Host Katie Jensen goes behind the scenes of Ontario’s 911 and ambulance system with Marie LaRocque, a paramedic Communications Officer with 25 years of experiences, and Acting Superintendent, and Norm Robillard, a former advanced care Paramedic with 37 years of experience. Across two episodes, Marie and Norm discuss the evolution of Ontario’s emergency response system, as well as its shortcomings and strengths. They share the reality of what it’s like working in a system that is underfunded, understaffed, and with high rates of burnout, while still sharing the impact they’re proud to have made. They also make it clear that a sense of humour is necessary for a job in first response, as they share stories about some of their craziest, and most touching calls.
Part 2 digs into the grind behind a “normal” 12-hour shift and the strain that chronic understaffing creates for both dispatch and crews. Communications Officer, Marie Larocque describes the dispatch “chess game” of moving ambulances to protect lunch breaks, often unsuccessfully, and the moral injury of holding exhausted paramedics on mandatory overtime. She also recounts a ride-along on the orange air ambulance, including a dramatic hospital transfer and being left behind due to weather. And Paramedic, Norm Robillard, reflects on the high standards emergency response personnel hold themselves to, learning from tough calls, and not “keeping score” on outcomes. Both critique offload delays and primary-care gaps, while stressing: if you’re truly sick, call 911.
[00:01:50] The lunch issue
[00:04:10] Overtime and moral injury
[00:05:29] Paramedics and Communications Officers relationship
[00:07:29] Marie’s ride-along adventure
[00:10:10] The hard side of the work
[00:14:11] Offload delay
[00:16:48] Community band-aids
[00:19:05] If you need help, call
Disclaimer:
Any statistics, facts or data references mentioned in this episode have not been independently verified and may not reflect the most accurate, complete, or current data. Please consult reliable sources for up-to-date and authoritative information.
[00:00:00] Katie Jensen: I'm Katie Jensen, and this is The Path of Public Service from Applaud, celebrating people who have spent their lives working in Ontario's public sector. What kind of person makes a good paramedic?
[00:00:12] Norm Robillard: Humble, good listener, and a sense of humor. Hi, I'm Norm Robillard.
[00:00:18] Katie Jensen: He's a paramedic, in case it wasn't obvious.
[00:00:21] Norm Robillard: I'm a former paramedic with a large municipal paramedic service, having completed about 37 years there before I left.
[00:00:30] Katie Jensen: Meet Norm's longtime friend and comrade, Marie Larocque.
[00:00:34] Marie Larocque: Hi, my name is Marie Larocque, and I am a communications officer and acting superintendent for the paramedic service.
[00:00:41] Katie Jensen: In part one, we talked about how dispatch technology changed everything:
[00:00:46] Marie Larocque: So, we had no clue where they were calling from, so if they didn't know where they were, then it was a lot of research on our end to try and find them.
[00:00:52] Katie Jensen: Frequent flyers:
[00:00:54] Marie Larocque: They would call, and all you would hear would be, "Euhhhhh," and you'd be like, "Oh, hey. What's wrong today?" And, "Oh, I'm hungry." "Okay, you want me to order you a pizza?"
[00:01:05] Katie Jensen: And what you should and should not call 911 for:
[00:01:08] Marie Larocque: Don't call 911 when you have a chipped tooth, a hangnail, a paper cut, a stubbed toe. Those are not 911 calls.
[00:01:17] Katie Jensen: In part two, we'll hear about what it takes to survive a 12-hour shift:
[00:01:22] Marie Larocque: You've gotta be able to laugh. That's number one. That's how we cope.
[00:01:26] Norm Robillard: And a small stomach, 'cause dispatch doesn't give you lunch.
[00:01:29] Katie Jensen: Marie takes us on the most unusual ride-along of her career.
[00:01:33] Marie Larocque: In the orange helicopter. That was something else.
[00:01:36] Katie Jensen: And Norm has some thoughts about the state of healthcare in Ontario.
[00:01:39] Norm Robillard: 1.5 million Ontarians don't have a family doctor. This is my rant now, so you guys can sit down. (Laughing).
[00:01:46] Katie Jensen: Here's part two of my conversation with Norm and Marie.
