A Child Dies as Ambulances Stall on Quebec First Nation
A Child Dies as Ambulances Stall on Quebec First Nation
Another tragedy in Manawan after years of warnings about the lack of access to healthcare services.
by Hal Newman
A seven-month-old baby died shortly after arrival at Sainte Justine children’s hospital in Montreal late Saturday night.
The child was Indigenous, from a remote community that didn’t have access to an ambulance because of Quebec’s profoundly dysfunctional prehospital care system. Local paramedics who would have usually taken the call were on a mandatory break because they’d worked too many hours that shift.
So the child and their family needed to wait for an ambulance to travel from St-Michel-des-Saints, up an unlit logging road and into Atikamekw territory some 88 kilometres north. By the time it reached the community of Manawan, the odds of the baby’s survival diminished drastically.
I had a tough time writing this story.
Pediatric calls are always a whole other level of stressful when you’re a paramedic. When a baby is critically ill, well, in the parlance of paramedics, you know the deal. There’s always a chance things aren’t going to work out well — and when there’s a two-hour response delay, ouff.
“This lack of resources (in Manawan) resulted in unnecessary loss of life and suffering.”
—Rob Bonspiel, Paramedic.
I heard about this story through the ecosystem which has coalesced around The Last Ambulance — The Rover’s Facebook page tracking the crisis in Québec’s prehospital care system in near-real-time. Gathering the loose ends that come together to form a story meant interacting with people for whom this wound was still raw.
After all, Manawan had been through all this before. That’s how a permanent ambulance presence was established in the community. Rob Bonspiel, the owner of First Nations Paramedics in Kanehsatá:ke, lobbied to have an ambulance based in the community.
“This lack of resources (in Manawan) resulted in unnecessary loss of life and suffering,” said Bonspiel, who operates the only Indigenous-owned ambulance service in Quebec.
“This situation continued regardless of the unanswered calls to action by the community to the provincial government for assistance. First Nations Paramedics saw it as our moral and fraternal duty to use lessons learned to help Manawan. We testified during the Viens Commission hearings in favour of an ambulance for Manawan (four years ago). We also offered technical advice to that community for establishing the service.”
The Viens Commission investigated dozens of ways in which Quebec’s public services discriminate against Indigenous people who live in the province. In the commission’s report, published in 2019, Judge Jacques Viens wrote that the need for a reliable ambulance service in Manawan goes way back.
Prior to the Viens Commission, the community had been struggling to provide a full-fledged ambulance service for its population for 20 years. Viens noted the evidence showed that deficiencies in pre-hospital services were linked to the death of at least two people, including a toddler.
Jaylia Jacob, who was 2 years old when she fell from a dock into the water and then — after paramedics responded from Saint-Michel-des-Saints — was transported to the nearest CLSC, and then to a hospital in Joliette, and then finally to Sainte-Justine in Montreal. She was resuscitated en route to the hospital by paramedics but she was critically hypothermic and died the next day.
Dave Flamand was 38 years old when he died in 1998. Despite his relatively young age, he had an extensive cardiac history. He was complaining of palpitations when he went to the clinic in the community. His condition rapidly deteriorated and the decision was made to call an ambulance.
The paramedics responded from Saint-Michel-des-Saints but by the time they arrived Flamand was in shock and suffered cardiac arrest. Despite the best efforts of paramedics and clinic staff, he died in Manawan. The medications that could have helped him were in Saint-Michel-des-Saints but there was no ambulance available in Matawan to get him there.
Viens noted: “Although the community has been compensating by way of a first responder service since 2006, it is not on a par with paramedics, according to the Manawan band council. As a result, the Conseil’s Chief, Jean-Roch Ottawa, confirmed that, when someone has an emergency, “getting to the hospital can take three or four hours.””
Last weekend, if the ambulance was not available in Saint-Michel-des-Saints, the next closest paramedics would have been coming from Saint-Jean-de-Matha (152 km) or Saint-Gabriel (163 km).
But there were paramedics available in Saint-Michel-des-Saints. They responded from almost two-hours away on this rugged logging road. I’ve made this drive in a pick-up truck because once, many years ago, I worked a brief stint as a paramedic in Manawan. The distance from the ambulance base in Saint-Michel-des-Saints to the Health Services Centre in Manawan is only 88 km but it’s a journey that’s not for the faint of heart — or the fragility of a critically ill infant.
From Manawan, the ambulance traveled back down the same road until it merged with Route 131 and then transported their patient to the Centre hospitalier régional de Lanaudière (CHRDL) in Joliette. At this point, more than five hours had passed since the decision was made to transfer the critically ill infant.
Once at the CHRDL, the baby was assessed and an emergency transfer to Sainte Justine in Montreal was arranged. That’s another 76 km and about 90 minutes of travel. The infant died at Sainte Justine.
Unfortunately, interruptions in ambulance service are not unusual for the community of Manawan. The “7/14 shifts” frequently result in mandatory pauses for paramedics and the combination of paramedic shortages and a lack of incentives to work in a remote community mean the shifts go unfilled.
In 1989, as a temporary measure, the government introduced what have come to be known as 7/14 shifts.
Paramedics are on-call 24 hrs a day for seven consecutive days and then off-duty for seven consecutive days. During the period they are on-call they must be within a 5-minute drive of the ambulance station — measured when the weather is ideal, of course — and there is no traffic.
And so shifts are constantly being interrupted in Manawan because every ambulance call entails a minimum of four hours travel time and often much more.
Beyond the impact to the population, the 7/14 shifts are brutal for the paramedics. Try to imagine being on-call 24-hours a day for seven consecutive days.
This is how paramedics describe the 7/14 shifts:
“I can sum it up in one word: prison. In our station the 7/14 schedule is referred to as the ‘Depression Schedule’ or the ‘Resignation Schedule.’ Nobody wants to work on this schedule but we know we have to go through this to get a position with an hourly shift. In our company, the employer forces rookies to be fully available for 7/14 shifts. It's a shame because it wears them out from the start, but they have no choice.”
-Anonymous paramedic
“The 7/14 shift is difficult for family life. Your spouse and children are often awakened (when you get a call). Difficult to go back to sleep. Rest for paramedics on a 7/14 shift is not easy. You may not go out all day and spend the night awake.”
-Anonymous paramedic
“Honestly. On the work-family balance it is quite hard. I have to stay in the ambulance station for seven days of work. So seven days away from my children and spouse. As for the work itself – I hallucinate radio tones at all hours of the day even during my seven days off. Having a day-evening-night work schedule means it’s difficult to anticipate when the next call is going to be.”
-Anonymous paramedic
Add to the mix that paramedics can only work a certain number of hours on actual emergency calls before they take a required break. On a 16-hour shift, if paramedics don’t have four consecutive hours of rest, there is a mandatory break. On a 24-hour shift, paramedics need eight consecutive hours of rest or there will be a mandatory break.
If during these breaks there are no paramedics available to fill the shift, the ambulance will be out of service. In many areas with 7/14 shifts, there is only one ambulance in the station. So if the shift isn’t filled, the community will be dependent on the closest available paramedics. In some cases, like Manawan, the response time for the next ambulance station is measured in hours.
And so, there are great challenges in trying to fill these shifts — or the shifts need to be paused to give paramedics a break — which result in many communities dealing with interruptions to ambulance service.
This is the same community that Joyce Echaquan left to seek care in the hospital in Joliette — where she died after being subjected to racist abuse and neglect.
The same community where now they are preparing for the funeral of a baby whose death may well have been prevented if Manawan had the same access to paramedics as other communities in the Lanaudiere region.