18. Before we decide if we should conduct a detailed investigation of a complaint, we look at if there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications something has gone wrong. We have set out our reasons for this below.
Delays
19. Mrs O complains the Trust delayed entering the property, transporting Mr O to the ambulance and hospital.
Entering the property
20. In terms of entering the property, Mrs O said the ambulance arrived promptly, but the clinicians were slow in exiting the ambulance as they were trying to find somewhere to park.
21. The Trust said the clinicians needed to bring in their equipment before assessing Mr O. It said this is a standard procedure to ensure they have the necessary tools to provide effective care. It said while this process can take some time, they made consistent progress toward the property and acted with urgency once they were able to see and assess Mr O.
22. Mrs O’s and the Trust’s accounts for the delay entering the property are different. As we were not there at the time of events and there is little information to gather from the records about this, it is hard to say which version of events is accurate.
23. However, we have considered both reasonings with our clinical adviser and whether these were in line with what should happen.
24. There are no specific guidelines that set out a required timeframe for clinician members to enter a property.
25. However, JRCALC guideline help us understand what should happen and the standards the clinicians should follow. One of the key points in this guideline says clinicians should detect time critical problems early and minimise time on scene.
26. We understand this means clinicians should not cause undue delay in transporting a patient to hospital if required. Our adviser explained running is not advised as this causes potential risks to the clinician, for example, falling over and injuring themselves whilst running.
27. From the clinical advice we understand there are a few tasks the clinicians must complete before they enter the property to assess the patient. The clinicians must put on the right personal protective equipment (PPE - for example, gloves, face masks or gowns) and pick up the right equipment to assess or treat the patient based on the notes available.
28. Therefore, this can cause a slight delay once they arrive, but ensures the clinicians have the correct equipment to detect time-critical problems early. This also helps to minimise the time on scene, by not having to go back to the ambulance for equipment, in line with JRCALC guideline mentioned above.
29. DTAG guidance uses the highway code as its basis and provides key considerations for clinicians when parking an emergency ambulance.
30. The guidance says clinicians have a professional and legal obligation to park in a way that means the vehicle is accessible to the clinician and the patient but also impacts other road users as little as possible. This is to ensure it is safe for everyone around.
31. Therefore, if the clinicians were slightly delayed due to finding an appropriate space to park to ensure safety, this is in line with the DTAG guidance.
32. Considering the above, whether the clinicians delayed entering the property due to collecting equipment or safe parking, this was in line with JRCALC and DTAG guidelines. On this basis, we do not consider there is an indication something went wrong in the Trust delaying entering the property.
33. We recognise how distressing it was for Mrs O to see her husband unwell and in distress whilst waiting for the clinicians to arrive. We hope our consideration provides Mrs O with reassurances the Trust followed the relevant guidelines.
Transporting Mr O to the ambulance
34. Mrs O said once the clinicians were upstairs, they put an oxygen mask on Mr O and were asking questions. She said the clinicians advised he needed transporting to hospital as his oxygen levels were very low.
35. Mrs O said the clinicians asked Mr O to move himself to the other side of the bed to get in the chair, but he was too unwell to do this himself. Mrs O said they used a bed sheet to slide Mr O towards the edge of the bed. Another family member then helped the clinician lift Mr O into the chair, which the clinician strapped him into. She is concerned this caused a delay transporting Mr O to the ambulance.
36. The Trust said the clinician was fully aware of Mr O’s condition. It said they acted promptly by applying oxygen and providing necessary care to address the situation. It said Mr O was very weak, and the clinician did their best to support him under the circumstances. It recognised family members stepped into assist, which it said was completely understandable in such a stressful situation.
37. As explained above, there are no specific guidelines for exactly how long a clinician should take to transport someone on to an ambulance. There are some cases where there is a specific aim, for example, if someone is having a stroke the usual aim is often to be on scene for less than 20 minutes.
38. The JRCALC guidelines says clinicians should detect emergencies early and minimise time on scene.
39. From the clinical advice we understand this means that as soon as the clinicians recognise it is an emergency, they need to minimise the time they spend on scene. This is especially true when the patient’s condition is time critical or where there is no definitive management the clinician can give to the patient on scene.
40. For example, if the clinician cannot work out exactly what is going on and therefore cannot give the specific treatment, or if they do not carry the specific treatment or surgical interventions. Therefore, it is important to transport the patient to hospital as soon as possible.
41. The medical records indicate the clinicians clearly identified Mr O’s condition was an emergency and he needed transporting to hospital for treatment.
42. Mrs O’s account of events indicates the clinicians provided Mr O with oxygen whilst also asking questions to complete their assessment. This shows they were working efficiently to minimise the time they were on scene, in line with JRCALC guidelines.
