Decision Report 201300720

Summary

Mrs C's husband (Mr C) cut his hand in an accident at home. She dialled 999 and asked for an ambulance. The ambulance service's call handler took details of Mr C's injury but concluded that an ambulance was not necessary. Mrs C had to ask neighbours to help transport Mr C to hospital, where his injury needed surgery. Mrs C complained that the ambulance service's refusal to dispatch an ambulance was unreasonable, and was dissatisfied with their handling of her subsequent complaint.

We took independent advice from one of our medical advisers, who is a paramedic, and after considering their advice we upheld Mrs C's complaints. Our investigation found that the call handler used a nationally recognised system of scripts to obtain information about the severity of Mr C's injury. During the call, they also asked for help from a clinical adviser, who could ask questions that were not included on the script to obtain additional information. An appropriate script was chosen and largely followed, which determined that no ambulance was required. However, we considered that the decision-making process was skewed because the call handler input inaccurate information. Assumptions were made about the severity of the bleeding and the clinical adviser asked questions that demonstrated a lack of knowledge of hand injuries. Furthermore, changes in Mr C's condition during the course of the call were not acted upon appropriately. We concluded that an ambulance should have been dispatched to take Mr C to hospital.

We found that the ambulance service's handling of Mrs C's complaint was generally reasonable. However, they failed to follow their own complaints procedure as they did not contact her to advise that their decision would be slightly delayed.

Recommendations

We recommended that the service:

• apologise to Mr and Mrs C for failing to provide an ambulance;
• take steps to ensure their call handlers are able to identify and act upon changes in patients' conditions during the course of a call; and
• share this decision with the clinician involved.