# **Annual Report** _**2023**_ **1** Bravo Medics is a registered charity in England & Wales (1189780). ## **Chairman’s Welcome** I have the great pleasure to once again welcome you to Bravo Medics’ annual report, covering our activities of 2023, our fourth year of operation. Our first three years of operation fell into clear phases - _**foundation**_ in year one, _**consolidation**_ in the second year and _**expansion**_ in the third. We were delighted to welcome Dr Matt Thomas as a volunteer responder. This left us in a strong position to start 2023; with four consultant responders, a new partnership with BrisDoc Healthcare Services, and having just been awarded the Volunteer Team of the Year award at the Bath and North East Somerset Community Awards. 2023 saw us continue to provide a reliable, high quality, clinical service for the community local to our area of operations with four volunteers providing increased coverage, particularly out of hours. This was further augmented in December with the recruitment of Dr Matt Thomas as a fifth volunteer consultant - we look forward to introducing him fully in the 2024 report. From January onwards, we started to carry a potentially life saving blood product (LyoPlas) within the service, becoming the first traditional, responding from home, BASICS scheme to carry this. Over the year we gave two transfusions, and one proved to be unquestioningly life saving. I was also invited to present nationally on the logistical and clinical elements of this innovation - hopefully allowing others to follow Bravo and for patients outside of Bravo’s area of operations to also see the benefit. We also purchased ultrasound devices for every responder - which will be used both diagnostically, but also to aid in provision of advanced pain relief. Moving into 2024 we plan to review how, alongside other services providing critical care in the region, we can best support 24 hour availability - to allow us to develop the charity responsibly for the future and ensure the efficient use of donated funds. We also plan to look at redesigning our primary response bags to ensure they are optimally set up for solo critical care responding. Thank you for your time reading the report and your ongoing support of our charity. **Andrew Heavyside** **2** **3** ## **Contents** ## **Bravo Medics** ## **Report of the Trustees for the year ended 31 December 2023** |Chairman’s Welcome|3| |---|---| |Mission Map|8| |Clinical Lead Report|10| |**Objectives & Activities**|**11**| |What We Ofer Patients|12| |**Structure, Governance & Management**|**14**| |Fundraising|16| |**Financial Review**|**18**| |**Accounts**|**2**0| |Indepnedent examiners report on the accounts|22| ## **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 2022. 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 Dr Glyn Thomas Dr Matt Thomas Dr Mark Tehan ## **Accounts reviewed by** Mrs Jackie Taylor ## **Registered bank** ## HSBC 10 Colliers Walk Nailsea, Avon BS48 1RL **4** **5** BRAVO MEDICS 2023 IMPACT 2023 Locations Wiltshire 177% Bristol 25.Th south GloucesTrrshire Somerset 4.4% Gloucestershire 6.2% Saving lives North Somerset 29.2% Withoth our intervention, an estirnaied one in every tour people we treated would have suffered lffe-changing injuries or died. 2021-2023 Locations Bath and North East Somerset Bristol Local demand Dorset GioucestershiTe Bristol Cty 25% Hampshire North Somerset North Somerset 28% Somerset Wih5hire 17% South Gloucestershire Wiltshire 20 40 60 80 loo 2023 patient ages 650 Multiple 10.7% 18-24 9.7% We retnain ihe lirsi volun urtic￿ care service io tany sustained increase Child 15.5% powdered blood for transfusions in cdl-ou15 gnce 2021. We responded 10 164 emergencies bemeen four Consultsnts 25-49 29.1% Babyltoddler 4.9% 70+ 50-69 18.4% Conditions and emergencies 2022 • 2023 loo 2021-2023 patient ages 18-24 25-49 50-69 Batyltoddler Child Multiple pr*term & nffwboTri 20 40 60 80 ## **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 4 years of operating, we responded to 488 requests for critical care. ## **2023** ## **2022** **----- Start of picture text -----**
8
1
24
37
45
9
21
9
**----- End of picture text -----**
**----- Start of picture text -----**
12
1
39
51
31
4
9
9
