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.
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.
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.
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.
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.
This isn’t an inherent flaw of public health care. A lot of the health care problems in this country (Australia) stem from a continued disinvestment in the public system after a decade (prior to the current government) of conservative mismanagement. Most state funding here comes from the federal governments standard sales tax. They intentionally gimped our public system to fund a private system that isn’t financially viable. Reversing that is going to take time. The problem exists it’s just important to attribute it to the correct sources. Medicare (our public insurer) is an incredible privilege that we should protect and hold our leaders accountable for managing.
I don't understand where you got that I am saying public health care systems are flawed. Both systems have pros and cons. And I have seen the "going to take time" phrase for quite a long time now and so don't think it holds any value anymore.
In terms of affordability which you also referenced in a separate comment, I disagree. Compared to some prices I've seen in the US, it is cheaper. Compared to other countries I've experienced, it is more expensive. Comparing private and public systems is not straight forward and I don't think this adds any value to the discussion.
In terms of attributing failure to correct sources, Victoria hasn't had a "they"(who you're claiming gimped our public system) for many years now but I am not interested in a discussion about politics.
I think it is mostly just a problem with Victoria - and they are are hardly conservative.
Hospitals and ambulance service is a state issue and other states fair much better.
Wow. I didn’t know that things are this way. I am a recent immigrant living close to the city and always seem to be able to see a GP on the same day. Is that because I have private insurance and I pay out of pocket anyways? If I were a citizen, I wouldn’t be able to go to those places (at least for “free healthcare”), and will have the same wait times? Or is it geography dependent with rural Victoria having issues and Melbourne city being well covered?
It depends on the location and it depends on what services you're after. If you have private healthcare insurance, you get to skip the wait times at hospitals and get a choice of public or private hospitals. For clinics, it's a different story and can get quite detailed. The private insurance can help you with the payment there but not wait times.
For some regional and rural locations, the wait times can be better or can be worse than metro depending on the service.
By the way, I also pay out of pocket on top of the medicare rebate so my experience is not with bulk billing clinics. When you get access to medicare, you'd probably still need to pay out of pocket on top of the rebate as bulk billing clinics have all but disappeared. Recent government incentives aim to bring them back but with cost of living increases I doubt that'll work.
With seeing a doctor we have two main systems that you can use and each will have a different waiting time. Bulk-billing and the fully public option has longer waiting times because there aren’t enough clinics/specialists or doctors, The reasons for this are complex but they stem from an unwillingness from prior governments to raise the amount the government pays for each service to adequately to support this system meaning less doctors and practices being willing to support it.
You’ve then got practices/specialists etc… that charge copays and they tend to have less waiting times because less people are willing to pay copays. A lot of these practices will also do outright private billing which is what you’re experiencing.
I pay ~500 US/mo for health insurance. Just for me, no dependents. Not an exotic low-deductible health insurance plan. 2% on top of income tax sounds like a dream.
It's actually anywhere between 1%-5% depending on your income but I didn't want to get too detailed in my comment. And you'd still have the absurdly long wait times. And the out of pocket expenses. Again, not a problem if you can actually make use of what you're paying for.
I do have to state though that the US healthcare system, minus the fact that most healthcare research/advancements happens there, is crazy.
It can be less/more than 2 percent too dependent on income. But yes we are extremely blessed in this country with a healthcare system that isn’t perfect but is extremely affordable.
Yes it's Hatzolah. It's a volunteer Jewish organization - run (and paid for) by the local Jewish community, but we respond to anyone who calls us, regardless of background or ethnicity.
(There are Hatzolah organizations all over the world, where there are Jewish communities.)
What about helicopters? Does Melbourne not have/use theirs in those cases or is the system just overwhelmed?
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. A couple minutes earlier basically. No fire engine dispatched but that made sense too as it's volunteer based and while they would've been much closer, getting them to the station would've taken longer than the helicopter.
Driving time for the ambulance if it came from the same place as the helipad would've been about 15 min for the ambulance. Fire engine driving time from volunteer department: 2 min but no dedicated paramedic services, just volunteer firefighters. Heli time in air probably about 2 minutes given the "as the crow flies" distance I just checked, add whatever time is needed to get them in the air and such.
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. For millions of people.
I don't think my taxes/insurance costs/donations to charity are high enough. London (donation funded) has a helicopter service that attends 6 serious trauma cases a day. Denmark, Germany and others has a Helicopter Emergency Medical Service which delivers a senior doctor and paramedic. It probably doesn't scale well.
Basic issues like overhead powerlines make life difficult for helicopters. They are used in rural Australia as an alternative to road, but only due to time saving. In a city, well you get a road ambulance/paramedic/medical team.
The (Melbourne) Victorian Ambulance Cardiac Arrest Registry claims third best in the world in out of hospital cardiac arrest.
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.
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.
There's a lot of interesting research on paramedics vs emts (I believe the term of art is basic life support vs advanced cardiac life support). In areas where there is a good ER, it's better to have low level basic life support and break the sound barrier to the ER than do significant intervention on site but slow arrival at the hospital, as far as I am aware.
- early recognition
- early administration of aspirin and/or nitro if indicated
- activation of, and transport to, a hospital with catheterization capabilities.
If medics can show up and do multiple ekgs to confirm and en route, thats even better. But critically the blockage needs to cleared, and they need definitive care (cath lab).
Depends on protocols, but hence why EMS’ job is recognition of the right issue (the best we can do), there are things we can evaluate to determine if we think its an aortic aneurysm even at the emt level to rule that out before making the determination to give aspirin (eg: comparing bilateral blood pressures, checking for pulsating masses)
a heart attack is far more common than an aortic aneurysm.
would comparing bilateral blood pressure (which I assume the patient could do themselves) be enough? I'm not asking for medical advice, just like... what would _you_ do if it was you who had sudden chest pain?
Id encourage you (generally, outside of hn) to lookup the symptoms of a heart attack and aortic aneurysm.
A aortic aneurysm can present with a pulsating mass in the abdomen, and is more common in older people and smokers. The inner lumen of the aorta starts to separate and blood can flow differently or be restricted, eg: right arm bp may be different than left arm. But absence of that doesn’t rule it out entirely.
Whereas a heart attack is going to feel pain in the chest, perhaps radiating to the jaw, shoulder, back, maybe nausea, sweating, and an impending sense of doom.
Automated bp cuffs are pretty inaccurate imo, we use them at the tail end of transport to the hospital and they usually spit out wild numbers. An auscultated bp with a stethoscope and sphygmomanometer is the gold standard.
Bottom line, If you are having chest pain, call 911.
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.
How can one preemptively test if they have an allergy? Is there a dosage that is known to trigger detectable allergy symptoms without going full anaphylaxis?
I'm getting up there in age and that is presumably something that I should learn about myself...
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
This is the laziest, most egregious "WeLl AkShUaLlY!!!" comment I've seen in a little while. Like, really embarrassing.
> 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.
> This is the laziest, most egregious "WeLl AkShUaLlY!!!" comment I've seen in a little while. Like, really embarrassing.
And yet I haven't heard how this affects this person's ability to be an endocrinologist. Most of any job is routine busywork—and if ethical purity is the requirement to hold a job that impacts the lives of the public, we may never have a politician (or hospital chief) for the rest of humanity.
I am not saying that OP should love their endocrinologist. I am saying that all of this is a non sequitur.
People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar.
Someone who takes the hippocratic oath and then behaves in this manner is not fit to be a caregiver. Medical care is about more than technical competence.
