Prevention of Future Deaths reports · 2022

Roy Middleton

Regulation 28 report to prevent future deaths, reference 2022-0369, written 17 Nov 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report17 Nov 2022
Reference2022-0369
DeceasedRoy Middleton
CoronerTanyka Rawden
Coroner areaSouth Yorkshire (West)
CategoryEmergency services related deaths (2019 onwards)
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS 

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS 
THIS REPORT IS BEING SENT TO: 

International Academies of Emergency Dispatch 
110 Regent St #800 
Salt Lake City 
UT 84111 
United States 

1  CORONER 

Tanyka Rawden, Senior Coroner for South Yorkshire (West) 

2  CORONER’S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice 
Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations 
2013.  

3 

INVESTIGATION 

On 16 February 2022 an investigation commenced into the death of     
Roy Middleton, aged 85 years. The investigation concluded with an inquest 
heard on 16 November 2022. The Coroner returned a narrative conclusion. 

4  CIRCUMSTANCES OF THE DEATH 

On 9 February 2022 Roy Middleton fell at his home address in Sheffield and 
struck his head. 

A carer requested emergency medical assistance at 16:41 advising the 
Yorkshire Ambulance Service that he was taking warfarin; he had a large cut to 
his head and there was ‘quite a lot’ of bleeding. The call was allocated a 
category 3 response time with a 90% centile target of 2 hours.  

A second call was made to the Yorkshire Ambulance Service by a carer at 19:52 
requesting an update on the arrival of an ambulance and expressing concern     
Mr Middleton was concussed. The call was allocated a category 3 response 
time. 

At 20:30 a paramedic from the clinical hub at Yorkshire Ambulance Service 
called and spoke to Mr Middleton’s son who described a 4-inch laceration to the 
back of Mr Middleton’s head and that Mr Middleton was becoming impatient and 
worried. He was also concerned about the amount of blood and stated his father 
was frail and concussed. The call was allocated a category 3 response time. This 
assessment was not performed correctly, and the call should have been 
changed to a category 2 which would have resulted in an ambulance would have 
arrived sooner. 

 At 22:04 a call was made by Mr Middleton’s son to Yorkshire Ambulance Service 
requesting an update on the arrival of an ambulance and stating his father’s 
condition had not changed. 

A resource was allocated at 22:33 and arrived on scene at 22:47, 6 hours and 6 
minutes after the initial call. 

Mr Middleton was taken to the Northern General Hospital in Sheffield where he 
was diagnosed with a traumatic acute subdural haemorrhage which was not fit 
for medical intervention. He died in hospital on 10 Feb 2022 as a result of this 
injury. 

The medical cause of death found was:  

1a.   Traumatic acute subdural haemorrhage 
2.

Atrial fibrillation, tricuspid valve replacement (anticoagulated), Type II
diabetes mellitus, ischaemic heart disease and chronic obstructive
pulmonary disease

The narrative conclusion given was as follows: 

Roy Middleton fell at his home address on 9 February 2022. Emergency medical 
assistance was requested but did not arrive until six hours and six minutes after 
the request was made due to service demands and a missed opportunity to re-
categorise the call. 

Mr Middleton was admitted to the Northern General Hospital where he was 
diagnosed with a traumatic acute subdural haemorrhage. He died in hospital on 
10 February 2022 as a result of this injury. 

Had he presented at hospital sooner it is possible he could have been treated 
but it cannot be said whether he would have survived. 

5  CORONER’S CONCERN 

During the course of the investigation my inquiries revealed matters giving rise to 
concern. In my opinion there is a risk that future deaths will occur unless action is 
taken. In the circumstances it is my statutory duty to report to you. 

The MATTER OF CONCERN is as follows:- 

The inquest heard that the International Academies of Emergency Dispatch 
system algorithm does not take into account whether a patient is on blood 
thinning medication when considering the category of emergency response 
required. The inquest also heard from a consultant geriatrician that “by the time 
he arrived at the hospital he was not fit for any intervention”. 

I am concerned that if the algorithm isn’t changed to take into account the affect 
of anti-coagulant medication on a head injury, deaths will occur in the future.  

I am aware the Yorkshire Ambulance Service have raised the same concern with 
the International Academies of Emergency Dispatch as a result of this incident. 

 6  ACTION SHOULD BE TAKEN 

In my opinion urgent action should be taken to prevent future deaths and I 
believe you have the power to take such action.    

7  YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this 
report, namely by 12 January 2023. I may extend this period upon your 
application.  

Your response must contain details of action taken or proposed to be taken, 
setting out the timetable for action. Otherwise, you must explain why no action is 
proposed. 

8  COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following 
Interested Persons:  

The family of Mr Middleton 
Yorkshire Ambulance Service 

I have also sent a copy of my report to the Secretary of State for Health  

I am also under a duty to send the Chief Coroner a copy of your response 

The Chief Coroner may publish either or both in a complete or redacted or 
summary form. He may send a copy of this report to any person who he believes 
may find it useful or of interest. You may make representations to me, the 
coroner, at the time of your response, about the release or the publication of your 
response by the Chief Coroner. 

17th November 2022 

9 

Mrs Tanyka Rawden 
HM Senior Coroner

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