Prevention of Future Deaths reports · 2024

Peter Stajic

Regulation 28 report to prevent future deaths, reference 2024-0053, written 1 Feb 2024. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report1 Feb 2024
Reference2024-0053
DeceasedPeter Stajic
CoronerCrispin Oliver
Coroner areaWest Yorkshire Western
CategoryEmergency services related deaths (2019 onwards)
Organisation namedBradford Teaching Hospitals NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses published1

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  Yorkshire Ambulance Service 

1  CORONER 

I am Crispin OLIVER, HM Assistant Coroner for the coroner area of West Yorkshire Western 
Coroner Area 

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 21 March 2022 I commenced an investigation into the death of Peter STAJIC aged 60. 
The investigation concluded at the end of the inquest on 01 February 2024.  The conclusion 
of the inquest was that: He died from a complication following a medical 
procedure to which a missed opportunity to provide medical intervention 
contributed. 

4  CIRCUMSTANCES OF THE DEATH 

Peter was pronounced dead at 04.50 on 27 February 2022 at Calderdale Royal Hospital, 
Halifax. He was aged 60, fit and well save that he had required a carotid endarterectomy -
undertaken on 12 January 2022. Due to a post operative haematoma, he was discharged 
on 16 January 2022. He developed an infection at the suture site. He was prescribed 
antibiotics by his GP. On 25 February he attended the Emergency Department at Calderdale 
Royal Hospital. This was an opportunity to discuss his case with a vascular consultant. It 
did not happen. On 26 February paramedics attended Peter at home at 10.42. There was 
evidence available of a herald bleed indicating that a major haemorrhage was likely to 
happen. This was not appreciated at the time and an opportunity was missed to admit Peter 
to the specialist Vascular Unit at the Bradford Royal Infirmary where, on the balance of 
probability, a procedure necessary to save his life could have been undertaken. In fact 
Peter was admitted to Calderdale Royal Hospital Emergency Department following a second 
attendance on his at home at 20.32 on 26 February.  The concern at that stage was in 
relation sepsis, not the risk of haemorrhage. He was triaged to level 3. At 22.56 a nurse 
noted bleeding at the suture site. She reported this to a consultant of the Department, who 
was not equipped to appreciate its significance. Its is not available to conclude on a balance 
of probability that at that stage there would have been sufficient time to intervene to save 
Peter's life. Peter suffered a catastrophic haemorrhage shortly after 01.05 and consequently 
died. 

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. 

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

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

Although detailed expertise concerning a herald bleed is specialist vascular knowledge that 
the paramedics who attended Peter at his home on the morning of 26 February 2022 would 
not be expected to possess, the evidence to the Inquest was that they would not have had 
any training in identifying one, nor any protocol for them to follow. 

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 March 28, 2024.  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 

I have also sent it to 

Bradford Teaching Hospitals NHS Foundation Trust 
Calderdale Royal Hospital Mortuary 

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. 

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. 

9  Dated: 01/02/2024 

Crispin OLIVER 
HM Assistant Coroner for 
West Yorkshire Western Coroner Area 

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

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 Association of Ambulance Chief Executives (PDF)
Association of Ambulance Chief Executives
25 Farringdon Street
London
EC4A 4AB

T:  020 7118 0977

E:

29 April 2024

BY EMAIL:  

Crispin Oliver
HM Assistant Coroner West Yorkshire Western coroner
area

Dear Mr Oliver

PETER STAJIC (DECEASED)

I am writing in response to the preventing future deaths report received at the Association of Ambulance
Chief Executives and I respond as our Director of Operational Development and Quality Improvement on
behalf of AACE.

On behalf of AACE, I would like to extend our sincere condolences to the family of Peter Stajic.

It may be helpful for us to explain that AACE is a private company owned by the English and Welsh NHS
ambulance services. Its purpose is to support its members, UK NHS ambulance services, in the
implementation of national agreed policy and to act as an interface, where appropriate at a national level,
between them and their stakeholders. It is a company owned by NHS organisations and possesses the
intellectual property rights of the Joint Royal Colleges Ambulance Liaison Committee UK ambulance
service clinical practice guidelines (the “JRCALC guidelines”). AACE is not constituted to mandate or
instruct ambulance services however it has national influence via the regular meetings of ambulance chief
executives and chairs along with a network of national specialist sub-groups.

We respond in relation to your matter of concern:

Although detailed expertise concerning a herald bleed is specialist vascular knowledge
that the paramedics who attended Peter at his home on the morning of 26th February
2022 would not be expected to possess, the evidence to the inquest was they would not
have had any training in identifying one, nor any protocol for them to follow.

Firstly it is important to note that the JRCALC guidelines are advisory and have been developed to assist
healthcare professionals inform patients and to make decisions about the management of the patient’s
health, including treatments. This advice is intended to support the decision making process and is not a
substitute for sound clinical judgement. The guidelines cannot always contain all the information necessary
for determining appropriate care and cannot address all individual situations; therefore, individuals using
these guidelines must personally ensure they have the appropriate knowledge and skills to enable suitable
interpretation.

All our JRCALC guidance is updated on a regular basis. The guidance is available to all UK ambulance
paramedics and is used on an App.  We often respond to incidents and issues raised so that we can
improve the guidance towards improving patient care. We currently have specific JRCALC guidance for
vascular emergencies and this details conditions such as aortic aneurysm, aortic dissection, ischaemic
limbs, AV fistula bleeds and diabetic foot problem.

We discussed your matter of concern at our JRCALC meeting on 9th April 2024. JRCALC consists of
expert advisors including those with vascular and surgical knowledge. It was decided that we will develop
some new guidance for paramedics to be more aware that some surgical wounds, particularly those

Chairman:

Managing Director:

 around blood vessels, can become infected and be at risk of catastrophic bleeding. It is likely this will be
included in our existing vascular emergencies guidance.

We will follow our existing process for the review and update of our guidance and this is expected to take
around three months.  When the guidance is updated it will be pushed out as a clinical update onto the App
following our usual process which involves approvals from JRCALC and our National Ambulance Medical
Directors group (NASMeD).

If you have any further questions please do not hesitate to get in touch.

Yours sincerely

Director of Operational Development and Quality Improvement

Chairman:

Managing Director:

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