I’d hate to see the state of the flattened world you seem to be arguing for. Please go read about the origins of professional standards.
> People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar.
> Someone who takes the hippocratic oath and then behaves in this manner is not fit to be a caregiver. Medical care is about more than technical competence.
> I’d hate to see the state of the flattened world you seem to be arguing for. Please go read about the origins of professional standards.
So much pathos—I was responding to an illogical set of statements.
People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar. - or maybe the evidence was insufficient?
I don't see a comment about research standards. Let's stick to rationality here, please.
> I’d hate to see the state of the flattened world you seem to be arguing for.
Exactly the opposite of what I am asking.
> about the origins of professional standards.
The suggestions of your comment have been falling flat, so I'm not going to take this ill-defined assignment. If there are logical statements you wish to provide, please do.
---
Again, the OP did not say anything about malpractice. Had the OP done so, I would have made no comment.
The incidental prior incidence of alleged research fraud has no a priori bearing on why OP did not like this person.
It is not alleged research fraud. It is admitted fraud. The person is saying they sensed something wrong with her. Dishonest behavior is often discernible in advance if you know what to look for.
> Jamal now takes full responsibility and “regrets having exposed patients to the risk of harm by enrolling them in studies which had no value.”
There is no pathos in my comment. Your statement is literally naive.
> "all of this is a non sequitur" ... I'm just speechless here. You're so completely off base there's not even any point arguing with you.
I am very specifically responding to the post I saw when I made my post.
Here is an example for the HN crowd.
"I really dislike my pointy-haired-boss project manager. He is unreasonable and terrible at management.
I learned that he was investigated at a previous job in computer science algorithmic research at a University—before he ever worked in industry—and ultimately found not liable for this. I am convinced that this is why I dislike my PHB"
---
> I also replied above, so at risk of overextending myself in this thread: you are either too lacking in discernment to effectively have this conversation, or you are willfully arguing in bad faith. You are describing completely different scenarios.
I can't respond to this comment—but if I am "arguing in bad faith" yet responding rationally, we truly cannot have a discussion.
I also replied above, so at risk of overextending myself in this thread: you are either too lacking in discernment to effectively have this conversation, or you are willfully arguing in bad faith. You are describing completely different scenarios.
It would appear fairly clear: she tried to claim a therapy would help someone when it clearly would not and when confronted with this fact, actively tried to hide it. How on earth would you trust such a person to be your caregiver?
> It would appear fairly clear: she tried to claim a therapy would help someone when it clearly would not and when confronted with this fact, actively tried to hide it. How on earth would you trust such a person to be your caregiver?
Where did you derive any of this from what the OP said? He said there was an allegation of research conduct, and this is the statement to which I responded.
Almost all research uses artificial cell lines and animals—where did you get the idea that we were talking about 'a therapy would help someone'?
The original commenter on the subject posted about the doctor Sophie Jamal.
She is the person who published a paper suggested a therapy of Nitroglycerin to treat osteoporosis, is she not?
If a therapy that doesn't help is adopted then those that suffer from lack of care as a result are harmed.
She blamed the research fraud on her assistant when she was initially accused of it and denied all liabilities. She only admitted to it after they had her cornered. I had her as my endocrinologist for a while and I would not recommend her. Edit: if you want to have a care-taker who doesn't mind lying or is a psychopath, you do you but it's a no go for me.
> if you want to have a care-taker who doesn't mind lying or is a psychopath, you do you but it's a no go for me.
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.
So if your endocrinologist was found to have ran a concentration camp in the past, it would have no effect on your decision on whether you wanted to use them as your doctor? Running a concentration camp also has no bearing on a doctor's performance.
> So if your endocrinologist was found to have ran a concentration camp in the past, it would have no effect on your decision on whether you wanted to use them as your doctor? Running a concentration camp also has no bearing on a doctor's performance.
The story presented here is that OP disliked their mother's physician. There was no discussion of malpractice. Then, OP seems to have searched for information about the physician.
'Research misconduct' and murdering your fellow man are... not the same thing.
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.
> But the doctor likely makes the same money for less effort that contributes to the patient dying, because it's hard to prove the link.
This makes no sense with how endocrinology works. And OP did not give any evidence of malpractice, so we have no reason to believe that less effort or patient risk regarding the practice of medicine was involved.
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.
Medicine is a team activity. There is no amount of money which could ever make it feasible to have multiple physicians working simultaneously on routine cases, but they do delegate some tasks to lower licensed providers such as nurses and technicians.
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.
> 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.
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).
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.
The 2020, in hindsight was largely correct. COVID was a highly infectious disease, it put a lot of people in the hospital, and a lot of people in the morgue. Social distancing and wearing masks slowed its spread, until an effective, safe vaccine was developed. Horse paste was not a cure for it, and after further investigation it turns out that it only had a positive effect on patients who, in addition to having COVID, also had worms. (To the surprise of absolutely everyone, it turned out that giving de-wormer to people with worms improved their health.)
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.
> few details that were gotten wrong during the fog of war
It’s fine to have your opinion but don’t dismiss others’ experiences and values.
The extreme lockdowns caused irreparable, long-term harm to many people. You’re glossing over this as if it’s a minor error that anybody could’ve made, which is not correct.
It is essentially a trolley problem. You value “extreme intervention that is statistically better overall but unnecessarily devastating to some”, whereas many other people are happy to let nature run its course to some extent than have their government turn against them “for the needs of the many”.
That is a moral discussion, not a scientific one, and people are rightfully angry when it’s misrepresented as purely a scientific one.
Every time I give this opinion I’m labeled as an a to science/anti vaxxer. Hopefully this context will help: I have virus induced asthma where even a simple cold can have me gasping for breath. I took every precaution imaginable before the vaccines were available, stayed home, got groceries delivered, masked up when I did have to go somewhere, asked my wife to retire from working in the school system as a special needs bus driver, etc. I got in early when the J and J vaccine was available and I got an mRNA booster before it was recommended in the US when I saw other countries health departments recommended.
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
> 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.
We have specific evidence that not masking and not distancing caused superspreader events. Before there were too many cases, contact tracing backwards showed that specific parties, weddings, etc. were responsible for accelerating the early spread above baseline.
Thus, the burden of proof is on the "anti-mask, anti-distancing" people to prove that they aren't worse than the alternative--doubly so given the post hoc analyses available due to Norway and Sweden.
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):
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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.
I get that in some societies there is a quick journey from something bad, to someone-to-blame. In litigious societies this means a quick trip to sue someone, anyone...
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.
My vent: I have very mild cerebral palsy- it affects my left hand and left foot slightly. But properly conditioned, I’ve run half marathons and ended up in the middle of the pack and I’ve been a gym rat and in above average shape all of my adult life.
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.
> 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.
you dissected the blog post to ascertain how bad you thought traffic would be at that hour. that's actually what made me notice the timeline she had established and the appearance that it seemed to get more severe later.
>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.
Something similar happened to a friend of mine. In San Francisco. I just sort of assumed it was just bad luck. Bad things happen occasionally even in good systems. But maybe that assumption is wrong? Is this a thing? Are ambulances just unreliable?
It Depends. It's going to depend on your location, how your health system works, and a bunch of luck.
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.
FWIW, I also live in Toronto and been in an ambulance a fair few times (generally for false alarms that were still worth checking out); I can't recall it ever taking that long for an ambulance to arrive, even reporting less severe symptoms.
