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Monday, 27 December, 1999, 13:34 GMT
On the scene
The quicker someone reaches hospital, the better their chances
Highly skilled paramedics, 'flying doctors' and helicopter crews can make a big difference to survival chances. BBC News Online looks at the professionals involved.

Accident and Emergency
The "immediate care" received by a seriously ill patient by the roadside has changed beyond recognition in the last few decades.

The UK has some of the most sophisticated facilities available to help accident victims.

Basically, you do whatever you have to do to keep the patient alive at that moment and get them in the back of the ambulance

Mr Richard Rawlins, trauma surgeon
But much of this is dependent on philanthropy and the dedication of individuals rather than the NHS.

The health service funds local ambulance services, training paramedics and drivers to a high standard.

But the so-called "flying doctors", who are loosely organised by the British Association for Immediate Care (BASICS), give up their spare time, and their money to offer skilled assistance.

Paramedics and BASICS doctors treat an accident victim (source: BASICS)
And many of those people whose area is covered by air ambulance services do not realise that private sponsorship is very often the only thing which is keeping them in the air.

The lack of public money for BASICS continues to amaze those who run the service.

Dr Iain McNeil used to be a GP who was called out to attend road accidents - now he is medical director for the Surrey and Kent Ambulance Services, and a pivotal figure in BASICS.

He said: "BASICS doctors get not money - it costs us money for equipment, clothing, even the extra costs of car insurance because of the work we do.

"It should be paid for separately through central funds."

The argument is strong - the estimated cost to society of one fatal road traffic casualty is 1,207,670.

At present, only a third of the country is covered by local BASICS schemes, and some 1,500 doctors are involved.

There are qualifications in immediate care - the skills needed to both save lives, and keep the doctor safe in dangerous situations.

Changing face of accident care

Both the foundation of BASICS, some 20 years ago, and the replacement of stretcher-carrying ambulancemen with more highly skilled paramedics recognises the importance of giving certain degree of treatment to casualties on the scene.

Paramedics can perform various life-saving treatments, such as inserting drips, and using defibrillators to restart the heart.

But recently, there has been a shift in emphasis from carrying out lots of treatments on the scene to getting the patient to A&E as quickly as possible.

Air ambulances reduce the time it takes to reach hospital
Mr Richard Rawlins, a consultant surgeon specialising in trauma cases at Bedford hospital, says the correct technique now is "scoop and run".

"Basically, you do whatever you have to do to keep the patient alive at that moment and get them in the back of the ambulance.

"The problem is, many of these paramedics have so many skills, and in a lot of cases putting up drips and administering pain relief on the roadside is entirely the wrong thing to do."

The helicopter services are part of that recognition that "the golden hour" is a rough limit between accident and and emergency room which greatly reduce disability and increase chance of survival.

In a road accident, the emergency services may take five to 10 minutes to arrive, it may take another half hour to make the scene safe and cut the victim free, leaving only a short time to make the transfer, often through congested streets.

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