The case for ‘door-to-door’ delivery: a cautionary tale!
In February I flew out to France to bring back a 22-year-old man who had been in a snow boarding accident. He was a week down the line, having spent most of that time in a large university hospital.
John (not his real name) had sustained a stable fracture to his C1 and C6 vertebrae and unstable fractures to C4 and C5. His unstable vertebrae were surgically treated with an arthrodesis and he was making a good recovery. Other than a bit of tingling in his right thumb and index finger he was neurologically intact – lucky chap indeed! The only future management was to spend the next three months in a wide soft collar.
The plan was to fly home seated as he was able to sit for a couple of hours with no problems, but have a stretcher for the road journeys, particularly necessary for the UK side as his home was nearly four hours away from Gatwick.
All went well. I gave him his prescribed oral analgesia and anti-inflammatory medication, and we had an uneventful trip back to his parents’ house. There was an emotional reception from his parents and two sisters, welcome home banners festooned the cottage and the kettle was on.
My parting advice ...
Over a cup of tea I handed over the rather sparse report and the wad of CT scans I had managed to obtain. I advised that John should be followed up by a neurosurgeon as soon as it could be arranged and that the best way would be to get himself referred through his GP.
This was now Friday night and his father said that he had already arranged for John to be checked over on Monday morning. I felt happy with that and, apart from saying that should John experience any problems over the weekend they should take him straight to an A&E, there would be nothing further I could do.
A week later imagine my shock when John phoned me to say that he was in a spinal unit having just had further surgery! The very switched on GP he had seen on the Monday morning had spotted something on the CT scan and arranged an urgent appointment with a neurosurgeon. A further scan revealed an unstable C7 fracture!
Several things have since passed through my mind
I telephoned the assistance company and spoke to one of the most experienced nurses there. Like me she was shocked, but we were both at a loss to know what else we could have done.
Should we send doctors on all spinal injury repats? Would all of them be able to read CT scans? Probably not. A French university hospital is probably one of the better places to be following a trauma and therefore we trust them to investigate and treat fully. So how are we to know if this hasn’t been the case?
The other awful thought I had was this.
Most of the assistance companies I work for do not have the policy to accompany the patient to their final destination, be it home or hospital. In this particular case the company did. I’ve started to think that perhaps we should always stay with the patients. What if I had handed John over to an ambulance crew and they mishandled him because they had no understanding of spinal injuries? Let’s face it, many private companies do not employ fully qualified crews. How would I have felt if a wrong movement had affected the undetected fracture and John had ended up partially paralysed?
Going the distance
Knowing we can hand over patients at the airport often raises the question: Would I go with the patient if he was going 20 miles down the road? If the answer is yes, then that should also be the case for 200 miles!
Setting a new precedent to always accompany the patient would have enormous implications, particularly regarding costs. Over-nighting far more often in places like Manchester and Glasgow, for example ... enormous added expenses. The underwriters would object but, finally, patient safety is surely the main concern and if we make it a policy that we deliver a “door-to-door” service then we would never have to face an “if only” situation!
PS. John continues to make slow but steady progress. As I write he is doing very well.
Val Pitman