Madeline Reding

“staff responses to the developing emergency were delayed and disorganised”

“An emergency alarm was not sounded promptly”

“A999 call was not made immediately on discovering Mrs [name redacted] was unresponsive”

“resuscitation was not commenced by a registered nurse as she did not appreciate that a "Do not attempt cardio-pulmonary resuscitation order" would not apply to the patient in the event that the cardiac arrest was due to a reversible cause, such as choking”

“First aid that was administered was ineffective”