When you see an air ambulance fly overhead, have you ever wondered what’s going on inside, or how the “heroes of the sky” do their job?  Pat and Marcie Auger, Ornge’s ‘dynamic duo’ take us through the finer points of Flight Paramedicine - and the lifestyle that goes with it.

Working out of Ornge's Ottawa base as Critical Care Paramedics, they share insights from some of their experiences on the job, discuss common misconceptions, and talk about how they navigate their relationship while working together.

 

See episode transcript below:

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. From the Manitoba border, the tip of James Bay, from the North shore of Lake Erie, to our nation's Capitol, Ornge helps patients get access to the care they need one transport at a time. This podcast will give you insight into 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 of helicopters, planes, and land ambulances. Will tell you what it takes to deliver life-saving care in an ever changing environment. Welcome to Ornge Pulse. I'm your host, Rachel Scott. In this episode, we're delving deep into what goes on behind the scenes at Ornge. But first, let's debunk some myths.

Marcie Auger:
Well, I think the public conception in a lot of cases is that we go to car accidents and we pick people up and we bring them to the hospitals because when we're most visible to the public is when we land on highways, roadsides or in small communities so that makes us very noticeable. Helicopters, people walking across the apron with a helmet on their hip and things like that. But those types of calls while very important, because we need to get to a trauma center within a certain amount of time is actually a small percentage of what we actually do.

Rachel Scott:
That's Marcie Auger.

Marcie Auger:
I'm a critical care flight paramedic. And currently the Paramedic Safety Investigations Coordinator at Ornge. I've been with Ornge since its inception in 2006. Prior to that, I've worked on air since 2002, and I've been a paramedic since 1996.

Rachel Scott:
She's here today with her husband, Pat Auger, to help introduce the work we do at Ornge.

Pat Auger:
I'm a critical care flight paramedic currently based out of Ottawa. I'm also currently the Special Operations Coordinator for Ornge. I've been involved in the air ambulance system since 1993, and then with Ornge since its inception since 2006.

Rachel Scott:
So what does Ornge do exactly?

Pat Auger:
Ornge is a very complex organization made up of a multidisciplinary team.

Rachel Scott:
We asked Pat and Marcie to list off as many team members as they could, in as little time as possible. Are you ready?

Pat Auger:
So one of our positions at Ornge is we have transport medicine physicians that are directly involved with the Ornge Communication Center for the provision of medical direction, for our transport crews, as well as advice to peripheral hospitals.

Marcie Auger:
Well, we have our aircraft maintenance engineers or AMEs who are responsible for all the day-to-day readiness and maintenance of our aircraft to ensure that we can complete our mission safely and ensure that we are ready as a system.

Pat Auger:
We have our pilots, both captains and first officers that are responsible for operating not only our rotor wing aircraft, but our fixed wing aircraft.

Marcie Auger:
We have our base managers and base administrators who contribute to ensuring base readiness overall, and that we have all the supplies and equipment and all the consumables and medications that we need in order to complete each of our types of calls.

Pat Auger:
So we have our medical communications officers that are responsible for taking the calls from the peripheral hospitals, triaging calls and giving us our call information.

Marcie Auger:
We have an entire education department through our base hospital and our education department is responsible for initial training and certification about paramedics and then ongoing maintenance.

Rachel Scott:
Now that we know who makes up Ornge, what do these team members do?

Pat Auger:
Okay. So there's many, many things that Ornge as an organization is involved with. And I'll start with the first one now. Scene call. So where you actually see a helicopter landing on the side of a road for a major car accident. So that's an example of something Ornge is involved in.

Marcie Auger:
We do organ transplants. Movements across the Ontario.

Pat Auger:
And then we're involved in doing critical care transport, but for example, we're involving neonatal transport. So the movement of premature babies.

Marcie Auger:
And we'll do pediatric transports.

Pat Auger:
We move obstetrics. So women in labor or high risk pregnancies that may be in premature labor.

Marcie Auger:
We do cardiac calls. So we'll transport patients from smaller hospitals who require a specialized cardiac or cardiology.

Pat Auger:
We move stroke patients. We'll move stroke patients into stroke centers.

Marcie Auger:
We'll move trauma patients in the trauma centers, which is where a lot of people see us land on the highway. But we also retrieve those patients who have presented to a smaller hospital and we'll move them to a trauma center as well.

Pat Auger:
So we provide ICU level of care on our aircraft.

