Transporting a Patient

Transferring a patient with Ornge? Here is a checklist of essential information required to booking an Ornge patient transport. 

In an effort to provide high quality care to patients, please ensure you read and complete this checklist before booking a patient transport with Ornge.
 
Patient severity:
 

• Emergent (life-threatening, unstable patient)
• Urgent (non life-threatening, prompt transport required)
• Scheduled (booked appointment/time sensitive, CT, MRI, clinic)
• Routine (deferrable, non-urgent)

  
Patient information:
 

• Name
• Date of birth
• Weight
• Health card or band number (may also include WSIB or other identifier)
• Escort if applicable (is this transport a treat and return?)                            
• Sending and receiving facility, department, and contact information
• Incident history/diagnosis and/or reason for transport
• Diagnostics and treatment
• Medical equipment required (ventilator, oxygen, IV pump(s), monitor, ECMO, IABP, etc.)
• Lines and tubes (IVs, art line, central line(s), chest tube(s), NG/OG, JP drain, foley, etc.)
• Infusions (sedation, inotropes, nitrates, anticoagulants, etc.)
• Medications and dosages
• Relevant past medical history
• Allergies
• Code status
• Isolation concerns (contact, droplet, airborne)

 
Please make copies of all documentation for the crew to bring to the receiving hospital.


Want more information?
A Communications Officer is available 24/7 in our Operations Control Centre to address any concerns you have by calling 1.833.401.5577.

The transport medicine environment is challenging. To carry out the transport safely, your patient may need interventions prior to transport that would not be performed if the patient remained in your hospital. To minimize the time the Ornge crew needs to prepare the patient for transport, please consider the following before the crew arrives:
 
Information – please have someone available to communicate pertinent details to the medical call taker, transport physician or crew and answer further questions as required. Physician to physician communication is often helpful and there is a transport medicine physician available 24/7.
 

• Incident history and relevant past medical history
• Medications and allergies
• Treatment and response to treatment, equipment, ongoing infusions and therapies
• Recent vital signs and pertinent physical findings
• 12-lead ECG (when pertinent) results and significant lab values
• Diagnostic imaging results – if on PACS or CD, please allow crew to view images
• Resuscitation status: DNR or advanced directives

 
Please make copies of all documentation for the crew to bring to the receiving hospital.
 
Patient preparation for transport (*as appropriate)
 

• Intravenous access (2 large bore peripheral IV’s if hypotensive, active/severe hemorrhage, severe trauma, sepsis or burns)
• Foley*
• Gastric tube*
• Airway supported / secured* (e.g. GCS<=8)
• Recent ABG if ventilated
• Spinal immobilization*
• Arterial line/central line*
• Blood products*
• Pregnant patients in active labour require a recent pelvic exam within the last hour prior to transport to assess likelihood of imminent delivery
• Medications (prn or regular) administered prior to transport particularly if being transported by primary care paramedics who will not be able to administer this in flight e.g. antinauseant, analgesics as appropriate
• Extremity fractures are splinted

 
On arrival, the Ornge transport team will:
 

• Take history and do brief physical assessment
• Review copies of patient's chart and other pertinent data
• Contact the Transport Medicine Physician for medical direction as required
• Ensure patient is prepared for the transport
  • cardiac, blood pressure, oxygen saturation monitoring
  • ensure all IV access is well secured and place pressure bags on intravenous fluid bags and use infusion pumps as necessary. Lines may need to be switched to the standardized air transport system
  • secure the airway for intubated patient by checking ETT placement (clinically and/or CXR) and ensure ETT taping is appropriately secured
  • stabilize patient on a transport ventilator for intubated/ventilated patients
  • perform other interventions as required
  • transfer patient to a stretcher and securely strap in place

Want more information?
A Communications Officer is available 24/7 in our Operations Control Centre to address any concerns you have by calling 1.833.401.5577.

Please have someone available to communicate pertinent details to the Communications Officer, Transport Medicine Physician or Paramedic. Physician to Physician communication is often helpful and there is a Transport Medicine Physician available 24/7. Verify with Ornge whether or not a parent can accompany the child.
 
Please make copies of all documentation for the Ornge transport team and the receiving hospital:
 

• Incident history and relevant past medical history.
• Medications and allergies.
• Treatment and response to treatment, equipment, ongoing infusions and therapies.
• Recent vital signs and pertinent physical findings.
• Significant lab values, ECG results, etc.
• Diagnostic imaging results – if on PACS or CD, please allow team to view images.
• For intubated patients - please obtain a chest x-ray post intubation.
• For trauma patients and other patients who may require blood products en route- please obtain 2-4 units packed red blood cells for the transport.

Monitoring and treatment while awaiting transport:
 

• Do not hesitate to request to speak to the Ornge Paediatric Transport Medicine Physician (TMP) who will provide advice on patient care pending the arrival of the Ornge transport team.
• For children going to the tertiary care units, the NICUs and PICUs in your region will remain accessible and help with providing advice on diagnostic workup and treatment pending the arrival of the transport team. In the event of changes in your patient’s condition you may call the Regional Tertiary Center for advice and inform the Ornge Control Centre.

