PLEASE NOTE: This entry is a work in progress, a draft that will be updated and added to, many times over the next few weeks. The segments in blue italics are from the SA report that can be found at: http://suspendedinc.com/cases/CaseReport2_fin.pdf.
Page 1:
In this report we have taken the broadest possible approach. We have included all forms of information available. We believe that any attempt to conceal negative factors will tend to damage credibility in cryonics, while full disclosure ultimately will encourage trust. Our only omission has been the names of personnel, since at least one person asked not to be named in the document.
Taking this case, in spite of the fact that the patient had recently been to the SA conference and had NOT selected their services for himself, (something that has been verified, and re-verified), and showing up with three extremely UNQUALIFIED team members, has done an enormous amount of damage to "credibility in cryonics." How can anyone involved in cryonics expect to be taken seriously, when they have this group making the cryonics community look like a bunch of blundering idiots?
Unfortunately for the "at least one" person who wanted to remain anonymous, Platt already made public the names of the personnel, on “Cold Filter," http://www.network54.com/Forum/291677/message/1183251761/, and it’s easy to figure out the rest:
Team Leader: Kelly Kingston
Second Team Member: Gary Battiato
Third Team Member: Ken Schroeder
Team Coordinator: Charles Platt
Consulting MD: Steve Harris
SA Administrator: Saul Kent
Procedures Consultant: Aschwin de Wolf
CI President: Ben Best
CI Facility Manager: Andy Zawacki
Page 3:
According to the SA Administrator, the next of kin planned to disconnect the ventilator at 11 am Central Daylight Time (CDT). The Team Coordinator was skeptical that equipment and personnel could be deployed to the bedside before this deadline, and he noted that he might be unable to participate because he was recovering from minor surgery and had been instructed by his doctor not to travel for another 10 days. The SA Administrator agreed that the Team Coordinator should not take part in the field work but authorized him to coordinate the case from Florida, and suggested that the patient’s son might delay withdrawal of the ventilator if this would give team members sufficient time to arrive.
I would be interested in knowing what minor surgical procedure Platt had, because I think that in all likelihood, he really just didn’t want to go, just as with the last two CI conferences and the last Alcor conference. More importantly, I would be interested in knowing WHERE he had the procedure. I find it doubtful he had it in Florida, as he thinks the entire state is filled with morons, (a statement he has made on numerous occasions). Did he have the procedure near one of his homes in Arizona or New York, travel to Florida to get in a few more “consulting” (management) hours at SA, and then play the "I shouldn't be traveling card" to get out of the case?
It’s interesting to note that he was in Florida at the time of the call, even though he resigned from SA, in November of 2006. Supposedly, his only continuing obligations were to be his presence at the conference, in May, and some participation in the development of the liquid ventilation and AutoPulse systems. He claimed he would participate in these projects, long-distance for the most part, through Gary Battiato, but he's been at the facility the majority of the time, since his "resignation," nearly seven months prior to this case.
I don’t know why SA won’t just admit Charles has been the acting manager of SA, long past his resignation, as the alternative is equally ridiculous. Neither of the two co-managers at the time of this case had prior medical or cryonics experience, and neither of them has adequate management or communication skills. The fact that SA has recently hired a new manager verifies this last statement.
Since the CI President believed that the patient’s son would still be awake, the Team Coordinator telephoned him. He found that the son was extremely tired and distraught over the loss of his father, but was adamant that his father’s wishes regarding cryonics should be honored as faithfully as possible.
This paragraph should be of great concern to the entire cryonics community. If the son had such a strong desire to carry out his father’s wishes, he should have left his father’s arrangements as they were.
KEY POINT: There is a contradiction in SA’s claims that the family wanted to carry out their father’s wishes, when it was well known that the patient did not want SA’s services.
At least one person on the ‘Cold Filter” cryonics forum claims to have been acquainted with CI-81, and states CI-81 did not sign up with SA as he found “little merit” in the services SA was offering. http://www.network54.com/Forum/291677/message/1185568671/Contacts+and+credibility
A quote from the CI case report verifies CI-81 had not voluntarily signed up for SA services:
“However, for reasons that are clear only to the patient, the patient did not sign up with Suspended Animation for their services.”
http://www.cryonics.org/reports/CI81.html
There has been some recent discussion on the Cold Filter forum, regarding the termination of contracts at the time of “legal death.” Many contracts have clauses that pass the obligations of the contract to the successors of the parties. My mother recently paid a substantial amount of money to a funeral home for her own burial arrangements, and they promised a lot of specific services, right down to the flowers, and specified numbers of limousines and police escorts. I firmly believe they will remain contractually bound to provide those services at the time of my mother's death.
Unfortunately, no matter what we each choose for ourselves, we are really at the mercy of our next of kin, at the time of “legal death.” While I do not believe Ben Best would intentionally subject anyone to "high-pressure sales tactics," I believe most people can be easily influenced during what certainly is a time of great duress, and I still disagree with the son going against his father's expressed opinions and wishes. Here is Ben Best's report on how CI-81 became the patient in an SA case: http://www.network54.com/Forum/291677/message/1187030699/Misconceptions+Concerning+the+Handling+of+CI%27s+81st+Patient
The son agreed to delay removal of the ventilator if necessary to allow the Suspended Animation team members to arrive, but since friends and family members were planning to be present, the delay before discontinuing life support should be as short as possible.
Again, this does not make sense. If the son, who had Power of Attorney, wanted "the best" for his father, and believed SA's services were the best, he would have made sure the SA team had all the time they needed. To suggest that he would compromise the level of care provided to his father, due to the arrival of other family members, just doesn't make sense.
In regard to SA's excuse of time constraints, this was not a case in which the patient had already expired, or one that might linger for weeks, requiring the standby team to be on site for an extended period of time. In fact, this was the ideal scenario, a case in which the patient was going to be supported until the standby team arrived and set up their equipment.
KEY POINT: The friends and family members being present should not have dictated that the discontinuation of life support be prompt, unless they were hostile, but SA states that "no hostile family members were known to exist" on page 6 of their report.
KEY QUESTION: Did CI-81 have a wife or other children? If so, what are their opinions of this case?
Page 4:
The SA Administrator suggested flying to a larger city located some distance away. From there, the team could travel to the hospital in a rented van. Google Maps indicated that the distance from the larger city’s airport to the hospital was 212 miles, entailing a road trip of up to four hours, which the Team Coordinator estimated would bring the team to the patient’s bedside by around 2 pm CDT.
This again brings up the issue as to why so much time and money has been invested in two vehicles that are unlikely to benefit the vast majority of SA’s clients. A “Long Distance Transport Vehicle” is an airplane, in any situation in which time is of the essence. If these two vehicles are for Bill and Saul, personally, let them just say so and quit trying to impress potential clients with two vehicles that not likely to benefit them.
At approximately 1:15 am EDT the Team Coordinator telephoned the Team Leader. Although the Team Leader did not respond to the phone immediately, she returned the call within two minutes and agreed to participate in the case. The Team Coordinator asked her to contact other Suspended Animation employees and then meet him at the Suspended Animation facility, while he telephoned a consulting paramedic who is retained by Suspended Animation to provide emergency medical service in conjunction with half-a-dozen other paramedics and other medically qualified personnel. The consulting paramedic said that he was sick, and was not willing to fly out of PBI at 7 am. He said he would call other personnel on the emergency list. When he called back, he said that none of them was available to assist.
This is not a surprise, and this failure to produce a reasonable number of qualified personnel is entirely Charles Platt’s fault. He is the person who wrote the contracts that paid a local paramedic group $1,000 a month, and individuals associated with that group a substantial hourly fee for attending rare training sessions, but didn’t require anyone to actually show up for a case. As the manager of SA, for the past three years, he has made no apparent effort to attain qualified medical personnel.
KEY POINT: Even an "official" SA client would have received the same, unqualified, inexperienced team members.
I’ve never seen any efforts made by SA to recruit medical personnel for their standby team, though a qualified standby team appears to have been one of their stated primary goals, for the last five years. It also appears to be a contractual obligation as per their own website and their information on the Cryonics Institute website, through which they have acquired most of their clients. The precept that it’s impossible to build a qualified standby team, in five years time, and with an average annual budget in excess of one million dollars, is nonsense. (Note the statement that Kelly Kingston “agreed” to participate in the case, indicating that even she, supposedly an SA "co-manager" at the time of the case, had no obligation to.)
Two other candidates normally would have been asked to participate as team members, since the first was a former Suspended Animation employee with a strong interest in cryonics, and the second had played an active role in numerous cryonics cases. The first was in Arizona, and determined that even if he took the best available flight, he could not arrive in time.
As much as I appreciate Aschwin's talents, even he has no practical experience administering medications, or operating the perfusion circuit. Aschwin wisely advised against the use of the ATP by unqualified personnel, as evidenced in this report.
Other people on the Suspended Animation call list as candidates for standby participation were in California, too far away to reach the hospital within such a short window of time.
