Commonly known as BASICS and referred to as a charity, this organisation that was formed in the late 70s with an aim to raise standards of immediate care and training in all those who undertake to practise the discipline.

As a paramedic or a member of an ambulance staff, you are aware of the challenges and pressures of saving and helping lives during an emergency. These critical situations are in need of the fastest response made be highly trained professionals. Along with these, you must also be aware of the difficulties and hindrances that an ambulance trust encounters. From funds down to manpower, every trust comes to a point where they cannot handle all the demands of the public. This is what BASICS understand and is trying to create a solution for.

The organisation relies on volunteer medical professionals and Allied Health Professionals to provide immediate healthcare assistance in support of the emergency services. In times like huge calamities, major accidents and critical rescue operations, further assistance is needed especially when healthcare systems are cutting back costs and saving funds. The British Association for Immediate Care is made up of entirely voluntary services. Healthcare professionals who have signed up for the charity are summoned whenever there are certain big events that need to be taken care of. Aside from disasters and accidents or advanced health injuries, BASICS also work together with the Red Cross or St. John Ambulance on events such as large sporting events, major public rallies, road traffic collisions and concerts.

And other that voluntary emergency service work, healthcare professionals from the charity also conducts trainings and seminars for new doctors, nurses and emergency technicians. Their doctors are usually involved in General Practice, Surgery, Medicine, Emergency Medicine, Anaesthesia and Critical Care and are  constantly looking for ways to improve the immediate cares schemes through charity events and awareness programs.

Because of BASICS dedicated and noble work in service of the people, they have garnered quite a large number of awards and recognitions all throughout the years. They have several professional health workers that have achieved Honorary Life Members merits, The Asmund S Laerdal Awards and last but not the least, the BASICS award.

Up until today, the British Association for Immediate Care has provided continuous selfless service to the people in need of immediate care. Working along with the ambulance trusts and the public as a whole provides effectiveness in cooperation, work and progress.

Emergency medical services in a country are usually handled by a single medical body or agency that is made up of council members headed by a Chair. As it happens in the UK, the National Health Service, popularly known as NHS, is the healthcare system of the country that is divided into three parts: NHS England (which is the only one referred to as NHS), NSH Scotland, NHS Wales and Health and Social Care Ireland (HSC). Though they are separately funded by their own legal systems and have their own unique regulations, they do not discriminate whoever is in danger. This means that, whenever someone is an emergency in a territory which they do not reside, it doesn’t matter. Ambulance

trusts and its emergency service personnel are always ready to help.

When it comes to planning out strategies, there are quite a lot of things to put into great consideration. Remember that an emergency has no set of typical category which means, anyone can be in an accident or in a critical situation. Because of this, emergency medical services must be aware on how to handle different kinds of patients- from senior ci

tizens to pregnant women, down to children and infants.

Along with these kinds of factors, emergency medical services staff and ambulance trusts build up a series of elements and topics to be involved when it comes to implementing strong and effective strategies. Aside from the profiles of their patients, execution of service, technology and external elements are also discussed.

Various ambulance trusts all over UK are monitored and are graded based on their annual performance. Because of this, they work hard in order to meet their standards. However, there are certain difficult times for them. And once they encounter glitches and hindrances, they must make sure that they find a solution and fast. For example, road traffic is one of the major hindrances in delivering a patient to the hospital as fast as possible. Because of this, EMS providers are keen on looking for the fastest routes and planning on where to provide strategic locations for healthcare centres.

Another area that involves strategic planning in order to deliver emergency care is communications. In line with technology, EMS providers and trusts must find ways to respond to people faster, starting from the moment they make an emergency call. As a matter of fact, technology plays one of the biggest roles in helping the ambulance trusts implement their strategies- from medical equipment inventory and organisation down to communications.

All in all, to formalised strategies and emergency care delivery, ambulance trusts together with their leading health care systems publish their own reports, studies and books in order to give a solid information to the public of what they really do and what can be expected from them.

Some countries closely regulate the industry and may require anyone working on an ambulance to be qualified to a set level, whereas others allow quite wide differences between types of operator. Here is a list of the different types of emergency service providers.

