Twenty years ago, if you suffered a sudden cardiac arrest while out and about, your outlook would have been grim—only two out of every hundred out-of-hospital cardiac arrests, or OHCA, victims survived. It was a needless loss of life in Marcus Ong’s view.
“These are preventable deaths,” he said. “Many of these patients were actually in the prime of their lives. But there was no way to save them because they received treatment too late.”
Changing those odds became the motivation for Ong, then a young medical doctor.
Carefully tracing the sequence of events starting from the moment someone collapses until they receive emergency treatment at the hospital, what he terms the “chain of survival”, Ong started looking at ways to strengthen each link in the system.
First, he looked at increasing public education on cardiopulmonary resuscitation (CPR). Then training for emergency medical dispatchers as well as continuing education for emergency medical services personnel, and enhancing the technology used in the emergency department.
“When Marcus is confronted with a problem, he literally attacks the problem—constructively...He’s indefatigable"
Prof John Rush
“When Marcus is confronted with a problem, he literally attacks the problem—constructively. If the first solution doesn’t work, he’s going to stay at it and find another solution and another solution. He’s indefatigable,” said Emeritus Professor Augustus John Rush, whom Ong had worked with at the then Faculty of Clinical Research at Duke-NUS, which has since become a part of the Office of Academic and Clinical Development at the School.
Now, the survival rate for OHCA based on the international benchmark of shockable rhythms stands at about one in four, a ten-fold increase that is largely down to Ong’s efforts in spearheading interventions that give these patients a fighting chance.
For his tenacity, determination and perseverance, he was recognised with the National Outstanding Clinician-Scientist award at the National Medical Excellence Awards earlier this year alongside a number of other clinicians from the SingHealth Duke-NUS Academic Medical Centre.
“It’s not one person’s work. It takes a whole team and it is something that everyone in my area has been working hard on,” said Ong, who is now one of the leading researchers in his field.
In fact, his international multi-centre real-world implementation trial from 12 countries to increase OHCA rates using telephone CPR was selected by the Global Emergency Medicine Literature Review Group as one of the top emergency medicine papers from 2021 for its clarity, study design, global importance and relevance as well as its likely impact on the global practice of emergency medicine.
Something new, something exciting
Becoming a doctor or a scientist wasn’t in Ong’s grand life plan. “Along the way, that was how it turned out,” he said, shrugging.
After graduating from medical school, where Ong met his wife, Dr Frances Lim, he was drawn to emergency medicine after chancing upon an advertised posting from the Ministry of Health (MOH).
“I like new challenges. I like variety in my life. Emergency medicine offered me the best of both worlds,” he added.
But back then, Singapore didn’t have a residency training programme in emergency medicine. So Ong was among the early batches of doctors who were sent on MOH scholarships to train at The Royal College of Surgeons of Edinburgh.
“We got to treat all sorts of conditions in emergency medicine—from surgical to medical, drawing on knowledge from fields ranging from obstetrics to paediatrics. It was something new, something exciting,” he recalled.
Upon his return, Ong was roped into setting up emergency departments across the island. “It was exciting to be part of the team that developed and shaped what have become world-class, modern emergency departments,” he said. Departments that he has worked in since.
“I thought it suited him pretty well,” said his wife, who is a general practitioner. “He is quick thinking, decisive, and unflappable even in difficult and high-pressure situations.”
There must be a better way
While fighting to improve OHCA rates, Ong continued to actively scan his surroundings for other areas where he could help improve the lives of patients.
It was his experience caring for patients who came to the emergency room with head injuries that led to one of his first clinical trials. These patients, many of whom were agitated from their injuries, had to keep still while Ong injected local anaesthesia into their scalp before shaving the hair around the wound so that it could be stitched up.
Apart from having to endure this uncomfortable ordeal, the patients would also have to make a return trip to the hospital to have their stitches removed while living with a bald patch on their heads for weeks—a predicament that made Ong wonder if something could be done to change the situation.
And it wasn’t long before an idea struck him.
Drawing inspiration from his national service days as a medical officer, Ong hit upon a solution in his jungle survival handbook. In it was a technique that used hair to stop the bleeding from a head injury, where the physician simply takes hair from either side of the wound to tie a knot.
“So I thought ‘Cool, maybe I could adopt this technique for the emergency department’”, recalled Ong, who promptly tried it on the next patient.
His first attempt failed—the knot got stuck when the patient combed his hair.
Undeterred, Ong continued. “At that time, I happened to be experimenting with tissue glue. So I decided to do a twist and use glue to secure the knot instead,” he said. As the glue is biodegradable, it softens after two weeks. “And voila, the hair fell back into place,” said Ong.
Known as the Hair Apposition Technique or HAT, it is now a routine method used in emergency departments worldwide. This project spelled the start of the first randomised controlled trial in a Singapore emergency department, as well as the beginning of Ong’s career as a clinician-scientist.
