I feel this, but in reverse. My son could be dead, but he’s not. He was born on the floor of a trailer park apartment, not breathing. His birth mother’s partner called 911, who dispatched an ambulance. All rescue units for his zone were already busy. An ambulance returning from the nearby hospital to another zone heard the call over the radio and happened to be passing by. The hospital was expecting a DOA, but the paramedics (HEROES) managed to get him breathing again on the way. He’s 11 now, and he is the source of all kinds of trouble and joy. Our home would be very different without him.
Ex-paramedic here. Happy to here your son is fine.
But either you mistold the story, or the paramedics made a mistake: ambulances are not supposed to transport a dead person - the paramedics are first to resuscitate and stabilize the patient, and only then initiate transportation.
(I understand you may not care, because the outcome of their action incidentally was one you like.)
There is probably some nuance that I am just not aware of. As the adoptive parents it is difficult to get the full account, since we weren't present until a few hours later.
From what I was told, he was born with the umbilical cord wrapped around his throat, and just kind of "fell out" while his birth mother was walking from the bathroom to the living room. I know that part is true, at least, because we saw the apartment floor the next day...
I think probably the paramedics were able to detect some faint vitals upon arrival. Since the birth mother and her partner weren't super reliable or coherent, we weren't really able to piece it all together until we tracked down the two young men who helped save our son's life that night.
He didn't say the baby wasn't breathing when they picked him up. He said the hospital was expecting a DOA - presumably because of the news along the way, before they resuscitated the baby.
I cannot even imagine the horror and the relief. I imagine if I were those paramedics, getting a card or a picture from that kid would make my whole year.
When the baby passes through the birth canal, the pressure forces any fluids (ideally) out of the baby's lungs, then the contact with air, the temperature drop, and other physiological changes trigger the first breath/inspiration. However, the baby is still attached via umbilical cord to the placenta, and is still receiving good oxygenated blood from mom until the placenta detaches, then the pulse of the cord stops (this can take minutes). But yeah, an apneic baby is a very time sensitive emergency.
I can speak to this. I recently joined a community first responder association (I've always wanted to know what to do in case of a medical emergency) and was shocked to hear the members' horror stories of how long it can take an ambulance to arrive. Like the author, I grew up with the narrative "in trouble, call the ambulance, they'll scream through the streets to get to you in moments".
That might still be true where I grew up, in the US, but that's certainly not a guarantee in Melbourne, where I now live. On joining the local volunteer organization, I went from thinking "oh this will be a useful bonus for the community" to "wow, we can literally be essential". Since our org is composed of people living within the community, average response time to ANY call is <5 minutes (lower for cardiac arrest, when people really move). Sometimes one of us is right next door.
We can't do everything an ambulance paramedic can, but we can give aspirin, GTN, oxygen, CPR, and defibrillation. We can also usually navigate/bypass the usual triage system to get the ambulance priority upgraded to Code 1 (highest priority, lights + sirens, etc.) If for some reason the ambulance is far away (it backs up all the time), we can go in the patient's car with them to the hospital, with our gear, in case of further issues in transit.
I tell everyone now to always call us first (since our dispatcher will also call the ambulance) but while I feel more confident in how I'd handle an emergency, I feel less safe overall, with the system's faults and failings more exposed, and the illusion of security stripped away.
My condolences to the author.
In terms of updating - consider whether The System is really working. If not, what can you do yourself (or within your larger network) to better prepare...
My cousin's 3yo daughter stopped breathing one night, woke up struggling for breath, turning blue. They called the ambulance. Dispatcher said, 3 hr wait, and pretty please get off the phone, as there's a queue of callers.
She started breathing again after a few minutes and seems fine, but they left the UK not long after that.
That’s wild. I fell off my garage roof almost 2 weeks back. My wife called the ambulance, they arrived within 20 minutes. We are in rural Ontario, 30 minutes from the nearest hospital, on a dirt road that is privately owned and maintained. I expected over an hour.
I plan to make a trip in to the ambulance hall and fire hall this week and say thanks. I am ok, fractured vertebrae, but honestly i just am so grateful for the public service they provide.
The dispatcher must not have understood right? This is like evil levels of incompetence otherwise, because the system can’t possibly be designed to do that right? So the dispatcher must have been in the wrong, but to make the dispatcher not completely evil we have to make her merely stupid and/or careless. That’s terrifying. Where did they go to if you don’t mind me asking?
Melbourne has an excellent ambulance response time (defined from the moment 000 call is received to when the first ambulance resource arrives on scene):
* Average Code 1 response time: 12 minutes 47 seconds
* Code 1 responses within 15 minutes: 77.2%
* Number of Code 1 first responses: 12,375
This places Melbourne among the faster councils in the state, and well ahead of the statewide average response time.
