Montreal paramedics told to suspend resuscitation on some patients for months due to COVID-19 risks

For five months this year, Montreal paramedics were told to suspend resuscitation efforts on patients whose hearts had stopped, since it was seen as too risky at a time when COVID-19 wasn't well understood.

“During the summer and spring we just modified our protocol to protect the paramedic, to protect the health system, to protect the people—all people—because we didn’t know… how to protect ourselves, how contagious it was,” said Pierre-Patrick Dupont, the director of care at the Urgences-Santé paramedic service, which serves Montreal and Laval.

The decision was made in conjunction with Quebec’s health ministry and its college of physicians, he said in an interview with CTV News. The move was first reported by Le Devoir newspaper.

During those five months, starting in early April, some patients who were in the midst of a certain kind of serious heart stoppage weren’t given CPR or a defibrillator while enroute to the hospital.

Paramedics would start their work the same as usual, but when people “flatlined,” the paramedics would stop their attempts to revive them, Dupont explained. 

“We [would] go see the people in cardiac arrest, we [would] just start the protocol, and when we see the flatline, that’s where we stop the protocol,” he said.

Normally, he said, “we go and do CPR until we go to the hospital.”

There are different types of heart attacks, and stages in heart attacks, each with their own prospects for survival. "Cardiac arrest" refers to the moment where a person's heart suddenly stops beating.

It can be caused by a heart attack that has created circulation problems, or by other, more sudden, causes.

These were the patients -- suffering what's very often a fatal event -- who were affected by the policy change. An exception was made for pregnant women, children, and people suffering from hypothermia. 

Shortly after COVID-19 arrived in Quebec, Urgences-Santé and those advising it looked at data around people who suffered cardiac arrests “in the street” or at home, Dupont said.

They concluded that the chance you’ll survive a cardiac arrest after flatlining is only 1 to 2 per cent. 

It’s unlikely that using a defibrillator or CPR will revive the person at that point, and if it does, and even if they are taken to the hospital, only that small fraction of people will recover fully.

A group of experts, doctors and paramedics, made the protocol, which is comparable to those in other countries, the health ministry said. The protocol was approved by the table of regional medical directors and by the College of Physicians.

The protocol has since returned to the way it was before the pandemic.

Still, for people who lost family members in the last few months to cardiac arrests, the news may be hard to hear. For patients’ rights advocate Paul Brunet, it’s another sign that Quebec wasn’t well prepared.

“If it was my mother, if it was their mother, how would they treat the situation?” he said.

“Again, we were not ready in the first place… so elders and patients are suffering because of ill-preparedness.”

Urgences-Santé says it’s been able to go back to the old protocol because it has better equipment, the training on how to use it, and because a lot more is now known about COVID-19 and how it spreads. 

Dupont said that it was crucial for Urgences-Santé to protect its staff during the early months of the pandemic, not just for their own sake but in order to keep them on the job. 

“Right now we know more about this disease, we know more how to protect [against it] and we always have all the protection we need,” said Dupont, “but it’s not the same thing in the second wave as the first wave.”

The order was also meant to prevent overloaded ICUs.

Dupont said that people shouldn’t take the news to mean that “we did nothing in the first wave” to help people whose hearts had stopped, “but we just adjusted and worked differently with a different protocol.”

Urgences-Sante doesn't know how many patients could have been impacted by the order because they don't keep track of deaths of those transported to the hospital. 

The Ministry of Health did not respond to a request for comment.

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