The British Association for Immediate Care (BASICS) and The Faculty of Pre-Hospital Care (FPhC) International Conference took place this year at the Copthorne Hotel, Dudley on Friday 11 and Saturday 12 October. The conference, entitled “Back to the Future”, looked at the origin of pre-hospital care, leading up through to the latest developments in research and practice.
Aimed at all levels of pre-hospital practitioner, the delegates were made up of GPs, consultants, paramedics, EMTs and students. This year also saw the inclusion of sessions specifically for first responders and first aiders, looking at airway management, history and handover issues of scene safety.
Day one
Traditional BASICS
Following a welcome from BASICS chairman Richard Steyn, lifetime member Kenneth Hines delivered the opening talk on the historical roots of immediate care. Outlining the formation of BASICS in 1977—when it was then known as the British Association of Immediate Care Schemes—through to its development as an organisation that provides immediate medical care nationally, Hines captured the ethos of BASICS perfectly in his closing comment: ‘We've gone from a bunch of enthusiastic doctors to a highly skilled professional body.’
Jonathan Bracken, special counsel, Bircham Dyson Bell, spoke on the concept of duty of care and the fear of liability for negligence. Providing the example of being on board an aeroplane and looking at where a doctor's duty of care lies should a passenger fall ill, Bracken highlighted the importance of recognising your limitations and not to make matters worse.
James Pallett, senior clinical research fellow, emergency medicine, King's College Hospital, spoke on the epidemiology of trauma. Presenting a number of shocking figures, including the fact that trauma forms 7% of the NHS budget, he stressed the need for more reliable data surveillance systems.
Practical developments
Matthew Cooke, professor of clinical systems design, WMS and associate medical director, Heart of England NHS Foundation Trust, outlined the latest research in pre-hospital care. This was followed by Sir Keith Porter, professor of clinical traumatology, Queen Elizabeth Hospital Birmingham, who provided a much-anticipated talk on the consensus statements from the FPhC, on topics including patient handling, spinal injury and pelvic injury.
Tim Harris, professor of emergency medicine and pre-hospital care, Barts Health NHS Trust and Queen Mary University London, ended the talks before lunch by exploring pre-hospital ultrasound. Outlining its many uses in the pre-hospital setting, Harris' talk was both informative and engaging.
Breakout sessions
After lunch, a number of breakout sessions took place, including a talk by Andrew Lee, fire officer, Derbyshire Fire and Rescue Service, and paramedic, on changes in entrapment management. With the help of a stripped down Volvo, Lee was able to highlight areas of concern to bear in mind when carrying out extrication services.
Throughout the day, students of all disciplines were invited to make presentations and compete for a prize generously donated by the FPhC. The inaugural event showcased a number of impressive proposed pre-hospital care programmes in the form of posters. The students were on hand to explain their ideas and the prize was awarded to Dr Matt Ellington of Addenbrookes Hospital, Cambridge. His poster, entitled “Medical Students: The Future of Pre-Hospital Care?” provided illuminating figures of average UK ambulance service response times with those being achieved by medical school students. As the winner, Matt received a cheque for £100. Students also gave oral presentations on pre-hospital care programmes and the developments of undergraduate programmes in the field.
Myles Gibson Eponymous Lecture
Following the breakout sessions, the Myles Gibson Eponymous Lecture was delivered by Stephen Hearns, consultant in emergency medicine, Royal Alexandra Hospital, Paisley. Hearns’ lecture gave an overview of the Emergency Medical Retrieval Service (EMRS). He explained that having finished his training with the London Helicopter Emergency Medical Service, where he developed experience in pre-hospital trauma care and aeromedical evacuation, he attempted to utilise this experience in Scotland, where he has helped to develop the EMRS. The service he has managed to produce in Scotland is truly admirable, and delegates enjoyed being given an insight into the work he has done.
Annual dinner and awards
The annual dinner and awards were an occasion for old colleagues to catch up and celebrate the great work being undertaken in pre-hospital care by a number of individuals.
