Coroner targets air ambulance transportation

TORONTO (Canadian OH&S News)

The Office of the Chief Coroner for Ontario has released a detailed review of the province’s air ambulance transport system which found that operational issues had an impact on the deaths of patients in eight different cases between 2006 and 2012.

The report, released on July 15, examined hundreds of cases between January of 2006 and June of 2012 in which death occurred following a request for an air ambulance, said a statement from the Ministry of Community Safety and Correctional Services. After screening these cases, the coroner’s expert panel identified 40 cases it felt required further review. In eight of those cases, the statement said, the panel concluded that operational issues had some degree of impact on the outcome, including two cases of definite impact, one case of probable impact and five cases of possible impact.

However, the statement notes that during the review period, Ornge conducted nearly 10,000 air ambulance transports each year, so those in which operational issues were thought to have some degree of impact on outcome represent a percentage of about 0.012 per cent or less than one in every 8,000 urgent or emergency transports.

Although the release of the report comes less than two months after a fatal air ambulance helicopter crash, the expert review panel was established in August of 2012 to review deaths related to Ornge air ambulance transport. Shortly after midnight on May 31, an Ornge helicopter crashed near Moosonee, Ontario, claiming the lives of the two pilots and two paramedics on board. The Sikorsky S-76 was on route to pick up a patient in Attawapiskat in northern Ontario when contact was lost shortly after take-off.

In total, the expert panel made 25 recommendations directed to Ornge and/or the Ministry of Health and Long-Term Care in eight different areas: decision-making; response process; international transports; communication; aircraft/equipment; staffing; paramedic training/education/certification; and investigation/quality assurance.

“It is the sincere hope of the expert panel that our efforts and the implementation of the recommendations will enhance public confidence in Ontario’s air ambulance system,” said Dr. Craig Muir, regional supervising coroner and chair of the review panel, in the statement from the ministry.

Among others, the expert panel recommended that Ornge:

– Re-examine its staffing and communication procedures in the company’s communications centre. Specifically, all reasonable efforts should be made to minimize hand-offs of a given call between call-takers and other communications centre staff, and to ensure that staff maintain situational awareness of calls in progress, assets available and other critical operational information;

– Review their current policy and procedures with respect to responding to calls for patients who are vital signs absent at the scene with ongoing CPR as such patients rarely, if ever, benefit from air ambulance transport and divert resources away from other patients;

– Review and upgrade its communication technology with a view to preventing loss of communication between paramedics and the transport medicine physician;

– Ensure that air ambulance cabins permit paramedics to perform critical resuscitation activities, including CPR, without interruption in all phases of flight;

– Review the current mechanism for securing the stretcher in the AWI39 aircraft to ensure that incidents of the stretchers becoming jammed (as occurred in one case) are avoided;

– Undertake a comprehensive review of the education, certification and ongoing training of paramedics in advanced airway management;

– Review oxygen equipment on all aircraft used as air ambulances in Ontario; and

– Audiotape all discussions and conversations related to air ambulance response for the purpose of quality assurance, improvement and case review.

Dr. Andrew McCallum, president and CEO of Ornge, said that many of panel’s recommendations have either been implemented or are in progress, including: installation of the AW139 helicopter interim medical interior to ensure CPR can be performed in the aircraft to ensure the stretcher does not jam during loading and unloading from the helicopter; a new examination and certification process for officers in the communications centre to improve decision-making and communication; and a revised helicopter auto-launch policy for on-scene response to ensure aircraft launches immediately following a weather check.

“A number of the issues raised by the coroner had been brought to our attention by frontline staff and we took steps to act upon these prior to the release of the coroner’s report,” Dr. McCallum said, adding that Ornge will report back to the Office of the Chief Coroner in the coming months on the progress made on the recommendations.