Perhaps my understanding here is lacking, but that doesn't sound good at all. Feels like if someone has some sort of cardiac event, or, worse, isn't breathing, by the time the ambulance gets there, they'll be dead, with too much brain death for any resuscitation effort to be worth it.
That response time is better than where I live, in the country about an hour north of Oakland. Paramedics are about 30m away. We're a volunteer district and I'm a volunteer, but when I get paged it takes a few minutes for me to get dressed, 5m to get to the station, a few minutes to get the engine started, and ? mins to get to the incident. Realistically, the minimum response time is 15m.
Sounds like you keep medbags at home and respond directly to the incident in personally owned vehicles? That's a neat idea. Does everyone have a medbag?
Yes that's right. We have a pretty extensive kit we keep in our car at all times. There's also a mobile app for alerts, navigation, and writing down vital signs and patient care records, and a radio for direct contact to dispatch and other responders.
I resonate with your thoughts about USA response times. We lived in a middle class suburb with mostly immigrants. When I was 10 my mom slipped in the bathtub and was knocked out. I dialed 911 crying and within 2 minutes a cop had arrived and only a few minutes later the fire truck first response had arrived. They helped my mom out and she was fine afterwards.
It was so crazy for 10 yo me. I thought my mom was gone.
I am so sorry for what the author and his family had to endure.
Even in the US, response times can really vary. As an extreme example, in Jersey City (population ~300k) there were a bunch of incidents a couple years ago where residents called 911 in an emergency and no one answered.
E911 (location information sharing) also doesn't work consistently.
The advantages of coming in an ambulance are traffic priority, priority attention in the ER, and medical triaging and coordination. The disadvantages in the US can be extremely expensive to some people if they don't have the correct insurance and inconsistent timeliness.
The advantage of coming in a private vehicle are speed (usually), but at the disadvantage of having to get past ER gatekeepers and lack of information and preparedness. It is probably wise if possible to have a third person in the vehicle call the ER at the destination hospital to let them know what generally should be expected.
Another issue is that it's inherently risky to live more than 30 minutes driving distance from a major city hospital. To do so basically necessitates a life flight which is extremely expensive and not necessarily quick either.
The for-profit, gotcha capitalism monopolization of hospitals and medical services by private equity also results in worse, deadlier patient outcomes, hospital closures, and more expenses. Medicare for all (m4a) isn't a fix because of the Medicare Advantage scam, the medigap scam, the part D scam, and the lack of long-term care, skilled nursing, dental, vision/glasses, mental healthcare, and hearing aid coverage that doesn't provide true comprehensive single-payer healthcare at a sane cost per patient and with better outcomes.
On the ambulance delay time. Have people perchance started calling ambulances for less and less serious matters over time? Thus increasing the calls per capita. I could kind of see that given what I’ve heard about 911, but then again maybe not. Also I feel like 50 years ago people would have been more worried about having some enforcement action taken against them for wasting the 911 line’s time on something inappropriate? Not sure if that enforcement ever actually happened, though.
Yes, but cities design for that. Urban paid departments have a 7 minute response time or less.
My mom lived in the country, and the sheriff there started a paramedic service and trained deputies as EMTs. It made a huge difference as the paramedics arrive first in most cases.
When everything is far apart, or you live away from a city, that is definitely true. This is one of the cons of living outside the city. There are many perks, but this one is a con for me for sure. Especially because I have MS and I do not drive nor have a car.
Oh yes. Quite bad and I don't know if things are getting slightly better than "bad" or the media is tired of reporting about it.
Up until a year or so ago, an appointment at a GP would take weeks of waiting. Specialist appointments were 1+ years waiting time. This is somewhat better now with the establishment of critical-care clinics operating after hours. This is from personal experience.
The emergency rooms often had waiting time of 12+ hours(or more). I know someone who has been waiting on a procedure at the public hospital for 6+ years. Another has a child waiting for an appointment with an estimated wait time of 3+ years. All non-urgent but a wait list in the years is no longer a wait list to me, it's a system that is not fit for purpose.
Initially all of this was attributed to the pandemic and the harsh lockdowns in Victoria. But a few years out, it seems difficult to still do that. When asked, our government just re-states that they've invested in this and that and then deflect. Recently, due to the horrible state finances, the healthcare system was being downsized with services cut and the bloodshed continues. This is without talking about the systemic issues and incompetence I've seen.
The funny thing is that outsiders think that public health care means free. It's really not. We pay for it on top of our income tax(1-2% on top, more if you're above a certain threshold) and it is not cheap. It wouldn't be so bad if it was working like you'd expect but paying for a non-functional system is....I don't know what to say.
I work as an EMT (911) and resourcing is certainly a problem. In my small city, our response time is around 5 minutes, and if we need to upgrade to get paramedics, that’s maybe another 5-10.
