BASICS type responders

ambo112

Is there any BASICS type responder programme in Ireland?

I was wondering if there is one for local doctors, paramedics and nurses to respond to calls as a first responder.

I know BASICS have a deal with insurance companies that allow you to get motor insurance through that company for social/domestic insurance but also for blue light response in your private car, kind of a fleet cover scheme, which would available in Ireland if there was such a scheme.

Most GP practices would sign up to it i would imagine as would a large number of paramedics and nurses.


Just thinking out loud is all

stevie06

yes there are in Cork.

http://www.westcorkrapidresponse.ie/


https://www.facebook.com/eastcork.rapidresponse.7

both very valuable resources and a great asset to the region.

ambo112

stevie06 wrote: »

yes there are in Cork.

http://www.westcorkrapidresponse.ie/


https://www.facebook.com/eastcork.rapidresponse.7

both very valuable resources and a great asset to the region.

Thanks for that, I was aware of them alright, exceptionally good work being done by all.

But I was thinking more of a national one similar to BASICS. Where you respond in your locality with the benefit of vehicle insurance.

Kwekubo

The field is still in its infancy in Ireland. The Cork schemes are the only ones that have been established to date.

PHECC apparently began preparing clinical practice guidelines for the role of "Pre-Hospital Doctor" in 2009 (see minutes), but there has been no news on this since.

ambo112

It would be a great step forward, especially when we hear of calls where ambulance were delayed and people died, I am sure in all those cases there would have been an off duty nurse, paramedic or doctor very close by, who was simply not aware of the call at the time.

What's more, this would not cost the HSE a penny!!

bobboberson

With the people who are taking part in the ems masters in UCD I would have though that there are doc and nurses interested in the area, and with paramedics trained for this work already, there are the skills out there

Issue with insurance could be a big one, as would the cost of kit and running cost, I don't know if the HSE would fund it

Maybe asking Brain Carling from UCD to give a talk on the topic to people interested could be a good way to getting people thinking about the idea

I know a lot of med and nursing students who are interested in the area, I know that might help right now but it means that there people who continue the programme in the future

Anthony

If you are thinking about getting a meeting/ talk going I'll help anyway I can

Bang Bang

You can sign up to a text alert community first responder programme as a member of the NAS.
Your home location is input into the AMPDS and when a cardiac call comes in you receive a text alert just like the volunteer community first responders and Ambulance Officers.

Now the only thing about this is it is quite basic, the job will set you up with a response bag minus the drugs. In certain areas AED's were issued on loan which is a big plus. If you an an Advanced Paramedic then you will be permitted to take your AP response bag home, but again there's the issue of drugs.

The idea of responding non NAS members who are also outside of the Community First Responder programme has come up but there were issues surrounding insurance.

Mycroft H

Bang Bang wrote: »

The idea of responding non NAS members who are also outside of the Community First Responder programme has come up but there were issues surrounding insurance.

Perhaps it's something the voluntaries could look into in conjunction with some appropriately trained doctors/Nurses/APs etc. They've already the fleet of vehicles and the insurance in place.

Bang Bang

BX 19 wrote: »

Perhaps it's something the voluntaries could look into in conjunction with some appropriately trained doctors/Nurses/APs etc. They've already the fleet of vehicles and the insurance in place.

I see where you're coming from but we know it would be faced with a lot of opposition if a patient transport service was also being provided. The Tramore model that was in place, I'm not sure if it still is, and the use of private ambulance companies in other regions raised many eyebrows and concerns.

Also the voluntary groups would need to be very careful with how much cover or vehicles they may provide for transporting responders, as in they would still need to fulfil their own duties.

Mycroft H

Bang Bang wrote: »

I see where you're coming from but we know it would be faced with a lot of opposition if a patient transport service was also being provided. The Tramore model that was in place, I'm not sure if it still is, and the use of private ambulance companies in other regions raised many eyebrows and concerns.

Also the voluntary groups would need to be very careful with how much cover or vehicles they may provide for transporting responders, as in they would still need to fulfil their own duties.

There is plenty of voluntary Jeeps/FRVs etc lying idle 6 days out of 7. This could be done with a little impact in most areas. My idea was exactly that of the BASICS, a FRV fitted out with ACLS/ALS meds/equipment and equipment with a trained Medical Practitioner bringing intermediate care to the scene. I'm not talking about transporting more bringing high level care to the scene.

