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January 27, 2012
Air ambulance design puts patients at risk, says Canada doctor
The Toronto Star
ONTARIO — ORNGE's top doctor has checked out the medical interior of the air ambulance's multimillion-dollar helicopters and found a disaster waiting to happen.
Dr. Bruce Sawadsky, in a report written Monday, calls the cramped interior of the brand new AW 139 helicopter a "high risk environment."
His findings? Tough to do CPR. Hard to prop up a patient who is having difficulty breathing. Takes too long to load and unload a patient. Risky, too. Many equipment malfunctions.
Even though paramedics have been warning the province and ORNGE for more than a year, it took until this week for somebody to act. That came after new ORNGE boss Ron McKerlie discovered that the service's medical director had never examined the problem.
Ontario taxpayers funded the $144 million purchase of the 12 helicopters (10 are flying) and $7.2 million spent to design and install the medical interiors.
The new helicopters went into service in December 2010.
Created in 2005, ORNGE is Ontario's air ambulance service, receiving $150 million a year in taxpayers' money. Founder and former president Dr. Chris Mazza chose the name because air ambulances are often painted orange. The "A" was dropped as a marketing ploy.
Sawadsky said ORNGE must fix the problems "as quickly as possible." McKerlie said he takes this issue "incredibly seriously."
The Star's ongoing investigation shows that Sawadsky (medical director), Tom Lepine (chief operating officer), Steve Farquhar (vice-president operations) and Rick Potter (chief aviation officer) have been made aware of all of these problems over the past 12 months.
The Star questioned Lepine, Mazza and others on these issues as far back as last summer. Each time, ORNGE has denied any problems.
That changed Monday. McKerlie discovered that longtime medical director Sawadsky had never looked at the air ambulances.
"I was actually surprised that he had not been out to see them and gone on a ride-out (flight)," he said.
Sawadsky drove out to the ORNGE base at Toronto Island airport and then wrote an email to fellow ORNGE executives.
"I spent the day at the Toronto Island base today and for the first six hours received feedback from the paramedics and played with the interior both as a patient and as a care provider in multiple positions, loading and unloading," he wrote.
In his two-page email, Sawadsky lists 26 serious items and says half are of critical importance. All relate to the Swiss-manufactured Aerolite medical interiors that ORNGE purchased for $600,000 each. The heavy system includes a stretcher on a swivel pedestal.
Aerolite designed it to specs provided by Mazza, himself a doctor, and other ORNGE executives.
Among the problems: During transport the patient is elevated to the shoulder height of a standing paramedic. "It is virtually impossible to intubate the patient and get above the patient," Sawadsky wrote, and the system to raise and lower the stretcher is subject to "frequent malfunction."
If a patient is in respiratory distress and must be propped up, his head bumps against the chopper ceiling. The hydraulic lift to raise the patient is "too weak" and will not hold its position.
There is a "significant risk" to patients who vomit in flight, Sawadsky wrote, because a device on top of the patient makes it almost impossible to turn him on his side to clear his airway.
Moving patients from a land stretcher to the helicopter stretcher is tricky and dangerous. Sawadsky said the system "poses a significant risk to patient safety."
Among the numerous examples of ORNGE and the province being warned is a Jan. 14, 2011, incident in which pilots and paramedics on a new helicopter had to struggle to save a patient's life.
A patient went into cardiac arrest midflight and the paramedics attempted cardiopulmonary resuscitation. However, they found the patient's position toward the chopper ceiling impeded this.
"Under tremendous pressure to save the patient's life" the crew devised a way to provide the life-saving treatment.
A document describing these problems was sent to ORNGE head office and the provincial Health Ministry. No action was taken, and last summer when the Star began inquiring about these issues, ORNGE said there were no problems with the medical interior.