Ambulance Service ignore surgeon’s letter leaving patient at home in excruciating pain

What happened to D after East Midlands Ambulance Service (EMAS) misses Red Flag Symptoms? 

D pulled her back in July. She felt pain shooting down her right leg to her knee and she had difficulty moving.  After a week she had not improved, so she attended her GP.  She was diagnosed with acute sciatica and was prescribed pain killers. 

D was advised to report to her GP if she developed “red flag” symptoms, so she knew exactly what to look out for.  She knew to look or symptoms such as bladder and bowel incontinence and anal and lower limb numbness.   

On 1 September D was still in pain so her GP referred her to a physiotherapist.   

The physiotherapist could not help so D was referred to a spinal orthopaedic consultant on 28 October.   

D was told she had a nerve root trapped at L5/S1, which meant that there was reduced sensation and sensitivity in her leg. The consultant arranged an MRI scan of the lumbosacral spine and referred D to physiotherapy. 
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The MRI scan showed L5-S1 large central disc protrusion causing central canal narrowing and nerve impingement.  She was given epidural injections and was warned of “red flag” symptoms.  She was referred to a consultant in pain management. 

By mid-February the following year, back and leg pain were worse.  Her orthopaedic consultant booked her for decompression and discectomy surgery.  He warned D of “red flag” symptoms and advised her if she experienced any deterioration in her condition to seek medical review urgently. D was given a copy of the letter the consultant wrote to the GP.  

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At the end of March D’s condition was so bad she was put on Morphine. 

Numbness in the vagina and saddle region 

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On 1 April D noticed a change.  Her pain changed. Pain was now spreading from one leg to both legs and she had begun to feel numb in her vaginal and saddle regions. 

An ambulance was called and came within 45 minutes. 

D gave a detailed history and told the paramedics of her symptoms.  She showed them a copy of the consultant’s letter to the GP.  The letter warned of concerns about Cauda Equina Syndrome.  

The paramedics ignored the letter and told D to show it to her GP. 

Paramedics ignore red flag symptoms and dismiss need to go to hospital  

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The paramedics did not examine her. They advised that as she was on high doses of analgesics already, they could not administer more pain relief. The paramedics concluded that transfer to A & E was not required and recommended that D consult her GP. 

On 2 April D contacted NHS Direct again. They arranged for her to be seen at the Emergency Care Centre. She was examined but no investigations were arranged.  

On 5 April D contacted NHS Direct for 3^rd time.  This time an ambulance took D to the Emergency Department of Queens Medical Centre.  

Urinary retention, fecal incontinence and unbearable pain 

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By now her symptoms had progressed. There was pain extending to the entire length of her right leg and pain in the left leg extending to the knee.  She had associated weakness and decreased mobility.  D has urinary retention, passing small volumes of urine and incontinence of urine on a number of occasions.  D had 2-3 episodes of fecal incontinence.  D had numbness in her “saddle” area but also hypersensitivity. 

Cauda Equina Diagnosed 

D was diagnosed with Cauda Equina Syndrome.