A descriptive review and discussion of litigation claims against ambulance services.
BACKGROUND
Litigation claims against the NHS are increasing. Society is less tolerant of mistakes or inadequate service and litigation claims are now becoming increasingly accepted.


METHODS
All claims registered with the NHS litigation authority, both closed and still open, were collated from all the ambulance trusts across England in the past 10 years. All incidents notified between 19 December 1995 and 19 April 2005 were included. The data were then analysed according to time, description of the incident, cause of the incident and type of damage incurred. Cases were also described according to the total claim. Potential actions and further work are discussed.


RESULTS
Between 19 December 1995 and 19 April 2005 there were 272 cases of litigation conducted through the NHS litigation authority against ambulance services across the United Kingdom. The greatest proportion of claims was as a result of lack of assistance or care, which was alleged in 75 cases. Another significant proportion of cases related to a "failure/delay in treatment" or "diagnosis" accounting for 36 and 34 cases, respectively. The most common type of injury was a fatality in 69 cases and unnecessary pain in a further 56 claims. 17 claims were for sums of over pound 1 million; however, most of these cases were still ongoing. These cases are described in more detail; the type of outcome tended to be brain damage or significant spinal injury rather than a fatality, reflecting the higher cost of continuing long-term care of a chronically injured person.


CONCLUSIONS
This study suggests that the key clinical areas that need to be addressed are obstetric care, spinal injury recognition and the decision not to convey a person to hospital. The first two of these have been addressed in the recent release of the Joint Royal Colleges Ambulance Liaison Committee guidelines. The major areas of organisation relate to reducing delays and providing the safe transfer of patients.
Dobbie
A E
AE
Royal London Hospital, London, UK.
Cooke
M W
MW
D000552:Ambulances / Q000191:economics / Q000331:legislation & jurisprudence*; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000592:standards; D006801:Humans; D016365:Liability, Legal / Q000191:economics; D010360:Patient Transfer / Q000331:legislation & jurisprudence; D006113:United Kingdom