Marcie Auger:
And we also provide some telemedicine in our transport medical physicians are involved in providing that as well as some logistics support. And that's all in the far north.

Pat Auger:
We're also involved in surge planning. So medical surge capacity for a major incident response. Currently doing some surge capacity planning for COVID.

Rachel Scott:
Did you catch all that? If not, that's okay. Every episode we're focusing on each role in depth. This episode, we wanted to get to know more about Pat and Marcie's experience as paramedics. What does a typical day in the life of Pat and Marcie look like?

Pat Auger:
There's a number of base responsibilities that are critical to the operation. And so, because we just don't know what we're going to get called out for. We could show up and we could get called out for an infant in respiratory distress. We could get called out for a male having a heart attack.

Phil Kim:
What are some examples of calls you've had in the past, or memorable experiences?

Rachel Scott:
By the way, that's Phil Kim, he's our podcast coordinator. He was able to sit down with Pat and Marcie. You'll be hearing his voice throughout this episode.

Pat Auger:
Recent that comes to mind is we got called to the Kingston General ICU to manage a sickle cell crisis, a pediatric patient that was in acute chest wall syndrome. So critically ill to the point where the Kingston General ICU, which is a tertiary care facility, we had difficulty managing the patient. And this patient ended up being intubated, was ventilated, was a very difficult vent and required massive amounts of medication to keep the blood pressure normalized. So quite a bit of epinephrin and other complicated medications.

Marcie Auger:
Yeah. We had several infusions and we were providing medication doses throughout the flight, just to keep her alive, to get to the receiving hospital.

Pat Auger:
And much higher than what we would normally do outside of our medical directives. And I remember that call in particularly being complicated because Marcy you're on the phone with three physicians at the time? Trying to figure out how to manage the patient.

Marcie Auger:
We've also had some tragic summer calls that seem to pop up. Every summer is a pediatric drowning due to backyard pool. It's very quick and it can happen in an instant.

Pat Auger:
Also related to summer calls that we see are burn patients. So we seem to get this call every summer where somebody is poured gasoline onto a campfire and the fire either explodes or accelerates back. And the individual ends up with massive burns. So I think our last one was either 70 or 80% body surface area burns. A patient had to have an airway place, was put on a ventilator, heavily sedated. And we transported to the burn center in Toronto.

Marcie Auger:
I see we've had several memorable, traumatic type calls. So we've had to attend to a pediatric who was in a car accident, was ejected with his car seat, went into a cardiac arrest. So we were able to resuscitate and get a pulse back of that patient on route to the trauma center.

Pat Auger:
Also had a pediatric patient that ended up hanging himself. So that was another example of a call.

Marcie Auger:
We see a lot of catastrophic head injuries, but one that's most memorable was a bunch of cyclists. There was a group of cyclists that were struck by a van within the city limits, actually. So we were dispatched to that and we moved one of those victims who had a quite severe head injury and has since recovered.

Pat Auger:
One of the things that we get called to at times is to move emergency obstetrics or preterm labor. One that comes to mind is a lady that was in a breech position. And we ended up having to deliver a double footling breech. So we didn't have enough time to get to the tertiary care facility.

Marcie Auger:
Delivering a baby in an aircraft is a little confining of an area to work in.

Pat Auger:
And a premature baby. So we're talking about delivering a neonate.

Marcie Auger:
We've had some gunshot calls. So we know we've had a gunshot to the head, gunshot to the chest, some of which have been related to-

Pat Auger:
Accidents.

Marcie Auger:
Hunting accidents. And accidental shootings when moving around fences or areas without keeping a firearm in a safe position. I would say related to some ICU patients, which we do a lot of ICU level transfers during H1N1. And we're seeing it again now with COVID, we're moving a lot of patients who are very challenging to ventilate and oxygenate, and really, the biggest challenge is keeping them ventilated and oxygenated. We can get them to an ICU center.

Pat Auger:
Some of the critical elements to our operation. So we carry narcotics very similar to what you'd have in emergency department or ICU. And we carry a number of medications for resuscitation, as well as antibiotics, all these things that need to be checked. So what's critical to the operation is to ensure that our vehicles, so whether they be our critical care land, ambulance are fixed wing aircraft, or a rotor wing aircraft are ready to go. And we primarily work out of medical response bags. And so those medical response bags need to be checked. So whether that be our airway bag, our trauma supplies, our medications, all this critical lifesaving equipment needs to be checked. We have ventilators onboard the aircraft for example, that are used in an ICU. And so we move intubated and ventilated patients on a daily basis. So what I mean by intubated, these are patients that have an airway placed in them that'll allow us to breathe for those individuals in between hospitals or from the scene to a hospital. So all that critical equipment needs to be checked.

