The provision of on scene medical support to ambulance services in the UK is fragmented, disorganised, and largely unregulated. Recent and evolving educational, professional, and regulatory developments in medical practice now provide an opportunity to remedy this situation and ensure that “immediate care” is governed and regulated in the same way as any other specialist undertaking within the NHS.

Immediate care has been defined as the provision of skilled medical help at the scene of an accident or medical emergency and during transportation to hospital.¹ Well before the development of modern ambulance services and the recognition of accident and emergency (A&E) medicine as a specialty, general practitioners (GPs) were required to deal with increasing numbers of critically injured patients in the pre-hospital environment. Their response, in most parts of the UK, was to form themselves into voluntary associations and create a framework within which their training, equipment, and operational activity could be organised and funded.^1–3 These “immediate care schemes”, in stark contrast to the systems developed in the United States and elsewhere in Europe, were, and still are, funded almost entirely through charitable donations.

In some parts of the country, hospital practitioners have also played a role in the provision of immediate care, either through “flying squads” or mobile medical teams or by individual membership of immediate care schemes.^2,3 Some hospitals continue to deploy mobile teams at the request of ambulance services. Unfortunately, the provision of such services continues to be unpredictable, and there are very wide variations in availability, funding, training, experience, and equipment.^4–6 There also appears to be considerable uncertainty regarding the composition, training, and role of hospital mobile medical teams in incidents that are not declared as major incidents.

Regardless of their background, the core activities that define the clinical …