Use of Fixed Wing Modified Scene Air Ambulance Responses for Injured Patients in Northern Ontario: A Pilot Study.

OBJECTIVE: Timely access to a lead trauma hospital (LTH) saves lives; however, the vast geography of Northern Ontario creates a barrier to equitable access to an LTH. Paramedics in Ontario follow the field trauma triage standard (FTTS) to identify which patients should be directly brought to an LTH. A pilot project was launched using a fixed wing modified scene response (MSR) to transport patients from Northern Ontario who met the FTTS directly to an LTH. This study aimed to 1) explore the impact of the fixed wing MSR pilot program on the time to LTH arrival for injured patients in Northern Ontario compared with the traditional interfacility transfer (IFT) process and 2) determine the frequency and specific FTTS criteria that were fulfilled. METHODS: This was a retrospective cohort study of injured patients in Northern Ontario who were emergently transported to an LTH by the provincial air ambulance service between January 2016 and October 2021. Electronic patient care records were manually reviewed, and patient cases were grouped by their sending and receiving facilities to evaluate time differences between MSR and IFT. RESULTS: For same-distance transports, the average time from injury to trauma center arrival was reduced with MSR (292.8 minutes) compared with IFT (507.8 minutes), with a mean difference of 130.3 minutes. All MSR cases and 90% of IFT cases met at least 1 FTTS criterion. CONCLUSION: Fixed wing MSR improves access to timely definitive care for injured patients in Northern Ontario, and all patients transported in this pilot project met the trauma bypass criteria.

The Role of Paramedics in Disclosure of Patient Safety Incidents: A Mixed Methods Study.

OBJECTIVE: Critical care transport is a high-risk environment ripe for patient safety incidents (PSIs). Disclosure is the process by which a PSI is communicated to a patient or substitute decision maker. Little is known on paramedic perceptions on disclosure PSIs. This study evaluated the impact of a disclosure training program on the perceptions of paramedics on disclosing PSIs. METHODS: This was a before-and-after mixed methods survey study on paramedic disclosure training at Ornge, the provincial critical care transport organization for Ontario, Canada. A paramedic disclosure training program was implemented at Ornge between 2020 and 2022. All paramedics were eligible for participation through pre- and posttraining surveys. RESULTS: In total, 54 and 69 paramedics completed the pretraining and posttraining surveys, respectively, representing 25% to 30% of all active paramedics. All of the paramedics (100%) expressed a moral and professional responsibility to disclose PSIs. All paramedics felt disclosure training was somewhat to extremely useful. After training, more paramedics felt comfortable disclosing PSIs, and more paramedics felt disclosure could occur at the time of transport. CONCLUSION: A training program on PSIs can improve paramedics' perceptions on disclosure. This study shows its feasible for paramedics to feel comfortable and participate in disclosure of PSIs within a critical care environment.