Trust A
Paramedics spoke to Mr L in a disrespectful and derogatory manner repeatedly
22. Mr L complains the paramedics who attended him when he called 999 were disrespectful and derogatory towards him when they said ‘you’re a 34 year old man’. We are sorry to hear Mr L felt this way. His friend was on the phone to him during the paramedic’s visit. The statement from his friend supports Mr L’s version of events.
23. The Trust asked the paramedics to provide a statement about the event. Both paramedics’ statements support one another’s. They did not consider they were disrespectful or derogatory to Mr L. The Trust have explained the paramedics were trying to ease his concerns by reassuring him his age did not place him in a risk category for his symptoms.
24. On balance of evidence, it is not possible for us to make a decision staff got things wrong because there are two conflicting versions of the event.
25. We understand Mr L perceived these comments to be disrespectful and understand how distressing this must have been for him. We can also see how the paramedics may have referred to Mr L’s age with the intention of reassuring him. Because of the conflicting accounts, we cannot comment on the intent behind the paramedic’s words. Whether the paramedics were disrespectful in the way they acted and used this statement is also a subjective consideration.
26. Our NHS complaint standards state an organisation should seek input from the relevant staff members, provide a clear account of the events and respond to the concerns raised.
27. We consider that the Trust has acted in line with our NHS complaint standards. It sought input from relevant staff, provided a clear account and responded to the concerns Mr L raised.
28. In these situations, where there are conflicting accounts and conflicting perception of events, we are unlikely to reach a view as to whether there are failings. For this reason, we have decided not to look into this part of the complaint further.
The paramedics did not support Mr L to get to the ambulance when he told them about his spinal injury and when physically struggling to stand
29. Mr L complains the paramedics did not provide him with support to get to the ambulance despite him telling them he has a spinal injury. The Trust has spoken with the paramedics and in its response say the paramedics were unable to remember him mentioning his spinal injury.
30. We have seen no other evidence to help us conclude either account was more likely. This leaves us with the two conflicting accounts, both of which are plausible. For this reason, we consider the conflicting evidence is equally balanced and we cannot reach a view on what happened. This means we can therefore not reach a view on whether the Trust acted in line with guidelines and will not be taking this matter any further.
Mr L asked to go to a particular hospital but paramedics refused
31. Mr L complains he asked to go to Hospital A. However, the paramedics took him to Hospital B. He says he explained he would be unable to wait to be seen at Hospital B due to his pre-existing spinal injury. In its response, the Trust explained the paramedics do not recall Mr L’s request to be taken to Hospital A.
32. It also explains Mr L is outside of the area for Hospital A and it requests the paramedics do not send patients out of area to them unless there is an operational need to do so. It goes on to explain the closest hospital to Mr L is Hospital B and patients are taken to the nearest hospital.
33. Trust A’s Patient Care Handbook says the core principle where conveyance to hospital is needed is the patient attends the nearest Emergency Department (ED). As Trust A’s staff took Mr L to the nearest hospital with an ED, we saw they acted in line with guidelines and no failing.
34. We recognise Mr L had a preference on which hospital he went to. We hope we have clearly explained Trust A’s procedure and why staff took him to Hospital B.
When he arrived at the hospital, Mr L was taken to a ward and left standing for fifteen minutes whilst waiting for paramedics to finish talking amongst themselves
35. Mr L complains paramedics took him to a ward on arrival to Trust B’s hospital and told him to wait by the door. He says the paramedics talked amongst themselves for about fifteen minutes while also assisting an elderly patient. He says he was then taken to A&E. Mr L says he questioned this and was told it was normal procedure.
36. Trust A says the paramedics took Mr L to Rapid Assessment Triage (a small area of A&E with beds). It says it is standard procedure for all patients brought in by ambulance to be taken there for the handover.
37. A statement from one of the paramedics says they attended to an elderly lady there whilst awaiting nurse availability to give the handover. When handover with the duty nurse was complete, the paramedics say they were instructed to take Mr L to A&E. Another of the paramedic crew has written in their statement the assisting of the elderly patient was whilst awaiting nurse handover and so did not delay Mr L’s treatment or care.
38. Having considered these accounts about what happened, we saw they align. Trust A’s account provides extra explanation on why paramedics left Mr L waiting and the interactions they had during this period.
39. The Standards of Proficiency for Paramedics, 2.9, state paramedics should understand the scope of a professional duty of care and exercise that duty. We feel the paramedics have exercised their duty of care when attending to the other patient whilst awaiting handover with the duty nurse.
