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Immediate Care - How to ... become a BASICS doctor

Immediate care GPs treat injuries at major incidents, writes Jennifer Taylor.

ASICS, but to be accredited you will need a pre-hospital emergency care certificate from the Royal College of Surgeo.

Today marks the anniversary of last summer's terrorist attacks in Central London, including the bomb on a bus outside BMA House.

GPC members and other doctors in the building rushed to help the injured passengers and their presence at the scene was, literally, life-saving.

They included GP negotiator Dr Peter Holden who, as the honorary secretary of the British Association for Immediate Care (BASICS), knew instantly what was required and how to organise the other doctors into an efficient team.

Local immediate 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. You can find the scheme nearest to you by visiting the BASICS website. Dr Holden 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.

Accreditation

Any GP can join Bns of Edinburgh.

This is a three-day residential course on all aspects of emergency care in the pre-hospital setting, including medical, obstetric, paediatric and trauma emergencies and incident management. The course fee is £800.

Ambulance authorities will not call doctors to a scene unless you have this certificate 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.

If you wish to become more highly qualified, the next step is a diploma in immediate care from the Royal College of Surgeons of Edinburgh. This five-day course covers all aspects of immediate care with the emphasis on practical skills as well as formal lectures and training scenarios.

It costs £1,270.

Finally, there is a four-year fellowship in immediate care.

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.'

HOW TO TRAIN

The BMA is supporting a national BASICS training course for the next three years - training more than 70 doctors who can be called out to major accidents and other civil emergencies - in memory of the victims of the 7 July 2005 bombings. (www.bma.org.uk)

For further details of immediate care training contact: BASICS www.basics.org.uk

Royal College of Surgeons of Edinburgh www.rcsed.ac.uk.

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