Deceased
Robert Norman Spencer
Demographics
59y, male
Coroner
Coroner Simon McGregor
Date of death
2022-02-18
Finding date
2024-04-23
Cause of death
ischaemic heart disease in the setting of chronic ethanol use
AI-generated summary
Robert Spencer, 59, called 000 at 4:27 am reporting weakness and inability to mobilise following a fall. He was triaged as Code 3 (non-urgent) and underwent secondary triage call-back attempts without success. An ambulance was not dispatched until 7:08 am, arriving at 7:38 am, by which time Robert was found in cardiac arrest and deceased. The autopsy confirmed ischaemic heart disease with chronic ethanol use as the cause. The 3-hour delay was attributed to staff shortages and decreased fleet availability rather than clinical factors. The pathologist could not determine whether earlier intervention would have changed the outcome. The coroner found the delay regrettable but due to systemic issues in ambulance operations, with Ambulance Victoria undertaking multiagency review to address fleet availability problems.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Clinical conditions
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