I won't call clickbait on this as it is a personal site and the headline is accurate. I saw another article recently with the same issues.

He is dead from a heart attack. If dispatch, EMS, hospitals, etc. didn't exist doesn't mean he would be alive. They didn't kill him, they failed to save him.

The other article I saw was how the hospital "killed" a drowning victim. Water was never mentioned.

There are many failures in our systems. There will always be exceptions to rules. It is a heart-breaking story but at the same time it is impressive. Maybe the system failed on this call but the fact that their is a system with this many resources is amazing. Hit 3 digits on the phone and LEO, EMS, Fire are all alerted 24/7 us pretty impressive to me.

I feel this, but in reverse. My son could be dead, but he’s not. He was born on the floor of a trailer park apartment, not breathing. His birth mother’s partner called 911, who dispatched an ambulance. All rescue units for his zone were already busy. An ambulance returning from the nearby hospital to another zone heard the call over the radio and happened to be passing by. The hospital was expecting a DOA, but the paramedics (HEROES) managed to get him breathing again on the way. He’s 11 now, and he is the source of all kinds of trouble and joy. Our home would be very different without him.

I can speak to this. I recently joined a community first responder association (I've always wanted to know what to do in case of a medical emergency) and was shocked to hear the members' horror stories of how long it can take an ambulance to arrive. Like the author, I grew up with the narrative "in trouble, call the ambulance, they'll scream through the streets to get to you in moments".

That might still be true where I grew up, in the US, but that's certainly not a guarantee in Melbourne, where I now live. On joining the local volunteer organization, I went from thinking "oh this will be a useful bonus for the community" to "wow, we can literally be essential". Since our org is composed of people living within the community, average response time to ANY call is <5 minutes (lower for cardiac arrest, when people really move). Sometimes one of us is right next door.

We can't do everything an ambulance paramedic can, but we can give aspirin, GTN, oxygen, CPR, and defibrillation. We can also usually navigate/bypass the usual triage system to get the ambulance priority upgraded to Code 1 (highest priority, lights + sirens, etc.) If for some reason the ambulance is far away (it backs up all the time), we can go in the patient's car with them to the hospital, with our gear, in case of further issues in transit.

I tell everyone now to always call us first (since our dispatcher will also call the ambulance) but while I feel more confident in how I'd handle an emergency, I feel less safe overall, with the system's faults and failings more exposed, and the illusion of security stripped away.

My condolences to the author.

In terms of updating - consider whether The System is really working. If not, what can you do yourself (or within your larger network) to better prepare...

My condolences, very sorry for your loss.

I work as an EMT (911) and resourcing is certainly a problem. In my small city, our response time is around 5 minutes, and if we need to upgrade to get paramedics, that’s maybe another 5-10.

However, if we are out on a call, out of service, or the neighboring city is on a call, now the next closest unit is 15+ minutes away.. sometimes there can just be bad luck in that nearby units are already out on multiple calls that came in around the same time, making the next closest response much further.

for a heart attack or unstable angina, the most an EMT will do (for our protocols) is recognize the likely heart attack, call for paramedics to perform an EKG to confirm the MI, administer 4 baby aspirin to be chewed and/or nitro (rx only), and monitor closely in case it becomes a cardiac arrest. If medics are far away we will probably head immediately to a hospital with a catheterization lab, or rendezvous with medics for them to takeover transport.

The few goals though:

- recognition (it could also be something equally bad/worse like an aortic aneurysm).

- aspirin to break any clots, assist administering nitro if prescribed.

- getting to a cath lab.

>my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing.

We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the system first, and then patients.

This is a very tragic story and my heart goes out to the family. It's one I've seen a few times now and hear about on a very regular basis from my coworkers.

I am a Canadian Paramedic (EMR soon to be PCP in a few months, roughly equivalent to EMT and AEMT respectively). Some things strike out at me:

- Here in BC our calltakers can advise patients on some treatments. I'm sure if that were to happen here, they would have advised the family to administer some ASA (Aspirin) to the patient which would have bought valuable time until professional care could be reached. Even if it was found to be contraindicated, the fact it was not mentioned in the blog post stands out to me.

- I'm not familiar with the geography of Toronto or its normal traffic patterns, but it's surprising that a single ambulance was not 30 minutes from the patient driving lights and sirens at that time of night (shortly after dinner).

