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.
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.