I’m not quite sure how it was determined that other standby team members in Arizona and/or California wouldn’t be able to arrive just as quickly as the team from Ft. Lauderdale. They wouldn’t have had to worry with equipment, and therefore would have been able to fly directly into the airport closest to the patient’s location, skipping the 200+ mile drive from the major airport. Had these people been called to action the moment the case was accepted, they would have probably arrived before the SA team.
SA accepted this case at 12:05am and did not arrive at bedside until 2:00pm. This case was somewhere near Detroit. Does SA expect us to believe that, in 15* hours, the only people who could get there were their inexperienced team members that are stationed in southeast Florida? Nonsense. (*Note that SA's timeline changes from Eastern time to Central time, meaning they gained an hour.)
KEY POINT: SA has been negligent in building and maintaining an adequate, qualified standby team.
Page 5:
Around 2:15 am the Team Coordinator drove to the Suspended Animation facility and met the Team Leader there. She reported that one employee had told her over the phone that he could not participate in the case because if he did, he could not report for work the next day at his part-time job at a local supermarket. (Subsequently he noted that he had warned some people at Suspended Animation that he might have limited availability for cases as a result of this part-time job.)
The Team Coordinator was concerned by the absence of this employee, who had prior experience in cryoprotective perfusion and could have been expected to run the Air transportable Perfusion kit (ATP) if he had participated in the case. Other personnel had received some training in running the ATP but had not practiced with it significantly.
The employee who couldn’t go on the case due to a second job, notified SA of his unavailability for standby, a long time ago. This person was brought to SA, by Platt, with the promise of the management position and a much higher salary, a few years ago. He’s been repeatedly passed over for promotions and raises, due to his habit of suggesting certain things, like purchasing real level detectors and lift gates, instead of agreeing that Platt can reinvent a better wheel, without question.
Assisting with the vitrification circuit and operating the ATP by one’s self are two very different things. Regardless, of his previous experience assisting with the vitrification circuit at Alcor, this person is not much more qualified than anyone else at SA to operate the washout circuit.
We did not need to know the nature of his second job, and I believe the mention of it was to trivialize this person’s situation. One of Platt’s main pleasures in life comes from belittling this person and trying to get Kent to fire him. I challenge Platt and the two co-managers to produce any documentation that they informed this person he was their primary “perfusionist” for the standby team, and/or any agreement from him to perform in this capacity.
SA does not require ANYONE to participate in cases, so why is this person being singled out for criticism, especially when he notified the company of his unavailability for cases, a long time ago? (I have documentation of this, and I know the co-managers have been made well aware of this person’s obligations to a second job.) Finally, why has no attempt been made to find a perfusionist in the seven months since my resignation?
The Team Leader reported that she had been unable to get through to the Second Team Member; she had left a message on his voicemail.
At about 2:30 am EDT the Team Coordinator telephoned the Third Team Member, who answered the phone immediately and agreed to come to the Suspended Animation facility. The Team Coordinator now made a second call to the Second Team Member, and got voicemail. He also tried another potential team member, who did not answer.
Since the Team Coordinator felt that the presence of the Second Team Member was essential, he drove to his home located a couple of miles from the Suspended Animation facility, and woke him. The Second Team Member promised to join him back at the Suspended Animation facility within a short time.
The “Second Team Member” objects to anyone at work calling him, or even emailing him, other than during normal working hours, so it’s no surprise that he did not answer his phone. Again, this is a failure of SA management to establish and maintain a dependable standby team. With such a small pool of personnel, and such generous salaries, I think it would be reasonable to expect the two co-managers, (and this person is one of them), to answer their phones at all hours, except for during scheduled vacation time. I took call 24/7, every other week, for most of nine years, as a perfusionist on a very active heart team; being called out once in three years at SA can’t be that much of an imposition.
The Team Leader assembled necessary containers, including medications and organ preservation solution from the refrigerators. She and the Team Coordinator decided to omit the Thumper, a mechanical device to give chest compressions and ventilations, since acquiring local supplies of compressed gas to power it would have been problematic.
I’m perplexed by this, as the Michigan Thumper has been repeatedly praised by SA for its ability to perform not only compressions of the chest, but active decompressions, for extended periods of time, and Platt has often stated that bottled oxygen can be easily obtained “anywhere.” Now, after several years of promoting this device, he decides getting the key ingredient is “problematic"? (I believe SA purchased four of these very expensive devices that they now intend to replace with the AutoPulse which does not perform decompressions.
KEY POINT: Not bringing the Thumper was a critical mistake made by Charles Platt and Kelly Kingston.
Platt had half a day to locate the bottled gas, while the team was en route. Ideally, someone from CI could have acquired the compressed gas and had it waiting at bedside, along with the needed ice that the SA team had to stop and pick up; they had 15 hours to do so. There is no way SA's three team members performed adequate manual chest compressions for nearly three hours.
KEY QUESTION: Are SA personnel even BLS certified? If not, why not?
Lastly the separate folding legs for the collapsible ice bath were omitted because the Team Coordinator saw no possibility that they could be used during this case.
The legs shouldn't be used in any case. There's a reason patients are situated near the floor in ambulances, it's called "safety." Yes, I know they have those handy-dandy PIB leg locking devices in the SA vehicles, but as I've pointed out many times, most SA clients will never benefit from the use of those vehicles.
The “portable ice bath” (PIB) is yet another SA design that is incredibly complicated and heavy. Even without the legs, the last version, (I think Platt’s on his fourth, or fifth), weighed in at 69 pounds. Compare this to lightweight transport baskets, (such as those used to airlift injured people from remote locations), that are commercially available for less than $1,000, weigh in at 30 pounds, and can be easily adapted for cryonics purposes. Paramedics recommended these to the SA staff at every training session I attended, but their suggestions were ignored. Platt told me these would not withstand the combined weight of the ice, water and patient, but that simply is not true; he is negligent in his steadfast refusal to explore existing equipment before designing and building his own. Alcor is adapting one of the same baskets the SA paramedics recommended, they showed it during the tour of their facility at the last conference.
Pages 5 & 6:
At this point the Team Coordinator considered calling other people to participate in the case. He felt reluctant to do so, for three reasons.
1. Financial. CI-81 had made no prior arrangements with Suspended Animation, and the case would be underfunded. While every effort would be made to assure full deployment, there was a need to contain expenditures. (All clients with whom Suspended Animation has executed formal agreements are funded sufficiently to enable a minimum of four personnel, as is specified in the Protocol for SA-CI Standby. See Appendix 5.)
The “financial” excuse for not calling out additional personnel defies logic. Any company that can spend over a million dollars a year, including a large sum spent on building their own designs, most of which do not work properly and are dangerous, when proven existing medical equipment is readily available for a reasonable cost, and can pay unqualified people two-to-four times what these people could expect to earn anywhere else, can certainly afford a few thousand dollars for a couple of paramedics. They should have called out all stops, in regard to money, for their ONLY patient in THREE YEARS.
2. Personnel compatibility. The Team Leader, the Second Team Member, and the Third team Member had worked together during several training sessions and case simulations. They had performed well and had derived a clear shared understanding of the tasks involved. The Team Coordinator believed they would function well as a team, and he was reluctant to experiment with the mix.
As for “personnel compatibility,” it’s been my experience that SA's two co-managers fight more than my 12- and 14-year-old sons. These people do not have a “clear understanding of the tasks involved,” they barely have a vague understanding of what the ATP does. I worked in heart surgery for nearly a decade, and we always had more than three people in the room, sometimes people who had never met, and sometimes even people who didn’t particularly like each other. At least they all knew what they were doing and cared more about the patient than anything else. Platt was reluctant to call anyone other than his loyal followers, as that might have meant questions he could not answer.
3. Favorable circumstances. No hostile family members were known to exist, and the Cryonics Institute had already established that the hospital and the local funeral director seemed willing to provide extensive cooperation including leaving the IV and endotracheal tube in place. Therefore, the case should be relatively easy to complete. On balance the Team Coordinator decided to proceed with three team members.
Do “favorable circumstances” (no hostile family members) grant license to SA to not make a better effort to provide an adequate number of qualified personnel? Again, we see the conflict in SA claiming cooperation on one hand, but time constraints due to the family's desire to remove the ventilator, on the other.
Page 6:
The Second Team Member and the Third Team Member moved all the standby containers into a pickup truck owned by Suspended Animation, since in this case there was no advantage in driving Suspended Animation’s transport vehicle to the airport.
The SA vehicles are of no use to anyone other than perhaps Bill and Saul, and one other client who lives in Florida. These vehicles were poorly chosen and have been a huge waste of time and money. SA team members took the pickup truck because neither of the vehicles Charles selected and purchased for SA will fit into the airport garage. The mini-pickup truck that Charles sold to SA, (pink, no less), spends more time in the shop than in the SA parking lot. (An exaggeration, but the truck has needed a lot of repairs.)
What if it had been raining? Would they have still carried their equipment in the back of the pickup truck, or would they have resorted to Charles’ ingenious backup plan of leaving the Dodge Sprinter at the airport drop-off curb, to be towed?
