Prevention of Future Deaths reports · 2013

Lucy Hannah Rose Bailey

Regulation 28 report to prevent future deaths, reference 2013-0176, written 6 Aug 2013. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report6 Aug 2013
Reference2013-0176
DeceasedLucy Hannah Rose Bailey
CoronerRobert Chapman
Coroner areaRutland & North Leicestershire
CategoryCommunity health care and emergency services related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

Trevor H. Kirkman M.A.
H.M. Coroner for Rutland & North Leicestershire

JRCALC

South Central Ambulance Service
NHS Foundation Trust

7 & 8 Talisman Business Centre
Talisman Road

Bicester

Oxfordshire

OX26 6HR

6th August 2013.

Dear Sir,

Re: Lucy Hannah Rose Bailey (deceased)
Inquest Hearing: 10" July 2013 at Loughborough Coroners Court

Report under Regulation 28 of The Coroners (Investigations) Regulations
2013 and paragraph 7(1) of Schedule 5 to the Coroners and Justice Act 2009

Lucy Bailey died at the Leicester Royal Infirmary on the 17% September 2010. |
resumed and concluded the inquest into the death of Lucy on the 10" July 2013 and
found that the medical cause of death was:

ta Hypoxic ischaemic encephalopathy ;
I gave a Narrative Verdict and enclosed a copy of the Inquisition.

Report under Regulation 28 of The Coroners (Investigations) Regulations
2013 and paragraph 7(1) of Schedule 5 to the Coroners and Justice Act 2009

| am reporting this matter to you in accordance with Regulation 28 of The Coroners
(Investigations) Regulations 2013 and paragraph 7(1) of Schedule 5 to the Coroners
and Justice Act 2009

This provides that where the evidence gives rise to a concern that circumstances
creating a risk of other deaths will occur or will continue to exist in the future, and in
the coroner's opinion action should be taken to prevent the occurrence or

HM Coroners Office, Southfield Road, Loughborough, LE11 2TG
Tel : 0116 305 7732 Fax : 01509 550473

In accordance with Regulation 28 and Paragraph 7 (1) a copy of this report is being
sent to the Chief Coroner and all the other properly interested persons identified at
the Inquest, together with other people | believe may find it useful or of interest. A list
of recipients can be found at the end of this report.

Your response to this report will also be shared with those listed.

The Chief Coroner may send a copy of the report and response to any person who
the Chief Coroner believes may find it useful or of interest, In addition, the Chief
Coroner may publish a full copy or a summary of the report and response.

Regulation 29 of The Coroners (Investigations) Regulations 2013 and paragraph
7(1) of Schedule 5 to the Coroners and Justice Act 2009

requires that you give a written response within 56 days of the day the report is sent,
If you are unable to respond within that time, you may apply to me for an extension,

The response must contain:

a. details of any action that has been taken or which it is Proposed will be taken
whether in response to this report or otherwise, and set out a time table of the
action to be taken or proposed to be taken, or

b. an explanation as to why no action is proposed,

Within 56 days you may make written representations to me about:
a. The release of your response; or
b. The publication of your response

The written response will be sent to the Chief Coroner who will decide whether there
should be any restrictions on the release or publication of the response

Facts and Circumstances

On the morning of the 16" September 2010 Lucy's mother, started her
contractions whilst she was at home. An ambulance was called and @ paramedic and
his colleague who was a qualified technician, arrived at 07.39. They in turn
summoned a midwife.

The labour continued and her waters broke. A second ambulance crew arrived
staffed by Emergency Care Assistants. The paramedic put into the
McRoberts position and the baby’s head was born but her body did not follow.

was then put on all fours, but the birth did not continue. At no time was there

any gentle traction to the baby’s head b edic or any internal manipulation
of the baby whilst she was in ia

position, and that her shoulders semi-rotated as the baby was expelled.

Lucy was not breathing, and CPR was applied. Lucy was placed in the ambulance to
= a to hospital and a heart rhythm and spontaneous circulation was recorded at
.56,

However at hospital it was clear that Lucy had been starved of oxygen and had
suffered irreparable brain damage. She died the following day, on the 17!
September 2010.

