The Ministry of Health(MOH) must launch an immediate inquiry and investigation towards the serious allegations of medical negligence by the Ipoh General Hospital’s ambulance service who failed to perform CPR which resulted in death of a 43-year old man who had heart attack last April.
Such issue must not be swept under the carpet or even merely handled internally as it is important to restore public confidence not just on this particular hospital’s emergency health response, but all governmental hospitals emergency response as well and bring justice to the aggrieved family members.
Based on a report by CODEBLUE (https://codeblue.galencentre.org/2022/06/22/ipoh-teacher-dies-in-ambulance-response-that-allegedly-skipped-cpr/) which cited evidence based on an internal document, an eyewitness account, and police photographs from the scene, the hospital’s ambulance service is accused of not performing life-saving procedures such cardiopulmonary resuscitation (CPR) or using an AED device (a machine that delivers a jolt of electricity to get the heart beating again) from the ambulance which is required and standard practice in such a situation.
Such life-saving interventions even though is not a guaranteed, but it can increase the chances of the patient being saved especially if there was early intervention.
Based on eye-witness report, the victim had still some movement, like it was very hard to breathe when they made the call to ambulance which arrived approximately 10 to 15 minutes later. Technically based on such time frame, life-saving interventions including CPR + usage of AED can still be performed. However, based on eye witness accounts the paramedic did not perform CPR, or use the AED device to attempt to revive the victim, claiming that the victim was “already gone”.
This was confirmed in the “Laporan Perkhidmatan Pra Hospital Dan Ambulans (No Sign of Life)” which the Medical Assistant(MA) or paramedic on scenesigned on April 13, 2022, claiming that at 6.40pm, “algor mortis” – a stage of death when a human’s body temperature drops to the external temperature – had set in, indicating a “clear sign of death”, thus did not perform such life-saving interventions.
However, if we based on the timeline and witness statements, assuming that the victim collapsed at around 6.10pm – the approximate time of the collision stated by eye-witness that the victim was reportedly still breathing – this means the paramedic pronounced the victim’s death in just 30 minutes at 6.40pm and even claimed the body had turned cold within that short period of time.
Generally, algor mortis only begins two hours at the earliest after the heartbeat stops, and is established at around 18 hours after death thus disputing claims of that Medical Assistant(MA), thus giving him no excuses why he did not perform any life-saving manoeuvres.
That is why, based on such evidence, there is definitely clear medical negligence and possible criminality in such a case. On top of that, based on the newsreport, it is not an isolated case as such similar case happened before as well in May of this year.
That is why, firs MOH must not sweep this issue under the carpet and it involves lives and public confidence in our hospital’s emergency response. We do not want public to worry everytime they call our ambulance and not trust our health services.
That is why first and foremost, MOH must do a clear investigation on the entire chain of events from the time the emergency call was received to the time the ambulance response team (PRA) left the scene of the incident and even a nationwide review to ensure such cases are isolated and are not happening in other areas around the country.
All medical assistant(MA) involved in such emergency situations must be given the needed support and even continuous training for proper management of patients who collapse at roadsides to ensure they are competent and have the right attitude when approaching such an emergency situation.
Secondly, they must also do an audit on all equipments and medications on all ambulance to ensure they are adequate and properly maintained to ensure when needed it can be used effectively and swiftly.
Thirdly, the government must increase public awareness and training on such life-saving interventions including CPR and the usage of AEDs. With the announcement by Health Minister Khairy Jamaluddin last March that the installation of AEDs would be made mandatory in public areas by 2025, the public must be trained to use them during emergencies while waiting for the arrival of first responders.
Lastly, the government must not take any disciplinary action against any public health workers or whistle-blower of such negligence practices. Instead they should review and improve on any short-comings to ensure quality of care to our people continues to improve.