The St John ambulance service has also been advised to assess emergency call-taking processes to see if improvement is needed in communication with callers who may not speak English as their first language.
The recommendations are contained in a coroner’s finding released late last year, after an inquiry into the July 2021 death of Auckland woman Solofua Sharon Tapuvae.
After the son called to say that his mother was not breathing, the call was then elevated to a purple (priority) response.
"I am also very mindful of the desperate situation Makarafu [the husband] found himself in, calling repeatedly for emergency assistance while his wife was dying, and being told that there was no ambulance available to assist them," Coroner Janet Anderson said in her finding into Tapuvae’s death.
She said the tragic death highlighted the serious and distressing impacts that can occur when there are insufficient ambulance resources available in communities.
In April this year, it was reported that an elderly Rangiora woman died after a 70-minute wait for an ambulance after her double-amputee husband called for help.
Deputy Health and Disability Commissioner Dr Vanessa Caldwell this month condemned the actions of an ambulance call-handler who in 2020 incorrectly classified and recorded triage information when taking a call from the mother of a teenage girl who was having an asthma attack.
She died on the floor at her home following a 28-minute delay in an ambulance arriving.
The Government and St John say steps have been taken since the deaths to address the concerns, including increased funding to address resourcing and workload issues.
The country’s ambulance service is funded by Te Whatu Ora - Health New Zealand and ACC, which fund about 82 per cent of the service, at a cost of about $380 million a year.
The rest is made up through donations, and a part charge of $98 for patients transported by ambulance.
The service was noted to be under extreme pressure at the time of Tapuvae’s death, with all available ambulances in the region committed to patients at the time the initial 111 call was made.
Tapuvae died from hemopericardium as a result of a tear inside her aorta, which is the main artery that delivers blood from a person’s heart. Obesity was noted as a contributing factor.
It was just after 6pm on July 29, 2021, when she collapsed at home. Her husband had arrived home about 15 minutes earlier and was outside exercising their new puppy when he heard her call out.
He went inside and found Tapuvae sitting on the lounge floor rubbing her chest and unable to talk so he immediately called 111.
When asked by the call taker about her symptoms, her husband noted that she had a "sore stomach" and had almost fainted.
Coroner Anderson said after the first call, Tapuvae’s husband was told it may take "up to several hours" for an ambulance to arrive.
He was asked if he was able to take his wife to the hospital himself, but he was unable to lift her.
He repeated the same on the third call when asked if he could get her to the hospital himself. He called for an ambulance again 13 minutes later, and a fifth time less than 10 minutes after that.
Just over an hour after the first call, the ambulance dispatcher was told by Tapuvae’s son that she had stopped breathing.
Her husband was advised to start CPR, which he did, and a paramedic ambulance was dispatched.
About 15 minutes later Tapuvae’s husband noticed that she had no pulse, was not breathing and had become cold.
Ambulance personnel arrived and continued resuscitation events, but she was unable to be revived.
The Coronial Service chief medical advisor, Dr Gary Clearwater said Tapuvae’s serious condition required prompt surgery.
He said the chances of survival were slim even in a best-case scenario, including immediate ambulance availability, prompt recognition of the condition at the scene and immediate transfer to Auckland Hospital.
Clearwater noted Tapuvae’s husband may have had difficulty understanding some of the questions he was asked, and that in his experience people with English as a second language sometimes had difficulty conveying their symptoms accurately.
The coroner said it was not possible to conclude if Tapuvae would have survived if an ambulance had been more quickly dispatched, but she was "very concerned" at the lack of ambulance availability.
She considered that there were opportunities for St John to reflect on aspects of the services concerning Tapuvae’s care.
"While these matters may not have changed the outcome for Solofua, they may assist in improving communication with families seeking urgent ambulance assistance in future."
She recommended that St John continue its efforts to obtain further funding and resources from central government, and consider whether any changes are needed to improve communication with callers who may not speak English as their first language.
Associate Health Minister Casey Costello told NZME that over the past two years, Government funding for ambulance services had increased by 32 per cent, and since 2022 the contract with St John has supported over 300 additional front-line and communication centre staff to be recruited.
Phil Riley, ACC deputy chief executive for prevention and partnerships, told NZME the current contract with Hato Hone St John runs for four years from 2022 to 2026, which includes an annual increase for inflation.
For 2023-24, ACC, which funds the transport of patients injured in accidents as opposed to medical emergencies, was forecasting to spend $157.2m on emergency ambulance services.
Hato Hone St John has continued to record an increase in demand for its ambulance services in 2023.
- Tracy Neal, Open Justice reporter
