Even in the most well-resourced system if your high-priority call comes in just after a bunch of other high-priority calls you may not get an ambulance in time as everyone's already helping someone else. Also in our current economic system there's a whole bunch of pressures that mean we can't base our medical care availability on the worst case, so sometimes people don't get the care they need due to lack of staff.
However I do think in a good system dispatchers would have visibility to know if an ambulance can be dispatched or retasked and how long it will take to get there. You can't make good recommendations without the information to do so.
I bet he's proud of you for writing and sharing this to help others.
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.
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.
For some reason, chronic contrarians always to point at a few details that were gotten wrong during the fog of war, and shout from the rooftops that if only they were in charge, we'd all be living in castles made of candy and shitting rainbows.
Joke's on us, though, those contrarians have since made a moron who doesn't believe in germs... The Secretary of Health.
But let’s not pretend that many of the precautions and policies weren’t performative. Mask mandates were always dumb. Most people didn’t wear effective masks and many didn’t cover their noses. You had to wear a mask on airlines long after the vaccines were available and everyone took them off at the same time to eat or drink.
The US government down played that immunity wore off within six months and that the vaccine was much less effective than they publicized at first even when there were credible studies and evidence from other countries health departments and domestically.
Again, I have every recommended vaccine imaginable. I get a flu shot every year and Covid shots at the recommended times
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.
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.
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.
[1] - https://web.archive.org/web/20250628065433/https://www.nejm....
That being said, anytime I’m looking on the web doing research, the first thing you find are lawyers looking to sue doctors. I absolutely hate that’s the first thing parents think about to blame doctors. Some times things just happen.
What's interesting to me is that in societies not prone to blame, or lawsuits, it can be much easier to have human interactions without being inhibited by legal fear.
Accepting that people make mistakes makes progress simpler. I recently had a medical issue which would have turned out simpler had he run a specific test earlier. I'm not the litigious sort (and I'm not in a society that is litigious) so I can now go back to him and we can discuss the mistake so he doesn't make it in the future.
I accept he's not perfect. I seek his development not his censure.
This is outside the US. No doubt inside the US fear of lawsuits would make this feedback untenable.
For really complex cases there is the Mayo Clinic model (also used in a few other health systems). A patient can come for a day and be seen by an integrated team of specialists to get a diagnosis and treatment plan. But this isn't really scalable.
https://www.mayoclinic.org/patient-centered-care/what-makes-...
How does alleged research fraud affect someone’s ability to be a caregiver?
We've gone from accused of research fraud to psychopath.
My original point is that I don't see how the effort to produce new knowledge has any bearing on the appropriate management of diabetes/thyroid hormone.
It has to do with the integrity and willingness of someone to tell the truth; if she's willing to destroy evidence to avoid criticism, what other types of mistakes is she willing to cover up when dealing with a patient?
This seems pretty obvious, how are you not understanding this? It isn't her effort to produce new knowledge, its her willingness to lie in the face of failure.
If a patient of hers dies or starts to decline, she could falsify cause. The list goes on. She is so far on the slippery slope that it is dangerous for her to care for anyone.
The doctor gets paid irrespective of their diagnosis—and I am yet to hear of a conspiracy where the doctor makes more money when their patients die.
Wuh wuh.
> According to the regulator for Ontario doctors, Jamal initially tried to place all the blame on her innocent research associate, almost ruining her career. She then tried to discredit her colleagues, claiming they had ulterior motives for questioning her results.
> When that didn’t work, they found Jamal tried to cover up her fraud: She illegally accessed patient records to destroy and change files, disposed of an old computer so investigators couldn’t examine it and even went into the Canadian Blood Services facility and changed freezer temperatures to damage blood and urine samples to mask her deception.
> And in March 2018, after admitting her misconduct before a disciplinary committee of the College of Physicians and Surgeons, Jamal was stripped of her medical license.
https://torontosun.com/news/local-news/mandel-despite-commit...
> We're told a lot of things by "officials" not because it's 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.
The bigger issue is the dispatcher not being aware of overloaded status nor conveying that information to the caller.
> Last year, Toronto paramedics reported that in 2023 there were 1,200 occasions where no ambulances were available to respond to an emergency call. That was up from only 29 occasions in 2019.
> CUPE Local 416, the union representing 1,400 paramedics working in Toronto, has also reported high instances of burnout in recent years.
https://www.cbc.ca/news/canada/toronto/ambulance-response-ti...
The federal government shifts the responsibility to the provinces, the provinces in turn try to download as much as possible onto the cities. There's not enough money for everything on every level of the government.
This also reflects on 911/dispatch systems, where there indeed might not be easy visibility of when an ambulance might be available, and even then it could be preempted by a higher priority call -- although a heart attack has to be close to the top of the list.
There are also occasional weather events, like the storm two days ago, that cause a surge in demand (>300 crashes reported and many of them needed attending to).
