Transport medicine is about delivering specialized medical care in a mobile environment. It could be a fixed-wing (airplane) or rotor-wing (helicopter) aircraft, or land transport. Transport medicine is the connective tissue for the hospital system – it links hospitals together enabling access to specialized care for the people of Ontario. Ornge transport medicine paramedics and paediatric transport paramedics are trained to provide care for critically ill or injured patients outside the traditional bricks and mortar of a hospital. They are experienced and highly trained in providing specialized care to patients in the medical transport environment – our virtual hospital.
History of Transport Medicine
Transport medicine is a complex service in which acute care meets air and land transport. Using aircraft to transport the injured has its origins in the military and is almost as old as powered flight itself. In 1870, during the Siege of Paris, 160 wounded French soldiers were transported back to France by hot-air balloon. In the Korean War in the early 1950s the U.S. had specially equipped helicopters dedicated for medical transport and by 1969, in the Vietnam War, specially trained medical corpsmen were providing in-flight care. Subsequent to this, a group of researchers concluded that servicemen wounded in battle had better rates of survival than motorists injured on California highways, which inspired the use of paramedics in civilian medical transport. Civilian use of aircraft as ambulances originated in remote parts of the world such as the Australian outback, northern Canada, Scandinavia and Africa. By the 1970s dedicated civilian air ambulance services were well established in Western Europe, Australia, the United States and Canada. Since then, these and other air ambulance services have grown significantly and now represent a fundamental part of the medical systems in several jurisdictions.
Transport Medicine in Ontario and Ornge
A vital part of Ontario’s medical system, Ornge provides sophisticated medical transport for very ill and critically injured patients, in the air and on the ground. The challenges are varied in a province that covers nearly eleven per cent of Canada’s total land area. In this environment, Ornge has one of the largest and most sophisticated transport medicine organizations in North America. Ornge provides an essential link for all Ontario patients, and particularly for those patients living in northern Ontario. More than 60% of Ornge patient transports occur north of Sudbury, providing an important access point to critical health care services for remote populations.
Ornge’s mobile intensive care units, located in helicopters, fixed-wing aircraft and land vehicles, handle more than 18,000 transports every year. On-board medical care is provided through a system featuring round-the-clock teams of Ornge paramedics with specialized training to care for patients in the aero-medical environment. Through a multi-system communication network, paramedics have constant access to transport medicine physicians for consultation and to receive medical orders.
Approximately ninety per cent of transports are from one hospital to another, facilitating the design and reorganization of the healthcare system and delivery of patient care around centres of excellence whereby certain hospitals are designated the responsibility for particular medical disciplines in a given region. Together, Ornge and its affiliates have more than 400 employees, including paramedics, paediatric transport nurses and transport medicine physicians, all supported by a team of educators and researchers. These highly trained and skilled health care professionals provide specialized health care.
Ornge provides three main medical transport services: (a) inter-facility patient transfers; (b) on-scene emergency response requiring aero-medical evacuation; and (c) transport of organs for transplant and the transport of surgical recovery teams to hospitals and transplant centres.
Inter-facility Patient Transfers
The majority of medical transports conducted by Ornge are transfers between health care facilities for patients who require critical, advanced or primary levels of care and who meet the criteria for Ornge transports. Historically, many hospitals throughout Ontario provided primary, secondary and tertiary care in a broad range of medical disciplines. In an effort to provide higher quality and more cost efficient medical care to patients, the healthcare system in Ontario has been reorganized around the concept of centres of excellence. The creation of centres of excellence involves the designation of certain hospitals in a given geographic area as responsible for specific medical disciplines such as neuro and cardiac sciences, cancer care, transplants, and paediatrics. For example, physicians working on a heart attack patient at one hospital may determine that the patient needs to be transported to a cardiac centre of excellence for a cardiac intervention. As another example, a child at a small community hospital in a remote region of Ontario with signs of a respiratory infection may need to be transported to a hospital in a larger metropolitan centre to be seen by a paediatrician. Therefore, the design of the medical system around centres of excellence located around the province not only necessitates more numerous and frequent patient transfers from one health care facility to another but often requires the services of Ornge for that transport. Indeed, approximately ninety per cent of the approximately 18,000 annual medical transports conducted by Ornge are hospital to hospital patient transfers.
Emergency Response
Unlike emergency medical service providers, Ornge is not accessible to the public through 911 calls. The coordination of Ornge services is the responsibility of the Ornge Communications Centre (the “OCC”). The OCC provides communication services as defined in the Ambulance Act. When requested by the local land ambulance dispatch centre, called the Central Ambulance Communications Centres or the Ambulance Communications Services, an Ornge aircraft may be deployed to respond to an accident or travel to a remote area, if the patient meets the established guidelines for transport by Ornge.
Organ Transplant
Ornge is the primary provider of organ transport services for Ontario-based organ transplant patients and organ donation surgical recovery teams within North America. Ornge is responsible for the rapid transport of recovered organs and the medical teams to transplant centres throughout Ontario.