Marcie Auger:
And the other part of what we do in a typical day as if we're not doing calls, we have continuing medical education that we do. And a lot of that is done online and we have monthly requirements and then we have annual requirements. So part of that is ensuring that we have that education done, and we also have operational training that needs to be done. So annually, we have to ensure that we do training and hover exit on the aircraft, which would be being able to exit the aircraft, perhaps in an area where the aircraft can't put all their weight down, or on the edge of a lake or certain areas where it would be hard for them to get into. If they can hover to a certain extent then we can exit but we need to do training in that to ensure that we do it safely.

Marcie Auger:
Annually, we do underwater escape training, which is not my favorite at all, but it teaches us how, if we were to have an incident around water, how to exit the aircraft in that sense, and then our other regular annual training. I mean, we always have to do CPR updates and equipment updates if we have different equipment that's on the aircraft. Our most recent newest piece of equipment would be our IV pumps. So we have to ensure that we have the training in that and that we can use them effectively and efficiently when we have a new piece of equipment that comes online.

Phil Kim:
May I ask why the underwater escape training is not your favorite?

Marcie Auger:
For me? Well, Pat loves it because he loves being in the water and underwater. And he's the guy that this machine you get strapped in. It puts you in the water, flips you upside down and you would learn to escape the aircraft. So Pat has a grand time with it, because it's all of his life guarding. And he's that person that'll sit in and wait it out a little bit while he's underwater upside down. I'm the person who is sure that I need to escape immediately. It's very, very safe. The trainers are there with you underwater every step of the way. It's probably the absolute best way for someone who has a fear of water to learn how to do escape training. So not my favorite, but I've gotten through it.

Phil Kim:
It seems like you two would be great candidates for Fear Factor at this point, with all that training.

Marcie Auger:
Somebody asked us about The Amazing Race to do that, The Amazing Race, but I don't know, we're trying to figure out who would do what. I think he would eat stuff that's not normal, and I can do the yoga, the artistic stuff. And the stuff that isn't terrifying.

Phil Kim:
How does this job impact your life?

Pat Auger:
It's easy to get caught up in work. And I think what's really impacted I think both of us is just our approach to life. And we make sure that we balance things out. When people ask us, "How are we able to do it?" Well, we actually plan it. We schedule our down time.

Marcie Auger:
Yeah. So we make a point of going through the calendar and scheduling this is going to be a camping trip. We don't need to know where it is or who all it's with yet, or what members of the family can attend, but we just ensure that we schedule it and put it in and make sure that we have downtime with each other, and that we spend time with family and spend time with people who are important.

Phil Kim:
That's awesome. One thing that I was thinking about, because you spend both your work time and downtime together, how is that dynamic and how amazing is it to sort of have the shared experiences you to do working together, thinking about how you two do the underwater training together, and you see how you respond to that.

Marcie Auger:
Differently to it. It's been interesting. I mean, we were partners for some time before we became involved with each other. And so we've known each other for quite some time. We both come from previous relationships. And when we started dating, we really had to put some considerable thought into that because we all know not all relationships go well. And we worked really well as partners, and we didn't want to damage that. So we approached with caution and we had some critical conversations, but it's always kind of worked for us.

Marcie Auger:
And it's weird in some cases that we do everything together. But I think part of it is our relationship really developed at work. And that's where we've built a really strong bond. And we're really able to work well together and then still come home and spend time together and debrief. And it might seem odd to a lot of people, but for us it's what works and a lot of what we do and what we do well and where we've excelled is because we totally understand each other. We understand each other's jobs. We're supportive of each other. And it works for us. We just work well together.

Phil Kim:
Yeah, I feel like that has to create such a strong bond. It's one thing for one partner to explain what they've been through during a day and what they've been through on the job versus both of you going through it together and having that understated empathy and understanding of what the experience is like.