 
On arrival, the Ornge transport team will:
 

• Continue cardio-respiratory monitoring, HR, RR, BP, Oximetry, Capnography.
• Review temperature, blood sugar and other point of care bloodwork eg. blood gas, lactate, electrolytes.
• Secure airway for intubated child - Check endotracheal tube (ETT) position (clinical and CXR) and will ensure that the tube is securely taped.
• Stabilize the child on transport ventilator as appropriate.
• Ensure all intravenous lines are working, and placed securely on infusion pumps with all medications double checked for transport.
• Administer any drugs or treatments required by TMP prior to departure.
• Transfer child onto special transport equipment.
• Speak to parents and family regarding patient’s condition, plans for transport and destination.
• Endeavour to bring a parent or other family member with the child for the transport.
• Provide an update on patient condition and expected time of arrival to the destination hospital - preferably done by the Paediatric TMP.

Want more information?
A Communications Officer is available 24/7 in our Operations Control Centre to address any concerns you have by calling 1.833.401.5577.

About Bariatric Patient Transport by Air

Ornge is the provider of air ambulance services for the province of Ontario. Transportion of complex patients is an important part of our mandate. However, providing safe, quality transport to the bariatric population can be challenging for Ornge in some instances because of operational limitations in our equipment and vehicles. Ornge is committed to safely minimizing service gaps to this patient population.
 
The purpose of this document is to:

1. explain how Ornge plans for safe transport of bariatric patients, including our operational limitations
2. provide guidance for health care partners, including a checklist for sending facilities

 
 
Ornge’s Planning Process and Operational Limitations

1. What level of care is required?
2. Which aircraft are available at that level of care?
3. Can the aircraft’s stretcher accommodate the combined weight (patient + equipment)?
4. Can the aircraft itself accommodate the total weight and the patient’s width?

>>>Vehicle selection made by Ornge
 

1. Level of Care

Ornge’s Transport Medicine Physician determines level of care required by the patient.  Ornge provides three levels of care:   

• Primary Care Paramedics (PCP) provide a basic level of care directed at symptom relief. 
• Advanced Care flight Paramedics (ACP) and Critical Care Paramedics (CCP) are capable of advanced resuscitation, and are also able to transport patients on mechanical ventilation and on multiple infusions. 
• CCPs are capable of using a broader scope of medications than ACP, including propofol and epinephrine infusions, and treating more complex patient populations (e.g. neonatal, obstetrical, ECMO, intra-aortic balloon pump).

 

2. Type of Aircraft Available

Depending on the level of care required for transport, Ornge can use its fixed wing aircraft (PC-12), its helicopter (AW-139) or several fixed wing aircraft types as operated by contracted Standing Agreement carriers.  Ornge’s dedicated aircraft function at the advanced and critical care levels, while its contracted carriers function primarily at the primary care level.

 

3. Weight Limitations of Stretchers

Each type of stretcher is rated to a maximum weight.  The weight of the patient plus the weight of the equipment needs to be taken into consideration.    
Patients requiring ACP/CCP level of care typically require more medical equipment.  As a consequence, the maximum allowable weight for an ACP/CCP patient is typically less than that of a PCP patient.  The following illustrates how equipment can influence the maximum patient weight:
 

EXAMPLE	PATIENT #1 PCP	PATIENT #2 ACP
Stretcher Weight Limit	500 lbs (227 kg)	500 lbs (227 kg)
Cardiac monitor	23 lbs (10 kg)	23 lbs (10 kg)
Pack rack	23 lbs (11 kg)	23 lbs (11 kg)
Ventilator	--	20 lbs (9 kg)tape
Infusion pumps x2	--	12 lbs (5 kg)
IV fluids (2 bags)	--	4 lbs (2 kg)
Patient Maximum Weight	454 lbs (206 kg)	418 lbs (190 kg)

 
Bariatric stretchers have varying weight limits, ranging from 500 lbs (227 kg) to 700 lbs (318 kg).  Availability of bariatric stretchers varies across the province, including by aircraft and land ambulance.

 

4. Weight and Size Limitations of Aircraft

Not all aircraft have the same operational capabilities.  Weight and balance considerations are important for aircraft safety. For this reason, accurate patient weight is essential.
For bariatric patient transports, accurate patient width is also essential. The size of the aircraft door and/or cabin configuration may present an issue, particularly if the stretcher is mounted against the cabin wall.  Ornge will ensure that a vehicle with appropriate capabilities is assigned.
 
 
Key Points for Health Care Providers
All patient transports should be requested through Ornge’s Operations Control Centre (OCC) or, in the case of a Life or Limb patient, through the One Number to Call process.