The joint FPhC and BASICS Lifetime Achievement Award went to Dr Dick Herbert. Dick retired in February this year after a long career in pre-hospital care. He, along with Dr John Hall and Dr Barry Davis, founded the first West Midlands based Immediate Care Scheme in Kidderminster in 1981. Since then, he has played an instrumental role in the West Midlands Care Team.
The annual Laerdal Award was presented to Dr David Zideman, a much-respected anaesthetist, past chairman of BASICS and the European Resuscitation Council, and honorary physician to the Queen. His award also served to recognise the invaluable role he played as Clinical Lead for Emergency Medical Care for the 2012 London Olympic and Paralympic Games.
‘Hines captured the ethos of BASICS perfectly in his closing comment: “We’ve gone from a bunch of enthusiastic doctors to a highly skilled professional body.”’
Further BASICS awards were presented to Andrew Butler, Simon Brown, Henry Frydenson, Colin French, David Hickson and Caroline Williams.
Day two
Practical developments
The second day of the conference began with a talk from Matthew Robbins on the latest street drugs. Providing an overview of legal and illegal drugs that are seeing prevalent use, he outlined clinical considerations before considering the future of drugs, where he questioned whether prohibition was the solution.
Simon Brown, chairman of the Joint Royal Colleges Liaison Committee Guideline Development Group, highlighted updates in the UK Ambulance Services Clinical Practice Guidelines. Brown explained the development process for the guidelines before outlining those that are new to the 2013 volume.
Riki Trivedi, consultant neurosurgeon in Cambridge, spoke on the pre-hospital management of head injury. He emphasised the role of “feld” personnel as the first contact for the patient, and how they should aim to prevent secondary brain injury such as hypoxia and hypotension. He went on to outline initial management for the head injury patient.
Development of integrated responses
Peter Bimson, senior collisions investigator, Cambridge Constabulary, then gave an engaging talk on crime scene preservation. Whilst he recognised that patient rescue and survival is the sole goal of pre-hospital care professionals, he mentioned the importance, where possible, for pre-hospital staff to be forensically aware.
Shane Roberts, head of clinical practice, trauma management, West Midlands Ambulance Service NHS Foundation Trust (WMAS), gave an overview of the Major Trauma Network that was introduced across the West Midlands last year. Although trauma only forms 4% of paramedic callouts, it often presents complex scenarios for on-scene staff.
Jonathan Leach, associate medical director revalidation, NHS England, gave the last talk before lunch on GPs working with the ambulance service. Highlighting the increasing pressures on all elements of the emergency care system, he emphasised that if patients can be treated on scene, hospital admissions can be reduced, thus relieving pressure on A&E departments.
The future of pre-hospital care
After lunch, Hal Maxwell, chairman of BASICS Scotland, gave an overview of the origins of the organisation. Explaining the differing demands of BASICS Scotland to its English counterpart, and how the rurality and isolation of many parts of Scotland affects the workforce demographic of the organisation, he went on to outline its role in the provision of education, equipment and support.
Roderick Mackenzie, consultant in emergency medicine, Addenbrookes Hospital, spoke on damage control resuscitation. He maintained that the important factor in a situation requiring damage control resuscitation is not to try and fix the emergency in one sitting, but to keep the ship floating and fighting, move to safe waters, and acknowledging that full repair and reconstruction can happen later.
‘…he emphasised that if patients can be treated on scene, hospital admissions can be reduced, thus relieving pressure on A&E departments.’
Richard Steyn delivered the final talk on BASICS and the FPhC. He questioned the role of doctors in the emergency setting before outlining differences in BASICS and the FPhC. He maintained that though different, the two organisations should not be competing.
As the conference came to a close, final comments were made by James Hickman, the newly elected chairman for BASICS. Thanking delegates for coming and the organisers for putting on a successful conference, everyone left with more than enough food for thought.
