Ornge Pulse Podcast

COVID-19 with Dr. Bruce Sawadsky

PULSE: EPISODE 1

February 17, 2021

17 February, 2021

|

Ontario

| By: Par:

Ornge Media

In this episode, we sit down with Dr Bruce Sawadsky, Ornge’s Chief Medical Officer. We learn a bit about his experience, through his 20 years of leadership within the provincial air ambulance program and we discuss how Ornge continues to provide essential service while navigating the changes that come with COVID-19.


Download PULSE on your favourite podcast app, or visit www.ornge.ca/pulse to see all episodes.


See episode transcript below:

Dr Bruce Sawadsky:
Three weeks ago, the COVID centers were 126, and now it's 73. So you can see the slow, steady decline on the COVID positive patients. The other thing that's new on this graph today is-

Rachel Scott:
That's Dr. Bruce Sawadsky speaking at the June 24th Ornge town hall meeting. Every other week, these live meetings enable staff across the organization to tune in and hear the latest COVID-19 updates, as well as ask any questions they may have. Our first COVID-19 town hall took place on January 29, 2020. Since then, we've taken time to document changes related to COVID-19, gather insight from staff on how we provide services throughout the province and learn about experiences from patients and members of the community we serve. Over the next few months, we'd like to share it with you through this podcast.

Rachel Scott:
Ornge is the largest provider of air and land ambulance services in Canada. We perform more than 20,000 patient-related transports per year. Ensuring patients get access to the care they need, from coordinating and dispatching calls, triaging patients across the province, and the logistics that come with operating a fleet of helicopters, planes, and land ambulances. We'll tell you what it takes to deliver life-saving care in an ever-changing environment. In this episode, Phil Kim sits down with Dr. Bruce Sawadsky, Ornge's Chief Medical Officer. We learn a bit about his experience through his 20 years of leadership within the provincial air ambulance program. And we discuss how Ornge continues to provide essential services while navigating the changes that come with COVID-19. I'm Rachel Scott and welcome to Ornge Pulse.

Dr Bruce Sawadsky:
My name is Bruce Sawadsky. I'm the Chief Medical Officer with Ornge, and I've been here about 20 years. I finished my emergency medicine residency and started at Sunnybrook Hospital in about 1996. I met a bunch of different merged docs, some of which had interest in aviation medicine and transport medicine. And so I got a job as a flight physician with a private air ambulance service called Samaritan. Really, as soon as I started working as an emerge doc at Sunnybrook.

Phillip Kim:
Did you always want to go into medicine?

Dr Bruce Sawadsky:
Medicine? Yes. Since early high school, I always had the idea of going into medicine. So yeah, I kind of had that focus from a young age.

Phillip Kim:
You said you did international transports too.

Dr Bruce Sawadsky:
Yeah.

Phillip Kim:
What was that experience like?

Dr Bruce Sawadsky:
It was good. They were long, a lot longer than the flights we do here. Although not some of the Northern flights we do here, variety of patient types. It really depends where you're picking them up from.

Phillip Kim:
Of those international flights, were there any sort of experiences or anecdotes that sort of stick out in your head?

Dr Bruce Sawadsky:
Yeah, I guess so. I mean, I actually did some of those flights with some of the paramedics that are still with trauma paramedic service, CCTU, because a lot of them worked for Samaritan. So yeah, there would be flights, for example, of a patient out of Cuba that had a moped accident that tended to present them as being better than they were. And so I don't know how clinical you want to get, but essentially he ended up requiring a chest tube before we could put them on the aircraft. So me and TPS paramedic at the time, Dan Pesach, had to insert a chest tube into this gentleman in the middle of a deserted Cuban airport in the middle of nowhere. So those kinds of things would happen sometimes, but rarely.

Phillip Kim:
So I'm sure that definitely prepared you well for facing Northern Ontario and the weird terrain that you encounter.

Dr Bruce Sawadsky:
Yes and no, it's still different, though, in the sense that I think that Northern Ontario, in how we service it has its own unique aspects to it in terms of the patient population, the limited healthcare resources that are there. So I think the flight length is the same, but the types of transports are quite different.

Phillip Kim:
Can you describe a typical day on the job in your current position?

Dr Bruce Sawadsky:
I mean, I literally... Today is my first day officially as CMO. So I've been doing it as an interim for quite a while. So I don't know, a typical day in the CMO job is basically meetings after meetings, after meetings, and in this day and age, Microsoft Teams meetings. So video meetings and really covering a variety of topics in terms of managing Trillium Gift of Life contract. Fatigue these days it's involving things like fatigue risk management and how do we provide resources for staff to get the appropriate places to sleep and minimize fatigue and risk. Focusing on and just going through things I went through today, our telemedicine program with the regional critical care program at Thunder Bay and Sudbury, and meeting with them to make sure that the telemedicine program is running appropriately, going to executive management team meetings to talk and make sure that we work cohesive as a group, as a management group in terms of where we want to go. So really, that's a typical day.