If it's done right, which it could be with a little impetus, it could become a fantastic resource.

ambo112

The desire is there amongst us all, it just seems like no one is there to
Coordinate it, I wonder if the Irish Society of Immediate Care (ICIS) would be interested?

Or if there is a way of setting up such a charity, any ideas?

The main issue is insurance, but if you went to an insurance company for fleet insurance for the charity to cover private cars with the ability to respond with blues and siren like BASICS then I am sure, if the price is reasonable, that a very large number would switch their insurance allowing them this cover.

The law now allows blue lights for a vehicle providing an ambulance service to cover response cars.

You would still have road tax.

PHECC accreditation would be straight forward as the charity could run course for its members.

AP/P's could have an equipment course for GP's and Nurses along with an induction on how we deal with calls and our CPG's. Maybe PHECC could revisit the Emergency Doctor CPG's?

GP practices could have one car at the surgery and maybe an internal rota for the Doc's to respond.

The call out would be simple with the responder App.

All the existing local responders could, if they wished, join this charity and amalgamate into the one. Or have dual membership.

It would allow all who join to respond from home at anytime, if they so wished without any requirement to.

How do you set up a charity? Any advice?

Vorsprung

There are plenty of GP co-ops out there, might be a good way of contacting GPs in large groups. Gerry Bury in UCD has traditionally had an interest in prehospital care (he's a GP and professor of GP there), might be worth a shout.

ambo112

Thanks for the names folks, certainly a main link to getting the word out to GP's.

One for nurses would be great, maybe a PhECC level for Emergency Nurse??

But would need to set up a charity, website, insurance (vehicle), bank acc, committee, mission statement, PHECC accreditation, possibly fuel discount for fleet and service charges etc... Before I could make any contact to get members.

Something, I would like to do the more I think about it. The workload would be huge but I would love it.

I'm gonna start making headway on this for the next few weeks and see if I can get something going, it may fail but worth a try, shouldn't lose too much if it does fail.

Any ideas of a good name to register for?

ambo112

Ok, so I need to get a legal constitution and set up as a charitable entity etc...

Then register with revenue...

Then I can open a bank account....

Then I can set up a website....

Then I can seek funding to get a building lease, pc equipment etc....

Then I need to get some PHECC tutors, educator to design up some courses for accreditation.

Then contact GP's, Nurses, APs and P's for membership.

Then if it gets big enough, contact PHECC about Emergency Doctor and Emergency Nurse course.

Set up finance committee, training committee, executive committee, I think.

Anything I missed???
I will look into the first couple of points over the next few weeks and see what I can get done, hopefully find a charitable solicitor and accountant!!!

Mycroft H

A good name would have to be something simple and descriptive. The public would need to know what it does right from the name.

By the way, I'd love to help, I doubt you've much use for a lowly EMT medically, but anything on the admin end.

ambo112

BX 19 wrote: »

A good name would have to be something simple and descriptive. The public would need to know what it does right from the name.

By the way, I'd love to help, I doubt you've much use for a lowly EMT medically, but anything on the admin end.

I am really just thinking out loud at the minute, need to get all the answers to my last post and get in contact with solicitors etc and see if I can take this anywhere, I will have to get the first steps done by myself so I don't waste anyone's time.

This will most certainly be an all inclusive charity for all levels from lay person to super duper chief consultant.

I feel that from a responder point of view that it should be P and above for various issues such as insurance - both vehicular and public liability.

Which is another question, any advice on public liability etc...

This may all fail by the wayside but it won't be from lack of trying. Will just take me a few weeks to get the first steps done so bare with me if it sounds like nothing is being done.

ambo112

ICCR - Irish Critical Care Responders ????

Critical Care Doctor
Critical Care Nurse
Critical Care Advanced Paramedic
Critical Care Paramedic

Vorsprung

ambo112 wrote: »

ICCR - Irish Critical Care Responders ????

Critical Care Doctor
Critical Care Nurse
Critical Care Advanced Paramedic
Critical Care Paramedic

I know this is a mute point at this stage but from a doctor's point of view, critical care doctor implies someone trained in anaesthetics/emergency or intensive care medicine.

Following on from the guys in Cork, how about something like "rapid response" or "community response" doctor?

ambo112

Vorsprung wrote: »

I know this is a mute point at this stage but from a doctor's point of view, critical care doctor implies someone trained in anaesthetics/emergency or intensive care medicine.

Following on from the guys in Cork, how about something like "rapid response" or "community response" doctor?

