Introduction

Throughout the United Kingdom, doctors and other healthcare professionals respond to requests for assistance from the ambulance service on a voluntary basis. These practitioners respond to a wide variety of incidents both medical and traumatic. West Midlands Ambulance Service's (WMAS) catchment area covers approximately 5.3 million people: from April 2009 to April 2010, doctors tasked by WMAS responded to 953 incidents. The role of such practitioners in the prehospital environment has yet to be fully defined: no formal skill set is established, with practitioners coming from a wide range of medical and nursing backgrounds. This variation in base clinical competencies can lead to disparities in the standard of care delivered, as well as leading to practitioners working outside of their established clinical skill set.

Clinical governance is a framework used to maintain and improve standards of medical care, and it provides a mechanism whereby the quality of care in the prehospital setting can be assured. Eight years ago Robertson-Steele et al1 indicated how clinical governance techniques should be applied to prehospital care, but it is clear that much remains to be done. Many prehospital practitioners partake in mandatory clinical governance activity as part of their paid National Health Service (NHS) commitments; however, this governance does not cover the service they provide within the prehospital environment. Furthermore, …