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Life-saving skills for accident scenes

GPs find it increasingly useful to learn immediate care skills in case they find themselves first at the scene of an accident, writes Dr David Hall

mmediate medical care is skilled help provided at an accident scene, medical emergency or during transportation to hospital. It can greatly reduce mortality and morbidity. There are currently 70 immediate care schemes, covering about one-third of the UK, designed to bridge the gap between site and time of accident to arrival at secondary care. It is true frontline work.

Pre-hospital care is an area we all should know about. It's what happens on our doorsteps and we need to be trained to react logically and clearly. Pre-hospital care is also attracting many GPs as they take up a wider variety of work. Events doctors or just those who work in remote areas, several hours from the nearest trauma centre, find the courses give them vital skills.

What is BASICS?

Formed in 1977, the British Association for Immediate Care (BASICS) is a voluntary organisation registered as a charity that co-ordinates all aspects of immediate care. More than 900 doctors are registered. BASICS aims to foster good co-operation between existing immediate care schemes and encourage new schemes to be formed across the UK.

Co-operation in immediate care is imperative; between doctors on schemes, other immediate care members and the emergency services.

Like any member of the public, a GP or GP registrar may find themselves first on the scene of an accident. With road traffic accidents causing significant mortality and morbidity this has to be an area that demands our attention.

You don't have to join BASICS or attend a residential course to make a difference. Keeping up to date on basic life support skills and knowing how to work an automated external defibrillator could save lives.

BASICS organises training courses on all aspects of immediate care across the country. They range from one to five days and cover pre-hospital emergency care, immediate care and refresher courses.

Training in good company

The pre-hospital care course is for anyone who may have to deal with emergency situations ­ GPs, practice nurses, emergency services personnel, voluntary aid society members and those involved with sports medicine.

It is designed to cover all aspects of emergency care outside of hospitals, and this is where it differs from work you are likely to have done in the safety and security of an A&E department. It ranges from medical, obstetric and paediatric situations to trauma emergencies and incident management.

A recent pre-hospital care course I attended was intense and the days were long but with good reason: the team of instructors had a lot of important knowledge and skills to impart. What made this course different was the instructors' variety of backgrounds. These ranged from military to paramedic, A&E consultant to nurse. Job diversity was almost matched by those attending the course: nurses, rural and remote GPs (including one working in Africa), a ship's doctor, A&E registrars and a fireman. Such a broad background of experience made for lively discussions and enjoyable practical tasks.

It was a valuable experience; the course was well run and the programme well crafted with a mix of lectures and hands-on sessions.

Can you tell a Seger splint from a Kendrick?

On the course we learnt about scene safety, airway care, performing needle cricothyrotomies, prioritising in a trauma situation, care of the cervical spine, treatment of anaphylaxis and acute coronary syndromes. There were sessions on entrapment and extrication, splintage and spinal protection. It was not an extended ATLS or a resuscitation update, but covered medicine in a new field. What we learned was general enough to be applicable to most settings.

We were taught important terminology such as the difference between a multi-casualty situation and a mass casualty one, whether a major incident was simple or compound ­ and practicalities like Seger splints and Kendrick splints.

Saving a life is as

easy as ABC

First you have to make the scene safe, then you assess the Airway (with cervical spine control if there has been a trauma), Breathing and Circulation (with control of haemorrhage)

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