Ambulance Delays and Negligence Claims

When you call for an ambulance, you generally want it now. To you, it’s an emergency and an emergency requires an immediate response.

Often the immediate need for an ambulance treatment is not met, there can be several reasons for this. On some occasions the call handler incorrectly assesses the nature of the call and the call is allocated a lower ranking for response time, on many occasions, there are insufficient available units to respond to the call. On occasions, the treatment that can be provided to the patient may be determined by the skill and experience of the responding ambulance crew. Some of these delays would be considered to be negligent.

Our Team can offer free initial advice as to whether you have a case in relation to poor ambulance care.

Cases involving poor ambulance care generally include the following :

  • Slow response time to an emergency
  • Delay in treatment due to slow transfer times
  • Misdiagnosis of life-threatening conditions
  • Delay in diagnosis of conditions
  • Medication errors
  • Excessive force applied to patients
  • Dropping patients

The decision to dispatch

Upon a call being connected the dispatching process commences with a Pre-Triage Sieve (PTS) conducted by reference to the Dispatch on Disposition flowchart. The purpose of this is for the emergency medical dispatcher (EMD), who receives the initial call, to identify as quickly as possible whether the call can immediately be identified as meriting a Category 1 response. This PTS function is thus limited to the prompt identification of obviously life-threatening illness or injury.

Three questions are initially asked. The first of these questions, “Is the patient breathing” will, if answered in the negative, result in the EMD presenting the call to Dispatch for allocation as a Category 1 response. The second question is “Is the patient conscious”, but regardless of how that is answered, it is only if the third question “Does their breathing sound noisy” is answered in the affirmative, that this results in the call being presented by the EMD to Dispatch at that point for allocation as a Category 1 response.

On occasions how a question is answered by the caller may impact the response. Sadly, a caller’s response to what is carefully worded specific questions is not always as clear as a “yes” or “no”. Any answer interpreted as a “don’t know” will not result in a dispatch request being put through at that point.

Assuming the call is not identified as Category 1 on the initial PTS, there is a further opportunity for an emergency (as opposed to urgent) dispatch to be requested if the next open question “What is the problem” produces a response that the EMD interprets as one of a number of specified problems which include choking and drowning listed in a Nature of Call list or if the caller uses one of a range of keywords or phrases which are listed in alphabetical order for the EMD to scan.

If the initial questions do not illicit a Category 1 response, the EMD will move to a triage process as contained in the Advance Medical Priority Dispatch System (AMPDS) which is a computer-based set of progressive screens, where the EMD is led through a succession of questions which will lead to a categorisation of the call. An initially lower categorisation can and sometimes is re-categorised to a higher level of priority if additional information is gleaned which merits that, with the EMD having the ability to refer to a clinician for advice and guidance based on the information elicited. This gives rise to the possibility of exploring whether a call, not categorised as Category 1 from the Dispatch on Disposition process, should nonetheless have been recategorised in the light of additional information. To argue this will likely require expert evidence as to why the clinician considering the information ought to have realised that the call in fact related to a life-threatening situation as opposed to one that was only urgent or of even lower priority.

Delays in dispatch once requested

Assuming that a Category 1 dispatch is requested, as a caller one would hope that the ambulance would be dispatched and en route to the scene immediately. Sadly, commonly this is not the case. In recent times a particular problem has arisen relating to the availability of resources. We are all familiar with hearing in the news about ambulances, occupied with patients transported to hospital from the community waiting, sometimes for many hours, to handover, their patients to staff in A&E. Until such time as that crew is clear from their previous job that resource is unavailable for dispatch.

On occasions, this can result in no resource being available to dispatch or there being a need to choose or prioritise one Category 1 over another Category 1. It is suggested that any delay that results from this situation is very unlikely to result in a finding of breach of duty. This delay, consequent upon the inadequacy of resources, is likely to be regarded as unavoidable. It will only be if resourcing can, in and of itself, be objectively demonstrated to be insufficient to enable the Trust to meet its obligations to exercise reasonable skill and care that this could potentially result in a finding of breach of duty. An example may be where the number of ambulances in service is patently insufficient to properly serve a population, perhaps lower than had previously been operated. It is suggested that such situations will be vanishingly small in number.

Delays after dispatch

Assuming that an ambulance is then available and is dispatched, operation performance standards require a specific response to be achieved. There will be many variations in response times, for example, the location of the patient, the availability of ambulance crews and units, road delays etc. Where a delay has potentially resulted in a fatality there is likely to be enquiry within an inquest setting, where the Coroner may be interested in missed opportunities and preventing future deaths

Pursuing your case

Cases involving ambulance treatment are complex. We have handled many cases involving ambulance treatment.

Browell Smith & Co have an experienced clinical negligence team who can assess all of the evidence relative to the way in which your treatment was handled. Our assessment may include obtaining the telephone call recording to 999, examining call logs and response times, evaluation of events from the initial call handling to the treatment provided at the scene and delivery to Hospitals A and E.

Contact our team today!

We are able to provide representation at Inquests when required. Our experienced team will be able to guide you through the process at all times. We are able to provide representation at Inquests when required. Get in touch with our team of Medical Negligence Solicitors today to find out how we can help you.

Cauda Equina Syndrome: what is it and what you need to know

Cauda Equina Syndrome is a medical condition that causes severe pain in the lower back and is very serious. It is not widely known about, but if it is not treated quickly and effectively, it can lead to paralysis of the legs, long-term pain, as well as loss of bowel or bladder functions.

Cauda Equine Syndrome mainly affects people aged between 31 and 50. It is estimated that one in five patients who have the condition go on to suffer serious long-term symptoms1.

In this blog, we look at what causes Cauda Equina Syndrome, what the symptoms are and what the long-term effects can be if it is not treated properly.

