Background Prehospital emergency care (PHEC) involves provision of hospital level care to patients prehospitally, often beyond the capability of local ambulance services. The availability of PHEC is variable, often delivered by Air Ambulance charities during their operational hours, and when not, by volunteer doctors (BASICS). This abstract relates to BASICS in the Thames Valley region (UK), and specifically, the process of quality assuring and developing such a service with the constraints of limited funding and time.The intervention described is the development of a solo responder, providing independent PHEC with indirect consultant supervision.

Strategy for improvement After sign off, an iterative process for service development started, involving electronic post incident reflections with subsequent face to face discussions. This was key to identifying good practice, development areas and root cause analysis of issues with near-peer review facilitating asynchronous, distance based discussions.

Improvement was based on number of incidents attended, and delivery of enhanced care. Any appropriate activation was taken as an improvement, in that the incident, patients and emergency staff would otherwise not have access to enhanced care other than conveying to hospital. Results are incomplete at present, however preliminary are as follows:

• 91 responses involving 106 patients

• 58 ‘assists’ – attended to, and left care of the ambulance crew

• 23 ‘escorts’ – patients subsequently escorted to hospital

• 4 paediatric and 5 traumatic arrests

  3 sedations

  1 resuscitative thoracotomy

Conclusions

1. The process from inception to service delivery requires significant financial, time and personal investment from the individual responder

2. Whilst post incident reflections help drive learning, ongoing obstacles include limitations of skillset such as PHEA, expenditure e.g. fuel, continuing professional development and equipment maintenance/upgrading and funding for this.