The Sprinter is too small for procedures, so it’s unnecessary to be able to stand up in it. It should be traded in on a shorter van that will fit into the airport garages and, unlike the pickup truck, can be kept loaded with the standby equipment. This way, nothing will be inadvertently left behind. (See my previous post on the SA vehicles, for more information.)
(Note: I believe that, in addition to the pickup truck, Charles also did SA the “favor” of selling them some of his old computers. It seems unethical for the manager of a facility to sell personal belongings he no longer wants to the company he manages.)
Page 8:
The Consulting MD returned the Team Leader’s call a short time later and advised her that the NiKy should dissolve if it was agitated sufficiently. After the Second Team Member had continued shaking it for a while without noticeable improvement the Team Leader drew some of the solution into a syringe, but only with great difficulty, and she could not pass it through a 0.2 micron syringe filter. At this point she gave up on it and continued with the other medications. She finished drawing medications at 12:52 pm CDT.
Why hasn’t this problem been resolved over the last several years? It was a known issue.
Page 9:
The standby equipment was transferred to a small room near the patient’s room. The Suspended Animation portable ice bath was unfolded and assembled, but the telescopic IV pole, which is normally included in the bag with the ice bath, was not found. (After the team returned to Florida they discovered that the pole had been placed erroneously with the set of folding legs for the ice bath, which the Team Coordinator had decided to omit.)
The IV pole was intentionally place in the bag with the legs, due to issues with airline weight restrictions and the cumbersome weight of the PIB. Without the legs and IV pole, the PIB weighed 69 pounds, one pound less than the limit for some airlines. The PIB is ridiculously heavy and awkward to assemble. Many viable alternatives have been suggested by paramedics, but those suggestions have all been ignored in favor of Charles Platt's designs.
The Second Team Member attempted to start a voice recorder, but found that it would not go into record mode. A second voice recorder appeared to have dead batteries, but worked when he transferred batteries from the first recorder.
The batteries in all SA’s equipment need to be replaced regularly. If someone is not diligent about this, there is a possibility of damage to equipment from battery corrosion, especially with cases being so rare. Extra batteries should also be included, and regularly replaced, in the standby kits.
"the sheet-drag method was used to move the patient and lower him into the ice bath with assistance from some nurses and the Regional Funeral Director. The patient had to be moved upward slightly in the ice bath to achieve properalignment with the Autopulse"
Padding. (There are dozens of examples of "padding" in this document. I don't have time to point out all of them, but I have included a few examples.)
Page 10:
Because the patient had a relatively large chest and was heavyset, the Second Team Member experienced some difficulty fitting the belt of the Autopulse around the chest. When he started the Autopulse it ran for three cycles and then stopped, showing an error message. The Second Team Member tried it twice more, with the same result each time. He felt that the problem was caused by the belt binding in contact with the body fat of the patient, and he saw no easy way to address this problem. He removed the Autopulse and resumed chest compressions manually with the CardioPump.
Were they not informed of the patient's body size, by CI? Why did they take the prototype of the Autopulse, instead of the proven Thumper that is not affected by body size?
...the patient in the ice bath was loaded into the rear of the Suburban with the Team Leader and the Second Team Member, while transport containers were stacked on the front passenger seat...Pulling up on the CardioPump was awkward and strenuous in the confined space at the rear of the vehicle...
This defies common sense. Ken was at the mortuary, setting up the ATP. Why didn't the funeral director use the van Ken arrived in, to pick up the patient? Why did SA let Ken take the van to the mortuary to begin with? Why didn't they rent two vehicles? It's difficult to believe good CPS was provided by inexperienced personnel, in the back of a Chevy Suburban. They should have had a van and the Thumper.
In any case, the patient’s chest had not been shaved, and there was no way to access the razor in its standby container during the drive.
Why wasn't the patient's chest shaved at the hospital, when they started CPS?
At 5:15 CDT the Team Leader started a drip but experienced difficulty obtaining sufficient flow with Vital-Oxy (a proprietary antioxidant emulsion supplied by Critical Care Research). She hooked up the Dextran 40 at 5:25 pm and experienced the same problem with slow flow
Did the Team Leader, or anyone else present, know how to test and flush IV lines without calling someone else? If not, why not? The paramedics SA promises for their cases wouldn’t have had to call anyone. They also may have been able to gain additional access.
She called the Procedures Consultant about the problems in getting adequate flow and headvised her to draw the Vital-Oxy in large syringes instead.
There's a very simple, much better way to do this, if you are properly prepared.
and an unknown amount of THAM at 6:13 pm (some of the THAM was spilled accidentally). kneeling in the rear of the vehicle while administering medications and chest compressions was extremely difficult and physically taxing. No attempt was made to administer Maalox (an antacid).
This is a tragic comedy of errors. The THAM was spilled, the Maalox was not administered, and not bringing the Michigan Instruments Thumper was a costly mistake.
Page 11:
Although the Third Team Member’s assistance at the hospital would have been welcome, it was felt that getting the ATP fully deployed and primed was a higher priority.
If they wanted someone to leave the hospital, they should have rented a second vehicle, so that they could have the van to transport the patient. Getting the ATP ready should not have been a priority for this team, in fact, it should not have even been considered.
The Third Team Member was not familiar with setup procedure for the circuit pressure monitor.
Why not? These pressure monitors arrived at the SA facility at least five months before this case. Pressure monitors are simple to operate; prime it, open it to air, zero it, and open it to the circuit.
He spoke to the Team Coordinator by phone, who explained the importance of the height of the pressure sensor relative to the position of the patient.
That's all? This shows the extreme limitations of Platt’s knowledge and understanding of important procedures and equipment. Did Platt tell Ken how to prime the sensor, zero the monitor and make sure it was measuring the pressure of the circuit? This was a case of “the blind leading the blind.” I doubt that Charles is familiar with these pressure alarms, as they’re not his own design, and he’s too busy building liquid ventilation systems for use in the dog lab at CCR, instead of making sure SA is ready for cases.
The Team Coordinator also suggested a conservative value of 90 mm mercury for the high pressure alarm (so long as the alarm was at a height equal to that of the patient’s heart)
Again, Platt’s limitations are glaringly apparent. That was far too conservative; it’s doubtful they would have had adequate flows without a circuit pressure of at least 90 mm Hg. Charles doesn't know any better; so much for "expert" advisors.
and advised that since no oxygen was available for this case, the gas inlet to the heat exchanger could remain unused.
What the heck else were they going to use it for??? Again, Platt patting himself on the back for giving meaningless, or common sense “advice.”
The Third Team Member went out to buy ice and returned to the mortuary around 5:50 pmCDT. He debubbled the ATP circuit
I doubt it. Did he know that the oxygenator requires a flow of 5LPM for a period of time to de-air it? Did he know you have to invert the arterial filter and rap on it with the palm of your hand, several times, while the circuit is at this high flow, to remove the air from it?
Page 12:
The Third Team Member continued applying chest compressions with the CardioPump during any window of opportunity when he felt that this would not interfere with the surgical procedures. At approximately 6:40 pm CDT the Regional Funeral Director asked what kind of instrument the team wished him to use “to get into the vessel.”
I suppose the Funeral Director, (just like the people who sign up for SA's services), operates under the mistaken assumption that the SA team members actually know what they are doing. Gary, Kelly and Ken don't know anything about cannulae, or the cannulation procedure.
The Second Team Member asked the mortician if he had cannulae of his own, at which point the Team Leader mentioned that the Suspended Animation washout kit contains cannulae of French sizes 15, 17, 19, and 21. The Regional Funeral Director noted that “he has a huge artery down here,” suggesting that he had already exposed the femoral artery. A few minutes later the voice record made at the mortuary indicates that the pressure alarm on the ATP went off. The patient was not yet on bypass. The Second Team member felt that the pressure monitor was not showing a valid reading, and he substituted a manometer.
In all likelihood, the alarm went off because they had the pump running when they should not have, with the bypass line either closed, or kinked. Instead of assuming the pressure monitor, (which is a model well-known for accuracy and reliability), was malfunctioning, the SA team should have run through the proper steps for eliminating causes of increased pressure in the circuit. Of course, they don't happen to know those steps, so they assumed equipment failure. I feel certain this was “operator error,” not equipment malfunction.
At approximately 6:45 pm CDT the Regional Funeral Director selected a 17 French cannula.This was actually a venous cannula, which the mortician inserted on the arterial side.
Why a venous cannula in an artery? And, why a 17French instead of the larger 21 French, if the patient had a “huge artery down there”? It’s obvious not one team member had an understanding of even the basics of what they were doing.
The Third Team Member asked the Regional Funeral Director if he was planning to drain blood from the venous side into the mortuary sink, and the Regional Funeral Director confirmed that this was his plan.
Too bad they put the venous return down the sink. If they had collected it in the waste bags, as it was intended, the return volume could have been measured. They would have known how much of what they put in came out.
EXTREMELY CRITICAL:
Two minutes later he exclaimed in surprise as he made an incision and found blood spurting onto him under pressure from the cannula that was already attached to the ATP on the arterial side. He was heard to ask if the ATP pump was running. The Third Team Member confirmed that it was.