Government Ambulance Service

This service provider is funded by a local, provincial or national government and usually established on major urban cities because of the population and congestion where more providers are needed. Government ambulance services usually are small emergency service providers and acts as a third degree EMS. They usually are used for back up on big catastrophes. However, in some countries such as the United Kingdom, the main emergency service provider is the NHS. The funds, equipment, recruits and regulations are all centred in the NHS’ lead.

Fire or Police Linked Service

Most fire services and police stations in UK have their own ambulance staff. This is to ensure a better form of rescue whenever they receive a call on most urban areas. Because of the huge population, some major EMS providers cannot handle everything on their own. That is why in case of fire and crime related emergencies, fire brigades and police stations are ready to provide their own EMS. On the other hand, rural areas also have fire and police linked services where the budget for public service can then be maximised and the regulations are all intact.

Volunteer Ambulance Services

Aside from the public services, there are other private organisations that support the masses by giving extra help in times of great need. Some charities offer voluntary EMS where private ambulance staff and trusts help out without anything in return. A great example of volunteer ambulance service that acts all throughout the world is the Red Cross. With various programs and campaigns regarding health and wellness, these charities aim to reach the grass-root areas and offer help for free.

Private Ambulance Trust

Usually this kind of service belongs to private hospitals with little connection to the government. It’s evident that most of the time their services are better and that their response may be faster than the others. However, their service isn’t free and sometimes it’s a bit pricey. Private ambulance services are great for patients with unique diseases or injuries that needs to have an EMS anytime. Private ambulance services are commonly used for huge private events as well.

To earn a title in the field of medicine, one must acquire the following qualifications such as degrees in med school, training courses and official registration. Handling people who are sick and injured is a very meticulous job that entails professionalism, skills and knowledge from a person who has undergone and submitted all the listed requirements. Using an occupation title like “paramedic”, “dietician”, or a “biomedical scientist” means that you must be authorized for your job and that you are entitled to help people in their specific health needs. It is considered a criminal offence whenever you are practicing the medical occupation without being recognised by the HPC. Because of this, the Health Professions Council has the right to prosecute illegal practicing medical workers.

At present, the council is monitoring fifteen health professions namely: arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dieticians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists/orthotists, radiographers, and speech and language therapists.

Along with the monitoring of the registration process, the Health Professions Council observes the performance of registered healthcare practitioners as well. If patients file complaints about a particular health professional on their medications and services, they may face certain charges and worse, discharge from the council and being prohibited to practice their profession.

The council is made up of committees and lead by twenty members made up of registrants and lay members where they are led by a Chair. They are the ones responsible for the development and policy strategies of medical practice in the country. Some of their major goals are to:

• Maintain and publish a public register of properly qualified members of the professions;
• Approve and uphold high standards of education and training, and continue good practice;
• Investigate complaints and take appropriate action;
• Work in partnership with the public, and a range of other groups including professional bodies; and
• Promote awareness and understanding of the aims of the Council.

Along with these goals, the Health Professions Council aims to provide quality services to customers and registering medical practitioners alike. The council would like to build a strong camaraderie between their registered healthcare professionals and the public in order to provide a better form of service to everyone who is in need.

Most of all, the Health Professions Council promotes their Equality and Diversity scheme that medical practitioners and patients deserve to have benefits and opportunities regardless of their gender, race and religion. As for the disabled, the HPC also set public standards in order to accommodate them properly and go on with their lives like the others.

Aside from the inner fulfilment, the benefits of a Paramedic are quite abundant as well. For a start, you get to have 27 days’ holiday annually and you’re guaranteed with life assurance, dependent benefits, voluntary early retirement, ill-health retirement benefits and the option to increase retirement benefits. And it doesn’t end here. Along with a great salary, you can acquire great discounts in terms of healthcare services for you and your family.

The benefits and job experience is totally different and worthwhile however becoming a paramedic entails series of trainings and exams that you need to pass successfully. Since the job requires huge responsibility, a paramedic applicant must be the total package in order to get the job.