However, if we are out on a call, out of service, or the neighboring city is on a call, now the next closest unit is 15+ minutes away.. sometimes there can just be bad luck in that nearby units are already out on multiple calls that came in around the same time, making the next closest response much further.
for a heart attack or unstable angina, the most an EMT will do (for our protocols) is recognize the likely heart attack, call for paramedics to perform an EKG to confirm the MI, administer 4 baby aspirin to be chewed and/or nitro (rx only), and monitor closely in case it becomes a cardiac arrest. If medics are far away we will probably head immediately to a hospital with a catheterization lab, or rendezvous with medics for them to takeover transport.
The few goals though:
- recognition (it could also be something equally bad/worse like an aortic aneurysm).
- aspirin to break any clots, assist administering nitro if prescribed.
I'm coming at this as someone who had an MI at a relatively young age:
For the goals -- and this may differ between EMT / paramedic & protocols -- but I would really wish that there was a blood draw done in the field. Before they bring you to the cath lab with a suspected MI, the ER is likely going to draw blood to get troponin levels at a 2-hour interval. You could save some time & heart muscle by getting a blood sample (containing initial levels) in the field.
Maybe paramedics, but basic EMTs don’t even start IVs where I am— It’s the sort of thing you can get certified to do in a few weeks and pays about as much as entry-level fast food work. Phlebotomy is a lot more nuanced afaik.
Assuming no sensitivities/allergies, give 300mg chewed for faster absorption immediately. Normally (where I am) the dispatcher will tell you to do that on the phone.
Possibly a dumb question, but wouldn’t the other thing you do be to carry the guy out on a stretcher? It seems like her dad was able to get into the car but that last bit where he got out at the hospital and walked was just too much. Or do you think the stretcher would make zero difference?
Yes! These patients are critical and we would not let them ambulate themselves to the ambulance, we would insist on loading them and moving them ourselves to limit exertion. Extra exertion could tip them into cardiac arrest.
>my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing.
We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the system first, and then patients.
Incompetence and laziness among doctors is a big cause. As a professional you've probably worked with many colleagues you thought were bad. Well there are doctors like that too. Many of them. And unlike in tech, they don't get let go if they're bad. They stay around and keep "treating" patients.
This is 100% true, especially in Canada. I've had multiple encounters with doctors who were not fit for their positions and should not have been working as doctors. One of them nearly killed my mom, and another one was suspended due to malpractice and performing research fraud, but was given her license back and is back to work at the moment. Yes she is fully licensed and back to working as a regular MD in Canada: https://en.wikipedia.org/wiki/Sophie_Jamal
I was thinking this the other day about GP. If I work in tech I work in a team and we pair. Why doesnt this happen with doctors. Why is everything all on one mind to get wrong or right. Yes there is a team of doctors sometimes but they communicate via emails async and you visit one then the next and so on. I guess I know the answer. Money.
We're also told to do a lot of things by officials because it's correct most of the time, but with the benefit of 20/20 hindsight, generally correct advice can turn out to be dead wrong for you.
Sometimes doing what you're told is the right thing. Sometimes, not doing what you're told is the right thing. Sometimes, you're told to do the intuitive thing, and it's wrong. Sometimes, you're told to do the unintuitive thing, and it's wrong. It's hard to tell the difference between those situations, even when you're not stressed.
> We're told a lot of things by "officials" not because it's correct
Often these rules are in place because they are statistically correct.
What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dealing with high stress and low information settings.
BUT being statistically correct does not mean correct. For example, if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
The world is full of edge cases. This is a major contributor to Moravec's paradox and why bureaucracies often feel like they are doing idiotic things. Because you are likely working in a much more information rich environment than the robot was designed for or the bureaucratic rules were. The lesson here is to learn that our great advantage as humans is to be flexible. To trust in people. To train them properly but also empower them to make judgement calls. It won't work out all the time, but doing this tends to beat the statistical rate. The reason simply comes down to "boots on the ground" knowledge. You can't predict every situation and there's too many edge cases. So trust in the people you're already putting trust into and recognize that in the real world there's more information to formulate decisions. You can't rule from a spreadsheet no more than you can hike up a mountain with only a map. The map is important, but it isn't enough.
This was exactly what I was thinking (though less eruditely) when I was reading the blog post. In this particular case, waiting for the ambulance led to a worse outcome, but I would not be surprised that, statistically, a you're better off waiting for the ambulance than trying to get to the hospital via other means.
But unfortunately:
> if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.
Like most things, it gets pretty complicated. I went through 200 hours of training (EMT) which essentially helps me sort into what makes me go safe, go fast to a medic en route or a hospital, and go fast to a hospital (where a paramedic can't help much or at all). The goal of all Emergency medical personnel is to get people to definitive care (not EMS).
