Dr Knapman, the Westminster coroner, recorded a verdict of accidental death on Lady Margaret Elton, 79, of Clevedon, Avon, who was airlifted to the Royal London Hospital after being hit by a cement lorry in Sloane Square, south-west London, last May.
He called for a review of the use of the helicopter service, echoing two earlier, official reports. Both a House of Commons select committee and an independent review of the service have questioned its management and effectiveness.
The inquest heard that there had been delays of 30 to 40 minutes in giving Lady Elton a blood transfusion when she could have been taken by road "in four minutes " to the nearby Chelsea and Westminster Hospital. Lady Elton, who had sustained massive lower leg and pelvic injuries, died later at the Royal London.
Dr Knapman said he would write to Stephen Dorrell, Secretary of State for Health, to William Wells, the chairman of South Thames Regional Health Authority and to the London Ambulance Service (LAS). He will ask Mr Wells's advice on "any action he considers necessary" about the use of the Helicopter Emergency Medical Service (Hems) and copy the letter to Mr Dorrell. He is also recommending that the LAS reviews its "acting instructions in Hems cases".
At the inquest, Dr Jeremy Booth, accident and emergency consultant at the Chelsea and Westminster Hospital, said: "I find it quite extraordinary to hear this lady could have been in our accident and emergency room . . . several minutes before the doctor arrived by air ambulance."
Because the Royal London is the helicopter's base it has been accused of "poaching" patients whose health authorities must refund the cost of treatment, and the question was raised by Dr Knapman.
Dr Stellios Panayiotou, who decided to airlift Lady Elton, said he would do the same thing again as he believed it was the best option. "Any suggestion that my decision had anything to do with a financial gain for the hospital is ludicrous," he added.
Summing up, Dr Knapman said: "There is no doubt that Dr Panay-iotou believed then, as he believes now, that he was doing the best for Lady Elton. If he was wrong, and evidence has been advanced that this may be so, I accept his motives were professional. At worst, he was too enthusiastic, no doubt subconsciously having a preference for a hospital where he knew precisely the facilities."
Dr Knapman said it was "very questionable indeed" whether admission to the closer hospital would have made any difference. "But in hindsight she could have received blood well over half an hour earlier," he said. He added: "Without the benefit of hindsight, the decision to transport her to the Royal London Hospital was understandable - even if, on mature reflection, it was a misjudgement."
Dr David Maclean, clinical director of Hems, said: "We will naturally look again at all procedures and protocol to try and make them as robust as possible." Russ Mansford, operations manager for the LAS, said: "We will take a full review of all our protocol."
He admitted that there were "communication problems with some of our staff and the helicopter service". He added: "We have seriously got to look at where the helicopter does land and the locations."
Mr Wells said the London health authorities responsible for buying ambulance services in the capital were looking at their spending plans for next year now. "By September, they will have taken a preliminary view of the way that Hems works."Reuse content