This story reminds me of how the high schoolers on the Korean ferry MV Sewol obeyed the instructions to stay in their rooms.
replies(3):
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.
Would be interesting to see everyone who jumped in here yesterday [1] to comment on this one as well.
> 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.
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.
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).
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.
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.
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.
It does get easier to deal with, in time.
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.
In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.
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.
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.
I lost my brother to a heart attack aged 50, but he died immediately. In the end it was very quick, but he had warning signs for years. Look after yourselves, people.
The same politicians that would say this is a tragedy in one breath will send millions to early grave in the next so long as it could line their own pockets.
We live in a world diseased by greed.
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.
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.
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...
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....
How does alleged research fraud affect someone’s ability to be a caregiver?
They 2x overloaded cargo, made it loose, captain abandons ship while staying in place order remains.
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.
https://www.youtube.com/watch?v=9U-TQrxBOxY
https://www.youtube.com/watch?v=nZuex_dnpBM (23-minutes of more raw video)
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.
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.
I'm sorry if I'm ranting under a post about a father's passing, but tragedies like this are so avoidable that it practically sends me into a rage. This person should still be alive, she should still have her father. Fuck sakes.
I am a Canadian Paramedic (EMR soon to be PCP in a few months, roughly equivalent to EMT and AEMT respectively). Some things strike out at me:
- Here in BC our calltakers can advise patients on some treatments. I'm sure if that were to happen here, they would have advised the family to administer some ASA (Aspirin) to the patient which would have bought valuable time until professional care could be reached. Even if it was found to be contraindicated, the fact it was not mentioned in the blog post stands out to me.
- I'm not familiar with the geography of Toronto or its normal traffic patterns, but it's surprising that a single ambulance was not 30 minutes from the patient driving lights and sirens at that time of night (shortly after dinner).
- Fire crews here in BC are dispatched to severe medical incidents (like heart attacks) and most of the time can even beat ambulance crews to a scene. They would have been able to provide CPR if needed, possibly even ASA or Nitro depending on their scope. So again it's surprising that there's no mention of them. Perhaps they aren't dispatched to medical calls in Toronto?
- Lastly it's surprising that the calltaker had no visibility on where the dispatched crews were at. At the very least they could have radioed the crew to get an ETA. I guess I just take it for granted that over here we are tracked as soon as we sign in to our vehicle (it's a safety thing especially in some of our more rural/remote stations). If the ambulance was just about to reach the patient right before the family decided to go to the hospital on their own, things might have turned out differently.
Also since I'm assuming that a large percentage of HN readers are older males who are at risk of a heart attack (due to factors like working desk jobs and not keeping up with fitness as much), read up on the signs and symptoms of a heart attack and keep a bottle of aspirin at the ready. Bodies are complicated and weird and you never know.
1,000%
> We're told a lot of things by "officials" not because it's correct
What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dealing with high stress and low information settings.
BUT being statistically correct does not mean correct. For example, if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
The world is full of edge cases. This is a major contributor to Moravec's paradox and why bureaucracies often feel like they are doing idiotic things. Because you are likely working in a much more information rich environment than the robot was designed for or the bureaucratic rules were. The lesson here is to learn that our great advantage as humans is to be flexible. To trust in people. To train them properly but also empower them to make judgement calls. It won't work out all the time, but doing this tends to beat the statistical rate. The reason simply comes down to "boots on the ground" knowledge. You can't predict every situation and there's too many edge cases. So trust in the people you're already putting trust into and recognize that in the real world there's more information to formulate decisions. You can't rule from a spreadsheet no more than you can hike up a mountain with only a map. The map is important, but it isn't enough.
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.
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.
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.
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.
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?
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.
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
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-...
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
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.
> 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.
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)
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.
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.
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.
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.
I've been thinking of joining that.
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.
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.
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.
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.
Source: Peter Attia
I'm getting up there in age and that is presumably something that I should learn about myself...
> 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...
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.
a heart attack is far more common than an aortic aneurysm.
Don’t want to suggest you do something and end up with anaphylaxis.
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.
