Nothing different could have been done to save the life of a teenager stabbed in Stapleford, an inquest has found.
Assistant coroner Elizabeth Didcock said that a decision to perform an operation on Joseph Whitchurch in an ambulance whilst on the way to hospital did not have any bearing on the outcome. She described the first response to the incident as "exemplary".
Joseph was 16-years-old when he was stabbed four times in the kitchen of an address at Hickings Lane in Stapleford on the morning of Boxing Day 2020.
He was taken to the Queen's Medical Medical centre via ambulance, but later died on December 29 2020.
After being found guilty of his murder on September 1 last year, Jake Rollinson had been set to be sentenced at Nottingham Crown Court on Friday (February 25), but that has been delayed again.
The sentencing had previously been delayed because he was to be seen by a psychiatrist.
Pre-hospital care of Joseph was questioned by a leading major trauma surgeon, and the responder who was first on the scene said he would not have done anything differently.
The stabbing happened following an argument between Rollinson and Joseph, accepted to be some time between 5.16am and when ambulance crews were called at 5.23am on Boxing Day 2020.
One of the stab wounds that Joseph suffered was through his chest and into his heart, and the knife had almost completely gone through the vital organ.
Before the ambulance arrived at 5.33am, Joseph suffered a cardiac arrest, and then suffered another one while under the care of clinicians.
Miss Didcock said the pre-hospital care Joseph received was to the letter of national and international standards of procedure (SOPs), and described the first response as "exemplary" during proceedings on Friday (February 25).
The inquest was told on Wednesday (February 23) that two minutes away from the QMC, at 6.03am, the ambulance stopped and a thoracotomy (a surgical procedure where the chest is opened) was performed in the back of the vehicle, with his chest then stapled back together).
It was so an internal cardiac massage to help with circulation of blood could be performed, and was because blood had built up around the heart meaning there was a lot of pressure on it.
However Joseph was still bleeding between the staples.
The vehicle was stationary for three minutes and 46 seconds, and arrived at the QMC at 6.10am.
Joseph was taken to the resuscitation area at 6.12am.
Adam Brooks, a leading major trauma surgeon in Nottingham and director of the East Midlands Major Trauma Centre at the Queen's Medical Centre, questioned if other factors, such as location, should have been taken into account.
But Christopher Press, a volunteer doctor at East Midlands Immediate Care Scheme and was the first on the scene, and who treated Joseph in the back of the ambulance, has said he would not have done anything differently.
He said he did not see the stoppage as a delay, and Joseph's state was improved before reaching hospital.
Expert witness Dr Gareth Moncaster was asked to give evidence and share his thoughts as an independent and external view of the case on Friday before Miss Didcock delivered her conclusion later that day.
Dr Moncaster was previously a critical care consultant at King's Mill Hospital, and has since moved to work in Devon.
He offered a suggestion that the ambulance driver could tell the clinical team how long they are away from a major trauma centre when they are in close proximity, prompting them to decide if a patient needs treatment in the back of an ambulance or can wait.
Current SOPs state that if a medical procedure is required, it should be done there and then, regardless of other factors.
During proceedings, Dr Moncaster said: "The person driving the vehicle can essentially create a 'spot moment', which is a term used in theatres when clinicians listen to one person in particular unless performing necessary work.
"For example, the driver could very clearly communicate that they're say five minutes away from a major trauma centre, telling the clinicians and prompting the major trauma centre to be ready.
"All individual circumstances are different, and clinicians could then decide with a more complete picture of what to do.
"Many experts have been discussing this over the last few months preceding this inquiry.
"I think that would be a sensible approach to take until more definitive evidence becomes available."
This suggestion was well received by other members of the inquest.
Concluding, Miss Didcock said she found the case "extremely challenging".
She said: "I find that all pre-hospital and hospital teams must find a solution that works to provide better outcomes for patients, particularly in this case of a stabbing to the chest."
The assistant coroner ruled Joseph's death as an unlawful killing.
She agreed with the post mortem, which found the cause of death had been: 1a) hypoxic ischemic encephalopathy (lack of oxygen to the brain)
1b) cardio respiratory arrest
1c) stab wound to chest
"I want to express my condolences to the family," she added.
"I am so sorry for their loss."
To read all the biggest and best stories first sign up to read our newsletters here.
