KUALA LUMPUR, June 24 – The Malaysian Medical Association (MMA) has demanded for an independent and transparent investigation into the death of 43-year-old teacher Kumaraveloo Terpari @ Thirupathy from Ipoh, Perak, who died of a heart attack amid allegations that paramedics withheld cardiopulmonary resuscitation (CPR) intervention.
In response to CodeBlue’s report published on June 22, the doctors group’s president Dr Koh Kar Chai, in a statement today, said the incident “raises concerns” as to whether the proper procedure to manage the case was followed.
“Based on the report, the MMA views this incident with deep concern and calls for an independent and transparent investigation to be carried out to determine if textbook first responder care was given by the paramedics in this case. We also hope that while investigations are carried out, no action will be taken against whistleblowers,” Dr Koh said.
Raja Permaisuri Bainun Hospital (HRPB), in a statement earlier today, insisted that its paramedic, who allegedly withheld CPR from Kumaraveloo, acted according to protocol.
CodeBlue reported, citing the HRPB medical assistant’s (MA) Pre-Hospital and Ambulance Service (No Sign of Life) report that he signed on April 13 at 6.40pm, eyewitness accounts, and photographs from the scene – that the paramedic did not remove 43-year-old Kumaraveloo from his car to perform CPR or to use an available AED device from the ambulance to revive him, claiming signs of algor mortis (body turned cold).
HRPB director Dr Megat Iskandar Megat Abdul Hamid said an internal inquiry found that the MA had performed a “clinical examination” and “confirmed that the victim had died” in the April 13 case of Kumaraveloo’s collapse in his car.
The Ministry of Health (MOH) hospital director also said that his facility’s investigation on the emergency medical response in Kumaraveloo’s case found that the MA had followed the 2016 guidelines – “Recommendations on the Minimum Standards Required for the Management of Adult Out of Hospital Cardiac Arrest in Prehospital Care Services” – by the College of Emergency Physicians, Academy of Medicine Malaysia (AMM).
According to AMM’s 2016 guidelines, CPR must be “initiated without delay when indicated” on out of hospital cardiac arrest (OHCA) adult victims – who are unconscious and have abnormal or stopped breathing – placed in a supine position on the ground. Guidelines state that CPR can only be withheld in situations of “clinical irreversible death”.
The “clinical irreversible death” situations listed by AMM’s College of Emergency Physicians do not include algor mortis, but include instead rigor mortis (body stiffens after a few hours from death); dependent lividity (bluish-purple discolouration of skin after death); fatal injuries like decapitation, transection (cutting across, typically a tubular organ), or incineration (more than 95 per cent full thickness burns); or decomposition.
The HRPB director also claimed that the MA had acted according to “Protokol Pengendalian Pesakit Pra-Hospital Negeri Perak (Polisi Operasi Perkhidmatan Pra-Hospital Negeri Perak, Edisi 2014)”.