It's not moloch. It's all health systems, even ones that are religiously oriented. Triage and logistics and having enough trained people working all hours to handle all cases of life threatening situations... it's a bug in all systems.
Nothing is scarier than the moment you realize you're in the hands of the medical establishment. Whatever that looks like, wherever you are. Ever tried to rush a mechanic to fix your car? Ever tried to argue with a gate agent at the airport about rebooking a cancelled flight? Now imagine doing that while your heart is failing and 10,000 other people are also trying to get their attention.
If you want to blame anything, blame the fact that our society has failed to produce sufficient numbers of people trained or willing to help in emergency situations. And the people who sacrifice their lives to doing it are heros, the finest of us. The difference between individual societies and governments is quite small in the long run.
The state has an incentive to encourage callers to wait for trained emergency drivers. Nobody wants mom in a panic and flying through red lights at the intersections.
Or worse, my former teacher drove himself to the ER while in the midst of a heart attack rather than wait for an ambulance. He didn't survive the attack but made it to the hospital without incident.
Yeah this is really way out there. The crew and captian straight up murdered those passengers. There was literally no reason to tell the students to stay put there were even rescue boats available.
For me the common element is in how people trusted authority when that authority issued instructions which seemed reasonable but turned out to be deadly. The character of the MV Sewol's captain isn't material.
My grandfather died at a hospital in South Africa in 1997 after experiencing chest pain. Apparently, he went to reception, and they told him and my uncle to take a lift/elevator up to the ward, and he died in the lift. I was told afterward that it's a no-no to exert oneself during a heart attack. No idea if that's true or not.
Anyway, not second guessing OP, just putting it out there.
What is not excusable is why he was told to wait. A man dies because a rent-seeking bottleneck of corruption sat between him and his doctor.
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.
And people wonder why Luigi Mangione had such wide appeal for so many people. It's not that what he chose to do was morally right (personally I dont condone it at all), more that he represented someone trying to do something about the disease you mention.
I’ve been reading Influence by Robert Cialdini and just finished a disturbing section about how we are wired to obey an authority figure even when it causes harm. In this instance, the 911 dispatcher was the authority figure. Sad story.
Causes harm is the hard thing to know. In the London Grenfell fire the dispatchers said stay in the appartment. This is correct advice, except when some dodgy supply chain middleman puts effectively what amounts to gunpowder up all the external walls.
During the 9/11 attacks in NYC, the folks in the second tower were instructed to stay in the building after a plane struck the first building. Also good advice until a second plane struck.
It's like we're wired to trust what we're told over what we see.
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?
From the caller's perspective the dispatcher is the authority figure. But that person is just at the bottom of a pyramid. The supervisor, the section manager all the way to the CEO and shareholders.
In such cases how do you in advance what causes harm? Waiting for the ambulance or driving yourself?
People died also because they didn’t wait for an ambulance.
(Not GP): Heart attacks and strokes are the two things where I will always load family members into the car and get to the hospital as quickly as practicable. Time is brain, and time is heart. I’d call 911 on the way and have them notify the hospital what’s going on.
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.
My dad also died of a heart attack at 57. I am so sorry to hear this. Thank you for writing it, theres a powerful message in there I think more people need to think about. Sending love and prayers your way.
> 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.
- Avg 90th Percentile response times have gone from 12 minutes in 2019 & 2020 to 14.5 mins in 2024 and almost 15 minutes as a 2025 target: (12.1, 12.1, 13.0, 14.2, 14.0, 14.5, 14.8)
- staffing is up more than 50% in that time, while number of patient transports is up just 10% during that same timeframe
- Page 4
- scary graphic - graph concerning Daily Hours with < 10% available ambulances
Healthcare funding is managed provincially and the Ontario government has been poorly managing the system, pretty consistently, for over a decade. Some would argue decades, but things do seem to be steadily declining post Covid, as they were pre-Covid. Over the last few years, several ERs have been experiencing intermittent closures, and at least one was closed permanently, due to staff shortage.
What's worse is that the closures are poorly communicated. I know of at least two people who, within the last couple of years, went to an ER only to find it closed.
With respect to Toronto, and more specifically ambulance services, they are jointly funded by the province and the city, but I understand that provincial funding is more significant.
All parties recognize things are not functioning well, and various attempts at increasing spending have been made, but any effort will take significant time before results are visible. I'm not particularly optimistic, and the current provincial government's track record here is dismal. Their policy is to be tight-fisted.
Toronto healthcare generally is quite below the bar. When I moved here 5 years ago, I was told that hospitals are short staffed, ambulances have significant delays, and when you do finally get care you are rushed through the system.
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.
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).
Healthcare is one of the exclusive powers of the provinces, as laid out in the constitution. There are things the federal government can do, such as provide money, but provincial leaders complaining about lack of federal involvement do so in bad faith; they would certainly complain louder if the federal government overstepped their bounds. It's worth pointing out that taxation and borrowing are also constitutionally protected powers of the province.
> The federal government shifts the responsibility to the provinces
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.
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.
My sincere condolences to the author. Wishing you strength and peace.
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.
Personally I see plenty of problems with a real-time public broadcast of all the addresses a medical event has occurred at, the patients' location in transit, and the hospitals that received those patients.
"Ambulance chaser" is a rather derogatory phrase for a reason.
An emergency dispatcher could send a Text message back with a link to a private, case-limited, web page with an ETA + a map + the ambulance location in real time.
See? no "real-time public broadcast of all the addresses a medical event has occurred at".
Very sad, for more reasons than one. For pretty much everyone, heart disease is totally preventable now. If you’re over 30, get your ApoB checked (non HDL cholesterol is a proxy), and if it’s high, get a calcium scan on your heart. If you score above zero, get your ApoB down as low as possible (which will probably require drugs - diet barely moves the needle on this for most people). Low ApoB -> no heart disease.
I’m so sad to see this. For anyone who reads this, get a day, learn CPR, and buy that machine if your parents or whoever has history of heart issues. The machine doesn’t fix every kind of heart diseases but the trainer told me it decreases the possibility of death from a heart attack greatly. I recall that the possibility is lowered by 50% if you do CPR and 80% with the machine.
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.
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.
Let me add one thing: high blood pressure is both very bad and sometimes has no clear tell signs, and cake people doing sedentary work like IT folks it's very common. Get tested regularly.
Someone, please, for the love of all that is holy: Set up a website with information on how to reach emergency services from x to y country. People are literally dying here.
I once tried to call an ambulance on an active suicide attempt in the United States (while I myself was in Europe).
Problem 1: What number should I call? My country's national emergency line could not help and had no direct communication with ANY emergency services in the USA. Unable to find the phone number for EMS in the USA, I called the local police department which was answering their regular phone line at that time.
Problem 2: This requires long distance calling and local police departments do not accept collect calls.
Problem 3: Police receptionist was hesitant to connect me to dispatch but did so anyways.
Problem 4: I am now easily 10-20 minutes into making an emergency phone call and I haven't even talked to anyone able to help me.
Problem 5: Ambulance took another 10-15 minutes to even show up.
I explicitly stated "they just took pills, they have no neurological symptoms right now, do not leave immediately."
Problem 6: Ambulance left after a simple "it's a prank call" given at the front door.
Not much later, this person started showing severe neurological symptoms. I repeated the call, told them they were now actively dying and needed help. Luckily an ambulance came and helped this person, but it was an incredibly close call.
