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THE SKY’S THE LIMIT – ALBERTA AIR AMBULANCE PAST, PRESENT AND FUTURE

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Cockpit

Alberta has a long history of fixed-wing air ambulance services. Starting as regional ad-hoc services in the 1970s; often staffed on an “as needed” basis with local nurses, paramedics and/or doctors, an air ambulance was formalized through contracts in the 1990’s mutual aid to neighbouring provinces and territories. In 2012, the program was expanded to include provincial Inter-facility Transfer Strategy, developing, and implementing provincial IFT strategies in collaboration with EMS zones, programs, and health service partners.

© Merle Prosofsky All Rights Reserved
© Merle Prosofsky All Rights Reserved

The goal of the Alberta Air Ambulance program is to provide air medical transport for rural and remote communities, supporting equitable access to health care services. The AHS Air Ambulance program operates 10 King Air 200/250 series aircraft, 1 King Air 350 across 10 bases across Alberta. The bases; High Level, Fort Vermilion, Slave Lake, Lac La Biche, Grande Prairie, Fort McMurray, Peace River, Edmonton, Calgary and Medicine hat, are staffed with 24/72 Advanced Care AMC (Air Medical Crew) and two pilots. Using a mixed model of the contracted and direct delivery staff, Alberta transports approximately 8000 patients annually, including the emergent and urgent responses and non-urgent, scheduled appointments and repatriations. In 2019, the Alberta Air Ambulance program was recognized for its innovation and excellent service delivery and was awarded the Association of Air Medical Services Fixed Wing Award of Excellence

AHS entered into new contracted services in 2017, requiring all the aircraft to have a standardized layout for the patient care area. This ensures any Air Medical crew can go on any air ambulance aircraft, providing seamless care. From seating locations to equipment securing mechanisms and storage, the aircraft interior was designed with input from the crews using it. To meet specialized patient needs, the King Air 350 was added to the fleet and stationed in Edmonton in 2017. Larger than the rest of the fleet it offers more cabin space and a wide door, enabling transport of specialty teams (NICU/PICU), bariatric patients; up to 800 lbs, and accommodating family escorts. The King Air 350 is also better suited to longer distances such as Yellowknife or Winnipeg, and for bariatric assistance in neighbouring provinces/territories.

Completing the bulk of Alberta’s Air Ambulance work, the King air model was chosen for its robust safety features, comfortable cabin area, twin-engine, two-pilot capability, the ability to land on shorter runways (~3000 ft for a King air 200/250) and operate in Alberta’s harsh winter climate. All aircraft are IFR capable and have a synthetic vision, augmenting pilot awareness. Equipped with a Skytrack TM satellite tracking system and sat phone, allowing for real-time tracking and medical crew direct contact with dispatch or a Transport Physician during flight. Work is also underway to have all aircraft on the provincial mutual aid radio system; called AFRRCs where the crew can communicate directly with a ground ambulance anywhere in the province.

Because of standardization, all Alberta aircraft can accommodate Alberta-based neonatal or pediatric teams and their specialized stretchers or incubators and bariatric patients. The limitations of the standard King-Air 27 inch wide door were overcome by including three aircraft with wider cargo doors. Hydraulic lifts were added to these three aircraft in order to assist in moving patients up to 850 lbs in and out of the aircraft. The lift fits nicely into the wing-locker taking up minimal space, uses minimal power and therefore keeps practitioners safe wherever they respond to.

Air Ambulance Base
Air Ambulance Base

The vast geography of Northern Alberta poses access challenges for critical patients requiring tertiary care, prompting the creation of an Urgent Response Plane. Based in Grande Prairie, this plane is dedicated to emergent and urgent medevacs, allowing for timely response to Northwestern Alberta communities. Supporting this, the air ambulance program also has a 12 hour “scheduled” air ambulance aircraft based in Peace River. This plane can carry multiple pre-booked stable patients from different communities that require access to care outside of their home community. Stops are scheduled to pick up patients along the way into Edmonton, freeing up other resources for urgent responses. Although discontinued during the COVID pandemic, this highlights the commitment to the timely care and equitable access of Albertans in rural and remote areas.

To match the “right patient with the right resource”, Air ambulance in Alberta is coordinated through a centralized dispatch system. This allows for integration with ground EMS for seamless response and efficient patient movements between the airport and hospitals. The program also benefits from strong partnerships with AHS EMS dispatch, STARS Air Ambulance and RAAPID (AHS bed placement agency). These partnerships enable unified pre-transport coordination of activities for the critically injured or ill from rural/remote areas. The strength of any EMS system is its people and Alberta Air Ambulance is proud of its frontline practitioners. The dedicated direct delivery and contract medical crew, provide two Advanced Care Paramedics (ACP) or ACP and critical care nurse team, trained to utilize critical care medical control protocols. STARS Air Ambulance, who, share the facility with AHS Air ambulance in Edmonton, support fixed-wing critical care through access to their Critical care training program. Critical care training and abilities have proven their worth as the fixed-wing program is an important component of the COVID 19 response in Alberta. The fixed-wing AMC is one of the first considerations for the transport of complex vented patients, whether by air or supporting in a ground ambulance.

