"The combination of haemopneumothorax in the right lung and pneumothorax in the left lung results in a drastic reduction in lung capacity, leading to severe hypoxia (low oxygen levels in the blood). The patient may struggle to breathe, and without immediate intervention, this could lead to respiratory failure and death. The blood loss from the haemopneumothorax, open fracture and any other associated wounds can lead to hypovolemic shock, a condition where there is not enough blood to circulate through the body, leading to organ failure and death if not promptly treated. The open fracture introduces a significant risk of infection, which could lead to sepsis if not treated properly. Sepsis is a life-threatening condition where the body's response to an infection causes widespread inflammation and multiple organ failure."
"The haemopneumothorax in the right lung and the pneumothorax in the left lung can significantly reduce … Mr Thomas' lung capacity and lead to respiratory failure. This would prevent Mr Thomas from getting enough oxygen, causing severe hypoxia … and eventually leading to death if not rapidly treated. Furthermore, without prompt medical treatment, the pressure in the chest could build up to the point where it compresses the heart and major blood vessels. This condition is called a tension pneumothorax and can cause the heart to stop (cardiac arrest), which is rapidly fatal without immediate intervention. The haemopneumothorax, the broken arm, and the multiple stab wounds could lead to significant internal and external blood loss. This can result in hypovolemic shock, a condition where there is not enough blood to deliver oxygen and nutrients to the organs, leading to organ failure and death if not promptly treated with blood transfusions and fluids."
"Each of these wounds individually could have (and will have) bled to some degree. It would be very easy for one of them to have bled to a life-threatening degree, even more so for all cumulatively to have caused life-threatening bleeding, given the high number of wounds. This does not appear to have occurred, however, and whilst they required surgical closure it does not appear that any of them required emergency packing, use of tourniquets or emergency blood transfusion. The wounds to the kidney could have caused substantial, potentially life-threatening bleeding as the kidney has a high blood supply, although this does not appear to have occurred. The wounds to the kidney could also have caused failure of the kidney, particularly if its blood supply were disrupted or if the kidney tissue itself was severely damaged, but I see no evidence of either of these occurring."
"The potential for harm was indeed much greater than that which actually occurred, although this does not appear to have been avoided by prompt medical intervention but rather by chance. I say this because the areas which were injured, not just over the back and the torso, but also the groin and the upper arm are areas containing very large and significant blood vessels, any of which if injured could have led to the patient rapidly bleeding to death within a matter of minutes. As well as these blood vessels there are numerous other vital organs and organs with a strong blood supply such as the heart, the lungs, the spleen, the liver, the bowel and (as mentioned above) the kidney, in very close proximity to the wounds and all of which if injured could have caused rapid deterioration and death. I would estimate that may of these structures were narrowly missed, by a matter of millimetres or centimetres at the most, hence severe life changing and life threatening injuries were very narrowly avoided."
"Harm All cases will involve 'really serious harm', which can be physical or psychological, or wounding. The court should assess the level of harm caused with reference to the impact on the victim. Where there are factors present from more than one category of harm, the court should weigh those factors in order to decide which category most resembles the offender’s case. Category 1 • Particularly grave or life-threatening injury caused • Injury results in physical or psychological harm resulting in lifelong dependency on third party care or medical treatment • Offence results in a permanent, irreversible injury or psychological condition which has a substantial and long term effect on the victim's ability to carry out their normal day to day activities or on their ability to work Category 2 • Grave injury • Offence results in a permanent, irreversible injury or condition not falling within category 1 Category 3 • All other cases of really serious harm • All other cases of wounding"
"(a) the offender's culpability in committing the offence, and (b) any harm which the offence — (i) caused, (ii) was intended to cause, or (iii) might foreseeably have caused."
"Harm – which the offence caused, was intended to cause or might foreseeably have caused … • An assessment of harm should generally reflect the overall impact of the offence upon the victim(s) and may include direct harm (including physical injury, psychological harm and financial loss) and consequential harm. … • Where harm was intended but no harm or a lower level of harm resulted – the sentence will normally be assessed with reference to the level of harm intended. • Where the harm caused is greater than that intended – the sentence will normally be assessed with reference to the level of harm suffered by the victim. • Dealing with a risk of harm involves consideration of both the likelihood of harm occurring and the extent of it if it does. • Risk of harm is less serious than the same actual harm. Where the offence has caused risk of harm but no (or less) actual harm the normal approach is to move down to the next category of harm. This may not be appropriate if either the likelihood or extent of potential harm is particularly high. …"