• For bariatric patient transports, OCC will use patient information provided by the sending facility (specifically, the patient’s weight, width and condition) to send the right aircraft.
• “Width” is a one-dimensional measurement, straight across the patient at their widest point when supine. Width is not to be confused with “girth” which is the circumference at the patient’s largest point, and is not needed for arranging patient transport.
• Transporting safely by air adds an extra layer of complexity. Capabilities vary with aircraft. Many factors need to be taken into consideration when Ornge makes a vehicle selection. For this reason, the timeline for arranging these transfers may be longer than a typical transfer request.
• Providing Ornge with accurate information about the total weight and width of the patient, and the type of equipment needed during transport, is essential.

 
Process for Sending Facilities

1. Determine if your patient meets bariatric criteria. For transport purposes, any patient with a weight >120 kg and/or a width >27” is considered a bariatric transport.
2. When choosing a destination, consider whether the Receiving facility has the ability to meet the bariatric patient’s needs (e.g. bariatric capability for diagnostic imaging).
3.  Initiate transport request. OCC will ask for the following, which is needed for the total weight calculation:
   1. weight of the patient
   2. width of the patient and
   3. identify what medical equipment will be needed during transport. Ornge will estimate the weight of the medical equipment.

Ornge will determine the patient’s level of care and the combined weight of the patient and medical equipment, and will assign an appropriate vehicle and crew to the transport.
Ornge will also liaise with the local paramedic service to plan logistics and determine any operating limitations it may have.

It is essential that weight and width measurements be as accurate as possible so Ornge can assign the right vehicle and crew. Inaccurate information can lead to lengthy delays.
 
What Happens If Air Transport Is Not Possible?
In some cases, air transport will not be possible, leaving land transportation as the only viable option. If the patient still cannot be moved (e.g. the patient is in an air only location), Ornge will work with health care partners to determine how we can offer support and what extraordinary means are available.

 
Want more information?
Want more information? A Communications Officer is available 24/7 in our Operations Control Centre: 1.833.401.5577

The following are guidelines for health care facilities when deciding if Ornge should be considered for medical transport (air or land). Each case will be individually evaluated and if required an Ornge Transport Medicine Physician/Paediatrician will be involved.
 
The child (age less than 18 years) should meet one of the following guidelines for medical transport:
 

1. Child requires specialized paediatric expertise.
2. Child requires the ongoing administration of intravenous medications and/or blood products during transport.
3. Child requires the use of specialized equipment or monitor- ing devices during transport. Examples include, but are not limited to:
   1. Ventilator
   2. Multi-channel infusion pump(s)
   3. Hemodynamic or invasive monitoring
4. Child is at high risk of deteriorating during transport and may require specialized medical intervention

 
There may be circumstances where a request for service does not meet the above guidelines. Ornge will assist health care professionals in determining the right level of care with the right type of vehicle (air or land).
 
Ornge does infant and paediatric transport.  For all infants < 28 days or < 5kgs- please continue to consider accessing the hospital based neonatal transport team for your region. Ornge works collaboratively to provide support to the neonatal transport teams for long distance transports.

Want more information?
A Communications Officer is available 24/7 in our Operations Control Centre to address any concerns you have by calling 1.833.401.5577.

Medical Scope of Service Utilization Criteria

The following is a guideline to be used to determine if a patient meets the scope of service criteria for the Ornge Critical Care Land Ambulance Program.
 
All issues regarding the medical use of the service will be resolved by the Ornge Online Medical Control (Transport Medicine Physician).
 

1. Patient requires the ongoing administration of medications and/or blood products during transport that is above and beyond the scope of practice of a Primary Care Paramedic.
2. Patient requires the use of specialized equipment or monitoring devices during transport. Examples include, but may not be limited to:
   1. Ventilator
   2. External pacemaker
   3. Multi-channel infusion pump(s)
   4. Hemodynamic or invasive monitoring
   5. IABP
3. Patient requires a level of care during transport that either:
   1. Exceeds that of general nursing care
   2. Beyond the scope of practice of a Primary Care Paramedic
4. Patient is at high risk of deteriorating during transport and may require specialized medical intervention.
5. There may be circumstances where a request for service does not meet the above criteria. These circumstances will be evaluated on a case by case basis and will be escalated to the Transport Medicine Physician for a final decision as required.

 

Call	Log on to
Operations Control Centre Please provide: Your name Hospital name and city Contact staff and number Patient name, age and weight (for air transport) Reason for transfer Medical history (including vitals & lab values if applicable) Drug infusions being administered Equipment requirements Receiving hospital contact information (name & person)  OHIP number	https://www.hospitaltransfers.com/transfer   Selecting “Emergent” and “Ornge for Critical Care Land Ambulance” will alert the Operations Control Centre that land transport is required.

 
 
Want more information?
A Communications Officer is available 24/7 in our Operations Control Centre to address any concerns you have by calling 1.833.401.5577.