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2021-12-31-accounts

Annual Report 2021

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Bravo Medics is a registered charity in England & Wales (1189780).

It is with great pleasure that I welcome you to Bravo Medics’ second annual report, covering our operations in 2021.

For me the charity has moved forward with some distinct themes. 2020, our first year of operations was about foundation – focusing on setting up a well governanced organisation, both borrowing medical equipment from other organisations and with our responders working free shifts in exchange for second hand equipment in order to develop a high-quality clinical service for the local community.

This year has focussed on consolidation – fundraising to replace our previously borrowed equipment which has firmly secured the charity’s ongoing operations.

Financially, we have benefitted from two individuals completing sponsored events as well as many generous grants from individuals and trusts. In the later part of the year we have started to invest in the future, forming partnerships with two fundraising organisations; Capidale who donated ten pro-bono fundraiser days towards grant writing, and Alchemy Fundraising, who we will be working with on an ongoing basis as Amber Fisher joins us to lead our local fundraising efforts.

We have also begun to raise the profile of Bravo Medics, through social media and presentations to local community groups, and are in the early stages of planning our first event, Running for Life, which will be held in Clevedon in partnership with BrisDoc in 2022.

This has put us in an excellent position for expansion – with two new volunteer consultant responders lined up to start in 2022, doubling our capacity for critical care coverage and moving us closer towards our ambition of being able to serve the local community, overnight, every night, and ensuring the people of Bristol and ‘Avon’ have a dependable, consultantdelivered, service whenever their hour of need arises.

Chairman’s Welcome

Andrew Heavyside Chair of Trustees

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Contents

Bravo Medics

Report of the Trustees for the year ended 31 December 202 1

Objectives & Activities 13
Structure, Governance & Management 14
Community Fundraising 18
Financial Review 20
Accounts 21
The Year Ahead 25
Objectives & Activities 13
Structure, Governance & Management 14
Community Fundraising 18
Financial Review 20
Accounts 21

Our Mission

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.’

The trustees of Bravo Medics present the annual report, including accounts, of the charity’s activities between 1 January and 31 December 2012. They additionally confirm that they comply with the Charities Act 1993, as amended by the Charities act 2006 and the Charities SORP applicable to charities preparing their accounts in accordance with the Financial Reporting Standard for Smaller Entities.

Charity name

Bravo Medics

Charity registration number

1189780

(Charity Commission of England & Wales)

Registered address

Garden Cottage Long Lane Wrington, Bristol BS40 5SA

Board of trustees

Dr Andrew Heavyside (Chair of Trustees) Dr James Tooley Mr Blair Sasada Dr Frederick Stourton

Clinical Lead

Dr James Tooley

Responding Doctors

Dr Andrew Heavyside Dr James Tooley

Accounts reviewed by

Mrs Jackie Taylor

Registered bank

HSBC

10 Colliers Walk Nailsea, Avon BS48 1RL

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94 responses 2021 +12% demand since 2020 to 111 people

53% 10% emergency anaesthesia

1,973 miles

trauma

56% at 30% 12% night cardiac arrest children

The number of people we estimate would have sadly died or suffered lifechanging injuries without us, just like this young man: 125% in 4

Ambulance control woke our volunteer responder, Andrew in the early hours one morning. A lady had found her partner, a man in his 20s, not breathing. Andrew rushed to the car and drove on blue lights to their house.

When the paramedics had arrived, they realised his heart wasn't beating. He was in cardiac arrest. Andrew helped by using a charitably-funded LUCAS mechanical chest compressor to deliver more-effective CPR. He also passed a tube into the patient's windpipe, aided by a video laryngoscope. This allowed oxygen to pass into the man's lungs.

The patient's heart then started to beat weakly. Andrew used strong medications to support this beating. He accompanied him to hospital in the ambulance, closely monitored him and gave anaesthetic medications to protect his brain.

After a long hospital stay, we are very proud that the man returned home to his normal life. Without Andrew and Bravo Medics, this would not have been the case.

It’s jobs like this which motivate us to keep volunteering, day after day and night after night.

*Details changed to protect patient confidentiality.

Clinical Lead’s Report

2021 was a difficult year in general for the health sector. On one hand COVID continued to take its toll on patients and staff alike , whilst on the other, after a year of ntermittent lockdowns people began to increase their activity levels to those of pre-COVID Times.

