Diverted ambulances delay response to heart attack victim

It took an ambulance crew nearly 30 minutes to reach an unresponsive heart attack victim in North Side Monday because there were no available ambulances in the area, according to 911 records of the call. 

The 41-year-old man’s life was saved after police first-responders continued performing CPR. When the ambulance crew arrived, they administered a shot of epinephrine and continued the CPR. The man’s pulse returned while the ambulance was taking him to hospital. 

The emergency call on Rum Point Drive was received at 9:35 a.m. Monday, according to 911 Emergency Centre records. At that time, both Medic 1, normally stationed at the Frank Sound Fire Station, and Medic 3, the George Town ambulance, were out on patient transport calls. 

Medic 1 was involved in a non-emergency patient transfer between Frank Sound and the Cayman Islands Hospital in George Town. Medic 3 had been called about 20 minutes before the North Side emergency call to another patient transport. 

“So, you’ve got the closest ambulance and the next closest ambulance tied up because they’re on non-emergency patient transfers,” 911 Centre Director Brent Finster said. 

The 911 center originally dispatched a third ambulance, Medic 4, which is based at West Bay Fire Station, at 9:38 a.m. However, Medic 3 radioed in at 9:40 a.m. from the hospital to inform dispatchers its crew could respond to North Side as soon as they were clear from the patient drop off. 

There are typically only three ambulances on duty in the whole of Grand Cayman – at West Bay, George Town and Frank Sound – on any given day and that was the case Monday, Emergency Medical Services chief Stephen Duval confirmed. Mr. Duval said when a situation like the one on Monday arises, calls are put in a queue and the most serious/life-threatening incidents get first priority. 

“The [ambulance] service demands have increased, there’s no doubt,” Mr. Duval said. “The key is to prioritize the calls.” 

At 9:47 a.m. – 12 minutes after the heart attack report was received – the George Town ambulance, Medic 3, started toward the emergency call on Rum Point Drive. The West Bay ambulance, Medic 4, which was already headed to the emergency, continued on in case the initial ambulance unit needed assistance with CPR or other medical treatment. 

Emergency center records show that Medic 3 arrived at Rum Point Drive as of 10:16 a.m. Monday. Medic 4 arrived at 10:19 a.m. It took the first ambulance unit 29 minutes to reach the patient location, driving from George Town to North Side, and a total of 38 minutes from the time the call was dispatched via 911. 

Mr. Duval said the driving time from George Town to North Side was cut from the typical 39 minutes to 29 minutes by the crew of Medic 3, which was doing the best it could in responding from far away. 

The ambulance was on its way back to the hospital, with the patient at 10:47 a.m. and arrived there at 11:19 a.m., 911 records show. 

The two police officers who responded to the call, Zachary McLaughlin and Carlyle Nation, were credited with saving the 41-year-old heart attack victim’s life after he collapsed in the bathroom of the home where he lived. Both police constables received CPR training through the Royal Cayman Islands Police Service. 

EMT training 

The life-saving training that officers McLaughlin and Nation received is conducted on a periodic basis at the RCIPS, and is planned to be conducted for the Cayman Islands Fire Service as well. 

A consultant’s report on the fire service, completed in early 2014 by U.K. Chief Fire and Rescue Adviser Peter Holland, recommended that firefighters receive emergency medical responder training, similar to that for emergency medical technicians and paramedics who serve on ambulances. 

“The level of demand for the fire service expressed in terms of fire calls and incidents attended is at consistently low levels,” Mr. Holland’s report stated. “The review team identified significant surplus capacity [within the fire service].” 

A Cayman Compass review of 911 calls up through the government’s 2013/14 budget year indicated that firefighters are answering, on average, fewer than three emergency calls per day, while ambulance crews receive more than 10 calls per day. 

Mr. Holland said allowing fire personnel to respond to some of the non-emergency or less urgent ambulance calls would free up local paramedics to respond when they’re needed most. 

“The introduction of this capability will improve the level of support to the communities of the Cayman Islands,” Mr. Holland said. 

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  1. Unless you are young, healthy, and fell into ice cold water at the moment your heart stopped, (and are resuscitated according to current protocols that can prevent additional damage), you WILL have brain damage.Irreversible damage begins to occur within five minutes of interruption of circulation to the brain.
    If an average adult keels over in the street, is found unresponsive and pulseless by a bystander, and is administered CPR while a 911 call is made, the odds that such a person will emerge from the eventualities of the resuscitation effort healthy and with a normally functioning brain are about 2 percent. The other 98 percent, die on the scene, die within 30 days, after expensive treatments and much suffering, or get discharged from a hospital alive but mentally impaired.
    Yet, automatically giving CPR to any person found unresponsive has become a societal norm, in part perhaps because of unrealistic depictions presented on television.
    I truly hope that this young man’s heart was still beating when he was found. It is not easy to locate the correct spot for detecting a pulse. Uninterrupted forceful continuous chest compressions should have been started immediately.

