Clinical Negligence Article
24 May, 2022
How long it takes an ambulance to arrive may determine the outcome for that person.
In the case of Kent v Griffiths (2000), the unanimous judgement in the Court of Appeal held that the acceptance of a call and dispatch of an ambulance established a duty of care.
In that case an ambulance arrived 40 minutes after the first call. It was 14 minutes longer than what was reasonable. Without the delay Mrs Kent who suffered respiratory attack, would have avoided miscarriage and brain damage.
Where there is delay without good reason and a failure by ambulance services to exercise reasonable skill and care in performing their statutory function, there is a breach.
The Sunday Times in an article 22.05.22 reports that there have been 90 cases in the last 3 years in which North East Ambulance Service (NEAS) have failed to provide families with the whole truth.
Quinn Evie Beadle, a teenager with poor mental health was found hanging on the 9th December 2018. The paramedic in attendance made no effort to clear her airway or continue with basic life support - despite the fact her heart was still active. In this case a witness statement was changed before it was given to the coroner at the first inquest, removing references to the paramedic's mistakes and inserting the claim that any life support offered would "not have had a positive outcome". Also withheld was a reading from the heart monitor that showed heart activity.
The service is subject to allegations of cover ups and vital information being withheld, altered, concealed and even destroyed. This information was provided to police by whistle-blowers . A report by AuditOne's investigators concluded that the NEAS was failing in its duty to disclose material about deaths to coroners in a proper and timely fashion. It is not for the Trust decide whether a document is disclosed. If it is relevant to the death it must be disclosed.
On the 13th July 2017 NHS England introduced a set of performance targets to apply across 999 calls to all ambulance trusts. All calls are recorded and the EMD's process is captured within the computer programme, and the timing of each critical decision can be seen.
The Emergency Medical Despatcher receives a call and is required to determine as quickly as possible which category it falls into. The categorisation is determined by a Pre-Triage SIEVE (PTS). This is limited to prompt identification of obviously life-threatening illness or injury. Three questions are initially asked; "is the patient breathing", "is the patient conscious", "does their breathing sound noisy"? Sadly, a caller's response to carefully worded questions are not always clear. If the answer to the first set of questions does not illicit an emergency response, there is further opportunity for classifications and emergency. The caller is encouraged to set out "what is the problem?" The EMD then moves to a triage process contained in the Advance Medical Priority Despatch System (AMPDS). A series of questions then lead to the categorisation of the call.
Availability of resource, and unavoidable delays like geographical area, day of the week, weather, an impact of roadworks call all have an impact.
In November 2019, Sandra Currington, 52 telephoned an ambulance complaining of pain in her arm and shoulder and difficulty breathing. The ambulance took 1 hour 27 minutes to arrive. By the time the paramedics entered the property, she was dead. The call was not graded as a category 1 which would have required an ambulance to attend within 7 minutes, but a category 2. That required attendance at the scene within 18 minutes. On either categorisation there was significant delay.
Often to get the full picture of what has happened, shift reports, despatch reports, staffing reports and audio records are required.
Ultimately the cover up of information does not lead to lessons being learned, but instead erodes the public trust and faith in the NHS.
For more information contact Leonie Millard in our Clinical Negligence department via email or phone on 01254 770517. Alternatively send any question through to Forbes Solicitors via our online Contact Form.
Learn more about our Clinical Negligence department here