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recurance

Amanda Gainford

21 Oct 2024 · Coroner Kate Roberts · Liverpool and Wirral

This report repeats 1 earlier warning. See the linked reports.

The coroner's concerns

  1. 1. inadequate medical training of call handlers

    “call handlers for the service are not medically trained but receive basic medical training”
  2. 2. lack of awareness among clinicians of escalation options

    “Doctor was unaware that he had the ability to challenge the call handler categorisation and to seek a review by a clinician at NWAS”
  3. 3. limited knowledge of escalation procedures among clinicians

    “only 1 was aware of the ability to escalate concerns regarding a patient and the categorisation of a 999 call to the Ambulance service”

Linked reports

Repeats an earlier warningColin Sluman21 Jun 2017 · 7 years 4 months earlier
Closely relatedConfidence 0.90 · high

Earlier report

“Call handlers are not clinically trained and are completely reliant on the Protocol for categorising responses”
Original on judiciary.uk ↗

This report

“call handlers for the service are not medically trained but receive basic medical training”
Full chain: Call handlers lack clinical training and rely on protocols

Responses

2024-0571-Response-from-NHS-England.pdf ↗· NHS England

Stated action · March 2021

“NHS England has published the National Framework for healthcare professional ambulance responses, which was last updated in March 2021.”
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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error