Coroner makes nursery training plea
All nursery school staff should undergo paediatric first aid training, a coroner has said.
The plea came after an inquest jury concluded a nine-month-old girl died of misadventure when she choked on shepherd's pie on her third full day at a nursery in Cheadle Hulme, Greater Manchester.
Millie Thompson started coughing and crying in a high chair during her mashed lunchtime feed from a supervisor at Ramillies Hall private school before her lips turned blue.
The nursery supervisor - whose basic first aid certificate had expired - shouted for help and passed her on to a colleague who did have paediatric first aid training and proceeded to give her back slaps.
Millie's condition fluctuated and then deteriorated as an ambulance arrived 10 minutes after staff dialled 999 on October 23 last year.
There were no signs of life as she was taken to Stepping Hill Hospital and she was pronounced dead soon after arrival.
It emerged during the hearing at Oldham Magistrates' Court that Millie suffered a rare complication as a result of the choking in which air was able to get into her partially blocked airway but not out.
The trapped air placed pressure on her heart which led to a fatal cardiac arrest.
An expert witness in paediatrics told the inquest that the condition was uncommon.
The only effective treatment would have been a medical procedure where a needle is inserted to the chest to release the air pressure.
Paramedics are trained to carry out such a procedure but it would have been difficult to make the correct diagnosis in such a young child.
Nursery staff could also not be criticised for not recognising its nature. The jury agreed it was "a difficult to diagnose complication" and that in the circumstances they "did not believe that the outcome for Millie could have been different".
Ramillies Hall did fulfil its legal requirements in ensuring at least one staff member with a paediatric first aid training certificate was on the premises at any given time.
It emerged that all its nursery employees had undergone paediatric first aid training in the wake of Millie's death.
Following the verdict, South Manchester Coroner John Pollard said he would write to the Secretary of State for Education Michael Gove to ask that all nursery staff have such training.
He said sending the letter "as a matter of national importance".
Millie's parents, building designer Dan and quantity surveyor Joanne, set up a charity called Millie's Trust following their only child's death in which they are encouraging more people to undergo first aid training.
They are campaigning to make such training readily available for minimal costs and in as many places as possible.
The inquest heard that Ofsted had the power to issue enforcement notices to schools which did not meet the bare first aid requirements and ultimately it could prosecute under the Child Care Act 2006 over a failure to meet welfare requirements.
During the inquest it also emerged that the 999 call handler in the choking incident admitted she made two "fundamental" errors in responding to the report from nursery staff.
After terminating the call, North West Ambulance Service employee Aaliyah Ormerod also made the comment : "Jeez, stop giving me information."
Ms Ormerod conceded in a statement to the court that she wrongly graded the call and did not recognise it as an immediate life-threatening situation which meant a rapid response vehicle was not sent to the nursery. She also admitted she should have stayed on the phone until the ambulance arrived.
The coroner said he expected her employers to take action over the end-of-call comment which he said had "added insult to injury, quite literally".
Outside court, Mrs Thompson said: "Unfortunately the 999 operator was not in the room with Millie and could not see the seriousness of Millie's situation."
She criticised the quality of first aid care given to "our beloved daughter" up to the point where the paramedics attended and added the ambulance service had conceded it had wrongly graded the call.
Mr Pollard said he would also write to the chief executive of the ambulance service on the subject of training for call handlers related to child illnesses and that all vehicles should have appropriate paediatric equipment on board.
Addressing Mr and Mrs Thompson, he said: "It is extraordinarily difficult for you to relive these horrific events and I am grateful to how you have conducted yourself."
When counsel for the nursery offered their condolences too, Mrs Thompson said: "It's OK, I don't want them."
Ramillies Hall School principal Diana Patterson said: "While today's outcome is comforting in that it confirms our understanding that we did everything we could to save Millie, it doesn't alter the fact that she's no longer with us and we'll continue to miss her and think of her family every day.
"This has been a devastating time for everyone involved and we would like to thank our parents, past and present, as well as the local community for all of their words of support and comfort which have helped sustain our dedicated nursery team, who've been heartbroken by Millie's loss."
Ged Blezard, director of emergency services for the North West Ambulance Service NHS Trust, said: "The Trust would like to express its sincere condolences to Millie's family for their very sad loss. We accept the jury's conclusion and would like to thank the coroner for his handling of this sensitive case. We are now considering his helpful recommendations."
The inquest heard that call handler Ms Ormerod had since received retraining but no disciplinary action had been taken.