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Cabin Design Hinders Ontario Air Ambulance Paramedics

20. January, 2012 Patient Care

Could simple cabin design problems be to blame for a number of serious incidents – including three deaths – related to Ontario’s newly-entrenched ORNGE air ambulance service? According to a recent article that appeared in the Canadian province’s Globe and Daily Mail, that’s a very real possibility that some important people are looking at.

A new investigation into two deaths related to Ontario’s ORNGE service is examining the possibility that problems with the medical helicopters’ interior design may have placed patients at risk. According to the investigators, the design of the ORNGE choppers’ interiors may have positioned the patients too near the ceiling of the cabin.

Consequently, ORNGE is now seeking the approval of Canada’s national transportation regulator so that it may take specific actions to resolve problems with their air ambulances’ design. These critical problems reportedly prevent on-board medical personnel from performing CPR on patients.

According to the Globe and Daily Mail sources, Canada’s Health Minister and ORNGE officials met with Transport Canada at Oshawa Airport on Wednesday. The air ambulance service had hoped to demonstrate that patient positions can be changed within the helicopter cabin without any risk to the patients.

The Health Minister has been looking into thirteen incidents, including a total of three deaths, revolving around slow response times and equipment inadequacy claims aimed at ORNGE. According to the air ambulance service, two of the three deaths were related to helicopter interior design problems.

In one incident, paramedics’ concerns about the adequacy of the on-board air medical facilities caused them to decide against transporting the patient by air, despite the greater speed. For the paramedics to forgo the speed of an air transport in favor of a slower ground transport, there may have been grave concerns for the patients’ well-being.

Canada ORNGE air ambulance helicopter

The cabin design of ORNGE’s Sikorsky helicopters force paramedics to set stretchers too high, preventing the administration of CPR.

ORNGE’s older Sikorsky helicopters have been replaced with new Italian AgustaWestland air ambulances with Swiss-built medical interiors, modern medical air craft that only went into service roughly a year ago. However, the air ambulance service soon discovered that the designs would place patients on stretchers too close to the cabin ceiling. Though the difference in height was only a matter of a few inches, it was just enough to make it much more difficult for air medical personnel to perform emergency CPR on patients.

The air ambulance design problem may be easier to solve than one might think, however. By placing the stretcher in an unconventional position in the cabin – perpendicular to the normal stretcher orientation – the height deficiency would become much less of an issue. Stretcher re-positioning is actually a mundane procedure during some air ambulance flights, particularly on smaller aircraft where quarters are especially tight, but current Transport Canada rules require paramedics to always return the stretcher to the “official” lengthwise position during takeoff and landing procedures.

If the Ontario air ambulance service were allowed to position patient stretchers in the alternate position during taxi, takeoff, and landing, paramedics would have enough room to perform CPR when called for. However, the air ambulance service will have to be patient and await approval from Canadian regulators before they can go ahead and make desired changes.

Nevertheless, ORNGE’s VP of operations is reportedly confident that his air ambulance service will get the required approval, going on to say that regulators are “fast-tracking” the approval because they realize the importance of the situation. He said, furthermore, that helicopters in the Ontario air ambulance in the days before ORNGE assumed control did not always make it possible for paramedics to perform CPR on air medical patients.

The not-for-profit air ambulance service ORNGE has suffered quite a bit of damage to their public image after a string of recent investigations, including a number of serious inquiries into executives’ salaries, that have been making headlines in recent months. The not-for-profit entity eventually branched into for-profit activities, including an airline service.

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