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  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

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  17 décembre 2020 | Local, Naval

  Top of the line Canadian-made naval equipment shut out of $70-billion warship program

  A spokeswoman says DND is “confident that we have competitively selected the best design to meet Canada's needs.” David Pugliese • Ottawa Citizen Dec 16, 2020 • Last Updated 1 day ago • 6 minute read Canadian equipment that taxpayers spent hundreds of millions of dollars to develop isn't being used on the country's new $70-billion fleet of warships because the consortium that won the bid selected its own affiliated companies and their foreign systems. A number of Canadian firms repeatedly tried to warn ministers and deputy ministers at the Department of National Defence, Public Services and Procurement Canada as well as Innovation, Science and Economic Development Canada that they would be shut out of the Canadian Surface Combatant project, according to federal government documents obtained by this newspaper. Those concerns were ignored. Instead, Canada left it up to the winning consortium, in this case, the U.S.-controlled Lockheed Martin Canada and BAE of the United Kingdom to determine the equipment that would make up key components of the proposed 15-fleet Canadian Surface Combatant, or CSC fleet. By selecting the consortium's Type 26 warship design for the CSC, the Royal Canadian Navy automatically agreed to what Lockheed Martin had determined was the best equipment for it to use. In the last week, this newspaper has chronicled multiple issues with the CSC project, the most expensive military procurement in Canada's history. This newspaper reviewed thousands of pages of documents, obtained through sources and through the access to information law, to reveal how the CSC's budget has spiralled upward and upward and how government officials previously tried to block the cost of the project from becoming public. In an email, DND defended its choice that shut out inclusion on the CSC of Canadian-made propulsion systems, sonar and communication systems, as well as radar. The Canadian-based firms that build those systems employ hundreds of people in the high-tech sector. “By selecting the design, Canada has selected the associated equipment,” said DND spokeswoman Jessica Lamirande. She noted DND is “confident that we have competitively selected the best design to meet Canada's needs.” As a result, a radar built by Lockheed Martin in the U.S., which hasn't yet been certified for naval operations, will be installed on the CSC. Passed over was a state-of-the art naval radar developed with the help of Thales Canada in Nepean. Canadian taxpayers contributed $54 million to the development of that radar, which is now being used on German, Danish and Dutch warships. Also shut out of the CSC competition is SHINCOM, a naval communications system built by DRS Technologies of Ottawa and considered one of the top such systems in the world. SHINCOM is in service on other Royal Canadian Navy vessels as well as 150 warships of allied navies around the world, including Australia, the U.S., Japan, New Zealand and South Korea. It was originally developed for Canada's Halifax-class frigates and taxpayers have poured millions of dollars into its development. Also left on the sidelines was General Dynamic Mission Systems of Ottawa, Canada's top developer of anti-submarine warfare and sonar equipment. The firm has its systems on aircraft or warships of militaries in Canada, Japan, South Korea, Portugal and various South American nations. Top government officials and politicians were repeatedly warned key Canadian firms would be shut out of the CSC project. Steve Zuber, vice president of DRS Technologies, wrote on Aug. 31, 2016 to alert innovation minister Navdeep Bains that the way the CSC procurement was designed would work against Canadian firms. “The CSC procurement approach may actually disadvantage Canadian companies,” Zuber warned. “The current evaluation approach puts our world-class Canadian solutions at serious risk of not being selected for Canada.” At the heart of the matter was a procurement system that penalized bidders if they deviated too much from their original ship designs to accommodate Canadian equipment. In addition, no competitions were held for key components of the new warships, such as sonar, radar or communications systems. General Dynamics Missions Systems Canada also tried to warn government officials in November 2019 that the lack of competition shut out high-tech Canadian systems developed over the years with both private and tax dollars. Company vice president David Ibbetson told navy commander Vice Adm. Art McDonald, DND deputy minister Jody Thomas, PSPC deputy minister Bill Matthews and ISED deputy minister Simon Kennedy about the lack of competition on the CSC anti-submarine warfare systems. That resulted in a “largely foreign solution with only limited Canadian content,” he noted. The documents also show bureaucrats at ISED countering such concerns by pointing out that the CSC program will include equipment from other firms such as L-3 and CAE in Quebec and MDA in B.C. Lockheed Martin has also committed to invest in priority areas such as cybersecurity, clean technology and the marine sector, innovation minister Bains was told. But the federal government has declined to release other documents requested through access to information law about specifics of the industrial benefits and job creation plan linked to the CSC. There is concern by some in the country's defence industry that the Liberal government has put at risk existing Canadian high-tech jobs, developed and established in part by federal contracts and development money, in exchange for the promise by foreign companies to create new jobs in the future linked to the CSC. In addition, in November 2019, the Lockheed Martin Canada executive responsible for delivering on the industrial commitments admitted the system had major problems. Walt Nolan said the policy the Canadian government developed has prompted defence firms to significantly overcommit on the jobs and industry benefits they claim they can deliver on the CSC. But Lockheed Martin has significant support from the leadership of the Royal Canadian Navy, including Vice Adm. McDonald. In July, McDonald took to Twitter to promote the company and its SPY-7 radar, noting that such a system is critical to a warship's survival and how it performs on missions. “For these reasons, the Royal Canadian Navy is delighted that Canada's Combat Ship Team under Lockheed Martin Canada leadership will fit the SPY-7 in CSC,” wrote McDonald, in retweeting the company's press release about the radar. But McDonald's enthusiastic corporate plug left out some critical information, namely that the SPY-7 radar had never been installed on an actual warship. Less than a month before McDonald's tweet, Japan's government, which had been hoping to use SPY-7 radar for a land-based missile defence system, suspended the project. Japan cited technical issues and cost for the decision and is now trying to figure out what to do with the systems it has already paid for. Japan's military has suggested using the SPY-7 on new frigates but some of the country's lawmakers are trying to scuttle that plan. They are worried that Japan will pay significant development costs to get the radar ready for maritime use and since the U.S. Navy will use a completely different system there will be problems operating with a key ally. While the SPY-7 radar issue has been debated in Japan's legislature, Canadian politicians have been silent. Lockheed's rival, Raytheon, the firm which will provide the SPY-6 radar for the U.S. Navy, has made several presentations to the Liberal government. It tried to convince politicians and bureaucrats the Lockheed Martin system could become a money pit that would potentially put Canadian sailors at risk. Switching to SPY-6 would save Canada tens of millions of dollars as the U.S. Navy would finance future research into modernizing the radar to deal with new threats, federal officials were told. In addition, Raytheon pointed out that unlike the SPY-7, the testing of its radar, which included intercepts of targets, was completed in 2019. The U.S. Navy intends to install the system on 50 of its warships. But cabinet ministers and federal bureaucrats dismissed Raytheon's overtures as an attempt to reverse the CSC procurement process that had already been completed. Neither Lockheed Martin nor the DND could provide a date on when the SPY-7 will be ready for naval operations and certified for use on the CSC. But they noted the company is supposed to deliver the first radar system in 2025. “Once fully integrated into the CSC design, the SPY-7 will provide Canada the capabilities it needs to meet the operational and interoperability requirements of the Royal Canadian Navy well past the middle of this century,” added DND spokeswoman Lamirande. Responses from DND and Lockheed Martin to questions posed by this newspaper for this story were answered in nearly identical fashion. Canadian taxpayers will finance the development and testing of any of the radar requirements for the CSC. The cost of that, however, is not known at this point. https://ottawacitizen.com/news/national/defence-watch/top-of-the-line-canadian-made-naval-equipment-shut-out-of-70-billion-warship-program

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  9 juillet 2021 | Local, Naval

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