This is critical. Anyone who is familiar with the cannulation process and perfusion will come to the same conclusions I have, after reading this. We know the femoral artery has already been cannulated, as per the SA report, (with a small venous cannula, in error). The next incision to be made is one into the femoral vein. Blood does not "spurt" from a venous incision of a "legally dead" patient. The SA report clearly states that the femoral artery had been cannulated and that the spurting of blood was a result of "pressure from the cannula that was already attached to the ATP on the arterial side." The report also states that Ken Schroeder confirmed that the pump was running.
This patient was subjected to high pressures by the improper use of the perfusion equipment by incompetent personnel. In order to reach the femoral vein, that pressure had to travel through the entire circulation of the patient, and therefore, was applied to every organ in the patient's body, including his brain.
This is a patient who has already suffered one stroke, prior to legal death, putting him at extremely high risk of additional strokes, especially if subjected to increased vascular pressure. People who have strokes often have generalized vascular disease, meaning their entire vascular system is compromised. How much damage did SA, through their arrogance and incompetence, do to CI-81's brain and other organs?
(Someone I respect has told my observations are "speculation," but I disagree. I think the report makes the events that transpired at the time of cannulation quite clear to anyone who understands the cannulation process, and perfusion in general. This same person argues that increased pressures can actually increase cerebral micro-circulation, but that is an invalid/dangerous argument for stroke patients. You do NOT increase a stroke patient's blood pressure to provide for increased micro-circulation, as the risk of additional damage far outweighs any possible benefit. There will be NO circulation distal to vessels that are caused to rupture.)
At around 6:50 the Regional Funeral Director inquired about the pressure in the ATP, in pounds per square inch, and was told that the pressure monitor displays data in millimeters of mercury.
I don’t know why the Funeral Director asked for pressure in pounds per square inch, but what was the pressure and flow?
On the femoral vein, the Regional Funeral Director began using a drain tube—a metal tube with a plunger in it, designed to promote flow and clear blood clots. He noted a few minutes later that he saw no clots, and attributed this to the anticoagulants administered earlier. He was unable to get good steady flow, however,
This doesn’t make sense. There were no clots, but they were unable to get good flow even in the presence of high pressures? Something wasn't right, and since nobody there knew what they were doing, we'll probably never know what that was. Maybe there were massive clots the funeral director could no access via the femoral vein. Remember, this patient had undergone nearly three hours of (probably inadequate) manual chest compressions, and had not been give additional heparin, (to prevent clotting), as he should have been, during that time, something the consulting MD (Harris) should have suggested.
and the Second Team Member increased pressure on the arterial side to a figure which he estimated as being near 300 mm mercury.
Extremely foolish. Only someone who had absolutely no idea what they were doing would do this.
Note that whereas perfusionists in conventional medicine are able to measure arterial pressure directly, pressure values in cryonics cases are measured as fluid pressure in the circuit on the arterial side, before the perfusate reaches the cannula, which can cause significant back pressure, or “pressure loss,” depending on flow rate and cannula size. Therefore the term “arterial pressure,” which has often been used in cryonics case reports, can be misleading, since actual arterial pressure may be lower by a value of 100 mm mercury or more.
Or less. Charles is spouting forth information that is “common knowledge” in regard to cannulae, information I provided him with, during my time at SA. He acts like he’s some kind of expert, but he just retains and regurgitates enough basic information to make people who don’t understand the procedures and equipment think he knows what he is doing. He does not have an adequate understanding of the perfusion process, or equipment. The patient had IVs left in place. Why didn't the SA team attempt to get a patient venous pressure during use of the ATP? Oh, that's right...they don't know what they're doing. Why didn't their Consulting MD suggest this?
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In a further attempt to obtain flow, the Regional Funeral Director asked for additional chest compressions. At approximately 7:00 pm CDT he noted that this resulted in an improvement. Around 7:05 the Third Team Member inquired about arterial pressure.The Second Team Member noted that it was “high” but since he could see no sign of edema, he felt it wasjustifiable.
Gary doesn't know anything about assessing edema. I believe the CI report mentioned significant generalized edema and distention of the abdomen, upon their receipt of the patient from the SA team.
He noted subsequently that the circuit pressure stabilized between 140 mm and 160 mm mercury. There was speculation that a kink in the tubing circuit might have caused the higher pressure previously.
There was “speculation” about every factor in the case, by the team members, because none of them knew what they were doing.
By 7:15 the Third Team Member had noted that no bubbles were visible in the lines,
This leads me to believe there bubbles in the lines BEFORE this, a problem that was virtually eliminated in the field of perfusion, decades ago. If this is the case, how much air was pumped into this patient?
while the Team Leader expressed concern that the nasopharyngeal probe showed insufficient decline in temperature. In response, the Third Team Member inserted it further. This resulted in a reading that is closer to what one would expect. At approximately 7:27 pm CDT the Second Team Member noted that circuit pressure had diminished to about 100 mm mercury, and flow had improved markedly.
Quantify. What was the flow?
The Second Team Member noted some minor leakage from IV sites, and stated that two-thirds of the washout solution had been used.
If they started perfusion around 6:45, and at this point it was close to 7:30, we have 20 liters of solution used in 45 minutes, which means an average of less than a half liter per minute. This is an extremely low flow rate; not enough to provide adequate tissue perfusion. As with everything else, they didn’t know enough to know this.
Around 7:39 the Second Team Member refreshed ice in the cooling reservoir. The ice was refreshed one more time during the remainder of the procedure. The ATP went into closed-circuit mode at approximately 7:43 pm CDT. Five minutes later the Second Team Member noted the circuit pressure on the arterial side as varying between 100 and 110 mm mercury.
But, what was the flow? A half liter per minute, or ten liters per minute? The pressure is almost meaningless, without mention of the flow.
Bypass continued without noticeable edema,
Who was assessing this? Since they didn’t seem to call their “experts” very often during the most important part of the procedure, were they looking for edema, or is this something they were asked about at the debriefing? Do they know what edema is, and how to assess it?
and around 8:13 pm CDT the Third Team Member noted that the temperature logged by the probe on the arterial side of the heat exchanger was 3.3 degrees Celsius, while venous fluid was 10.8 degrees and the nasopharyngeal probe gave a reading of 9.0...At 8:24 the venous fluid was reported as being at 10.2 degrees Celsius while the nasopharyngeal probe indicated 7.8. The ATP was shut down at approximately 8:45 pm CDT because team members felt that it had achieved its purpose, with a venous temperature just below 10 degrees.
This was far from being cold enough. The venous temperature is not a good indicator of patient core temperature; the core temperature was likely much higher than ten degrees. (Remind me to look for the first patient temp recorded at CI.)
The Second Team Member placed a call to the Consulting MD and asked for advice on best technique to close the incisions. The Regional Funeral Director proceded to suture the vessels and close the incisions with staples.
Why did they ask for advice for this, but not about the temperature before they quit cooling? Were they more worried about the appearance of his skin than the condition of his brain and other organs?
At 9:00 pm CDT the Team Leader placed a call to the Team Coordinator to ask if a body bag should be used to line the interior of the Ziegler case before the patient was placed in it.The Team Coordinator felt this was advisable
Here we, again, see team members asking questions that should really require only common sense to answer, and Platt patting himself on the back for his cryonics "expertise."
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The patient reached the Cryonics Institute according to plan, and surgery prior to cryoprotective perfusion began at 7:40 am EDT on Tuesday, June 5th. Shortly after 9 am EDT on June 5th, the Team Coordinator telephoned an employee of Suspended Animation who had not gone on the case and asked him to load the backup (“B” kit) standby equipment containers into the transport vehicle, to be ready for use until the “A” kit containers returned with the team and were restored for subsequent use.
This is common sense. Why does SA need to overpay a “consultant” to tell them this? The consultant, Charles Platt, has been the manager of SA for three years. Why didn’t he hire people with enough sense to do this on their own? (Because, if he did, he would be out of a six-figure, part-time job.)
The team members arrived at PBI on June 5th, 2007 at approximately 11 pm EDT. The pickup truck was retrieved from the parking lot and loaded with the twelve transport containers, and was driven to the facility for unloading.
Who cares? Padding.
Cleaning and refurbishing the equipment and replenishing the supplies took place during the ensuing week. Sound files from the digital voice recorders were uploaded and were transcribed manually as plain text.Temperature data from the DuaLogRs were uploaded and saved in an Excel document. Subsequently these data were imported into the graphing tool of Adobe Illustrator and are presented in Appendix 4, below. The returning standby kits were reviewed and documented for quality control purposes.
This is Charles justifying the large number hours he puts in at SA. Why do they need to pay a “consultant” $50 an hour to do these menial tasks while most of the people at the facility are wasting huge amounts of time? Shouldn’t their staff members be capable of these elementary tasks? Charles is an overpaid secretary. He uses Adobe Illustrator, and other programs most people never use, so that the people he hires won't know how to modify his files. He even creates text files, (such as the standby list), in Adobe Illustrator, so that no one else can easily modify them. There are other graph-producing programs that are much more commonly used and "user friendly."