Thanks to this I looked where my nearest ER is and found that it's 7 minutes away, so I can't imagine calling an ambulance for my wife unless I was worried about her spine. (I don't think she can lift me so the reverse isn't true.)
> 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.
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.
First, I want to offer my condolences to the author. I lost my father suddenly at a similar age—it's terrible. Sending positive energy.
Former Firefighter-EMT here — I did this a long time ago in a rural setting). Now to the practical matter. I want to offer some frameworks for thinking about this in rural or exurban transport situations. This is not risk-free or even optimal, and can put you in worse position, but it's worth considering seriously if you suspect you may have a very long or delayed transport time to the hospital.
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.
It is terrible to lose a relative in young age.
But at least 80% percent of all heart diseases are known to be fully avoidable. The risk factors are known for ages and as matter of fact every adult is fully responsible to care for his own health. The right thing to do, is to watch out for a healthy diet.
There's another scenario where someone heads to the hospital and get stuck at a red light or behind and accident or you're speeding and kill someone. It's just hard to know sometimes which path to pick when you don't have a guaranteed outcome on either one.
In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.
This just doesn't seem like it takes probability into account. Getting someone to the hospital fast is almost always going to be better than waiting, and moving someone isn't usually inherently damaging if they don't have a spinal injury. In the context of a heart attack, it seems indisputable to me that it is better to drive if you have a safe and sober driver available.
It isn't all about getting somebody TO the hospital but getting them INTO the hospital/ED/ER. EMS in an ambulance who are alerting a hospital of an MI enroute will get their attention, a walk-in will have to wait unless there are obvious signs.
Calling 911 will normally get LEO on scene that know CPR and can do radio communications. A lot of dispatchers are EMDs (emergency medical dispatchers) that can start helping immediately. You may have off duty EMTs nearby that are scanning the radio. Finding a fixed target it much easier than finding a moving target (white car headed towards hospital), you are on your own if you get stuck in traffic. Statistically, 911/EMS is the best outcome. I agree with another commenter, exceptions do exist.
> 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.
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.
Such a tragedy, and I'm really not surprised it happened in Canada. Our healthcare system here is utter garbage and there isn't really any political will to do anything about it because "it's better than the Americans at least" (it's not). I don't buy that it's underfunded either, it's just sorely mismanaged and nobody wants to build or grow. Even a child could tell you if you increase the population of a country by 10% in ten years, you also need to grow its infrastructure by at least that amount - but our political class are idiots and haven't even considered it. After all it's not "green" to build more hospitals. And thus we get situations like this where there literally aren't enough ambulances to handle the load.
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.
Not 10% population increase in ten years, it was 10% population increase in 3 years. (An increase in immigration rate of 4x over those three years compared to the previous 20 years - makes the USA's southern border influx look minor in comparison)
And the population increase wasn't spread evenly across the country...
The problem with Canada and the USA is that there's no educated ideology primed to capture the inherent distrust people have of systems that used to work and now don't, such as government authority.
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.
What terrifies me personally is that people with 2-digit IQs are apparently being employed in virology labs. That's the kind of realization that could undermine anyone's confidence in government.
I don't know that there really exist any jobs where someone with a 99-IQ who's hard-working and dedicated to getting through the hiring process would never get hired.
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.
Canada has experienced an unprecedented spike in both legal and illegal immigration over the past decade of Liberal rule. Every system has its carrying capacity: the health care / EMS system is overloaded (and underfunded). This no doubt contributed to that ambulance not arriving in time.
If Canada just made those illegal immigrants legal, they could volunteer for EMS training, work on ambulance crews and staff hospitals. Open the borders and let the people work god damnit!
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.
Amazing story, Thank you!
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.
Source: The Victorian Parliamentary Budget Office’s 2025 report: https://static.pbo.vic.gov.au/files/PBO_Ambulance-funding-an...
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.
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.
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.
The emergency service number should be calling the closest first responders, not the other way around...
Would that first responder association be Good Sam?
https://www.goodsamapp.org/oz
I've been thinking of joining that.
Wow melbourne is getting that bad! Does your org have a name?
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.
This isn’t an inherent flaw of public health care. A lot of the health care problems in this country (Australia) stem from a continued disinvestment in the public system after a decade (prior to the current government) of conservative mismanagement. Most state funding here comes from the federal governments standard sales tax. They intentionally gimped our public system to fund a private system that isn’t financially viable. Reversing that is going to take time. The problem exists it’s just important to attribute it to the correct sources. Medicare (our public insurer) is an incredible privilege that we should protect and hold our leaders accountable for managing.
I don't understand where you got that I am saying public health care systems are flawed. Both systems have pros and cons. And I have seen the "going to take time" phrase for quite a long time now and so don't think it holds any value anymore.
In terms of affordability which you also referenced in a separate comment, I disagree. Compared to some prices I've seen in the US, it is cheaper. Compared to other countries I've experienced, it is more expensive. Comparing private and public systems is not straight forward and I don't think this adds any value to the discussion.
In terms of attributing failure to correct sources, Victoria hasn't had a "they"(who you're claiming gimped our public system) for many years now but I am not interested in a discussion about politics.
I think it is mostly just a problem with Victoria - and they are are hardly conservative. Hospitals and ambulance service is a state issue and other states fair much better.
Wow. I didn’t know that things are this way. I am a recent immigrant living close to the city and always seem to be able to see a GP on the same day. Is that because I have private insurance and I pay out of pocket anyways? If I were a citizen, I wouldn’t be able to go to those places (at least for “free healthcare”), and will have the same wait times? Or is it geography dependent with rural Victoria having issues and Melbourne city being well covered?
It depends on the location and it depends on what services you're after. If you have private healthcare insurance, you get to skip the wait times at hospitals and get a choice of public or private hospitals. For clinics, it's a different story and can get quite detailed. The private insurance can help you with the payment there but not wait times.
For some regional and rural locations, the wait times can be better or can be worse than metro depending on the service.
By the way, I also pay out of pocket on top of the medicare rebate so my experience is not with bulk billing clinics. When you get access to medicare, you'd probably still need to pay out of pocket on top of the rebate as bulk billing clinics have all but disappeared. Recent government incentives aim to bring them back but with cost of living increases I doubt that'll work.
With seeing a doctor we have two main systems that you can use and each will have a different waiting time. Bulk-billing and the fully public option has longer waiting times because there aren’t enough clinics/specialists or doctors, The reasons for this are complex but they stem from an unwillingness from prior governments to raise the amount the government pays for each service to adequately to support this system meaning less doctors and practices being willing to support it.
You’ve then got practices/specialists etc… that charge copays and they tend to have less waiting times because less people are willing to pay copays. A lot of these practices will also do outright private billing which is what you’re experiencing.
I pay ~500 US/mo for health insurance. Just for me, no dependents. Not an exotic low-deductible health insurance plan. 2% on top of income tax sounds like a dream.
It's actually anywhere between 1%-5% depending on your income but I didn't want to get too detailed in my comment. And you'd still have the absurdly long wait times. And the out of pocket expenses. Again, not a problem if you can actually make use of what you're paying for.
I do have to state though that the US healthcare system, minus the fact that most healthcare research/advancements happens there, is crazy.
It can be less/more than 2 percent too dependent on income. But yes we are extremely blessed in this country with a healthcare system that isn’t perfect but is extremely affordable.
Sounds like Hatzolah Melbourne, https://hatzolah.org.au since 1994
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
Yes it's Hatzolah. It's a volunteer Jewish organization - run (and paid for) by the local Jewish community, but we respond to anyone who calls us, regardless of background or ethnicity.
