While she was at work on April 17, 62-year-old Janice Thomas ordered a vermicelli chicken dish for delivery from a nearby restaurant. She had forgotten to warn the staffer of her shellfish allergy, and as it turned out, the dish contained her allergen, likely from cross-contact.
She realized she was having an allergic reaction and left work for home. Once she arrived, she administered a dose of epinephrine and called emergency services.
Paramedics arrived in short order and administered another dose of epinephrine while transporting her to St Boniface Hospital in Winnipeg.
She was relieved to arrive at the emergency department, but it was then that her ordeal took a turn for the worse.
Said Ms Thomas:
I was placed in a hallway unable to breathe. The paramedics said a room was coming.
I was having such a hard time trying to get any air and all my concentration was to keep myself breathing. I sat there wheezing very loud.
She said she was in such distress that a man who was attending to his 90-year-old mother yelled to demand someone bring her oxygen.
Still no nurse came, though a paramedic brought oxygen and placed the tube prongs in her nose.
She continued her story:
But it was my throat closing, so I couldn’t get air that way.
I sat on that stretcher, unable to breathe, for over 20 minutes. With an anaphylactic reaction, I am considered life or death. I can’t wait for a room. During this time, not one staff member from the St. Boniface Hospital came to check on me.
When she was finally wheeled into the treatment area, the ER staff immediately administered more epinephrine and connected her to an IV drip.
Ms Thomas was later told by the hospital’s patient relations that she was triaged as a Level 2 emergency patient, a step below the most serious cases. The Canadian Association of Emergency Physicians recommends on its website a Level 2 patient in emergency should be checked on every 15 minutes.
Even in the treatment area after she was stabilized, Ms Thomas said she was ignored. When she flagged down a nurse to show her that the vein her IV was placed in had blown out and was leaking, “the nurse threw a compress at me and left.” She took a photo of the swelling, which had grown to the size of a tennis ball:
She said another nurse came by, “freaked out,” and changed the IV to the other arm.
Ms Thomas gradually recovered and left the hospital a number of hours later, confident in the knowledge that she had additional epinephrine auto-injectors at home if she needed.
A spokeswoman from the Winnipeg Regional Health Authority said that because the hospital’s resuscitation room was full when Thomas arrived:
After being triaged with normal vital signs, the nurse went to make space in the resuscitation room.
We don’t want to say we didn’t respond to the patient’s needs — we did do that.
Molly McCracken, interim spokeswoman for the Manitoba Health Coalition, said what happened to Thomas shouldn’t happen to anyone:
It is imperative that adequate staffing be in place in ERs to help patients in need and prevent critical incidents from taking place.
This terrible incident shows that Manitoba’s health-care system is still under stress and adds urgency to our calls for the Manitoba government to ensure adequate staff to help those in life-and-death situations.
Said Ms Thomas:
They said I was failed. Their excuse was it was too busy. There was no resolution offered…
I could have become a critical incident and all they’re saying is sorry. Now I not only worry about not breathing, but I have to worry about whether I will survive at the hospital.
Someone is going to die in that hallway.
We are grateful Ms Thomas survived the ordeal despite the lack of adequate care she received at the hospital.
As we always do when reporting on such situations, we look for strategies others in the food allergy community can employ to avoid similar circumstances.
There isn’t much we can say about the care she received upon arrival at the hospital. We hope the incident triggers an extensive investigation into what precisely went wrong and that steps are taken to ensure this never happens again.
As for the time prior, we remind our readers that every time you order food from an eatery, you must be explicit in detailing your food allergies and be left with confidence that the establishment understands your restrictions and can accommodate you safely.
Another critical error in this scenario was waiting until she arrived home before administering her epinephrine. We encourage everyone prescribed epinephrine to always take two auto-injectors along everywhere, every time, and to administer the first when anaphylaxis is first suspected. If symptoms do not abate within a few minutes, administer the second and await emergency services.
Epinephrine is the only drug that can halt and reverse the progression of anaphylaxis, but it must be administered soon after the onset of symptoms to be most effective. Don’t wait until you’re drowning to use your life preserver.
