Dear Sir, I am writing in relation to your letter sent to the Joint Royal Colleges Ambulance Liaison Committee dated 5th August 2013, in relation to the death of Lucy Hannah Rose Bailey (deceased) and report under regulation 28 of the Coroners (investigations) Regulations 2013 and paragraph 7 (1) of schedule 5 to the Coroners and Justice Act 2009. I wish to inform you that a review of the UK ambulance service clinical practice guidance on the management of the birth delivery complication shoulder dystocia has taken place. The guidance has been updated with advice and input from specialists in obstetrics and midwifery. We issued the updated guidance to the Medical Directors of Ambulance Trusts across the UK on 1y!h December 2013. We asked that the updated guidance is issued, made available to and implemented by clinical staff within their trusts.