- Fire crews here in BC are dispatched to severe medical incidents (like heart attacks) and most of the time can even beat ambulance crews to a scene. They would have been able to provide CPR if needed, possibly even ASA or Nitro depending on their scope. So again it's surprising that there's no mention of them. Perhaps they aren't dispatched to medical calls in Toronto?

- Lastly it's surprising that the calltaker had no visibility on where the dispatched crews were at. At the very least they could have radioed the crew to get an ETA. I guess I just take it for granted that over here we are tracked as soon as we sign in to our vehicle (it's a safety thing especially in some of our more rural/remote stations). If the ambulance was just about to reach the patient right before the family decided to go to the hospital on their own, things might have turned out differently.

Also since I'm assuming that a large percentage of HN readers are older males who are at risk of a heart attack (due to factors like working desk jobs and not keeping up with fitness as much), read up on the signs and symptoms of a heart attack and keep a bottle of aspirin at the ready. Bodies are complicated and weird and you never know.

>i don't understand why the common narrative that i was told, that we were all told growing up, is that one should wait for an ambulance

My wife had a seizure a few years ago, and the first response team clocked in under 5 minutes (close to 3 by my count but I wasnt paying a lot of attention). Then 2 more ambulances arrived <5 more minutes. There was straight up an emergency services gathering at my front door.

The emergency response team is an SUV rather than a full ambulance, with 2 trained paramedics and as much kit as they can fit in. They are faster, because they don't do patient transport, and can arrive ahead of patient transport vehicles. See issues with "ramping" and so forth.

Anyway, this is really an issue of local government policy. Just vote/spay/neuter/tar/feather your politicians.

I have the opposite story. Friend collapses in front of the house. I pick him up and rush him to the hospital, he is a geek and we had spent great amount of time going over his rare genetic condition that randomly causes internal bleedings from his organs. No ambulance available but no traffic also, we arrive soon at the hospital. Only to wait for 1hr or more because he didn't look bad, since internal bleeding doesn't look bad, and his arrival time (or cause) had not been registered on the system since we came by car.

After we were finally admitted in the actual room the doctor said his ematocrit was lower than a dead person’s, but fortunately he was saved that time.

This is not a criticism of the author of the article; I can feel their frustration and the pain of their loss but I don’t have anything to say that can ameliorate that.

I’m coming up on 60 years old. The mindset that many people have now seems to be to wait for someone from the government to help them- whether it’s ambulance, police, health care, food assistance, college, whatever.

Back in the 80s when I was coming of age the mindset among the people around me was different. The mindset of many people today seems more “I’m helpless”.

The government has never been good at anything; it doesn’t have the right organizational incentives and doesn’t give the right personal incentives to employees. I’m not criticizing government employees; there are individuals that do a great job, and from time to time I am delighted with an interaction, but mostly it’s just lots of waiting for mediocre service.

I don’t know how to change a widespread mindset of helplessness, but I suspect that it involves changing laws to remove all the obstacles that government and lawsuits have put in place to helping yourself and helping others.

Something similar happened to a friend of mine. In San Francisco. I just sort of assumed it was just bad luck. Bad things happen occasionally even in good systems. But maybe that assumption is wrong? Is this a thing? Are ambulances just unreliable?

The state has an incentive to encourage callers to wait for trained emergency drivers. Nobody wants mom in a panic and flying through red lights at the intersections. Or worse, my former teacher drove himself to the ER while in the midst of a heart attack rather than wait for an ambulance. He didn't survive the attack but made it to the hospital without incident.

I'm really sorry about your dad.

I bet he's proud of you for writing and sharing this to help others.

It's not moloch. It's all health systems, even ones that are religiously oriented. Triage and logistics and having enough trained people working all hours to handle all cases of life threatening situations... it's a bug in all systems.

Nothing is scarier than the moment you realize you're in the hands of the medical establishment. Whatever that looks like, wherever you are. Ever tried to rush a mechanic to fix your car? Ever tried to argue with a gate agent at the airport about rebooking a cancelled flight? Now imagine doing that while your heart is failing and 10,000 other people are also trying to get their attention.

If you want to blame anything, blame the fact that our society has failed to produce sufficient numbers of people trained or willing to help in emergency situations. And the people who sacrifice their lives to doing it are heros, the finest of us. The difference between individual societies and governments is quite small in the long run.