Our hospitals were considerably busier than usual throughout the year and staff sickness within them led to significant issues throughout the UK. Gaps on medical rosters led to both our doctors having to work an increased number of shifts within their respective hospitals, thus reducing the amount of time available to spend with their families and volunteer for Bravo Medics. However, despite these challenges our doctors were still able to respond to a significant number of patients during the year, and our presence certainly supported a hard-pressed emergency services system and bore some amazing results.

Some of the benefits relating to a Bravo’s response are from our doctors arrive as the first resources on scene - importantly we are able to maintain a high first on scene rate as we respond directly from home to our local communities with the emergency equipment and drugs we carry in our personal cars. But many of the benefits relate to our subspeciality and prehospital emergency medicine training (for example undertaking operations at the roadside , rather than conveying to a hospital to have these procedures undertaken with a delay.) In one week alone during 2021 our paediatric intensive care trained doctor attended three paediatric cardiac arrests and was able to support the ambulance service team with his expertise.

During 2021 we approached 2 new doctors (Dr Glyn Thomas and Dr Mark Tehan) and they attended our clinical governance and training days in preparation for joining the team in 2022, they will be a fantastic addition to the team and I look forward to working with them.

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Mission Map

Bravo (Bristol and Avon Volunteer) Medics is an accredited British Association Immediate Care (BASICS) scheme, and has been supporting volunteer responding since January 2020. Over our first two years of operating, we responded to 178 requests for critical care.

January 2020 - January 2022

2021

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What We Offer Patients

Life Saving Surgical Procedures including Open Heart Surgery

A very small number of our patients have conditions that require immediate intervention with a surgical procedure on-scene to save their life. All of our clinicians can carry out procedures to relieve a pneumothorax (collapsed lung) or place a tracheostomy to assist with breathing. Our volunteer doctors are also trained to perform open heart surgery, in the event of a patient’s heart having stopped beating after a penetrating injury to the chest, including stab wounds. Our team practice these skills regularly so they can be reliably performed in an emergency.

Sedation

Sometimes it is necessary to perform unpleasant procedures that cannot, or should not, wait until the patient gets to hospital but that will cause them significant pain, such as straightening and splinting badly broken bones or freeing patients that are trapped in car wreckage. Bravo Medics are able to administer strong sedative medications which reduce the pain and distress associated with these procedures and ensure their safety with our high-tech monitors.

Consultant Level Decision Making

Pre-Hospital Emergency Anaesthesia

Often the very sickest patients need to be put into a medically induced so that we can take over their airway and breathing. This is done for many reasons, including allowing us to protect their lungs from aspiration of vomit, ensure their blood oxygen is at appropriate levels and reduce ongoing damage to brain tissue after traumatic injury or a brain haemorrhage.

Traditionally this procedure was only performed by anaesthetists and intensive care doctors in hospital. 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 during transfer to hospital.

Advanced Pain Relief

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 can support crews on scene and increase patient comfort by administering stronger pain relief. This can include using ultrasound to numb the nerves supplying an injured body part. This is known as regional anaesthesia and is usually performed in the operating theatre by highly trained anaesthetists.

Drugs & Treatments Normally Only Available in Hospital

We carry medications that are not available on standard ambulances, these are used to treat the following conditions:

Bravo Medics volunteer clinicians bring significant experience to the roadside, gained through many years of training and working both in hospital and within the prehospital environment. This allows them to work outside of generic guidelines in order to ensure that every patient receives care tailor made to their specific circumstances. We 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.

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“I was extremely relieved that your team arrived so quickly & took on leadership of the situation”

Objectives & Activities

Achievements and performance

Objectives

Ultimately, our performance is measured by the number of people we treat and the lives we save. Every incident to which we are dispatched is critical and the people involved are at an immediate risk of losing their lives. We deliver gold standard critical care. In 2019, the BMJ stated that pre-hospital care provided by critical care teams was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians (Maddock et al, 2020).

Bravo Medics’ main objective is to save lives in the community by providing equipment, training and financial support to Critical Care doctors who respond to emergencies in their area at the request of the local ambulance service.

