Girl on school trip to US would have survived if given antibiotics, inquest told
A teenager who died during a school trip to New York would have survived if she had received antibiotics in the days before her death, an inquest heard.
Ana Uglow 17, a student at Bristol Grammar School, collapsed in her hotel room and was pronounced dead at Mount Sinai West hospital on December 19 2019.
Avon Coroner’s Court has heard that Ana, a senior prefect who aspired to attend Oxford University, was on a school history trip to Washington, Philadelphia and New York at the time.
Her parents, David and Natalia Uglow, said Ana told teachers she thought she had a chest infection and asked to see a doctor two days before her death but this was “refused”.
However, the two teachers Rory Hambly and Ellice Clare have insisted that Ana only complained of feeling tired and having a blocked nose, and did not directly ask to see a doctor.
A report by the chief medical examiner of the city of New York concluded that Ana, of Redland, Bristol, died from bronchopneumonia and sepsis complicating an influenza upper respiratory infection.
On Thursday, two experts told the inquest that Ana would have survived if she had been given antibiotics in the days before her death.
Dr Nelly Ninis, a consultant general paediatrician, said Ana’s pneumonia would have been cured if she had received “high-dose, broad-spectrum oral antibiotics” and taken them as directed on December 17.
“If she had received oral antibiotics, I think that would have prevented the secondary infection,” she said.
That day, Ana had raised the issue of seeing a doctor with her teachers during a train journey. They took her to a pharmacy that evening, where she bought nasal decongestant and cough syrup.
On December 18, Ana asked her teachers if she could stay in her hotel room rather than going on a walking tour but went along after speaking to them.
She went shopping with a friend that afternoon and to the Empire State Building, where she was seen coughing and retching over a bin, that evening.
At 6am, her chance of survival was not zero, it was above zero
Dr Ninis said: “If two doses of antibiotics could have been taken and kept down by the evening of December 18, I think it would have slowed down what happened.”
She told the inquest that if Ana had attended a hospital “at any point” that day, she would have been assessed and started on high-dose intravenous antibiotics.
“I believe she would have survived,” Dr Ninis said.
Professor Andrew Lever said Ana would have survived if she had been given antibiotics on either December 17 or 18.
The inquest heard it is likely Ana had flu when she went on the trip, on December 14, with her symptoms worsening and becoming pneumonia between December 16 and 18.
She is believed to have developed a secondary bacterial infection, group A streptococcus, around that time and sepsis between December 18 and 19.
Ana told her teachers she felt tired during the trip and asked to stay in her hotel room on both December 16 and 18, rather than taking part in planned activities.
In the days before her death, Ana’s body was able to “compensate” for the infection and her symptoms would have fluctuated, the experts said.
On December 19, Ana woke Mr Hambly at about 6.15am and told him she felt unwell, her heart was racing, she was anxious, had difficulty sleeping and had a sore back.
Prof Lever was asked whether he believed Ana would have survived if a paramedic had been called and provided her with appropriate treatment at that stage, before she suffered a cardiac arrest at 8.15am.
“On the balance of probabilities, the things that influence me to say that she could have survived is that her collapse was a very sudden event,” Prof Lever, an expert in infectious diseases, said.
“In terms of that morning, the fact that she was physically well and walking around and able to go and knock on the teacher’s door suggests that things had not reached a critical point.”
Prof Lever said young people such as Ana were “very resilient and they do bounce back”.
Mr Hambly fetched Mrs Clare, who previously described how she did “breathing exercises” with Ana to calm her down, before she ate a banana and took painkillers.
The teachers, who had both received first aid training and were experienced at taking pupils on school trips, walked Ana back to her room so she could get some sleep.
Dr Ninis was asked whether it would have made a difference if Ana had been taken to hospital at that point.
“At 6am, her chance of survival was not zero, it was above zero,” she replied.
However, she said Ana would have needed to go to hospital – where she would have been admitted to intensive care – at least six hours before her collapse at 8.15am.
“At the point Ana went into cardiac arrest, I think her chance of survival was zero,” Dr Ninis said.
“What I believe is that six hours earlier, it was was above 50% that her life could have been saved.”
However, Prof Lever said he believed some of the physical changes taking place may have been reversed “if prompt medical attention had been provided when she went to her teacher”.
At 7.30am, two students sharing Ana’s hotel room awoke to find she had suffered a nose bleed, was pale and her breath was gasping.
She was struggling to form words and told her friends: “I think I’m going mad” and “I can’t feel anything”, as well as asking Mr Hambly – who was brought to the room – “Why is this happening to me?”.
Mr Hambly previously told the inquest that Ana was “lucid, responsive and articulate” when he went to the room but suddenly collapsed at 8.15am.
Prof Lever said there was a “delay” to Mr Hambly giving Ana CPR before paramedics arrived, as the teacher “picked her up and put her over his shoulder and carried her to the bathroom” before placing her on the floor.
“If someone collapses, then people who have first aid experience would immediately reach for a pulse then they should start CPR straight away,” Prof Lever said.
However, Dr Ninis said she did not believe “there was any delay” in Mr Hambly administering CPR.
Paramedics arrived at the hotel at 8.26am and Ana was taken to hospital, where she was pronounced dead at 10am.
The inquest continues.
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