Resuscitation decisions in a general hospital.

Comment Over 10000 claims for compensation for injuries sustained as a direct result of tripping over broken, uneven, or loose paving stones were made against local authorities in England and Wales in 1987, and this figure seems to be rising (A Walker, Municipal Mutual Insurance Company, personal communication). The number of patients seen in fracture clinics, however, suggests that far more people injure themselves on pavements than make a claim. Although less than 40% of claims for such injuries are successful, payments exceeded £10m in England and Wales in 1987 alone. Indeed, insurance companies that are responsible for meeting settlements reached by the courts insist on regular inspections of pavements to ensure that such hazards are quickly rectified (A Walker, personal communication). Claims against local authorities are likely to be successful if the injury was caused by loose or rocking paving stones or if there was a difference in height of 15 mm or more between the stones (A Walker, personal communication). Injuries caused by paving stones are not uncommon: over 150 patients are referred to the fracture clinics of this hospital each year for such injuries. In addition, numerous patients sustain soft tissue injuries and are not referred. The nature of the fractures incurred varies; patients often require admission to hospital, and the injury is occasionally serious. The cost to local authorities and ultimately rate payers in compensation is considerable and seems to be rising, yet our pavements do not seem to be getting any safer. Doctors and the general public alike need to be aware of the considerable risk of injury associated with the poor state of pavements, and local authorities must ensure that resources are made available for maintaining footpaths.