Коронер подверг сомнению работу операторов экстренных служб после смерти подростка от сепсиса

Sepsis death of Surrey teen sees way certain 999 calls are handled called into question The Assistant Coroner for Surrey raised concerns with how certain types of 999 calls are handled by the NHS The way in which ambulance staff handle and categorise certain 999 calls has been called into question by a Surrey coroner following the death of a 17-year-old boy who died in 2024 from septicaemia caused by meningitis bacteria. ‌ Oliver Shelley, 17, died at 11.30pm on July 22, 2024 at East Surrey Hospital in Redhill just under eight hours after he was first taken to the hospital by his parents. ‌ HM Assistant Coroner for Surrey, Dr Karen Henderson declared that Shelley's cause of death was as a result of complications of overwhelming meningococcal septicaemia, a severe form of blood poisoning caused by meningitis bacteria. ‌ Prior to his death, the report states that Ollie was "generally fit and well with no underlying medical problems". However he begun showing symptoms of meningitis and sepsis that afternoon, which led his parents to call 999. The Coroner has since raised concern with the way in which 999 calls regarding sepsis symptoms are dealt with by the NHS ' call handlers, also known as emergency medical advisors (EMAs). Dr Karen Henderson warned that because EMAs generally do not have any medical or nursing qualifications, the use of a title such as 'advisor' is "misleading" for those who use the 999 service. ‌ The Assistant Coroner for Surrey said in a recently published report: "Other than some in-house training, Emergency Medical Advisors (EMAs), generally have no qualifications in medicine or nursing. "As such, the use of this title to describe their role raises a real concern they are misleading the public who use the 111/999 service. ‌ "Oliver’s parents gave an extremely clear assessment of Oliver’s condition and also informed the EMA that they were concerned it was meningitis. However, this was not recognised by the EMA reaffirming their limited abilities." Dr Henderson raised specific concerns about the lack of a sepsis algorithm pathway to assist an EMA during emergency service calls. Suggesting that, because there is not one in the NHS system, the EMA was left unable to advise Oliver's parents at the best course of action. ‌ Emergency medical advisors (EMAs) for Surrey are managed by the South East Coast Ambulance Service (SECAmb). The service's Chief Nursing Officer has told SurreyLive that their "deepest sympathies remain with Oliver’s family". Also thanking the family for their involvement in helping the service to address what led to Oliver's death. NHS England has also responded to the concerns raised by the Assistant Coroner, publishing a response which identifies a number of ways services could improve, such as implementing "clearer rules of escalation", faster access to clinicians and new technologies to "prioritise risk". ‌ According to the Coroner's report into the death, SECAmb's investigation into the matter deemed that the EMA’s management of the 999 call was "not compliant". The service also acknowledged that a dedicated sepsis algorithm in the NHS Pathway would make it less challenging for EMAs when dealing with individuals who may have sepsis. According to the Prevention of Future Deaths report regarding Ollie Shelley, a timeline of events on July 22, 2024 reads as follows: ‌ At 2.51pm - Oliver’s parents phoned emergency services after he had become "noticeably unwell" Oliver’s parents called 999 indicating their concern that Oliver was suffering from meningitis as he was suffering from a non-blanching rash, vomiting and reduced level of consciousness. At 2.57pm - the EMA handling the 999 call requested operational support after being unbale to find a meningitis pathway within the NHS Pathways system At 3.51pm - the EMA ended the call indicating to Oliver’s parents that a call back was scheduled within 20 minutes At 3.55pm - Oliver's parents take him to East Surrey Hospital At hospital Oliver was reportedly "gravely unwell" and was given maximal supportive management While they were at hospital, SECAmb EMAs called the parents back at around 5.30pm and again at around 6.10pm. In the absence of a response, the service closed the referral. At 11.30pm - Oliver Shelley dies in East Surrey Hospital as a result of complications of overwhelming meningococcal septicaemia Speaking to SurreyLive regarding the matter, Jo Turner, the SECAmb Interim Chief Nursing Officer said: "Our thoughts and deepest sympathies remain with Oliver’s family. We are extremely grateful to them for working so openly with us throughout our investigation and since. Article continues below "Their involvement has helped us better understand what happened and implement necessary improvements to our systems, processes and training. "We are committed to continuing to learn from Oliver’s death and listening to all patients and families to further improve the quality of care we provide."