22 avril 2020 | Local, C4ISR, Sécurité

Canada’s air medical transport providers say collaboration, communication are keys to pandemic response

Posted on April 22, 2020 by Lisa Gordon

As news of the novel coronavirus – first identified in Wuhan, China in late December – began to percolate its way through the mainstream news media, a few staff members at Ornge, Ontario's air medical transport provider, began to take notice.

“It piqued our interest quite early on, since many of us had been through SARS [in 2003],” said Justin Smith, chief flight paramedic. “We began to figure out what PPE we had and what would be required to move forward.”

Canada's first case of the novel coronavirus, later named COVID-19, was reported on Jan. 15, 2020. Subsequent cases occurred gradually through the end of February, all among travellers who had returned to Canada from countries affected by the virus. The number of Canadian cases increased sharply in March, and that's when Ornge activated its pandemic plan.

Smith was outlining the organization's response during a webinar hosted by the Association of Air Medical Services (AAMS) on April 21. Moderated by association president and CEO, Cameron Curtis, the discussion was billed as a town hall meeting focused on the Canadian air medical community's pandemic response. In addition to Ornge, representatives from Shock Trauma Air Rescue Service (STARS) and B.C. Emergency Health Services (BCEHS) participated in the panel.

Ornge, which operates 13 bases across Ontario with a mix of rotary, fixed-wing and land-based patient transport assets, has so far moved 209 confirmed or suspected COVID-19 patients. Overall, 57 per cent were moved with land vehicles, 24 per cent with the Pilatus PC-12 fixed-wing fleet and 19 per cent with its Leonardo AW139 helicopters.

So far, the total number of missions Ornge is performing has dropped by about 35 to 45 per cent across the board. Medical director Dr. Michael Peddle attributed that decrease to the cancellation of non-urgent elective procedure transports as well as about a 10 per cent decline in urgent cases compared to last year.

Communication has been critical to developing Ornge's pandemic response.

Smith said a joint clinical/operational committee has been formed and meets daily to tackle questions that come up about personal protective equipment (PPE), for example, or the way paramedics carry out clinical procedures.

Added Peddle: “We discuss active challenges within the fleet. We write operations clinical guidelines – a living document for all frontline staff including aviation AMEs [aircraft maintenance engineers] and paramedics. It outlines operational management processes, PPE, decontamination etc. One of the things we've found very important is communication with frontline staff.”

Ornge has implemented weekly town hall meetings for all staff, where some clinical and operational information is provided and questions are answered. In addition, an internal web page provides further resources.

“From a process perspective, we've made some changes to our pairings and our staffing to make sure we have capacity if we have issues with our workforce being sick or unable to attend work,” said Peddle. Overall, staffing has been adequate to this point, but Ornge has built a plan for surge management to help it meet the needs of communities across Ontario, if required.

While all Ornge employees are screened when they come to work, the patient transport provider has also rolled out some additional skills, said Peddle, including prone ventilation and expanded rapid sequence intubation.

A standing item on the organization's checklist is an evaluation of current PPE standards. Ornge medical staff wear gowns, gloves, face shields and eye protection, in line with Ontario guidelines.

“One of the mainstays of our approach has been do what you know and do it perfectly,” Smith commented. “We instituted PPE donning and doffing checklists and created a PPE utilization flowchart. As we know in transport medicine, where you don and doff your PPE can vary. We found the flowchart reduced anxiety because it provided rules, including for the pilot group.”

While fixed-wing pilots have a high rate of PPE “burn,” it's much lower with rotary-wing. Helicopter pilots don't usually have to help with patient onboarding due to the AW139's self-loading stretcher system.

Keeping safe is the priority

Ornge is not the only air medical provider who has noticed an overall drop in missions during the pandemic.

STARS operates a fleet of Airbus H145, BK117 and Leonardo AW139 helicopters from three bases in Alberta, two in Saskatchewan and one in Manitoba. STARS has been slowly acquiring new H145 aircraft since April 2019, and plans to replace its BK117 and AW139 fleet with a total of nine H145s.

“We're actually seeing a decreased mission volume,” said Dave Evans, senior director, Clinical Services, STARS. “We're still transporting urgent patients, the typical heart attacks and strokes we would typically transport. ILI [influenza-like illness]-type transports account for 13 per cent of mission volume right now.”

Fortunately, COVID-19 spread in Alberta, Saskatchewan and Manitoba has been below some of the predictive models, he added, and hospitals aren't necessarily overwhelmed yet. STARS has so far transported two confirmed COVID-19 patients since the numbers shot up about a month ago.

