Ornge (pronounced Orange), formerly Ontario Air Ambulance Corporation and Ontario Air Ambulance Service, is a Canadian not-for-profit corporation and registered charity that provides air ambulance and associated ground transportation services for the province of Ontario, under the direction of the province's Ministry of Health. The provision of ambulance services in Ontario is governed by the Ambulance Act, which states that the Minister of Health "has the duty and the power" to make sure Ontario is serviced by a "balanced and integrated system of ambulance services and communication services used in dispatching ambulances." Its headquarters are in Mississauga, Ontario, Canada.
The name Ornge is not an acronym, but is based on the orange colour of the organization's aircraft and land ambulances. According to the organization, "The 'a' was removed from the name, partly to make people stop and take a second look, and also so that it could be trademarked."
As of 2024, Ornge has the largest air ambulance and critical care land ambulance fleet in Canada, and employs more than 700 people, including paramedics, pilots, and aviation specialists. It serves more than 14 million people over one million square kilometres of land, deploying from 14 bases across Ontario as well as its Mississauga, Ontario, Canada headquarters. Ornge is responsible for approximately 20,000 patient-related transports per year. It also contracts some of its non-urgent patient transport service in Northern Ontario to private air carriers.
History
Prior to Ornge, the air ambulance program was established in 1977 to serve remote areas, primarily in Northern Ontario, that are inaccessible to land ambulances or that land ambulances would take too long to reach. Ontario was the first Canadian province to provide a helicopter-based air ambulance system to transport critically ill patients to hospital. Air ambulances are also used to transport medical teams and organs for transplant. A large part of the air ambulance service is involved in serving aboriginal communities, of which there are approximately 117, in 6 treaty areas of Northern Ontario.Northern Ontario School of Medicine (undated), Aboriginal Communities in Northern Ontario , retrieved 30 May 2014
The first air ambulance, "Bandage One" a Bell 212, was operated out of Buttonville Airport by private operator Viking Helicopters Incorporated (later to become part of Canadian Helicopters). A second Bell 212, "Bandage Two", was after one year pilot deemed successful and located in Sudbury, Ontario, followed by "Bandage Three" in Thunder Bay, "Bandage Four" in Timmins and "Bandage Five" in Sioux Lookout for a total of 5 by 1981. Fixed-wing service began in 1978, provided by Austin Airways, with a Timmins based Cessna Citation I. Eventually almost 90 private aircraft would be employed.
This arrangement lasted more than 25 years, until about 2005, as the Ministry of Health and Long-Term Care contracted with private operators to provide its air ambulance program's aircraft, pilots and paramedics. The Ministry directly operated the central air ambulance dispatch centre and was responsible for overseeing the overall effectiveness of the air ambulance program.
In 2005, the Ministry announced that it was appointing a not-for-profit corporation called the Ontario Air Ambulance Corporation to be responsible for all air ambulance operations. This was done to establish clearer lines of authority among the different parts of air ambulance operations. An arm's-length corporation was also consistent with the Ministry's objective of moving away from direct service delivery. The corporation's name was subsequently changed to Ornge. Ornge was described in 2012 as being neither a Crown corporation nor an agency directly controlled by the Government of Ontario, but rather a non-profit organisation incorporated under the federal Canada Corporations Act.
The Ministry operated an air ambulance dispatch centre in Toronto until Ornge took over and MATC (Medical Air Transport Centre) became the Ornge Communications Centre.
On 17 September 2007, Ornge Air was created. It would purchase aircraft and compete with the private-sector providers. Today, the air ambulance program has become an integral component of the larger emergency health system in communities across the province.
In 2020, Dr. Homer Tien was appointed President and CEO, replacing Dr. Andrew McCallum (2013-2020). From 2015 to 2020, Dr. Tien served as Chief Medical Officer for Ornge, during which time, Ornge became the first air ambulance service to achieve accreditation in Ontario through Accreditation Canada, a third-party healthcare accreditation body.
In 2023, the Government of Ontario announced it would fund the renewal of Ornge Air Ambulance’s fixed wing fleet with a new fleet of aircraft. During this announcement, the Ministry of Health also pledged an additional $10 million to facilitate the procurement of a larger hangar for their Sudbury base to accommodate the expanded fixed wing fleet (in addition to their existing helicopter fleet). The Ontario Ministry of Health said that this $108 million investment will allow Ornge to provide safe and consistent air ambulance services to all Ontarians, especially in rural and remote areas of the province. By 2026, Ornge air ambulance service will have upgraded its existing fleet of eight fixed wing aircraft and will add four additional aircraft in Northeastern Ontario, adding two new 24/7 Critical Care crews to provide service in the region.
COVID-19 Operation Remote Immunity Ornge provided logistical and operational leadership for Operation Remote Immunity, a public health initiative launched on February 1, 2021, in response to the COVID-19 pandemic. This operation aimed to deliver COVID-19 vaccines to residents of remote Indigenous communities in Northern Ontario, which faced heightened vulnerability to the virus due to factors like overcrowded housing, limited healthcare access, and the remoteness of the areas.
