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Written on 12th March 2021 by Richard Money-Kyrle

HSIB, the healthcare safety watchdog, has raised concerns about the increased safety risk to patients experiencing heart attacks as a result of increasingly delayed ambulance response times to 999 calls. Their latest national report, Emergency response to heart attack, follows an investigation into delays in the emergency care given to a heart attack sufferer after it took nearly four hours for him to receive life-saving hospital treatment to restore the blood flow to his heart. HSIB’s national investigation examines the danger of increasing delays in ambulance response times for people needing emergency care for STEMI heart attack.

What is STEMI heart attack?

STEMI stands for myocardial infarction with ST segment elevation, the most dangerous type of heart attack. STEMI occurs when a blood clot blocks a coronary artery, cutting off the supply of oxygenated blood to the heart. This is a medical emergency in which every minute counts. The longer the ischaemia (lack of oxygen) to the heart, the greater the patient’s risk of permanent damage to the heart, leading to heart failure, further heart attacks or death.

Emergency treatment for STEMI heart attack often begins with a 999 call, during which the patient’s priority for an ambulance is assessed (‘triage’ process) and an ambulance sent out. Once the patient is known to have symptoms of a life-threatening STEMI heart attack, the NHS must act within time limits set by national guidelines to ensure the patient receives emergency treatment to restore adequate blood flow to their heart.

How is STEMI heart attack treated?

National and international guidelines recommend two possible treatment options for patients who have been diagnosed with STEMI.

Primary percutaneous coronary intervention (PPCI) is the primary treatment option in England for a STEMI heart attack. It is carried out at specialised heart attack treatment centres. PPCI involves the patient undergoing a coronary angioplasty to widen the blocked artery. A tube (catheter) with a balloon at one end is inserted through one of the large arteries in the patient’s groin or arm and the balloon is inflated within the blocked artery to widen the artery so that a stent (tube) can be inserted to keep the artery open.

PPCI has fewer complications than the other option, thrombolysis, including lower recurrence of heart attacks, lower incidence of stroke and a lower mortality (death) rate. It costs the NHS more than thrombolysis but is more effective when it is given within 2 hours of a patient’s first call for medical help. National and international guidelines recommend that PPCI should be carried out as soon as possible, within 90 minutes of the patient’s arrival at hospital and within 2.5 hours of a patient’s call for help. Delays are associated with a higher rate of death.

Where PPCI can’t take place within the recommended time, guidance recommends the patient receives pre-hospital thrombolysis by the ambulance staff. Thrombolysis involves using ‘clot-buster’ medication to dissolve clots inside the blood vessels and improve the blood flow. Thrombolysis used to be a common treatment for STEMI patients, and was often used by paramedics before the patient reached hospital (pre-hospital treatment). Some people with pre-existing medical conditions should not be treated with thrombolysis, as it causes complications, such as an increased risk of bleeding into the brain. In around 20% to 30% of cases, additional treatment (such as PPCI) may still be needed to resolve the STEMI.

Why are heart attack patients at increased risk from ambulance delays?

Heart attacks are life-threatening, medical emergencies. Ambulance delays in attending the patient or transporting them to hospital increase the patient’s risk of additional harm. Prompt recognition and treatment of STEMI is known to increase the patient’s chance of recovery and improve their long-term outcome.

31,364 patients in the UK were diagnosed with STEMI from 2018 to 2019, but HSIB found that ambulance services are increasingly failing to ensure that patients are transferred to a PPCI centre and receive treatment within recommended timescales. HSIB quotes data which identified that there was an increase in the death rate in hospital, at 30 days and a year, for patients who suffered delays in receiving PPCI beyond 2 hours from their call to emergency services. Further data suggested that for every 15-minute delay beyond the target timescale, there were 6.3 more deaths per 1,000 STEMI patients.

In November 2019, times from 999 calls to PPCI treatment were the longest that had been seen since November 2017 when these measures were first recorded. More recent (but pre-COVID-19) data shows that a significant proportion of STEMI patients wait longer than 2.5 hours to receive PPCI from the time of their 999 call. 

HSIB identified that the period of time between the patient making a 999 call and arriving at hospital is the main factor affecting delays in treatment. This is also increasing the risk of death or additional harm to the patient.

Despite the delays in getting patients to PPCI treatment on time, fewer STEMI patients are being given the recommended alternative treatment, pre-hospital thrombolysis. HSIB found that the majority of ambulance services have completely removed thrombolysis medication from their ambulances and are failing to follow guidance to give thrombolysis where timely PPCI can’t take place. Causes for this failure included: 

  • the cost of thrombolysis treatment;
  • the infrequent use of the thrombolysis treatment; 
  • ambulance staff concerns about the number of contraindications (circumstances in which it must not be used);
  • staff concerns about the complications that can arise from its use;
  • lack of training, competence and experience in administering thrombolysis.

This means that the reality for STEMI patients is that even when they cannot get to PPCI treatment in time, the recommended alternative treatment method is not available to them. This makes it even more essential that ambulances transport patients suffering STEMI heart attacks to hospital within the target time to receive emergency PPCI treatment.

Can I claim compensation for death or increased injury caused by ambulance and emergency treatment delays?

Heart attack is life-threatening and can be devastating even with correct care, but where death or disability are the result of negligent or delayed treatment, the patient or their bereaved family may be entitled to compensation.

We understand that in the weeks and months following a family member’s death or catastrophic injury, the focus will naturally be on recovery and adjusting to your loss. Our clients often find that compensation can be a lifeline to financial security whilst providing the means to pay for equipment, home adaptations and essential care.

If you have suffered serious injury or the death of a family member as a result of medical negligence, and would like to find out more about making a claim, contact us by email at