The evidence given at the Inquest by the paramedic concerned and by an expert in
paramedic training, was that shoulder dystocia was.a known hazard, and that the
training guidelines specifically provided for the paramedic to put the mother into
different birthing positions to try to assist a natural birth. The evidence was that the
paramedic training process prohibited the paramedic from Providing traction to the
baby’s head, or providing any internal or external manipulation of the baby whilst in
the mother’s vagina.

The standard training reference documents on paramedic training are provided by
the Institute of Health Care Development (IHCD) training manual, and the Joint
Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.

BE consurant in Obstetrics and Fetal Maternal Medicine, was
instructed by HM Coroner to provide an independent report. In his evidence at the
Inquest he felt it likely that the baby was large, and that the birth was hindered by
soft tissue dystocia rather than shoulder dystocia. He felt that had the paramedic
been in a position to provide gentle hands on traction of aby’s head or gentle
internal manipulation of the baby whilst in pn bd Lucy may have
been born without injury.

He went on to suggest that it was appropriate for paramedic training to provide for
hands on assistance in giving gentle traction to the baby’s head and that the risk to

Action which, if taken, may prevent a future fatality or reduce the risk of death
created by such circumstances

That consideration should be given to amend the training manuals and guidelines to
provide for the training of paramedics to assist a birth by Providing gentle traction to

the baby’s head and/or gentle internal manipulation of the baby whilst in the mothers
vagina.

Following the Inquest into Lucy’s death there has been so)
of e mail correspondence between and
Obstetrician, who is a reviewer and author of the JRCALC guidance. Copies of the
exchange of emails are attached and it appears that agrees that it was
to be expected that the birth attendant would apply gentle traction outwards and
downwards on the baby’s head after two contraction had elapsed.

in his e mail Says: “In order to know if McRobert’s (or any other
manoeuvre) has worked, the Person delivering MUST apply appropriate gentle
traction to the head (with maternal affort) in order to see if the shoulders will deliver.
Just applying McRoberts (with or without suprapubic pressure) but not applying
gentle traction to the head will not likely lead to completion of delivery.”

Distribution of this Letter

Reply required from:

helpful exchange
Consultant

or ceummm rasa JRCALC Chairman, South Central Ambulance Service NHS
oundation Trust.

East Midlands Ambulance Service, through their solicitors, Brown Jacobson.

For information to:

_ e am on = Children Board

he Chief Coroner

Time for Response

This letter is being sent out on the 6" August 2013. | therefore calculate that the
detailed reply should be received by 1§ October 2013.

| have power pursuant to Regulation 29 to extend the period of 56 days for the
response if application is made by the recipient of this letter and sets out detailed
grounds which are sufficient to persuade me that an extension of time is required.
| await hearing from you accordingly.

Yours sincerely,

Robert Chapman
Assistant Deputy Coroner

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from South Central Ambulance Service (PDF)
South Central Ambulance Service  t~J:ki 

NHS Foundation Trust 

, Assistant Medical 
Director (North) 
Units 7 & 8 
Talisman Business Centre 
Talisman Road 
Bicester 
Oxfordshire
OX26 6HR 

19 December 2013 

To:  Robert Chapman 
Assistant Deputy Coroner 
H.  M.  Coroner's Office 
Southfield Rd 
Loughborough 
LE11  2TG 

Dear Sir, 

I  am  writing  in  relation  to  your letter sent  to  the  Joint  Royal  Colleges  Ambulance 
Liaison  Committee dated  5th  August 2013,  in  relation  to  the  death  of Lucy Hannah 
Rose  Bailey  (deceased)  and 
report  under  regulation  28  of  the  Coroners 
(investigations)  Regulations  2013  and  paragraph  7  (1)  of  schedule  5  to  the 
Coroners and Justice Act 2009. 

I  wish  to  inform  you  that  a  review  of the  UK  ambulance  service  clinical  practice 
guidance  on  the  management  of the  birth  delivery complication  shoulder dystocia 
has  taken  place.  The  guidance  has  been  updated  with  advice  and  input  from 
specialists  in  obstetrics  and  midwifery.  We  issued  the  updated  guidance  to  the 
Medical Directors of Ambulance Trusts across the UK on  1y!h  December 2013. We 
asked  that the  updated  guidance  is  issued,  made  available to and  implemented  by 
clinical staff within their trusts. 

Yours sincerely 

Chairman JRCALC Guideline's sub-committee 

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road,  Bicester 0X26 6HR

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