What is not excusable is why he was told to wait. A man dies because a rent-seeking bottleneck of corruption sat between him and his doctor.

The same politicians that would say this is a tragedy in one breath will send millions to early grave in the next so long as it could line their own pockets.

We live in a world diseased by greed.

This story reminds me of how the high schoolers on the Korean ferry MV Sewol obeyed the instructions to stay in their rooms.

My sincere condolences to the author. Wishing you strength and peace.

I once saw a man have a heart attack on the beach, less than a 5 minutes drive from a fire-station and rescue team. A helicopter arrived after 45 minutes, and the man was deceased already. That was in Martinique, french Caribbean.

There's a need for an app to let patients track the ambulance. It's been possible for 10+ years, as seen with Uber. It seems existing products have focused on tracking only for the purpose of managing a fleet, missing the focus on patients needs.

I’ve been reading Influence by Robert Cialdini and just finished a disturbing section about how we are wired to obey an authority figure even when it causes harm. In this instance, the 911 dispatcher was the authority figure. Sad story.

The post mentions Toronto, so I'm going to assume that the publicly funded Canadian health care system bears some responsibility for the sad outcome.

My dad also died of a heart attack at 57. I am so sorry to hear this. Thank you for writing it, theres a powerful message in there I think more people need to think about. Sending love and prayers your way.

This is horrible. What is going on in Toronto that ambulances take 30 minutes to respond?

If the author sees this, I'm sorry for your loss.

Losing family is hard, but losing them suddenly makes it harder. Losing them suddenly because of poor advice or (in)action of people who are supposed to help is yet more difficult. I know from experience.

It does get easier to deal with, in time.

My grandfather died at a hospital in South Africa in 1997 after experiencing chest pain. Apparently, he went to reception, and they told him and my uncle to take a lift/elevator up to the ward, and he died in the lift. I was told afterward that it's a no-no to exert oneself during a heart attack. No idea if that's true or not.

Anyway, not second guessing OP, just putting it out there.

Very sad, for more reasons than one. For pretty much everyone, heart disease is totally preventable now. If you’re over 30, get your ApoB checked (non HDL cholesterol is a proxy), and if it’s high, get a calcium scan on your heart. If you score above zero, get your ApoB down as low as possible (which will probably require drugs - diet barely moves the needle on this for most people). Low ApoB -> no heart disease.

Source: Peter Attia

I’m so sad to see this. For anyone who reads this, get a day, learn CPR, and buy that machine if your parents or whoever has history of heart issues. The machine doesn’t fix every kind of heart diseases but the trainer told me it decreases the possibility of death from a heart attack greatly. I recall that the possibility is lowered by 50% if you do CPR and 80% with the machine.

It is not hard to use the machine as it has clear instructions. They probably expect you to still be able to read when in panic.

I'm sorry this happened to you/Jenn.

I lost my brother to a heart attack aged 50, but he died immediately. In the end it was very quick, but he had warning signs for years. Look after yourselves, people.

Someone, please, for the love of all that is holy: Set up a website with information on how to reach emergency services from x to y country. People are literally dying here.

I once tried to call an ambulance on an active suicide attempt in the United States (while I myself was in Europe).

Problem 1: What number should I call? My country's national emergency line could not help and had no direct communication with ANY emergency services in the USA. Unable to find the phone number for EMS in the USA, I called the local police department which was answering their regular phone line at that time.

Problem 2: This requires long distance calling and local police departments do not accept collect calls.

Problem 3: Police receptionist was hesitant to connect me to dispatch but did so anyways.

Problem 4: I am now easily 10-20 minutes into making an emergency phone call and I haven't even talked to anyone able to help me.

Problem 5: Ambulance took another 10-15 minutes to even show up.

I explicitly stated "they just took pills, they have no neurological symptoms right now, do not leave immediately."

Problem 6: Ambulance left after a simple "it's a prank call" given at the front door.

Not much later, this person started showing severe neurological symptoms. I repeated the call, told them they were now actively dying and needed help. Luckily an ambulance came and helped this person, but it was an incredibly close call.

Thanks to this I looked where my nearest ER is and found that it's 7 minutes away, so I can't imagine calling an ambulance for my wife unless I was worried about her spine. (I don't think she can lift me so the reverse isn't true.)

Absolute sympathy for the author.

