North West Ambulance Service NHS Trust

4. Mr I complains about the care and treatment he received from North West Ambulance Service NHS Trust (the Trust) following a fall at home on 16 April 2021. Specifically, he complains a paramedic misdiagnosed him with pulled muscles.

5. Mr I says his misdiagnosis resulted in a delay in getting appropriate treatment. He says he has been left with lasting pain and mobility problems. Mr I tells us he has had to pay for private treatment and can no longer walk without crutches.

6. Mr I wants £2,000 compensation towards the cost of private physiotherapy and the purchase of a mobility scooter.

7. Mr I fell at home on 16 April 2021 and was unable to get up. He called for an ambulance, which arrived five hours later. The Trust paramedic gave him pain relief, including gas and air, then used an inflatable chair to get Mr I off the floor. After examining him, the paramedic diagnosed Mr I with pulled muscles.

8. Mr I had another fall in June 2021 and broke his wrist, which was put in a cast. In September 2021, Mr I went to hospital to get the cast removed and told staff he still had back pain. The hospital staff decided to do an X-ray and discovered a break in Mr I’s spine. He was put in a back brace for three months.

11. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and we have not seen any signs something has gone wrong.

12. The paramedic did an initial assessment as shown in the ‘Trauma emergencies in adults’ section of the JRCALC guidelines.

13. The guidelines provide a flowchart to help assess the treatment of patients who have fallen and whether they are likely to have spinal cord damage or a fracture to the surrounding bones. The flowchart describes a risk-based approach for a paramedic to follow. It starts with what to do for patients at high risk of spinal cord injury and moves down to what to do for those at low risk.

14. The records taken at the time show the paramedic followed the examination as set out in the flowchart. The guidelines say the patient must be immobilised (a procedure to reduce movement to prevent further damage) immediately if they meet certain criteria, such as spinal pain or a history of spinal problems. Mr I did not meet these criteria, so the paramedic moved down to the next section of the flowchart.

15. The guidelines say a high-risk patient is one who has had a ‘dangerous mechanism of injury’ – that is, how the injury happened. Our adviser says the way Mr I was injured made a spinal fracture very unlikely. Mr I fell from standing onto a carpeted floor. The JRCALC guidelines say for a fracture to take place, the injured person would have to fall from a height of at least one metre or onto something like a coffee table.

16. The ‘upon examination’ stage of the flowchart says a patient demonstrating ‘any abnormal neurology’ must be immobilised. Once again, Mr I did not meet the criteria, so the paramedic moved down to the next section of the flowchart: ‘low risk’.

17. The ‘low risk’ section of the flowchart describes patients who can sit comfortably and have no midline cervical spine tenderness. If they meet these criteria, the final section of the flowchart asks if they can rotate their head 45 degrees and mobilise (move) without abnormal neurology. Mr I was able to move to an armchair, therefore the spine was cleared. The paramedic noted no abnormalities.

18. In summary, the notes indicate the paramedic looked for any evidence of spinal cord damage and found none. Our adviser says, in view of this, the paramedic’s initial diagnosis of muscular injury being the most likely cause of Mr I’s back pain was reasonable from the information available at the time.

19. In summary, we can see no signs the paramedic did not follow the JRCALC guidelines. We see no signs Mr I did not receive care and treatment in line with the relevant standards and so we see no signs of service failure by the Trust. We will take no further action on Mr I’s complaint.

20. We thank Mr I for bringing us this complaint and wish him well with his ongoing treatment for his back injury.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mr I’s complaint about North West Ambulance Service NHS Trust. We have seen no signs anything went seriously wrong.

2. We have looked at the paramedic records and got advice from a clinical adviser. Based on our investigation, we can see no evidence of service failings, so we will not take further action on this complaint. We explain the reasons below.

3. We are sorry to hear about Mr I’s experiences and the problems he is having with his mobility. We know this must be very difficult for him.