A N N U A L R E P O R T

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1 A N N U A L R E P O R T

2 ORNGE ANNUAL REPORT 2 In Memoriam: Moosonee Crew 7793 On May 31, 2013, the Ornge family experienced an unspeakable loss. Shortly after midnight, the Ornge Moosonee crew Captain Don Filliter, First Officer Jacques Dupuy, Flight Paramedic Chris Snowball and Flight Paramedic Dustin Dagenais departed the base to do something they had done many times before: provide care for a patient who needed their help. Not long after takeoff, the air ambulance helicopter crashed in a wooded area not far from the Moosonee airport, claiming the lives of everyone on board. This tragic loss was felt throughout the Ornge organization and the James Bay community at large. As these men were laid to rest, we have heard countless tributes, describing each member of the crew as compassionate and professional. We dedicate this report to the memory of Don, Jacques, Chris and Dustin. The patients of Ontario will always be grateful for your sacrifice. Andrew McCallum, MD, FRCPC President and CEO

3 Captain Don Filliter First Officer Jacques Dupuy Flight Paramedic Dustin Dagenais Flight Paramedic Chris Snowball

4 ORNGE ANNUAL REPORT 4 Overview Ornge provides air ambulance and related services for the province of Ontario. A not-for-profit, charitable organization, Ornge has more than 600 employees, including paramedics, pilots, aircraft maintenance engineers, communication officers, physicians, educators and head office staff. Ornge performs sophisticated medical transport for critically ill and injured patients across Ontario, and is responsible for contracting flight service providers for non-urgent air medical transports. The organization currently owns a fleet of aircraft and land ambulances operating out of 11 bases across Ontario: Ottawa Toronto Sudbury London Kenora Moosonee Thunder Bay Timmins Ornge also operates a dedicated paediatric transport program out of its Markham base. Sioux Lookout Peterborough Markham The coordination of Ornge services is the responsibility of the Operations Control Centre (OCC). The OCC works with Central Ambulance Communication Centres (CACCs), as well as sending and receiving hospitals, to facilitate the transport of patients, plan and follow flights, and authorize patient transports through the Provincial Transfer Authorization Centre (PTAC). Through the OCC, Transport Medicine Physicians are available 24 hours a day to provide medical guidance to paramedics in the field and to make triage decisions when there are multiple requests for resources.

5 ORNGE ANNUAL REPORT 5 The organization currently owns a fleet of aircraft and land ambulances operating out of 11 bases across Ontario. Sikorsky S76 x5 Pilatus PC-12 x10 AW-139 x10 The Ornge Fleet Ornge operates Sikorsky S76 helicopters, Pilatus Next Generation PC-12 airplanes, AgustaWestland AW-139 helicopters, and Crestline land ambulances. Crestline x18

6 ORNGE ANNUAL REPORT 6 CEO s Message... we are building a service that is a model for safety, responsiveness, accountability, transparency and integrity. Ornge is a vital part of Ontario s health care system. We provide high quality air ambulance service and medical transport to people who are critically ill or injured. In the air and on the ground, our job is to be there for patients, so they can get where they need to be. Over the course of 2012, Ornge has come under considerable scrutiny. Many media stories have documented concerns over transparency, accountability and operational integrity. Despite these challenging circumstances, our people have continued to carry out their duties professionally. And yet, these concerns have also represented a remarkable opportunity for improvement. Among the many changes at Ornge over the past year, the most significant has to

7 ORNGE ANNUAL REPORT 7 do with our focus. We are committed exclusively to the delivery of high quality air ambulance and critical care transport service to the people of Ontario. Every activity that happens within Ornge takes place with this patient-focus in mind. Our organization has dramatically improved its level of transparency and has strengthened our relationship with the Ministry of Health and Long-Term Care under the Amended Performance Agreement. We have established a clear path, a good plan, and a commitment that extends across our entire organization. Our 2012 Annual Report provides a recap of the many improvements that have been made, along with some of the key milestones and achievements that have put us on a better course. It also provides a preview of the many longer-term initiatives to come, as we still have much work to do in rebuilding Ontario s air ambulance system. We want to reassure Ontarians that we are building a service that is a model for safety, responsiveness, accountability, transparency and integrity. Going forward, our hope is that when Ontarians catch a glimpse of one of our vehicles, they will have a sense of pride in knowing they are witnessing a world class medical transport service in action. They deserve nothing less. Andrew McCallum, MD, FRCPC President and CEO

