Meet David (Dave) Kodama, a Transport Medicine Physician (TMP) at Ornge. Dave spoke with us about his role, what he enjoys about being a physician, and what accountability and transparency mean to him.

Can you explain your role as a TMP and in Medical Affairs? What does your day-to-day look like?

It's a dynamic position and quite broad in scope, which is what keeps things interesting. Our primary role is to ensure patients get to where they need to go in the most efficient and safe way possible. We review all the calls that come through the Operations Control Centre (OCC), and assign both a paramedic level of care and level of urgency based on the clinical condition of the patient. We often collaborate with the sending and receiving health care teams, as well as the Ornge paramedics, to ensure the patient continues to receive the highest level of care while in transit. While that is the majority of the TMP role, we are also involved in paramedic training and certification, which often takes us into the field with the crews. 

Can you describe your academic and professional background apart from Ornge?

I'm an Emergency Physician and Trauma Team Leader at St. Michael's Hospital in Toronto. I'm also a Civil Aviation Medical Examiner for Transport Canada and work at one of the large commercial airlines in Canada in an aviation medicine role. Between my three roles, my primary focus is in acute medicine, especially as it pertains to aviation and transport medicine.

Who or what inspires you in your career?

What drives me in my career is being there for people in their highest level of need, whether that be in the emergency room, trauma bay, or in the back of a helicopter. Those one-to-one interactions at the bedside for those having a really bad day and being that person to help them through that and see them through those challenging times is what really drives me. From an Ornge standpoint, I like to expand that more towards system-level operations, ensuring that there's equity across the province so that it's not just that one person that I'm able to assist, but all of those needing care throughout the province, no matter where they may be.

What is the most enjoyable part of working as a physician, both specifically at Ornge and overall?

As I mentioned earlier, the most rewarding part is seeing the difference you can make in someone’s life. However, one of the more engaging parts, especially as an Ornge physician, is frequently managing cases that most physicians might only see once in their career. I truly enjoy the clinical variety of what we see, along with managing the logistical challenges of transport medicine in a province that is as large and diverse as Ontario.
I also enjoy the team aspect of it - working with all the staff in the OCC, the communications officers, the Managers, and our awesome paramedics who are highly trained. Simultaneously navigating all the clinically complex cases, systems challenges, patient care issues, etc, is a huge part of the job that I find both enjoyable and rewarding.

How does your work as a TMP complement your role as an emergency physician?

I find that working in the emergency department is like working on a microscopic level. It's really that bedside one-to-one interaction and focus on a single individual. It's easy to get lost in that relationship, especially if the patient is very sick and needs to be transported out. This is where my interest in Ornge comes in, particularly how that patient fits into the broader healthcare system and how they can get to the care they need.  As a TMP, I get a more macroscopic view of the healthcare system and a broader understanding of how our system operates. When I'm on the phone with a nurse or physician in a smaller centre, I can relate to what they're going through and at the same time, use my understanding of the bigger picture to make sure their patient gets to where they need to go.

I understand you are involved with medical research. How do you decide what research you do, and how does it eventually help you in the field?

I'm a clinician in Quality Improvement and Innovation at the University of Toronto, so my research has to do more with practical improvements, specifically in the emergency department. I have a background in occupational medicine, and so a lot of my clinical focus is on improving the safety of our frontline staff. We see a lot of violence, unfortunately, with our colleagues, especially our nurses, and so a lot of the work that I do focuses on preventing verbal and physical harassment and violence to our staff. A lot of what I do also involves aviation medicine, and so I engage in quality improvement projects in terms of trying to improve the care that passengers receive while travelling in commercial aircraft.

Can you speak a little bit about Ornge’s TMPs and their fit into the process of a call?

Any call that comes in is reviewed by the transport physicians, and our responsibility is to assign an urgency to it as well as a paramedic level of care. Based on those decisions, the wheels get set in motion for our planners to begin servicing that call. We are also there to support our paramedics in terms of any questions they might have along the course of the journey of that patient. We also support our nursing stations and smaller hospitals through telemedicine capabilities. That said, we’re just one aspect of the care team, and it really takes our flight planners, communications officers, pilots, paramedics - the whole team - to complete a call.

Why did you choose to join Ornge over other organizations?

Ornge is very unique in Ontario. It is the only critical care air ambulance service in the province, and that of itself is extremely appealing. The diverse nature of the job is a huge draw for me, specifically getting to partake in a systems-level process of care. Also, getting to engage with our talented paramedics. They are extremely hard-working and quite knowledgeable, and getting a chance to support them as they provide care for the province’s most unwell patients is something that only Ornge does. Ornge is the premier prehospital organization; it's the only critical care prehospital and interfacility system that we have. It was a no-brainer as it aligns with my interest in aviation medicine and critical care medicine.

What does accountability and transparency mean to you as a physician?

It means everything. As physicians, we have to make challenging decisions every day. Sometimes they are difficult for others to hear, including patients, their families, or their healthcare teams. I believe being open and honest about that decision-making process, so our stakeholders can see where we're coming from and why some of those decisions were made, helps to create the trusting relationship that they are entitled to. I think that being accountable for the decisions you make, the actions that you take, and being open and honest in terms of that transparency, is such an integral part of being a physician.

• Inside Ornge