4Īt the time of Joshua Fleuelling's death, emergency departments in the Toronto area were experiencing severe overcrowding. The family has recently commenced legal actions against the Government of Ontario alleging negligence, breach of contract and breach of fiduciary duty, 3 and against the ambulance service and the hospital that was on critical care bypass alleging negligence and breach of contract. 5 The jury made recommendations with respect to asthma prevention, improvements in the ability of emergency personnel to respond to a problem and to provide advanced life-support, and resolution of emergency department overcrowding. 3, 4 A coroner's inquest was held to examine the circumstances surrounding the death. 2 The family has estimated that only 3 to 4 minutes would have been needed to reach the first hospital and that the ambulance was required to travel 4 times as far. Newspaper reports suggested that the closest hospital was a 10-minute drive from the Fleuelling's home and that the second hospital was 18 minutes away. 1Įstimates vary as to the extent of the delay in reaching the emergency department. An endotracheal tube was inserted and a normal cardiac rhythm was eventually established however, there was irreversible brain damage, and on Jan. CPR was continued, and the ambulance arrived at the emergency department at 2:23 am. Defibrillation was attempted again en route, but Fleuelling's heart remained asystolic. The emergency department at the first hospital was not contacted. A decision was made to go to another hospital, and the ambulance departed at 2:11 am. The dispatch centre informed the crew that the nearest emergency department was on critical care bypass. A second request was made for advanced life-support, but a unit was still unavailable. Two unsuccessful attempts were made to defibrillate his heart, and CPR was continued. The ambulance crew was advised by the dispatch centre that an advanced life-support unit was not available in the area. Cardiopulmonary resuscitation (CPR) was initiated and an oral airway inserted. As they began their assessment, Fleuelling collapsed and experienced full body convulsions. At 1:57 am a basic life-support ambulance crew arrived. Fire personnel arrived first and administered oxygen. Despite being given Ventolin and Serevent by his mother, he experienced severe respiratory distress, and at 1:48 am a call was made to 911 asking for an ambulance to transport him to the hospital. 14, 2000, 18-year-old Joshua Fleuelling was having trouble breathing.
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