A snowmobile accident that led to the death of an American tourist earlier this month in Quebec has prompted questions about the role of paramedics.
Do they have the duty to rescue the people who are injured in places they are unable to reach with an ambulance?
Quebec regulations dictate that ambulance technicians or paramedics can refuse to intervene if they believe taking action might put them in danger.
But the province's ombudsman has said the regulations need updating, and one legal expert says the paramedics should also use common sense.
Glenn Dumont, 69, a former college football star from Maine, died March 2 near the town of L'Étape, 100 kilometres north of Quebec City, after his snowmobile collided with another.
His brother, Lewis Pelletier, says paramedics refused to help his brother because they didn't want to go to the scene of the accident, a wooded area three kilometres from the nearest road.
According to provincial law, paramedics may travel to a scene on a snowmobile or an ATV, but only if they have proper safety equipment, including a helmet. They should also be accompanied by a police officer, firefighter or other designated volunteer.
The law is meant ensure a balance between the right of patients to be rescued and the paramedics to practise their profession in a safe setting.
In this case, the second victim involved in the collision got up and left the wooded area, which complicated matters, according to Dominic Chaput of the Coopérative des techniciens ambulanciers du Québec, an organization representing paramedics in the province.
Parademics saw him, treated him and decided to transport him to hospital, he told CBC News.
Chaput said there was no other crew at the site, and a second ambulance had to travel from Quebec City, which caused a delay of about an hour.
Right to assistance
Jean-Pierre Ménard, a lawyer specializing in health law, says paramedics should use their judgment and avoid applying the protocol to the letter at all times.
He believes that a paramedic must intervene if the safety risks are minimal, especially if a person is in danger.
According to him, a refusal to intervene in these circumstances could violate Article 2 of the Quebec Charter of Rights and Freedoms, which states that every human being whose life is in peril has a right to assistance.
In a report published in 2013, Quebec's ombudsman noted a series of shortcomings in the ambulance interventions outside the road network.
To reduce the number of deaths, Raymonde Saint-Germain recommended forcing the paramedics to go "outside of the road network to stabilize and provide the necessary care for the victim," which is not the case now.
Saint-Germain also suggested the Ministry of Health and Social Services should purchase protective equipment that would enable all ambulance Quebec to go to rescue the people who need care.
The ombudsman estimated it would cost $1.3 million to outfit paramedics with snowmobile helmets,visors and hoods, among other equipment. It appears the purchases have yet to be made, however.
Quebec Health Minister Gaétan Barrette said Tuesday a coroner will investigate Dumont's death.
"We all need to understand that in this province paramedics do have the possibility to provide services on snowmobile trails, but only under specific conditions where they have to make sure security is there," Barette told reporters at the National Assembly.
"Light has to be shed on this event to see if things went according to protocol."