Ornge (formerly Ontario Air Ambulance) is the air ambulance service for the province of Ontario and for the Ministry of Health and Long-Term Care (Ontario). The provision of ambulance services in Ontario is governed by the Ambulance Act.

Under the Act, the Minister of Health and Long Term Care must ensure that “the existence throughout Ontario of a balanced and integrated system of ambulance services and communication services used in dispatching ambulances.”

History

The air ambulance program was established in 1977 to serve remote areas primarily in Northern Ontario that are inaccessible to land ambulances or that land ambulances would take too long to reach. Ontario was the first Canadian province to provide a helicopter-based air ambulance system to transport critically ill patients to hospital. Air ambulances are also used to transport medical teams and organs for transplant. A large part of the air ambulance service is involved in serving the aboriginal communities, of which there are approximately 140, in Northern Ontario.

The Ministry operates an air ambulance dispatch centre located in Toronto called Med-Com.

Today, the air ambulance program has become an integral component of the larger emergency health system in communities across the Province.

Aircraft Fleet

In a press release dated August 28, 2008 Ornge announced that it would be purchasing 10 new AgustaWestland AW139 helicopters to replace the current fleet of Sikorsky S-76 helicopters, to be delivered over a period of two years from late 2010. The S-76 helicopters were previously owned and operated by Canadian Helicopters, but are now owned by Ornge and operated by Canadian Helicopters. Canadian Helicopters will continue to provide operations services for helicopters through April 2012, with the possibility of a further two-year extension.

Helicopters

Eleven Sikorsky S-76s located at:

• Billy Bishop Toronto City Airport (3)

• Ottawa International Airport (1)

• Thunder Bay International Airport (2)

• Moosonee Airport (2)

• Kenora Airport (1)

• Sudbury Airport (1)

• London International Airport (1)

From the first long weekend of the summer to Labour Day one of the Toronto crews is relocated and based out of Muskoka Airport for the increased number of trauma calls in cottage country during this period.

Fixed-wing aircraft

Four Beechcraft King Air 200s provided on contract with Voyageur Airways of North Bay, Ontario located in:

• Sioux Lookout Airport (2)

• Timmins Airport (2).

Ornge is moving to provide dedicated service with the Pilatus PC-12. Scheduled delivery for the first PC-12 is late 2008.

Standing agreement aircraft

Additional aircraft are available under the Standing Agreement (as and when required) contract with other operators:

• Canadian Flyers International operating a Piper PA-31-350 Chieftain from the Toronto/Buttonville Municipal Airport and Piper PA-31 Navajo from Dryden, Ontario

• Wabusk Air operating a Beechcraft A100 King Air from Moosonee Airport

• Thunder Airlines - Beechcraft A100 King Air; Cessna 208B Grand Caravan; and Mitsubishi MU-2 from Thunder Bay International Airport, Sudbury Airport and Timmins Airport

• Flightexec at Toronto/Buttonville Municipal Airport and London International Airport

Aircraft inventory

! style="text-align: left; background: #aacccc;"|Aircraft
! style="text-align: left; background: #aacccc;"|Country of Manufacture
! style="text-align: left; background: #aacccc;"|Type
! style="text-align: left; background: #aacccc;"|In Service"World Military Aircraft Inventory", Aerospace Source Book 2007, Aviation Week & Space Technology, January 15 2007.
! style="text-align: left; background: #aacccc;"|Notes
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| Sikorsky S-76
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| multi-purpose medium-size commercial helicopter
| 12
| contract with Canadian Helicopters Income Fund.
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| Beechcraft 200 Super King Air
|
| twin engine turboprop/light utility aircraft
| 3
| contract with Voyageur Airways
|

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| Beechcraft B200C Super King Air
|
| twin engine turboprop/light utility aircraft
| 1
| contract with Voyageur Airways
|

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| Cessna 421
|
| twin engine light transport aircraft
| 1
| Brock Air Services
|

