Health Minister Horne misinformed about medevac system Doctors say government will be putting lives at risk

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1 Press Release Website: January 21, 2013 For Immediate Release 8:00 pm Health Minister Horne misinformed about medevac system Doctors say government will be putting lives at risk Edmonton: Medical doctors are expressing concern about the Alberta Government s announcement regarding relocation of medevac services from the City Centre Airport out to the Edmonton International Airport at Leduc. Dr. Kerry Pawluski, an Edmonton medical doctor and orthopedic hospitalist at the Royal Alexandra Hospital, is president of a new group of medical doctors concerned about changes to medevac air ambulance services. This group, the Save Our Medevac Services Society, has set up a website to inform Albertans about the serious health care implications of relocating medevac planes away from Edmonton s two downtown tertiary care hospitals. I have spoken with some of the other doctors who routinely send patients on air ambulance planes to Edmonton, said Dr. Pawluski. We are surprised by the Minister s announcement. We were expecting more from the government to protect our existing emergency medical services and our rural/northern communities. He added, the deficiencies with the government s relocation plan will needlessly put lives at risk, increase suffering, and compromise health outcomes.

2 - 2 - The Save Our Medevac Services Society is particularly concerned with Health Minister Horne s lack of understanding of the current medevac system. The Edmonton Journal reported that Minister Horne said that the vast majority of trauma cases coming into Edmonton are coming by helicopter anyway. The truth is that it s actually fixed-wing air ambulances not helicopters that bring in almost all of the critical patients to Edmonton s two tertiary care hospitals for specialized care from Fort McMurray, Grande Prairie, Peace River, Hinton, Lloydminster and other rural and northern communities. Unfortunately, helicopters do not have the range or speed of fixed wing planes. That is why there are 12 dedicated fixed-wing air ambulances stationed throughout rural and northern communities in Alberta. These planes have the range and fly at over twice the speed of helicopters to get critical patients to care quickly. The doctors are also concerned about the government s plan to use STARS to shuttle patients from the international airport to downtown hospitals. We have to remember that STARS plays a vital role in responding to critical accidents around the Edmonton region. The government s plan to take STARS away from their current role and trying to make the rescue helicopter into an airport shuttle reduces emergency response capabilities for the Edmonton region and still adds critical time to the transfer of rural and northern patients compared to the current system, said Dr. Pawluski. Many critical patients are located too far for a helicopter to reach them quickly and need to get to Edmonton as fast as possible. That means using one of the 12 fixed-wing air ambulances. What will happen when a critically injured oil sands worker from highway 63 arrives by medevac plane at the International Airport in March and there is no helicopter to take him to the Royal Alexandra Hospital? asks Dr. Pawluski. Even if the helicopter were available at EIA, that patient may not survive the delays in medical transport involved with using the international airport including long taxi times and getting him out of the plane and into the helicopter among other problems. Right now that patient lands on the runway directly beside the trauma unit at

3 - 2 - the Royal Alexandra Hospital and is in our hands in minutes. We need to find a better way to solve this. The doctors point out that the Health Quality Council of Alberta report found that there were 3,059 Alberta patients delivered to Edmonton s downtown tertiary care hospitals by fixed-wing air ambulance in (Another 805 from adjoining provinces and territories.) Of those Alberta patients, 1,779 (58%) were classed as critical or time-dependant. Dr. Pawluski said: The reality is that every day and every night critically injured patients are brought to Edmonton s two specialized care hospitals: the Royal Alexandra and the University of Alberta. Those patients can now be delivered to the Royal Alex in 5 minutes the relocation to the International Airport will mean those patients will face a delay of at least 40 minutes. That can mean the difference between life and death. The findings of the HQCA report show that if the relocation goes ahead as currently planned, it will result in northern Albertans going from having the best medevac response time in Canada to the worst. The Save Our Medevac Service Society is urging the government to delay the March relocation of medevac flights away from the City Center Airport until a proper plan is developed and implemented that will not result in avoidable loss of life, increased suffering, and reduced health outcomes. In the case of critical patients, Dr. Pawluski emphasizes, minutes matter lives depend on it. (See attached backgrounder) Media inquiries: Dr. Pawluski at Dr.Pawluski@SaveOurMedevac.ca and Dr. Liam McGowan at info@saveourmedevac.ca Due to their medical and hospital duties there may be delay in responding to media inquiries.

