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Gold, incentives and meh

Could you be an immediate care doctor?

Members of the British Association for Immediate Care (BASICS) are often on the scenes of major incidents before they've had time to even make the headlines. Dr Jonathan Leach explains what being a volunteer involves

Members of the British Association for Immediate Care (BASICS) are often on the scenes of major incidents before they've had time to even make the headlines. Dr Jonathan Leach explains what being a volunteer involves

It's 6am, the telephone goes – it's the ambulance service. Can I go to a remote location in Herefordshire where a car has been hit by a large juggernaut? Initial information is that the four passengers in the car are very badly injured after the lorry hit the car.

After confirming the location, putting on my high visibility clothing, getting in to the car and switching on my blue flashing lights I drive the 15 miles to the incident as fast as is safe.

I am confronted by carnage. Two children have already been taken to hospital, one of whom is badly injured. The two adults in the front are badly trapped in the bent metal and they are clearly in a serious condition. They are breathing, but only just; they are obviously very shocked, and most likely suffering from internal bleeding.

The team has worked under these conditions before, but it is always challenging. What can we do to get the patients out? Can we give drugs to relieve pain? What other resources do we need to get the patients out as fast as possible? Which hospital is the best for them, given their injuries? Can we get helicopters to speed the time to hospital?

What is BASICS?

Doctors from BASICS (or, more correctly, immediate care practitioners – as nurses and paramedics can also be members of BASICS) are unpaid volunteers who respond to medical and other emergencies usually to support their local ambulance service, though sometimes they are called upon by other local emergency services such as coastguard, a lifeboat or mountain rescue service. They have been present at most of the serious incidents that have hit the headlines; for example, the rail disaster in Lancashire in February this year and the M25 coach crash in January when five people died and 38 were injured.

Having trained doctors on the scene enhances the role of the paramedics because our training means we can administer certain drugs and equipment that patients might otherwise not receive until they were in hospital. We can also spread the risk paramedics face by assisting in making some of the most difficult decisions such as when to stop resuscitation.

Another recent case I attended was a home birth; it was during a heavy snowfall and the roads were unsafe. The baby had been delivered but was still attached by the umbilical cord to the placenta. I cut the cord, delivered the placenta, checked mother and baby (who were fine) and, because the weather was so bad, agreed mother and baby should stay at home. A paramedic would have had to take them to hospital (and might I add this would be exactly the right decision to make under the circumstances).

Reasons for joining

Reasons for GPs joining BASICS include:

•maintaining or improving skills in management of patients who are seriously ill

•professional satisfaction of being able to put to use the full breadth and depth of training most GPs have had

•wanting to improve patient care in an area of the health service where doctors are generally not found.

As an armed forces GP, I could be deployed to look after service personnel at short notice so I need to make sure my skills stay up to speed. In a previous posting as a GP in Cyprus some 10 years ago, I was required to provide the equivalent of a civilian ambulance service and my interest in emergency care medicine has stayed with me since then.

It can be weeks before interventions you make in general practice make a difference to patients but in immediate care you see the results of decisions in a matter of seconds or minutes. Little can come close to the thanks I received recently from a man I attended who had suffered a cardiac arrest. With the paramedics present we provided advanced life support, he was defibrillated, treated with additional drugs (such as adrenaline) and thankfully his heart restarted. He is now fully recovered, has an implantable defibrillator (should he suffer the same again) and is planning on returning to work. It is rare to get such thanks in general practice. It's perhaps an old-fashioned thing to say but being a BASICS volunteer for me is also a way of giving something back to the community.

Training involved

As in all areas of medicine, training (both initial and continuing) is essential. Initial training normally consists of attendance on courses (such as the pre-hospital emergency care course) – however, this will vary according to the background of the individual practitioner. Some schemes (such as the West Midlands CARE team) operate a competency based training programme, supported by mentorship from a senior practitioner.

To respond as an individual, perhaps in their own car, many schemes now insist upon a higher level of academic attainment (such as the Diploma in Immediate Care from the Royal College of Surgeons of Edinburgh) and an advanced driving qualification (essential if driving to incidents using blue lights and sirens).

BASICS volunteers also receive training in dealing with a major incident such as a rail crash or terrorist attack.

Colonel Jonathan Leach is director of general practice education in the Armed Forces Deanery in Birmingham. He works in an NHS practice in Birmingham seeing a mix of NHS and military patients. He directs courses in pre-hospital care and is an examiner for the Diploma in Immediate Care of the Royal College of Surgeons of Edinburgh

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