Muddasir Ali's referral to Srinagar hospital: Was golden hour lost in transit?

Photo Source: Facebook/ Mudasir Ali

Within 15 minutes of complaining of pain in chest, Greater Kashmir senior editor Muddasir Ali was brought to Sub-District Hospital (SDH) Chrar-e-Sharif, a health center catering to 11,000 souls of the hilly town.

It just took Muddasir’s brother and two cousins three minutes to reach the SDH in the car but more time to find where the doctor on duty was sleeping. The doctor came, saw Muddasir and asked a few questions. Muddasir spoke himself: “I can’t breathe, put me on oxygen.”

However, the doctor instead of any other emergency treatment, directed the attendants to take the patient to the ward “up there”.

“An ECG technician was there but the doctor directed him to do the ECG in the ward in the other building,” said Jehangir Ali, the shattered younger brother of Muddasir Ali.

“We asked for a stretcher, there was none. We asked for a wheel chair, none,” he said. He had driven his brother to the hospital at 3 am from their home to the nearest health facility within 3 minutes, realising that an emergency like the one he looked to be in, needed immediate medical intervention.

Jehangir and two cousins, who were accompanying them, lent support to Muddasir to help him tread the elevated path to the ward he had to reach to get any medical help.

“After walking 10-15 steps, he collapsed,” recalled Jehangir. With the help of one hospital staff, they carried him to the ward in the other building. The doctor on duty started pumping his chest, took an ECG and soon gave up. He asked them to take the patient to SMHS Hospital Srinagar.

“He told us that Muddasir had suffered a heart attack and needed specialist care,” Jehangir said, adding if SDH Chrar-e-Sharief failed to handle heart ailment issue of Muddasir what would be the condition of gullible patients who are generally referred to Srinagar be.

Jehangir said that they were told that SDH Chrar-e-Sharief had no ventilator but the on-duty doctor referred his brother to the Srinagar hospital without stabilizing him.

“We were later told by specialist doctors that Muddasir should have been stabilized first at SDH Chrar-e-Sharief by giving him aspirin drug and Hydorocort injection,” he said. “They told us that the Deep Vein Thrombosis was not a difficult procedure and the doctor on duty should have done the procedure before referring him to Srinagar as it dissolves the clot and could have saved him from collapsing.”

Muddasir was put in a newly furbished 108 Critical Care Ambulance. An ambulance attendant also jumped in before the vehicle drove off on the winding, long 35-km journey to Srinagar at 3:20 am.

“I remember him taking the readings of my brother in the vehicle,” he said.

At SMHS Hospital, doctors declared him “brought dead”.

The fact that Muddasir was referred to Srinagar instead of stabilising him and the journey cost him his life points at the failure of the healthcare system to provide emergency medical care in peripheral settings, experts said.

DrShowkat Shah, a senior critical care specialist said Basic Life Support (BLS) is a “basic” and should be available in every hospital, no matter how small.

“If the doctor felt that the patient has difficulty in breathing, he should have secured his airway first,” he said.

Dr Shah said intubation of the patient would have given time to find out the cause of his emergency and helped in making a life saving intervention.

“If the patient collapsed, the doctor should have done Cardio-Pulmonary Resuscitation (CPR) first,” he said adding that CPR is a long and tiresome process but has saved more lives than can be imagined. “A mere thumping of chest a couple of times is not called CPR,” he said commenting on the narration of the attendants regarding the on-duty doctor’s efforts.

“If it was a heart attack, the doctor should have chosen to thrombolyse him at the hospital instead of sending him for a journey,” he said.

BMO Chrar-e-Sharif, DrMastoora said the doctor on duty had followed the protocol and did the necessary medical interventions.

“An IV line was secured, and necessary drugs given before the patient was shifted to higher health center. Treating a massive heart attack was not in our domain that too when the patient reached us in a deteriorated condition,” she said.

However, in case of a heart attack, or any similar medical emergency, delaying treatment by minutes can be the difference between life and death.

DrIrfan Ahmed, a cardiologist working at SMHS Hospital said in presentations like Muddasir’s, a doctor should have taken a prompt ECG and flagged it with an expert.

“Golden hour in case of heart attacks demands that we start the treatment immediately, wherever the patient is,” he said. “We started the Save Heart initiative for such kinds of emergencies but it has taken a hit since the past one year.”

Director Health Services Kashmir, Dr SumirMattoo said the department had sought a detailed report into the circumstances of the death from the Block Medical Officer.