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A small town in Nova Scotia is asking the province to take action after a patient died in the local hospital when no doctor was on duty.

Volunteer firefighters had to deal with a patient in cardiac arrest while a doctor was called in from a town almost 40 minutes away. Attempts to resuscitate were unsuccessful.

“Our firefighters are on call to provide emergency aid to the public. That emergency aid should not extend to a hospital where inpatients should already have access to a doctor,” said Mayor Sylvester Atkinson of Middleton, N.S., in a letter to Premier Tim Houston last week.

The Middleton Fire Department and emergency health services responded to a call from Soldiers Memorial Hospital at about 9 p.m. on June 15. First responders performed chest compressions and life-saving measures on an inpatient in cardiac arrest until a doctor arrived from Kentville, N.S., at which point the patient was pronounced dead.

“The fact that our fire department had to respond and provide care to help save patients in our hospital is frightening. As a municipal body with much responsibility on our shoulders, we are not okay with this,” Mr. Atkinson wrote.

His letter to the Premier detailed the events of the incident and called for a meeting with Mr. Houston and the Minister of Health to discuss the problems facing emergency care in town.

A statement from the Nova Scotia Health Authority said senior administrative staff “conducted a thorough review of the details surrounding this situation” and concluded that “the process followed at Soldiers Memorial Hospital is consistent with the process followed in many Nova Scotia Health sites without after-hours, hospital-based physicians.”

Staffing shortages in hospitals and a dearth of access to primary-care physicians are affecting people across the country – particularly in Nova Scotia.

Colin Audain, the president of Doctors Nova Scotia and a practising anesthesiologist in Halifax, says the province is struggling to recruit and retain doctors and other health-service professionals.

According to a registry managed by the Nova Scotia Health Authority, more than 148,000 people in the province were without a family physician as of June 1, the majority of them because their doctors had retired or had closed or moved their practices.

The shortage of doctors is also affecting staffing in emergency departments across the province. Sarah Newbery, a general physician in Marathon, Ont., for the past 27 years, says the conversation going on in Nova Scotia and other parts of the country doesn’t often consider smaller and rural hospitals.

“There isn’t always an understanding that the emergency physician is covering much more in a small hospital than just the emergency department,” Dr. Newbery said. “There needs to be another way of ensuring that emergency services on the ward can be provided in a really timely way.”

Dr. Audain said the normal response time for a hospital doctor on call would be about 30 minutes. In an emergency such as a cardiac arrest, most hospitals would have a physician already there or a cardiac-arrest team consisting of nurses and respiratory therapists trained to give CPR and advanced cardiac life support.

“They should be able to do the resuscitation the way that a physician would be able to because we would all have the same training in that regard, as would first responders,” he said.

But Dr. Newbery said that, given her experience, a 30-minute response time would not be normal.

“The expectation is that if you are the emergency physician, and you’re not in the emergency department, you’re expected to be available for emergencies within five to 10 minutes,” she said.

Mr. Atkinson previously sent a letter to Mr. Houston in April expressing the town’s concerns regarding the hospital’s emergency-room closings. He received a response from Nova Scotia Health’s vice-president of operations for the western zone, Tanya Nixon, and a meeting was held between Middleton, Nova Scotia Health and other local municipalities on May 11.

However, Mr. Atkinson said the town does not feel confident that there’s a site-specific plan to restore the emergency room to full-time hours.

Darlene Davis, the interim executive director of rural and community health for Nova Scotia Health’s western zone, said the health authority is committed to Middleton and the goal “is to restore full emergency-department services or hours” by recruiting more physicians to the area.

“That has been our consistent message to the town of Middleton,” Dr. Davis said.

A statement from the Premier’s office said the province works regularly with health providers in rural communities and is currently trying “to recruit and secure additional physician resources to increase emergency department coverage at Soldiers Memorial” and across the province.

Editor’s note: (June 27, 2023): A previous version of this article incorrectly noted that the call to the Middleton Fire Department and emergency health services came from the Soldiers Memorial Hospital emergency department. Although the it was the location given on the call, the emergency department was, in fact, closed. This version has been updated.

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