4 Backgrounder Who we are: The s society is a group of medical doctors, medevac pilots, and rural advocates who are working to preserve quality medevac air ambulance services in rural Alberta and northern Canada. The provincial and city governments had previously committed to delay closing the last runway for medevac flights at the City Centre Airport until proper arrangements were in place to preserve timely medevac services for rural communities. As of today, effective arrangements have not been made as is clearly indicated in the attached table showing the increase in patient transportation times that families, workers, and communities will experience after March Without a doubt, the relocation needs to be delayed until viable options are presented and implemented: lives depend on it. As medical doctors we have a duty to ensure that Albertans understand that delaying patients getting to Edmonton s tertiary care hospitals can have life threatening consequences. Unnecessary loss of life, increased suffering, and reduced health outcomes can be avoided by our government taking steps so that the medevac planes continue to land until proper arrangements are in place. This is the Alberta Government s legal duty as guardians of our provincial health care system. It is the right thing to do. How rural and northern communities receive critical health care: Alberta s health care delivery system in rural and northern Alberta relies on a combination of fixed wing and rotary wing medevac air ambulances to quickly deliver patients needing critical time-dependent care to Edmonton s tertiary care hospitals. Medevac air ambulance flights into the City Centre Airport are an essential link in our health care delivery system. It is the essence of what defines accessibility for rural and northern communities especially patients injured in serious accidents, those with critical illness, or needing timely access to specialized care. The current city centre medevac landing strip is uniquely located just 5 minutes from the Royal Alexandra Hospital and only 13 minutes by ground ambulance from the University of Alberta Hospital. Why we are concerned: The Alberta Government has recently decided that in March 2013 all fixedwing air ambulances will have to stop landing at the Edmonton City Centre Airport and relocate to the Edmonton International Airport (EIA) near Leduc. Yet the City has said the medevacs can continue to land well into The government planes carrying the Premier and Ministers will continue to land but critical patients won t. The Alberta Government s proposed relocation of medevac services away from the City Centre Airport will adversely impact patient access and health outcomes for you, your family, and your community. As physicians involved in the delivery of rural health care, we highlight below just a few examples of common situations where patients will be put at risk by the Alberta Government s forced relocation of medevac air ambulances because minutes do matter: > Heart Attack Patients: Most regional hospitals can give the same care as the Leduc Hospital, clot busting drugs. The problem is only a limited number of patients will respond to the drugs. The goal is to get them to a Cardiac Catheterization Lab within 90 minutes of presenting with chest pain. This is only SaveOurmedevac.ca

5 - 2 - available at the Royal Alexandra Hospital (RAH) and University of Alberta Hospital (UAH). Time to cathlab is directly related to the amount of heart muscle damaged. This can mean the difference between death and survival, or becoming a cardiac cripple and a normal life. > Strokes: All patients need a CT scan and then possibly a clot busting drug or a neurosurgeon again time to treatment is directly related to the amount of brain tissue lost, with increased times resulting in increased disability. > Major Trauma: People injured in vehicle collisions, industrial and farm accidents moderate to severe closed head injuries, trauma involving the brain or spinal cord, intra-cranial hemorrhages can require critical care not available at rural hospitals and that will need interventional radiologists, trauma surgeons, and intensive care only available at the RAH and UAH. > Premature Labor and Premature Births in Rural Areas: Sending hospitals from rural communities need timely access to neonatal ICU, pediatricians, obstetricians that are only available at the RAH and the UAH. It is troubling to know that there could be mothers stuck delivering a premature baby in the back of an ambulance on QE2 highway by Nisku. Why you should be concerned: At some point, emergency medevac services will be needed for someone you know. We need to be clear and honest about what will happen if this relocation away from tertiary care hospitals occurs. In some cases, critical patients will not survive the delays in transportation times. In others, the delay will cause patients to endure greater adverse health effects, suffering, and complications. All of which are preventable under the current medevac service. Unnecessary loss of life, increased suffering, and reduced health outcomes are preventable if our provincial government takes steps so that the medevac planes continue to land until proper arrangements are in place to ensure health care access. The Alberta Government has the legal tools and authority to act to keep the airport open for medevac air ambulances until proper arrangements are in place. None of the "mitigation measures" announced by the Alberta Government to date (STARS as a shuttle from EIA to hospitals; triage holding unit at the International Airport; naming Villeneuve airport as alternate bad weather landing strip) provide patients with the timely access to critical care that they have today. The relocation of medevac is going change patient safety and quality of care for the worse. See Myth Busters below. From Best to Worst Health Quality Council of Alberta Report: An independent study by the Health Quality Council of Alberta (HQCA) on medevac relocation found that in 2010 there were 3,059 Alberta patients delivered by fixed wing medevac air ambulance to Edmonton s City Centre Airport. (Another 805 from adjoining provinces and territories.) Of those Alberta patients, 1,779 (58%) were classed as critical or time-dependent. The relocation away from the City Centre Airport will take us from the best medevac response time to the worst in Canada. In 2012, there were an estimated 5,000 Albertans sent to Edmonton by fixed-wing air ambulance. The government has recently claimed that only 20% of patients are in a critical, time-dependent condition. The government has provided no data to back up its claim despite the detailed and authoritative analysis conducted by the Health Quality Council of Alberta s independent study which found that 58% were critical, time-dependant patients. Even if the government s recent claim were true, we could be facing about 1,000 patients a year being delivered to Edmonton in a critical, time-dependent condition (20% of 5,000). How many kids, moms, dads, wives and husbands does the government think it is okay to put into a life threatening delay? SaveOurMedevac.ca