In our second year we have increased our resilience as a charity. We have diversified our funding streams with help from external organisations. We have started to build links among our local community. We have replaced loaned items with equipment that we now own outright, and have secured capital funding for new state-of-the-art patient monitors. We have undertaken more missions, becoming a reliable source of support for the Ambulance service in our area.

Our work is also cost effective: We can provide hospital level critical care, potentially including anaesthesia and emergency surgery, to a patient for at a similar cost to a GP appointment to the NHS.

Our support after treatment is not only informative but can aid people’s recovery. Providing information - in some cases when people have no memory - can help people understand what happened so they can focus on their recovery.

Bravo Medics is built on the ethos of providing a life-saving service to the local communities of its responders. The charity’s activities are designed to further that goal. All decisions made by the trustees are done so with due regard to the Charity Commission’s guidance on public benefit.

References

Maddock A, Corfield AR, Donald MJ, et al Prehospital critical care is associated with increased survival inadult trauma patients in ScotlandEmergency Medicine Journal 2020;37:141-145.

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Structure, Governance & Management

Tooley. Review of clinical activities is performed on a regular basis in conjunction with other BASICS schemes in the BASICS South West umbrella in order to ensure high quality care. Appointment of responding doctors is performed by the clinical lead, subject to approval by BASICS South West.

Governing document

Bravo Medics is a Charitable Incorporated Organisation (CIO), registered with the Charity Commission under number 1189780. The first meeting of the trustees was on 12 February 2020. The CIO is governed by a constitution dated 12 February 2020.

Appointment of new trustees

Duties of Trustees

Organisational structure

The overall responsibility for the control and management of the charity lies with the trustees in accordance with the duties of trustees as laid out below. The trustees give their time freely and receive no remuneration or other financial benefits. The trustees meet at least 3 times a year, either virtually or in person.

Bravo Medics responds on behalf of South West Ambulance Service Trust, and under the umbrella of BASICS South West, and complies with the organisational requirements of both organisations.

Oversight of clinical activities is delegated to the Clinical Lead, who is a member of the board of trustees. For the recorded period, this role was filled by Dr James

Trustees are selected and appointed by the current trustees. Every trustee must be appointed for a term of three years by a resolution passed at a properly convened meeting of the charity trustees. In selecting individuals for appointment as charity trustees, the charity trustees must have regard to the skills, knowledge and experience needed for the effective administration of the CIO.

The holder of the Clinical Lead role is also invited to become a trustee. The Clinical Lead must be a full clinical member of Bravo Medics and is usually at consultant level (or equivalent post CCT) level. The Clinical Lead shall be appointed by the charity trustees following advice from the clinical members of the organisation and the outgoing Clinical Lead as to who, in their considered opinion, would be best suited to fulfil the position.

The Trustees shall perform their duties in accordance with the constitution of the CIO and the law, in particular the preparation of an annual report and financial statements.

The Charity trustees shall manage the affairs of the CIO and may for that purpose exercise all the powers of the CIO. It is the duty of each Charity trustee:

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Fundraising

Alchemy Fundraising - Amber Fisher

Fundraising Partnerships

In 2020 all grant applications and fundraising was undertaken by our trustees. As a growing charity this became an unsustainable model and in 2021 the decision was made by the trustees to enlist the help of a select group of fundraising professionals to start to optimise our income stream.

Fresh Fundraising

A recommendation from another member of BASICS South West, BASICS Devon, Fresh Fundraising revolutionised their charity several years back by recruiting Amy, their fundraiser, who has now become a vital member of their charity staff with fundraising and administrative duties.

We enlisted the help of Fresh Fundraising to run a recruiting campaign for a freelance fundraiser to assist our local fundraising - with three candidates identified, Amber Fisher of Alchemy Fundraising was invited to join the team.

Capidale

Capidale is a Yorkshire based, successful, fundraising company specialising in grant applications. In late 2021 they took on a new fundraiser, Jasmine Dominey, as part of her induction package we were able to benefit from 10 days of her time, for free, writing grant applications - only paying for some supervisory hours from a senior fundraiser. Excitingly, we therefore end the year with a range of grant applications awaiting decision in early 2022 - hopefully setting us up for a successful year.

Amber Amber has worked in fundraising for over 15 years. She has raised over £4 million for a range of causes including medical, youth, m e n t a l health, animal and environmental charities. She holds the Chartered Institute of Fundraising's Certificate in Fundraising Management.

