Woman dies after waiting 3 hours for ambulance

After woman stopped breathing, call level jumped to ‘most urgent’

By Angela Gilbert and Nicole Reinert, CBC News Posted: Feb 13, 2013 5:06 AM

Woman dies after 3-hour ambulance wait

An 87-year-old Toronto woman died in December after waiting three hours with abdominal pain for an ambulance that was delayed “due to limited resources,” a CBC investigation reveals.

An internal Toronto Emergency Medical Services ambulance dispatch record also shows seven ambulances were dispatched to her location but then diverted to other calls.

The incident highlights a growing challenge for Toronto and the rest of Canada, as an aging population puts more demand on emergency services, including ambulances, advocates for the elderly say.

“When we’re talking about people in retirement homes or nursing homes, by definition people are there because there are certain things they can’t do for themselves,” says Susan Eng from CARP, a not-for-profit seniors advocacy group.

“It’s our obligation to make sure that they are safe,” she said, “And in this case, obviously the system failed them.”

Ontario Ministry of Health and an internal review by Toronto EMS are both investigating the incident.

Ambulances diverted to other calls
911 CALL TIMELINE: Dispatch record details 3-hour delay in ambulance response
The initial 911 call was placed by an employee at the woman’s retirement living residence at 3:14 p.m. ET on Dec. 30, 2012. At that time the Toronto Emergency Medical Services dispatcher advises the home of a possible delay.

The woman’s complaints of abdominal pain and aching body had been rated alpha, the lowest-priority emergency call. EMS aims to respond to alpha calls within 21 minutes.

Fifteen minutes after the call, an ambulance was dispatched, but it was diverted to another emergency before it arrived.

At 4:20 p.m. a dispatcher called the retirement residence back. The call report states the dispatcher noted “late response due to limited resources” and explained the closest ambulance was approximately 18 minutes away.

But that ambulance was also diverted at 4:25 p.m., just a few minutes after being dispatched, and more than an hour after the 911 call was placed.

According to the EMS report, dispatchers tried sending seven ambulances in all, but each one was diverted.

At 6:29 p.m., more than three hours after the initial call, the woman stopped breathing, and EMS was told she was “VSA,” or vital signs absent. The woman was then rated an echo-level call — the most urgent — but by the time paramedics arrived, she was dead.

“Once we received notification about the change in the patient’s condition, we responded with our highest level of response, and paramedics were there within five minutes of the change in call status,” Toronto EMS said in an email to CBC News on Jan. 30.

EMS officials warned city about staffing woes Mike Merriman, a chair with CUPE Local 416, says he has tried for years to warn the City of Toronto that someone would get hurt because of insufficient resources for ambulances.

“You can’t keep operating at 10- to 12-year-old staffing levels with population growth and an aging population and not expect problems,” Merriman told CBC News.

Toronto EMS officials also tried to warn the city in December 2011. Facing a hiring freeze for the following year, then Deputy Chief John Lock sent a report to the budget committee stating:

“By December 2012, it is expected Toronto EMS will have 36 vacant paramedic positions which will require EMS to reduce the available ambulances by an equivalent of 6.5 ambulances on a 24-hour period. The decreased vehicle count will reduce the availability of ambulances for emergency calls.”

EMS was also approved for 50 hires in January of this year. The positions will take months to fill, and Toronto EMS told CBC News even that is not enough to meet demand.

According to a January 2013 report from Toronto EMS, between 2005 and 2011, transport volumes increased 36 per cent. During that same period, the department saw only a one per cent increase in staff.

The same report states: “EMS treats 30 per cent of all residents 75+ years of age at least once per year,” and that the demographic is a key driver in the increased number of emergency transports.

Toronto EMS and the city manager’s office are expecting the results of a third-party EMS efficiency study in March, which will make recommendations on resources, including staffing.

Toronto EMS officials say they don’t have enough paramedics and ambulances to meet the city’s demand. Paul Charbonneau, president-elect of the EMS Chiefs of Canada, says emergency medical services across the country are facing growing demands in a climate of restrained budgets. He says innovative solutions and strategies are needed.

“I think the longer we go down this timeline, the more urgent it’s going to become,” says Charbonneau. “We’re beginning to hit the beginning of the tsunami, and we know it’s coming, and we have to prepare for it.

“There are pressures on the system. There are needs for strategies in every province on how to deal with the increase.”

In Nova Scotia, for instance, health officials are looking at making a pilot project from the city of Halifax a province-wide program.

Officials say the project, which assigns one specially trained paramedic per 12-hour day shift to respond to calls in nursing homes only, has kept more ambulances on the road, while treating patients at home and keeping them out of the emergency room.

source
http://www.cbc.ca/news/canada/story/2013/02/12/ambulance-delay.html

Responding to people, not just emergencies

Angie Morrison. January 9 2013

I have been an advanced care paramedic for almost 13 years, and over the course of my career I have attended to thousands of citizens in distress.
I often have people remark, “Wow, you have such an exciting job,” or, “You must see some really crazy stuff!” Well, perhaps there is some truth to that, but what really stands out in my memory is the people I encounter. Human spirit at its best and at its worst.

