I need some information please...

[WestSideBorderPatrol]

Ok, so heres what's up.

Last saturday (9-22) my Uncle was in England on a business trip, specifically the Yorkshire area, and was involved in a serious car crash. From the information that I could piece together he was broadsided by a police car that was possibly in pursuit of another car. Well anyway, the car was totaled and the air bags did deploy.

When the ambulance arrived they didn't put a cervical collar on him, nor did they put him onto a backboard. He was transported sitting upright in the ambulance and while he was at the hospital they didn't do any CT scans or x-rays. He received stitches for the laceration above his eye and he cannot remember much of the accident. They did not admit him to the hospital and he is now at some type of Bed and Breakfast. Now a few days later he is complaining of chest pain and shortness of breath.

I guess my question is, why weren't spinal immobilization precautions used and why wasn't he given a CT scan or x-rays once at the hospital?

I'm just curious as to the protocols over there and if the lax treatment he was given is standard.

I honestly don't know anything about EMS overseas and would appreciate any information that can be provided.

Many thanks,

Scott

[zippyRN]

the simple answer is

1. you weren't at the scene - therefore you are relying on the descriptions of others

2. seatbelts and airbags do work - don't forget EU spec airbags are different to US ones in activation criteria , size and inflation pattern due to the fact that seatbelt wearing is legally mandated and generally followed ... also EU standard lap and diagonal intertia reel with pyrotechnic pretensioner seatbelts are of a higher standard than some US seatbelts

3. JRCALC GUIDELINES do not 'require' spinal immobilisation just because someone has been in an RTC and the airbags deployed

if the crew at scene were able to apply the immobilisation decision algorithim documented in JRCALC and satisfy themselves that the patient does not require immobilisation ( and the consequent risk of airway compromise, raised ICP, pressure damage, and the other iatrogenic sequalae of immobilisation )

http://www2.warwick.ac.uk/fac/med/research...006/guidelines/

4. the uk has legislation that requires medical exposure to ionising radiation to be justified, if the ambulance crew ( remembering that UK paramedics are clinicans in their own right by virtue of their professional registration with the HPC) and the emergency department were able to adequately clear his neck BY CLINICAL EXAMINATION then x- rays or a scan are not indicated ... current UK head injury imaging guidelines were adapted from US guidelines to limit the number of CT scans performed - but have increased substantially the number of scans performed in the UK ...

5 . some chest wall discomfort is quite common following an RTC where airbags and /or pretensioners fire ...

[scott33]

I have to agree with Zippy for the most part, so you may not get the answers you are looking for. Although I will say, the chest pain may or may not be related, so perhaps this should be looked into further.

I would also like to know if your Uncle was unhappy with his treatment from the outset, or if you were asking him leading questions. You say you were the only medical person in the family, so perhaps he was unaware of how the call would have been handled in the US, until you mentioned it

As Zippy said, guidelines replace protocols in the UK, which gives UK ambulance staff, more say in the ultimate treatment, and disposition of the patient. Over here, that would definitely be a board and collar job, but why??? Well, much of the time it is purely based on mechanism of injury, not the clinical findings of a thorough assessment.

Now it should be noted that there have been some times when UK crews have been accused of being a little indolent (for want of a better word) in their approach to treating the less sexy jobs, given their prehospital autonomy. Indeed, there is a picture online somewhere of someone who had fallen from a horse, with a c-collar in place, being walked to the ambulance by an NHS crew. In general however, regulation of their practice is more strictly scrutinized (at the paramedic level) than it is in the US, due to the ever-watching eye of the HPC (healthcare professionals council). There are documented cases of paramedics being struck off, and therefore, being unable to practice, for being negligent in their assessment or treatment of their patient. It is not something they can expect to get away with for long.

Here is a brief example of the consequences of improper assessment and treatment.

http://www.hpc-uk.org/complaints/hearings/...6&showAll=1

Just like in the US, UK PCR’s are checked all the time to make sure that correct procedure was followed, but if the crew can justify the lack of c-collar and board, as laid down in their guidlines, and include all relevant documentation of clinical findings, then there should not be a problem. It should also be noted that in the UK, those cases which the crew feel warrant proper immobilisation and extrication, are obligated to have the roof taken off the vehicle (even if there was previously little or no damage) and the patent removed out the back. How many of us routinely do that in the US?

Perhaps if the shoe was on the other foot, and a UK citizen was in an MVA in the US, had some poorly-organised EMS system come out, slap on a collar and KED, and use the all too common twisting forces to put the patient from a sitting position to a supine one (seen it too many times), then they too would have the right to question what they believe to be improper clinical practice.

Taking your Uncle's case out of the picture for a minute, how many times have we boarded and collared perfectly stable post MVA patients, only to find them strolling out of the hospital by the time we have handed in our PCR’s? We know many of these calls are BS, and purely for lawsuit purposes, we just don’t possess the authority to do something about it. Thankfully, it is not like that the world over. Next time you get someone who you are sure is a faker, and is giving it the neck and back pain in their unscathed vehicle, tell them you may need to take the roof off their car to extricate them, explaining the importance of proper spinal alignment; then watch their attitude change. I have had people jump out of their seats and onto the road, for suggesting it, only to say they can't move. Thank God for the narrative component of a PCR continuation form :twisted:

As for the treatment in the hospital, the NHS takes a slightly different approach to treatment than the US. Remember, NOTHING is billed, so justification for intervention is more the norm. Even if all protocols were to be followed had it been a US hospital, he would have needed a digital rectal exam, before being taken off the board, and we all know that never happens. In the UK, it is more "we will treat for what we have found you to have" rather than the US model of "we will treat what we have found you to have, what you may or may not have, and what we don't want you to get" It's a billing and legal issue, not a matter of beneficence

Sorry he appeared to have a bad experience, and he has every right to look into why he received the treatment he did. To repeat though, he may not get the answers he is looking for.

[UKMedic1]

I fully support what Scott33 has said. I woud also add the following thoughts.

The original post said the car was "totalled". European cars are designed to collapse in the event of a collision - crumple zones are built in to the vehicle to disperse the energy, so the car may appear severely damaged even though the impact speed was not that high.

It is also highly possible that in addition to the higher autonomy of the paramedics, your uncle may have been seen and assessed by a BASICS doctor (immediate care specialist) on scene andclinically cleared in the same way as he would be in hospital.

Finally, the most telling part of the story is that the collision involved a police vehicle. I smell a fishing trip for a lawsuit here.

[courageheartx]

England EMS....I have to research this one.

[scott33]

England EMS....I have to research this one.

Here you go, including links to some of the different trusts at the bottom. The Scottish, N. Irish and Welsh EMS services come under the same "NHS" umbrella as the English ones.