Asking a lay person to know what a BLS (non-EMT fire & police), EMT (Ambulance), Parmedic, or MSO can take care of, or even what the differences are, is, I don't think, super useful. The red vehicle shows up and takes you to care.
In the case of MCI, EMTs can a) give aspirin or nitro (rx), b) have an AED and lots of CPR training but have to stop the vehicle to give effective compressions, c) a radio and the ability to meet up with Paramedics.
Paramedics have more complex treatments (drugs) and EKGs, but it's still 2 folks in a truck, not a hospital. They can do amazing things.
But as the joke goes, sometimes the best treatment is High Volume Diesel Therapy (burn rubber).
It kind of depends. EMTs are able to do some things, paramedics are able to do more things, and the hospital itself can do even more things.
I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it.
But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.
Do you really think that in a high stress situation you’re going to make the best decisions?
Do you really think health workers are all concerned about legalities first?
Not moving a patient unless you explicitly know how is probably right the vast majority of the time. Sometimes that’s wrong, but how are you going to get the entire public to understand what the right situation is?
It’s so easy looking at a single case in hindsight. May we all have the ability to make the right choices all the time.
It's not that health workers are always thinking about legality; it's that they're following policies either written by people thinking about legality or re-written by people in response to legality, i.e. they got sued and changed the policy in light of that.
> Do you really think health workers are all concerned about legalities first?
100%. Legal issues are a huge deal in healthcare. This is a snippet from a study [1] on the topic, just to get an idea of the scale (which I think most do not realize at all):
---
Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties.
---
I can give a very specific example of how legal issues play directly into behavior, and how it leads to antibiotic over-prescription. Antibiotics are obviously useless against viral infections but many, if not most, doctors will habitually describe them for viral infections anyhow. Why? Because a viral infection tends to leave your body more susceptible to bacterial infections. For instance a flu (viral) can very rarely lead to pneumonia (bacterial). And that person who then gets very sick from pneumonia can sue for malpractice. It's not malpractice because in the average case antibiotic prescription is not, at all, justified by the cost:benefit, but doctors do it anyhow to try to protect themselves from lawsuits.
There have been studies demonstratively showing this as well, in that doctors who live in areas with less rampant malpractice lawsuits are less likely to prescribe antibiotics unless deemed necessary. Or if you have a friend/family in medicine you can simply ask them about this - it's not some fringe thing.
> Do you really think that in a high stress situation you’re going to make the best decisions?
I mean that statement could be used to excuse any mistake in any project/system ever made, and is mostly a cop out. Yes, the system is definitely designed to minimize legal risk for the health-workers/hospitals. A system is only as good as what it's' design objectives are, and if "save a life at all cost" was the objective the system might as well look entirely different.
This is a very tragic story and my heart goes out to the family. It's one I've seen a few times now and hear about on a very regular basis from my coworkers.
I am a Canadian Paramedic (EMR soon to be PCP in a few months, roughly equivalent to EMT and AEMT respectively). Some things strike out at me:
- Here in BC our calltakers can advise patients on some treatments. I'm sure if that were to happen here, they would have advised the family to administer some ASA (Aspirin) to the patient which would have bought valuable time until professional care could be reached. Even if it was found to be contraindicated, the fact it was not mentioned in the blog post stands out to me.
- I'm not familiar with the geography of Toronto or its normal traffic patterns, but it's surprising that a single ambulance was not 30 minutes from the patient driving lights and sirens at that time of night (shortly after dinner).
- Fire crews here in BC are dispatched to severe medical incidents (like heart attacks) and most of the time can even beat ambulance crews to a scene. They would have been able to provide CPR if needed, possibly even ASA or Nitro depending on their scope. So again it's surprising that there's no mention of them. Perhaps they aren't dispatched to medical calls in Toronto?
- Lastly it's surprising that the calltaker had no visibility on where the dispatched crews were at. At the very least they could have radioed the crew to get an ETA. I guess I just take it for granted that over here we are tracked as soon as we sign in to our vehicle (it's a safety thing especially in some of our more rural/remote stations). If the ambulance was just about to reach the patient right before the family decided to go to the hospital on their own, things might have turned out differently.
Also since I'm assuming that a large percentage of HN readers are older males who are at risk of a heart attack (due to factors like working desk jobs and not keeping up with fitness as much), read up on the signs and symptoms of a heart attack and keep a bottle of aspirin at the ready. Bodies are complicated and weird and you never know.
