Paramedics not required to explain delay in response, coroner's inquest told

When two paramedics responding to a call decided to wait more than 20 minutes for police back up, it wasn't anyone's responsibility to ask them why, a coroner's inquest heard Friday.

The inquest began this week probing the death of 59-year-old James Hearst in 2009. The five-person jury may make recommendations as to how to avoid other deaths similar to Mr. Hearst's.

He died in the lobby of his Alexander Street apartment building waiting more than half an hour for an ambulance. After he collapsed, two people and a security guard performed CPR and placed three calls to 911.

Mr. Hearst died of a heart attack and was without vital signs when the first emergency workers, firefighters, reached him.

The two paramedics arrived near the apartment, but out of sight, in about 10 minutes. They waited there for police because they were concerned about their safety, the jury heard.

Officers were requested after the original caller said Mr. Hearst may have been drunk.

On Friday, CUPE Local 416 lawyer Michael Mitchell cited a 2005 written directive from the EMS chief about the protocols for "staging," the term used for when paramedics wait for police or firefighters to respond to a call when there's a potential for violence or danger.

Mr. Mitchell said the directive outlined that a supervisor and senior dispatcher should get updates, contact the 911 caller to find out more about the scene and contact the police dispatcher.

Under cross examination, EMS commander of professional standards Arthur Graham said the directive doesn't give management the responsibility to ask why paramedics are waiting.

"I don't think this policy prescribes anybody to ask why the crew [is staging]" Mr. Arthur said.

Staging policies have been revamped since 2009, city lawyer Robert Baldwin said on the first day on the inquest. He said a supervisor is required to attend each staged call now and training about such calls was enhanced after Mr. Hearst's death.

The inquest also heard that not all Toronto paramedics are given work cell phones, unlike other jurisdictions. All use portable radio communications and pagers, but only Toronto's advanced-care paramedics carry work cell phones so they can contact doctors.

"You could ask them why they're staging," Mr. Mitchell said.

He suggested regular paramedics carry their personal phones and use them on the job despite strict rules not to.

Mr. Graham said he was unaware whether it was true that many paramedics carry their own phones. He agreed that there are areas across the city, particularly downtown, and within hospitals where there's no service for the radios all paramedics have.

The inquest continues on Monday and is expected to last several weeks.