**----- End of picture text -----**
**8** **9** ## **Clinical Lead’s Report** 2023 saw Dr Matt Thomas join the team as a medical responder Our doctors work in a voluntary capacity during their free time. As a consequence, each time we increase the number of responders our availability to respond increases (especially overnight when other critical care resources are not available within our region). We have been able to treat a wide range of patients over the year covering a vast area (particularly overnight) – the critical care skill and multidisciplinary nature of our team lends us to being a sought after asset for the ambulance service. As well as providing a critical care service for the wider region, I am very pleased to see that we are still able to maintain a high first-on-scene rate due to our response directly from our homes around the area that we serve, with the emergency equipment and drugs that we carry in our own cars. The introduction of Lypoplas to our team has been an excellent innovation, in particular, knowing that we have blood products available has been a great reassurance when tasked to the critically injured patient. The introduction of personal ultrasound devices to each team member has also been a very welcome development and they have been used to guide decision making in many cases so far. Our plans for 2024 include reviewing our kit bags and the way we deploy kit to scene. As the amount of equipment we carry has increased, our ability to carry it all at once has become more of an issue with our current bag system. ## **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 We effective: 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. **10** **11** ## **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 coma 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: - Seizures resistant to initial treatment 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 circumstances. We learn from specific 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. - Eclampsia (seizures which can occur in late pregnancy) - Asthma - Severe sepsis - Life threatening cardiac arrhythmias (the electrical activity driving the heart) - Cardiac arrest **12** **13** ## **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: - To exercise his or her powers and to perform his or her functions in his or her capacity as a trustee of the CIO in the way he or she decides in good faith would be most likely to further the purposes of the CIO. - To exercise, in the performance of those functions, such care and skill as is reasonable in the circumstances having regard in particular to: - any special knowledge or experience that he or she has or holds himself or herself out as having; and, - if he or she acts as a Charity trustee of the CIO in the course of a business or profession, to any special knowledge or experience that it is reasonable to expect of a person acting in the course of that kind of business or profession. **14** **15** ## **Fundraising** In 2023, despite a volatile economic climate, we were pleased to sustain our growth in income and raised £117,000. We continued to receive no statutory funding. We are very grateful to have received support from a number of individuals and organisations. The amount of funds we raise has a direct impact on the number of responses we can deliver to critically ill and injured patients. gifts in kind which further enabled us to achieve our mission. ## **Donations** In 2023 we received several donations from individuals towards our work. We would like to thank each and every donor for their generosity. ## **Trusts and foundations** We received a variety of grants from trusts and foundations towards our work and would like to thank everyone who awarded Bravo Medics a grant. We receive no Government funding and continue to rely on donations to fund our life-saving work so are very appreciative of any gift, no matter the size. We would like to especially thank the John James Bristol Foundation and Wiltshire Community Foundation who awarded us substantial grants in 2022. ## **Events and challenges** ## **How we spent donations** A number of people embarked on challenges to raise funds for Bravo Medics, some in memory of loved ones and some to celebrate the work we do. We extend our most sincere thanks to everybody who supported our work in this way. ## **Businesses** We would like to thank BrisDoc Healthcare Services who partnered