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recurance

Ronald Volante

28 Jan 2016 · Coroner Andre Rebello · Liverpool

The coroner's concerns

  1. 1. lack of medical history communication to ambulance

    “Magenta Living Support Link had access to Mr [name redacted] medical history and there is no evidence that this was used to advise the ambulance service of his cardiac problems - is this covered in the induction training of call handlers?”
  2. 2. failure to communicate change in condition

    “Magenta Living Support Link were aware that there had been a change in Mr [name redacted] presentation by 18.46 as he did not respond to the news that an ambulance was on the way - is this covered in induction training of call handlers with regard to advising a doctor or emergency service of a change in circumstances after the first call?”
  3. 3. inadequate training manual and method

    “The training manual and method of training call handlers needs to be revisited in the light of the experience from Mr [name redacted] tragic death”

Responses

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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.

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