“Preventable delay” in EMS response to 911 call

TORONTO [PeterPaul.ca] — The Ontario Ministry of Health admitted in a report Thursday that there was a “preventable delay” in the ambulance response time by Toronto EMS responding to an ailing man who had just collapsed in the lobby of his apartment building.

The victim, 59-year-old James Hearst, was found lying in the hallway of his 40 Alexander Street apartment on June 25, 2009, by a passer-by.

During a 911 call placed at 11:04 p.m., a caller said he had found Hearst lying in a hallway on the main floor of the apartment, the report said.

The unidentified caller said he had approached Hearst to ask if he was all right but received no response, adding that he moved away from Hearst to place the emergency call but “there was someone with the patient.”

The caller noted that Hearst was attempting to “stand up,” looking as if he had fallen face down and hit his face.

“He looks like he may be drunk,” the caller added.

Responding to the incident, EMS Paramedics, who feared for their safety, advised dispatchers that they were “staging” at the intersection of Alexander and Yonge streets after receiving word that the victim might be drunk. Just minutes away from the scene, Hearst lay in the building desperately waiting for help.

“Staging” is when a Paramedic is in doubt about their safety and can request that police officers attend the scene by securing it before there arrive. Shortly after the exchange, dispatchers notified the Paramedics that there are “no police to attend the call.”

Responding Paramedics “do not need to enter until police get there. However, they need to go to the scene and confirm that’s the case. They can’t sit down the street and wonder,” EMS Chief Bruce Carr said Thursday.

Against protocol, the Paramedics remained as Alexander and Yonge as their patient became worse.

At 11:14 p.m., Paramedics in ambulance “1956” again relayed information to a second dispatcher that they were staging at Alexander and Yonge.

After the second call, dispatch notified there superiors as to 1956’s staging, a supervisor said he would “keep an eye” on the event. At the same moment, a security guard from the apartment building called 911 a second time, saying Hearst was conscious but not talking. He was bleeding from the nose, he said.

The guard said the right side of his face was turning blue.

Thirty-two minutes later, a third call to 911 was placed by a security guard saying the victim was no longer breathing. The original call was upgraded prompting the Toronto Fire Service to be dispatched.

When Toronto Fire Fighters and an Advanced Care ambulance arrived on scene at 11:43 p.m., the original ambulance assigned to the call, 1956, was still at Alexander and Yonge awaiting Toronto Police.

By the time any Paramedics arrived at the scene 38 minutes later, Hearst was already dead.

Following protocol, Advanced Care paramedics notified an external Base Hospital Physician, who declared Hearst dead at 12:07 a.m.

An investigation by the Ministry of Health found that dispatchers and paramedics did not follow appropriate processes, which were already in place by EMS at the time of Hearst’s death.

One instance cited by the report is “MPDS Card 17”, which deals with falls. It indicates that if a patient in unconscious or not alert, which the original 911 caller pointed out, the call would be prioritized as a Delta response — which is identified as a serious, potentially life-threatening situation. The targeted EMS response time for a Delta response is eight minutes and 59 seconds. The dispatcher did not asked any of the four questions indicated on card 17.

Two Paramedics, two dispatchers and one supervisor will have to take 10 to 17 days if unpaid leave, Chief Carr said. The victims partner said the disciplinary action was “a joke.”

On the day the 911 call was placed, unionized city workers had been on strike for three days — causing Toronto EMS to operate at a 75% capacity — a capacity Chief Carr said Thursday had nothing to do with the delayed response.

Chief Carr offered his condolences Thursday to the victims family.

“My deepest sympathies are extended to Mr. Hearst‘s family on behalf of the entire Toronto EMS team. I want to assure the family and all Torontonians that we have learned from what transpired and will take action to strengthen existing policies and procedures so that this situation can be prevented in the future,” Chief Carr said.

Toronto Mayor David Miller also weighed in.

“While Toronto EMS provides an exceptional service to our residents 24 hours a day, seven days a week, it is clear that on this particular day our system did not function as it should. And for that I apologize on behalf of City Council and the Toronto Public Service,” Miller said Thursday.

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