EMS missed life-saving chance in high-speed crash
Cayman Islands Hospital, George Town
(CNS): The family of Zak Quappe, who was killed in a road crash two years ago, has released the findings of an independent enquiry regarding medical care given to him at the scene of the collision. The report reveals that no attempts were made by paramedics to resuscitate the 21-year-old man, despite standard requirements to do so and following reports to 911 that seconds before their arrival Quappe was still breathing, missing an albeit slender opportunity to save his life, the family has said.
Having pressed the authorities to undertake an independent enquiry, they hope that the findings of the report by Dr Dan Cass, a Canadian expert in emergency medicine, will help inform the local health services, improve protocols and ultimately save lives in the future.
The Quappe family accept that, given the injuries sustained by their loved one, he may very well have died even if the emergency services personnel had attempted CPR, but the report confirms that no effort was made, and although leads were attached to Quappe’s chest, the paramedic called the man’s death at the scene and instructed the fire officers to stop their efforts to get him out of the trapped car.
“Whatever small chance was there, was taken away from us,” Barrie Quappe, Zak’s mother, told reporters Monday when the report was released.
Barrie Quappe and Zak’s sister, Terry Quappe, have both worked in the medical field and from the beginning they raised their concerns that an opportunity to save Zak was missed, since records show that the first responder, a police officer, recorded in the event log the fact that he was still breathing. But paramedics did not try to revive Zak, who was a healthy 21-year-old before the collision, when they arrived some 40 seconds later and there is no record in the event log that the decision to pronounce the young man dead was made with a physician.
In his conclusions Dr Cass stated, “The paramedic response deviated from established protocols for the Cayman Islands EMS service in terms of the completeness of certain aspects of the assessment and in the decision not to initiate resuscitative measures in the absence of specific direction from their medical control physician.”
As a result of his findings he made a number of recommendations, including equipping police and fire service officers with AEDs, developing specific protocols for responders over traumatic cardiac arrest, and continuing education. The report points to the need for better management over decisions regarding resuscitation and the need to document all observations and actions taken.
The doctor also found that the time pieces used by the emergency services in the Cayman Islands are not synchronized and recommended that the entire emergency system move onto one tightly synchronized time. The 911 call centre, police, fire crews and ambulance services all work on separate time recorders, leaving room for significant discrepancies when it comes to coordinating a life-saving response.
Quappe was killed as a result of what the courts found to be competitive racing in South Sound with his friend, Igor Domladis, in the early hours of the morning on 18 May 2013. Domladis admitted causing death by dangerous driving and was jailed for four years in November last year.
Quappe’s parents have accepted that the two friends were likely racing and the death of their son and the incarceration of his friend could have been easily reversed. But they also wanted to ensure that if, as has been demonstrated by the report, their son, for whatever reason, did not receive the best possible treatment after the crash that this is addressed and that it will not happen to someone else in the future.
As a civil servant working in the health ministry, Barrie Quappe said she has taken a significant risk by not only pressing for the independent enquiry, which took a long time, but by releasing the findings to the press. But she said the family want nothing from the Health Services Authority other than for them to learn from the mistakes.
Pointing to a reluctance by the authorities to talk openly about problems or shortcomings, she said, “Dialogue needs to happen if we are to effect change.”
Quality of Care Review of EMS response to fatal crash involving Zak Quappe (deceased)
Quappe family response to Dr Cass report re Quality of Care Review, July 2015
Category: Health, Medical Health
Yes, EMS protocol should always be followed when necessary but in their professional opinion it was not necessary had he already passed. This young driver chose to race his friend that night exceeding the speed limit and sadly caused his own demise.
You know how all of this could have been avoided? If it never happened in the first place. Just as how Zak was being negligent racing on the road killing himself, he could have easily killed other people who are road users. My condolences goes to his family though. If the Ambulance workers pronounced him dead, chances are he was dead. These people aren’t amateurs. They come across situations like these way too often. People need to understand that the EMTs aren’t God, they do their best, not work miracles. I have seen them work, and I have been transported by them and I had absolutely no problem. Even if the police said he was breathing when he (the police ) arrived on scene, it only takes a split second for someone to stop breathing. We’ve all heard the saying ” you’re here one minute and the next you’re gone ” well guess what? It’s as true as it sounds.
I have been practicing prehospital medicine for over 24 years. It is common practice to either not begin resuscitation or to terminate efforts in the outside of the hospital setting. This is nothing new and it is based on provider descression. Chances of resuscitating a traumatic cardiac arrest are about 1/1000 of 1%. Basically, if a needle thorantisis does not fix the issue, chances of survival are extremely grave. Unless there is a tell tale sign of death ( visible organs, decapitation, rigor mortis, dependent lividity, etc) I may attempt resuscitation as long as that is the sole patient but this is decided on a case by case basis. If there are other patients, we need to focus or attention to those that are injured and have a much better chance of survival; especially with limited emergency resources. If we focus on the diseased, many critical, yet salvageable lives could be lost. This system is call triage and literally means ” to sort”. A person in this case that is not breathing on their own and does not begin to spontaneously breathe after placing their airway in a patient position is determined to be dead. The resources need to concentrate on those that can be saved statistically. As awful as this sounds, this is medicine and those that are not in the medical field have a heard time understanding this logic. My thoughts go out to the family of the deceased.
