text: Hillsborough inquests: teenager 'thrown' on top of man in ambulance
  Tony Bland may have been treated differently, say doctors, had they realised nature of crush injuries and had it not been an emergency situation
  Fri 16 Oct 2015 14.54 EDT Last modified on Tue 26 Apr 2016 14.39 EDT
  Tony Bland's funeral in March 1993. In a historic legal battle, his parents, Allan and Barbara Bland, fought for the right for Tony to die with dignity after he had been on life support for four years. Photograph: ANL/Rex Shutterstock
  An 18-year-old man critically injured in the crush at Hillsborough, who subsequently became the 96th person to die, was "thrown" into the back of an ambulance on top of another injured man, the new inquests into the disaster have heard. Tony Bland, from Keighley, west Yorkshire, was taken to hospital in the ambulance and spent four years on life support until it was withdrawn on 3 March 1993, when he died.
  Efforts by police officers and Liverpool football club supporters to resuscitate Bland on the pitch and in the ambulance had led to him having a heartbeat and breathing, the inquests heard, by the time he arrived at Sheffield's Northern General hospital.
  Two doctors who attended to Bland at the hospital rejected suggestions that they had made mistakes in the immediate treatment they recommended when they assessed him, although one, Dr Rani Naidoo, said she might "possibly" have done things differently had she realised the nature of his crush injuries.
  The inquests in Warrington heard that Bland lost consciousness in pen 3 of the Leppings Lane terrace at Hillsborough, where he had gone with two friends to support Liverpool in the FA Cup semi-final against Nottingham Forest. The three men had arrived in Sheffield at about 11.15am, gone to a pub until approximately 1.45pm, then walked to the football ground and entered through the turnstiles at 2.10pm.
  By 3.22pm, Bland has been identified being passed over the fence that split the terrace into pens, then carried by police officers through a gate in the metal fence at the front of the pens, and laid down on the pitch. There a South Yorkshire police constable, Steven Plows, worked to revive him with Colin Flenley, a GP who was at the match as a Liverpool fan.
  The court heard from both men that they did not find a pulse when they first attended to Bland on the pitch, but after two minutes of cardiopulmonary resuscitation (CPR) they managed to feel a pulse, although the teenager was still not breathing. Flenley said he told Plows to keep performing mouth-to-mouth resuscitation while he left to find another critically injured person to help.
  Plows said he could not recall what happened in the intervening seven minutes before he carried Bland into a St John Ambulance vehicle on the pitch, helped by some Liverpool fans. Inside the ambulance there were already three injured or dead people, the court heard: two on trolleys at each side, and one laid on the floor between them.
  Ronald Wicken, a police officer inside the ambulance, said in a statement read to the court by Christina Lambert QC, representing the coroner, Sir John Goldring, that the ambulance then stopped for a child, who was in fact Bland.
  Lambert said: "'That child casualty was then' – to use Mr Wicken's precise words – 'thrown on top of the adult male casualty who was lying on the floor of the ambulance.' Mr Wicken said that the adult casualty on the floor kicked and threw his arms throughout the journey and had to be held down by Mr Wicken and an injured supporter."
  Another police officer in the ambulance, Paul Jenkinson, said that he gave Bland mouth-to-mouth resuscitation while he was laid on top of the other injured man, who was being held down so that Jenkinson could try to help Bland.
  "I was aware of the casualty underneath becoming restless," Jenkinson told the court. "He was obviously starting to regain consciousness and that was causing some problems with me giving mouth to mouth."
  Jenkinson said it helped that Bland was lying on top of somebody because he could get his head in a better angle for the CPR, and Bland did start breathing by the time they reached the Northern General hospital. There he handed him over to the care of doctors.
  Naidoo, now a consultant gynaecologist at St Mary's hospital in Manchester, was a junior doctor at the time, who went to the accident and emergency department to help when the scale of the disaster was becoming apparent. Naidoo made the first assessment of Bland and insisted, under questioning, that she was told a stand had collapsed at the football ground so believed he may have suffered head injuries and she did not know there had been a crush.
  Naidoo did not recommend intubation and ventilation – the insertion of a tube to enable breathing, partly designed to protect patients against the risk of vomiting and breathing in the vomit as Bland ultimately did. Under repeated questioning by Nick Brown, a barrister representing Bland's family, Naidoo said she did not accept this was a mistake.
  Referring to an interview Naidoo gave recently to investigators for the inquests, in which she said she had not been aware of the nature of Bland's injuries or how he sustained them, Brown asked her: "Now, the inference from that is that if you had been aware of the nature of his injuries, you might have done things differently. Is that not what you were trying to convey?"
  "Possibly," Naidoo replied. "I may have done things differently. But I can't speculate on that."
  Dr Steven Hunter, who assessed Bland after Naidoo, also did not arrange for him to have intubation and ventilation, nor to go immediately to intensive care. Questioned by Lambert, Hunter said he did not believe he had made a mistake when only recommending that Bland be monitored regularly. Now a consultant at the Northern General, Hunter said they had to deal with many injured people who had arrived from Hillsborough requiring urgent attention and the anaesthetists who are needed to relax patients before intubation were busy, so it was a question of priorities.
  Asked if, by the normal medical standards of 1989, not in an emergency major-incident situation, a person in Bland's condition would have been transferred to intensive care, Hunter replied: "I think he would have. He would have been ventilated and transferred, via a CT scan, probably."
  Hunter contrasted the lethal nature of the Hillsborough injuries with the lack of broken bones in victims, saying that it was if they had been crushed by a "constrictor snake".
  Bland's parents, Allan and Barbara, his sister, Angela Duncan, and her husband, Andrew, were in the courtroom, listening in silence to the evidence.