Connecting care

There’s a sheet of clouds beginning to cover the dirt air strip where pilots Terry Brooks and Dan Strevel need to land their plane.

They’re flying to Big Trout Lake and they don’t have many options. Water surrounds the isolated northern community and the plane needs a runway.

The two pilots are part of a four-person Ornge Transport Medicine crew that includes flight paramedics Scott McNab and Keith Simons. They need to reach a woman about to deliver her second baby, but weather isn’t co-operating.

Ornge’s job is to transport her to the hospital in Sioux Lookout. If the plane can't land, there's nothing the paramedics can do. The plane will have to turn around. The pregnant woman will have to give birth without the help she’s expecting.

There’s no road connecting Big Trout Lake to the rest of Ontario. The small fixed-wing plane approaching from above is the community’s only link to services in other cities.

"It's disappointing to have to turn around," McNab says. "It's disappointing when you have to do that but often times, I find that I have to be able to move to the next, most appropriate patient. There's always somebody else somewhere that needs help."

This is health care in Ontario’s far north; it’s not always a smooth ride.

McNab faced a different situation a few hours ago. The 35-year-old was calmly attending to routine base duties in the Ornge station, located near the Thunder Bay International Airport, he works out of.

He stuffed his red backpack with more than 50 pounds of medical equipment Friday morning. Not knowing where he might go, or what kind of call he might receive, every piece of equipment is important.

"Hopefully you get a chance to finish base duties before you go to work," he says. "This part of the province is geographically challenged for health care. If you want to give people to the highest level of care possible there's going to be some travel time."

McNab’s day starts as a question mark. A call could come at any moment and send him across the province with no guarantees of returning by the end of the 12-hour shift.

He and his 28-year-old colleague, Simons, continue loading gear onto the plane. That’s when the first call comes in.

Minutes later the air ambulance takes off. Early morning sunlight shines through the plane's side windows. The loud drone of the engine forces everyone to put on their headsets.

There isn’t a lot of space inside the plane. Neither paramedic can stand up straight. The space may be tight, but it’s efficient – every syringe, drug and tool is within reach.

McNab logs on to his laptop and starts typing information about the patient while Simons reads over a few notes. There's not much else to do on the flight, so completing some paper work is ideal.

The ride to Big Trout Lake is quiet for nearly an hour-and-a-half. But the smooth ride ends as the paramedics approach the remote First Nation.

While the situation is tense, it isn’t too bleak. There’s a small break in the clouds, which means the plane has just enough visibility to land safely.

Big Trout Lake community nurse Tamara Randall is already waiting by her parked, dirt-covered truck near the plane. Randall, sporting purple and olive green scrubs and pink Crocs, has been working in the remote community for 20 years and understands its health-care limitations.

"We usually have one medical evacuation here every day," she says as she leads the paramedics to the nursing station, also known as a medical yard.

"We’re using Ornge a lot. We’re not qualified. Here we stabilize the client, start the IVs, get the medication in and with an active labour like this one, we could be delivering, which we don’t want to do."

A bumpy dirt road leads them into the heart of the community.

Inside the small nursing station, Randall shows the paramedics into the patient's room. Family and friends watch from the hallway.

On an average day in Big Trout Lake, the community nurses have to deal with everything from sore throats to heart attacks. Each nurse on duty can expect to deal with more than 15 patients a shift.

In serious cases, having to wait for additional medical treatment could place the patient’s life in jeopardy.

"Ornge has been great, because when we have traumas like this one, or the patient is beyond our skill levels, Ornge paramedics will come right in, assess them here, stabilize them for us and get them out quick," she says.

"They can work with us and give us orders if they can’t get in. They can walk us through procedures."

The nurses can deliver a baby if necessary, but that’s a last resort. The facility in Sioux Lookout has better equipment to handle child birth.

The nurses aren't the only health-care workers in Big Trout Lake.

Dr. Robert Allen runs a clinic in the community. His commute is longer than the average doctor – 647 kilometres from Winnipeg. He practiced medicine in Arizona for 20 years before arriving in Big Trout Lake last September.

The 68-year-old says he’s trying to improve the level of care for patients with chronic diseases, like diabetes and heart disease, through diet changes and regular treatments.

While he's working on long-term prevention, Ornge is providing the immediate and emergency assistance.

"Just today, we had that young girl come in," he said. "She’s in labour and we’re not really set up or authorized to provide deliveries. But they are and they will take her and that’s it."

Simons and McNab spend about 40 minutes preparing the patient before they lead her out of the nursing station. They load her into an SUV that doubles as an ambulance.

The two paramedics, a driver and the pregnant patient stuff themselves into the make-shift ambulance.

The patient holds her own IV bag, attempting to hang it on the coat hanger near the door.

But Ford didn’t design the SUV to double as an ambulance. The coat hanger is intended to hold dry cleaning, not medical equipment. With each bump, the patient’s IV bag drops onto her lap.

After a couple more bumps the patient concedes and holds the IV bag herself.
Back on the plane, the paramedics prepare for their flight to Sioux Lookout, an estimated hour-long ride.

McNab says if they have to, they can deliver the baby on the plane.

Landing in Sioux Lookout is a smoother process than it was in Big Trout Lake. Once on the pavement below, an ambulance from the Meno Ya Win Health Centre arrives for the patient.

Unlike the Ford in Big Trout Lake, the ambulance is properly equipped to monitor the patient. The woman is able to lie down and the IV bag hangs securely from a nearby hook.

Simons and McNab ride along in the back. They keep a close watch on the woman as they make the last leg of their journey together.

Once they reach the hospital, the paramedics say their good-byes.

Simons and McNab call a taxi and head to the Ornge hangar.

There’s no immediate call, and the team has time for a quick breather in the lunchroom.

"Travelling can be exhausting at times," McNab says. "I think some people have become accustomed if they want health care, they have to travel. Other people are shocked by it, especially when you take them from northern communities to southern Ontario or to the states, wherever that hospital bed may be for that specific sickness."

The 20 minute break ends when another call comes in. This time it’s a 24-year-old patient experiencing severe stomach pains in Summer Beaver.

They head toward the plane, unsure of what they might be flying into.

This call, if they can make it to Summer Beaver, could take only a few hours. Or it could take much longer, putting a return flight to Thunder Bay in jeopardy.

McNab says it’s a small price to pay to ensure that wherever there's someone in need, Ornge will be there to help.

"The most satisfying aspect of the job is doing it well and facilitating patient care for sick people across the province."