Understanding The W5 Report: A Journalist-Paramedic Responds

This post is intended for an emergency / paramedic audience.

Paramedics and physicians outraged by CTV’s investigative broadcast W5 episode “911 Roulette” took to social media last night to display their disappointment and shock in what one paramedic called “irresponsible journalism.”  The episode, which questioned primary care paramedicine in Ontario, was hosted by experienced journalist Kevin Newman in the second episode of the show’s 51st season.  As both a paramedic and a journalist, I offer my analysis of 911 Roulette and attempt to answer the question: How could W5 get it so wrong?

Before we get into the journalism, I’d like to express my condolences to Karen Calberry.  In the broadcast, Karen discusses the death of her husband David, a 54 year old firefighter, in the back of an ambulance while being transported to a hospital after suffering a heart attack.  Her contributions to the episode offer insight into public perceptions of a technically challenging dilemma facing paramedicine: what is the right level of care?

The Goal of Journalism

I believe that a free press is required for a free society.  The goals of journalism are two:
1) to protect democracy by holding those in power accountable
2) to deepen an honest understanding of the world around us

The role of a journalist is to answer questions that achieve one, or both, of those goals using accurate and balanced reporting.

If you were to call me right now and say “Blair, that piece you wrote for VICE.com last week (plug!) was full of shit” I would say to you:
1) Were there factual inaccuracies?
2) Was it balanced?
The goals of journalism essentially involve tension.  They involve questions and answers that some people may not like.  There will always be criticism, more detail that could have been added, more jargon that could have been said.

And, yes, those goals involve communicating those questions and answers to an audience.  It is HERE that paramedics must stop and reflect; journalists and their editors know their audience.  We must put ourselves in their shoes: how do we communicate a complex issue to an audience? This was the greatest struggle for me in J-school.  “World Peace!” is not a story, and neither is “Dopamine causes more arrhythmia than norepinephrine in the treatment of septic shock.”  Too broad.  Too specific.  Journalism requires laser focus and the ability to communicate complexity to people who don’t possess technical expertise, without being condescending or boring.  It’s actually quite hard to do well!

The Question Wasn’t Wrong

Journalists start with a question.  At the beginning of the broadcast, Mr. Newman ponders if people are playing “roulette” when they call 911; he observes “in Canada, calling 911 doesn’t always guarantee the paramedic who arrives can do everything in their power to save your life – in fact in most provinces, some of them are prevented from doing that.”

Put more technically, Mr. Newman asks what harms a person might experience if a primary care paramedic – rather than an advanced care paramedic – arrives on scene, noting that it seems to, at least at times, be chance.

This question is not unreasonable.  Health human resource questions like this have been prominent in public discourse for decades.  As governments fight to contain costs, we have seen RN positions replaced by RPN positions, we have seen physician services transfer to pharmacists and nurse practitioners, and we have seen family doctor home visits replaced by community paramedics.  It is not unreasonable to ask “what impact does this have on patients, systems and the economics of health care?”

Let’s Just Admit One Thing…

Allow me a brief anecdote.  Many years ago I suffered a kidney stone.  When I say suffered, I am of course exercising restraint.  It was fucking awful.  A paramedic, I called 911, begging for morphine.  When two PCPs arrived at my door, my heart sank.  Not because I didn’t trust or respect the PCPs – but because, in that moment, I really wanted a narcotic!  Years later, when a colleague was involved in a car accident, I was relieved when I heard it was an ACP crew that transported her to a trauma centre.  There is little rationale in this comfort, but I nonetheless felt that way.  I’m sure many of you can relate.  We want the very best caregiver in our personal circumstances – everyone does – evidence and economics be damned.

So, to begin, I say “bravo!” to W5 for asking a reasonable question.

Then, I wonder how the hell a well respected group of journalists could get the answer to that question wrong.

What Makes A Good Story?

Tension – there must be some component of debate.
Important or Counterintuitive – the story that makes me say “I want to read that.”
Underreported – if I have already heard about it, I’m unlikely to pay any attention.
Timely – it must be something that is happening now (or soon).
Substance – while cat videos defy this criteria, a good story has meat to it.

Let’s apply these criteria to 911 Roulette
Tension: emergency patients are critically ill, but not all paramedics are equally trained.
Important or counterintuitive: when you call 911, you might not get the help you need.
Underreported: while we all know about level of care intimately, the public, it seems, does not.
Timely: not particularly, but we all might need an ambulance tomorrow.
Substance: Ahhhhhh…. more on this later.

So, we have a reasonable question that makes a good story.  Sounds like it’s worth answering!

How Do Journalists Answer Questions?

