Associate Professor Marcus Ong - Shaking up pre-hospital emergency care

When Associate Professor Marcus Ong was still a medical officer trainee with the Department of Emergency Medicine at Singapore General Hospital (SGH) in 2002, he created a technique known as the “Hair Apposition Technique” or HAT to close deep scalp cuts by twisting the hairs on either side of the wound together and securing them with tissue glue.. Now, HAT is a standard of care for scalp cuts in emergency departments worldwide.

That was Prof Ong’s first foray into research and the beginning of his startling career in emergency medicine. The senior consultant today has published over 200 papers and is a mover and shaker of pre-hospital emergency care in Singapore and the world.

Emergency medicine was not Prof Ong’s first choice. The eldest son of an accounts manager and a secretary was the first in the family to have a chance to go to university and had set his sight on becoming a surgeon as it seemed “exciting and action-packed”. However, when he was serving national service, the Ministry of Health (MOH) was awarding traineeships in emergency medicine, which was then emerging as a new specialty. The wide scope and variety that emergency medicine offers was enough to pique his curiosity and made him change tack.

The specialty is now widely recognised for the critical role it plays but pre-hospital emergency care is still developing in Singapore. Recognising the immense opportunities to improve care in this area, Prof Ong has over the last 20 years initiated and led landmark studies that looked at out-of-hospital cardiac arrest and other pre-hospital emergency care issues in Singapore. For instance, the implementation of dispatcher-assisted cardiopulmonary resuscitation (CPR) by the Singapore Civil Defence Force (SCDF) in 2012 helped double bystander CPR from just over 20 per cent in 2011 to more than 50 per cent in 2015.

His other studies to improve survival of out-of-hospital cardiac arrest victims include evaluating the efficacy of mechanical CPR to avoid unnecessary delay in reviving patients; therapeutic hypothermia to reduce brain damage and death; intraosseous devices to deliver life-saving drugs; the CPR-card to give first responders on-the-spot feedback on CPR quality; and more recently, a series of ambulance-based interventions to be administered by SCDF paramedics.

The findings of his numerous studies were valuable basis for national policies such as the MOH’s Pre-hospital Emergency Care 5-year Plan. Survival of out-of-hospital cardiac arrest victims has dramatically increased by more than 10-fold since – from 2 per cent in 2001 to over 20 per cent in 2015.

As Medical Director of MOH’s Unit for Pre-hospital Emergency Care, Prof Ong helps develop and implements policies and programmes to enhance pre-hospital emergency care in Singapore. An example is the introduction of the Dispatcher-Assisted First REsponder (DARE) programme, a simplified CPR training for lay persons, in 2014. 

More than 40,000 individuals in the community and 28,000 students have been equipped with the life-saving skills since.

Prof Ong has also been actively involved in developing Health Services Research (HSR) capability locally in his capacity as Associate Director, Health Services and Systems Research, Duke-NUS Medical School and Head, Data Science, Health Services Research Centre, SingHealth. One of Prof Ong’s earlier HSR projects uses a simulation model to predict patients’ demand for emergency care in Singapore by location and over time. The research identified cardiac arrests patterns, which enabled SCDF to re-deploy its ambulances and shorten response time.

His drive to improve pre-hospital emergency care extends beyond Singapore. Prof Ong is the founding chair of the Pan-Asian Resuscitation Outcomes Study (PAROS) group, comprising 16 countries across Asia-Pacific. Since its inception in 2010, the group has enrolled over 200,000 patients, published over 40 collaborative papers and has begun to impact related policy in Asia.

In 2010, he became the first local Emergency Medicine physician to receive the National Medical Research Council’s Clinician Scientist Award. Prof Ong received the Public Service Medal (Pingat Bakti Masyarakat) National Day Award for his work with SCDF in 2016. His efforts in pre-hospital emergency care were also recognised by his international peers. He was conferred the inaugural Ian G.Jacobs Award for International Group Collaboration to Advance Resuscitation Science and the Lifetime Achievement Award by the Asian EMS Council in 2014. In 2017, he was the American Heart Association’s Paul Dudley White International Scholar.