Ornge will ensure the provision of service to a specifically identified scene when requested by the local Land Ambulance CACC (Central Ambulance Communication Centre). Ornge transport medicine services transport patients directly to a Provincial Trauma Centre when the trauma patient meets the requirements for the MOHLTC Trauma Triage Criteria (refer to Emergency Health Services Branch, Ontario Ministry of Health and Long-Term Care). Ornge defines a scene call if the trauma patient(s) is picked up at the scene.
Modified Scene Response
Occurs when Ornge has been dispatched to the scene but the local land ambulance has already initiated transport of the trauma patient to the local hospital prior to Ornge’s arrival.
Ornge will directly transport the patient to the Provincial Trauma Centre without use of Criticall if:
- The patient meets Ministry of Health Field Trauma Triage Guidelines
- The local physician approves
- The local hospital does not engage in medical care or investigation beyond primary resuscitation after the arrival of Ornge
The modified scene response was created to facilitate rapid medical transport of trauma patients to a Provincial Trauma Centre. In addition, the modified scene response assists local hospitals when they receive a trauma patient meeting field trauma triage criteria guidelines (FTTG) that requires a lead trauma centre and Ornge arrives without the physician needing to request aero-medical response. When Ornge paramedics arrive at the local hospital they will speak with the staff physician and advise him/her that they are able to transport this patient, if the physician agrees, under a modified scene response to the lead trauma centre. If the physician elects for this service the crew will contact the Ornge transport medicine physician on call and receive medical orders for patient management if required.
Any disagreement between the sending physician and Ornge staff on the patient’s clinical condition and meeting FTTG for transport should be discussed by the Ornge transport medicine physician and the sending physician.
Once the patient arrives at the local hospital the most responsible physician is the one in the local hospital. If the attending physician wishes to manage the patient in excess of the usual primary survey and resuscitation after the arrival of the Ornge medical staff i.e. CT head, C-spine x-rays then the “modified scene call” policy does NOT apply. The attending physician will make arrangements with CritiCall in the normal manner and advise which Trauma Centre has accepted the patient.
The receiving Trauma Team Leader (TTL) must be advised of the patient’s condition and estimated time arrival (ETA). The referring physician should attempt to contact the TTL themselves via Criticall to discuss the patient’s condition. If the referring physician is unable to call then the Ornge transport medicine physician will contact the TTL directly. The Ornge Communications Centre will advise the trauma centre of the expected time of patient arrival.
The referring physician has the right to decline a modified scene response at any time. If this occurs the paramedics will advise Ornge and may remain positioned at the hospital available for other calls until the physician makes a decision whether or not to transport the patient.