Taking the lead in training, the AHS AIR Ambulance program has developed a dedicated mobile Simulation unit using an actual King Air 200 fuselage. Routinely used by our Flight Paramedics, high-fidelity simulation can be offered anywhere in the province. The simulator is based at the Air Operations Center in Edmonton, which can be accessed by Air Ambulance crews during their wait time. The training program is comprised of a dedicated air ambulance clinical educator and medical leadership, who develop annual sim training along with monthly clinical rounds and other air ambulance-specific education modules.

What helps the Air Ambulance program be successful is the fully integrated provincial health system. EMS is a core component of the health system and overall patient experience in healthcare. Evolving from a large mix of private, municipal, and government agencies, EMS in Alberta is a part of the provincial healthcare system, affording further congruent and collaborative opportunities for integration within AHS. Inter-facility transport, air, or ground, touches a multitude of programs and services and one provincial system provides opportunities to improve patient flow thus creating efficiencies for all health service partners in turn improving the overall patient experience.

Plane_Ground
Plane_Ground

One such opportunity came with the opening of the Air Ambulance Operations Centre (AOC) at Edmonton International Airport in 2013. The AOC is the hub for 75% of Alberta’s air ambulance activities. A 40,000 sq ft. hangar allows for a single one-stop shop for patient transfers. The hangar is well suited to inside patient transitions during inclement weather. The AOC also benefits from dedicated ground ambulance support, onsite leadership, and aircraft services such as a dedicated Fixed-base operator, some maintenance, crew sleeping quarters, common rest and eating areas.

The Air Ambulance Operations Center also has a one-of-a-kind dedicated Patient Transition Room (PTR). Staffed by an Advanced Care and Primary Care Paramedic team, the PTR can accommodate up to 6 patients, which enables better coordination of air ambulance resources between sending and receiving sites. This improves systemic patient flow, maximizes air ambulance efficiency and timely return of aircraft to the rural areas. The AOC has become a hub for not only Alberta but for western and northern Canada, utilized by British Columbia, Saskatchewan, Yukon, Northwest Territories and Nunavut.

 Alberta’s Air Ambulance program, including the AOC, has also become a critical resource for mass casualty incidents in Alberta and for the Edmonton International Airport. The first major test of the AOC’s full capacity came in 2016, where over 110 patients were due to the Fort McMurray fire. Patients were triaged and evacuated to the AOC, where they were cared for until they could be transferred to regional hospitals. The AOC is a part of the Edmonton International Airport Emergency response plan and used again in 2019, for a mass evacuation as a result of forest fires; solidifying the value of the AOC. Looking to the future, AHS is implementing a provincial electronic health information management that provides untapped possibilities to align traditional hospital patient movement with EMS IFT capacity, an incredible opportunity for efficiency and cost-effectiveness especially considering the utilization of air ambulance resources.

The Air Ambulance program in Alberta has come a long way since its inception. Improving healthcare integration and enhancing high-quality critical care for seamless patient transport anywhere in the province remains two top program priorities. . There is much more to come and we are looking forward to the future.

Steve Sutton

Steve Sutton

Steve Sutton is an ACP whose career has spanned 23 years in practice areas such as urban and rural ground, air, fire-integrated, industrial, and remote EMS. Steve holds a Master of Arts Degree in Health Leadership and is a Manager with the Alberta Air Ambulance & IFT Strategy Program.

Jessica Stevenson

Jessica Stevenson

For the past 8 years, Jessica Stevenson has been a manager with the Alberta Health Services Provincial Air Ambulance Operations and Inter-facility Patient Transport Strategy Department. Prior to this, Jessica spent over 14 years in the Canadian Helicopter Industry as a Pilot, a Base Manager and finally as Flight Operations Safety Specialist before moving to Air Ambulance. Jessica holds a Master’s Degree in Aviation Human Factors, is trained in the HFACS (Human Factors Analysis and Classification System) approach to incident/accident investigation and will have completed a Master’s in Business Administration in December 2019. Jessica currently works out the Air Ambulance Operations facility at the Edmonton International Airport.

Canadian Paramedicine

Canadian Paramedicine

Canadian Paramedicine provides a platform for exchanging ideas and innovative programs, emerging news, trends, research, politics, and association information affecting Paramedicine in Canada and around the world.

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