# COVID-19: Canadian military preparing to send ICU nurses, medics after Ontario’s request for help



## dimsum (26 Apr 2021)

Sent "to ON" - as in "not the folks in Pet, Borden, etc"?



> As Ontario continues to get a handle on the surging third wave of COVID-19 cases and crushing patient loads at intensive care units, the Canadian Armed Forces is preparing for a potential deployment of medical personnel to the province after a recent request for assistance.
> 
> “There are over 1,900 patients with COVID-19 in the province of Ontario’s hospitals and of those, 659 are being treated in intensive care for COVID-related illnesses. Nearly 450 patients that are in critical care require a ventilator to breathe,” an unclassified warning order obtained by Global News on Monday said.
> 
> ...











						COVID-19: Military, Red Cross being sent to Ontario’s hospitals after provincial request for help  | Globalnews.ca
					

The federal government announced on-the-ground assessments by the Canadian Armed Forces are underway in order to determine the exact number of personnel needed.




					globalnews.ca


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## mariomike (26 Apr 2021)

> If ultimately approved, critical care nursing officers and up to three mobile medical assistance teams, which would be able to assist with 24-hour medical transports, could be sent to Ontario.


Regarding "24-hour medical transports".

Toronto is using their 40-foot ambulance buses running a Covid shuttle dispersing patients to out of town hospitals around the clock. Not the first time they have been used for line hauls, but we more commonly used them for milk runs. They would usually be for mass casualty incidents like high-rise fires, and can accommodate a large number of patients in an emergency. Now they only transport two Covid patients at a time, attended by two ORNGE paramedics, and a Toronto paramedic driver.

It's a shame that the Multi-Patient fleet is no longer what it used to be. Especially during this time of great need.

Our first bus ambulance was a GMC "New Look". Since then OBI, MCI and Eldorado.

I know the CAF has ambulances, but do they also have ambulance buses?


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## daftandbarmy (26 Apr 2021)

Tally ho!

Ontario requests help from Canadian Armed Forces as critical care COVID-19 cases surge​3,510 new cases of virus recorded; admissions to ICUs climbed to 877, another pandemic high in Ontario​Ontario has made a formal request to the Canadian Armed Forces for help in dealing with a surge in critical care cases associated with COVID-19, just days after it rebuffed an offer by the federal government to send in extra personnel.

In a statement Monday, a spokesperson for Solicitor General Sylvia Jones said the province has "made a request for the assistance of those identified resources, many of whom reside, for example, within the Canadian Armed Forces and Canadian Red Cross organizations."

"In addition to health human resources, we are requesting logistical and operational support as we seek to augment our response to COVID-19," the statement from Jones's press secretary Stephen Warner said. 

Speaking to reporters, Jones said the request, made Friday, did not request a specific number of personnel.

"What we are looking for is very specialized nurses that can help out in our intensive care unit beds and medical personnel that can assist our hospitals that are seeing disturbing rises in cases of COVID-19," she said.

Sunnybrook puts first patient in field hospital​ 
Meanwhile, the Sunnybrook Health Sciences Centre is, for the first time, putting patients in its field hospital. The centre  reported its first patient Monday. A total of 10 beds have been made available there so far to help ease pressures in acute care hospitals.

Ontario also reported a third case of a rare blood clotting condition known as vaccine-induced immune thrombotic thrombocytopenia (VITT), this time in a man in his 70s currently in hospital after receiving the CoviShield vaccine, a version of the AstraZeneca vaccine.

The news comes as Ontario reported another 3,510 cases of COVID-19 on Monday, while the number of patients with the illness who need a ventilator to breathe topped 600.

According to the Ministry of Health, 877 people with COVID-19 are being treated in intensive care units across the province, twice as many as there were at the beginning of April.

Critical Care Services Ontario, a government agency that compiles daily a report for hospitals and health organizations, said that 59 patients were admitted to ICUs yesterday alone. Anthony Dale, president of the Ontario Hospital Association, said that a total of 1,415 COVID patients have been sent to ICUs this month so far.

Of those in intensive care, 605 patients are on a ventilator — nearly double the number seen at the peak of the second wave in January. 

Public health units also recorded the deaths of 24 more people with the disease, pushing the official toll to 7,935. The seven-day average of deaths has climbed to a third-wave high of 28.6.

