Public Safety Committee on Oct. 2nd, 2018

[The Chair, Liberal, John McKay]

Let's commence, ladies and gentlemen.

This is the 128th meeting of the Standing Committee on Public Safety and National Security. We have before us three sets of witnesses: St. John Ambulance, the Ottawa Police Service and Urgence Bois-Francs Inc.

We're about five minutes late starting, so we will extend the time by a further five minutes. Why don't I call you in the order that you're listed, which is the Ottawa Police Service first, Urgence Bois-Francs Inc. second, and St. John Ambulance third.

Gentlemen, we look forward to your opening statements.

[Constable Bruno Gendron, Ottawa Police Service]

Hello. My name is Bruno Gendron, and I have been a police officer with the City of Ottawa Police Service for 10 years. Before that, I worked as a paramedic in Ottawa for 17 years.

Since joining the Ottawa Police Service, I have been in charge of the defibrillator program, which was launched in 2001. The Ottawa Paramedic Service partnered with the City of Ottawa to install defibrillators in patrol cars. There are currently 171 defibrillators assigned to the Police Service. The main objective of installing defibrillators is to support patrol officers who respond to 911 calls. There is a defibrillator in each marked police cruiser.

Police respond as soon as they receive a request from the paramedic service following a 911 call. They may be dealing with a person who is unconscious, is having seizures, or is in cardiac arrest. In the City of Ottawa there are 42 patrols at all times. Therefore, there are 42 defibrillators available in the city at all times. The City of Ottawa alone has more defibrillators than paramedics and firefighters combined.

There is an advantage to having defibrillators in police cruisers. Most of the time, police officers are in their vehicles ready to respond to a call. In my experience, paramedics spend most of their time at an ambulance station or hospital. When they must respond to a call, it takes time to get on the road and respond. There is always a delay of one to two minutes before they can respond to the call, whereas a police officers sitting in their vehicle can react more quickly when they receive a call.

There is another important factor. Police officers work in different areas of the city. They know their neighbourhood, where there is construction and which roads are closed, for example. That is advantageous. The response time is critical when someone is in cardiac arrest because time matters. In Ottawa, defibrillators are used an average of six times a month, and police use of defibrillators saves at least two people every year.

There is a disadvantage to putting a defibrillator in a police car. Defibrillators must be stored indoors and at a certain temperature. Ottawa's climate is a little problematic. The electrodes are made of gel and can freeze if stored at very cold temperatures, which can cause problems in the long term. There is not enough space to keep the defibrillators in the cab, where the police officers sit. Thus, the defibrillator must be put in the trunk. That is one of the problems.

The defibrillator comes with a first aid kit, which includes a mask to be put on when the device is being used.

Our joint program with the City of Ottawa and Ottawa Paramedic Service works very well. We have been using the defibrillators since 2001, and there has never been any question of taking the defibrillators out of police vehicles.

[The Chair, Liberal, John McKay]

Thank you, Mr. Gendron.

Mr. Girouard and Mr. Grondin are next.

[Jocelyn Grondin, Chief Executive Officer, Urgence Bois-Francs Inc.]

Good afternoon. My name is Jocelyn Grondin, and I am the Chief Executive Officer of Urgence Bois-Francs. I am accompanied by Philip Girouard, who is the President of the company and also a paramedic. Urgence Bois-francs is a co-operative.

We will begin with a presentation about Urgence Bois-Francs.

We cover all of the Regional County Municipality of Arthabaska, which means that we are located midway between Quebec City and Montreal. It is a very large rural area of 2,000 km². To give you an idea of the magnitude of the task, we employ 42 paramedics, operate five ambulances and respond to between 7,000 and 8,000 calls a year. Given that we serve a very large area, the fact that first responders and other people have access to automatic external defibrillators, or AEDs, is very important to our work as paramedics.

I will begin with a statement that may seem a little opportunistic, but this is popular right now. Urgence Bois-Franc also provides training services and sells AEDs so that there are as many as possible in our area. We sell them to municipalities, first responders, seniors' clubs, and so forth.