[00:01:50] Marie Larocque: In the early days of my career, I didn't really get, like, why paramedics were always complaining about not getting their lunch. And then they started allowing us to do ride-alongs, and I remember I got one shift in particular where we just got hammered. And, like, at one point, I had to pee so bad. You know, you're sitting there, you got your legs crossed, and you're like, "Oh, just let me get to the base." And we're pulling into the base, and they call us out on a call, and I was like, "Okay, I'm never gonna say anything when they complain about their lunch again." Like, it gave me a very different perspective, a very valuable perspective, and from that point on, it really changed how I addressed, like, the lunch issues and getting guys their lunch.
[00:02:33] Katie Jensen: So it's your job to say, basically, "You can take lunch now. I don't need you now."
[00:02:39] Marie Larocque: Yeah. The rule was, is that they had to get 30 minutes uninterrupted at a fixed post, at a fixed base. So yeah, it was our job after they clear a call, we'd have to go and look. Okay, are they due their lunch? Yeah, they're due their lunch. Okay, where do I have an available base? Okay. And in Ottawa, especially in the early days, we didn't have an overabundance of bases, and we weren't allowed to double up. We couldn't have two ambulances at the same base. So you're like, "Okay, well, these guys are almost done their lunch. Okay, well, if I send them that way, it's gonna take them 15 minutes to get there. By the time they get there, the other guys will be done. I can boot them out." So it really was like a giant chess game that we were playing. We were constantly moving vehicles to try and accommodate lunches and breaks, and we do our best.
[00:03:28] Norm Robillard: Uh, yeah. Sure.
[00:03:29] Katie Jensen: Where are you going? Are you eating from the convenience store?
[00:03:32] Norm Robillard: So I ate way too many shawarmas over the years, but yeah, yeah. That was the, some of the most stressful stuff. You go in, and there's a lineup. Oh, there's people ahead of me. You know what I mean? And you know that dispatch doesn't have any other crews in your area. You just know that, and your order's gonna be in, and, "Code four, da, da, da," and you're like, "I just wasted 10 bucks." Maybe try to get back to the same place later, but that's just, I should have packed a lunch. You know what I mean? But some of your listeners will say, "Okay, well, you chose that job, right? You chose to be a comms officer, paramedic, or cop, or firefighter, whatever job you pick." Yeah, you're right. And if I miss a lunch break on a given shift, that's not the end of the world.
[00:04:10] Norm Robillard: Like, it becomes chronic, this shift, then that shift, then the next shift. I'm telling you, when you wake up for the 17th shift, and you know you're not gonna get a break again, honestly, we're human beings, too. It's just constant, constant workload, and that's the stuff that wears a person down, too. So, it's not one missed lunch random. You know what I mean? It's a constant, chronic, never getting a break, right?
[00:04:32] Marie Larocque: And always getting stuck on overtime. You guys did overtime every shift. At one point, there was actually a policy in place that if we didn't have X amount of ambulances available on the road, we were not allowed to send them home. We were to hold them until their 16-hour mark. So then imagine the moral injury that that then imposes on us as dispatchers, 'cause you're like, "I know he's put in 12 hours, 13 hours, 14 hours. He's exhausted. He hasn't had a lunch. He's been nonstop all day. I want to send him home, and I can't."
[00:05:05] Norm Robillard: Cause the next day you gotta do it all over again, right? 'Cause you do three 12s in a row or-
[00:05:08] Marie Larocque: Yeah ...
[00:05:08] Norm Robillard: five in a row or whatever, right?
[00:05:10] Marie Larocque: Mm-hmm.
[00:05:11] Norm Robillard: So it's not the job itself. It's the systemic-
[00:05:15] Katie Jensen: Under-resourcing.
[00:05:16] Norm Robillard: Oh, sure. You can use that.
[00:05:19] Katie Jensen: Can you tell me a little bit more about the relationship between dispatch and the paramedic teams, and how you're kept separate?
[00:05:29] Marie Larocque: Yeah. When I started, I started at dispatch right around the time that the city of Ottawa amalgamated. All the separate paramedic services became one, and the guys worked out of what we lovingly referred to as the barn. And dispatch was what we lovingly referred to as ghetto cac, this little dark hole in the wall. And it was very much we were kept separate. You're a dispatcher, they're a paramedic. We definitely tried to bridge the gap, which is how Norm and I met. You know, they would come by. We would sometimes get together for breakfast after a night shift or, you know, grab a drink after a day shift or when, when we could.
