Finding into death of Veronica Campbell
Deceased
Veronica Campbell
Demographics
23y, female
Date of death
2008-12-31
Finding date
2010-04-12
Cause of death
complications of ruptured ectopic pregnancy with massive intra-abdominal haemorrhage
AI-generated summary
A 23-year-old woman with a ruptured ectopic pregnancy at a rural hospital required urgent transfer to a tertiary centre. The initial response was classified as routine, and the first ambulance crew arrived late without a MICA-trained paramedic. When deterioration occurred, a helicopter was appropriately activated, but significant delays resulted from communication confusion about landing sites, destination hospital uncertainty, and difficulties arranging ground crew at the destination. The patient was intubated during transport and became critically unwell with severe intra-abdominal haemorrhage. Key lessons include: classification of ectopic pregnancy cases should reflect criticality from the outset; initial triage and communication with receiving hospitals must be clear and timely; rural facilities need pre-agreed protocols for helicopter landings; dispatcher-clinical liaison must ensure destination clarity before patient transport; and adequate staffing levels are essential for emergency response.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Drugs involved
Clinical conditions
Contributing factors
- initial call coded as routine transfer rather than emergency
- delay in first ambulance crew arrival at rural hospital
- absence of MICA-trained paramedic in initial response
- communication confusion regarding helicopter landing site
- uncertainty about appropriate destination hospital
- delays in arranging ground crew at destination
- distance from tertiary facility
- limited medical resources at rural hospital
Coroner's recommendations
- Review and improve triage protocols for ectopic pregnancy and other obstetric emergencies to ensure appropriate classification as urgent/emergency cases from initial call
- Establish clear pre-agreed protocols for helicopter landing sites at regional hospitals
- Improve communication between dispatch control, treating clinicians, and receiving hospitals to ensure destination clarity before patient transfer
- Ensure availability of MICA-trained paramedics for emergency calls to rural areas
- Review dispatcher training and communication procedures to prevent confusion about landing sites and hospital destinations
- Improve staffing levels in dispatch control centres to ensure adequate coverage during periods of high demand
- Establish liaison protocols between air ambulance services and regional hospitals regarding helipad availability and activation
Full text
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