SINGAPORE: A toddler died after accidentally drowning in his home pool, with his parents alleging a delay in taking him to hospital as paramedics wanted to see the child's birth certificate.
The State Coroner on Wednesday (Apr 29) ruled the death of the child, aged one year and eight months, as a tragic accidental drowning.
He found that the Singapore Civil Defence Force (SCDF) paramedics' "insistence" on obtaining the toddler's birth certificate before the ambulance left for the hospital was "unnecessary".
He said there should either have been better and calmer communication about why the certificate was necessary, or a compromise when the parents were unable to obtain the document quickly.
Even so, the "delay" was unlikely to have changed the outcome, the coroner said.
One of the paramedics denied the claims, but body-worn camera footage proved otherwise.
CNA has contacted SCDF for comment.
Parties in the case are not named due to a gag order imposed by the court.
According to written findings released on Thursday (Apr 30), the boy lived with his parents, his grandfather and two siblings in a three-storey semi-detached house at a redacted location. The house had a car porch and a swimming pool measuring 25m by 1.5m.
The toddler's mother said she was in the living room at about 12pm on Jun 9, 2024. At the time, the boy was running around on the first floor. Other accounts stated that the helper was in the kitchen, while relatives were in other parts of the house.
Footage from the car porch showed the boy leaving the house through an unlocked, ajar main door at about 12.51pm and heading towards the pool.
He was later seen entering the water at about 12.55pm. Moments after, he appeared to struggle before becoming unresponsive.
The mother testified that she noticed the house had gone quiet and could not hear her son playing. She searched the first and third floors but could not find him.
She eventually found him face down in the pool. At her screams, the boy's father, who had been in the living room, ran over and pulled his son from the water.
He saw that the boy's stomach appeared bloated and began cardiopulmonary resuscitation. The boy vomited and his father continued CPR while his mother called for an ambulance.
SCDF received a call at 1.15pm and Sergeant Muhammad Noor Azwan Abbas and his ambulance team were dispatched to the house, arriving at 1.23pm. According to SGT Azwan, the ambulance left the house at about 1.43pm and arrived at the hospital at 1.48pm.
The boy was pronounced dead at around 4pm the same day despite rescue efforts.
During the hearing, the boy's father stated that three of the paramedics asked him for his son's birth certificate, saying that they would be unable to take him to hospital without it.
"I begged with them to please send him to the hospital first and I would get another family member to send the birth certificate to them," he said. "They claimed that it was their procedure, and the were unable to proceed without the birth certificate."
The boy's father claimed the exchange "dragged for almost seven to eight minutes" as the parents tried to obtain the birth certificate, adding that he had repeatedly asked the paramedics to take his son to hospital but was told they needed the document.
The mother said she later realised she only had a digital copy and sent it to her husband. The parents felt time had been wasted when the boy should have been taken to hospital immediately.
In further statements, SGT Azwan said he was in the ambulance performing CPR on the boy when the father climbed in and placed his hand on his son.
He said he could not recall how long it took for the father to let go, describing the situation as chaotic and saying the father had "hindered" medical procedures.
He said he did not tell the father a birth certificate was required before sending the boy to hospital, and that this was not part of standard operating procedures.
He said he had shouted "where was the birth certificate?" in general but nobody responded to him.
A police review of his body-worn camera footage found he had repeatedly asked for the toddler's birth certificate.
He was seen asking for it in the house, saying "birth cert, where birth cert, birth cert", and repeating his request multiple times.
At about 1.40pm, he was recorded in the ambulance telling the father: “I cannot go until the birth cert is here … I thought you said it is digital.”
The coroner noted that the father sounded distressed.
The ambulance left at 1.43pm - twenty minutes after the SCDF team arrived - when the father showed SGT Azwan the digital copy of the birth certificate.
SCDF conducted an audit into the incident and found that SGT Azwan, a paramedic with six years of operational experience, was managing his first paediatric cardiac arrest case here.