On June 6th, 2007 at 2:20 pm EDT, Suspended Animation hosted a debriefing session attended in person by all available staff members, plus the Team Coordinator and Procedures Advisor, plus California advisors participating via phone. The debriefing lasted approximately 90 minutes and resulted in a list of action items and lessons that had been learned from the case. Subsequently the Consulting MD wrote a lengthy review of the case, focusing in particular on surgery and ATP issues.
How could he write a "lengthy review, when he wasn't even there? If he properly addressed the "ATP issues," he should have suggested replacing overpaid RUPS with real perfusionists. Of course, then he and CCR would be out some consulting hours and they wouldn't get paid for that "DIY" perfusion video.
Aschwin de Wolf assembled all the available records, created a timeline, and submitted the data to Charles Platt, who wrote the first draft of this report. This was corrected, amended, and elaborated by Aschwin de Wolf. The corrected draft was circulated to all persons who participated in the case, and corrections were invited.
Here we have two SA CONSULTANTS who were NOT at the case, writing the case report. Why is that? The reason for this is that no one at the case was capable of writing the report, much less doing the case.
Five people responded with requests for edits, and significant discussions ensued on some points.
My guess is, the only "significant discussions" took place between Aschwin and Charles, neither of whom were at the case. The three team members who performed the case didn't have a clue as to what they were doing, other than a few common sense procedures they've been taught over and over...pack the patient's head in ice, blah, blah, blah... They don't understand even the basics of anatomy, physiology, pharmacology, or perfusion. They are not capable ofdiscussing these procedures, and should not have been performing them.
The edited text was again circulated for comment. The SA Administrator acted as final arbitrator regarding amendments to the text. The document was then converted from Microsoft Word document format (which had been used with its Track Changes feature active) into a plain text document, from which a PDF file was created in Quark XPress.
This is yet another example of Charles patting himself on the back, and trying to make himself appear to be useful by mentioning things like the "Track Changes" feature of Word, and creating PDF files in Quark Xpress. Anybody of average intelligence can do these things, but Charles has made an art out of hiring people who aren't even interested in learning about simple tasks, such as these. With five fulltime staff members, three of whom were at the case, there should have been no reason for two highly paid outside consultants to write up the case report. It's obvious the powers that be at SA think their staff members are not capable of writing reports, while at the same time, they claim these people are capable of performing advanced medical procedures they are totally unfamiliar with. Kent is apparently willing to spare no expense when it comes to professional writing and PR, but doesn't make any effort to hire qualified medical personnel.
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9. Discussion and Recommendations
For almost three years prior to this case, Suspended Animation did not participate in any standby-stabilization-transport procedures. Despite this long hiatus, employees were able to respond rapidly, energetically, and effectively.
I disagree that they responded “effectively,” as they failed to bring EVEN ONE qualified team member, and I question “rapidly” and “energetically,” as they had a rough time getting one of their team members out of bed, and their Team Coordinator neglected to call enough team members, including two very capable research scientist/surgeons.
Most medications were administered, surface cooling was applied, cardiopulmonary support was maintained for a considerable period, and blood washout was completed, despite a very tight deployment schedule.
They were VERY LUCKY to have as much time as they did; this was NOT a “very tight deployment schedule.”
The collapsible portable ice bath, the icewater recirculation system, the medications packaging, the revised ATP with hard-shell reservoir, the watertight cases for DuaLogR data recorders, the patient lifting sling, and other pieces of Suspended Animation equipment had been used during practice and training sessions but had never been deployed in an actual case before. All equipment worked without problems, with the exception of the ATP pressure monitor (which was not set up correctly)
This shows the lack of even the most basic training. The pressure monitors arrived at SA, just before I resigned, so SA had at least five months to hold a training session for this equipment. The alarms are extremely reliable, and very simple to operate. (Prime it, zero it, open it to the circuit.) How can we be expected to believe they couldn’t operate a simple pressure monitor, but they could operate the more complex perfusion circuit? That’s ridiculous.
and the Autopulse, which was still in its development phase.
They should have brought the Thumper, which is known to perform well, rather than a piece of equipment “still in its development phase." Will someone from SA discuss why the AutoPulse is replacing the Thumper? What about the lack of active decompressions? (This was brought to my attention, while I was still working at SA, by one of my co-workers.)
A new configuration of the Autopulse has already been developed for use in conjunction with a portable ice bath.
More Platt design and fabrication hours on a device that does not perform active decompressions that might be of great benefit during extended periods of CPS.
Suspended Animation deploys almost 30 liters of MHP2 organ preservation solution instead of the 20 liters that has been customary in cryonics in the past.
They didn’t deliver all 30 liters.
The 30 liters are packaged in amedical-grade plastic bag inside a plastic box, inserted in an aluminum shell which is embedded in lightweight closed-cell insulating foam inside a Pelican-brand transport container. This containment system had been drop-tested from a height of four feet onto a concrete floor but had not gone through airline baggage handling before. It survived the process without any leaks or other problems.
I've read this information in at least a dozen documents; it doesn’t need to be in this case report. Platt is patting himself on the back for “designing” a plastic container, surrounding it with insulating foam and putting it in a suitcase.
The Suspended Animation team members worked well together without interpersonal friction.
Who cares if a team that was unqualified to perform the procedures got along? Which would you rather have…a surgeon, a paramedic and a perfusionist, or three “BFFs” (Best Friends Forever)? I can assure you that qualified personnel get along much better than unqualified personnel, because everyone knows what has to be done. In addition, experienced personnel wouldn't be wasting enormous amounts of time on the phone, asking people what to do next. Note that two of the three advisors they were calling have absolutely no medical experience.
Advisors were quickly available via phone. Cooperation with staff at the Cryonics Institute was excellent. Relations with hospital staff and with relatives of the patient were extremely good. No personality-related issues occurred.
Why does Platt keep beating this personal interaction issue to death? Is he saying the RUPs are incapable of working alongside trained medical professionals? Tens of thousands of surgeries take place in this country each and every day, (if not more), and people who actually KNOW what they are doing, get along just fine. You don’t send three incompetent people to do a medical procedure, because they are best buddies, (which Gary and Kelly are NOT, by the way). Again, two of the three advisors have no prior medical experience.
The lack of response from paramedics retained by Suspended Animation was very disappointing.
It was predictable, and it’s Platt’s fault for continually focusing on design projects for himself, (without investigating existing equipment), instead of building and maintaining a strong standby team.
Although this can be ascribed partly to exceptional circumstances,
What “exceptional circumstances”" The fact that they had a case?? They had plenty of time to prepare and get to the patient’s bedside. It’s insulting to the intelligence of anyone who is familiar with SA’s budget to ask them to believe a few thousand dollars was an issue. It’s also a serious contradiction for SA to report that the family was not hostile and that the son wanted the best of care for his father, and then say the family placed time constraints on the standby team preparations. It just doesn’t make sense.
Suspended Animation must take action to find additional contractors who can guarantee their availability even where a case occurs without prior warning.
They should have established a strong standby team years ago. Platt is the leader of SA, and he does not know how to establish, train and maintain the proper personnel for these cryonics procedures. That is why the focus at SA has been on the design and fabrication of his ill-advised equipment, for the last three years.
Five people did respond to phone calls that were placed to them after midnight, but two others did not. One had turned his phone off, while the other did not wake up when his phone rang. Subsequently the latter stated that if more than one attempt had been made to reach him, probably he would have woken up, and he would have wanted to take part in the case.
What was that about the staff members responding “rapidly and energetically”?
The Team Coordinator should make multiple attempts to reach personnel who do not answer immediately.
I really can barely tolerate these banal, common sense remarks. The “Team Coordinator” should be replaced at SA, and banned from the cryonics community, altogether. He makes everyone associated with him look like an idiot.
Staff should never turn off their cell phones without prior warning and should try to have their cell phones with them all the time. Suspended Animation will conduct periodic tests of telephone response.
This is all common sense, and the testing of telephone response is not a new policy at SA, though it’s one that hasn’t been frequently carried out, in the past.
As has been noted in the body of this report, the decision to limit the number of personnel was affected by financial considerations (the patient was not a client of Suspended Animation and was underfunded),
It really makes me ill to keep being subjected to this very lame EXCUSE. SA can’t spend somewhere in the neighborhood of $600,000 a year on inexperienced, unqualified personnel and consultants, and then be stingy with their first real patient in three years. That’s absurd. SA spends an average of well over $20,000 per week and accomplishes basically nothng. Everyone reading this report should find these financial excuses intellectually insulting.
good prior experience of the three team members working together,
Has anybody counted how many times the compatibility of the team members is mentioned in this report? And, how many times were their qualifications, or lack thereof, mentioned? Yes, Platt has a "good prior experience" of these three team members doing exactly what HE tells them to, usually without question. He’s made sure to surround himself with compliant people who do not know enough about cryonics or medicine to question him, and then he’s overpaid them for their loyalty to him, rather than their capabilities.
A research surgeon in North Carolina who is available for cryonics cases could have been called, but the Team Coordinator was concerned about the difficulty of finding additional flights and arranging a rendezvous between him and the other team members.