Phillip Kim:
With all of the communications and technology changes that are happening and evolution that's happening. What do you see as the future of that or what the future of that could look like?

Dr Bruce Sawadsky:
Well, I think there's a lot more we could do. So right now, we have video links with pretty much all of the Northwestern and Northeastern small community hospitals and most of the Northwestern nursing stations. And so our current basis is that we do two things. We link when the Thunder Bay ICU or the Sudbury ICU is providing telemedicine support to critically ill patients in small hospitals. And they need to be transported. Our docs get on the telemedicine line with them to provide input on resuscitation and packaging prior to transport and patient management. And then the other group is we do a direct telemedicine support to Northwestern nursing station. So that helps us with our triage and dispatching decisions to make sure we're accurate, and it's in the right resource for the right patient. And also to support them in managing critically ill resuscitation patients.

Dr Bruce Sawadsky:
And we recently added in our pediatric docs to that group, which is a big need in Northern Ontario. So I think that we can expand that. I think that we're already looking at ways to expand it involving how we would support rural and remote communities with surge capacity planning. For example, if there's a COVID-19 surge in a small community hospital, and they have a number of ventilated patients but unfamiliarity with how to resuscitate or ventilate, our TMPs could be on the telemedicine line, helping, provide them guidance on how to manage the patients until we can get in there to transport them.

Dr Bruce Sawadsky:
We also offer our services up as a telemedicine support to all rural remote hospitals in a setting of a provincial surge in case ICU docs who would maybe overwhelmed with COVID patients. We could step in and provide support to those communities while they wait for the receiving hospital docs to come on. So I think we can use it a lot more and even to the point where we could help prevent transports at some point. Providing other consults, I think it could be used to add in people that aren't related doing psychiatric consults or obstetrical consults via telemedicine, anything to reduce inappropriate transports, given the cost and the impact of the system. I think there's a lot of opportunity there.

Dr Bruce Sawadsky:
There's also some technology that we've looked at isn't may relate to ultrasound. So we're thinking about adding ultrasound in for paramedics, and there's a particular software with an ultrasound that allows you to guide somebody else's hand. Essentially I could be sitting in our dispatch center, they could be sitting in Thunder Bay, and I could guide their hand on where to place the probe through this technology. So I certainly think it should probably first have a role in training for sure.

Phillip Kim:
How, with that limited amount of space, do you make the decision on what equipment you can include in there?

Dr Bruce Sawadsky:
It's pre-determined essentially so that the paramedics in each of these vehicles have a standardized set of bags, and those bags are the same across the system in terms of their medications and disposable equipment and hardware they need to do their jobs. Recently, we've standardized all the bags across the system, which allows more consistency of paramedics to move from one to another defined things. And so that just happened really over the last couple of years. Now they also store, and this is a better question for a paramedic because I'm on the aircraft sometimes, but not very often. And so they also store certain things within the aircraft because there's cupboards and places to put disposable equipment. There's a standardized place where the actual fixed monitors will go and ventilators. So really, the answer to the question is, is already pre-determined what they can carry on that. And we always try to keep it as light as possible and keep it to things that we really need to have because weight is a huge deal on the aviation side of things.

Phillip Kim:
I guess, on a similar note, have you had any discussions recently or decision-making processes that were particularly challenging?

Dr Bruce Sawadsky:
Oh boy. Yeah. There's always a lot of difficult decision-making processes that we have to sort of deal with. I can give you a bunch of examples. Well, let's start with sort of paramedic competency and training. So we always have the challenge of having paramedics who are highly skilled with training to do a large number of critical care procedures and manage procare patients. But sometimes they don't transport that many of them based on their region and the number of flights and types of patients they get every year. So a consistent challenge for us is how do we maintain their competency despite low frequency of experience for those kinds of patients. And we're always trying to find different ways to do that. We know conceptually that they need to have frequent training on the skills that they rarely do. So, low frequency, high acuity skills.

Dr Bruce Sawadsky:
We currently have an educational service that provides four-day blocks for these paramedics once a year, which doesn't really work. So we're experimenting with a new method of having a clinical lead paramedic at a base who actually provides peer-to-peer training on these low frequency, highly acuity skills at the base on a regular basis to try to improve that. But it's always a challenge to implement something like that and change it.

Dr Bruce Sawadsky:
Another challenge is we're dealing now with how to reduce fatigue on staff on nights so that you don't have to fly and manage patients at 3:00 in the morning if you don't have to. But to do that, we have to reduce the number of flights that we have at night and to do that means we go to get less patients at night. So the question for us is how do we reduce fatigue and reduce risk but also service all the stakeholders and the patients that need our services 24/7? So we're currently engaged with how we can focus on the most emergent acutely ill patients only at night and service the less acute ones during the day, but still, do that in a timely fashion that keeps our stakeholders happy. And obviously, it gives our patients the best service possible.

