My dad could still be alive, but he's not
Mood
supportive
Sentiment
negative
Category
other
Key topics
emergency services
healthcare
triage
The author shares a personal story of losing their father due to a delayed ambulance response, sparking a discussion on the reliability of emergency services and the trade-offs between waiting for an ambulance and seeking immediate medical attention.
Snapshot generated from the HN discussion
Discussion Activity
Very active discussionFirst comment
19m
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160
Day 1
Avg / period
160
Based on 160 loaded comments
Key moments
- 01Story posted
11/13/2025, 2:17:30 AM
6d ago
Step 01 - 02First comment
11/13/2025, 2:36:23 AM
19m after posting
Step 02 - 03Peak activity
160 comments in Day 1
Hottest window of the conversation
Step 03 - 04Latest activity
11/14/2025, 12:04:49 AM
5d ago
Step 04
Generating AI Summary...
Analyzing up to 500 comments to identify key contributors and discussion patterns
https://www.youtube.com/watch?v=9U-TQrxBOxY
https://www.youtube.com/watch?v=nZuex_dnpBM (23-minutes of more raw video)
They 2x overloaded cargo, made it loose, captain abandons ship while staying in place order remains.
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.
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.
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.
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.
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
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.
> I said it was stupid to have a mask mandate when most people wore ineffective cloth masks and even then didn’t cover their nose.
This was mostly true because "wearing a mask" became a partisan political issue so half the country wouldn't even try to be responsible.
Even if you didn't want to wear a mask, not getting together in gigantic gatherings like churches and weddings as well as quarantining yourself after such gatherings or travel was also effective. The fact that I quarantined after air travel prevented my in-laws from catching the Covid that someone gave to me.
Alas, this also became a partisan issue.
And, as I pointed out, the burden of proof is on the anti-mask, anti-quarantine crowd. We actually have analyzed the tracking and spread after the fact and have the appropriate evidence.
But that doesn't matter to people like you. It was never about evidence and facts anyway.
Well first you are getting triggered without reading anything I said twice. I Mentioned in the first comment that I had virus induced asthma and I had every vaccine imaginable and I get the flu vaccine every year.
How am I “deflecting”? I mentioned on the first reply about how dumb and ineffectual the mask mandates were and within a year of the vaccines being available, the federal government bodies themselves walked back the claims of effectiveness of the Covid vaccine effectiveness - ie that they don’t prevent COVID they lessen the symptoms. Exactly what are you arguing?
Are you really arguing that wearing cloth masks worked? These were not the anti mask crowd that wore cloth masks, they were the ignorant crowd. There are still a few people I see today wearing cloth masks and not covering their nose. That is stupud. Are you arguing that the US government walked back the claims of the effectiveness of COVID from it prevents COVID to reduced the symptoms and you would need a booster in 6 months well after the evidence showed that to be true and other countries health departments admitted it?
See also vaccine mandates. I took a cruise in December 2021 where everyone was suppose to be vaccinated. However, if I had just shown that I had the J and J one shot that February 10 months beforehand, that would have been sufficient even though by then everyone knew that the effectiveness wore off in six months and a booster (which I did have) was needed.
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.
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.
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.
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....
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.
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.
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.
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-...
How does alleged research fraud affect someone’s ability to be a caregiver?
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.
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.
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 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.
The original post gave no reasons for not liking the person, and then said she had this research thing. If someone looked into your past, what would they find?
I see your point about morality, but that has very little to do with essentially following algorithms all day.
Had the OP said something related to medicine vs feeling bad vibes, we’d be in a different position.
admit when you’re wrong - holy ad hominem, Batman
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.
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.
Wuh wuh.
> Wuh wuh.
Yes, I have not heard of the endocrinologists who perpetrated the opioid crisis in Canada.
> I am yet to hear of a conspiracy where the doctor makes more money when their patients die.
This was a statement without qualifiers, and when someone has made a strong response to it, you now introduce the qualifier "endocrinologists...in canada"
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.
