Local Immediate Care Schemes
Immediate care doctors are specialists, trained to provide medical support at the scene of an accident or major medical emergency, or while patients are transit to hospital. They also provide medical support at mass gatherings.
If you want to become an immediate care doctor, BASICS has local schemes across the country. Dr Holden, Communications Director for BASICS advises paying a visit to the scheme to discuss what is involved in being an immediate care doctor. 'What you do in the well regulated, warm environment of a surgery or hospital may be very different to the hostile environment of the street,' he says, adding that when attending incidents, treatment must sometimes precede diagnosis.
Shadow a BASICS doctor
If, after an exploratory discussion, you are still interested in pursuing immediate care training, it is advisable to spend a few shifts with a doctor on your local ambulance service rapid response team. This will allow you to see what happens at an incident. The scheme also has a chance to assess your ability to work as a team member. If you decide to continue training then you will need to pass a course in Pre-hospital Care. Response Driver training and safety training are also required by many schemes
Ambulance authorities will not call doctors to a scene unless you have this training because it ensures you are 'street safe'.
'Doctors need to be able to add value over and above the basic paramedic skills,' says Dr Holden.
Medical kit is required
Essential equipment costs around £2,000, but experienced immediate care doctors will usually have between £10,000 and £20,000 worth of emergency medical gear. Local BASICS schemes are often registered charities and equipment is bought from public donations. You will also need appropriate clothing including overalls, a high visibility coat and boots.
On hand at events
As an immediate care doctor, GPs can specialise in events, such as air shows, football matches and motor sports and there are opportunities to work on cruise ships. BASICS doctors do not have an official pay scale, but in general the size of the fee rises with the size of the event. Some immediate care doctors are on attachment to the local NHS ambulance trust to a greater or lesser degree. Primary care organisations can commission them under an enhanced service contract.
Dr Holden says being a BASICS doctor is an immense professional challenge.
'Immediate care is no longer the traditional GP model. It has evolved into appropriately trained physicians and the team approach.'
CASE STUDY - MEDICAL INCIDENT COMMANDER
Teesside GP Dr Simon Stockley trained as an immediate care doctor in 1988. He obtained the immediate care diploma in 1991 (see main text) and the fellowship in immediate care in 2000.
Dr Stockley's main area of interest is managing major and complex incidents and emergency planning. He is the medical incident commander for several PCTs and takes operational control at incidents. When not in his commander role, Dr Stockley responds to call-outs and treats injured patients.
At the last major incident he attended, 10 people had to be decontaminated after contact with paraquat - a weed killer which can be absorbed through the skin. Dr Stockley helped the ambulance service paramedics decide which people at the scene needed to be decontaminated.
Primary care organisations can commission immediate care as an enhanced service for which they pay up to £2,000 a year, plus a call-out fee.
Dr Stockley's PCT (North Tees) does not to pay for his services but he is still is on call around the clock on a voluntary basis. His £15,000 worth of equipment was largely funded from donations, although some disposable equipment is replaced by the ambulance service or local hospitals.
Dr Stockley says: 'I am very lucky in that I am supported well by my partners and family. And my patients have never complained when I have had to dash out.'