Lack of knowledge about emergency response codes and delayed staff training on
His Majesty's Prison and Probation Service received 2 coroners' reports about this hazard between 28 Mar 2017 and 16 May 2024.
They came from 2 different coroners in 2 coroner areas. A similar concern was raised again 1 time after the first warning.
A published response was found for 1 of the 1 earlier reports, stating 0 specific actions.
The story, report by report
Spacing grows with the time between reports.
“The issue of the difference between a code blue and a code red is one about which | have written before.”
Original on judiciary.uk ↗ His Majesty's Prison and Probation Service responded.Response (PDF) ↗
- 7 years 2 months laterClosely relatedConfidence 0.90 · higha different coroner
“relevant training and guidance to equip staff to understand when and how to enter a cell in a medical emergency, and the appropriate use of Code Blue and Code Red communications in a medical emergency”
Original on judiciary.uk ↗ Repeated from the earlier report:CodeBlue
His Majesty's Prison and Probation Service responded.Response (PDF) ↗
- All reports to His Majesty's Prison and Probation Service
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2017 → 2024Luke Pearce7 years 2 months after John Williams · different coronerClosely relatedConfidence 0.90 · high
Closely relatedConfidence 0.90 · highBoth reports highlight insufficient staff understanding of when to use Code Blue versus Code Red communications during medical emergencies. The later report expands the concern to include timely training on entering cells, while the earlier focuses specifically on officers not knowing the code difference.
John Williams · 28 Mar 2017
“The issue of the difference between a code blue and a code red is one about which | have written before.”
Original on judiciary.uk ↗ Luke Pearce · 16 May 2024
“relevant training and guidance to equip staff to understand when and how to enter a cell in a medical emergency, and the appropriate use of Code Blue and Code Red communications in a medical emergency”
Original on judiciary.uk ↗
No specific action could be extracted with a verified quote.
No specific action could be extracted with a verified quote.
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to His Majesty's Prison and Probation Service at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2017 → 2024 | 0.76 | 0.32 | Closely related · 0.90 | different |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
Next
Other chains for His Majesty's Prison and Probation Service
- Obscured observation panels hinder monitoring3 reports · 2024–2026
- Lack of basic first aid training and CPR among prison officers12 reports · 2015–2026
- Inadequate ACCT training leading to incomplete documentation16 reports · 2014–2026
- Lack of certified safer cells outside segregation unit4 reports · 2023–2025
This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.