with Bravo Medics and provided 69% of every £1 donated was spent on supporting people in the community. ## **Fundraising Regulator** Bravo Medics is registered with the Fundraising Regulator. We are pleased to report that the charity received no complaints in 2023. ## **Looking forward** Bravo Medics is currently developing its fundraising strategy to ensure a balanced, sustainable income portfolio. The charity welcomes support from the community and potential partnership approaches. **16** **17** income for the year was £117,023. ## **Financial Review** ## **Significant financial events** No significant financial events occurred over the accounting period. ## **Reserves policy** ## **Treasurer’s comments** 2023 was a transformative year for Bravo Medics in terms of finances. The creation of a reserve fund at the end of 2022 represented the transition from intial growth to a sustainability-based approach. This is also reflected in the doubling of our expenditure compared to 2022, as the charity completed the capital purchases required to future-proof our responders with new equipment. It was also possible to fund innovation within the charity – our responders now carry LyoPlas, a blood product, while responding from home. As far as we know, this is the first time this has been done. We are hugely grateful to all of our supporters and organisations that have provided us with grants to continue this lifesaving work. ## _Dr Frederick Stourton_ The reserve was maintained at £3,000 over the course of 2023, with the aim to further expand this in 2024. The Reserve is primarily for unexpected costs, however the aim for 2024 is to start increasing the reserve so it could absorb the set-up costs for a new responder in a short period, and could then be re-filled. ## **Investment policy and objectives** The charity has no long term investments at present. ## **Liabilities** As of the 31st of December 2023, the charity had no outstanding liabilities. ## **Plans for future periods** ## **Summary of year aims** The charity’s financial aims over the fourth year of operation, as laid out in our annual report for 2022, were as follows: There are no current concerns over the charity’s ability to operate as a going concern. Over the next year, the charity will aim to maintain its current stability, build its reserves to prepare for any further expansion, and plan for future expenditure including renewing equipment. - To significantly increase our charitable income through grants and other means - Capital purchases including equipping further responders - To fund a feasibility trial for the carriage of Lyophilised blood products (LyoPlas) by our responders. At the end of the period, the Charity held £9,253, split between restricted and unrestricted funds. This includes an operational reserve fund of £3,000 to deal with unexpected costs. ## **Preparation of accounts** 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 ## **Exemptions from disclosure** The Charity reports no exemptions from disclosure. ## **Principal funding sources** ## **Funds held as custodian trustee on behalf of others.** The charity’s main source of income was grant applications, raising £103,402 over the period. The majority of this was restricted to particular spending or capital projects. £9,558 was raised by volunteers who completed events to fundraise for the charity. Other income came through personal donations (£3,652) and online fundraising via various means. Total The Charity does not act as a custodian trustee, nor do any of its individual trustees. **18** **19** **Bravo Medics 1189780 Receipts and payments accounts For the period** 01/01/2023 31/12/2023 **To from** ## **CC16a** ## **Section A Receipts and payments** **----- Start of picture text -----**
Unrestricted Restricted Endowment
Total funds Last year
funds funds funds
to the nearest £ to the nearest £ to the nearest £ to the nearest £ to the nearest £
A1 Receipts
Fundraising - AmazonSmile 62 - - 62 -
Fundraising - Easyfundraising 190 - - 190 -
Fundraising - events 9,558 - - 9,558 -
Fundraising - Online 111 - - 111 -
Grants - Unrestricted 8,800 - - 8,800 -
Personal Donations 3,652 - - 3,652 -
Other 48 - - 48 -
Grants - Restricted - 94,602 - 94,602 -
Sub total (Gross income for AR) [ 22,421 ] 94,602 - 117,023 -
A2 Asset and investment sales,
(see table).