The lead auditor found that SGT Azwan, despite reported nervousness for his first such case, maintained focus on critical interventions "while also indicating areas that could potentially be refined".
State Coroner Adam Nakhoda said this was a truly tragic accident resulting in the untimely death of a child, the loss of whom has clearly had a "devastating effect" on his family.
He said that while access to the swimming pool could be controlled by ensuring that sliding doors were kept closed and locked, there was "unfettered access" to the pool from the car porch.
"I would take this opportunity to strongly encourage the owners of houses with private pools, especially if there are occupants in the house that do not know how to swim or there are very young children, to ensure that the pools are effectively barricaded to prevent non-swimmers from falling in," he said.
"Failing which, children or non-swimmers should be kept under constant watch to ensure that they do not inadvertently enter a swimming pool."
The evidence is unclear on when the father retrieved the toddler from the pool. In any case, said Mr Nakhoda, the toddler would have been submerged and not breathing for between 10 and 20 minutes.
He cited a medical expert who said that it was "most important" in drowning cases that CPR and ventilation are started as soon as possible.
"Unfortunately, in the present case, because it was not realised that the toddler had entered the pool, the time lapse before CPR was commenced, by the father, was not inconsiderable," said Mr Nakhoda.
He found no delay in the dispatch or arrival of the ambulance. SGT Azwan and his team had carried out first aid in an appropriate and timely manner.
However, the coroner found the insistence on obtaining the toddler's birth certificate to be unnecessary.
"Whilst I accept that the additional time spent in the ambulance whilst it was parked at the house would likely not have materially changed the outcome in the present case, especially as CPR was ongoing throughout, I found that the additional time would have caused unnecessary additional distress to the parents," he said.
"In situations where there is a need to bring patients as expeditiously as possible to hospital, paramedics should exercise some flexibility with regard to procedural requirements, such as the necessity of obtaining a birth certificate."
He conveyed his deepest condolences to the family of the toddler on their loss.
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The State Coroner on Wednesday (Apr 29) ruled the death of the child, aged one year and eight months, as a tragic accidental drowning.
He found that the Singapore Civil Defence Force (SCDF) paramedics' "insistence" on obtaining the toddler's birth certificate before the ambulance left for the hospital was "unnecessary".
He said there should either have been better and calmer communication about why the certificate was necessary, or a compromise when the parents were unable to obtain the document quickly.
Even so, the "delay" was unlikely to have changed the outcome, the coroner said.
One of the paramedics denied the claims, but body-worn camera footage proved otherwise.
CNA has contacted SCDF for comment.
THE CASE
Parties in the case are not named due to a gag order imposed by the court.
According to written findings released on Thursday (Apr 30), the boy lived with his parents, his grandfather and two siblings in a three-storey semi-detached house at a redacted location. The house had a car porch and a swimming pool measuring 25m by 1.5m.
The toddler's mother said she was in the living room at about 12pm on Jun 9, 2024. At the time, the boy was running around on the first floor. Other accounts stated that the helper was in the kitchen, while relatives were in other parts of the house.
Footage from the car porch showed the boy leaving the house through an unlocked, ajar main door at about 12.51pm and heading towards the pool.
He was later seen entering the water at about 12.55pm. Moments after, he appeared to struggle before becoming unresponsive.
The mother testified that she noticed the house had gone quiet and could not hear her son playing. She searched the first and third floors but could not find him.
She eventually found him face down in the pool. At her screams, the boy's father, who had been in the living room, ran over and pulled his son from the water.
He saw that the boy's stomach appeared bloated and began cardiopulmonary resuscitation. The boy vomited and his father continued CPR while his mother called for an ambulance.
SCDF ARRIVES
SCDF received a call at 1.15pm and Sergeant Muhammad Noor Azwan Abbas and his ambulance team were dispatched to the house, arriving at 1.23pm. According to SGT Azwan, the ambulance left the house at about 1.43pm and arrived at the hospital at 1.48pm.