Marcie Auger:
There's quite a few couples in the industry. I mean, that's a pretty common thing. I mean, in Ottawa over the years, there's been anywhere from four to five, six couples between both bases all at one time. And just seems to be a bit of a common trend. I think, when you go through a lot of difficult calls together, you can develop some really strong bonds. And I think even at our base, we have a lot of our colleagues and coworkers. I mean, they're all good friends also because we do a lot and we see a lot together.

Phil Kim:
This might be a bit of a difficult question, but was there a particularly challenging day or experience you've had in your career in recent memory?

Marcie Auger:
It's not recent recent, but we call it our career call. This was in around 2006.

Pat Auger:
I don't know if we can use his name.

Marcie Auger:
Oh, well, we reunited with him on TV. We had some media surrounding that, but perhaps, maybe not his name. So he was 18 months old and Pat and I received... What?

Pat Auger:
He was 19.

Marcie Auger:
19 months old? Pat and I received a call to go to Winchester?

Pat Auger:
Yep.

Marcie Auger:
And then the call taker said to us, "We don't know what's going on there. They just need you to go. You just need to get an aircraft and go, we have no idea what's going on."

Phil Kim:
Is that a commonplace thing you hear, when you get a call or is that a rare thing where it's just like, "We don't know what's going on. Just go."

Marcie Auger:
No, no. That happens every once in a while, when the call takers and the dispatch center recognize that there's something going on and they haven't been able to get all the information, sometimes it's important just to get us going in that direction and figure it out. Because worst thing that happens is they don't need us and they cancel us and send us home. And that happens quite often on scene calls where we'll get called out, the land crew arrives and says, "This patient doesn't meet aircraft requirements." So they'll cancel us. But in this case, there just seemed to be a real sense of urgency to the request. So we proceeded, went on our way.

Pat Auger:
And then we got the call information and then the call information came in as a toddler, run over by a lawnmower. So then we understood the gravity of the situation.

Marcie Auger:
When we arrived, there's a parent standing in the corner of a room covered in blood, put his son in his lap and drove to Winchester. So dad was standing in the room, all the facial structures that you use to landmark and to place a mask on, to get a good seal, to provide ventilation and oxygenation were missing.

Pat Auger:
So we had to secure an airway. We had to suction blood out of his mouth. We had to intubate him. It was a very difficult intubation, very intense because you're trying to figure out the anatomy because everything was distorted. I think we started interosseous on the child, which is where you drill a needle into the bone. And we started a blood transfusion. So we secured the airway, resuscitated this, and we did this all in front of his father who was standing there. So we just did what we needed to do, but it was just a memorable call because it was difficult to manage the airway, the extent of the injuries, the amount of blood.

Marcie Auger:
We asked the dad to come.

Pat Auger:
Yeah, we did.

Marcie Auger:
We asked him to come because in all honesty, we weren't sure that he would survive the flight, let alone what his survivability was beyond that. So he was quite stoic, but he came, we strapped him into the seat. We got a briefing from the pilots and we just thought it was really important that we had a parent with us when we brought him in. So we brought him in to CHEO.

Pat Auger:
And we followed up with him
.
Marcie Auger:
We did. So we went in a couple of days later into the ICU. We brought a patient in and we wanted to go follow up to see how he was doing. And the dad spotted us from across the room actually, and literally ran and leaped into Pat's arms. He said, "Oh my God, you saved my son's life." And he had a total complete recollection of everything that we had done right down to he said, "I saw when you moved the little wheel on the IV to get the fluid going because it wasn't going." He had a very vivid recollection and he recalled every step. The baby, toddler survived that. And we have been in touch with him since then and we've kept in touch.

Marcie Auger:
And generally that's not something that we do once we transfer a patient, they're no longer our patient, but this was part of the family also reached out to us to keep us posted on how he had done. We did do a reunification with him. I can't remember what year that was. I have the video of that though, where him and his dad came out and checked out the aircraft and came out to the base. And at the time he was probably, I want to say four-ish. And he said that he was coming to show us that he was okay. It was pretty cute actually. It was really a miracle story for us because he was so severely injured. We were concerned about him surviving the flight. And he has gone on to do really well.

Rachel Scott:
Throughout this season, we'll focus on different people in our organization who make an impact on the lives of patients. This episode was produced by Rachel Scott, Phil Kim, and with support from our wonderful staff on team Ornge.

Marcie Auger:
I would just say thanks for having us and thanks for putting in the time and working on this podcast. I think it's great to be able to get more information out there about what we do and provide some more understanding to the public as to what our role is in the healthcare system.
 

     

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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