It's not a 'shift'. Healthcare has always largely been in the hands of the provinces.
The federal government funds research, distributes money from have regions to have not regions, and sets federal standards, but the actual spending of money and provision of services is in the hands of provincial authorities.
Fortunately I only had one encounter with a situation requiring ambulance (and subsequent hospital visit). Ambulance arrived in about 10 minutes, triaging before seeing a medical professional took hours. There were no rooms so I was kept in a hospital bed in the hallway along with other patients but with some monitoring.
Now to be fair - this was during Covid which understandably put pressure on medical resourcing.
Would be interesting to see everyone who jumped in here yesterday [1] to comment on this one as well.
And really, if your critical virology lab procedures depend on having a double-digit IQ as a floor... you're probably hooped anyway the next time your 120-IQ employee is having a bad day where they slept poorly and are distracted by family problems.
People should absolutely question authority basically all of the time. Authority should be justifying its competence to tell you what you should be doing with every decision it hands down. But there's nobody on the other side of the AM radio hosts to say "yeah the flip flop on COVID masks was weird but it's probably not because billionaires are putting tracking devices in the masks and more because the CDC just didn't understand the issue correctly yet. Here's some studies on the effectiveness of mask wearing in slowing the spread of disease, seems smart to wear one just in case?"
Instead you have neoliberal America, politicians on every side of the aisle saying "no matter who we are, at least always trust us," and the only vent from that is alt right and conspiracy theorist podcasters.
1,000%
> just finished a disturbing section about how we are wired to obey an authority figure even when it causes harm.
I mentioned the Milgram Experiment specifically in the context of this comment.
I figure that if I’m a 10 minute drive from the hospital, it’s highly unlikely that lights and sirens will get to me and then to the hospital quicker than I can do only the second leg. If they want to meet me halfway, fine - but if they aren’t there, I’m not waiting.
Everything else? Sure, we can wait for the ambulance. I can control bleeding or whatever and you’ll live through some pain without lasting side effects. But if there isn’t blood going to an organ, we are gonna get that fixed ASAP.
The one doing the telling is the confident man on tv and the people around us.
What's funny is, 9 out of 10 people are totally credulous. They'll swallow any foolish thing as long as a authority says it. That last guy is a skeptic. BUT if everybody around him AND the authority are saying the thing, then he believes it. Because that's reasonable, right?
Hindsight is 20/20. There are also cases where people died because they didn’t wait for the ambulance. So without proper statistics that‘s a dangerous conclusion.
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.
I'm getting up there in age and that is presumably something that I should learn about myself...
Don’t want to suggest you do something and end up with anaphylaxis.
a heart attack is far more common than an aortic aneurysm.
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.
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.
Losing family is hard, but losing them suddenly makes it harder. Losing them suddenly because of poor advice or (in)action of people who are supposed to help is yet more difficult. I know from experience.
It does get easier to deal with, in time.
In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.
I lost my brother to a heart attack aged 50, but he died immediately. In the end it was very quick, but he had warning signs for years. Look after yourselves, people.
The same politicians that would say this is a tragedy in one breath will send millions to early grave in the next so long as it could line their own pockets.
We live in a world diseased by greed.
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...
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
Asking because (different country) when we had a person present with stroke symptoms and called 911, they sent both an ambulance and the helicopter. The heli came first but it had to land a ways off on a field and they had to walk over and basically arrived around the same time as the ambulance. No fire engine dispatched.
Now I can't really trust these numbers fully of course but according to "a quick AI analysis" :P Melbourne with millions of population has 0.08 helicopters and 8-10 ambulances per 100k population while the aforementioned location is at about 0.3 helicopters per 100k and 6-12 ambulances. Can it be true? It also says New York City has no emergency helicopters at all? Los Angeles has 0.18 per 100k? I know my current location definitely also has none at all.
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've been thinking of joining that.
She started breathing again after a few minutes and seems fine, but they left the UK not long after that.
I once saw a man have a heart attack on the beach, less than a 5 minutes drive from a fire-station and rescue team. A helicopter arrived after 45 minutes, and the man was deceased already. That was in Martinique, french Caribbean.
There's a need for an app to let patients track the ambulance. It's been possible for 10+ years, as seen with Uber. It seems existing products have focused on tracking only for the purpose of managing a fleet, missing the focus on patients needs.
I don't want to blame anyone, but I'm pretty sure that kind of visibility is not desired.
The primary goal of the state is to ensure the power of the state is perpetuated. It's really the only goal of the state, anything it does good for its people is a side effect in its pursuit of maintaining power.
The government doesn't care about you, doesn't care about your health, your children's education, your safety, your house, your job, anything else about you except in as far as they provide conditions for people sufficient to avoid large scale civil unrest and threat of government losing authority. If individuals get crushed in the machine, nobody gives a shit, least of all the government.
This is the reason vigilantism is viewed so harshly by the state and tends to attract much more attention and harsher punishment than a crime that was not motivated by justice. Not because the outcome for a victim of vigilantism is any different, but because the act threatens to undermine the authority of the state in application of justice.