From August she started to work with us, on a freelance basis, with a remit to focus on community engagement and local fundraising.

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Community Fundraising

We have been delighted that 2021 saw the start of fundraising by members of the Bravo community. We are very grateful for their efforts and look forward to more people raising funds and awareness of the work of Bravo Medics volunteer doctors.

David’s Ironman

In September, one of our supporters, David, completed the Weymouth Ironman 70.3 with 50% of his sponsorship going towards Bravo Medics.

This was a great achievement, raising over £2,500 for the charity

Struan’s Run

Jenny and her partner Rich raised an amazing £5,488 for Bravo Medics. Jenny ran 84 miles over 3 days, joined by Rich on the last day. If this wasn’t enough friends and family ran with them wherever they were, in places as far away as Canada and Italy. Between them, they ran an incredible 650 miles.

Their amazing work has both raised vital funds and awareness of the work that Bravo Medics does.

and also increasing our profile. As one of our first sponsored events it also gave us an opportunity to develop processes to assist our supporters in raising sponsorship effectively and we hope this will develop as an important income stream for the future.

“Our community fundraisers’ mammoth efforts have provided essential funds that have helped treat patients.” Dr Frederick Stourton, Treasurer

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Financial Review

in order to provide financial resilience. However, it was decided that this goal should be delayed to the following year to free up unrestricted funds allowing the charity to continue to pursue growth-related objectives.

Investment policy and objectives

The charity’s financial aims over the second year of operation were as

follows:

At the end of the period, the Charity held £34,355, the majority in restricted funds to be used for further core and operational costs as delineated by the restrictions including;

Principal funding sources

Significant financial events

The charity’s main source of income was grant applications, raising £33,218 over the period. The majority of this was restricted to particular spending or capital projects. £8,354 was raised by volunteers who completed endurance events to fundraise for the charity. Other income came through online fundraising via various means.

No significant financial events occurred over the accounting period

Reserves policy

The charity held £5,619 of unrestricted funds at the end of the period. It was the intention of the trustees to build a small noncommitted reserve over the period

Preparation of accounts

The charity has no long term investments at present.

As a CIO with an income of under £250,000, the accounts were prepared on a receipts and payments basis in accordance with the Charities SORP. These were then checked by Mrs Jackie Taylor

Liabilities

Exemptions from disclosure

Funds held as custodian trustee on behalf of others.

Plans for future periods

Accounts

Exemptions from disclosure

The Charity reports no exemptions from disclosure.

Funds held as custodian trustee on behalf of others.

The Charity does not act as a custodian trustee, nor do any of its individual trustees.

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Bravo Medics Bravo Medics Bravo Medics Bravo Medics Bravo Medics 1189780 1189780 1189780 CC16a
For the period
from		 1/1/2021 To 12/31/2021
Section A Receipts and payments
A1 Receipts Unrestricted
funds
to the nearest £		 Restricted funds
to the nearest £		 Endowment
funds
to the nearest £		 Total funds
to the nearest £		 Last year
to the nearest £
Fundraising - AmazonSmile
Fundraising - Easyfundraising
Fundraising - events
Fundraising - Online
Grants
Other - Equipment rebate
Other - Mileage repayment		 53 - 53 -
216 - - 216 -
8,354 - - 8,354 -
455 - - 455 -
2,868 30,350 - 33,218 -
380 - - 380 -
187 - - 187 -
- - - - -
Sub total
(Gross income for AR)		 12,514 30,350 - 42,863 -
A2 Asset and investment sales, (see table).
- - - -
- - - - -
A3 Payments
Sub total
Total receipts
Sub total
Core - Fundraising
Core - Publicity
Opera�onal - Equipment maintenance
Opera�onal - Equipment purchase
Opera�onal - Equipment running costs
Opera�onal - Insurance
Opera�onal - Mileage
Opera�onal - Professional development
Opera�onal - Uniforms and PPE
Opera�onal - Vehicle f�ng and maintenance
Opera�onal - Cri�cal Care Medica�ons & Mangement		 - - - - -
12,514 30,350 - 42,863 -
3,203 450 - 3,653 -
630 421 1,051 -
- 226 226 -
564 840 1,404 -
741 1,449 2,190 -
- 110 110 -
340 475 815 -
368 807 1,175
- 444 444
- 1,403 1,403 -
3 1,738 1,741 -
5,849 8,363 - 14,212 -
A4 Asset and investment purchases, (see table)
Core - Start-up loan repayments 2,000 - - 2,000
- - - -
A5 Transfers between funds
A6 Cash funds last year end
Sub total
Total payments
Net of receipts/(payments)
Cash funds this year end		 2,000 - - 2,000
7,849 8,363 - 16,212 -
4,665 21,987 - 26,652 -
30 -
30		 - - -
925 6,779 - 7,704 -
5,619 28,736 - 34,355 -
Section B Statement of assets and liabilities at the end of the period
Categories
B1 Cash funds		 Details Unrestricted
funds
to nearest £
5,619
-
-		 Restricted funds
to nearest £
-
28,736
-		 Endowment
funds
to nearest £
5,619 - -
- 28,736 -
- - -
Total cash funds
(agree balances with receipts and payments
account(s))
Details		 5,619 28,736 -
OK OK
Unrestricted
funds
to nearest £		 Restricted funds
to nearest £		 Endowment
funds
to nearest £