Among those Ontarians who recently died with COVID is a 13-year-old girl from Brampton.



			https://www.cbc.ca/news/canada/toronto/covid-19-ontario-april-26-2021-update-1.6002130


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## lenaitch (26 Apr 2021)

mariomike said:


> I know the CAF has ambulances, but do they also have ambulance buses?



I think they would have to make an emergency order to waive provisions of the _Ambulance Act_.

I saw a Toronto EMS ambulance (regular) at our small hospital on Saturday.  I don't know if it was a Covid transfer but I've never seen one here before.


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## CBH99 (26 Apr 2021)

Curious, how do military ambulances compare to ambulances from a civilian service?


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## Blackadder1916 (26 Apr 2021)

daftandbarmy said:


> Sunnybrook puts first patient in field hospital​Meanwhile, the Sunnybrook Health Sciences Centre is, for the first time, putting patients in its field hospital. The centre  reported its first patient Monday. A total of 10 beds have been made available there so far to help ease pressures in acute care hospitals.
> 
> . . .



From several days ago a couple of views of the Sunnybrook field hospital with an overview of its operational mission.

from the CBC


			https://www.cbc.ca/player/play/1887585347516
		


And a Sunnybrook video


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## mariomike (26 Apr 2021)

CBH99 said:


> Curious, how do military ambulances compare to ambulances from a civilian service?


I don't know about now, but we operated the Dodge M43 3/4 ton 4x4 ambulance. MSE Op driver with a Med A attendant.

Although a little sluggish, the M43 was tough and reliable.
​


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## mariomike (26 Apr 2021)

lenaitch said:


> I think they would have to make an emergency order to waive provisions of the _Ambulance Act_.


Good point.


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## medicineman (26 Apr 2021)

lenaitch said:


> I think they would have to make an emergency order to waive provisions of the _Ambulance Act_.
> 
> I saw a Toronto EMS ambulance (regular) at our small hospital on Saturday.  I don't know if it was a Covid transfer but I've never seen one here before.


Depends which ones they use - the F350's are pretty decent, newer Bisons weren't bad when I showcased one in 2005...as for the LSVW, well they're LSVW's...


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## brihard (26 Apr 2021)

Might they be considering that new sea container isolation unit for patient transfer? RCAF was bragging on it via social media a few days back.

Interestingly, the figures quoted in the warning order are the 1030 am ICU update from April 15th. So this has been in the works since about the same time (April 16th) that Doug Ford rejected federal help and the Red Cross. Slimy, that.

I’m not sure how many critical care nurses CAF has, but it can’t be many, and they’ll be working in hospitals somewhere already. This is a reallocation of critical care resources from somewhere else that needs them too.


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## medic5 (26 Apr 2021)

Forgive my ignorance on this matter, but why has Canada not built any large field hospitals? It's been a year since the start of the pandemic, surely there was enough time to build more hospitals?


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## dapaterson (26 Apr 2021)

Hospitals are useless without the medical personnel to operate them.


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## daftandbarmy (26 Apr 2021)

dapaterson said:


> Hospitals are useless without the medical personnel to operate them.



That doesn't stop us from building war ships


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## Kilted (26 Apr 2021)

daftandbarmy said:


> That doesn't stop us from building war ships


The length of time it takes for them to be built is probably enough to conceive and raise to majurity sailors to man them.


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## FJAG (26 Apr 2021)

medik05 said:


> Forgive my ignorance on this matter, but why has Canada not built any large field hospitals? It's been a year since the start of the pandemic, surely there was enough time to build more hospitals?



There have been some set up for the first wave but almost all were not required. There are two set up now: one at Sunnybrooke and one at Hamilton's Health Sciences. Staffing is an issue.

https://www.cbc.ca/news/canada/hamilton/hhs-field-hospital-1.5980959

🍻


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## lenaitch (27 Apr 2021)

medicineman said:


> Depends which ones they use - the F350's are pretty decent, newer Bisons weren't bad when I showcased one in 2005...as for the LSVW, well they're LSVW's...