>Fire crews here in BC are dispatched to severe medical incidents (like heart attacks) and most of the time can even beat ambulance crews to a scene
according to the blog post, the father was talking (said "be careful" about a left hand turn) and apparently ambulatory (collapsed on his way into the hospital), so perhaps it wasn't yet considered a severe medical incident yet.
in the post she was told by her mother that father was in the hospital and she could visit him in the morning. This was at 11:30pm, hours after the arrival at the hospital which was within an hour "after dinner"
seems to me the father's condition was not known to be that severe, and well after the "late" arrival at the hospital he was thought to be in good condition. (tho always possible the hospital staff was not keeping the mother informed)
At least in my area, King County area, a call of severe chest pain would immediately get units rolling code (lights+sirens) for CHEST PAIN. Pulse point, which works in our area, would also start paging BLS certified people in the neighborhood who have the app.
When I've called 911, the dispatchers grilled me going right down the list of signs and symptoms and did an excellent triage job.
I'm a volunteer EMT / FF at a pretty rural station, and the thing that slows us down the most is traffic if we're coming from behind the accident, and distance. As the sibling / gp said, the dispatchers know where we are via gps at almost all times and usually tell the RP (Reporting Party) when we're close so someone can go out and flag us down.
I don't mean to be argumentative, just provide what I know working as a volly FF/EMT for a year. As others have said, this is tragic.
So I don't know exactly how Toronto operates their ambulance service, but unless the family gave some bad details, the calltaker should have gleaned that they were likely dealing with a case of cardiac-related chest pain, and that's right at the top of the list of severe emergencies, regardless of how far along it has progressed, at least over here anyways.
I should add I feel a little queasy about dissecting this blog post for details. It seems more like a cathartic exercise for the author rather than some breakdown review of how the incident went, so it seems like some details were left out on purpose.
>i don't understand why the common narrative that i was told, that we were all told growing up, is that one should wait for an ambulance
My wife had a seizure a few years ago, and the first response team clocked in under 5 minutes (close to 3 by my count but I wasnt paying a lot of attention). Then 2 more ambulances arrived <5 more minutes. There was straight up an emergency services gathering at my front door.
The emergency response team is an SUV rather than a full ambulance, with 2 trained paramedics and as much kit as they can fit in. They are faster, because they don't do patient transport, and can arrive ahead of patient transport vehicles. See issues with "ramping" and so forth.
Anyway, this is really an issue of local government policy. Just vote/spay/neuter/tar/feather your politicians.
I have the opposite story. Friend collapses in front of the house. I pick him up and rush him to the hospital, he is a geek and we had spent great amount of time going over his rare genetic condition that randomly causes internal bleedings from his organs. No ambulance available but no traffic also, we arrive soon at the hospital. Only to wait for 1hr or more because he didn't look bad, since internal bleeding doesn't look bad, and his arrival time (or cause) had not been registered on the system since we came by car.
After we were finally admitted in the actual room the doctor said his ematocrit was lower than a dead person’s, but fortunately he was saved that time.
This is not a criticism of the author of the article; I can feel their frustration and the pain of their loss but I don’t have anything to say that can ameliorate that.
I’m coming up on 60 years old. The mindset that many people have now seems to be to wait for someone from the government to help them- whether it’s ambulance, police, health care, food assistance, college, whatever.
Back in the 80s when I was coming of age the mindset among the people around me was different. The mindset of many people today seems more “I’m helpless”.
The government has never been good at anything; it doesn’t have the right organizational incentives and doesn’t give the right personal incentives to employees. I’m not criticizing government employees; there are individuals that do a great job, and from time to time I am delighted with an interaction, but mostly it’s just lots of waiting for mediocre service.
I don’t know how to change a widespread mindset of helplessness, but I suspect that it involves changing laws to remove all the obstacles that government and lawsuits have put in place to helping yourself and helping others.
Readit News
But either you mistold the story, or the paramedics made a mistake: ambulances are not supposed to transport a dead person - the paramedics are first to resuscitate and stabilize the patient, and only then initiate transportation.
(I understand you may not care, because the outcome of their action incidentally was one you like.)
From what I was told, he was born with the umbilical cord wrapped around his throat, and just kind of "fell out" while his birth mother was walking from the bathroom to the living room. I know that part is true, at least, because we saw the apartment floor the next day...
I think probably the paramedics were able to detect some faint vitals upon arrival. Since the birth mother and her partner weren't super reliable or coherent, we weren't really able to piece it all together until we tracked down the two young men who helped save our son's life that night.
He didn't say the baby wasn't breathing when they picked him up. He said the hospital was expecting a DOA - presumably because of the news along the way, before they resuscitated the baby.
That might still be true where I grew up, in the US, but that's certainly not a guarantee in Melbourne, where I now live. On joining the local volunteer organization, I went from thinking "oh this will be a useful bonus for the community" to "wow, we can literally be essential". Since our org is composed of people living within the community, average response time to ANY call is <5 minutes (lower for cardiac arrest, when people really move). Sometimes one of us is right next door.