Phillip Kim:
So I think we can maybe start from the beginning of the COVID-19 pandemic. So like January, February, what was going on in your world within Ornge?

Dr Bruce Sawadsky:
You're hearing the news, reading the news, looking at some of the medical literature, and hearing about something that's sort of starting up in China and spreading into a few countries. And you're always wondering, is this really to turn into a true pandemic, or is it not because we've never experienced that? So I think the first part is observing it, assuming it's going to be like every other outbreak we've had things like MERS-CoV or SARS, but Toronto was particularly badly hurt by SARS. And usually assuming, "Ah, it's not going to happen." And then, you just start to watch it spread, and then you start to realize, "Oh no, this is going to happen. And we need to really prepare." And so that happened for us probably middle of February. I think we started our pandemic steering committee, but the third week of February to start to plan.

Dr Bruce Sawadsky:
And thankfully, we had a pretty comprehensive Ornge pandemic plan already laid out. So we really just dusted that off started a steering committee, started to work through all the sections we had already sort of planned. And each group, individual, and department started to work through the instructions for their area. And we gradually started to build a cohesive plan for how we're going to manage all the challenges related to a pandemic. It was actually pretty remarkable how much we could achieve in a short period of time when people are really focused on it. So we simply created an action list per department of all the things we need to go through. And we had two primary objectives. One was to protect our staff and make sure that no one got sick or became ill from it. And two is to maintain service to our stakeholders.

Dr Bruce Sawadsky:
So we really only had two core objectives. And so in the protect your staff front, one of our immediate needs was PPE, the personal protective equipment. Do we have enough masks? Are we using the right PPE? Which means really talking to experts researching the literature. There was a bit of confusion as to what you needed to wear to protect yourself from this, given it was a droplet spread disease. So we erred on the side of caution. We went with N95 respirators rather than just surgical masks, although that is only required during aerosol-generating procedures. But it's based on the unique nature of our transport environment.

Dr Bruce Sawadsky:
We started at what PPE we need, and then the operations folks worked really hard to get us the right amount of PPE because that was very difficult through most of it is the shortage of PPE and people thought of very unique ways of getting reusable PPE. Justin Smith, connected with our Alteryx... can never say it right. Did make us gowns. So everybody was really working as hard as they could to make sure we had the appropriate amount of PPE. We had to put together clinical protocols on how to manage certain patients that may be too high risk to put in the transport environment and expand our protocols to support the province in terms of things like what we call prone ventilation. So the clinical folks quickly sort of kicked into gear, and we had a clinical subcommittee that looked at all of this.

Dr Bruce Sawadsky:
We had to do HR planning. We had to assume we're going to have a lot of staff that wouldn't come to work, put in place from OC health. They really worked diligently to make sure that we had appropriate screening processes. People don't come to work sick. If you get sick or you're exposed that we follow up, make sure you're okay. Make sure you get a test, manage all the restrictions regarding self-isolation if you are exposed or get a test.

Phillip Kim:
I think I want to go back to when we were talking about the beginning of the pandemic, and it was very, very difficult to gauge the severity of the situation. As working professionals in the field, how do you critically analyze situation? And then how do you get trustworthy information?

Dr Bruce Sawadsky:
You do honestly get some of it from the news because the news cycle now is so fast that it's faster than the medical literature cycle. So you can't wait. You mean you can't wait for the first official paper on COVID-19 because that's going to be way slower than what The New York Times headline is. So you do rely on that to a certain extent. You rely on for us on Ontario Public Health and the Chief Medical Officer of health's office in terms of them having links with other large organizations and providing us information. And then just making sure you stay on top of things like the World Health Organization, webpages, the CDC webpages, or public health Ontario webpage, and really just staying on top of those information.

Dr Bruce Sawadsky:
So we are quickly on daily COVID calls with the emergency management branch, which allowed us to ask questions to get updates from the experts. You talk with colleagues if you have colleagues in countries that are affected, and you hear it that way. And then you keep your eye on the literature because a lot of stuff was fast-tracked in terms of evidence and papers to get it out. So we could have a better understanding, but most of that had to do with acute therapies and some stuff about PPE. So you really take all that into consideration and then try to make a plan from there.

Phillip Kim:
As all that was happening, what was sort of the emotional landscape of Ornge?