I wasn't thinking so much of the platform as the certification who can operate an ambulance service  and who can operate an ambulance.  For example, the St. Johns folks you see at events are not 'certified to  transport'.  Patient transfer services can move stable patients between facilities but they are unregulated and only have very basic training.  This might already be covered in the EMCP Act or could be fairly easily waived by an emergency order (Regulation).  Communications with designated base hospitals might be an issue as well.


medik05 said:


> Forgive my ignorance on this matter, but why has Canada not built any large field hospitals? It's been a year since the start of the pandemic, surely there was enough time to build more hospitals?



There are at least two; Sunnybrook and Royal Victoria in Barrie.  I think the one at Sunnybrook received its first patient either yesterday or today.


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## mariomike (27 Apr 2021)

The tricky thing about these Covid transfers is they require Land or Air ambulance ( Ontario licensed ) Critical Care Paramedics. Their scope of practice is waaay above my old pay grade!



> The Critical Care Paramedic (CCP) functions with the broadest scope of Paramedic practice. Their knowledge and skill sets are based on the foundations of the PCP and the ACP paramedic scopes of practice. The CCP specific training is an additional 2 years. This is inclusive of Didactic, Clinical, preceptorship, and multiple evaluations leading to certification.





> The Critical Care Paramedic is specialized in the care of Critically ill or injured Adults and Paediatrics as well as High Risk Obstetrics. Intra Aortic Balloon Pump, and shared care ECMO/ECLS are also part of their scope. Their primary responsibility is servicing Critical Care Calls. Functioning as a mobile ICU CCP's respond to the needs/requests of various hospital units that require Critical Care and transport of patients. The CCP is capable of assessing, initiating care, resuscitation, and continuity of care in the management of virtually any clinical condition.





> In addition to the skills that ACP's perform, the Critical Care Paramedic practice includes:




Transvenous pacing
Management of PA Lines
Art Line Monitoring
CVP monitoring
An extensive pharmacology scope
Administration of blood and blood products
UVC Line insertion
Foley catheter insertion
NG tube insertion
CT-head scan interpretation
Chest X-ray interpretation
Multiple Difficult Airway maneuvers
Mechanical Ventilation, multiple modes
Chest Tube management
Blakemore Tube management
Lab value analysis
Blood gas analysis
Various medications with physician's orders


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## brihard (27 Apr 2021)

I expect we have at least some CAF Med Techs with comparable qualifications as part of CAF’s air medevac capability. Also note that strict scope of practice is going out the window. The province has already, through emergency order, allowed qualified medical practitioners to work out of scope if in a hospital setting. Besides that, legally, I expect CAF medical staff, when performing military duties, would fall under the constitutional authority granted to the federal government to oversee and regulate them. If acting in good faith in th course of duties they’re qualified to do, I don’t think the province could really raise issues of licensure. And it is the province asking for the help in the first place.


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## SeaKingTacco (27 Apr 2021)

brihard said:


> I expect we have at least some CAF Med Techs with comparable qualifications as part of CAF’s air medevac capability. Also note that strict scope of practice is going out the window. The province has already, through emergency order, allowed qualified medical practitioners to work out of scope if in a hospital setting. Besides that, legally, I expect CAF medical staff, when performing military duties, would fall under the constitutional authority granted to the federal government to oversee and regulate them. If acting in good faith in th course of duties they’re qualified to do, I don’t think the province could really raise issues of licensure. And it is the province asking for the help in the first place.


Even stripping the military of every highly trained ICU specialist, we can’t be adding much more than a token amount to Ontario. We are not that deeply staffed with ICU specialists.


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## mariomike (27 Apr 2021)

lenaitch said:


> I wasn't thinking so much of the platform as the certification who can operate an ambulance service  and who can operate an ambulance.  For example, the St. Johns folks you see at events are not 'certified to  transport'.  Patient transfer services can move stable patients between facilities but they are unregulated and only have very basic training.  This might already be covered in the EMCP Act or could be fairly easily waived by an emergency order (Regulation).  Communications with designated base hospitals might be an issue as well.


Maybe transfers. ORNGE ( Land and Air ) and the privates handle those anyway. The City handles the 9-1-1 calls.

If it ever got desperate, as it almost did during SARS, the SOP would be to use a police officer or firefighter driver. ( From scene to hospital only. The lone paramedic would drive when no patient on board. ) It didn't come to that. But, I think it came pretty close.


