In this edition of the EMJ (see page 457) Dobbie and Cooke1 review the most common causes of litigation against UK ambulance services. They conclude that the key clinical areas to be addressed are obstetric care, spinal injury assessment and decision-making regarding non-conveyance to hospital. As with hospital practice, prehospital obstetric incidents resulting in litigation made up a significant proportion of the more costly claims. In the period from December 1995 to April 2005 there were 13 obstetric cases out of the total 272 claims (4.8%). However, the average value of the obstetric cases was £815 000. For all claims, regardless of cause, there were 24 between £100 000 and £1 million and 17 valued at more than £1 million. Of the latter, four were obstetric cases, based on either an alleged failure to identify and manage a problem or lack of appropriate equipment for the treatment of a preterm baby. The largest claim from the total was for £3 375 000 and relates to an alleged lack of equipment to care for a baby born at 26 weeks.

The development of paramedic practitioners, emergency care practitioners and treat and refer guidelines for paramedics may be beginning to address concerns about the accuracy of decisions related to non-conveyance of patients seen by ambulance services.2 The introduction of guidelines for ruling out cervical spine injury should, conversely, focus the attention of practitioners on …