“With the cancellation of pro sports . . . things got really busy within that first week, with the amount of info needing to be shared and the learnings coming out from Europe and China,” recalled Evans.

“It became evident we needed to start a small group just to field all those questions from our crew. So we started the COVID Communications Working Group right away. Our role was to support our chief medical officer to make sure we're following best practices, medical evidence, provincial guidelines across the three provinces. Keeping safe was the priority.”

The working group has been sending out frequent communications, both written and video, twice a week.

STARS is lucky to have 100 per cent staffing right now, despite a dip in the beginning of the pandemic related to mandatory post-travel isolation. Staff are currently checked for symptoms before each shift, including temperature screening, with documentation required before crews can enter hospitals.

Luckily, PPE procurement has been relatively painless and the organization is adjusting usage parameters in accordance with emerging evidence.

The COVID Communications Working Group is being led by Dr. Jamin Mulvey, incoming STARS Calgary medical director, who also participated in the webinar. He was working in the U.K. with London Air Ambulance and returned to Canada early in the pandemic.

“The biggest challenge is that with a lot of information out there, it's rapidly changing practices and emerging guidelines,” said Mulvey. “We're dealing with a lot of opinion and low-level evidence, and we're trying to sift through it effectively and make robust guidelines for our group.

“Some areas that have been a little bit challenging is the discussion on what exactly is an AGMP – or aerosol generating medical procedure – and with non-invasive ventilation strategies, what are the relative risks of AGMP compared to, say, intubation.”

STARS has moved away from non-invasive and high flow procedures on its helicopters unless absolutely necessary, based on very strict guidelines and discussion with the on-duty transport physician.

Procedures are constantly being evaluated and adjusted where necessary, for both medical staff and flight crews.

Jenny Thorpe is a flight nurse who handles stocking and preparedness ordering for the STARS base in Saskatoon, Sask.

“Being on the front lines and directly involved in patient care, it's been a learning curve for myself and our crews,” she told the group. “A month ago, there was a high anxiety level. But we've worked as a group and with our leadership, just taking it one day at a time and realizing this isn't a fast process. It's a journey that won't be over quickly.”

Thorpe said the team has found success by focusing on the little things that will keep them safe during a mission, such as following strict PPE donning and doffing procedures for medical crew as well as pilots.

She is also an advocate of practice drills. “You can talk about PPE and being prepared, but if you haven't prepared and simulated it, you're going to miss steps. I encourage everyone to simulate caring for a COVID patient.

“It's about slowing things down, making sure you're making your decisions with purpose and not reacting.”

There is no emergency in a pandemic

In Canada's westernmost province, the BCEHS team is following the same steady, purposeful path.

“When we're doing a call, we've emphasized there is no emergency in a pandemic,” commented Dr. Steve Wheeler, BCEHS medical director, Critical Transfers and Aviation Medicine. “It all comes down to crew safety. We don't rush into it; we plan and make sure everything is set up. We don't run positive pressure other than intubation. If the patient needs to be intubated for the flight, our threshold is very low, we'll have them intubated in the sending facility. We try to methodically plan out the whole trip.”

With six air bases throughout the province, BCEHS has also noticed call volumes have declined by about 30 per cent.

“We're not doing the regular amount, we're doing one to two COVID transfers per day that are spread between rotor, fixed-wing and ground transports,” said Wheeler.

He said the B.C. team's Australian manager established a network of about 15 global air medical organizations early on in the process. They met three times a week by Skype “to try to prepare for PPE, crew safety, medical procedures, how to ventilate or oxygenate patients in flight, etc. That was extremely helpful for us.”

To prepare for a possible surge, BCEHS paused its paramedic training and released the instructors for work, placing some senior and junior students into station support roles.

The organization examined available PPE options and decided to adopt Tyvek suits, which has decreased the PPE “burn” rate. The service also purchased 3,000 silicone half-mask respirators with reusable canisters and face shields.

Educating its pilots was a high priority for BCEHS. They were heavily trained on donning and doffing PPE; they wear gowns instead of Tyvek suits.

Wheeler said the pandemic has delivered several lessons to the province.

