Representatives of Ornge, Ontario’s air ambulance operation, told a coroner’s inquest it’s still impossible to meet the Ministry of Health’s timelines for transportation of critically ill patients in the north, although response times have improved since 2021.
Chief operating officer Wade Durham and the chief medical officer, Dr. Bruce Sawadsky, testified at the hearings into the deaths of five members of Constance Lake First Nation during an outbreak of fungal lung disease blastomycosis in 2021.
Luke Moore, 43, and Lizzie Sutherland, 56, died at the Notre Dame hospital in Hearst while waiting for flights to better-equipped hospitals. Their cause of death was blastomycosis.
Sawadsky explained the most critically ill patients, described as having a life- or limb-threatening conditions, are supposed to be picked up and taken to their destination within four hours and cannot be refused care, according to the province’s policy.
He said, however, even with Ornge’s best efforts, that is impossible in northern Ontario because of the vast distances.
Sawadsky said that in reality, in 2021 at the time of the outbreak, the time to get an air ambulance to a critically ill patient in the north, to a town such as Hearst, was five hours, but that has since improved to just under four in most cases.
That does not, he said, include the time to then get the patient to their destination and receiving higher levels of care.
However, weather conditions also can wreak havoc on getting to patients, as the witnesses described in Moore’s case.
Late in the afternoon of Nov. 18. 2021, doctors said Moore was critically ill at the Hearst hospital and needed the fastest response that Ornge could muster to airlift him to Health Sciences North (HSN) in Sudbury.
However, it didn’t take long for the pilot of the plane at the nearest base in Timmins to say it wasn’t possible to land at Hearst’s airport. The reasons given were snow on the runway, high crosswinds and lack of de-icing equipment at the airport.
Durham said even if the runway had been clear and there was de-icing equipment available, the crosswinds would have prevented the plane from landing.
As well, a helicopter in Sudbury couldn’t fly in because of poor visibility and helicopters generally don’t fly through clouds in winter because they pick up ice.
Durham said another weather check around 8:40 p.m. found the same conditions in Hearst , and pilots declined the transfer.
Around midnight, the pilots for a plane at the Thunder Bay base also said conditions had not changed.
The runway was still slippery and crosswinds were high.
Sawadsky said the idea of transporting Moore by ambulance to Kapuskasing where crosswinds were less of a factor at the airport and there was some de-icing equipment was quashed as too risky because Moore was so critically ill and there was no guarantee the plane could take off in the weather.
While weather conditions improved by the next morning, Durham said pilots did not have a report from the Hearst airport on runway conditions and it wasn’t expected until 10 a.m.
Moore died around 9 a.m. on Nov. 19 while Ornge was waiting for someone to provide information on whether a plane could land at Hearst’s airport.
He noted that limitations such as single runways, lack of de-icing equipment and lack of standards to clear runways are not uncommon at other airports around northern Ontario.
Later that day, Sawadsky said the process was much smoother for Lorraine Shaganash.
She was designated as ranking at the highest level of being critically ill around 5:10 p.m. and pilots were in the air five minutes later.
In a little under six hours, she was at HSN in Sudbury.
Sawdsky said it would have been faster if the responding plane had been in Timmins rather than at the base in Thunder Bay.
Unfortunately, Shaganash died the next day, on Nov. 20.
On that afternoon, Sutherland was in Hearst hospital.
Doctors said she likely had blastomycosis and, although very ill, was fairly stable but needed advanced care, so HSN was contacted for a bed.
“She was at risk, but not necessarily high risk,” said Sawadsky.
Because Ornge frequently has more requests for service than planes, it has to put patients on a list, said Sawadsky.
Sutherland was placed third out of three.
Sawadsky said they were also struggling to staff aircraft because of COVID-19 and there were only about three planes instead of five that would normally have been available.
Later in the afternoon, Sutherland was ranked second of two patients needing transfers.
She would have been transported if all planes had been in the air at that time, he said.
Then, Sutherland was stuck in Hearst when HSN said her bed was filled by someone else.
He said there seemed to be a communication problem between hospitals about HSN’s bed availability but it’s not something Ornge is involved in.
Finally, late that night, with a bed again available, Sutherland was now further down on the waitlist, fourth out of four patients needing transportation.
A nurse who has already testified said it troubled her that Sutherland didn’t seem to be a priority.
However, Sawadsky said doctors used the word “priority” in a clinical manner, to put patients in order, but that they were all important.
With the window to transport Sutherland closed overnight, her condition suddenly worsened, and when a plane was available in the morning, she was declared palliative and not likely to survive the trip.
Durham said he and others went to Hearst on Dec. 13 to meet with hospital and airport respresentatives, the community and paramedics to hear their concerns.
He said he heard a lot of frustration and admitted there was room for improvement especially in communication.
Since the outbreak, Sawadsky said, there has been a look at how to improve response times in the north, noting at the time there were three planes serving northwestern Ontario, but only one in the northeast.
“There shouldn’t be a different standard,” he said.
Since then, he said, the first of two planes has been added to the Ornge base in Sudbury, with the second to be operating by July of next year.
As well, he said, a jet has been ordered and it will be based on Lake Simcoe.
That jet, said Sawadsky, will travel faster, reducing transport times, and be able to transport two critically ill patients instead of one.
That jet, he said should be in use by mid-2028.
As well, 80 more paramedics have been hired in recent months, he added.
Durham said even more assets for Ornge would be helpful, but the next project is renewing their helicopter fleet, which would take about 10 years.
As for airport facilities, Durham said it would helpful to have someone on call at all times to clear runways and provide reports.
As well, Durham said, there is a list of minimum standards for northern airports, but he welcomed a suggestion that the jury could make a list of improvements to make transports safer and easier.
He noted that Hearst airport has since introduced de-icing equipment, but still needs equipment to keep planes clear of ice while on the tarmac to make sure there’s time to transfer patients before taking off again.
Under questioning from the lawyer for Constance Lake First Nation, Bianca Braganza, Sawadsky said he’s aware that as a health-care organization that’s fully funded by the Ministry of Health, it has an obligation to First Nations patients.
She said 60 per cent of their clients are Indigenous, and she reminded the witnesses of the sections of the calls to action from the Truth and Reconcilation Commission regarding health care.
“I agree the area is underserviced and we’re trying to correct that with the resources we have,” he said.
“We are making the arguments [to the Ministry of Health] that we need the resources to service Indigenous communiites, and the ministry has been quite supportive,” he said, referring to the purchase of the new planes and hiring of new staff.
The inquest, which began in mid-October, continues.