The boy was pronounced dead at around 4pm the same day despite rescue efforts.
During the hearing, the boy's father stated that three of the paramedics asked him for his son's birth certificate, saying that they would be unable to take him to hospital without it.
"I begged with them to please send him to the hospital first and I would get another family member to send the birth certificate to them," he said. "They claimed that it was their procedure, and the were unable to proceed without the birth certificate."
The boy's father claimed the exchange "dragged for almost seven to eight minutes" as the parents tried to obtain the birth certificate, adding that he had repeatedly asked the paramedics to take his son to hospital but was told they needed the document.
The mother said she later realised she only had a digital copy and sent it to her husband. The parents felt time had been wasted when the boy should have been taken to hospital immediately.
In further statements, SGT Azwan said he was in the ambulance performing CPR on the boy when the father climbed in and placed his hand on his son.
He said he could not recall how long it took for the father to let go, describing the situation as chaotic and saying the father had "hindered" medical procedures.
He said he did not tell the father a birth certificate was required before sending the boy to hospital, and that this was not part of standard operating procedures.
He said he had shouted "where was the birth certificate?" in general but nobody responded to him.
A police review of his body-worn camera footage found he had repeatedly asked for the toddler's birth certificate.
He was seen asking for it in the house, saying "birth cert, where birth cert, birth cert", and repeating his request multiple times.
At about 1.40pm, he was recorded in the ambulance telling the father: “I cannot go until the birth cert is here … I thought you said it is digital.”
The coroner noted that the father sounded distressed.
The ambulance left at 1.43pm - twenty minutes after the SCDF team arrived - when the father showed SGT Azwan the digital copy of the birth certificate.
SCDF conducted an audit into the incident and found that SGT Azwan, a paramedic with six years of operational experience, was managing his first paediatric cardiac arrest case here.
The lead auditor found that SGT Azwan, despite reported nervousness for his first such case, maintained focus on critical interventions "while also indicating areas that could potentially be refined".
CORONER'S FINDINGS
State Coroner Adam Nakhoda said this was a truly tragic accident resulting in the untimely death of a child, the loss of whom has clearly had a "devastating effect" on his family.
He said that while access to the swimming pool could be controlled by ensuring that sliding doors were kept closed and locked, there was "unfettered access" to the pool from the car porch.
"I would take this opportunity to strongly encourage the owners of houses with private pools, especially if there are occupants in the house that do not know how to swim or there are very young children, to ensure that the pools are effectively barricaded to prevent non-swimmers from falling in," he said.
"Failing which, children or non-swimmers should be kept under constant watch to ensure that they do not inadvertently enter a swimming pool."
The evidence is unclear on when the father retrieved the toddler from the pool. In any case, said Mr Nakhoda, the toddler would have been submerged and not breathing for between 10 and 20 minutes.
He cited a medical expert who said that it was "most important" in drowning cases that CPR and ventilation are started as soon as possible.
"Unfortunately, in the present case, because it was not realised that the toddler had entered the pool, the time lapse before CPR was commenced, by the father, was not inconsiderable," said Mr Nakhoda.
He found no delay in the dispatch or arrival of the ambulance. SGT Azwan and his team had carried out first aid in an appropriate and timely manner.
However, the coroner found the insistence on obtaining the toddler's birth certificate to be unnecessary.
"Whilst I accept that the additional time spent in the ambulance whilst it was parked at the house would likely not have materially changed the outcome in the present case, especially as CPR was ongoing throughout, I found that the additional time would have caused unnecessary additional distress to the parents," he said.
"In situations where there is a need to bring patients as expeditiously as possible to hospital, paramedics should exercise some flexibility with regard to procedural requirements, such as the necessity of obtaining a birth certificate."
He conveyed his deepest condolences to the family of the toddler on their loss.
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