MP: Are Public Ambulance Services Also Withholding CPR Outside Ipoh?

Dr Kelvin Yii calls for a nationwide review to ensure that the case of HRPB’s ambulance response team allegedly withholding CPR from a patient who collapsed is not happening elsewhere.

KUALA LUMPUR, June 23 – Bandar Kuching MP Dr Kelvin Yii has called for an immediate inquiry and investigation from the federal Ministry of Health (MOH) on “serious allegations” of medical negligence against the Ipoh general hospital’s ambulance service.

CodeBlue yesterday detailed an account by a doctor from Raja Permaisuri Bainun Hospital (HRPB) in Ipoh, Perak, who accused the public hospital’s emergency medical response team of allowing his brother to die from a heart attack by withholding cardiopulmonary resuscitation (CPR) intervention.

“Such issues 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 to bring justice to the aggrieved family members,” Dr Yii said in a statement yesterday.

“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.” 

Despite arriving on the scene within 10 to 15 minutes from an emergency call last April 13, HRPB’s paramedic team did not even remove Dr Thiru Terpari @ Thirupathy’s brother, Kumaraveloo, from the latter’s vehicle, where Kumaraveloo collapsed, to try to revive the 43-year-old man with CPR or by using an available AED device (a machine that delivers a jolt of electricity to get the heart beating again) from the ambulance. 

This was based on an internal document, an eyewitness account, and police photographs from the scene. 

Dr Yii, who also chairs the Dewan Rakyat special select committee of health, science and innovation, described CPR and the use of an automated external defibrillator (AED) device from the ambulance as “standard practice” in such a situation and that life-saving interventions – even if they don’t guarantee that someone will survive – can increase the chances of the patient being saved, especially if there was early intervention. 

Based on eyewitness reports, Kumaraveloo still had some movement and he had difficulties breathing when a bystander made an emergency call. An ambulance from HRPB – comprising a medical assistant and the ambulance driver – arrived 20 minutes after the St Michael’s Institution school teacher collapsed in his car.

“Technically based on such a time frame, life-saving interventions including CPR and usage of AED can still be performed. However, based on eyewitness 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 scene signed 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,” Dr Yii said.

He noted that algor mortis generally only begins two hours at the earliest after the heartbeat stops, and is established at around 18 hours after death, thus disputing claims made by the MA, giving him “no excuses” why life-saving manoeuvres were not performed. 

“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 news report, it is not an isolated case as a similar case happened before as well in May of this year,” Dr Yii said.

CodeBlue reported that the MA that attended to Kumaraveloo similarly withheld CPR and pronounced the death of another patient last May 11, who was involved in a motor vehicle accident in Chemor, Perak, claiming that the 85-year-old man showed algor mortis despite arriving at the scene in 15 minutes from HRPB.

Dr Yii stressed that all MAs responding to emergency calls must be given the needed support and 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. 

He said the MOH must also do an audit on all equipment and medications on all ambulances to ensure they are adequate and properly maintained so that they can be used effectively and swiftly when needed. 

The government must also increase public awareness and training on 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,” Dr Yii said.

Dr Yii told the government not to take any disciplinary action against any public health workers or whistleblowers of negligent practices. 

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