Very valid point, I will need a name to start with before I register anything.

Would like to avoid conflict in terms such as that.

IEMR - Irish Emergency Medical Responders

Old diesel

Good evening all

Hope you don't mind a normal layman joining/following the discussion - my own interest is that ive been thinking about the possibility of getting this type of BASICs/East and West Cork rapid response set up operational in my own area of the country.

Im actually from North Cork - but as far as I know there is no service of this type operational in North Cork - its just East and West Cork.

Just a few things off the top of my head.

Someone asked would the HSE fund it - but what Ive been wondering - is whether there's any possibility of this type of service working in partnership with Primary care from a funding viewpoint (I thought Primary Care was a key policy for government - hence money available??).

If such a partnership was possible - id see it as bringing into play the potential for responders to get payment for providing this service.

I think the London Air Ambulance doctors are NHS funded for example??.

Would have thought that in terms of insurance etc - a marked dedicated charity vehicle would be better then everyone using their private personal cars. Hard to imagine an Insurance company quoting for 999 response on someones private personal car - and the whole thing repeats itself over a good number of vehicles. Also it gets very impractical and messy fitting peoples private personal cars with lights/markings and all the other equipment a 999 response car would be fitted with - imo.

Would love to keep in touch with whats happening with this - if that's possible.

Eugene

resus

Ambo112. Get in touch with West or East Cork Rapid Response now. Don't reinvent a wheel that's been turning well for >5yrs!

"Irish Communities Rapid Response" ICRR is already an established Charity entity under which East and West Cork Rapid Response function.

North Cork already has the doctor and APs, just needs the voluntary committee around it to establish North Cork Rapid Response.

ICRR is working on securing more Social Entrepreneur type funding to steadily, and in a safe and structured manner, role the model out in interested communities around Ireland, in collaboration with and support of the National Ambulance Service and DFB.

Biggest hurdle is well on its way to being overcome, ie. the NAS communications infrastructure being upgraded to allow for any of its personnel to be dispatched in a voluntary capacity if the so wish.

Cork works so well for a range of reasons, mostly that it has a concentration of Prehospital Emergency Medicine Doctors from a range of specialties that work and train voluntarily together and have done so for many years. They also have a strong governance group which meets monthly to discuss important cases, under Professorial oversight, at the Emergency Department at CUH and most importantly the NAS through its Medical Directorate. Most of these doctors come from ambulance service or similar backgrounds, ie. they've been Paramedics or sImilar in the past and have the necessary training already to work effectively in difficult environments.

You can't just put any doctor into a RRV, no matter how well it is equipped or what specialty the doctor comes from! It actually is a step backwards. They would need to have considerable training and mentorship and a structure to work in to be anywhere near as effective as an AP or paramedic in an emergency on the road. The logistics and safety alone can not simply come from even a few months training !

UCDs Masters Programme is an excellent academic start, as are specific hands on trauma courses such as ATACC. But they are only a start. Across the waters the specialty of Prehospital Emergency Medicine is better established and recognised by the Medical Council. They talk of a full 2 years on the road training in addition to a base specialty training of Anaesthetics, ICU or Emergency Medicine.

BASICS, the model of simply equipping GPs, has changed completely in the last 10years. To add to the service, over and above an AP, a doctor needs to be as trained in working prehospital as an AP and then bring additional skills to the roadside such as prehospital anaesthetics and surgery. To achieve this as a GP is not impossible, eg East Cork Rapid Response, but that GP has an established IN hospital Emergency Medicine practice and regularly does anaesthetic cases in theatre as well.

There is also not necessarily the interest out there amongst doctors to do all this voluntarily. Those that have are already being paid to do Prehospital Emergency Medicine as a job in Australia or the UK.

Bottom line is concentrate on communities supporting existing APs, Paramedics etc. that live in an area to respond. When solid schemes are up and running, such as those around Cork, then perhaps those schemes can initiate a structured programme of training and safely incorporating the right type of doctors.

ie. Speak to Cork

Old diesel

Fantastic post resus - thank you for that.

The model in East and West Cork - is as you say - a very good model which seems to work well.

The one issue though that I see going forward in the long term - is that what would be expected of a doctor under that model - is too much in the long term for a voluntary doctor - in my opinion. That's one of the things that's been putting me off slightly from moving the idea from being an idea in my head - to a fully functioning working service.