Normally in the United Kingdom, applicants can become a paramedic by training in an ambulance trust for a couple of years. After they have completed their training courses, they will be eligible to apply for registrations in the Health Professions Council thus they will be officially a paramedic. But it doesn’t work like that anymore today. Students who want to become a paramedic must garner a degree in Paramedic science. They must maintain a high or passable GPA in order for them to be accepted in an ambulance trust for a training course that lasts up to three years.

Aside from the degree and training, another standard requirement in becoming a paramedic is to be a UK citizen according to its jurisdiction and have a driver’s license. You must have a satisfactory clearance of a standard Criminal Records Bureau (CRB) and your residence mustn’t be too far away from your work area. Other than that, what seniors are looking for in new applicants is how their personality reflects their decisions and actions in an emergency.

Upon entering the formal training, what you need to impose in order to perform your tasks well and be qualified for further training courses are:

• A helpful and approachable personality
• A responsible and dedicated attitude towards work
• Good teamwork and communication skills, oral or written
• The ability to be calm, quick-thinking and decisive in a crisis
• A good health status mentally and physically
• The ability to relate to people from a wide range of socio-economic backgrounds, races, religions and cultures;
• A commitment to continuous professional development and education.

To have a clearer idea of the duties of a paramedic based on their level of certification, here’s a list of the most common issues in an emergency that needs to be treated as soon as possible. Along with these, the specific skills on each level will be presented.

Airway Management

Most of the emergency patients are caused by accidents or severe health failures that obstruct their normal way of breathing. Without initial help, lack of air can lead to cardiac arrest and worst, death. For a basic technician, what he/she can do to the patient is to assess the patient’s condition, remove all the air passageway obstructions e.g. underwear, tight clothing, jewelleries etc. and reposition the oropharyngeal and nasopharyngeal airway adjuncts manually.

The general paramedic on the other hand can do advanced airway management through intubation, ETT, LMA, and combitube, deep suctioning, and use of Magill forceps while the advanced Paramedic can perform rapid sequence induction, surgical airway procedures including needle cricothyrotomy and surgical cricothyrotomy.

Blood Circulation

For accidents that may partially lead to haemorrhage and stroke, blood circulation must be monitored at all times. For minor emergencies, the basic technician can handle blood circulation issues by assessing the rate, rhythm and volume of the pulse, blood pressure, skin colour, and capillary refill. They can also control haemorrhage of all types using direct and indirect pressure and tourniquets.

For patients that need a more serious form of care, general paramedics can perform intravenous fluid replacement and use of vasoconstriction drugs while the advanced paramedic is in charge of intravenous plasma volume expanders, blood transfusion and intraosseous (IO) cannulation.

Cardiac Arrest and Monitoring

Cardiac arrest and heart diseases are one of the most common emergency situations. Because of this, paramedics are trained to keep the patient’s heart rate stable until they get to the hospital for a more formal medical care. Once a person dials an emergency 999 call that is about cardiac arrest, the basic technician has to be the first one to arrive on the scene. They are allowed to administer cardiopulmonary resuscitation, airway management and manual ventilation with BVM and automatic external defibrillator.

On the other hand, general paramedics are trained to facilitate dynamic resuscitation through intubation, ECG interpretation and usage of semi-automatic or manual defibrillator. For intense cardiac arrests that need urgent treatment, advanced paramedics are the ones to decide on expanded drug therapy options, ECG interpretations, manual defibrillator usage, synchronized mechanical or chemical cardioversion and the external pacing of the heart.

• Assess the patient’s condition and then give essential treatment
• Use high-tech medical equipment such as defibrillators, spinal and traction splints and intravenous drips.
• Administer oxygen and drugs
• Perform airway management techniques
• And sometimes perform obstetrics and stitch incisions.

With vital responsibilities and roles in emergencies and accidents, qualifications of a Paramedic are quite of high standard. They are required to finish a degree in Paramedic Science, pass series of assessments and exams and of course, undergo extensive trainings.

The trainings are usually the crucial part in being a certified Paramedic. Before being qualified to the official training courses, a Paramedic student must learn the academic area of the profession first by taking a degree. On the later years, they are required to train within an ambulance service for three years. Paramedic trainees will be trained in separate levels of modules and workshops starting from the basics down to the advanced medical care.

