B.C.'s 911 software too slow to recommend CPR, says witness at inquest into student's overdose death

An expert in emergency medicine testified at the Sidney McIntyre-Starko coroner's inquest that software used by British Columbia 911 operators takes too long to recommend potentially life-saving cardiopulmonary resuscitation (CPR).

Dr. Michael Kurz said the medical priority dispatch system (MPDS) that guides 911 call-takers in their over-the-phone response does not meet the "agreed-upon standard of care."

"I am sure that if you make it down the protocols in MPDS, there are instructions for CPR," said Kurz, an emergency physician and professor of medicine at the University of Chicago.

"The concern I have — and why I'm testifying today — is because I think the order in which they choose to do it is incorrect."

MPDS is proprietary software made by a Salt Lake City company and licensed in B.C. The system directs 911 operators through questions and protocols that include what first aid measures to advise over the phone and when to dispatch paramedics.

McIntyre-Starko, 18, died of an accidental fentanyl overdose in her University of Victoria student dorm room in January 2024.

The inquest into her death was called after her parents went public with concerns over the response of UVic campus security and the length of time it took to give naloxone and CPR.

Kurz said based on peer-reviewed research, the American Heart Association advised a more simplified protocol than what MPDS employs. The AHA system is called "no-no-go."

He said no-no-go saves lives because 911 operators are quicker to dispatch paramedics and instruct CPR to be started.

"There is no more time-dependent illness that emergency medical services respond to than cardiac arrest," he said. "The amount of time we have to make a difference in whether or not that person survives is vanishingly small."

With no-no-go, the 911 operator asks two questions: Is the patient conscious, and is the patient breathing normally? If the answer to either question is no, CPR is advised and a priority paramedic response triggered, according to Kurz.

Kurz said no-no-go can result in a degree of over-response of resources, but that the margin of error is acceptable when life is in the balance.

The student who called 911 when McIntyre-Starko and another female student fell unconscious did not immediately reveal that drugs were involved. Instead, she said the two were seizing and turning blue.

The report of seizures put the 911 operator into the MPDS seizure protocol, where she was directed to inquire if the unconscious students were pregnant, among other conditions.

It took seven minutes for the 911 operator to dispatch paramedics to McIntyre-Starko and 13 minutes to direct Narcan.

An adviser for MPDS, which is made by a company in Salt Lake City, defended the software at the inquest.

Brett Patterson, standards council chair of the International Academies of Emergency Dispatch, said the issue with the 911 call for McIntyre-Starko was not the MPDS software protocols, but rather the description given by the caller.

"The call-taker listens to that description and chooses one of the chief complaint protocols," he said.

"We do not encourage the call-taker to question what the caller is telling us. If the patient is seizing, then we expect certain behaviours based on the presentation of that patient that are dealt with on the seizure protocol," he said.

Patterson said no-no-go is oversimplified and potentially dangerous.

Fentanyl overdose affects the part of the brain that controls breathing. Absence of breathing will, within minutes, trigger brain damage and cause the heart to stop beating.

CPR chest compressions can keep a person in cardiac arrest alive by forcing oxygen into the lungs and blood circulation.

The inquest is scheduled to run into next week.