> The decision to remove a spinal board once in place I believe
> is the sole
> remit of doctors. This is based on the increasingly
> developing culture of
> 'no win, no fee'. The fact is, that medical decisions have to
> be justified
> legally. Who but a doctor is willing to stand up in court and
> justify a
> decision that has left somebody paralysed?
Medical decisions have to be justified legally one way or the other. Spinal
board use can be inappropriate and therefore potentially negligent (it is no
longer always a defence to say it is standard practice). This can lead to
compensation pay outs in just the same way an failure to use the board can
(for example if a pressure sore is caused by a board that should not have
been used in the first place- proportion of payout between hospital and
ambulance staff could be decided by the court). But it is entirely possible
for ambulance crews to have to stand up in court and justify their decision
either to use or not to use a board (on the basis that if they are using a
board they should be aware of its indications and contraindications). We all
make decisions all the time. In any decision affecting a patient there is
the possibility of a negligent act and resulting prosecution.
The decision that a board is not needed seems a fairly simple one- the NEXUS
or Canadian c- spine x-ray criteria are both fairly straightforward and
clearly a patient who does not require imaging does not require
immobilisation (otherwise, saying you don't x-ray, how do you decide to
remove immobilisation). In the future I can see more circumstances in which
ambulance crews have protocols that allow (? compel) them to avoid spinal
boards.
Evolving field.
Hopefully the business of a patient being transferred on to a board in A and
E rarely happens now (certainly used to be commonplace).
Matt Dunn
Warwick
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