[00:06:08] Marie Larocque: December 2002, the city took over dispatch, and then we moved into our new facility in 2010, and then we were literally a parking lot between headquarters and dispatch, and it still became an us versus them. And so management would come out with a new policy, and they would tell dispatch, "Oh, well, this is because of the paramedics. It's all their fault. You know, be mad at them." And they would tell the paramedics about the exact same policy, "Oh, well, this is all because of dispatch. It's dispatch's fault." So then it created a lot of tension between the two groups. We never did any training together. We never did anything together. It's very much a, a very separate coexistence, but then they want us to all believe that, oh, we're one big, happy family. This is their new favorite tagline, you know? But the reality is, is that for 24 years they've fostered this, this animosity between the two. But I can't do my job without Norm, and Norm couldn't do his job without me, so why are you trying to create that divide? That was always my hangup.
[00:07:18] Katie Jensen: Yeah, you're like a pair of hands.
[00:07:20] Marie Larocque: Yeah.
[00:07:20] Katie Jensen: Right? Like one hand's in the cupboard and the other hand's out, and they can't see each other, but they need to communicate.
[00:07:26] Norm Robillard: And look at the job we're doing. It's not as if we're making widgets or whatever, you know?
[00:07:29] Katie Jensen: I suppose the ride-alongs really helped too.
[00:07:32] Marie Larocque: When those started, yeah, they were great. It really gave us insight into their world, which we wouldn't have otherwise have gotten. One of the most fascinating ride-alongs, though, that I ever did was in the orange helicopter. That was something else.
[00:07:44] Katie Jensen: How was it getting into it? Do you really have to duck when you get into a helicopter?
[00:07:48] Marie Larocque: Well, they, they tell you to kind of, like, bend down a little bit. It's not like the rotors are gonna chop off the top of your head. Like, especially when I was getting in, like, the rotors were already spinning, so they're above the top of the helicopter, right? So, but it was my first experience flying, ever. I had never been on an airplane or anything at that point. I had no clue how I was gonna feel, and then the call that we ended up attending was a transfer from the community hospital into one of the trauma centers here in Ottawa, and it was a shotgun injury. Gunshot wound to the abdomen with a sawed-off shotgun. So that was really cool to get to see that, and, like, when I got to the hospital, the emerge doc recognized that I was a dispatcher, and he's like, "Come see this." And he, like, showed me the X-ray. And then he showed me the bullet wound, and-
[00:08:36] Katie Jensen: Did it have an exit?
[00:08:37] Marie Larocque: No, when it went in, it just, like, there was, like, a million pellets, and then he was showing me, like, on the X-ray, like, "This is the spleen, and you see all these little dots? These are all, like, bullet fragments, and this is the kidney, and this... " And so, it was really cool. It was really educational for me, but I was also the first time they ever had to leave somebody behind on a ride-out. So they end up having to leave me behind at the hospital, and then OPP drove me back to Ottawa, 'cause it wasn't within our area. They always tell you when you go, like, "Make sure you bring cash, and you bring a credit card just in case we have to leave you behind." But up until that point, they had never done it before, and then I got left behind. (Laughing).
[00:09:17] Katie Jensen: Regrettably, it was you.
[00:09:18] Marie Larocque: Yes. It was my luck. Let's just say.
[00:09:23] Norm Robillard: Is that because they had, like, a physician and a nurse jump on board with them, or they just ran out of seats?
[00:09:29] Marie Larocque: No, the guy was under arrest, so police were with him, and just after we landed, a storm front blew in, and so the cloud cover was too low, so they couldn't have the extra body on board. It was just my luck. I'm at the hospital, and I'm, like, calling dispatch. "Okay, do you have anybody coming up to this area? No." So I called the other dispatch center. "Do you have anybody going down to Ottawa? No." And then this OPP officer walks in, and he's like, "Excuse me, are you Marie Larocque?" And I was like, "Uh, yeah?" (Laughing). "Come with me." And I'm like, "Oh."
[00:10:00] Norm Robillard: Here's your bus ticket.
