Deaths in Toronto Shelters at All Time High: CEO of Heart to Heart CPR Says That Shelter Staff is Taking the Wrong Course – A Claim Recently Supported by Newest Canadian 2020 Resuscitation Guidelines Released October 19, 2020

Toronto, Ontario, CANADA

TORONTO, Oct. 21, 2020 (GLOBE NEWSWIRE) -- Nick Rondinelli, CEO of Heart to Heart CPR, issued the following announcement:

My name is Nick Rondinelli, CEO of Heart to Heart First Aid CPR Services Inc. We are one of the largest Trainer Partners for the Canadian Red Cross and we have been in operation for 21 years. I had identified some time ago, the missing link to the chain of survival for overdose deaths, particularly opioid overdoses, when I came to learn that the current training recommendations for Toronto shelter staff excluded important components like "pulse check", how to use a Bag Valve Mask (BVM), and the option to provide an essential life-saving technique known as "Assisted Breathing”. This ventilation-only technique is often the critical component to preventing a person's heart from stopping if the person suffering from an overdose has stopped breathing effectively but STILL maintains a heartbeat with proper blood circulation. This condition is called Respiratory Arrest which is often the root cause of most drug overdoses. This is especially true in opioid overdoses where the opioid blocks the receptors in the brain that controls breathing. Opioids are a group of drugs that includes morphine, heroin, methadone, fentanyl and oxycodone.

A Media Snippet accompanying this announcement is available by clicking on the image or link below:

Currently the City of Toronto recommends "compressions-only CPR" and advises NO ventilations during COVID-19 (See - 5 Step Overdose Response). Neither the federal, provincial or local government has a comprehensive overdose response plan that provides the best emergency care practices using the most effective PPE equipment and life-saving devices. Having an Automated External Defibrillator (AED) and a Bag Valve Mask (BVM) should be mandatory in all shelters. Currently Toronto shelters do not require these lifesaving devices (See Toronto Shelter Standards – 11.2 Safety Standards).

If ventilations are not provided quickly or effectively during Respiratory Arrest, the brain begins to get damaged within 4-6 minutes.  The heart stops beating soon after.  The average 911 response time in the Toronto area is around 9 minutes. By the time EMS arrives, if there is no bystander care, the person has a lower survival rate. This scenario plays out time and time again in overdose cases.

The highest number of deaths in shelters occurred in 2019 when there were 48 (an average of four deaths per month). Reported deaths for 2020 have already exceeded all previous annual totals.   Since 2007, Seaton House's Annex/Infirmary and long-term programs have reported the most deaths (166 combined), representing 46.2% of all shelter deaths ( See -Deaths of Shelter Residents).

Changing Training Courses from Lay Rescuer CPR to Basic Life Support (BLS) for Toronto Shelters is Critical to Saving Lives – Supported by New Guidelines

Overdose prevention and response plans must be flexible and include strategies for all types of drug overdoses, which means that there must be different responses and outcomes to both the respiratory system and the circulatory system. Having the knowledge and skills to protect against both respiratory and cardiac-related causes of arrest with the use of a Bag Valve Mask (BVM) serves as one of the strongest arguments for shelter staff and outreach workers to immediately change the requirements for training from the currently recommended "Standard First Aid with CPR (AED) level A or C" certification to "Standard First Aid with "Basic Life Support" certification. Basic Life Support (BLS) provides training for ALL drug overdose outcomes. These include training in ventilations-only, compressions with ventilations and compressions-only.   Basic Life Support (BLS) covers all of these while the current recommended training course does not. The following are some compelling and urgent reasons why we must make the switch to BLS immediately.

Rescuers trained in CPR/AED (level A or C) or "Bystander CPR" are trained to bypass "pulse check" and go straight into chest compressions if they are not breathing (30 compressions) followed by 2 ventilations. They may also choose to do a modified version of CPR called “compressions-only CPR. The problem with chest compressions-only is that they do not provide the person experiencing the opioid overdose what they need. The person needs oxygen either by ventilations-only, or at minimum compressions with ventilations (30:2).

Other delays include not having the proper breathing barrier to provide Assisted Breathing. The rescuer may be extremely reluctant to give ventilations for fear of disease transmission or cross-contamination with dangerous drugs.  There are many reasons why someone would feel apprehensive about giving ventilations.  Even in the best circumstances where the rescuer has access to a traditional "pocket mask" with a one-way valve, they still may be reluctant to place their mouth on the mask and provide ventilations. This is especially true now, given COVID-19.  For this reason, I am strongly advocating for the use of the "Bag Valve-Mask" (BVM), also known as "Ambu-Bag” to be the primary breathing barrier device. This process is safer and will provide the person with higher levels of concentrated oxygen since the ventilations are not being supplied from the rescuer's exhaled ventilations.  The willingness to provide this critical ventilation increases with the use of a BVM.

Additionally, the "team approach" that Basic Life Support training provides gives the rescuers more confidence to handle the situation with others as opposed to doing so individually (which is another negative aspect to the current recommended "CPR level A or C" training).  A "team rescue" approach allows a team to manage a stressful situation while providing extra knowledge and skills to give the best care possible. For this reason, I am strongly advocating for the change in standards to at least have two (2) staff who holds a valid certification in Standard First Aid and Basic Life Support in Toronto Shelters.

Currently the City of Toronto requires only one (1) staff who holds a valid certification in Standard First Aid CPR/AED level A or C. (See section 11.2 Safety Standards). We strongly believe this is inadequate.