This is simply unbelievable and inexcusable. They should have called this person, as soon as they accepted the case, and sent him to the patient’s bedside. Platt dropped the ball. My guess is, he didn’t want this person at the case, because he would have not needed Platt, or Harris, to tell him what to do.
The Team Coordinator could have called another research surgeon located south of Fort Lauderdale, who might have been willing to assist. Whether this surgeon would have felt sufficiently confident of procedures to supplant the mortician in his own prep room is a matter for speculation.
This person is a competent researcher who has been affiliated with SA for a long time, why do they need to speculate about him? I know this person, he’s very confident; they should have called him. As I implied above, Platt was probably concerned about losing control of the case if a knowledgeable team member was present. He seems to suffer from the delusion that he is better qualified than anyone else, to lead medical procedures.
Also, while a third team member at the hospital would have been very welcome, adding him to the overloaded vehicle that transported the patient to the mortuary would have been problematic, since the passenger seat was loaded with equipment in containers.
Lame excuse, wrong vehicle. If he knew what he was doing, the “Third Team Member” could have set up and primed the ATP in minutes, and returned to the hospital with the Funeral Director IN THE VAN, instead of the Suburban.
In the future, the Team Coordinator should make additional calls when trying togather personnel for a case.
Does anyone notice the total absence of common sense displayed during this case? This sounds like "Cryonics Kindergarten.”
This case demonstrated yet again that while two people can perform the most necessary procedures after cardiac arrest, they may omit to obtain good temperature data and almost certainly will have insufficient time to take written notes or photographs. Three people at the bedside should be considered the minimum number, and four are preferable where a patient is sufficiently funded to cover the full range of procedures.
Ten are not enough, if none of them know what they are doing. Again, SA has no shortage of funds.
All clients with whom Suspended Animation has executed formal agreements are funded sufficiently to enable a minimum of four personnel.
Again, a few thousand dollars is NOT an issue at SA, and this is a very feeble excuse. If they were not willing to pay for the required personnel and equipment, they should not have accepted the case. If an uninsured person arrives at a hospital, in need of surgery, the hospital can’t get away with having a janitor and a couple of cafeteria workers do the procedure.
This case was staffed by team members who had not made arrangements for futurecryopreservation personally. In the past, some activists have theorized that “noncryonicist” team members will be insufficiently motivated to extend themselves in the interests of the patient, since they may be unconvinced that future revival is possible. In this instance the theory turned out to be untrue, since the team members worked extremely hard to achieve the best outcome within their abilities.
The "best outcome within their abilities"??? They had NO abilities, unless you want to count packing the patient in ice, which anyone could have done. They are not formally trained, or experienced at administering cardiopulmonary support, and I believe they most likely caused additional harm to the patient through their use of the ATP. CI could have packed that patient in ice, administered the meds, and had been back at their facility in a relatively short period of time. (How far was the patient initially from CI?)
I really don’t understand why being signed up for cryonics is brought up in this report. The issue here is the total lack of qualified personnel; it doesn’t matter if they are signed up for cryonics, or not. I may not be signed up for cryonics, but as a perfusionist, I would perform to the best of my abilities with ALL patients, cryonics patients included, as I’m sure most medical personnel willing to participate in cryonics cases would.
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Some commentators have advocated “professionalizing” cryonics. In this instance, none of the eight professionals who had undergone training and agreed to be on call was willing or able to participate at very short notice.
Eight? In five years, they’ve only found eight? Platt drives away anyone who is professionally qualified, because these people invariably question his projects. And what about the two research scientists/surgeons Platt admits to not even calling? They are SA standby team members, and I believe at least one of them has cryonics case experience. How many others did Platt not even bother to call? He claims in this report that I, a qualified and vastly experienced perfusionist, had refused to be available for cases, but neither he, nor Kent, ever bothered to ask if I was willing to participate. In fact, Platt, who was Kent's designated "Team Leader," had refused to work with me, even while I was still an SA employee.
Because Suspended Animation was unable to deploy a paramedic or any other individual with experience in intubation and/or administering medications (outside of training sessions) the team lacked proven skills in these important areas. Suspended Animation had received assurances in this particular case that hospital personnel were willing to leave not only IVs but the endotracheal tube in place.
They were very fortunate, in this regard.
Since the next of kin had also pledged that the patient would remain on a ventilator until the team arrived, there were good reasons to believe that the Team Leader would be able to verify that the hospital personnel would follow through on their commitment.
Once again, we have the same contradiction. Time constraints have been repeatedly used in this report, yet it has also been stated, many times, how cooperative the family was. If the family was truly cooperative, there were no time constraints.
However, there was of course a chance that the commitment would not be honored, or the endotracheal tube might have become dislodged accidentally. If this had happened, the team would have had difficulty intubating the patient and might not have been able to administer medications.
Very important point; it was totally irresponsible to send these three people to do a case.
Overall, it remains Suspended Animation policy to deploy at least one and ideally two people with experience in emergency medicine, as stated in the Protocol for SA-CI Standby reproduced in Appendix 5.
And we can see just how much that policy means…zero, zip, nada. When they start spending as much time and money on building a standby team as they do building poor imitations of existing equipment and overpaying unqualified personnel, they will be able to supply adequate personnel for cases.
Other team members may serve competently without medical experience in tasks such as scribing, surface cooling, and mechanical or manual cardiopulmonary support. What constitutes “enough” prior experience in cryonics cases is another matter for debate, since extensive case experience doesn’t necessarily indicate great skill or extensive knowledge in cryonics.
NONE of the three SA team members on this case had ANY experience. These three people should have been performing these simple tasks, while QUALIFIED people performed the medical procedures.
Unlike conventional medicine where an endpoint such as resuscitation without neurological damage can be observed, evaluating the quality of care in cryonics requires a lot of subtle indirect observations and data that are rarely collected in cases.
These three team members were not capable of making the basic observations a medically qualified team would instinctively make, much less more "subtle" observations.
Team members must be willing at all times to recognize their limits and seek advice from others.
Charles should apply this advice to himself.
During the case of CI-81 the team did call frequently for advice regarding medications, ATP setup, and other issues. The team did not call for advice while the Regional Funeral Director was performing surgery and initiating washout. As a result the team lacked guidance regarding choice of cannulae, the details of gravity-assisted venous drainage, and customary limits on arterial pressure.
Why did they call about simple things, but not about the most complex, critical portion of the procedure? I find this hard to believe. Regardless, does anyone reading this think two metal fabricators and an office clerk can be talked through these procedures over the phone? Especially when only one of the three people they were calling has any real medical experience?
While washout and cooling were achieved despite the lack of expert advice, seeking advice is generally desirable.
I do not believe “washout and cooling were achieved” without additional damage. The people performing the medical procedures should know what they are doing; they should not have to call anyone for advice. This situation is a result of Platt’s efforts to maintain control of procedures he is not qualified to lead.
One team member stated subsequently that no one intentionally neglected to call, and oversights resulted simply from fatigue and lack of experience.
Again, it's hard to believe they called about minor details, but not more important issues. Then again, they weren't qualified enough to know what was important.
As a general rule, since the pickup truck at Suspended Animation may be used in emergencies, its tank should be kept at least half full of fuel.
This document is heavily padded with details that anyone with a little bit of common sense would take for granted. Comments like these belong in SA’s protocols, not in case reports. The pickup truck and the Dodge Sprinter should be sold and replaced with a small van that can fit in the airport garages.
A global positioning system (GPS) fitted with a street-finding feature would be a useful addition to standby kits, to guide team members when they find themselves in a place where they have never been before.
These aren’t as wonderful as they seem. My neighborhood is five years old, and people still get the wrong directions, using their GPS devices, when trying to find my home. I’m still not sure why CI didn’t send someone to with a suitable vehicle to pick up bottled gas, ice and other supplies, and meet SA at the bedside. This would have been ideal, and they had every opportunity to do this. No doubt Platt is now collecting consulting fees for investigating and comparing GPS devices to get his RUPs to the cases in time, instead of looking for QUALIFIED personnel.
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The team allowed a normal amount of time for check-in to their flight out of PBI, but found that airline staff were confused and overwhelmed by the 12 heavy containers of standby equipment to be processed as checked baggage.In the future, wherever possible, a team should allow at least an extra half-hour for check-in, and should use curbside check-in if available.
Why are we being subjected to this drivel? A twelve-year-old would know this.
Three or four of the transport containers were opened during transit by the Transportation Security Administration. None of them was delayed as a result. So far as we can determine, Suspended Animation’s standby-stabilization supplies conform with all airline and security regulations.
I am waiting for the day when their medications get confiscated and the team member checking them in gets arrested. This needs to be addressed; surely LEF keeps some attorneys on retainer that could look into this.
The question of whether commuter-size aircraft can carry large quantities of checked baggage (such as the Pelican brand containers used by Suspended Animation) should be resolved definitively.
Again, all this belongs in SA’s internal protocols, not in an individual patient’s case report.
The decision to deploy the team via a nonstop flight to a city 200 miles from the ultimate destination was fortuitous. The rented van enabled the team to prepare medications and pick up supplies en-route.
