EMS Programs in Canada

1
EMS Programs in Canada

• An overview
• Presented by Transport Canada

June 30, 2005
2
Canadian EMS activities

• dedicated EMS services in Canada
• British Columbia (BC)
• Alberta
• Ontario
• A private operator is developing an EMS program
  based on a different model in the Province of
  Quebec at this time.

3
Types of service

• The services in BC and Ontario are based on the
  same model and are administered in much the same
  manner. These programs are fully funded by the
  Provinces.
• The Alberta program is different in that funding
  for their program comes from a combination of
  Provincial (40) and private and corporate
  donations (60).

4
Ontario BC

• The process to acquire EMS services is started by
  a Request for Proposal (RFP) sent out to all
  operators.
• The RFP describes the details of the dedicated,
  and in some cases, standing offer services
  required and operators bid competitively for the
  exclusive right to provide these services in each
  province

5
Contract Services

• Once a successful bid has been received, the
  competitive process is over and the winner
  becomes the sole provider of services for the
  contract period, usually 5 years.

6
Contract Services

• This process provides considerable stability and
  continuity of service for the provincial programs
  and removes any pressure for operators to compete
  during the term of the contract to get the
  work.

7
Equipment

• Dedicated provincial helicopter EMS programs are
  based on the same requirement for aircraft,
  either fixed or rotary wing.
• All aircraft must be multi-engine IFR certified
  and flown by 2 IFR qualified pilots.

8
Ad-Hoc Services

• Ad-hoc medivac services can be conducted in
  multi-engine or single engine aircraft. However,
  Canadian Regulations prohibit the carriage of
  passengers at night, or under IFR, in single
  engine helicopters.

9
Canadian Regulations

• Transport of Passengers in Single-engined
  Aircraft
• 723.22 Transport of Passengers in Single-Engine
  Aircraft
• Operations Specifications for transporting
  passengers at night and under IFR are not
  applicable to single-engine helicopters.

10
Minimum Visual Meteorological Conditions for VFR
Flight in Uncontrolled Airspace

• 602.115 No person shall operate an aircraft in
  VFR flight within uncontrolled airspace unless
• (a) the aircraft is operated with visual
  reference to the surface
• (ii) during the night, flight visibility is not
  less than three miles, and
• (iii) in either case, the distance of the
  aircraft from cloud is not less than 500 feet
  vertically and 2,000 feet horizontally

11
Commercial Requirements

• 723.34 Routes in Uncontrolled Airspace
• The standard for establishing company routes in
  uncontrolled airspace is
• (1) A minimum obstruction clearance altitude
  (MOCA) shall be established for each route
  segment by the use of aeronautical charts and the
  Canada Flight Supplement for updating of
  significant obstructions as follows
• (b) for flight at night in VFR conditions a
  minimum altitude of 1,000 feet above the highest
  obstacle located within 3 miles from the centre
  line of the route.
• (7) the flight visibility shall not be less than
  3 miles for flights in VFR at night

12
Regulatory Restrictions

• DAY VFR Controlled airspace
• Ceiling 1000ft., minimum 3 miles visibility with
  the provision for Special VFR within Control
  Zones
• Uncontrolled airspace (outside of built up areas)
  
• ½ mile visibility, clear of cloud
• All dedicated aircraft capable of IFR flight
• Most companies have pre-approved areas of
  operation under IFR at a given MOCA and company
  approaches in many locations.

13
The Ontario Model

• The following slides were prepared by the Ontario
  Ministry of Health for this presentation
• At this time I would like to introduce Ken Wong,
  Aviation Safety Office for the Province of
  Ontario.

14
Ontario

• Ministry of Health and Long-Term Care

15
Canadas Health Care System

• Publicly funded through the Federal and
  Provincial tax dollars
• The Federal Government provides a percentage of
  the overall costs for health care within the
  province
• What is the percentage?

16
History

• Pilot program started in 1977
• Aircraft were contracted by the Ministry of
  Health from the private sector
• Dispatch Centre was created in 1980
• Multi dedicated bases set up for both rotary and
  fixed wing aircraft
• Standing Agreements, Dedicated and Preferred
  contracts

17
Dedicated Aircraft

• Contracts are 5 years with an option to extend
  for 2 more years
• Request for proposals (RFPs)
• Safety was the first priority not the dollar
  value
• The RFPs are evaluated and each section is a
  percentage of the overall total score
• The safety component was the highest value

18
Preferred Aircraft

• 5 year contract with an option of 2 more years
• Helicopter operations only
• Safety is the first priority not dollar value

19
Standing Offer Agreement

• Fixed Wing aircraft are on a on-call basis for
  patient transfers and organ retrievals
• 14 Air Operators and two who reside in another
  province

20
MATC

• Medical Air Transport Centre (dispatch centre)
• All air requests come through MATC
• Assess medical condition of the patient and
  select the appropriate aircraft and care level
• Three way communication patches between
  paramedics, hospitals and the doctors
• Flight Following
• Last fiscal year 14,046 flights
• 6,200 flights were helicopter operations

21
Philosophy of the MOHLTC

• Long term contracts are competitive through a
  bidding system with safety as the 1 issue
• Payment for contracts are not based on flight
  hours
• No pressure on the flight crews to accept calls
• To maintain and/or improve all safety aspects in
  the Air Ambulance operations

22
Ken Wong

• Ministry of Natural Resources
• 2621 Skead Rd, Unit 14A Postal Bag500
• Garson ON
• P3L 1W3
• ken.wong_at_mnr.gov.on.ca

23
The Alberta Model

• Air Ambualnce Activities in Albert are conducted
  by the Shock Trauma Air Rescue Society (STARS).

24
Key Safety Elements

• Structure of the competitive bidding process
  removes competition in the field.
• All services conducted with twin engine, 2 pilot,
  IFR certified aircraft.
• Night VFR ceiling and visibility limits of 1500
  feet minimum and 3 miles

25
Key Safety Elements

• Where NVGs are used there is no reduction in
  weather limits, in fact the minimum visibility
  for NVG use in mountainous areas is 5 miles
• Dispatch decisions are based on aviation
  priorities only such as weather, duty day, or
  maintenance considerations
• The state of the patient is not known until after
  dispatch
• If it is likely that the trip may be turned back
  due to weather, the trip is rejected and land
  ambulance will be used to save total enroute time
  for the patient.

26
Summary

• The combined industry / regulator framework for
  HEMS activities in Canada has resulted in a very
  favourable safety record.
• All parties continue to work hard to maintain
  this as the industry evolves, expands, and adds
  new technology, such as NVGs