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The Last Ambulance

For forty years, Hal Newman worked in Emergency Medical Services. After retiring, he decided to start an online platform, The Last Ambulance, where he investigates the problems he saw in the EMS system. 


Messages started pouring in from EMS workers from across the country. Now his platform has become a voice for many health care and emergency service workers who are demoralized, exhausted, hanging on by a thread – and who are afraid to speak publicly about what is happening inside the system. 


Despite having worked in the system for so long, he didn’t realize just how broken it was until he started publishing The Last Ambulance.


Host: Karyn Pugliese

Credits: Tristan Capacchione (Audio Editor and Technical Producer), max collins (Production Manager), Bruce Thorson (Senior Producer), Karyn Pugliese (Editor-in-Chief)


Additional music by Audio Network


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Duration:
40m
Broadcast on:
15 Jul 2024
Audio Format:
mp3
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One more time, have a look, Douglas.ca/canadoland. Canada Land, funded by you. This episode contains descriptions of real-life medical emergencies and death. Please listen with care. What you're about to hear is a recording of a 911 call. This is one of thousands of calls to 911 across Canada every day. That's 65-year-old Myron Zabursky. He had just retired, and he's explaining that he cannot get out of bed because he keeps losing his balance. He tells the 911 operator that he's not able to get out of bed for four days. This is the first time he's been in the hospital. Myron died. After his death, his daughter Stephanie reached out to Hal Newman. Hal Newman is an ex-parametric who worked in emergency health services for 40 years, but that's not why Stephanie called him. These days, Hal is an investigative journalist, and he runs a website. It's called The Last Ambulance. His platform has become a voice for many healthcare and emergency service workers who are demoralized, exhausted, and hanging on by a thread, and who are afraid to speak out publicly about what's happening inside the system. And that's why I want to talk to him today. If anyone knows what's going on with our emergency healthcare system, it's Hal. It is the public safety service where your life literally depends upon it. And I find this really weird that I can look up online and track snowplows in real time. But I don't know which ambulance is in service. I don't know which ambulance is closed. I don't know what the parametric staffing level from Montreal is, but I can tell you where the snowplows are. There is something seriously skewed. Wait for it. Today's episode is brought to you by Joe Otto, Erin Wulette, Steve Vuavere, Kathryn Hamilton, Teddy Nolan, Hector Diaz, Beth Whitney, and Janya. Hi, I'm Janya. I'm a UBC Vancouver student, and I support Canada Land because it brings me relevant and important information that I wouldn't find anywhere else. I also support Canada Land because I feel better than my friends who don't, no matter how much I tell them to listen. My name's Hal Newman, and I'm the founder and editor and journalist of The Last Ambulance Project. So Hal, before you were a journalist, you were a frontline healthcare worker. I had a whole lot of parallel lives. I worked as an emergency management consultant, specializing with people with special needs, where I worked a lot in the United States on federal legislation. I worked in emergency management post-Katrina. I worked as a paramedic in West Virginia, in Baltimore County, in Quebec, and loved it. I absolutely loved EMS. Yeah, but why did you love it? Why did you love being a paramedic? Why did you want to do that? I love being a paramedic because I love the interaction with people. I love the concept of you're an advocate for the patient and for their family, and you're kind of their guide to both a turbulent system and to one of the most difficult moments of their lives when they're calling. So it's an odd combination. It's like you need kind of accumulated wisdom to figure out how to navigate them successfully through the system. You need to advocate for them at the ER. And then there's this part of it that's kind of immediate gratification, right? Because if you do your job really well, there are immediate results. It's kind of unlike anything else out there. I guess there must be a risk-taking gene in there somewhere. You were a paramedic, and we had these experiences, and I guess retired left. I'd always promised myself that when it stopped being enjoyable, when I felt like I stopped making a difference, that I would just find another chapter. And is that what you thought? You stopped making a difference? I absolutely stopped making a difference. What happened? The pandemic was the end of my career. Initially our call volume decreased, but then it started picking up again, and of course people were very, very sick, people who had COVID. People were terrified of going to the hospital. It's like, I go to the hospital, I'm going to contract COVID, and I'm going to die. Because they were so terrified, they waited too long. People who were in diabetic crises, people who had strokes and didn't even call, can't blame the people. They were absolutely terrified, and our ERs, of course our hospitals, were all jammed. So people saw the news, anyway, it was a medic that just ate me up. I kept thinking there's got to be something more that we could do. I wrote to the government and said, hey, you know, I'm an emergency management strategist. I do emergency health strategy in the States, in addition to being a medic. Can I help? And they got back, and they said, yeah, we've determined that you're qualified to be an orderly in an emergency room and nothing more. But you wanted to help with a big picture stuff, that's what you wanted to do? Right. Frankly, I got hired by the Americans and ended up drafting strategy, big picture strategy for hundreds