Dr Bruce Sawadsky:
I think at the beginning, most of us, certainly us as frontline providers, was anxiety, was fear, right? Because here you have a virus that you see headlines that of large number of people getting sick and dying and even healthcare staff. So I think, to be honest, the first thing we feel is a certain amount of angst. Like what are we dealing with? Am I going to be appropriately protected? And so, which is why we focus from a leadership point of view on making sure people knew that our primary priority was their safety and that we're going to make sure that they had the training and the equipment you needed to be safe and that you'd be supported in decisions you needed to make to stay safe in the management of something like this. And then, I think that quickly becomes a certain level of comfort, but there's still a low level of angst, which I think you always need to have to make sure that you stay safe.

Dr Bruce Sawadsky:
And then you start to get into a new normal, which is we went through this, and for those of us who are old enough, like me, we went through this with SARS. So we've been through it once, honestly, with a disease that now we know is way less lethal than SARS was, but it still doesn't take away the concern that you're going to get it or you're going to give it to one of your family members and they might get sick. And so, but I think that we felt our plan was actually quite good in a generic sense. We learned a ton from this, and now we're going to rewrite the plan based on everything we've learned from this because it is a once-in-a-lifetime, hopefully, experience.

Phillip Kim:
I guess like on a more personal level, how has the pandemic changed your life view if it has?

Dr Bruce Sawadsky:
I've never seen anything like this. I guess it sort of reaffirmed my belief in the system that we have. And I speak at it's just in sort of looking at how things have gone in the US compared to here. And I think that a big part of that was that we have a universal healthcare system with public health care that's funded, maybe not enough, but way more than it is in a private system. And that I think it's actually changed my viewpoint on public health, that it is I didn't pay a huge amount of attention to before given my line of work is much different than that, but it certainly cements that public health is a vital pillar of our healthcare system. Then it needs to be funded and supported appropriately outside of disasters as well.

Dr Bruce Sawadsky:
And I think, whenever we have disasters, there's a cycle because one of my other jobs is as a medical director with the emergency medical assistance team, which is a potential disaster team, and you see disaster cycles. So you have a disaster, the wallet's open, everybody gets funded, and you're supported. And then, when it dies down, people ease up and forget about it. So I really hope on this that we don't do that, that we maintain a certain amount of vigilance on all the things that we had some weaknesses on, like PPE, nursing homes in Ontario was a difficult one for us at the beginning and how we, as Ornge are prepared for it and respond to it and plan for the next one.

Phillip Kim:
How did working at Ornge impact your life?

Dr Bruce Sawadsky:
Overall for the last 20 years?

Phillip Kim:
Yes. Summarize those 20 years in five seconds.

Dr Bruce Sawadsky:
Oh, well, that's a tough one because I've been at orange since Ornge wasn't Ornge. So before, it was regional-based hospitals that managed their local air ambulance services, and then it gradually got consolidated into one organization and then subsequently became Ornge. It's certainly been something I've been focused on and involved in my entire career, and it's become my subspecialty area of expertise. So I love it. And I'm very happy to be in this position now, where I get to impact some of the broader decisions we make as an organization going forward. It's just been overall a very positive experience for me to be lucky enough to be involved in something as unique as this. And I'm in such a solid organization currently.

Phillip Kim:
What are some changes you'd like to see over the next few years?

Dr Bruce Sawadsky:
From an internal perspective, I want to see more delegation of responsibility and leadership to frontline paramedics as reflected in what I talked about with our education plan, like more peer-to-peer learning, more local clinical leadership at the bases where we provide paramedics, the tools to be the local leader and provide the mentorship to their younger colleagues and other colleagues in terms of training. I think externally, we need to focus and continue to focus on supporting rural and remote Northern and first nations communities. We're doing the cert support and telemedicine. I think we need to expand our role beyond just critical care transport, but we've got expertise, and we're in those communities, which is different from a lot of other organizations. So I think we have to focus our efforts beyond air ambulance work and onto supporting those communities with education and training, and search support.

Phillip Kim:
Thank you so much for taking the time to talk to me today. I really appreciate it.

Dr Bruce Sawadsky:
It's been a pleasure spending some time with you, Phil. And I think it's been kind of fun doing it. So I appreciate your time. And hopefully, I answered all your questions.

Rachel Scott:
Thanks for listening to today's episode. Throughout the season, we'll focus on different people within our organization who make an impact on the lives of patients. This podcast was proudly brought to you by Ornge Air Ambulance. This episode was produced by Rachel Scott and Phil Kim with support from our wonderful staff on team Ornge.
 
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Ornge is the largest provider of air and land ambulance services in Canada. We perform more than 20,000 patient-related transports per year. This podcast will give you insight to the inner workings of our organization.

From coordinating and dispatching calls, triaging patients across the province, and the logistics that come with operating a fleet a helicopters, planes and land ambulances. We will tell you what it takes to deliver life saving care in an ever changing environment. Download PULSE on your favourite podcast app, or visit www.ornge.ca/pulse for the latest episode.

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