8 ORNGE ANNUAL REPORT 8 Special Acknowledgement We wish to offer special recognition for Ron McKerlie, who served as the Interim President and CEO of Ornge from January 2012 to January Mr. McKerlie was appointed to this position by Hon. Deb Matthews, Minister of Health and Long-Term Care, having been the Deputy Minister of Government Services. He provided an invaluable service to the people of Ontario by restoring and refocusing the organization and providing strong leadership through difficult times. Mr. McKerlie ensured that Ornge s day-to-day business functioned effectively, implemented immediate changes in the best interests of patient care, and set in motion many initiatives to improve the service. On behalf of all the people at Ornge, we wish to offer our sincere appreciation for an exemplary job. The Ornge board is committed to delivering on the promise of a worldclass air ambulance system for the people of Ontario.

9 ORNGE ANNUAL REPORT 9 Chair s Message I am indeed honoured to serve as the Chair of the volunteer Ornge Board of Directors, leading a dedicated group of board members who devote their time, energy, and expertise to this vital public service. Together, we represent industry, health care, aviation, education and public service a wide range of expertise, spanning the province. The new board was appointed in January Our task is to provide oversight of the operations of Ornge, to work with the Ministry of Health and Long-Term Care to establish a strategic direction and ensure it is implemented, and ultimately, to re-establish the credibility of the organization. Our first and foremost preoccupation is the safety of Ornge patients, crews and vehicles. Secondly, we are focused on efficiency; that is, ensuring the organization is providing excellent value-for-money. This is no small undertaking, and there are challenges ahead; however, the Ornge board is committed to delivering on the promise of a world class air ambulance system for the people of Ontario. Ian W. Delaney, Chairman, Ornge Board of Directors

10 ORNGE ANNUAL REPORT 10 Board of Directors Ian W. Delaney Barry A. McLellan, MD, FRCPC Maneesh Mehta Patricia Lang Patrice Merrin Charles A. Harnick, Q.C., B.A., LL.B., LSM. Patricia (Trish) Volker, BSc., CPA, CA Board Committees Corporate Governance Committee Human Resources and Compensation Committee Finance and Audit Committee Quality of Care Committee Operations Committee

11 ORNGE ANNUAL REPORT 11 Meet Our Team Executive Management Andrew McCallum President and Chief Executive Officer Rob Giguere Chief Operating Officer Dan Wright Chief Financial Officer Julius Ueckermann Vice President, Logistics Jim Feeley Vice President, Aviation Jo-Anne Oake-Vecchiato Vice President, Clinical Affairs Stephen Patterson General Counsel, Interim Secretary, and Acting Chief Administrative Officer Jim Vair Vice President, Human Resources and Organizational Development We would like to thank Bruce Farr and Wayne Howard who served as Acting Vice President of Operations and Acting Vice President of Finance respectively during the fiscal year.

12 ORNGE ANNUAL REPORT 12 Focus on Patients Ornge exists to meet the needs of Ontario patients. Ours is a vast province. The job of rapidly transporting people who are sick or injured to a place where they can receive the care they need is enormously challenging and complex. We are a critical part of Ontario s health care system. Ornge transports approximately 18,000 patients per year. We make best efforts to ensure that what is otherwise a trying and stressful time for our patients, is also an experience that is as safe, comfortable and as reassuring as possible.

