By Jim O'Sullivan
News Editor

The family of a 47-year-old Port Norfolk man, who died last month after suffering an apparent heart attack at his home, says he might have survived if emergency responders had arrived more rapidly. Their questions have prompted an internal investigation into the response of the city's emergency medical personnel and into why a nearby fire truck, temporarily stationed a few hundred yards away because of blocked road access, and manned by trained Boston firefighters with lifesaving equipment, was not dispatched.

Two weeks before he lost consciousness, and less than a month before his death, Thomas Cook was talking with his wife and brother-in-law about the perils of closing of the Redfield Street Bridge. Mandated by the MBTA reconstruction of the decaying bridge, the shutdown left Dorchester's Port Norfolk neighborhood with its only access road four-tenths of a mile away down Morrissey Boulevard. To reach the Port's 150 households, emergency vehicles would have to drive up Morrissey, take a right onto Conley St., and then south along Tenean Beach into the residential area.

The temporary fire station on Conley Street arranged by the Boston Fire Department and the MBTA eased Cook's mind, his brother-in-law Bill Ryan said. The neighborhood association, safety officials, and the T had negotiated in the months leading up to the bridgework a satellite station, funded by the transit agency, but without the necessary means for an ambulance.

"He said, 'If it saves one person's life, it's worth it'," remembered Ryan. "Whoever thought it was going to be him?"

But what Cook and his family didn't realize was that certain types of emergencies, including the one that led to the 47-year-old's death, couldn't be handled by the Boston Fire Department, according to procedural policies mandating how certain cases are answered.

The events of November 7 - a 911 call, dispatched paramedic and EMT crews, and a man in cardiac arrest who never regained consciousness &endash; are now the subject of an internal review and could become the basis for a legal complaint from the family of Thomas Cook.

The fire department, with its four-man-crew satellite station less than a quarter-mile from the Ryan home, was not notified when Joanne Cook awoke to find her husband "out of it" and unresponsive after 11 p.m. on Nov 7.

In a 911 call, Cook told the dispatcher that her husband, a diabetic who had suffered diabetic episodes previously, was sweating and wheezing. Less than 40 seconds into the call, Cook said, "He's just out of it, and he won't wake up."

That indication of unconsciousness should immediately have spurred fire department involvement, officials said.

Instead, because the 911 dispatcher treated the call as one for a conscious man in distress, two crews from Boston Emergency Medical Services were called. Almost two minutes into the call, a panicked Joanne Cook told the dispatcher, "Except there's one problem: In the Port Norfolk section, the bridge is closed." The dispatcher assured Cook she would alert the drivers, and six-and-a-half minutes later two paramedics arrived on the scene.

By that time, according to an incident report obtained by the Reporter, eight-and-a-half minutes had elapsed since the call began, vital time during which Cook's brain was not receiving oxygen.

Later, said Ryan, doctors found that brain activity ceased due to lack of oxygen. His heart was revived at the Cook's Walnut St. home, his wife said, but doctors at Boston Medical Center, where he was taken after 37 minutes of on-scene treatment, induced a coma to prevent further brain damage. With little hope for recovery, his wife, who had been "by his side every day," "made the difficult decision to let him go" on Nov. 18, according to a letter written by Bill Ryan.

The death certificate lists the cause of death as a ventricular fibrillation arrest, a heart condition that affects blood flow, which incurred an anoxic brain injury, a total loss of oxygen to the brain.

Initially, in a phone conversation with the Reporter, Richard Serino, chief of Boston Emergency Medical Services, said the dispatcher who was talking with Joanne Cook during the time lapse never ascertained whether or not her husband was conscious.

But, as Serino later acknowledged in an office interview, and the 911 tape and an incident report confirm, Cook was diagnosed as unconscious as early as 11:05:48, less than a minute after the dispatcher accepted the call.

Shared BFD and BEMS policy dictates that any calls for unconscious victims require a fire department response, Serino said.

"The bottom line is we were not notified, unfortunately," said BFD spokesman Scott Salman, adding that the fire truck would have arrived in under two minutes. The ambulance's response, he said, took "an awfully long time."

Serino said EMS is conducting an internal investigation.

Now, Cook's family is angry both that the call appears to have been mishandled, and that public safety officials never established a case-specific mechanism for dealing with all emergency calls for the Port while the bridge was out. Ryan said he and brother John, both of whom live downstairs from their sister, are considering a family lawsuit against the city.

"We think if the fire truck was down here, it should be responding to all the emergencies because it's so close," Bill Ryan said Monday, sitting at his kitchen table. "That was the whole idea of the fire truck being down here."

Cook's death has inflicted a financial as well as emotional hardship on the family, according to Ryan.

"She's always been a stay-at-home mom," Ryan said of his sister, who raised daughter Kelly, while her husband managed a Watertown Stop & Shop. "Now she has nothing."

Kelly, 18, is a senior at Archbishop William's High School in Braintree who plays volleyball. Her uncle said she was hoping to go to college next year. "That might change because she probably won't be able to afford it," Ryan said.

Bill Ryan said the family is concerned immediately with apprising their neighbors of how the story unfolded. The family and others question whether Cook would still be alive if help had arrived sooner.

"Who knows what a couple of minutes would have done?" Salman said.

Serino said he was unsure about the route the ambulance took, but said the response time was "slightly above average," and said the detour, if it impacted the response at all, "wouldn't have added more than a minute."

The department's professional standards division is conducting the internal investigation, Serino said, reviewing tapes and "gathering incident reports." He said, "We hope to have it certainly within 30 days."

Serino declined to release the dispatcher's name, but said, "Based on the information that she had, the call taken, and the information from the family member, she thought it was a purely diabetic case," he said.

"Our condolences go out to the Cook family," Serino said.

"The fire truck had all the equipment needed to help my brother in law but were not called," Bill Ryan wrote in a letter to the Reporter.

While Ryan said the family faults the decision not to call the nearby fire truck to respond, the bridge shutdown was scheduled to have ended in October, according to MBTA spokeswoman Lydia Rivera. The bridge, which opened again for limited hours on Dec. 4, was closed for renovation on August 21, with the T promising residents that the shutdown phase of the project would last no more than eight weeks.

One key weekend construction period was scheduled for Oct. 16-17, but the T ordered the private contractor to interrupt construction so as not to interrupt Red Line service for the Red Sox playoffs game.

The bridge is expected to reopen full-time Dec. 17; in the interim, said Rivera, two police officers stand by during shutdown hours to allow emergency vehicles to pass. The satellite fire station closed last weekend, two weeks after an EMS policy change mandated that all Port calls, regardless of "nature code" be directed to fire department personnel.

The decision to alter procedure was made "in direct response" to the Cook case, Serino said. John Ryan and several city officials familiar with the case said it highlighted a turf war between EMS and the BFD over who handles certain calls.

Salman said special arrangements "should have been worked out" between the two agencies. "Any emergency in that neighborhood should have been responded to by us. Or they should've had an ambulance next to the fire truck."

Salman said, "We don't have great communication between the two agencies."

Serino said his department is reviewing response procedures. "We're in the business of trying to save lives. Everything we do here is to try to protect the lives of the people of the City of Boston. Anything we can do to improve that is what we look to do," he said.

Rivera defended the T's decision not to locate an ambulance there and said the bridge shutdown was not expected to affect a medical emergency. "We thought we had everything secure with regard to emergency response," said Rivera.