Source · Prevention of Future Deaths
Alyn Rees
Ref: 2020-0190
Date: 9 Sep 2020
Coroner: Caroline Saunders
Area: Gwent
0 responses identified · 2 indexed addressees
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AI-generated concerns summaryThe coroner noted a two-hour wait for an emergency ambulance and that the family was not informed of the expected arrival time. Concerns also included significant delays in transferring patients to hospital, preventing ambulance release.
Date
9 Sep 2020
56-day deadline
18 Jan 2021 est.
estimated from the Judiciary.uk publication date
Responses identified
0 of 2
Coroner's concerns
The coroner noted a two-hour wait for an emergency ambulance and that the family was not informed of the expected arrival time. Concerns also included significant delays in transferring patients to hospital, preventing ambulance release.
View full coroner's concerns
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-~ &tllJ!Sfll~~Jr.'JJ~ my opinion there is·a risk that future deaths will occur unless action is taken. During the-inquest I referred to a report from WAST which described the assessment process. I am of t~e opinion that the assessment made and the status afforded to Mr Rees throughoutwas correct and no criticism was made ofthis. '\ . However, the famHy raised concerns, with which I agreed, that 2 hours is a long time to wait for an _emergency ambulance. At no time were the family advised of the expected time:of arrival and potentially, if they had been aware of this, they may have contacted e.arlie,rthe local GP. The report did, no·~ in~icate what the expected response time for an Amber 1 call should be. · · ... ·.. .1.' ·1, I was advised:thaf'on·this occasion there were significant delays (up to 3 hours) transferring pat~~~ts_ into the care of Aneurin Bevan University Heath Board Hospitals. This is also of sigh1ficant concern as it prevented emergency ambulances being released. ·.-·:·. ·. ' I . . . :, .•· .. I should emphasise that I do not consider that in this case Mr Rees' life would have .. . • 1 . been saved if f.ie t,Jad received medical attention earlier. He was (quite unbeknownst to him) suffering. from a widespread lymphoma which presented acutely on the day ···1 . he died. , , ,,, · I
-~ &tllJ!Sfll~~Jr.'JJ~ my opinion there is·a risk that future deaths will occur unless action is taken. During the-inquest I referred to a report from WAST which described the assessment process. I am of t~e opinion that the assessment made and the status afforded to Mr Rees throughoutwas correct and no criticism was made ofthis. '\ . However, the famHy raised concerns, with which I agreed, that 2 hours is a long time to wait for an _emergency ambulance. At no time were the family advised of the expected time:of arrival and potentially, if they had been aware of this, they may have contacted e.arlie,rthe local GP. The report did, no·~ in~icate what the expected response time for an Amber 1 call should be. · · ... ·.. .1.' ·1, I was advised:thaf'on·this occasion there were significant delays (up to 3 hours) transferring pat~~~ts_ into the care of Aneurin Bevan University Heath Board Hospitals. This is also of sigh1ficant concern as it prevented emergency ambulances being released. ·.-·:·. ·. ' I . . . :, .•· .. I should emphasise that I do not consider that in this case Mr Rees' life would have .. . • 1 . been saved if f.ie t,Jad received medical attention earlier. He was (quite unbeknownst to him) suffering. from a widespread lymphoma which presented acutely on the day ···1 . he died. , , ,,, · I
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Report details
- Reference
- 2020-0190
- Date of report
- 9 September 2020
- Coroner
- Caroline Saunders
- Coroner area
- Gwent
Responses identified
Responses identified
0 of 2
2 responses not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 18 Jan 2021 (estimated from the Judiciary.uk publication date).
Sent to
- Aneurin Bevan University Health Board
- Welsh Ambulance Services NHS Trust