“For us, this has highlighted to government and health authorities the need to improve and increase the capacity of our inter-facility transfers. Government announced yesterday they will provide five new aircraft. In every pandemic or catastrophe, sometimes there is opportunity.”

https://www.skiesmag.com/news/canadas-air-medical-transport-providers-say-collaboration-communication-are-keys-to-pandemic-response

Sur le même sujet

  • Le Canada négocie l’achat de nouveaux véhicules blindés d’appui tactique

    19 août 2019 | Local, Terrestre

    Le Canada négocie l’achat de nouveaux véhicules blindés d’appui tactique

    De : Défense nationale Communiqué de presse Le 16 août 2019 – London (Ontario) – Défense nationale/Forces armées canadiennes Le gouvernement du Canada franchit une autre étape pour procurer aux Forces armées canadiennes (FAC) l'équipement moderne dont elles ont besoin pour fonctionner dans tout le spectre des opérations, et ce, mieux protégées contre diverses menaces, comme le souligne la politique de défense du Canada Protection, Sécurité, Engagement. L'honorable Harjit S. Sajjan, ministre de la Défense nationale, a annoncé que le gouvernement achètera 360 véhicules blindés légers (VBL) d'appui tactique de la General Dynamics Land Systems-Canada (GDLS-C). Les fonds nécessaires sont compris dans le budget approuvé réservé à la mise en œuvre de la politique de défense susmentionnée. Le gouvernement du Canada a également l'intention de fournir un prêt à remboursement à la GDLS-C. Afin d'accroître au maximum les retombées économiques de ce projet pour la population canadienne, le fournisseur réinvestira une somme rigoureusement égale à la valeur de ce contrat dans l'économie canadienne afin de créer des emplois et des possibilités en matière d'innovation. En plus des quelque 1 650 emplois existant à l'usine de la General Dynamics Land Systems (GDLS) à London, des travailleurs occupant près de 8 500 autres emplois disséminés dans tout le Canada aideront à fournir les pièces et l'équipement nécessaires à la construction des véhicules blindés légers. Le VBL est essentiel au parc de véhicules de combat de l'Armée et il appuie nos militaires, femmes et hommes, dans toute une gamme d'opérations, y compris les missions de soutien de la paix à l'étranger et les opérations de secours qui ont été menées lors des vastes inondations s'étant produites au Nouveau‑Brunswick, au Québec et en Ontario. Le VBL est une plateforme qui a fait ses preuves et qui répond aux besoins de l'Armée canadienne. La présence de véhicules d'appui tactique semblables dans le parc des Forces armées canadiennes offrira de nombreux avantages opérationnels, y compris la réduction du coût de l'instruction et du maintien en puissance et la disponibilité de pièces de rechange communes pour réparer les véhicules rapidement au cours d'opérations critiques. Les véhicules blindés d'appui tactique remplissent des rôles clés et servent notamment de postes de commandement, d'ambulances et d'ateliers mobiles de réparation. Cette nouvelle flotte offrira la protection et la mobilité dont les membres des FAC ont besoin pour exécuter leur travail dans les environnements opérationnels. Citations « Le VBL est l'épine dorsale de la flotte de véhicules de combat de l'Armée et il soutient nos militaires, femmes et hommes, dans tout un éventail d'opérations, allant des interventions de secours en cas de catastrophe au Canada telles que l'opération LENTUS aux missions de soutien de la paix à l'étranger. Je suis heureux de pouvoir renforcer notre flotte de véhicules blindés d'appui tactique, comme notre gouvernement s'est engagé à le faire dans la politique de défense Protection, Sécurité, Engagement, tout en soutenant des emplois canadiens et en favorisant l'innovation gr'ce à notre partenariat avec GDLS-C. » – Le ministre de la Défense nationale, Harjit S. Sajjan « Nous sommes résolus à fournir à nos militaires, femmes et hommes, l'équipement qu'il leur faut pour exécuter leur travail important. Dans le cadre de la politique de défense du Canada Protection, Sécurité, Engagement, l'annonce d'aujourd'hui nous fait avancer dans l'exécution de notre plan qui vise à fournir aux Forces armées canadiennes l'équipement moderne dont elles ont besoin, dans les limites du budget établi, tout en garantissant des emplois à la classe moyenne dans l'ensemble du pays. » – La ministre des Services publics, de l'Approvisionnement et de l'Accessibilité, Carla Qualtrough « Notre gouvernement continue de créer de bons emplois et des possibilités économiques pour les canadiennes et les canadiens. Chaque dollar dépensé aux fins de ce projet sera réinvesti dans l'économie canadienne en créant des débouchés pour les fournisseurs canadiens et en soutenant de bons emplois pour la classe moyenne. » – Le ministre de l'Innovation, des Sciences et du Développement économique, Navdeep Bains Faits en bref La flotte actuelle de véhicules blindés d'appui comprend des VBL II Bison et des VBL chenillés M113. Le gouvernement du Canada en est aux dernières étapes de la négociation d'un contrat avec GDLS-C. Le coût estimatif du projet pourrait atteindre trois milliards de dollars, et le prêt remboursable atteindra jusqu'à 650 millions de dollars. Ce premier montant comprend aussi le coût de la nouvelle infrastructure où les véhicules seront logés et entretenus. Les véhicules blindés d'appui tactique des FAC seront livrés en huit versions et pourront ainsi remplir divers rôles tels que: ambulances, récupération de véhicules, travaux de génie, atelier mobile de réparation, guerre électronique, transport de troupes et postes de commandement. En acquérant les véhicules maintenant, le Ministère épargnera les frais liés à l'entretien et à la prolongation de la durée de vie de la flotte actuelle de véhicules. La politique de défense du Canada Protection, Sécurité, Engagement contient l'engagement « d'intégrer l'analyse comparative entre les sexes plus (ACS+) dans toutes les activités liées à la défense dans l'ensemble des Forces armées canadiennes et au ministère de la Défense nationale ». Cela garantit que chaque activité, y compris l'acquisition de nouvelles plateformes majeures, prend en compte l'ACS+. L'opération LENTUS correspond aux interventions des Forces armées canadiennes (FAC) en cas de catastrophes naturelles au Canada. Elle suit un plan d'action établi pour soutenir les collectivités en crise. Les FAC peuvent alors utiliser des navires, des véhicules, des aéronefs et divers autres équipements. La Politique des retombées industrielles et technologiques est le principal outil dont dispose le gouvernement pour assurer les retombées économiques des grands marchés de défense, ce qui signifie que le fournisseur réinvestira dans l'économie canadienne un montant rigoureusement égal à la valeur du contrat. Liens connexes Protection, Sécurité, Engagement : la politique de défense du Canada Véhicule blindé d'appui tactique – Programme des capacités de la Défense Personnes-ressources Todd Lane Attaché de presse Cabinet du ministre de la Défense nationale Téléphone : 613-996-3100 Relations avec les médias Ministère de la Défense nationale Téléphone : 613-996-2353 Courriel : mlo-blm@forces.gc.ca https://www.canada.ca/fr/ministere-defense-nationale/nouvelles/2019/08/le-canada-negocie-lachat-de-nouveaux-vehicules-blindes-dappui-tactique.html