We can't do everything an ambulance paramedic can, but we can give aspirin, GTN, oxygen, CPR, and defibrillation. We can also usually navigate/bypass the usual triage system to get the ambulance priority upgraded to Code 1 (highest priority, lights + sirens, etc.) If for some reason the ambulance is far away (it backs up all the time), we can go in the patient's car with them to the hospital, with our gear, in case of further issues in transit.
I tell everyone now to always call us first (since our dispatcher will also call the ambulance) but while I feel more confident in how I'd handle an emergency, I feel less safe overall, with the system's faults and failings more exposed, and the illusion of security stripped away.
My condolences to the author.
In terms of updating - consider whether The System is really working. If not, what can you do yourself (or within your larger network) to better prepare...
She started breathing again after a few minutes and seems fine, but they left the UK not long after that.
I plan to make a trip in to the ambulance hall and fire hall this week and say thanks. I am ok, fractured vertebrae, but honestly i just am so grateful for the public service they provide.
We called an Uber
* Average Code 1 response time: 12 minutes 47 seconds
* Code 1 responses within 15 minutes: 77.2%
* Number of Code 1 first responses: 12,375
This places Melbourne among the faster councils in the state, and well ahead of the statewide average response time.
Source: The Victorian Parliamentary Budget Office’s 2025 report: https://static.pbo.vic.gov.au/files/PBO_Ambulance-funding-an...
I can drive to an ED within 3-5 minutes.
This report doesn’t make me feel good.
Sounds like you keep medbags at home and respond directly to the incident in personally owned vehicles? That's a neat idea. Does everyone have a medbag?
I resonate with your thoughts about USA response times. We lived in a middle class suburb with mostly immigrants. When I was 10 my mom slipped in the bathtub and was knocked out. I dialed 911 crying and within 2 minutes a cop had arrived and only a few minutes later the fire truck first response had arrived. They helped my mom out and she was fine afterwards.
It was so crazy for 10 yo me. I thought my mom was gone.
I am so sorry for what the author and his family had to endure.
The advantages of coming in an ambulance are traffic priority, priority attention in the ER, and medical triaging and coordination. The disadvantages in the US can be extremely expensive to some people if they don't have the correct insurance and inconsistent timeliness.
The advantage of coming in a private vehicle are speed (usually), but at the disadvantage of having to get past ER gatekeepers and lack of information and preparedness. It is probably wise if possible to have a third person in the vehicle call the ER at the destination hospital to let them know what generally should be expected.
Another issue is that it's inherently risky to live more than 30 minutes driving distance from a major city hospital. To do so basically necessitates a life flight which is extremely expensive and not necessarily quick either.
The for-profit, gotcha capitalism monopolization of hospitals and medical services by private equity also results in worse, deadlier patient outcomes, hospital closures, and more expenses. Medicare for all (m4a) isn't a fix because of the Medicare Advantage scam, the medigap scam, the part D scam, and the lack of long-term care, skilled nursing, dental, vision/glasses, mental healthcare, and hearing aid coverage that doesn't provide true comprehensive single-payer healthcare at a sane cost per patient and with better outcomes.
My mom lived in the country, and the sheriff there started a paramedic service and trained deputies as EMTs. It made a huge difference as the paramedics arrive first in most cases.
https://www.goodsamapp.org/oz
I've been thinking of joining that.
When everything is far apart, or you live away from a city, that is definitely true. This is one of the cons of living outside the city. There are many perks, but this one is a con for me for sure. Especially because I have MS and I do not drive nor have a car.
Up until a year or so ago, an appointment at a GP would take weeks of waiting. Specialist appointments were 1+ years waiting time. This is somewhat better now with the establishment of critical-care clinics operating after hours. This is from personal experience.
The emergency rooms often had waiting time of 12+ hours(or more). I know someone who has been waiting on a procedure at the public hospital for 6+ years. Another has a child waiting for an appointment with an estimated wait time of 3+ years. All non-urgent but a wait list in the years is no longer a wait list to me, it's a system that is not fit for purpose.
Initially all of this was attributed to the pandemic and the harsh lockdowns in Victoria. But a few years out, it seems difficult to still do that. When asked, our government just re-states that they've invested in this and that and then deflect. Recently, due to the horrible state finances, the healthcare system was being downsized with services cut and the bloodshed continues. This is without talking about the systemic issues and incompetence I've seen.
The funny thing is that outsiders think that public health care means free. It's really not. We pay for it on top of our income tax(1-2% on top, more if you're above a certain threshold) and it is not cheap. It wouldn't be so bad if it was working like you'd expect but paying for a non-functional system is....I don't know what to say.
Since 1998, in Melbourne for anything that might need a defibrillator a fire engine is sent at the same time as the ambulance (EMR Emergency Medical Response Program). https://www.mja.com.au/journal/2002/177/6/cardiac-arrests-tr... Medical Journal of Australia article. There is also GoodSAM https://www.ambulance.vic.gov.au/goodsam/ for individual helpers
I work as an EMT (911) and resourcing is certainly a problem. In my small city, our response time is around 5 minutes, and if we need to upgrade to get paramedics, that’s maybe another 5-10.
