Lawyer’s Death Reveals E.M.S. System Failures

When Thomas A. Twomey, a well-known East End lawyer, died of an apparent heart attack at home in East Hampton on Nov. 16, it was during 1 of 10 times since May that East Hampton Village’s paid first responder program had gone unmanned, prompting questions about whether the outcome for him might have been different if someone had been on duty.



In mid-May, the East Hampton Village Ambulance Association joined Amagansett, Montauk, and other agencies on the South Fork in moving from a volunteer-only system to a partially paid system to help deal with the increasing 911 call volume. Every day, from 6 a.m. to 4 p.m., a paid advanced life support provider, which includes certified critical care technicians and paramedics who provide a higher level of care, is supposed to be at the ready to answer calls within the association’s coverage area, which extends past the village into Northwest Woods, areas of Wainscott, and areas east to the Amagansett district line.



But on the morning of Nov. 16, “No one was available to work that shift,” said Village Police Chief Gerard Larsen, who helped set up and oversees the program. The provider scheduled to work had a family emergency and called in before his shift, according to Lt. Tony Long, who said other providers were called and emailed in an effort to get the shift covered to no avail.



About 45 minutes into that vacant shift, at 6:44 a.m., the East Hampton Village Communications Department received a call for help from Mr. Twomey’s wife, Judith Hope, Chief Larsen said. A minute later, the ambulance crew was summoned for an adult male experiencing chest pain on Two Holes of Water Road in Northwest Woods.



It would be 21 minutes before the ambulance arrived at 7:06 a.m.



Because the town police and the emergency medical services throughout the town are dispatched by separate agencies, police and E.M.S. might be dispatched at different times. Often police are notified about a medical emergency a minute or so after a call for an ambulance. According to town records, police dispatchers were notified at 6:46 a.m., and dispatched an officer a minute later. He arrived within five minutes, and found that Mr. Twomey was not breathing. (While Two Holes of Water is in the East Hampton Village Ambulance Association’s coverage area it is outside of East Hampton Village police jurisdiction.)



Meanwhile, the volunteers were assembling a crew. They confirmed a crew, but without any advanced life support, in eight minutes. At 6:57 a.m., 12 minutes after Ms. Hope’s call for help, the ambulance was on its way.



Back at Mr. Twomey’s house, the town officer had started cardiopulmonary resuscitation, and used an automated external defibrillator, which police carry in their vehicles since they are often the first to arrive on scene. Over the next 15 minutes that the officer performed CPR alone, two shocks were administered to Mr. Twomey in an attempt to re-establish a heartbeat. The portable electronic machine reads the heart’s rhythms and will indicate that a shock is needed to establish a life-sustaining beat only for patients with two types of life-threatening cardiac arrhythmias. After that, no further shocks were advised.



The officer did not radio in that CPR was in progress until 7:05 a.m., according to village records. The ambulance pulled up at the house one minute later.



At 7:09 a.m., a volunteer certified in advanced life support — who was unaware there was no paid provider on duty that day — signed on. The provider made haste, arriving eight minutes later, though it was 32 minutes after the 911 call. The provider met the ambulance as it was pulling out of the driveway on its way to Southampton Hospital, where Mr. Twomey would be pronounced dead.



Diane O’Donnell, the chief of the village ambulance association, said it was unfortunate the call happened during one of the times a paid advanced life support provider was unavailable. Asked if she felt it would have made a difference she said, “I don’t know how. He was already in cardiac arrest. The first thing the A.L.S. provider has to do is make sure there’s good [basic life support] CPR going on,” she said. “It’s a process, no matter how you look at it.”



“The most important component of the whole thing was CPR and that was already being provided. A provider who could have gotten there between three or four minutes sooner than the rest of the people, he would still have had to do basic CPR before he started any interventions,” such as intubation or more detailed cardiac monitoring, she said.



Still, the program administrators had been aware that they needed to find more help to ensure all shifts get covered. “We had already done interviews to hire four more people to make sure we didn’t have holes in the schedule,” Ms. O’Donnell said, adding that four were officially added to the ranks of part-time providers at a village board meeting on Friday.



“Even though we do have paid people 6 a.m. to 4 p.m., then it’s back to volunteer,” Ms. O’Donnell said. There are three advanced life support providers who volunteer with the association, answering calls when they are available and on squads in the evening hours. “It can happen any time. It’s unfortunate that it happened during a time that people expected a provider to be there, but the crew that handled the call did everything they had to do.” Aside from good care, she pointed to the fact that they got Mr. Twomey into the ambulance in 10 minutes.



Chief Larsen, who is in charge of scheduling and personnel in the paid A.L.S. program, said adding more people to the pool of providers does not guarantee shifts will be covered. “The only way to fix the problem is to have full-time employees,” with a provider on duty 24 hours a day, 7 days a week, year round, he said.



“There’s no way of knowing if it would have made a difference, but it certainly couldn’t have hurt,” the chief said.



Though he said it is not a criticism of the volunteers, “Twenty-one minutes is not a reasonable response time for someone having a heart attack,” he said. Longer response times also burden dispatchers, who are often are fielding multiple emergency calls at once, especially when mutual aid is being requested from neighboring agencies.



East Hampton Town Police Chief Michael Sarlo said his department is also reviewing the incident. “Obviously, there is a delay here and we have to look at why this happened,” he said.  



The officer “did everything right” except letting dispatchers know earlier that CPR was in progress. He said there was an expectation that a paid A.L.S. provider would have arrived before the ambulance. “Our officers really rely on the help of E.M.S., and we have a great working relationship. We do anticipate the idea that if there’s a paid paramedic, to hand the call off to them,” he said. “That’s disappointing to put that much time and effort into this program not to fill the gaps.”    



Barbara Borsack, the village’s acting mayor and a longtime volunteer with the ambulance association, said she reviewed the call with the chiefs, but is not sure it would have made any difference for Mr. Twomey had there been a paid provider on duty. He was defibrillated right away, she said, and the officer was performing CPR.



“I think the gap is in informing the ambulance people that the paid provider wasn’t on that day. I think that’s the gap that we have to address,” she said, calling the program a work in progress. “Short of having full paid staff all the time, what is the answer? I’m not sure people are ready for that yet. I’m not sure they’re ready for the tax implication yet.”



The village board will continue to look at the issues, she said, but added, “We are generally pleased with the way the new program is working and hope we can constantly be improving. That’s the first step, to make sure the volunteers know when nobody is on duty.”