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  2. Just in case we have not noticed, the Cayman population has grown. We are not in the 70’s any more, and North Side is a long way from George Town.
    One thing I must admit is that we have a very efficient ambulance crew, but they can only drive so fast to these emergencies without endangering themselves and other persons on the way.
    Cayman need more ambulances, Period; and the distance is too far. Many times persons have died in the eastern districts just because the ambulance had to come from George Town; and God forbid if we have a real catastrophe in George Town and at the same time people are dying on the Eastern side. What are we going to do? Just living in hope that this will not take place is not good enough. As the population grows we can expect anything. There should be an ambulance service always ready to serve North Side and East End. There should be an ambulance service always ready to serve Bodden Town district which includes Central, Savannah Newlands and Breakers. So may I ask,if we are divided in constituencies, we still need to wait until an ambulance arrive from one of the George Town Constituencies to ours? The Dr. Shetty Hospital is a stone throw away, why can’t arrangements be made between our government and them to assist with these types of emergencies. Why should a patient have to be taken from all the way Rum point to George Town when Dr Shetty Hospital is very qualifies to help. Is it because we do not want to pay the bill? The Cinico Poor People Insurance need an overhaul big time. Imagine it can only be used at George Town Hospital. Even if a patient has to pay a little stipend every month, that Poor People Insurance need an overhaul. All district clinics now-a-days should be up to date with handling emergencies. But they are not. In the 70’s we had round-the clock service at the old Clinic in Bodden Town with Nurse Salesman and her team. Lives were saved in the Eastern district back then.
    I want to commend the two police officers, McLaughlin and Nation for a job well done, and at the same time say, lets not wait until the call is for someone dear to us. Do the right thing now, put on that to-do list for 2017. Ambulances for Eastern district.

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  3. In France fire personnel are trained in emergency medicine and carry the proper gear.

    Consequently, in a medical emergency your first call is to the "pompiers" (firemen) not the ambulance service.

    Just saying….

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  4. Thank God the police were there and well trained in effective CPR to save this man’s life. In addition to considering how the paramedics should be deployed, it would be beneficial to consider strategic placement of AEDs (automatic external defibrillators) around the more remote areas of Grand Cayman (Rum Point and East End) as well as the Sister Islands. These devices are less than 1000USD and have audio instructions that even a young child can follow. A very inexpensive investment that saves lives.

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  5. So ,can we send heart attack patients to Shetty’s hospital? How about other emergencies that happen in the Eastern Districts? Would that be faster? What about the new Eastern -Western highway will that speed things for new emergencies? How much longer before one project starts?

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  6. I agree with Mr Duval that prioritising calls is important.I also agree even more with Mr Finster’s thinly veiled criticism when he refers to Mr Duval allowing both ambulances from the nearest locations to be out simultaneously on non emergency patient transfers (taxi services).This should not have happened and hopefully lessons will be learned.

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  7. @Barbara
    If you scroll down the Wikipedia page it says:
    After approximately three to five minutes in cardiac arrest,irreversible brain/tissue damage may begin to occur. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation), the chance of survival decreases by 7 percent per minute in the first 3 minutes, and decreases by 10 percent per minute as time advances beyond ~3 minutes. It also says:sixth-grade students have been reported to begin defibrillation within 90 seconds. 90 seconds is the key here.
    @David&Twyla
    I agree, to have the world class cardiac center on the island and not utilize it in emergencies like this one is beyond my understanding.

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  8. This nearly 30 minutes for emergency team to respond to a emergency, on a island size of Grand Cayman. I think that this issue should be looked into, and all emergency units, Fire,911, ambulance all needs to be addressed to be called the emergency services. I think that it should be mandatory C.P.R and other life saving techniques training for all police officers, Fire fighters, and emergency responders.

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  9. @L.Bell, I believe the reasons were that there were concerns about the Shetty Hospital taking business way from the CI and Chrissie Tomlinson Hospitals. There was a concern that because of the affordable Heath care offered at the Shetty Hospital that people would stop going to the others for care.

    Obviously the bottom line if more important than lives.

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  10. We all know that variety is the spice of life, and I am inclined to think seriously about the reasons and concerns in comments made by Mr, Michael. Maybe there is some truth there. But the question is, Should we allow competitions to override the price of life.
    People have their special doctor, and it does not matter if he is in Sing Sing prison they will find him and go to him. So I do not think it is fair to deprive the right of people to go to the Shetty Hospital if they care to. Cinico need to make serious considerations on the part of their clients. Why in the world would an ambulance have to gamble with a persons life in crossing a reputable hospital like the Shetty to take a dying heart patient twenty five miles to George Town. It just does not sound right.

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  11. Cayman Compass, can you please verify that SHETTY Hospital, is not permitted to respond to emergency calls in the eastern districts of Cayman, and is not involved with the health care system in the Cayman Islands. If so, I find it applauding that government/politicians would let this happen against the people of Cayman Islands, to have a hospital of its kind on the Island that is not a benefit to all the people is a disgrace.

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  12. I agree 100% with Ms Vargas first comment, why government is not paying more attention to the needs/emergency of the people and a growing population . This looks to me that the Government/ politicians DO NOT CARE ABOUT THE PEOPLE, only for the vote. With this issue, if I lived on the Island I would be furious with the government. It’s a shame and disgrace that Government can spend millions of dollars on surveys and studies to collect dust, but can’t spend the money to protect the people’s lives.

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