Training Variability and Omission Liability in Emergency Ultrasound‐Guided Nerve Blocks
Year: 2026
Type: article
Abstract: I read with great interest the recent article by Shultz et al1 on medicolegal risk assessment and mitigation strategies for ultrasound-guided nerve blocks (USGNBs) in emergency medicine. The authors offer a comprehensive overview of complication profiles, comparative safety versus opioids and procedural sedation, and practical recommendations for training, consent, and documentation. However, several critical gaps limit the clinical applicability of their framework. First, the manuscript underemphasizes the substantial variability in USGNB training and credentialing across emergency medicine programs. While Shultz et al advocate for structured education, they do not sufficiently address how inconsistent residency curricula and faculty expertise create uneven competency levels, potentially increasing liability exposure for less experienced practitioners.2 Second, although short-term complication rates are well documented as low, the paper provides limited discussion on long-term neurologic outcomes specific to the high-acuity emergency department environment. Prospective data with systematic 30- to 90-day follow-up remain scarce, leaving clinicians without robust evidence regarding persistent peripheral nerve injury risk in real-world ED practice.3 Third, and perhaps most importantly, the evolving standard of care raises the specter of omission liability. As USGNBs become increasingly recognized for superior analgesia and reduced opioid requirements, failure to offer an indicated block when alternatives lead to harm may itself become a source of litigation. The authors touch on this concept but do not explore it deeply. Closed claims analyses of point-of-care ultrasound demonstrate that “failure to perform” allegations now outnumber procedural errors in many jurisdictions.4 Recent meta-analyses further support the safety advantage of USGNBs, underscoring the need for research into medicolegal consequences of non-utilization.5 To advance the field, future work should prioritize standardized national credentialing criteria, simulation-based curricula tailored to ED constraints, and studies specifically examining omission liability. Addressing these unmet needs will strengthen both patient safety and medicolegal protection. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
DOI: 10.1002/jum.70236
Authors: Wang Honghao, Zhang Nianzhi, Wang Yuanyuan
Institution: Anhui University of Traditional Chinese Medicine
Language: English
Subfield: Pharmacy
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7142970217