As I was saying, our area is very large and the response time in the municipalities we serve is more than 10 minutes. I am sure you know that, in the event of cardiac arrest, for every minute that passes the chance of survival decreases by 10%. Generally speaking, we have a 10-minute window to intervene. We are talking about survival, not survival without adverse outcomes. Ideally, in order not to have any adverse outcomes, an AED must be used within four minutes, more or less. Insofar as we are concerned, and given the number of ambulances we have covering the area, it is practically impossible to meet that response time unless the emergency is near the station. If there is an emergency near Victoriaville, we can intervene in two and a half or three minutes. However, if people are 15, 20 or 30 km away, it is not realistic to think that we can intervene fairly quickly.

There are 53 AEDs in the our area. They belong to the municipalities and are located in public places. We estimate that twice that number of AEDs are located on business premises. The area has a good number of AEDs because governments have taken up that responsibility, especially at the municipal level. At the federal level, Alain Rayes ensured that a motion was adopted to have RCMP cars equipped with AEDs. He was very proactive. This did have an impact.

What is interesting is that our results are quite good considering what I was saying. The area is very large, it is a rural area and sometimes certain locations cannot be reached quickly. The Sûreté du Québec, or the SQ, decided to launch a pilot project in 2013 to support paramedic services, because the response times were long, and to improve the survival rate.

Since 2013, the Sûreté du Québec vehicles in RCM Arthabaska have been equipped with automated external defibrillators. The numbers were small to begin with. In 2013, police equipped with AEDs used them four times; in 2014, they used the equipment six times; in 2015, it was four times; in 2016, it was 14 times; in 2017, three times; and in 2018 they have been used five times so far. This may not seem like much, however, since 2013, Sûreté du Québec officers whose vehicles were equipped with an AED used them 36 times.

According to the SQ's statistics, two lives were saved by AEDs. The police consider that they saved those lives. We believe it is the result of team work. When paramedics intervene after the police, we get the credit for saving the person's life. People believe that we saved the person's life. However, in many cases the Quebec police were able to respond quickly and use their good training and a good tool before we were on the scene.

Given the success of this initiative, in 2015 the neighbouring RCM, the RCM of l'Érable, followed our lead. I have the statistics for you: in 2015, there were eight interventions; in 2016, there were four; in 2017, there were eight; in 2018, there have been two so far. AEDs were only used 22 times, but two lives were saved: a 48-year-old woman from Notre-Dame-de-Lourdes and a 57-year-old man from Saint-Norbert-d'Arthabaska, as well as another 48-year-old man.

The fact that the Sûreté du Québec officers have AEDs in their vehicles makes our work as paramedics easier for two reasons. First, even if we know that we will be driving for 15 or 20 minutes when responding to a call, it is encouraging to know that at least someone from the SQ has responded in the meantime. It gives us hope that, when we arrive, the individual will have a better chance of surviving than if only the ambulance was dispatched. As I mentioned, we should also remember that we operate in a rural setting.

We work with first responders a lot. There are three official first responder services in our area.

In 2015, there were 612 interventions carried out by first responders; in 2016, there were 644; in 2017, 681; and in 2018, there have been 490 so far.

We have to remember that many first responder services, such as firefighters and others, have AEDs in their vehicles. I was unable to determine the number of lives saved with AEDs, but lives were definitely saved because of the intervention of first responders before we arrived. In rural areas, we need this assistance because the ambulance service will never be able to respond to all calls.

However, there is still room for improvement. We have been both lucky and unlucky. On April 19, 2018, my assistant stopped at the scene of an accident on the side of the road to carry out cardiopulmonary resuscitation, or CPR. It was about 25 minutes from the ambulance station. They had to wait for an ambulance. The first responder, in this case the fire department of the municipality where the accident took place, arrived first. My assistant asked the fireman to bring her an AED. Unfortunately, he did not have one and she was very surprised.

The fireman did not intervene. As the fire department does not have an AED, it probably does not provide CPR training. The injured 40-year-old man died. An AED does not perform miracles. We cannot say whether the man would have survived if an AED had been available, but his chances would have been better. My assistant administered CPR, and the AED arrived with the ambulance about 20 minutes later. They arrived 10 to 15 minutes too late. Unfortunately, the man died.