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## Maxman1 (27 Apr 2021)

daftandbarmy said:


> That doesn't stop us from building war ships



Perhaps we should also build hospital ships like the American Mercy and Comfort.


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## brihard (27 Apr 2021)

SeaKingTacco said:


> Even stripping the military of every highly trained ICU specialist, we can’t be adding much more than a token amount to Ontario. We are not that deeply staffed with ICU specialists.


That’s what I figured.


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## Kilted (27 Apr 2021)

lenaitch said:


> I wasn't thinking so much of the platform as the certification who can operate an ambulance service  and who can operate an ambulance.  For example, the St. Johns folks you see at events are not 'certified to  transport'.  Patient transfer services can move stable patients between facilities but they are unregulated and only have very basic training.  This might already be covered in the EMCP Act or could be fairly easily waived by an emergency order (Regulation).  Communications with designated base hospitals might be an issue as well.


St John Ambulance can transport when directed by a higher Medical authority. They were used for patient transport during SARS. However, not every member has the required F license. You do however have many members who are paramedics or firefighters in actual employment who have that license as part of their job.


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## mariomike (27 Apr 2021)

Kilted said:


> St John Ambulance can transport when directed by a higher Medical authority. They were used for patient transport during SARS. However, not every member has the required F license. You do however have many members who are paramedics or firefighters in actual employment who have that license as part of their job.


Regarding that. Private-for-profit medical transport services provide routine, non-emergency transports and coverage for special events. But, the City is the only provider permitted to service 9-1-1 calls.

In extreme circumstances, a City employee, specifically a police officer, ( police do not require a Class F, if requested at a scene to drive by a solo paramedic ) can drive to a hospital. This could happen at a multi-patient scene where one paramedic stays behind to triage.

For accident insurance purposes, it is necessary that whoever drives any City vehicle be a City employee.

Firefighters have a Class D, which does not qualify them to drive a Class F vehicle. However, ( only during SARS ) firefighters - as City employees - were authorized to drive Class F vehicles ( staffed by a single paramedic ) owned by the City. This was due to so many paramedics being on quarantine.

However, it didn't come to that. Because Toronto paramedics were put on "Working Quarantine", ambulances were always fully staffed.


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## medicineman (27 Apr 2021)

lenaitch said:


> I wasn't thinking so much of the platform as the certification who can operate an ambulance service  and who can operate an ambulance.  For example, the St. Johns folks you see at events are not 'certified to  transport'.  Patient transfer services can move stable patients between facilities but they are unregulated and only have very basic training.  This might already be covered in the EMCP Act or could be fairly easily waived by an emergency order (Regulation).  Communications with designated base hospitals might be an issue as well.


There would likely be some sort of Federal/Provincial waiver put in place, as I'm willing to bet they'd be using something along the line of a Critical Care Transport Team with ICU RN's, MD's and Med Techs for both Air or Ground movement.  Communications these days would likely not be as bad as you think because of cell phones and radios can always be added to ground based units on civvy freqs.  Aircraft still have to communicate within Canadian Air Traffic Control pathways, so would be able to patch onto civvy freqs anyway.  I seem to recall that when I was a Superintendent with St John Ambulance in Kingston that all that was required for us to be able to transport folks was an order in council - this was in place for special circumstances like a disaster.  We would of course have had to have radios added/updated to be on freqs in use by local hospitals/EMS - again, advent of cell phones has changed that somewhat.


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## mariomike (27 Apr 2021)

This "what if" stuff is hypothetical. The reality is, the only time I saw the Army deployed into the streets of this town was when Mayor Mel declared war on snow.


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## lenaitch (27 Apr 2021)

medicineman said:


> There would likely be some sort of Federal/Provincial waiver put in place, as I'm willing to bet they'd be using something along the line of a Critical Care Transport Team with ICU RN's, MD's and Med Techs for both Air or Ground movement.  Communications these days would likely not be as bad as you think because of cell phones and radios can always be added to ground based units on civvy freqs.  Aircraft still have to communicate within Canadian Air Traffic Control pathways, so would be able to patch onto civvy freqs anyway.  I seem to recall that when I was a Superintendent with St John Ambulance in Kingston that all that was required for us to be able to transport folks was an order in council - this was in place for special circumstances like a disaster.  We would of course have had to have radios added/updated to be on freqs in use by local hospitals/EMS - again, advent of cell phones has changed that somewhat.