13 ORNGE ANNUAL REPORT 13 A Conversation With Our Patients We recently reviewed descriptive comments on 5,000 past patient surveys to determine what is most important to patients. We then surveyed our patients to rank these values, forming the basis of our new Patient Declaration of Values, which informs every interaction between Ornge staff and the patients in their care. GOALS: Patient Relations Process Our commitment is to provide the highest quality of care for patients. We want patients and their families to know this, so that they feel comfortable in asking questions, raising concerns, and learning more about the transport process at every stage. In 2012, we developed a streamlined complaints and feedback process, including an improved patient relations page on the Ornge website that is easier for patients and their families to navigate. Acknowledge inquiries within 1-2 business days Provide contact information to patients Ū Ū Respond to patient inquiries, provide clarification and work toward a resolution

14 ORNGE ANNUAL REPORT 14 Meet our Patient Advocate Denise Polgar was appointed Ornge s first Patient Advocate in September, Ms. Polgar began her career as a paramedic, and has worked as an ambulance dispatcher and trainer, a program developer, coordinator for emergency telecommunications, as well as an injury prevention specialist. Denise s role involves reaching out and responding to patients and families, and working to resolve their concerns about patient care and service. She provides information and assists patients in accessing Ornge s complaints and patient relations processes. Ms. Polgar also advocates for operational improvements within our system, and works to ensure that Ornge s actions reflect the principles of the Patient Declaration of Values.

15 ORNGE ANNUAL REPORT 15 Patient Declaration of Values Comments from our most recent survey were used to develop the Patient Declaration of Values. I am safe from harm in the care of competent, highly skilled staff who provide excellence in my medical care The urgency of my transport will be prioritized according to need State-of-the-art technology and equipment supports my care Staff respond to my anxieties, fears, concerns and questions in my time of need and in an unfamiliar environment The experience is well organized and seamless The environment is clean My family are involved in care and receive timely communication regarding expectations and responsibilities My comfort needs are met I receive compassionate, kind and considerate care by professionals who respect my privacy, religious and cultural background I receive information on the plan and any changes during transport

16 ORNGE ANNUAL REPORT 16 Focus on Safety We are committed to making Ornge Canada s leader in patient and employee safety by achieving a safe environment of care for all our patients and promoting healthy lifestyles and injury free workplaces. Patient Safety Safety is Ornge s top priority. This is reflected in all aspects of our operation, including the medical care we provide, our transportation services and our head office functions. This means working to maximize the safety of our patients, crews, vehicles and other staff. Vehicle Safety The Ornge fleet of AW139, Sikorsky S76 and Pilatus PC-12NG aircraft is maintained to the highest standards. We have developed a robust Safety Management System to address any safety concerns as quickly as possible. We are the holders of two valid Operating Certificates from Transport Canada and have a dedicated and experienced aviation team working on a daily basis to ensure safety and compliance is a top priority at Ornge. Aviation Audits The Performance Agreement between the Ministry of Health and Long-Term Care and Ornge requires Ornge to meet the aviation standards established by the Ministry of Natural Resources and Transport Canada. In 2012, audits were conducted by both organizations. Audit findings were either addressed immediately by Ornge or through the corrective action plan process. In addition, ARGUS International, a globally recognized company, completed an on-site safety audit, recommending a Platinum rating for Ornge s fixed wing operation. The ARGUS audit report concluded that our aviation staff are exceptionally well qualified and experienced. Audits are a normal course of business for every aviation company. Ornge welcomes audits and inspections as a way of ensuring our operation is safe and effective.

17 ORNGE ANNUAL REPORT 17 AW139 Interiors In 2012, Ornge staff identified deficiencies in the medical interior of our AW139 helicopters. The medical interior of our aircraft is the workplace of Ornge paramedics, where medical care for patients is provided during transport. Paramedics must have a safe, efficient, comfortable environment that supports them in delivering the best possible patient care. The original layout of the helicopter s medical interior prevented paramedics from performing certain procedures effectively. As a result, a committee made up of paramedics, operations managers, health and safety representatives, aviation personnel and medical staff provided their expertise to address these concerns. Improvements include: Enhanced ability for paramedics to perform CPR on a patient at all times during flight. Reduced risk of lines and tubes getting caught on equipment during loading and unloading. Better access to the patient to place IVs. Ū Ū Improved access to medical bags and supplies. This committee approved an interim interior solution for the aircraft. Modifications to the interiors were made in January It is expected that the interim interior will be in place for about 18 to 24 months while a permanent solution is procured, designed, installed and tested.