During my first year as a paramedic, I was dispatched to a hospital ward to pick up a patient and transfer him to another hospital.

He had a brain tumor and was being sent to a palliative care unit to finish out his days. He was 36 years old and was an immigrant to this country who spoke very little English. He had no family present with him, but when we arrived at his bedside, a woman arrived at the same time and introduced herself as the man’s neighbor.

Now, this woman admittedly barely knew her neighbor, she just knew enough to know that he was sick and alone. She wanted to accompany him in the ambulance to the destination hospital, even though the two didn’t speak the same language. So we started driving. The patient was on the stretcher, with the neighbour and I both sitting with him in the back. The woman was stroking the man’s head, uttering tearful prayers and holding his hand. The patient had tears welling in his eyes and slowly running down his cheeks, never speaking a word or making a sound.

Me, I stared out the window, trying to choke back tears at witnessing the true kindness displayed in front of me. I wasn’t trained in school on how to handle that kind of emotion. Human emotion. Turned out these two people weren’t so different after all. At first glance they came from different walks of life, but in reality they were part of a community. They did speak the same language; they could both understand love, caring, compassion, and need.

As for me, I learned a great lesson that day; I don’t respond to emergency calls, I respond to people.

Source www.northumberlandnews.com

Angie Morrison

Paramedic Porn

Region plan aims to enhance care, reduce ED wait times

The Winnipeg Regional Health Authority announced today a new initiative to improve patient flow throughout the healthcare system.

Arlene Wilgosh, President and CEO of the Winnipeg Health Region, said the new plan was recently approved by Region’s Board of Directors and will be implemented in the weeks and months ahead.

“When patient flow is operating efficiently, it means our patients are getting the right care at the right time in the right place,” Wilgosh said in announcing the plan during a speech to the Winnipeg Chamber of Commerce. “When the system fails to move patients efficiently, these failings can manifest themselves in extended waits, often in our Emergency Departments and ambulance bays.”

The plan includes specific targets for the enhanced delivery of services. Not surprisingly, the majority of the targets are aimed at monitoring the effect of patient flow improvements on the Emergency Department. They call on the Region to ensure by 2015 that:

- Ninety per cent of all non-admitted patients are in and out of an Emergency Department within four hours;

- Ninety per cent of admitted patients are in and out of an Emergency Department within 8 hours;

- No patient will be in an Emergency Department for longer than 24 hours;

- All ambulances are able to off-load patients within 60 minutes; and

- All non-emergent visits will make up no more than 20 per cent of all Emergency Department visits.

“These targets are clear. These targets are measurable,” said Wilgosh. “Meeting these targets will require all of us working in the system to be innovative, ready for change and accountable while maintaining patient safety as our number one priority.”

In order to meet these goals all our health care providers must work together to better integrate and co-ordinate care,” she said. “From the Emergency Departments to the in-patient units, to the care provided in the community and in our long-term care facilities. These targets belong to all of us.”

Wilgosh also highlighted a number of initiatives recently undertaken also designed to improve patient flow, including the Bell Hotel partnership with Manitoba Family Services and Housing, Centre Venture and the Main Street Project, the city’s two QuickCare Clinics and the stationing of paramedics 24/7 at the Main Street Project.

Winnipeg Paramedics applaud the health authority on the announced patient care targets. We are excited to see a willingness to innovate in order to meet the needs of patients. Paramedics have been at the forefront of innovation to reduce non-emergent use of the emergency room. Through Community Paramedicine initiatives we believe we can have a measurable impact on reducing demands on the emergency room. This has been demonstrated with the award wining program that has Paramedics stationed at the Main Street Project. By addressing the health care needs of the facilities’ residents we have seen reduced demands on area hospitals.

Aiming to reduce Paramedic off load delays to a maximum of 60 minutes is achievable and our hope is to be involved in efforts to reduce this wait. Ultimately this target is higher than historical targets of 30 minutes to off load ambulances. This will require additional investment in ambulances in order to continue to respond to life threatening emergencies in a timely manor.

Paramedics look forward to working with the Winnipeg Regional Health Authority and other stake holders to find innovative and sustainable solutions to help achieve these patient care goals.

Let Your Voice Be Heard

It’s budget time again here in Manitoba and our government is asking Manitobans about their priorities. Please share your thoughts on issues facing Paramedics and their patients.

Click on the link and fill out the questionnaire, be sure to include comments on ACP Training, Paramedic Resource Deficiencies, and Community Paramedicine.

http://www.gov.mb.ca/finance/consult/questionnaire.html