A woman is air lifted to Sunnybrook Health and Sciences Centre by Ornge air ambulance. Officials are investigating design problems with a fleet of ambulance helicopters (not pictured here).John Hanley for The Globe and Mail
An investigation into at least two deaths involving Ontario's embattled air ambulance service is looking at whether a design problem that places patients too close to the ceiling in the helicopter cabin played a role.
The air ambulance service, Ornge, is seeking permission from Canada's transportation regulator to take steps to resolve the design flaw, which restricts paramedics from performing life-saving CPR on patients.
Officials from Ornge and the Health Ministry, including senior investigator Rick Brady, met with Transport Canada on Wednesday at the Oshawa airport, according to a source familiar with the session. Ornge was seeking to demonstrate that patients can be repositioned aboard the helicopter without compromising their safety, the source said. Inspectors from the transport regulator examined one of the helicopters at the hangar.
A Transport Canada spokeswoman confirmed that the meeting took place, but referred further questions to Ornge.
The ambulance service replaced its Sikorsky S-76 helicopters with the AgustaWestland model from Italy. Swiss company Aerolite built the medical interiors. The first one went into service in December, 2010.
Ornge vice-president of operations Steve Farquhar said that despite initially being satisfied with the design plans, Ornge realized once the interiors were delivered that the pedestal where the stretcher rests was too high.
"When we took the measurement between that and the S-76 Sikorsky, it was only a matter of inches," Mr. Farquhar said in an interview. "But it was enough to make it difficult to get above the patient when your elbows are locked in the CPR position to do chest compression."
The Globe and Mail has reported that the Health Ministry is investigating 13 Ornge-related incidents, including three deaths, related to complaints about either response times or the adequacy of the agency's recently purchased helicopter fleet. (Ornge officials initially said the probe involved four deaths, but later revised that figure to three.)
Ornge saystwo of the three deaths under investigation were related to the helicopter's interior.
In at least one of the 13 cases, concerns about the on-board facilities led paramedics to decide against using the air ambulance – opting to transport a patient to a nearby hospital by land.
"It's always the prerogative of the paramedics to do what they feel is in the best interests of the patient," Mr. Farquhar said. "And the decision was made by the paramedic at the scene to use the land option."
Mr. Farquhar said Ornge believes the problem with the design of the cabin can be solved by placing the stretcher in an unconventional position, across the cabin rather than lengthwise. Paramedics often turn the stretcher so they can perform CPR when the aircraft is on the ground or in the air. But under Transport Canada rules, they must return a patient to the lengthwise position during takeoff and landing, regardless of the patient's medical condition.
Ornge is seeking an exemption the regulations to allow the stretcher to be in a transverse position for taxi, takeoff and landing. The exemption would resolve the current issues related to clearance for performing CPR.
An additional problem posed by the proximity of the stretcher to the ceiling is that larger patients sometimes must lie flat when they should be positioned more upright. As with the CPR constraints, Ornge says the exemption from Transport Canada would resolve the issue.
The regulator, whose main concern is the safety of the travelling public, issues operating certificates stipulating how an aircraft is used. Ornge is awaiting the regulator's approval to make the design change.
Mr. Farquhar said he is "very confident" Ornge will get the waiver.
"They're fast-tracking it," he said. "They understand the implications of this."
He noted that it was not always possible to perform CPR in the helicopters operated by the Health Ministry before Ornge assumed responsibility for the province's air ambulance service in 2006.
Ornge is a not-for-profit agency that provides transport for ill and critically injured patients. It has also created several for-profit companies, including an airline.
Karen Howlett
Adam Radwanski