My own story of heavy industrialized medical process goes the other way. My daughter could be dead, but she isn't. At birth, she presented with some abnormalities around her stomach. Not good. We lived in a somewhat remote location where the hospital's capacities were modest. Really not good.

Within 8 or 10 hours of birth, she and I were aboard the smallest plane I've ever been on, with a pilot, and neonatal specialist nurse and respiratory therapist (all had arrived on the plane). Daughter was in an incubator and I couldn't touch her.

Five or six hours later we were in one of the largest children's hospitals in Canada. Another hour or two and a probable diagnosis was sussed out, and a plan made for a surgical exploration / opportunistic fix.

I'm at an age where there are real professionals who register to me as children, and in the pre-op meeting, this is how the anesthesiologist struck me. He was even wearing a Star Wars t-shirt. I didn't mind either the age or the t-shirt, but it was jarring because it situated me somehow as a more responsible participant in the whole situation - a grown-up. Failing to tell him to use the force will proably be the esprit d'escalier that follows to my grave. (I mean, don't turn off the targeting computer, but use the force too.)

Anyway. Another six or seven hours - the worst of my life by far - and finally the good news emerges. Seven years ago now.

There were probably close to 100 people directly involved in providing care to her that day, and I couldn't imagine the number for indirect involvement.

To be honest, all of it was the first experience of gratitude in my life.

---

We are all burned daily by the rough edges of our approximating policies and norms - life's outrageous slings and arrows.

I'd spent a lifetime being too smart and too aloof to be impressed with anything. Suddenly the most important thing to have ever happened to me went sideways, and put me completely at the mercy of the great machine. It really came through for me. It's a good time to be alive.

---

aside: People will have lots of reasonable principled and pragmatic objections to $MEGACORP laundering image via $OUTREACH_EFFORT, but I'll also take the moment to say that Ronald McDonald House is the real deal. Lifesaver. Extraordinary reach to provide a sense of "new-normalcy"

utterly snide and unnecessary dig: The weakest meal (although not bad by any means) that I had at McDonald House came from Microsoft. Hard for a tech company to compete with groups named "3rd Street Grandma's Club" in terms of banger comfort food. Thanks for the pizza, MS.

> my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing.

Hindsight is 20/20. There are also cases where people died because they didn’t wait for the ambulance. So without proper statistics that‘s a dangerous conclusion.

My condolences.

Did the ambulance ever show up to your house?

Really sorry for you man! May his soul rest in peace.

First, I want to offer my condolences to the author. I lost my father suddenly at a similar age—it's terrible. Sending positive energy. Former Firefighter-EMT here — I did this a long time ago in a rural setting). Now to the practical matter. I want to offer some frameworks for thinking about this in rural or exurban transport situations. This is not risk-free or even optimal, and can put you in worse position, but it's worth considering seriously if you suspect you may have a very long or delayed transport time to the hospital.

Before anything else, ask yourself two things:

Would this person possibly benefit from (A) an automatic external defibrillator (AED) or (B) Narcan[1]?

Can the person safely get into a car and be driven to the hospital?

If the answer to 1A or 1B is YES: Don't drive. Call 911, clearly state "cardiac arrest," or "overdose" give your exact location, and start effective CPR if required. A police officer with an AED will likely arrive quickly. Getting the location right is critical—this is life-saving information.

If 1A/1B don't apply and you can answer YES to question 2: You have some thinking to do. I suggest doing it now, in advance, whenever you move—think through how you'd handle massive bleeding, heart attack, or stroke symptoms.

It's worth briefly considering emergency scenarios and the risks you're willing to accept. Ambulances or fire engines sometimes can't reach you quickly: logistical issues, mechanical failures, dispatcher problems, insufficient volunteers. In rural settings during a cardiac event, waiting thirty minutes for basic EMS care—followed by a 30-60 minute hospital transport when you have alternative transportation—may not be your best choice. Even in a volunteer live-in program with career-grade response times, I found it could take 20-30 minutes to reach people at the edge of our territory. That's not counting the 2-3 minutes to get us awake and out the door at the station, plus another 2-3 for dispatch.

