Oct 20 2009

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from Canadian OH&S News Tetracycline Minocycline, The improper execution of a safe-work procedure on the part of Toronto paramedics this summer has come under the spotlight after a patient they were to attend to died following a 38-minute wait.

An investigation by Ontario's Ministry of Health and Long-Term Care into the June 25 incident, released publicly on October 8 by Toronto Emergency Medical Services (TEMS), concludes the "preventable delay" was caused mainly by the actions of the two responding paramedics, and that the wait was exacerbated by the actions of two TEMS dispatchers and a supervisor. 750mg Tetracycline Minocycline, "This delay was caused primarily by the inappropriate decision made by [the paramedics] to park their ambulance... away from the scene without obtaining sufficient information, either by assessing the scene or by requesting further information from the dispatcher," the report notes.

The paramedics opted for a staged response - a procedure whereby they wait a safe distance from a potentially dangerous scene until it is cleared by police - because of their concerns about their own health and safety, investigators indicate, 30mg Tetracycline Minocycline.

Bruce Farr, chief of TEMS, says in a statement that he wants to assure the patient's family and all Torontonians "that we have learned from what transpired and will take action to strengthen existing policies and procedures so that this situation can be prevented in the future."

Investigation spurs 13 recommendations
In all, the health ministry investigation prompted 13 recommendations to TEMS covering areas such as remedial training for staff involved in the incident, review of the TEMS staging policy and requirements around emergency call processing and documentation, Tetracycline Minocycline. Many of the recommendations, TEMS notes, are already being addressed.

The following timeline, 100mg Tetracycline Minocycline, based on the health ministry's investigation, details some of the key events surrounding the incident:

- Just after 11 pm on June 25, ambulance dispatch receives an emergency call about a man who had been found lying in a hallway on the main floor of an apartment building at 40 Alexander Street in Toronto. The caller notes the man appears to have fallen and hit his face on the ground, resulting in a gash. It also appears as though the man is drunk, Tetracycline Minocycline mexico. Tetracycline Minocycline, - At about 11:07, a TEMS ambulance with two primary care paramedics (PCPs) is assigned to the call. Seven minutes later, they advise dispatch that they are staging nearby the apartment building (citing concerns about potential violence), and request notification upon police arrival at the scene. Dispatch notifies the paramedics at about 11:17 that police have not yet assigned officers to the scene. Tetracycline Minocycline us, A TEMS supervisor, notified of the staged response at about 11:19, says he will "keep an eye" on the event.

- Police dispatch officers at about 11:35. Minutes later, at 11:37, ambulance dispatch receives a second update from building security officials indicating the patient is no longer breathing and that CPR has been underway for 10 minutes, Tetracycline Minocycline. At about 11:39, the paramedics tell dispatch they do not feel safe approaching the scene, Tetracycline Minocycline ebay, at which point they are notified that the fire department and two advanced care paramedics (ACPs) are also en route.

- Firefighters enter the apartment building at 11:42. About one minute later, the ACPs and PCPs reach the building. Tetracycline Minocycline japan, Police arrive at about 11:48. Tetracycline Minocycline, The patient is declared deceased at 12:07 am.

Under provincial regulations and TEMS policies on staging, the two PCPs were required to get as close to the scene as possible to assess the suspected safety concern. The investigation faults the paramedics for making the decision to stage "based upon very little known information as to what had, or was, occurring on scene." Also, Tetracycline Minocycline australia, they "made no attempt to request additional information from the dispatcher."

At the same time, investigators note the TEMS supervisor contravened operating policies when he failed to attend the scene or to make direct contact with the paramedics to discuss their reasons for staging. Two ambulance dispatchers were faulted for failing to, among other things: appropriately prioritize the emergency call, Tetracycline Minocycline india, document important information on the patient's condition and the scene, and, upgrade the call's response priority at the appropriate time.

All five TEMS staff have been reprimanded, says Kim McKinnon, a spokeswoman for the service, Tetracycline Minocycline coupon. Punishment has included suspensions of between 10 and 17 days, the aforementioned remedial training and six to 12 months of individual performance monitoring, Tetracycline Minocycline.

Roberta Scott, public relations director with the voluntary Toronto Paramedic Association, says she's concerned that the current focus on staging may ultimately prompt paramedics to take unwise risks. "That could just be dangerous for the paramedics," she says. "It's an awful situation to be in," Scott adds, referring to the judgement calls that are inherent in deciding to stage.

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