The Patient's Charter: views of patients attending an inner-city accident and emergency department.

We conducted a prospective study of patient's understanding of the Patient's Charter. Every patient attending the Accident and Emergency (A&E) Department of St Bartholomew's Hospital over a 7-day period was questioned by an interviewer. Those not interviewed by this process were sent a postal questionnaire. A total of 584 patients attended during the study period, from whom 451 data sets were collected, a response rate of 77%. Only 51 patients were aware of The Patient's Charter guarantee of 'immediate assessment'. When asked what they understood by 'immediate', 67% of respondents considered this to mean 15 min or longer. Fifty-four per cent of respondents felt that this assessment should be performed by a nurse. A follow-up study conducted over a 48-h period in January 1994 showed no significant difference in the responses to the same questions. We conclude that the vast majority of patients in this study exhibited a very low level of awareness regarding the guarantees of The Patient's Charter. We also note that their interpretation of the term 'initial assessment' is at variance with that expressed by the NHS Chief Executive in a widely circulated document.

Cannon Street rail disaster--lessons to be learned.

We studied the types and mechanisms of injury suffered by passengers involved in the Cannon Street rail crash, by a telephone and postal survey of all passengers attending St Bartholomew's Hospital for treatment of their injuries, and retrospective examination of their hospital records. There were 104 patients of whom 91 had complete data sets. Of the 91 patients included in the study, 63 (69 per cent) had suffered craniofacial trauma. Of the 63 patients with this type of injury, 50 had been standing at the time of impact and 48 of these were able to say exactly how they had sustained their injuries. Of these 48 passengers, 34 said that they had collided with the luggage racks (71 per cent). Of the 32 passengers who had been seated at the time of impact, only 13 sustained craniofacial injuries and none had hit the luggage racks (P = 0.0001). Craniofacial trauma was the commonest type of injury. Those patients who suffered these injuries were most likely to have been standing at the time of impact and to have sustained their injuries following collision with a luggage rack. The type of luggage racks on this train were particularly dangerous and we recommend that the internal design of new British Rail rolling stock addresses this problem. This specific recommendation is in support of the more general measures discussed in the recently published official report of the incident. In the meantime, we consider that passengers should be advised to remain seated until trains have come to a halt.

Injuries related to wind speed.

This is a retrospective study of the injuries caused by high wind speeds during the storms of early 1990. Injured patients seen on windy days were compared with those seen on a group of control days. It was found that high wind speeds were associated with an increased risk of injury, especially when wind gusts exceeded 60 knots. This apparent wind speed threshold, above which injury is more likely, corresponds to the curve used by the Meteorological Office to predict wind-related structural damage. It is postulated that this finding may be of use in assisting the Government in formulating its guidelines on when to warn the public that it is unsafe to venture out.

Massive chloroquine overdose--a survivor.

Large chloroquine overdoses are almost inevitably fatal. We describe the presentation and management of a patient with such an overdose who survived, due to general supportive care and new specific treatment.