Briefing re Early Day Motion 1334 – Wednesday 11th June
SPECIALIST TRAUMA RESPONSE TEAMS
The British Association for Immediate Care –BASICS supports the concept of an integrated seamless regional trauma service utilising specialist trauma response teams but this must not be at the expense of the wider practice of immediate care by locally based practitioners which is a valuable and crucial part of Prehospital Emergency Medicine particularly in the “shire” counties and smaller or more geographically discrete urban environments.
The British Association for Immediate Care - BASICS briefing notes
- BASICS welcomes parliamentary interest in the subject of Immediate Care in particular those aspects requiring a specialist physician led multidisciplinary team both at the scene of a serious injury or illness and during the retrieval of the patient to the most appropriate hospital (which may not be the nearest one) for continued treatment.
- It is now almost 40 years since the issue was first raised in Parliament. BASICS has been educating and supporting primarily doctors in the delivery of such specialist care for 31 years almost entirely from charitable funds.
- The philosophy of Immediate Care is to prevent deterioration of the patient during the first critical minutes and during the time before arrival at the right hospital. These are lessons from the First World War. It is only in the cardiac arrest scenario that an ambulance 8 minute response time affects quality survival. In trauma cases, it is what happens after arrival on scene that can save lives.
- The seriously ill and injured start to fall down a staircase of complex deterioration in their physiology following initial injury or collapse and the aim of immediate care is to limit this deterioration. Optimal emergency medical treatment and management on scene and in transit to the most appropriate hospital can not only have beneficial patient outcomes but actually save money as well as health and social care resources.
- At its crudest, for road accidents alone utilising the Parliamentary Advisory Committee on Transport’s ( PACT) own figures the cost differential to the nation between a fatal road accident and a serious injury accident is of the order of £1.2 million pounds per life saved. Fewer than five lives per annum per regional ambulance service area would easily pay for the helicopter and the crew including the clinical staff – and that is just for road accidents.
- Successful, cost effective, modern, prehospital emergency medical practice is a multi disciplinary, multi professional process always including paramedics and sometimes nurses. It is crucially dependent upon skilled tasking of a tiered clinical response according to the type and nature of incident. The skill of the control room in recognising, during the first minutes, the need for advanced medical skills is crucial to timely and effective tasking. The best current systems have a member of the team scanning the calls continuously looking for those calls needing their specialist skills.
- Specialist trauma response teams are part of the wider spectrum of Immediate Care and the presence and constitution of Immediate Care systems varies from region to region based upon the “history”, functional geography of the region concerned and also whether there is a local air ambulance helicopter and / or a BASICS scheme.
- Almost all such training, education and operational work in relation to Immediate Care is undertaken voluntarily and on a charitable basis by BASICS members in their own time.
- The equipment necessary for such work is charitably funded mainly from the BASICS member’s own pocket and is supported occasionally by local charitable donations. It can cost anything upto £25,000 to equip each doctor.
- BASICS is concerned that because of the lack of NHS provision there is considerable postcode lottery as to which members of the public can receive these skilled services provided charitably by volunteers.
- The clinical skills required of Immediate Care doctors and nurses are different from but include skills used within hospital. The primary medical specialty of the doctor concerned is not fixed but primarily comes from the disciplines of General Practice, Anaesthesia and, Emergency Medicine. The essential feature is that all such practitioners have had specialised clinical training, skills and experience in Immediate Care outside hospital in addition to their own primary specialty.
- BASICS delivers many educational courses to prepare doctors, nurses and paramedics for the examinations set by the Faculty of Prehospital Care of the Royal College of Surgeons of Edinburgh from the entry level PreHospital Emergency Care Certificate (PHEC), through the intermediate level Diploma in Immediate Medical Care (DipIMCRCSEd) to the highest level for doctors which is the Fellowship in Immediate Medical Care (FIMCRCSEd). There is currently at an early stage of preparation an application being made to the Postgraduate Medical Education and Training Board - PMETB by several sponsoring Medical Royal Colleges for the subspecialty recognition of Immediate Care.
- BASICS doctors do not supplant but rather support Paramedics bringing an additional range of skills. In the best schemes they train together and work in rostered functional teams. Elsewhere they operate on an ad hoc team basis each supporting one another clinically as well as “watching out” for one another at hazardous scenes.
- BASICS acknowledges that for the average “emergency call” paramedics provide a thoroughly professional and sufficient service. However paramedic limitations must be recognised both in terms of their length of training and their diagnostic as well as therapeutic capabilities. None of the doctors involved in the type of Immediate Care work being described will have less than 10 years of training and experience including their primary degree (5 years) plus almost always a postgraduate diploma and more likely a Fellowship. It is in the prolonged entrapment, the severely compromised airway, the serious chest/ head injury or the seriously ill patient that physicians are required urgently at scene and en route to hospital because of their broader diagnostic skills and greater therapeutic repertoire than their paramedic colleagues working alone.