No doubt.  I think Ornge already uses sat phones in remote areas.  The use of cel/sat phones would probably make a lot more sense than trying to quickly find and cobble together radios.  Ontario land ambulances already use the province-wide trunked emergency services network (don't know about GTA) and back when I had any involvement in, trunked radios were not approved for aviation use but that has probably changed.  Using aviation radio frequencies for 'back of the bus' traffic would likely require some action by TC to dedicate a frequency or two, but way above my pay grade.


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## daftandbarmy (27 Apr 2021)

Maxman1 said:


> Perhaps we should also build hospital ships like the American Mercy and Comfort.



Except that the Comfort was basically idle for the whole show in New York:

Hospital ship Comfort departs NYC, having treated fewer than 200 patients​The Navy’s hospital ship Comfort departed New York City today after spending the last month supporting the region’s COVID-19 efforts.

The ship arrived in New York’s Pier 90 exactly one month ago with the mission of accepting non-coronavirus patients to alleviate the burden on local hospitals, but a minimal number of patients admitted during the first week prompted officials to modify the ship’s mission.









						Hospital ship Comfort departs NYC, having treated fewer than 200 patients
					

“I believe Comfort not only brought comfort but also saved lives,” said New York Gov. Andrew Cuomo.




					www.navytimes.com


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## lenaitch (27 Apr 2021)

mariomike said:


> This "what if" stuff is hypothetical. The reality is, the only time I saw the Army deployed into the streets of this town was when Mayor Mel declared war on snow.



And the rest of the country thanked you.


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## mariomike (27 Apr 2021)

Mayor Mel took some ribbing. But, NYC  calls in the National Guard during snowstorms. Even in anticipation. Their City has been hit pretty hard by wrongful death lawsuits over EMS delayed response times when they didn't.

Damned if you do. Damned if you don't.  🤷‍♂️



> "FDNY EMS has a aprox 5 hour delay to Emergencies. FDNY personal are advised not to do CPR more then 20 min due to high vol of jobs." [ sic ]
> FDNY-EMS reported a backlog of 1,300 9-1-1 calls and a 3-hour to 12-hour delay in response to critical cases, including cardiac arrests and heart attacks.
> A report of a mother unable to breath. Her daughter called 9-1-1, but could not get through for 50 minutes. A neighbour administered CPR, but EMS was unable to arrive for another 45 minutes, and they still had to walk to her house. The lady did not survive.
> A man died of a heart attack after it took paramedics three-and-a-half hours to arrive. It took another 28 hours for a city medical examiner to pick up the body, which had been resting in a bag on a bed.
> ...


Jan 19, 2011
"Family of NYC Woman Who Died in Blizzard Plans $20M Lawsuit:
Suffering a heart attack during the New York City blizzard after Christmas, Yvonne Freeman "never had a chance," her daughter says, because an ambulance took three hours to reach her over unplowed streets. By the time it got there, it was too late.
Now Freeman's family is planning a $20 million lawsuit against the city -- the first blizzard-related wrongful death case.":








						AOL - News, Politics, Sports, Mail & Latest Headlines
					

Get breaking news and the latest headlines on business, entertainment, politics, world news, tech, sports, videos and much more from AOL




					www.aolnews.com
				





			http://www.nydailynews.com/ny_local/2011/01/19/2011-01-19_20m_suit_vs_city_in_snowdelay_death.html
		

"...the city is slammed for failing to declare a snow emergency."



> In the aftermath of the snowstorm, the Chief of NYC EMS was demoted and replaced. No explanation as to why.











						Blame and the Blizzard — Is City Hall Looking for a Scapegoat?
					

There is an aroma here of scapegoating.




					www.nbcnewyork.com
				





> Bill O'Reilly of Fox News had this to say, “The root of the problem is the same that we had in Katrina, that the local mayor- [Ray] Nagin- and the governor- [Kathleen] Blanco- of the state didn’t ask for the feds to come in and people died."











						Blame and the Blizzard — Is City Hall Looking for a Scapegoat?
					

There is an aroma here of scapegoating.




					www.nbcnewyork.com


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