Operation Remote Immunity was co-led by Ornge in collaboration with Ontario’s vaccine task force, Indigenous leaders, Indigenous organizations including the Nishnawbe Aski Nation and the Weeneebayko Area Health Authority, and local health units and authorities. Teams of healthcare professionals were trained before deploying to ensure that members were prepared to work respectfully and effectively within Indigenous communities. Indigenous leaders were directly involved in the planning and execution of the vaccination campaign to ensure that it aligned with community needs and values.
Operation Remote Immunity deployed over 800 missions, reaching 31 fly-in First Nations communities and the town of Moosonee. By April 2021, nearly 25,000 doses of the Moderna COVID-19 vaccine had been administered, with approximately 14,000 people receiving their first dose and over 11,000 receiving their second dose. Over 90% of eligible individuals were vaccinated as a result of Operation Remote Immunity. Ornge also provided leadership for Operation Remote Immunity 2.0 which delivered the vaccine to young people aged 12 to 17.
ICU Transports During the COVID-19 pandemic, Ornge had a leading role in the transport and care of intensive care unit (ICU) patients across Ontario. Specifically, Ornge assisted hospitals in managing patient capacity during COVID-19 by 'decanting' patients, which refers to the process of moving critically ill patients from one hospital's ICU to another hospital with more available capacity. This was done to alleviate overcrowding in overwhelmed ICUs by redistributing patients to less burdened facilities. The practice became common during the COVID-19 pandemic, as surges in ICU admissions, especially among ventilated COVID-19 patients, led to capacity issues in certain hospitals. This practice ensured that hospitals with stretched resources could maintain the ability to care for incoming critically ill patients.
In 2020 and 2021, Ornge experienced a significant increase in demand for its services as hospitals faced capacity challenges. Patients were transported as far as 110 kilometers from Toronto to other hospitals, including in locations such as Barrie and Kingston. During a COVID-19 wave of infections between November 2020 and January 2021, Ornge transferred approximately 240 ICU patients, representing a 60% increase from the previous year. Many of these patients were COVID-19 positive or exhibited symptoms, and most were sedated and on ventilators.
Financial scandal and police investigation
Executive compensation In 2011 Ornge was involved in a controversy regarding executives' compensation, including President and CEO Chris Mazza. The Toronto Star uncovered that Mazza was receiving $1.4 million a year while remaining off the "sunshine list" of public employees earning over $100,000. That salary made him the highest publicly paid official in the province. Ontario Health Minister Deb Matthews stated that Mazza's salary was "outrageous, shocking and unacceptable". On 9 February 2013 Dr. Chris Mazza received $4.6 million in public dollars in his last two years at Ornge, including salary, bonuses, cash advances and two housing loans. In 2013, it was revealed that Mazza made $9.3 million over six years at Ornge. Mazza expensed ski trips and international junkets, often with his girlfriend; hotel room bills of $2,400 were reported.
Other executives were "highly paid", but Ornge failed to disclose their salaries. Chairman Rainer Beltzner received $232,757 in 2011. The board members received almost $2 million between 2007 and 2011. In 2011, 50 executives received a total of $11.8 million (average $238,000) which was not disclosed on the Sunshine list.
Executives were granted company-paid executive MBA educations, at a total of $600,000. Kelly Long, Mazza's girlfriend and an ORNGE vice-president, received an MBA from Western University in London.
Mazza went on an indefinite medical leave on 22 December 2011 at the height of the scandal.
Kickback allegations After Ornge bought helicopters from AgustaWestland for $144 million, AgustaWestland then made a $4.7 million payment to Mazza-controlled ORNGE Global. A later additional payment of $2 million was promised. Allegedly, the payment was for "marketing services". It was found that this "consisted of a small binder of information pulled together by Long." Subsequent Ornge leader Ron McKerlie said the two small binders do not justify the large payment. The binders are said to be in the possession of the OPP.
Later, a former executive indicated that Ornge had paid AgustaWestland $7 million more than should have. It was this allegation that prompted the OPP investigation. Tom Rothfels indicated that Mazza insisted on paying about $600,000 extra per helicopter (roughly $7 million). Rick Potter, former COO, indicated about $10 million extra.
AgustaWestland also agreed to donate US$2.9 million to Ornge's charitable foundation.
Inappropriate purchases Ornge paid $28 million for 11 used helicopters, believing this to be cheaper than renting. The fleet was subsequently sold for less than $8 million.
Ornge purchased 12 helicopters from AgustaWestland, although only 9 were required. Two of the units were not equipped to carry patients; these were sold in 2013. The remaining 10 were found to have a poor cabin layout which made CPR difficult. In 2015, Ornge was looking at replacing the AW139s, citing complexity and fuel consumption concerns.
Ornge purchased 10 Pilatus PC-12 airplanes, although only 6 were needed. Two of the 10 were for sale in 2015.
The auditor general noted that "an open public competitive tender was not used" and Ornge overbought.