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SINGAPORE: The death of a 19-year-old national serviceman from heatstroke after a fast 8 km march in 2018 was truly a sad loss to his family and the nation, the state coroner said in his findings on his death on Wednesday (Jan 27).
Calling Corporal First Class Dave Lee Han Xuan “a good soldier” who did his best, State Coroner Kamala Ponnampalam noted the “lousy management of the site” after its collapse following the rapid march in Bedok, and the “delay excessive in evacuation. “
She found no foul play in his death, adding that the lapses contributed to his disappearance.
CFC Lee’s parents and sister attended the hearing, and his mother and sister wiped away tears as they listened to the findings.
When asked by the CNA if she had any comments on the findings, CFC Lee’s mother, Jasmine Yeo, said she was “just sad.” He later told the media that the fouls were “too scandalous” and “totally unacceptable.”
Dave Lee Han Xuan and his mother Jasmine Yeo. (Photo: Facebook / Jasmine Yeo)
READ: Officer rejected suggestions to evacuate NSF Dave Lee, who died of heatstroke: Forensic Court
CFC Lee had died of heatstroke after the mandatory 8 km fast march as part of his training in the scout platoon of the 1st Guards Battalion.
The night before the march, instead of having the necessary seven hours of rest, three section commanders called out the entire platoon of scouts at 9:40 p.m. to punish them for various infractions.
These included a perceived lack of teamwork and the use of mobile phones before the lights went out the night before.
The platoon performed bear, leopard crawls, sit-ups, sprints and push-ups, and the commanders punished them without the sanction or knowledge of their superiors, before sending them back with the lights off at 10:45 p.m.
As a result, CFC Lee received approximately 45 minutes less rest than he was supposed to. He woke up the next morning and started his march around 6.45am after a meal of oatmeal cookies and a chrysanthemum drink.
He was noted to be fine for most of the walk, but suffered from calf cramps and took several 10-second breaks in the final kilometers of the walk.
Captain Tan Baoshu, the commanding officer of the Support Company, 1st Guards Battalion and the supervising officer of the march, joined CFC Lee for the last 300m of the march and urged him to run.
Although visibly tired, CFC Lee agreed and raced to the finish line. He was the last to complete the march, but he finished it within the required time and fell to his knees on the table where his timing was recorded.
They helped him to a rest area, but he was swaying, incoherent, drooling from his mouth, and gasping for air before he stopped responding.
They took off his equipment and unbuttoned his shirt, with water spilled or sprayed on his face. The commanders tried to give him isotonic water but the liquid just flowed.
CPT Tan assessed that CFC Lee was suffering from physical exertion rather than heat exhaustion, rejecting suggestions to evacuate him to the medical center.
He repeatedly asked to wait for CFC Lee to recover after resting, and rejected a commander’s suggestion to give him intravenous fluids. He had CFC Lee cover him with a sheet and did not move him to a shady area away from the parade plaza.
Roughly 15 minutes after CFC Lee collapsed, CPT Tan gave permission for the security officer to remove the security vehicle, a violation of protocol. When an off-duty doctor passed by, he was asked to see CFC Lee, saying he should be evacuated without delay.
However, CPT Tan said they should wait another five minutes. He was finally evacuated on foot to the medical center, arriving around 9:05 am with a delay of about 40 minutes.
He did not respond well to body cooling measures at the center, with a recorded temperature of 42.7 degrees Celsius when he first arrived and was taken to hospital.
His condition continued to deteriorate and he eventually died of heat stroke with multiple organ failure on April 30, 2018.
After the incident, six SAF servicemen were fined by a military court for the case. CPT Tan was charged in state courts in October 2018 with causing the death of CFC Lee through a reckless act that does not amount to wrongful death.
However, CPT Tan received a discharge that does not amount to an acquittal in early February last year. A spokesman for the Attorney General’s Office (AGC) said CPT Tan had been diagnosed with stage 4 cancer. He died a few weeks later, in February 2020, at age 31.
After CFC Lee’s death, an Investigation Committee was convened to investigate the incident and recommendations were made to minimize recurrences. An external review panel commissioned by the Ministry of Defense in May 2018 found that SAF’s heat management measures were generally robust and in line with prevailing industry practices.
READ: Death of NSF Dave Lee: SAF to improve prevention, management of heat injuries after review
The panel suggested several additional measures, such as adjusting the work and rest cycle, improving awareness of heat injuries, and addressing impediments to self-assessment that could discourage soldiers from speaking up when they feel unwell.
The panel also emphasized that early recognition of heat injuries was the most important of its recommendations, saying they all have a key role to play in recognizing signs and symptoms in fellow soldiers.
The coroner noted “with satisfaction” that SAF has since adopted several recommendations and instituted changes.
When asked by the media if the family was taking any civil action, CFC Lee’s mother said they were “not ready yet” as the verdict had just been rendered, but added that they obviously “did not agree with the lapses. “.
“It’s amazing that something like this can happen in such a large organization, when we deliver our guys.
“It is totally unacceptable that this kind of thing can happen in the camp,” he said.
“Each child is very precious. We only have sadness.”
