Meet Michael (Mike) Peddle, one of Ornge’s Adult Transport Medicine Physicians. Mike has over 17 years as a staff emergency physician and has held various EMS, Education and Healthcare Leadership positions over those years. Mike spoke with us about his experience as a physician, what he has learned in his different roles, and how his experience invoked a passion for supporting Ontario’s healthcare system.

Can you start by introducing yourself and your role here at Ornge?

My name is Mike Peddle, I am a Transport Medicine Physicians (TMP), and I have been with Ornge since 2013. In addition to my clinical work at Ornge I took on an administrative role in 2016 as an Associate Medical Director and then progressed to Medical Director. Since 2021, I have been an Associate Medical Officer with responsibilities spanning Operations, Education and the Operations Control Centre (OCC).

Can you describe what a TMP does?

TMPs have a unique role in the healthcare system. They facilitate and support the medical care of patients being transported in Ontario. They provide support for the physicians and nurses managing patients wherever they may be. They also provide support for the OCC in the planning and logistics of patient transports and provide medical support to the paramedics transporting the patients.

Can you speak a little bit about Ornge’s TMPs and their fit into the process of a call?

TMPs have numerous roles throughout the process of a transport. The first is reviewing the medical details to determine the level of care and priority for a given transport. That includes talking to the sending staff and the receiving staff to better understand the patients’ needs and timelines for transport. Since we sometimes have more patient transport requests than we do assets, we then work to triage patients. We spend time working with the Communications Officers in the OCC providing medical input to optimize the logistical aspects of transport for our patients. All the while we are continually reviewing the calls on the board throughout our shift to reassess patient condition and any changes in their status that may impact the timelines for transport.
On the medical side, we support the sending staff while they are waiting for Ornge crews to arrive; providing advice and helping them prepare the patient for transport. We communicate with the paramedics to coordinate and support the medical aspects of care and transport.

What sets Ornge TMPs apart from everyday physicians?

Transport Medicine Physicians (TMPs) hold a uniquely specialized role within the healthcare system, blending clinical expertise with operational awareness and system-level insight. TMPs are experts in emergency medicine, trauma care, critical care medicine, along with our Paediatric and Neonatal specialty colleagues. What sets TMPs apart is their ability to pair this specialty knowledge with an understanding of the transport environment. They are experts in managing critically ill or injured patients while understanding the physiological and logistical challenges that transport imposes on patient care and clinical decision-making. Beyond the clinical and operational domains, TMPs bring a broad systems-based perspective. They recognize how geography, infrastructure, and regional differences impact access to care—and how timely, well-coordinated transport can bridge those gaps.

Can you describe your academic and professional background apart from Ornge?

I was born and raised in Newfoundland and went through medical school there. That’s where I had my first experience working in remote fly in, fly out First Nations communities. It is also where I had my first experience with medevac and it helped me understand the importance of a comprehensive medical transport system for those communities. I then moved to London, Ontario where I attended Western University and completed my FRCPC in Emergency Medicine. Following residency, I was fortunate to have the opportunity to be involved in the land prehospital system as a Base Hospital Medical Director and a College Program Medical Director. Then, in 2013 I moved to Ornge and have been here ever since. Additionally, I am an Associate Professor at Western University and a collaborator with the FIRST60 research group. I also have a special interest and training in emergency preparedness and I work as one of the physicians for the provincial Emergency Medical Assistance Team.

When did you decide you wanted to do prehospital medicine?

I had an interest in prehospital medicine while I was in university and medical school, but I only began considering it from a career perspective when I did my residency.

As a physician, you balance many responsibilities; from lecturing, working as an emergency physician, and working here at Ornge. Why are all these experiences important to you, and how do you manage everything at once?

As a physician, balancing multiple roles - clinical, educational, administrative – provides me a broader and more integrated perspective on the healthcare system. Each role informs the other, and together they help me understand not just the practice of medicine, but also how care is delivered across different contexts. I find that teaching keeps me connected to current medical research and emerging evidence. The medical literature is always evolving, and engaging with learners helps me stay sharp and up to date. Practicing frontline emergency medicine remains central to who I am as a physician. It keeps me grounded in real-time patient care and provides that direct, hands-on experience that first drew me to the field.