There was another case recently. A man experienced cardiac arrest in Saints-Martyrs-Canadiens, a municipality located about 25 minutes from us. Once again, we had to go get the AED in the village. Had the fire department had an AED or if there had been one closer to an emergency service other than an ambulance, things probably would have ended better. Although this man survived, he may end up with health issues that he would not have incurred had a working AED been available.

Therefore, we believe in AEDs. This device is easy to use and it only takes 20 minutes to teach the average person how to use it. It is foolproof and affordable. The best models cost about $1,000 when large quantities are purchased. A lower quality model can be purchased for a few hundred dollars. They are easy to maintain and will last almost forever if you look after them. You only have to check the status indicator. It is a durable device.

We would like to make the following recommendations based on the Sûreté du Québec experience with AEDs.

First, if AEDs are provided, the ambulance services of neighbouring municipalities should be informed. The Sûreté du Québec has an AED model that is not compatible with our monitors. Given that everyone in Quebec has the same monitor, it would have been easy to purchase the same AEDs with the same electrodes. We would have saved time and money because we could have used just one set of electrodes rather than two.

Second, we should opt for a model with a practically unlimited life expectancy. Some models have a limited life expectancy. The model should have only one set of electrodes. At present, some AEDs need a set electrodes for adults and one for children, whereas other models only need one set of electrodes. This could result in cost savings.

Finally, there should be a budget for training and not just for the device. Not much is gained from having the best device in the world if CPR was not performed properly and the person does not know what to do. It is important to have a tool, but we have to know how to use it.

[The Chair, Liberal, John McKay]

Thank you, Mr. Grondin.

We now have Mr. McLaren and Mr. Stanzel.

You have 10 minutes. Thank you.

[Shawn McLaren, Chief Learning Officer, National Office, St. John Ambulance Canada]

Thank you.

St. John Ambulance trains over 500,000 Canadians annually in first aid, CPR and the use of AEDs, and 2018 marks the 135th year that St. John Ambulance has been training people in Canada.

My name is Shawn McLaren and I'm the chief learning officer for St. John Ambulance. My counterpart is Andrew Stanzel. Andrew is the council commissioner for the federal district council. He leads all of our medical first responders, is a medical first responder himself and is a registered nurse.

CPR is often what comes to mind when people think of first aid for a cardiac arrest. However, CPR is only part of the picture. St. John Ambulance teaches the chain-of-survival approach, which has five steps that are important when helping someone in cardiac arrest.

Step one is immediate recognition of a cardiovascular emergency and calling 911. Step two is early CPR with a focus on chest compressions. Step three is rapid defibrillation.

I would like to break here and give more specifics on the use of an AED, considering the nature of this committee. During the initial compressions and breaths of CPR, we instruct that someone should locate and then prepare an AED for use. Time is a critical factor in determining survival from cardiac arrest. The heart will only stay in fibrillation a short period of time before all electrical activity ceases. Defibrillation must be performed early to be effective.

CPR can keep oxygenated blood flowing to the brain and help extend the length of time the heart will remain in VT or VF—the only arrhythmias an AED will shock. CPR can then buy some time for the casualty until the AED is attached and can deliver a shock. Thus, the more readily available an AED is, the sooner it can be used. The sooner an AED is used in this situation, the greater the chance of survival for the casualty.

The steps then resume. Step four is effective advanced life support. Step five is integrated post-cardiac arrest care.

Each one of these steps is as important as the others. Time is the vital ingredient. To give a casualty in cardiac arrest a reasonable chance of survival, CPR must be started immediately, followed by defibrillation as soon as possible. For both procedures, the sooner they happen, the better. A first aider who is willing to act is crucial to the first three links in the chain of survival.

Beyond the use of AEDs in response to a casualty in cardiac arrest, there are two other factors that need to be addressed: the availability of the AED, and the confidence or effectiveness in the use of the AED. Having more AEDs in the community equates directly to reducing the time it takes to put one into use. Having AEDs in RCMP vehicles places an AED in prime position to be used quickly.

Optimum confidence and effectiveness require annual recertification in CPR and AED, and this is recommended, though few in the public follow this recommendation. Without annual certification of the public, it is even more important that AEDs are placed in the hands of those who are certified annually in CPR and the use of AEDs. To the best of my knowledge, RCMP officers are among that population. If they are not currently recertifying these officers annually for CPR and AED, they should be if the finding of this committee is that AEDs should be placed in all of their vehicles.

