Wednesday, 18 June 2008

Child dies

A sad story has emerged in which paramedics elected not to bring a child into hospital following a head injury, the child died a few hours later after another ambulance had been called.

Whatever the facts of the case, it is clearly unfair to put paramedics in this decision making position given their minimal levels of training in medical diagnosis and treatment. In the NHS these days managers frequently pressurise paramedics to leave patients at home.

This is a high risk strategy to say the least, these kind of decisions are hard enough for fully trained and highly experienced doctors, so it is not safe or fair to put paramedics in this position.

This is a familiar tale in the NHS today. Those without sufficient knowledge and training are routinely empowered to make decisions outside of their so called 'spheres of competence', the system is set up to encourage this dangerous practice. It's very sad indeed and it just isn't good enough.


the a&e charge nurse said...

Perhaps you will permit me to put the flip side of the argument, ferret ?

Children bang their head........... a lot.

Lets say a child, falls from standing and bumps their head - no LOC is reported, GCS15 throughout, no vomiting, no visual disturbance, no limb deficits, etc, etc, in fact, the child seems OK post incident.

Since it may be impossible to exclude a bleed at scene [clinically] does EVERY well looking child who sustains a head injury, no matter how trivial, need to be transported to A&E ?

In my experience mistakes are just as likely to occur when services become overwhelmed, because so much time and energy is spent trying to seperate the wheat from the chaff, or just trying to ensure that the 'basics' are being done.

Remember A&E visits are already up by 30+% over the last few years [and we now have far less time to sort patients out].
Emergency admissions have also gone through the roof, while most ambulance services are struggling to cope with a huge surge in demand.
In short we are finding it hard to cope as it is.

Everybody [it seems] has got something wrong with them nowadays and the answer, surely, is urgent medical examination, followed by a battery tests, just to be on the safe side - after all, who wants to be responsible for missing an extradural after an innocuous bump on the head ?

Anxieties about risk lead us inevitably to a mind set that says:
All headaches = meningitis [until disproved].
All backpain = AAA [until disproved].
All indigestion = MI [until disproved].
All pyrexia/myalgia = septacaemia [until disproved]
All head injuries = intracraniel bleed, etc, etc, etc.

You worry about dumbing down [fair enough].
I worry about the legion of relatively well people who are convinced that a sinister medical condition has been missed, or who have forgotton how to trust their own immune system [the sort who insist on the need for an MRI after a simple knee sprain] - both roads can lead to adverse outcomes but I don't pretend to know what the answer is ☺

Garth Marenghi said...

good point.

however I still firmly believe we should be more strict with who should be allowed to take responsibility for these kind of decisions