OK - not necessarily hypothetical - but it's an open list so let's just say
it's a case I know of - who knows when / where / who told me / age / sex
etc. etc.? - and all the info you chaps are giving is very helpful - Thanks
Nick
-----Original Message-----
From: fred [mailto:[log in to unmask]]
Sent: 06 May 2003 20:27
To: [log in to unmask]
Subject: Re: pre-hospital spinal control
Anton
You beat the fire service response time of generally five minutes in built
up areas? I know Stafford Ambulance Service is good, but that does take some
doing?
Agree with you on the medical negligence or duty of care has a low input in
the fire service, As a conversation I had with the "Training Command" at
FSHQ's this afternoon is that they learn how to do all the right stuff,
cutting cars, applying collars, ked and spine board, over 3 days at Morton,
then 1 - 2 days refresher training, what they lack is the underpinning
knowledge on why they are doing this and SIGNS & Symptoms, but what they do
have in their favour, is protocols on spinal immobilisation, If they called
the shots on no spinal immobilisation, then that LFF / Sub Officer should be
accountable for the duty of care, by not acting on greater knowledge of
medical input and not adhering to their protocols.
Roles reversed, I do think that we need to re-train the ambulance crews on,
not using rapid extrication or the drag method as the norm, as I'm certainly
seeing more of it.
Nick did it happen for real??
Fred
SR Para / Leading Fire Fighter
----- Original Message -----
From: Anton van Dellen <mailto:[log in to unmask]>
To: [log in to unmask] <mailto:[log in to unmask]>
Sent: Tuesday, May 06, 2003 3:27 PM
Subject: Re: pre-hospital spinal control
Dear Nick,
You are quite entitled to raise concerns and hopefully you have access
to the ambulance adverse incident monitoring system. We certainly
encourage feedback from hospitals, both formally and informally. My
view is that I would hope that you would raise concerns as though the
patient was a member of your family.
With regards to possible negligence, duty of care rests with the
ambulance service upon receipt of the 999 call.
If the paramedics on scene had concerns with the extrication, their
ambulance incident officer needed to raise this with the fire incident
officer, in accordance with standard inter-agency operating procedure.
If the fire incident officer declined the advice of the ambulance
incident officer with regard to patient management, I suspect a good
case could be made by the ambulance service for medical liability to
rest entirely with the fire service, though this would be dependent on
the conversation. I suspect that as the accounts would invariably
differ, the ambulance service would retain the bulk of liability.
The monetary amount in the event of possible negligence would
substantially rest on the level of the pre-extrication neurological
function, though it could probably be successfully argued that the lack
of immobilisation decreased the potential for recovery.
Interestingly, very, very poor evidence base for spinal immobilisation
pre-hospital.
Interesting scenario - are you sure it is hypothetical? ;)
I do agree that awareness of medical negligence and duty of care is
probably low in the fire service, but is very, very rare for them to be
on scene before us. "Common law" is that we tend to retain medical duty
of care for actions undertaken by the fire service as we are on scene as
the "senior" medical presence.
Best wishes
Anton
Staffs
Nick Jenkins wrote:
>
> Dear all,
> Imagine a hypothetical case of serious RTA resulting in neck injury with
> paralysis. Patient extricated by fire service without spinal control
> despite para-medic requests for same. Did paralysis follow RTA or
> extrication?
> There would clearly be a need for the pre-hospital providers to learn for
> the future.
> Given the pre-hospital expertise on the list how would that take place /
> what would be the lines of responsibility?
> How should it be initiated if not already done so?
> Should the hospital docs involved in treating only after the case crosses
> the hospital entrance become involved / initiate this?
> What do people think?
>
> Nick Jenkins
> A&E Consultant
> Abergavenny
> http://www.ae-nevillhall.org.uk <http://www.ae-nevillhall.org.uk>
>
>
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