u.s. doctor tells inquest b.c. 911 operators don't use best approach to cardiac-arrest calls
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sidney mcintyre-starko's mother, father and brother hold her hand while she was in critical condition in hospital. photo courtesy sidney's family. for lori culbert.
family photo
the software used by 911 call takers in b.c. can delay getting help to people in serious medical distress, an american doctor and cardiac-arrest expert testified at a coroner’s inquest on wednesday.
any time someone in b.c. phones 911 for an ambulance, the call-taker, who typically has no medical training, asks a list of questions. the answers are entered into a computer program that eventually determines the type of emergency and what level of ambulance to send.
this system, owned by the american company priority dispatch and used across canada, takes too much time, argued michael kurz, head of emergency medicine at the university of chicago.
“the minutes that i may use in order to get to that answer … are the minutes that matter to someone in cardiac arrest surviving or dying,” said kurz, an emergency physician whose research focuses on treating cardiac arrests.
kurz testified wednesday at the coroner’s inquest into the 2024 drug-poisoning death of university of victoria student sidney mcintyre-starko, whose friends told 911 that she was “seizing” and turning blue. that led the call taker into the computer system’s 911 protocol for seizures, rather than for an overdose, and sidney would not get the cpr she required for 15 minutes.
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by then it was too late.
people at the scene described sidney’s breathing as faint and shallow, and kurz said that should have prompted an immediate ambulance dispatch rather than the call taker continuing to ask a series of questions about her apparent seizure.
“the point is that (the breathing) is not normal, and that is all the information that should be necessary in order to dispatch the appropriate response,” he said.
kurz testified that he was the lead author of a 2020 american heart association policy statement that advocates a so-called “no, no, go!” system for emergency dispatch.
that involves asking a person phoning 911 two simple questions which can be asked by any lay person, including children: is the patient conscious? is the patient breathing properly?
if the answer is “no” to either question, the highest priority ambulance with the most skilled paramedics should be dispatched. and cpr should be initiated, he said.
when these types of peer-reviewed position papers are published, they are generally adopted as the “standard of care” in the medical community, kurz said. he tried to speak with the priority dispatch owners about changing their system to use the “no, no, go!” formula, but testified that they have not made the change.
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the international academies of emergency dispatch, which approves protocols for the priority dispatch computerized system, objects to implementing “no, no, go!”, said brett patterson, chair of the academies’ medical standards council.
that policy would send an ambulance immediately “with not much regard to safety at the scene, or what the actual situation is at the scene, or whether it’s normal not to be breathing for that particular case,” said patterson, a paramedic.
“what we do as an alternative is much more complex than that.”
the priority dispatch protocols identify when emergencies, such as a confirmed cardiac arrest, require quick action.
patterson insisted the call-taker was correct to choose seizures as the chief complaint for this case, even though she had concerns it could be an overdose.
“the chief complaint is what the call taker has interpreted the description as, and there’s a tremendous amount of reliability with the complaint of seizures. … so we do not encourage the call taker to question what the caller is telling us,” he said.
“i found nothing wrong with the pathway the dispatcher took. it took awhile to get there because the answers were ambiguous, and she was dealing with two patients.”
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patterson, though, agreed with sidney’s family’s lawyer anthony vecchio that between 2020 and 2023, the leading cause of multi-patient 911 calls was overdose. and that seizing can happen during overdoses because of a lack of oxygen getting to the brain.
kurz maintained that instructions to start cpr or send an ambulance are too far down priority dispatch’s protocols.
“the concern i have, and why i’m testifying today, is because i think the order in which they choose to do it is incorrect,” said kurz, the former medical director of chicago’s emergency services dispatch.
under questioning by the b.c. ambulance service lawyer, kurz acknowledged the burden on the public heath system of sending the highest priority ambulance to someone who might not need it after all. but he argued that is the trade-off for saving lives.
“i absolutely understand the stress that puts on the system,” he said.
the elephant in the inquest room on wednesday was that this type of response will cost more money, and potentially require an expansion of the ambulance service.
none of the lawyers representing the province, the ambulance service or priority dispatch asked directly whether this computer software was designed to save the province money.
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they did, though, probe kurz about why his system may not work every time: there will be situations when a patient doesn’t require a lights-and-sirens response, or that applying cpr unnecessarily to patients could result in breaking of ribs.
he agreed those were true, but worth the risks.
“this is a messy business, which is why we would rather err on the side of caution, err on the side of maximal response and provide it.”
kurz’s aha policy statement has been endorsed in some u.s. states, but he could not say how many.
it has also been endorsed by the international liaison committee on resuscitation, of which the canadian heart and stroke foundation is a member.
canadian provinces or municipalities that have contracts with priority dispatch for this software would not be able to adopt “no, no go!” on their own, he added.
kurtz acknowledged “no, no, go!” would require someone waiting for an ambulance for a lower-priority injury to potentially have to wait a little longer.
the vast majority of 911 calls are not for cardiac arrest, he added, but when they are time is of the essence. he said the window to get those patients life-saving help is “vanishingly small.”
you can follow ongoing coverage of the inquest here:
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