(There are Hatzolah organizations all over the world, where there are Jewish communities.)
What about helicopters? Does Melbourne not have/use theirs in those cases or is the system just overwhelmed?
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. A couple minutes earlier basically. No fire engine dispatched but that made sense too as it's volunteer based and while they would've been much closer, getting them to the station would've taken longer than the helicopter.
Driving time for the ambulance if it came from the same place as the helipad would've been about 15 min for the ambulance. Fire engine driving time from volunteer department: 2 min but no dedicated paramedic services, just volunteer firefighters. Heli time in air probably about 2 minutes given the "as the crow flies" distance I just checked, add whatever time is needed to get them in the air and such.
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. For millions of people.
I don't think my taxes/insurance costs/donations to charity are high enough. London (donation funded) has a helicopter service that attends 6 serious trauma cases a day. Denmark, Germany and others has a Helicopter Emergency Medical Service which delivers a senior doctor and paramedic. It probably doesn't scale well.
Basic issues like overhead powerlines make life difficult for helicopters. They are used in rural Australia as an alternative to road, but only due to time saving. In a city, well you get a road ambulance/paramedic/medical team.
The (Melbourne) Victorian Ambulance Cardiac Arrest Registry claims third best in the world in out of hospital cardiac arrest.
First of all, my condolences to the author.
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.
My condolences, very sorry for your loss.
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 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.
There's a lot of interesting research on paramedics vs emts (I believe the term of art is basic life support vs advanced cardiac life support). In areas where there is a good ER, it's better to have low level basic life support and break the sound barrier to the ER than do significant intervention on site but slow arrival at the hospital, as far as I am aware.
There is a chain of things that need to be done
- early recognition - early administration of aspirin and/or nitro if indicated - activation of, and transport to, a hospital with catheterization capabilities.
If medics can show up and do multiple ekgs to confirm and en route, thats even better. But critically the blockage needs to cleared, and they need definitive care (cath lab).
Certainly protocol dependent, and likely more in the paramedic realm.
Is it recommended to take or give aspirin ASAP before the EMTs arrive? If so, I wonder if the dad took it.
Apparently it's no longer recommended, since it could also be an aortic rupture, and aspirin would make it worse. https://www.health.harvard.edu/heart-health/should-i-take-an...
Depends on protocols, but hence why EMS’ job is recognition of the right issue (the best we can do), there are things we can evaluate to determine if we think its an aortic aneurysm even at the emt level to rule that out before making the determination to give aspirin (eg: comparing bilateral blood pressures, checking for pulsating masses)
a heart attack is far more common than an aortic aneurysm.
would comparing bilateral blood pressure (which I assume the patient could do themselves) be enough? I'm not asking for medical advice, just like... what would _you_ do if it was you who had sudden chest pain?
Id encourage you (generally, outside of hn) to lookup the symptoms of a heart attack and aortic aneurysm.
A aortic aneurysm can present with a pulsating mass in the abdomen, and is more common in older people and smokers. The inner lumen of the aorta starts to separate and blood can flow differently or be restricted, eg: right arm bp may be different than left arm. But absence of that doesn’t rule it out entirely.
Whereas a heart attack is going to feel pain in the chest, perhaps radiating to the jaw, shoulder, back, maybe nausea, sweating, and an impending sense of doom.
Automated bp cuffs are pretty inaccurate imo, we use them at the tail end of transport to the hospital and they usually spit out wild numbers. An auscultated bp with a stethoscope and sphygmomanometer is the gold standard.
Bottom line, If you are having chest pain, call 911.
Thank you for sharing.
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.
Yes you could (assuming no allergies or gi bleeds) and just inform the incoming EMTs
How can one preemptively test if they have an allergy? Is there a dosage that is known to trigger detectable allergy symptoms without going full anaphylaxis?
I'm getting up there in age and that is presumably something that I should learn about myself...
As an EMT, I’d say to ask your primary care provider :-)
Don’t want to suggest you do something and end up with anaphylaxis.
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.
Does this mean that someone having a likely heart attack should have someone drive them to an ER in advance of paramedics arriving?
I’d say no if it were my family, and I know the response times in my area, but the story in the blog is a nightmare scenario.
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.
>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
> 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
How does alleged research fraud affect someone’s ability to be a caregiver?
This is the laziest, most egregious "WeLl AkShUaLlY!!!" comment I've seen in a little while. Like, really embarrassing.
> 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...
> This is the laziest, most egregious "WeLl AkShUaLlY!!!" comment I've seen in a little while. Like, really embarrassing.
And yet I haven't heard how this affects this person's ability to be an endocrinologist. Most of any job is routine busywork—and if ethical purity is the requirement to hold a job that impacts the lives of the public, we may never have a politician (or hospital chief) for the rest of humanity.
I am not saying that OP should love their endocrinologist. I am saying that all of this is a non sequitur.
I think the simple answer is: a person who cannot be trusted cannot be trusted with your health.
People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar.
Someone who takes the hippocratic oath and then behaves in this manner is not fit to be a caregiver. Medical care is about more than technical competence.
I’d hate to see the state of the flattened world you seem to be arguing for. Please go read about the origins of professional standards.
> People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar.
> Someone who takes the hippocratic oath and then behaves in this manner is not fit to be a caregiver. Medical care is about more than technical competence.
> I’d hate to see the state of the flattened world you seem to be arguing for. Please go read about the origins of professional standards.
So much pathos—I was responding to an illogical set of statements.
People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar. - or maybe the evidence was insufficient?
> hippocratic oath
https://en.wikipedia.org/wiki/Hippocratic_Oath
I don't see a comment about research standards. Let's stick to rationality here, please.
> I’d hate to see the state of the flattened world you seem to be arguing for.
Exactly the opposite of what I am asking.
> about the origins of professional standards.
The suggestions of your comment have been falling flat, so I'm not going to take this ill-defined assignment. If there are logical statements you wish to provide, please do.
---
Again, the OP did not say anything about malpractice. Had the OP done so, I would have made no comment.
The incidental prior incidence of alleged research fraud has no a priori bearing on why OP did not like this person.
It is not alleged research fraud. It is admitted fraud. The person is saying they sensed something wrong with her. Dishonest behavior is often discernible in advance if you know what to look for.
> Jamal now takes full responsibility and “regrets having exposed patients to the risk of harm by enrolling them in studies which had no value.”
There is no pathos in my comment. Your statement is literally naive.
"all of this is a non sequitur" ... I'm just speechless here. You're so completely off base there's not even any point arguing with you.
> "all of this is a non sequitur" ... I'm just speechless here. You're so completely off base there's not even any point arguing with you.
I am very specifically responding to the post I saw when I made my post.
Here is an example for the HN crowd.
"I really dislike my pointy-haired-boss project manager. He is unreasonable and terrible at management.
I learned that he was investigated at a previous job in computer science algorithmic research at a University—before he ever worked in industry—and ultimately found not liable for this. I am convinced that this is why I dislike my PHB"
---
> I also replied above, so at risk of overextending myself in this thread: you are either too lacking in discernment to effectively have this conversation, or you are willfully arguing in bad faith. You are describing completely different scenarios.
I can't respond to this comment—but if I am "arguing in bad faith" yet responding rationally, we truly cannot have a discussion.