Start by turning a given truth upside down.  Some of the best journalism comes by asking questions we thought we actually knew the answers to, but didn’t.  Then, use human sources, data, documents and field work to  answer the question.

Step 1: Question everything you think you know.
Step 2: Pick up the phone and talk to people.  Lots and lots of people.  Ask those people questions.  Question everything they think they know.  “How you know that?”  “Who might disagree with you?”  “When might that not be the case?”
Step 3: Research the data.  Policies.  Legislation.  Reports.  Manuscripts.  Graphs.  Charts.  Look at the data: does it reflect what people are saying?
Step 4: Get the documents.  Court files, government registrations, computer records.  Find hard evidence of what is happening.

Communicating A Story: it’s ugly, but it works.

Now the tricky part: communicate the answer.  This is where you sell a little bit of your soul to communicate your message in a way that someone will hear it.  Attention spans are short, and demand for attention high.  This makes the art of journalism critical, if not a bit ugly.  A radio clip might be limited to 75 seconds; an article to 600 words; a broadcast to 23 minutes.  Here, clarity and brevity are required, leading to one cutting, slashing and burning their story from a beautiful thesis to a reported story.  In this process, granularity is lost, details are left out, and jargon is replaced with terms my grandmother would understand.

For example, a needle thoracostomy and a tube thoracostomy are two very different things.  Colloquially, we might call one a “chest needle” and the other a “chest tube”.  But in a brief broadcast, it really doesn’t matter to my grandmother; ACPs can stick a thing in her chest to make her better, and a PCP cannot.  If I tried to explain the difference to her (she’s dead, so this is metaphorical) she would roll over in her grave.  So, paramedics, get over it: no jargon, no details, just clear facts.  (Yes, some of the facts were wrong… keep reading!)

What W5 Got Right

The electronic record of the defibrillator is a document that raises legitimate concerns about delays to defibrillation.  Out of context, it is hard to fully interpret… for example, a patient may be in V Tach with a pulse, receive an alarm, but not require a shock.  Still, it’s worth reporting.  They also gave the context that the paramedics were investigated and received additional training.  While they missed that “STEMI – pads on!” is a new standard, they raise a fair point in asking if a different crew might have done something different.

The controversy of making paramedicine self-regulated isn’t new, but it’s worth having in the public eye.  W5 correctly raised the issue.

Three Things W5 Got Wrong

I will not list every factual inaccuracy in the piece, aside from noting the following, and cautioning that a simplification is not necessarily an inaccuracy.
The Medicine: Nitroglycerine does not save lives.  Chest needles do not fix pulmonary arteries.  To say that the difference between life and death was an ACP intervention is dubious.
The Evidence: there is a large base of scientific evidence to draw from to make decisions about how best to model an emergency medical system.  W5 didn’t report any of it.
The Balance.  There was no interventional cardiologist to explain that STEMI bypass is preferred to closest hospital.  There was no base hospital physician or Paramedic chief explaining why different levels of care exist.  There was no PCP to offer perspective.  The paramedics in question were not featured.  The system in Saskatchewan was selectively reported, and the Ontario-Saskatchewan comparison, framed as like-like, is apples-and-oranges.  It’s hard, in a 23 minute broadcast, to present all points of views, and first person accounts are important.  But in this case, they swayed away from balanced reporting.

My Analysis:

Objectively, the episode in question accomplished the goal of journalism: to deepen an honest understanding of an issue that is relevant to the audience.  The issue of “why doesn’t everyone get an advanced care paramedic” is controversial and not settled.  It is debated throughout North America.

The idea of self-regulation and the public benefit of such is also hotly debated, and many in Ontario have been advocating for this for years.  Further, it is fair to question why certain features of scopes of practice are the way they are: the current model is a bit archaic, and perhaps not fully patient-oriented despite the best intentions of those involved.  The model is, in fact, the reason I left paramedicine and went into a self-regulated profession.

Yet, as a paramedic, scientist, physician and journalist (I think I need to stop going to school!) I was saddened by how this story was told.  I will focus on the following critiques of the story:

1)Some of the facts were wrong, and that led the story in the wrong direction.

2) The balance was way off.  The closing statement of Ms. Calberry in particular required a counterstatement to offer a different point of view; surely it is not smart to drag loved ones into your car and rush them to hospital when they are dying of a heart attack.  Emotion should be balanced with reason, and that was missing from the episode.  W5 has since responded to this criticism online.

This story hits close to home; not only does it offend me as a paramedic, it challenges me as a journalist.  As I strive to achieve the goals of journalism, I must always challenge my own biases, question everything, and seek proof over hyperbole, no matter how sexy the headline may be.

