Highly trained dispatchers aim to let us know about critically ill patients very shortly after a 999 call is made, so we can rapidly arrive on scene.
On scene we provide hospital level intensive care to patients, improving their chance of survival and reducing any ongoing disability they might suffer. We then aim to transport patients to the most appropriate hospital for them, alongside our ambulance service colleagues. The patient's treatment continues en-route.
By following up with patients we can offer them explanations of what care was provided, if that will help their recovery; as well as learning from each patient's experience in order to optimise the service that we provide the community.
To serve the local community and support the local ambulance service in caring for the sickest patients, wherever they become ill or injured.
We do this by providing volunteer doctors, highly trained in critical care and equipped with specialist medical equipment - ‘bringing the Emergency Department to their side.’
Ambulance service paramedics are highly trained to provide treatment to patients with all manner of injury and illness and either safely discharge them on scene or transfer them to hospital.
The volunteer clinicians from Bravo Medics complement this care by offering high level interventions, normally only available in hospital, to the most critically unwell patients seen by the ambulance service. Sadly, there is no state funding through the NHS for this additional, potentially life-saving, care so it is provided by charities like us.
The additional treatments we can provide include:
Often the very sickest patients need to be put into a medically induced coma to allow a tube to be placed in their windpipe so that a machine can take over their breathing. This is done to return their blood oxygen levels to safe limits and to protect their lungs from aspirating vomit, something which can happen to patients who are unconscious.
In patients who are unconscious because of a head injury or brain haemorrhage the anaesthetic itself can reduce any ongoing damage to the brain. It does this by reducing the brain’s demand for oxygen and controlling blood flow to reduce swelling and pressure inside the skull.
Traditionally this procedure was only performed by anaesthetists and intensive care doctors in hospital, and despite the best efforts of the ambulance service some patients would sadly die en-route to the Emergency Department.
Every doctor volunteering for Bravo Medics is trained to be able to administer an anaesthetic on the roadside, or at a patient’s home, optimising their care and reducing the risks of ongoing transfer to hospital.
A very small number of our patients have conditions which if left untreated would kill them before they get to hospital and thus require us to intervene on the road side with surgical procedures to save their lives.
All of our clinicians can carry out procedures to relieve a pneumothorax (air that is trapped in the patient’s chest outside of their lung) and to surgically place a breathing tube via a tracheostomy type incision in a patient’s neck if they are unable to breath.
Our volunteer doctors are also trained to perform open heart surgery, in the event of a patient’s heart having stopped beating after being stabbed in the chest/abdomen, or other penetrating injury, to the chest.
Our team practice these skills regularly so they can be reliably performed in an emergency.
Sometimes it is necessary to perform unpleasant procedures in the pre-hospital environment that cannot, or should not, wait until the patient gets to hospital but that will cause them significant pain. These are procedures such as straightening and splinting badly broken bones or freeing patients that are trapped in car wreckage.
To facilitate these procedures Bravo Medics would be called and are able to administer strong sedative medications, which work in a similar way to a short general anaesthetic, and reduce the pain and distress associated with these procedures. Whilst a patient is under sedation we use our high-tech monitors to ensure the patient stays safe.
One area in which the ambulance service can find themselves limited is in the provision of pain relief to patients, particularly children.
Bravo Medics clinicians are happy to support crews on scene and increase patient comfort by administering stronger pain relief.
In rare cases we might use ultrasound to block nerves to an injured part of the body thus numbing it completely, this is known as regional anaesthesia and is usually performed in the operating theatre by highly trained anaesthetists.
We carry medications that are not available on standard ambulances, these are used to treat the following conditions:
A harder to quantify attribute that Bravo Medics volunteer clinicians bring to every scene is experience, and the ability to work outside of guidelines in order to ensure that every patient receives care tailor made to their specific circumstances.
This experience has been gained through many years of training and working both in hospital and within the pre-hospital environment. We also learn from every case we attend as they are reviewed as part of our clinical governance and case review process, which ensures that we deliver safe and consistent care to every patient.
Volunteers for Bravo Medics carry several basic items of medical equipment that you would normally find on an ambulance, these are supplied by the NHS via an agreement with South Western Ambulance Service.
Many of the higher-level treatments performed by our clinicians require more advanced and often very expensive equipment, for which no NHS funding is available and for which we rely on generous grants and donations from companies and individual donors.
The Zoll is both compact and powerful, allowing us to monitor our patient’s blood pressure, oxygen saturations, heart rate and analyse the gasses that they breath out; providing the same standard of monitoring that you would receive in hospital during an anaesthetic.It also doubles as a defibrillator, providing potentially life-saving shocks to patients in cardiac arrest (whose hearts have stopped).
Giving a patient an anaesthetic to take over their breathing is a potentially dangerous procedure – as failure to pass a tube into their windpipe can result in their oxygen levels falling to dangerously low levels, resulting in brain damage or even death. A video laryngoscope (which beams a picture from the end of the scope in the patient’s mouth onto a video screen) is often used in hospital where they feel this might be a difficult procedure, but has been adopted as standard practice in our service and adds to the safety of our emergency anaesthetics.
At present we carry the simple, but robust, VentiPAC ventilator. This allows us to breathe for patients once they have been anaesthetised, using either pure oxygen from cylinders, or a mix of oxygen and air.
Unfortunately, many of our patients have damaged lungs, either from trauma or from being affected by infections and other disease processes. For this reason, we are currently fundraising to upgrade our ventilators to a more modern device, which will allow more controlled ventilation more akin to what a patient would receive in an intensive care unit.
Whilst seemingly a very basic piece of equipment, reliable suction is vital in the care of critically unwell patients, and every bay of an emergency department and intensive care unit will be equipped with this.
As we have to carry everything by hand, the size and weight of this device makes it perfect for pre-hospital use.
Chest compressions are used in cardiac arrest (when a person’s heart has stopped) to pump blood around the body to the vital organs.
This machine provides chest compressions mechanically and therefore offers advantages on scene; allowing people to concentrate on other, life-saving, tasks and reducing the levels of exertion, improving decision making.
A very select group of patients, benefit from being taken to hospital with chest compressions ongoing. Usually this is people who might need an artery around their heart opening up, or to be put onto a cardiac bypass machine. This is virtually impossible to achieve with manual compressions, but the LUCAS device allows the transfer to be made safely and effectively.
Ultrasound is used more and more by emergency medicine and critical care doctors in hospitals. It allows them to directly view the heart and lungs of patients to target care more precisely. It can also be used to look for bleeding in the abdomen and site intravenous cannulas.
The Butterfly device is a robust ultrasound device that pairs with an iPad tablet. This offers huge functionality and even allows clinicians not on scene to view images in almost real time to offer advice.
Based in Bristol and Avon we are primarily tasked to patients in Bristol, Bath and North East Somerset, South Gloucestershire and North Somerset – but we also attend incidents in Somerset, Gloucestershire, Wiltshire and Wales when our specialist skills are required.
Bravo (Bristol and Avon Volunteer) Medics is an accredited British Association Immediate Care (BASICS) scheme, and has been supporting volunteer responding since January 2020. Our inaugural volunteer doctor has been busy, responding to 43 requests for critical care in the first half of this year.