“Apparent lack of training of paramedics in the use of Buccal Midazolam (2) No other form…”
Dated 14 Jan 2022, from the coroner for Northamptonshire. Sent to 1 organisation or person.
A coroner wrote this report after an inquest, to warn the organisations below about a risk of further deaths.
The 56-day response deadline
All responses publishedReplies were due by 11 Mar 2022.
Organisations that receive a report must reply to the coroner within 56 days, saying what they will do or why they will do nothing. We show whether a response is published on judiciary.uk; a reply may have been sent and not yet published.
- Report dated14 Jan 2022
- Deadline11 Mar 2022
- Published on judiciary.uk20 Jan 2022
- Today23 Oct 2026
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Responses from each recipient
| Sent to | Response |
|---|---|
| East Midlands Ambulance Service NHS TrustNamed in the report as “East Midlands Ambulance Service” | Response publishedPublished on judiciary.uk in January 2022. |
The coroner’s concerns
(1) Apparent lack of training of paramedics in the use of Buccal Midazolam (2) No other form of oxygenation attempted such as bagging or the child being taken earlier to the ambulance to secure and deliver oxygen (3) No suction attempted and the question was not asked of the parents as to whether the child had vomited. (4) No evidence of training to the paramedics who attended and gave evidence following an independent Serious Incident Report and its agreed recommendations (5) East Midlands Ambulance Service not accepting the recommendation 3 within the report to carry and administer Buccal Midazolam when necessary.
An extract. Read the full report, including the circumstances of the death, on the Courts and Tribunals Judiciary website.
- Source
- judiciary.uk, Prevention of Future Deaths reports, 2022-0013
- Added to Minute Book
- 8 Oct 2026
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- We show short extracts and link to the original. We don’t host the full report.
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Contains public sector information licensed under the Open Government Licence v3.0. Source: Courts and Tribunals Judiciary, judiciary.uk. Open Government Licence v3.0
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