of hospitals in the States while working from my house in Quebec, and going out on calls. And then that was it for me. In a nice twist to a long career, one of my last calls was, I resuscitated one of my neighbors in cardiac arrest. You've now brushed off a degree that you had before in journalism, and you decided to start writing about the system, and you launched the last ambulance. What was the idea there? So at the end of my career on the street, when I was working in Chefford as a first responder every single day, we would hear a radio called called a 1015, "Discains." And "Discains," 1015 means literally, you're the last ambulance available. And I thought, I'm going to write about the emergency pre-hospital care system. Of course, when I started the project, I had no concept of how bad things were. What do you mean you were in the business for 40 years? So how could it be worse than what you imagined? Didn't you know how bad it was? How much worse? So it's interesting, when you work as a paramedic, you work in a very tiny silo. You work in an elevator shaft. That's your region. That's your district. You don't get out and talk with other paramedics, except maybe once a year at a conference or something. Hell, I don't really remember going to any conferences. You have no idea what's going on elsewhere in the province. You have no idea how the system functions elsewhere. You're a paramedic. You talk to the dispatch system that your ambulance or your vehicle is assigned to. And that's it. And you could go through your whole career without working in another place. For me, it was this incredible revelation when I should be embarrassed to say this. But I knew nothing about the North Shore of Quebec. I never knew where, you know, Riviere-Tunner was. I had no clue where these places were. And I also didn't realize that when a paramedic responds from a call from Natasquan and goes out to take care of someone in an ATV accident, that then they have to transport to Setil, which is hours away, and there's no other ambulance in Natasquan. But then you laughed and you launched the last ambulance. And you said you started getting texts from sources. Who was texting you? So everybody who worked on the front line was texting me. And then I started getting 30 to 50 messages a day. They were coming in from the entire province and well beyond. Many states in the U.S. and across Canada and as far afield as New Zealand and Australia and Europe, but a huge concentration from Quebec. Not only medics though, interestingly, medics, emergency medical dispatchers, police officers, firefighters, nurses, doctors, hospital admins, and they were like, you know, the front lines never had a voice. If we speak, we get fired, you know, you should know what's going on. This is what's going on. And then of course, you know, as a journalist, I'd go out to corroborate these stories and I'd find out, oh my God, they're, you know, this is true. This is actually happening. Can you give me an example of what one of those stories was? Yeah, sure. I mean, some of the most tragic heart-wrenching stories, you know, family members. One guy who, whoof, I'll cry, I'll try not to, I'll try and get through this, but a paramedic in a town called Sirel Tracey wrote to tell me that his sister, who was, I think in her late thirties, went into cardiac arrest, sudden cardiac arrest, so young. And she was a kinesiologist, I can't think of her name at the moment, but she was absolutely beloved in her community. She worked with seniors and waiting for paramedics and it was an extended response time. Her husband and her 12-year-old son did CPR on her and she didn't make it. And I wrote that story and it was just heartbreaking. And then another family reached out to me from La Salle in Montreal. And it was a story about a guy. He called at about 540 in the morning, 65-year-old guy. He had just retired. I remember his daughter sent me a picture of him, of the two of them at a stone's concert in Boston. He was a big stones fan. And he called in the morning to say that he had fallen and hit his head a couple of days earlier and he just didn't have the strength to get out of bed. He felt funny. And there were problems with the call and he was prioritized as a very low priority call. And there were a number of problems with the process and there were supposed to be people who called back to check on him, but no one did. And the paramedics arrived at 450 p.m. and he was dead. And he had, according to the coroner, died around noon. The family was trying to get the last tapes of his voice. And they were getting stonewalled by everybody. So they reached out to me and said, "Could you get involved?" And I was like, "New territory for me." I was thinking, "Really? What the hell am I going to do here?" But to my surprise, I was able to get the tapes. This is the gentleman that we heard audio from, it was his 911 call we heard just at the beginning of the episode. Right. Got to listen to his last words, his daughter got to listen to her dad's last words, which ultimately didn't really provide closure because he died so unnecessarily. He believed help was coming and help didn't come. He went and lay back down in bed thinking, "Okay, the paramedics are coming." He died six hours later. And they didn't arrive until almost 12 hours later from the first call. And I get a lot of those actually. I used to say it's kind of like, "I'm not a religious guy at all, I'm extremely secular." However, if I were ever to be a priest in a confessional, I'm pretty sure that the last ambulance has become the confessional of the Church of EMS. And then paramedics and emergency medical dispatchers, because they have nowhere else to go, they tell their stories to me. And their stories are just, "Oh my God, awful." Yeah, so I want to ask you about that because that's one of the hardest things as a journalist and I guess with your background, you're somebody that they can trust. And to me, having the families reach out to you, I understand that, but