> If ambulance personnel can place the patient onto the boards in the first
place then why cant
> they (and the nursing staff in A&E) remove them from the board.

They should be able to do so.

> I believe nurses can clear C-spines if educated to do so. It doesn't
appear to be rocket
> science. I may be naive and maybe you guys on the list will advise me why
I am wrong. If the
> nurse palpates the spine and the patient doesn't go 'OUCH' AND there is no
neurological deficit
> then the C-spine has been cleared. If the patient has any S&S of pain or
deficit then the
> patient is strapped down to the trolley and X-rayed for the docs to
review. Or is there more to
> this than I have witnessed over the past 17 years of watching A&E docs
performing a clearance.

Slightly more, not a lot. Nurses (and paramedics) should be able to do this.


> MOI is out of date and needs to be reviewed. 30mph with a seat belt is an
indication for trauma
> calls to the A&E!!. This was based on US vehicles with box frame chassis
and no seat  belts. We
> now have crumple zones and seatbelts, head rests, side impact bars and
have had for a few years
> now. A need to review is indicated.

Agreed.


> > In any decision affecting a patient there is
> > the possibility of a negligent act and resulting
> prosecution. (Matthew
> Dunn)
>
> Negligent acts might lead to litigation, but only rarely
> result in criminal
> charges or prosecution.

Writing fast, the word 'litigation' did not come into my head at the right
time.
However, I believe the term 'prosecution' can cover both civil and criminal
prosecution.

> The Bolam test has now been superseded by Bolitho:
> While I acknowledge that this represents merely a modification of Bolam,
it
> is generally viewed as strengthening the plaintiff's position in medical
> negligence cases. I hasten to add that I'm not trying to engender
defensive
> behaviour; I agree wholeheartedly with John's comments, "I think it is
vital
> that clinical practice remains patient centred and is not medico-legally
> driven".

Bolitho is a bit patchy in its application. I think it actually moves us
away from defensive medicine- I've previously heard an argument that you
must follow guidelines however wrong they appear because they are the
standard practice used for defence under Bolam. Under Bolitho you must be
prepared to show that the guidelines are reasonable rather than standard
practice i.e. move away from time honoured (and defensive) to evidence based
practice. The relevance here is of course that certainly use of spinal
boards has been standard practice in the past. This is no longer a defence-
you have to consider whether they benefit this patient.

Matt Dunn
Warwick


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