Decision Report 201500443

Summary

Mr C complained about an ambulance crew that attended his wife (Mrs C). After Mrs C was taken to hospital, she was diagnosed with a ruptured abdominal aortic aneurysm (a weak point in a blood vessel), which was a life-threatening condition. Mr C said the crew did not diagnose his wife's condition or provide treatment for it, and did not regard the situation as an emergency. In addition, Mr C was unhappy with the ambulance service's response to his complaint.

We took independent advice from an adviser who is a consultant in emergency medicine. Although we would not expect the crew to make a definitive diagnosis of an abdominal aneurysm, we found that they should be able to recognise when a patient is seriously unwell. In this case, the crew assumed that Mrs C's symptoms were due to sciatica (back and leg pain caused by irritation or compression of the sciatic nerve) or muscular back pain, and they failed to recognise that she had a life-threatening condition. We upheld this part of Mr C's complaint. Once the crew decided to take Mrs C to hospital they gave her morphine. In this respect, they provided treatment to Mrs C and so we did not uphold this part of Mr C's complaint.

The crew did not use blue lights when taking Mrs C to hospital, which was reasonable as it was the early hours of the morning. However, doing this was another indication that the crew did not recognise Mrs C was seriously unwell, as was their discussion about leaving Mrs C at home for review by her local doctor. We upheld Mr C's complaint that the crew failed to regard the situation as an emergency. In addition, we had concerns about the accuracy of the ambulance service's response to Mr C, and we upheld this aspect of his complaint.

Recommendations

We recommended that the ambulance service:

• apologise to Mr C for the failings identified by our investigation;
• ensure that staff are aware of the signs and symptoms of leaking abdominal aortic aneurysms, including atypical presentations;
• ensure that staff are aware that normal vital signs do not exclude serious and life-threatening medical and surgical conditions;
• ensure that, when making a decision not to transport patients to hospital, their staff document detailed history and examination findings which confirm the diagnosis of a minor illness. Documentation in these circumstances should demonstrate that significant clinical findings, both positive and negative, have been interpreted within the context of the clinical history and inform the clinical outcome;
• ensure that, when making a decision not to transport a patient to hospital, their staff reference which alternative pathway route is being followed; and
• ensure that staff investigating complaints use appropriate reference material, such as clinical textbooks, when considering matters of clinical judgement.