MASHPEE — During a frantic 911 call that lasted more than 12 minutes, Brent McFarland can be heard screaming his fiancée's name, describing her condition and making what sounds like attempts to blow into her mouth.
McFarland tells the dispatcher he is with someone who is choking and is told an ambulance is on its way. Later in the call, the dispatcher does not say a word for nearly a minute, and later for two minutes, and again for nearly two minutes.
Around eight minutes into the call, McFarland calls for help and repeatedly says, "Hello?" but does not receive a response.
"I was asking for help from the dispatcher but there was nobody there," he said Wednesday. "I thought, 'Oh my God, I'm on my own.'"
McFarland's 39-year-old fiancee, Kate, was pronounced dead at Falmouth Hospital that September day. Nearly two months later, there are still unanswered questions about the response to McFarland's call for help.
The Times reported Tuesday that McFarland believes Mashpee paramedics were slowed in their response to his 911 call because they could not find his address. He has been in a lengthy dispute over the listing of his home on official maps and proper signage for the address.
The 911 tape raises other questions about what assistance McFarland received from the Barnstable County Sheriff's Office dispatcher who took the call.
McFarland says he found his fiancée on the kitchen floor, choking on a marshmallow she'd eaten as a snack. He says he attempted the Heimlich maneuver, then called 911 for help.
The 911 call was placed at 1:45 a.m. Sept. 4, according to Mashpee Fire Department documents. Once McFarland tells the dispatcher that Kate is choking, she mentions the Heimlich maneuver but does not provide instructions on how to perform the procedure. The dispatcher then asks McFarland his name and does not mention the Heimlich maneuver again.
Later, it sounds like McFarland is breathing into her mouth and possibly giving chest compressions, to which the dispatcher responds, "You're trying to give her CPR? I thought you said she was choking on something."
For about two minutes and 31 seconds toward the end of the 911 call, the dispatcher does not speak to McFarland, though in the call she can be heard telling someone else that, "this guy is like out of control right now."
A national expert the Times asked to review the 911 tape said the dispatcher could have done more to assist McFarland during the emergency call.
"The difference between what it is you should do, and what it is that was done in this case is so glaring. I'm dumbfounded," said Dr. Jeff Clawson, founder and medical director for the National Academies of Emergency Dispatch based in Utah, of the treatment of the 911 call McFarland placed to the sheriff's emergency dispatch center.
NAED, which Clawson founded in 1988, provides emergency dispatch training and protocol for about 3,000 public safety departments worldwide.
Clawson believes the way the dispatcher handled the McFarland's 911 call was "devoid of any help."
"Choking is one of the few medical emergencies that's completely correctable," he said. "Following the correct protocol, a child could've helped that man."
Barnstable County Sheriff James Cummings said he has listened to McFarland's 911 call but declined to comment because the death is under investigation by the state Medical Examiner's Office. He also would not comment on the dispatcher's status with the sheriff's department or whether the response to the call was being investigated.
Speaking generally about the dispatch department, Cummings said there likely would have been four dispatchers working that Sept. 4 shift.
Dispatchers receive calls from several Cape towns, then direct the calls to the appropriate public safety officials, depending on the circumstances. The positions are redundant, Cummings said, so that "you don't have to worry about taking two phone calls."
Cummings said Barnstable County dispatchers, who are certified first responders in addition to being trained in emergency medical dispatch work, are authorized to provide instructions on medical procedures in appropriate situations but are also supposed to use their judgment to decide what to tell callers.
"It just depends on what the scenario is, and how much information they have and whether they can determine exactly what is happening on the other end of the phone line," the sheriff said.
He declined to elaborate on specific details of dispatchers' training. The Times has made a public records request for documentation on the training Barnstable County dispatchers receive and what protocols they are expected to follow.
Clawson's NAED competes for dispatch services with other groups, including Florida-based Association of Public-Safety Officials International, the company Barnstable County relies on for its dispatch training and dispatch protocols.
But state Executive Office of Public Safety spokesman Terrel Harris said dispatch groups "are all on the same page, and they all have the same ultimate goal" of providing dispatchers with the tools they need to handle emergencies.
A spokeswoman for APCO said the company does not typically comment on "specific incidents or people." Representatives from APCO did not return phone calls and e-mails requesting information on their training by the Times' press deadline Wednesday.
A paramedic who works for a Cape Cod fire department, who asked not to be named in this report, said after listening to the 911 call that the information McFarland provided was enough for the dispatcher to determine how he could have helped Kate.
The dispatcher could have told McFarland to do a "finger swipe" in Kate's mouth to attempt to remove the marshmallow she was choking on, given instructions on the Heimlich maneuver, and attempted to calm McFarland down while he waited for Mashpee rescuers to arrive, he said.
"She didn't get involved as much as she should've," he said. "It was disgustingly quiet."
Clawson likened the dispatcher's treatment of the call to what he described as "dispatcher abandonment."
"Just sitting there listening to someone die on the phone for 12 to 13 minutes isn't reasonable. It's outrageous," he said.
Times staff writer Aaron Gouveia contributed to this report.