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> I would refer list members to the Bolitho judgement but > basically the defendant > (Healthcare Trust) succeeded as the failure to intubate was > according to accepted > opinion (despite plaitiffs expert evidence to the contrary) > AND was SENSIBLE > given the risks of RSI in a young child. Not quite. Bolitho failed on causation- it was negligent for the registrar not to attend the child. However this act of negligence did not cause the damage as expert opinion held that it was likely that had she attended she would not have intubated. The issue was not whether intubation was sensible but whether it would have been done. The registrar was negligent in her actions but the injuries would still have occurred had she not been. However on the standard of care issue, Bolitho (particularly the judgement of Dillon LJ) allowed the courts to reject a body of medical opinion if satisfied that 'the reasons of one group of doctors do not really stand up to analysis'. Another case of note is Smith v Tunbridge Wells HA from 1994- on consent for TURP, failure to warn of impotence was held negligent although at the time of the incident that was the practice of some surgeons because the judge felt it neither reasonable nor responsible. > It seems however that a plaintiff could now successfully > argue that "full immobilisation > would be safest until the spine can be cleared" as this would > be the sensible > thing in lay opinion, despite a "reasonable body of medical > evidence" that may > say full immobilisation would not necessarily always be > appropriate. There is scope (under Bolitho) for a court to accept the plaintiff's argument that there is no evidence for the safety or efficacy of full immobilisation. Unlikely but possible > Full immobilisation > may considered a cheap, non-hazardous intervention, so little > harm result; the > argument against is of course pain, pressure sores, and > potential harm occuring > during the immobilisation procedure. (yet to be tested in law). If a patient suffers a pressure sore (as many do) it is no defence to say that this is a rare complication. In that case it occurred. Conversely, there is the theoretical risk of spinal injury from not using a board. I am not aware that this is an actual risk. Overall, use clinical judgement. The decision to use or not to use a board should be based on this rather than defensive practice. Useful questions for study: 1. Are spinal cords ever injured from 'normal' movement in A and E departments/ wards (as opposed to during extrications)? 2. Does spinal 'immobilisation' prevent this (and I am aware of studies suggesting that longboards or collars have little effect on movement of the unstable neck) and if so, what are the effective interventions? 3. What is the incidence of serious side effects (raised ICP, pressure sores etc.) from each of these interventions. Has anyone done a formal literature review? Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.