A 36-year-old woman died from a heart attack after waiting almost 10 hours for an ambulance, a coroner said.
Gina Bywater became ill at her Suffolk home on 12 December and an ambulance was called at 00:01 GMT on 13 December, but one did not turn up until 09:45.
Nigel parsley, senior coroner for Suffolk said “that delay directly contributed to Gina’s death”.
The East of England Ambulance Service apologised to Ms Bywater’s family and said response times had since improved.
An inquest into her death concluded on 1 November that Ms Bywater died from acute myocardial infarction together with fatty liver, pancreatic cyst and fibrosis, as the East Anglian Daily Times first reported.
In a prevention of future deaths report the coroner wrote: “Gina had become unwell at approximately 22:00 on 12 December 2022, with vomiting and shortness of breath.
“An ambulance was requested via a 999 call at 00:01 hours on the 13 December 2022, but due to high service demand, and ambulances waiting to off-load their patients at the local hospitals, no ambulance was immediately available.”
He said a further 999 call was made at 01:08 stating that Gina was now suffering chest pains, and a third call was made at 04:07, but no resources were available.
“All of the 999 calls had been coded at Category 2, with an average expected response time of 40 minutes, and a target attendance time of 18 minutes,” Mr Parsley wrote.
“The East of England Ambulance Service made a welfare call at 09:36, and during this call it was identified that Gina had gone into cardiac arrest.
“A Category 1 response was therefore initiated and an ambulance arrived with Gina at 09:45.”
She died at her home.
‘Future deaths risk’
A post-mortem examination found she died as the result of a heart attack.
“The delay in an ambulance attending meant that lifesaving treatment could not be given, so that delay directly contributed to Gina’s death,” Mr Parsley concluded.
He further stated he believed there was “a risk that future deaths could occur unless action is taken” to address the “continuing and regular instances of non-availability of ambulances occurring in Suffolk and the wider east of England region”.
The coroner said a consultant interventional cardiologist, whose unit treats thousands of patients with serious cardiac issues such as Gina’s each year, identified that “had an ambulance for Gina arrived within the target time, the drugs she could have been given by ambulance personnel, and her early transport to hospital, would on a balance of probabilities have saved her life”.
An East of England Ambulance Service spokesperson said: “We would like to offer our sincerest apologies to Gina Bywater’s family for the delayed response.
“We have noted the coroner’s comments to the Secretary of State and will consider them carefully.
“At the time of this incident the Trust was under significant pressure due to 999 call volume and hospital handover delays.
“Since the start of 2023 our response times have improved due to work to increase the number of frontline staff and available ambulances, but we recognise there is a lot more work needed by us and our partners to improve our response to patients.”