when you're telling me that the service workers and the frontline workers are reaching out to you and they've got a story to tell, it tells me that they're also anxious and maybe pissed off or wounded in some way. What are they trying to tell you? Yeah, they're all wounded. It's the invisible trauma of working as a medic. I thought I got out unscathed. I was thinking, "Wow, this is pretty cool. I've had this really long career and I've managed not to develop PTSD." So he says, "My last shift was on December 15th and my first day of therapy was on January 15th." So no one gets out unscathed. The system is such a mess. And so if paramedics speak out or emergency medical dispatchers, emergency medical dispatchers, what a mistake I made. I thought it would be cool, talk about a dumbass idea. I thought it would be cool to allow emergency medical dispatchers to share the most, if they wanted to offload some of their trauma, we would find a way to tell their stories. I have no idea what the fuck I was thinking about when I did that. What a stupid idea for me. Their stories are just absolute nightmarish stories that happily we don't get in the movies because you would scream and then cry. Stories because they get these calls, right? Mom just backed over their baby in the pickup truck. And then it's the emergency medical dispatcher who is coaching mom on how to do CPR on the child that the emergency medical dispatcher knows there's no chance in hell that they're going to save. And those are their memories. And I just got a flood of those. And as it turns out, we couldn't even publish them because shit, we would have sparked like so much trauma in our audience. Yeah. You know, I spoke to psychologists and said, what do I do with these? And they were like, you can't publish that hell. I mean, like you can't, you know, I'll reach out to the people who sent, you know, and that was cool. I didn't get people in touch, but wow. Yeah. I mean, that is one of the things when you're covering a beat that involves death and involves trauma is like there's always that question of how much do you tell? What is the public interest? Because there's some public interest there, like people knowing how hard it is on like the medical teams, people knowing that they are developing post-traumatic stress disorder, people knowing that they leave after five years because the stress is just so much and along with some of the other things that you mentioned. And then the job is just so emotionally hard like that. So on one hand, you want to tell it because if people understand like, isn't that how systems change? So the last ambulance is, you know, it became the voice of the front lines, kind of amplified their voice. And so they share their, they share their stories, good, bad and ugly. I think you've been documenting that there's some places where you're going to end up waiting maybe 13 hours or longer for an ambulance that should have been there in 20 minutes. Maybe you could walk me through in like a really simple sense as somebody who doesn't work in the medical field. What happens when like, I think I'm having a heart attack, I call 911, what is the process that's supposed to kick in? Maybe if we understand kind of how, how ideally it would work, then we can start looking at where the holes in the system might be. Sure, in an ideal world, you would call 911 and wherever your 911 center is, they would say, Karen, what's going on, where are you? And you'd answer a few key questions and they would be able to say, well, okay, you need to speak to the EMS center. So they transfer the call over to the EMS communication center. And EMS being emergency medical services, is that the right? Yeah, emergency medical services. Through the last ambulance, we do a lot of access to information and we're in the middle of analyzing a whole lot of data that points to the fact that the problem isn't on the streets. It isn't with the paramedics. The problem is in the communication center. So they're running into staffing issues and there's a Q developing. So they don't have enough staff to process the calls efficiently and they start queuing up. And by queuing up, literally, so, you know, call for difficulty breathing, on hold waiting for someone to process the call. We've looked at a subset of about 90,000 calls between November 2023 and March 2024. We're looking at the processing time, how long it takes for that process when the call is transferred to the EMS communication center, the time that's elapsed between the call arriving at that center and the call being assigned to a responder, whether it's a first responder or a paramedic. And what we're finding is that those times, there's two, three minutes lost in the communication center. And if you're thinking two, three minutes, you know how, really, that's not that long of time. And that's exactly what I was thinking. I said, that doesn't seem too long. That doesn't seem too bad. Let me frame that. You're going to tell me it is. Yeah. Let me frame that. In the case of a cardiac arrest, cardio, respiratory arrest, you have no pulse, you're not breathing. For every minute that you don't receive CPR or aren't defibrillated, you have a 10% less chance of survival. So we just chewed up 20% see you. And then we're talking about the response time. So even for the first responders who have excellent response times. So let's say it's five, six minutes. Well, now we're up to 80% chewed up. Because from the time your call arrived in their dispatch center, let's say it takes two minutes to process plus a six minute or seven minute response time. What are the odds? We're going to resuscitate you slim to none. So yeah, two minutes, huge difference. So one of the really sad revelations I've had in the last couple of weeks actually as a result of the latest access to information request is that mainstream media people would interview me and they'd say, you know, but in case of a critical emergency, they're able to respond promptly, right? Yes, if you fall down and you're lying on your bathroom floor, it might take seven, eight hours. But if you're having a heart attack, how, right, you know, they'll be there. And I always said, yes, yes, even, you know, for the critical emergencies, they'll be there. But as I've gone through the data and we analyze the data, I realize that I've been falsely reassuring people and that's a real kicker. They're not getting there for the critical calls. On the West Island in Montreal, nine times out of ten, it's within 22 minutes. Within 22 minutes, we're talking critical emergencies. What should it be? The target is nine, nine minutes. This episode is brought to you by Oxio, who provide Canadians with internet. Listen, we live in an increasingly hostile and divisive culture and the chief division that is putting hate in the heart of Canadians is our blinding hatred for our telecom operators and internet service providers. 