I also replied above, so at risk of overextending myself in this thread: you are either too lacking in discernment to effectively have this conversation, or you are willfully arguing in bad faith. You are describing completely different scenarios.
It would appear fairly clear: she tried to claim a therapy would help someone when it clearly would not and when confronted with this fact, actively tried to hide it. How on earth would you trust such a person to be your caregiver?
> It would appear fairly clear: she tried to claim a therapy would help someone when it clearly would not and when confronted with this fact, actively tried to hide it. How on earth would you trust such a person to be your caregiver?
Where did you derive any of this from what the OP said? He said there was an allegation of research conduct, and this is the statement to which I responded.
Almost all research uses artificial cell lines and animals—where did you get the idea that we were talking about 'a therapy would help someone'?
The original commenter on the subject posted about the doctor Sophie Jamal. She is the person who published a paper suggested a therapy of Nitroglycerin to treat osteoporosis, is she not?
If a therapy that doesn't help is adopted then those that suffer from lack of care as a result are harmed.
She blamed the research fraud on her assistant when she was initially accused of it and denied all liabilities. She only admitted to it after they had her cornered. I had her as my endocrinologist for a while and I would not recommend her. Edit: if you want to have a care-taker who doesn't mind lying or is a psychopath, you do you but it's a no go for me.
> if you want to have a care-taker who doesn't mind lying or is a psychopath, you do you but it's a no go for me.
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.
So if your endocrinologist was found to have ran a concentration camp in the past, it would have no effect on your decision on whether you wanted to use them as your doctor? Running a concentration camp also has no bearing on a doctor's performance.
> So if your endocrinologist was found to have ran a concentration camp in the past, it would have no effect on your decision on whether you wanted to use them as your doctor? Running a concentration camp also has no bearing on a doctor's performance.
The story presented here is that OP disliked their mother's physician. There was no discussion of malpractice. Then, OP seems to have searched for information about the physician.
'Research misconduct' and murdering your fellow man are... not the same thing.
Her behavior is completely psychopathic.
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.
> if she's willing to destroy evidence to avoid criticism, > ts her willingness to lie in the face of failure.
This was not presented in the original post. My question was, why is alleged research misconduct a disqualification?
Also a panel of this person's peers decided she merited reinstatement.
> If a patient of hers dies or starts to decline, she could falsify cause.
Not something that is happening in outpatient endocrinology.
You don’t see how being a dishonest person committing research fraud should disqualify you from treating patients?
> You don’t see how being a dishonest person committing research fraud should disqualify you from treating patients?
Correct. And, a panel of this person's peers found that, in fact, the alleged research fraud should not disqualify the person from treating patients.
Lol the idea that a scamster will only pull one scam in their life is such a gullible position hahaha.
> Lol the idea that a scamster will only pull one scam in their life is such a gullible position hahaha.
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.
But the doctor likely makes the same money for less effort that contributes to the patient dying, because it's hard to prove the link.
> But the doctor likely makes the same money for less effort that contributes to the patient dying, because it's hard to prove the link.
This makes no sense with how endocrinology works. And OP did not give any evidence of malpractice, so we have no reason to believe that less effort or patient risk regarding the practice of medicine was involved.
Well you clearly haven't looked into the opioid crisis.
Wuh wuh.
> Well you clearly haven't looked into the opioid crisis.
> Wuh wuh.
Yes, I have not heard of the endocrinologists who perpetrated the opioid crisis in Canada.
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.
Medicine is a team activity. There is no amount of money which could ever make it feasible to have multiple physicians working simultaneously on routine cases, but they do delegate some tasks to lower licensed providers such as nurses and technicians.
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-...
Short supply, high demand
And imagine if we had the same requirements to write software as we do to perform surgery! Things would be very different.
Yep. I had a misdiagnosis because of a dumbfuck doctor and I’m eternally grateful for the Cleveland Clinic doctor who fixed me up.
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.
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.
Okay, but we're also specifically told to wait for ambulances because they can administer certain forms of care within the vehicle, right?
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).
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.
Perhaps 2020 hindsight, even.
The 2020, in hindsight was largely correct. COVID was a highly infectious disease, it put a lot of people in the hospital, and a lot of people in the morgue. Social distancing and wearing masks slowed its spread, until an effective, safe vaccine was developed. Horse paste was not a cure for it, and after further investigation it turns out that it only had a positive effect on patients who, in addition to having COVID, also had worms. (To the surprise of absolutely everyone, it turned out that giving de-wormer to people with worms improved their health.)
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.
> few details that were gotten wrong during the fog of war
It’s fine to have your opinion but don’t dismiss others’ experiences and values.
The extreme lockdowns caused irreparable, long-term harm to many people. You’re glossing over this as if it’s a minor error that anybody could’ve made, which is not correct.
It is essentially a trolley problem. You value “extreme intervention that is statistically better overall but unnecessarily devastating to some”, whereas many other people are happy to let nature run its course to some extent than have their government turn against them “for the needs of the many”.
That is a moral discussion, not a scientific one, and people are rightfully angry when it’s misrepresented as purely a scientific one.
Every time I give this opinion I’m labeled as an a to science/anti vaxxer. Hopefully this context will help: I have virus induced asthma where even a simple cold can have me gasping for breath. I took every precaution imaginable before the vaccines were available, stayed home, got groceries delivered, masked up when I did have to go somewhere, asked my wife to retire from working in the school system as a special needs bus driver, etc. I got in early when the J and J vaccine was available and I got an mRNA booster before it was recommended in the US when I saw other countries health departments recommended.
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
> 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.
We have specific evidence that not masking and not distancing caused superspreader events. Before there were too many cases, contact tracing backwards showed that specific parties, weddings, etc. were responsible for accelerating the early spread above baseline.
Thus, the burden of proof is on the "anti-mask, anti-distancing" people to prove that they aren't worse than the alternative--doubly so given the post hoc analyses available due to Norway and Sweden.
This is very conspiratorial thinking.
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.
[1] - https://web.archive.org/web/20250628065433/https://www.nejm....
I get that in some societies there is a quick journey from something bad, to someone-to-blame. In litigious societies this means a quick trip to sue someone, anyone...
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.
My vent: I have very mild cerebral palsy- it affects my left hand and left foot slightly. But properly conditioned, I’ve run half marathons and ended up in the middle of the pack and I’ve been a gym rat and in above average shape all of my adult life.
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.
> 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.
you dissected the blog post to ascertain how bad you thought traffic would be at that hour. that's actually what made me notice the timeline she had established and the appearance that it seemed to get more severe later.
Yes they send fire here in Toronto too. They frequently beat the ambulance. And yes they prioritize heart issue above all else too.
>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.
What country was this?
Australia.
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.
Something similar happened to a friend of mine. In San Francisco. I just sort of assumed it was just bad luck. Bad things happen occasionally even in good systems. But maybe that assumption is wrong? Is this a thing? Are ambulances just unreliable?
It Depends. It's going to depend on your location, how your health system works, and a bunch of luck.
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.
FWIW, I also live in Toronto and been in an ambulance a fair few times (generally for false alarms that were still worth checking out); I can't recall it ever taking that long for an ambulance to arrive, even reporting less severe symptoms.
It's not moloch. It's all health systems, even ones that are religiously oriented. Triage and logistics and having enough trained people working all hours to handle all cases of life threatening situations... it's a bug in all systems.
Nothing is scarier than the moment you realize you're in the hands of the medical establishment. Whatever that looks like, wherever you are. Ever tried to rush a mechanic to fix your car? Ever tried to argue with a gate agent at the airport about rebooking a cancelled flight? Now imagine doing that while your heart is failing and 10,000 other people are also trying to get their attention.
