Full North East Ambulance Service statement as coroner rules failures contributed to County Durham dad's death
by Nicole Goodwin · ChronicleLiveNorth East Ambulance Service has apologised after an inquest found failings and neglect contributed to a dad-of-five's death.
Aaron Morris, 31, was due to become a dad to twins when he was involved in a motorbike collision in Esh Winning, County Durham, and died on his wife Samantha's 28th birthday. Today, a coroner ruled that there were elements of neglect from North East Ambulance Service (NEAS) in Aaron's death on July 1, 2022.
Throughout a five-day inquest, County Durham and Darlington Coroner's Court heard how Aaron lay injured in the road for almost an hour before an ambulance arrived at the scene. It took 54 minutes for an ambulance to arrive by his side, when it should have arrived in 18 minutes.
There was a high demand on the ambulance service around the time of the collision, with 56 calls recorded at 12pm. The call should have been picked up within five seconds. However, the inquest heard that the first 999 call requesting medical support for Aaron at 12.27pm was on hold for 96 seconds.
A third-party ambulance company, Ambulnz, which was supporting NEAS, was allocated at 1.08pm and arrived on scene at 1.21pm, coming to a stop at 1.22pm. However, the inquest ruled that critical support from a Critical Team Leader (CTL) could have been on the scene sooner.
The court heard that the CTL was based approximately 9.1 miles away in Stanley at the time of the collision and could have attended. But she was in a meeting she didn't need to be in and did not dispatch to the scene when a colleague queried whether she was available.
Senior Assistant Coroner, Crispin Oliver, ruled that "failure of [the] ambulance service's Clinical Team Leader to deploy to the scene from 12.52pm, when there was certainly enough information for her to do so", was another failure which could have led to Aaron's death.
He concluded that it was "highly likely" that Aaron would have survived had "available specialist medical treatment been applied in a timely manner."
Following Aaron's death, NEAS conducted an investigation and admitted there were failings in the treatment he received. The Trust said that it accepts today's findings and has already taken steps to ensure this won't happen again.
Dr Kat Noble, medical director for North East Ambulance Service, said: "Firstly, I would like to say to Samantha, and all of Aaron's family that I am deeply sorry.
"When concerns were raised with us about Aaron’s care, we reported these as a serious incident and undertook a thorough investigation into what had happened. We shared the outcome of the serious investigation review with Aaron's family.
"There were a number of organisations involved in this case and we unreservedly apologise for not providing the right care from our service when Aaron needed it. We accept that opportunities were missed to deploy a clinical team leader to this incident. This is the responsibility of the teams monitoring incoming and changing information about a patient’s condition, rather than one responder alone and we have made changes to our deployment processes to ensure that this couldn't happen again.
"There were a number of other actions arising from the review of this incident that we have taken forward to improve the coordination of our response and we fully accept the coroner’s findings and conclusion."
Samantha and the coroner have both praised NEAS for their open and honest approach throughout the inquest and investigations following Aaron's death.
Samantha said: "The transparency and proactive approach of NEAS and GNAAS is appreciated and I am glad lessons have been learnt. Changes have already been implemented to prevent other families having to go through such a terrible experience. They have offered me support before, during and after the inquest and we have had open discussions about how the new trauma desk works and the organisation changes that have been made."
The coroner told the court: "The response to what happened here has been a model of how institution interested persons in inquests should respond to a situation like this."
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