18 ORNGE ANNUAL REPORT 18 Focus on Quality We strive for continuous improvement, and are committed to finding better ways to improve the delivery of our service. To reinforce this commitment, the new volunteer Board of Directors established a Quality of Care Committee under the direction of Dr. Barry McLellan, President and CEO of Sunnybrook Health Sciences Centre. This committee has responsibility for overseeing the quality of patient care and patient safety, as well as reviewing critical events, and compliance with quality, safety and care policies.

19 ORNGE ANNUAL REPORT 19 First Quality Improvement Plan Quality Improvement Plans are filed annually by hospitals and other provincially funded health care partners. They are a key element of the Ministry s oversight responsibilities, and are intended to highlight areas for continued improvement. In 2012, Ornge submitted its first Quality Improvement Plan to the Ministry of Health and Long-Term care. Ornge s plan is posted publicly on the Ornge website and will be updated annually. Ornge uses the template developed by Health Quality Ontario to design its Quality Improvement Plan. We strive for continuous improvement, and are committed to finding better ways to improve the delivery of our service.

20 ORNGE ANNUAL REPORT 20 Operations Control Centre As the nerve centre for Ontario s air ambulance system, the OCC is Ornge s first point of contact with hospitals, Central Ambulance Communications Centres, Nursing Stations, fire, police and other stakeholders. The OCC s Communication Officers and Transport Medicine Physicians play a crucial role in coordinating Ornge s crews and vehicles to ensure patients get timely access to medical transport. OCC staff and management have been working hard to identify ways to improve core service delivery, ensuring that Ornge personnel are poised to respond to the needs of their patients across the province. A number of changes, projects and initiatives have been put into place, including: A new Quality Assurance Department was created with full time staff to conduct quality reviews. As of June 1, 2012 the Aviation Control Centre has been fully integrated into the OCC.The former cross-training staffing model has been replaced by a specialist model, where communications officers have been re-trained in specific specialization areas through a certification process. An Operational Service Delivery Model design has been completed in conjunction with input from OCC staff. This model is being implemented and will be fully rolled out in the fall of The shift handover process has been changed to allow for better one-on-one sharing of information between staff. A call management software system has been introduced and went live in July This system allows for better management of OCC call volumes in real time and will also assist the OCC staff and management in call priority management.

21 ORNGE ANNUAL REPORT 21 Other Quality Improvements Three divisions within the organization were consolidated under a single Chief Operating Officer. This strengthens internal accountability measures by ensuring all aspects of the organization are working toward common organizational goals. OCC staff and management have been working hard to identify ways to improve core service delivery. All of Ornge s scheduling functions including the scheduling of paramedics and pilots were brought together under a single central scheduling department operating as part of the OCC. This ensures proactive steps are being taken to limit situations where aircraft are downstaffed by looking at both pilot and medic availability at the same time. The U.S. Federal Aviation Administration approved Ornge s application to fly helicopters to the U.S., allowing Ornge s air ambulance helicopter fleet to fly in U.S. airspace and transport patients to or from any U.S. destination. While helicopter patient transports to the U.S. are rare, this approval offers one more option to ensure patients receive the care they need. Ornge launched a pilot project at its Ottawa air and land bases where land ambulances will be used in place of the helicopter on certain types of calls to specific hospitals within the region. Early data shows an increase of approximately 20 per cent in use of the land vehicles since the project started. This has resulted in a decrease in the number of rotor hours, leaving the helicopter available to respond to high acuity calls.

22 ORNGE ANNUAL REPORT 22 Focus on Transparency and Accountability As a Broader Public Sector organization, Ornge has a responsibility to ensure it operates in an open and transparent fashion, providing accountability for taxpayer dollars. In 2012, a number of steps were taken to promote these values and demonstrate to the people of Ontario our commitment to improving the organization and re-gaining their trust.

