Gandhi M J, Freitas D, Lewis M, Bolton L, Bhasin S, Leonard D, Marsh A
Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
Surgeon. 2014 Feb;12(1):26-31. doi: 10.1016/j.surge.2013.05.006. Epub 2013 Jun 19.
The application of a plaster cast is known to affect driving ability, but patients continue to drive. The individuals and authorities involved in assessing driving safely include doctors, the Driver and Vehicle Licensing Agency (DVLA), police, insurance companies, and patients, but it is unclear who should take responsibility for the advice given, especially in the event of an accident.
We contacted senior plaster technicians in 348 hospitals in the UK. We recorded their responses regarding advice given to patients on driving in specific casts. Sixteen motor insurance companies and 40 police forces were also contacted in order to canvass their opinions.
188 technician interviews (response rate 54%) were conducted. Only 10% of respondents offered advice unprompted; an average of 48% of patients asked for advice. 88% of respondents referred patients to their motor insurance companies, and also to the DVLA (11.7%), doctor (10.6%), or police (5.9%). Only 20.2% of plaster rooms provided written information. All insurance companies would insure patients provided the doctor had not explicitly objected to driving, but there was no consensus amongst the responses received from police. In the event of an accident after the treating doctor had advised against driving, insurance companies were likely to invalidate the policy, and the police would seek penalty punishment or prosecution.
Although doctors are not specifically trained to assess the ability of patients to drive, insurance companies and police forces place the responsibility on doctors to advise patients. Since current evidence suggests plaster casts can impair driving ability, we suggest patients should be advised not to drive. Patients accept all responsibility if they continue to drive after receiving this specific advice and understanding its implications.
众所周知，使用石膏固定会影响驾驶能力，但患者仍继续开车。参与评估驾驶安全性的个人和机构包括医生、驾驶与车辆牌照局（DVLA）、警方、保险公司和患者，但不清楚谁应对所提供的建议负责，尤其是在发生事故的情况下。
我们联系了英国348家医院的资深石膏技师。我们记录了他们对于向使用特定石膏固定的患者提供驾驶建议的回复。我们还联系了16家汽车保险公司和40支警察部队以征求他们的意见。
进行了188次技师访谈（回复率54%）。只有10%的受访者主动提供建议；平均48%的患者询问建议。88%的受访者将患者转介给他们的汽车保险公司，还有转介给DVLA的（11.7%）、医生的（10.6%）或警方的（5.9%）。只有20.2%的石膏室提供书面信息。所有保险公司都会为患者提供保险，前提是医生没有明确反对驾驶，但从警方收到的回复中没有达成共识。如果在主治医生建议不要开车后发生事故，保险公司可能会使保单无效，警方将寻求处罚或起诉。
尽管医生没有接受过专门培训来评估患者的驾驶能力，但保险公司和警方将向患者提供建议的责任推给医生。由于目前的证据表明石膏固定会损害驾驶能力，我们建议应建议患者不要开车。如果患者在收到此特定建议并理解其影响后仍继续开车，则承担所有责任。