“It’s no use going back to yesterday, because I was a different person then.”
― Lewis Carroll, Alice in Wonderland

Want to read more about my foray into journalism? Click here!

Need some lighter reading? Click here to read how you cram more into a day.

18 Replies to “Understanding The W5 Report: A Journalist-Paramedic Responds”

  1. Hey Blair, as someone that’s worked in journalism and as a PCP, your response was well played — I should say that written. Thanks keep up the good work!

  2. Thanks for your thoughtful reply, Blair. As a physician with significant respect for, and involvement in, the prehospital community I also felt deeply disappointed in the W5 story.

    As you alluded in your response, there are many reasons for different levels of training amongst prehospital providers, and the scopes of practice attached to each level. This is true amongst physicians, nurses and many others in the the health care professions. Does the public believe that all emergency physicians in all hospitals in all communities of varying sizes across Canada have the same credentials, certifications and training?

    I agree that the coverage missed the critical balance required to thoughtfully explore complicated issues.

    Thanks for advancing the discussion.

    Adam

    1. Thanks Adam! Appreciate your comments. I’m so surprised that the story was told in this superficial way. Of course nearly every industry has – for lack of a better term – graduated levels of practice. Whether a lifeguard or a neurosurgeon, everyone in healthcare has a unique and unmistakably essential role in helping others to achieve wellness.

  3. I don’t disagree with most of what you’ve said, however it is the journalist’s responsibility to make sure he understands those fine points – the boring stuff you mentioned – they report on and then present the well balanced and relevant points. The W5 journalists involved in Kevin’s story did NOT appear to do that (or did not care), and therefore failed at the 2nd of the 2 “Goals of journalism.” It may be irrelevant that they did a disservice to paramedics, but it is inexcusable that, unbeknownst to their general viewers, the general viewership has been let down.
    As a paramedic, I am not worried about what this one misrepresentation will do to our field. If anything, it is balanced out by the inane fire medic arguments. I do however find it so very disappointing that now I question the accuracy and credibility of all W5 reporting. It not because it strikes close to home. It is because I know how easily obtained the correct information can be, and like I said, they either did not try to obtain it or wanted a story IN SPITE of it.

    1. I agree – the journalists do not seem to have fully understood the nuances of what they reported. The data and documents to support/refute the interviews are out there. Thanks for your insight and comments.

  4. Blair,

    Once again, your unique perspective brings some much needed context to what is a very emotional discussion for paramedics. Understanding both the goals of journalism and the tools used to achieve them gives the non-journalist (me!) a yardstick by which to measure Kevin Newman and 911 Roulette. Your article answers many questions, but raises many more.
    I agree with your arguments: the factual errors, the complexity of issues such as self-regulation and the ACP vs PCP staffing as well as the nuance of simplification. However, I do question your conclusion that “the episode in question accomplished the goal of journalism: to deepen an honest understanding of an issue…” By your own definition, journalism requires facts and balance to achieve this goal and as the W5 episode was neither balanced nor accurate, it is difficult to appreciate logic behind this conclusion. So if 911 Roulette does not meet the definition of journalism than what is it? I would argue that Kevin Newman stimulated discussion not understanding and question whether the benefit of that discussion is worth a national audience being told not to call 911.
    I would like to pose a question to you, the journalist – is there anything I can do about my profession being misrepresented by W5? You have told me a journalist’s job is to hold those in power accountable, how do I make sure the journalists are held accountable?

    1. Jon, thanks for the comments! You have indeed identified a contradiction on my part. I think this story raised a valid issue, that of scope of practice in Ontario. It has “exposed” an issue and advanced a discussion. With that said, it was very sloppy; unbalanced, factually inaccurate, and overly reliant on character quotes that ended the show with a shocking comment that most people will not take literally. Today my blog had twice the activity than my previous best-post. The episode, it seems, has activated discussion. Goal accomplished?

      To answer your question: retroactively, we can write to W5, comment on social media, and campaign for a balanced and fair discussion. Going forward, we can engage journalists and collaborate to tell the important stories that will affect health care for Ontarians. Wishy washy? Probably not as concrete as you’d like, but I don’t have a solid answer for you. But let’s keep the conversation going with thoughtful, humble and reflective discourse.

  5. Well said Blair. I think you clearly articulate the most salient point – the balance was lost.

    When we strip away the emotion of “my husband died” or ‘how dare you speak ill of Paramedics’ what we are left with is a simple set of facts that raise valid questions:

    – a higher level of care is available but wasn’t provided. Would it have made a difference?
    – are the constraints on the practice of Paramedics, PCP’s specifically, reasonable given their education
    – does the public know about the differences
    – self regulation appears to have resulted in improved care in other jurisdictions, would the same thing happen in Ontario

    I’m not shocked by the negative response by the Paramedic community – who actually likes having the microscope pointed at them. Generally people prefer to avoid in depth scrutiny of their actions, especially when someone has died.

