A 75-year-old man, who suffered a brain haemorrhage when he fell and hit his head while visiting Spike Island in Cork Harbour, was left waiting almost two hours for an ambulance after two other ambulances were diverted to more higher priority calls, an inquest has heard.
Edmond Horgan, a retired garda from Crosstown, Killarney, Co Kerry, died at Cork University Hospital on July 8th of last year, less than 24 hours after being rushed there by ambulance, following a fall while walking up a gangway from a ferry to Spike Island shortly after 11am.
The inquest at Cork City Coroner’s Court heard from HSE advanced paramedic James O’Brien that the National Ambulance Service (NAS) control centre received the original call at 11.32am and other ambulances were dispatched to deal with the case, but were diverted elsewhere.
Mr O’Brien and his colleague, Paul Murray, who are based in Dungarvan, Co Waterford, had just delivered a patient at the Mercy University Hospital in Cork when they were dispatched at 12.47pm to go to Cobh to attend to Mr Horgan. They arrived at 1.22pm.
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He said they carried out various tests on Mr Horgan, who was conscious and lucid, including performing an ECG and setting up IV access, and departed for CUH at 1.59pm. As they were passing by Mahon Shopping Centre, Mr Horgan began to lose consciousness and vomited twice.
Mr O’Brien, who was in the back of the ambulance with Mr Horgan, contacted CUH to advise them that he believed that Mr Horgan may have had a brain bleed. When they arrived at CUH 10 minutes later, a full resuscitation team was on standby to receive him. The inquest heard that Mr Horgan had suffered a significant brain bleed and his condition deteriorated and he died at the hospital the following day.
Mr O’Brien said that diverting ambulances to higher priority cases was a common occurrence as the ambulance service was “completely under resourced ... and you can get lucky or unlucky”.
Questioned by members of the Horgan family, Mr O’Brien said that when he and his colleague were told by a dispatcher to go to Cobh, they had no idea how many ambulances had already been dispatched and diverted elsewhere.
“We know nothing about dispatching — for me, in this case there was no delay — we go job to job,” he said, adding that the question of why it took almost two hours for an ambulance to reach Mr Horgan should be directed to NAS management.
Mr O’Brien said Mr Horgan was lucid with a Glasgow Coma Scale reading of 15, which was good, and while he had told him he was taking anticoagulant medication, he did not have any major concerns for him as he had walked into the ambulance and engaged fully with him until he suddenly deteriorated.
The inquest heard that Noel McCarthy, a trained first responder and head of the tour guides on the day with Spike Island Development Company, checked Mr Horgan after he fell. He said Mr Horgan, who had lost consciousness momentarily, told him he had no recollection of what happened, but he was aware of who and where he was. He said Mr Horgan showed a good level of responsiveness and engaged fully with him and wanted to continue with the tour.
Mr McCarthy said he persuaded Mr Horgan to return to Cobh for medical assessment and he rang the NAS at 11.29am to tell them what had happened.
He said that once before, in 2020, he had requested an air ambulance when a man had a heart attack on Spike Island. He said Mr Horgan continued to be lucid and the practice was not to call the air ambulance unless there was a threat to life such as a cardiac arrest.
Assistant State Pathologist Dr Margaret Bolster said Mr Horgan had not suffered a skull fracture but had suffered a subdural haemorrhage in the brain, which can often be quite slow, but as the volume of blood and pressure builds up can lead to a sudden loss of consciousness.
She said that the cause of death was a traumatic subdural haemmorhage with sub arachnoid haemorrhage with hypoxic ischaemic encephalopathy — or shortage of blood flow and oxygen to the brain — due to a fall.
Questioned by the Horgan family about the original categorisation of the case as non-life threatening, Dr Bolster said she was not a clinician and could not comment but as a general principle, the sooner a patient got to hospital, the better their chance of survival.
However, she did point out that even if somebody does get to hospital quickly, people on anticoagulant medication do bleed more quickly if they get a brain bleed and those aged over 75 on such medication have a mortality rate of 60 per cent.
Cork City Coroner Philip Comyn noted that the original ambulance dispatched to Mr Horgan was diverted for reasons unknown to the inquest and this also happened a second time when another ambulance was diverted to a higher priority case, leading to a delay of more than an hour and 50 minutes.
He noted that Mr Horgan’s deterioration was ultimately very rapid, just 10 minutes out from CUH, but the event which precipitated his death was an accidental fall on the gangway. He returned an accidental verdict before extending his sympathies to the Horgan family.
