A coroner demanded an overhaul of resuscitation training after hearing how a teenage swimmer was revived at a poolside, only to die when a lifeguard stopped giving her mouth-to-mouth too soon.
Sophie Konderak had a cardiac arrest moments after starting a training session at a leisure centre.
The 16-year-old was dragged from the water unconscious and young lifeguard Katy Butler began cardiopulmonary resuscitation - mouth-to-mouth breathing and chest compressions.
Swimming star: A lifeguard left Sophie Konderak to die after wrongly believing she had saved her life
Miss Butler, 23, who had never tried to revive a swimmer before,believed she had saved Sophie when she started breathing again.
However, she did not take the crucial step of checking for a pulse -to determine whether the heart had restarted - and unwittingly leftSophie dying on the wet floor.
Paramedics arrived four minutes later and resumed CPR, only to beasked by one of the lifeguards: "Why are you doing CPR? She"s alive,"the hearing was told.
As a paramedic gave evidence to the inquest, the teenager"sdistraught mother, Lesley, 46, broke down in tears and cried out: "It"smy child"s life, why didn"t anybody do anything?
Braunstone Leisure Centre"s lifeguards had received "insufficient training"
"How could you just leave her lying there? She would have survived."
The ambulance crew tried to revive Sophie, a talented swimmer whodreamed of winning an Olympic gold, with a defibrillator at the leisurecentre in Braunstone, Leicester, on September 15 last year.
However, she was pronounced dead shortly afterwards at the city"s Royal Infirmary.
The inquest heard Sophie"s initial cardiac arrest was caused by an undiagnosed heart condition.
Heart expert Dr Christopher Duke said Sophie "would have survived"if she had received continuous CPR. He said: "You don"t stopresuscitation just because a patient appears to be breathing. You onlystop if there"s breathing and a pulse."
The inquest on Wednesday heard that Miss Butler, who was employedby Leicester City Council and was performing CPR for the first time,spent four minutes trying to revive Sophie and believed she hadsucceeded when the teenager began breathing.
She said: "If a person is breathing we"re told to stop CPR and put them in the recovery position."
Sophie"s heart was not restarted by defibrillator until 4.52pm - 14 minutes after she was pulled out of the pool.
The inquest heard the lifeguards had been trained by the RoyalLife Saving Society, a charity which provides training and education inlifesaving.
Recording a narrative verdict, coroner Catherine Mason saidshe would write to the Resuscitation Council of the UK, which providesguidelines for life-saving techniques, to ask it to amend its trainingguidelines to include checking for a pulse.
Mrs Mason, coroner for Leicester and South Leicestershire, said: "The crucial point of this is that the CPR was stopped.
"The guidelines should be changed so that from when CPRcommences it is conducted until a medically qualified person arrives orthe patient regains consciousness."
After the inquest, Mrs Konderak and Sophie"s father, John,said the "shortfall in the level of training and equipment" contributedto their daughter"s death.
They added: "We hope the coroner"s recommendations will leadto an improvement in lifesaving training and no further lives will belost."
No comments:
Post a Comment