Toddler breaks jaw in kōhanga reo fall, St John backs call not to send ambulance

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Hato Hone St John is backing its decision not to send an ambulance for a 2-year-old who fell at a kōhanga reo playground and broke her jaw in two places.

Hastings mother Alana Moriarity is calling for St John to change its processes when it comes to the triaging of toddler falls after her daughter Puāwai’s experience.

Moriarity says the actions of the kōhanga reo, which she doesn’t want identified, were appropriate.

However, she has made a complaint to the Health and Disability Commissioner and asked for an investigation into the way the situation was handled by St John.

St John says the fall was not deemed immediately life-threatening, and sending an ambulance to the scene of an injury is not always the most effective form of treatment.

About 11am on June 3, 2-year-old Puāwai fell face-first from a kōhanga reo playground structure onto a bread tray, resulting in dislodged teeth, a swollen upper lip and a bruise on her right cheek.

Kōhanga reo staff assessed the injury and decided it required emergency medical attention, a spokeswoman said.

“One teacher observed the fall and quickly arrived at the mokopuna’s side to assess the injury and apply first aid.

“The ambulance operator conducted an over-the-phone assessment and advised that there was no immediate or life-threatening danger.”

Alana Moriarity with daughter Puāwai, who fell from a playground structure onto a bread tray. Photo / Michaela Gower

Moriarity said she received a call from the kōhanga reo at 11.20am and was shocked that an ambulance hadn’t been sent to assess her daughter in person, given the nature of the fall and her age.

“I asked if an ambulance had been rung, and I was told yes, but that she had been triaged over the phone, and I remember feeling surprised about that.”

Moriarity said she arrived at the kōhanga reo about 11.50am to find Puāwai in shock.

“She wasn’t crying or anything ... I knew something was terribly wrong.”

She and a staff member took Puāwai to hospital, where she was looked at by a nurse.

“When we went to open her mouth, the whole thing was like a flap.”

It was later discovered that her jaw was broken in two places.

Puāwai needed two hours of emergency surgery to repair her broken jaw.

Puāwai had two hours of surgery to insert a temporary wire in her bottom jaw to help stabilise the break. A week later, she needed more surgery as the wire had dislodged.

Moriarity has since been given the transcripts of both the initial 111 call and the follow-up call.

“The thing we are feeling the most that added to our trauma was the failure of St John to come and help when it was most required.”

She said Puāwai faces ongoing dental issues and potential speech problems, and has been put on a soft-food diet.

Hato Hone St John’s acting head of clinical governance, Cheryl Des Landes, said the complaint was investigated by the consumer experience team.

“St John acknowledges that any circumstance involving a child being injured can be distressing.”

The incident was triaged through the falls protocol and was deemed eligible for an enhanced clinical telephone assessment, Des Landes said.

The kōhanga reo was told a nurse or paramedic would call back in 10 to 30 minutes to assess Puāwai’s injuries and arrange the most appropriate care.

A kōhanga reo spokesperson said that, during this wait, the head kaiako and another staff member remained with Puāwai, continued to apply first aid, and contacted her mother.

Two attempts were made by a clinician to call the kōhanga reo at 11.25am and 11.26am, but the calls went directly to voicemail. The second call was followed by a text, Des Landes said.

Puāwai, mum Alana and sister Te Pūaroha look through Puāwai's get-well cards. Photo / Michaela Gower

At 11.34am, the emergency nurse and head kaiako discussed Puāwai’s injuries, and a decision was made not to send an ambulance.

Des Landes said that, from the information provided, the clinician determined the patient should be taken to an emergency department for further assessment.

“Considering the patient’s condition was not immediately life-threatening and the proximity of her mother, it was deemed appropriate and safe for the patient to be taken to the hospital by private vehicle.

“The most appropriate treatment for the patient may not always involve an ambulance response.”

The kōhanga reo spokesperson said the safety of its mokopuna remained its highest priority, and “we are committed to learning and improving from this tragic experience”.

An internal review confirmed all relevant policies and procedures were followed.

“We have engaged an independent expert to carry out an assessment on our facilities and are dedicated to implementing any recommendations for improvement.”

Michaela Gower joined Hawke’s Bay Today in 2023 and is based in the Hastings newsroom. She covers Dannevirke and Hawke’s Bay news and loves sharing stories about farming and rural communities.