A critical manpower shortage left paramedics scrambling Sunday, according to a union official.

Paramedics were dispatched to a call for a male in his late 30s in life-threatening condition near Birchmount Rd. and McNicholl Ave. Sunday afternoon. The man was pronounced dead at the scene.

But when the highest priority “vital signs absent” call came through to Toronto EMS, dispatch had no available ambulances to send to the scene.

“If this isn’t a system in crisis, what is?” said paramedic Mike Merriman, shop steward with CUPE 416.

Dispatchers, when unable to find any available ambulances, had to begin calling different hospitals to find out if any paramedics were free to go to the scene.

“They were grasping at straws,” said Merriman.

One paramedic at Scarborough Grace hospital, waiting with an inbound patient alongside his partner, responded to the direct request and volunteered to be a first responder to the scene. As he was leaving, a paramedic from another crew caught wind of the situation and offered to join him.

Two ambulance crews were thus separated to fill the 2-person ambulance, noted Merriman. Ideally, it should have been advance life support crews (ALS), added Merriman, as they are the best trained to handle a cardiac arrest.

However, as the closest ALS team was too far away at the time of the call, the first responders were only “basic life support paramedics.”

“The dispatchers did the best they could with what we have,” said Merriman. “But what if we all had been at a call?”

“We were there within minutes,” insisted EMS spokesman Kim McKinnon. McKinnon was not able to comment on details as to the dispatch of paramedics.

Without being able to look into the details, Councillor Giorgio Mammoliti, chair of the Community Development and Recreation Committee — which oversees Toronto EMS — said he feels the situation emphasizes the frustrations the city has faced when asking the province to remedy EMS off-load delay times.

“Many of our EMS would have been sitting in emergency rooms waiting to be relieved,” said Mammoliti. “The province needs to be held responsible for any situation when we need our EMS to be relieved for emergencies.”

Opinion has been divided on issue of trauma, including serious head injuries, and benefits of traveling longer distances to specialist hospital

UNITED KINGDOM — A pioneering research trial has been launched in the North-East to investigate whether serious head injury patients should be taken to the nearest hospital or a specialist neurological centre.

Opinion has been divided on the issue of trauma, including serious head injuries, and the benefits of travelling longer distances to a specialist hospital.

The National Institute for Health and Clinical Excellence (NICE) stated that evidence for bypassing the nearest hospital in favour of a specialist centre was inconclusive, so the issue was in need of further study.

The North East Ambulance Service (NEAS) has teamed up with counterparts in the NorthWest to launch HITS-NS, the Head Injury Transportation Straight to Neurosurgery Study, with funding from the Department of Health, through the Health Technologies Assessment Programme.

A ground-breaking initiative, the research involves three specialist neurosurgical centres and 11 general hospitals. In the NorthEast eight general hospitals and two neurosurgical centres — based at the James Cook University Teaching Hospital in Middlesbrough and the Royal Victoria Infirmary in Newcastle - are taking part in the trial. More than 900 NEAS staff, based at 46 ambulance stations in the NorthEast, will also be involved.

During the trial, two approaches will be followed at random by NEAS paramedics.

Patients will either be taken to the nearest hospital A&E department or transported directly to a specialist neurosurgical centre. The patients who go to the nearest A&E will be expected to transfer to specialist neurosurgical care after being stabilised.

NEAS medical director, Kyee Han, said: "It's important to stress that patients in each arm of the trial will continue to receive the very best available care from themoment of injury.

"The aim of this trial is to look at the journey the patient takes to get to neurosurgical care as it is widely accepted that patients with severe traumatic brain injury should bemanaged in neurosurgical centres."

Graham McClelland, the NEAS paramedic overseeing the project, added: "During this initial feasibility study the research team will evaluate how well ambulance service crews are able to comply with the study protocol before a larger full-scale trial is designed."

That oxygen mask they strap on patients rushed to the ER after a heart attack or a stroke? It could be doing more harm than good in many cases, Dutch researchers say in a new report.

In a review of earlier research, they found no support for routinely giving critically ill patients high-dose oxygen, a common practice among paramedics and emergency physicians.

"There is not a single study that points to beneficial effects," said Dr. Yvo Smulders, a professor at VU University Medical Center in Amsterdam. "All of the evidence that we found points to detrimental effects."

Most doctors believe extra oxygen is life-saving and many guidelines recommend it, he and his colleagues write in the Archives of Internal Medicine.

"What you would expect is that oxygen is healthy," Smulders told Reuters Health. "But it seems that God didn't introduce 20 percent oxygen in room air for nothing."

Studies on animals dating to the 1960s and 70s have found that higher-than-normal oxygen levels could be dangerous.

Smulders' team gathered all the human research they could find on supplemental oxygen after heart attacks, strokes, cardiac arrest and acute attacks of chronic obstructive pulmonary disease, or COPD.

The 18 studies they came up with all had the same grim message: supplemental oxygen doesn't work, and there is some weak evidence that it might be harmful.

For instance, one trial from 1976 found nine out of 80 heart attack patients who got oxygen died, compared to just 3 out of 77 who got compressed air. Although that difference could have been a statistical fluke, it was still bad news for oxygen.

Another trial, this one in stroke patients, had to be stopped early because too many patients who got extra oxygen died.

And for cardiac arrest, in which the heart stops beating, a study out last year found that people who had a lot of oxygen in their blood after they were revived died more often than people with normal levels.

"It has potentially far-reaching implications, because supplemental oxygen is just ubiquitous in the care of critically ill patients," Dr. Stephen Trzeciak, who led that work, told Reuters Health.

Too much oxygen in the blood can lead to the formation of molecules known as free radicals, he said, which can damage organs such as the heart and the brain.

But this is still theory, Trzeciak warned, and so far there is no iron-clad proof that supplemental oxygen is harmful. What is clear is that too little oxygen can be lethal.

"My concern is, if we just indiscriminately stop giving supplemental oxygen to post-arrest patients, they might end up having low oxygen, which is just as harmful or more harmful" than high oxygen, said Trzeciak, who studies resuscitation at Cooper University Hospital in Camden, New Jersey.

The American Heart Association currently recommends giving supplemental oxygen to people with cardiac arrest until the heart is restarted.

At that point, the group urges doctors and paramedics to use measurements to ensure that oxygen levels in the blood don't get too high. The same goes for heart attacks.

But what often happens is that providers just leave the oxygen on full blast, according to Dr. Michael Sayre of the American Heart Association.

"They don't realize they are giving too much oxygen," Sayre told Reuters Health. "It's just not something they are paying attention to."

The Dutch researchers call for more studies. But until then, Smulders said, health providers should only give oxygen when blood levels are very low and they should make sure they never become too high.

"I think it is about time that you step away from your intuitive approach and look at the evidence," he said.