What causes Cauda Equina Syndrome?

The syndrome occurs when nerves below the end of the spinal cord, known as the cauda equina (Latin for “horse’s tail”), are damaged as a consequence of a number of factors, not exclusively but most usually:

  • Disc herniation
  • Spinal stenosis
  • Cancer
  • Traumatic injury
  • Epidural abscess
  • Epidural haematoma

The nerves from this part of the spine, the bottom third of the spine from T12/L1 vertebrae to the coccyx, are essential for sending messages to and from your legs, feet and pelvic area, including your pelvic organs.

What are the symptoms of Cauda Equina Syndrome?

The onset of symptoms of CES may be rapid or gradual, and can include:

  • Severe pain in the lower back
  • Sciatic pain radiating down one or both legs
  • Numbness around the anus
  • Loss of bowel and/or bladder control
  • Paralysis of the leg or loss of function
  • Motor weakness and sensory deficit in the extremities of the lower limbs
  • Reduction/absence of reflexes in lower extremities

If you are suffering any of these, you should seek medical attention straight away.

What are the long-term effects of Cauda Equina Syndrome?

Unfortunately, if not treated early, the symptoms in a number of patients, may become permanent. Even with treatment a small percentage will not recover function fully or at all. Occasionally the consequences of not seeking treatment or diagnosis being missed or delayed can result in permanent Bowel or Bladder problems and/or sexual dysfunction.

If you suffer from any of these symptoms then consult your GP. If severe, especially if displaying more than one of those symptoms, you should consider attending your local Accident and Emergency Department as time is, in the case of CES, of the essence.

Patients must be treated quickly to avoid symptoms displayed becoming permanent.

Cases of suspected are usually identified by the non-invasive use of MRI or CT Scan. Treatment is usually surgical, by way of laminectomy or lumbar decompression surgery2.

If you believe that you have had Cauda Equina Syndrome and it was either not diagnosed properly or incorrectly treated, then you can read more about making a claim on our dedicated Cauda Equina Syndrome page.

Our team of personal injury and medical negligence specialist solicitors will be able to tell you if you have the basis of a successful claim. All enquiries are made in complete confidence and will be treated with the sensitivity you deserve.

More information on CES is available from the NHS via this link (opens a PDF file).

  1. “Assessment and management of cauda equina syndrome.” https://www.sciencedirect.com/science/article/pii/S246878121830211X#bib11
  2. “Lumbar Decompression Surgery.” https://www.nhs.uk/conditions/lumbar-decompression-surgery/why-its-done/
Learn more about Cauda Equina Syndrome

Awareness of meningitis vital for parents, university students

The Meningitis Research Foundation recently issued a warning to parents and healthcare professionals about the importance of seeking treatment for meningitis quickly.

Meningitis is an infection of the protective membrane that surrounds the brain and spinal cord. If not treated quickly, it can be life-threatening.

The Meningitis Research Foundation reported that almost half of children who present at hospital with a meningococcal infection, the most common cause of bacterial meningitis, are not admitted to hospital and sent home, only to become rapidly more ill. This detracts parents from seeking further medical advice even though the child is developing a life-threatening illness.

The charity also said that 30 per cent of young babies who are taken to the doctor with bacterial meningitis initially receive inappropriate or inaccurate treatment, which delays parents seeking further advice.

Meningitis symptoms can be very difficult to recognise and can develop in any order. People who develop meningitis often only exhibit non-specific symptoms during the first four to six hours, which is especially true for children.

Individuals may never display the ‘classic’ symptoms of meningitis, and in many cases, meningitis can resemble a cold, the flu or even a hangover. However, it’s a serious infection that can cause life-threatening blood poisoning and leave permanent damage to the brain and nerves.

The Meningitis Research Foundation has recommended strategies around ‘safety netting’ – providing information about meningitis and sepsis to parents and patients if they present at hospital with any meningitis-related symptoms. Parents should also trust their instincts, and not be afraid to seek further medical help if symptoms are getting worse.

Meningitis and university students

Meningitis most commonly affects babies and young children, but the second-most “at risk” group for the disease is teenagers and young adults.

It’s a growing threat for young people starting university. Public Health England has said that the disease has seen a rapid increase in recent years. One factor is when freshers enter into confined environments with close contact in university halls. It’s also often overlooked by young adults since the symptoms can resemble a hangover.

Awareness of the disease is key for young people starting at uni, and many universities are now providing information as part of students’ inductions. Vaccinations are also available from the NHS.

Spotting the symptoms of meningitis

Meningitis is spread by sneezing, coughing, kissing, or sharing utensils. Some people may carry the bacteria but not become ill.

The following symptoms may or may not appear, and they could show up in any order.

  • a blotchy rash that doesn’t fade when a glass is rolled over it
  • high temperature: 38C or above
  • lack of energy
  • headache
  • irritability
  • aching muscles and joints
  • a stiff neck
  • cold hands and feet
  • fast breathing
  • pale, mottled skin
  • confusion
  • sensitivity to bright lights
  • drowsiness
  • fits or seizures

 

Babies may experience the same symptoms, as well as:

  • refusing to eat
  • agitation
  • uncomfortable when being picked up
  • fontanelle, which is a bulging soft spot on their head
  • being unresponsive
  • floppy or stiff
  • high-pitched crying

 

You can learn more about meningitis from the NHS website.

 

Browell Smith & Co Solicitors specialise in medical misdiagnosis claims, where illnesses like meningitis are not diagnosed or diagnosed too late. We help secure compensation for people who have suffered unnecessarily or families who have lost a loved one too early. 

Contact us if you or someone you know has experienced a delayed or missed diagnosis. We can arrange a no-obligation appointment at any of our offices in Newcastle, Cramlington, Ashington or Sunderland.

Learn more about missed diagnosis

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