My household is minutes from two decent suburban EDs (we're lucky). Certain situations would lead us to skip 911 and drive straight to the ED: massive hemorrhage or an obvious heart attack when another adult is present to drive. This requires nuance. Time saved by skipping the ambulance can easily be lost to an incompetent admissions screener. You need to use the magic words: "heart attack," "chest pain," "think I am going to die." If you're having a stroke, you may not be able to drive at all (and you shouldn't). You'll also need to choose the right hospital—challenging in the moment, potentially impossible if you're impaired. The wrong hospital can be as lethal as waiting for an excessively delayed ambulance. In large cities with saturated EDs, this strategy often doesn't work: too many false alarms and just overall volume mean you won't skip the line.

I have direct experience managing and assessing these issues. You may not—consider getting meaningful first aid training. It helps.

The general rule: If you're confident in your department and know a nearby fire station generally has a paramedic-engine or paramedic-staffed ambulance with reasonable response times, wait for it - paramedics can do a lot for you on the way to the hospital and most critically get you to the best facility for care. You could crash your car or deteriorate en route to the point where you can't drive. But if you're fifteen to twenty minutes in and don't hear sirens (admittedly, not all departments use sirens properly), it's time to consider leaving—and how you're going to do it.

[1] Regarding Narcan: I won't engage in broader discussion about police possibly asking about circumstances requiring it—that's your business. IANAL. But many cops and almost all ambulances carry it, and the person will be alive after they administer it.

It is terrible to lose a relative in young age. But at least 80% percent of all heart diseases are known to be fully avoidable. The risk factors are known for ages and as matter of fact every adult is fully responsible to care for his own health. The right thing to do, is to watch out for a healthy diet.

There's another scenario where someone heads to the hospital and get stuck at a red light or behind and accident or you're speeding and kill someone. It's just hard to know sometimes which path to pick when you don't have a guaranteed outcome on either one.

In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.

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> my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing.

The primary goal of the state is to ensure the power of the state is perpetuated. It's really the only goal of the state, anything it does good for its people is a side effect in its pursuit of maintaining power.

The government doesn't care about you, doesn't care about your health, your children's education, your safety, your house, your job, anything else about you except in as far as they provide conditions for people sufficient to avoid large scale civil unrest and threat of government losing authority. If individuals get crushed in the machine, nobody gives a shit, least of all the government.

This is the reason vigilantism is viewed so harshly by the state and tends to attract much more attention and harsher punishment than a crime that was not motivated by justice. Not because the outcome for a victim of vigilantism is any different, but because the act threatens to undermine the authority of the state in application of justice.

The biggest perpetrators of atrocities and injustice, war, murder, theft, genocide, death and suffering through negligence and incompetence, has been the state and agents of the state. Everybody should be critical of everything the government, politicians, bureaucrats, "experts" tell you at all times. Consider they can and do lie and cover-up as easily as a person drinks water, consider motivations, and explore outcomes and alternatives and consider what is best for you, your family, your community, your society. Use your common sense, don't prejudice your ideas with what gets repeated about things. Develop plans accordingly, or at least spend a little time to think about these things.

This is not "conspiratorial". The actual conspiracy theory would that those in government are conspiring to actually help the people foremost. Anybody who puts forward that kind of crazed unfounded conspiracy theory had better come up with air-tight evidence, otherwise they'd just be peddling far-something ultra-something disinformation.

Such a tragedy, and I'm really not surprised it happened in Canada. Our healthcare system here is utter garbage and there isn't really any political will to do anything about it because "it's better than the Americans at least" (it's not). I don't buy that it's underfunded either, it's just sorely mismanaged and nobody wants to build or grow. Even a child could tell you if you increase the population of a country by 10% in ten years, you also need to grow its infrastructure by at least that amount - but our political class are idiots and haven't even considered it. After all it's not "green" to build more hospitals. And thus we get situations like this where there literally aren't enough ambulances to handle the load.

I'm sorry if I'm ranting under a post about a father's passing, but tragedies like this are so avoidable that it practically sends me into a rage. This person should still be alive, she should still have her father. Fuck sakes.

[flagged]

>family members were too naive to know that the thing they were instructed to do by the state was a false thing

Would be interesting to see everyone who jumped in here yesterday [1] to comment on this one as well.

1: https://news.ycombinator.com/item?id=45889297

Canada has experienced an unprecedented spike in both legal and illegal immigration over the past decade of Liberal rule. Every system has its carrying capacity: the health care / EMS system is overloaded (and underfunded). This no doubt contributed to that ambulance not arriving in time.