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.
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.
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.
Good afternoon, Mr. Chair and honourable members of the committee. Thank you for inviting the RCMP to speak to you about motion 124 regarding AEDs.
I am joined today by my colleagues Bruce Christianson, from occupational health and safety, and Nathalie Guilbault, from our materiel and assets management section. We are here to provide you with information and to answer your questions to help inform your deliberations on this motion.
According to the Heart and Stroke Foundation of Canada, approximately 40,000 Canadians suffer from sudden cardiac arrest each year, of which 80% occur outside of hospital settings. This is one reason that all RCMP officers are required to be trained and recertified in CPR and first aid, which includes the use of AEDs. The RCMP is committed to our communities, with CPR and first aid training for our officers being one demonstrable enhancement to our public safety role as first responders.
Currently in most Canadian communities, more than half of all cardiac arrest patients do not receive CPR prior to the arrival of paramedics and first responders. All police are committed to community safety and well-being. Fortunately, public access to AEDs has increased significantly in recent years across Canada, and we are encouraged by the installation of AEDs in public spaces, including public rinks, arenas and recreation centres across Canada.
We are aware that motion 124 calls for the equipping of all RCMP vehicles with AEDs to support greater public access to these life-saving devices. We are here today to provide the committee with information and to highlight for the committee's deliberations considerations related to the motion.
I will briefly outline to the committee the current use and policies for AEDs within the RCMP.
The RCMP has adopted a limited AED program, which is guided by the RCMP's national occupational safety manual. AEDs have been approved for installation and use in the following RCMP operational areas: emergency medical response teams, the divisional fitness and lifestyles program, some protective policing details, and in those instances where provincial policing standards require that an AED be available. Furthermore, the standard first aid curriculum in which all RCMP members are required to be recertified every three years includes the use of AEDs.
In addressing costs, several operational rollout and financial considerations must be assessed. We undertook a preliminary scope analysis that sought to highlight some of the RCMP's specific challenges and to provide you with some variables for financial order-of-magnitude figures.
As an example, to support the G7 summit in June 2018, the RCMP undertook a procurement exercise to purchase a limited number of AEDs specifically for this event. These devices cost approximately $1,700 per unit, which aligns with the range of costs that was reported to the committee in June. Additionally, compact AEDs, which were purchased for our emergency response team in 2016, cost approximately $4,500 per unit.
As of September 2018, the RCMP has approximately 12,200 vehicles in its fleet, of which close to 5,000 are marked police vehicles. The remainder are unmarked, operational, administrative and special purpose vehicles.
It is important to consider the additional costs required for ongoing maintenance and replacement of these devices. Furthermore, there are a number of other considerations that could result in higher costs or difficulties in rolling out AEDs to the RCMP fleet.
While the RCMP has procured a limited number of AEDs, these devices have been purchased for use primarily within RCMP facilities or for short-term events such as the recent G7. To determine what devices or series of devices would be required for use nationally in RCMP vehicles, an in-depth analysis would be necessary to evaluate operational parameters, including climate, temperature, durability and interoperability with existing equipment. The analysis would provide information to ensure that any device purchased would operate to a known standard, regardless of weather, temperature or location in Canada.
The RCMP takes a number of factors into consideration when determining whether to purchase or roll out new police equipment.
Given the unique contract policing role the RCMP plays in Canada, decisions taken by provincial, territorial and municipal governments play a significant part in how the RCMP purchases, trains, maintains and equips front-line members with new equipment. However, from a Canada Labour Code perspective, for officer safety reasons the RCMP does set minimum standards. Currently, the RCMP provides contract policing services to all provinces and territories, with the exception of Ontario and Quebec, as well as some 150 municipalities. These services are provided through police service agreements, which see the cost for RCMP services shared by provincial or municipal governments and with the federal government.
In consultation with the RCMP, the provinces, territories and municipalities establish the level of resources, the budget and policing priorities in their respective jurisdictions. It is through these consultations and decisions by the government of local jurisdictions that the RCMP is allotted funding for the purchase of new equipment.
To implement M-124, the RCMP would need to first determine the range of device options that would be appropriate for use nationally. An analysis would need to be undertaken to determine how and where these devices could be housed in a vehicle, being mindful of the multitude of other equipment our officers require for their daily duties, specifically in the north. Additionally, consultation with contract partners would be required to determine the extent to which these devices could be deployed.
The RCMP is committed to the safety of its employees and the citizens it serves. While our primary mandate is for the provision of law enforcement, we often get called upon to support the broader first responder role. We will continue to work with our partner stakeholders, including provinces, territories and municipalities, to establish policing priorities in their respective jurisdictions.
Thank you for the opportunity to speak to you today. We look forward to answering your questions.
Right. Again, that's exactly what's in the cars with the Pelican case that are $1,700.
You indicated, Superintendent, that you have not done a cost-benefit analysis to roll this out. This motion has basically been on the books since March last year. I'm wondering why that cost-benefit hasn't been done. I'm just curious.
Pam, did you say about $8.5 million for the cost?
The Omar Khadr payout was $10.5 million. The hockey rink on the Hill was $8 million. You'd almost be covered off with the hockey rink.
When you look at the 3,000-plus lives that it's estimated to save, that you could be involved in saving, you see that we're talking about $2,800 a life. It's a pretty small price to pay especially when you can get four years or so out of an AED without....
Mr. Scott Reid: It's 10 years.
Mr. Glen Motz: The pads have a four-year life. You can do minor maintenance on them. I think that would help, as your officers are already CPR trained. Included with the CPR training, you have AED training.