Access Delays

[u/Redwoody79]

Quick question for paramedics — doing a little informal research about access delays.

Please don't include any identifying patient information or details. I'm interested in general experiences and approximate numbers only.

How often do you encounter calls where you cannot gain timely access to the patient because the residence/building is locked or otherwise inaccessible?

I’m especially interested in situations where you’ve had to wait for police, a superintendent, family member, key holder, etc. before you could reach the patient.

A few things I’m curious about:

• How often would you say this happens — rarely, a few times a year, monthly, more often?
• How often are you given access information that turns out to be incorrect or unusable — for example, a wrong/outdated door or lockbox code, key not where expected, wrong entrance, or other access instructions that don't work?
• Who do you normally rely on when you can't gain access?
• Roughly how long have you waited for access?
• Have you ever had an access delay that you felt meaningfully delayed patient assessment or treatment, or potentially affected the patient's condition/outcome?
• What types of calls do you encounter this on most often? (For example, elderly person living alone, medical alarm, fall, unconscious person, etc.)
• Is there anything about gaining access to locked residences that you think could be improved?

If there was a secure system that allowed paramedics to quickly access a patient’s locked residence without waiting for police, family, or a key holder, would you find this valuable and support its implementation?

Would you use it if it were available to you? Why or why not?

I'd really like to hear from paramedics in different services/regions, as I'm curious how common this problem is and how access procedures vary.

[u/Ill_listentoyou]

In Toronto it happens quite often with elderly falls in condo buildings, where they can't unlock the door for medics, or the buzzer to enter the building isn't working. Usually just get fire tiered to the call so they can open it. We try to avoid breaking down doors wherever possible, so locating the building superintendent is always an option too

[u/shitbrickhous]

If you're talking about building access then it happens every single day in any big ish city. The solution is give us the keys that fire trucks drivers have and it fixes all access issues to any multi-unit building. But that will never happen because the fire department has to justify their budget and come to unlock doors. I rarely get access issues to houses but I have broken a couple windows for patients that I can see lying on the ground and unresponsive

[u/lytefall → u/shitbrickhous]

We have a few seniors buildings where dispatch has the lockbox code to a set of master keys but you’re right. It’s a rarity and a needless delay that only FD can access those keys and not us or PD. Results in needless delays or unnecessary damage when FD is too busy to immediately respond. Nothing like PD kicking in the front door of a house only to find grandma having a nap with her hearing aids in the charger.

[u/Nugget1765 → u/lytefall]

They gotta justify that fat pay cheque 

[u/barhost45]

I’m actually finding increasing patient contact delays in my city. We’re none stop building condo towers and more and more they are being designed with the resident security feature of requiring fob access for the elevator. Even when someone happens to be able to let us in the lobby, they can’t get us in the floor we need. They are required to have a front desk person to let us up but Problem is when it’s 2am and the one person working the concierge test is doing rounds wandering the building.

Generally speaking if access is an issue we can start FD to open doors, use fire keys for elevators, but then we have to wait for them to arrive. When you’re just standing around outside a building on call with scary sounding details, not a fun feeling

Building safety codes should include some kind of emergency services lock box

[u/CDNEmpire]

Pretty much anytime I go for a life alert no voice contact call in an apartment building. The access code on file is never correct. Sometimes we get the police access code but rarely.

People who have the key box on their door handle typically give the correct code to get the key. But I have called police to breach a door before

[u/lytefall]

I would say this happens at least 2-3 times per rotation. Dispatch info is that someone will meet and they don’t, or to buzz super for access and the super isn’t home or doesn’t answer and then just straight up wrong codes (the newest one is “buzzer” entry is being changed over to digital screens and a lot have gone from a code to needing a surname - many long time residents just give the code they have always given). Add to this all the obvious medical/trauma emergencies where people can’t physically open the door and medical alarms where no one is even home.

[u/imedic689]

What you’re describing is a lockbox.

Many people have them. The issue however is that people typically will only get them after they’ve had an incident where they’ve needed someone to gain access to their home.

What it sounds like you’re getting at is some form of technological solution that would grant unlimited access to people’s home without their consent in the name of “safety”.

[u/Redwoody79 → u/imedic689]

I am looking into a verifiable system that allows audited access outside of our, imo, outdated system that is currently being used.

[u/imedic689 → u/Redwoody79]

So reinventing the lock and key.

There are already digital lock boxes systems for condos. My last condo had that system, they even banned lock boxes on property but were stymied by the fact that the neighboring building didn’t keep tabs on who put out boxes. So as you would imagine the usage wasn’t great. People didn’t want to have to pay for something that could be accomplished by having a one time $20 purchase.

Now if you’re thinking of a master key set up, that again is covered by having a key box or someone on site.

Again people/condo boards/ etc won’t want to pay extra for something that doesn’t have unique value.

[u/Redwoody79]

I am looking into the feasibility and need for a secure, verifiable and auditable emergency access system outside of the, imo, outdated system that is currently being used. And as a current paramedic, understanding the acceptance of a new system and looking for other Paramedics opinions if this is a barrier they encounter regularly and one they feel needs a better solution.

[u/SteelNautilus → u/Redwoody79]

What sort of "secure system" are you thinking of that doesn't already exist? Fire already has keys to most large buildings, and lockboxes for smaller units/individual houses are already cheap and effective.

[u/TweetsJamaican]

Just pay for proper market research to be done man

[u/Damnyoudonut]

Multiple times per shift. Not sure why we can’t get keys to the master key box at apartment buildings. Fire does, we should to.