40. Further, 4.5 of the above guidelines states paramedics should exercise personal initiative and demonstrate a logical and systematic approach to problem-solving. We view the paramedics assisting the other patient whilst waiting for further instruction a good use of their initiative. We consider they were trying to be helpful at a time they were awaiting instruction from Trust B’s nurse about Mr L. Therefore, we see no indication that something went wrong.
41. Trust A says it is standard procedure to take patients to the Rapid Assessment Triage if it is open. It says the duty nurse looked at Mr L’s observations and told the crew to take him to triage. The paramedics have handed over to the duty nurse and the duty nurse has instructed them on where to place the patient in order to be seen by a doctor.
42. The Standards of Proficiency for Paramedics, 8.1 and 8.2 state paramedics should work in partnership with colleagues and other health and care professionals and recognise the principles and practices of others. In this instance, the paramedics worked with the duty nurse at Trust B to ensure the appropriate next course of action was taken. This is in line with the Standards of Proficiency.
Trust B
Trust B did not provide pain relief for Mr L’s fever
43. Mr L complains Trust B did not provide pain relief for his fever when he asked for it in triage at 5.41am.
44. In its response to his complaint, Trust B explained his fever was within normal parameters at triage and throughout his time in A&E. It also explains the handover notes from the ambulance noted he had paracetamol at 4.35am, prior to arrival, and could not be given further paracetamol at that time.
45. The triage notes from Trust B show Mr L had a National Early Warning Score (NEWS) of zero. NEWS is a scoring system created by the Royal College of Physicians (RCP) and is endorsed by NHS England and Improvement. It measures respiration rate, oxygen saturation, systolic blood pressure, pulse rate, consciousness and temperature.
46. Mr L’s NEWS of zero indicates his temperature was within normal parameters. On this basis, our ED adviser said he did not require paracetamol to control it, or for any fever.
47. The British National Formulary (BNF) states paracetamol cannot be given to a patient any closer than four hours a part. As it was less than four hours since paramedics gave Mr L paracetamol, our ED adviser would not expect staff to have given him this medicine at the time.
48. Having considered the above information, we saw Trust B acted in line with this guidance as only one hour had passed since Mr L previously had paracetamol. We see no indication that anything went wrong.
Trust B did not give Mr L oxygen or a nebuliser to aid his breathing
49. Mr L says he was not given oxygen or a nebuliser even though he was struggling to breathe.
50. Trust B’s response states Mr L’s observations, including blood pressure, respiratory rate and oxygen saturations were all within normal range so additional oxygen and nebulisers were not indicated clinically at that time.
51. The medical notes from A&E confirm this as his NEWS was recorded as zero.
52. We understand Mr L feels he should have been offered oxygen as he is a sickle cell carrier. We asked our ED adviser if being a sickle cell carrier should have made a difference to being offered oxygen or a nebuliser for his breathing. Our adviser said Mr L being a sickle cell carrier would not have changed the treatment offered because his observations gave him a NEWS score of zero.
53. The NHS guidelines on Sickle Cell Disease states carriers are only at risk of health problems in rare cases where they do not get enough oxygen. Given Mr L’s oxygen levels were within normal levels, he was not at risk. This meant staff were not required to give him oxygen or a nebuliser.
54. For this reason, we have found no indications of failings and will not be taking any further action on this part of the complaint.
Trust B left Mr L with a cannula in his arm for fifteen hours
55. Mr L says he was left with a cannula in his arm for fifteen hours without fluids or medication given to him through it. Trust B explained in its response all patients who require blood tests have a cannula inserted during triage to prevent delays for when medical treatment is required. It also explains the cannula stays in until the patient leaves the department in case the patient’s clinical state worsens and intravenous fluids and medication are required.
56. We asked our ED adviser what should have happened. Our ED adviser stated it is common practice to leave a cannula in for the same reasons Trust B highlighted. The adviser explains cannulas can be left in a patient for up to 72 hours. The Cochrane Review (2016) says the US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72-96 hours, which is every three to four days.
57. Based on the evidence we have seen, Trust B acted in line with relevant guidelines when leaving Mr L’s cannula in for the duration of his A&E stay. We therefore will not be taking this part of the complaint further.
58. We recognise Mr L was left feeling disappointed after the Trusts’ investigation of his complaint. We are sorry to hear that following his visit to A&E, his symptoms of COVID-19 worsened and he needed treatment.
59. We thank Mr L for taking the time in bringing his complaint to our attention. We hope our explanations offer reassurance that both organisations provided care and treatment in accordance with guidelines, and we have clearly explained our decision.