Man died after four-hour ambulance wait

Mr Briggs, who had spina bifida and was paralysed from the waist down, lived in supported living accommodation in Lowedges Crescent, Sheffield.

He was being treated for a possible urinary tract infection when he began to have breathing difficulties on 14 November last year.

Carers called 999 at 20:49 GMT and Yorkshire Ambulance Service (YAS) designated it a Category 2 call, meaning an ambulance should arrive within 40 minutes.

Mr Briggs' carers again called 999 three more times between 21:45 GMT and 23:39 GMT, telling call handlers that his breathing was getting worse.

Two of the calls had been routed through to the East Midlands Ambulance Service (EMAS).

According to Ms Berry, EMAS at one point incorrectly designated the call as Category 2 rather than Category 1, the priority given to the most life-threatening emergencies.

Carers made their fifth call at 00:27 GMT on 15 November, by which point Mr Briggs was unresponsive and not breathing.

Yorkshire Ambulance Service then designated it a Category 1 incident and carers were advised to start CPR.