If you want to blame anything, blame the fact that our society has failed to produce sufficient numbers of people trained or willing to help in emergency situations. And the people who sacrifice their lives to doing it are heros, the finest of us. The difference between individual societies and governments is quite small in the long run.
I'm really sorry about your dad.
I bet he's proud of you for writing and sharing this to help others.
The state has an incentive to encourage callers to wait for trained emergency drivers. Nobody wants mom in a panic and flying through red lights at the intersections. Or worse, my former teacher drove himself to the ER while in the midst of a heart attack rather than wait for an ambulance. He didn't survive the attack but made it to the hospital without incident.
This story reminds me of how the high schoolers on the Korean ferry MV Sewol obeyed the instructions to stay in their rooms.
Just read about it on Wikipedia. Straight up murder. This isn't "you shouldn't follow instructions" but more "dont get murdered".
They 2x overloaded cargo, made it loose, captain abandons ship while staying in place order remains.
Yeah this is really way out there. The crew and captian straight up murdered those passengers. There was literally no reason to tell the students to stay put there were even rescue boats available.
For me the common element is in how people trusted authority when that authority issued instructions which seemed reasonable but turned out to be deadly. The character of the MV Sewol's captain isn't material.
I don't have this one in my memory but... high schoolers? I'm not going to look that up.
There are a few docs out there on it, extremely extremely extremely insane/sad situation. https://www.youtube.com/watch?v=5_A8dq2fA5o
Some haunting cellphone video from the students' view:
https://www.youtube.com/watch?v=9U-TQrxBOxY
https://www.youtube.com/watch?v=nZuex_dnpBM (23-minutes of more raw video)
Also the Grenfell tower fire
My grandfather died at a hospital in South Africa in 1997 after experiencing chest pain. Apparently, he went to reception, and they told him and my uncle to take a lift/elevator up to the ward, and he died in the lift. I was told afterward that it's a no-no to exert oneself during a heart attack. No idea if that's true or not.
Anyway, not second guessing OP, just putting it out there.
What is not excusable is why he was told to wait. A man dies because a rent-seeking bottleneck of corruption sat between him and his doctor.
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.
And people wonder why Luigi Mangione had such wide appeal for so many people. It's not that what he chose to do was morally right (personally I dont condone it at all), more that he represented someone trying to do something about the disease you mention.
I’ve been reading Influence by Robert Cialdini and just finished a disturbing section about how we are wired to obey an authority figure even when it causes harm. In this instance, the 911 dispatcher was the authority figure. Sad story.
Causes harm is the hard thing to know. In the London Grenfell fire the dispatchers said stay in the appartment. This is correct advice, except when some dodgy supply chain middleman puts effectively what amounts to gunpowder up all the external walls.
During the 9/11 attacks in NYC, the folks in the second tower were instructed to stay in the building after a plane struck the first building. Also good advice until a second plane struck.
It's like we're wired to trust what we're told over what we see.
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?
From the caller's perspective the dispatcher is the authority figure. But that person is just at the bottom of a pyramid. The supervisor, the section manager all the way to the CEO and shareholders.
In such cases how do you in advance what causes harm? Waiting for the ambulance or driving yourself? People died also because they didn’t wait for an ambulance.
(Not GP): Heart attacks and strokes are the two things where I will always load family members into the car and get to the hospital as quickly as practicable. Time is brain, and time is heart. I’d call 911 on the way and have them notify the hospital what’s going on.
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.
See also the Milgram Experiment.
Doesn’t fit here because you don’t know if obeying or ignoring causes the harm.
The comment I replied to mentioned Cialdini's Influence:
> 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.
The post mentions Toronto, so I'm going to assume that the publicly funded Canadian health care system bears some responsibility for the sad outcome.
Yes. If emergency services were run by a private company, like airlines for example, they will never ever be 30 minutes late!
My dad also died of a heart attack at 57. I am so sorry to hear this. Thank you for writing it, theres a powerful message in there I think more people need to think about. Sending love and prayers your way.
This is horrible. What is going on in Toronto that ambulances take 30 minutes to respond?
https://www.cbc.ca/news/canada/toronto/toronto-paramedic-sta...
> 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.
There were several reports during the pandemic about lack of ambulance service in Toronto:
- 2022 - https://www.blogto.com/city/2022/01/toronto-ran-out-ambulanc...
- 2023 - https://www.blogto.com/city/2023/10/paramedics-raise-alarm-c...
from the 2025 Program Summary for Toronto Paramedic Services, https://www.toronto.ca/wp-content/uploads/2025/04/8d5d-2025-...:
- Page 3
- Avg 90th Percentile response times have gone from 12 minutes in 2019 & 2020 to 14.5 mins in 2024 and almost 15 minutes as a 2025 target: (12.1, 12.1, 13.0, 14.2, 14.0, 14.5, 14.8)
- staffing is up more than 50% in that time, while number of patient transports is up just 10% during that same timeframe
- Page 4
- scary graphic - graph concerning Daily Hours with < 10% available ambulances
- 2019-2020 - Daily Average - 0 hours, 43 minutes
- 2021 - Daily Average - 2 hours, 29 minutes
- 2022 - Daily Average - 5 hours, 57 minutes
- 2023 - Daily Average - 4 hours, 33 minutes
- 2024 - Daily Average - 4 hours, 9 minutes
Healthcare funding is managed provincially and the Ontario government has been poorly managing the system, pretty consistently, for over a decade. Some would argue decades, but things do seem to be steadily declining post Covid, as they were pre-Covid. Over the last few years, several ERs have been experiencing intermittent closures, and at least one was closed permanently, due to staff shortage.
What's worse is that the closures are poorly communicated. I know of at least two people who, within the last couple of years, went to an ER only to find it closed.
With respect to Toronto, and more specifically ambulance services, they are jointly funded by the province and the city, but I understand that provincial funding is more significant.
All parties recognize things are not functioning well, and various attempts at increasing spending have been made, but any effort will take significant time before results are visible. I'm not particularly optimistic, and the current provincial government's track record here is dismal. Their policy is to be tight-fisted.
I’d assume it’s there’s X ambulances and Y calls and occasionally Y>X.
The bigger issue is the dispatcher not being aware of overloaded status nor conveying that information to the caller.
There are also things like accidents or traffic jams
Toronto healthcare generally is quite below the bar. When I moved here 5 years ago, I was told that hospitals are short staffed, ambulances have significant delays, and when you do finally get care you are rushed through the system.
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.
TL;DR chronic underfunding of the system, here's one example article:
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).
Healthcare is one of the exclusive powers of the provinces, as laid out in the constitution. There are things the federal government can do, such as provide money, but provincial leaders complaining about lack of federal involvement do so in bad faith; they would certainly complain louder if the federal government overstepped their bounds. It's worth pointing out that taxation and borrowing are also constitutionally protected powers of the province.
> The federal government shifts the responsibility to the provinces
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.
If the author sees this, I'm sorry for your loss.
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.
My sincere condolences to the author. Wishing you strength and peace.
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.
> There's a need for an app to let patients track the ambulance
I don't want to blame anyone, but I'm pretty sure that kind of visibility is not desired.
Not desired by whom? I think transparency is desired by citizens/customers. Do you think there are (good) reasons why obscurity is preferred?
