WHEN DOES A GUIDELINE BECOME A STANDARD - THE NEW AMERICAN-SOCIETY-OF-ANESTHESIOLOGISTS GUIDELINES GIVE US A CLUE

被引:13
作者
GINSBURG, WH
机构
[1] Ginsburg, Stephan, Los Angeles, CA, Oringher and Richman
关键词
STANDARDS; AMERICAN-SOCIETY-OF-ANESTHESIOLOGISTS;
D O I
10.1016/S0196-0644(05)80418-4
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
So when does a guideline become a standard? The answer is when an inexpensive, reliable device comes onto the market, the technology and concept of which have already been adopted by a group who specialize in the concept of intubation-anesthesiologists. A guideline becomes a standard of care when the device behind the guideline is available and readily usable as a practical matter by members of other medical specialties who have cause and reason to consider its use. By the time a piece of technology is recognized by legislators or insurance company underwriting departments as a necessary tool in the arsenal of a group of medical professionals, essentially as a standard of care, it is too late in the sense that the damage will already have been done because the malpractice suits that motivated the legislative or underwriting change already will be inescapably present. The mandation of a standard of care by legislative or insurance underwriting fiat certainly ensures the existence of the standard and will serve to require the use of the procedures, techniques, or technology so mandated. Before the mandation by law, however, the profession must recognize the matriculation of the idea to the guideline to the standard. Waiting for adoption of the standard by law or insurance company underwriting departments gives the plaintiff's trial bar "an edge," in that they are able to assert that a standard exists that the physicians are ignoring. From a legal point of view, a physician, EMT, or paramedic who does not use a disposable end-tidal CO2 detector in the process of intubation, in the absence of electronic capnography, is not acting as the average reasonable reputable physician, EMT, or paramedic would under the same or similar circumstances in the same or similar location and therefore may be said to have breached his or her duty to exercise reasonable care. If the failure to use the device results in a catastrophic untoward result secondary to esophageal intubation, the physician, EMT, or paramedic may be said to be a "legal cause" or "substantial factor" in the outcome and thus responsible for the damages determined to be present. © 1993 American College of Emergency Physicians. All rights reserved.
引用
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页码:1891 / 1896
页数:6
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