    I think it’s important to conduct this kind of analysis, preferably in a more balanced fashion, so that we can truly learn from our ‘failures’ and I thank for for taking the time to provide such a thoughtful break down of this.

    1. Thanks Ian, you summarize real issues here… constraints on practice, which W5 was trying to get to, is an interesting dilemma for paramedics and regulators/physicians… certianly worth talking about in an analytic fashion. Cheers!

  6. Both my husband and I are ACP’s in BC and EMT-P’s in AB. We were dismayed by the facts reported in the W5 report, and immediately recognized that there was a much bigger picture that had not been brought forward and researched. Having worked in Calgary EMS for our entire careers, we were lucky enough to have an EMT-P on every ambulance, thanks to the Chief of Calgary EMS at that time. He advocated for city funding to support the need of a fully supported ALS system and to this day, even though the Province took over EMS from the municipalities, Calgary still has a full ALS system.
    We now live on Vancouver Island and are exposed to the BCEHS system. Needless to say, the island does not have a fully supported ALS system, and the general public has no idea how it works. Considering the demographic of the population here on the island, it’s amazing that there haven’t been serious complaints regarding the lack of ALS, as people just seem to believe that there’s a price to pay to live in such a beautiful environment. Seriously, that’s their attitude.
    You’re absolutely correct in saying the the report was not well balanced in terms of having a cardiologist, a PCP, or the Chief of Paramedics weigh in on the statements made.
    Thank you for your well written response to a marginally truthful report that did ask significant questions, but neglected to look at the full picture.

    1. Thank you Petra! Appreciate your comments. The patchwork of EMS delivery is not unique to Canada – globally, calling 911 can result in any number of permutations that may not always serve patients optimally. It sounds like Calgary is ahead of the curve – thanks for pointing it out, and thanks for the service you and your husband provide to your community.

  7. I am an advanced care paramedic in a large urban service (Calgary). Our standard here is to have 100% advanced life support units responding to all 911 calls. This has been the standard here for decades. However, that is not the norm, even amongst communities throughout this province (Alberta). Typically, two-tiered systems (comprised of a combination of Advanced Life Support and Basic Life Support units) are the standard because of two fundamental realities: 1) advanced life support is expensive, 2) there are currently not enough advanced care paramedics to have one (or more) in every ambulance at all times. With these facts in mind I fully appreciate how I may not always get the best of the best care in any given prehospital situation. For example, if I was experiencing a STEMI, I would want a full cardiac ICU team attending to my emergency care from my house all the way to the Cath lab. Obviously, it is unreasonable to imagine this would be plausible. I would have to make due with the best that is plausible. I might get an advanced care unit, or it might be a basic care one. For economic and logistical reasons, the standard of care in my situation will not necessarily be the highest level conceivable. If I want that to change I need to appeal to the political leaders who control budgets and set policies.

    This brings me to the next point – suggesting that patients experiencing life threatening emergencies might be better off if they did not wait for an ambulance to transport them. This is illogical. It is illogical to suggest that calling 911 is ever a bad idea in case of a life threatening medical emergency. Despite the fact that advanced care can be superior to basic care, and you may only have a Basic Life Support team responding to your emergency, PCPs are well trained in basic life support techniques. Data recently collected from multiple sources conclusively demonstrated that strong BLS intervention is critical to positive patient outcomes. BLS crews save lives on a regular basis. The implication that people are better off driving themselves or being drive into the ED independent of EMS is fallacious and dangerous.

  8. Suggesting not calling 911 could be better for the patient
    Is dangerous
    Like yelling “FIRE” in a theater

    yet…

    As trauma is concerned
    Immediate transport by private vehicle or police van
    Provides a higher survival rate
    Transport by BLS is better than ALS
    Paramedic, better than Doctor based EMS
    Most possibly
    EMS that stick to the platinum 10
    Probably better than other EMS,S
    ACP or PCP

    And, Nominally, an all ACLS system
    Does, by definition, dilute knowledge and experience
    A urban Medic is exposed to greater call volume and higher level of care hospitals
    American Medics see sicker patients than Canadian Medics

    The second layer
    So true in all fiels is: EXPERIENCE
    Problems(and solutions) to hairy pads
    Is not an ACP Vs PCP issue
    It’s an experience issue
    Our EMS do not really take this into account (Crew composition, dispatch, etc.)

    And EMSs have not optimised the level of QA/QC to palliate the experience/knowledge dilution gap

    Nothing is simple

    Charles

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