A 12-year-old girl would have survived if an ambulance had not taken an hour to get to her, a coroner has stated.
Ffion Jones from Cardiff was taken to Rumney Primary Care Centre on 7 December 2016 as she been vomiting and appeared torpid.
When she deteriorated additional a GP known as for an ambulance and requested an eight-minute response.
But by the point paramedics arrived an hour later she had gone into cardiac arrest and died later in hospital.
The inquest in Pontypridd reached a story conclusion and heard Ffion had Addison’s illness, a uncommon situation the place the adrenal glands within the kidneys cease functioning.
GP Nicola Leeson, who assessed Ffion, stated she had not too long ago acquired coaching in requesting ambulances to GP surgical procedures and had been given a specialist quantity.
She stated she made the primary call at 14:24 GMT however was informed she wanted to dial 999.
She stated she was “very disappointed” however the operator stated she would prepare an ambulance rapidly.
The inquest heard Ffion briefly improved earlier than collapsing and Dr Leeson put out a cardiac arrest call and different workers got here to assist her.
Dr Leeson stated: “Just as we have been making use of the oxygen one other receptionist appeared to say that I needed to go and ensure it was an actual cardiac arrest earlier than the ambulance service would ship an ambulance.
“I was clearly barely distracted by the data I had simply been given and was rendered speechless for a number of seconds.”
The ambulance arrived at 15:30 GMT and took Ffion to the University Hospital of Wales.
She was pronounced lifeless the next afternoon after assessments did not detect mind exercise.
Assistant coroner David Regan stated: “The call was not escalated to the scientific desk because it ought to have been.”
He added if it had been escalated “it’s possible she would have survived”.
He stated he would make a prevention of future deaths report back to the Welsh Ambulance Service NHS Trust.
‘Pillar of our household’
Nia Gowman, representing the ambulance service, stated it was accepted there was a “missed alternative” to escalate the GP’s call.
But she added: “In as far as Dr Leeson’s call is worried, it’s not accepted that had the call been appropriately escalated this may have led to Ffion not passing away.”
Speaking after the conclusion, Ffion’s father Anthony Jones thanked the coroner for a “thorough investigation” and said the family “completely settle for” his conclusions.
“Ffion was a beneficiant, humorous and bubbly little girl and was a pillar of our household,” he stated.
“We hope that essential classes have been learnt and that no household has to endure because of system failures.”