"We all just want answers to why he was waiting for so long," says grandson of stroke survivor Robert Llewellyn
The family of a grandfather who waited eight hours for an ambulance when he suffered a stroke are demanding answers.
Robert Llewellyn, 66, from Pen-y-Graig in Rhondda, has been left unable to speak, swallow or move one side of his body and he remains in hospital.
For every minute a stroke goes untreated a patient loses almost 2 million braincells, according to stroke doctors, making early intervention crucial.
But almost all stroke-related 999 calls are classed as 'amber' in Wales, meaning there is no target response time because they are deemed "serious but not immediately life-threatening".
Cameron Spiller, Mr Llewellyn's grandson, said his family are now questioning what his outcome could have been had he been able to access treatment sooner.
"It's horrible, there's no words that could describe how we actually feel," he said.
"Going to the hospital and seeing him as bad as he is now, we're all questioning whether he's that bad because of the extent of the stroke, or whether the ambulance times actually had an effect on his rehabilitation process.
"To see him go from the sort of bubbly, happy man he was to then what he is now after having a stroke, it's completely heartbreaking for all of us, it's horrible.
"We all just want answers to why he was waiting for so long."
Dr Terry Quinn, a stroke consultant and member of the British and Irish Association of Stroke Physicians, explained why it is likely the ambulance delay did have an impact on his outcome.
"When someone has a stroke, there's not enough blood getting to a part of the brain, and we know for every minute that that happens almost 2 million braincells are dying.
"So you can see why we're not talking about you can wait hours, you can wait until tomorrow - if you need treatment for that kind of stroke you need that treatment immediately.
"The treatments we have have a time window, and within that time window the earlier we give the treatment, the greater the possibility that that person's going to be left without those life-changing disabilities."
There are two types of treatment that can significantly reduce the impact of a stroke, but they both have a time window and are more effective the faster they are administered.
Thrombolysis is a clot-busting drug that can be given up to 4.5 hours from the onset of a stroke, but the most favourable time is within 90 minutes.
Thrombectomy is the surgical removal of a blood clot, and is most effective within six hours of the stroke but can be extended to 24 hours for some patients.
Around two in ten stroke patients are eligible for thrombolysis, while one in ten are eligible for thrombectomy on average.
Charities have warned that hundreds of people in Wales are missing out on thrombectomy because it is not widely available.
Stroke costs the Welsh economy £1.63 billion a year, with the first year of stroke treatment costs around £45,000. A third of this cost is to the NHS.
Wales' national clinical lead for stroke Shakeel Ahmed said early access to these treatments, as well as acute stroke units and rehabilitation can reduce this cost.
The Welsh Ambulance Service said it is "deeply sorry about Mr Llewellyn's experience and know how distressing this must have been for him and those around him as they waited for our assistance".
It said 'red' calls are reserved for immediately life-threatening incidents, mainly cardiac or respiratory arrest where resuscitation on scene could be lifesaving.
Dr Brendan Lloyd, Executive Director of Medical and Clinical Services at the Welsh Ambulance Service said: "It is clinically important to differentiate these calls from others given how unwell the patient is and the way that we respond to them.
"For red calls, multiple resource types, including solo responders and community first responders can be sent."
Dr Lloyd added that some patients who are not in immediately life-threatening conditions are facing very long waits as a result of hospital handover delays, an increasing number of life-threatening 999 calls, staff absence and Covid-19.
"We sincerely regret these delays and are working with health board colleagues and the Welsh Government to ensure we make improvements," he said.
The Welsh Government is currently working on a new stroke delivery plan, including the introduction of a Wales-wide thrombectomy service.
It also has an active delivery plan in place to increase ambulance capacity, improve response times and ambulance patient handover.