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Backgrounder: Transcripts of anonymous Reports from health professionals regarding EMS response times SET ONE Four cases I have heard that you are looking for calls that have happened in the Edmonton region where long response times have been a factor. I will give you information on a few of the events that I know of. I give this information to you hoping that it will be anonymous. The first event happened the night of Jan 9 we were on a red alert for most of the night. A 67-year man had a witnessed cardiac arrest by his daughter who was a doctor. The PRU took 12 minutes to respond and the ambulance arrived few minutes after that. There was by all reports good bystander CPR done immediately and the fire department arrived shortly after being dispatched with an AED. The patient died. It is unknown what caused the patient’s death but the long response time assured that he would not be given a chance. The second event happened on the evening of Jan 15th. A call came in for a 48 year female having a severe asthma attack. The call was at approx 180st and 85 ave. the closest ambulance responded from 101 street and 111 ave. Dispatch also assigned a fire pump and an ALS PRU. Not sure how long it took the PRU to respond but he was there by himself for at least 5 minutes before the ambulance arrived. While the PRU does have an equipped paramedic on board the patient was in cardiac arrest when he arrived on scene and it would be exceptionally hard to run a cardiac arrest by yourself. The patient was transported to the Misericordia Hospital where she was pronounced dead. Again there is no direct proof that our response times lead to her death but we sure didn’t help. In the summer time I responded from (IDENTIFIER REMOVED) to Lewis Estates in the far west edge of the city for a cardiac arrest. It was for an unwitnessed cardiac arrest and no bystander CPR was done. Due to our long response time I decided not to begin resuscitation as too much time had passed and there was unlikely to be a positive outcome. February 1, 2012 we consolidated with another crew so that they could go home on time. We assumed care for a patient that had been waiting for a bed at the RAH for about 2-3 hours at that point. We waited approx another 2 hours before patient received a bed on B side. Within an hour of patient getting a bed her condition deteriorated and she was moved to a trauma room. Patient went into cardiac arrest and was resuscitated. When we left the hospital at the end of shift the patient was still

unconscious on a ventilator and likely not going to survive

SET TWO Case Five To recap the call in question. On March 22, 2011 We were at 149 st and 89 ave NW. and dispatched to a 12d4 seizure at castledowns medic enter. At 153 ave and 127 street nw. When (NAME REMOVED) and I were dispatched being that we are unable to see where other units are or also be able to tell how busy the system is at any given time with the new changes to the dispatch. (NAME REMOVED) and I upon being dispatched to the above event immediately as we started to respond hot to the call asked dispatch 1 if we were actually the closest unit to this event. We were told to standby and no dispatcher responded back to us. As we continued to respond hot we asked for an update on dispatch 2 and still no update was given or clarification if we were still the closest unit available. We did talk with Fire dispatch as we saw that their was a fire response added but were told immediately by grant on the fire channel that Pump 17 were stood down as it was a doctors office. During our 17 min response time we asked a few more times for an update we were never given an update. ONLY information on the i -mobile cad screen was a "35 year old male" 2 doctors with Pt. As we turned into the parking lot 17 minuttes after our initial response we were met by a frantic wave in the parking lot and subsequently as we pulled in front of the large windows on the outside of the building we could clearly see that staff were performing CPR. We notified dispatch that this was indeed a cardiac arrest and asked for additional resources. As we approached the medical clinic staff were holding the door opened and I asked her "Did you call back" more surprised that staff were doing CPR for such a long period of time with no one phoning back after an unacceptable response time to a cardiac arrest Patient. Staff said to me as I was entering the waiting room that they indeed had called back. On our arrival the medical staff were performing CPR and Ventilating the Pt with a BVM with O2 supply and the RN ventilating was very specific in time lines as she said they have been performing CPR for 16 minutes already. My question to you is why were No update available other than CAD? If the patient’s condition changed and if dispatch were notified of the change in the patient’s condition why was it not passed to the responding crew so the all the appropriate responses could have been sent.? I also would like to know if there were no ambulance available for a high priority call then maybe the fire response would have been appropriate first response. Not all medical centers have the appropriate equipment such as AED'S in case of the severe emergency. Now as I said earlier (NAME REMOVED) I know it was very trying having

the new dispatch system start up the night before and there will be operational pains we will have to bare as the system becomes fully operational and works out its own problems, BUT as a tax payer in a population of 1 million people its totally unacceptable to have a 17 minute response time for a 35 year old cardiac arrest Patient. In closing as we discussed you said you would forward the concerns of this call to see how operationally the system could better serve this patient and its future patients. SET THREE Case 6 On January 9lh 20121 was at Station (REMOVED) changing a radio battery while working a night shift on 2PRU4. While I was in the station I heard 2S3 get disptached to a cardiac arrest in the Teruilliger area from the Misercordia with no transport unit available. I stated to dispatch that I could respond also and was attached to the call. I responded "hot" from station (REMVED) and I believe my response time was approx 10 minutes. Upon my arrival I realized l was the only paramedic on scene and the transport unit (2A60) was still aprox 5 minutes away. I went into the residence with all my gear (ainvway kit, drug kit, monitor, suction) and found a 67 yo male patient in his bedroom, unresponsive/pulseless, with CPR being performed my Pump #28. The patient was asystolic on my arrival. This patient is a retired surgeon and although he is retired, he still teaches and assists in surgeries from time to time. After a 12 hour day of surgeries and complaining of chest shoulder/back pain he collapsed in his bedroom. His daughter in law (who is also a physician) realized he was in cardiac arrest and began bystander CPR immediately until Pump #28 arrived. On the arrival of 2A60 (after an approx 20 minute response time), I had an lV established and was just beginning the administration of first line ACLS drugs for asystole. After one dose of Epi/Atropine/Bi carb, RSOC was noted, an advanced ainvay was secured (King LT) and he was transported to theUofA. The patient's pupils were still fixed and dilated (likely due to an anoxic brain injury). I understand the EMS system was extremely stressed last night, but I feel that if an ALS provider could have responded to this cardiac arrest in a more timely fashion, the patient's prognosis for a full recovery would have been much better. SET FOUR (1-800 transcriptions from voice mail from EMS ) Case 7 Last week an asthmatic 46 yo female and ambulance took approximately 20 minutes and on arrival the patient was in a cardiac arrest...

Case 8 There was a choking in the North end took ambulances about 12-15 minutes to get there. That man passed away. Case 9 Obviously there was a child in Sherwood Park the asthmatic intubated by the Fire Department but the closest Tofield about 55 km away to get the kid transported to the U. Case 10 There was a lady with abdominal pain. She called at 6:30 pm; the ambulance showed up at 1:30 AM That’s all for this time. Case 11 Also there was that St Albert crew that had to drive to the southwest - Terwilliger area – they arrived on scene and had to deliver a baby – so prolonged time there... I have a friend who is a dispatcher and she said when she got off work last week there were only 12 trucks in the City – twelve. Case 12 (Homecare Aide) It was about 2 summers ago I was working as a healthcare aide in homecare and had a patient to visit for routine activities. I found the patient in bed, losing consciousness, not able to sit up and vomiting every few minutes with brownish-red vomit. So we called for an ambulance we were told there were no ambulances. They couldn’t say how long it would be but they would have to wait to get a truck back before sending it out. - so they couldn’t say how long it would be and it really concerned me as she was in critical condition. So I think we waited about 40-45 minutes to arrive. She was in a pretty critical state so they took her right in but it really concerned me as a healthcare worker that it took so long. It would have been quicker if we had taken her in ourselves but we couldn’t lift her anyway so that wasn’t an option...so it was just very unfortunate...