Decision Report 201300911

Summary

After Mr C's daughter (Mrs A) experienced several episodes of breathlessness, she was seen by her GP who concluded she had a virus. Over the following days, Mrs A remained breathless. She collapsed at home and her GP was called out. He found that her blood pressure was low, but rising. He concluded that she had had a vasovagal episode (a temporary loss of blood to the brain) but was improving. Mrs A had further collapses over the following days. An ambulance was called on one occasion, but was cancelled when Mrs A became more alert. However, an ambulance was again called later that day after Mrs A collapsed for a second time. The ambulance crew reportedly helped her into bed, but said that there was not much more that could be done at that point, even if they took her to hospital. Mrs A continued to struggle with her breathing the next day and, in the early hours of the following morning, an ambulance crew attended and took her to hospital. Shortly after arriving there, Mrs A collapsed and, despite attempts to revive her, she died. Mrs A was found to have had a pulmonary embolism (a blockage in the artery that transports blood to the lungs). Mr C felt that Mrs A might have survived had an ambulance crew taken her to hospital after the first attendance, or had the crew that did eventually take her to hospital acted with more urgency.

We were satisfied that the ambulance crews obtained relevant information about Mrs A's recent symptoms and carried out thorough examinations during both attendances. We took independent advice from one of our medical advisers, who said that Mrs A was displaying two symptoms that could indicate pulmonary embolism, but that these were also consistent with other more common illnesses, including viral infection. We concluded that although with hindsight it was evident that Mrs A's symptoms were related to a serious underlying condition, this would not have been apparent to the ambulance crews when they attended. Although the consequences were tragic for Mrs A and her family, we found that the ambulance crews' assessments and conclusions were reasonable under the circumstances.