AMBULANCE 3 HOURS AWAY
Allergic reaction a low priority
When her 16-month old baby had a lick of peanut butter last week, Marina Byezhanova wasn’t particularly concerned.
Axel had had peanut butter before, and was just fine.
But this time, within seconds, the infant broke out in hives, started screaming inconsolably, and began to scratch his arms, chest and face until he drew blood. Byezhanova called 911.
But the response she got from Urgences Santé was far from urgent.
“They said they would send an ambulance but we would have to wait up to three hours for it,” Byezhanova said.
“We asked them to repeat that twice. They said if anything changes to call them back, but we knew if something else happened it would be that he was choking and it would be too late.”
Byezhanova and her husband hung up the phone and rushed the baby to Ste-Justine hospital themselves, shaking at the wheel.
A triage nurse spotted them from down the corridor and immediately took the baby to inject him with a shot of epinephrine.
They would spend the next five hours at the hospital, monitoring the baby and getting Benadryl and a prescription for an Epi-Pen to administer at home.
It was only later that Byezhanova thought about what might have happened if they had simply waited.
The physical symptoms of an allergic reaction to peanuts can include itchiness, swelling, eczema, sneezing, and asthma.
But an anaphylactic reaction can also cause abdominal pain, a drop in blood pressure, trouble breathing, and cardiac arrest.
“At the hospital they told us when someone’s having a reaction they should get a shot within 10 minutes,” Byezhanova said.
In this case, the parents had spent those crucial minutes calling Info-Santé, where they were put on hold for 10 minutes, and then 911.
“I felt it was appalling that a 911 dispatcher wouldn’t immediately send someone,” Byezhanova said.
“I can’t help but think he’s fine and great now, and everyone at Ste-Justine was great. But had we decided to wait ... you start thinking of all those things that could have happened and it’s scary.”
In its 2015-16 annual report, the ambulance operator claimed its average response time, for the highest-priority calls in Montreal and Laval, was 7.11 minutes.
The target response time mandated by the province is eight minutes and 59 seconds.
Yet anecdotal evidence suggests the wait for what is not deemed a top priority can be much, much longer.
In February, several media reported on the case of a 78-yearold woman who had broken her hip and was initially told to wait up to four hours for an ambulance — her situation was unlikely to change in that time, Urgences Santé concluded.
Only after three hours went by did Urgences Santé reclassify the call as a priority one, implying a risk of mortality.
A spokesman for Urgences Santé confirmed Monday that the call about Axel had been classified a priority 4 — in other words, nonurgent — allergic reaction, based on the answers the dispatcher received from the parents.
“Our dispatchers ask key questions to evaluate whether it’s an emergency — is the person conscious, breathing, talking?” said Benoît Garneau. “We rely on what the caller tells us. But if there is a doubt, our dispatchers are trained to treat a case with more urgency, not less.”
Garneau said the ambulance service is now reviewing the case. In the meantime, he could not give any more details.
Paul Brunet, the president of the Conseil pour la protection des malades, a patients’ rights group, agreed that how a call is prioritized depends largely on the questions asked and answers given.
“But if the baby was treated as a priority at the emergency room he should have been a priority for ambulance transportation,” Brunet said.
Tales of long waits for ambulances are symptomatic of the more generalized problems afflicting the health system — extreme rationalization of resources to limit service to what is strictly necessary, Brunet said.
In the case of the 78-year-old woman, she was left on the floor with a broken hip, Brunet said. “She was not alone, she was breathing. So they comforted her and waited for an ambulance.”
Brunet spoke of a man rushed to hospital in the Côte-Nord region in the back of a pickup truck because there was no ambulance available.
“You see that in Afghanistan — and you can see it in some regions of Quebec,” Brunet said.