BASICS Aviemore

Immediate care is the provision of skilled medical attention in the pre-hospital setting. For us in Aviemore, this primarily involves attending any medical or trauma emergencies that occur on our patch as part of a coordinated response with the other emergency services - primarily, of course, the Scottish Ambulance Service.

We have been active in this area for over thirty years, and our response scheme as been a member of BASICS ever since this organisation was formed in 1977 and recently moved over to the newly devolved BASICS Scotland. Members of BASICS provide immediate treatment in many different emergency situations. In road traffic accidents for example, the time between injury and arrival at hospital may be prolonged, perhaps because the victim is trapped or the distance from hospital is considerable. In our location, severe winter weather can complicate matters considerably! BASICS doctors with their additional medical expertise increase the casualty's chance of survival. At times, our doctors arrive before ambulance service (the local ambulance may be out on other duties and a vehicle is sent from a neighbouring village)

This work is performed voluntarily out with our day to day commitments as general practitioners and at present we receive no payment for providing this 24 hour service. The vast majority of our equipment is supplied thanks to fund raising by the local Aviemore community through our medical equipment trust fund. Unfortunately, this is no mean feat, as a full set of equipment costs over £3000!

In September 2006, BASICS Aviemore (along with all BASICS practices in Highland) integrated into the new Scottish Ambulance Service EMDC system. The practice has been geofenced on the EMDC system, which means whenever a call comes in at the ambulance control room that falls within the Aviemore practice area, the controller is alerted to call an Aviemore GP. In addition, Dr Langran's car is fitted with the same VLS satellite tracking unit found in all Scottish ambulances so that at any time, the exact position of his car is shown on the EMDC control screen. This unit has been generously funded by the Sandpiper Trust through BASICS Scotland.

Most of our call outs come from the Scottish Ambulance Control centre based in Inverness, although not infrequently we receive calls directly at our health centre from locals and also from the Police (especially in the case of road traffic accidents). Despite the changes with the new GP contract, there is always a doctor on call 24 hours a day who is available to attend (if requested and sober) via the new satellite tracking system. In the case of major road accidents in hours, several of the doctors will attend all at once depending on the nature of the accident. Our patients understand this commitment and the inevitable delays - if it was your wife or child in trouble, where would you want the doctor to be?!

Type of incident	Percent of total calls
Medical emergency	15
Road traffic accident	76
Mountain related incident	0
Other trauma	9

We all use our own motor vehicles to attend emergencies. We are equipped with green rotating beacons that signify a doctor attending an emergency. When we are attending at the request of the ambulance service (and therefore as part of their response) we can use sirens although at present only Dr Langran's car (his old one is pictured!) is equipped with this facility. It certainly ensures a safer (albeit noisier) drive to the scene!

We also all carry our own individual equipment bags - stocked as each of us prefers with a range of medical kit. Oxygen, personal protective gear and additional medications are also carried. In the case of a heart attack, we can perform pre-hospital thrombolysis with tenecteplase (Metalyse) - this is a "clot-buster" drug that breaks down the clot causing the heart attack. It has been shown in clinical trials to significantly improve both the chances of survival and reduce the longer term chance of heart problems in those who receive it. Full resuscitation kit including advanced airways (LMA, ET tubes and surgical airways) are also carried, as are drugs that give us the ability to anaesthetise a casualty at the road side if need be. We can also manage life-threatening emergencies like collapsed lungs (tension pneumothorax) and anaphylaxis.

Dr Langran has had additional training in order to perform the duties of a Medical Incident Officer in the event of a major incident (i.e. big train, plane or automobile crash) any where in the Scottish Highlands, and so carries more specialist equipment to deal with this.

Immediate medical care training in Scotland is coordinated through BASICS Education (Scotland), under the leadership of Dr Colville Laird and is based in Auchterarder, Perthshire. These courses cover a full range of topics including basic and advanced life support, defibrillation, management of head and spinal injuries, paediatric and obstetric emergencies, pre-hospital thrombolysis and the fundamental principles of major incident management.

The courses are very practically orientated and include mock demonstrations of road traffic accidents and safe

driving procedures with officers from various Scottish police forces. Participants on the courses are finally put through a series of scenarios using actors as realistic casualties to test that the training has sunk in! Separate specific ALSG courses are organised including MIMMS (major incident medical management and support) and PHPLS (pre-hospital paediatric life support) from time to time. Dr Langran is a member of the instructor team for BASICS Education (Scotland) and this enables most of our training in Aviemore to be performed in house.

Click on the photo above to see a descriptive photo-montage of a road accident being managed from start to finish.

An ongoing grant from the NHS Education means there is now funding available to finance the training of all rural GP's in Scotland. For more information on the courses on offer and available dates, email BASICS Scotland by clicking here.

If you live in the Aviemore area and would like to know more about this work, please contact Dr Mike Langran on 01479 810258. If you would like to help our medical equipment trust to raise fund

s for the scheme then please contact Kiki Malcolm on the same number.

If you live out with Aviemore, there are over 80 other immediate care schemes throughout the UK - click on the thumbnail to the left to see where your local scheme is and/or go to the main BASICS website by clicking here.

BASICS Scotland

BASICS UK

Advanced Life Support Group (ALSG)

UK Resucitation Council (includes the current BLS/ALS guidelines)

Scottish Ambulance Service

SIGN Guidelines on the early management of head injuries (2000)

Critical Care Paediatrics on line