Assessment of Mr V’s condition
18. Mr R complains paramedics did not fully assess Mr V. He says the neck fracture may have been identified if they had done a full assessment.
19. When paramedics arrived, Mr R had been giving CPR to Mr V for around ten minutes. Mr V was unresponsive. While no one had seen what happened, Mr R thought he knew how Mr V had fallen. Mr R told us he raised concerns to paramedics that Mr V may have a neck injury.
20. The records show paramedics assessed Mr V and noted he was not breathing and was still unconscious. This was also confirmed in the call Mr R’s partner made to emergency services.
21. JRCALC guidance says that when a patient has an altered level of consciousness, an initial primary assessment should be done. The guidance explains paramedics should follow a C-ABC assessment. This means paramedics should first check for a catastrophic haemorrhage, then check that a patient’s airway is clear. After this, paramedics should check and assess breathing. If a patient is breathing, paramedics should then assess their circulation to make sure the heart is beating.
22. Our adviser explained the C-ABC assessment is followed in order. If one of the assessments is a problem, this needs to be corrected before moving on to the next stage of the assessment.
23. We can see from the records that paramedics quickly ruled out a catastrophic haemorrhage and moved on to the next part of the assessment, which was to check whether Mr V’s airway was clear. The notes show an endotracheal tube (a tube that is inserted into the throat to manage the airway) was inserted. Once paramedics established Mr V’s airway was clear, they moved to the next stage of the assessment to check and maintain breathing.
24. The records show Mr V was still having difficulty breathing. Our adviser explained this needed to be managed immediately because when a patient is not breathing there is a high chance that their heart will stop.
25. Our adviser told us the main priority at this stage would have been to keep Mr V breathing to save his life. When his breathing could not be stabilised, paramedics took Mr V to hospital because this was a critical situation.
26. We looked at the assessment and found it was done in line with JRCALC guidance. We did not see evidence of failings. We know the assessment process will have been very distressing for Mr R to witness, but we hope we have given some clarity and assurance about what the paramedics did and why.
Questions about opioid use
27. Mr R is concerned that paramedics focused on whether Mr V had used opioids before he fell. He says this meant they were focusing on the wrong issue, instead of the neck fracture.
28. When paramedics arrived, the notes show they asked questions about what had happened. This included asking whether Mr V had used opioids.
29. JRCALC guidance says paramedics should make sure that respiratory arrest (when someone is not breathing) has not been caused by an opioid overdose, because in these situations a cardiac arrest (where the heart stops beating) is likely to happen shortly after.
30. It is important to recognise that, while some opioids are illegal, others are found in many prescription drugs and sometimes people may accidently overdose.
31. Our adviser told us paramedics carry naloxone, a medication that can reverse potentially life-threatening effects of an opioid overdose. When a patient is unconscious after a fall, paramedics may still decide to give naloxone as it is unlikely to cause harm.
32. The records show paramedics did not give Mr V naloxone because his history was taken from the family and they said opioids, in any form, had not been taken.
33. We understand this question may have concerned Mr R. We hope to reassure him that the questions were asked appropriately and in line with guidance to make sure a full assessment was done to find the cause of the fall.
Identifying the fracture
34. Mr R complains paramedics did not recognise Mr V may have fractured his neck. He says this meant they assessed him differently and he told us that if the fracture had been recognised, treatment may have been different.
35. We listened to the emergency call Mr R and his partner made. They explained they were upstairs and heard a loud bang. They went outside to find Mr V on the floor in the garden and he was unresponsive.
36. The records show paramedics noted ‘no obvious trauma’ when they arrived and assessed Mr V using the C-ABC approach.
37. JRCLAC guidance says that for patients aged 65 and older, paramedics must be particularly aware of the potential for severe brain injury or spinal cord injury in cases where a patient has fallen from a height greater than one metre or five stairs.
38. Having looked at the records, we cannot see evidence Mr V had fallen from a height greater than one metre. The Trust’s investigation report says the height from the place he likely fell was around 0.3 metres.
39. We also considered that the fall was not witnessed and, while the family did raise concerns, it was not clear what the cause of the fall was.
40. Our adviser explained that Mr V did fit into the category of being over 65, but in their opinion when paramedics arrived it was still very uncertain that Mr V had fallen and, if he had, what had caused it. There could be many reasons for someone to collapse, and these needed to be ruled out or investigated further.
41. The records show paramedics ruled out serious trauma because there were no obvious signs of a fall from a height of more than one metre, or an injury that had been caused by a fall. As there were no obvious signs of a fall from a height, paramedics used the C-ABC process to make sure Mr V’s breathing could be stabilised and to look at the cause of the collapse.
42. We know that Mr V was later diagnosed with a neck fracture, but we have not seen evidence that the paramedics failed to identify this when they arrived. We hope this gives Mr R reassurance that his father was assessed in the most appropriate way and the assessment was in line with guidance.
Moving Mr V to the ambulance
43. Mr R told us he has concerns about how Mr V was moved to the ambulance. He feels Mr V should not have been moved in a wheelchair with no neck support. He is concerned this made a difference to the outcome and could have made the fracture worse.
44. The records show Mr V was moved through the house in a wheelchair with no leg straps.
45. JRCALC guidance says crews must detect time critical emergencies early and reduce time on the scene of the accident.
46. We asked our adviser if the way paramedics moved Mr V was appropriate. Our adviser explained this situation was time critical and there was an immediate threat to Mr V’s life as he was not breathing. Our adviser told us that in these situations the priority is to stabilise the patient and transport them to hospital for further assessment.
47. We cannot say whether the way paramedics moved Mr V made a difference to the fracture, but we have seen paramedics ruled out spinal cord injury. As explained above, we think this was reasonable based on what they could see at the scene. It was appropriate for them to move Mr V as quickly as possible so he could be assessed at the hospital.
48. We know it will have been distressing for Mr R to see his father moved while he was still unconscious. We hope our findings help to explain that paramedics worked quickly to try to stabilise Mr V and they acted in line with national guidance.