Deceased
Thomas Redman
Demographics
18y, male
Coroner
Decision ofMagistrate Ross Hudson
Date of death
2015-12-16
Finding date
2020-01-24
Cause of death
Incised wound to right axilla with complete transection of basilic vein, brachial artery and subscapular artery causing massive haemorrhage and exsanguination
AI-generated summary
Thomas Redman, aged 18, sustained a catastrophic laceration to his right axilla involving complete transection of major arteries and veins after putting his arm through a glass window at a rural property near Gloucester, NSW on 16 December 2015. Despite appropriate pre-hospital care, retrieval, and inter-hospital management, he died approximately 4 hours after injury in a retrieval helicopter en route to John Hunter Hospital. The case presented extraordinary clinical challenges with massive uncontrollable bleeding in a remote location. Key clinical learning points include: (1) the State Retrieval Consultant should have been involved when the helicopter was initially tasked, not hours later; (2) communication failures occurred regarding aircraft refuelling and weather decision-making, with the pilot's perspective on weather constraints not directly included in the clinical teleconference; (3) whole blood and clotting factors availability in rural hospitals remains critically inadequate; and (4) protocols for early escalation to senior retrieval oversight have since been strengthened. The coroner found the clinical management reasonable given the dynamic circumstances, though some communication and coordination improvements would have been beneficial.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Drugs involved
Clinical conditions
Procedures
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