  • Plan to buy more fighter jets puts Canada on hook for bigger share of F-35 costs

    31 janvier 2019 | Local, Aérospatial

    Plan to buy more fighter jets puts Canada on hook for bigger share of F-35 costs

    Lee Berthiaume, The Canadian Press OTTAWA -- Canada is being forced to shoulder a bigger share of the costs of developing F-35 fighter jets even though it has not decided whether it will actually buy any. Canada is one of nine partner countries in the F-35 project, each of which is required to cover a portion of the stealth fighter's multibillion-dollar development costs to stay at the table. Each country pays based on the number of F-35s it's expecting to buy. Canada has pitched in more than half-a-billion dollars over the last 20 years, including $54 million last year. But that amount was based on the Stephen Harper government's plan to buy 65 new fighter jets to replace Canada's aging CF-18s, which the Trudeau government has since officially increased to 88. Even though Canada has not committed that those 88 jets will be F-35s, the Department of National Defence says that change means it will have to pay more to remain a partner -- including about $72 million this year. "Canada's costs under the F-35 (partnership agreement) are based on an intended fleet size," Defence Department spokeswoman Ashley Lemire said in an email. "Canada changed its fleet size within the F-35 (agreement) from 65 to 88 aircraft to align with government decisions on the size of the intended permanent fighter fleet to be acquired through competition and the payment increased accordingly." As each partner contribution is determined annually, based on the overall cost of the F-35 development program for that specific year, Lemire said she could not provide details how much more Canada will have to pay. The F-35's development costs have been a constant source of criticism over the life of the stealth-fighter program, which Canada first joined under the Chretien government in 1997. The entire program is believed to have already cost more than US$1 trillion. The Trudeau government says it plans to keep Canada in the F-35 development effort until a replacement for the CF-18s is chosen -- partners in the development work can buy the planes at a lower price and compete for work associated with their production and long-term maintenance. Canadian companies have so far won more than $1.2 billion in contracts related to the F-35, according to the government. The F-35 is one of four planes slated to participate in the $19-billion competition that the government plans to launch this spring, the others being Boeing's Super Hornet, Eurofighter's Typhoon and Saab's Gripen. The competition isn't scheduled to select a winner until 2021 or 2022, meaning Canada will be on the hook for several more payments. The first new aircraft is expected in 2025 and the last in 2031, when the CF-18s will be phased out. F-35 maker Lockheed Martin says more than 350 of the stealth fighters have been delivered to different countries, while Israel became the first country to use the plane in combat last year when two of the jets struck targets in neighbouring Syria. Acting U.S. defence secretary Patrick Shanahan, a former Boeing executive, nonetheless criticized the program on Monday, saying it "has room for a lot more performance." "I am biased toward performance," he was quoted as saying when asked if he is biased toward Boeing. "I am biased toward giving the taxpayer their money's worth. And the F-35, unequivocally, I can say, has a lot of opportunity for more performance." https://www.ctvnews.ca/politics/plan-to-buy-more-fighter-jets-puts-canada-on-hook-for-bigger-share-of-f-35-costs-1.4275372