The biggest perpetrators of atrocities and injustice, war, murder, theft, genocide, death and suffering through negligence and incompetence, has been the state and agents of the state. Everybody should be critical of everything the government, politicians, bureaucrats, "experts" tell you at all times. Consider they can and do lie and cover-up as easily as a person drinks water, consider motivations, and explore outcomes and alternatives and consider what is best for you, your family, your community, your society. Use your common sense, don't prejudice your ideas with what gets repeated about things. Develop plans accordingly, or at least spend a little time to think about these things.
This is not "conspiratorial". The actual conspiracy theory would that those in government are conspiring to actually help the people foremost. Anybody who puts forward that kind of crazed unfounded conspiracy theory had better come up with air-tight evidence, otherwise they'd just be peddling far-something ultra-something disinformation.
Well, that makes sense considering failure of the state is a very, very bad situation. Ultimately we're all just animals roaming around on some land.
I'm sorry if I'm ranting under a post about a father's passing, but tragedies like this are so avoidable that it practically sends me into a rage. This person should still be alive, she should still have her father. Fuck sakes.
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)
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.
It is not hard to use the machine as it has clear instructions. They probably expect you to still be able to read when in panic.
Sometimes lightening strikes, you have bad luck. And there is no guarantee that getting to the hospital faster would changes the outcome.
But taking the car is decidedly a decent option of the hospital is only 15 mins away.
From: https://www.npr.org/sections/health-shots/2023/05/29/1177914...
Referenced underlying study: https://pubmed.ncbi.nlm.nih.gov/20123673/
Absolutely worth training for and administering, but far from 100% success.
Before anything else, ask yourself two things:
Would this person possibly benefit from (A) an automatic external defibrillator (AED) or (B) Narcan[1]?
Can the person safely get into a car and be driven to the hospital?
If the answer to 1A or 1B is YES: Don't drive. Call 911, clearly state "cardiac arrest," or "overdose" give your exact location, and start effective CPR if required. A police officer with an AED will likely arrive quickly. Getting the location right is critical—this is life-saving information.
If 1A/1B don't apply and you can answer YES to question 2: You have some thinking to do. I suggest doing it now, in advance, whenever you move—think through how you'd handle massive bleeding, heart attack, or stroke symptoms.
It's worth briefly considering emergency scenarios and the risks you're willing to accept. Ambulances or fire engines sometimes can't reach you quickly: logistical issues, mechanical failures, dispatcher problems, insufficient volunteers. In rural settings during a cardiac event, waiting thirty minutes for basic EMS care—followed by a 30-60 minute hospital transport when you have alternative transportation—may not be your best choice. Even in a volunteer live-in program with career-grade response times, I found it could take 20-30 minutes to reach people at the edge of our territory. That's not counting the 2-3 minutes to get us awake and out the door at the station, plus another 2-3 for dispatch.
My household is minutes from two decent suburban EDs (we're lucky). Certain situations would lead us to skip 911 and drive straight to the ED: massive hemorrhage or an obvious heart attack when another adult is present to drive. This requires nuance. Time saved by skipping the ambulance can easily be lost to an incompetent admissions screener. You need to use the magic words: "heart attack," "chest pain," "think I am going to die." If you're having a stroke, you may not be able to drive at all (and you shouldn't). You'll also need to choose the right hospital—challenging in the moment, potentially impossible if you're impaired. The wrong hospital can be as lethal as waiting for an excessively delayed ambulance. In large cities with saturated EDs, this strategy often doesn't work: too many false alarms and just overall volume mean you won't skip the line.
I have direct experience managing and assessing these issues. You may not—consider getting meaningful first aid training. It helps.
The general rule: If you're confident in your department and know a nearby fire station generally has a paramedic-engine or paramedic-staffed ambulance with reasonable response times, wait for it - paramedics can do a lot for you on the way to the hospital and most critically get you to the best facility for care. You could crash your car or deteriorate en route to the point where you can't drive. But if you're fifteen to twenty minutes in and don't hear sirens (admittedly, not all departments use sirens properly), it's time to consider leaving—and how you're going to do it.
[1] Regarding Narcan: I won't engage in broader discussion about police possibly asking about circumstances requiring it—that's your business. IANAL. But many cops and almost all ambulances carry it, and the person will be alive after they administer it.
Did the ambulance ever show up to your house?
Source: Peter Attia
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.
rectang•1h ago
davidw•1h ago
neom•1h ago
gblargg•1h ago
https://www.youtube.com/watch?v=9U-TQrxBOxY
https://www.youtube.com/watch?v=nZuex_dnpBM (23-minutes of more raw video)
prmph•1h ago
nrhrjrjrjtntbt•1h ago
They 2x overloaded cargo, made it loose, captain abandons ship while staying in place order remains.
kingstnap•32m ago