[00:10:01] Marie Larocque: And he walks over to the cruiser, and he opens the back door, and he's like, "Oh, I'm just joking." And he opens the front door, and he's like, "I'm giving you a lift back to Ottawa." I was like, "Okay, thank God."
[00:10:10] Katie Jensen: Seeing each other's world up close didn't make it any easier to carry.
[00:10:15] Norm Robillard: There's shifts, particularly earlier in my career, where I had to be my worst critic, but you can't hang on to that. You just have to learn from your mistakes. Try not to be too, too hard. You gotta be hard. I remember partners, I don't know if they lasted, but they were like, "Oh, that, that didn't go so well. You know, let's go for lunch." I'm like, "Dude, no, we gotta talk about this. You know what I mean? This did not go well." Like, you know what I mean? No one else saw it. We're the only two people that know that this didn't go well. Not that the patient died or anything like that, but we didn't do the job as effectively as we should have, and learn from it.
[00:10:48] Katie Jensen: I mean, it sounds like there's a low tolerance for mistake, but also, like, a high caliber that you hold yourselves to, like a high standard for perfection.
[00:10:58] Norm Robillard: Correct.
[00:10:58] Katie Jensen: That's hard.
[00:10:59] Norm Robillard: Yeah, but you can't keep score. And I know medics, maybe some dispatchers that kept score, you know, whether they knew it or not, and we get a call, right? And we get there within six minutes, and the patient's VSA, vital signs absent, they're in cardiac arrest. No one's started CPR. Maybe they have. Well, six minutes, you know how lucky you have to be as a patient to have a paramedic crew there in six minutes? It should take like 10 or 14 or 15. It could be bad weather that day. It could be rush hour traffic, snow, you name it, right? Look, the air ambulance couldn't fly on that day.
[00:11:32] Marie Larocque: Mm-hmm.
[00:11:32] Norm Robillard: Right? S*** happens all the time. So if we can get there in time and make a difference, that's great, but sometimes, if not the majority of times, things are out of our control. Didn't get there in time, or the patient had the massive stroke where it was a bleed and not a stroker, they had the widow-maker heart attack. You know, it wasn't just a small heart attack, it was the biggest one you could have. Or someone got hit by a dump truck. Well, it wasn't ... They didn't get hit by a bicycle. They got hit by a dump truck, you know? That wasn't my fault.
[00:12:09] Marie Larocque: Mm-hmm.
[00:12:10] Norm Robillard: You know what I mean? But I think some of us kept track of how many times we weren't able to save lives and make a difference, and I think I naturally was able to not- And not belabor, but not let that stay with me for too long, and riding my bicycle home probably helped. But Marie could give you situations where the address, the patient's really sick, they're unconscious, they're not breathing, we don't know if they're, don't have a pulse or not, and they don't have the address, you know? Or the address is screwed up, and the crew's yell- well, not yelling at you, they're on the air saying, "We're on County Road," whatever. It's, you know, and there's that heightened anxiety. I've been there too, right? But that's when you gotta breathe and calm down. So Marie could tell you about feeling guilty for things that were out of her control.
[00:12:58] Marie Larocque: Oh, absolutely, yeah.
[00:12:59] Norm Robillard: Some of my worst frustrations were how the healthcare system failed the person that's in front of me.
[00:13:07] Marie Larocque: Mm-hmm.
[00:13:08] Norm Robillard: Wound care, discharge from the hospital, and they didn't get the proper follow-up care. If there were more family doctors, 1.5 million Ontarians don't have a family doctor. This is my rant now, so you guys can sit down. (Laughing). My doctor, I told her already, I've known her for 25 years ago, "You can't retire, Kathy. You can't retire," you know what I mean? Like, where am I gonna go? So not enough primary care, right? And EMS, paramedics, is a band-aid for society, as I call it. Mm-hmm. When you got nowhere else to turn, they call 911. And then Marie gives us the call, and it could be for nothing, but worse, it could be for somebody that should have been back, that should have been seen by a doctor or community nurse or somebody, and her family's failed her, too, for whatever reason. And are we in Ontario, or are we in, like, some third world country? Because sometimes-
[00:14:02] Marie Larocque: Yeah ...