Again the Cork services are absolutely fantastic - and great work is being done - im not disputing that for a moment and the communities who set up the East Cork and West Cork rapid response - and the doctors who volunteer have done amazing work - and lives are being saved as a result.

Just unsure about whether its reasonable for someone to be expected to have to do a day job - whether its as a GP, A & E consultant or and Advanced Paramedic - and then in their time off be going out to serious 999 calls at all hours of the day or night.

I see BASICs Hampshire in the Uk are/were calling for pre hospital Emergency doctors outside London to be funded by the NHS in the same way the doctors on the London Air Ambulance are.

As a potential alternative starting point - I see that in Scotland - rural GPs are been trained up by BASICs - and when they do that - a charity called the Sandpiper trust provides them with an emergency bag with equipment needed for the provision of pre hospital care.

They also have vehicle locator devices fitted that the doctor can switch on when he/she is available to respond to calls - and the control room can see that the doctor is available - and where they are. Im not suggesting that's a good model or recommending it - just putting it forward as an alternative model that might be worth consideration

Again the Cork model is very good though - but its still worth keeping an open mind on alternative models - with the aim being to develop the very best model of pre hospital emergency care that can be put together.

That may end up being the entire Cork model of service - or it may be a model that brings good aspects of other models operating elsewhere into play along with all the considerable brilliant aspects of the Cork model

Finally resus - am I picking you up right - in that you are saying that there is a Pre Hospital Doctor operating in North Cork??. I would like to send you a pm or contact you if that's okay with you

Thank you

Eugene

ambo112

All of the groups out there are excellent and have there own merits.

The only thing I would like to see is a national group, where I as a paramedic can apply to be a first responder through membership.

I would like to know that i have the right insurance and will then respond to calls that are in my area if available or willing to.

Private vehicle insurance is a must, trying to run, maintain, fuel, mark etc... A fleet of vehicles would cost a fortune and would not be manageable.

It is for a purely first responder point of view, a quick response time where BLS and basic intervention is used not ALS.

The doctor schemes are certainly a massive support for ALS but the charity would have to set up the training, provide vehicles etc... Which could be done at a later date once the finances where there.

This would be a charity for Nurse/Paramedics/AP's to quickly get membership and be able to respond with their own personal BLS kit bag, not massive interventions or meds, just the basics on scene in a few mins while waiting for the NAS crew.

As for the insurance, it is possible to get fleet for this but to individualise it may be tricky but several of the companies in the UK that provide this cover also operate in Ireland. Will have to wait and see.

Overall, a simple organisation which gives vehicle cover through membership, links with HSE NAS control and hopefully discounts for vehicle maintenance services, fuel and maybe an agreement with the HSE to replace stock.

Providing basic interventions, no meds, just good old, hands on while waiting for NAS.

dredre

ambo112 wrote: »

All of the groups out there are excellent and have there own merits.

The only thing I would like to see is a national group, where I as a paramedic can apply to be a first responder through membership.

I would like to know that i have the right insurance and will then respond to calls that are in my area if available or willing to.

Private vehicle insurance is a must, trying to run, maintain, fuel, mark etc... A fleet of vehicles would cost a fortune and would not be manageable.

It is for a purely first responder point of view, a quick response time where BLS and basic intervention is used not ALS.

The doctor schemes are certainly a massive support for ALS but the charity would have to set up the training, provide vehicles etc... Which could be done at a later date once the finances where there.

This would be a charity for Nurse/Paramedics/AP's to quickly get membership and be able to respond with their own personal BLS kit bag, not massive interventions or meds, just the basics on scene in a few mins while waiting for the NAS crew.

As for the insurance, it is possible to get fleet for this but to individualise it may be tricky but several of the companies in the UK that provide this cover also operate in Ireland. Will have to wait and see.

Overall, a simple organisation which gives vehicle cover through membership, links with HSE NAS control and hopefully discounts for vehicle maintenance services, fuel and maybe an agreement with the HSE to replace stock.

Providing basic interventions, no meds, just good old, hands on while waiting for NAS.

The CFR schemes approved by NAS indemnify responders clinically.

Insurance isn't an issue with most insurers but not on blue lights. Can't see responder scheme getting authority to operate under lights and sirens.

ambo112

dredre wrote: »

The CFR schemes approved by NAS indemnify responders clinically.

Insurance isn't an issue with most insurers but not on blue lights. Can't see responder scheme getting authority to operate under lights and sirens.

It is one of the things that has to be looked into, if it can be done in the UK, then I would imagine it can be done here too.

