There were some interesting responses to my last post about the treatment of a minor collision victim by firefighters. The general thought was that they immobilised the patient to prevent being sued by overzealous lawyers. In addition I was told that only doctors were able to remove the immobilisation collars, that the ambulance staff wouldn't touch the collars.
This makes me incredibly angry.
At what point did we stop performing good medical treatment and instead treat everyone as if they are angling to make money off of us.
The placing of a C-Spine collar is something that should only be done where there is a clinical need for it. We are trained to decide if there is a risk of a C-spine injury. We shouldn't be putting collars on just because we might get sued. Once we start doing that there is an argument that we should just follow written protocols. If we are doing that then we are be going to lose our skills and this will impact the care of our patients.
If I place a C-spine collar on someone it is because I have a reasonable suspicion that they have a neck injury – if I have this suspicion then the patient will be cut out of their car and placed on a hard backboard.
If I have someone cut out of their car and put onto a hard backboard (which can cause injuries itself) for no good reason then there could be the case for me to be sued for unnecessary treatment. And for ordering the destruction of the patient's car.
One more case of damned if you do and damned if you don't.
But unlike some of the dilemmas we have in this job (and there are plenty of them) we have the training to rule out serious neck injury. We shouldn't be doing this treatment unless it is needed.
Whenever I treat, or don't treat a patient I am thinking constantly of what benefit this has for the patient. I am always able to justify my treatment of a patient, whether to the patient, to the hospital staff or to a judge, magistrate or coroner. This isn't 'defensive medicine' this is 'good medicine'.
I try to keep up to date on the current research, and for those of us who don't, we also have medical bulletins from our management explaining the correct way to do things.
This isn't even counting the research that is initiated by the LAS.
We aren't stupid and we shouldn't be doing treatments 'just because', we should be confident in our use of evidence based medicine. We should also be confident enough to correctly document our treatment so that we can justify our decisions to anyone.
To do anything else turns us into taxi drivers.