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Alejandro Martinez-Ramirez is photographed outside Coroners Court on January 24 2012. An inquest into the death of his partner James Hearst who died following a collapse at his Toronto apartment, began on Jan 24 2012. Hearst died as a result of a delay in the ambulance's response time on June 25, 2009 when Hearst suffered a heart attack and died in the lobby of his building.

Fred Lum/The Globe and Mail/Fred Lum/The Globe and Mail

The 911 calls placed for James Hearst, who died while waiting more than half an hour for an ambulance, were played at a coroner's inquest Wednesday.

It took a third call, and the person on the line saying that Mr. Hearst had no pulse, for Toronto EMS to upgrade the call's urgency.

Mr. Hearst, 59, died in the lobby of his downtown Alexander Street apartment building. After he collapsed at around 11 p.m. on June 25, 2009, two people and a security guard performed CPR, waiting for paramedics. Mr. Hearst died of a heart attack.

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The audio from all three 911 calls, and the conversations between paramedics and dispatchers, were played for a five-person jury and coroner Albert Lauwers during the second day of the inquest, which is expected to last several weeks. The jury may make recommendations on how to avoid similar deaths.

The second-lowest priority was given to the initial call, made by a passerby in the lobby who said Mr. Hearst looked like he had passed out and fallen on his face. He said Mr. Hearst wasn't conscious when he tried to talk to him initially, but it appeared he was trying to get up. "He looks like he might be drunk," the man said.

During the call, the emergency worker asked police to attend, using the acronym HBD for "has been drinking."

About 10 minutes later, an ambulance arrived nearby but idled out of sight, waiting for police, because the paramedics were concerned for their safety, coroner's counsel Stefania Fericean told the jury.

The second 911 call came about 15 minutes after the first, from an employee of the apartment building's security company, who said Mr. Hearst had a bleeding nose and was turning blue in the face. The employee transferred the call to the security guard at Mr. Hearst's side. The latter said the blue looked like bruising and Mr. Hearst was conscious and breathing.

"Reassure him help is on the way," the emergency call taker said.

By the third call, the security guard was audibly distraught. She was repeatedly given CPR instructions after she said she couldn't hear Mr. Hearst breathing and that he had no pulse.

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"I don't think you guys are listening to me, that's what we've been doing for the last 10 minutes," she said before being interrupted. "We have three people here taking turns conducting CPR on the gentleman."

The only witness Wednesday, Toronto EMS commander of professional standards Arthur Graham, explained the priority levels used for calls. The case was upgraded to the highest priority during the last call because Mr. Hearst wasn't breathing, he said.

Firefighters and advanced-care paramedics then rushed to the scene, but Mr. Hearst was without vital signs.

His death came days into the 2009 citywide strike, when paramedic staffing was at 75 per cent. The city maintains the strike wasn't connected to the delay, but jurors will tackle how the Essential Services Agreement was administered and how paramedics were scheduled during the strike. The inquest began as potential labour action looms – city workers could be locked out or go on strike as early as Feb. 5.

Outside court, Mr. Hearst's partner of eight years, Alejandro Martinez, said he heard the tapes only the day before. He said he doesn't place blame with the information callers gave to EMS, including that his partner may have been drunk.

"Can we rely always on what people who don't have any medical knowledge tell you on 911 calls?" Mr. Martinez said. "Or should they give more emphasis to say, 'Okay, well, this person just fell, is bleeding, we should help him.' "

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