POLICE and ambulance bosses will be asked to improve cooperation at the scene of accidents following the death of road crash victim Brian Savage in a police cell.
An ambulance paramedic failed to spot the pensioner had life-threatening injuries at the crash site in Bridge Road, Sutton Bridge, and police took him to Spalding Police Station on suspicion of drink-driving.
An expert told a jury that Mr Savage (pictured right) would “probably have survived” had he been taken straight to hospital.
Mr Savage (69), of Queen Street, Sutton Bridge, died at the police station on February 25 last year after sustaining extensive injuries to his chest, abdomen and pelvis.
His death was confirmed a little over three-and-a-half hours after the crash.
Speaking at the end of the inquest, Coroner Gordon Ryall (pictured far right) said it was clear Mr Savage had consumed some alcohol.
But he continued: “Such people are vulnerable and that’s the reason why they should be dealt with in accordance with procedures that allow for the possibility of another explanation for their behaviour.
“There was no evidence at any time that it was thought by those who examined him that Mr Savage had sustained injuries that proved to be fatal.
“Mr Savage’s family will always believe that he should have been taken to hospital.”
A toxicology test after Mr Savage’s death showed 97 milligrammes of alcohol in 100 millilitres of blood – 17 mgs above the legal drink-drive limit – but at the police station he gave one breath test under the limit.
Mr Savage was assessed by ambulance service paramedic Angela Bone in the back of a police van at the accident scene and by G4S nurse Kevin Sawyer at the police station and both failed to pick up on his injuries.
Medical experts, including pathologist Professor Guy Rutty, said the injuries should have been found and Mr Savage should have gone to hospital from the crash scene.
Professor Rutty gave the cause of death as chest, abdominal and pelvic injuries sustained in a road accident – twinned with potentially fatal levels of fat emboli, where bone marrow tissue leaks into the blood stream.
Mr Ryall began summing up at 4pm on Tuesday – day seven of the inquest – and outlined key evidence, including that of an expert who said Mr Savage could have lived had he been taken straight to hospital.
He reminded the jury that Stephen McCabe, a consultant in emergency medicine, said Mr Savage would “probably have survived” had he been taken straight to hospital – and his “chances of survival would have been less if he had been admitted from the police station”.
The expert also pointed out that a number of patients do survive fat emboli.
The jury went out at 4.46pm on Tuesday to start discussions so it could return its verdict – simple answers to ten questions of fact.
The inquest resumed yesterday and the jury began giving its unanimous verdict at 2.11pm.
Mr Ryall praised Mr Savage’s family who attended all eight days of the hearing.
He said: “Mr Savage’s family have attended the whole of this inquest and have therefore had to experience re-living all the details in connection with Mr Savage’s death and much of what has been seen and heard they must have found extremely distressing.”
Rules governing Coroners’ Courts allow Mr Ryall to take action to prevent further fatalities in similar circumstances.
He will write to Lincolnshire’s Chief Constable and the chief executive of East Midlands Ambulance Service to ensure there is full cooperation at the scene of accidents for the benefit of the member of public concerned.
He will also write to G4S asking that instructions are given to their health professionals for them to obtain details of any previous medical examinations.