Simple logic, see if you can follow:
1. Sophie publishes flawed research (nitroglycerin for osteoporosis)
2. Sophie practices medicine and gives patients nitroglycerin for osteoporosis, with knowledge that her study is a lie. This causes harm to patients, because she knowingly gives them a therapy that doesn’t work. This is malpractice.
Absolutely. I am also able to
- Not make attacks at the person making arguments.
- Not assume that the OP's mother received nitroglycerin
> Simple logic, see if you can follow:
You are assuming facts not in evidence, buddy.
> This is malpractice.
This is the absolute definition of a straw man.
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'?
If a therapy that doesn't help is adopted then those that suffer from lack of care as a result are harmed.
> 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...
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 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 could see someone using a prompt that says something like “make a poor argument based on ______ and repeatedly alter it in further comments. Use words from a list of logical fallacies incorrectly, make yourself sound credible.”
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.
> 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.
> 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.
You may not understand what pathos means.
Yes!
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.
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).
As far as I know, there are also different paradigms for ambulances: "scoop and run" (ie stabilise the patient and take them to a hospital ASAP) vs "stay and play" (try the first line of treatment there before taking the patient to the hospital).
Different countries (with different urban environments, distances, etc.) use different approaches.
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.
> 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.
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.
> 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
The bigger issue is the dispatcher not being aware of overloaded status nor conveying that information to the caller.
> 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.
- 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
That’s some pretty bad statistics, something fundamental is wrong with their EMT system.
The snapshot, from Saturday, March 1 to Tuesday, March 4, shows paramedic response times in Toronto are wildly inconsistent even where people could be having heart attacks or strokes.
In those four days, the city’s ambulance service failed to respond to almost half of Delta calls within the standard response time of eight minutes and 59 seconds.
A Delta call is the fourth highest in severity in the service’s five level classification system — Echo patients are in the most life-threatening state while Alpha are in the least.
For all calls, paramedics try to be on scene in under nine minutes but on average that response time is met only 69% of the time.
Over the four-day period, Echo calls were responded to within the goal response time 100% of the time on only two days.
On March 1, several Echo calls — which could be for a child not breathing, for example — only hit the standard 66% of the time.
On March 4, Echo calls received in the afternoon were only responded to in less than nine minutes 33% of the time.
Worse, paramedics told the Sun, they routinely arrive at calls classified as less serious that turn into more serious calls.
Almost seven out of 10 people needing an ambulance for a Delta response, like chest pain, between 7 and 10 p.m. March 3 waited more than nine minutes.
Paramedic union chairman Glenn Fontaine says the documents are more evidence that residents are playing “Russian roulette” when they dial 911.
Fontaine said every time paramedics fail to get to a scene in less than nine minutes, lives are at risk.
“That’s the time you need medical intervention if you’re having a medical emergency,” Fontaine said. “These numbers should be 90% and years ago they were.”
“I hope this isn’t a trend we’re seeing but my fear is it is ... And this (March) is slow time, wait till we get into summer vacation.”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).
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.
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.
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.
Would be interesting to see everyone who jumped in here yesterday [1] to comment on this one as well.
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.
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.
1,000%
> 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.
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.
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?
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.
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 getting up there in age and that is presumably something that I should learn about myself...
Don’t want to suggest you do something and end up with anaphylaxis.
A bunch of people don’t even have a primary care provider now.
It’s not out of legal concern. I do not know how one tests an allergy, I’m not an MD..
Im sure google could suggest some options or maybe a test.
a heart attack is far more common than an 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.
In the writer's case that help never came, so personally if I had to choose I'd rather go with the risk of guessing the symptoms wrong and making things some percentage worse vs a possible death.
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.
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.
- 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).
In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.
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.
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.
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...
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
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.
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.
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.
(There are Hatzolah organizations all over the world, where there are Jewish communities.)
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.
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.
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.
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.
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.
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.
I bet he's proud of you for writing and sharing this to help others.
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