Death of man, 50, could have been prevented had he not faced 8-hour ambulance wait, says coroner

Christopher Hart was unresponsive by the time paramedics reached him, 8.5 hours after they were called (PA Wire)
Christopher Hart was unresponsive by the time paramedics reached him, 8.5 hours after they were called (PA Wire)

A 50-year-old who died of cardiac issues would likely have survived had paramedics not taken more than eight-and-a-half hours to reach him, a coroner has said.

Christopher Hart, 50, died at his home in Woodbridge, Suffolk, last October after the hours-long wait for an ambulance, which should have responded to his 999 call in around 40 minutes.

A coroner has said the hours-long delay "directly contributed" to his death, and warned there could be similar incidents unless improvements are made to ambulance services.

Mr Hart fell ill at his home around 1am on October 25 last year, and 999 was called.

The call had been graded Category 2 - the second most urgent - by the control room meaning paramedics were expected to respond within 40 minutes on average, while the target attendance time was 18 minutes.

But it took more than eight-and-a-half hours for paramedics to arrive, due to high demand, and as ambulances were queuing to drop off patients at local hospitals.

A member of Mr Hart's family arrived at his home around 9.30am to find him lying on the living room floor, unresponsive and not breathing.

East of England Ambulance Service finally attended, but Mr Hart could not be resuscitated and he was pronounced dead at 9.35am.

An inquest that ended on October 27 concluded he died as a result of a previously undiagnosed heart condition - coronary artery atherosclerosis.

The inquest heard expert evidence from a consultant interventional cardiologist, who said Mr Hart need not have died.

"Had an ambulance for Christopher arrived within the target time, the drugs he could have been given by ambulance personnel, and his early transport to hospital, would on a balance of probabilities have saved his life", said coroner Nigel Parsley in a report, recounting the cardiologist's evidence.

Meanwhile evidence from East of England Ambulance Service revealed at the inquest that despite previous measures put in place, "there are continuing and regular instances of non-availability of ambulances occurring in Suffolk and the wider East of England region", said the coroner.The coroner has issued a stark warning following Mr Hart's death, in a rare "prevention of future deaths" report which he has sent to both the Health Secretary and East of England Ambulance Service."The delay in an ambulance attending meant that potentially life saving treatment could not be given, so that delay directly contributed to Christopher’s death," wrote Mr Parsley."I am...concerned that the continuing lack of sufficient ambulance resource in Suffolk will lead to future loss of life."

Mr Hart's sister, Sheena Clements, has also called for ambulance response times to be urgently improved.

"The cardiologist said if [Christopher had] had the medical attention, he would have had a chance of surviving of between 93 per cent and 97 per cent," Ms Clements told the BBC.

She said her brother's previously undiagnosed heart condition could have been treated using a stent.

She paid tribute to Mr Hart as "a kind man, who was well-read and loved his movies and music".

"Losing a family member for anyone is hard, it's emotional, especially if you know things could have been different," she told the BBC.

"All we want is for the government to take notice and do something about it."

East of England Ambulance Service apologised to Mr Hart's family and said although its response times have improved since his death, "a lot more work" is needed.

A spokesperson said: “We would like to offer our sincerest apologies to Christopher Hart’s family for the delayed response.

“We have noted the coroner’s comments to the Secretary of State and will consider them carefully.

“As we related to the inquest, at the time of this incident the Trust was under significant pressure due to 999 call volume and hospital handover delays.

“Since the start of 2023, our response times have improved due to work to increase the number of frontline staff and available ambulances, but we recognise there is a lot more work needed by us and our partners to improve our response to patients.

“Our thoughts remain with the family and friends of Mr Hart at this time.”

The Department for Health and Social Care has been approached by The Standard for a comment