She started breathing again after a few minutes and seems fine, but they left the UK not long after that.
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.
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.
Well, that makes sense considering failure of the state is a very, very bad situation.
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.
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.
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.
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.
"Ambulance chaser" is a rather derogatory phrase for a reason.
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'?
- 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).
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.
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.
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.
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.
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.
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.
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.
> Wuh wuh.
Yes, I have not heard of the endocrinologists who perpetrated the opioid crisis in Canada.
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?
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.
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.
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"
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> 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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
- 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
getting compressions going and getting an AED onboard is the focus of this program. that means getting people and responders trained on CPR + AED.
* 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...
Anyway, not second guessing OP, just putting it out there.
> 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.
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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.
(There are Hatzolah organizations all over the world, where there are Jewish communities.)
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.
And the population increase wasn't spread evenly across the country...
> 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.
edit, to add this old gem: "I want to die peacefully in my sleep, like my grandfather. Not screaming and yelling like the passengers in his car."
I do have to state though that the US healthcare system, minus the fact that most healthcare research/advancements happens there, is crazy.
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".
If a therapy that doesn't help is adopted then those that suffer from lack of care as a result are harmed.
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.
Then there were aspects that we had pretty quickly figured out made no sense (no hiking by yourself, no leaving to do solitary things). Worse, they were broadly ignored by most people-- I was worried I'd get busted in a parking lot with my telescope when I knew people who were having dinner parties.
Then the very strict orders continued well after the containment was ineffective and the rest of the country had, to some extent, eased up. A couple of weeks to flatten the curve became "wait until there's a vaccine" which is not what we'd all signed up for, and unnecessarily restrictive even for these purposes.
It would have been better to pick a "set point" for policy that could have been actually upheld, rather than setting a very strict policy that was often ignored and then enforced arbitrarily.
But unfortunately:
> 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.
I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.
Yes!
My own story of heavy industrialized medical process goes the other way. My daughter could be dead, but she isn't. At birth, she presented with some abnormalities around her stomach. Not good. We lived in a somewhat remote location where the hospital's capacities were modest. Really not good.
Within 8 or 10 hours of birth, she and I were aboard the smallest plane I've ever been on, with a pilot, and neonatal specialist nurse and respiratory therapist (all had arrived on the plane). Daughter was in an incubator and I couldn't touch her.
Five or six hours later we were in one of the largest children's hospitals in Canada. Another hour or two and a probable diagnosis was sussed out, and a plan made for a surgical exploration / opportunistic fix.
I'm at an age where there are real professionals who register to me as children, and in the pre-op meeting, this is how the anesthesiologist struck me. He was even wearing a Star Wars t-shirt. I didn't mind either the age or the t-shirt, but it was jarring because it situated me somehow as a more responsible participant in the whole situation - a grown-up. Failing to tell him to use the force will proably be the esprit d'escalier that follows to my grave. (I mean, don't turn off the targeting computer, but use the force too.)
Anyway. Another six or seven hours - the worst of my life by far - and finally the good news emerges. Seven years ago now.
There were probably close to 100 people directly involved in providing care to her that day, and I couldn't imagine the number for indirect involvement.
To be honest, all of it was the first experience of gratitude in my life.
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We are all burned daily by the rough edges of our approximating policies and norms - life's outrageous slings and arrows.
I'd spent a lifetime being too smart and too aloof to be impressed with anything. Suddenly the most important thing to have ever happened to me went sideways, and put me completely at the mercy of the great machine. It really came through for me. It's a good time to be alive.
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aside: People will have lots of reasonable principled and pragmatic objections to $MEGACORP laundering image via $OUTREACH_EFFORT, but I'll also take the moment to say that Ronald McDonald House is the real deal. Lifesaver. Extraordinary reach to provide a sense of "new-normalcy"
utterly snide and unnecessary dig: The weakest meal (although not bad by any means) that I had at McDonald House came from Microsoft. Hard for a tech company to compete with groups named "3rd Street Grandma's Club" in terms of banger comfort food. Thanks for the pizza, MS.
He is dead from a heart attack. If dispatch, EMS, hospitals, etc. didn't exist doesn't mean he would be alive. They didn't kill him, they failed to save him.
