BURST
An American doctor who created the computer software used by ambulance dispatchers in B.C. was peppered with questions about how to improve the widely used system at a coroner’s inquest on Monday.
The five-person jury, which has entered its third week of hearing evidence about the 2024 fentanyl-poisoning death of a University of Victoria student, made several suggestions for change to Dr. Jeff Clawson. He is the founder of the Priority Dispatch system, which is used in most ambulance 911 calls in Canada, including all in B.C.
Why, one juror asked, didn’t the call-taker follow up on her suspicions and just directly ask the student who phoned 911 if the two unconscious patients had taken drugs, rather than follow the system’s rigid rules about not asking leading questions?
“We’re definitely looking at it. It makes sense if it can be done right,” Clawson said.
Sidney McIntyre-Starko, 18, and a friend collapsed in a UVic dorm, but the student who phoned 911 didn’t reveal the three of them had taken drugs. She described her friends as turning blue and “seizing,” which led the call-taker into the seizure protocol on her computer system — and therefore delayed the urgent life-saving response required to reverse an overdose.
The inquest has heard the call-taker suspected the students could have overdosed, but was prohibited by the Priority Dispatch system from asking “leading questions” such as one about drugs.
Instead, Clawson testified, the call-taker asked several clarifying questions to try to get to the root of what happened.
But the juror noted they all sounded the same — what happened before this? Was anyone else with them? What’s going on now? — and didn’t result in new information being provided in an urgent way.
“Instead of asking all of those multiple times, one of those (questions) could have been: ‘Were there drugs involved?'” the juror put to Clawson.
When the seizure protocol was chosen for this case, a box popped up warning the call-taker it was an unusual medical complaint for two patients. That required her to confirm she wasn’t mistaken about this choice.
Wouldn’t that be a good place to ask the call-taker for more follow-up questions, since the inquest has heard it is highly unusual for two people to have seizures at the same time?
Clawson said that change is under discussion, but said none of the 3,000 jurisdictions worldwide that pay to use his software have submitted this exact proposal for change.
“Maybe you can be the one that does,” Clawson told the juror. “That (proposal) does make some sense, and that’s actually on my list of things here that we want to look at based on learning from every event as much as possible.”
Call-takers are typically not medically trained, so rely on the Priority Dispatch system to guide them through 911 calls by entering information provided by witnesses and then getting next-step questions and medical advice from the algorithm.
A juror asked Clawson what potential changes could be made to the system in light of Sidney’s preventable death, which happened nearly 16 months ago.
He said possible changes that have been mentioned include improving the “usability” of the breathing tool that call-takers rely on to get witnesses to test whether a patient is breathing.
The inquest has heard that witnesses are unable to complete this test in nearly a third of cases. In Sidney’s case, it took three people — including two security guards with first aid training — before it was completed, a full five minutes after the call-taker first asked for someone to do it.
Other areas Clawson said could be changed include how to better identify when someone is having a seizure, and how to better handle calls with more than one patient. In Sidney’s case, it was never clear on the 911 call which patient the witnesses were talking about when they reported medical information, so the call-taker did not realize that one student was still “seizing” while Sidney was largely lying motionless.
The seizure protocol guided the call-taker to ask a serious of questions that seemed bizarre when there were two patients: are they both pregnant or do they both have brain tumours?
One juror asked if the software could be changed so that in a multiple patient situation, the questions would make more sense, such as probing about a poisoning, noxious gas or overdose?
More to come …
For more health news and content around diseases, conditions, wellness, healthy living, drugs, treatments and more, head to Healthing.ca – a member of the Postmedia Network.