Paramedics who "hid" broke law, Canada inquest told

   The Toronto Star


TORONTO — Two Toronto EMS paramedics who waited for police and delayed attending to a 911 call about a man who collapsed of a heart attack were breaking provincial law, an inquest was told Thursday.

Instead of hiding around the corner, out of sight of James Hearst's downtown Alexander St. building, the paramedics should have attended and assessed the scene, said Rick Brady, a health ministry investigator.

By not doing so, Trevor Cornwell and Hayley Rothwell-Cusack contravened the Ontario Ambulance Act, he testified.

The act requires that paramedics who decide to withhold or delay patient care must "go to the scene, see it, make an assessment: Does the environment appear to be safe? Can I get out of my vehicle?'' he said.

Brady has investigated what went wrong on June 25, 2009, when Hearst waited more than a half-hour for an ambulance.

The inquest has been told the paramedics decided to "stage'' or wait for police. An EMS dispatcher classified the 911 call as "unknown trouble'' and put the code "HBD'' ("had been drinking") into the system because the original caller said the man had fallen on his face and looked like he "might be drunk.''

Errors were made in processing the 911 call, said Brady. From the original caller, it was apparent a man had fallen and had a "head injury and was possibly unresponsive.''

Because the caller "was not a trained medical person'' he might mistake head injury symptoms for drinking symptoms.

"In my opinion, it should have triggered more questions . . . you have a patient who's fallen and has a head injury,'' he said, adding to call it "HBD" was "inappropriate.''

The dispatcher should have said "possibly HBD,'' Brady testified.

The first caller was calm, "no one was yelling in the background'' and there was no indication of trouble that might require police. There was enough information to not have termed it an "unknown call, '' Brady said.

The second 911 call from the apartment lobby where Hearst collapsed, about 15 minutes after the first, came from a building security employee who said he was turning blue.

Again, the dispatcher erred by not asking for clarification, said Brady. "I would want to clarify, 'What do you mean by blue?' ''

The dispatcher should have asked if Hearst was alert, was he fully awake and more. Somehow the fact Hearst was turning blue was taken to mean bruising.

It's important not to make assumptions. "Ask the questions and wait for the answers,'' Brady said, noting the dispatcher sometimes "talked over'' the caller.

In his report, the inquest heard, Brady advised remedial training for the dispatcher and other staff. He made 13 recommendations which have since been implemented.

Contributing to the problems that night was the fact that paramedics supervisor Brian Toshoff, who was working in the field, did not follow up directly with the two paramedics after he was told about the staging, as per protocol, nor did he go to the site, Brady noted.

Lawyer Jordan Goldblatt, representing the paramedics' union, questioned why Brady did not interview key EMS staff on duty that night, including supervisor Lawrence Knox who was on lunch when the call came in and didn't find out what happened until weeks later; Keith Kelly who was left in charge by Knox, wasn't advised about the staging and didn't hear of Hearst's death until months later; dispatcher Stephanie Bennett who was out for lunch at the time and remained unaware Hearst had died until three weeks later; and others.

"The overall impression is . . . an absence of people who were around to do this monitoring,'' said Goldblatt.

"I would have to agree that no one seemed to be paying attention to this,'' said Brady, adding he had no reasons to question those people during his investigation.

The inquest continues. 

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