According to a media report, Coroners have warned that 35 patients have died in the past 5 years after experiencing delays of up to 6 hours in an ambulance reaching them, and mistakes by 999 call handlers and ambulance crew.
The Coroners’ warnings also highlighted that:
- Staff shortages were involved in 4 deaths
- Ambulance service call handlers made mistakes in 9 cases
- Ambulance staff at the scene provided poor care in 9 of the deaths
- Delayed handovers of patients to hospital A&E staff were involved in 3 cases
It has been reported that out of these 35 deaths, in 5 cases the patient would or might have lived if the ambulance had either got there sooner, or the attending crew had provided better treatment. Whilst it is recognised that ambulance services across the country take millions of emergency calls each year, it is clear that improvements need to be made as the service is under strain. Many of the challenges faced are due to a lack of resources and a national shortage of paramedics. Alongside these complicating factors, it is important that ambulance services prioritise their resources to those most in need of their help so that patient safety is not put at risk and the number of avoidable deaths is reduced to zero.
A system of prioritisation is in place in England to ensure that the most serious circumstances are attended to within a specific time frame. Situations involving a cardiac arrest and where the patient is not breathing are categorised as “red one”, whilst other life threatening situations are categorised as “red two”. Both red one and red two situations are meant to be responded to within 8 minutes but the latest figures show that in March, only 66.5% of red one calls and 58% of red two calls were dealt with within that time frame, falling short of the 75% national target.
We have seen a number of reports over the last few months highlighting the delays in Accident and Emergency Departments and this is having a knock on effect on ambulance services. It is reported that in some cases, ambulances are having to queue outside the hospital because there aren’t any free beds available. This is concerning as ambulances waiting to hand over to staff in an A&E department cannot answer calls and get back on the road.
This month, specific concerns were raised over East Midlands Ambulance Trust following an assessment by the Care Quality Commission at the end of last year. Safety was deemed inadequate: however many of the problems were due to recruiting and keeping hold of staff. The report also found that delays at hospital emergency departments also delayed ambulance crews which affected their ability to respond to calls and meet targets. Richard Henderson, acting chief executive of the Trust said, “… there are concerns that ultimately relate to our lack of resource (staff and vehicles, made worse by the numbers often kept waiting at hospital, and lack of capacity to do things as quickly and as well as we need to.”
The Chief Inspector of Hospitals for England has recently invited residents falling under the remit of North West Ambulance Service to contact the Care Quality Commission about their experiences of the emergency service and we would encourage anyone with feedback to engage with this as it is an opportunity to voice your experience and potentially make a difference to the service provided.
With attention in the media often focused on the standard of care delivered on hospital wards, it is important to ensure that standards are also scrutinised and where necessary, improved within the ambulance service. Valuable and sometimes lifesaving minutes can be saved with an efficient and appropriately prioritised service, giving medical professionals the best chance of achieving an optimum outcome for patients when they do reach hospital.
One final point: the fact that these warnings come from coroners’ reports shows the value of the coronial investigation in helping to identify concerns and areas for improvement. Let us hope that it does not have to fall to coroners in the future and that the emergency service is able to address these concerns promptly.