On June 5, 2022, at 2:02 p.m., a neighbour of 86-year-old Betty Ann "Rusty" Williams placed a call to 9-1-1 after the elderly woman had been attacked by three dogs in a back alley behind her home in Northwest Calgary. It wasn't until 2:38 p.m. that an ambulance arrived on the scene. Williams would eventually succumb to her wounds and passed away. 

The circumstances of the prolonged response time of EMS were investigated by The Health Quality Council of Alberta (HQCA), which released its findings earlier last week.

The report stated that a series of factors contributed, including the fact that on that day there were a high number of high-priority EMS dispatch events at the time of the incident and no available ambulances for lower-priority calls.

Initial 9-1-1 call 

According to transcripts that were obtained by Discover Airdrie via The Freedom of Information and Protection of Privacy Act (the FOIP Act) from the Calgary Police Service, the neighbour who first called 9-1-1 stated that Williams' head was bloody.

"Ahhh, they pulled out, it looks like half the hair on her head," the caller said at one point.

After a series of questions, the C911 call taker told the caller that they would get an ambulance on the way shortly. 

According to the HQCA report, because the call was about a dog attack and there may have been a potential danger to the public, police were assigned as the lead agency. However, in calls where further evaluation is needed to determine if other first response branches are needed, a co-evaluation should be initiated.

A diagram from the Health Quality Council of Alberta depicting how the 9-1-1 dispatch system works. (Diagram provided by Health Quality Council of Alberta)A diagram from the Health Quality Council of Alberta depicts how the 9-1-1 dispatch system works. (Diagram provided by Health Quality Council of Alberta)

"In co-evaluation, the lead agency establishes a three-way call between the 911 caller, the lead agency, and the secondary agency. The ideal is to have the call taker speak directly to the person closest to the on-scene situation to gain information that is as accurate as possible," an excerpt from the findings of the HQCA report stated. In this case, the 9-1-1 was never able to speak to an EMS call taker. The police call taker phoned an EMS call taker to request an ambulance.

At one point during the initial 9-1-1 call, William's neighbour made a comment about the dispatch system.

"This is why being a centralization system is so s*****. I'm sure you know that," they said.

The call taker said they could not comment.

Though the police call taker did call EMS call takers, due to the fact that all other EMS call workers were busy, a specialized dispatcher (SSM coordinator) who may be used as a backup call taker took the call. The report underscored on June 5, the Southern Communications Centre (SCC) where EMS call takers work was understaffed. There were three call takers, three dispatchers, and one lead position assigned to support emergency communications officers (ECOs).

"The expected daytime staffing for that day at 2 p.m. was 19 ECOs, whereas there were 12 on duty at that time, and one of those ECOs was on a scheduled break at 2 p.m."

At 2:10 p.m. the 9-1-1 call was assigned as a Bravo determinant, which meant that the incident was serious but not life-threatening and was added to a pending list for EMS, as at that time no ambulances were available to respond to events.

The report stated that because the C911 call taker had mentioned that multiple dogs had been involved in the mauling, the call should have been given a higher priority.

"It would have been more appropriate, to assign a delta priority (life-threatening) determinant labelled as 03D08 (event involves a mauling or multiple animals). Calls assigned to this determinant are given a red priority response (immediately life-threatening or time critical). If assigned a red priority level, this call would have taken priority over other calls waiting for an ambulance to be dispatched. Additionally, ambulances from outside the city would also have been considered for dispatch."

Calgary ambulances in red alert 

The HQCA report stated that for Calgary Metro to meet response target times, 13 or more ambulances would have needed to be available to respond to an event.

"At no point on June 5 were 13 ambulances available, despite 31 ambulances being in service that day. For more than 18 hours that day, there were only between one and three units available."

At approximately the same time as the 9-1-1 call had been assigned a Bravo priority, a bylaw officer arrived on the scene, after having been dispatched. Minutes later, the officer radioed the C911 police dispatcher that EMS is required immediately due to the severity of the injuries. 

A table shows the sequence of events after a bylaw officer was dispatched to a 9-1-1 call involving dogs attacking an 86-year-old Calgary woman. (Graphic provided by Health Quality Council of Alberta) A table shows the sequence of events after a bylaw officer was dispatched to a 9-1-1 call involving dogs attacking an 86-year-old Calgary woman. (Graphic provided by Health Quality Council of Alberta) 

According to documents obtained by Discover Airdrie via the FOIP act, documents and transcripts from Alberta Health Services illustrate that police dispatch was requesting EMS 'hot'.

foipDocuments that Discover Airdrie obtained via the FOIP act, illustrate the timeline of events after Williams' neighbour called 9-1-1. 

At 2:25 p.m. more than 20 minutes after the very first 9-1-1 call from William's neighbour came in, the event was updated from bravo (serious but not life-threatening) to delta (life-threatening) by the AHS EMS deployment manager. At 2:28 p.m. an ambulance was assigned to the event, but by 2:29 p.m., the bylaw officer noted patient is barely conscious.

The Calgary fire department assigned automatically to all Delta events arrived on the scene at 2:31 p.m., with EMS arriving at 2:38 p.m. Williams arrived at the Foothills Medical Centre at 2:59 p.m. 

According to the report, the EMS response time for the dog attack was logged in at 30 minutes and 22 seconds.

"This is calculated from the time when the EMS call taker entered the event into the computer-aided dispatch terminal (CAD) (14:07:46) until the first EMS unit arrived on the scene (14:38:08). From when the 911 call was made, EMS arrived 36 minutes and 9 seconds later."

But the report underlined that if the event had originally been assigned as a Delta determinant during the initial call to EMS, it would have reduced the EMS response time by 15 minutes and 56 seconds. 

In its recommendations, the report stated that when it came to the shortage of ambulances, partner agencies, including Calgary Police and the Calgary Fire Department indicated that it would be helpful to know when an ambulance is not immediately available to respond to a call. 

"Although the response plan would not change with this information, it would help first responders with decision-making, such as reaching out to an emergency medicine physician located at an AHS EMS PSAP (referred to as Online Medical Control) sooner in order to assess any alternatives. At no point in this event was C911 police PSAP informed by EMS PSAP that an ambulance was not immediately available."

The report also urged Alberta Health Services that they should develop a process for callback procedures to callers (i.e., 911 caller or partner agency) for events that exceed 20 minutes on the pending list. 

According to AHS, EMS is already acting on several of the recommendations, including working with the Calgary Police Service and Calgary Fire Department to develop a Memorandum of Understanding for co-evaluation of 911 calls, as well as working on an additional process for triaging low-acuity patients alternate clinical supports.

Despite the report illustrating the complicated system of the way the 9-1-1 dispatch system works, the report noted that the consolidation of dispatch was not found to have contributed to the outcome of the incident nor to response times.

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