At Ornge, I’ve had the opportunity to apply my clinical knowledge in a completely different setting, one that allows me to engage with system-level challenges. Working in transport medicine offers insights into the operational and geographic barriers that affect timely access to care. It’s a unique vantage point that I wouldn’t get in a traditional emergency department role.

Managing all of this requires careful planning, time management, and the ability to prioritize. It also requires teamwork, and I am fortunate to have fantastic teams in all my areas of work. Every project I am involved in relies on collaboration and a concerted team effort. Over time, I’ve also come to appreciate the importance of balance and self-care. Maintaining a sustainable work-life balance is something I continue to actively work on.

What is the biggest challenge as an emergency physician?

Emergency care has changed significantly since I began my career. In many ways, it has become a barometer of the overall health of the system. When the rest of the healthcare system is under strain, the effects are immediately visible in emergency departments.

Right now, the biggest challenge we face is a lack of system-wide capacity. Most hospitals are operating near or over 100 percent occupancy, which leaves little flexibility to respond to surges in demand. This leads to bottlenecks in patient flow, longer wait times, and challenges in system performance overall.

The issue isn’t limited to emergency departments—capacity constraints are felt across the entire continuum of care. From primary care to prehospital services and EMS, inpatient care, and even post-discharge community supports. When every part of the system is operating at its limit, it becomes difficult to move patients efficiently and provide timely care.

Can you speak on the education initiatives that are planned for the next few years?

We’re always looking for ways to improve and adapt the delivery of our education at Ornge, both for our continuing professional development and our initial education programs. We are actively reviewing and adapting our CPD delivery model to look for opportunities to expand not only scope of practice but also the delivery model for our staff to make sure it’s meeting their needs in a timely fashion. From an initial education perspective, we are working on changes to the delivery model that we anticipate will improve not only the learning experience for our new paramedics but will also be a more effective model for delivery from an organizational perspective.

As a physician, caring for a patient is a central responsibility. As an AMO, how do you keep the patient at the centre of our operations when thinking about the future?

One of the unique parts about being involved in administrative healthcare leadership is the opportunity to influence and impact the systems of care for Ontario’s patients, which ultimately trickles down to the individual patient that we’re caring for. So, it’s really about looking at our system and ensuring that it’s responsive to our patients and the needs of our healthcare partners. We need to ensure that we are positioned now and, in the future, to be able to address those needs by providing the system with the tools and resources that it needs to be responsive.
 
How do you work towards improving timeliness and optimizing response, and how do you keep that as a priority when you make decisions?

Timeliness and responsiveness are fundamentally about being operationally ready to meet the demands of the patients and communities we serve. In my role that readiness spans multiple domains - education, operations, and the Operations Control Centre (OCC) - each playing a critical role in our ability to deliver care when and where it’s needed.

From an education perspective, it’s ensuring that our education is efficient and effective so that we have the staff that we need at our bases, and that we are optimally staffed to respond to calls. That also means that staff have ongoing and continuous education which gives our clinicians the confidence and competence to deliver high-quality care in complex transport environments.

From an Operations and OCC perspective, it’s ensuring that our fleet is optimally resourced and positioned and our deployment plans are data-informed and aligned with system demand. We need to appreciate the challenges within the entire system so that we can efficiently process calls and dispatch our crews. We do this by reviewing and understanding our data as a team which allows us to develop decision support tools and adapt our system to be responsive to our community partners, patients and staff.

What does accountability and transparency mean as a physician?

I think accountability in this role is about knowing what I have to do and then understanding why it matters. It means having a clear understanding of my roles and responsibilities, and recognizing why they matter within the broader context of the health care system and individual patient care. It involves more than just completing tasks, it's about consistently delivering systems and care that are timely, effective, and patient-centred. That includes engaging in regular self reflection, and critically evaluating the healthcare system as it exists, with the goal of identifying areas for improvement. Accountability also includes a commitment to best practice, continuous quality improvement, and professional growth. It's about being proactive, taking initiative, responding thoughtfully to challenges, and always striving to elevate the standard of care we provide. Ultimately, we want to be action oriented and take the initiative to make changes within the system so that so that we can respond to the needs of both the patients and the healthcare system as a whole.

• Inside Ornge