"There is good cause for those around her to feel aggrieved. "The tragedy could not have been avoided by any more timely arrival but that doesn't in anyway minimise the distress and concern on behalf of the family. "I'm satisfied the ambulance service has been found wanting and has already taken many steps to address the issues raised." He returned a narrative conclusion that Elouise died from an acute asthma attack but, although an ambulance was sent to the wrong address, earlier intervention was unlikely to have changed the outcome. Outside the air evac services inquest solicitor Peter Collins read a statement on behalf of the family. He said they hope to establish a charity, the Elouise Keeling Memorial Asthma Trust, in her memory. Mr Collins added: "The past two days have been an emotional and testing time for the family. "Whilst some questions will inevitably remain unawanswerd, they have finally been provided with an account of events that led to the tragic loss of their daughter. "They hope lessons will be learnt and perhaps other families will be spared the same heartache and devastation that they will always feel as a result of Elouise's death." The East of England Ambulance Service (EEAS) has been widely criticised over a series of delays in recent months. Most recently crews were described as "chaotic" after another coroner heard that three-month-old Bella Hellings died when paramedics took more than three times longer than national targets dictate to reach her home in Thetford, Norfolk. Darren Maguire, general manager at EEAS, told the inquest steps had been taken to improve procedures since Elouise's death. He said: "We are moving to improve the level of service that we provide." Emergency care expert John Heyworth, who compiled a report on behalf of the EEAS, said the prognosis had been "grim" and it was unlikely Elouise would have survived even if paramedics had arrived earlier. "There is no doubt earlier intervention would have increased the chances of a better outcome," Dr Heyworth added. "But by that point her chances of survival were low and if the ambulance had arrived a few minutes earlier, it would not have made a significant difference." On the day of her death, Elouise had only managed to jog to a playing field and had not taken part in any activity when she suffered the attack. She had seen a paediatrician about her worsening asthma earlier that day but was not considered an immediate risk, the inquest heard. Pathologist Martin Goddard found she died of acute, severe asthma. Dr Goddard told the inquest: "This case is quite unusual. "Her condition was very difficult to treat and potentially irreversible. "Cases that are rapidly progressive in this way, tend to have a bad outcome." RAF Brampton was only four minutes by ambulance from Hinchingbrooke Hospital but, because she suffered a cardiac arrest, paramedics decided it was better to treat her at the scene. The inquest earlier heard that ambulances had struggled to find RAF Brampton during incidents in 2006 and 2012 due to confusion over the postcode. These problems were reported to the ambulance service and flagged on its system but this data was lost when the trust updated its systems, the inquest heard.
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