However, if we are out on a call, out of service, or the neighboring city is on a call, now the next closest unit is 15+ minutes away.. sometimes there can just be bad luck in that nearby units are already out on multiple calls that came in around the same time, making the next closest response much further.
for a heart attack or unstable angina, the most an EMT will do (for our protocols) is recognize the likely heart attack, call for paramedics to perform an EKG to confirm the MI, administer 4 baby aspirin to be chewed and/or nitro (rx only), and monitor closely in case it becomes a cardiac arrest. If medics are far away we will probably head immediately to a hospital with a catheterization lab, or rendezvous with medics for them to takeover transport.
The few goals though:
- recognition (it could also be something equally bad/worse like an aortic aneurysm).
- aspirin to break any clots, assist administering nitro if prescribed.
- getting to a cath lab.
For the goals -- and this may differ between EMT / paramedic & protocols -- but I would really wish that there was a blood draw done in the field. Before they bring you to the cath lab with a suspected MI, the ER is likely going to draw blood to get troponin levels at a 2-hour interval. You could save some time & heart muscle by getting a blood sample (containing initial levels) in the field.
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People can go from heart attack to cardiac arrest quickly, and you don’t want to then tell medics you’re on the freeway and now need to do CPR.
See: https://m.youtube.com/watch?v=mxUqHwHbNtk&t=1520s
Around the 11 minute mark this man went into cardiac arrest, a moment prior was still talking.
We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the system first, and then patients.
Fuck that bad doctor, it’s not like they’re some Holy Paladin. He had no remorse either and didn’t really pay much attention to me.
I hope AI puts as many doctors out of work as possible so that only the best, like my CC doctor, remain.
Sometimes doing what you're told is the right thing. Sometimes, not doing what you're told is the right thing. Sometimes, you're told to do the intuitive thing, and it's wrong. Sometimes, you're told to do the unintuitive thing, and it's wrong. It's hard to tell the difference between those situations, even when you're not stressed.
What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dealing with high stress and low information settings.
BUT being statistically correct does not mean correct. For example, if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
The world is full of edge cases. This is a major contributor to Moravec's paradox and why bureaucracies often feel like they are doing idiotic things. Because you are likely working in a much more information rich environment than the robot was designed for or the bureaucratic rules were. The lesson here is to learn that our great advantage as humans is to be flexible. To trust in people. To train them properly but also empower them to make judgement calls. It won't work out all the time, but doing this tends to beat the statistical rate. The reason simply comes down to "boots on the ground" knowledge. You can't predict every situation and there's too many edge cases. So trust in the people you're already putting trust into and recognize that in the real world there's more information to formulate decisions. You can't rule from a spreadsheet no more than you can hike up a mountain with only a map. The map is important, but it isn't enough.
But unfortunately:
> if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.
Asking a lay person to know what a BLS (non-EMT fire & police), EMT (Ambulance), Parmedic, or MSO can take care of, or even what the differences are, is, I don't think, super useful. The red vehicle shows up and takes you to care.
In the case of MCI, EMTs can a) give aspirin or nitro (rx), b) have an AED and lots of CPR training but have to stop the vehicle to give effective compressions, c) a radio and the ability to meet up with Paramedics.
Paramedics have more complex treatments (drugs) and EKGs, but it's still 2 folks in a truck, not a hospital. They can do amazing things.
But as the joke goes, sometimes the best treatment is High Volume Diesel Therapy (burn rubber).
I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it.
But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.
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Do you really think that in a high stress situation you’re going to make the best decisions?
Do you really think health workers are all concerned about legalities first?
Not moving a patient unless you explicitly know how is probably right the vast majority of the time. Sometimes that’s wrong, but how are you going to get the entire public to understand what the right situation is?
It’s so easy looking at a single case in hindsight. May we all have the ability to make the right choices all the time.
100%. Legal issues are a huge deal in healthcare. This is a snippet from a study [1] on the topic, just to get an idea of the scale (which I think most do not realize at all):
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Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties.
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I can give a very specific example of how legal issues play directly into behavior, and how it leads to antibiotic over-prescription. Antibiotics are obviously useless against viral infections but many, if not most, doctors will habitually describe them for viral infections anyhow. Why? Because a viral infection tends to leave your body more susceptible to bacterial infections. For instance a flu (viral) can very rarely lead to pneumonia (bacterial). And that person who then gets very sick from pneumonia can sue for malpractice. It's not malpractice because in the average case antibiotic prescription is not, at all, justified by the cost:benefit, but doctors do it anyhow to try to protect themselves from lawsuits.
