Emergency services ignored protocol in road death, review says

The first emergency medical responders did not follow protocol and did not try to resuscitate a man who died in an early morning car accident two years ago, according to an independent review of the death. 

When 21-year-old Zak Quappe lost control of his car and crashed while racing along South Church Street early in the morning of May 18, 2013, his injuries were most likely fatal, regardless of what paramedics did when they arrived on the scene, according to the independent review by Dr. Dan Cass, the chief coroner in Ontario, Canada. The Cayman Islands Ministry of Health commissioned the report and this week Mr. Quappe’s family made it available to the media. 

Zak’s sister Teri Quappe, who worked as an emergency medical responder in Cayman for two-and-a-half years, said, “We’re not saying his injuries wouldn’t have killed him anyway,” but, she said, “they didn’t even try to resuscitate him.” 

She said she saw the EMS report soon after the accident “and it threw up all sorts of red flags.” 

The Ministry of Health issued a statement in response to questions from the Cayman Compass. The statement says, “The Ministry decided to seek a review from a medical expert outside of the Cayman Islands jurisdiction so that there could be no questions about having our own medical and emergency staffs reviewing themselves.” 

Barrie Quappe, Teri and Zak’s mother, also works in the medical field. She was a cardiovascular nurse and now works as the sole medical facilities inspector for the Cayman Islands government. 

On the day of the crash, Zak and a friend, Igor Domladis, were racing on South Church Street, exceeding 60 miles per hour on the narrow, winding stretch of road. Just after 3 a.m., according to the report, both cars lost control as they headed out of central George Town, and Zak’s car hit a wall. The other car hit another wall and a parked car. 

A bystander called 911 and the closest ambulance, at the Cayman Islands Hospital, was dispatched to the scene. 

The first responder, a police officer, said Zak Quappe was “trapped in the car and losing consciousness fast … still breathing,” the review quoted from an event log. About a minute-and-a-half later, the first medic arrived. 

The EMS patient treatment report from the first paramedic on the scene, cited in the independent review, notes the serious damage to the car and “significant trauma” to Zak Quappe, including a head injury with major blood loss, possible spine fracture and broken legs and arm. The report does not note any attempts to resuscitate Zak, to open an airway, or to remove him from the car. 

The paramedic reported that Zak was “DOA” (dead on arrival) when she got to the scene, according to the notes examined by the coroner. 

Dr. Cass, in his report, said there were “a number of deviations from existing protocols,” including failing to open an airway, assess the heartbeat and eyes, and initiate CPR. “The rationale for these deviations is not documented; nor is there evidence of contact with the medical command physician regarding these deviations,” he writes. 

In the report, he notes, “There is no evidence that this deviation was sanctioned or directed by the medical control physician.” 

In an interview this week, Barrie Quappe thought back to her time as a nurse working with heart patients. “You know how many people I’ve brought back from asystole?” she asked, using the technical term for no measurable heartbeat. “If only I had been there with the right equipment. 

“Two young men made a stupid decision,” she said of the road racing in which her son and his friend took part, which led to Zak’s death and Domladis’s subsequent conviction and imprisonment. 

By pushing the ministry for this review, she hopes health authorities will make changes to how the EMS works. 

Barrie Quappe said after her family received the report they asked the Health Services Authority and the ministry for a response by the end of July but never received one. 

The report makes six recommendations: equip police and fire officers with automated external defibrillators, known commonly as AEDs, in case officers come across a victim with no pulse; develop protocols for when paramedics respond to patients with traumatic cardiac arrest, such as in this case; more training on protocols for deciding how to treat patients and when to give or withhold resuscitation; develop new response time standards; remind paramedics to document observations, not make conclusions or diagnoses; synchronize event recorders so police, fire and EMS can all track response times together in one system. 

The ministry, in a statement, notes that is has implemented some of Dr. Cass’s suggestions. “For instance, the Department of Public Safety Communications, which falls under the remit of the Ministry of Home Affairs, is coordinating with stakeholders on modifying dispatch protocols and procedures with the intent of reducing emergency response times. Work is also under way to synchronize event recorders throughout the system,” the ministry notes in a written statement. 

Zak Quappe
Zak Quappe


  1. You can’t just equip police and fire officers with automated external defibrillators, they must have Emergency Medical Responder, Medical First Responder, or First Responder certification.
    I will be surprised if paramedics did not already have step by step protocols. It comes with the profession.

  2. While offering my sincerest condolences to the Quappe family, I simultaneously applaud them for utilizing Zak’s unfortunate and tragic death to question, test and strengthen emergency services and public safety in Cayman. Best practices should always be the goal of emergency services and public safety and errors can’t be fixed or improved upon if they are not raised and addressed.