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I think one of the ways in which social media can really harm people's mental health is by ingesting all of these kind of Instagram posts that people put up there, which really advertisements for their life that, you know, take a snapshot of like a very highly curated moment and tell you that other people are just doing fabulous things and are happy in ways that you are not. And we kind of like can't look away. We consume this stuff even though it forces us to make these comparisons and comparisons are the thieves of joy. Nobody has it together all the time. Why not use your screen to do something that helps your mental health and doesn't hurt it? Why not use your screen to connect with a mental health professional as the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a wide variety of expertise. Stop comparing and start focusing with BetterHelp. Visit BetterHelp.com/canodaland today. That'll get you 10% off of your first month. That's BetterHelp, BetterHELP.com/canodaland. A lot of your pieces on your site are these short pieces that will say that there was no ambulance available on this day or the ambulances were backed up because they couldn't unload their patients into the emergency room. You'll have those examples and you can see the problems with the healthcare and the problems with the system. How do you know that? Where are you getting that information from? So get the information in real time from a variety of sources. We get real time feeds from a whole lot of people who work in the system. So it's interesting that it's not just paramedics who can let you know when the system is faltering. All of the hospital ERs are aware of when the system is falling down because they're among the partners who are notified by Arza Asante that, "Hey, we're in crisis mode. I'm very proud that I've never compromised a source that would never identify a source, never going to." People are calling you to tell you this information even though they know they could get in trouble for it because they believe that it should be out there in the public space and that's how you're getting your information. Absolutely. And just to further emphasize this point, in the contract that was just signed last fall between all of the ambulance providers in the Ministry of Health and Quebec, there is a clause that says that ambulance companies are not allowed to criticize the emergency pre-hospital care system to the media and then a special sideline for the last ambulance and to social media. And I actually wrote to the Ministry of Health to say, "Doesn't that go against whistleblowing? Doesn't violate freedom of expression?" And the ambulance services, all of the ambulance companies in Quebec had to agree to that. And in order for them to speak to me, because I'm doing a piece on indigenous representation in paramedics and I was talking to Robert Bonspiel from First Nations paramedics, just in order to talk to me in a non-critical manner, he needs to consult with his attorneys to see if speaking to the last ambulance about anything violates his contract. What are you hoping that that website does? Are you advocating for change here? What are you doing? Yeah. So the idea was to raise people's awareness of the risks of living and dying with a dysfunctional emergency pre-hospital care system. There was a community in the Bus Saint Laurent area where they were going to remove an ambulance at nighttime coverage. They got organized and they stopped it. And so that's the goal. The goal is really to raise awareness and to ensure that there's a political cost because I think that's really important. There needs to be a political cost to neglecting emergency pre-hospital care. I think it's insane that the Atikumet community in Manawan was neglected for so long that they had extremely sketchy paramedic service, that if the one ambulance in the res wasn't available that it could take four hours for another rig to show up up a logging road. You had a story there about a young First Nations girl who was sick. It was an incredibly sad story. It was a baby in dire need of advanced care who needed to be transported, cared for and transported to definitive care at Lanagier hospital in Joliet, with an eventual transfer to Saint-Ges-Styn or to the children's. And there was an enormous delay for paramedics because there were no paramedics available. And the baby died, died on hours after arriving at Saint-Ges-Styn finally. And there was a coroner's in question, the coroner agreed that delays in access to emergency pre-hospital care were a major contributing factor. I'd really like to get to a point where we're not doing these coroners in quests though. You know, I think shining a light is really important, but it's absolutely heartbreaking that we need to. It's 2024. Come on, folks. Do you think in that case, do you think that your story made a difference for that community? Has anything changed there? I think we're making a difference. Like, you know, damn, I hope we're making a difference. As an indie journalist, it's just, you know, there are days where I'm like, what