- BASICS notes that in much of Western Europe a physician is sent to the scene of serious trauma or medical emergencies.
- BASICS is concerned that although the new GP contract contains a National Enhanced Service (NES) for Immediate Care almost no PCTs have commissioned it
- BASICS recognises that the Emergency Preparedness Division of the Department of Health is currently developing the concept of Mobile Emergency Response Incident Teams (MERIT) team (as described in the NHS Emergency Planning Guidance 2005). We would hope that this early day motion would support and encourage this process.
- There is a role for the Immediate Care trained nurse operating as part of the specialist response teams. Paramedics associated with such specialist response teams have undergone specially extended training in critical care in conjunction with their team doctors and the best exemplars of these approaches are in Birmingham with the CARE team and Cambridgeshire with MAGPAS
This briefing note has been prepared on behalf of The British Association for Immediate Care – BASICS registered charity number 276054 by its Communications Director.
A full list of references can be provided upon request
Our website is www.basics.org.uk. This website is undergoing major renewal and re-launch within the next few weeks and we apologise if not all functionalities are operational at the present time.
Peter JP Holden FIMCRCSEd MRCGP
Trustee and Communications Director
BASICS – The British Association for Immediate Care
Contact details
07802 305335 mobile
pjpholden@dial.pipex.com
BASICS – The British Association for Immediate Care relevant research papers
General Immediate Care references
- A short history of Immediate Care, 1 st Edition. Hines K. ISBN 0 947652 22 0 British Association for Immediate Care, Ipswich UK . 1998.
- Cooke MW Immediate Care- Speciality or Pastime? Injury 1994 25 347-348.
- British Medical Association Board of Science and Education report Immediate Care Schemes. Contributing author Holden PJP ISBN 0 7279 0818 9 British Medical Association London 1993.
- BASICS Operational and accreditation standards available at www.basics.org.uk
- Audit Commission A Life in the fast lane – value for money in emergency ambulance services HMSO 1998
- DoH Guidelines for the appointment of General Practitioners with Special Interests- Emergency and Unscheduled Care. Department of Health England April 2003
- Investing in General Practice – The new GP contract.- National Enhanced Services
Specialist trauma response team references
- Organized trauma care: does volume matter and do trauma centers save lives? Chaira 0, Cimbanissi S. Curr Opin Crit Care 2003; 9:510-4
- Our Healthier Nation -A Contract for Health. Department of Health, 1998
- Addition of physicians to paramedic helicopter services decreases blunt trauma mortality. Garner A, Rashford S, Lee A, Bartolacci R. Aust N Z J Surg. 1999 Oct;69(10):697-701.
- Prehospital care and survival of pediatric patients with blunt trauma. Suominen P, Baillie C, Kivioja A, et al. J Pediatr Surg. 1998 Sep;33(9):1388-92.
- Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. Sampalis JS, Denis R, Frechette P, et al. J Trauma. 1997 Aug;43(2):288-95.
- Beneficial effect of helicopter emergency medical services on survival of severely injured
patients. Frankema SP, Ringburg AN, Steyerberg EW et al. Br J Surg. 2004Nov;91(11):1520-6.
- Air medical transport of the injured patient: scene versus referring hospital. Falcone RE,
Herron H, Werman H, Bonta M. Air Med J. 1995 Oct-Dec;14(4):197-203
- Trauma -Who cares? NCEPOD. London 2007. http://www.ncepod.org.uk/2007b.htm
- Impact of pre-trauma center care on length of stay and hospital charges. Schwartz RJ,
Jacobs LM, Yaezel D. J Trauma. 1989 Dec;29(12):1611-5.
- Better Care for the Severely Injured. A Report from The Royal College of Surgeons of England and the British Orthopaedic Association, July 2000
Peter JP Holden FIMCRCSEd MRCGP
Trustee and Communications Director The British Association for Immediate Care
Contact details
07802 305335 mobile
pjpholden@dial.pipex.com
EDM 1334 Wednesday 11 June 2008
Oaten, Mark
That this House applauds the invaluable work undertaken by specialist trauma response teams that provide life-saving and expert treatment to patients at the incident location; notes that providing accident and emergency support direct to the patient before they reach hospital can make the difference between life and death; further notes that outside London this is conducted on a voluntary basis with no public funding; believes that it is an unacceptable risk for the health service to be relying on off-duty volunteers to provide such an essential service that saves lives; supports the recommendations made by the `Trauma: Who cares?' report of the National Confidential Inquiry into Patient Outcome and Death 2007; and calls on the Government to urgently review policy in this area with a view to providing funding for these services.
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