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. 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”. Contract Services

7. 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. Equipment

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. Canada’s 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 (RFP’s) Safety was the first priority not the dollar value The RFP’s 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 MOH&LTC 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 Bag#500 Garson ON P3L 1W3 ken.wong@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