BASICS, NWPCCC and EPHC. St Emlyn's • St Emlyn's

Just a short post this week to highlight some of the most rewarding elements of my clinical life. For several years now I’ve been working as a BASICS doctor in the North West. This is a voluntary role that supports our local ambulance service (NWAS) with enhanced pre-hospital care skills. Despite BASICS being around for many years, there are still many people out there who don’t know much about us, so here’s a short and rough guide.

What is BASICS?

BASICS is the British Association for Immediate Care. It was established way back in 1977 by Dr Ken Easton. Back then enhanced prehospital care was very much in its infancy and our ambulance colleagues were simply not taught the range of resuscitation skills we see today. You can read more about the history of the association on the BASICS website. In the modern era BASICS is a broader church with paramedic, nursing, medical and AHP membership. Individuals can join and respond as independent clinicians, but more commonly they are part of a scheme where a group of clinicians come together as a local organisation. I am in the latter, volunteering with NWPCCC (North West Prehospital Critical Care Charity). This is based in the NW of England and primarily works alongside the North West Ambulance Service. There is another BASICS scheme in Cumbria (also NWAS area) known as BEEP doctors. There are also a handful of independent responders across the patch. BASICS has 28 schemes and over 1400 members nationally.

Who are NWPCCC?

NWPCCC is my local BASICS scheme (North West Prehospital Critical Care Charity). It grew out of CSI BASICS (Cheshire and Shropshire Immediate Care Scheme), to now cover the Southern part of the NW of England. We can travel/respond anywhere within the region but most of our activity is across Wirral, Cheshire, Merseyside and Greater Manchester.

What can a BASICS responder do?

This varies around the country and so I can only really speak for our own scheme. In general terms it depends on the skills of the clinician, and the equipment available to them and that can be a little confusing. In the NW we have agreed a series of standards for clinicians that are based on their training, role and development. We have 4 groups of responders

Group 1: Doctors with Advanced Surgical/RSI capability. All these doctors also work on an air ambulance and have been signed off as RSI capable.
Group 2. Critical Care Paramedics. Senior clinicians from an air ambulance. Higher training to include surgical skills and Pre-hospital Emergency Anaesthesia assist roles.
Group 3: Doctors with additional prehospital training but without group 1 skills. Typically these are Consultants/GPs with relevant training, including additional training in prehospital care through BASICS courses or equivalent.
Group 4. Advanced paramedics. Senior NWAS clinicians with advanced clinical skills including surgical airway, thoracostomy, command roles etc. At the moment the minimum entry requirement for a paramedic responder with NWPCCC is a CCP/Advanced Paramedic (other schemes may have different criteria).

So whilst there is some variability in the capability of providers, all have significant training in prehospital care in addition to their usual roles. They are all also used to making complex decision in time limited and information light settings. Whilst it is easiest to understand,compare and contrast capability around clinical skills, in practice the added value from the BASICS clinicians I work with is often around decision making.

Activation, travel and transportation.

All BASICS responders are despatched by the ambulance service, and when activated we are subject to NWAS governance and regulations. We are despatched as an ambulance resource for the duration of the event. This makes sense for lots of reason, the majority of which will be obvious around governance and protection. It also means that the selection of which cases we attend is overseen by the ambulance service who can see a wider picture of what’s going on with a particular incident and a wider picture across the region. All responders carry an Airwaves radio with our own personal call signs and this is trackable by ambulance control, and more specifically the critical incident hub that deals with the most serious cases. My callsign is MX1962 with the MX indicating a BASICS doctor. In addition we receive a text about any high acuity call within a 20 mile radius of the handset. This is an automated function that can give a ‘heads up’ about a potential job. When I started with BASICS we used AMPDS codes which were quite specific and fantastic for planning, but more recently these have been replaced by NHS pathways which is less able to differentiate the type and severity of jobs.

If we are needed on a job then the Critical Incident Hub (CIH) of NWAS will phone us, check availability and then despatch us to scene together with information on the job, RVPs, resources etc.

In order to get to scene there are two main options.

Proceed in our own vehicles with lights and audible warnings. This is only possible if the driver has completed both advanced driver training and blue light training. Training may be part of their day job (typically paramedics) or via independent courses. I completed this about a year after joining the scheme.
Respond in one of our team cars with lights and audible warnings.

Our scheme has two response cars that members can use to respond to incidents if their own vehicles are offline or more commonly when we put a clinical team out on the car for a shift. These team shifts are typically 1800-0200. When we do a ‘shift’ we try to do this with one CCP and one doctor when possible as that’s the best mix of skills on the vehicle. The car is deployed to a central location in the NW and we respond to critically ill/injured patients as directed by NWAS. We also use these shifts to introduce and induct new members onto the scheme and occasionally to have observers (observers must apply in writing and are vetted, only those with legitimate needs/interest in NW prehospital care are permitted – no jollies!).