“I realised that a lot of these problems had to do with system-level issues rather than the care provided by individual clinicians. So I decided to go into research and use data to help improve things and make things better for patients,” said Ong, who decided to deepen his understanding and acquire new skills by completing a pre-emergency fellowship that saw him work in emergency departments in the United States and Canada.
Getting people excited about his mission
To everyone he met, Ong stood out for his enthusiasm in solving problems. “He was like an energizer bunny, and he was always full of ideas,” said Professor Ian Stiell, Ong’s mentor at the University of Ottawa, where he is now a distinguished professor and the clinical research chair for emergency medicine at the university.
“He’s just full of energy and he understood very early on that it would be very important to collect data on emergency medical services and resuscitation care,” added Professor Joseph Ornato from the Departments of Emergency Medicine and Internal Medicine at Virginia Commonwealth University who took Ong under his wing. Ong also pursued his masters degree in public health there.
Ong with Joseph Ornato and Mary Ann Peberdy at a gathering in 2005 // Credit: Marcus Ong
Within two years, Ong had learnt to build clinical research networks and even tried his hand at developing innovations in emergency medicine, including a novel mechanical CPR device that delivers automated chest compressions to cardiac arrest patients.
Then, it was time to bring this knowledge and expertise, along with his family of 4 back to Singapore.
By then, Ong had completed a clinical trial of the device, with the results of his study published in JAMA. Known as the Autopulse, it is now a ‘standard of care’ device in emergency departments and ambulance services around the world.
In 2006, he joined Duke-NUS as a member of the School’s clinical research faculty with the then Office of Clinical Research and later the Health Services and Systems Research (HSSR) Programme.
But combining clinical work and research was tough initially. As a budding clinician-scientist, he had no protected time for research, instead he had to make use of whatever spare pockets of time that he could find.
“It was my passion, so I just pursued it in my own time. Post-night call, off day or sleeping day after shift—that’s when you’ll find me doing research,” he said. “So when other people are going pak tor (a slang that refers to dating), I’ll be analysing data—that’s what we have to go through to build up our research portfolio and to learn the ropes.”
Ong’s efforts paid off. In 2009, he set up the Pan-Asian Resuscitation Outcomes Study (PAROS), a multi-centre prospective registry of OHCA across the Asia-Pacific region, an initiative that was instrumental in bringing about the marked increase in OHCA survival rates in Singapore and other countries through changes in policies and practices.
And as his research grew, so did his team.
“He will get other people excited about the problem and participating not in just its definition, but in its solution,” said Rush, who saw how Ong had inspired the people around him.
One such person was Duke-NUS Associate Professor Liu Nan, whom Ong had mentored.
“Working with Marcus was an eye-opening experience and it made me realise for the first time that my expertise and knowledge could be useful in saving lives,” said Liu, who had initially joined Ong’s team as a postdoctoral fellow working on the use of ECG-derived measures for cardiovascular risk prediction. “I was encouraged by him to pursue my dream and passion for research, and he provided me with opportunities to grow as a researcher.”
Today, Liu is a full-fledged research professor and Ong’s colleague in the HSSR Programme at Duke-NUS. “I think he has done very well, and he has made us all very proud of his excellent research,” said Ong, who is also director of the programme.
This mentor-mentee pair have since collaborated on multiple projects, changing healthcare systems with their research, such as through their latest innovative technology designed to help hospital emergency care providers to quickly and efficiently identify sepsis patients at higher risk of dying.
Doing the best he can
With the multiple hats he wears, Ong’s time is spilt over many research pursuits, as well as family time. But he doesn’t see it as a juggling act.
“These are not mutually contradicting,” he said, matter of factly. “We all have to do the best we can, with what we are given. If you are a father which I am, then you be the best father that you can be. If you are a doctor, then you try to be the best doctor that you can be. If you are a researcher, you try to be the best scientist you can be.”
At home, he is a dedicated father who makes it a point to have birthday dates with each of his three children every year, without fail. “Marcus is patient and kind, but yet balances that with firm and steady fathering,” said his wife.
Ong on a vacation to Northern China with his family in 2019 // Credit: Marcus Ong
“There’s no KPI in terms of marks or anything else. What is most important is that the kids must enjoy what they are doing, and find purpose in it,” added Ong, who jokingly lamented how none of his children have followed in his footsteps so far. His eldest son is a practising lawyer, his second son is on track to becoming a computer scientist, while his daughter, the youngest of the three, is still at school.
“What’s important is that we need to build a sustainable system, so that whatever we have achieved, it will continue even beyond our lifetime..."
Prof Marcus Ong
And when he dons a clean set of scrubs, Ong’s focus switches back to the systems he has helped build. “What’s important is that we need to build a sustainable system, so that whatever we have achieved, it will continue even beyond our lifetime and the system will continue to learn and improve,” he said.
This steadfast devotion even extends to the family cat, two frogs and many fish. His wife quipped: “He faithfully takes care of them, when all of us fall short.”