It would be helpful if our Fires Service and Police were taught at the very least CPR. Some first aid wouldn’t hurt either.
A very sad case and the Quappe family deserve sympathy for their loss. The report by the Canadian expert is careful and balanced and is worth reading in full as it is by no means as critical of the care rendered Zac at the scene as a casual reading of CNS’s summary and the negative comments that follow would suggest. He does point out shortcomings and makes recommendations -helpful ones which the HSA should implement – but this is not one of these stories (which unfortunately some people love to get their teeth into) where “if only they had gotten there faster and given better care the patient would have lived”. Dr Cass makes his view clear that based on all his experience of such incidents and injuries, survival was unlikely. The Quappe family, to their very great credit, seem to understand and accept this.
Amen. This story is not even close to what the report said. Sensationalism at its finest!
We only come here for the comments.
Meaning what, 5:31? That you give no importance to CNS’s initial article?
I think it’s pretty clear. We only come here for the comments.
Meaning if it was in print, page three would be its only selling point
That is seriously worrying and should be a red flag to CIG…but…lets guess whats gonna happen???
Doctor Cass need not make recommendation regards AED’s as those were standard issues with most police vehicles from the year 2000, as was training to use the equipment to police officers who were issue a personal face mask by the Red Cross, but alas came the great UK recolonization program and “modernization” of the RCIP where we lost both highly trained and experienced officers and the equipment which they now claim Hurricane Ivan took. Their final solution was to dissolve the Traffic Department telling us this bul%$#@ that every officer is a traffic officer when they well know traffic officers and accident investigators are specialized. Did stop their friend and colleague, who now flies business class on Delta Airlines all the way home in Manchester UK at great expense to come here to tell us locals how it goes???? Aaah boy this little place is in a real mess I tell you. Fortunately for us we have our own local EX police officer and US certified crash investigator Expert Colin Redden. Whom they have constantly tried to undermine and discredit at any opportunity they can get.
Well, cardiac arrest is an emergency, until we get there. By we I refer to any prehospital provider, be it a BLS fire crew, ALS ambulance, or any combination thereof.
We should, of course, treat any and all cardiac arrest with alacrity. We of course know the things that we as providers need to focus on doing: performing quality chest compressions, providing prompt defibrillation (if warranted), securing the airway, and providing ventilations. These are all things that have been shown to have any usefulness, and are all BLS interventions, at least where I work.
Once any reversible causes of cardiac arrest have been treated, and once those interventions I just mentioned have been performed, there isn’t much else to do. Sure, the AHA says we should give epinephrine to cardiac arrest every 3-5 minutes. But epinephrine doesn’t save lives in cardiac arrest.
My system frowns upon pronouncing cardiac arrest in the field. It’s been done, but pretty rarely. We have a few doctors at the hospital who are more than willing to call an arrest when requested by telephone, but the majority insist on transport to their hospital. The vast majority of providers in this area, be it firemen or ambulancemen, would never think to pronounce a patient at a scene without signs of obvious death, so the call to the doctor never gets made.
“But asystole is a sign of death!”
“No it’s not; asystole is a workable rhythm!”
Asystole is, of course, an absence of electrical activity in the heart. The heart is done. Finished. Checked out. It sucks, yeah, but it’s going to happen to each and every one of us at some point.
In my years in EMS, I have been a part of 75 cardiac arrest saves. Not a single one of those saves received a single drug prior to their conversion to a normal rhythm. Some of those did receive some drugs, be it amiodarone, lidocaine, or whatever, but not one got any medication prior to converting into a perfusing rhythm. Not one.
I have performed CPR on at a minimum, hundreds of patients in asystole. Not a single one of those has ever been resuscitated. Not one.
Asystole is a confirmation of death, and not a workable rhythm.
If we can wrap our heads around that fact, then we stand a better chance of gaining more respect in the healthcare field.
Funeral homes don’t drive as fast as they can to the hospital to have someone pronounced dead. Why do we?
Let’s wrap our heads around the only way that there would be any changes at HSA/CI EMS is the removal of the CEO and the EMS Manager. This call for change is not something new, both of these individuals has been aware of these same issues raised by Dr. Cass for sometime now and did nothing to change the system or EMS standards and training.
And the Medical Director!
My heart goes out to the family. My brother also died following significant negligence and serious delays in treatment at the CI Hospital following a head injury. However, this was over 20 years ago. And we, as a family, declined to take action against the hospital as it would not bring my brother back. Nothing would.
This very tragic case highlights the inadequacies of our A&E services at the HSA.
My experience with EMTs has always been very positive (differing from this case) however the quality of the doctors in the Emergency Room is frightening (in general, there may be a few good ones that I have yet to encounter).
They are not only young and inexperienced, they lack concern or interest in properly dealing with serious medical emergencies and are furthermore defensive and rude to families who might raise questions about their treatment of their loved ones.
I’d say it more points out one of the countless problems that lie within the EMS department.