Prevention of Future Deaths reports · 2022

Arthur Trott

Regulation 28 report to prevent future deaths, reference 2022-0387, written 29 Nov 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report29 Nov 2022
Reference2022-0387
DeceasedArthur Trott
CoronerKaren Henderson
Coroner areaWest Sussex
CategoryChild Death (from 2015) · Emergency 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 

NOTE:  This form is to be used after an inquest. 

REGULATION 28 REPORT TO PREVENT DEATHS 

THIS REPORT IS BEING SENT TO: 

1  Joint Royal Colleges Ambulance Liaison Committee (JRCALC) 
2  CEO Association of Ambulance Chief Executives 

1  CORONER 

I am Karen Henderson, Assistant Coroner, for the area of West Sussex. 

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 and INQUEST 

On 02 June 2021 I commenced an investigation into the death of Arthur Ronnie TROTT 
aged 4 Days.  The investigation concluded at the end of the inquest on 17 November 2022. 
The conclusion of the inquest was that: 

 went into spontaneous labour at home with her son Arthur Ronnie Trott 

at 0300 hours on 24th May 2021 at 37+2 weeks gestation. Having sought advice from 
labour ward at Princess Royal Hospital, Haywards Heath, she remained at home. At or 
around 0535 hours it was recognised Arthur was an unanticipated footling breech and as an 
acute obstetric emergency a 999 call was made to facilitate urgent admission into the 
labour ward. The first paramedics attended at or around 05.50 hours and Mrs Trott and 
Arthur arrived at the hospital at or around 0635. Arthur was delivered at 06.38 hours on 
24th May 2021 in a very poor condition.  Active resuscitation was undertaken with transfer 
of Arthur for ongoing care to the neonatal unit of RSCH but sadly died there 4 days later on 
28th May 2021 from complications from severe hypoxic ischaemic encephalopathy. 

4  CIRCUMSTANCES OF THE DEATH 

Arthur died following an unexpected breech delivery at home where the delay in transfer to 
hospital materially contributed to hypoxic ischaemic encephalopathy 

5  CORONER’S CONCERNS 

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

The MATTERS OF CONCERN are as follows: 
(brief summary of matters of concern) 

The initial advice from the labour ward and the consultant midwife employed by the 
ambulance service was to bring the mother into hospital as an acute obstetric emergency 
but on arrival at the mother's home a decision was made to attempt delivery from JRCALC 
guidelines indicating that it may be possible for breech presentation babies to be delivered 
at home. Whilst this was recognised as possible in different breech (bottom first) 
presentations it was not advisable nor should an attempted delivery be made for footling 
breech presentations. This resulted in a delay in transferring mother and baby to the 

Regulation 28 – After Inquest
Document Template Updated 30/07/2021 

 nearest obstetric unit which played a material contribution to the baby's death. 

1.The JRCALC guidance on the emergency management of footling breech presentation by 
the emergency services is insufficiently robust in that it should be recognised as different 
from other breech presentations and considered an acute obstetric emergency requiring 
immediate transfer to the nearest hospital obstetric unit. That is, no attempts should be 
made to attempt a home delivery due to difficulties with the baby's head not being able to 
be delivered. 

2. On evidence heard in court there are only two consultant midwives employed by the 
Ambulance services despite there being 11 Ambulance organisations within England. This 
leaves the majority of ambulances services having no obstetric support, guidance or 
ongoing teaching and training. As a matter of urgency there is a need to provide resources 
to employ more consultant midwives - at least one to two per service - throughout all the 
Ambulance organisations. 

6  ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you (and/or 
your organisation) 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 January 24, 2023.  I, the coroner, may extend the period. 

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 

South East Coast Ambulance Service - Sussex HQ 
HSIB 

Brighton and Sussex University Hospital NHS Trust 

I have also sent it to 

President of Royal College of Obstetrics and Gynaecologists 

who may find it useful or of interest. 

I am also under a duty to send a copy of your response to the Chief Coroner and all 
interested persons who in my opinion should receive it. 

I may also send a copy of your response to any person who I believe may find it useful or 
of interest. 

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. 

Regulation 28 – After Inquest
Document Template Updated 30/07/2021 

 
 
 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. 

Dated: 29/11/2022 

Karen HENDERSON 
Assistant Coroner for 
West Sussex Coroners Service 

Regulation 28 – After Inquest
Document Template Updated 30/07/2021

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