The inquiry was told that Orange took an average of just under 4 hours to reach seriously ill patients in Northern Ontario

Representatives of Ontario’s air ambulance operation, ORGE, told the coroner’s inquest that it is still impossible to meet Ministry of Health deadlines for transporting critically ill patients north, although response times have improved since 2021.

Chief Operating Officer Wade Durham and Chief Medical Officer, Dr. Bruce Sawadsky, testified at a hearing into the deaths of five members of Constance Lake First Nation during a 2021 outbreak of the fungal lung disease blastomycosis.

Luke Moore, 43, and Lizzie Sutherland, 56, died at Notre Dame Hospital in Hearst while waiting for flights to better-equipped hospitals. The cause of his death was blastomycosis.

Sawadsky said the province’s policy is that the most seriously ill patients, those in life- or limb-threatening conditions, must be picked up and transported to their destination within four hours and cannot be refused care.

However, despite ORG’s best efforts, this is impossible in Northern Ontario due to the vast distances, he said.

In fact, at the time of the outbreak in 2021, the time for an air ambulance to deliver a critically ill patient in the North to a city like Hurst was five hours, but that has since improved to just under four hours, Sawadsky said. In most cases.

This does not include the time it takes to get the patient to his destination and receive a higher level of care, he said.

However, as witnesses in Moore’s case pointed out, weather conditions can also wreak havoc on reaching patients.

On the afternoon of November 18, 2021, doctors said Moore was critically ill at Hurst Hospital and needed the fastest response ORG could muster to airlift him to Health Sciences North (HSN) in Sudbury.

However, it did not take long for the plane’s pilot at the nearest base in Timmins to say that landing at Hearst’s airport was not possible. Snow on the runway, high winds and lack of de-icing equipment at the airport were cited as the causes.

Durham said that even if the runway was clear and de-icing equipment was available, crosswinds would have prevented the plane from landing.

Also, a helicopter could not take off in Sudbury due to poor visibility and in the winter helicopters generally do not fly through clouds because they pick up snow.

Orange says multiple factors prevented plane from landing

Durham said another weather check around 8:40 p.m. found the same conditions at Hurst and the pilots refused to transfer.

Around midnight, pilots of an aircraft at a Thunder Bay base also said conditions had not changed.

The runway was still slippery and there were strong winds.

Sawadsky said the idea of ​​flying Moore by ambulance to Kapuskasing, where crosswinds were less of a factor at the airport and there was little de-icing equipment, was deemed too risky because Moore was so seriously ill and there was no guarantee that the plane could fly in the weather.

While weather conditions improved by the next morning, Durham said the pilots had no reports from Hearst Airport on runway conditions and were not expected until 10 a.m.

Moore died around 9 a.m. on November 19, while Orange was waiting for someone to give him information about whether a plane could land at Hearst’s airport.

He said limitations such as a single runway, lack of de-icing equipment and lack of standards for clearing runways are not uncommon at other airports around Northern Ontario.

Later that day, Savadsky said the process was very easy for Lorraine Shaganash.

He was designated as ranking at the highest level of critically ill around 5:10 pm and the pilots were in the air five minutes later.

In a little less than six hours, she was at HSN in Sudbury.

Saudsky said it would have been faster if the response aircraft had been based in Timmins rather than the base in Thunder Bay.

Unfortunately, Shaganash died the next day, on 20 November.

That afternoon, Sutherland was at Hearst Hospital.

Doctors said she probably had blastomycosis and, although very ill, was quite stable but needed advanced care, so HSN was contacted for a bed.

“She was at risk, but not necessarily high risk,” Sawadsky said.

Because Orange often has more requests for service than planes, he has to keep patients on a list, Sawadsky said.

Sutherland was ranked third out of three.

Sawadsky said they were also struggling to staff aircraft due to COVID-19 and only had three aircraft instead of the five that would normally have been available.

That afternoon, Sutherland was placed second among two patients requiring transfer.

Had all the planes been in the air at that time, he would have been taken away, he said.

Then, Sutherland ran into Hearst when HSN said her bed was filled by someone else.

He said there appears to be a communication problem between hospitals about HSN bed availability, but it is not something Ornge is involved with.

Eventually, late at night, with beds available again, Sutherland was now further down the waiting list, the fourth of four patients requiring transport.

A nurse who has already testified said she found it troubling that Sutherland was not being prioritized.

Doctor says some people misunderstand the use of the word ‘priority’

However, Savadsky said that while doctors used the term “priority” as a clinical way to organize patients, they were all important.

With the window to transport Sutherland closed overnight, his condition suddenly worsened, and when a plane became available in the morning, he was declared palliative and unlikely to survive the journey.

Durham said he and others went to Hurst on Dec. 13 to meet with hospital and airport representatives, the community and paramedics and hear their concerns.

He said he had heard a lot of frustrations and acknowledged there was room for improvement, particularly in communications.

Since the outbreak, there has been consideration of how to improve response times in the North, Sawadsky said, adding that at the time there were three aircraft serving northwestern Ontario, but only one in the northeast.

“There should be no different standards,” he said.

Since then, he said, the first of two aircraft has been added to the Orange base in Sudbury, and the second will be operational by July next year.

Additionally, he said, a jet has been ordered and will be based at Lake Simcoe.

That jet would travel faster, reduce transport time, and be able to carry two critically ill patients instead of one, Savadsky said.

That jet should be in use by mid-2028, he said.

Also, 80 more Associate The hires have been made in recent months, he said.

Durham said more assets would be helpful for Orange, but the next project is refurbishing their helicopter fleet, which will take about 10 years.

For airport facilities in Northern Ontario, Durham said it would be helpful to have someone on call at all times to clear runways and provide reports.

‘This area is under-served,’ says the chief medical officer.

Additionally, Durham said, there is a list of minimum standards for northern airports, but he welcomed the suggestion that the jury could create a list of improvements to make transportation safer and easier.

He said Hearst Airport has since introduced de-icing equipment, and has also acquired equipment to keep planes clear of ice on the tarmac to ensure there is time to transfer patients before taking off again.

Under questioning from Constance Lake First Nation attorney Bianca Braganza, Sawadsky said he knows that as a health care organization that is fully funded by the Ministry of Health, it has an obligation to the First Nation’s patients.

He said 60 percent of his clients are Indigenous, and reminded witnesses of the sections of the Truth and Reconciliation Commission’s call to action regarding health care.

“I agree that there is a lack of service in the area and we are trying to fix it with the resources we have,” he said.

“We have been arguing (to the Ministry of Health) that we need resources to serve indigenous communities, and the Ministry has been quite supportive,” he said, referring to the purchase of new aircraft and the hiring of new staff.

The inquiry, which began in mid-October, continues.