Other notable delays to care is providing administration of naloxone. Naloxone hydrochloride (naloxone) is a drug that can temporarily stop the effects of opioid drugs. Naloxone can help restore breathing during an opioid overdose. Although lay rescuers are encouraged to search for an application of naloxone for a respiratory or cardiac arrest, it should not delay basic first aid measures. Additionally, many who provide naloxone will only depend on it and not provide other lifesaving measures sooner such as placing the person into the recovery position or starting CPR. Since naloxone takes several minutes to start working, without the immediate intervention of Basic Life Support, the person may experience a prolonged lack of oxygen, causing an increase to brain damage and loss of life. “Basic Life Support”, in conjunction with naloxone administration, with no delays is vital.

Newest Canadian First Aid, Resuscitation Guidelines 2020 for Narcotic Poisoning Supports our Recommendations

This critical work (First Aid, Resuscitation Guidelines 2020) is supported by the International Liaison Committee of Resuscitation, International First Aid, Resuscitation, and Education Guidelines—coauthored by clinical and education specialists via the Global First Aid Reference Centre. New guidelines for narcotic poisoning are:

  • Based on the outcome of the initial assessment of the casualty, First Aid measures like recovery position of unconscious person or CPR in any unconscious person not breathing normally should be started without delay.
  • The search for and application of naloxone (narcotic antidote) may be used by lay rescuers in suspected opioid-related respiratory or circulatory arrest. Naloxone should not delay basic first aid measures.
  • Specially trained First Aiders like social workers and peer support/outreach workers should be familiar with naloxone.
  • CPR should be started without delay in any unresponsive person not breathing normally, and naloxone should be used by lay rescuers in suspected opioid-related respiratory or cardiac arrest.
  • It is recommended that those whose job may involve responding to opioid poisoning (e.g., peer support/outreach workers) be trained in full CPR protocols to the BLS level and have access to both Naloxone and proper PPE.
  • It is important to mention the emerging problem of drug/opioid addiction. Information about local helplines and support centers should be given.
  • Social workers and peer support/outreach workers should be trained in the usage and potential side effects of naloxone. This is not just a matter for social workers and peer support/outreach workers, however, but a global epidemic affecting everyone.

My Commitment to Toronto's Shelter Services

I have decided to implement a social entrepreneurship branch of my company, Heart to Heart First Aid CPR Services Inc., called THE JOHNSTON-BRAIS INITIATIVE. It is a task force to provide education, awareness, and best practices for the unique and challenging circumstances that shelter staff and outreach workers face each day.  This task force is made up of industry leaders from the Canadian Red Cross, Emergency Medical Responders, First Aid/CPR Instructors, Health Care Professionals, and Harm Reduction workers. This team brings with them years of frontline experience including indigenous communities.

THE JOHNSTON-BRAIS INITIATIVE will provide free Canadian Red Cross training and certification in "Basic Life Support (including naloxone administration and overdose prevention strategies) and donate 2 adult BVM's to all shelters located within Toronto (additionally 1 child BVM and 1 infant BVM for family shelters)

I am very proud to dedicate and name this social entrepreneurship strategy after two of my closest and dearest friends. Garth Johnston, my best friend for over 18 years, died from HIV/AIDS-related causes in 2016. He experienced homelessness several times in his life and suffered from mental illness. Natalie Brais, a long-time friend for over 25 years, succumbed to drug addiction in March 2019 and overdosed in her apartment in downtown Toronto. The cause of her overdose death is still not known whether to be accidental or by suicide.

Pilot Programs

We hope to pilot this initiative in the following weeks. We are confident that this initiative will save lives and provide a platform for offering programs across the country.  It will provide a legacy that I know my friends would be proud of. One that will keep their memories alive in the form of a movement that will save countless lives. 

I am confident that my team and I can empower and prepare shelter staff and outreach workers to circumvent the current tragedy that we are faced with today – the unnecessary deaths resulting in drug overdoses, particularly opioid overdoses in our shelters and community.  We can do better, and we must do better. 

We call upon the City of Toronto and the Shelter, Support & Housing Administration (SSHA) to create an alliance with us and accept our offer to run a series of Canadian Red Cross training sessions in Basic Life Support programs geared for harm reduction and overdose prevention. These series of pilot programs (BLS with naloxone administration, plus overdose prevention strategies) will fine-tune a standardized approach by incorporating expert feedback, learner feedback, video evidence for skill competency, and other recommendations outlined in the latest First Aid, Resuscitation Guidelines 2020. Our goal is to have one reliable program that becomes accepted as the standard of care for those experiencing an emergency due to overdose.

Their willingness to take action will change how we enact emergency response training within our shelters, harm reduction, and overdose prevention support services for our most vulnerable. Our goal is to provide the best training possible and create skill competency for all support staff and service providers. It starts with the immediate retraining of all the shelters in Toronto. Once all Toronto shelters have retrained staff in Basic Life Support, our initiative will focus on incorporating training for other staff and services for our most vulnerable. A new standard of care can be achieved for overdoses, one that empowers and develops highly skilled professional responders to provide excellence in emergency care so we can save lives.

The time to take action is now.  People's lives are at stake.  Will the City of Toronto and Shelter, Support & Housing Administration support this worthy cause?  We will pursue our quest and provide regular updates on our progress.

For any further inquiries, please contact:

Nick Rondinelli – CEO
Heart to Heart First Aid CPR Services Inc /
Recipient of the Canadian Red Cross Rescuer Award 2019