How Air Ambulance Services Can Improve Care Delivered to Remote Indigenous Communities

Introduction Approximately fifty percent of Canada's Indigenous population resides in remote and rural communities, where life expectancy is five to seven years shorter than in the rest of Canada. Barriers to health care include, but are not limited to: low population density, long transportation and wait times, high rates of staff turnover, harsh weather climates, and inadequate human resources. Ornge is the air ambulance and critical care transport provider for the province of Ontario. Ontario is Canada's second largest province, with a landmass of more than 1 million km2, and a population of about 13 million people. Northern Ontario constitutes 87% of the land area of the province, but has less than 7% of the population. Ornge operates 12 bases across the province, and employs a fleet of 8 Pilatus PC-12 fixed wing aircraft and 11 AW 139 rotor wing aircraft to support the air ambulance transport needs of the province. As well, Ornge utilizes contract air carriers to provide transport for predominantly low acuity patients. We hypothesized that air ambulance services have the medical, logistical, educational, and technological and data capabilities to improve access to care for remote Indigenous communities. Increasing involvement of air ambulance services in delivering health care to remote Indigenous communities will improve patient outcomes and represent an opportunity for air ambulance services to expand their scope of work. Methods Ornge has developed a five-part strategy to help improve access to care for Indigenous communities. Results 1. Telemedicine: Over the past year, Ornge has conducted approximately 75 telemedicine consultations with the nurses servicing four remote indigenous communities. Survey data from the nurses has uniformly been extremely positive of the value of the telemedicine support. 2. Point of Care Lab Tests: Over the past six months, 58 patients within two communities have benefitted from point of care lab tests supplied by Ornge. Patient care has been improved dramatically and unnecessary transports have been prevented. 3. Education: Ornge has delivered educational sessions to nurses and doctors servicing these remote communities. This has improved the working relationships between all parties. As well, Ornge has helped develop a proposal to train indigenous members as first responders within seven remote communities. 4. Outreach: Ornge has delivered three sessions of first aid/cpr and "Stop the Bleed" training to Indigenous youth. As well, Ornge is now delivering Primary and Secondary Injury and Opioid prevention sessions to Indigenous Youth. 5. Data: Stakeholders are now using Ornge data to help identify strategies to improve access to care for Indigenous communities. Conclusion Air ambulance services have the expertise and capabilities to help improve access to care for remote Indigenous communities. This represents an area of potential opportunity for air ambulance services. Expanding the mandate of air ambulance services to improving access to care to these remote communities can help improve patient outcomes, allow for care closer to home, and allows for accurate triaging of air ambulance assets in a relative resource-poor environment.