the hell am I doing? You know, what did I get myself into and is there an extrication plan possible? So all the tips that you're getting by email, by Facebook Messenger, from people inside the system who are frustrated, who want to see it changed. And I know you said that they're afraid to speak out, but you kind of just think if there was like kind of this critical mass, couldn't they change the system? Like why isn't it happening? No, they'd get fired. They'd fire them all. You know, EMS emergency medical services, paramedic services. It is the public safety service where your life literally depends upon it. And I find this really weird that I can look up online and track snowplows in real time. But I don't know which ambulance is in service. I don't know which ambulance is closed. I don't know what the paramedic staffing level from Montreal is. But I can tell you where the snowplows are. There is something seriously skewed. Wow. When you put it that way, it sounds like you're solving a problem here, but the government doesn't seem to be very thankful to you. But are they even listening to you? I think in some parts of the government, perhaps they are. But it's also really important to realize that a lot of these problems have already been identified, and solutions have been preferred by other people, just amplifying them. One of the real tragedies about pre-hospital care, especially in Quebec, is that paramedics have really cool ideas. They have great solutions. And a lot of the things I write about are from paramedics, but they can't even speak out on that. Why isn't the government listening? I don't really have an answer. I realize you can't answer it. It seems, though, like it's so out of place, that people within the system are proposing solutions. They're going to get shut down. There's something very wrong about people working in a system that they think is broken or has broken pieces, trying to express how to fix it and getting punished for it, or getting thrown out of the system. You're onto something there. How when we first contacted you about doing an interview, you told us something. You told us that the government is keeping a file on you. I'm wondering, how did you know that? I was informed by a very trusted source that there are-- Inside government, I presume. Inside the government, yeah, inside Quebec City, telling me, "Hey, you know there's a file on you, and you might want to file on access to information on yourself and on the last ambulance project." And you did. So I did. So I went ahead through the process. And then I got these five pages. And they were all blacked out. And honestly, my first reaction was I just laughed. I just couldn't believe it. I thought, "Well, who's keeping notes on me, and why would you black them out?" And then-- Well, I should say something about that, too, because normally, if you file an FOI on somebody else, they might black everything out because they might say, "Well, we were just talking about the person, and we were wondering, or we were speculating, and that stuff's not true, so it could be libelous, so let's black it out." But when you file on yourself, that isn't a problem, because you're the one receiving the information. So nothing should technically be blocked out. I mean, you had a good laugh about it, but then you must have thought about it a bit more. What did you do? If I tell you the truth about what I did, maybe it's not the appropriate reaction, but I just turned one of those pages into a subscription ad for the last ambulance and said, "Hey, you know, I asked for the file on the last ambulance on myself, and this is what came back, and I'm fairly certain this isn't what democracy looks like or some other pithy statement." And I posted that as opposed to try and drive interest in the last ambulance. And then it seems that there's some other politicians, though, that thought that this was interesting and tried to get it themselves. Is that right? Right. A member of the National Assembly in the West Island of Montreal, and Greg was always very interested in emergency pre-hospital care response on the West Island, because response times lag for his constituents. And so I contacted him to say, "Hey, this is pretty weird. There's a file on me, but it came back all blacked out." And Greg is married to Marwa Risky, who's also an M&A member of the National Assembly, who's very popular, very well-known, education critic, and extremely articulate. And Marwa called me back and said, "Hey, I'm going to file an exit AFO for your file." I said, "Okay." And apparently she did with Greg, and they notified me just recently that it's been moving forward slowly, but that they couldn't get the information, though. They were told that it would compromise cabinet security to release the file. Is that all they were told? Like, were they given a reason? How would it compromise cabinet security? Did they get any explanation? Well, I don't know, perhaps they did, but they appealed that decision. And that was a note from Greg saying that they appealed, and access to information, has now requested mediation with them. And as Greg said, the wheels of justice turned slowly, but apparently they've made good progress. So I look forward to finding out, because in order to compromise cabinet security, that would imply that it was a cabinet-level decision to keep a file on me in the last ambulance, which is really incredible when you think that that was in the early days of the last ambulance. Well, when you find out, we're going to have to get back together, and you're going to have to tell us what's in there. Hal, thank you so much for talking to me today. Thank you. I mean, it's really a privilege for me to share the story. Thank you. That's your Candleland. If you value this podcast, please support us. We rely on listeners like you paying for journalism. As a supporter, you'll get premium access to all our shows ad-free, including early releases and bonus content. 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