For anyone in dire need of medical attention, the closer you are to a hospital the better it would seem to be.
But just over two weeks ago a woman in Lethbridge, Alta., waited 15 minutes for an ambulance as she received CPR from a bystander in the hospital parking lot, just 100 metres away from the front entrance of the building.
"I kept thinking, Where's the gurney? Where's the people with the white smocks and the stethoscopes from the hospital?" witness Tony Stephan told the Edmonton Journal. "They never did come, and by the time the ambulance arrived, this woman was blue."
Calling the paramedics is the normal response for medical emergencies outside Alberta hospital buildings, said Alberta Health Services spokesperson Bruce Conway.
However, the incident at Chinook Regional Hospital has triggered a review of the hospital's response. The result will be a provincial policy that would ensure there is a process in place to treat patients requiring medical attention anywhere on hospital grounds, Conway said.
Like Alberta, Ontario does not have a provincial policy; response plans are determined by individual hospitals. Saskatchewan has a framework established in 2009, requiring hospitals to develop their own specific response plans.
But establishing a strict policy for how staff should react is a challenge because there are so many different factors at play, said Dr. Kevin Smith, supervisor of the Niagara Health System. Among the considerations are the size of the hospital grounds, the available emergency room staff and whether they are dealing with a crisis. Calling paramedics could be the right method if a patient needs special transportation.
The Greater Niagara General Hospital has paid particular attention to this issue after three high-profile incidents where staff did not provide care on hospital grounds - the most recent in October when Doreen Wallace, 82, broke her hip falling in the lobby of Niagara General Hospital. Wallace said she was told by staff that no one could help her until an ambulance arrived.
In April 2010 a Jennifer James, 39, died from a "catastrophic heart event" a few days after emergency department staff refused to help her in the hospital parking lot. Later that year, Joyce Morocco, a local councillor with a history of heart problems and asthma, was semi-conscious when her husband brought her to hospital. He was also told to call an ambulance.
Smith said the incident inside the hospital building should never have happened and stemmed from staff confusion over procedure.
"If there is a person who is in the building who is in distress, we will have a code to respond to that person," Smith said.
Calling a "code" means a medical team on standby would respond. Codes have different colours for different emergency situations - Code Blue usually means someone needs immediate medical attention.
The difficulty comes in deciding the distance that "code" team covers, said Dr. Tom Closson, president of the Ontario Hospital Association. The team usually has a "crash cart" with the equipment they need on it - so they may not be able to get to a parking lot location reachable only by stairs, as paramedics can.
That's why hospitals need to train staff for these situations, Closson said. "You can't call a code if you don't know what it looks like."
Rather than a strictly laid out policy, Smith said staff at Greater Niagara General Hospital have been told to respond using common sense.
"We're dealing with smart people who are regulated heath-care providers," he said. "If it puts the patient or you in an unsafe position to respond to their needs, then by all means call for support and an ambulance."
That's the crux of the Saskatchewan framework implemented in 2009 which hospitals adapt to their operational needs, said Patrick O'Byrne, director of acute and emergency services in Saskatchewan's health ministry.