- - - -
- - - - -
Sub total - - - - -
Total receipts 22,421 94,602 - 117,023 -
A3 Payments
Core - Accounting and Finance 64 - - 64 -
Core - Fundraising 5,945 1,113 - 7,058 -
Core - Publicity 236 25 - 261 -
Core - Regulatory 1,514 - - 1,514 -
Operational - Equipment purchase 14,276 92,731 - 107,007 -
Operational - Insurance 3,535 1,795 - 5,330 -
Operational - Mileage - 1,279 - 1,279 -
Operational - Uniforms and PPE - 4,069 - 4,069 -
Operational - Vehicle fitting and maintenance 728 1,568 - 2,296 -
Sub total [ 26,297 ] 102,580 - 128,877 -
A4 Asset and investment
purchases, (see table)
- - - -
- - - -
Sub total [ - ] - - - -
Total payments 26,297 102,580 - 128,877 -
Net of receipts/(payments) - 3,876 - 7,978 - - 11,854 -
A5 Transfers between funds - - - - -
A6 Cash funds last year end £ 12,849.00 8,258 - 21,107 -
Cash funds this year end 8,973 280 - 9,253 -
**----- End of picture text -----**
## **Section B Statement of assets and liabilities at the end of the period** **----- Start of picture text -----**
Unrestricted Restricted Endowment
Categories Details funds funds funds
to nearest £ to nearest £ to nearest £
B1 Cash funds Unrestricted spending 5,973 - -
Reserve fund 3,000 - -
Restricted funds - 280 -
Total cash funds 8,973 280 -
(agree balances with receipts and payments
account(s)) OK OK OK
Unrestricted Restricted Endowment
funds funds funds
Details to nearest £ to nearest £ to nearest £
B2 Other monetary assets - - -
- - -
- - -
- - -
- - -
- - -
Fund to which Current value
Details asset belongs Cost (optional) (optional)
B3 Investment assets - -
- -
- -
- -
- -
Fund to which Current value
Details asset 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 None -
-
-
-
-
Signed by one or two trustees on behalf Date of
of all the trustees Signature Print Name approval
Frederick Stourton 05/10/2024
**----- End of picture text -----**
19/10/2024 2 CCXX R2 accounts (SS) **20** CCXX R1 accounts (SS) **21** 19/10/2024 1 CHARITY COMMISSION FOR ENGLAND AND WALES Independent examinerfs report on the accounts CHARITY COMMISSIO FOR ENGLAND AND WALE Section A Independent Examiner's Report Receipts and payments accounts CC16a Report to the trusteesl members of Fort1* ￿rIOd from Bravo Medics To On accoun1• for tho y￿r ended 31 December 2023 Charity no 1189780 Secti(Trn A Rp.c.pipt% and payments Uwestn"¢tsd funds Ilf anyl Endowmerrt fund3 fund5 Total lun L4•tyoor Set out on pages 20-21 A1 Retsfp I report to the tru?tee3 on my examination of the accounts of the above charity ('the Trust"} for the year ended 3111212023. FuTrJr8ksir8. FuffwJraw- thitit Grnnts. Unrestr¥Aed R•8pon8lbllities and As the Gharity trustees of the Trust, YVU ¢11V responsible for the preparallon basis of report of the accounts in accordance with the ￿uIreMents of the Charities Aca 2011 rthe Acr). 1652 3,652 ¥602 602 I re￿rt in reqpAd of my examination of the Trust's accounts earried out under section 145 of the 2011 Act and in carying out my examination, I have followed ltte applicable Direth"ons given by the Charity Commission under section 145(51(bl of the Act. I have compfeted my examination. I conffim that no material matters have come lo my attention in connection with the examination which gives me cause to believe that in. any material respect.. accounting records were not kept in aGGordan¢e with seGtion 130 of the Act or the accounts do not accord with the accounting records Sub tOtal(GnX￿ inconw forARJ A2 As8•t and inbvty*nt ule8. l¥ee tabl*l. If7.023 Ind•pondènt examiner's statement Sub tst•i 21421 M802 117.023 CNe. Furn*8tsr 1,113 7,058 I have no concems and have come s￿0%$ no other matters in eonnecbon with the examination to which attention should be drawn in order to enable proper understanding of the accourrts to be reached. 1,514 14,276 92.731 107,N7 1.279 4.W9 Signed: Date: 16 October 2023 Sub total 26.297 102,580 124.477 Name: Jacque ine Taylor Relevant professlonal qualifi¢ation(s) or body (rf any): Chartered Accountant Sub total Address: klolly Tree LTrJ9e, Hockley Lane Stoke Poges Bucks, SL2 4QE 26,297 102.560 128.817 Pl•t ￿m¢￿p￿{PaYrne￿ts) . 3,876 7.978 11.8S4 A6 Cash funds lat year end 12,849 (K) 8,973 8,258 21,107 9,253 IER October 2018 CCXX F1 *x>Junls ISSI 1811012024 22 23 “Without your attendance that night, I wouldn’t be here - thank you.” _The first patient given LyoPlas by Bravo Medics._ **24** **25** ## 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). **26**