Again, they had plenty of time, why didn’t someone from CI, or the “oh-so-cooperative” family meet them at the bedside with supplies and an appropriate vehicle?
The van also enabled one team member to continue onward to set up the ATP at the mortuary, while two team members performed duties at the hospital.
The CPS could have been better performed in the van, than it was in the Chevy Suburban.
The fly/drive combination may be used advantageously where future cases occur beyond the range of Suspended Animation ground vehicles.
Almost every case will be "beyond the range of the Suspended Animation ground vehicles." The time and money that has been put into the two vehicles, as compared to the time and money spent developing and maintaining a qualified standby team, is inappropriate. They should have rented two vehicles and kept the van for transporting the patient, instead of letting Ken take it to the mortuary, or had Ken and the Funeral Director return to the hospital in the van.
The medications container in the refrigerator at Suspended Animation is prominently labeledwith a reminder to bring additional medications, one of which is frozen, and one of whichmust be kept at room temperature. However, there is no equally prominent reminder to bring MHP2 organ preservation solution, which is kept in a separate refrigerator.
Padding…belongs in an internal document.
The MHP2 could have been left behind accidentally in this case. Labeling is necessary to prevent this.
These labels will no doubt be created in Adobe Illustrator, which none of the staff members at SA know how to use, or modify. More secretarial/office clerk-type tasks for an overpaid consultant.
This case served as a reminder of the need for a portable ice bath that can be deployed easily,with cardiopulmonary support, to the patient’s bedside in a remote location.
Platt's PIB designs are awkward, too heavy, and too costly. When is someone at SA going to use their head and take this simple task, and others like it, away from Charles?
This remains true even for cases in which a fully equipped transport vehicle is available nearby. The vehicle can enable prompt blood washout and rapid cooling, but the patient should begin to receive cooling, chest compressions, and medications before reaching the vehicle. If a noncollapsible ice bath in a vehicle is equipped with multiple resources including oxygen cylinders and washout equipment it may become so heavy that it cannot be moved over curbs or other obstacles, and cannot be located easily at the patient’s bedside. Therefore, an additional, collapsible, easily deployed ice bath should be included on any future vehicle developed by Suspended Animation, and should have ends that articulate to reduce its effective length so that it can enter small elevators and negotiate turns in hallways.
This is Charles setting himself up for more SA “engineering” projects. He’s been billing SA for PIB design and fabrication hours for three years now, (possibly longer, and perhaps Alcor, before SA), without performing due diligence in investigating existing equipment or listening to the advice of medical professionals. All his designs are "Rube Goldbergs." ("Comically involved, complicated inventions, laboriously contrived to perform simple operations." http://www.rube-goldberg.com/ Think “Mouse Trap.”) Charles has been "taking SA to the cleaners," for years, now, with his hokey "engineering" projects.
Without such an ice bath there will be at least some lag time before procedures can begin, and the team may find itself without any purpose-built container at all, to move the patient to the vehicle. A hospital is likely to provide a gurney for this purpose, but patients do not always die in hospitals. Currently Suspended Animation is commencing the fabrication of a second fully collapsible ice bath for future deployment with its smaller transport vehicle, which will be relocated in California.
I guess FD and Phil are right; one cryomobile for Bill, and one for Saul. Again, all of this was to justify Charles Platt’s stupid “engineering” projects. (Yes, I said “stupid.”) I recently spoke with an engineer who has worked with Charles. He said, “Charles has a habit of surrounding himself with people who don’t know what’s going on. When someone is qualified to make valuable input, they are excluded.” This has also been my experience with him. Is Kent ever going to realize what is going on with Platt at SA?
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The Michigan Instruments Thumper requires at least one H-size cylinder of compressed gas and, ideally, two smaller additional E cylinders, to maintain operation continuously from bedside to blood washout. Since cylinders are not air transportable, any remote deployment beyond the range of a ground vehicle
Then, why are there two vehicles and four Thumpers?
...will negate use of the Thumper unless enough time is available for team members to locate a source of welding gas, execute necessary paperwork, and install the gas cylinders safely in a rented van.
Then why has that always been the plan, until now? Why couldn’t someone from the "cooperative" family, or CI, have done this, while SA was en route? If this was my client, I would have rented a van, loaded my PIB, found some bottled gas to drive the Thumper, picked up some ice chests and filled them with ice, and I would have been waiting for the SA team at either the airport or the patient’s bedside.
The electrically driven Autopulse provides an elegantly simple answer to this long-standing problem, but in its off-the-shelf configuration it is vulnerable to water, making it incompatible with an ice bath. While Suspended Animation had attempted to convert the Autopulse for use with an ice bath, the conversion was incompatible with the physical attributes of the patient in this case. (We note that the LUCAS, a Swedish competitor to the Thumper which is also driven by compressed gas, very likely would have been unable to accommodate a patient of this size.) Suspended Animation already has a functional prototype of a new Autopulse modification which we believe should overcome the problems experienced in this case.
What about the SA-touted advantage of active decompressions, which the Thumper performs, but the AutoPulse does not? When discussing long periods (hours) of mechanical CPS, the issue of a non-compliant chest becomes of concern. To put it simply: when you keep squeezing the chest, for an extended period of time, at some point, it is not going to rebound. The Thumper not only presses down on the chest, it suctions onto the chest and pulls up, opening the lungs and vascular system; the AutoPulse does not do this. (Someone else pointed this out to me, a long time ago, when the AutoPulse was first being worked on; if he wants to take credit for this observation, that's fine.)
The time between cardiac arrest and start of blood washout exceeded 2.5 hours. During this interval the patient received chest compressions and was ventilated with ambient air at a ratio of approximately 30:1. Although cardiopulmonary support was augmented by vasopressor support and the impedance valve, this case involved a very long period of manual chest compressions which we doubt were sufficient to produce adequate cerebral perfusion pressure at normothermic temperatures.
Due to the lack of experience of the personnel and the physical limitations of the Chevy Suburban, I would say the manual chest compressions were unlikely to have provided adequate cerebral perfusion pressures even under hypothermic conditions. They also should have administered more heparin, (to prevent clotting), during this period of slow cooling.
Whether induction of hypothermia and administration of neuroprotective medications outweighs the risk of reperfusion injury in cases like this is a matter that cannot be settled without extensive case data and research.
Something no one at SA can do (research). Forget about reperfusion injury, (something no one at SA is capable of even discussing), what about the risk of injury to the patient caused by incompetent persons operating the perfusion circuit and performing other medical procedures they are not capable of performing???
Because chest compressions are necessary to circulate the medications and improve cooling rates, the question is not so much whether to do chest compressions but whether to ventilate—and if the patient will be given oxygen, at which rate and whether 100% oxygen or room air is desired.
Contrary to what Platt previously stated on CF, the RUPs do not know enough to even discuss these issues, much less make these decisions. Regardless, this discussion does not belong in this case report.
It’s clear that doing vigorous chest compressions manually (even with more team members)cannot be maintained for such a long time without extreme fatigue. The successful use of a mechanical chest compression device is extremely desirable during cases in which long transport times are expected.
So, again...why didn’t they bring the proven Thumper? Is it one of the items promised in their contract and advertised on the SA and CI websites?
Although the impedance valve was placed immediately after pronouncement of legal death the team omitted to attach the end tidal CO2 monitor to the airway.
Bring a team that knows what they are doing.
As a result, the team was deprived of an opportunity to assess the efficacy of cardiopulmonary support and maintenance of correct endotracheal tube placement. The importance and techniques of end tidal CO2 monitoring will be emphasized in future trainings.
Who is going to train these people? Charles? He doesn’t know what he is doing, in regard to the medical procedures. The answer isn’t additional training of the RUPS; the answer is to replace these people with persons who are qualified to perform the procedures involved. Fire two RUPs and hire four, or five, people who actually know what they are doing, for the same amount of money. The refusal of SA to hire qualified personnel when they have an ample budget is negligent, at best. Platt has hired everyone at SA, and designed most of the equipment. He makes everybody there, including Kent, look foolish.
SA’s standby kit includes a disposable colorimetric end tidal CO2 detector. Some limitations of the disposable ETCO2 detectors are that they are not quantitative, not continuous, hard to read in the dark, and can give false readings.
Then, why have them, especially when only inexperienced personnel are present? These people don’t even know what end tidal CO2 is.
A significant benefit of continuous quantitative ETCO2 measurements is that we will have a better understanding of the efficacy of CPS and the hemodynamic effects of the various medications. Suspended Animation is currently investigating the possibility of obtaining a new, relatively inexpensive prehospital quantitative capnography device.
They can buy and/or build all the equipment in the world, and it is not going to make up for unqualified personnel. SA needs to FOCUS on building a strong standby team and forget about adding more complexity to cases. Almost every suggestion in this report, for improvement, is based on future work for Charles Platt.
Page 20:
Data acquisition was incomplete in this case. This has been an issue in cryonics cases generally during the past ten years. While some temperature data were collected, there was no point during the case where temperature readings from different locations in the body were collected concurrently as the protocol prescribes. Because of poor placement of the nasal probe, some of its readings have been rejected as unreliable. In addition, as is common in cryonics cases, there was no blood and fluid sampling during stabilization or washout. Suspended Animation will emphasize the need for this during future training.