23 ORNGE ANNUAL REPORT 23 Winding up of Corporations Work continues toward the goal of winding up the remaining for-profit entities under Ornge, or amalgamating them within the Ornge company itself. In early 2012, several of the for-profit entities that had been established to conduct business outside of Ontario ceased to operate. The transfer of employees from Ornge Global Corporate Services to Ornge was completed on December 26, Whistleblower Policy As part of its commitment to improving transparency, Ornge has implemented a whistleblower policy that allows employees to bring forward concerns with anonymity. Ornge appointed Grant Thornton LLP a leading Canadian accounting, audit and business advisory firm as the organization s Independent Ethics Officer (IEO). As IEO, Grant Thornton LLP will receive and track employee disclosures in a safe and confidential manner, and will then determine if further steps are warranted. The firm has full discretion to conduct investigations and make recommendations, and will ensure the complaint is handled with discretion. Ornge has a responsibility to ensure it operates in an open and transparent fashion. Conflict of Interest Policy Ornge employees are expected to conduct themselves with personal integrity, honesty, and to exercise due diligence in performing their duties. As a means of promoting integrity and public trust at all levels of the organization, the Ornge Board of Directors approved a new Conflict of Interest Policy. Under the policy, all Ornge employees and board members are required to declare potential or actual conflicts of interest annually. The new policy also includes rules about real or potential conflicts in hiring, outside business interests, and the disclosure of confidential information.

24 ORNGE ANNUAL REPORT 24 Auditor General s Report March 2012, the Auditor General of Ontario released a Special Report on Ornge Air Ambulance and Related Services that resulted in a number of recommendations. Ornge s senior leadership and Board of Directors welcomed the Auditor General s findings and committed to moving forward with the recommendations in conjunction with the Ministry of Health and Long-Term Care. Actions Taken to Date: Improved Call Tracking Ornge is improving its call tracking and time stamping functions through the procurement of a new Computer Aided Dispatch system, which will be implemented in the OCC beginning in Complaints Process Ornge has streamlined its complaints process where each complaint is directed to the Patient Advocate. Complaints are tracked and reviewed to make recommendations for change that benefit patients. Under the amended Performance Agreement, Ornge is required to report all complaints and aviation accidents/incidents to the Ministry, where a determination with respect to the need for an investigation will be made.

25 ORNGE ANNUAL REPORT 25 Amended Performance Agreement An amended Performance Agreement (PA) between Ornge and the Ministry of Health and Long-Term Care was ratified in March This renewed agreement strengthened government oversight of Ornge, improved air ambulance care for Ontarians and provided taxpayers with more value for money by: Ensuring full compliance with the Broader Public Sector Accountability Act; Requiring public reporting of expenses and restrictions on meals, travel and hospitality; Requiring regular, detailed, financial reports from Ornge and creating new financial planning controls. Giving the Ministry increased audit and inspection powers to enter Ornge s premises at any time to review Ornge s performance of its obligations under the agreement and inspect and copy records, and/or conduct an audit or investigation. Additionally, Ornge is required to disclose any information requested by the Ministry. Linking the compensation of Ornge executives to public performance improvement targets. Tying Ornge s funding to key performance indicators. Requiring Ornge to seek Ministry approval on any sale of assets valued at $100,000 or more. Requiring Ornge to seek Ministry approval on bylaw amendments altering its corporate structure. Requiring Ornge to use government funding solely to provide air ambulance and related services as specified in the PA and Ornge is required to submit a zero-based budget annually to the ministry. Giving the Ministry the ability to recover funding based on performance. Ornge s senior leadership and Board of Directors welcomed the Auditor General s findings and committed to moving forward.

26 ORNGE ANNUAL REPORT 26 Focus on Partnerships The transport of patients cannot be performed by Ornge in isolation. Each patient transported across Ontario requires the collaboration of many health care partners. Critical Care Land Ambulance (CCLA) Utilization Responding directly to increasing community needs throughout the province, Ornge has positioned a CCLA vehicle at each of our helicopter bases in Kenora, London, Ottawa, Sudbury, Thunder Bay and Toronto. These vehicles are available for any Ornge paramedic crew to transport patients from the airport to the receiving facility, or from the sending facility to the airport. This was a service previously provided by our Upper Tier Municipal (UTM) Emergency Medical Service (EMS) partners. The switch to CCLA vehicles will result in fewer delays for Ornge, and will allow local land EMS services to better serve their patients. We appreciate being included in the process of strengthening Ontario s air ambulance program. -John Cunnane Chief, Niagara Emergency Medical Services

