Man who suffered fatal brain bleed at Spike Island waited almost two hours for ambulance
John and Edward Horgan, sons of the late Edmond Horgan pictured at Cork Coroner’s Court. Picture: Daragh Mc Sweeney/Cork Courts Limited
A man who suffered a catastrophic brain bleed after a fall exiting the boat for a tour of Cork’s Spike Island was waiting for almost two hours before an ambulance arrived.
Edmond Horgan, 76, a retired Garda from Crosstown, Killarney, fell while walking down the gangway from the boat to the pier on July 7 last year.
His family raised concerns at an inquest that Mr Horgan was first tended to immediately after his fall at 11.22am but did not get to Cork University Hospital until 2.30pm.
They said that because he was on blood thinning medication, Rivaroxaban, an anticoagulant sometimes sold under the name Xarelto, his fall should have been treated as an emergency.
But Cork Coroners Court heard that the ambulance called for Mr Horgan that morning was diverted to another call first, deemed more urgent by the National Ambulance Service control room.
Concerns about under-resourcing of the National Ambulance Service were raised in court.
Noel McCarthy, a supervisor at Spike Island with First Aid training, and who volunteers with St Johns Ambulance, was the first person to try to help Mr Horgan that day.
He was with Mr Horgan moments after the fall. Mr Horgan was then conscious but had no recollection of what happened, he said.
He had a cut above his eyebrow, a nose bleed and appeared to have fallen.
“Mr Horgan was aware, conscious and breathing. He was reacting to me, he was aware of himself and his surroundings,” he said.
As Spike Island is a remote location, if someone is injured or in distress, the patient is removed to the mainland where they have better access to medical care as a matter of protocol, Mr McCarthy said.
An ambulance was called and Mr Horgan and Mr McCarthy got the ferry back to Cobh to meet the ambulance.
Mr Horgan was clear and conscious and walked unaided to have his wounds dressed before the ambulance arrived.
“He continued to engage, was alert, was responsive, engaged with staff in Cobh as well. I did not see any deterioration in responsiveness, he remained alert and engaged throughout,” Mr McCarthy said.
Mr Horgan was still conscious and lucid when advanced paramedic James O’Brien arrived at the scene. Although the National Ambulance Service control room in Dublin was first called at 11.32, an ambulance did not arrive on the scene until 13.22. This was because another call, deemed to be higher priority by the control room, came in so paramedics were diverted there first.
On arrival, Mr O’Brien received “a very good handover” from Spike Island staff.
“Edmund was sitting in the cabin, with a dressing over his left eye. He was conscious, breathing, fully alert,” Mr O’Brien said.
His blood pressure and heart rate were taken, an ECG was performed and he was given an IV with paracetamol. Because he was already on blood thinning medication, no other medications were given.
Mr O’Brien said that Mr Horgan was “very independent” and “a gentleman”.
He insisted on walking to the ambulance himself and was fully conscious. Although he said that he was fine and would take the bus back home to Killarney, being on blood thinning medication was seen by paramedics as a “red flag” and Mr O’Brien insisted they take him to hospital. The ambulance left at 13.59.
He said that the deceased was good company, was “good craic” with “good banter”. He spoke about his sons and former life as a garda.
But as the ambulance passed Mahon Point shopping centre, approximately 10 minutes from Cork University Hospital, Mr Horgan became unwell.
He said that he had a headache and then vomited twice.
Mr O’Brien was concerned there may have been a brain bleed and called CUH so that the resuscitation team would be ready for him as soon as they arrived in hospital.
Mr Horgan’s deterioration happened “extremely suddenly”, Mr O’Brien said.
Despite getting to CUH minutes later, Mr Horgan could not be saved.
His family asked why it took almost three hours from the time of their father’s fall for him to arrive in hospital.
They said that the “golden hour” within which a patient with a head injury has to get help was missed because of delays in the service.
Mr O’Brien said that the ambulance service is under-resourced. Sometimes they get sent to calls two hours away and it can be a matter of luck whether you have an ambulance available near you or not. He said that a helicopter would have been there in 10 minutes.
But it was noted that the Heli ambulance was not called in this circumstance because the patient was responsive and a ferry was almost immediately available to take them back to the mainland.
Gerald McSweeney, safety inspector with the Health and Safety Authority, inspected the scene after Mr Horgan’s tragic death. He said there appeared to be no obstacles on the gangway where Mr Horgan fell when exiting the boat. The gangway appeared to be covered in non-slip plastic and appeared to be dry at the time.
Although CCTV captured images of the deceased falling, there was no clear reason for that fall, he “just dropped down” Mr McSweeney said.
State Pathologist Dr Margot Bolster gave the cause of death as a large traumatic subdural haemorrhage, or brain bleed, with subarachnoid and hypoxic ischaemic encephalopathy due to a fall (while on Rivaroxaban).
Secondary to that was ischaemic cardiomyopathy due to calcific coronary artery disease and bronchopneumonia.
She said that this type of brain bleed is usually slow and the patient is initially conscious — a lucid interval.
But as the bleeding increases, it gets trapped in the skull cavity. That pressure causes loss of consciousness and death if not treated.
This subdural haemorrhage has a high mortality rate, especially in older patients and for people taking anticoagulant medication as they bleed more quickly, even in those who get to hospital for surgery, she said.
Cork City Coroner Mr Philip Comyn gave a verdict of accidental death and extended his condolences to the family.
“This 77-year-old gentleman went to visit Spike Island on a dry day with no particular wind factor. On disembarking the boat onto the pontoon, he was making his way up the gangway when he fell and banged his head. The fall itself appears to be an accident, an unfortunate event.
“The precipitating event was the fall on the gangway which led to the haemorrhage. It was an accident.”Â
Although Mr Horgan was tended to by trained personnel, because he had a slow-acting haemorrhage, his symptoms would not have been visible to those attending him, Mr Comyn said.
“When it does manifest, it does so very acutely which is in line with the evidence of the advanced paramedic,” he said.
“The ambulance was called and dispatched, but was diverted on the basis of a more urgent call that came in at that time.
“That led to the delay of one hour and fifty minutes before the ambulance crew arrived, but that was all done from Dublin.”Â
The national drug authority would be advised about the incident, he said.
Concerns the family may have about the ambulance delay and procedures and protocols followed on the day may be for another forum, he said.
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