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| Beechcraft King Air A100
|
| twin engine turboprop/light utility aircraft
| 6
| operated by Wabusk Air and Thunder Airlines
|

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| Cessna 208B Grand Caravan
|
| single engine turboprop light transport aircraft
| 1
| operated by Thunder Airlines
|

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| Mitsubishi MU-2
|
| twin engine turboprop
| 4
| operated by Thunder Airlines
|

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| Lear Jet 36A
|
| twin engine business jet
| 1
| Fox Flight Air Ambulance
|

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| Lear Jet 35A
|
| twin engine business jet
| 1
| Fox Flight Air Ambulance
|}

Staff

Paramedics

The same year that the service was established (1977), the Ontario Ministry of Health also developed and implemented a training system for critical care flight paramedics who perform advanced life support and controlled medical acts during air transport. An air ambulance base hospital, Sunnybrook Hospital, also located in Toronto, provides medical direction, oversight, and certification of air ambulance paramedics.

Flight paramedics are trained to one of 3 levels of capability:

• Primary

• Advanced

• Critical Care

From September 2005 the employment of the flight paramedics in the Ontario Air Ambulance system was taken over by Ornge.
Pilots

Ornge does not employ any pilots directly. They are employed by the company who is contracted to supply the aircraft.
Aircraft Mechanics

Likewise, aircraft mechanics are employed by the contractor. Aircraft require ongoing maintenance by skilled mechanics who keep the aircraft in safe mechanical order, contributing to the overall system of air ambulance service.
Dispatchers

Dispatch system

Current Ministry policy states that an air ambulance can be used instead of a land ambulance when: transfers cover a distance of at least 240 kilometers; all land ambulance alternatives have been exhausted; there are poor road conditions or severe weather; or specialized equipment or medical escorts are required. However, a first responder, paramedic, or dispatcher may use their judgement to override these criteria for on-scene emergencies requiring a helicopter.

Once the necessity for an air ambulance is established, the dispatcher selects an aircraft based on flight time, cost, and patient need.

In February 2005, the Ministry agreed to pay the base hospital about $430,000 to independently develop a computer-aided dispatch system for air ambulances.

In addition to Satellite Phones, the helicopters also use the UHF frequency of 413.6875 MHz for radio communications between helicopters and the communication centre, as well as 129.2750 MHz for communications to ATC.

Contracts

The Ministry uses a competitive process to contract with private operators to provide three different categories of helicopter and airplane ambulance service. The three categories are as follows:

• One "Preferred Provider" operator using helicopters primarily

• Two "Critical Care" operators using either helicopters or airplanes primarily

• Ten "Standing Agreement" (as and when required) operators using airplanes primarily

Operators who meet the Ministry's minimum requirements, including certification, and who wish to be on a roster to provide air ambulance services under Standing Agreements submit bids for their services. These bids can be adjusted every six months. The contract for the Preferred Provider is intended to establish a fixed cost for a set term, with no price escalations over the life of the contract. The fleet on contract now consists of 12 helicopters and 4 fixed-wing airplanes, plus 19 aircraft supplied by contractors.

Certification of operators

All air ambulance operators must be certified under the Ambulance Act at least once every three years. Certification is based on the results of scheduled service reviews conducted by the Ministry in conjunction with the base hospital. These reviews include and evaluation of the qualifications of the patient-care providers, the maintenance of aircraft and equipment in accordance with Ministry standards, and other measures taken to ensure proper patient care. Sanctions and the revocation of a certificate are considered as last resorts when all other reasonable efforts of recourse to resolving the deficiencies of an operator have failed.

Reaction times

The Ministry establishes reaction times for each category in its contract with operators as follows:

• One Preferred Provider operator uses helicopters primarily to transport critically ill or injured patients and must be ready to be airborne within 10 minutes of accepting a call.

• Two Critical Care operators use either helicopters or airplanes primarily to transport critically ill or injured patients and must be ready to be airborne within 10 minutes of accepting a call, 90% of the time.