6 - 3 - Who is responsible: The Alberta Government has both a legal duty and the needed authority to ensure that medevac flights can continue to land at this location-critical airport. This is a health care issue and as such, it is a provincial issue. It is not a City of Edmonton issue. Acting now to keep Edmonton s tertiary care hospitals accessible to timely medevac air ambulances will help avoid preventable deaths, suffering, and impaired health outcomes. Myth Busters MYTH: We Can Just Use STARS Some have suggested that STARS helicopters could be used to solve the problem by having the STARS air crews use the Edmonton-based helicopter to shuttle patients from fixed wing air ambulances landing at the Edmonton International Airport to Edmonton s tertiary hospitals. However, burdening STARS with shuttling upward of an additional 1,800 time-sensitive patients annually is just not feasible. Shifting STARS role over to an airport shuttle service takes away from STARS mission of responding to critical accidents and other emergencies. Also, unlike the fixed wing air ambulances landing at the city centre airport, rotary aircraft are unable to fly during low visibility and other adverse weather conditions. The HQCA report noted that STARS was forced to cancel 206 missions in 2010 because of weather factors. And finally, there are range and speed limitations with helicopters relative to the speed and distance of fixed wing air ambulances. Helicopters fly at half the speed of fixed wing. Helicopters have limited range and can experience delays due to the need to refuel. STARS is an excellent and growing component of our medevac system but it s not feasible to expect STARS to replace the thousands of fixed wing medevac flights into Edmonton from across Alberta, our neighbouring provinces, and the northern territories. Even if STARS can be available to perform the occasional shuttle service and is able to fly in the weather conditions, the added time for the medevac plane to fly further south to the International Airport at Leduc, the long taxi distance for the air ambulance plane to get from the end of the runway to the new STARS hanger at the farthest end of the airport, the time to get the patient out of the medevac plane and onto the helicopter, the added time it will take the plane s paramedics to brief the STARS crew, and the time it will take the helicopter to fly north again to get back into the City s tertiary care hospitals all mean that lives are needlessly being put at risk. Trying to burden STARS will mean that patient safety and quality care will change for the worse. Consider this: what if 2 medevac planes landed at the same time: one at the City Centre Airport and the other at the International in Leduc? If you started a stop watch when the planes got to the end of the runway, the City Centre Airport patient would be going into the emergency room at the Royal Alexandra Hospitals before the plane at the International was even beside the helicopter. And then there are all of the delays getting into the helicopter, switching medical teams and flying back north into Edmonton (assuming the helicopter is even available.) Make no mistake lives are about to be put at risk after the relocation of medevac services is implemented by the province. SaveOurMedevac.ca

