Ornge (Ontario Air Ambulance)

Ornge (formerly Ontario Air Ambulance) is the air ambulance service for the province of Ontario and for the Ministry of Health and Long-Term Care (Ontario). The provision of ambulance services in Ontario is governed by the Ambulance Act. Under the Act, the Minister of Health and Long Term Care must ensure that “the existence throughout Ontario of a balanced and integrated system of ambulance services and communication services used in dispatching ambulances.” The air ambulance program was established in 1977 to serve remote areas primarily in Northern Ontario that are inaccessible to land ambulances or that land ambulances would take too long to reach. Ontario was the first Canadian province to provide a helicopter-based air ambulance system to transport critically ill patients to hospital. Air ambulances are also used to transport medical teams and organs for transport. A large part of the air ambulance service is involved in serving the aboriginal communities, of which there are approximately 140, in Northern Ontario. The Ministry operates an air ambulance dispatch centre located in Toronto called Med-Com. Today, the air ambulance program has become an integral component of the larger emergency health system in communities across the Province.

Aircraft - Fleet and Location
Ornge (formerly Ontario Air Ambulance) does not own any planes or helicopters and instead contracts with private operators to provide aircraft, pilots, and bases to house the aircraft when not in use.

12 helicopters in total Sikorsky S-76 provided on contract with CHL Helicopter Ltd. and located at Toronto City Centre Airport (3) Ottawa International Airport (2) Thunder Bay International Airport (2) Moosonee Airport (2) Kenora Airport (1) Sudbury Airport (1) London International Airport (1) Four airplanes in total Beechcraft King Air  provided on contract with Voyageur Airways of North Bay and located in Sioux Lookout Airport (2) and Timmins Airport (2).

Additional airplanes available under the Standing Agreement (as and when required) contract with other operators


 * Brock Air Services operating a Cessna 421 from the Kingston/Norman Rogers Airport
 * Wabusk Air operating a Beechcraft King Air A100 from Moosonee Municipal Airport
 * Thunder Airlines - Beechcraft King Air A100; Cessna Grand Caravan 208B; and Mitsubishi MU-2 in Thunder Bay International Airport
 * Flightexec in Toronto/Buttonville Municipal Airport and London International Airport
 * Fox Flight Air Ambulance operating Lear Jet 36A and 35A from Toronto Pearson International Airport

Professionals on the front line - Paramedics, Pilots, Aircraft Mechanics, Dipatchers
Paramedics

The same year that the service was established, 1977, the Ontario Ministry of Health also developed and implemented a training system for critical care flight paramedics who perform advanced life support and controlled medical acts during air transport. An air ambulance base hospital, Sunnybrook Hospital, also located in Toronto, provides medical direction, oversight, and certification of air ambulance paramedics.

Flight paramedics are trained to one of 3 levels of capability:

From September 2005 the employment of the flight paramedics in the Ontario Air Ambulance system was taken over by Ornge.
 * Primary
 * Advanced
 * Critical Care

Pilots

Ornge does not employ any pilots directly. They are employed by the company who is contracted to supply the aircraft.

Aircraft Mechanics

Likewise, aircraft mechanics are employed by the contractor. Aircraft require ongoing maintenance by skilled mechanics who keep the aircraft in safe mechanical order, contributing to the overall system of air ambulance service.

Dispatchers

Dispatch system
Current Ministry policy states that an air ambulance can be used instead of a land ambulance when: transfers cover a distance of at least 240 kilometers; all land ambulance alternatives have been exhausted; there are poor road conditions or severe weather; or specialized equipment or medical escorts are required. However, a first responder, paramedic, or dispatcher may use their judgement to override these criteria for on-scene emergencies requiring a helicopter. Once the necessity for an air ambulance is established, the dispatcher selects an aircraft based on flight time, cost, and patient need.

In February 2005, the Ministry agreed to pay the base hospital about $430,000 to independently develop a computer-aided dispatch system for air ambulances.

Contracts
The Ministry uses a competitive process to contract with private operators to provide three different categories of helicopter and airplane ambulance service. The three categories are as follows:


 * One "Preferred Provider" operator using helicopters primarily
 * Two "Critical Care" operators using either helicopters or airplanes primarily
 * Ten "Standing Agreement" (as and when required) operators using airplanes primarily

Operators who meet the Ministry's minimum requirements, including certification, and who wish to be on a roster to provide air ambulance services under Standing Agreements submit bids for their services. These bids can be adjusted every six months. The contract for the Preferred Provider is intended to establish a fixed cost for a set term, with no price escalations over the life of the contract. The fleet on contract now consists of 12 helicopters and 4 fixed-wing airplanes, plus 19 aircraft supplied by contractors.