There have been studies demonstratively showing this as well, in that doctors who live in areas with less rampant malpractice lawsuits are less likely to prescribe antibiotics unless deemed necessary. Or if you have a friend/family in medicine you can simply ask them about this - it's not some fringe thing.
[1] - https://web.archive.org/web/20250628065433/https://www.nejm....
I mean that statement could be used to excuse any mistake in any project/system ever made, and is mostly a cop out. Yes, the system is definitely designed to minimize legal risk for the health-workers/hospitals. A system is only as good as what it's' design objectives are, and if "save a life at all cost" was the objective the system might as well look entirely different.
I am a Canadian Paramedic (EMR soon to be PCP in a few months, roughly equivalent to EMT and AEMT respectively). Some things strike out at me:
- Here in BC our calltakers can advise patients on some treatments. I'm sure if that were to happen here, they would have advised the family to administer some ASA (Aspirin) to the patient which would have bought valuable time until professional care could be reached. Even if it was found to be contraindicated, the fact it was not mentioned in the blog post stands out to me.
- I'm not familiar with the geography of Toronto or its normal traffic patterns, but it's surprising that a single ambulance was not 30 minutes from the patient driving lights and sirens at that time of night (shortly after dinner).
- Fire crews here in BC are dispatched to severe medical incidents (like heart attacks) and most of the time can even beat ambulance crews to a scene. They would have been able to provide CPR if needed, possibly even ASA or Nitro depending on their scope. So again it's surprising that there's no mention of them. Perhaps they aren't dispatched to medical calls in Toronto?
- Lastly it's surprising that the calltaker had no visibility on where the dispatched crews were at. At the very least they could have radioed the crew to get an ETA. I guess I just take it for granted that over here we are tracked as soon as we sign in to our vehicle (it's a safety thing especially in some of our more rural/remote stations). If the ambulance was just about to reach the patient right before the family decided to go to the hospital on their own, things might have turned out differently.
Also since I'm assuming that a large percentage of HN readers are older males who are at risk of a heart attack (due to factors like working desk jobs and not keeping up with fitness as much), read up on the signs and symptoms of a heart attack and keep a bottle of aspirin at the ready. Bodies are complicated and weird and you never know.
according to the blog post, the father was talking (said "be careful" about a left hand turn) and apparently ambulatory (collapsed on his way into the hospital), so perhaps it wasn't yet considered a severe medical incident yet.
in the post she was told by her mother that father was in the hospital and she could visit him in the morning. This was at 11:30pm, hours after the arrival at the hospital which was within an hour "after dinner"
seems to me the father's condition was not known to be that severe, and well after the "late" arrival at the hospital he was thought to be in good condition. (tho always possible the hospital staff was not keeping the mother informed)
When I've called 911, the dispatchers grilled me going right down the list of signs and symptoms and did an excellent triage job.
I'm a volunteer EMT / FF at a pretty rural station, and the thing that slows us down the most is traffic if we're coming from behind the accident, and distance. As the sibling / gp said, the dispatchers know where we are via gps at almost all times and usually tell the RP (Reporting Party) when we're close so someone can go out and flag us down.
I don't mean to be argumentative, just provide what I know working as a volly FF/EMT for a year. As others have said, this is tragic.
I should add I feel a little queasy about dissecting this blog post for details. It seems more like a cathartic exercise for the author rather than some breakdown review of how the incident went, so it seems like some details were left out on purpose.
My wife had a seizure a few years ago, and the first response team clocked in under 5 minutes (close to 3 by my count but I wasnt paying a lot of attention). Then 2 more ambulances arrived <5 more minutes. There was straight up an emergency services gathering at my front door.
The emergency response team is an SUV rather than a full ambulance, with 2 trained paramedics and as much kit as they can fit in. They are faster, because they don't do patient transport, and can arrive ahead of patient transport vehicles. See issues with "ramping" and so forth.
Anyway, this is really an issue of local government policy. Just vote/spay/neuter/tar/feather your politicians.
After we were finally admitted in the actual room the doctor said his ematocrit was lower than a dead person’s, but fortunately he was saved that time.
I’m coming up on 60 years old. The mindset that many people have now seems to be to wait for someone from the government to help them- whether it’s ambulance, police, health care, food assistance, college, whatever.
Back in the 80s when I was coming of age the mindset among the people around me was different. The mindset of many people today seems more “I’m helpless”.
The government has never been good at anything; it doesn’t have the right organizational incentives and doesn’t give the right personal incentives to employees. I’m not criticizing government employees; there are individuals that do a great job, and from time to time I am delighted with an interaction, but mostly it’s just lots of waiting for mediocre service.
I don’t know how to change a widespread mindset of helplessness, but I suspect that it involves changing laws to remove all the obstacles that government and lawsuits have put in place to helping yourself and helping others.