To illustrate the importance of training in the use of AEDs, we have included a survey from February 2018 conducted in British Columbia. People were asked, among other things, about the likelihood of their having to use an AED, as a bystander, in a medical emergency. Sixty-seven per cent of those polled said they would be “very likely” or “somewhat likely” to use an AED.

For contrast, compared to using an AED, those polled were more likely to take the following actions as a bystander in a medical emergency. Ninety-eight per cent said they were “very likely” or “somewhat likely” to call 911. Ninety-one per cent said they were “very likely” or “somewhat likely” to check if the individual was breathing normally. Seventy-two per cent said they would provide CPR, so that the use of an AED ranked fourth in those stats.

The main reasons the people in this survey were less than “very likely” to use an AED as a bystander in a medical emergency were as follows: 56% said they didn't know how to use an AED; 53% were worried about using it improperly and causing harm; 36% said they would not know when to use the AED; 19% were worried about being sued by the casualty; and 13% were worried about hurting themselves in the use of an AED.

These responses are telltale signs of people who have not had training or have not been trained recently. Proper training on how to use an AED could eliminate the majority of these fears of taking action. The issue in this particular survey, though, is that only 23% of people in British Columbia have taken AED training.

With less than a quarter of the people having taken AED training, and even fewer having taken it in the last year, presumably, there is a small number of people who would feel confident in using an AED in an emergency situation. This is all the more reason to place AEDs into the hands of first responders, who are not only receiving annual CPR and AED recertification but would have them readily available for their use.

To illustrate the benefit of having an AED in close proximity to potential emergencies, I would like to share the details of an event that happened on September 23, 2018. In support of the Canada Army Run here in Ottawa, our medical first responders were part of a team tasked with providing first aid at the finish line for all the races that day. During the half marathon, one of our volunteers witnessed the sudden collapse of a runner in the last 100 metres.

Shortly after the collapse, the MFR team was at the side of the casualty, where CPR was started and an AED—which is part of the first aid equipment our MFRs carry when on duty—was prepared for use. After the application of one AED shock, the casualty regained breathing and normal sinus rhythm prior to the arrival of EMS. He was transported by Ottawa paramedics to the heart institute, where he successfully underwent an emergency angiogram.

In closing, being able to provide rapid defibrillation is a key component in the chain of survival. In order to provide rapid defibrillation, an AED must be readily accessible, and having AEDs in RCMP vehicles helps make that a reality.

[The Chair, Liberal, John McKay]

Thank you very much.

We'll now go to the rounds of questioning.

Ms. Damoff, you have seven minutes.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Thanks, Chair.

Thanks to all the witnesses for being here.

I was in a situation where I had to perform CPR on someone, so I and my staff all do the training, and I think what struck me the most was how easy the AEDs are. But without having done that training, I know I would never have gone to use one.

I guess I would put this out to all of you. One of the things that has struck me is that, while my community office is actually in a medical building, we have no idea who in that building has an AED. If there were ever a situation in the building, there's no record of where these are. That's quite common, I think.

What do you think the benefits of that would be, versus putting them in first responder vehicles? I put that to any of you.

Are they two totally separate things? Maybe I'll put that to St. John Ambulance.

[Andrew Stanzel, Council Commissioner, Federal District, St. John Ambulance Canada]

There are programs throughout the world that have apps that will tell you where the closest AED is. There is one, I believe, in Canada as well. I don't think there's one in Ontario at this point in time.

Yes, that would be beneficial in buildings where AEDs are already in place. If it's a building where an AED doesn't already exist, then it's not going to help in that situation, but having more knowledge of where AEDs are present, for the public to be able to access them, would definitely be an asset.

I know you mentioned that you were in a medical building. Not all medical clinics are even required to have AEDs in some situations, so there may not necessarily be one in those offices, even though there is a doctor's office there.

I think it's two separate issues, yes.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

To the Ottawa Police Service, one of the issues is cost. I spoke to the Halton police about this motion, and with so many pressures on municipal police services.... Even though the actual unit isn't that expensive, it's an additional cost to the service. How did your police service become so committed to doing this, and how do you fit that in with the other pressures on the police, to be able to provide equipment and services for the community?