----- Start of picture text -----
B2 Other monetary assets - - -
- - -
- - -
- - -
- - -
- - -
Fund to which asset Current value
Details belongs Cost (optional) (optional)
B3 Investment assets - -
- -
- -
- -
- -
Fund to which asset Current value
Details belongs Cost (optional) (optional)
B4 Assets retained for the charity’s own use - -
- -
- -
- -
- -
- -
- -
- -
- -
Fund to which Amount due When due
Details liability relates (optional) (optional)
B5 Liabilities Zoll Monitor Purchase Restricted 25,000
Alchemy Fundraising - December 2021 Unrestricted 500
-
-
-
Signed by one or two trustees on behalf of all the trustees Signature Print Name Date of approval
Dr Frederick Stourton 1/28/2022
----- End of picture text -----

Section B Statement of assets and liabilities at the end of the period

Unrestricted Restricted funds Endowment
Categories Details funds funds
to nearest £ to nearest £ to nearest £
B1 Cash funds 5,619 - -
- 28,736 -
- - -
Total cash funds 5,619 28,736 -
(agree balances with receipts and payments
account(s)) OK OK OK
Unrestricted Restricted funds Endowment
funds funds
Details to nearest £ to nearest £ to nearest £

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CCXX R accounts (SS)

CCXX R accounts (SS)

The Year Ahead

Bravo Medics are committed to a slow, but steady, expansion of our service to ensure that we remain financially viable as an organisation whilst delivering high quality, safe, care to patients in our local community.

Community Partnerships

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Andrew met Dr Louise Whyte, BrisDOC’s Deputy Medical Director, when we were called to a young patient who had fallen off his motorbike just outside of one of their clinics.

Impressed by the high-level clinical interventions we were able to offer,

whilst our doctors gave up their own time for free, Louise is determined to help us. In 2022 we are looking forward to working closely with BrisDOC to develop fundraising opportunities and to ‘Running for Life’ a charity run in Clevedon, which will be organised by BrisDOC in aid of Bravo Medics.

New Responders

Two new consultants have been identified who are keen to join our volunteer team over 2022.

Dr Glyn Thomas

Glyn has been a Consultant Cardiologist in Bristol for over ten years and specialises in the treatment of heart rhythm disorders which can lead to sudden cardiac death. Having witnessed first-hand the importance of pre-hospital critical care in his patients, he undertook additional training in Anaesthesia, Paediatrics, and Trauma to become a Critical Care Doctor with Great Western Air Ambulance in 2019. He lives in central Bristol and we are looking forward to him joining our team in 2022.

Dr Mark Tehan

Mark is an Emergency Medicine and Pre-Hospital Emergency Medicine consultant. He trained in London and the East of England before becoming a consultant in 2018 and then moving to live in South Gloucestershire. He has previously responded for BASICS Essex so has a strong background in supporting his community, something he is keen to continue with Bravo Medics.

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bravomedics.org

bravomedics BravoMedicsUK BravoMedicsUK

Garden Cottage Long Lane Bristol BS40 5SA 0117 287 0199

Bravo Medics is a registered charity in England & Wales (1189780).

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