7 - 4 - MYTH: The Edmonton Airport Authority's announcement of Villeneuve Airport as a bad weather alternative land site fixes the problem With Villeneuve airport being announced as an alternate landing site for medevac flights, Minister Doug Horner publicly stated in the St. Albert Gazette that, the Sturgeon Community Hospital in St. Albert recently upgraded its emergency room and can handle any medevac patients at Villeneuve that need immediate help. Unfortunately with the relocation of the fixed-wing medevac air ambulances, the Alberta Government is failing to understand that emergency patients have already been triaged by sending physicians located in rural Alberta. Patients are being transferred to a higher level of specialty care arranged by the sending physician. Sending physicians have already contacted the receiving hospital primarily Royal Alexandra Hospital and University of Alberta Hospital and to a lesser extent, the Misericordia and Grey Nun's Hospital. Remember that not all hospitals have the same capabilities and services. Although the Sturgeon Hospital is in close proximity to Villeneuve Airport, as is the Leduc Hospital to the Edmonton International Hospital, these regional hospitals do not have the same services and specialists as the tertiary care hospitals. If they did, hospitals like those in Grand Prairie, Peace River, Fort McMurray, etc would not need to send patients on medevac air ambulances in the first place because everyone could be treated in their local communities. Critical and complicated medical cases are brought to Edmonton because of the specialty health care services, facilities and staff available at Edmonton s tertiary care hospitals. Examples of specialized services include; Cardiac Catheterization Labs for heart attack patients; CT Scans, clot busting drugs and/or neurosurgeons for stroke victims; burn units for burn victims; neonatal ICU, pediatricians and obstetricians for premature labour and premature births; and critical care not available at rural hospitals for major trauma victims such as interventional radiologists, trauma surgeons, and specialized intensive care. Therefore, although Sturgeon Hospital and Leduc Hospital are in close proximity to the two landing strips potentially available to medevac flights once the Alberta Government forces medevacs to stop landing in Feb 2013, our medevac services will still go from the best in Canada to the worst due to delays in ground transportation to receiving tertiary care hospitals in Edmonton. MYTH: The Alberta Government's plan to build a new triage unit in the new hanger at the Edmonton International Airport solves the problem Not true. Health Minister Horne has attempted to reassure rural Albertans by publicly stating that a triage unit would be added to the Edmonton International Airport (EIA) to help aid in the response time, allowing some patients to be immediately treated at the airport " A new triage unit at the EIA hanger will serve no medically beneficial function to critical or time-sensitive patients arriving on medevac flights. The reason anyone finds themselves on a Code Red or Code Yellow medevac flight is because that patient has already been triaged by two or more medical doctors who have determined that the patient needs immediate care in one of Edmonton s tertiary care hospitals for specialized services not available in Northern Alberta. Here are some examples: SaveOurMedevac.ca

8 If you are having a heart attack and the drugs administered by your local northern hospital aren t working, then the doctor wants you to be delivered to the Cardiac Catheterization Lab at the Royal Alexandra Hospital (RAH) immediately. Holding you in the EIA hanger s triage unit will only reduce your chance of survival or avoiding serious heart damage. The proposed triage unit will not be able to help treat you. Same applies if you having a stroke. 2. If you having pre-mature high-risk labour, being taken off of the medevac plane and being put into the holding triage unit at the EIA hanger will not help you or your baby. 3. If you have been medevaced because you were injured in a vehicle collision, an industrial or farm accident moderate to severe closed head injuries, trauma involving the brain or spinal cord, intra-cranial hemorrhages you will require critical care not available at either rural hospitals or the new triage holding unit. You will need interventional radiologists, trauma surgeons, and intensive care only available at the RAH and University of Alberta Hospital. Laying in the new triage unit at EIA won t help you. It will make things worse. The Alberta Government s suggested triage unit implies that patients will be receiving essential emergency care when in fact the triage unit could further delay patients needing critical medical services in one of Edmonton's specialized hospitals. The triage hanger idea creates a life or death problem. It does not solve it. MYTH: There is nothing that can be done because the City has made up its mind Not true. We have received legal advice confirming that the Alberta Government has the legal authority under its health care laws to keep the planes landing at the City Centre Airport during the transition period if the City of Edmonton is not prepared to agree. Something can be done to prevent needless loss of life and suffering. MYTH: This is a City issue, not a provincial issue Not true. This is health care issue. The Alberta Government is responsible for ensuring that our families and communities have access to critical tertiary health care. The Alberta Government has the legal and financial tools to fix this and should do so. The Alberta Government also passed the laws that deal with the control and management of the City Centre Airport (Regional Airports Authority Act). We encourage you to visit our website find us on Facebook (search: save our medevac services), or attend one of our public information meetings for more information and updates. SaveOurMedevac.ca