[00:14:02] Norm Robillard: f****** feels like that, right? And that's the very frustrating part. So how to separate that, kinda hard. That gnaws at you, too.
[00:14:11] Marie Larocque: Well, and there's that element, too, of, like you were saying, people don't know where to turn. We also become educators in the community, and I remember taking a call, this woman was freaking out on the phone, like absolutely losing her marbles, and she's screaming about her baby, her baby, oh my God, she's dying. And, and I'm thinking, "Oh, God, we've got an infant. There's something wrong with the baby." Finally managed to get the mom calmed down enough to figure out where they are, and then when I ask her what happened, find out that their teenager had gone to a party and smoked a joint. And mom is losing her mind because she thinks that their teenager is gonna die from smoking a joint. And then the kid turned around and said, "Mom, stop freaking out. It's not even the first time." And I was like, "Ohhhh wrong." But then we ended up having to send paramedics, and they had to do, like, a drug 101 talk with the parents and explain to them, like, you know, the realities of drugs and teenagers in today's society.
[00:15:10] Norm Robillard: Not just teenagers. And ever since these gummies and all this stuff became available, you get these 60-year-olds. They're like, "Take one gummy, nothing's happened." And next thing you know, they're two or three gummies later, and they're, like, stoned, like-
[00:15:22] Marie Larocque: Half a pan of brownies! But that becomes a big part of our job, both as a dispatcher and as a paramedic, is doing those educational pieces, you know?
[00:15:32] Norm Robillard: Are you aware of this phenomena called offload delay? So, pick any place in Ontario, Timmins, Sarnia, Ottawa. Well, not too many ambulances in Timmins and Owen Sound or whatever. It's a small place, right? So if three of them go to a particular hospital, 'cause there's, happens to be a busy time, there is no fourth ambulance. They're backed up at the hospital because the hospital has become ill-equipped with staff and beds. And so the three ambulances- I'm giving you a small number. In Ottawa, it'd be 15 ambulances. Three ambulances, paramedic crews with everything ready to do an ambulance call out in the community, but they're stuck at the ER. The hospital can't accept the first patient, second, or third patient, because they don't have enough nurses. They don't have enough beds. They don't have enough everything.
[00:16:15] Marie Larocque: And often it's compounded, 'cause there's not enough beds up on the floor, so there's all these patients that are trapped in emerge beds because they can't move them up to the floor. We now, in Ottawa, have paramedics that their entire job is to take the lower acuity patients off of paramedics that are coming in and watch them in emerge. They'll have four or five patients that they're watching, either on stretchers or in chairs, until emerge can relieve those patients just so that we can get an ambulance back out to the community.
[00:16:46] Katie Jensen: It's a good Band-Aid measure.
[00:16:48] Marie Larocque: It's a Band-Aid, yeah. 'Cause then you're also then taking that paramedic that could be out in an ambulance running calls, and you're sitting them in emerge, doing what the nurses and everybody else in emerge is supposed to be doing. They're doing emerge's job.
[00:17:02] Katie Jensen: Like any of the essential services that we have, it's only gonna become worse as the population grows and ages.
[00:17:08] Marie Larocque: I worry about our aging community. Like, you know, my parents aren't spring chickens anymore. My grandmother's 102. If she ends up in the hospital, and she gets stuck in offload delay, sitting in a hallway in emerge, she's all of a sudden being exposed to all kinds of viruses and stuff. Because at 102, you just don't bounce back the same way you do when you're 30. If you're exposed to ... Even getting a common cold is dangerous for my grandmother. So, you know, I worry about those kinds of things, you know? And I have a sister who works at the hospital, and she's told me she treats patients in the hallway up on the floor, and she works in a post-op oncology floor. So, you know.
[00:17:49] Katie Jensen: Not great, doing post-op care in a hallway.
[00:17:51] Marie Larocque: Yeah. Or in a boardroom or, you know, you're like, "What the heck?" The problem, too, is that the people that are doing the funding have no clue what it's like to work in those environments. They've never done it, so they have no idea. You can tell them that the hospital is at a 120% capacity, and they're like, "Okay. Well, you're making it work. Okay. Well, then we're not gonna change anything. If you can make it work, then that's fine. Why are we gonna throw more money at it?" And then you're like, "Yeah, but do you realize that the hospital being at 120% capacity all of the time means everybody's chronically overstaffed, patients are sitting out in the hallways?" There's so many other things that they just see, "Well, you're making it work. Okay."
