(This week’s story involves an ongoing investigation into Ontario’s provincial air ambulance service, a story that is quickly showing up in Canadian newspapers and blogs, but should be rather interesting to those of us south of the border as well). According to a recent article by Kevin Donovan at The Star, “a series of mistakes and miscues” may have contributed to the 44-minute delay of dispatch for an air ambulance helicopter to the scene of an accident involving a truck and a young cyclist.
Records reportedly show that the air medical service ORNGE, which receives $150 each year from the Ontario government to fund its air ambulance service, is in the midst of a campaign to minimize the number of times that aircraft are launched and then called back. Due to this policy, the article states, numerous instances have occurred in which an air ambulance has not been dispatched immediately to an emergency scene, but rather delayed for varying stretches of time while the situation is analyzed.
Investigators from Ontario are expanding their investigation to the patient care provided by the provincial air medical service, suspecting similar problems may be lurking in that aspect of the service as well.
ORNGE’s $150 million annual funding covers not only helicopter air ambulance services to emergency scenes, but fixed-wing services meant to transport patients between hospitals in the province.
The patient, 21, was cycling on the side of the road last August, when, according to reports, a truck drifted outside of its lane and collided with her. A witness called 911.
Paramedics, who arrived on the scene of the accident within only two minutes, called for an air ambulance helicopter immediately.
After the headquarters in Toronto received the call, ORNGE reportedly readied an AW139 medical helicopter for takeoff. In the cold temperatures, the helicopter required approximately 15 minutes to warm the engine and take off. As the engine warmed up, critical care paramedics from ORNGE’s air ambulance team boarded the helicopter and awaited the mission.
Logs from ORNGE show that the communication center gave the order to “stand by” at 3:46 PM. However, no reason for the order was given or recorded.
A spokesperson for a regional emergency medical service told the Star that ORANGE informed them that the helicopter was “unavailable.” However, the Star claims, through their own investigation of documents, that the helicopter was, in fact, available.
Back at the accident scene, paramedics were tending to the injured patient. They quickly loaded her into a ground ambulance and drove her to a 20-bed community hospital with a small ER. Given the circumstances, the paramedics had wanted the patient flown to one of several trauma center hospitals in Toronto.
At 4:15, 29 minutes after the vague “stand by” order was given, the communication center ordered pilots at the base to “stand down.” Again, a reason was not given. The flight time between Toronto and the area of the accident is approximately 28 minutes, so an air ambulance could have been nearing the accident scene and ready to transport the patient to a trauma center – excepting the delay.
As the medical staff of Uxbridge Cottage Hospital valiantly tended to the patient, the hospital called the air ambulance service again, requesting the helicopter for a second time.
Again, pilots readied the helicopter. They were able to lift off within three minutes and landed outside the community hospital in just about half an hour. Paramedics from the air ambulance service hurried inside but were stopped by a furious police sergeant and local paramedics.
According to a source, the police sergeant was heard to shout “where the hell have you guys been?”
Minutes later, doctors at the community hospital announced that after the patient had expired.
Due to the patient’s injuries (a broken neck and a severed spinal cord) the response time of the air ambulance may not have made a great difference in this specific instance. Still, many find the 44 minute delay of the air ambulance dispatch in this case less-than-reassuring.
Some at the air ambulance service say that paramedics are frustrated that they are not dispatched to all critical emergency calls. A reasonable argument, considering that the purpose of an emergency medical helicopter and a trained air medical crew is to transport critical-care patients and save lives – or at least try to.
The Star has embarked upon an ongoing investigation into the way air ambulances are dispatched in Ontario. Some of the problems they’ve apparently found include pressure to cut costs and only launch air ambulances when there is no alternative. The paper also mentions problems at the service’s communication center, where staff have been under immense pressure from their (now-former) president, who would reportedly berate workers about wasted money when air ambulances were recalled after being dispatched to their objective. Furthermore, there are possible issues being looked at involving the not-for-profit service spinning off for-profit entities.
The acting president of ORNGE described the service’s current policy thus: (we’re paraphrasing the language it was originally written in, but these are the hard points) if a call comes in, and a land ambulance is less than 10 minutes from the scene, the helicopter will be readied but not launched, pending confirmation of the need for the helicopter by land EMS.
What do you think of the 44 minute delay in this case? Clearly, in this case (both times), land EMS workers felt that an air ambulance was needed, given the patient’s critical injuries. Whether the delay affected the patient’s outcome, no one may really be able to say with absolute certainty. However, it is clear that some things went wrong during this air medical mission. Hopefully, with the investigations and perhaps some changes at headquarters, these problems can be fixed speedily, so that they do not affect future operations.