New Toronto paramedics should be paired with a trainer for their first 12 weeks on the job, and for the rest of their first year work with someone with more than one year's experience, the jury at a coroner's inquest has recommended.
The five-person jury on Tuesday made 29 recommendations to prevent deaths similar to that of James Hearst, who had a heart attack in 2009 and waited more than half an hour for an ambulance.
One of the paramedics who responded to Mr. Hearst had worked four shifts, the other had a year's experience.
Toronto Emergency Medical Services is considering the recommended changes for new paramedics, Chief Paul Raftis said in an interview. EMS does not send trainers with new paramedics, but tries to pair them with someone more senior for their first six months, he said.
"[With]the operational demands, it has been a little bit of a challenge for us to do that in the past sometimes," he said. "But, again, our team is looking at how we can do that better in the future considering this type of recommendation."
Many of the other recommendations focused on improving communication and protocols when paramedics decide to "stage," the term used for waiting for police to respond with EMS because there's a chance of violence or danger.
After Mr. Hearst, 59, collapsed in the lobby of his Alexander Street apartment building downtown, two people and a security guard performed CPR and placed three calls to 911.
The first 911 caller mistakenly said Mr. Hearst may have been drunk and the emergency-call taker flagged that for the paramedics, as well as requesting that police accompany them. The two paramedics arrived at a spot near the building, but out of sight, in about 10 minutes. They waited for police because they were concerned about their safety, the jury heard.
Protocols for staging have been updated since Mr. Hearst's death, which prompted recommendations from the Ministry of Health. The jury recommended that the new policy be clarified to explain what assessing and securing a scene means for paramedics and the role of managers in monitoring response.
As well, the jury recommended that dispatchers require paramedics to explain the perceived danger that's preventing them from responding immediately.
"The jury enhanced and clarified those protocols," coroner's counsel Stefania Fericean said. "Some of the paramedics that testified in the inquest appeared to have some lingering concerns about how to actually implement the protocols."
Chief Raftis said he will review all of the recommendations, but it will take a few days.
Another recommendation was that a memo to be sent to all Ontario ambulance communication centres to underscore the need for every call taker, during each 911 call, to say verbatim: "Okay, tell me exactly what happened."
Mr. Hearst died when the city's outside workers, including paramedics, were on strike and staffing levels were reduced.
The jury noted recent agreements between the city and the union that mean 100 per cent of paramedics will work during future labour disruptions, compared to the 75-per-cent staffing level during the 2009 strike.
Ms. Fericean said the evidence presented at the inquest, including testimony from the paramedics, indicated that the strike wasn't a factor.
But Mr. Hearst's former partner, Alejandro Martinez, said he still has questions that weren't answered by the inquest, including whether the strike contributed to the delay.
"The reason for them to stage, the only reason that was given at the inquest, was that the paramedics thought it was unsafe for them," he said. "I don't think that's reason enough for paramedics to withhold service."