He was 24 years old. He was a paramedic. And, sadly ironically, he died of respiratory arrest, even though the ambulance was slow to come to his aid.
We would have hoped that the death of Hugo St-Onge in 2017 would give a shock to Quebec’s ambulance system. But seven years later, too many deaths still occur before the ambulance arrives on the scene.
Think of little Malek, 18 months old, who died after waiting for paramedics for an hour in a village in Abitibi.
Or to Monique Labrecque, 72, who died of respiratory arrest in Lévis, when the ambulance arriving in front of her home turned around to respond to a more urgent call.
Or to Marilyne Turcot, 27, who died of suffocation while swallowing a piece of meat, in an apartment in the heart of Montreal where the ambulance took 22 minutes to reach.
All of this is unspeakably sad.
According to a compilation of Montreal Journalnearly 85% of Quebec’s largest municipalities are generally unable to respond within 8 to 10 minutes, the time limit recommended by experts for a person whose life is in danger.1.
We play with fire. With people’s lives. It’s intolerable.
The slowness of ambulances in Quebec is matched only by that of successive governments who have been slow to resolve the problems of the pre-hospital system for decades. The committees follow one another. The reports are piling up. The recommendations are known. But it doesn’t move quickly.
Already in 2000, then in 2014, the Dicaire committees2 and Ouellet3 recommended establishing targets, as is done in other provinces. In British Columbia, for example, paramedics must be on scene within 8 minutes, in 75% of cases, in urban areas (15 minutes in peri-urban areas, 30 minutes in rural areas).
Nothing here. No specific target. That would be a good start though.
Some will say that we will need more ambulances if we want to reduce delays. Maybe. But could we start by better managing the current system?
Because in recent years, costs have increased much faster (+ 44%) than the number of transports carried out (+ 12%), according to an analysis by the Auditor General of Quebec, for the period 2011-2012 to 2018- 20194.
And the bill continues to climb. This year, ambulance services will cost 923 million, the government estimates.
How can we get more bang for our buck?
For example, paramedics sometimes line up in a hospital garage because the emergency triage department is overflowing. If the patient was taken care of more quickly by the establishment, the ambulance would be released more quickly to save other lives.
It’s all well and good to shoot the ambulance when a disaster strikes, but paramedic services are only one link in a chain that must be completely strengthened if we want to improve response times.
This chain begins with training the community in first aid. However, Quebec is not doing well. In our country, 43% of households have no one with training, the worst score of all the provinces5.
Why not take inspiration from countries at the forefront? In Norway, this training is compulsory at school and to obtain your driving test.6.
And why not have a mandatory register to identify places that have a defibrillator? Currently, the 911 line does not always know if there is a device near the person it is helping on the line.
To save even more lives, we could also create first aid stations with not only a defibrillator, but also equipment to treat hemorrhages, overdoses and allergies.
A quick and effective community response can make the difference, before the ambulance arrives.
Note, an ambulance is not always required. When it is not a life-threatening emergency, a paramedic can attend and provide assistance in conjunction with a nurse on the line. Over the past 10 months, Quebec has managed to avoid some 12,000 transports this way.
This avenue deserves to be explored further. Moreover, the creation of a professional order for paramedics would give them greater professional autonomy to make the most optimal decisions in the field.
But the issues are too serious for us to simply make piecemeal improvements. There Emergency Pre-hospital Services Act dates from 20 years ago. And she hasn’t aged well. Health establishments that had the mandate to make a plan every three years have never done so. Zero leadership.
It is therefore up to Quebec to provide the impetus. The Minister of Health, Christian Dubé, said on X that his teams have been actively working since 2022 on an action plan which should be tabled in the coming days.
Let’s hope that this plan will look broad and move away from silo thinking, affecting the entire ecosystem and not just ambulance workers. The goal of prehospital services is not necessarily to transport people to hospital, it is to save lives.
1. Read the file on ambulance delays from Montreal Journal
2. Consult the Dicaire report (2000)
3. Consult the Ouellet report (2014)
4. Read the Auditor General’s report on ambulance services
5. Consult the results of an Ipsos survey (in English)
6. Read an article from the French newspaper The cross