Ambulance service faced 'extreme pressure' on night wife called six times for dying husband

Lesley and Robert Weekley
Lesley and Robert Weekley -Credit:Mark Lewis

A 999 call handler incorrectly categorised a call made by the wife of a man who died from a heart attack, an inquest has heard. The Welsh Ambulance Service Trust (WAST) handler should have escalated the call for Robert Weekley, 75, who died in his flat in Barry, to the most urgent level of 'red', which requires an ambulance to be sent within eight minutes.

Instead they wrongly categorised it as the second-highest level, 'amber one', which has no set response time, an inquest into Mr Weekley's death at Pontypridd Coroners' Court was told. It was the fifth of six 999 calls Mr Weekley's wife Lesley had made in the early hours of January 4, 2023, over the course of an hour and a half as she watched her husband rapidly deteriorate.

On the sixth and final call she "begged" for an ambulance and did CPR on him for 20 minutes before paramedics finally arrived 21 minutes later. But the court heard that even if the fifth call had been properly categorised, the ambulance that would've been sent to Mr Weekley's address would not have arrived sooner than the one sent after the sixth call was made. Join our WhatsApp news community here for the latest breaking news.

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Lesley Weekley made six 999 calls on the night her husband died
Lesley Weekley made six 999 calls on the night her husband died -Credit:Mark Lewis

This was due to the "extreme pressure" the service faced on the night Mr Weekley died, which was categorised at 4a – the second-highest level of pressure – meaning demand was outstripping capacity. In her statement submitted to the inquest Mrs Weekley, who was married to her husband for more than 30 years, said he led an active life and enjoyed sport and playing gigs in south Wales.

She explained her husband experienced chest pain in the days before he suffered the fatal cardiac arrest, feeling a sensation as if his "lunch was stuck in his chest". He refused to got to A&E as he didn't think he needed to, the hearing was told.

Then at 1.45am on the night he died he woke his wife complaining of chest pain. The court heard evidence from cardiology expert Dr Klaus Witte, of the University of Leeds, that Mr Weekley was suffering from an anterior myocardial infarction resulting from a blockage in one of his arteries.

He was "cold and clammy" and his wife made the first 999 call to WAST at 1.56am. Robert Brunnock, the service manager for EMS coordination for WAST's 999 call centre at Cwmbran, which received Mrs Weekley's calls, told the inquest emergency responses to 999 calls were classified in different categories.

Red calls have the highest clinical priority and are deemed immediately life-threatening whereas amber one calls, the level below, have a high clinical priority and are deemed a life-threatening emergency. Mrs Weekley's initial called was allocated by the call handler to the amber one level and then was screened by a clinician before she made the second call, who determined at around 2.10am that Mr Weekley would need a face-to-face assessment by a paramedic or advanced paramedic and so Mrs Weekley's call was put in a queue of incidents requiring an ambulance, the court heard. For the latest court reports sign up to our newsletter here.

Mrs Weekley made her second, third, and fourth calls at 2.18am, 2.36am, and 2.55am respectively. Over the course of these calls she described how she was told to give her husband aspirin but he continued to have chest pain, vomited, was writhing on the floor, and became unresponsive.

She told the inquest she was told by the handler that a clinician would ring her back and she was told to call them again if Mr Weekley deteriorated but she said a call from a clinician never came. However Mr Brunnock explained to the court that the line about a call back was part of a general script call handlers have to follow and said the handler would have told Mrs Weekley a clinician would be reviewing the call and would have asked her to "please keep the line clear if the clinician deems it likely for a call back".

Robert Weekley died from a fatal cardiac arrest on January 4, 2023
Robert Weekley died from a fatal cardiac arrest on January 4, 2023 -Credit:Mark Lewis

Mrs Weekley also said she mentioned over the phone two or three times that she couldn't find a pulse in Mr Weekley's wrist. Questioning Mr Brunnock at the inquest she asked: "Why [didn't] that raise a red flag?" He explained that call handlers are non-medical so it "wouldn't come up as a red flag [to them] as it would a clinician" and therefore they only focused on whether the patient was breathing, which is why her call remained at the amber one level for the first four calls.

The court heard she had also not been asked until the fifth call whether she had any alternative means of getting him to hospital but she said she didn't drive and would not be able to carry him down numerous flights of stairs. The fifth call, made at 3.11am, was also categorised as 'amber one' but should have been categorised as 'red' because by this point Mrs Weekley said her husband had "intermittent breathing". Mr Brunnock told the call the handler had "made a mistake" and "learning has taken place" for that individual.

Mrs Weekley made her final call at 3.32am and at that point Mr Weekley said "quietly and calmly: 'I'm dying'" and then stopped breathing, she said in her statement to the court. Dr Witte said it is likely at or around the time of this sixth call Mr Weekley suffered his fatal cardiac arrest. It was not possible for the paramedics to save his life when they arrived at 3.53am, the court heard.

Asked by Mrs Weekley's daughter if the ambulance had arrived after the first call and paramedics had used a defibrilliator on Mr Weekley whether this would've improved his chances of survival Dr Witte said: "If he had arrived in hospital sooner and had his coronary artery opened sooner he probably wouldn’t have had his cardiac arrest on the balance of probabilities." He said a cardiac arrest outside of hospital in the absence of a defibrillator has a "dismal mortality".

Robert and wife Lesley
Robert had experienced chest pains in the days before his death -Credit:Mark Lewis

Mr Brunnock said an investigation by the Welsh Ambulance Service found that even if the fifth call had been correctly categorised there was a vehicle on the way to another address that could've been diverted but, after factoring in the distance that ambulance was from Mr Weekley's house, it would've arrived at roughly the same time as the vehicle dispatched after Mrs Weekley's sixth call.

Explaining the "extreme pressure" the service faced he said on that night the longest wait times for amber one calls across the southeast Wales region before a vehicle arrived were recorded at 2.28am, 3.18am, and 5.34am with times of 10 hours and six minutes, 15 hours and 10 minutes, and 10 hours and 26 minutes respectively. He added that hospital handover should be completed within 15 minutes of ambulances arriving but between Mrs Weekley's first and sixth call the ambulance service lost 1,521 minutes waiting outside hospitals, with the average wait time being 108 minutes, so paramedics were unable to respond to others in the community.

Delivering his findings assistant coroner Andrew Morse said the medical cause of death given by a pathologist was 1b coronary artery atherosclerosis leading to 1a coronary artery thrombosis. He said he did "not find the allocation to amber one [for the first four calls] was wrong" though he said "communication could possibility have been clearer" and it was "unfortunate" that Mrs Weekley had the impression a clinician would call her back. He noted the "extreme pressure" the service was operating at during that night and added that even though the fifth call should have been reclassified as a red call the "ambulance would not have arrived sooner even if dispatched on the fifth call". He said he was "not satisfied on the balance of probabilities that any actions on behalf of WAST contributed minimally, negligibly, or trivially to his death.;" He recorded a conclusion of natural causes.