche. (Photo courtesy Ornge)

A vital part of Ontario’s medical system, Ornge provides sophisticated medical transport for ill and critically injured patients in the air and on the ground. The history of the non-profit organization dates back to 1977, when the province established a helicopter-based aero-medical program at Toronto’s Buttonville Municipal Airport associated with Sunnybrook Hospital.

After more than two decades of service, the program grew to include a variety of fixed- and rotary-wing aircraft and several bases across Ontario. In 2002, base hospitals in Sioux Lookout, Thunder Bay, Sudbury, Timmins and Toronto were amalgamated under the Ontario Air Ambulance Base Hospital Program.

In 2005, the Ontario government announced that the OAASC (Ontario Air Ambulance Services Co.) was appointed to co-ordinate all aspects of the province’s air ambulance services. The company changed its name to Ornge in 2006, a play on words to describe the uniqueness of the colour of the medical transport vehicles. Since assuming responsibility for all aspects of the provincial transport medicine programs in 2006, Ornge has been actively seeking ways to modernize its service and make it more sustainable for years to come.

Serving an area of more than 1.1 million square kilometres is a daunting task, especially given the province’s unique geographical and
climate-related realities. To ensure the safe transport of patients to and from medical facilities provincewide, Ornge deploys a variety of fixed- and rotary-wing aircraft from its various bases.

The Ornge air fleet includes 11 Sikorsky S-76A helicopters, an aging fleet that is currently being phased out after the introduction last year of 10 state-of-the-art AW-139s from AgustaWestland. Ornge also owns 10 Pilatus PC-12 fixed-wing aircraft and has access, through its subcontracting agreements, to more than 50 aircraft operating a number of bases across Ontario. The co-ordination of these medical assets is a challenging task, as helicopters, fixed-wing aircraft and critical care land vehicles handle approximately 21,000 transports annually.

Co-ordination of all medical transport assets is handled from the company’s head office and medical command centre in Mississauga, an impressive facility that houses administrative offices, the Ornge Academy of Transport Medicine, and a busy control centre, known as the Ornge Communications Centre, manned by a bevy of communications officers at the ready to cycle priority calls to various bases for crew deployment. It’s a highly complex operation that accurately reflects the Ornge mandate – compassion, collaboration and innovation to provide the highest level of care to patients in need quickly and efficiently.

Ornge CEO Christopher Mazza has witnessed firsthand the tremendous disconnect that can exist between the medical and air transport teams, and it’s a situation he contends will never happen at Ornge. “Transport medicine is not about aviation and medicine. It’s not about ‘you fly and we’ll do our thing.’ It’s a team,” says Mazza, an emergentologist who has had an accomplished career as a transport medical professional in the U.S. and Canada. “It’s the integration of the two most regulated professions on the planet. You don’t make decisions without me. I don’t make decisions without you. Ornge was created on that philosophy.”

Excellence personified
The Ornge philosophy is easily discernible at the Sudbury base, which is home to some 10 pilots, 16 medics, six AMEs and an avionics specialist. The Nickel City base is one of the busiest bases in the province and, as operations manager Frank St. Jean points out, there’s plenty of pride to fulfil the Ornge mandate.

Ornge has added 10 new AW-139s to its fleet to replace the aging Sikorsky S-76As. (Photo courtesy Ornge)

“It’s a very busy base, a very senior base. We have some of the most senior medics and pilots in Ornge,” says St. Jean. “Attrition is slow here because it’s a lifestyle choice. It’s a career base and people stay here for the long run and, generally speaking, they enjoy their jobs.”
Flying an average of more than 1,500 hours annually in one rotary-wing aircraft, the Sudbury base is unique to the Ornge operation, he says. And given its location in the province, near several provincial parks, major highway traffic from southern Ontario, and significant population bases, it’s not surprising that the new AgustaWestland AW-139 is of critical importance.

“This helicopter is very precious to the community – and rightly so,” he says. “We are on demand a lot. I don’t even see my staff when I come in because they are out the door . . . it’s Collingwood here, Toronto there . . . they get the job done and they do it well.”

Mike Trottier, chief pilot at the Sudbury base, concurs, and he too has high praise for the teams manning and maintaining the aircraft. Trottier is a veteran pilot with Canadian Helicopters, the company that has been contracted to fly medical transport helicopters for the Ontario Ministry of Health since 1977/78. Ornge has now formed its own air division and many former Canadian pilots, including new Ornge chief pilot Kendal Beatty, are moving over to the Ornge team.

