Doctor specialising in pre-hospital care

BASICS started life from a small number of General Practitioners, concerned that the pre-hospital care for those involved in serious motor vehicle crashes in their locality was not as good as it could be. They aimed to bring increased clinical expertise to the scene in an attempt to improve care and did so on a voluntary basis.

The BASICS Doctors of today come from a wide range of specialities, including general practice, surgery, medicine, accident & emergency and anaesthesia & critical care; from civilian and military backgrounds. The breadth and depth of knowledge and skills brought to the patient by this range of clinicians has continued to grow since BASICS’ inception. Much of this is still provided on a voluntary basis.

BASICS Doctors provide medical services in numerous places:

• Clinical support for ambulance services
• Sporting events e.g. motor sport, football matches, boxing
• Concerts
• Expeditions e.g. polar trips

Qualifications

A BASICS Doctor is medically qualified and registered with the General Medical Council.

Many have postgraduate qualifications in their base speciality, such as:

• Fellow of the Royal College of Anaesthetists (FRCA)
• Member of the Royal College of Physicians or Surgeons (MRCP or MRCS)
• Member of the Royal College of General Practitioners (MRCGP)

Generic skills in life support and resuscitation are taught on a variety of courses and BASICS doctors are encouraged to attend these. In addition, they have undertaken specialist training to learn about the pre-hospital environment, its dangers, delivery of healthcare in non-clinical areas and how the other emergency services work.

Pre-hospital care is becoming recognised as a specialist area of medicine and the Faculty of Pre-hospital Care was founded in 1996 as part of the Royal College of Surgeons of Edinburgh. The affiliated examination, the Diploma in Immediate Medical Care (DIMC) was the first definitive examination in this developing specialty anywhere in the world. Full Fellowship in Immediate Medical Care is now also attainable by immediate care doctors with several years experience in the field.

The role of a BASICS Doctor is often multi-factorial. It encompasses:

Organisational

BASICS doctors do not always need to provide hands-on treatment for patients.
By taking the clinical lead, alternative pathways of care that are not open to the paramedic crews can be facilitated. This may involve discharging the patient from scene or arranging for transport to a hospital other than the one normally serviced by a local ambulance crew.

As Medical Incident Officer during major incidents, BASICS doctors work alongside senior ambulance personnel to co-ordinate healthcare resources. They are well suited to this role due to their experience working with the ambulance service on a regular basis. Similarly, at mass gatherings, such as sporting or musical events, the organisation of medical services frequently involves immediate care doctors.

Medical directors of several UK ambulance services are BASICS doctors.

Clinical

Many immediate care doctors deal with critically ill patients as part of their normal in-hospital practice. This experience adds to the care provided by the ambulance crews. An important role is the support of ambulance service colleagues who deal with critically ill patients on a less regular basis.
Appropriately trained BASICS doctors also undertake advanced skills that are not part of UK paramedic practice. These skills include:

• Rapid sequence induction
• Surgical airway
• Thoracostomy and thoracotomy
• Amputation
• Sedation
• Alternative analgesic strategies

Educational

BASICS doctors can be found in all tiers of healthcare education:

• Informal support and instruction for emergency service personnel at the scene of an incident.
• Instructors on many courses, both immediate care and generic life support courses. E.g. PHEC, ATLS, ALS, MIMMS, DIMC
• Undergraduate training in pre-hospital care and life support (www.wmcareteam.com , http://medweb.bham.ac.uk/rmd/history.html)
• Examiners for a variety of medical colleges. E.g. RCS, RCA
• National and international involvement in the development and provision of immediate care and other resuscitation courses. E.g. European Resuscitation Council, Resuscitation Council UK, Trauma Care UK and BASICS itself.

Research and Development

Important guidelines on many aspects of treatment, including the use of fluid in resuscitation, burns management and paediatrics have had significant involvement from BASICS Doctors. National ambulance service guidelines (JRCALC) have been similarly supported