27 ORNGE ANNUAL REPORT 27 Standing Agreement Carriers A Standing Agreement Carrier is a third-party aircraft company that has a contract with Ornge to provide air ambulance services with primary and/ or advanced level of care patients. Ornge is grateful to our valued partners in aviation who provide more than 40 per cent of Ornge patient transports around the province: Organ Transport Carriers In addition to providing air ambulance services, Ornge also provides organ recovery flight services working in partnership with the Trillium Gift of Life Network, organ transport carriers incude: Air Bravo Corp Thunder Airlines Northern Air Solutions Nova Jet SkyCharter Air Nunavut ALCI Aviation Ltd Flightexec Air Ambulance Skycare Wabusk Air Air Bravo Corp Image Air ExpressAir EMS Partners Ontario has one of the finest EMS and pre-hospital care systems in the world. Ornge s goal is to become fully integrated in this system. Over the past year, new leadership at Ornge has been reaching out to members of the EMS community across the province for support, guidance and advice as the organization maps out a future for the air ambulance program. To gain a frontline perspective on perceptions of our service, Ornge recently performed a stakeholder survey which garnered 162 responses from paramedics, supervisors and communication officers from EMS services and CACCs throughout Ontario. Respondents spoke favourably about Ornge s quality of patient care and respect for paramedics and their professionalism. Consistent themes in areas needing improvement include response times, consistent staffing, availability of various types of resources, leadership and communication. The results of this survey are being incorporated into Ornge s operational and Quality Improvement Plan.

28 ORNGE ANNUAL REPORT 28 Focus on the Future While there has been much focus on implementing many important and immediate changes to our operations, we have not lost sight of the importance of planning ahead. Indeed, there is no better time than the present to map out the future of Ontario s air ambulance system. A number of initiatives are in the works to ensure a high-quality, effective and sustainable service to Ontario patients.

29 ORNGE ANNUAL REPORT 29 Computer Aided Dispatch In order to effectively manage our resources and measure performance, communications officers need to have the proper information technology tools at their disposal. The implementation of a new Computer Aided Dispatch system or CAD has been a top priority in order to more effectively dispatch our crews and improve our ability to gather data and information. Following a request for proposals process, a new software system was selected. The first phase of implementation of the CAD software is expected to begin in fall 2013, and will be put into active use once OCC staff members are thoroughly trained in the new system.... there is no better time than the present to map out the future of Ontario s air ambulance system. Education and Training In providing feedback for our Patient Declaration of Values, the patients we surveyed told us it is important to them to be in the care of competent, highly skilled staff who provide excellence in medical care. In practical terms, this means ensuring our staff is trained to the highest level as quickly as possible. In Ontario, paramedics are certified at three levels: Primary Care (PCP), Advanced Care (ACP) and Critical Care (CCP). We look forward to implementing a new learning management system that will leverage technology and enable education across a vast province and multiple bases. Having paramedics trained to the highest levels improves not only our frontline patient care but also our overall availability and responsiveness. The ongoing training of paramedics is a lengthy and complex process which we are actively trying to simplify and accelerate.

30 ORNGE ANNUAL REPORT 30 Strategic Planning Ornge and all its stakeholders share a common goal of enhancing air ambulance services for the people of Ontario, and we are interested in hearing their thoughts on how to deliver on that promise. With that in mind, we are undertaking an unprecedented strategic planning exercise to formulate a three-year plan. This process includes the development of our mission, vision and values, mission profile, and a framework for setting priorities. To help us with this exercise, we are reaching out to many of our key stakeholders for input and guidance. The end result will be a roadmap for delivering our core business throughout the next three years. Ornge has a well established series of clinical performance indicators and metrics, and has been a leader in publishing results.