  • A cyber war has started and Canada isn't ready to fight it, says report

    9 avril 2019 | Local, C4ISR, Sécurité

    A cyber war has started and Canada isn't ready to fight it, says report

    Murray Brewster · CBC News Analysis says Canada lagging far behind its allies in responding to cyber warfare threat A new report questions how well prepared the Canadian military and the federal government are to fight a cyber war that, for all intents and purposes, has started already. The Canadian Association of Defence and Security Industries (CADSI), which represents major weapons and high-tech manufacturers, warns in a new report that, despite recent investments and policy papers, the country is lagging far behind its allies in preparing to fight a new kind of war. "The cyber threat to the Canadian Armed Forces (CAF) permeates domestically through vulnerabilities in critical infrastructure, combat systems and equipment, and extends to where the military is deployed abroad," said the association's report, released Thursday. "Russia have proven their ability to launch attacks that cripple critical systems in seconds or quietly collect intelligence for years. The CAF has only recently received approval to engage in active and offensive operations at scale (though specialized activity has been present for years)." 'A genuine sense of urgency' To compile the report, researchers at CADSI conducted 70 interviews with government and military officials, as well as defence industry leaders. Christyn Cianfarani, the association's president, said the feedback was frank. "There's a genuine sense of urgency for Canada to advance in this space," she said. Even if the public doesn't feel the country is vulnerable, she added, "we could stand to be vulnerable by not moving forward very quickly." The report comes just weeks after a House of Commons committee heard that online attacks on Canada's financial system and other key infrastructure could become far more destructive as more militaries around the globe get involved in cyber operations. That testimony came from security expert and former CIA analyst Christopher Porter, an executive at the U.S. cyber security company Fireeye, Inc. He said the west's imposition of sanctions on "some countries" has in the past been met with denial-of-service attacks on financial services websites, but those attacks have only been disruptive. "In the future, they may respond with destructive attacks," he testified on Feb. 6. Cianfarani echoed that warning. "I think, if you look, other nations are attacking Canada," she said. "Other nations aren't just attacking Canada in a short-game play. They are attacking Canada and trying to influence things in our country in a long-game play." The defence association report also took aim at the federal government's ponderous procurement system, noting that adversaries and allies have "demonstrated their ability to deploy new cyber capabilities in months or weeks, while the CAF remains burdened by a years-long and sometimes decades-long procurement cycle." Time to 'blow up' the procurement system? Cianfarani said the procurement system has to "be blown up" and "torn apart" when it comes to acquiring cyber equipment and services. It should take six months, not 10 years, to get those kinds of products into the hands of cyber operators, she added. Defence Minister Harjit Sajjan's office declined comment and referred CBC News to the Communications Security Establishment, which defends the federal government's networks. While CSE spokesman Evan Koronewski did not address the specific criticisms in the industry association report, he pointed to the creation of the Canadian Centre for Cyber Security, which brings "operational security experts from across the Government of Canada under one roof" — something that is expected to deliver a more unified approach. "Although we cannot speak specifically to the Cyber Centre's capabilities, we are confident our men and women have the tools they need to deliver on their mission," Koronewski said in an email. The study found "government and industry lack the mutual trust required to effectively collaborate in the cyber defence of Canada" and proposed a series of remedies. "This distrust has been sown over time through a history of unproductive engagements, limited communications and inadequate mutual understanding of each other's capabilities," said the analysis. The Council of Canadian Innovators has delivered a similar message to the federal government on many occasions over the last two years, but Cianfarani said she believes that the upcoming federal election and the possibility of interference in it — foreign or otherwise — will focus the attention of both the public and decision-makers. "I think around an election is probably when we have the loudest voice, and it's when we're probably, as a country, the most vulnerable," she said. The report pointed to other countries, such as the United States, where cyber defence strategies are primarily driven by industry, supported by the academic community and funded by the government without bureaucratic limitations. "A similar approach for Canada could mobilize a strong, sovereign line of defence against rapidly evolving cyber threats," the report said. https://www.cbc.ca/news/politics/a-cyber-war-has-started-and-canada-isn-t-ready-to-fight-it-says-report-1.5045950

Toutes les nouvelles