On the first level, Paramedics will be taught about the basics of ambulance aid. They will learn how to operate and drive an ambulance properly and with good speed. They will also know about all the equipment needed inside and ambulance and its functions. On the late phase of the first level, they are going to perform ambulance service work with supervision and by the end, student paramedics will be able to assess patients and perform heart rate monitoring with ECG and clinical examinations.

Once the paramedic trainee learns about the basic fundamentals of paramedicine practice, the second level comprises one year of work-based placement with a direct mentor. On this phase of the training, the paramedic will be with a mentor all the way in real situations and realistic workshops where the trainee will have more to place in their portfolio for future employment purposes.

After a year and a good performance, the paramedic trainee is then transferred to the third level where they are taught about the ethics and law, clinical decision-making, clinical audit and research, sociology, psychology and health promotion for about a year as well. They can now be on duty where mentors can still give them advice and support while on their way to the final level of the training module.

Level four of paramedic training is the shortest level however it’s the most crucial. It’s the turning point of every trainee’s career as they will be in a 16-week practical placement undertaking all skills learned on the course including paramedic-level skills under direct supervision. They have to complete their portfolio by this time and they have to complete a one-week course where they will be working on their own. If they finish the course successfully, only then will they have their diplomas and will be eligible to apply for registration in the Health Professions Council.

Specific medications that are permitted to be administered by a paramedic vary widely. The use of strong prescription drugs depends on each country’s jurisdiction and legal medication restrictions. For accurate description on your locality’s permitted drugs and medications, it’s best to inquire your jurisdiction directly. On the other hand, these are the common drugs that Paramedics usually use on their patients. They’re all legally approved by most countries and they may vary between over-the-counter and prescription drugs.

Analgesic medication is the most common and most used group of drugs to relieve pain, moderate nausea and vomiting. This drug is in the form of Apirin, Paracetamol, Ketorolac and Tylenol which are all considered over-the-counter drugs. Emergency response patients are mostly severely injured and in physical pain where Paramedics must be able to respond fast enough to regain the patient’s strength and of course, moderate the throbbing feeling.

Another common classification of drug that is usually on emergencies is Narcotics. This is also a pain reliever however, it is only used for severe, intolerable throbbing and aches such as burns and fractures. Drugs under the narcotics category are morphine, pethidine, fentanyl, and dilaudid and they cannot be bought without any doctor’s prescription.

During emergencies such as accidents and calamities, victims enter a state of traumatic shock because of the sudden impact of the situation that it upsurges their heart rates. This may not be a good sign especially on patients with a weak heart and respiratory system. To ease the problem Paramedics offer a right dose of Adenosine. Drugs such as Diltiazem and Verapamil that are considered calcium channel blockers are under this category and help slow down excessively high heart rates making the patient calm and initially stable all throughout the travel period in the ambulance.

Opposite of Adenosine is the Parasympathomimetic drugs. Instead of slowing down the heart rate, this kind of drug such as Atropine is used in speeding up slow heart rates known as bradycardia. Heart rate is considered slow whenever it beats 60 to 50 times per minute. A situation such as may lead to cardiac arrest whenever initial emergency response is failed to perform.

Aside from the usual patient issues of low heart rate and physical pain, another example that a Paramedic normally treats is low blood sugar or hypoglycaemia. Low blood sugar is accompanied by the intravenous infiltration of D50W, a solution with 50% of dextrose water. Failing to control low blood sugar may produce effects that can range from mild dysphoria to more serious issues such as seizures, unconsciousness, and permanent brain damage or death.

Lastly, an emergency situation will never be complete without irritable and agitated patients. Because of the unfortunate events, it’s normal for Paramedics to prescribe sedatives such as midazolam, lorazepam, and etomidate to prevent more damage and health issues from happening.

