### Paramedics Criticised for Lack of Advance Warning Before Young Woman’s Sepsis Death in Cardiff
The death of 21-year-old Bethan Amy James, daughter of former Glamorgan and England cricketer Steve James, is under the spotlight as an inquest examines whether paramedics should have pre-alerted emergency staff at the University Hospital of Wales, Cardiff, where she died from complications relating to sepsis, pneumonia and Crohn’s disease. The inquest, now underway, has raised significant questions about the urgency of the response provided by those involved in her care during the critical hours before her death.
Bethan James, described as a “caring” and “beautiful” young woman with ambitions of becoming a journalist, was brought to hospital by ambulance on 8 February 2020, and tragically passed away the following day. Her father, a distinguished sports journalist, was abroad covering the Six Nations rugby match in Ireland at the time and was unable to reach her side due to flight delays and adverse weather. The sense of loss has been compounded by the family’s concerns that her declining health was not treated with the seriousness it warranted by a series of medical professionals.
During proceedings at the inquest, it was revealed that neither a pre-alert was sent nor were blue lights used during the ambulance journey to the hospital. Paramedic Laura Wilson, who accompanied Bethan, told the coroner that she accepted a pre-alert should have been made. Ms Wilson reflected that her practice has evolved because of this tragedy, and admitted she did not fully appreciate the severity or fast-changing nature of sepsis at that time. Her colleague, emergency medical technician Aaron Hook, concurred that notifying the hospital would have been essential.
The decision to forgo blue lights, Ms Wilson explained, was taken to reduce stress for Bethan, who was visibly distressed and unwell during the journey. She told the court, “Using sirens and lights would have only served to add to Bethan’s stress,” although she acknowledged that Bethan was clearly deteriorating. The inquest also heard that the total ambulance response time at Bethan’s home lasted 29 minutes, which Ms Wilson maintained was within reasonable parameters.
Questions have also been raised around hospital protocol after Mr Hook entered the emergency department to urgently seek a bed for Bethan. Carys Williams, the nurse in charge of the resuscitation ward, told the hearing that at the time the department was at capacity and Bethan was initially placed on a “buffer bed” in the adjoining majors department, designed for patients requiring close observation. Bethan subsequently suffered cardiac arrest and died, despite later transfer to resus.
Ms Williams stated that if a pre-alert had been given, it would have triggered earlier discussions with consultants and potentially enabled a patient move to clear a critical care bed. Mr Hook, when queried, had only described Bethan as “unwell” upon arrival, which Williams claims gave her little scope for further action due to the overwhelming patient load.
Discussions within the inquest have also reflected on whether a resuscitation bay was genuinely unavailable for Bethan upon arrival. The family’s advocate referenced information potentially suggesting otherwise. Williams maintained that only paediatric space was open, which was not suitable for adult patients. In response to suggestions that she referred to Bethan’s deceased body as “it”, Ms Williams denied using such language.
Consultant Dr Bethan Morgan, who assumed responsibility for Bethan’s care for less than an hour before her death, was asked if an earlier and more urgent hospital transfer could have averted the outcome. Dr Morgan expressed uncertainty, stating, “My opinion is I think Bethan would have died of this illness regardless,” citing the atypical and swift progression of her condition and the fact that her sepsis was later determined to be “viral” rather than bacterial, making it harder to diagnose and treat.
On the first day of the inquest, Bethan’s mother Jane James gave a moving tribute to her daughter, recalling her selflessness and drive. Bethan, who had been diagnosed with Crohn’s disease just a year before her death, documented her struggles online and aspired to use her experiences in a journalistic capacity. Her mother described her as “someone who never made a fuss,” always placing the wellbeing of others ahead of her own.
This inquest continues to pose difficult questions about how young adults with chronic illnesses and complex symptoms are triaged and managed both pre-hospital and upon arrival at A&E. It remains to be seen whether any significant changes in policy or practice will result once the coroner’s findings and recommendations are published.
Cases like Bethan’s highlight the challenges frontline healthcare staff face in rapidly recognising and acting upon subtle but life-threatening conditions such as sepsis, as well as the emotional toll such cases inevitably have on those involved.