[00:18:33] Katie Jensen: I feel like people don't care until they've had to go through, like, a really bad life-changing experience and go through the system, and then they get it.
[00:18:41] Norm Robillard: Yep. Yeah, we've often said that, you know, me and my partner driving around, seeing how crummy the system has turned into, it's gonna take some politician whose wife or their family member or something bad happens to them, and it takes 18 minutes for an ambulance to get there on Bank Street, where it should be four minutes, 'cause there's none available 'cause they're all stuck in a hospital bed, for things to change.
[00:19:03] Marie Larocque: Yeah.
[00:19:05] Katie Jensen: Both of them wanted to make sure that our conversation didn't leave anyone with the wrong impression. Yes, the system has real problems. That doesn't mean you shouldn't call.
[00:19:15] Norm Robillard: If you're sick, right? If you have chest pain or whatever, like, don't hesitate to call.
[00:19:23] Marie Larocque: Absolutely.
[00:19:24] Norm Robillard: We don't want the message to have gone the wrong way here, and someone said, "Oh, yeah, I don't want to burden them."
[00:19:29] Norm Robillard: 'Cause I've gone to calls, and she has taken calls where it's usually the nicest people that have waited too long, right?
[00:19:36] Marie Larocque: Yeah.
[00:19:37] Norm Robillard: And again, you know, if you wait too long and that heart attack's been happening, once we get you into the cath lab, it may be too late, right? So we don't, certainly we don't want this to have gone too far in terms of, yeah, the system is kind of broken to where it was, but it's still great.
[00:19:54] Norm Robillard: For those acute patients, the system is awesome.
[00:19:58] Marie Larocque: Yes.
[00:19:59] Katie Jensen: And also, if any healthcare workers are listening, I suspect that healthcare are the most likely to downplay their symptoms and say, "It's fine. It's fine," when in reality perhaps is masking some very severe symptoms that could progressively get worse very quickly.
[00:20:16] Marie Larocque: Farmers are notorious for that too. I used to cringe when I'd pick up the phone and, "I hate to be a bother, dear," and you're like, "Oh, crap, somebody's dying." And nine times out of 10, it was out in the, like, rural area on a farm, and like, yeah, it was something big. And you're like, "Oh." You just, you know when you pick up that phone, you're like, "Crap, this is not gonna end well." (Laughing).
[00:20:39] Marie Larocque: My brother-in-law, his cousin was a volunteer firefighter, and he's a farmer as well, and he was out baling hay or something, and he actually got his arm caught in a piece of machinery. And he didn't call 911. No, he called his neighbor. Then when he couldn't reach his neighbor, he called another farmer that's not far down the road, and then he called my brother-in-law, and then he called the first farmer back.
[00:21:03] Marie Larocque: He finally managed to get ahold of him, and so he came over, and his wife is the one that called 911. And you're like, "Dude, his arm ended up having to be amputated." You're like, "Well, why didn't you call?" And he's like, "Uh, didn't think of it." (Laughing).
[00:21:15] Katie Jensen: Well, okay, yes, the story ended sadly 'cause he had to be amputated, but I can see why you have to have a sense of humor about it, because otherwise it's just too sad.
[00:21:23] Marie Larocque: And to be fair, if you talk to him, like, he's very, "Eh, it is what it is," you know? He gets along. He has a prosthetic. He doesn't wear it most of the time, and he's still a very able-bodied farmer, works the farm by himself, has a whole herd of cows. And to him, it's just, "Okay, it's another day."
[00:21:44] Katie Jensen: Tough people out there.
[00:21:45] Marie Larocque: Farmers are some of the toughest people you'll ever meet.
[00:21:52] Katie Jensen: Thanks for listening. Applaud is proud to showcase the dedication of those who make decisions for the greater good, and strive to leave the world a better place for all Canadians. All personal views expressed by guests and our host are their own. Applaud will continue to recognize those in public service, offer a kaleidoscope of perspectives, and operate in good faith to build trust with Applaud members and all public citizens. You can share feedback on this episode by visiting applaudpublicservice.ca.