St John paramedics slammed for failing to assess man with suspected heart attack

The man was found to have experienced a heart attack.
The man was found to have experienced a heart attack. Photo credit: Getty Images

St John has been slammed for failing to assess a man with a suspected heart attack and contradicting a GP's advice, in a new report.

The report, released on Monday, found the Deputy Health and Disability commissioner found Hato Hone St John breached its code for its failures.

The man, who remains anonymous, visited his general practitioner (GP) on May 18, 2021, and reported experiencing chest discomfort in the days prior to the visit. The GP carried out various tests and sent the man home, advising him to call an ambulance if the pain returned.

The man was contacted by his GP later that same day after tests confirmed elevated troponin levels, which can indicate a heart attack.

As the man lived approximately 90 minutes from the hospital, and the GP was concerned about possible deterioration in his condition, they advised the man to call for an ambulance to take him to the hospital's emergency department immediately.

The man called the 111 call centre where his condition was initially triaged as being potentially serious but not immediately life-threatening and a first response team was sent. 

The man told the call operator he was feeling fine until the doctor called him with his test results which made him scared.

"My wife will be home soon, is it better that we just drive ourselves? [GP] seemed quite insistent that I got an ambulance and that's worried me more than anything," he told the operator.

"Oh I see, he was probably being a bit cautious and ah wanting to make sure you weren't driving yourself, but we can just triage you and we can go from there okay," the operator replied.

A Fire First Response (FFR) arrived at the scene first and carried out an initial assessment of the man which found that other than a slightly elevated blood pressure, the man was showing no abnormal signs and symptoms.

An ambulance arrived just over an hour after the first response team to take over the man's care. The ambulance staff consisted of an intensive care paramedic and two emergency medical technicians. 

The man told the ambulance staff he was "pain-free", prompting the staff to suggest self-transport was an option. The man also said he inferred that it was a waste of ambulance time for St John to transport him as he thought there were more urgent cases than him.

After discussion, it was decided that the man's wife would drive him to the hospital. 

When questioned by St John about why the man was not transported to hospital, one of the emergency medical technicians said the patient was competent to make any transport decisions. 

"I have always been instructed to respect [a] patient's wishes. If the patient had been transported by the ambulance, I feel that there would have been no interventions carried out apart from monitoring and baseline observations. Transport by ambulance was never refused," they said.

"I feel that as a GP referral, like all GP referrals, they are easy tasking[s] for the ambulance. First job of the night, a 'load and go' job. The weather was extremely poor so transport time for this patient would have been approximately two hours."

Once the man and his wife arrived at the hospital, he was admitted and then referred to the critical care unit and found to have experienced a heart attack. He was discharged from the hospital one week later.

The Deputy Health and Disability Commissioner, Dr Vanessa Caldwell, found the organisation breached Right 4(2) of the Code which provides people the right to services of an appropriate standard that complies with legal, professional and ethical standards.

St John completed an audit that found that the patient care and documentation provided by its ambulance staff was "well below expected standard" due to no thorough assessment being completed for the man, it was unclear whether a 12-lead ECG was done and staff did not transport him to hospital.

"I am concerned that attending St John staff failed to recognise the seriousness of the man's condition and ensure he was assessed fully prior to leaving the scene, when he was not to be transported by ambulance," Dr Cladwell said.

"Further, the team's decision to support the man to self-drive to hospital was in direct contradiction of the man's GP who had directed him to go by ambulance even if he was not in pain."

Dr Caldwell added that a lack of documentation by Hato Hone St John led to confusion about which team performed the assessments and what was assessed.

Dr Caldwell was critical about a St John officer's lack of appropriate care of the man and the call handler for minimising the clinical advice of the man's doctor to use an ambulance.

Hato Hone St John has told HDC that education and guidance continue to be given to its ambulance staff on using its clinical procedures and guidelines, clinical bulletins and education material about the need for complete and accurate documentation.