1. AIR AMBULANCE CANADIAN HELICOPTERS EMS Ornge- Transport Medicine AIR AMBULANCE

2. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Goals for Today Introductions Who are we, and why we are here

3. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Goals for Today Introduction to Air Ambulance Structure of air program Helicopter utilization Introduction to aeromedicine

4. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance History of Air Ambulance First U.S. military presence in 1936 WW II - 1.5 million patients transported by fixed wing aircraft Korea and Vietnam - utilization of rotary wing aircraft

5. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance History of Air Ambulance in Ontario First flight in 1977 Aircraft types Base Locations

6. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance History of Air Ambulance in Ontario Structure Ornge Program (OAABHP) Medical Air Transport Centre (MATC) Operators

7. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance History of Ornge EMS Operating Air ambulance helicopters in Ontario for 25+ years Operating medical component since 1999 Provides ACP(F) and CCP(F) service 120+ Employees in Ontario 7 bases, 8 online aircraft, 11 available Also operates aircraft in Nova Scotia

8. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Employment Opportunities OAABHP-Base Hospital MATC CHL EMS

9. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance OAABHP - Base Hospital Training Certification Defining Scope of Practice Medical Direction Quality Improvement

10. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training Distance Education Human Patient Simulator

11. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training Aeromedical Course PCP (F) to ACP (F) Course ACP to ACP (F) Course CCP (F) Course

12. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training PCP (F) EMCA Aeromedical Course SR / SAED Course CME

13. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training ACP(F) PCP(F) plus ACP(F) course CME

14. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training CCP (F) ACP (F) plus: CCP (F) course CME

15. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Certification Oral Board OSCE CME Flight Rounds

16. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Scope of Practice PCP (F) SR / SAED 12 Lead ECG ETCo2 IV administration via Pumps BLS Trauma and Medical Care

17. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Scope of Practice-ACP (F) ETT, LMA, RSI, needle cricothyrotomy (Quick-Trach), volume control mechanical ventilation, needle thoracostomy, chest tube drainage monitoring, IV / IO initiation, IV medications (bolus and infusion pump), blood transfusion, thrombolysis, other medications NG/OG placement, TCP, manual defibrillation / cardioversion, urinary catheterization.

18. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Scope of Practice-CCP (F) pressure control mechanical ventilation, transvenous pacing, invasive pressure monitoring (arterial and PA catheters), CCP (F) medications, Intraaortic Balloon Pump Critical care obstetrics and Neonates Plus everything else on previous slides

19. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Medical Direction Base Hospital Physician on call 24/7 Standing Orders Medical Directives Patch Orders

20. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Quality Improvement Chart Audits Site Visits Customer Service Inquiries / Incident Report investigation Paramedic Surveys

21. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Capabilities of the Sikorsky S-76A 2 stretcher patients, 4 attendants Usual ambulance equipment Oxygen, suction, cabinets full of “gear” Radio, satellite phone Electrical power 713 km range with 30 min. fuel reserve 287 km/h cruise

22. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Why Air Ambulance? Goals of aeromedical transport On-scene response Rapid transport - “Golden Hour” Provide advanced life support Interfacility transfers Decreased out-of-hospital time Decreased depletion of resources

23. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines When to call Should meet one “Operational Guideline” plus one “Clinical Guideline” OR: IF DEEMED APPROPRIATE by the paramedic or dispatcher

24. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Operational Guidelines Land Ambulance >30min to scene Land Ambulance >30min from scene to Lead Trauma Centre Pt needs ACP care which land medics cannot provide Multiple patients Pt not easily accessed If deemed appropriate

25. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Clinical Guidelines Field Trauma Triage Guidelines Medical Condition Environmental Condition Obstetrical Condition Unknown Condition with MOI If deemed appropriate

26. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Scene selection Assign a Landing Site Coordinator Pilot has final say Generally prefer on the road 100ft x 100ft Clear of wires Flat surface no debris / gravel

27. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Scene safety Stop vehicular and pedestrian traffic Close doors Secure equipment, stretcher Charge any hoses

28. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Working around the helicopter Approaching the aircraft (Don’t!) Approach only from side (NOT THE FRONT) Approach from downhill side Carry equipment horizontally, below waist Secure clothing, blankets, equipment

29. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Modified scene calls Not to scene but either to helipad or hospital and aircraft still comes Transport prior to aircraft arrival If a/c not visibly on final, depart Night utilization Must land at nearest airport / helipad Still gets patient to trauma center quicker than if paramedics didn’t call

30. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Guidelines Helicopter limitations No SAR No freezing conditions No scene landings after dark Weather / light decisions are up to the pilot - don’t be afraid to make a request!

31. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Utilization Case Studies Accessibility - Pediatric GSW in field Modified scene - 2y/o struck by tractor trailer Delay - Pt. trapped between dump truck and tractor

32. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Helicopter Interaction Airport / heliport procedures Where to park Required equipment

33. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Aeromedical Physiology Effects of flight Temperature Vibration Noise Decreased Humidity Fatigue G Forces Atmospheric pressure

34. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Aeromedical Physiology Gas Laws Dalton’s Law The pressure of a gas mixture is equal to the sum of the partial pressures of its’ component gases... P=P1+P2+P3+P4… What are the implications? How do we compensate?

35. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Aeromedical Physiology Gas Laws Boyle’s Law At a constant temperature, the volume of a given mass of gas varies inversely to its pressure... P1V1=P2V2 What are the implications? How do we compensate?

36. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Aeromedical Physiology Gas Laws Henry’s Law The quantity of gas dissolved in a liquid is proportional to the partial pressure of the gas in contact with the liquid Open a bottle of pop

37. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Transport Medicine Preparation for flight Priority - Patient safety Provide care Package patient Cabin safety briefing

38. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Transport Medicine Providing care in flight Challenge: Atmospheric Pressure Challenge: Space Challenge: Noise Challenge: Vibration Challenge: Isolation

39. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Principles of Flight Bernoulli Effect Bernoulli and the helicopter Autorotation

40. Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Questions? All photos courtesy of the staff at Canadian Helicopters EMS And Ornge.