The prehospital emergency care (PhEC) course is a three day course covering various aspects of prehospital care, from anaphylaxis to dysrhythmias to trauma management. It is run by the British Association for Immediate Care (BASICS) and is examined and accredited by the Royal College of Surgeons of Edinburgh (RCSEd).
The first course was run in April 1993 and it has been developed and redesigned ever since, with the last major restructuring occurring in 2006. The PhEC course is also becoming an internationally respected course, with BASICS running courses in; Romania, Malta, Greece, Goa and Cyprus. To date, approximately 4000 people have successfully passed the PhEC course.
However, not everyone is successful. In 2009, the PhEC courses attracted 201 candidates with 40 candidates not being successful; this represents a pass rate of 80%. This seems to be fairly typical, as the average pass rate is between 75%-85% with this being fairly consistent across the various professionals undertaking the course.
The course is publicized as a Level 2 qualification, meaning it is aimed at the professional care provider who occasionally works in the prehospital environment. Although this may imply that by its very nature the course is aimed below the level of knowledge and skills already possessed by UK paramedics, this is certainly not the case in the prehospital environment (Box 1).
| Course | Academic level |
|---|---|
| IHCD first person on scene | 1 |
| Pre-hospital emergency care (PhEC) | 2 |
| Diploma in immediate medical care | 3 |
| Fellowship in immediate medical care | 4 |
The course requires an in-depth knowledge of the whole range of current paramedic practice, as well as a reasonable working knowledge of more advanced skills and interventions. However, despite this high level of required knowledge, a number of non-registered prehospital care providers have excelled at the PhEC course in the past, including first aiders, firefighters and combat medical technicians.
‘The course requires an in-depth knowledge of the whole range of current paramedic practice’
The course
The weekend course currently costs £735 for BASICS members and £800 for non-members, candidates might also want to consider paying for accommodation during the course and this can be booked online via the BASICS website. It may also be worthwhile for potential candidates to consider joining BASICS in order to benefit from this discount and to receive the various other benefits of membership to this leading organization. Currently, BASICS membership costs from £47 for student members (with no journal subscription) to £177 for full members, including a paper subscription to the Emergency Medicine Journal.
As mentioned previously, the course material is delivered over three days. There is however a large syllabus to be accommodated within these three days and candidates can expect to begin lectures at 08:00–08:30 each day and not leaving before 18:00. It is also advisable not to expect to be ‘spoon-fed’ information during the course; as although there are excellent lectures and instructional practical sessions, a large amount of prior knowledge and preferably experience is certainly needed.
Once you have registered for the PhEC course on the BASICS website, you will be sent further registration documents, recommended reading lists, the Manual of Core Skills produced by the RCSEd and a practice test paper (with answers).
It is definitely advisable that all candidates work through the Manual of Core material and other recommended reading thoroughly, prior to the course. It is also important to remember that the course culminates in a national examination and participants are expected to have a broad understanding and knowledge of the subject areas covered, even if certain interventions are beyond their current scope of practice. For example, it would not be unreasonable for a candidate to be able to state that the patient in their moulage may benefit from interventions such as ketamine, escharotomy or surgical cricothyroidotomy. Equally, one should anticipate the exam to require knowledge of drugs or interventions not currently available to paramedics, or not covered by the basic paramedic curriculum.
Overall the course encourages all candidates to be aware of the latest developments in evidence based practice, especially in terms of relevant NICE guidance, which may be a change from other prehospital care courses; where either the course material or the word of the instructors is taken as gospel, without necessarily being supported by the current evidence base. Typical course content is outlined in Box 2.
Personal experience
Having completed this course, I certainly feel more confident in my practice and also in recognizing the limits of my practice. It is also worth noting that for the majority of paramedics within the UK, upon registration with the Health Professions Council (HPC), they may never again be tested on their knowledge and skills related to trauma management and as such this course is an excellent refresher of these vital areas.
Although there are of course many other ways in which to maintain ones knowledge base and satisfy continuing professional development (CPD) requirements in the area of trauma care, many of these centre on self directed learning or e-learning and lack the face-to-face instruction available with a course such as the PhEC. The course also provides an excellent addition to any practitioner's Curriculum Vitae, especially when applying for promotion or for a position as a critical care paramedic or HEMS aircrew.
My main criticism of the course would be that it is only 3 days long and that additional time to practice moulages and gain experience with the wide range of equipment provided would have been beneficial. It was also interesting to see the myth of estimating blood pressures values from radial, femoral and carotid pulses with any degree of accuracy surfacing again, despite there being a lack of evidence supporting its effectiveness (Deakin and Low, 2000).
The course was also an excellent opportunity to work in a truly interprofessional team and gain a more in-depth understanding of the scope of practice and knowledge base of other professional groups. Before this course, I had little idea what our combat medical technicians were dealing with on a regular basis in Afghanistan or the level of immediate care training received, or not received, by general practitioners during their specialist training. I was also impressed to learn that the course faculty was made up of doctors, nurses, paramedics and firefighters. This mix of professions certainly made the course a valuable interprofessional experience and definitely made the practical sessions much more representative of the usual skill mix encountered in the prehospital environment.
The next steps
As mentioned previously, the PhEC exam is aimed at the occasional provider of prehospital care, and no doubt many paramedics will want to stretch themselves further after successful completion of the PhEC course. So what is the next step? The most obvious choice would be the advanced PhEC course which BASICS run over two days for candidates who have successfully completed the PhEC course.
The advanced course covers a number of more complex topics only briefly touched on during the three day course. For paramedics wanting to achieve an even higher level qualification, there is the Royal College of Surgeons of Edinburgh Diploma in Immediate Medical Care (DipIMC) examination and although there are a number of specific preparatory courses available for those planning to sit this exam, the PhEC and Advanced PhEC are also excellent preparation.
Conclusion
Overall, the PhEC course is far more than a basic level course for occasional providers; it is an intensive, educational and fun course, taught by an excellent group of instructors with a passion for prehospital care.