31 ORNGE ANNUAL REPORT 31 Research and Development Benchmarking of Clinical Quality Indicators There has been very little work done in the field of air transport when it comes to clinical quality performance measurement in the air and land critical transport setting. Ornge has a well established series of clinical performance indicators and metrics, and has been a leader in publishing results in this regard. However, Ornge has only been able to compare its performance with emergency departments and intensive care units because there is little conmparison data in the transport setting. In 2012, our Medical Director, Quality and Research, started leading a small international group that developed consensus statements on critical care transport performance indicators, based upon the latest medical evidence and industry best practices. The goal was for Ornge to develop and use transport-specific performance indicators and benchmarks that can also be used by similar transport agencies. These new Ornge benchamarking tools are currently being tested by the small consensus group. The concept of clinical performance measures in the transport setting is now the focus of a Quality Metric Consensus Conference planned by the Air Medical Physicians Association (USA) for July Our Medical Director will help this large international organization of medical leaders develop and adopt benchmarking tools, which will ultimately permit comparison of performance results amongst a large number of air and land critical care transport providers.

32 ORNGE ANNUAL REPORT 32 Focus on Financial Accountability To deliver on our mandate of providing air ambulance and related services to the province of Ontario, Ornge receives approximately $152 million in annual grant funding from the Ministry of Health and Long-Term Care. The summary of financial statements in this report provides an overview of how those dollars are spent. Ornge has a responsibility to make sound, responsible financial decisions and to ensure maximum value for money as we carry out our core business of providing high quality patient transport. We operate with limited financial resources. Air medical transport is an especially costly endeavor with potential variability from year to year which could create considerable financial challenges. There are a number of cost factors driving our financial position, including increased flight hours, fuel prices and overtime costs. In addition, Ornge has significant debt obligations as a result of the 2009 bond offering for $275 million related to aircraft and other capital assets, the 2011 debenture for $24 million related to its head office building, and a line of credit.

33 ORNGE ANNUAL REPORT 33 Despite these challenges, savings have been found in a number of areas including: A management and incentive fee was eliminated following the internalization of rotor wing operations; Savings in aircraft maintenance cost following the internalization of rotor wing operations; Savings related to executives compensation; Savings in Board of Directors fees. Current Directors on the Ornge board provide their services on a strictly volunteer basis Financial Improvements The new leadership at Ornge has taken important steps to address the financial challenges. In May 2013, Ornge completed the sale of two surplus AW139 helicopters. These aircraft, which have been in storage since Ornge took delivery, were not outfitted for emergency medical services use and were not required for operations in Ontario. We continue to identify opportunities to close the funding gap, including optimizing flight dispatch, finding efficiencies in training, investing in automation, and restricting the hiring of support staff. Link to Consolidated Financial Statements

34 ORNGE ANNUAL REPORT 34 STATEMENT OF OPERATIONS in thousands of Canadian dollars 2013 REVENUE* 153,446 EXPENSES Labour related expenses 65,266 Aviation and other operating expenses 72,976 EXCESS OF REVENUE OVER EXPENSES BEFORE UNDERNOTED 15,204 Amortization and other 26,970 Interest expense 18,037 Income tax expense and others 297 DEFICIENCY OF REVENUE OVER EXPENSES (30,100) *Revenue excludes recognition of deferred contribution related to capital assets. Please refer to Consolidated Financial Statements.

35 ORNGE ANNUAL REPORT 35 Financial Snapshot STATEMENT OF FINANCIAL POSITION in thousands of Canadian dollars As at March 31, 2013 ASSETS Cash and cash equivalents 17,112 Other current assets 29,685 CURRENT ASSETS 46,797 Restricted cash and cash equivalents 478 Capital assets 214,758 TOTAL ASSETS 262,033 LIABILITIES Short-term loan 18,941 Accounts payable and other short-term liabilities 20,777 Current portion of bonds payable 6,764 CURRENT LIABILITIES 46,482 Bonds payable, net of transaction costs 285,991 Capital lease and other long-term obligations 3,985 TOTAL LIABILITIES 336,458 TOTAL LIABILITIES AND NET DEFICIENCY 262,033

36 Ornge 5310 Explorer Drive Mississauga, ON L4W 5H8, Canada Tel or