John Keen

“It is unfortunately clear, when comparing the evidence heard at the inquest with the findings of SWAST NHS's clinical review, that there was inadequate analysis of this incident by SWAST NHS, with concerning circumstances surrounding the care provided by attending paramedics not being identified and analysed properly - therefore whether there were any appropriate recommendations to inform future care provision were not considered by SWAST NHS”

“there is a section entitled 'aortic aneurysms', but when the detail of this section is considered it becomes apparent that this only relates to potential rupture of an abdominal aortic aneurysm. There is then a separate section entitled 'aortic dissection' and it is clear that this relates primarily to ascending and descending aortic aneurysms, but also in some respects to abdominal aneurysms. The headings of these sections are confusing and it is not easily apparent which one should be considered in respect of each different type of aneurysm, which is of course particularly relevant to presenting symptoms, particularly location of pain”

“hypotension on examination is listed as a risk factor in this risk score table, however later on in the guidance (in a section headed 'risk factors') it is stated that 'hypotension is a poor prognostic sign'. Immediately above this it is stated that 'blood pressure may be high as a consequence of the dissection'. It is therefore unclear whether, in respect of a potential aortic dissection, high or low blood pressure is concerning, or how the issue of a patient's blood pressure may be relevant to overall clinical risk”