Air Emergency Medical Service (Air EMS) provides unique and important medical transport capabilities to society. Air EMS can move patients or live organs more rapidly than surface modes over long distances or congested areas. Air EMS also provides unparalleled access to accident scenes in regions where surface transportation is compromised such as in the backcountry or during disaster scenarios. However, despite these unique capabilities, Air EMS is currently provided to only a small minority of the most critical medical cases. This is due to the high historical cost and risk of airborne operations. Air EMS costs are driven primarily by the high level of availability required of these services and their low utilization. The elevated accident rate compared to other forms of aviation is in large part due to the operation of these services to and from off-field landing areas with unmarked and perhaps unknown obstacles. This research investigates opportunities to increase the number of Air EMS operations provided in a region by reducing the cost per operation and increasing the level of care. Significant recent investments in Urban Air Mobility (UAM) systems are maturing a new class of electric aircraft and automation technologies that may provide benefits to Air EMS operations. Furthermore, opportunities to deploy Air EMS assets as part of a UAM system to increase utilization and reduce costs through revenue management are also reviewed. Finally, potential pathways to leverage Air EMS as a proving ground and forcing function to overcome constraints in air traffic control and community acceptance for broader UAM services are discussed. The results of this study suggest that near-term electric aircraft are not expected to meet the requirements of the Air EMS mission and also provide little cost reduction potential for the industry. However, new operational models that leverage UAM markets and airline revenue management systems show promise to enhance Air EMS scale. Finally, flight automation technologies in development for UAM aircraft show potential to increase Air EMS safety.

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109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.