Certification of operators All air ambulance operators must be certified under the Ambulance Act at least once every three years. Certification is based on the results of scheduled service reviews conducted by the Ministry in conjunction with the base hospital. These reviews include and evaluation of the qualifications of the patient-care providers, the maintenance of aircraft and equipment in accordance with Ministry standards, and other measures taken to ensure proper patient care. Sanctions and the revocation of a certificate are considered as last resorts when all other reasonable efforts of recourse to resolving the deficiencies of an operator have failed.

Reaction times The Ministry establishes reaction times for each category in its contract with operators as follows:

The Ministry generally requests the service of the Standing Agreement operator that can meet the patient's needs at the lowest cost. These operators are required to notify the dispatcher within 10 minutes whether they accept the call, as only these operators may decline a dispatcher's request for an air ambulance. On accepting a call, the pilot is required to request takeoff clearance within 30 minutes of the agreed departure time. All contracts allow for delays due to extenuating circumstances, including bad weather.
 * One Preferred Provider operator uses helicopters primarily to transport critically ill or injured patients and must be ready to be airborne within 10 minutes of accepting a call.
 * Two Critical Care operators use either helicopters or airplanes primarily to transport critically ill or injured patients and must be ready to be airborne within 10 minutes of accepting a call, 90% of the time.
 * Ten Standing Agreement operators use airplanes primarily to transfer patients between hospitals and to transport organs for transplant. The Ministry uses the Standing Agreement operators to respond to air ambulance calls when Critical Care and Preferred Provider operators are not available.

Management
In July 2005, the Ontario government announced the appointment of Ornge (formerly the Ontario Air Ambulance Services Co.) to co-ordinate all aspects of Ontario's air ambulance system. This transfer was completed in January 2006. The OAA, a non-profit body accountable to the Ontario government through a performance agreement, is now responsible for all air ambulance operations including the contracting of flight service providers, medical oversight of all air paramedics, air dispatch and authorizing air and land ambulance transfers, as well as the development and implementation of the software system technology used for air ambulance dispatching.

RE-BRANDING

New name: In August 2006 the Ontario Air Ambulance Service Corporation was re-named “Ornge.”      Ontario’s minister of health, George Smitherman, and Ornge’s CEO, Dr. Chris Mazza, unveiled a King Air 200 (owned by Voyageur Airways) and a Sikorsky S-76 (owned by Canadian Helicopters) in the bright orange livery during a ceremony at Toronto City Centre Airport. In addition, the service is now referred to as TRANSPORT MEDICINE. The word AMBULANCE and the Ontario Logo have been removed.

New look: The former colours of white and orange have been changed and the entire aircraft is now painted a bright orange colour with the letters ORNGE and a symbol of two open hands, which look like wings, in white.

Cost for air ambulance only
Ministry expenditures for the air ambulance program totalled approximately $93 million in the 2004/05 fiscal year. There is no direct cost to patients who are covered under the Ontario Health Insurance Plan (OHIP). If they are not covered, individuals are generally billed for the cost of their air ambulance trip. In the 2003/2004 fiscal year, the Ministry billed individuals, mainly Americans and Canadians from other provinces, $537,000 for air ambulance services.

Land ambulances are funded separately Ontario municipalities are responsible for the provision and cost of land ambulance services within their municipality. The province provides grants to the municipalities for 50 per cent of the approved costs for providing services required under legislated standards.

Cost comparison with similar services in other countries
Royal Flying Doctor Service of Australia Total operating expenses for 2005 were Aus$31 million of which $ 2,325,467 was funded by donations while the remainder came from Government and internal funding. Until the 1960s the Australian service predominantly hired aircraft, pilots and service technicians from contractors. Now,the RFDS (Royal Flying Doctors Service)owns its own 50 aircraft which operate from 22 bases and has 495 full time and 145 part-time staff members including pilots and mechanics.

Other Canadian Provinces Air Ambulance Service
There are some differences between the organizational structure of air ambulance services in the other provinces of Canada:

BC Ambulance Service   In BC the air and land ambulance service is combined into one service, unlike in Ontario where they are separately organized and separately funded.

Alberta Air Ambulance Service Alberta Health and Wellness pays dedicated air ambulance providers according to contract agreements. The Workers' Compensation Board covers air ambulance services for workers. Health Canada pays for services for First Nations members.

Saskatchewan Air Ambulance Service

Manitoba Air Ambulance Service

Quebec Air Ambulance Service

New Brunswick Air Ambulance Service