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recurance

Colin Sluman

21 Jun 2017 · Coroner Elizabeth Earland · Exeter and Greater Devon

A similar concern from this report was raised again 1 time later. See the linked reports.

The coroner's concerns

  1. 1. reports of dizziness and patient on their own as triggers for rapid response to catastrophic haemorrhage

    “The protocol supplied by NHS Pathways to South Western Ambulance Service Trust (SWAST) call handlers does not include reports of”
  2. 2. call handlers not clinically trained and reliance on protocol for categorising responses

    “Call handlers are not clinically trained and are completely reliant on the Protocol for categorising responses”
  3. 3. insufficient clinical supervisors for call handlers

    “There are not enough Clinical Supervisors available to call handlers for advice (on appropriate response) at all times”

Linked reports

Raised again laterAmanda Gainford21 Oct 2024 · 7 years 4 months later
Closely relatedConfidence 0.90 · high

This report

“Call handlers are not clinically trained and are completely reliant on the Protocol for categorising responses”

Later report

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

Responses

2017-0200-Response-by-NHS-England.pdf ↗· NHS England

Stated action · 15 February 2017

“In addition to this, the Clinical Lead of SWAST raised with NHS Pathways concerns surrounding dizziness symptoms not being part of the”

2017-0200-Response-by-South-Western-Ambulance-Service.pdf ↗· South Western Ambulance NHS Foundation Trust

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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