The other article I saw was how the hospital "killed" a drowning victim. Water was never mentioned.
There are many failures in our systems. There will always be exceptions to rules. It is a heart-breaking story but at the same time it is impressive. Maybe the system failed on this call but the fact that their is a system with this many resources is amazing. Hit 3 digits on the phone and LEO, EMS, Fire are all alerted 24/7 us pretty impressive to me.
I answered your question clearly: research misconduct and her reasoning for it indicates a willingness to lie that should not be allowed in a high trust field such as medicine. She has been banned from receiving Canadian federal funding for life. Her medical license was reinstated but it was a split vote (3-2) and widely criticized, but she is banned from conducting research and has to be monitored by a therapist.
I get that you like to argue, but you should probably learn to admit when you're wrong.
I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it.
But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.
The moloch reference is a shibboleth for the rationalist community. It’s not an actual religious reference. There’s another reference to “updating” further down which is another rationalist term meaning “updating your priors”.
A bunch of people don’t even have a primary care provider now.
> I expect the operator just is not allowed to give advice like that
I also want to say that I'm giving this advice as someone who loves math, data, and statistics. Someone who's taken and studied much more math than the average STEM major. It baffles me how people claim to be data oriented yet do not recognize how critical noise is. Noise is a literal measurement of uncertainty. We should strive to reduce noise, but its abolishment is quite literally impossible. It must be accounted for rather than ignored.
So that's why I'm giving this advice. It's because it's how you strategize based on the data. All data needs to be interpreted, scrutinized, and questioned. And constantly, because we're not in a static world. So the only way to deal with that unavoidable noise is to have adaptable mechanisms that can deal with the details and nuances that get fuzzy when you do large aggregations. In the real world the tail of distributions are long and heavy.
A rigid structure is brittle and weak. The strongest structures are flexible, even if they appear stiff for the most part. It doesn't matter if you're building a skyscraper, a bridge, a business, or an empire. This is a universal truth because we'll never be omniscient. As long as we're not omniscient there will is noise, and you have to deal with it
Whether the success or failure of the state is good or bad for people is irrelevant to the goal of the state, as I said. You can and do have states that are better or worse for the people, all share the goal of the perpetuation of the power of the state.
Link (Spanish): https://www.elespanol.com/alicante/vega-baja/20251028/hijo-c...
A helicopter seems like it would be pretty useless for landing in an urban area. I can't imagine winching is risk-free or would save much time, and you can probably put many more ambulances on the ground for the cost of a single air ambulance.
That must be a great deal for the insurance company. If it takes multiple years to get an appointment, they must pay out significantly less claims as well.
Sadly, A heart attack can be fatal even with immediate medical intervention at a hospital. A defibrillator can only correct certain kinds of abnormal heart electrical activity.
In my experience as soon as the dispatcher understands it's a medical problem, has confirmed the address and that the patient is not breathing, they will begin talking the caller through performing CPR.
I suppose if I was concerned about it, the burden would be on me to move somewhere closer to the hospital or wherever the ambulance stages between calls. Unfortunqtely, there's always a chance no ambulance is available or that an accident has blocked the road.
How soon do you believe assistance should arrive?
Still, you feel like you are having a heart attack, call 911 (in the US) right away. The main time killer is probably just you recognizing that you need help (vs the time it takes to get help once called).
If you have an emergency when no one else has one, you can get a quick response. If there happens to be three other emergencies in your area at the same time, then the response time may be very slow.
The clear enemy authority figure. I.e. cop wants you to talk. Dont talk.
But then there is the if you do A you might die if you do B you also might die you have no probabilities, just your instinct plus what you are being told to do. And you have 10 seconds to decide.
The advantages of coming in an ambulance is traffic priority, priority attention in the ER and medical triaging and coordination.
The advantage of coming in a private vehicle are speed (usually), but at the disadvantage of having to get past ER gatekeepers and lack of information and preparedness. It is probably wise if possible to have a third person in the vehicle call the ER at the destination hospital to let them know what generally should be expected.