43. Although, we recognise this will have felt like a long time for Mrs O to see her husband unwell and in distress.
44. The Trust’s ‘Health, Safety & Risk Management Framework’ helps us understand what should happen in terms of the clinicians asking Mr O to move himself.
45. This guidance on manual handling says clinicians must assess risks identified with hazardous manual handling to ensure the safest methods are employed. Manual handling refers to any activity that involves lifting, carrying, pushing or pulling.
46. The guidance says carrying or moving a patient is one of the most common forms of manual handling and clinicians should make effort to reduce the risk as much as possible. Therefore, the guidance states clinicians should ask themselves ‘can the task be avoided as far as is reasonably practicable?’
47. Our adviser explained, in line with this, the expectation of the clinicians is to do the least amount of patient handling required. This is because as soon as a clinician gets hands on this introduces risk for themselves, the patient and the people around them.
48. In line with this, it was therefore reasonable for the clinician to ask Mr O if he could move himself across the bed as the records indicate he was still responsive at that time.
49. The records show the clinicians were at scene at 3.15pm and left scene at 3.40pm. This was a total of around 25 minutes on scene. This time involved the clinician’s collecting equipment from the ambulance on arrival, entering the property, assessing Mr O, providing oxygen and transporting him to the ambulance.
50. Our advisers view, which we share, is that this is a reasonable amount of time to complete these tasks and does not appear to be a significant delay in transporting Mr O to hospital.
51. Based on the above, we consider the time the clinicians spent on scene was reasonable, they took steps to minimise time on scene and reduce manual handling risk in line with JRCALC and the Trust’s guidelines. For this reason, we have not seen an indication something went wrong, and we will not consider this further.
Transporting Mr O to hospital and oxygen
52. Once on the ambulance Mrs O said the clinician’s experienced issues with the oxygen which delayed them transporting him to hospital. She is also concerned Trust did not provide Mr O with oxygen promptly once in the ambulance. We have considered these two concerns together as they are interlinked issues about oxygen once on the ambulance.
53. There is no information within the medical records regarding what happened with the oxygen once the clinician’s and Mr O were on the ambulance. The Trust confirmed this in its complaint response.
54. Mrs O said once they were on the ambulance the clinicians noted the oxygen was not working and that it had ran out. She said one of the clinicians collected another cylinder, attached the correct tubing and gave this to Mr O. She said they then set off to hospital.
55. We discussed these events with our clinical adviser. From this advice, we understand it seems like the oxygen tank had run out on the ambulance and the clinicians needed to swap it for another.
56. The records clearly indicate Mr O required oxygen to help with his breathing. Therefore, it was important and in line with JRCALC guidelines referred to above for the clinicians to ensure this was working enroute to hospital.
57. Our adviser explained swapping an oxygen cylinder would typically take between 30 to 60 seconds. Therefore, we do not consider this caused a significant delay in providing Mr O with oxygen or setting off to hospital. Although we recognise how distressing this would have been for Mrs O.
58. Considering the above, we have not seen an indication something went wrong here. For this reason, we will not consider it further.
Responsiveness in the ambulance
59. Mrs O also complains the Trust did not respond promptly once he stopped breathing.
60. The Trust said the clinicians were regularly and closely monitoring Mr O’s condition throughout the situation. It said they were regularly checking his oxygen saturation, ensuring he was still responsive, and taking all necessary steps to provide appropriate care.
61. The Trust said when the clinician noticed a need, they changed the equipment and began assisting Mr O’s ventilation to support his breathing.
62. The records indicate that Mr O, Mrs O and the clinicians set off to hospital at 3.40pm. Around this time the notes indicate Mr O’s breathing rate dropped and so the clinician began airway management.
63. The airway management involved the clinician inserting an OPA (oropharyngeal airway). This is a device used to maintain or open a patient’s airway. It prevents the tongue from obstructing the airway, ensuring proper breathing.
64. The clinicians also provided Mr O with ventilation. This is when the oxygen is attached to a breathing bag which forcibly inserts air into and out of the lungs. This is different to a standard mask where oxygen is pushed out for the person to breathe in.
65. The above therefore indicates the clinician did react to Mr O’s decreased breathing. This was in line with JRCALC guidelines which say to initiate treatments enroute and fix any issues as they arise.
66. For this reason, we have not seen an indication something went wrong here, and we will not consider it further.
67. We hope our consideration of Mrs O’s concerns provides her with reassurances the Trust followed the relevant guidelines when treating Mr O. We thank Mrs O for bringing her complaint to us.