The NAS CFR scheme isn't really up and running, I have yet to meet a single member of NAS in this scheme, or anyone else for that matter.

ambo112

Insurance example from UK

http://www.towergatemia.co.uk/news/basics-motor-insurance-scheme.aspx

dredre

ambo112 wrote: »

It is one of the things that has to be looked into, if it can be done in the UK, then I would imagine it can be done here too.

The NAS CFR scheme isn't really up and running, I have yet to meet a single member of NAS in this scheme, or anyone else for that matter.

Athea, Clonakilty, Wicklow, Lismore are a few of the schemes up and running.

I'm sure insurance could be obtained but I doubt that NAS would task untrained drivers in vehicles they have no control over the quality/safety/maintenance of.

ambo112

dredre wrote: »

Athea, Clonakilty, Wicklow, Lismore are a few of the schemes up and running.

I'm sure insurance could be obtained but I doubt that NAS would task untrained drivers in vehicles they have no control over the quality/safety/maintenance of.

Not heard about any I these schemes unfortunately. NAS would not be tasking untrained drivers, they would be linking with a first responder charity.

The drivers who would use blues and siren would have to have the PHECC level 2 driver course completed otherwise it will be under normal conditions, same as BASICS.

A lot of BASICS doctors use off duty cops to drive as some of the doctors don't want to do or can't make time to do the driver courses.

This would not be any dissimilar to all the other various charities.

It will allow a far greater number of people to become first responders and offer a far larger number of vehicles - if it even takes off!

At the moment there are sporadic services with dedicated vehicles covering various areas.

This would simply offer all those interested to be cover to respond in their vehicles, in their time - if they wish to, there will be no requirement to.

Imagine a large rural area, instead of one vehicle with one person, there may be several responders with several vehicles, this should allow a larger number of response options for NAS in all regions.

At the end of the day we all want to see a responder at a patient as quick as possible and the majority of us would like to make ourselves available, this just simplifies it for us all to compliment the various charities already in existence.

Old diesel

ambo112 wrote: »

Not heard about any I these schemes unfortunately. NAS would not be tasking untrained drivers, they would be linking with a first responder charity.

The drivers who would use blues and siren would have to have the PHECC level 2 driver course completed otherwise it will be under normal conditions, same as BASICS.

A lot of BASICS doctors use off duty cops to drive as some of the doctors don't want to do or can't make time to do the driver courses.

This would not be any dissimilar to all the other various charities.

It will allow a far greater number of people to become first responders and offer a far larger number of vehicles - if it even takes off!

At the moment there are sporadic services with dedicated vehicles covering various areas.

This would simply offer all those interested to be cover to respond in their vehicles, in their time - if they wish to, there will be no requirement to.

Imagine a large rural area, instead of one vehicle with one person, there may be several responders with several vehicles, this should allow a larger number of response options for NAS in all regions.

At the end of the day we all want to see a responder at a patient as quick as possible and the majority of us would like to make ourselves available, this just simplifies it for us all to compliment the various charities already in existence.

Worth having a look here imo http://www.sandpipertrust.org - maybe its not the ideal model for you - and im not recommending it - but it may give you some ideas.

Sounds closer to what your looking to do Ambo112 then the cork model - that's if im hearing you right in terms of what your looking to do.

Hope the link works for you - bear with me - im not great with links

Eugene

Old diesel

Brian Carlin from UCD was mentioned earlier in the tread.

He did up an article about immediate care - potentially interesting bed time reading here http://www.imt.ie/features-opinion/2012/03/gps-role-in-immediate-care-schemes.html.

Hope the link works - some good interesting stuff there imo.

Eugene

ambo112

Definitely where I am coming from. There are a range if fragmented responders out there.

All we need is a single entity that all the responders and future responders could link up with. That PHECC could regulate, that NAS could manage and direct, that members can link into for insurance and a range of other benefits. For donations to be channeled into etc...

Start with pure basics, a kit bag, vehicle insurance and the PHECC app for the national control room.

As it evolves, the potential for specialist GP's or even marked vehicles on lease to GP surgeries with off duty cops as drivers or GP's who completed the driver training is endless.

The possibilities if these GP's and other Doctors/consultants to run training courses for members in specialist areas I.e. burns, trauma, peads etc...

The possibilities are endless. Just need to try get the start that's needed.

Hopefully find a charitable solicitor and accountant.

I'm making progress with other areas at the minute, will be a long road to travel yet.