Left waiting: Alexandria man in cardiac arrest waits for EMTs in Ocean City
From the start, time was working against Richard Rehmann, 52.
It was Oct. 3, 2009, the end of beach season, and the Alexandria resident was busy cleaning his boat with his son outside his Ocean City home. Then he collapsed.
“He did not complain of anything, he did not yell out. One minute he was standing there and the next he was on the ground,” recalls Rehmann’s wife, Jackie, who was sitting nearby on the back deck with family.
Rehmann was having a heart attack. He needed help quickly. “I looked up on the boat and my husband was on the floor of the boat face down,” said Jackie Rehmann.
Cheryl Monno, Rehmann’s sister-in-law, quickly called 911. What happened during the nine minutes on the line with dispatchers raises a number of questions about how the response was handled.
While Monno was able to give dispatcher Jo Ann Burbage the intersection to the Rehmann’s home, she did not immediately have the address. At one point Burbage asks, “And he’s in Bayshore Court, Ocean City, Maryland?”
Monno responds, “Yes! It’s at the end of Bayshore Drive.”
“I felt like the dispatcher had no idea where I was,” Monno told ABC7's Kris Van Cleave during a recent interview.
It would take Monno and Burbage the first two minutes of the call to clarify the address, even after Monno tells the 911 operator that she believes Rehmann had suffered a heart attack.
While paramedics were sitting at a fire station just a mile and a half away from where Rehmann lay face down, it would be four and a half minutes before the 911 operator dispatched them.
Documents obtained through an open records request include an Ocean City Department of Emergency Services Communication Division “Critical Incident” report reviewing this call that says the “average time for processing” a “Cardiac or Respiratory Arrest” call is 2 minute and 59 seconds, well below the 4 and a half minutes the Rehmann call took.
While there are no definitive national standards for EMS dispatch, an EMS expert consulted by ABC7 News, wrote by email, “the generally accepted standard for dispatch of Emergency units is 90 seconds or less from call reception.”
A second EMS expert, who is also a cardiologist, consulted as part of this investigation says survivability drops ten percent for every minute it takes to get a defibrillator to the scene.
In fact, ABC7 News asked three EMS experts to review the recording. All three asked their names not be used, because they did not want to publicly criticize an EMS agency, but all three pointed to problems with how the call was handled.
At one point Monno is heard asking the dispatcher, “Come on, tell me what do ma’am. He’s not breathing.” Monno would ask repeatedly for help and directions on CPR.
“Monno: Ma'am, he is not breathing now.
Dispatcher: OK. Is he all right?
Caller: NO, HE IS NOT BREATHING NOW
Dispatcher: He is not breathing now?
Caller: No, tell me what do, hurry it up here.”
It took more than two additional minutes before a different dispatcher begins an explanation of CPR — an explanation that came more than seven minutes into the call.
That dispatcher, identified in city documents as Anna Blue, tells Monno, “OK, I'm going to tell you how to give mouth-to-mouth, OK?”
But the American Heart Association recommendations for cardiac arrest dating back to 2005 emphasize beginning chest compressions immediately, and more than a year before Rehmann collapsed, the American Heart Association Emergency Cardio Vascular Care Committee wrote an AHA Science Advisory recommending, “If a bystander is not trained in CPR, then the bystander should provide hands only CPR.”
The findings were based on a belief that bystanders were often unwilling to perform mouth-to-mouth and that explaining and implementing proper mouth-to-mouth took too much time.
Rehmann was pronounced dead at 6:05 p.m. at Atlantic General Hospital, according to his death certificate, which lists the cause of death as myocardial infarction, commonly known as a heart attack.
Further, an internal Ocean City EMS Department “incident report” dated October 6, 2009, written by division supervisor Janet Guiton, says Burbage called her concerned “about PCO II Anna Blue, her inexperience with the EMD Protocols [Emergency Medical Dispatch Protocols] and said that Blue ‘froze’ when directed to speak with the complainant to provide CPR instructions.”
Talking about the whole experience, Monno says, “this should never ever happen to anyone else again whether it’s Ocean City, Maryland or anywhere.”
In an October 29 email sent by Ocean City Fire Chief Chris Larmore’s personal email account to City Manager Dennis Ware, Larmore writes “I was previously made aware of this incident…and I will add there is some validity to her [Jackie Rehmman] concerns.”
Jackie Rehmman, Richard’s widow, demanded a formal investigation by email on January 6 of this year.
In late February, several town leaders including the mayor, city manager, the EMS director and members of the Ocean City Fire Department command staff met with Rehmann, her three children, and Monno ((see meeting notes taken by town officials they incorrectly refer to Cheryl as Shirley)).
Leaving the meeting, Rehmann provided a letter putting the town on notice that she was “asserting a tort claim against the Town of Ocean City, Maryland for gross negligence resulting in the death of my husband.”
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