Trottier has noticed a marked change in the nature of calls at the Sudbury base and it’s a dynamic that illustrates how the new AW-139s will be used going forward. “There’s a fundamental difference with a helicopter and a specific call. It’s a fairly extensive vehicle,” he says. “Our flying hours haven’t changed dramatically since the old days, but what’s happened is we are being tasked with much longer – and I suspect the medics would say, lower priority, calls. This helicopter [AW-139] really shines in the scene calls, but we have fewer scene calls.

Snowmobile accidents, accidents in the park, this is where the helicopter really comes through. The focus now seems to be more on transport medicine, which is moving bodies.”

St. Jean is cognizant of changing dynamics but is impressed by the commitment his team delivers – an altruistic purpose that makes it more than just a job. “For 20 years, there hasn’t been a lot of change, but there has to be a realization that after two decades, things change,” he says. “And the demands change with it. As a company, we have to look at the model and ask, as a company, how do we adapt to make things run more efficiently? That’s where some of those decisions are coming from.”

Making the Switch
The secure transportation of patients throughout the province is made possible not only by Ornge staff but by the aircraft it flies. For years, Ornge has depended on the reliability of the Sikorsky S-76A aircraft and the team has high expectations for its new fleet. Since its introduction in 2005, the AW-139 has gained an international reputation as a highly versatile, adaptable and respected aircraft, and its transition into a state-of-the-art flying hospital for Ornge has been a sound transformation.

A large number of the AW-139’s medical calls are patient transfers to hospitals throughout the province. (Photo courtesy Ornge)

Dr. Christopher Denny, a transport medical physician with Ornge, says the AW-139 offers several improvements over the S-76A. Denny helped design the medical interior with a team of Ornge employees, travelling to Switzerland prior to delivery last fall to work with the team from Swiss firm Aerolite. The design team went through several real-life medical scenarios to get the interior configuration just right.

The concept phase was to block out an interior that would work for the mission profile that is done in Ontario.

Some considerations included:

• Access to the patient – the interior was configured with longitudinal access in the middle of the aircraft.
• Multi-paramedic implementation – the configuration had to be considered for two paramedics with access on both sides of the patient, so if you wanted to start an IV, it didn’t matter which side of the patient you were on – both paramedics had the ability to do so.

And although there have been issues with elements of the design not working up to snuff – paramedics have complained about the stretcher system, design elements of the interior, and other aspects of the configuration – Denny remains confident the bugs will be ironed out. So far, to those who matter most – patients being transported – only positive things have been conveyed.

“The patient feedback has been very positive and the reality is we are going to continue to work on what we have,” Denny says. “This is going to be our first summer season, it’s a busy time of year for us, so we will be challenged, looking after primary responses. We will be able to find ways to make the design even better.”

Plenty of Muscle
Pilots and AMEs echo the sentiment that the new aircraft will help Ornge continue to deliver the critical care service that Ontario residents deserve. “There’s no doubt it’s been positive from their perspective,” says St. Jean. “The ambient temperature is a good example. It’s been a huge issue for us in the past and it affects the payload of our fuel. Now, we can go with what we call full regular dispatch fuel no matter the ambient temperature. And you can run air conditioning and be able to have full power for those engines for a vertical scene. Before, we would go to a scene and worry if we had too much fuel on board and we might not be able to go vertical enough to go above the tree line after we take off. Even the medics have commented about this.”

An AME crew at the busy Sudbury base prepares an AW-139 for another potentially hectic day. (Photo by Matt Nicholls)

Other attributes have caught St. Jean’s eye, specifically the power. “The pilots tell me it’s more than double what we had before from a horsepower perspective,” he says. “We had the A-model S-76, but compared to the A-model it’s a huge difference. And the cabin size is tremendous.”

The avionics is also a huge transformation, he says. “From what the pilots are telling me, the GPS approaches coming on board . . . coupled with de-icing, the power, and so on, it’s just going to allow us to service calls that we just couldn’t before.”

Building for the Future
Although there have been definite issues with the conversion of the new AW-139 fleet, there’s a sense of optimism that it’s a solid choice for Ornge in its commitment to serve Ontarians with the best medical transport possible. Working to improve the process and make key refinements is just par for the course.

“We just have to remember that you start with this and it takes a while to see it grow,” says Laroche. “When you operate for many years doing something the same way, it takes time to get up to speed. Come back and talk to us in a year. It is an evolving operation right now. We’re learning, management is learning, engineering is learning.”