• Ten Standing Agreement operators use airplanes primarily to transfer patients between hospitals and to transport organs for transplant. The Ministry uses the Standing Agreement operators to respond to air ambulance calls when Critical Care and Preferred Provider operators are not available.

The Ministry generally requests the service of the Standing Agreement operator that can meet the patient's needs at the lowest cost. These operators are required to notify the dispatcher within 10 minutes whether they accept the call, as only these operators may decline a dispatcher's request for an air ambulance. On accepting a call, the pilot is required to request takeoff clearance within 30 minutes of the agreed departure time.
All contracts allow for delays due to extenuating circumstances, including bad weather.

Management

In July 2005, the Ontario government announced the appointment of Ornge (formerly the Ontario Air Ambulance Services Co.) to co-ordinate all aspects of Ontario's air ambulance system. This transfer was completed in January 2006. The OAA, a non-profit body accountable to the Ontario government through a performance agreement, is now responsible for all air ambulance operations including the contracting of flight service providers, medical oversight of all air paramedics, air dispatch and authorizing air and land ambulance transfers, as well as the development and implementation of the software system technology used for air ambulance dispatching.

New Name

In August 2006 the Ontario Air Ambulance Service Corporation was re-named “Ornge.” Ontario’s minister of health, George Smitherman, and Ornge’s CEO, Dr. Chris Mazza, unveiled a King Air 200 (owned by Voyageur Airways) and a Sikorsky S-76 (owned by Canadian Helicopters Income Fund) in the bright orange livery during a ceremony at Toronto City Centre Airport. In addition, the service is now referred to as TRANSPORT MEDICINE. The word AMBULANCE and the Ontario Logo have been removed.

New look

The former colours of white and orange have been changed and the entire aircraft is now painted a bright orange colour with the letters ORNGE and a symbol of two open hands, which look like wings, in white.

Cost for air ambulance only

Ministry expenditures for the air ambulance program totalled approximately $93 million in the 2004/05 fiscal year. There is no direct cost to patients who are covered under the Ontario Health Insurance Plan (OHIP). If they are not covered, individuals are generally billed for the cost of their air ambulance trip. In the 2003/2004 fiscal year, the Ministry billed individuals, mainly Americans and Canadians from other provinces, $537,000 for air ambulance services.

Cost comparison

Total operating expenses of the Royal Flying Doctor Service of Australia (RFDS) for 2005 were AU$31 million of which $2,325,467 was funded by donations while the remainder came from Government and internal funding. Until the 1960s the Australian service predominantly hired aircraft, pilots and service technicians from contractors. Now, the RFDS owns or leases all of its aircraft (51 in total), operates from 22 bases, and has 495 full-time and 145 part-time staff members including pilots and mechanics.

Land ambulances

Ontario municipalities are responsible for the provision and cost of land ambulance services within their municipality. The province provides grants to the municipalities for 50 per cent of the approved costs for providing services required under legislated standards.

Other Canadian Provinces

There are some differences between the organizational structure of air ambulance services in the other provinces of Canada:
BC Ambulance Service In BC the air and land ambulance service is combined into one service, unlike in Ontario where they are separately organized and separately funded.
Alberta Air Ambulance Service Alberta Health and Wellness pays dedicated air ambulance providers according to contract agreements. The Workers' Compensation Board covers air ambulance services for workers.
Health Canada pays for services for First Nations members.
Saskatchewan Air Ambulance Service
Manitoba Air Ambulance Service
Quebec Air Ambulance Service
New Brunswick Air Ambulance Service
Emergency Health Services (Nova Scotia)

Ornge and Orange County Choppers

On the November 12, 2009 episode of American Choppers, the crew at Orange County Choppers were shown in Toronto at Ornge. The full episode was dedicated to the Ornge Chopper, which included an Ornge supplied stretcher as a sidecar.