By Blair Bigham
Paramedics and physicians across Canada united after a shocking broadcast speculated that Canada’s paramedics were ill-equipped to respond to 911 calls. CTV’s investigative broadcast W5 ran an episode titled “911 Roulette.”
The episode, hosted by experienced journalist Kevin Newman, featured registered nurse Karen Carberry, whose husband David died in the back of an ambulance while being transported to a hospital after suffering a STEMI. Newman questioned why some ambulances were staffed with primary care paramedics while others were staffed with advanced care paramedics. Newman categorized a 911 call as a game of Russian roulette – you might get paramedics capable of saving your life, or you might not. It then went on to question the base hospital system and why paramedics were not self-regulated through a college the way nurses and doctors are.
The oversimplification of the system – and in some cases, factual errors – outraged the EMS community and led to vitriolic discourse among both frontline providers and senior leaders. As a paramedic and physician, I too was outraged; but as a journalist, I was confused. How could an established newscast like W5 get it so wrong?
The Goal of Journalism
To understand how W5 went wrong, I started in their shoes – surely they thought they were reporting an important and factual story. Journalism is based on the notion that a free press is required for a free society. The goals of journalism are to protect democracy by holding those in power accountable and to deepen an honest understanding of the world around us.
The role of a journalist is to tell stories that achieve those goals using accurate and balanced reporting. A good story is something the audience wants to read: it must be some blend of timely, underreported, counterintuitive, important and meaty. Usually, there is tension or debate.
The Question Wasn’t Wrong
Good stories start as good questions. At the beginning of the broadcast, Mr. Newman ponders if people are playing “roulette” when they call 911; he observes “in Canada, calling 911 doesn’t always guarantee the paramedic who arrives can do everything in their power to save your life” referring to the tiered response system and the fact that not every community has ALS providers.
Put more technically, Mr. Newman asks what harms a person might experience if a primary care paramedic – rather than an advanced care paramedic – arrives on scene, noting that it seems to, at least at times, be chance.
This question is not unreasonable. In fact, EMS agencies and governments that fund EMS have been debating the right scope of practice and blend of practitioners since the 1980’s. Such controversy is not limited to EMS; as governments fight to contain costs, we have seen RN positions replaced by RPN positions, we have seen physician services transfer to pharmacists and nurse practitioners, and we have seen family doctor home visits replaced by community paramedics. It is not unreasonable to ask “what impact does this have on patients, systems and the economics of health care?”
What W5 Got Right – And Wrong
The electronic record of the defibrillator is a document that raises legitimate concerns about delays to defibrillation. The paramedics were investigated and received additional training. While they missed that “STEMI – pads on!” is a new standard, they raise a fair point in asking if a different crew might have done something different.
I will not list every factual inaccuracy in the piece, aside from noting the following, and cautioning that a simplification is not necessarily an inaccuracy.
1) The Medicine: Nitroglycerine does not save lives. Chest needles do not fix pulmonary arteries. To say that the difference between life and death was an ACP intervention is dubious.
2) The Evidence: there is a large base of scientific evidence to draw from to make decisions about how best to model an emergency medical system. W5 didn’t report any of it.
3) The Balance. There was no interventional cardiologist to explain that STEMI bypass is preferred to closest hospital, no base hospital physician to explain why different levels of care exist. The system in Saskatchewan was selectively reported, and the Ontario-Saskatchewan comparison, framed as like-like, is apples-and-oranges.
The question “why doesn’t everyone get an advanced care paramedic” is controversial and not settled. It is debated throughout North America. Similarly, the idea of self-regulation and the public benefit of such is also hotly debated around the globe. The current scope-of-practice model is horribly dated and mostly dogmatic. Kudos to W5 for trying to tackle this quagmire.
It’s hard, in a 23 minute broadcast, to present all points of views, and first person accounts are important. But in this case, the journalists failed to fact-check their own sources and swayed away from balanced reporting. They had the wrong facts, so they told the wrong story.
It’s an important reminder to a budding journalist like myself; I must always challenge my own biases, question everything, and seek proof over hyperbole, no matter how sexy the headline may be. It’s also an important reminder to our paramedic profession; we must engage in controversial conversations not just amongst ourselves, but among those who we serve. We may not always like the message they report, but journalists are the ones we embrace to do that.
About The Author
Blair Bigham is a paramedic, physician, and scientist completing specialty training in emergency medicine at McMaster University. He has worked in health care settings on five continents and has responded to emergencies in urban, rural, and remote settings on helicopters, boats, and vehicles that could generously be described as pick-up trucks. He witnesses the relationship between wealth and health on a daily basis, and reports on the undertold stories of patients, healthcare providers, and the systems that help or fail them.