{"id":318547,"date":"2025-10-20T12:37:14","date_gmt":"2025-10-20T12:37:14","guid":{"rendered":"https:\/\/www.europesays.com\/us\/318547\/"},"modified":"2025-10-20T12:37:14","modified_gmt":"2025-10-20T12:37:14","slug":"inquest-finds-death-of-mount-barker-man-waiting-for-ambulance-potentially-preventable","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/318547\/","title":{"rendered":"Inquest finds death of Mount Barker man waiting for ambulance ‘potentially’ preventable"},"content":{"rendered":"

A man’s cardiac arrest death could have “potentially” been prevented had an ambulance arrived earlier, and if a paramedic had not interfered with the dispatch process, South Australia’s deputy state coroner has found.<\/p>\n

Mount Barker man John Douglas Kennedy died in the early hours of April 16, 2020, after his wife sought urgent assistance at 12:19am when he was experiencing severe chest pains \u2014 but an ambulance did not arrive until 12:43am.<\/p>\n

Paramedics performed CPR, including administering 10 shots of adrenaline and delivering 25 defibrillations, before taking Mr Kennedy to the Mount Barker Hospital where he was pronounced dead at 2:08am.<\/p>\n

South Australia’s Deputy State Coroner Naomi Kereru began the inquest in February this year<\/a> to determine why the ambulance was delayed, the cause of his death and whether it could have been prevented had the ambulance arrived sooner.<\/p>\n

The court previously heard Mr Kennedy’s family had been told an ambulance was on the way, despite it having not yet been dispatched, with the inquest finding the call-taker should not have given that assurance.<\/p>\n

Inquest into cardiac arrest death<\/a><\/p>\n

John Kennedy suffered a sudden cardiac arrest at his Mount Barker home in April 2020. An inquest has heard his wife was told an ambulance was on its way when it had not yet been dispatched.<\/p>\n

The inquest heard there were two crews nearby which could assist Mr Kennedy; the Barker Crew, which was about 6 minutes away from his home at the Mount Barker Hospital, while the second was on a crib break and were about 14 minutes away at Stirling.<\/p>\n

The dispatcher, Tina Lynch, “verbally assigned” the job to the nearest ambulance, the Barker crew, with the paramedic radioing to say they would be “a few minutes”.<\/p>\n

In her published reasons, the deputy state coroner found Ms Lynch should have clarified how long before that ambulance would be available.<\/p>\n

“Notwithstanding her busy role, Ms Lynch should not have allowed in excess of 8 minutes to pass without receiving confirmation that the Barker crew were available,”<\/p><\/blockquote>\n

Ms Kereru said.’Interfered with dispatch process’<\/p>\n

Ten minutes after Mrs Kennedy contacted triple-0, and after the job was verbally assigned, a paramedic from the Barker crew, Dean Wilson, contacted the operating centre and said he had been approached by a doctor at the Mount Barker Hospital wanting to transport a patient to the Royal Adelaide Hospital.<\/p>\n

“In his oral evidence, Mr Wilson explained that [he] contacted Ms Lynch to seek her permission to be tasked to the Mount Barker Hospital patient, knowing that she had previously requested that his crew be tasked to attend Mr Kennedy,” Ms Kereru said.<\/p>\n

She said it was “difficult to convey in words the feeling of unease when listening to” the audio recording of this phone call.<\/p>\n

“The aspects of the call that invoked this reaction included the knowledge that 9 minutes had already passed from Mrs Kennedy first contacting triple-0, and that there was no mention of Mr Kennedy \u2026 or the severity of his condition,” she said.<\/p>\n

\"The<\/p>\n

The deputy state coroner says the death of Mount Barker man John Kennedy could potentially have been prevented. (ABC News: Justin Hewitson)<\/p>\n

The inquest found the request amounted to an interference in the dispatch process, and should not have been entertained.<\/p>\n

Ultimately, Ms Kereru concluded that had either the Barker crew been dispatched to Mr Kennedy, or if the other crew which were on a crib break had been dispatched immediately, Mr Kennedy’s death could have “potentially” been prevented.<\/p>\n

“There were clear opportunities to have potentially prevented Mr Kennedy’s death,”<\/p><\/blockquote>\n

she said.<\/p>\n

Ms Kereru recommended the SA Ambulance Service discourage paramedics from contacting the operations centre to advocate for assignment to specific cases, and that dispatchers are reminded of their obligation to assign resources to appropriate cases, rather than what paramedics ask for.<\/p>\n

She acknowledged the guilt that Mrs Kennedy had “expressed about not choosing to take her husband the short distance to the hospital in their private vehicle”.<\/p>\n

“I feel it is important to reassure Mrs Kennedy and her family that their actions were entirely appropriate given the information they were provided by SA Ambulance Service,”<\/p><\/blockquote>\n

she said.<\/p>\n

“I hope that this reassurance provides some comfort to the Kennedy family.”<\/p>\n

Government to take findings seriously<\/p>\n

Speaking before the inquest findings were handed down, SA Premier Peter Malinauskas said his government would take any recommendations seriously.<\/p>\n

He said this case showed why his government’s investment in ambulance services mattered.<\/p>\n

“This goes exactly to the reasons why we took to the election in 2022 the policy we did, which is to dramatically invest in ambulance resources,” he said.<\/p>\n

“What matters more than [ramping] is the ambulance getting to a patient on time, because that is the difference between life and death.”<\/p><\/blockquote>\n

\"A<\/p>\n

SA Premier Peter Malinauskas says the government will consider the recommendations. (ABC News)<\/p>\n

Mr Malinauskas said that while the government was “seeking to tackle” ramping, it had invested in the ambulance service more broadly.<\/p>\n

“Which has seen ambulance response times, including for lights and sirens emergencies, dramatically improve,” he said.<\/p>\n

“We’ve effectively doubled the number of patients for lights and sirens emergencies being seen on time.”<\/p>\n","protected":false},"excerpt":{"rendered":"A man’s cardiac arrest death could have “potentially” been prevented had an ambulance arrived earlier, and if a…\n","protected":false},"author":3,"featured_media":318548,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[63284,4740,159972,148171,37555,27438,6994,11846,41057,8761,34131,37165,159970,159974,159971,50,159973],"class_list":{"0":"post-318547","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-news","8":"tag-ambulance","9":"tag-australia","10":"tag-cardiac","11":"tag-chest-pain","12":"tag-coroner","13":"tag-cpr","14":"tag-delay","15":"tag-died","16":"tag-dispatch","17":"tag-father","18":"tag-heart-attack","19":"tag-inquest","20":"tag-john-kennedy","21":"tag-kristen-de-gilio","22":"tag-naomi-kereru","23":"tag-news","24":"tag-prevented"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115406533323962574","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/318547","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=318547"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/318547\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/318548"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=318547"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=318547"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=318547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}