FWIW: In Sweden, there's been a bunch of cases of emergency personnel being attacked when responding to incidents
I understand, I know it's a problem in France too, even in hospitals. Or Firefighters being called only to be attacked...
However that exists already, without a way to track the rescue team sent to you...
Personally I see plenty of problems with a real-time public broadcast of all the addresses a medical event has occurred at, the patients' location in transit, and the hospitals that received those patients.
"Ambulance chaser" is a rather derogatory phrase for a reason.
I'm certainly not suggesting that. Read on.
An emergency dispatcher could send a Text message back with a link to a private, case-limited, web page with an ETA + a map + the ambulance location in real time.
See? no "real-time public broadcast of all the addresses a medical event has occurred at".
Very sad, for more reasons than one. For pretty much everyone, heart disease is totally preventable now. If you’re over 30, get your ApoB checked (non HDL cholesterol is a proxy), and if it’s high, get a calcium scan on your heart. If you score above zero, get your ApoB down as low as possible (which will probably require drugs - diet barely moves the needle on this for most people). Low ApoB -> no heart disease.
Source: Peter Attia
I’m so sad to see this. For anyone who reads this, get a day, learn CPR, and buy that machine if your parents or whoever has history of heart issues. The machine doesn’t fix every kind of heart diseases but the trainer told me it decreases the possibility of death from a heart attack greatly. I recall that the possibility is lowered by 50% if you do CPR and 80% with the machine.
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.
Alas the data doesn't agree: "Bystander-initiated CPR may increase [survival] odds to 10%"
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.
yet it can help. no direct counter stats to your stats but different data: https://www.mediconefoundation.org/whyandhowtohelp/ https://newsroom.uw.edu/news-releases/study-spotlights-cardi...
getting compressions going and getting an AED onboard is the focus of this program. that means getting people and responders trained on CPR + AED.
This was the first heart attack.
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.
Which machine? Defibrillator or EKG?
I'm sorry this happened to you/Jenn.
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.
Let me add one thing: high blood pressure is both very bad and sometimes has no clear tell signs, and cake people doing sedentary work like IT folks it's very common. Get tested regularly.
Someone, please, for the love of all that is holy: Set up a website with information on how to reach emergency services from x to y country. People are literally dying here.
I once tried to call an ambulance on an active suicide attempt in the United States (while I myself was in Europe).
Problem 1: What number should I call? My country's national emergency line could not help and had no direct communication with ANY emergency services in the USA. Unable to find the phone number for EMS in the USA, I called the local police department which was answering their regular phone line at that time.
Problem 2: This requires long distance calling and local police departments do not accept collect calls.
Problem 3: Police receptionist was hesitant to connect me to dispatch but did so anyways.
Problem 4: I am now easily 10-20 minutes into making an emergency phone call and I haven't even talked to anyone able to help me.
Problem 5: Ambulance took another 10-15 minutes to even show up.
I explicitly stated "they just took pills, they have no neurological symptoms right now, do not leave immediately."
Problem 6: Ambulance left after a simple "it's a prank call" given at the front door.
Not much later, this person started showing severe neurological symptoms. I repeated the call, told them they were now actively dying and needed help. Luckily an ambulance came and helped this person, but it was an incredibly close call.
Thanks to this I looked where my nearest ER is and found that it's 7 minutes away, so I can't imagine calling an ambulance for my wife unless I was worried about her spine. (I don't think she can lift me so the reverse isn't true.)
> 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.
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.
My condolences.
Did the ambulance ever show up to your house?
Really sorry for you man! May his soul rest in peace.
First, I want to offer my condolences to the author. I lost my father suddenly at a similar age—it's terrible. Sending positive energy. Former Firefighter-EMT here — I did this a long time ago in a rural setting). Now to the practical matter. I want to offer some frameworks for thinking about this in rural or exurban transport situations. This is not risk-free or even optimal, and can put you in worse position, but it's worth considering seriously if you suspect you may have a very long or delayed transport time to the hospital.
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.
Excellent summary!
It is terrible to lose a relative in young age. But at least 80% percent of all heart diseases are known to be fully avoidable. The risk factors are known for ages and as matter of fact every adult is fully responsible to care for his own health. The right thing to do, is to watch out for a healthy diet.
There's another scenario where someone heads to the hospital and get stuck at a red light or behind and accident or you're speeding and kill someone. It's just hard to know sometimes which path to pick when you don't have a guaranteed outcome on either one.
In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.
This just doesn't seem like it takes probability into account. Getting someone to the hospital fast is almost always going to be better than waiting, and moving someone isn't usually inherently damaging if they don't have a spinal injury. In the context of a heart attack, it seems indisputable to me that it is better to drive if you have a safe and sober driver available.
It isn't all about getting somebody TO the hospital but getting them INTO the hospital/ED/ER. EMS in an ambulance who are alerting a hospital of an MI enroute will get their attention, a walk-in will have to wait unless there are obvious signs.
Calling 911 will normally get LEO on scene that know CPR and can do radio communications. A lot of dispatchers are EMDs (emergency medical dispatchers) that can start helping immediately. You may have off duty EMTs nearby that are scanning the radio. Finding a fixed target it much easier than finding a moving target (white car headed towards hospital), you are on your own if you get stuck in traffic. Statistically, 911/EMS is the best outcome. I agree with another commenter, exceptions do exist.
test
> 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.
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.
>The primary goal of the state is to ensure the power of the state is perpetuated.
Well, that makes sense considering failure of the state is a very, very bad situation.
Such a tragedy, and I'm really not surprised it happened in Canada. Our healthcare system here is utter garbage and there isn't really any political will to do anything about it because "it's better than the Americans at least" (it's not). I don't buy that it's underfunded either, it's just sorely mismanaged and nobody wants to build or grow. Even a child could tell you if you increase the population of a country by 10% in ten years, you also need to grow its infrastructure by at least that amount - but our political class are idiots and haven't even considered it. After all it's not "green" to build more hospitals. And thus we get situations like this where there literally aren't enough ambulances to handle the load.
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.
Not 10% population increase in ten years, it was 10% population increase in 3 years. (An increase in immigration rate of 4x over those three years compared to the previous 20 years - makes the USA's southern border influx look minor in comparison)
And the population increase wasn't spread evenly across the country...
[flagged]
>family members were too naive to know that the thing they were instructed to do by the state was a false thing
Would be interesting to see everyone who jumped in here yesterday [1] to comment on this one as well.
1: https://news.ycombinator.com/item?id=45889297
The problem with Canada and the USA is that there's no educated ideology primed to capture the inherent distrust people have of systems that used to work and now don't, such as government authority.
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.
>Authority should be justifying its competence to tell you what you should be doing with every decision it hands down.
1,000%
What terrifies me personally is that people with 2-digit IQs are apparently being employed in virology labs. That's the kind of realization that could undermine anyone's confidence in government.
I don't know that there really exist any jobs where someone with a 99-IQ who's hard-working and dedicated to getting through the hiring process would never get hired.
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.
Canada has experienced an unprecedented spike in both legal and illegal immigration over the past decade of Liberal rule. Every system has its carrying capacity: the health care / EMS system is overloaded (and underfunded). This no doubt contributed to that ambulance not arriving in time.
If Canada just made those illegal immigrants legal, they could volunteer for EMS training, work on ambulance crews and staff hospitals. Open the borders and let the people work god damnit!
Immigration is like the free square in Bingo. It can be the cause of any problem you want!
In fairness it is actually causing a lot of problems in the West...