[Cst Bruno Gendron]

The main cost is the pads, once the unit has been bought. Everything comes through the City of Ottawa, then Ottawa paramedics are the leaders of the program, and they are the ones who do the preventive maintenance about every three years. Recently we just changed all of our units. The shelf life there is long—10 years. That's what Ottawa paramedics are recommending, so every 10 years, we're switching defibrillators for new ones. Now we all have new units in every vehicle. I don't know the cost of the unit. That's paid through the city. We're just being provided with the unit. We have to pay for the pads when they're used. That's approximately $75.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Is that you personally?

[Cst Bruno Gendron]

The service purchases the pads, which are $75, and then the batteries need to be changed every three years, when they do preventative maintenance.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Okay. Obviously, having them in the vehicle is beneficial. Your service has police and paramedics combined. Do you know of any issues from the paramedics about having these in a police vehicle?

[Cst Bruno Gendron]

Issues in which way?

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

I know that there have been concerns expressed by paramedics about firefighters, for example, doing paramedic work when they arrive on a scene. Would there be jurisdictional issues?

[Cst Bruno Gendron]

Not at all. Like they explained, our co-workers, our friends, it's teamwork. The chain, the link, the early defibrillation and early CPR—for paramedics, when CPR or defibrillation is started on the patient, like it's been explained, the travel time.... They're overwhelmed with calls, so it's a great asset. It's great teamwork. There's no problem at all and no issues with police or firefighters starting CPR or early defibrillation.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

One issue that we would have as a federal government is making recommendations that would impact municipal forces. The only one we have jurisdiction over is the RCMP and that's part of the study, but do you have any suggestions about what we could do to make a suggestion or recommendation that wouldn't necessarily have to be followed by the municipalities? Getting you on the record as saying, “Yes, every vehicle should have one”, would probably be helpful.

[Shawn McLaren]

If we're talking chain of survival, then yes, absolutely, every vehicle should have one and where possible the AEDs could be the same model or have the same sort of alignment with the ones that are being used at our level. Even once an AED has been used and the pads are already on, it's much easier if the next level of assistance can simply plug their electrodes into the pads that are already on. If you have Zoll, right from the base of our medical first responders, all the way to police and to ambulance servers, they don't have to take the pads off. They plug it in and away they go, then we recoup our pads.

Yes, I'll clearly say that every vehicle should have an AED in it.

[Philip Girouard, President, Urgence Bois-Francs Inc.]

In my opinion, it is not necessary to insist that we have the same brand of defibrillator electrodes, AED monitors and defibrillators. In Quebec, we had a call for tenders to supply AEDs and ambulance monitors for the entire province, which is a good thing. It is easier to sync the AEDs with the ambulance monitors.

What really matters is how quickly the first shock can be administered. If the defibrillator electrodes or the monitor are not the same as those used in our region, the defibrillator electrodes can be changed later. The delay is short and occurs at the beginning. I think that we do not have to insist that we have the same monitors. We can consider the cost and which one is more useful, or use other criteria. My colleague spoke earlier about devices whose defibrillator electrodes can better tolerate Quebec's temperature differences. That might be more useful.

[The Chair, Liberal, John McKay]

Thank you, Ms. Damoff.

Mr. Reid, welcome to the committee. You have seven minutes.

[Scott Reid, Lanark—Frontenac—Kingston, CPC]

Thank you very much, Mr. Chair.

I want to start dealing with a technical issue that I hadn't heard of before. This is directed to Constable Gendron. You mentioned an issue with the pads losing their adherence, as a result of repeated freezing and thawing. I wanted to ask you a little bit about that and whether that's an issue that only arises while the pads are actually very cold or if it's something that occurs even when it's warmer weather, due to the past repeated heat-thaw cycles.

For example, is this something that could occur at this time of year, with a pad that had gone through last winter, having been thawed, frozen, and thawed and frozen again?

[Cst Bruno Gendron]

We had one incident that was reported to us. There was an arc when the shock was given to a patient and it was attributed to the fact that the pads were defective. The cause was most likely that they had been left in cold temperatures, warmed up, frozen, and warmed up again.

[Scott Reid]

Were they cold at the time they were applied, do you know?

[Cst Bruno Gendron]

No, I don't have that information.