To fully perform the duties, an ambulance trust is composed of team of professionals who are assigned with specific tasks in handling an injured patient. Each of these emergency personnel has undergone series of separate education, trainings where they are qualified for their rankings in the staff. Usually there are five people in an ambulance team starting with the Ambulance Care Assistant

The Ambulance Care Assistant is the one responsible for the patient transport service of an ambulance trust. They usually are the ones who drive the disabled, elderly and weak confined patients to and from clinics, therapy appointments or day care centres. Their duty is to ensure that the patient is comfortable and safe while they’re being transported from one place or another. The ambulance care assistant is usually the one in the ambulance trust staff that gets to spend more time with patients regularly because of their job. Sometimes they work in twos where one is going to drive the ambulance and the other is going to assist the patient all the way- wheelchairs, errands and all. Aside from those, this member of the emergency response staff is also responsible for keeping the ambulance clean and organised- always prepared whenever there’s an emergency.

Next in rank is the Ambulance Technician. Basically, their task is to assist the paramedic. They are allowed to assess the patient’s condition and prior to the paramedic’s presence however they cannot perform any advance treatment or offer any medications. On the other hand, when they’re working in-house, they answer emergency 999 calls. Ambulance technicians who are on duty to answer emergency calls must have a flexible time schedule. Aside from that, when the Ambulance Care Assistant cannot perform its duty to drive, they must take place.

The Emergency Care Assistant on the other hand is somewhat similar to the ambulance technician however, they vary little in skills and shifts. ECAs are assigned also assigned to answer emergency calls and they are obliged to be the first responders in an emergency. If the emergency is categorised as intense, ECAs must find a way to get to the patient the fastest way possible. They usually administer the patient’s status and vital signs so when the actual emergency staff comes, assessment is already done and the patient can proceed to initial treatment.

Emergency Care Practitioners are higher in ranking and they have more sets of advanced duties. They can carry out and interpret diagnostics tests and prescribe a wider range of medications. They also refer patients to social care services and direct them to specialised units. The emergency care practitioners are usually next in rank with the Paramedic. The paramedics have the most extensive duties as they can treat cardiac arrests, perform minor surgical operations and incisions on the patient while in the ambulance and up until it reaches the ER.

These senior centurions weren’t physicians however, they became surgeons by default as in times of battles and war, they were the only once present in the area that are capable of providing fast treatment to everyone who was injured. They were able to suture wounds and perform complete amputations.

Aside from the Roman Legion, early traces of Paramedicine were also recorded during the 11^th up to the 13^th century during the Crusades where the Roman Catholics were fighting with the Muslims to regain Jerusalem back from being the Holy Land. Again, because of the battles, an organisation called Knights Hospitallers of the Order of St. John of Jerusalem functioned similarly to the senior centurions of Rome. Today, this organisation still exists however its name was changed to St. John Ambulance.

Though the ambulance already existed during the ancient times where transportation was already a part of civilization, there weren’t any clear regulations and organisations back then. People used carts and carriages to transfer incurable patients to the nearest physician where they cannot give prior treatment while travelling. On the other hand, while paramedicine already existed way back in AD 467, ambulance service only began to emerge in late 15^th hundredths where the earliest recorded instances were during the bubonic plague in London where the service was done temporarily because again, there weren’t any sturdy organisations that conducted regulations.

It was only until the American Civil War when Jonathan Letterman devised a system of mobile field hospitals employing the first uses of the principles of triage. This has brought the others who have witness the system to bring it back in their hometowns and introduce ambulance service where they have commenced volunteer life-saving and emergency responses at all times within their communities.

From the military and the battlefields, ambulance service began to formalise and diverse public services in communities such as the police and fire brigades began to cooperate and build a sturdier emergency response. Motorised ambulances and advanced medication began to develop in World War I and improved significantly in World War II thanks to the military. Medics then were already trained to inject narcotics to injured soldiers in order to moderate the pain and produce temporary treatment while the physician was not yet around. Mobility also wasn’t a problem since injured soldiers and civilians in the outskirts were transported via helicopters to the nearest hospital or basecamp.

The wars have brought an immense improvement in the practice of Paramedicine and it has continued on. The cardiac monitoring and assistance as well as the passage airway treatment became a part of the ambulance service in the 60s. At present, every country already has its ambulance service providers where in the United Kingdom, it’s commonly called as ambulance trusts. There are fifteen public ambulance trusts in UK receiving over 7 million annual emergency calls.