By John Spears and Paul Moloney
The Toronto Star
Toronto EMS Report Overview By Art Hsieh, EMS1 Editorial Advisor As EMS providers, we are trained to ensure that the priority in establishing scene safety is our own safety. Staging, or waiting until a potentially unsafe scene has been secured by the police, is not an unusual system procedure. Generally, there is some information that is received by the communications center that would provide an indication that police officers should access the scene prior to other rescuers. According to this and other news releases, it’s not clear whether that information was received or available. Nor is it clear what the mindset of the field providers were at the time they elected to stage rather than to arrive on scene. However, there appears to be several points of failure, perhaps provider related, or system related, that may have contributed to the incident that occurred in this situation. The actual memo outlining the changes in policy and training enforce several key concepts: 1) Have a clear set of protocols. Ambiguity can set up for confusion and a wide range of interpretations. 2) Understand the protocols. If you are not, ask for clarification. Sometimes it may be because of point #1! 3) Document well. If some unusual incident occurred, whip out that pencil and paper and write down key facts and observations that you believe caused that incident to occur. I can’t speak for most managers, but many I know would prefer the documentation rather than asking for it after a complaint has been lodged. Art Hsieh, MA, NREMT-P, is Chief Executive Officer & Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects. |
TORONTO — Ambulance supervisors must now go to the scene when paramedics decide to delay their response to an emergency call, says Bruce Farr, the chief of Toronto’s Emergency Medical Service (EMS).
In addition, paramedics are to be been given a checklist of questions that must be answered when they think it’s necessary to delay responding. The practices result in part from the death of Jim Hearst on June 25, when two paramedics who had been directed to respond parked their vehicle nearby but did not go to the scene.
Paramedics can delay their response if they think their health and safety is threatened.
Hearst had been found bleeding on the floor near the entrance to his apartment building at 40 Alexander St. It took more than half an hour from the time of the first 911 emergency call until the first medical help arrived.
The ambulance service was on reduced staff because of the municipal workers’ strike at the time of Hearst’s death, but ambulance officials have said emergency response times should not have been affected.
Following Hearst’s death, a unit of the Ontario health ministry made a number of recommendations about how to handle delays.
Working group
A working group of city and provincial officials, along with officials of the union and staff association representing city employees, made more recommendations Monday. They include making sure a management supervisor is informed of the decision to delay. A supervisor must then go to the scene.
Farr said that’s been the practice since last summer, but a formal directive to supervisors will be issued within the next few days.
If paramedics do delay, both the paramedics and the supervisor will have to fill out reports explaining the circumstances.
One of the questions is: “Has the crew directly observed and assessed the scene?”
That was an issue in the Hearst case, Farr said. “The specific training that they will (now) receive will ensure that they go as close to the address as possible until they see danger for themselves,” Farr said.
‘Make sense’
Mayor David Miller said the new procedures make sense.
“The paramedics under the new policy are required to go there, and they have to notify their supervisor so there’s oversight immediately once a decision is taken that there is violence or a weapon that could be a threat to the paramedics’ health,” he told reporters.
Farr stressed that paramedics still have to look after their own health and safety. “If paramedics see danger and if the call includes information from the 911 caller that there’s violence on the scene, then we’re going to support the paramedics’ request to stage until the arrival of the police,” he said.
Related Resource: Read the Toronto EMS report |
The report also urges better training for paramedics on “problematic patient behaviour” to help them make better decisions about whether to delay service.
Mark Ferguson, president of Canadian Union of Public Employees Local 416, which represents paramedics, said better training is needed because patients are often “combative, and we know that happens for a number of different reasons.”
But he said the report doesn’t address the “root cause” of the problem, “which was the lack of the availability of police on scene when they were needed.”