美国国家公共电台 NPR A Baby In Cardiac Arrest And An Emergency Dispatcher Who Did Not Know Telephone CPR

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DAVID GREENE, HOST:

Around the country, people who answer emergency 911 calls are increasingly being trained to give CPR instructions over the phone, but that is not the case in Rhode Island. A 911 call last year about a baby drove that point home. Lynn Arditi, a reporter for The Public's Radio in Rhode Island, has the story. And just a warning to listeners here, this story does contain graphic¹ and disturbing content.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED 911 OPERATOR: 911, what is your emergency? Please...

JESSICA: I have a baby. He's unresponsive, and he has throw up around his mouth and nose.

LYNN ARDITI, BYLINE²: In a medical emergency, every minute can matter and mean the difference between life or death. And that was the case one Friday morning in February of 2018.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED 911 OPERATOR: OK. Is he on his back?

JESSICA: He's throwing up right now. My aunt is holding him.

UNIDENTIFIED 911 OPERATOR: Is he on his back?

ARDITI: Six-month-old Alijah had gone down for his nap. About 20 minutes later, he was found unconscious. The baby's aunt, Jessica, is talking with 911. We're not using last names at the family's request to protect their privacy.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED 911 OPERATOR: Is he on his back? Make sure he's on - not on his back.

JESSICA: Make sure he's on his back.

UNIDENTIFIED 911 OPERATOR: Not on his back.

JESSICA: He's on his back, but he's turning purple.

UNIDENTIFIED 911 OPERATOR: Not, not on his back.

ARDITI: Turning purple is a sign the baby isn't breathing, and every minute without oxygen increases the likelihood of brain damage and death. But 18 seconds into the call, the woman at 911 is still trying to position the baby to prevent choking.

JEFF CLAWSON: I would say that this particular call is in the top 15 worst calls I've ever heard in my life - maybe in the top 10.

ARDITI: That's Dr. Jeff Clawson, medical director of the International Academies of Emergency Dispatch in Salt Lake City. He's 1 of 3 experts that reviewed the call. Clawson and others say the call is a disturbing example of what's wrong with the way Rhode Island is training its 911 call takers. There are no national training requirements for 911 call takers, and experts say the country is a patchwork³ of different systems where performance varies widely.

But at the urging of groups like the American Heart Association, last year, Louisiana, Wisconsin and Kentucky passed laws requiring 911 call takers and other emergency dispatchers to be trained in telephone CPR.

The benefits are well-documented. Seattle launched its program in the 1980s. Dr. Mickey Eisenberg is medical director of King County Emergency Medical Services.

MICKEY EISENBERG: And they saw, very quickly, that they were literally⁴ snatching lives from the jaws⁵ of death among patients who had cardiac arrest in their homes and in the community.

ARDITI: On average, about 1 in 10 people in the U.S. who go into cardiac arrest outside of a hospital survive. But even in a small state like Rhode Island, experts say the survival rate could double or triple - potentially saving hundreds more lives a year with earlier CPR. That didn't happen with the baby in Rhode Island. About one minute into the call the baby's aunt, Jessica, asked the woman at 911...

(SOUNDBITE OF 911 CALL)

JESSICA: Do we give him mouth to mouth? What do we do?

ARDITI: Jessica never got a good answer. The 911 call taker - who officials refused to identify - repeatedly asked the baby's age. She gives unhelpful instructions like the ones taught in basic first aid for a baby who is actively⁶ choking. And more than one minute into the call, she still hasn't figured out if the baby is breathing.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED 911 OPERATOR: He's not - he's not breathing. Are you he's not breathing?

JESSICA: You're sure he's not breathing?

UNIDENTIFIED 911 OPERATOR: Because you can't do CPR if he's breathing at all.

JESSICA: Because she said you can't do CPR if he's breathing at all.

ARDITI: Dr. Peter Antevy says the dispatcher's instructions are just plain wrong. You can do CPR if the baby is breathing. Antevy is a pediatric emergency medicine physician and medical director for several EMS agencies in South Florida.

PETER ANTEVY: When she says, we cannot do CPR if the baby's breathing - that's not true. It's if the child or adult is not breathing normally, then you have to move to the next step which is start CPR.

ARDITI: The call goes on. At 3:37, the woman at 911 finally sounds convinced the baby is not breathing and needs CPR. And she tells this to the family like it's a choice rather than a life saving intervention⁷.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED 911 OPERATOR: OK. All right. So who's going to give CPR?

JESSICA: Do you want to give him the CPR?

ARDITI: The call ends abruptly⁸ after 3:51 when paramedics arrive. And still the baby has not received CPR. State public safety officials declined comment on the handling of the call. The lack of good pre-arrival medical instructions from 911 frustrates⁹ Jason Umbenhauer. He's a deputy chief of emergency medical services in Rhode Island, and Umbenhauer says his staff are doing everything possible to improve care.

JASON UMBENHAUER: But when it comes to what happens prior to our arrival, unfortunately, it's not in their control. So they a lot of times wish that somebody would - tell somebody to do something before we get there.

ARDITI: Dr. Joseph Lauro, an emergency medicine physician in Rhode Island, puts it more bluntly.

JOSEPH LAURO: It's something that's a relatively¹⁰ easy fix. It's something that's been studied. It's something that happens elsewhere, so why the hell aren't we doing it?

ARDITI: It took just three minutes for the fire department to arrive at Barbara's house. She was waiting at her front door, Alijah in her arms. An emergency medical technician whisked him into the ambulance and within a minute began CPR. He had no pulse and was not breathing.

At 10:39 a.m. - about 20 minutes after arriving at the hospital - Alijah was pronounced dead. The final autopsy¹¹ report said the baby had been propped¹² on his left side with a bottle in his bassinet. He was later found unresponsive on his back. The report states the cause of death as sudden unexplained infant death.

Doctors who reviewed the case say it's impossible to know whether Alijah would have survived with an earlier intervention, but afterwards everyone had questions - the police, the state child welfare agency, the neighbors who saw the police parked in front of their house. But as for the 911 call, nobody asked about that.

JESSICA: But I specifically remember here, not a single person ever questioned anything about the 911 call - ever I mean there were a million other questions. No one ever said, you know, what was 911 call like? Did they give you clear instructions? Nope.

BARBARA: Nope, never asked.

JESSICA: Not once.

BARBARA: Not once - none of them.

ARDITI: For NPR News, I'm Lynn Arditi in Rhode Island.

GREENE: Lynn's story was reported in partnership¹³ with the ProPublica Local Reporting Network. And we should say since an earlier version of this story aired on The Public's Radio in Rhode Island, the state police superintendent¹⁴ has pledged to conduct a thorough review of procedures and training provided to 911 call takers.