East Midlands Ambulance Service NHS Trust

6. Mrs I complains on 21 June 2025 East Midlands Ambulance Service NHS Trust (the Trust) did not refer her husband for further treatment after he had fallen at home three days earlier.

7. Mrs I says he was in pain for longer than necessary and the correct treatment was delayed. This meant his pelvis healed in the wrong position, which meant surgery was not possible. He is now permanently dependant on a wheelchair, which she says could have been avoided.

8. Mrs I wants an apology and acknowledgement of the impact this has had on her and Mr I.

9. Mrs I says her husband had a fall at home on the 18 June 2025 whilst tying his shoelaces. Mrs I is his primary carer and noticed his pain was getting worse.

10. On 21 June Mrs I called 999 and explained her husband had a hips replacement 17 years ago and he was experiencing worsening pain in that area.

11. Paramedics from the Trust came out to the home. A paramedic assessed Mr I and called an out of hours doctor to prescribe oral analgesia (pain medication).

12. Mrs I informed Paramedics that her husband had a physiotherapy appointment in the next could of days. The paramedics decided to leave Mr I at home with the pain medication.

13. Ms I says Mr I was in too much pain to do his therapy session. She says his pain continued to worsen so she took her husband to their GP surgery. The GP referred Mr I for a CT scan.

14. On 17 July 2025, Mr I saw a doctor at the Trust to review his CT scan. This showed he had an acetabular fracture on his medial wall, and there are some superior defects.

15. Mrs I says this was caused by the fall and the Trust should have recognised this when it attended on 18 June.

16. In the Trust’s response, it says the paramedics conducted thorough assessments, ruling out any emergency concerns at that time. In addition, a functional mobility assessment was completed and documented.

17. The Trust says the paramedics recorded they discussed the options with Mr I and with his agreement referred him to an appropriate care provider for pain relief, prior to him seeing his physiotherapist two days after the crew’s attendance.

18. The Trust says it reviewed the electronic patient report form (ePRF). It says based on this and the lack of sudden onset, serious clinical findings, there was no immediate requirement to take Mr I to the nearest receiving emergency department for further assessment.

Trust did not transfer to emergency department

22. JRCLAC guidance explains most pelvic injuries do not result in major disruption of the pelvic ring (the area connecting the spine to the legs) but involve fractures of the nearby bones (pubic ramus or acetabulum). Presentation of these injuries is very similar to neck of femur (hip bone) fractures.

23. It says pelvic and acetabular fractures can present in a similar way to hip fractures. It also states that older people with pain or altered mobility following a fall should be carefully assessed.

24. The Trust recorded a pain score of five out of ten. Our advisor explained this is a clinical tool used to guide care, a pain score is achieved by the patient answering questions about their pain and how it is making them feel.

25. The records show that the Trust considered the possibility of a pelvic or hip injury. It assessed Mr I’s pain, mobility and functional ability. It did not identify any acute findings at the time.

26. Our adviser explained the Trust completed a full assessment of mobility and a pain score, as they would expect to see. We are satisfied the Trust’s conclusion was in line with the JRCALC guidance.

27. The records show that the Trust completed and documented a functional mobility assessment and made a clinical judgment based on its findings at the time. Our advisor confirmed this was in keeping with what they would expect to see.

28. Taking all this evidence into consideration, we are satisfied the Trust acted in line with guidance in assessing Mr I’s injury.

29. NICE NG249 says taking an older person to hospital also carries risks. These include loss of strength and ability, and hospital-acquired infection. The guidance supports shared decision making when it is safe to manage a patient at home.

30. Our adviser explained based on the assessment findings and the lack of acute red flags (symptoms that require immediate medical attention), there was no clinical requirement to take Mr I to hospital at that time.

31. It is our view it was appropriate and safe for the Trust to consider arranging follow up care for Mr I at home. The Trust’s records also show it involved him and Mrs I in this decision-making process. This was in line with NICE NG249 guidance.

JRCLAC guidance also states clinicians should use a balance pain relief plan that considers best practice. Our adviser also explained the Trust cannot leave ongoing pain medication after 999 visit.

32. The decision to contact the on-call doctor to arrange additional pain relief was reasonable. This plan aimed to manage Mr I’s pain until his physiotherapy appointment.

33.

34. We have seen the Trust also gave Ms I clear advice on what to do if the pain continued or worsened. We consider these actions were in keeping with JRCLAC guidance.

35. We considered whether Mr I had capacity to make the decision to remain at home. The records show that he could understand information, communicate effectively and report his pain score.

36. The Mental Capacity Act requires a person to understand, retain and weigh information and communicate a decision. The available evidence supports a finding that Mr I met these criteria.

37. We recognise that this was a distressing time for Ms I, we were sorry to hear about her experience.

38. Based on the evidence, we have seen the Trust followed relevant guidance, carried out appropriate assessments and made reasonable decisions at the time, in line with guidance. For these reasons we will not be looking at this complaint any further.

39. We hope this explanation is reassuring and shows that the complaint has been considered thoroughly and fairly, in line with guidance.

1. We are sorry to learn of Mrs I’s dissatisfaction following her and her husband’s (Mr I) experience with East Midlands Ambulance Service NHS Trust (the Trust). We acknowledge the difficult circumstances around this complaint, and the impact this had on Mrs I and the family.

2. We have carefully considered Mrs I’s complaint about the Trust. Having done so, we have decided we will not investigate this complaint further.

3. This is because we have not seen any signs anything went seriously wrong with the Trust’s assessment on Mr I’s fall nor in its treatment plan.

4. We understand this was and continues to be an upsetting time for Mrs I. Our decision is not made without recognition of the upsetting experiences she and her husband had with his treatment and its outcome.

5. We have explained the reasons for our decision below and we hope this provide Mrs I with some reassurance about the care her husband received.