'Lessons learned' as elderly islander dies from undetected tetanus

Friday 14 October 2022

The Ambulance Service and A&E Department have said they have learned important lessons after both failed to identify that an elderly islander had tetanus or was at risk of being infected.

Remembered by loved ones as "delightful and lively", Gwendoline de la Haye died of the bacterial infection, and sepsis, at the Hospital in August 2020, 18 days after cutting her leg in a fall in her garden.

The 94-year-old had not been vaccinated against tetanus as a child because the now-standard inoculation programme was not introduced in the British Isles until 1961.

This was not picked up until it was too late.

Despite Mrs de la Haye having had an open wound in the garden – which heightened the risk of tetanus – she was not asked by the Ambulance crew who attended to her if she had been vaccinated.

Nor did subsequent health professionals who treated Mrs de la Haye suspect tetanus, despite her showing symptoms, including being unable to open her jaw, having a dry mouth and feeling cold.

At an inquest held at Morier House (pictured top) on Thursday, the family of Mrs de la Haye – who was described as a “delightful and lively lady” – said that they didn’t seek to blame anyone but wanted people to learn from the shortcomings that had contributed to the up-to-then-exceptionally-fit 94-year-old’s death two years ago.

After Mrs de la Haye had been admitted to Hospital, the family had themselves suggested to staff that she had tetanus after researching her symptoms online, but it was only in the final hours of her life that doctors diagnosed the infection.

Her relatives said they wanted to raise awareness of the importance of considering tetanus at an early stage of intervention, especially among the elderly.

Associate Chief Ambulance Officer James Inglis told the inquest that policies and procedures had since been updated within the service, including the checklist that Ambulance crews go through when attending calls. 

At the time of Mrs de la Haye’s fall, there had been no prompt on the checklist to consider tetanus or capture vaccination status.

Ambulance staff had also been made more aware of what circumstances can lead to tetanus, its symptoms and who is most at risk, he said.

A&E Consultant Nicola Charles told the inquest that the triage nurse at the Emergency Department should have asked if Mrs de la Haye had been vaccinated for tetanus. Staff had incorrectly assumed that it would have been considered earlier in the process, such as when she had visited her GP.

Dr Charles added that one of the difficulties with tetanus was that the principal symptom – lockjaw – only developed typically ten days after the bacteria had entered the body. 

She said that tetanus, while serious, was also very rare – with only, on average, five people a year contracting the infection in the UK. 

The consultant said that, since Mrs de la Haye’s death, posters with the headline ‘Think Tetanus’ had been put up on the back of the triage room’s door at A&E and in the treatment room of the minor injuries’ unit.

Staff were now more aware to consider the infection in those unvaccinated and/or with wounds up to 21 days old, which is the period in which tetanus can develop,’ she said.

They also knew of the increased possibility that someone born before 1961 would not be vaccinated.

Dr Charles added that the new Health Electronic Patient Record system included details of tetanus inoculations and boosters.

She said that the pandemic had restricted the ability to family to visit patients and speak with medical staff, which had unfortunately been the case in August 2020.

At the end of the inquest, Deputy Viscount Mark Harris said that the Ambulance Service and Emergency Department had learned important lessons from Mrs de la Haye’s death.

He added that he intended to write to the Primary Care Governance team – which oversees the care provided by GPs - to raise the profile of tetanus infection within primary care.