I have little faith in SA’s promise of the benefit of “future training,” as it will just be more of "the blind leading the blind." Besides, their training sessions are as infrequent as their news bulletins, and though they won’t admit it, most SA personnel have previously regarded the training sessions as Platt’s social events. As I've stated, over and over again, the obvious answer is to hire people who know what they are doing. They is no one at SA capable of training personnel to perform these procedures, unless you are talking about simple tasks such as placing ice.
Administering medications and performing chest compressions in a Chevy Suburban was difficult and strenuous. Ideally the Suburban should have been used to take the ATP ahead to the mortuary, while the van remained near the hospital for patient pickup. However, the Regional Funeral Director stated initially to the Team Coordinator, over the phone, “You’re not going to use your own vehicle to pick up the patient, are you?” which suggested he would have disliked this arrangement.The Team Coordinator chose not to force the issue.
Platt is should have asked the funeral director to clarify his remark, and stated the need for a van. This is just Platt's poor excuse for not doing something he should have done. It reminds me of something that happened, while I was at SA. Platt had told me a funeral director SA was associated with, in Ft. Lauderdale, had initially offered to allow SA personnel to practice cannulation on indigent patients, but that he had withdrawn the offer, due to fear of some kind of regulations. I went to visit the funeral director, and he said this was not the case at all. What had actually happened was he had lost his contact at the county coroner's office and was no longer receiving indigent cases. Platt needs to quit thinking he can read other people's minds and ask the right questions. Asking if they could use the van, instead of the Suburban, would not have been "forcing the issue."
Possibly the team could have rented two vehicles instead of one, but in that case one of the two team members performing chest compressions and administering medications would have had to drive a vehicle, and the procedures would have been severely compromised.
This makes no sense at all. If Ken knew what he was doing with the ATP, he could have had it set up and primed, within minutes. Then, he and the Funeral Director could have driven back to the hospital in the van, and they would have had three people to perform chest compressions, instead of two.
As he has already admitted, it is Platt's fault there were not more personnel available to help out.
When the collapsible, portable ice bath is used in conjunction with a vehicle such as an SUV or a van, some kind of restraint should be provided to prevent it from rolling from side to side in the vehicle.Common sense. It's also common sense that the PIB should be on the floor, not standing on legs, in the vehicle, but no one seems to realize that, yet. It's in the best interest of the safety of the patient and the team members.
A battery-powered electric razor is included in the standby equipment, for shaving chest hair so that the suction cup of the CardioPump will make good contact with the skin, provided the time of complete ischemia is minimized. This razor could be attached to the CardioPump so that it is readily available.Why did they not get this out of the case, while they were still at the hospital? They must have started using the CardioPump there.
More padding.
The team used an Ambu Cardiopump to administer active compression-decompression chest compressions. They also had a prototype device available, employing a belt that is tightened repeatedly with a pair of hand-powered levers. This device could have reduced the effort required to administer chest compressions, but might have failed to work in conjunction with this patient for the same size-related reasons that defeated the Autopulse. During the stress of the case, the team members did not consider using the prototype. Its suitability remains unknown at this time.
I'm not sure what prototype they are talking about, probably yet another Platt “invention.”
The Consulting MD has suggested that a rectal temperature probe provides readings which are generally not useful, since feces may possess heat conduction characteristics different from those of the body and the brain. The Team Coordinator has argued that a rectal probe will at least confirm that some cooling did occur, and this alone is a useful piece of information. A rectal plug must be inserted anyway to diminish the risk of fecal matter entering the portable ice bath when the sphincter muscles relax after cardiac arrest. Since each plug is equipped with a temperature probe, this is a simple way to insure that some temperature data will becollected. The Consulting MD has responded that the existence of rectal probes may make team members feel less motivated to place a nasopharyngeal temperature probe. The Team Coordinator finds no evidence for this, and also feels that the nasal probe is so vulnerable to icewater,
And the rectal probe that was so poorly inserted it fell out, isn’t?
its readings have been unreliable (as was shown initially in the case of CI-81, before the probe was pushed deeper). The Consulting MD feels that a nasal probe can produce good data if it is placed properly, at sufficient depth, with wax sealing the nostrils, and the wire secured with surgical staples or adhesive tape. The Team Coordinator agrees but finds numerous cryonics cases where personnel have been too pressed by time to follow this procedure. On the other hand, rectal temperatures have also been found to be less reliable in cases of reduced blood flow to the rectum and hypothermia induced temperature changes. Perhaps bilateral tympanic temperature measurement needs to be revisited again. The question of the rectal probe remains unresolved.
Harris is right, Platt is wrong; rectal temps are not reliable and esophageal temps are good indicators of brain temps. Forget about tympanic temps; they aren't accurate and cryonics patients should have their head s in the ice and water, as deeply as possible, meaning their ears will no doubt be filled with water. Bladder temp is a good indicator of core temp, but I don’t see a cryonics team inserting a Foley catheter, anytime soon.
Page 21:
The question of whether the ATP should have been used remains open to debate.
This should not be open to debate, only a total and complete moron would think inexperienced personnel could operate the ATP properly. It should not have been used by unqualified personnel. And, any medical doctor who suggested he could talk a metal fabricator through this procedure, over the phone, should be subjected to some sort of disciplinary action. (Ahhh…the beauty of “legally dead” patients is that Harris can’t be held accountable for his actions.)
The ATP offers the unique, irreplaceable capability of blood substitution with organ preservation solution, with very rapid cooling. However, since blood washout enables direct access to the circulatory system, it also opens up the possibility of doing great harm.
Which is what exactly what happened.
Perfusionists normally require extensive training at an appropriate medical school. During 2006 Suspended Animation was pleased to have a qualified perfusionist as one of its fulltime employees, and accepted her recommended improvements to the ATP circuit that had been used formerly. Regrettably, when she left Suspended Animation in 2007 she refused to make herself available to assist in future cases even as an independent contractor.
I was NEVER asked, by Kent nor Platt, if I would remain on the standby team, as an independent contractor, or otherwise. I may have been asked, personally, by my friend Aschwin, but I wouldn't have taken that as a serious offer, since he had no authority to retain me. Besides, I was effectively removed from the standby team, prior to my resignation, by Saul Kent insisting Platt would be the Team Leader on cases and Platt stating he would not work with me.
I have an old email from Aschwin, asking me if I would participate in some research at a local university if Platt was not involved, and I eagerly agreed.
The above SA paragraph was Charles Platt’s lame and improper attempt to lay blame for his total and absolute failure to assemble a qualified standby team in three years' time, on a former employee (me). I quit five months prior to this case, in conscientious objection to working under Platt, a person I considered to be dishonest, unethical, malicious and unproductive. SA did not have a perfusionist before, or after, I was there, because they have never tried to find one. I found them, quite by accident.
THIS IS A PUBLIC REQUEST FOR SA TO REMOVE ANY AND ALL MENTION OF ME FROM THEIR CASE REPORT AND TO CORRECT THE REASON GIVEN FOR MY RESIGNATION IN THEIR NEWS BULLETIN. I DID NOT RESIGN MY POSITION AT SA, TO RETURN TO WORKING WITH MY HUSBAND; I QUIT BECAUSE I COULD NOT WORK WITH CHARLES PLATT, AND SAUL KENT SEEMED DETERMINED TO ALLOW PLATT TO MANAGE THE FACILITY, IN SPITE OF HIS "RESIGNATION."
To address this problem the company ran some ATP training/familiarization sessions for team members, using assistance from an employee who had participated for many years in cryoprotective perfusion procedures.
This is an idiotic approach to resolving the deficits in SA’s personnel. Mathew probably knows more than anyone else at SA, about perfusion, but he is not qualified to give lessons in perfusion. Assisting with the cryoprotective perfusion is quite different from doing whole body perfusion for the washout procedure, on one's own. The obvious solution to this problem is to hire a qualified perfusionist.
When this employee stated that he could not participate in the case of CI-81, the Procedures Consultant expressed an opinion that the wisest course of action might be to eliminate use of the ATP.Aschwin was correct; the ATP should not have been used by unqualified personnel.
The Consulting MD, on the other hand, felt that with telephone support, the ATP could be used safely enough.
Harris, an MD who schedules his dog experiments around the availability of a qualified perfusionist, was extremely arrogant to assume he could talk a metal fabricator through the perfusion process, over the telephone. The surgeons and anesthesiologists I worked with in heart surgery would have never suggested this, even though they have a thorough understanding of perfusion. Many times, during long cases, (especially during my pregnancies), I would jokingly ask one of them to take over for me, so I could have a quick break. They would laugh and say something, like, "Sorry, Mel, you're just going to have to hold it." A mistake on the part of a perfusionist can cause great harm to a patient, and perhaps even kill them. The use of the ATP by unqualified personnel was an extremely poor choice on SA's part, that was based on the advice of their consulting MD, Steve Harris.
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