A PREVENTION of Future Deaths (PFD) report has been issued to the Welsh Ambulance Service after an inquest heard that a Prestatyn lady died following delays in paramedics arriving at her home.
Rashdah Bhatti died aged 77 from blood loss at her home on June 14, 2022, with a full inquest into her death, held in Ruthin on September 11, resulting in a narrative conclusion being given.
Mrs Bhatti had began haemorrhaging from her varicose veins and although ambulance assistance was requested, there were no resources available to respond for some hours.
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This resulted in a delay which denied her “timely and potentially life-preserving treatment”, and she was pronounced dead at the scene at 9.15pm.
Following the conclusion of her inquest, John Gittins, senior coroner for North Wales East and Central, has sent a PFD report to the ambulance service, requesting a response by November 7.
An initial 999 call was made at 6.25pm, with a further six calls made before a response was allocated, with the first ambulance arrival on scene at 8.36pm.
Mr Gittins’ PFD report highlighted the following concerns:
- The trust utilises the Medical Priority Dispatch System (MPDS) and there are specific instructions within the same in relation to a varicose vein bleed, namely: “elevate the affected leg/arm (above heart level on a cushion pillow or other soft object)”.
- Although from the outset this was recognised to be a varicose vein bleed, this advice was not given in at least two of the first four calls due to human error.
- It appeared from the evidence that, until the fifth call was made at 8.04pm, no such clinically beneficial advice was given to the family members attending to Mrs Bhatti.
- Evidence was provided that a memo/reminder had been issued to staff regarding this error, but there was no evidence as to how effective this was.
The trust’s response must contain details of action taken or proposed to be taken, setting out the timetable for action.
Otherwise, it must explain why no action is proposed.
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