Our first car (TS1) is shown below with Adam (CCP) and John (doc). It’s clearly marked and equipped to a high spec. In general we align equipment and functionality with our regional air ambulance service (NWAA). However, we do not currently carry blood, invasive arterial pressure devices, or a LUCAS device. We do carry ultrasound, RSI capability, Surgical kit, additional drugs etc. We also carry the same defib/monitors as the air ambulance. This is important for many reasons. As many of our team also work with NWAA, it allows familiarity, but it also helps in jobs where both BASICS and NWAA attend. I recently attended a local job where myself and another BASICS CCP were dispatched to a serious trauma patient. The Air Ambulance was a distance away having just cleared off another incident. We were able to make an assessment, set up an RSI kit dump and start patient optimisation in advance of the air ambulance arriving. On arrival of the NWAA crew (Who were also both NWPCCC volunteer responders too) we collaborated to continue the care for the patient. Such seamless working is clearly better for patient care.

Governance, records and indemnity.

Some years ago, and before my time a decision was made to align SOPs across all EHPC (Enhanced Pre-Hospital Care) organisations in the NW. That means that the SOP for head injury when I work for BASICS is the same (in terms of content) as that which I use when working for NWAA. The obvious advantages of this are too obvious to need explanation. In terms of record keeping then we make clinical notes on the NWAS record which forms part of the patient record. We also keep operational notes on a secure database to keep record of the number, type, location of our calls. I pulled off the data for 2022 and for NWPCCC the data is below. Considering the size of the organisation at the moment it’s a significant number of calls for critically injured/ill patients, especially when we consider the voluntary role and availability issues.

We also hold regular mortality/morbidity reviews and can, if requested, contribute to ambulance service reviews, coroners inquests and police investigations.

As we are working as an NWAS resource when activated we are covered by NHS insurance in. the usual manner, but as always it is recommended that we have personal indemnity insurance and so I have cleared this with my defence organisation. They were happy to cover and it did not increase my premium (but the blue light insurance for the car certainly went up!).

BEEP doctors who cover the North of the region had a similar number of incidents in 2022.

Who funds you?

That is an excellent question and a difficult one. All that we do is funded by donations, or by the clinicians buying their own kit and training. We are always looking for ways to get more funding so we can bring more responders on board, and to improve the equipment we carry. In recent years we have been able to buy new defib/monitors, ultrasound etc. but there is always more to do. Fundraising in the current climate is really tough and we are incredible grateful to those who have supported us. In particular the HELP appeal has supported a number of BASICS schemes and we are very, very grateful for their ongoing support. If you are interested in supporting us there are a few things you could do….

Join us for our 999 party night in Manchester on 2nd November 2023 https://www.nwpcc.charity/party-night/
Please follow us and share our posts on ….
- Instagram https://www.instagram.com/nwpccc/
- Twitter/X https://twitter.com/NWPCCC
- Linkedin linkedin.com/company/nwpccc/
Join our lottery for £1 a week (this would be amazing if you could). https://www.onelottery.co.uk/support/north-west-pre-hospital-critical-care-charity
Make a one-off donation here. https://www.nwpcc.charity/donation/
Visit our website here. https://www.nwpcc.charity/

TS2 our Land Rover Discovery response vehicle

Why volunteer for this?

I’ve been asked this a few times, and it’s complicated. It takes a lot of time, it’s sometimes intrusive, and it’s cost me a lot of cash (kit, training, insurance costs etc.), but it is worth it. One of my hospital based colleagues told me that he would never do anything for free that he could get paid for. Personally I really don’t hold that view as I’ve gained so much over the years from volunteering in many ways, and since St Emlyn’s is largely personally funded then this is a bit of a volunteer project to. So the rewards are not financial!

Clinically, the work in prehospital care is incredibly challenging, but also really rewarding at times when we make a difference (and we do). Working alongside our NWAS and NWAA colleagues is a very interesting place to be. The cases we are despatched to are those where our skills and experience can potentially make a difference and that feels as though the work has value, which is not always the case in hospital medicine in these difficult times. I get to work with a well equipped, well trained and highly motivated group of team members (and beyond) and that in itself is rewarding. From an EBM perspective there is work that shows that just volunteering in itself is a psychologically positive thing to do, and that has certainly been my experience.

I also learned a great deal as a BASICS responder which no doubt made a difference when I eventually (successfully) applied to join our local air ambulance as an enhanced prehospital care consultant. It’s not an official training path, but I’m not the first, and I doubt the last, to follow that route.

If you are interested in becoming a responder I would suggest getting in touch with your local scheme and also contacting the BASICS HQ team via the website links below. If you’re in our part of the world then you know how to get in touch.

Summary

This is just a brief introduction to BASICS and in particular to the North West Prehospital Critical Care Charity (NWPCCC). If you want to know more, if you have fundraising ideas or think you can help in any other way please do get in touch.